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Ah, you too should go away. Here's why .... No, they are not. I have not been to a "boring" or "bullshit" call in my life! Anybody who says that shows a lack of understanding and empathy with your patients and a wider perspective of people's needs in general. It's also likley to rub off on how you come across and talk to your patients. I've been to jobs where you can tell who I am with just doesn't care, doesn't want to be there, honestly just doesn't give a fuck. It is sooo obvious by the way the Officer speaks, how they act, what they say and the bitching they do about the job afterwards. Sure I've been to jobs where as the person is speaking all I can think is wanting to shout "stop saying things!" at the top of my lungs and crawl back to bed but I won't let it show. Doesn't matter how tired you are, how much food you haven't eaten, how much your body aches, how many jobs you've done that you consider to be stupid and a waste of time; your callers have called YOU because they have very real needs be they medical or otherwise and YOU have a duty to try to help that person with thier problem. I went to a job the other night which you might consider "stupid". It was a girl about ten who had a high temp and was a bit chesty because she had tonsillitis. It was a simple job, give her a bit of pamol and see you later sort of thing; no drugs, no lights and sirens, no cardiac arrests. Didn't require an Intensive Care Paramedic and flashy stuff you see on Trauma. The crux of this job was that the mother had called us because she couldn't get down to the after hours pharmacy and her kid was sick, as a parent she was worried about her child because she was sick. To me that job is not stupid, it's not worthless, it's not bullshit, it's not anything like that and if you see simple, unexciting jobs (perhaps like this one) as being boring or bullshit then go away and come back when you have gown up. Little simple jobs (perhaps like this one) are about meething people's needs and showing them you care and will help in whatever capacity you can because this person is in some situation they cannot deal with (which might just COINCIDENTLY be slightly medical in nature) so the LAST THING they need is YOU coming in with the attitue of "this job sucks, I can't be bothered dealing with it and want to go back to the station and watch telly!".

This is a good topic I think. 80% of our staff wear Body Armor while working...how about you? We are an innercity EMS agency that share the same style of uniform with the police. Badge/pins/uniform color/coat all look the same with the exception of the patches and what we wear on our duty belts. We feel it is mostly for our safety but most of us really wear them to reduce blunt trauma should we get in am accident. Tell me your story about why you choose to wear one or why you want to get one. Do you think that your agency should atleast provide universal fitting "Outer Wear" body armor to leave in the truck should you get unfortunetly caught in a situation wear you think you may need it.

I agree about not mincing words. Each situation is different- depends on the culture, ethnicity, family dynamics, age of PT, terminal illness or a sudden death. No standard text to follow- you need to use language and phrases that seems genuine coming from you, and appropriate for the situation. It's never "easy", many times families are well aware of what has happened, but occasionally someone may be in denial. You may hear questions like- Are you sure? I think I just saw him breathe- even though they may have profound rigor and dependent lividity. In cases such as those I tend to get clinical-"We have asystole or flatline on the monitor, the time limits of someone responding to treatment or surviving without oxygen, I'm sorry, it's long past the point where we can help them, etc. Sometimes people need a more clinical approach, sometimes they need it explained to them more informally. Experience will tell you which tactics to try, and sometimes you may need to switch gears in midstream. A person may seem to need a detailed clinical explanation, and suddenly they become overwhelmed. At that point, you need to bring it back to a more humanistic approach. ALWAYS suggest they call a family member, neighbor, priest- someone- especially when they are alone. Give them a purpose- get together their identification cards, a list of medications, their doctors names and numbers, and a funeral home preference if the death was expected. It keeps them going, and there will be plenty of time for grieving later. Be there when they begin to make those calls, if possible.

My first one went surprisingly well. The pts husband knew that his wife was dead and basically just wanted to hear someone else confirm his thoughts. My last notification was pretty brutal. It was a call for 'man hasn't been seen in a few days'. We arrive at the pts apartment and his family was waiting out front and were quite frantic. They tried getting into the apartment but were unable. My partner and I were able to get in through the balcony and found the pt dead in his living room. He'd been dead for a while. I left the apartment through the door to get some paperwork from the truck. On my way down the stairs I ran into a cop and let them know that the patient was obviously dead. Unfortunately I hadn't noticed that a couple of the patients family members had made their way inside the building and were within earshot when i passed the word. Learned a valuable lesson that day.

Didn't mean anything by the question. I live in a small town that has a VSU that responds within 30 minutes of dispatch. Now I know for certain that the EMS crew in this area does their own death notification on scene as needed. I was just curious if others would rather have the VSU intervene on their behalf. I have been with those who have died, including several of my own family members. I haven't, though, been the one to notify a loved one of the death. You posted a good question and I'm trying to get perspective on the subject. Dwayne - I like your input.

Are you against ending life support? We have terminated several ventilators in the ED although not by EMS. Sometimes it is when a patient is alert and their DPOA has shown up with the paperwork for a DNR. If the patient is in agreement and expresses a wish for end of life support, we will honor it. However, more often than not, if a patient is intubated in the field before the patient's wishes are known, they may linger for days until the family, physicians and/or ethics committees can come up with a plan. I have never had a problem pulling the tube and shutting off the ventilator for termination of life support. While some cases are sadder than others especially when it comes to infant and children but there is still a peace in knowing the alternative would be alot worse if the suffering or hope was allowed to continued.

I have. They're called FD stand-by and rehab. But other than that, I agree with you.

Am I the only one who finds EMS exciting? You see crazy stuff all the time and you help people (some calls are BS and stupid) but i enjoy my profession a lot!

Not if they're less than 20 feet away in the other room and it takes a full day for VSU ... I mean working a code etc etc ... EMS doesn't usually go to doors making notification if that's what you thought I meant.

I have given notification several times when I work an arrest and obtain medical control for termination. I put myself on the same level of the patient, i.e., if the patient were seated, I would kneel near them before I began to talk. I calmly describe that when we arrived their family member did not have a heartbeat and was not breathing. I then explain that what we did, such as medication, breathing tube, CPR, defibrillation, etc. I do not go into gory details, but I make sure that the person I'm talking to understand how hard we worked to save their family member. I then tell them that I spoke with a physician at XX ER and he agreed that everything that could be done had been done and that we should cease efforts. I offer to answer any questions that I can, or obtain any outside support that they may need such as additional family or clergy. Of course, the above only works for me if the family is not hysterical to the point that I feel we are in danger. As of yet, that has not happened to me. Most family is so busy grieving that they want comfort more than they want to fight. It's a delicate situation, and something they do not teach you how to do. I really feel that a large part of my job involves social work, not just fancy medications and toys. I'm there for a patient, and I'm there for family when I have taken care of the patient. I am a big fan of requiring sociology and psychology for paramedics for this reason.

I'd like to add to your line of questioning. In some areas, a member of the victim services group would provide that information. If given the chance, would you leave it up to the advocate to give the death notification?

If you notice the crash test dummies have full movable safety harnesses yet did you see the head in a low speed crash smack the cabinet. It honestly is not a bad ideal to have them on for those in the patient compartment. As to CPR you should not be in motion while CPR is in progress so should not be a problem.

I think we are missing a few facts from a brief Yahoo article. This probably wasn't one of those come into the ER, CT shows you are paralyzed for life, let's pull the plug situations. I can almost guarantee that this case involved the hospital ethics committee. These are made up of MD/DOs, JDs, bioethitists(sp??) and anyone else that may be interested. There were probably several exams to decide if this woman was competent. There were probably several meetings of the ethics committee with some of these involving going over legal cases to look for precedence. I can guarantee you that this was a thought out and researched decision. My feeling is that you cannot force treatment on someone who does not want it (as long as they have the capacity). She said no vent and to do that against her will is assault/battery.

No - F_cking - Way.

I think if a "helmet in the vehicle" rule was implemented, compliance would be very low. People don't even wear their helmets at MVC's unless there is a sup present. As far as improving the trucks safety, nothing will be done until someone dies. That is the Canadian way.

I have to admit that I accidentally gave a point when I was trying to hit the "reply" button. Maybe I'm not the only one?

yup I chew and we all quit chewing or smoking eventually.

I don't give a flying fuck what the statistics are. All I know is that I AM one of those statistics, and I damn sure wish I had been wearing a helmet. Skull fractures are no fun. And I was already ugly enough without this scar over my eye. So yes, I am all for REQUIRED headgear in the ambulance. I was pleasantly surprised to see it being worn in Japan (where you can't go ten minutes without seeing an ambulance flying by). But no, I do not know of any agency that currently requires them, nor have I ever been with such an agency. We had a very thorough discussion of this issue here a few years back: http://www.emtcity.com/index.php/topic/3679-would-you-wear-a-helmet-during-transports/page__hl__helmet I'll repeat my initial (among many) response to that thread: A quarter of respondents to that thread said they would voluntarily wear a helmet. A quarter said they would not, and would even defy any policy requiring them to do so. The other half were somewhere in the middle. I'm curious if the numbers have changed as the makeup of the board has changed.