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Hi, Kyle. I'm just a student, and I haven't seen the number of code blues that probably the majority of people on this board have, but if it's not too presumptuous I'll share my opinions, such as they are. To be honest, I guess I don't. I've had, if I'm recalling correctly, a total of eight codes that I've been involved in. On all but one, I took part in performing CPR at some point, and in the two I've had thus far in my field internship, I intubated both of them, and on the second one was leading the code. I say this just to clarify that I wasn't merely a passive observer (or maybe I was?), but involved in their care in some fashion. Now maybe I'm too green in the job to be affected by it yet, but to be honest they haven't interrupted my day or otherwise affected me emotionally. In the EMS/Police/Fire TV series, Third Watch, there's an episode where one of the new paramedics recounts also feeling nothing for his patient who coded, to which the senior paramedic "Doc" replies something along the lines of, "You didn't know them when they were alive, so it's hard for you to miss them when they're gone." I think this is very true in a lot of ways, at least for me. Now, maybe this will change as I get more experience and run more codes, maybe it won't. In the end, who is it for anyone to decide how we should react to death? We all experience it differently, and hopefully we process it in a healthy way. I don't and haven't, and to be honest I, in my humble student opinion, don't think we should cry in the presence of family. Not that it's inappropriate to be sad, or to cry later in the ambulance or back at station or wherever, but for two reasons. First of all, we are there to be calm and collected when no one else is. Family is there and is freaking out and they need to know and see that we are calm, that we are doing (or have done) everything possible to save their loved one, but were unable to. And secondly, and this is more of my own personal take on things, because I feel like if I were to cry in front of family that I would be stealing something from them. It isn't our tragedy, it's theirs. I don't have any definable reason to feel that way but it's how I feel and maybe it will change someday, but not today. Like I said before, I think that, at least for me, dealing with the death of someone you knew and loved is different from dealing with the death of someone else. Losing someone you were close to is putting the back cover on a book of memories that will never grow any bigger; precious memories that you held dear and had an expectation of adding to. You have no fond memories of the patient (unless you've run them before or otherwise had the opportunity to really enjoy their company before their passing, even the idle happy chit-chat after you've done what you needed to and now have time to kill en route to the hospital), and no expectation to continue to grow upon them. Again, that's just my take for myself. No, thank you. I hope what I've said helps, or at least makes some semblance of sense. As I continue through my internship and later in my career in medicine, I wonder if my opinions will change. I haven't had any peds code on me yet, and I understand that for a lot of people those are the heartbreakers that tear down even the toughest of medics, so I really don't know how I'll react to them. Either way, thinking about death now helps me try to make sense of it and my role in it, both in the death of my patients, my family and friends, and myself.

I think you handled this patient very well. Although I probably would have considered an anti-emetic, I can understand your line of thinking with not wanting to stop his body from throwing up a potential poison. But considering you did not have a strong suspicion of an oral medication or illicit drug OD, his continual vomiting is likely due to being really intoxicated. Besides if the ER doctor decides that his stomach contents really do need to be evacuated, an NG tube will do the job regardless. His continuous vomiting is a threat to his airway, and remember that is your priority. Break out the suction and do the best you can. Roll him on his side and keep his airway clear. Remember that as a newer generation paramedic you should not be relying on intubation as much as in the past. Expect some differences in opinion with the old-school folk. There is much less emphasis on field intubations, because in so many cases the benefits fail to outweigh the risk. Less than 8, intubate is a thing of the past. If you can manage an airway without a tube, do it. If this guy is a simple drunk, control his airway and let him sober up in the ER. He'll go home in a few hours. But if you tube him, you are potentially buying him several days in the hospital maybe even the ICU. He will require sedation (which brings in a whole new set of risks.)He may have problems surrounding extubation and be exposed to dangerous hospital acquired infections, including a potentially fatal ventilator acquired pneumonia. I am not saying not to intubate, because sometimes it is necessary. But remember that it is one of many tools in airway management and every tool has an appropriate usage.

This thread caught my eye. Kyle, the questions you raised are good ones, and as others have said, everyone reacts differently. I will try to give my two cents worth. I formally got into EMS later than some, and have been in for almost 15 years.. I have seen a lot of death, both on the job, and in my personal life. I work both in a small community, and in a larger centre. Deaths in the small community are harder, because I am not only EMS, but am also a friend, a neighbour, or a relative to the person who died, or one of their family members. As EMS, they look to me for support and guidance during the situation at hand. It is difficult, but it is also an honour to be able to help them during one of the worst times of their lives, and know that by supporting the family, I was still able to do something positive, even if I couldn’t save the family member. Some of those calls are very hard, when it is someone I am close to, or it is a child that I know – but in those cases, for me, it helps for me to remind myself that I didn’t cause the problem (illness or injury), but I am just there to do my best to provide care. If I can provide compassionate care, and respect the emotions of family members, I am doing my job. Have I cried on scene? Not that I can think of. Have I cried after, in the privacy of my own home, or at work when I could have some privacy? Absolutely. Some calls just suck. You are very lucky to have reached the age you are without losing someone very close to you. I have lost family members and close friends throughout my life, including friends who died when I was in school – I lost a close friend to cancer just after Grade 12, and several friends at university. Two of my grandparents had passed away before I was born, and the other two died within 6 months of each other when I was in junior high. I lost several uncles and aunts when I was very young, two of whom I was very close to, as I lived with them when I was very small. The worst losses I have had is the loss of my parents – my dad in 2002 from cancer, and my mom this past January from complications from surgery, due to kidney failure. I was very lucky to have been very close to both my parents, closer than most, I think, but that also made the loss harder to bear. As hard as it has been, I do think in the long run, it makes me a better EMS provider. With the losses I have had, I think I am better able to understand the anger, the terror, and the incredible sadness of losing a loved one, and respect that everyone grieves in their own way. Can I say I know how they feel? No – everyone feels differently, and I would never say “I know how you feel.” I have seen practitioners say “oh, that family member over-reacted,” or “how could they be so calm?” I think it is important to respect their grief, not question it. You will find your way, and you will figure out your way of dealing with death, both on the job and personally. Death is a fact of life – sometimes it is a terrible thing, and sometimes it is a blessing, and it is up to us to decide how we are going to deal with it.

I'm doing my FI in a county with a large urban city (where all of the posts on my preceptors rotation are located) and a large rural area as well. I've had a little bit of rural experience at some of our posts (we're on a three post rotation) where we respond further out in the county, but most of my experience has been in the city. I'm not a paramedic yet, and I haven't worked in a rural setting (though after I get my paramedic I plan on working both at the service where I'm doing my FI and also at a smaller, rural service as well) but I can offer my limited take on things. Or at least, the reasons why I do most of my treatments in the truck. First of all, because that is the way I've been instructed. Perhaps not the noblest of reasons, but true nonetheless. I have my own quirks to patient care, and I have my own way of doing things, but I was taught to run calls the way my preceptors run them and so I generally follow their template; not solely because they want me to, but also because I agree with their way of doing things. Second, why I agree with my preceptors and also prefer to do my treatments in the back of the truck, is for a number of reasons. Now, I don't withhold all treatment until we get to the truck, for example I like to get an initial 12-lead on cardiac patients on scene, put my patients who need the monitor on the monitor, get a blood sugar (if I think it could be a sugar problem, otherwise I get it off the IV needle) and place them on O2 and get my first breathing treatment in if necessary, but I prefer to do most everything else in the truck. I usually save the on scene IV for code blues or symptomatic tachy/bradyarrhythmias because I don't want the line getting yanked while we're moving the patient, and because most of the time we can get them to the truck within a reasonable amount of time if they really need an IV stat (not a lot of high rises where I am, and those that are around I've never gotten a call at). Also, the vast majority of my patients need three things: an IV, a monitor, and a paramedic to monitor their condition. Most of their conditions are either non-life-threatening, but require vascular access and monitoring, or aren't so acute that I expect their condition to deteriorate in the time it takes me to get them out to the truck. Now, that's not necessarily always the case, my fourth patient on my first day of field internship as a difficulty breather who went from respiratory failure to arrest in about the time it took us to walk all ten feet from the front door to them. In that case, I probably would have preferred to run the code on scene (I'm in favor of not transporting codes, however that's not currently what the service advocates), but we scooped her up, bagged her to the ambulance and took care of things there. Thus far, that has been the only patient I have had who has deteriorated that quickly on me, and even then we were able to manage her long enough to get her into the truck. The final reason, and this is really an operational/administrative issue, but one I (and certainly others as well) have to deal with, is that scene times are closely monitored and it's my perception that dawdling around for too long can attract unwanted attention. And that's not necessarily bad in se, we're a very busy service and there's a lot of pressure for trucks to have a quick turn around, lest we get short on manpower, but all the same, I wish it wasn't necessarily pushed so fervently. Also, along the same lines as the first, is it becomes an issue of both billing and the continuum of patient care if you treat the patient on scene, they decide they feel great and don't want to go to the hospital, and refuse transport. Not to say they can't change their minds en route, but I think there's less of a willingness to do so when we're already going and also when they find out that we're not a taxi service and they only get two destinations: the hospital, or right where we are when we hit the brakes. I'm not a fan of making patient care decisions based on finances, but at the same time, that same policy DOES also help to discourage patients who decide they're fine after they've been converted from their new onset of a-fib from not going in for further eval at the hospital. Anyway, that's my take on it, such as it is. To clarify, I'm not saying either way of doing things is wrong (I'm a student, I have no opinion), and I think what's most important is patient care. To me, it seems more like two different styles of doing things. If anything, I'm kind of surprised it's not reversed. The folks with 30 minute transport times have a plenty long transport to do everything they need en route, while those of us in the city are often scrambling to get everything done in the 10-15 minutes we spend with the patient. I'd almost expect urban EMS'ers to do what they need on scene and for those out in the boonies to be loading and going and getting things done en route.

I have to agree, the insanity of the "regulations" for travel by air are just that. The Israelis have it figured out they do staged "observations" of possible suspects background checks +++ Two other observations: 1- Was awaiting in line to go through security when a women in her 80s was mentally accosted by "security experts" that did NOT have a good grip of the English language (yup another topic) She was stopped because she had more than 100 mls of "denture cleaning paste" now very embarrassed and quite pissed off, so she squeezed out half the tube into one of those gray change trays asking if that was less than 100 mls now ? This much to the amusement of an RCMP officer and myself standing watching the idiotic actions of the security experts .. we both stood their laughing and the look on the faces of the crowd, who were also very amused / annoyed at the delay, but now clapping. 2- My best friend who has a "concealed carry permit" well he is a Captain with a Major Airline and was the Kanadian equivalent an Air Marshall in a past life,(shush) he got busted by "security experts" and not because he had a handgun in his bag with appropriate documentation, but busted and had his nail clippers were in his overnight bag, then removed while he just shook his head in utter disbelief. He WAS the f*******g Captain .. like with 4 bars on his uniform too. Just what was he going to do hijack his OWN aircraft ? Besides the fact that this friend also has a "crash axe" clipped behind the left seat. I wish any terrorist a hearty "good luck" if they walk uninvited into his cabin .... ! Yup the regulations of air transport are beyond rational thought process these days, water bottles, toothpaste, or a jar of peanut butter +++ at the Edmonton International they have a glass viewing cabinet of all things restricted .. the situational irony is that NONE of these confiscated / displayed items are dangerous in any way shape or form, proof positive to my way of thinking that harassment of passengers does exist based on rules that are simply idiotic. Personally I believe they should do "racial" profiling, just look to the last fool trying to blow up his underwear going into Detroit with possible "undetectable" binary explosives. HE was from a known terrorist country. He affiliated with an extremist Muslim group. He had ONE way ticket, purchased by ANOTHER party, purchased within ONE day prior to flight departure. He and had NO farking PASSPORT on an INTERNATIONAL FLIGHT out of Heathrow ... WTF? So good job "travel security experts" I sure feel safe having handicapped folks getting their wheel chairs searched, busting granny, and the Pilots getting strip searched ... <insert sheesh> cheers

doesn't bother me...I actually think it's kind of amusing. Don't take yourself so seriously!!

Do you get worked up about every other commercial that parodies a profession or trade in order to sell their products? Does the 7/11 commercial poking fun at the cops/donut stereotype rub you the wrong way? What about the NFL commercial where a bunch of office workers take over the office to watch football since they have to work on the weekend?