Leaderboard

Uhmm..both? If the patients s/s are easily remedied with a non invasive intervention ...with no adverse side effects (i.e. a position of comfort that relieves or markedly reduces the s/s to a well tolorated level) ......then further intervention is not warranted in the prehospital setting. IF this is NOT effective or practical to even try (i.e. hyperemesis) then more invasive and more risky (by comparison only, its still pretty safe)interventions such as medications (anti-emetics with or without benzo's) are indicated. Its not an either /or question. Its a basics before (and side by side with) ALS solution. I hope that makes sense.

When my cerebral aneurysm presented, I felt like I was on the merry-go-round from hell! Not only was there that 'spinning feeling' but it also felt like I was pulling barrel rolls and loop-de-loops as well. I wasn't exactly nauseated, but I would have paid any price just to get it to stop! The biggest difference I noted between that and the ever popular 'bed spins' from drinking was that with the 'bed spins', you can put a foot on the floor and it usually goes away because you've got a solid point of reference. With vertigo, it doesn't work that way. You keep telling yourself that the floor is solid, and you're not actually spinning; but the reference point spins and tilts right along with you. It's more than just a 'scary feeling', it's down right terrifying! If someone were to tell me that I couldn't have a certain medication to ease those feelings, simply because they thought I might be faking; well, I can almost assure you that there would be someone getting hurt! Granted, I'm very 'uneducated' when it comes to pharmacology (that starts next week), but I can see absolutely no justification in withholding comfort/pain management measures; and the provider that DOES needs either remedial training or removal from that position. I'm not talking about the junkie that needs 'tweaked' because it's getting close to their next fix....I'm talking about those patients that have shown a bona fide NEED for symptom alleviation (i.e. pain management, vertigo).

Personal opinion- I think the reason so many providers cannot wrap their heads around psych patients and their problems is because there is so little we can actually do for them. As EMS providers, we want to fix things- ASAP- and there is little we can do for a truly disturbed individual. We cannot "see" the problem, so often times we minimize or even dismiss it's impact or importance. There can be a chemical imbalance, some sort of emotional trauma, or an extended history of personal problems that lead a person to the point in time were we encounter them. If someone is having chest pain, we can "cure' that pain with one pill. If someone is depressed, all we can offer is a sympathetic ear. Sure, if they are exhibiting symptoms from an OD or physical trauma, we know how to treat that. Therapy, counseling, trial and error with various treatments and medications- it's often a long and difficult process to get a person on solid emotional ground, and that process usually includes multiple trials and errors of medication combinations; there is no quick fix. As for suicide in particular- we all know that a legit attempt makes folks far more likely to try again- and eventually succeed. I've had folks with extensive psych histories finally succeed after many half-assed attempts. I also had one guy who immediately after receiving a diagnosis of cancer(unknown type or stage) go from his doctor's office to the high rise building he worked as a building engineer. When he arrived at work, he made an offhand comment to a coworker about receiving the diagnosis, proceeded to the roof of the building and jumped 40 stories to his death. He went from a cancer diagnosis to dead in a matter of a couple hours. (That one was particularly disturbing) Point is, everyone has a different threshold and tolerance for physical as well as emotional pain. A problem that may seem inconsequential to most folks can completely overwhelm another person's ability to cope. As a provider we need to look at psychiatric patients through their eyes- as much as possible. No, we should not begin talking to someone's visual hallucinations, but at least try to understand their stated concerns. Even with seriously delusional folks, there are usually nuggets of truth embedded in their rantings. Yes, many of our suicide calls are not serious. A teen girl takes 4 Motrin because she is upset her boyfriend dumped her. Is she serious about her desire to die? No, but she does need perspective, which is something we can give- at least until counseling can take over.

OK, then, I won't invite a second copyright violation case.

I am not against higher education, I am against wasting money on courses for a career you are not already in. I think you should take courses that help you advance in your career and in your personal life. I think that the entry level EMTB is taught the amount of A&P they need for their level in their EMT B class, when considering their limited scope of practice. Should that EMT B student become an actual EMTB, and then they decide they want to progress, it would then be appropriate for them to take those higher level courses. You can argue that I need to have an advanced degree in chemistry if I work with chemicals every day. At face value that is a true statement. But if my exposure to chemicals is only because I am a custodian mixing cleaning products, then maybe an advanced chemistry degree is a bit much, unless I want to leave custodial work behind and become a chemist. The question was asked by someone who isnt even a student in our industry yet, who knows, she may end up in a totally different industry a year from now, so I feel it is a waste to take medical courses until she has decided that this is her calling. Sorry you misunderstood, toodle-loo. I would agree if you told me that your department had a VERY AGGRESSIVE citizen CPR and PUBLIC AED PLACEMENT initiative. But if you are like most departments and only being reactive (responding to calls) in between naps and TV time, instead of being proactive and preventing calls through education and partnerships with your community, then I dont think you can say you have done everything that is in your control. Is there really anyone in this room who doesnt believe you could improve survival rates if you found a way to place 1000 AEDs throughout your community ?