Of Hats

It is a difficult thing, being released as a medic on the transport gig, but Basic Life Support (BLS) on the rescue side.

Those not in the EMS field might think, “Hey – a medic is a medic is a medic. Why can’t you do medic stuff running 911 calls?” The short answer to all that is that each jurisdiction has its own medical director – a doc – and it is under the doc’s license that advanced life support (ALS, or medic stuff) is practiced. Naturally, the doc is placing his license on the line with each medic operating under him. Docs therefore like very much to know the medic’s capabilities before releasing said medic to the World.

On the rescue side, there is no one available to DTs to precept him as an ALS provider – so that’s not a Happenin’ Thing. One must continually glance upwards at the Hat currently in use. Is it the heroic white Stetson of ALS? IVs and ECGs all around! Raise your hand if you’re having chest pain, the attendent will be handing out nitro and morphine shortly.

Ah, but do we see the brim of the diminutive brown fedora of BLS? Yes? Uh, have some O2.

Indeed. One of DTs’ partners in the past was a fully-certified ER nurse, “slumming” on the ambulance, who had not yet gathered in an EMT-Basic certification. So saith the Seinfeld EMS Nazi: “No patient contact for you!”

The urge to provide care in excess of my current Hat status can be strong. An elderly patient fainted when he stood up? Medic sense is tingling… could be a heart problem, but must… restrain… hand… from… monitor. Can’t… hook patient up… as a BLS provider.

We were called out to a Recreation Place recently for a fellow who felt chest pain on exertion. He was sitting in the manager’s office when we arrived, no pain, no tightness or shortness of breath, slightly diaphoretic (sweaty), alert and oriented, no history of cardiac problems, hypertension, etc.

The medic arrives and places the patient (as medics may do) on the heart monitor – 3 lead. Everything looks fine. Hmmm, says the medic. Let’s do a 12-lead (which gives a more detailed picture of the heart’s electrical function).

“Aha,” says DTs, pointing, “ST elevation in AVF. Inferior wall injury. Yay 12-lead.”

The medic is amused, outwardly, but inwardly… DTs’ psychic abilities detect a “why the heck did you guys make us drive all the way over here when you could have handled this?” Or perhaps it is not his Psychic Abilities, but his Overactive and Defensive Imagination.

Sometimes it feels like being Clark Kent, with nowhere to change clothes…

The amusing thing, thought DTs, is that this patient would probably end up with a coronary stent – a procedure not performed at the hospital to which the medic was taking him. It would be entirely possible that in his transport gig it would be DTs who took him to the cath lab.

“Say,” he imagines the patient saying. “Nice Stetson. Aren’t you that guy with the fedora?”


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