The Unwired Medic

Teaching EMS providers & other public safety pros about using mobile tech to improve their practice, patient care, continuing education, scene safety, general entertainment, & productivity.

April 24, 2015
by The Unwired Medic
55 Comments

Texas ENA’s Unprofessional Attack on EMS

Texas ENA’s Unprofessional Attack on EMS

Author’s note: I generally avoid posting non-tech matters on my blog, but this unprofessional, unsubstantiated, fear-mongering attack of EMS in Texas has me boiling. I present to you something that doesn’t just affect Texas EMS, but EMS in the entirety of the United States of America. This has been fought in other states, and if it isn’t stopped now, will set a precedent and spill into many more states and regions. If you want to advance, you don’t do it by holding your siblings down in mediocrity and attacking their skills and intelligence. They seem to have taken a page out of the book, “How to Get Ahead in Life by Attacking Your Colleagues.” It is uncalled for. It has been professionally sanctioned by the San Antonio Chapter of and the Texas ENA, and they are imploring their members to spread this insult as if it were fact and we will bring the end of competent emergency care. I submit that they owe us a retraction and public, formal apology. My dog in the fight directly is that I have been a Texas Paramedic and if I want to return there in my future, my career options should not be limited by a board that played dirty politics from the word go with lies and mudslinging! My article also appears on Facebook (here) and I invite you to share it ad libitum. I would like to see the NAEMT take a professional position on this matter, and I would appreciate if you took time to contact the Texas NAEMT region board and state leadership, and the Texas EMA, decrying this deplorable behavior.

Warmest regards…


 

The Texas ENA is pushing to keep their thumb over EMS again and trying to keep EMS providers from crowding “their” domain. Consider asking your political representation to oppose the ENA efforts and to move to allow EMS to practice out of the preshospital-only areas. This push is to allow EMS to work to its full scope, under guidance of a physician, in ER and urgent care type sites, not ICU or other full admissions patient care environments.

I provide my counter-points to the letter at the end, factually debunking most of the ENA letter. Thanks for considering this and please SHARE!


The following is a letter sent to me by a Texas Paramedic:

URGENT TEXAS PARAMEDICS!!!!!!
The following is an email being sent to Texas ENA members in regards
to legislation being considered that would allow Texas EMT’s and
Paramedics to function within their scope in the hospital setting
under the direct supervision of the MD. HB 2020 and SB 1899 would
allow us to perform our clinical abilities in the emergency department
or urgent care setting with a physician in close proximity.
The stance of the Texas ENA essentially states that these procedures
are best performed by and RN and that we do not have the necessary
education or competency to perform these procedures within the hospital
setting despite performing them in the out of hospital setting.
Unfortunately we lack the legislative representation as EMS but if we
all call, write or visit ourstate representatives and senators we
might be able to fight back!
I have copied the email being circulated and you can read it in the
text below. The link is a link that will allow you to contact your
representatives both in the house and senate.
PLEASE SHARE THIS LINK TO ALL IN EMS; even if you do not practice in Texas!

Dear SAENA Member,

The Texas ENA Government Affairs Chair has asked that the following information be sent out to all of Texas ENA members:

House Bill 2020 and Senate Bill 1899 are currently under discussion and maybe moving for vote in the near future.

These bills would change the scope of the EMT-P and licensed paramedic to include the initiation of advanced life support measures such as; IVs, intubation, defibrillation / cardioversion and administration of medications under the supervision of a physician who is present in the same area or an area adjacent to the area. These actions would occur in an emergency or urgent care clinical setting, including a hospital emergency room or a freestanding emergency medical care facility.

The Texas ENA is opposed to the passing of these bills and requests members immediately contact their House and Senate representatives by calling, writing a letter or email, to express opposition to the bills. (To identify your representative, go to http://www.house.state.tx.us/memb…/find-your-representative/ )

The Government Affairs Chair included a letter, written by a member, which identifies the issues related to these bills. Members may use the basic information in the document to compose their own letters to their legislator or to identify points to discuss when speaking to their representative.

I am writing today as a registered voter in opposition to HB2020 relating to the scope of duties of an emergency medical technician-paramedic and a licensed paramedic. This bill allows EMTs and EMT-Paramedics the authority to provide healthcare services including advanced life support in hospital emergency rooms and freestanding emergency medical care facilities under a physician delegation.

As an emergency nurse, I am concerned that this bill will potentially affect the safety and level of care provided to patients in the emergency department and encourage hospitals to utilized less qualified providers for staffing. Currently, EMT and paramedics are provided the authority to provide life saving measures in the pre-hospital environment until the patient can reach the emergency department which is a higher level of care. This role utilizes physician-developed protocols and direct communication with the hospital to direct care until the patient arrives at the emergency department. The focus of the training is on skills. The Texas Board of Nursing rules limits what tasks can be delegated to others. This restricts paramedics from administering medications and intravenous fluids in the hospital setting.

This differs significantly from the registered nurse role which is an autonomous provider who’s training includes independent decision-making in which the RN works collaboratively with the physician to ensure that adequate care is provided to the patient. There is extensive preparation in pathophysiology, pharmacology, skills, and critical thinking/clinical judgment. Current research shows a direct correlation between nursing care and positive patient outcomes. Most emergency departments require that emergency RNs are trained in advanced cardiac life support and trauma nursing care. There is a national certification body that also provides certification in emergency nursing. Furthermore, the Texas Board of Nursing rules does not allow nursing to carry out orders from an EMT or paramedic.

EMTs and EMT-Paramedics temporarily receiving direction for a physician could create a very unsafe situation during the most critical time in the patients hospital stay. Currently they receive directions (delegation) from a nurse so who do they listen to in this critical situation when the nurse needs help and the physician requests their assistance. Who is accountable when they accidentally misunderstand the delegation instructions.

I urge you to vote no on this bill for patient safety reason.’

Attached to this email is a copy of HB 2020 for you to review. In addition, at the end of the email are the names of the committees and links to the specific legislators now discussing these bills. You may contact these legislators even if they are not your district representatives.

I urge you to stand up and be heard! Contact your legislator NOW and tell them to vote NO on HB 2020 an SB 1899.

Carol Twombly

President

San Antonio Chapter

Texas Emergency Nurses Association


Allow me to dissect their letter, its inaccuracies, outright lies, and unsubstantiated “fact” and offer counter-points:

Using less qualified providers…”

So we’re only less qualified when we pass through the magic portal that separates the ER from the parking lot? I don’t recall a statement in law showing Paramedics are less qualified providers. Desire to compare academic requirements? I do it later in this article. And before the “degree-based” requirement for nursing comes up, perhaps we can make sure to include all the presently certified/licensed nurses who maintain their certification/licenses despite being from diploma-based training programs. It was not very long ago that these were still commonplace and accepted, or has nursing forgotten the inconvenient. We in EMS are clearly moving toward a degree-based requirement as a field. In fact, in Texas, you must have an Associate’s Degree in EMS, or a Bachelor’s degree or higher (any field is allowed) to be a Licensed Paramedic.

a) Requirements for paramedic licensure.  (1) A currently certified paramedic may apply for a paramedic license if the candidate has at least one of the following degrees from an institution of post secondary education which has been accredited by an agency recognized by the U.S. Department of Education as an approved accrediting authority:    (A) an associate degree in emergency medical services (EMS);    (B) a baccalaureate degree; or    (C) a postgraduate degree. (link to Texas Administrative Code here)

So much for the degree argument.


Currently, EMT and paramedics are provided the authority to provide life saving measures in the pre-hospital environment until the patient can reach the emergency department which is a higher level of care.”

So, the issue actually is authority, not skill or qualification.


 

This differs significantly from the registered nurse role which is an autonomous provider who’s training includes independent decision-making in which the RN works collaboratively with the physician to ensure that adequate care is provided to the patient.”

RN’s are not autonomous providers. Ask an RN for an over-the-counter medication like Acetaminophen while you are a patient. A physician orders, and they execute, no different from Paramedics. You must be a licensed Nurse Practitioner, or more precisely, an Advanced Practice Registered Nurse (APRN) to work completely autonomously (https://www.bon.texas.gov/laws_and_rules_nursing_practice_act_current.asp). This also makes it sound as if we don’t work collaboratively with physicians, which although is only implied, it is strongly implied and not true.


 

“Furthermore, the Texas Board of Nursing rules does not allow nursing to carry out orders from an EMT or paramedic.”

This is completely irrelevant. Under what pretext would this statement be necessary unless nurses were acknowledging that Paramedics are higher levels of practitioners than they. No one has made such an assertion, and no one should. In Texas, a nurse and a Paramedic are neither higher than the other. No authority has been given to nurses to delegate to a Paramedic or EMT either. We are governed by different laws and boards. We take our patient care orders from physicians and other licensed independent providers, not RN’s.


EMTs and EMT-Paramedics temporarily receiving direction for a physician could create a very unsafe situation during the most critical time in the patients hospital stay.”

STOP! There isn’t a shred of evidence presented to support this egregious attack on our clinical competency, and it is nothing less than an attack. How do physicians and nurses interact with Respiratory Therapists, lab technicians, radiology technicians, PA’s, NP’s, RN’s, and LVN’s now? By virtue of this statement, there must be an extraordinary quantity of unsafe situations that already exist in the ER and in urgent care. One might wonder how a patient survives an encounter at the ER at all.

Are we truly supposed to believe adding another clinical professional into the equation will absolutely mean detriment to patient care? It could create a very unsafe situation… It’s absurd and inflammatory. It’s no better than saying, “The end of the world could occur at any moment,” and rather than support this statement with statistics and fact, we should resort to unqualified, unsubstantiated fear-mongering.

Here is the reality… Paramedics are trained extensively to work with physicians and nursing staff in the most critical and emergent situations, and after certification and licensure, we then do it nearly independently in austere and isolated environments, so should we be expected to crumble into babbling, incapable dolts the moment we are suddenly surrounded with an army of physicians, nurses, and other complementary healthcare providers? Hardly, and if anything, it will serve to bolster the patient care competency portfolio (fair note: I cannot substantiate my assertion here, but that isn’t stopping the ENA from urging their members to do that very same thing to us. The difference is I’m not suggesting a class of healthcare providers be prophesied as causing the downfall of emergency care by virtue of its delivery withing a walled building – read: ER or Urgent Care – instead of an uncontrolled physical and social environment – read: everything not an ER or Urgent Care – or a 100 square foot box on wheels).

And lest we forget, Paramedics undergo extensive clinical instruction and precepting in the Emergency Room under the supervision of, that’s correct, physicians and nurses, long before we are deemed competent and permitted to sit for our local and national certification boards. Nurses sign off on this competency! Again, the magic portal that separates the ER from the parking lot has astounding effects, and the best part is that the outcomes of the magic portal are selectively applicable when it suits the nursing lobby! The argument is contradicted within their own presentation against EMS. How can you decry our competence when you signed off on it?


Currently they receive directions (delegation) from a nurse so who do they listen to in this critical situation when the nurse needs help and the physician requests their assistance.

Fact: There exists no authority, whether self-derived from the Board of Nursing, or from any lawful EMS oversight committee or statute, to allow, or even imply a nurse is allowed to provide, direction or delegation to an EMT or Paramedic. If this relationship exists, it is that of a person who also happens to be a Paramedic working as an uncertified, unlicensed technician employee for a hospital, and it is because hospital policies, not law, have placed that person as an ER tech under the direct supervision of a nurse. They are absolutely NOT practicing under their license as a Paramedic… yet. Search job listings for ER Technicians in Texas and you will see that current or past certification and/or licensure is commonly highly recommended. It is not a position where a Paramedic is employed to use his license. Here are a couple major health providers in Texas to show examples from:


Who is accountable when they accidentally misunderstand the delegation instructions.

On its face, this seems like a valid argument, but like all the previous arguments I present from this letter sanctioned by the Texas ENA, it fails to recognize the reality of placing a licensed and/or certified provider in the job. When a certified or licensed Paramedic, employed under their own certification and/or licensure, makes a misunderstanding of delegated instructions in providing prehospital care, it is their own license that is on the line, not a nurse, and rarely a physician is held liable (disclaimer: I’m not an attorney, but a well-respected attorney and Paramedic in Texas has told me as much – I will endeavor to present more fact from case history if requested). It is no different than if a nurse “misunderstands the delegation instructions”. The nurse isn’t magically liable for any other provider’s license, but their own. Again, this statement serves to cloud the issue and incite fear of liability where it doesn’t exist. Logically, if you cannot substantiate your claim on fact, plea to the emotion of the bureaucracy and legislation and use fear-mongering to support your position.


There is extensive preparation in pathophysiology, pharmacology, skills, and critical thinking/clinical judgment.

Again, they imply that Paramedics haven’t this training, which we can document we have as part of the core curriculum of Paramedicine and in the NHTSA educational requirements. I don’t have anything on the national accreditation standards for Paramedic education as required by the NREMT, but I can’t see them negating the national educational model. Requirements from the federal government are the baseline and accreditation would only work its way up. To allay the fears that we are uneducated oafs given power tools and a license to kill, I provide a link below to the national education model standards for Paramedic training. You may find the 385 page outline on the curriculum stimulating, and that’s only the outline, not the multiple-volumes of anatomy, physiology, pathophysiology, pharmacology, life span development, terminology, differentiations from medical and trauma on each major body subsystem and age group, operations, incident response and coordination, documentation, and more, nor does it even touch the prerequisites of our allegedly subpar (per Texas ENA) education. All of that also doesn’t detract from the fact that although nurses are trained holistically and through a complete care cycle from admit to discharge, Paramedics are trained specifically for everything spanning from pre-admit through every conceivable emergency and critical care situation, and for inter-facility transport of the critically and chronically ill. We are emergency care specialists, not medical generalists.

http://www.ems.gov/pdf/811077e.pdf


Most emergency departments require that emergency RNs are trained in advanced cardiac life support and trauma nursing care.”

Again, anecdotal, and a broad overgeneralization, completely unsupported by facts and statistics. Texas isn’t most emergency departments. . This is a hospital matter and if it is driven by anything, I would suspect it is accreditation and reimbursement, and certainly not law. What Texas Department of State Health Services EMS (TX DSHS EMS) does regulate is trauma center level designation: http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=157&rl=125

In other words, this is smoke and mirrors and does not justify the Texas ENA position. ACLS and TNCC (continuing education certification courses for cardiac and trauma care) are not commonplace for typical nurses. ACLS is mandatory for Paramedics to maintain certification and licensure, and it is commonplace to see Paramedics teaching the courses, and we have a couple equivalent courses to TNCC specifically for EMS, or can even take TNCC for ourselves. So why bother bringing this up? To show that after you are licensed you need additional training so you can do what Paramedics had to do before they even left school? It isn’t helping your care, but when taken alone, it sure sounds like you are implying that your skillset exceeds ours.


There is a national certification body that also provides certification in emergency nursing.”

So what? We have a national certification board too. The difference is national certification in emergency nursing (a.k.a., CEN) isn’t required for state licensure, nor is it a regulatory requirement to work in an ER or hospital. In Texas, national certification IS required to obtain new or reciprocal certification and licensure as a Paramedic. The statement implies the untrue, that nursing is more qualified than EMS.

However honorable obtaining this prestigious certification, and it truly is, it is accreditation and reimbursement driven. Most states in the USA require national certification for Paramedics before being granted state or local certification and/or licensure to practice. Additionally, while emergency medicine is fully within our purview, the CEN (Certified Emergency Nursing – http://www.bcencertifications.org/Home.aspx) certification is not a core requisite of nursing. It is an adjunct certification to demonstrate competency in a specialty field which is not part of the primary nursing curriculum. Emergency medicine, pre-, peri-, and in-hospital, is at the very root of Paramedic education.

According the the BCEN (Board of Certification for Emergency Nurses), currently, more than 30,000 nurses hold the CEN certification. In my experience (anecdote), it is uncommon to encounter a CEN outside a large hospital system. I cannot recall encountering any in my 20 years in EMS that worked in rural hospitals. In fact, I have worked at a few rural places that call the local ambulance to the ER to run their codes (cardiac arrests) for them. You aren’t making a case that nurses are safer than Paramedics in an ER for patient care.


Furthermore, the Texas Board of Nursing rules does not allow nursing to carry out orders from an EMT or paramedic.

So what? The Texas Board of Nursing does not regulate emergency rooms or hospitals, nor does it write Texas law. The Texas Board of Nursing does not regulate EMS providers, either. We have already covered this ground. Under what circumstances would a Paramedic be giving orders? None. They aren’t independent healthcare practitioners. That’s the physician’s job. If a Paramedic were administratively higher than a nurse in an ER or Urgent Care, it would be a hospital decision, not a legislative one. Imagine that, a Charge Paramedic giving staffing orders to nurses. Of course, the Paramedic still could not dictate patient care or give orders. That has to be left to the physician/PA/APRN.


Now, I want to head off the next tired argument before it is presented. Nursing will sing to you of the requirements for continuing education to ensure clinical competency does not stagnate and the nursing practice is forever advanced, and the continuing education opportunities are impressive, to be sure. They are required to obtain a full 20 (twenty) CNE (Continuing Nurse Education) hours per two-year licensure cycle. Ten whole hours per year of class time dedicated to maintaining and expanding their knowledge base in nursing!

However, this pales in comparison to the 144 hours required by TX DSHS EMS for Paramedics (http://www.dshs.state.tx.us/emstraumasystems/scehours.shtm), every four-year certification/licensure cycle. Paramedics have the option of forgoing continuing education for renewal in lieu of sitting for a complete written licensure re-examination. To maintain national certification, the National Registry of EMT’s, our national certification board, requires 72 hours of continuing education every two-year cycle, which is nearly four times the continuing education requirement for nurses in Texas regardless if you look at annual, bi-annual, or four-year cycle. Of course, employers may always opt to require more education for their staff, Paramedic or nurse. As as comparison note, Texas physicians are required to obtain 48 continuing medical education hours per two-year cycle (http://www.tmb.state.tx.us/page/resources-cme-for-md-dos).

I am frankly appalled at the unprofessional, unwarranted, baseless attacks on EMS provided by the Texas ENA and the San Antonio chapter. I respectfully demand they retract their letter to their membership, require their membership that have submitted it to their legislative representation to issue a retraction letter and apology for unprofessional conduct, and issue a public, formal apology to all Texas EMS providers and especially Paramedics, both certified and licensed. Had an EMS organization the audacity to behave in the same manner, I have no doubt there would be attorneys representing nursing breathing down our necks asking this and perhaps more.

Nurses, we have decades working together symbiotically to support the patient care spectrum. We applaud your advancement professionally and encourage it. We have likewise opened our educational offerings to you in good faith, as you have to us. We are modeling your growing pains as a profession and we are walking in your footsteps, striving to implement national degree-based requirements and it will take time for us as it did for you, but this condescending air of superiority has got to stop. We are not your pawns. We are not inferior to you. We are not subordinant providers to you like CNA’s. We are no longer even technicians. We Paramedics are certified and licensed in our own right, just as you are. We are not subject to your boards, rules, and regulations. We are a profession unto our own. We have separate regulatory bodies, enforcement, and accountability. A good big sister helps her siblings grow, mature, and come into their own, leading them to betterment. She doesn’t beat them down every time they try to stand on their own or bully them into submission. Grow up.


Contact the Texas ENA here:

http://www.txena.org/contact-tena/

Link to Texas ENA contact information provided by the National ENA

ENA, Texas State Council

ENA, Texas State Council

 

 

 

 

 

 

 

 

Contact the San Antonio Chapter of the Texas ENA here:

http://www.sanantonioena.org/

And the author of the insult letter here:

Carol Twombly, RN at cltwombly@aol.com

Carol Twombly, President of San Antonio Chapter of the Texas ENA at ctwombly@aol.com or (210) 260-3699

Carol Twombly, President of San Antonio Chapter of the Texas ENA

 

 

 

 

 

 

 

 

 

 

 

Contact the NAEMT leadership here and ask them to address this professional misconduct head-on:

http://www.naemt.org/about_us/Leadership/bod.aspx

Conrad T. “Chuck” Kearns
President
ctkearns@aol.com

Dennis Rowe
President-elect
emtp296@gmail.com

Terry L. David
Director, Region IV
david27@peoplepc.com

Troy Tuke
Director, Region IV
ttuke@cox.net

Matt Zavadsky
At-Large Director
mzavadsky@medstar911.com

 

Ben Chlapek
At-Large Director
bchlapek@aol.com

National Association of Emergency Medical Technicians
PO Box 1400
Clinton, MS 39060-1400

Physical Address:
132-A East Northside Dr.
Clinton, MS  39056

Phone: 601-924-7744
Toll Free:
1-800-34-NAEMT
Fax: 601-924-7325

info@naemt.org


Addendum:

I encourage you to read this article from “A Day In The Life Of An Ambulance Driver” for his considerations of this deplorable attack on EMS, and he is offering a template letter for EMS and anyone else to base their own letter to your Texas Legislators.

http://www.ambulancedriverfiles.com/2015/04/26/an-urgent-call-to-texas-ems-professionals/


I invite you to use this preformatted letter as a starting point for your own letter to the Texas Legislature. Please remember to keep your own responses professional, without stooping to unsubstantiated data, opinion, and lies, unlike our colleagues at the Texas ENA.  You may wish to open the PDF and then copy the text into your text editing program (Word, Google Docs, etc.).  Thank you for your support in this matter!

Texas Legislature Preformat Letter for HB2020 – PDF

April 1, 2015
by The Unwired Medic
0 comments

Phillips MRX to Feature Add-On Voice Mods

Just a short article today. More articles coming down the pike soon though. Thanks for reading!!!


A couple years ago, I was beta testing the Philips MRx defibrillator/monitor for an agency and I ran a code almost right out of the chute with it on my unit. We had hooked everything up in our cramped little apartment and began CPR, then I applied the CPR “puck” to the sternum and had the crew resume CPR. After a moment, it began coaching the compressions.

“Compress a little deeper.”
“Compress a little faster.”

Blah, blah, blah.  After about two minutes of this, one of my firefighters exclaims, “Man, that thing’s worse than my wife!”  After a brief moment of ensuing guffaws, we continued the serious business of the task at hand. The MRx really did provide good feedback on compression quality, but the ability to mute voice was used on nearly every event from then on.

Still, it got me thinking about how to make the voices more appealing and recently, it hit me… I’ll broker a deal between Philips and TomTom!  Success!  Now, just like you can buy voice packs to upload to your GPS and hear Yoda say, “Turn right in a quarter mile, you should, hmm?”, you can have R. Lee Ermey sing you a CPR cadence and say things like,

“Why you lazy little maggot! Compress faster!”
“You do CPR like old people F***, Pyle! Compress deeper!”
“I don’t know, but I’ve been told… Compressions fast and deep are mighty bold!”

But we didn’t stop there, no.  You can also get featured voices from Samuel L. Jackson, Justin Bieber, Gilbert Gottfried, Patrick Warburton, Beyonce, Angelina Jolie, Rosanne Barr, and more.  Try as I might, I couldn’t get stars like Pamela Anderson or Anna Nicole Smith as it was felt that if a patient were successfully resuscitated, that crews getting caught in the moment might not stop compressions when indicated.

If you are interested in learning more about this special add-on, find your Philips MRx dealer or contact them for more info here: Philips MRx for EMS

During the first month of this feature’s availability, they’re offering the add-on voice modules for free, but they will start charging in May 2015, so act now!

September 18, 2014
by The Unwired Medic
0 comments

Are You Kilted?

More than half of September has passed and the Kilted To Kick Cancer (KTKC) campaign is gaining a lot of attention nationally, spreading the word to gain awareness about male specific cancers. Fantastic! It’s gaining traction that it’s okay to talk about male health concerns as openly as women discuss breast cancer. But… we have a long way to go.

image

If you are reading this, you’re already of the fact that you are or know a man who is going to get prostate and/or testicular cancer. The statistics for prostate cancer compared to breast cancer are truly alarming. Women face the likelihood that they are the 1 in 8 who will contract invasive breast cancer, whereas men face the high probability that they will be the 1 out of 7 men who get prostate cancer (the good news being that is this improved from last year’s rate of 1 out of 6). The fatality rates are identical for breast and prostate cancers at 1 in 36.

So why aren’t we talking about it more?

Breast cancer advocacy is strong in the US, due in no small part to the Susan G. Komen Foundation and awareness tools like the Pink Ribbon. Some fun with awareness has made its way into mainstream society too. For instance, “Save The TaTas” or “Save Second Base”. Not having a ribbon color to adopt, the KTKC founders adopted the most manly thing they could find… the kilt!

So, for September, the KTKC Army wear kilts every day we can to raise awareness about male-specific cancers. It’s a great conversation starter, and every day this month I have worn mine, it has been the conversational segue into proselytizing about KTKC. I keep a few business cards around and pass them out to people I tell about KTKC. Men, women, young, old, it doesn’t matter. I tell everyone.

Prostate cancer risk increases proportionally after the age of 40, and it is recommended that men get their prostate checks and PSA blood draw annually, just as women should be getting their mammograms annually.

So man up!

If the ladies can endure a machine squishing their bosom for 15-30 minutes. A prostate check is over in less than a minute. Suck it up and get your caboose to the doctor and get it checked. The longer you wait, the harder the treatment course. Women should do monthly breast exams. Men, check your sack! 5 minutes of self-exam is more than enough. Hey, it can even be a co-ed exam! Your mate may spot something you don’t!

So you know to Get Checked, now Get Kilted!

So you say you have or will get checked. Super! But you’re hesitant to get a kilt. Why? You aren’t Scottish? So what! You can get a plain kilt like the one I have pictured above, which is more formal, or a tactical kilt :-* , or a clan tartan. You can wear the colors of your branch of military (my Leatherneck Tartan will arrive in a couple days), or even your favorite pro football team.

So this is your multiple choice challenge from me. Pick one, pick many, pick all:

  1. (Required:) Get Checked!
  2. (Strongly Recommended:) Get Kilted! (see recommendations below)
  3. (Critical:) Go to bit.ly/getkilted – Learn more about male-specific cancers and make a tax deductible donation to KTKC! Make sure to select “Team Unwired Medic” on the donation page!
  4. (Extremely Dedicated:) Take the #DunkYourJunk Ice Challenge! Go to  the KTKC Facebook page at to see how it’s done! Note: Not for the faint of heart. This also provides demonstrative proof that you do not suffer from Low-T! You also don’t get credit for this unless you publicly post video proof.
  5. (Altruistic:) Spread the word! Reblog this! Share it on your social media profiles (Facebook, Pinterest, Instagram, Twitter, Google+, etc.!

Thanks for reading my blog and learning about male-specific cancers and the Kilted To Kick Cancer campaign. Be safe and be blessed!


Where to get a kilt:
Alt.Kilt (KTKC Sponsor)
SportKilt (KTKC Sponsor)
Atlanta Kilts
Highland Kilts
5.11 Tactical (limited availability annually)
UtiliKilts
Linda Clifford
Kilt & Thistle Scottish Shoppe
The Celtic Croft


 

What does a kilt cost?
Economy kilts can be found at some of the sites I mentioned for even as low as $50, but you get what you pay for, so it may be adequate for your needs or suitable for short-term use, but may not hold up over time. Mid-grade kilts that use only ~3 yards of fabric and are fleece or acrylic fabrics are about $89-120 off the shelf, with custom options adding cost (buckles, belt loops, fringe, stitched pleats, etc.). True wool, formal kilts can start at $400 and go up, but are suitable for weddings and black tie events, and you usually get 5-8 yards of fabric.


 

What accessories can you use?
Sporran (essential)
Kilt pin (essential)
Leather Belt, 2″+ (recommended)
Sash and broach (formal)
Highland shirt
Headgear
Kilt hose and flashes
Ghillie brogues (footwear)

September 8, 2014
by The Unwired Medic
0 comments

Infomercials Inspire Confidence

I have to say I find more confidence in a product advertised on an infomercial. When they slash 75% off the retail price, then as I’m picking up my phone to dial and order, they double-down and offer a second identical item and add some special bonuses for just the cost of separate postage and handling! Mind blown! Then they add an additional money back guarantee, so I feel like I have nothing to lose!

I wonder if we can start selling backboards this way?

They’re so versatile! Use them as a coffee table or a spare surfboard, then, when you are out of project space, flip it and turn it into a portable workbench! Did granny FDGB? Get her to the car with your backboard and some duct tape!

image

Image credit: http://media-cache-ak0.pinimg.com/736x/67/8a/4f/678a4f7fe41c876ccb65b2c52c9fde75.jpg

Did the po-po kick down your door in another bullsh– raid? Just take two backboards and tape them to the door frame! Got a saggy mattress? Just slip your backboard between the mattress and boxspring! Having a hard time painting that second floor of your house? Just place a backboard between two ladders and VOILA! Instant plank!

Don’t wait! Order now… But, wait, if you call in the next 30 seconds, we’ll throw in a second backboard ABSOLUTELY FREE!!! (Just pay separate processing and handling) Not enough? Well act now and we’ll throw in a set of removable seatbelts and a roll of camouflage duct tape! Call 1-800-4-DARWIN right now!

Disclaimers: Not available in all areas. Product shown may not be identical to the product you receive. This post is satirical. If you don’t understand the word “satirical”, please visit the following website: http://www.thefreedictionary.com/satirical

August 30, 2014
by The Unwired Medic
1 Comment

Feast Yer Eyes!

I’ve been out of the blogosphere for a few months (3 jobs, a family, and full-time school to get my BS-IT will force you to do that). Well, if this Jarhead expects to make a triumphant return, I guess this is about the best reason to have…

Team Unwired Medic” Joins The

Kilted To Kick Cancer – 2014 Campaign

This will be my first year participating in the Kilted Army. I feel so strongly about supporting this year that I’m getting my very first kilt, even though I haven’t the faintest idea how Scottish I am. But, I am Once A Marine, so I’ve at least earned the right to sport the Leatherneck Tartan. So, ladies and mateys, get ready to…

“Feast yer eyes!”

image

 

That’s (an older) me, flashing Kelly Grayson, by the way. Join me and the rest of the Kilted To Kick Cancer (KTKC) Army throughout September as we raise awareness (and funds) for Prostate and Testicular cancers.  So far, in its short history, KTKC has raised over $50,000 for male-specific cancers. Jump in and help us raise more. Raise awareness by talking with your bro’s. Need some talking points? Got ’em right here…

More euphemisms and puns than you can shake a stick at:

  • Don’t get sick – Check your stick!
  • Don’t be a putz – Check your nuts!
  • Before it turns black, check your sack!
  • Don’t be a dud – Every year, check your blood!
  • Although it ain’t super to get checked in the pooper, your monkey will say thanks during the subsequent spanks!
  • Check your prostate before you become prostrate!
  • Don’t be silly – Go see your doctor and check your willy!
  • Don’t get the funk – Check your junk!
  • Check ’em in the shower – You have the power!
  • You can’t go wrong if you check your schlong!
  • Here’s a PSA to get your annual PSA!
  • Even a monk needs to check his junk!

Feel free to comment with your own. :-)

This is my rifle! This is my gun!

This is my rifle, this is my gun! This one’s for fighting, this one’s for fun! – From Stanley Kubrick’s 1987 movie, “Full Metal Jacket”.

Now, for a brief (hahaha, brief) pause in the silliness – Time for some serious facts:

September is prostate cancer awareness month. According to the American Cancer Society, 1 in 7 men will contract prostate cancer, whereas 1 in 8 women will develop invasive breast cancer. Men, it is just as fatal as breast cancer (which, incidentally, also can affect men). Presently, 1 in 36 men will die from prostate cancer, just like 1 in 36 women will die from breast cancer. This trails just behind lung cancer deaths for both sexes. Additionally about 1 in 270 men will contract testicular cancer. These are mostly treatable diseases. Prostate cancer is predominantly diagnosed in mature men (>60), but it isn’t exclusively old man’s diseases. Some are diagnosed as early as their 40’s. In fact, testicular cancer is more of a younger man’s disease, most prominent in post-adolescent and middle-aged men. 1 in 5,000 will die from testicular cancer. Serious enough?

Are you willing to live with those risks? What about you as a cancer survivor? Are you willing to live with the complications? It’s not just about live-or-die. What about impaired sexual function? Sex is an important part of life and a man’s self-image, in your teens, adulthood, and, yes, even your years in maturity (eww, grandparent nookie!). Besides, if sex wasn’t so great, we wouldn’t have a booming world population, right? What about just going to the bathroom? Is it more honorable to be stoic and go 30x/day and to get up at least 4x/night to dribble a little pee than to be the guy who doesn’t have to fight his own body to pee?  I don’t know about you, but my penis is EXIT ONLY! I don’t relish the idea of having to stick a catheter or dilator wand (read: Roto-Rooter) up there just to go to the bathroom.

As is mentioned on the KTKC blog PSA, if 1 in 36 men were getting killed by buses, we’d be doing something more about it. Now is the time! You are the person to act!


 

How can you help?

The first step is to spread awareness. Wear a kilt – ladies, there are kilts designed for you too. Talk to other men (and women!) about exactly “what’s going on under there”. Get a KTKC t-shirt and wear it everywhere you can, whether you have a kilt or not. Share this post on Facebook, Twitter, Instagram, Pinterest, Google+, MySpace, AOL, Prodigy, Earthlink, your own webpage, e-mail, or even by word of mouth. Also, check out this video by The Happy Medic and Motorcop, “Dunk Your Junk” at http://youtu.be/F_fxdMCysBc/. Don’t forget to share it too!

Second, get yer arse to the doctor! Literally! Get your annual prostate exam. Suck it up, buttercup! Drop your drawers or lift your kilt and get poked and prodded. Is it uncomfortable? Perhaps, but it isn’t as bad as a mammogram, right ladies? Oh, and speaking to the ladies, nothing can move a stubborn ox like a good nagging from the old ball and chain. (See what I did there?) Be relentless and remind him that his duties to you and family include taking care of himself. Ladies, you get your annual squishy smooshy, so make him go get his annual blood test and grab his knees. It’s only fair, right!

Third, to find a cure takes research; to research takes money. Funding for research of causes and treatments for these cancers matters. Last year, it was 1 in 6 men. Now it’s 1 in 7 men. It may not seem like a lot of difference, But personally, I’d rather be one of the seven that doesn’t get prostate cancer or can at least catch it early.

To provide awareness campaigns also takes money. If you are so motivated and enabled, PLEASE make a tax-deductible donation to KTKC, a 501(c)3 organization, on the following page:

http://bit.ly/ktkcdonate

Follow the tips in this infogram to help Team Unwired Medic win the team contest! Whether you donate and pick Team Unwired Medic, don’t donate and can spread awareness, or if you donate without picking my team, THANK YOU!!!

KTKC Team Donation Helper

Select “Team Unwired Medic” to help us win!

 

Thanks for helping to raise awareness! Now go forth and spread the, um… er… good news… in a kilt!

Kilted To Kick Cancer

Kilted To Kick Cancer

April 1, 2014
by The Unwired Medic
1 Comment

FDNY Agency Name Change

EMSNY's proposed uniform patch design

Here’s a sketch of the new EMSNY uniform patch. Details should be finalized early June 2014.

In a stunning move, today FDNY formally announced they are changing their agency name to EMSNY.  This move comes in light of agency audits conducted of FDNY’s call statistics dating back more than two decades.  For example, just in February 2014, FDNY ran 4,609 structure and non-structure fire calls, but ran 15,167 medical emergencies (grand total of 38,188 calls)* (330% more than fire calls).  FDNY’s EMS division, however, ran 110,154 ambulance calls in February 2014**.  (Editor comment: please note the enormous disparity in call volumes for fire suppression and non-medical – 20%, versus medical calls – 80%.)  This is a typical monthly example.

FDNY’s Interim EMS Chief, Phil Anselmo, says this name change has been considered for the last three years, but has been put off due to the expense of changing station shirts, patches, and stationary.  “Really, this should have happened years ago, as FDNY has run more significantly EMS calls than fire for the last two decades.  You know the old adage, ‘150 years of tradition, unimpeded by progress.'”

While the FDNY’s ambulance drivers are lauding the decision which they believe shines a bright light on the department’s most significant investment of time and labor, not everyone is pleased with this bold move.  Firefighter/Engineer Terry Glaze believes this will remove firefighters from the limelight.  “I have over 25 t-shirts with flames and bulldogs, and my favorite one is ‘Find ‘Em Hot and Leave ‘Em Wet‘.  I’ll have to replace them as they won’t be authorized under the new uniform standards,” says Glaze.  To pad the egos of the single-function firefighters who may not fully embrace this long-overdue change, the department will allow blue EMS-themed t-shirts that feature the grim reaper, blue flames, and skulls, and references to “cheating death”.

Union vice chairman David Peacock is expected to file grievances against FDNY EMSNY and are considering filing for legal protection of the FDNY department name.  As the case is ongoing, no comments were offered by the Union.

Ambulance driver Donnie Hart hopes the city will start spending less money on suppression apparatus and more money on better ambulances.  “Honestly, who spends 3/4 of a million bucks on a fire truck? I could buy, like, 10 ambulances for that!”

* – http://www.nyc.gov/html/fdny/pdf/stats/2014/fire/cw/fire_cwsum_0214.pdf

** – http://www.nyc.gov/html/fdny/pdf/stats/2014/ems/cw/ems_cwsum_0214.pdf

*** – Legal disclaimers: This post is a spoof article on honor of 01 April 2014.  The names used in this article are not intended to reflect actual staff of the FDNY EMSNY.  Names and likenesses are purely coincidental, even though they do accurately resemble men known to sport big hair in the 1980’s.  If you believe that the nation’s largest fire department, a.k.a. New York’s Bravest, would actually change their agency’s name to reflect the significant majority of work they actually perform, you should consider seeking counseling and researching the word, “gullible” (I hear if you say that word slowly, it sounds like “oranges”).  No part of this article should be construed to imply that the author does not appreciate the fine work firefighters perform all over the world everyday and the value they bring in support of the EMS mission.  The author himself has even been a firefighter in the distant past.  The article is intended to bring light to the dark side of the fire service, gollum.

March 18, 2014
by The Unwired Medic
0 comments

Who’s Packing Your Parachute?

I read an article today in the DAV (Disabled American Veterans) magazine about “Life’s Parachutes”, a story about Charles Plumb, a Naval Fighter Pilot shot down over Vietnam and was subsequently a POW for six years. Plumb was back in the US dining with his wife at a restaurant when a man walked up to him and said, “You’re Plumb. You flew jet fighters in Vietnam from the aircraft carrier Kitty Hawk. You were shot down.” The man who approached Plumb said he packed Plumb’s parachute. You can imagine Plumb’s gratitude.

parachute

Photo credit: www.sxc.hu; User: pixelbase; http://www.sxc.hu/browse.phtml?f=download&id=616941

This story made me think of how we often take our vehicle stock techs and maintenance staff for granted. They’re packing our parachutes every day so we can go out on our missions to provide EMS to the communities we serve. Their ability to do their jobs correctly and completely ensure we aren’t doing a disservice to our communities or putting us at liability for abandonment or failure to provide adequate care to our patients.

I had a significant problem with some supply techs at a previous employer, and was burned a few times, having LSB’s with incomplete straps (when it was still acceptable to use them for all manner of trauma patients), missing a pedi BVM from the cabinet on a traumatic arrest peds (I had my second in the peds bag, but that cost me time to ventilation), etc. I worked with the logistics manager for several months to refine the restock process, implementing a QA process and shrink-wrapped bins through a supply-line, and one of the goals was to ensure every unit in the fleet of 43 ambulances was identically configured for consistency. I got a lot of flack from management for leaving the HQ over an hour late every shift for several months (no overtime was allowed so I couldn’t come in early to complete my checks) as I checked every single piece of equipment and inventoried the entire unit, but there were failures and missing items every day. I made a deal that if my unit was perfect every day for two weeks, I would leave on time and perform my checks in the field on my downtime, but not until then as it was my license on the line. No one would come back to a logistics manager or supply tech and tell them they couldn’t practice supplying anymore, but I could be held liable by the state for failures or missing equipment, and I wouldn’t live with causing harm or not being able to help my patient due to a problem. I still opened every single shrink-wrapped bin (much to the chagrin of supply and management) for another two weeks until I was comfortable with results of the new process, but eventually, I didn’t even need to do that anymore. The deal worked and I never had another supply problem at that agency. It took time to trust, but eventually, I trusted my parachute to open every time without fail and it did. I don’t work for the agency anymore, but I still keep in contact with a few of the supply techs and supervisors. They aren’t nameless, faceless, automatons. Many of them would later move on to becoming field providers there or at another agency. I never made friends with the fleet people, but I didn’t cause them any trouble and when I had an issue, they took it seriously and fixed it the best they could, and I’d like to believe it was due to some mutual respect.

Plumb delivers speeches and presentations now and one of his questions to his audience is, “Who’s packing your parachute?”

Read the DAV Magazine article on page 27 of the pdf magazine here: https://www.dav.org/wp-content/uploads/magazine_201402.pdf

February 19, 2014
by The Unwired Medic
0 comments

It’s like Instagram for Healthcare

I just got word that the Figure 1 app that was previously only available for iOS is now available for Android.  I now have an account, and if you happen to be one of the first 1,000 to sign up for a free account, you are in the mix for a $25 Google Play gift card.

Figure 1 is like Instagram, but for healthcare professionals.  You can crowdsource a photo to see if you can come up with a probable diagnosis, say for something like a skin rash, or use the app as a way to share a rare encounter with a medical condition.  I have seen radiology films and quick smartphone snapshots uploaded through the app.  I expect to see a lot of images of dislocations, avulsions, amputations, obvious fractures, rashes, and more.

The Figure 1 apps could also be a great teaching tool to support anatomy and physiology lectures.

You can register for a free account right from the app, and if you are also a presently licensed physician, you can have your account verified.  If you are a Paramedic, you should choose “Other Healthcare Professional” and scroll down to “Paramedic”.

If you happen to grab the app, sign up for an account, and connect with Figure 1 on social media (Twitter and Facebook), please let them know that The Unwired Medic pointed you their way. :-)

November 2, 2013
by The Unwired Medic
0 comments

Mutual Aid Requested – November 2013

I have been more than busy with working at three jobs and going back to school to get my Bachelor’s Degree in IT, so I am sorry I haven’t posted much on my blog or social media sites.  I’m making a diligent effort to get back into posting regularly.  This time, I haven’t had the occasion to test any new apps or equipment, but I have come across a few tech articles that I think are worth mentioning.  Be safe out there!

Health data on your smartphone:

Samsung and Cigna are partnering to harness the broad base of users on the Samsung S Health platform (announced on October 28th, 2013).  Apparently, when used on the Galaxy S4, the S Health app has the ability to monitor activity, ambient temp and humidity, and allows you to log your food and exercise activity, which for now sounds just like  what you can do with apps like Edomondo and others, but it will allow partnering with many other devices, probably like the Samsung Body Scale, a heart rate monitor, probably a pedometer or FitBit, glucometers, blood pressure cuffs, etc., in an effort to bring telemedicine to a cell phone.  I hope to be able to bring you much more on this as my full-time job is expecting to replace my iPhone 4S with a Galaxy Note 3 in the next couple of weeks to upgrade me to 4G and a better platform to administrate the Critical Incident Management System (CIMS) I’m in charge of.  From what I’ve found, it too will include access to the S Health app.  Unfortunately, the price of the Galaxy Gear smartwatch is too high for me to pick up as an accessory, though I’m sure the S Health app will use data retrieved from it too.

Read what the HIT Consultant has to say about this partnership here: http://www.hitconsultant.net/2013/10/28/samsung-partners-with-cigna-mobile-health/

MobiHealthNews: http://mobihealthnews.com/26771/samsung-cigna-partner-to-expand-s-health-app/

Cigna made an official announcement on their site here: http://newsroom.cigna.com/NewsReleases/cigna-and-samsung-team-up-to-deliver-digital-health-improvement-platform-worldwide.htm

iMedicalApps.com:

From time to time, I write professionally for iMedicalApps.com, providing special project articles on EMS-relevant technology or apps, but I’m not linking to any of my own articles in this post.  Instead, I’d like to show you some of the neat things their regular writing staff have come across and evaluated that may be of use to us in the prehospital care arena, and maybe also for some of you branching into Community Paramedicine.  Caveat: Not every app or device is free…

I miss having my old OB Wheel app for my Palm m125 and Treo.  Unfortunately, it isn’t compatible with any newer generation devices.  Finally, a good substitute has arrived.  A new OB wheel app: http://www.imedicalapps.com/2013/10/medical-app-replace-pregnancy-ob-wheel/

The future of wearable sensors in healthcare: http://www.imedicalapps.com/2013/10/body-computing-conference-panel-sensors/

Use of a virtual procedure app improves intubation success rate: http://www.imedicalapps.com/2013/09/virtual-procedure-app-intubation-success/

 

September 24, 2013
by The Unwired Medic
0 comments

iOS 7 Security Flaw in Siri

Apple is waving the victory banner over the tremendous amount of users who have upgraded their devices to iOS7 or have bought the new iPhone 5c and 5s with iOS7. Truly they have achieved success, but because of that success, they are the target of those who would hack and compromise the security of their devices and software.

Application security vendor, Cenzic, has discovered a flaw that allows a person to access a locked device without the password using Siri to send Facebook messages posing as the device owner. They have also been able to text, e-mail, and access contacts. The flaws also exist in iOS6, but apparently to a more limited extent. They recommend disabling Siri until Apple fixes the compromised code.

Read more about this from: Dark Reading article