Pure Pretense

You’re responding with an ALS engine to the rural home of James Colbert, an 80-year-old guy whose wife has called 9-1- numerous times for shortness of breath. James’ cardiovascular system is a train wreck; and sure enough, you arrive to find him in fulminant pulmonary edema. Not only is he struggling for his life, but he appears exhausted. He’s gray, he’s diaphoretic, his head is bobbing, he’s oblivious to questions, and you can hear him gurgling feebly across the room, 60 times a minute.

Craig, the engine company medic, has been on scene for 11 minutes when you arrive. But he has no vitals, no ECG, no history, and nothing to say about his observations or his activity. There’s no O₂, no IV and no CPAP. He makes no effort to help you with your gear as you enter. Instead, he stands between you and Mr. Colbert with his hands on his hips. You try to be polite and somehow still get past him, so you can get the old man into a sitting position.

“We were wondering what took you so long,” he says, in front of the family. “This man’s pretty sick.”

(Ya think so, Craig?)

You’ve played this pathetic game so often, you’d really like to meet somebody at NBC. About two years ago, your fire chief clamored to get into the paramedic biz and spent a ton of public money to put medics on “his” engines. (Only he doesn’t live in the district, so he doesn’t own so much as a lug nut.) And there’s nothing medical about the medics. All they do is get in the way. They don’t assess, they don’t treat, they don’t transport, they don’t write charts, they don’t read the literature, they don’t respond to QI inquiries, and they don’t even handle their own restock (‘cause that’s your job.) When they do attend CE, it’s never off duty. Even then, they’ll sign in. But they’ll take off at the slightest rumor of a car fire or a smoke alarm—and not return. On scene, they act like super-medics, appointed to oversee and approve your decisions, all without the benefit of any actual medical expertise on their part. It’s pure pretense. And no one, not even your medical director, ever confronts them about it.

Q. It seems nobody ever brings this up, but it’s a problem, and it’s really been worse since 9/11. I’ve already left two good systems to get away from it, and that hasn’t helped. Isn’t there some way to fix it?

A. I know you’re smart enough to have tried the first solution to every team issue; and I can probably guess what you’re going to say. But it’s important. Please, please, if you haven’t already done so, talk to Craig first. He deserves to know how he comes across and how you feel about it. If that doesn’t work, document this and every occurrence for someone who has a little more collar brass than either of you.

Q. You don’t understand. The whole system works this way, and it’s like the engine crews are being told by their officers it’s their job to supervise us.

A. Actually, I do understand. I know what you’re dealing with is no fun, and I don’t blame you for leaving other systems to get away from it. No medic worth their salt wants to be constantly second-guessed by people who don’t know their medicine or don’t care about it. But this won’t get solved right away, it won’t get solved by you alone, and it won’t get solved as the result of a single instance. The solution really is consistent, persistent dialogue about anything that’s not good for sick people, conducted as honestly and as respectfully as possible. If you’re not part of the solution, you’re part of the problem.

Q. I know I can’t fix this by myself, but it’s like the Big Red PR Machine can do no wrong. I’ve complained many times in the past, and everybody just shakes their head and shrugs their shoulders. What makes you think documentation is going to change anything?

A. See, I think there’s a difference between chronic complaining and consistent advocacy. Complaining is lazy; advocacy is work. But none of us is omnipotent. I think we just have to keep on trying.

And never, ever give up.

Thom Dick has been involved in EMS for 41 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of the EMS World editorial advisory board. E-mail boxcar_414@yahoo.com.