EMS World

OCT 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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24 OCTOBER 2018 | EMSWORLD.com COVER REPORT: UNIQUE JOB SETTINGS tinuous. "You get quickly overwhelmed by the scope of your responsibility," says Montgomery, adding that OSHA comes down hard on any preventable injuries or safety violations. Treatment decisions are called in to a medical command physician for approval, but you're expected to have a detailed care plan already in place. If something goes wrong, "Suits come in on choppers," he says of the high-pressure environment. His schedule was 14 days on, during which you're on-call around the clock, then 14 days off. Traveling all the way home to Florida during his off-time became a grind. But there are perks. While there can be 100 men on a midsize platform, sharing close sleeping quarters and eating in shifts in a four-table dining room, OSHA require- ments mandate a large separate sick bay that doubles as the spacious living quar- ters for the on-site paramedic. The food is plentiful and top-notch. The money can be excellent—Montgomery cleared a six- figure salary with bonuses. Responsibili- ties such as deck logistics management, helicopter landing, and health, safety and The Show Must Go On There I was, a properly licensed medical professional standing by at a chess tournament in a really big hotel. That would be me at Opryland, fellow thrill-seekers. I was a paramedic at that Nashville resort for six years. It did not remind me of working EMS in Brooklyn. At the center of the huge banquet hall were dozens of teen- age players paired at desks with chessboards and clocks. Family members and other enthusiasts whispered as they wandered from game to game not far from where I was stationed. Discreetly attired in a generic work shirt, I could have been the guy called to change a lightbulb. Did I mention I was nearing collapse after six hours of handing out Band-Aids and Tylenol? But wait, there's more… I was nodding off when I heard raised voices from a cluster of adults among the contestants. I grabbed my gear and hoped for a reason to use it. And that's how it was in the recreation business, folks: many hours of inertia punctuated by the occasional chance to practice. Playing paramedic at Opryland's most prized properties—the hotel, the Grand Ole Opry, and the General Jackson showboat— was a big change for me after 15 years of 9-1-1 in New York. It wasn't a Nor th-South thing—just a different set of rules where EMS had more to do with hospitality than hospitals. You had to stay ready for that rare, real emergency, knowing your employer cared more about your smile than your experience (I say that because a nice lady in HR told me my smile got me hired). If you're considering employment in the entertainment indus- try, perhaps my story will help you prepare. One of the first things I learned as a healthcare provider at Opryland is that the show goes on despite medical emergencies. By show I mean whatever services, accommodations, recreation, or entertainment guests are paying for. Unlike real EMS agencies, where patient care and transpor t are the revenue producers, amusement centers make money on people having fun. Mood killers like illness or trauma interrupt fun. Our priority as para- medics was to minimize those interruptions. At that chess tournament my patient turned out to be a high- school student in the clonic phase of a generalized seizure. People around me kept playing as the kid became apneic. It was tempting to suggest "medic takes both kings" as the next move for the game closest to my BVM, but at Opryland we risked disci- pline for disrupting guests' good times. It was common to work conventions carrying small subsets of supplies and equipment found on most ALS ambulances. For example, I didn't have benzodiazepines that day—less of a factor when the young man's seizure stopped, but I still had to use my own glucometer to make sure hypoglycemia wasn't an issue. Most of my calls at Opryland involved potentially emergent conditions only if one considered worst-case scenarios. Of 1,000- plus patients complaining of headaches, none bled into their brains on my watch. A similar number suf fering from nausea didn't need cath labs, and just as many with abdominal pain got through the week without appendectomies, bowel resections, or liver transplants. Still, cutting patients loose without a signature made me nervous. There were no procedures for tur fing high-risk refusals to physicians. Our medical director, a good guy who helped me with a couple of outside-the-box scenarios, wasn't hired to f acili t ate infor med c on s en t . Emp l oye e s , p er- formers, and gues t s who s umm o n e d EM S u s u all y preferred to keep doing what they were paid or had paid to do, rather than tak- ing time-consuming trips to hospitals. When transport was inevi- table we'd call Nashville Fire. They'd respond with an engine and an ambulance. Their personnel expected the same diligent preparation from us as ED nurses do from most of you. Medication routes, current vitals, and thorough histories were much appreciated. My super visor at Opr yland was a medic, but his boss and everyone else up the chain of command had only as much EMS knowledge as the average titan of industry. What those execu- tives did know was the value of happy guests. That's why being a human buzzkill could cost you your job. Once my postictal patient started breathing on his own, I tried to expedite transport but was confronted by a delegation from guest services. They told me the tournament director was unhap- py about the evening's distraction and wanted a copy of my PCR. I said no. Then I went about my business. The suits eventually found something better to do. When I showed up for work the next day, nobody sent me home. That was almost as good as a thank-you. Author's note: Opryland no longer provides in-house EMS. Mike Rubin is a paramedic in Nashville and member of the EMS World editorial advisory board.

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