EMS – You Can Never Leave

Last thing I remember I was running for the door

I had to find the passage back to the place I was before

“Relax,” said the night man, “We are programmed to receive

You can check out any time you like but you can never leave”

EAGLES – Hotel California

EMS is like the Hotel California: “You can check out anytime you like… but you can never leave” the memories, faces, successes and failures will always be with us. They dim at times over the years, but they are always there. I read a thought provoking and honest analysis on being a paramedic a few months back and have been mulling over her post, digging through ramblings from my field journals and the skeleton of a story I have been working on for about 2 years… these all prompted me to ramble further…

The blog post that triggered this article is: Unless you’ve been there, you wouldn’t understand: A Paramedics farewell to the job. Posted on February 10, 2015 by Di McMath

https://dimcmath.wordpress.com/2015/02/10/unless-youve-been-there-you-wouldnt-understand-a-paramedics-farewell-to-the-job/

One of the key issues for me is the ability/or lack thereof to detach from what we are doing and seeing; this drags one into the massively dehumanising temptation of EMS. I do feel that this dehumanisation is both inexorable and dangerous – as practitioners we need to know how to halt or slow it down. After 30 years of emergency medicine practise; I am still not entirely sure if we can entirely halt the process, which is why we can never fully check-out.

Being a fan of the poetry of Wilfred Owen, and as I reread his poems on a regular basis, I was drawn back to his poems during this thought process and found some further insight on reading “Insensibility”:

And some cease feeling

Even themselves or for themselves

Dullness best solves

The tease and doubt

The poem plays along the interesting juxtaposed lines of detached versus involved, and the varied degrees of these mindsets. Those of us in the profession have over the years dabbled with both approaches, the trick is for each individual to find his/her own balance. That is all part of the process of slowing down the dehumanising process. Finding this balance is key, if we do not, then we are doomed to keep repeating the mistakes of our past (mistakes as regards emotions and those of a clinical nature).

Emergency Medicine has the ability to dehumanise and diminish or renew and expand our powers of feeling. It is our choice to decide which path to follow. We realise soon on in our profession that this is one of the many choices that we have to make. How we deal with this choice determines how we deal with another key critical decision we as practitioners in the field are confronted with at numerous times in our career. Who lives or dies, or why do some people die despite our best efforts; and the pain of admitting defeat and saying okay, we need to stop now, the patient is deceased.

It is on these crucial scenarios, that I have to agree with the title of Di’s blogpost:

Unless you have been there you wouldn’t understand – Its sounds trite, but it is so true.

Trying to explain this process of immediate Triage, that at times needs to be done in very short time frames, less than a minute, is very difficult. Those are some of the choices we can never walk away from, and even when we do make them we cannot stop thinking about “What If?” the curse and bane of every paramedic. The cursed ability to second guess yourself long after the fact on an ongoing basis. It is here where we as emergency medicine practitioners are faced with the dehumanising and diminishing or the renewing and expanding of mental and medical health.

The goal of our profession should be a living force in the quest for and prevention of human suffering, but that sometimes comes at the cost of our own mental health. As we enter, continue in and exit this amazing profession, lets consider the cost to those we have served and continue to serve. All we can do as practitioners is warn, and that is why the practitioner needs to be truthful.

Updated:

Read these 2 poems I wrote on the cost of service:

https://mikesnexus.com/2017/04/23/at-what-cost/

https://mikesnexus.com/2016/10/30/god-is-in-session/

CORPORATE RESPONSIBILITY AND DUTY OF CARE – HEALTH INSURANCE AND ASSISTANCE

“Between one in two and one in three expatriates has no international health insurance”
International Private Medical Insurance Magazine from the report: International And Expatriate Healthcare And Insurance 2014

I believe this to be a very accurate statement notably, with regard to the African continent (where I spend most of my time), this figure might even be flattering to some companies employing expat staff in Africa.

The globally mobile population has grown dramatically. There are over 50 million expatriates, and by 2020 this will be 60 million. 232 million people now live away from their country of birth.
Between one in two and one in three expatriates has no international health insurance, although a minority is covered by domestic health insurance. Several countries seek to get expatriates and migrants to pay for healthcare or have compulsory health insurance.

This is a disturbing issue, as too many companies are happy to send their staff abroad, or to remote work sites, without any or inadequate medical cover; be it insurance or assistance. This shows very poor duty of care. In discussions with some of these companies, when trying to assist them with advice on even basic assistance packages or client managed services, their responses are troubling; when viewed against the light of corporate responsibility and duty of care. To defer the responsibility to the employee and abdicate corporate responsibility, should be cause for concern.

The duty of care of the employer, is a term that is often thrown about and The UN Global Compact, is one way that companies are being encouraged to show a greater duty of care, although some would cynically say that Corporate Social Responsibility is a box-ticking exercise, companies are just paying lip service, but do no more than is necessary to avoid affecting the bottom line. The UN Global Compact, is engaging over 8,000 companies in more than 145 countries on human rights, labour standards, environment and anti-corruption, hopefully at the same time pushing to commit to a sustainable workforce, via duty of care and corporate social responsibility.

The level of care offered by companies, will depend where the company is registered, as to what laws could be enforceable, hence most companies register an off-shore shell for hiring, staffing and contracts. (this is in itself a topic for another day – relating to contracts, taxes etc.)

Possibly other avenues should be explored, with respect to medical assistance/insurance; by pushing that investors use their muscle, ensuring that their investment capital is being well managed. Staff that cannot be properly cared for (ex-pat and local), via medical cover that is in place, place a further drain on company resources, shifting capital away from its intended purpose. A well managed corporate health care plan, ensures ongoing confidence in the company.

Till now I have only been speaking about expat staff, but the issue of medical care for local staff would also need to be addressed, in fact poor care for expat staff, could be viewed as an indicator of poor care for local staff. The ever growing impact of business on society means that staff, investors and consumers expect corporate power to be exerted responsibly, the corporate community will have to step up its game and build greater trust with respect to duty of care. Business are being expected to do more in areas that used to be the exclusive domain of the public sector – ranging from health, education and to community investment.

Having insurance/assistance programs from reputable companies, linked to well managed onsite managed health care programs, which is in place for ALL staff, makes good business sense. This then empowers staff to work safely in environments that might be deemed risky, allowing them to work with confidence and be fully focussed on their daily tasks.

Reference’s:

http://www.researchandmarkets.com/reports/2788557/international_and_expatriate_healthcare_and

https://www.unglobalcompact.org/abouttheGC/thetenprinciples/index.html