Hard Roll: A Paramedic's Perspective of Life and Death in New Orleans

Written by Jon McCarthy

Narrated by Arthur Flavell

Known as one of America's most dangerous cities, New Orleans plays host to incidents ranging from the tragic and disturbing to the completely bizarre-and during his career as an emergency medic, Jon McCarthy saw it all. He chronicles some of the most formative calls of his career in this autobiography that reads like crime fiction. McCarthy demonstrates with detail and clarity that the difficult choice is often the right choice. While not for the faint of heart, each entry in this collection provides poignant insight into the bonds between medics and the people and city they serve.

Born in Tallahassee, Florida, and a veteran of the United States Coast Guard, Jon McCarthy is proud to be an emergency room paramedic. Since 1996, he has worked in emergency medical services in helicopters, clinics, hospitals, and on the streets of New Orleans. He is one of the cocreators of the New Orleans EMS Field Training Officer (FTO) program and served as the Lead FTO for five years. McCarthy was featured on The Learning Channel program Paramedics and has a side career as an actor.

• Language: English
• Publisher: Tantor Media, Inc
• Release date: Apr 30, 2019
• ISBN: 9781977346797

Reviews for Hard Roll

[MyFirstName MyLastName · Rating: 2 out of 5 stars]

I was so disgusted by the writers assertion about what RNs know that I couldn't listen anymore. The idea that an RN knows a little bit about a lot of things is absolutely absurd and this tells me that this man knows next to nothing about what an RN actually does know. I have great respect for paramedics because they do work in very scary situations that make it hard to do simple things like insert an IV the back of an ambulance peeling around the corner. And because there is no one else to do it part of their training evolves doing things that otherwise only a surgeon would do or a physicians assistant (not to be confused with a medical assistant). They may insert a needle into the sac around the heart to relieve it of blood that is squeezing the heart to death or they may I believe be allowed to insert a tube into the chest space around the lung to relieve a vacuum in there that is causing the lung to collapse. They can insert a tube into the lungs between the vocal cords. These are very big things but quite frankly an emergency room RN knows how to do them too and it's just not allowed to do them. And if you don't get to practice something you won't be as good at it even if you know Point by Point how to do it well enough you can actually coach someone, like a new medical resident how to do that procedure. Every hour and I know has coached a first-year medical resident through a procedure that only he or she is licensed to do and the RN will never be allowed to do. Then after the resident has gained some skill they both pretend that the RN didn't actually coach that same person through the procedure. The RN was once the only person besides the physician who knew how to do such things as insert tubes into bladders and stomachs and lungs and ears and digestive tracts. They were the only ones who knew how to deliver babies and give oxygen and someone. They were the only ones besides other Physicians who knew how to assist surgeons. Now they do all of that and a whole lot more of course. Ones with Advanced degrees diagnose and prescribe, they do anesthesia, and surgery. Because of medical politics there are things that aren't who have every bit of the knowledge they need to do them are not allowed to do. They tend to be things that are reserved for male dominated professions like paramedic or military field medic that used to be entirely occupied by men. Medical doctors don't work side by side with these people and consider them extensions of themselves when they can't be in these locations. As such they aren't threatening in the way the RN is because the RN works traditionally in the same areas of medicine side by side and carries the risk of learning by observing and assisting and so Physicians have needed to draw a hard line between themselves and nurses. And even when nurses have every bit as much training as Physicians just different training but 70% overlap Physicians make every effort to restrain them from having at least some of the skills because they want to make sure they will never overtake physicians in usefulness or popularity to Medicine in general. They want to hang on to that power in that territory. And that's okay because in the end other disciplines have had to grow out of nothing. Doctors of osteopathic medicine used to be considered little more than chiropractors but eventually they work their way up so that they have the same scope of practice, fees, and Prestige that medical doctors do. Nurse practitioners are headed that way as well but they have to fight because doctors are threatened by them in a way they are not by these other professions over which they have more control. The only control doctors have over nurses is to make damn sure they know that they are nurses not doctors. And this shows up in stupid political ways for example that every other profession that might benefit from dissecting a human body in training is allowed to do so except nursing. Paramedics, physician assistants ( essentially assistant Physicians who have the same training as first year Medical School interns do at graduation), even respiratory therapist dissect human bodies in their training. But because that was once reserved for the hallowed profession of medicine it is withheld from nurses to make the point that they will never be doctors. They don't want to be but it is assumed they do. And male-dominated professions have jerks like this one who also believe that they are superior to registered nurses. A registered nurse who works in critical care labor and delivery, the emergency room, and even the operating room knows as much about emergency medicine as the paramedic does. Even if they wouldn't know how to make it work out in the field outside of burning building or in a rapidly moving ambulance etc. And even if it would be a lot harder for them to do it in the fireman's hat and rubber boots without a lot of practice. They do know how to do those same procedures and their training in medications and reading EKG strips and things like that is actually Superior. They can't just look and see if the ST segment is elevated or if they see a particular Rhythm that is or is not shockable. They have to know more than just a few medications that are given in life or death moments. Those are terribly important and it's very impressive that the paramedic can do all of those things but the RN has to know those same medications and how and when they should be given because the dose is a paramedic gives are not determined by the paramedics Advance wisdom. There are rules about the condition, the age, body composition, and weight of the victim that determine how much dopamine is used for example to lift blood pressure into a livable zone. The RN has to know those rules and can apply them just as easily. An RN is not allowed to be able to intubate or insert a chest tube or put a long needle into the chest to relieve the pericardial sack of the blood that is squeezing the heart to death after a crushing chest injury. But the RN knows how to do that and could talk a new medical resident through that procedure and therefore if allowed to practice it could become proficient as any paramedic is with a couple of supervised experiences. But we like to pretend that an RN just has some book knowledge and has observed some and therefore it's hubris to think that he or she could actually do the procedure as well. Meanwhile the registered nurse has to know a lot more than just what a medicine is for and a typical dose so they know what their patients General medical conditions are or what the patient might have overdosed on in the emergency situation a paramedic encounters. They have to know enough to know exactly what that medicine is for and the normal dose and the side effects and which patient should not be taking them and what parts of the body's might also be affected by those medications and which medications cannot be taken at the same time or are forbidden to a diabetic or a pregnant or nursing woman etc etc. They have to know more about each of those things then the paramedic does. A paramedic has to be able to run a cold blue wall by themselves also known as advanced cardiac life support, acls, or p a l s the Pediatric Advanced life support. But so does every critical care, emergency room, or operating room registered nurse. Increasingly these days registered nurses on regular medical floors and certainly any step down units have to have the ACLS training as well. So I have great respect for paramedics who have great respect for nurses. But the statement this man makes is so ignorant and demeaning to registered nurses who know a hell of a lot more about many areas of medicine then the paramedic will ever even know exists. And that's fine because what they do is intense and they have to be able to do it under very challenging conditions and respect to them for that. But before you go popping off about other medical professions Mr paramedic you need to learn a little bit more about the subject. Your ignorance was so glaring that I couldn't bring myself to listen past the first paragraph of your book.