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Do you realize ?

That we have been granted a unique privilege by society, to enter into individuals most private lives (to share their most intimate thoughts, feelings, emotions and sorrows) it is a rare privilege which we think so little of and teach so little about in our medical schools, yet it is central to everything we do”

– Fisher “Back To Happiness” 1987

Those words resonate with me at the level of my very being. It is something we so often take for granted. I wonder how many of us stop to actually think about it…

Think about what it is like for someone to call 911 – to know that regardless of who shows up, the police officer, the fire fighter, the paramedic – regardless of who it is – they are opening up their entire life; to you… their home, the most sacred aspects of their lives – mostly without limitation because the situation is out of control for them and they need help…

That is what we do everyday, when we go on 911 calls.

There is an awful lot of gravity to that – what an incredibly special a privilege that is.

Speaking only for myself – I am not a very trusting person, I do not welcome strangers into my home – in fact I am VERY thankful the state I live in has a “Make My Day Law” – I feel strongly about that personally…. But when I need help; I’m calling 911 and no matter who shows up it’ll be “by all means, come on in.” All of a sudden everything flips, because I feel out of control in the situation and I ask for help.

It is all of us that are put in the position to help those people – I hope we always remember what a truly special opportunity that is…

It is a delicate line we walk each and every time we put on our uniform. That fine line between EMT or paramedic/patient relationship and public safety.

Where do lines of confidentiality begin, and end… where are we willing to blur them a bit? ARE we willing to blur them at all?

Due to HIPPA laws we are not allowed to tell the police officer how many drinks our “drunk driver” patient admitted to… but in the interest of public safety do we allow the officer to stand at the back door of the rig and listen to the responses our patient gives to our assessment questions? Do we ask the officer to ride along for “our safety” so he can get the information he needs for his investigation and we don’t breach HIPPA laws? Or do we steadfastly protect the privacy of that patient and close the doors of the bus behind us when we get in and tell the officer he can meet us at the hospital and do his investigation there?

What is the right answer to that question… both options are completely legal – and neither is necessarily right or wrong.

What about the call you respond to for chest pain and see a huge pile of cocaine on the coffee table? Does that change the answer, does it influence your judgement?

I’m not talking about the “mandatory reporting” issues those are clear-cut… I’m talking about those calls that fall squarely in the middle of that grey area.

Where do your ethics draw the line between respecting that immense privilege you are granted in being allowed into someones most sacred and private places and the general safety of the public? Have you ever thought about it?

It was suggested that we think about these tough decision type of calls ahead of time, so that we can make a split second decision we can live with when we are called upon to do so.

In theory that sounds like a damn good idea, however, I wonder if that isn’t like playing “Who Wants To Be A Millionaire” on your couch… It’s easy to find the answers when there is no pressure…

When there isn’t $ 1,000,000 on the line and no lifelines left I can right off the top of my head tell you that Dr Ignaz Semmelweiss is the Hungarian obstetrician that required his students to wash their hands in an antiseptic chloride solution before examining patients, and because of that simple task, maternal death rates plunged from a high of 18 percent to a low of nearly 1 percent in 1847. (Our pharmacology instructor is a big fan of “cocktail party trivia”)

I wonder if the memory of that particular nugget of information would come quite so easily with the spotlight shining on me under all the pressure a game show contestant feels…

Is coming up with answers to these difficult ethical questions any different?   Isn’t it easy to know what the right answer for you is sitting there at your desk reading this? Isn’t it easy for me to say “well this is what I would do” hiding behind the blinking cursor of this blog?

I’m not by any means suggesting we should never think about these things… more that, I’m not sure we can answer them with any degree of certainty until it is OUR feet that are being held over the fire.

What do you think?

 

 

Posted by on October 24, 2011 in EMS, Ethics, Paramedic School

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What would you do?

Watch your thoughts, for they become words. Watch your words, for they become actions. Watch your actions, for they become habits. Watch your habits, for they become character. Watch your character, for it becomes your destiny.
— Unknown

 

It never ceases to amaze me when the classes you think you are going to get the absolute least out of, prove to be the ones that make you go home thinking. Ethics class proved to be full of  ”things that make you go hmmmm…”

I went into class fully expecting to be bored out of my gourd, which for paramedic school is not such a bad thing, easy nights are few and far between. Class opened with the instructor saying this would be one of those classes where they weren’t there to give you answers; instead they were hoping we would leave with questions, questions about our own set of values and how we exercise those values in the field.

Whatever let’s just this over with so we can go home” – none of us actually said it, but I know I wasn’t the only one thinking it.

The lecture proceeded as expected for a while, the definition of ethics, ethics vs. morals, etc.

Then an interesting “case” was presented.

A foreign “dignitary” was brought into the hospital via ambulance – the hospital was rather busy as you would expect from an urban  level 1 facility, but tonight was exceptionally busy… the dignitary was placed into one of the rooms in the old ER which is now used as the psych ER. The room was perhaps not the cleanest in the hospital, nor was it the newest, it was however fully stocked and equipped with all the necessary equipment.

The nicer rooms in the ED were all filled with “regular people”, homeless folks, the drunk that passed out in front of 7 – 11, junior who fell and broke his arm etc.

The dignitary received the top-level of care and was treated as any other person would have been.

After their release the dignitary filed a complaint about their treatment they received and about being put into the sub standard room.

Then the questions started…  Was it OK to put that dignitary into a sub optimal room instead of homeless Joe? Should that person, based on who they are or what they do receive “special treatment”? Was the complaint justified?

Of course, all of us reacted the same way you probably just did; “Damn spoiled brat politicians” Why should they have gotten a nicer room, or faster care, or any other special treatment. We were all convinced we would have done the same thing the ambulance crew in question did, and the same thing the nursing staff did when the assigned the room…

All of a sudden though what was black and white a moment ago became cloudy and grey with a single question….

What if the dignitary had instead been a police officer, a firefighter or one of your fellow paramedics who was hurt in the line of duty? What if it had been your partner? What if it had been you?

All of a sudden we all were faced with having to admit that each and every one of us (in my class) carry some level of double standard, because we all had to acknowledge that we would have expected DEMANDED better treatment if it had been one of our “brethren”

Where do we draw the line? What is the right answer? What would I have done?

Another case was presented… You are en route to the hospital with a patient suffering from symptomatic V -tach… You call the doc for a med order and to your surprise it’s your medical director who answers… You present your finding and tell the doc your plan; he denies your request to deliver an amiodarone drip and tells you instead to push 1 mg Atropine. Stunned by such an order you request confirmation, and he confirms 1 mg Atropine IV push.

What do you do?

I haven’t had my pharmacology classes yet, but even I know that if you follow the doctor’s order, you will likely kill this patient.

I pride myself on my integrity, my patient advocacy, and my absolute commitment to endeavor to do no harm… My answer was immediate and loud – I give the amiodarone drip to help my patient and I deal with the doc’s fury later…

It’s the RIGHT answer if you ask me, but then the student sitting next to me said ” I totally see what you are saying and I agree that that is probably what you SHOULD do… but how much will that help you when the medical direction gets you fired and your certification pulled, and you are standing in front of the supermarket holding out a can hoping for donations to feed your family”

I paused and considered what he had… Would that change my actions? Would the prospect of losing my chosen career after so much hard work force me to change my mind?

I like to think the answer is no… At least I will know I didn’t sell my soul to make a doc happy and potentially kill someone in the process… But it’s easy to answer that sitting here typing, much different than rolling down the road hot 3 minutes out from that very same doc, holding a patients life in the balance.

All of a sudden this stuff isn’t quite so boring, nor is it quite so cut and dry.

I’m not a huge country music fan, but Aaron Tippin sings a song called “You’ve Got To Stand For Something” there’s a line in the song that says ….

“… Whatever you do today, you’ll have to sleep with tonight…”

I guess it never really hit me much until after that class how true that was…

What would you do my friends?

 

Posted by on October 21, 2011 in EMS, EMT, Ethics, Paramedic School

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