What`s That Smell?

     EMS Reruns addresses dilemmas in EMS. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. E-mail ideas to Nancy.Perry@cygnusb2b.com.

     You're sleeping heavily when the alarm goes off in your dorm. At first it sounds vague and far away, intended for somebody else. You feel yourself lightening, as though your body has been heavily submerged in your bunk, and now you're softly rising. Then you remember, you're on duty. There's a call, and you're invited. You roll out of bed, slip into your boots, pull up your pants, grab your coat and head for the bay. Doors slam. The engine catches and roars, and you're lit. You reach for the map, but you know the address: 490 Quintard. Soon, almost awake, you're on your way.

     A couple of times in the course of the response, you think you detect a whiff of something familiar. You're a new medic, so you're nobody's expert observer. Your last patient, a couple of hours earlier, had significant EtOH on board. That was it; must have been. But on scene, confined in a small bedroom, you're pretty sure you smell it again. You look at your partner, Jeff. He's all business, and he seems to be acting normally.

     Jeff is much more experienced than you are, and his experience is unmistakable as he glides through the practiced routines of a pro. You would never have considered the possibility that he may be a drunk, but now you're wondering.

     Q. What can I do? I'm a rookie here, and this guy is my field instructor. He has a fine reputation. If I blow the whistle on him and it turns out he's innocent, nobody will ever want to work with me again.

     A. A very wise man is believed to have observed, "The truth shall set you free." Time and again your best patient assessments will reveal not what you expect to find but what's really there. The same holds true in your assessment of the people you work with. But don't forget that the odor in your ambulance and the odor in this bedroom may be coming from two different people, neither of whom is Jeff. I would simply ask, "EtOH?", and see what he says. Then, following the call, ask him if he also noticed the odor in the ambulance.

     Q. What if I'm just not sure where the odor is coming from and the question keeps bothering me? Is there some way I can pin it down definitively?

     A. Good question! If you transport this patient, you're going to encounter a number of ED nurses—very skilled observers in their own right. Trust me, they've sampled plenty of eau de ethanol. Ask one of them to assess the patient (and the patient's spouse) for unusual breath odors. (You don't need to mention alcohol.) If they don't identify anything, ask them to assess your partner as well. If they still don't find anything, there probably isn't. If they do, you should confront your partner and let him know you are consulting a supervisor. You'll probably be asked to document your observations in detail (including the name of the nurse).

     Q. Back to my first question! What if this turns out to be nothing after all? I'll be responsible for questioning the reputation of a good medic. Jeff is bound to take that hard, especially in the middle of his sleep time. And the supervisor isn't going to appreciate me ratting on the guy.

     A. If Jeff and the supervisor are good people, they'll eventually respect your courage. We work hard for our certs and licenses, but we never really own 'em. They belong to the public, who can take them away from us anytime. If you're right about Jeff, not only does he need to be off the street, but he needs—and deserves—some help. Neither of those things will happen if you just look the other way. Nor will the public receive the full benefit of their trust.

     Q. It seems totally alien to me, to think about an EMT drinking on duty. I shouldn't have to go through this.

     A. It's actually a significant problem. Especially in the East, where many departments have bars in their stations, and it's not unusual for crews to take calls with alcohol in their systems. In December, an inebriated Texas paramedic killed two people en route to a call. In EMS, and in the fire service, it goes on happening for one reason.

     A shortage of courage.

     Thom Dick has been involved in EMS for 39 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at boxcar_414@yahoo.com.