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What she said! Seriously, the most common mistakes I see are: 1.) Placing leads V1 and V2 one intercostal space too high on the anterior chest (in some cases even higher) 2.) Placing leads V1 and V2 too far apart (make a "peace sign" with your fingers and you should be able to touch both electrodes) 3.) Placing lead V3 directly under lead V2 4.) Placing lead V4 under the nipple instead of visualizing the midclavicular line Other common mistakes that aren't related to lead placement are failure to undress the patient from the waist up and leaving a female's bra on. Protect a female's dignity and get her covered up as soon as possible, but don't place leads down the front of a shirt or reach up under a bra. It's absurd. STEMI patients should be completely undressed (similar to trauma) anyway. Beyond that it's just taking pride in your workmanship. Shave the chest (hopefully for male patients) and use the benzoin tincture. It works! Also, if you're using rectangular electrodes, line up the edges and make it all symmetrical. It helps keep you organized. There's no value in putting some lengthwise, some width-wise, and some diagonal. Make sure the leads aren't all tangled up. Strand them out individually to minimize artifact. Don't wrap the O2 line, the IV line, the ECG line, and the BP line together. It's a mess, it looks unprofessional, and it's harder to troubleshoot problems. Be sure the patient isn't holding him/herself up with his/her arms. The muscle tremors will be noted as artifact. The patient should be in a relaxed semi-Fowlers position and breathing normally. You can lay a towel and/or blankets on top once the electrodes are placed to minimize shivering or Parkinsonian tremors. If you don't settle for imperfection you will almost never have problems with poor data quality (which confounds computerized measurements and interpretations, makes nuanced interpretations more difficult, and harms the credibility of prehospital 12-lead ECG programs). Good luck! Tom

I happened across these old videos from the 70s of the Melbourne ambulance service (aka Ambulance Service Melbourne, then more recently Metropolitan Ambulance Service and now Ambulanve Victoria). Now as unlikely as I am to promote the Australians they are a great look at the how things in this part of the world have changed since the 70s and they feature MICA (mobile intensive care ambulance (ALS)) of the day which is a serious whoot frickin Johnny and Roy down under! As lure has it, Melbourne's MICA Paramedics were in the third such service in the world starting in 1971 (behind Seattle, '67 and Miami in 1969). New Zealand unfortunately rounds out at #4 with the Auckland mobile life support project beginning in 1972 - grumble, grumble. http://www.paramedic-community.com/ahsv/videos/archive/asm_rotary.html http://www.paramedic-community.com/ahsv/videos/archive/25yrMICA.html

First of all, good morning:) Okay, so I am beginning my training to become an EMT. I do intend of course to go headstrong into this career path, in attaining Paramedic one day. Seeking counselors advice on how to go about acheiving my goal has been a nightmare. Even having one tell me to get my Physiology, Math, English and Bio. out of the the way and just apply for the Paramedic portion because EMT 1 was a waste of time...to only have me "snort" at him and ask him if he even knows what he is talking about. Okay so needless to say I am with a new counselor who is awesome. Right now my community college only offers EMT 1..so I will have to transfer to another community college or tech school. Because of this is has me scrambling to find out what preq's are required for the course. And, it also has me wondering. Tech school, or from what I understand, a credible community college. I dont mind investing the time, because I do in all honesty, want to get the most from my schooling. I am curious from step 1 to the end, appx. How much time will I have invested? Having already 6+ years invested into healthcare (including volunteer EMS), I know you get out of it, what you put in. So basically I welcome any and all advice from the experienced to my rather new adventure. I can't wait, I am totally stoked that now at 33, having been a single mom since 20, that I am now able to pursue my dream. I am just hoping by the time I am done with school I am not too old and worn out to get out there! haha. Thanks for listening and looking forward to the feedback. Anna

I had the most critical call I've ever been on the other night. It seems that I missed something that would have given us a slight chance to save a life (very slight). There were multiple critical pt's so I was trying to do a million things at once, and I missed something huge. My boss, my partner, and my one friend I have told about it all stand behind me, but I can't get over the fact that I took away that .01 percent chance at life. I did. ME. "Everyone makes mistakes," or "you did your best and that's all you can do," or "most people would have missed that too," just doesn't seem to be cutting it. I'm sorry if this is repetitive, but I've read the other stress reduction polls and I'd kind of like something that addresses my situation a little more. How do you move on let alone work again after something like this? How big of a mistake is too big to make? Also, I don't really want to talk about the call specifics thanks (I know that's kind of a dick move, but please respect it).

Tough call, Tom. I agree with your assessment that a normal 7 month fetus is not 1kg. In other words, no way you could have done anything to affect the outcome. Unless I missed it, did you say this mom had any prenatal care? I suspect drugs and/or ETOH may have been involved here too which could also explain the condition of the fetuses. Actually I'm amazed this woman carried these twins to 7 months if they were so deformed. Mother nature usually spontaneously aborts when such profound problems are present. Hang in there- these calls are the worst, but you'll get past it.

Maybe he was just very worried about homeland security and wanted to do his part to protect the country?? Granted I'm just a city boy who doesn't hunt, but a rocket launcher?? How big are the deer in his area?

How far along they were is indeed in question, it's hard to know, but I do think they were probably well short of 7 months. I would love to talk it over with an ob specialist...I did discuss it with a nicu rn who is a close family friend. Essentially I keep hearing the same thing; they were likely not viable and nothing else could have been done. The word from the pathologist is that the first infant was simply premature, the second "substantially deformed." Things I would do differently: 1) inspect the placenta, 2) work more aggressively on a and b of the first child...it was tough, the smallest bvm out of our broselow went over the entire face (tips?)!

I agree and that is exactly my approach. You can't go wrong with being educated. Unfortunately math IS my weak point so I know Im on a long road in that department, which I dont mind because knowledge is power. I am pretty well versed in patient care, since it has been my life now for 6 years or so. I interact very well with my patients. The problem with that is having worked with nurses who think Ima fool for forfeiting better pay to be in the action. "Why not an ER nurse..." Meh, I guess unless you have the passion to do so, you wouldnt understand. Thanks for the advice!

Of course a counselor will tell you to take all those other classes, they are employed by the college and most likely instructed to push classes on students. But it's not a bad thing. Take the classes. That being said, having a pysch, math, English, world history, etc etc will not necessarily make you a better EMT, but in my honest opinion, they will. Psychology will teach you how to understand people and their feelings/actions better. That will help you better treat them. Math is a no brainer since math is a big part of medications, you would not want to make mistakes there. English is always good since we speak it. The smarter and more professional you talk, the better a patient will trust you. The only person you have to listen to, is yourself. If you want to be an EMT, go be an EMT. No one can tell you what you should do with your life. My advice is, do what you want. Learn as much as you can even if it "isn't in the field".

Thanks! and oh yes I do plan to get those preq's out of the way while, I can here at my community college. The other school is over an hour away so I'd like to do what I can close to home. My snorting was at the fact he thought EMT 1 was a waste of time. I was under the presumption it was mandatory for the EMT-Paramedic course, correct? My friends mother is a Paramedic Supervisor and she thought that it was a good foundation to start, then move over to the Butte College program. The only other close school would be American River College, which has an excellent program but isn't as sensible for travel. Either way I want the most out of schooling, so....I will do whatever it takes. Oh, and I also forgot to mention, having worked with nurses for several years now, my desire for "nursing" is slim to none. Although I realize the basis of schooling is similiar. I feel no passion for that field. When I think back on my time volunteering with Emergency Services..my blood boils and Im excited. I know where Im meant to be and totally dedicated to make that happen

If you really want to become an EMT, then go for it. It's a relatively quick process and an easy field to get into especially in California. There are several 1-6 month programs that can give you the most basic education to function as an EMT. However, I'd agree with your counselor to get more of your basic classes out of the way and then re-assess your options in the medical field. There are many other positions aside from EMT which also tend to pay better and allow a more regular schedule (plus you'll need them to become a Paramedic if that's also your thing). I only say this as I prepare to go back to school next month to work on my nursing school pre-requisites. Welcome to the forums though and good luck in your endeavors! Let me know if you need any help.

Hi everyone. I've wanted a career in health care my whole life, and I've waffled quite a bit in terms of deciding which path to choose. This fall I chose to enroll in a CNA course and I am loving it so far. Over the past few months, however, EMS has become more and more attractive to me, and I'm considering enrolling in an EMT-b course that is going to be offered in my town next year. I've done a good deal of research (in fact, that's how I stumbled across this site) and I have had some good conversations with the president of the local EMS provider, but there are still a few things I would like to have cleared up. First, some background-- in this neck of the woods, if you say "BLS ambulance" or "private ambulance company," people will look at you as if you have two heads. It's basically all ALS, hospital-based, dual role 911/IFT. There is only one hospital in the whole county and, hence, one EMS provider, which runs from five bases scattered all over the place answering a good 5500 calls a year. Even though the pay is lower than the national average, EMT's (even basics) are held in high regard, and the utmost professionalism is expected. And I probably don't need to clarify, but this is rural EMS. That aside, here are some questions I have. Do you ever regret becoming an EMT? What is the most enjoyable part of your job? What is the least enjoyable? Do you hold a second job? Have you ever felt that your EMT-b course didn't prepare you enough for a certain situation? What would you change about EMS if you could? What is the most productive way I could spend my down-time? Thanks in advance.

Generally speaking all of the electrode wires are color coded. They are also labeled. RA means Right Arm. LA means Left Arm and so on. Place them in the proper places and you'll get an accurate ECG. http://library.med.utah.edu/kw/ecg/ecg_outline/Lesson1/lead_dia.html V1: right 4th intercostal space V2: left 4th intercostal space V3: halfway between V2 and V4 V4: left 5th intercostal space, mid-clavicular line V5: horizontal to V4, anterior axillary line V6: horizontal to V5, mid-axillary line Generally start placing V1 & V2, then V4, then V6. Then you place V3 between V2 and V4 and V5 between V4 and V6.

First of all, thank you for posting. I was and am still interested. That has got to be one of the shittiest calls ever. No wonder you had some difficulty with it. The pediatric calls seem to affect most people the hardest, and you had two dead babies. Was not inspecting the placenta a mistake? yes. Would many of us have missed it? especially in the heat of battle over the 1st infant? yes Did it make a difference in outcome? probably not. The only consolation I have for you is that that is a pretty rare call. A woman with twins and no prenatal care is not something many medics ever run on. Birth at 7 months is usually typical for twins. The small size of the babies tells me that these infants may have been much younger and likely viability was in question even if they had been born in the best of circumstances. Have you discussed this with a pediatric/OB specialist? What is their opinion? Thanks again for posting. It says a lot that you are willing to open up this very sensitive call for the scrutiny of your peers. I hope you are doing better with all this.

Ok...so if anyone even cares anymore, I think I feel alright discussing some specifics. Maybe you can learn from my mistake. My medic, myself, and our driver (we run crews of three) got paged out in the wee hours of the morning to a premature birth, approximately seven months along, in full arrest. So...after I scooped the crap out of my pants, we responded to the scene. Sure enough, the smallest baby I have ever imagined. First responders are doing half-assed compressions. We cut the cord, bring the baby out to the rig, fire carries out mom. We begin our attempt at multi-tasking. Mom still hasn't delivered the placenta (but is fairly stable, minimal hemorrhage), so I'm trying to keep a close eye on her, while also trying to do compressions so my medic can attempt to intubate. We worked on this poor kid forever, we had the smallest stuff out of our broselow bag and everything was still too big. We were unable to intubate, unable to start an umbilical IV, and when we attempted an eazy-IO, the drill barely touched before it blew all the way through. This kid weighed maybe 1 kg. Somewhere in here, I deliver the rest of the placenta, bag it, and set it down for the hospital. Bear in mind, I had watched the placenta come out, not constantly, but as maybe 8-9 stages during its delivery. With medical control on-line, we have to call the kid. We clean up mom as best we could and deliver her to the hospital. So...still reeling from all this, I receive a call from my manager a couple days later: they found a second baby tangled up with the placenta. Unless it's not clear, I never saw a second child, and while I never did an inspection of the placenta, I did have an eye on it from its first presentation until delivery. Hence...why I felt awful. Realistically this pt was not viable and would had to have been even smaller than the first for me to miss it. There was also no pre-natal care, so no way of knowing we had to expect another patient. I've moved on from it and learned a few things: I will be inspecting placentas in the future. I've also learned to work even harder on airway because full arrest in kids is usually secondary to respiratory arrest. Any other thoughts?

To reinforce that a little, I'm sympathetic to the cries of "better education" and "better training," but until those changes run through the system, folks like me are left to learn on their own. So while I think it's great to complain that Basics et al. should already know this stuff, I'd much rather that you just explained as much of it as possible. I don't want to get in the way of whatever other discussions you guys want to have, but if you really believe in creating more educated providers, well -- we're reading, and that's why we're asking questions.

I'm happy to hear that you have had some clarity and are feeling better about it. If my commentary did help, I'm glad it did. I wasn't trying too point fingers at you, but the 'suspicious' aspect is a manner of perspective and perception. Often when people try to tell a story about something that happened they will omit, alter or add information to sell their vesion of events. It doesn't have to be conscious, it's a matter fact that it happens. Take for example you didn't establish an open and patent airway - this might change the response you would get (not to suggest that was the case in your actions or lack there of.) As hard as it is to hear, if you learned from what happened, you and your patients will be better for it.

To parrot what Dwayne said, thanks for sharing with us how you feel. I would suggest that if you continue to have issues with the call, that you may wish to seek the help of a counselor. Psychological issues/stresses are not 'our' specialty. Honestly, this is a fairly anonymous forum. I think people want you to share the specifics of your call because it will help us all give you better advise about the situation. You obviously have the guts to come forward and tell us you have an issue. The choice is your's though and we still respect you either way you choose. From you post, it seems that you have taken a situation that you did not create, and in that situation did not perform some intervention that may, or may not have given the patient a 0.01% chance of living. It may be silly, but why not only blame yourself only 0.01%, instead of the 100% that we perceive you blaming yourself for? It seems you were only accountable for that 0.01% and not the full life of the patient (as in you did not cause the situation). You quoted 'everyone makes mistakes', 'you did your best', and all that Jazz. Sure, everybody makes mistakes, and a number of people try and do their best. What separates the professionals from the check collectors is what I believe to be 'perfect practice'. (that is not my saying, but one I like). Perfect practice does not mean you go through motions and hope to gain the experience you need. Perfect practice means that each time you go to your next call, you apply your past experience and new knowledge to perfect that task at hand. It is not something that just comes, but rather something you work hard to obtain. This is what the other posters were trying to say, in a sense. They say to review the call and be critical of yourself, to a point. I am saying to review the calls but to be active in using the review to make yourself a better provider. I hope you can find that inner peace you are probably needing. Good luck bro ! Matty

One call I had this summer that made me feel like that. I was beating myself up about whether or not each decision I made was the right one; had I made a different choice at one of many points would things have turned out differently? I know now they wouldn't have, injuries were simply not compatible with life. I was offered a chat by one of our CISM people I trust, at the time I just wanted to go home. She gave me her cell and said to call if I needed. After I realized I couldn't normalize myself after work and was really reacting, I called and was able to arrange a meeting. That was probably the best thing I could have done; very informal, just a chance to vent and get all that stuff off my chest to someone who was able to make the time to listen (for two hours). So without minimalizing what you're feeling as I truly do understand, most or all of us have been or will be in that same position probably more than once during our careers. Definitely talk to someone, maybe take a debriefing. Get the specifics off your chest with someone trusted. Whatever happened, mistake or not, you're human. Take the initiative and talk to someone about what's bothering you, because if you don't it will quite likely eat you alive.

Kev makes a great point, as usual. There is ALWAYS "something else" that could have been done. Always. It may be something you forgot. It may be something you never even learned. It may be something outside of your protocols. Most times it's just a total shot in the dark "feel good" measure that would have made no difference at all in the outcome. But remember, there is ALWAYS something else that could be done, so there is no point in agonising over it, because it makes no difference in the bottom line. Of course, this is not to stay that you should not critically review each and every run. You should. And when you have that revelation of the major step that you overlooked for whatever reason, the finality of the situation should drive the point home in a way that never again allows you to forget. But it IS going to happen. Period. You can either deal with it or not. But your career depends on you discovering that method which helps you to do so. That is where conversations such as this one are valuable. Nobody here can tell you how YOU should deal with it. We have no way of knowing what will work for you. The best we can do is to share what has worked for us, and for you to then go with your best instincts. On that, I wish you luck.

Now that you have had time to decompress and reflect, are you more comfortable telling more of the story to allow those here to provide more insight? To be honest, it's hard to provide honest feedback without knowing what it is you are holding back. On the surface, based on what you are saying a very slight increase in saving a life (0.01%) though statistically is possible, practically is impossible. It is probably speculation at best that anything would have helped. If what you missed truly was 'huge' then the statistical odds would probably have been much better in favor of the patient. I'm sorry to say that I remain suspicious of your intent. If you missed something huge and messed up, like others have said, accept responsibility, ask for forgiveness, learn from it and move on. It will make you a better practitioner. If it was a long shot in the dark, hindsight is always 20/20 and you can critique until the cows come home. You can't change the past, only what you do in the future. If you look at hindsight, you will always be stuck in the past and will never move forward and won't make progress. Learn to trust your instincts and respect the decision you made. If you can't, no one else will be able to trust you either. As long as you made the best decision based on the information that was available to you at THAT time, don't ever question it. It might not always be the right decision, but that's why you learn from it.

Word. That was a great move for your professional development. If anyone in EMS has any problem with the death of total stranger patients here in the world, then don't even think about going to combat, where the victims are people you know and live with every day. You'll eventually crack. It took me three wars, but I cracked, and I have NEVER had any problem with death in civilian EMS.

Though I most often disagree with Spenac as he tends to parrot the more popular opinions expressed by those before him, I do think he makes a half assed decent point here. My first call on my own truck at the service I work for now was a 3 month ped arrest. First friggin' call. In fact it was relatively famous locally. I got pulses back but the child died when removed from life support two days later. There were tears all around me, but what did I feel? Nothing but an intense need to review my personal performance as well as my direction of the team. I was told by others that I would be damaged after I had a chance to think, but thanks to Akflightmedic I'd had Afg to refer to and knew differently. This child was in a trouble not of my making, and though I did the best that I could, I made many significant errors in treatment. But, on this day, it was my best. One of the many debts I owe to EMTCity, Dustdevil, Ak and many others is that I entered that situation with the knowledge that it was unhealthy to let other, non psychiatric professionals, tell me how I should react to that situation. You did, in my opinion, exceptionally well with your pain. EMS is going to bring pain sometimes. We know that, and should accept it I believe. But deciding whether to seek sympathy, or instead find the help we need to stay healthy and then move forward separates the men from the boys. I'm glad you let us see, hear, and thus learn from your experience. It was brave, and we're all the better for it. Look me up if you get to Colorado. Dwayne

Most of those I work with would disagree with you- from new guys to old farts like me. Ironically, I've been told by many that I can be a cold-hearted SOB, and that may very well be true- except when it comes to kids. If an 80 year old dies, is it tragic- of course. The family experiences a loss and they mourn the death of a relative, but the person lived a long life, had the opportunity to experience all kinds of things- raise a family, work, contribute to society. When a child dies, I look at the wasted potential, of all the things they could have done, of what they could have become, of what might have been. This child could have grown up to find a cure for cancer, or solved our energy problems. Any child- regardless of their surroundings, has nothing but possibilities and a blank page they will fill. Different strokes, I guess.

You'll be fine, bud. Peds arrests are horrible. ALWAYS. Regardless of the situation. They will make you angry, sad, disgusted, amazed, and every other emotion in between- as will any call you run. The problem is, with peds, the most vulnerable of us all, those emotions are amplified 10 fold. I have no idea what your call volume is or where you work, but there WILL be more horrible calls. You'll question yourself(and that is a good thing), question your personal deity, and question the sanity of the human race. The longer you do this, the more you'll realize that we do our parts, do the best we can, and despite it all, people live, and people die. Sometimes we can change those outcomes, sometimes we cannot. Go hug your child, a relative, and appreciate what you have. It helps.

Also, although not to any extreme, take a clue from M*A*S*H's Frank Burns. His attitude was, any patient who died on him was either unsalvagable, God's decision, or someone else's fault. Having said that, NEVER let it just roll off your back. Follow any and all of the suggestions made, and that will be made, in this string. One or more of them will be the right answer(s) for you.

Key to surviving in any medical field is to quickly review each case. Learn form any mistakes you spot. Then let it go and move forward. Everyone has had patients that could have faired a little better or had a slightly better chance of survival had they done everything perfect, yet none of them are perfect. But you grow as a provider when you learn and improve rather than dwelling and withdrawing.

funkytomtom, glad to hear you are feeling better & I have waited to post because i think there are some principals we all need to remember here. It has been so well put before but we do need to remember patients do die. Trauma patients especially & the younger they are, the harder it is. Your reaction is/was a normal reaction to an abnormal situation. Self criticism, while at times can be self destructive is a necesarry part of the way we in EMS grieve (yes we grieve the loss as well as the family). What we need to remember is this should only last 2-5 days. If it persists then you really need some further help. The longer you have been in the system, the more likly you are to suffer from PTSD. There can be a cumulative effect. What I have read from you is what we would expect to see over a few days. Acceptance that you did your best. There are many jobs where the patient has a negative outcome, & in reality no matter what we do, nothing would save them. Not even 0.001% of a chance. Take heart, it gets better & those jobs are few & far between. When you dont think about it, leave the profession, you have become to callous.

Good for you brother. I'm grateful you took my comments in the spirit intended. I too think that you will do outstanding. Sometimes we get kicked in the boys and need to rely on our friends to tell us to stop, think, then rethink, and then get back to work. I'm practically a mistake factory. What keeps me up and running is identifying what I would have liked to have done differently, make a plan to help insure that I do so in the future, and then refuse to waste a bunch of mental energy, that my patients can use, telling myself what an idiot I am. I'm proud of you for deciding to be a professional, to take a little time to be confused, accept that that's sometimes necessary, seeking help, steering yourself back up out of the ditch and onto the road and going back to work. Good for you man... Dwayne

I really hope that you continue to "get over" this call and move on in a healthy and productive way. Feel free to reach out whenever you need! Best of luck to you!

Thanks for the replies. I've managed to relax a little bit about this call since my first post. In relation to Herbie mentioning pediatric arrests, this was one of those calls. Two pediatric deaths in the back of the rig. And to Dwayne, I just came here as another resource because I have never had to deal with anything like this and felt you probably all had. I do appreciate your comments, I think the mistake did involve a little bit of tunnel vision, but yes the patient was almost surely doomed. Anyways, I'll be ok, and all your comments have helped.

That's quite a story, Paul- thanks for sharing it. Sounds like you went through hell and back. Yours is an object lesson anyone can learn from. I tell all my students and new guys/gals that one of the most important things you can do is watch the back of your coworker. We have had several members commit suicide or drink themselves to death over the last few years. I realize you cannot help someone who isn't ready to accept it, but you have to try. Hopefully you can intercept someone before they go down such a dark road that turning around is nearly impossible. Here's a little story. About a year ago, a friend of mine- an Iraqi war vet returned to the job after his tour of duty. As with many vets, he was having trouble adjusting to life back home and ending up with personal problems- a divorce, anger issues, and discipline problems at work. I notified our employee assistance people that this guy probably needed some help. To make a long story short, there was no program in place to deal with vets and their issues unless the person requested it. We all know how stubborn public safety folks can be about asking for and/or accepting help, so clearly we need to be more proactive in our efforts to reach out to folks. My buddy was approached by the counseling staff, was agreeable to the help- thank gawd, because it may have saved his life. He received counseling, the divorce was settled, after awhile felt a lot better, and he's dealing with everything in a healthy way.

Rookie Ease up on yourself. You'll thank yourself for it in time. EMS practitioners are by far, the worst offenders of being one's own worst enemy when it comes to looking back and wondering what could have been. After 21 yrs in EMS (17 + as an ALS practitioner and 18 as an EMS educator) this I know; trauma patients die. A lot. And mostly in spite of what we do. Five years ago on Memorial day weekend, my brother in law suffered a cardiac arrest in the driveway. He was 43. I was with him the day before when he was complaining of palpitations and like all of us would, strongly advised him to go to to the ER. Not strongly enough. I, like you, beat myself up over it, over and over until the weeks turned into months and the months to years. In the process I began to lose my faith in my abilities as an ALS practitioner, insomnia set in, then came a couple of med errors, (strangely things continued to get worse despite my avoidance of the real issue), my long term relationship failed (not related to this incident), and my desire to care took flight. I was the poster child for EMS related stress and Accumulative Stress Disorder. I existed as a shell of myself for a little over two years, until I became seriously ill. The illness was the last straw and I ended up on stress leave. Four months later I walked away from my twenty year career without blinking an eye. After a year and a half of unemployment, some menial jobs for minumum wage, and five months on welfare, I returned to prehospital health care. I kicked my arse for a long while for not getting the help I needed when I needed it. Don't make the same mistakes many of us have made, Rookie; everyone makes a mistake or two, and most of them are not life critical. Some mistakes are, but I doubt yours was. Given the chance to do the call again, knowing what you know now, the outcome would be the same. Trauma patients die. A lot. If you need to speak with someone professionally have your service provider make the arrangements. Speak with someone outside of your service / agency. And stop beating yourself up over something that would have happened regardless of what you, I, or anyone else would have done. Also keep in mind; you weren't the only one on scene; if whatever it was had been obvious, someone else would have caught it. I don't have all the answers, just a lot of experiences of things not to do again. I wish you only the best, and then some. Take care of yourself, Paul

"Those" calls SHOULD bother any provider worth their salt. I'd hate to work with anyone who didn't get upset when something bad happens. "Those" calls could be anything from a question about the care you provided or simply a bad situation. My (and most provider's) Achilles Heel is kids. Had a stretch years ago when every shift I had a pediatric arrest- 4 in a row. SIDS, trauma, abuse, medical issues- it was bad. I was a new dad at the time, so they hit me hard, and after the 2nd one, I dreaded going into work. I talked with coworkers and even the department chaplain. Sometimes there are no "answers" and simply talking it out gets you through it. Like you said, anyone who's been doing this awhile has been in the same boat- more than once and the key is to NOT keep it bottled up inside. We are human, we get upset, and we wonder how we can do it better the next time. That's what it's all about.

Everyone has had one of "Those" calls somewhere along their career. You review the textbooks, talk it over with others on the call, talk with supervisors as you feel necessary, speak with the Clergy person(s) of your choice. Believe me, you'll survive. It might take more time with one individual than with another to "get over it", but sooner or later, you will. Good luck, PM me if you feel it will help, or any of us on the city, as I feel sure we all care.

I noticed you said there were multiple critical patients. Well, this is basic triage, then. The "best" solution is a very grey area in these situations. It is crucial to QI/QA your actions- especially on critical calls, but you cannot beat yourself up over it. You do the best you can given your resources,, the surroundings, and available personnel. Shoulda, coulda, and woulda's are OK to help you for the next situation, but unless you did something like a missed esophageal intubation, I'm sure it's not as bad as you think. Sometimes we are forced to make judgment calls that may not sit well with us later. You simply do the best you can. The most difficult thing in the world is to leave a critically injured person who if they were your only victim, you may be able to help. With multiple victims, you look for people who have the best chance at survival and hope for the best. There's always second guessing- even with single victims- maybe I could have driven faster, maybe I could have pushed more fluids, if only we didn't hit that traffic on the way to the call, if I had gotten the IV quicker we could have pushed the meds faster... generally it's not as bad as you think. As we all know, when someone's number is up, there's usually not a damn thing we can do about it. The fact that it's bothering you means it's a learning experience- either you can do something better next time, or you may simply realize that sometimes "feces occurs" despite our best efforts.

I think it's important to decide why you messed up, and why it's effecting you so severely? I mess up something on every call. I know, as I find something else I wish I would have done, or asked, or discovered while reviewing them later. That doesn't destroy me for two reasons. One, I'm never likely to be perfect, so I review each call to help guarantee that I'll be the best that I know how to be next time. Second, in my opinion, EMS is a learning environment. On the most critical calls I rarely have as much time as I'd like, nor access to the amount of competent help that would allow me to perform at the level that I would like. But you know what? It's the gig I signed on for, I don't really deserve the luxury of having people pat me on the back for my mistakes...I learn from them, make sure others have the benefit of learning from them, and then move on. Did you miss something because you don't have a good plan for running calls? Were you tunnel visioned by one thing, causing you to ignore something else? Did you trust part of care to someone else that didn't follow through? All of these are correctable, none of them should cause the kind of angst you're showing here. Why did you miss what you missed? Answer that question, and then follow Kaisu's advice and make sure you don't do it again. That's kind of how this game works brother. I'm not sure what level you're working at, medic/intermediate/basic but I'm guessing that you may be overstating things just a bit as well, and that's certainly easy to do if you don't have a lot of experience. It's a rare thing when we make a massive difference in the mortality of our patients in pre hospital environment, and even more rare when a 'slight error' (.01 % I think you said?) would have made any difference at all. Is it possible that what you're agonizing over is the difference between your treatment and following the protocols to the letter? If so, then you should stop that. It's simply making you miserable and not producing anything positive. I'm sorry I don't have more sympathetic things to say, but not discussing the call really only leaves room for general advice and shotgun sympathy. The first I gave my best shot, the second won't really do anything but make you a weaker person and less potent provider, so I'll let it alone. I hope you find whatever it is you're looking for. Dwayne

My first critical call and I missed something too. It tore me up. I got a great deal of support from my EMS family but it took time for me to feel better about it. One of the things that helped me was that I knew I would NOT make the same mistake twice. The protocol for that type of call is forever seared into my soul. I knew that I will use what I learned on that call to save someone else. I later found out that the mistake was meaningless as the patient was doomed. Perhaps if you follow up on the patient, you may find information that will put your .01 into perspective. The other thing is a psychological point. It is hard to accept that sometimes you cannot do everything right and people die. Your overall responsibility in the situation is very small. You did not create the illness/crisis and I am certain that you did the best you could at that time. By raking yourself over the coals, in a way you are trying to control what is essentially uncontrollable. It will happen. Take this as an opportunity to be a better provider and learn from it. Forgive yourself and move on.

It really is a great family to have. Reach out when you need it and help others when they need it Best of luck to you!

Thank you. It has been amazing seeing my co-workers and now you really being there. EMS truly is a family, and I would be lost without it.

I can't imagine how you are feeling. And I know saying "you did your best" etc, brings little comfort right now. The only advice I can give is we do all mess up at some point...I'm sure even dust, ak, the best among us have messed up at some point in their career. A bigger mess up would be to let this ruin you. The best thing you can do is to show up next shift, and do the best you can. It just takes time to move on from crappy situations. Sounds like it was a rough call, and talking to others on the call might help you work it out. Best of luck, and feel free to PM me if you just want to talk. Keep your head up and keep on going

Haha, not today it won't. Starting fights on the with roadies who will crucify you no matter what you do/say/breath is not wise. Still, my marks don't depend on this forum's "reputation bar" so, maybe That comes in the degree. My advice to chaser a little while ago was to take a ganda at the CPGs to get a little familiar with some of the stuff he'll have to know in semester one. Its just easier come exam time when you are reviewing more complex concepts if you don't also have to spend time wrote learning stuff you could have memorized in grade 3 if anyone had told you; but instead they decided to tell you in the revision lecture a week before the exams.

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