Or M³ if you prefer. Maybe I should title Random Rescuer Rants, but that sounds sort of silly. All of which is to say TOTWTYTR is on vacation and not really thinking about medicine (or much else) this week.

On with the show.

Partners AD over at his blog has a longish post about one of his partners. Bitchy Partner I think he calls her. She’s a stack of incident reports just waiting to be dated and signed. I’ve been blessed in that I haven’t had many partners like that over the years. For the most part I’ve been blessed with pretty good partners. I just hope they’d say the same about me. Then again, at one point or another I’ve had the same partner for nine or more years so I couldn’t be that bad.

A good partner can make even the toughest call flow well. Once you mesh, you hardly have to talk to each other on a call. Each partner knows what they are going to do and more importantly, they know what the other person is going to do. Equipment flows back and forth almost like you can read the other guys mind or he can read yours. That even extends to working with the BLS crew as one medic can tell them what his partner wants. At it’s best, this sort of synchronicity works to the benefit of everyone, especially the patient.

Conversely, a bad partner makes even the easiest call as painful as a root canal without Novocaine. On calls like these, IVs get pulled or contaminated, airways are never completely secure, equipment breaks or gets lost. You and your partner see different things when you look at the patient or an ECG. You find yourself asking “What the hell is he thinking?”, or making excuses for dumb ass mistakes. You can’t wait for the call to be done, the shift to be over, and you dread hearing your unit ID over the radio. You just know that on the next routine chest pain call, your partner is going to discover the elusive Zebra.

The BLS crews can see what’s happening and it makes them nervous. An ALS crew that’s at odds with each other makes the call tougher on them and of course the patient.

This isn’t limited to just ALS crews either. A BLS crew that can’t work well together make my job as a medic just that much tougher. Now, in addition to having to think about managing all of the ALS aspects of a call, I have to watch the BLS crew to make sure that the things they are responsible for, packaging the patient, making sure that the O2 is flowing right, the stretcher is where it needs to be, the path to the ambulance is clear, and so on are done. A good BLS crew on a tough ALS call is a blessing and I know I’m lucky to work in a tiered system where most of the time I have good EMTs to do the fundamentals. If they aren’t doing that, my work load on a call has just about doubled. Add an out of sync ALS partner, and you’re like the last man standing at the Little Big Horn.

“Toys“ I really hate when a medic refers to our equipment as “toys”. Just a pet peeve, I guess. Still, it brings up that there are two types of medics. Actually probably more. The two I’m talking about are the “use every drug in the drug box on ever call” type and the “do what needs to be done for the patient and no more” type. I’m one of the latter, and I sometimes find the former more than a bit annoying sometimes. Just because we have a drug in the box or a piece of equipment on the ambulance doesn’t mean that we need to use it. As I said in one of my first posts, our job is not to cure the patient, it’s to mitigate their problems and get them to definitive care alive. Every drug we have has positive and negative effects. I mean every drug, including Oxygen. If you’ve read this blog for more than a few days, you know what I’m talking about. Peter, over at Street Watch has a good post that touches on this subject. Those drug inserts are about the size of the Bayeaux Tapestry and are written using a font that would make a lawyer dance with joy. They do, however, contain far more detail about a drug you’re likely to use than you’re likely to get during an in service. If you read enough of them there is some risk that you’ll never give any drug, but it’s a small risk. Give the right drug at the right time in the right amount by the right route at the right rate. That’s so easy to remember that I won’t even come up with a dopey mnemonic for you.

HIPAA Hysteria First of all, it’s HIPAA, not HIPPA. Health Insurance Portability and Accountability Act. For the love of whatever Deity you worship, spell it correctly so that you don’t look like a boob. Well, not that there’s anything wrong with boobs displayed in a tasteful way, but you know what I mean.

I don’t recall ever seeing so much hysteria over one set of regulations. It’s actually pretty easy to understand if you follow a couple of simple rules.¹ If you are discussing a case, make sure that that you don’t give details that would allow someone who wasn’t involved in the case to identify the patient. If you presenting a case at rounds, redact identifying information on any written materials. Make sure that you don’t leave copies of your report in unsecured areas of the ED. Don’t leave your clipboard or laptop lying where someone can pick it up and read your report. If you blog about specific cases, change enough details so that the time, place, and patient ID are obscured. You are not prohibited from calling the hospital on your radio since emergency communications are exempt.

Some smart lawyer is going to write “HIPAA for Dummies” and make a fortune. Gene, Wes, are you paying attention? Really, there is a whole cottage industry of consultants and risk managers out there teaching people about HIPAA. Some of them are no doubt doing it wrong, too.

Tourniquets Seems like I was right. JEMS has an article about research done in Boston. It’s a pretty interesting article and bolsters my position on this subject. I wonder what took them so long?

1. Once again, I’m not a lawyer and I’m not giving legal advice. Whatever your institutions policy is, even if it’s a silly one, follow it. Just understand that the default position for risk managers is “Don’t do it”.