Unsafe At Any Speed: EMS and Fatigue.

I am past the point of being dangerous by the time I realize it. My vision has been blurry for the past twenty miles and I can feel my brain shutting down.

Jesus, did I just fall asleep driving?

I’m not sure, there seems to be a second or two of consciousness missing but we are still on the road so I don’t know. Even though we are just ten miles from the station on a return trip from a midnight transfer I throw in the towel and ask my partner “can you drive?” Continue reading “Unsafe At Any Speed: EMS and Fatigue.”

The Second Death of Marjorie Mangiaruca: The Unjust Culture of EMS Resuscitation.

The first time Marjorie Mangiaruca died was on October 10, 2011. She was 90 years old, suffering from significant dementia and living in a skilled nursing facility.


She was found unresponsive with blue lips, gasping for air at Oakbridge Healthcare Center. EMS was called and they quickly began to transport her to the ER. While en route they tried to establish an airway. Before a definitive airway could be established by EMS the patient suffered a cardiac arrest. The ambulance was pulled to the side of the road and CPR was begun and a tracheostomy* was performed. The patient was given medications to “restart her heart” ( I assume epinephrine, but I do not know) and for reasons that are unexplained she was given paralytics by the EMS crew. Continue reading “The Second Death of Marjorie Mangiaruca: The Unjust Culture of EMS Resuscitation.”

“No evidence of mistakes” is not the same as “evidence of no mistakes.” [1]

Bad paramedics are conspired against by others; they are a victim of circumstances beyond their control and are almost always wrongly persecuted by the QA department. Bad paramedics never make mistakes

Continue reading

The Six Deadly Sins of EMS Continuing Education Presentations

If you are presenting EMS education at a conference please avoid the six following deadly sins.

Reading power point slides to the audience. No presenter should do this. Ever. If I believed in hell I would hope that there is a special place in the hottest part of it for presenters who do this. EMS is taught to the 10th grade level which means we can all read.

Having slides that suck. See figure one for an example. Few things in this world truly offend in the way a presentation that uses comic sans as a default font does. Additionally the use of WordArt should be kept to a minimum. When a presentation has more than a few slides using Microsoft WordArt there are two possibilities; the slides have not been updated since 2003 or the presenter has the kind of bad taste where they think Olive Garden is a really fancy restaurant (1).

(figure 1) If your slides look like this, you need to read this article.

Continue reading “The Six Deadly Sins of EMS Continuing Education Presentations”

Resuscitation: Nuremberg

This is not a story of heroism.

Danse Macabre by Michael Wolgemutin

People stop you and thank you for the work you do, they tell you that you are a hero, that you save lives, how you are doing God’s work and that what you do is just and right and good. You politely shake their hand and tell them you are just doing your job. Some days you can barely stop yourself from telling them that you are a god damn fraud.

Once, you believed the world to be black and white; assured that you would be able to decipher right from wrong.  You were more idealistic then, perhaps even naïve; you thought saving people from death would always be the right thing to do.

Continue reading “Resuscitation: Nuremberg”


The Death of Socrates 

(Portions of this post previously appeared on an EMS facebook group, The EMS Mentoring Society)

Does your agency have protocols for treating and not transporting terminally ill patients?

Scenario: It is 3am early Tuesday morning when you paged to a male party in terrible pain.Mike Sanders is a 56 year old male* with terminal pancreatic cancer. He is gaunt and emaciated, probably weighing 120 lbs at the most; in short, he looks like a terminal cancer patient.

He is lying in a bed, moaning loudly and appears to be in significant pain. His sister tells you that she brought him to her house yesterday because he wishes to pass away in their family home where he grew up. She says he has been battling pancreatic cancer for 6 months and that she expects he has a few days or maybe a week at the most left. Continue reading

EMS: Save the Red Lights and Sirens! A primer on anti-intellectualism.

People are always mentioning about EMS having a seat at the table in health care. If you are like me, you don’t want EMS to have a seat at the table in some boring meeting with other health care professionals. But that is exactly  what some people want. They want us to be college educated and to never use our lights and sirens again. They  want us to do less for our patients in the name of science. When discussing issues about EMS  on social media here are some pointers to ensure that EMS never becomes seen as health care professionals and we continue get to do the things we all love like drive fast and use backboards. Continue reading “EMS: Save the Red Lights and Sirens! A primer on anti-intellectualism.”