The EMS Military Industrial Complex

2000px-star_of_life2-svgWhen I was a paramedic, I noted a very disturbing trend among EMS providers that seems to have only worsened since I hung up my stethoscope. A lot of providers were getting themselves confused with the police and military medics. While some of the clothing is akin to police and military – and this truly is out of necessity… for the most part – there is also a very hard line between EMS providers and law enforcement. EMS is a medical profession, at least that’s what EMS is supposed to be. EMS providers working in a given county are not law enforcement and are not the military and should not act like they are.

Many EMS providers already seem to think they need tactical pants, tactical boots, tactical flashlights, tactical shirts, tactical jackets, tactical socks, tactical hats, tactical underwear… Yeah, it’s as ridiculous as it sounds. Some EMS providers even want to be able to carry firearms while on duty (something that I am adamantly opposed to except in some very specific situations such as taking part in a raid as a SWAT medic). But now, we have a new tacticool item.

Enter the tactical ambulance.

BusinessWire has announced that ambulance manufacturer REV Group is now marketing a tactical ambulance. “The REV Guardian, an ambulance wrapped in Level IIIA ballistic protection with run flat tire inserts.” The vehicle is painted a subdued black/gray color (which is against design regulations in several states, including Mississippi) and sports such features as bulletproof glass and a Kevlar wrapping around the entire vehicle. As it is, the average ambulance before any equipment is placed in it is around $150,000 so you can bet your next paycheck that this unnecessary monstrosity probably costs at least double that.

The continued militarization of EMS disturbs me to no end. As it is, EMS providers are often placed in more peril because of already resembling police officers due to their uniforms and a vehicle such as this will do nothing but increase the divide between patient and provider. Experience tells me that if a patient thinks that an EMT or paramedic is a cop, they will not be honest with the provider about drug use, alcohol use, etc. out of fear of being arrested. EMS is fighting to be recognized as a medical profession and many – thankfully – are fighting to increase educational standards for licensure. This continued desire to become more like our brothers and sisters in blue by responding to a nursing home transport in an armored troop carrier has no place with such endeavors.

If one wants to be a cop, that’s fine but they should join the police force and not the EMS.

“But what about provider safety? The EMTs should be protected!” My friend Justin Schorr – AKA “The Happy Medic” – refutes this argument nicely.

Ambulances aren’t getting shot up. Send in one of those fancy military grade trucks PD is buying up. No need for a reclined cot van with those features. None. It would make as much sense to have a mailman with this level of protection. They’re riding the Tacticool wave.

Gotta love when a company takes advantage of mass hysteria and engages in fear mongering for profit.

Pension Reform At What Cost?

Matt Bevin, Kentucky’s governor, has been riling the dander of many people as of late with his proposed pension reform plan. Under the plan, public employees – including teachers, police offers, firefighters, road department employees, many EMS providers, and much more – would be moved from the current pension plan to a defined-contribution plan that would work like a 401(k) retirement plan. Governor Bevin and supporters say that this will end Kentucky’s considerable debt and underfunding that has occurred under the current pension plan. Opponents, of which I am one, argue that this bill breaks promises made to the Commonwealth’s public employees and will reduce retirement benefits. I will take it a step further.

Governor Bevin’s proposal is immoral.

Nevermind the fact that the proposal being passed around Frankfort includes language that ends the legal requirement of school districts to provide any paid sick days per year for our educators. Nevermind the fact that current language also takes away line of duty death benefits from a significant portion of Kentucky’s current law enforcement personnel and all new hires. Nevermind the fact that such defined contribution plans have limits on contributions and are tied to a volatile stock market. This plan is immoral because it breaks promises made to generations of employees who have filled our schools, government offices, ambulances, fire trucks, police cars, and road crews with the best and the brightest to serve the citizens of Kentucky. The message being conveyed is that the short-term and long-term well being of Kentucky’s public workers does not matter and that the governor seems them as expendable.

This is immoral.

And let’s not forget that Governor Bevin thinks that you and I, Joe Q. Public, are not smart enough to get how such things work and what needs to be done. Governor Bevin stated:

The people who do not have the sophistication to understand what’s at stake, but will bear the brunt of it, are the ones that are going to suffer if people like us who get it, who are willing to fight for it, don’t step up.

Governor Bevin would do well to know that we are smart enough to understand what’s going on. Here’s what else we are sophisticated enough to know: We understand that promises should be kept. We understand that the people who are the ones who will shape the future of this state, who provide for the safety of all of us, and who ensure that our infrastructure is maintained at the best possible levels matter and should be looked after. We are smart enough to know that something much be done in order to shore up the state’s retirement fund but we also are smart enough to know that gutting the pension plan and replacing it with something that simply is not in the best interest of the people is what should be done.

Perhaps Governor Bevin lacks the sophistication to understand that the people elected him and the people can also vote him out.

For my wife and I, this is personal. She is an educator who wants to have a secure future. I am a former paramedic who ministers to those who continue to work on the streets every day to ensure that the best out-of-hospital healthcare is provided to Powell County, Kentucky. We are also taxpayers who want our money to be used wisely and in ways that will benefit the employees that our taxes go to the pay the salaries and other benefits of.

But perhaps more importantly as Christians, we have a responsibility to see that people are cared for. Taking away their retirement and other vital benefits is not getting that job done. As a disciple and especially as a pastor I have a responsibility to name and fight that which is an injustice. If this does not fit the nature of an injustice that is repugnant to anyone’s morals, I don’t know what does.

One early sign we see of this being a bad idea is the sheer number of teachers, school administration, and other public employees who either have retired or will before the end of the year. We are about to see a crisis in our classrooms the likes of which no one has ever imagined. If you don’t believe me, ask any school employee. They will tell you of people within their districts who either have retired or will very soon. In other words, Kentucky’s teacher shortage is about to grow exponentially. And that’s just in our schools. This does not include the firefighters, police officers, and others who are taking the same action.

Kentucky is about to be in a real mess.

I call upon our representatives in Frankfort to work against this bill. I would also love for our clergy in Kentucky to fight against this injustice and to pray for its defeat. We must stand with our public employees, especially our teachers and public safety workers. This is simply not in the best interest of the Commonwealth.

We Don’t Get to Choose Who Receives Compassion

compassionIf you didn’t know, I’m a former paramedic. During my time on the ambulance, I responded to my share of overdose calls and I also expressed by share of frustration over them. Part of the reason was that I was simply following the example of my peers – I was expected to deride and offhandedly insult people who had overdosed so that’s what I did. One day I realized how wrong that attitude was when I responded to an overdose call and had to administer the drug Narcan. The house I responded to was where the patient lived with her husband and two young children. The husband expressed to me that he had been trying to get her to seek help for addiction but that so far his efforts were ignored by her. While I was working on his wife, I remember him saying “I just hope she gets help before it’s too late.” This with the backdrop of two young children who had to witness their mother almost die right in front of them because addiction had sunk its sharp teeth into her was used by God to convict me of my attitude and to change my heart.

EMS responders have a moral and an ethical (and when on duty legal) to render the best care possible to all regardless of who they are, what they look like, where they live, or the choices they made. None of the matters. EMTs and paramedics practice medicine and are not supposed to base their care on the circumstances of the patient. If someone calls for help, EMS is supposed to respond and is supposed to render the best possible care they are able, period, full stop. For the most part, in spite of some who feel that only certain patients deserve the best care (these providers have no business in EMS and should be stripped of their patches, but that’s another rant), EMS responders give excellent care and indeed save lives.

So imagine my shock, disappointment, and anger when I read about an elected official who wants EMS providers to pick and choose who deserves to live simply because of their poor choices.

Dan Picard (hopefully no relation to Jean-Luc) is a city councilman in Middletown, Ohio and wants EMS units to stop responding to calls for help involving opioid overdoses (story). He says that these calls are too expensive and that the city can not afford it. Mr. Picard is also in favor of issuing a court summons to overdose patients and requiring them to perform community service to compensate the city for saving his/her life. Here’s what Mr. Picard said he wants to do:

I want to send a message to the world that you don’t want to come to Middletown to overdose because someone might not come with Narcan and save your life. We need to put a fear about overdosing in Middletown.

That statement drips with something but compassion is not that with which it is dripping.

The councilman wants to punish people for seeking help for a condition which could very easily kill them (the fact that they took the drug is irrelevant). This plan is illegal, immoral, and unethical but let’s say it was implemented. The city would have a much larger problem: A sudden influx of overdose deaths because people are afraid to call for help for fear of being branded a criminal. I feel that would have a much worse effect on their budget than administering a bunch of Narcan (in addition to the moral, legal, and ethical considerations). Addiction is a disease (this is not up for debate – medical science proves this) and should be treated as a disease, not as a criminal offense.

For Christians, there are other issues to consider.

Whether we are talking about the medical field or anything else, we don’t get to pick and choose to whom we will show compassion and mercy. For Christians, compassion is supposed to be our way of life. Compassion is what Christians are supposed to be known for! From the very beginning, God was setting the example of showing compassion. We read in Genesis of the fall of humanity when Adam and Eve ate the fruit that God told them not to eat. He could have killed them where they stood but instead of showed compassion on them by making them animal skins to cover their newly discovered nudity.

Throughout scripture, we see other examples of compassionate action and instruction that as we have shown compassion we should show compassion. We read the words of Paul: “Since God chose you to be the holy people he loves, you must clothe yourselves with tenderhearted mercy, kindness, humility, gentleness, and patience” (Colossians 3:12 NLT). We also see an account in Matthew’s gospel where Jesus happened upon some blind men who cried out to him for their sight. This was his response: “Jesus had compassion on them and touched their eyes. Immediately they received their sight and followed him” (Matthew 20:34 NIV).

While we don’t have to be Jesus, we are called to be like Jesus (Ephesians 5:1-2). Jesus did not pick and choose to whom he showed mercy and compassion when they were crying out. He freely showed compassion. If we are Christians, this is part of our calling. We do not get to pick and choose to whom we show compassion. We are called to be compassionate to the entire world.

I have no idea what, if any, faith Mr. Picard claims but I feel that he would do himself and his citizens well to follow the example of Jesus rather than the example of a group of politicians who do not believe in showing mercy to the poor and marginalized.

We all would.

Paramedics are taught not to risk their lives after mass shootings. Rightly so.

2000px-star_of_life2-svgI became a paramedic to provide medical care out of a hospital setting to the sick and injured. I, for the most part, enjoyed my career and I was able to even save a few lives along the way. One of the things I discovered early on in my career was that a large part of being an EMT or paramedic is about making some kind of connection with the patient and/or their family. Sometimes this means holding the hand of the elderly lady who you just picked up off their bathroom floor after she fell and broke her hip. Sometimes this means listening, truly listening, to the young guy who has reached rock bottom and wants to kill himself because he feels that no one cares. And sometimes it means talking to the gang member who just got the everlasting crap beaten out of him over a girl he asked out on a date who, unbeknownst to him, was attached to a member of a rival gang.

I’ve ran many calls like the ones above in the eight years that I have worked in EMS. The last scenario in particular stands out because this guy made it clear that he was not talking to anyone because he was going to get his revenge as soon as he was out of the hospital. He refused to tell the police anything. Once in my ambulance after I completed an assessment and treatment which I could provide, I began to talk to him. At first he wouldn’t even talk to me because, as he put it, “you work with the pigs (his words, not mine).” I pointed out that I was unarmed, didn’t even have a ballistic vest, and that I was not a cop. After a few moments he did begin opening up to me about what happened. I talked to him about letting it go and allowing the cycle of violence to stop with him, how beating the other guy up was not going to solve anything and how at the end of it all he could possibly be dead. Perhaps he listened to me. Perhaps not. I will never know. But one thing is for sure: If I had presented myself as an authority figure by acting like “Billy B.A.” like so many in EMS do, I may not have had the opportunity to reach out to this kid.

From that experience alone, I make a case for why EMS providers should not be armed or otherwise regularly take on the role of a combat medic. We are not authority figures contrary to what many of us think. Those of us working the streets for Someplace County EMS are not combat medics in need of tactical gear. When we work for AMR as contractors for a hospital or nursing home we have no need for a duty belt with a side arm, extra ammo, and cuffs. Certainly, a SWAT medic does need these things from time to time but for the 99% of us who will never attend an active swat raid, we simply do not need those things.

Presenting ourselves as no different than the police serves no real purpose, gives people more reasons to distrust us, and paints and even bigger bull’s eye on our backs than are already there.

A former medic turned writer for the CBS show “Code Black” (I will reserve my opinion on this show except to say that I’ve watched one episode and don’t plan to watch another) thinks differently. The Washington Post published an opinion piece written by Kevin Hazzard where he lays out a ridiculous case for EMS providers regularly being placed in harm’s way. In case you want to go ahead and know how I feel, Mr. Hazzard is way off base and is advocating for things which only work in Hollywood shows and movies.

I will respond directly to some of Mr. Hazzard’s statements.

I was a paramedic for nearly 10 years. In that time, my job certainly put me in danger’s way; like many of my co-workers, I believed that saving a patient’s life was worth losing my own.

Nonsense. I know not one EMS provider, not a single one (including and especially myself), who would die for a patient. Perhaps Mr. Hazzard didn’t care about going home at the end of the shift but the rest of us do. The reasons for one going into EMS are varied but I can assure you that dying for a patient is not on the list or reasons for the vast majority. Perhaps Mr. Hazzard needs to remember the part in EMT class where one is taught that if the provider is hurt, they are no good to anyone. When this situation occurs, further strain is put on the system by forcing someone else to care for the patient and for the injured EMS worker because they felt the need to play GI Joe.

Mr. Hazzard, if you’re indeed interested in risking your life in such manners, the military are always recruiting medics.

In many cases, people died while waiting for help that was just outside the door. Patients treated within 60 minutes of an injury — the “golden hour,” in emergency-medicine parlance — have the best chance of survival.

This is barely worthy of a response, as the notion of the so-called “Golden Hour” has been debunked again and again by this thing that so many EMS providers seem afraid of called science. This statement was never based on anything other than some surgeon’s slick marketing phrase for a tack-on certification. If someone is going to bleed out from traumatic injuries, I can assure you that it will likely happen in much less time than the “golden hour.”

Imagine if paramedics had entered the Pulse nightclub and started treating patients immediately. Imagine medics in flak jackets and helmets, surrounded by police assault rifles, setting about the critical work of saving lives right there on the dance floor. Would more people have survived if EMS had been able to treat patients sooner? The answer is almost certainly yes.

Any EMT or medic with any kind of knowledge and experience (and any other person with knowledge of traumatic injuries) knows this simply is not true. An uncomfortable fact: When one sustains multiple significant injuries from a high-powered assault riffle, they likely will die. Again, the notion of a “golden hour” is hogwash. Besides, what good does sending EMS providers into an active shooting scene do Shooting victims can be somewhat stabilized by EMS but, at the end of the day, they need a surgeon (and sometimes even that isn’t enough). Last time I checked, a thoracotomy was not in my scope of practice and I doubt it is in any other medic’s either.

If I have not made it obvious enough, I could not disagree with Mr. Hazzard any more if I had to. He’s wrong, ignorant, and needs to understand that such notions are dangerous. The image of a medic arriving at an active shooting scene and, without regard to himself or his family, running in to drag a victim out makes for a good TV show but in practice it’s not quite that simple and not worth the risk to the provider’s safety.

I believe Mr. Hazzard is getting Hollywood and the real world mixed up.

Take my advice, sir: Stick to Hollywood. Your fantasies should only exist there.

(Some edits made after publication for clarity and correction of typos)

A Tale of Two States

I am a transplant to Kentucky, having just moved here in June. One of the things I have found myself doing often is comparing how each state differs in its traditions, customs and certainly in their government. I want to offer you the same opportunity.

As you may have seen in a previous post, I wrote a letter advocating for the General Assembly of Kentucky to pass a bill allowing EMS providers to receive the same benefits as police officers and firefights should they die in the line of duty. I had received some bad information that the bill was in danger of failing to pass and I urged my state senator and representative to support this measure. The next morning I received a call from Representative David Hale who took time out of his busy schedule to call me personally and tell me that the bill was indeed expected to do well and that he was not sure how information had gotten out that the bill was in danger. He let me know that he fully supported the bill and many of his counterparts in the senate did well. He then took a few moments to get to know me, thanked me for making the choice to move to the Commonwealth and also asked if I had any other concerns related to EMS workers. He also commended me for taking up pastoral ministry as he is also a pastor and knew how difficult it can be to balance the duties of the church with everything else life throws at you. He was very pleasant and I thanked him for giving me a call when he certainly did not have to. He said, “I work for you. It’s my pleasure.”

Contrast that to how I have been treated by a Mississippi official.

A couple of years ago, I wrote Representative William Shirley and expressed my concerns about cuts to education and the fact that teachers in Mississippi had not, at that time, received a raise in quite some time. He did not even bother to return the email. I get it, I know he has bills to vote on, committees to sit on, campaign fund money to give to himself (see page 11) and to spend at the fish camp he owns (page 10).

But I digress.

I emailed him again and this time he responded. Essentially the exchange was not very polite on his end. He essentially let me know that he would vote for and against bills that were in his best interest of staying elected and to heck with everything else.

He also made it clear that my opinion was not valued.

And then there’s this guy who told a constituent that he “could care less” about her views, that her views were not Mississippi views, and that she should consider moving back to Illinois. Her crime was the same as mine: She dared to advocate for education and questioned the wisdom of tax cuts when revenue was already projected to be lower than expected to a member of a legislative regime who is determined to cut as much spending as possible from education for the benefit of their donors who happen to be “non-profit” private education companies.

Legislators in my home state of Mississippi could learn a lot from their Kentucky counterparts.

Jonathan

An Open Letter to the Kentucky General Assembly about EMS Death Benefits

1andyride
The ambulance carrying paramedic Andy Sharp on his last ride as it passes under a United States flag held in place by ladder units from the Philadelphia (Mississippi) and Choctaw Fire Departments. Credit: Brandi Smith-Wyatt

This letter is also being emailed to my state Senator and Representative. If you would like to use this letter as a template for your own, please feel free to modify it however you wish. I encourage you to contact your elected officials and encourage them to support line duty death benefits for EMS providers both in the Commonwealth of Kentucky and elsewhere. – Jonathan

To the Representatives and Senators of the General Assembly of Kentucky: Grace and peace to you in the name of our Lord Jesus Christ.

My name is Jonathan Tullos and I am the pastor of Shiloh United Methodist Church in Stanton. I am also a licensed paramedic in the Commonwealth and work part time at Powell County EMS as a paramedic and chaplain. When I attended paramedic school one of the things I was taught was to be an advocate for every patient I care for. Part of my call to pastoral ministry involves EMS chaplaincy – to be an advocate for the advocates. It is in that capacity that I contact you.

I, like many other EMS providers in the Commonwealth, am very disappointed to hear that the Senate defeated House Bill 54. As you are aware, line of duty death benefits are not currently offered to Kentucky’s EMS providers. According to the National EMS Memorial, there have been 27 reported line of duty deaths in Kentucky since they began collecting data. The recent line of duty death of paramedic John Mackey of Jessemine County EMS will be number 28. This means that at least 28 families in the Commonwealth have had to struggle with end of life expenses and income instability because they are not currently entitled to the same benefits that families of law enforcement officers and firefighters killed in the line of duty receive. Simply, this is an injustice that needs to be corrected.

There are many who view EMS as a vocation that is not as dangerous as law enforcement and firefighting. According to data available from the federal government, this is simply not true. EMS has death rates that are comparable to those of firefighters and police officers. Among the leading causes of death for EMS providers are heart attacks, vehicle accidents and violence. The notion that EMS is not a dangerous profession is a myth.

Daily, EMS providers in Kentucky and elsewhere face harsh working conditions, sleep deprivation, violence, and exposure to infectious disease among many other hazards. EMS providers often have to work more than one job due to low wages and inadequate benefits for themselves and their families. They do all of this in order to help others in need – possibly even yourself someday. Their families should not have to be saddled with the burden of financial difficulty due to their loved one dying in service to their community.

I encourage you to support Kentucky’s EMS providers by ensuring that their families will be taken care of if they are killed in the line of duty. Please do all you can to enact line of duty death benefits for Kentucky’s EMS providers.

Thank your time and your service to the citizens of the Commonwealth. May God bless you and may God bless Kentucky.

Sincerely,
Rev. Jonathan K. Tullos, Nationally Registered Paramedic (NRP)
Chaplain, Powell County EMS Stanton, KY

Powell County EMS Devotional January, 2016

mousepad_ems_chaplainIf you don’t know, one of the hats I wear is chaplain of Powell County EMS located in Stanton, KY (this is where Shiloh, the church I serve, is located). Every month I’m writing a devotional to share with the crews. This is the one I wrote for January; I shared it with a few friends and it was suggested that I post it here. So, here it is! February’s will be written this coming week and I will post it here as soon as it’s finished. – Jonathan

From the Chaplain:
Devotion – New Year 2016 Edition

Did you make a resolution for 2016? Some stats I found online indicate that about 44% of us will make resolutions but very few of us will keep them. The tradition of making promises at the beginning of the new year goes all the way back to the Babylonians making promises to return things they had borrowed and to repay debts. If you made a resolution, you are in some numerous and even ancient company!

Hopefully one of your plans in 2016 is to take better care of yourself and your family. I know all too well how tough it is to practice self-care, especially working in EMS. Self-care is essential, I would even say it’s as essential as keeping up with our own medical conditions. In order to be good providers, we simply have to make taking care of ourselves a priority. Last semester, I took a class in seminary that spent a decent portion of time talking to us, a room full of mostly future pastors, about the importance of caring for ourselves. In scripture, God looked at rest for our bodies and souls with great importance.

We know about the fifth commandment where God instructed the Israelites to work for six days and rest on the Sabbath because God rested on the seventh day. We also see God’s concern for Elijah’s physical wellbeing in 1 Kings 9 when he sent an angel to look after his needs. There are some ways that we can ensure that we are caring for our needs adequately. Doing so ensures that we are better care providers, better for our families and better for ourselves. We also honor God by taking the time to care for ourselves. Her are a few simple ways we can do just that:

• Do the basics. Things like eating right, getting enough exercise, getting annual physicals as well as regular vision and dental care contribute much to our overall wellbeing. It’s vital to make taking care of our health needs one of our highest priorities.

• Rest. This is difficult to do in our fields as we often work more than one job or at least work 24 and are off 48 and all of that in addition to family commitments. Simply, we must make time to rest our bodies. God did not tell us to rest one day a week just because He felt like it. He knows that we have our limits. Lack of bodily rest can not only impact our physical health but also our mental health. Studies have shown that sleep deprivation contributes to depression and suicidal ideations. Making time for rest is vital.

• Use your vacation time! I cannot stress this enough: If you have vacation time, take it. Take time off to do things you enjoy, travel, or simply hang around the house and rest. Working for extended periods of time without adequate time off to recharge is detrimental to your health and performance as an EMS provider. Lack of time off also leads to burn out. Take time off at regular intervals. It’s one of the best things you can do for yourself.

• Don’t neglect your spiritual life. Again, the EMS lifestyle is not always conducive to being able to read scripture or attend worship on a regular basis. When you are able to attend worship, I certainly encourage you to do so. When I have had to be away from church for a long time, going back to a community where I am loved and where God is praised was always such a huge relief. It is also possible to study scripture anytime using such things as the Bible app, which is available for free on your phone or tablet. From there you can access a variety of translations, reading plans and devotions. There are even EMS devotionals! If you are interested, I would be happy to make recommendations so please don’t hesitate to contact me. On a similar note: If there is enough interest, I will be happy to figure out a way for there to be a short time of worship on Sundays at the station.

These are but a few ways where we can begin 2016 on the right foot: By taking care of ourselves.

As always, if you need help with anything do not hesitate to ask for it. Part of my job is make myself available to you anytime you have spiritual concerns or just need someone to talk to after a bad call. Please do not hesitate to contact me if I can help you in any way. Remember: You are loved and you are never alone.

May God bless you and keep you. May He cause His light to shine upon you now and always.

Grace and peace,

Jonathan Tullos, NRP
Chaplain, Powell County EMS

An Open Letter to Houston County, TN Commissioner George Jeram

Credit: WKRN-TV Nashville
Credit: WKRN-TV Nashville

Dear Mr. Jeram,

I have been following with great interest the ongoing saga involving Houston County EMS and the mandate that you helped to craft which prevents them from effectively doing their job. This policy, while you may have intended it well, endangers patients and can very possibly cause great harm to them.

The policy where Houston County EMS providers are forced to call doctors at Houston County Community Hospital is dangerous.

I believe, however, that this policy is borne out of two things: Ignorance and desperation to try and save your county hospital. As for the ignorance portion of this equation, please allow me to educate you.

On a typical ambulance crew you will find two levels of providers: An Emergency Medical Technician (EMT) and a Paramedic. I am not sure of the specifics of scopes of practice and protocols for Tennessee so allow me to speak in general terms. An EMT is someone who has completed what is typically a semester long course and passed skills and cognitive testing certifying they are competent to render care at the basic life support level. EMTs can perform a variety of functions including obtaining vital signs, administering medications such as oxygen and oral glucose, performing various procedures such as applying a traction splint for a fractured femur, perform defibrillation by using an automated defibrillator and even more. Many patients require only this level of care en route to a hospital.

Paramedics have completed the EMT course and certification and have also completed a technical program (often leading to an Associate’s degree) through a hospital, community college or other institution of higher learning. Paramedics typically take two years to complete all of the requirements for their education and certification. Paramedics are educated in things such as anatomy and physiology, pathophysiology (disease process), a variety of medications, cardiac rhythms and their treatments, and airway management. Paramedics can initiate IVs, administer various medications such as Morphine and Valium (often without consulting a doctor due to standing orders), intubate (placing a breathing tube in a patient’s trachea) and perform many other invasive procedures. In some places, paramedics can even initiate and maintain chest tubes, surgical airways and more.

In short, EMTs and Paramedics do much more than simply throw someone on a stretcher, take a blood pressure, and drive 80 MPH to the closest hospital. There was time when that was the normal… 50+ years ago. A lot has changed and now EMS crews are able to keep a patient stable until they reach an appropriate facility for definitive care.  Typically they do not have to call a doctor for orders or to “find out what’s going on” because they have already determined that and are treating the patient. Perhaps you were simply not aware of the capabilities of EMS providers. I would encourage you to ride a full shift with Houston County EMS in order to see it up close. I’m sure they would have no problem letting you see what they are capable of.

As for the second part of this issue. A Google search reveals that you are a member of the committee which oversees Houston County Community Hospital and have fought hard for the hospital by encouraging your elected state officials to provide more funding for the hospital. A store by WKRN also reveals that the hospital is in serious financial trouble. I admire that you are willing to do anything in order to help the hospital stay open but this policy related to EMS is not the way to save your hospital.

As I mentioned, this policy is dangerous. If a patient is having a heart attack they need to be transported to a facility with a cath lab as soon as possible. If EMS is forced to transport to the local hospital first, this only serves to delay care. The patient can have a significant impact on their health up to and including death because of this delay. If there is nothing the local hospital can do in order to fix the heart attack, stopping there is a waste of time.

I am no longer a full time paramedic but I work part time in a county that does not have a hospital within its boundaries. The nearest hospital from here is at least 30 minutes away by ground depending on which part of the county the scene is in. If a patient is having a heart attack, stroke, or has severe trauma then we have to call for a helicopter to transport the patient to a facility further away with more capabilities. We do not transport simply because the hospital is nearby. We make a decision based on the best interest of the patient. Your EMTs and Paramedics should have the same ability. That is part of their job.

I hope that this policy is reconsidered soon and rescinded. While I will not presume to speak for your local EMS providers, I know I would not work at an EMS with such a policy and would immediately resign. I could not ethically or morally be employed for a service with policies that will not allow me to render the best care or to ensure that my patient receives the best care once they leave my cot. This policy not only hamstrings your EMS crews but is also a disservice to the citizens of Houston County.

I highly doubt you will ever see this post, Mr. Jeram, but I hope that someone is able to convince you that while this policy may have good intentions it is most assuredly flawed. For the sake of the citizens and EMS providers of Houston County, I hope this policy is changed.

Sincerely,
Rev. Jonathan Tullos, BS, NRP

Officer Down: Michael Walters, Pearl (Mississippi) Police Department

ImageThis morning three investigators  – officers with the Pearl Police Department – were attempting to do something they do day in and day out: Serve a warrant. This warrant was for the arrest of a suspect charged with sexual battery of a minor and possession of child porn. The suspect hid in a bathtub and when he was discovered he resisted arrest. One of the officers attempted to use a taser but the suspect had a gun and fired. All three officers were hit – Investigator Walters was hit in the face. All three were transported by EMS to the University of Mississippi Medical Center (a Level I trauma center). Approximately 40 minutes later, Investigator Walters died from his wounds. The other two detectives were listed in “good” condition as of the last time I looked at the various news sites in Jackson.

Anytime a police officer, firefighter or EMS worker is killed in the line of duty, it’s a reminder that we put our lives on the line to serve the public. I particularly hate these situations because it’s a reminder to me that at any point I can get that one call where it all goes wrong and where the end isn’t going to be a good one. I never want my wife to get that visit that tells her that something has happened to me.

If I had my way no one would ever get that visit.

Believe what you want about prison, the death penalty or whatever but these acts are inexcusable. Anyone who kills a firefighter, police officer or EMS worker in the line of duty should at the least be sentenced to life in prison without possibility of parole. If the DA wants to pursue the death penalty, I say bring it on. People like this suspect are the scum of the earth and should have no right to be among those in civilized society.

Let’s remember this officer, his family, the other two officers who were shot and their families and the Pearl Police Department in our thoughts and prayers. They’re all going through something that no one should ever go through.