Evening in Milwaukee. The call is dispatched as NAUSEA/VOMITING AND DIZZINESS. We arrive on scene and find a male patient sitting in the driver's seat, pulled over on the side of the road. His son is with him. We begin our assessment. He's been feeling this way for a couple hours. He takes a number of cardiac medications. I begin to take vitals, find a blood pressure of 92/60. Pulse is rapid, respirations are rapid and shallow. He's had an MI in the past. As I'm assessing him, his implanted defibrillator begins to fire. We follow protocol and request ALS on scene. I know this is a mixed blessing. On the one hand, it would be nice to have ALS responders on scene with their bigger bag of tools to bring to bear on the patient. On the other hand, our fire department--plainly put--hates EMS. Paramedics here are for the most part firefighters who got stuck in the academy with the task of going through paramedic training. They wanted to fight fires, not coronary artery disease. Now they're putting in their two years on a MED unit and waiting until they can get back to what they really wanted to do. But my protocols say I call them, so I do.
The Engine Company arrives at the same time as the MED unit. We give our report, and the paramedic directs one of the Firefighter/EMTs to get a set of vitals. I stand by and watch. He turns around and tells the paramedic, "120/80." In Milwaukee, this is what we call "Engine 12ing the vitals." Make 'em up. Out of thin air. ER docs and nurses use the phrase, as do paramedics and EMTs. It's a common phrase because it's a common event.
I cannot imagine a scenario in which Engine 12ing vitals might be justifiable. It's falsifying a patient care report. And in the case of a patient with a cardiac history, who describes his symptoms as exactly the same as when he had his previous heart attack, and his defibrillator is firing right in front of us--no. Unacceptable. Perhaps even criminally negligent. This is a cardiac case--the next step might very well be to administer nitroglycerin, which is contraindicated in patients with a systolic pressure under 100mmhg. This guy is 92, but the paramedic thinks it's 120. If he gets nitro, he might crash. He might not die, but losing consciousness due to a screw-up in medication isn't a good thing.
I'm taken aback by the audacity of an EMT to not only fake a set of vitals, but to do so in such a blatant manner as to pick the textbook 120/80 as the set. My reaction was involuntary--I laughed. Not the amused laugh of someone who just heard something funny. It was more the, "I can't believe you just said that," laugh--a guffaw.
The paramedic heard my reaction, and asked, "Why, what'd YOU get." I glanced at my gloved hand, where my vitals were still written down, and read him my set. The firefighter/EMT glared at me as I did it. I can't bring myself to look at him, because I'm calling him a liar to his face and I'm embarrassed for him. The paramedic enters my set into the computer. I walk back to my rig and begin writing up my PCR.
I spend the next few weeks fuming about the incident. I'm an applicant to this department. I'm high enough on the eligibility list that I'll probably be hired sometime in the next year. And I don't want to work with these guys. I don't want to be the only guy who cares about EMS in my crew. I don't want to tell people, "I work for MFD." I imagine it now, and I'm imagining the embarrassment I'll feel if I'm speaking to someone who knows the department--the need to qualify that statement with something like, "and I'm not like those other guys, I promise."