I just stumbled upon a “civilian” out there who really understands what is going on with Emergency Medical Services. His name is John Dubensky and I bet he’s been reading my blogs! He writes for an on-line rag www.cracked.com . Okay, You can Slam! me for using this as a source with any credibility. But when you read some of their articles — especially the one’s meant to de-bunk common wisdom — they are so bare knuckles right on, well, you have no choice but to laugh at the tragedy!

This is especially pertinent for those of you who aren’t too familiar with EMS and have come here to learn: http://www.cracked.com/article_19798_5-terrifying-secrets-about-riding-in-ambulance.html

The article came out May 15th (today!) and already there have been 512 comments! Some fun ones:

I got in a serious car accident as a passenger last year, and kept going in an out of consciousness, head bleeding, and I couldn’t think straight and my whole right side of the body was hit, so what did the ambulance do? It didn’t even turn on the sirens…

But EMTs get paid a lot, right? Right??

But just the fact that the article is there…that SOMEONE is paying attention to what is a critically neglected field…can make a huge difference because there were many responses like this:

I know this is no where near some of the horrific calls the EMT gets, but I in no way will ever take for granted the job they do. It must be extremely stressful to see all these people you’re trying to help and save and not only not be able to save them, but also have them somehow blame you or harm you. People calling when they don’t need it would piss me off too. I think there should be a fine for any call that doesn’t have anything to do with the persons health being in serious jeapordy or close to death.

In fact, I was rather encouraged by all the support that came out from the public. Sure, some active ambulance medic respondents took the article to task on some points. But little gems like this came out as well:

I do agree that the system is severely abused, EMTs suffer from PTSD, and the work burns you out. If we had better safeguards in place some of this could be reduced, but there are protocols in place to reduce these issues presently. I think a big problem with EMS is the abundance of ignorant, under-educated EMTs on the streets that don’t know what they are doing and lack improvisation.

And here was the Magic of the piece; regular folks read the article and got involved! Medics got to speak for themselves in a public arena where the people were listening. Some of those medics got to say things that most regular folk don’t get to hear. Things like this:

One thing Cracked forgot to mention: Killing your patients. It happens to everyone. Whether it gets reported or not, patients WILL die because you showed up to work. Push the wrong drug, or the wrong dose? Perform a skill like endotracheal intubation (breathing tubes) or cardioversion (shocking) wrong? Fail to catch a critical change in a patient’s status or miss a diagnosis? Someone is going to die, and their blood is on your hands. You either learn from it and make yourself better, or it haunts your dreams and you quit. It happens to every single provider–doctor, nurse, paramedic or otherwise. Anyone who says it doesn’t is lying.I guess I must sound pretty burned out right now, huh? But you know what? I’ll take it. That’s the burden we bear. The fat, angry, violent, back-breaking burden. And when my days off are over and my week starts again? I’ll be back out there, hauling your drunken asses off the street and praying for someone sick enough to need my help. Because that’s just what we do.

That’s a dose of reality right back at you, isn’t it? Although not pristine, the article is more than adequate to have gotten a lot of attention. What more can be said than we need more of this and like this article shows, there is much to talk about!

I’ve been AWOL, concentrating on marketing my book, something I dread like hemmorrhoids; I’m an Artiste, dammit, not a Shill!

At first, my book was an exercise to save my soul; an attempt to make sense out of my experiences as one of the first paramedics. It turned into part of a much larger American story that I am only just now getting to fully understand.

It wasn’t too long ago that a lot of our medicine was practiced within the matrix of community and connection. In the Stone Age by today’s standards, fifty years ago the Doctor’s bag held most of the tools available to treat patients and he brought it to your house! But things started to morph very quickly. The tools got bigger and more complex, new species of drugs spread like rabbits and the Doctor took on the roll of High Priest, now sequestered in the Institution where he/she uses all these Mysteries-Cloaked-in-Secrecy to prolong our lives but not necessarily improve the quality of them. It’s all a big experiment that is still in its infancy.

When I joined EMS around 1974 there was little more than “Head, Hands, and Heart” to work with. Within five years I was an Emergency Room on wheels! By 1985 a crucial transition had completed; Medicine no longer expressed itself as a by-product of people connecting with each other, it became something “delivered”. Once we started to have to use gloves to protect ourselves from our patients (as a result of AIDSfear) the umbilical cord to our Mother was cut.

All of this happened most visibly in EMS. We actually were the embodiement of that crucial transition of medicine. These were the times I wrote about; the times when I found myself with all these things to place between me and my patients whereas yesterday I had no choice but to face the humans I transported eye-to-eye. In a sense, EMS was a great metaphor through which to examine a societal movement toward institutionalization of most aspects of our human interaction. I, as a medic in a brand new approach to patient care, happened to be a reflection of that shift.

Since 2005 my focus has been to get the book out there and make it the best piece I could to express a lot of the worlds that my EMS colleagues experience but don’t talk much about. My focus has been on using my writing to influence the culture of EMS; to expand it a little to include conversations about Bigger Pictures than shifts and pay and how everyone marginalizes us.

This is quickly becoming a major theme in Radio Interviews I’ve been doing recently.

So, in one respect, I’m still learning what the book is really about and where to make it most useful; how best to use the book as a vehicle to increase the public’s awareness of EMS workers value to society, and how costly it is for them to do the work. I believe the public-at-large can actiually help EMS become the profession that it never really became.

Here is a recent interview I did on-line with Dresser After Dark, on Blogtalk Radio with Michael Dresser. Enjoy, and please let me know what you think:

(Sorry, folks…I’m working up a bad link here, please check back!)

I woke up one recent morning and realized that I have lived through more than one-quarter of the American Experience!

It’s simple, terrifying Math. In 1776 the Nation was born. That was 235 years ago. In 1951, I was born. That was 60 years ago. Yep, I’ve been around for about 26% of the American Experience!

As I review my own life, and figure out where to from here, I realize I can’t help but to take a look at where the time of my life has been spent historically. I suppose I had the typically American experience of getting older, getting curious about other cultures, and then finding that there was a lotta stuff going on over and back there that I was absolutely oblivious to! Why? Because I was so wrapped up in the NOW as defined by today’s America. Oddly enough, in this moment, it’s kind of easy to pinpoint what occurred with me but it has taken me a while to see how it worked.

My first thought when I had my realization was, Lordy, this country hasn’t been around for but a heartbeat! I’m not quite sure whether that was my way of diverting thoughts of my own mortality, but regardless, it comforted me. And that is a key perspective that keeps coming up for me in many areas. NOTHING of what we accept as reality has been around very long and we best not lose sight of that fact.

That includes what we call “Modern Medicine”, you know. Here are some things that Wikipedia has to say about it:

Modern medicine
Medicine was revolutionized in the 19th century and beyond by advances in chemistry and laboratory techniques and equipment, old ideas of infectious disease epidemiology were replaced with bacteriology and virology.
Ignaz Semmelweis (1818-1865) in 1847 dramatically reduced the death rate of new mothers from child bed fever by the simple expedient of requiring physicians to clean their hands before attending to women in childbirth. His discovery pre-dated the germ theory of disease. However, his discoveries were not appreciated by his contemporaries and came into general use only with discoveries of British surgeon Joseph Lister, who in 1865 proved the principles of antisepsis in the treatment of wounds; However, medical conservatism on new breakthroughs in pre-existing science prevented them from being generally well received during the 19th century.

So, really folks, what are we talking, less than 150 years? It took a good fifty years for the concepts we accept as standard operating procedure to get traction, so functionally, we’re looking at just since the 20th Century. And the point that we need to consider in medicine today is that it takes a long time to get people to start using techniques and therapies that make a difference.

Is it fair to say that Western Medicine as a whole is in its infancy? Is it fair to say we haven’t even begun to know what we don’t know? Let’s put it this way; all the medicine we used today is based on the failure of most every medicine that came before it.

In this very minute, using emergency medicine as a metaphor, there are people out there working on new approaches to emergency intervention based on the knowledge that what we’re using right now is outdated and ineffectual. They are going to have to spend YEARS convincing everyone else they are on the right track before any of it gets into an ambulance. The process will involve a coming together of such things as the legal system, politics, publicity and marketing, for these things are the grease that turns the wheels in our society.

It will be DECADES before we find things that are ALREADY developed being used in the streets. And, in our American way of fulfillment of Darwinism, the end result will be survival of the fittest, but that means determining factors mentioned above will set the pace. First, whatever efficacious approach that has been devised must be run through a huge gauntlet of resistance; usually by the very experts who will eventually embrace the new approach. First comes innovation; then comes the sale.

I keep harping on this. I know I’m a pain! But for me, that perspective has really simplified what I’m doing here. I’m emphasizing that medicine is not about the system or the interventions used, it’s all about the people served and the people who serve them and how they are treated as human beings! Everything else is interchangeable. At all times we must remember that both our therapies AND our therapists are subject to failure!

All I’m asking is that you keep this in mind when you choose to hook up your patients to the newest and the greatest gadgets and not listen to them. It is so very easy to place your priorities on following your protocols and ABC’s and not really see that there’s a human being in front of you because your focus is on the “Problem”.

And how much more does that apply to how you deal with each other? How much attention do you pay to each other as human beings doing stressfull and important work? Really, since no one else seems to recognize how challenging the work is, what’s wrong with you acknowledging that to and for each other?

You see, historically we have advanced in our medical techniques, therapies, medicaments, procedures and on and on. We have increased our knowledge exponentially in how the body works. Good Lord, we’ve certainly done enough experimentation, haven’t we?! But as that body of knowledge has gotten expanded, we’ve pretty much put zero energy into learning how to mobilize the patient’s own defenses through such things as word and touch.

Call me crazy, but I predict fifty years from now medics in all modalities will be using speech and sound patterns to help patient smobilize their own immune or rejuvenative systems to stabilize THEMSELVES for transport! And call me even crazier because I know such concepts are being worked with right now, by medics who won’t dare talk about it until they are my age!

And that leads me into my conclusion. With all these advances in medical innovation we’ve done next to nothing to learn how to really work with each other or others so that the stress of DELIVERING all this new stuff is more evenly distributed. Right now, we’re just handed stuff and told to use it. I don’t know if you’ve noticed, but a big part of being a human being is asking “Why?” That, indeed, is what precedes innovation.

But questions of “Why” also live in such areas as morals, philosophy, spirituality and emotion. This is what we deny. Essentially, we throw our medics into patient care with overloaded toolboxes but little support in carrying them. The culture EXPECTS that the medic can figure it out on his or her own. But there’s no attention being paid to what that looks like. Unfortunately, many medics are penalized in one way or another (burnout) for even looking.

We can do better.

read more here: http://en.wikipedia.org/wiki/History_of_medicine

We all think we know what compassion is and how to show it, but too any of us drop it like a hot rock once we realize that there is a cost to it and we have nowhere to go to work through its aftermath.

Yes, I said “aftermath”. Just like it takes investment to get good in the technical aspects of practicing our chosen modalities, it takes commitment, dedication and investment to incorporate compassion into the work we do.

So how do we practice compassion? I think it’s important to really take the subject seriously. I’m asking each of you to really take an honest look at what compassion means to YOU. I just want you to think and then figure out your own ways to contribute to building a new, more realistic “culture” within the modality you practice; one that has room for the human experience. Interweaving compassion into all aspects of it is a good place to start.

Let’s start with a simple definition of the word “compassion”.

Here’s what The Online Dictionary says:

com·pas·sion? Show Spelled[kuh m-pash-uh n]

-noun

1. a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering.

I checked other dictionaries and they all basically said the same thing. This isn’t reaching out to hold a hand; this is about connecting your emotions to theirs. Now THAT is heavy; especially in the dominant “Culture of Silence” in Western Medicine!

In Wikipedia we find a more in-depth look and among the things it mentions is that it even goes beyond empathy, it is a heart-to-heart thing!

Kelly Grayson, a fellow EMS Blogger and author accurately describes the dominant culture in healthcare today as such:

“We’re told to cultivate professional distance in our careers, to sympathize but not empathize, that objectivity helps us maintain the focus needed to render lifesaving care when the world has turned to chaos around us.”

a feeling of deep sympathy and sorrow…accompanied by a desire? How could those experiences possibly fit in to the “professional distance” Kelly just described? Haven’t we been taught that going to those places is much too personal to allow us to render competent care?

Each of us, as individuals, have to figure out the balance between performing at peak capacity and remaining sensitive to the emotional lives of ourselves and the people we serve. But there are no textbooks or on-line courses to teach us how. In fact, let’s get real, how many medics, seriously talk about the ramifications of compassion on themselves at all?

And something else that must be looked at is that there is a price to having compassion; at least as far as what we were taught about being workers in healthcare.

It works something like this.

The people we deal with are often in the most vulnerable moments in their lives. When you express com-passion (literally “suffering with”) you are opening yourself up to sharing that sense of vulnerability.

But wait a minute, isn’t “accompanied by a strong desire to alleviate the suffering” exactly the opposite of how we’re told to do our jobs?

So it’s clear, I completely acknowledge that we often must be Warriors who are efficient machines. Yet, when all we are is the Warrior what Kelly describes as “soft-skills” get lost.

My point is this: Compassion is not to be feared. Experiencing that degree of connection with the moments in which you and your patient are involved does not have to interfere with the rendering of competent care. In fact, it can be one of many fuels that allow you to take that extra step that might make all the difference in the life of that patient, and through that, yes, it is a form of healing for yourself.

But you might have to hurt a little as you learn how to use it.

Can you accept that, or is that a bit too terrifying?

I’m in the business of doing my best to articulate my experience as a human being while being involved in the healing arts so that others may find things useful for their own journeys. Emergency medicine has provided me with an incredibly potent metaphor to work with. I come back to you with things that will give you things to think about that place the work you do within a broader context; no matter what modality you use.

Let’s file this one under “All Things Must Pass!”

“Evidence-based medicine” is nothing more than using the knowledge you have available at the time. At any one time you have the limitations of not being able to see into the future as to what “new” will be uncovered. Therefore, at any one time your information is incomplete.

Does that make sense? It sure does when you look at our technologically driven practice of medicine. Of course, there are many alternative approaches to health and well-being. Many of which are based on centuries (if not more!) of experience and much trial and error. But for now, I’d like to make a point about the direction that so-called “Western Medicine” is headed.

My stock-in-trade, the PRIMARY approach to saving lives in the late 1970′s, namely 2 ampuoles of Sodium Bicarbonate, 5 cc of Epinephrine and Zap with a Cardiac Defibrillator and repeat, Repeat, Repeat, ad nauseum, was based on evidence that the regimen had a favorable effect.

That is to say, enough people in the know believed it to work well enough to set standards of care based on their information and experience which included utilizing scientifically-gathered data.

That information was as scientific as it could be — for the time. Now what happened is, by more evolved processes and understandings, we’ve come to understand that those regimens produced what are called “poor patient outcomes”. Basically, they didn’t really enhance lives, they just saved them for the moment.

One of the more devastating things that I’ve had to face in my life is that it is quite possible I retrieved many dead and assured them that the remainder of their lives would be spent as “Cardiac Cripples” with no real quality of life to speak of!

That means, back in the 1970-s and 1980′s I really did successfully raise people back from the dead! Unfortunately, they would be hospitalized for a while, gaining enough strength to go home and live minimally for a while until they’d have another cardiac collapse, in which case, I’d come back and save them again. And again.

I worked in a small town, so I actually got to see this pattern unfolding before me. But it wasn’t until about 30 years later that I made the connection!

I have had to come to terms with the fact that my role was to use the best knowledge I had at the time. Or was it to, just like so many of us in the medical arts, “Do what you’re told!”? Regardless, as cold as this seems, it’s something many who practice “Allopathic” medicine are going to have to face as well thirty years from now!

Every process or procedure starts somewhere. JUST ENOUGH evidence is accumulated to say it’s worth using on human beings. Then, as time, further trials, and experience go on, more is learned about its efficacy. It is found to be effective, effective under certain circumstances but not others, or effective for this but damaging to that such that its initial application is rendered useless. These, of course, were things that were not foreseen.

A chilling example would be the initial use of X-rays to “kill” cancer. It was found to be very effective, but also killed every cell in the neighborhood! But that was a long time ago, things like that don’t happen now.

Or do they? One of our most potent diagnostic tools, the CAT (or CT) Scan is now being shown to have a similar effect from overexposure to it.

Do you see what I mean?

What this means to medical personnel is that you must understand, as I have had to, that the stuff you’re using today may be debunked tomorrow. You may say that’s the nature of being involved in a tremendously rapidly evolving technology. I can say this because about 95% of what the paramedic program was BASED on has been found to be ineffectual if not further damaging to the human beings it was meant to help!

From a paramedic’s perspective, we really haven’t made much of a dent in our quest to beat death. Our current-day medicine is very, very much oriented toward beating death; often at ANY cost without true consideration of the quality of life.

What practitioners have been a part of has been aggressive attacks on things like cardiac arrest and Cancer. I will not negate that a lot of people are “cured” of Cancer through aggressive surgical and chemical interventions, but I suspect that time will tell that the quality of life of many, many more of the recipients of the treatments will have been lessened en route.

Of course, this is heresy, but I still see all of medicine as being based on hope against the inevitability of death. And I’m not necessarily saying this is a bad thing; I’m just asking all of us involved to get real!

This is all spoken of in terms of “Buying time” by pumping drugs into patients that will “jump-start” the parts of a crippled machine back into function.

In a nutshell, what evidence-based medicine is showing is that all the stuff I used DID work for the moment, but the rebound effect — how other bodily systems reacted to the forced support of the primarily affected system — slowed, stopped or killed any chance of recovery. This is a pattern that is not limited to emergencies.

So, the science of today and what is being done is based on the concept that aggressive treatment produces favorable results. Still, if you look back you’ll see that for every drug or therapy used there were a good ten others that were once claimed to be effective for the same conditions and now are “known to be” counter-productive or useless if not deadly on their own!

You can’t neglect the fact that the majority of these drugs and procedures are introduced into a “marketplace” as salable commodities. The degree to which the perception continues that they are efficacious determines their profitability, therefore, their continued use. As soon as up-to-date science kicks in, however, then what you could call “the truth” becomes known. In our system, this usually occurs AFTER the introduction, way after.

Science, in this case, becomes a system of checks and balances, not the TRUE initiator of the therapies we use. NOTHING that enters the marketplace is “proven”. It is just “proven enough” until more of what we call “scientific” evidence comes in. What that boils down to is that most patients are part of a long-term experiment.

How can I bring this home to you?

Consider this: The very definition of “Buying time” is changing. Now, in emergency medicine we’re finding that it is evolving into buying time by “slowing down” the bodily functions AT the scene (through such things as hypothermia and drug-induced suspended animation). Once in the hospital, more advanced teams have days rather than hours to repair the damage.

Don’t be surprised if things like this become commonplace in treating Cancers as well.

My point is we can count on science to evolve. Little of what we use today will be used tomorrow and every couple generations the whole concept of what we provide and how we provide it will shift.

How can those of us still participating in “Western Medicine” come to terms with this? What’s the lesson?

Understand you are an agent of an evolving system whose tools are always changing. Your effectiveness boils down to whittling away at death, one minuscule increment at a time.

That also means you must accept yourself as part of an experiment. Your job is to deliver what appears to be the best that science offers today so it can find out if and how it really does work.

In the meantime, I’d like to see our focus move more toward improving the quality of life we have (yes, including “Alternative” means) and with less emphasis on snatching our fellow travellers from the jaws of death at any cost.

Something that comes up fairly regularly in discussions or stray comments from healthcare practitioners is how to handle off-duty situations where you come across someone in physical distress in need of help. Could be serious, maybe not. The central questions that come up are “Should you take action and to what degree?” and “Since you’re trained, do you have an obligation to act?”

At first, I was quite disturbed to hear so many of today’s practitioners commenting that under no circumstances would they physically intervene, citing legal or personal endangerment issues. This runs the gamut from Nurse’s Aides to Doctors! This very often included life and death situations; Far worse they also often went so far as to say they wouldn’t even BEGIN an assessment. Based on nothing more than “Nobody knows I’m trained so I don’t have to act,” they would literally turn their backs and walk away. Even stopping to learn more about the situation; to determine if a higher level of care was needed might imply they were committing to actually take action. Horrors!

Many of our healthcare practitioners have been trained in some form of First Aid or another. There was a time, and it wasn’t too long ago that that was not so.

Back in the 1950′s and 1960′s lots of people were dying for no reason. People were dropping dead, getting run over, shot, choking, bleeding out, seizing, or whatever and NOBODY WAS HELPING because no one knew how. What could have been ameliorated by simple interventions became fatal maladies.

When I was in Grammar School, one of my classmates (coincidentally the ONLY boy my age I ever bullied!) “choked to death on a chicken bone”. The memory of that both haunted me and drove me into the profession of EMS in a weird sort of way because as I got older I came to learn that if you had the right knowledge, maybe that wouldn’t have had to have happened and maybe, someday, I could actually PREVENT something like that from happening.

In the 1950′s, some people got together, sacrificing time and energy, and started to institute some changes. The idea was to make it so life-saving skills became available to the public. Commensurate with that came a push to raise the standards of emergency medical care as a whole. The idea was to make it so people who for no reason of their own (or even if self-inflicted!) got wounded, they’d get help. They wrote up manuals, began courses and set up progressive levels of certifications so the people who did get trained were competent. It seemed to be the civilized thing to do at the time and the American National Red Cross led the charge.

All of a sudden, there was this wave of people, scattered throughout the populace, that could actually DO SOMETHING to help their stricken neighbors! This was all about knowledge allowing you to step beyond your fears and into action so people didn’t need to die needlessly.

Many who lived during the time that no one knew how, now had the knowledge to make a difference. They felt like it was a sacred trust. Walking by someone in trouble wasn’t even in the equation; especially for someone trained and working in healthcare! How could it be? It would negate the intention of ALL those people who came before to make sure that such knowledge would never be withheld from anyone again! Intervention now became a trained citizen’s duty.

Here’s what I’m hearing today: Knowledge is enough to justify NOT taking action.

You know there are blood borne pathogens, so you don’t get involved in anything with blood. You know that somewhere there’s a Lawyer waiting to make a buck so you don’t even let your skills be shown. What I’m hearing is that many in of today’s practitioners feel it’s okay to use their skills arbitrarily and it’s okay to actually withhold training unless the situation is perfect.

It could easily be a “No Go!” because there is a chance a stricken person has a blood borne pathogen. A big one is the potential for being sued; something that is spoken of as if 20% of off-duty medical personnel taking action WERE being sued. I’ll gamble you can’t use all the fingers on one hand to tally the number of lawsuits nationwide in one year for such happenings.

Because of this? Because of that? Another theme that I keep hearing is the unavailability of equipment, translated to something like “Sorry, Buddy, can’t work on your heart because I ain’t got a defibrillator and we all know that’s the only thing that works.” If you are trained to handle an emergency at whatever level and can’t do something without your tools, you shouldn’t be in the medical profession.

Having come up from where no one could do anything and I sacrificed so I could, I can’t turn my powers on and off at my convenience, that is a betrayal of my mission. The skills are there to use and I have an obligation to use them.

“Not if your life is in danger!” you exclaim.

The things we anticipate are usually NOT the things that take our lives. YOU are as fragile as the people you’re called on to help. What is the essence of debility and death? Stuff comes out of nowhere and strikes people down. Being alive puts you in danger.

There are things you can do to insulate yourself from (blood, sharp objects, smoke, the emotionally disturbed…FILL IN THE BLANK!) and at least do something. The words that infuriated me the most were the ones where people trained in emergency intervention, or who are in positions where they often manage unmanageable situations, stated they wouldn’t even approach a person fallen in the street, but they would call 9-1-1 on their cell phones so the professionals could handle it!

Step One (after the ABC’s) is to get a handle on what’s really happening. Immediate care CAN make the difference between life and death, or function and permanent deformity. Of course, those are extreme examples. NOBODY even mentions how, just by being there and offering support you immediately place the affected person on a favorable course of recovery.

And that’s something to consider. Perhaps your most formidable skills lie in just being there for someone who is traumatized.

In light of that, does it make sense to just walk by?

(Modified from EMSOutsideAgitator.com)

You can write this off as one more off-the-wall, left-leaning, New Age Airey-Farie rant by that firetender character, or you can open up your heads just a touch.

Over at Rogue’s Blog Site there’s a (now) 3 part series examining the Placebo Effect. You can find the last installment HERE. (I wish I had the patience to put all those neat pictures in MY blog!)

Perhaps to avoid some incoming I ought to start with a disclaimer: The following is not meant to provide a substitute for sound medical advice, nor is it to be interpreted as a call AGAINST (so-called) Evidence-based Medicine.

But do you realize you work with the Placebo Effect every day and it’s one of the most potent tools you carry?

Your ambulance is a Placebo.

Your uniform is a Placebo.

The equipment you carry in to the house? Placebos.

As soon as you present yourself, you present HOPE.

Many years from now, maybe tomorrow, we will figure out that the hormones released by the individual’s PERCEPTION of their situation will DECIDE just what the course of recovery will be for that person.

We will find that the drugs we administer today are not much more powerful to effect healing than are the patient’s ability to mobilize their own auto-immune systems to combat what ails them; no matter how severe.

I’m taking into consideration that, yes, sometimes people – through anomalies — are physiologically incapable of producing certain hormones or chemicals. For most of us, however, given the proper stimulation, we can produce our own chemicals. My point is a bit more complex.

I have a personal example. Back in the 1970′s I took a motorcycle trip into the Florida Ocala National Forest. Around sunset, I dumped my bike, roadrashed my knee, and deformed my bike’s headlight and turn-signals and my glasses! I limped in to a deserted campsite (off-season mid-week), set up my small tent and conked out.

A couple of hours went by and I awoke with a slight itch on my abdomen. Some critter had bit me. I scratched it. It kept getting worse and I noticed that where I scratched now was a couple inches away from where I scratched just before. I turned on my flashlight, raised my shirt and what I saw was a classic case of urticaria progressively moving out from the source bite and spreading out over my body. I WAS WATCHING IT just long enough to recognize anaphlaxis!

I bolted out of the tent and RAN about 1/4 mile to the only phone booth at the Ranger Station (unmanned). I remembered I had seen a Volunteer ambulance parked outside of an empty fire station and realized I wouldn’t trust my life to their hands. OF COURSE I was a paramedic at the time! So rather than chance 9-1-1 would dispatch THEM, I called the local hospital ER, about 20 miles away.

In the time it took me to dial and get a Nurse on the line, my tongue had swollen up so much in my mouth I could not speak! I knew what was coming next.

I ran to my bike, fired it up, hopped on and with my glasses tweaked and the headlight pointing UP to the trees on my right side, I hauled ass down the dirt road and then on to the highway, all the time taking very slow and easy inhalations as I noticeably felt my airway restricting.

I was literally in a race against death and I bet you know what happened, too. Unless I’m sadly mistaken and on another plane, I won! Probably around the time I hit 100 MPH on the Highway, in my panic I had auto-manufactured enough Adrenaline to overcome the anaphylaxis.

The point I have to make about this example is people are curing themselves of critical shit all the time and it’s not unlike what happened to me. Somehow, in that situation, I was able to “create” what I needed (literally!) to survive.

Don’t do this in the field, but do you think for your next response to anaphylaxis if you picked up your patient off the floor, swatted his butt and yelled “Run, Forrest, run or I’ll kill you!” that would work?

Even I wasn’t crazy enough to try that one! But something I learned was that given the proper circumstances (and perhaps proper training) we will likely be able to “jolt” people into the production of their own life-saving chemicals.

History is strewn with cases of people who have survived, recovered or repaired themselves on thousands of therapies that have since been PROVEN NOT to work. Each of them were presented with the best identifiable options of their day and time. SOME of them responded, even if what they were administered were poisons. You cannot minimize the power of the human mind.

Maybe that’s why Placebos work slightly better than nothing in tests where a segment of the Testees are not even aware they are part of a test. Perhaps just the knowledge you’re part of a search for hope is enough.

Could BELIEF in the Practitioner or the therapy have made the difference?

How many of you have known the patient on your gurney was going to get through their trauma PRECISELY BECAUSE you happened to stumble on just the right words that gave her hope? Conversely, how many of you have cringed when you brought a patient in who you had just “turned around” into having hope and then seeing it instantly crushed by the insensitivity of the recieving personnel? Have any of you witnessed the extended recovery periods as a result of hopes dashed into fear?

We know very little about how our bodies and minds work, don’t fool yourselves. There is still mounds of “evidence” that needs to be uncovered. Keep in mind, at all times the place I return to is that we need to use the best that our technology affords us even though odds are it will out-date itself!

I’m kind of saying we need to use the stuff given us as if we BELIEVE it will work!

That worked for me, didn’t it? There are actually a few people who walked the earth way beyond their own, my or anyone else’s expectations BECAUSE I administered drugs to them while they were dead that brought them back. Even though each and everyone of those drugs and therapies have been clinically proven to be inneffectual, if not dangerous. Most of them are written about in Rogue’s columns.

Of course, you’ll say “In spite of” and you’re right. But you know what? I really BELIEVED that that stuff would work. I SAW it working, didn’t I? Or am I truly Certifiable? Maybe the ONLY thing that made them work was that I believed they would.

That’s where that ole firetender guy steps us out into the Twilight Zone, apologies to Rod Serling.

Consider this, however. Today we manipulate a person’s chemical status by introducing outside agents called medications. Do you think it’s so out-of-this-world that some day we could learn how to manipulate vibration through sound to get the patient in the back of the ambulance to stimulate production of their own chemicals to retard or even reverse life-threatening processes?

If you’re not thinking about stuff like this, you’re not keeping up with medicine. But that’s okay because medicine has not yet caught up with the idea that matter is both wave and particle which was recognized over one-century ago! We’re still treating with particles.

Just ask your Pharmaceutical Rep!

(Adapted from EMS Outside Agitator.)

Kelly Grayson just wrote an extremely important message to the EMS community. It applies to all of us in the medical community. You can find it HERE.

Please read it now if you haven’t already. In fact, even if you’ve read it, read it again; I have a number of times. Take your time, enjoy it, I’ll wait.

Thanks, it was worth it, wasn’t it?

Kelly has wonderfully articulated the keystone of what we do. All the stuff in our bags of tricks can, will, did and do run out and even lose their effectiveness at one time or another and all that’s left is our head, hands and heart. For some, like myself, I learned that’s where the miracles really come from, but that’s a blog yet to come.

Kelly’s call for compassion and his showing us examples of both its importance and how it works was one of the most powerful things I’ve read in the EMS Blog World, and, before anything else, I want to express my appreciation to him for it!

Through it, all of a sudden, a real important part of the puzzle that is EMS just fell into place for me: We all think we know what compassion is and how to show it, but most of us drop it like a hot rock once we realize that there is a cost to it and we have nowhere to go to work through its aftermath.

Yes, I said “aftermath”.  Just like it takes investment to get good in the technical aspects of EMS, it takes commitment, dedication and investment to incorporate compassion into the work we do.

EMS, to me, is all the little annoyances all healthcare practitiones experience, thrown into a pressure cooker and pushed to the max. It just takes longer for you guys to burn out, and you get paid better along the way! But the things we’re beginning to talk about in EMS apply to you as well.

A sub-theme of Kelly’s blog is that he’s calling on us to really take a look at it and incorporate compassion into the very fiber of our work. I hope I’m hearing him right.

The curse of a busy EMS career is that compassion is the skill that erodes while all the rest become stronger with constant practice. And make no mistake, compassion is a skill. If you don’t use it, you lose it.

So how do we practice compassion?

I completely agree with Kelly and think it’s important to really take the subject seriously. I’m asking each of you to really take an honest look at what compassion means to YOU. Kelly and I each have a part of the puzzle that may very well help you put all the pieces together for yourself.

I’d like to start simply, and then, in later blogs I’ll build on themes as they develop.

AN ASIDE: I’m working out these concepts as we go along. I’m learning much from blogs like Kelly’s, forums like EMTLife, and you, and making my attempt to bring subjects like this into the light. I honestly don’t have any conclusions; I just want you to think and then figure out your own ways to contribute to building a new, more realistic “culture” of not only EMS, but medicine as a whole as practiced in the US; one that has room for the human experience. Interweaving compassion into all aspects of how healthcare is offered is a good place to start. Think about it.

The point I’d like to make today is that everybody talks about it, but are we in EMS really ready to face what it takes to BE compassionate?

Let’s start with a simple definition of the word “compassion”.

Here’s what The Online Dictionary says:

com·pas·sion

?/k?m?pæ? ?n/ Show Spelled[kuh m-pash-uh n] Show IPA

–noun

1. a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering.

Oops! Is that what Kelly is talking about?

I checked other dictionaries and they all basically said the same thing. This isn’t reaching out to hold a hand; this is about connecting your emotions to theirs. Now THAT is heavy!

In Wikipedia we find a more in-depth look, here and among the things it mentions is that it even goes beyond empathy, it is a heart-to-heart thing!

Kelly accurately describes our “culture” as such, and this also applies to medicine as a whole:

We’re told to cultivate professional distance in our careers, to sympathize but not empathize, that objectivity helps us maintain the focus needed to render lifesaving care when the world has turned to chaos around us.

“a feeling of deep sympathy and sorrow…accompanied by a desire”? How could those experiences possibly fit in to the work Kelly just described? Haven’t we been taught that going to those places is much too personal to allow us to render competent care?

Kelly’s on the right track, though, because he goes on to describe the consequences to us and our patients when we lose sight of compassion as we fixate on the nuts and bolts:

But when that emotional wall of professional distance keeps us from connecting with the other 75 percent of the people we serve, it diminishes us as caregivers. It keeps us from being our best. We go from being committed to EMS, to merely being involved in its delivery.

But there’s a HUGE gap there, can you see it? And can you also see how EMS is just a metaphor for anyone entrusted with the care of others?

Kelly’s suggesting we open ourselves to being part of more compassionate experiences but he doesn’t really mention how to balance it with performing at peak capacity. This is in no way a dis of Kelly. We’re all exploring new territory here and building on each others ideas.

Each of us, as an individual, has to figure out the balance between the two. But there are no textbooks or on-line courses to teach us how. In fact, let’s get real, how many blogs, let alone medics, seriously talk about the ramifications of compassion?

And something else that must be looked at is that there is a price to having compassion; at least as far as what we were taught about being emergency workers.

It works something like this.

The people we deal with are often in the most vulnerable moments in their lives. When you express com-passion (literally “suffering with”) you are opening yourself up to sharing that sense of vulnerability.

But wait a minute, isn’t “accompanied by a strong desire to alleviate the suffering” exactly the opposite of how we’re told to do our jobs?

So it’s clear, I completely acknowledge that we often must be Warriors who are efficient machines. Kelly understands this well. Yet, isn’t he asking us to look a little more closely at how we miss something personally when all we are is the Warrior?

But, as it is in many organizations, the benchmarks most often measured are the ones that are easy to measure. The soft skills are far harder to quantify, and often more valuable. Ultimately, the only people impressed by our cardiac arrest survival rates and intubation prowess are other EMT’s. Our patients are the ones who value the soft skills, and chief among those is compassion.

In his book, ‘People Care,’ Thom Dick points out that prompt, skilled and professional emergency care is what we owe to all our patients. It’s expected. It’s our job. But compassion is our gift to them, and like all gifts, bestowing it rewards the giver as much as the recipient.

My point builds on this: Compassion is not to be feared. Experiencing that degree of connection with the moments in which you and your patient are involved does not have to interfere with the rendering of competent care.

In fact, it can be one of many fuels that allow you to take that extra step that might make all the difference in the life of that patient, and through that, yes, it is a form of healing for yourself.

But you might have to hurt a little as you learn how to use it.

NEXT: The Price of Compassion

…you wake up one morning and realize that you have lived through more than one-quarter of the American Experience!

(Adapted from a blog on EMSOutsideagitator.com)

It’s simple, terrifying Math. In 1776 the Nation was born. That was 235 years ago. In 1951, I was born. That was 60 years ago. Yep, I’ve been around for about 26% of American time!

Maybe coming to terms with stuff like this is what has caused me to take so much time writing this damn thing; mostly because I want to frame my experience in terms of today’s medicine as viewed through the prism of Emergency Medical Services and I’m not too sure how to articulate it. Truth is, I’m so behind in my blog that I’m forcing myself to work this out as we speak! 

As I review my own life, and figure out where to from here, I realize I can’t help but to take a look at where the time of my life has been spent historically. I suppose I had the typically American experience of getting older, getting curious about other cultures, and then finding that there was a hell of a lotta stuff going on over and back there that I was absolutely oblivious to! Why? Because I was so wrapped up in the NOW as defined by today’s America. Oddly enough, in this moment, it’s kind of easy to pinpoint what occurred with me but it has taken me a while to see how it worked.

My first thought when I had my realization was, Lordy, this country hasn’t been around for but a heartbeat! I’m not quite sure whether that was my way of diverting thoughts of my own mortality, but regardless, it comforted me. And that is a key perspective that keeps coming up for me in many areas. NOTHING of what we accept as reality has been around very long and we best not lose sight of that fact.

That includes what we call “Modern Medicine”, you know. Here are some things that Wikipedia has to say about it:

Modern medicine

Medicine was revolutionized in the 19th century and beyond by advances in chemistry and laboratory techniques and equipment, old ideas of infectious disease epidemiology were replaced with bacteriology and virology.

Ignaz Semmelweis (1818–1865) in 1847 dramatically reduced the death rate of new mothers from child bed fever by the simple expedient of requiring physicians to clean their hands before attending to women in childbirth. His discovery pre-dated the germ theory of disease. However, his discoveries were not appreciated by his contemporaries and came into general use only with discoveries of British surgeon Joseph Lister, who in 1865 proved the principles of antisepsis in the treatment of wounds; However, medical conservatism on new breakthroughs in pre-existing science prevented them from being generally well received during the 19th century.

read more here: http://en.wikipedia.org/wiki/History_of_medicine

So, really folks, what are we talking, less than 150 years? It took a good fifty years for the concepts to get traction, so functionally, we’re looking at just since the 20th Century. And the point that we need to consider in EMS is that it takes a long time to get people to start using techniques and therapies that make a difference.

Is it fair to say not only EMS, but medicine as a whole is in its infancy? Is it fair to say we haven’t even begun to know what we don’t know? Let’s put it this way; all the medicine we use today is based on the failure of most every medicine that came before it. What makes you think that pattern will not change? We’re talking history here.

There’s a pattern as well in all of today’s medicine. In this very minute there are people out there working on new approaches to intervention based on the knowledge that what we’re using right now is outdated and ineffectual. They are going to have to spend YEARS convincing everyone else they are on the right track before any of it gets into the hospital or an ambulance. This is a long time AFTER the development first occurred.

The process will involve a coming together of such things as the legal system, politics, publicity and marketing, for these things are the grease that turns the wheels in our society.

It will be DECADES before we find things that are ALREADY developed being used in the streets. And, in our American way of fulfillment of Darwinism, the end result will be survival of the fittest, but that means determining factors mentioned above will set the pace. Whatever efficacious approach that has been devised must be run through a huge gauntlet of resistance; usually by the very experts who will eventually embrace the new approach. First comes innovation; then comes the sale.

(Right now, I’m working on a piece that illustrates my point. You will learn that the Grandfathers of EMS were Techno/marketing Geeks!)

I keep harping on this. I know I’m a pain in the butt! But for me, that perspective has really simplified what I’m doing here. I’m emphasizing that EMS, as is all of health care, is not about the system or the interventions used, it’s all about the people served and the people who serve them and how they are treated as human beings! Everything else is interchangeable. At all times we must remember that both out therapies AND our therapists are subject to failure! 

All I’m asking is that you keep this in mind when you choose to hook up your patients and not listen to them. It is so very easy to place your priorities on following your protocols and ABC’s and not really see that there’s a human being in front of you because your focus is on the “Problem”.

And how much more does that apply to how you deal with each other? How much attention do you pay to each other as human beings doing some damn stressfull and important work? Really, since no one else seems to recognize how challenging the work is, what’s wrong with you acknowledging that to and for each other?

You see, historically we have advanced in our medical techniques, therapies, medicaments, procedures and on and on. We have increased our knowledge exponentially in how the body works. Good Jesus, we’ve certainly done enough experimentation, haven’t we?! But as that body of knowledge has gotten expanded, we’ve pretty much put zero energy into learning how to mobilize the patient’s own defenses through such things as word and touch.

Call me crazy, but I predict fifty years from now medics will be using speech and sound patterns to help a patient mobilize their own immune or rejuvenative systems to stabilize THEMSELVES! And call me even crazier because I know such concepts are being worked with right now, by medics who won’t dare talk about it until they are my age!

And that leads me into my conclusion. With all these advances in medical innovation we’ve done next to nothing to learn how to really work with each other or others so that the stress of DELIVERING all this new stuff is more evenly distributed. Right now, we’re just handed stuff and told to use it.

I don’t know if you’ve noticed, but a big part of being a human being is asking “Why?” That, indeed, is what precedes innovation. But questions of “Why” also live in such areas as morals, philosophy, spirituality and emotion. This is what we deny. Essentially, we throw our medics into the frey with overloaded toolboxes but little support in carrying them.

 The culture EXPECTS that the medic can figure it out on his or her own. But there’s no attention being paid to what that looks like. Unfortunately, many medics are penalized in one way or another (burnout) for even looking.

We can do better.

(Adapted from a piece on  EMSOutside Agitator)

This is a theme I keep coming back to in my blogs.  I see it coming up regularly in EMS forums so it’s worth another look.

I’m in the business of doing my best to articulate my experience as a human being so that others in the healing arts may find things useful for their own journeys.

EMS has provided me with an incredibly potent metaphor to work with. I come back to you with things that will give you things to think about that place the work you do within a broader context.

Let’s file this one under “All Things Must Pass!”

“Evidence based medicine” is nothing more than using the knowledge you have available at the time. At any one time you have the limitations of not being able to see into the future as to what “new” will be uncovered. Therefore, at any one time the information you work with is incomplete.

My stock-in-trade, the PRIMARY approach to saving lives in the late 1970′s, namely 2 amps Bicarb, Epi and Zap! Bicarb, Epi and ZAP!, Bicarb, Epi and Zap! ad nauseum, was based on evidence that the regimen had a favorable effect. That is to say, enough people “in the know” believed it to work well enough to set standards of care based on their information and experience which included utilizing scientifically-gathered data.

That information was as scientific as it could be — for the time. Now what happened is, by more evolved processes and understandings, we’ve come to understand that many of those regimens produced what are called “poor patient outcomes”. Basically, they didn’t really enhance lives, they just saved them for the moment.

(One of the things that I’ve had to face in my life is that it is quite possible I retrieved many dead and assured them that the remainder of their lives would be spent as “Cardiac Cripples” with no real quality of life to speak of! I have had to come to terms with the fact that my role was to use the best knowledge I had at the time. Or was it to, just like you, “Do what you’re told!”? Regardless, as cold as this seems, it’s something you’re going to have to face as well thirty years from now!)

Every process or procedure starts somewhere. JUST ENOUGH evidence is accumulated to say it’s worth using on human beings. Then, as time, further trials, and experience go on, more is learned about its efficacy. It is found to be effective, effective under certain circumstances but not others, or effective for this but damaging to that such that its initial application is rendered useless. These, of course, were things that were not foreseen.

What this means to people in health care is that you must understand, as I have had to, that the stuff you’re using today may be debunked tomorrow. I can say this because about 95% of what the paramedic program was BASED on has been found to be ineffectual if not further damaging to the human beings it was meant to help!

If you think I’m crazy, consider this perspective from looking at EMS over the last 40 years or so:

What we have been a part of has been an aggressive attack of death; “Buying time” by pumping drugs into patients that will “jump-start” the parts of a crippled machine back into function.

Hospitals, as further illustration have been, in part, designed to provide follow-up care (through ICU’s and CCU’s as example) for the people that Emergency workers bring back.

In a nutshell, what evidence based medicine has shown is that all the stuff I used DID work for the moment, but the rebound effect — how other bodily systems reacted to the forced support of the primarily affected system — slowed, stopped or killed any chance of recovery.

That did, however, certainly make hospitals pretty busy, didn’t it?

Medics in emergency medicine are pretty much doing the same thing today; going at individual symptoms aggressively. They’re just using different drugs!

So, the science of today and what medicine is doing on the whole is based on the concept that aggressive treatment produces favorable results. Yet, if you look back you’ll see that for every drug that was used in a paramedic’s drug box, there were a good ten others that were once claimed to be effective  for the same conditions and now are “known to be” counter-productive or useless.

You can’t neglect the fact that the majority of these drugs and procedures are introduced into a “marketplace” as salable commodities. The degree to which the perception continues that they are efficacious determines their profitability, therefore, continuing use. As soon as up-to-date science kicks in, then what you could call “the truth” becomes known. In our system, this usually occurs well AFTER the introduction and use on patients.

Must I say more than “Vioxx (r)” which produced more than 27,000 heart attacks and sudden deaths  as it treated arthritis!

Science, in this case, becomes a system of checks and balances, not the TRUE initiator of the therapies we use. NOTHING that enters the marketplace is “proven”. It is just “proven enough” until more of what we call “scientific” evidence comes in.

How can I bring this home to you?

Consider this: The very definition of “Buying time” is changing, and that means the essence of what the very hospital system does. The base upon which EMS was founded on, and upon which many hospital services of today are based as well is making a paradigm shift.

What once was buying time by interposing powerful drugs into the system to shore up damaged organs is likely to evolve into buying time by “slowing down” the bodily functions AT the scene (through such things as hypothermia and drug-induced suspended animation). Once in the hospital, more advanced teams have days or longer rather than hours to repair the damage.

My point is we can count on science to evolve. Little of what we use today will be used tomorrow and every couple generations the whole concept of what we provide and how we provide it will shift.

What’s the lesson? Understand you are an agent of an evolving system whose tools are always changing. Your effectiveness boils down to whittling away at death, one miniscule increment at a time.

That also means you must accept yourself as part of an experiment. Your job is to deliver what appears to be the best that science offers today so it can find out if and how it really does work.