uglyEMT

No problem Artickat. Dont mind a seide track now and then. Yea it was just an example thats all, having had the jaw pain present on 3 female cardiac patients with the stomach issue (2 females called it upset stomach, one said heartburn) with no other S&S I kind of drew the conclusion. That was the point I was trying to make there the experience got the ball rolling vs vitals. In the rig the rookie did ask why he was having such a hard time getting the pulse right. During Q&A the rookie did tell me if he was alone or with someone else he would of called ALS at that point because he felt the pulse was "funky". So the patient would have gotten the proper care but just a little later in the process. It was something I was pushing for in my squad, a great mentoring program. As Dwayne probably remembers I was a huge patient care advocate, something he helped instill in me, and we chated about mentoring and possibly making a thread or something about it to help new EMTs along. That was the biggest resistence I got, the more experienced members not wanting to "babysit" when in reality I was trying to make us stronger as a unit by helping the rookies think critically, make connections between different patient's S&S based on experience, and to do good medicine. Thus more people that can be paired together to help with scheduling and other things that come up so we can be flexible as needed but with the best in patient care as possible.

Welcome Back. I too have recently came back here. Glad to see a fellow Jersey EMT.

Welcome to the ranks Hex. Yup 200 hrs is what I went through as well. My instructor actually did the barber statment then upon graduation actually added this little tid bit. If anything remember it at all times... "Congradualtions on becoming an EMT. You now posses the knowlege to save someone but the experience to kill someone." Like Mike said up there. Dont let it dicourage you let it empower you. Strive to be the best you can be and garner all the experience and knowlege you can from your mentors both here and out in the world. These are a bunch of great guys and gals here. They helped me immensly when I was a rookie. Any questions feel free to ask us and also please participate in discussions around the board. It will help as you go through your schooling. Best of luck

Thanks Guys and Gals!!! I am glad to be back. Thanks for making me feel welcomed. Dwayne. Thanks Buddy. Yea I will be back as the force I once was, I have learned alot about myself in the time off and will dust myself off and be strong. I guess the opening post was more of me not knowing how I would be recieved more so then being a whiney bitch. I make no excuses for what I did. I didnt go out with a whimper thats for sure, I fought tooth and nail right up until it all took its toll on me physically and my health took a crap. My wife looked at me one day and asked me why I was litteraly killing myself over alll this. At that point I had to think about her as well. It was for the best I think. I realized that during my recert classes, when we were doing some of the practicals and other EMTs (some with more time in then me) turned to me to lead the scenario. I thought about that afterwards and realized I DO have the skills, I DO have the knowlege, and I never lost it I just compartmentalized it and let the bullshit take over. Captain yes it was a Volly agency. I am going to be back on the road soon. Just getting my ducks in a row so to speak to make sure I can be active with whatever agency I join to. Even though I haven't been riding I still have been helping folks when I can. Its amazing how it kicks back in. Paramike thanks. I will always look twords the future with the knowlege of my past. Happiness like I just said to Dwayne I stuck it out till my health was being affected but I know what you mean. I got the promotion for a reason and I did have my backers. Even though the others were the minority they made it a living hell. I mentioned before it wasn't so much a physical problem with patient care as it was a lack of involvment which made me have to put less experienced people together more and more which could have led to something. Not that they did anything wrong but sometimes the experience does help spotting the unusual S&S that on the surface look benign but are more serious. They would eventually get it I am sure of it but not intially. Good example would be one I witnessed. 40 yo Female with jaw pain and nausea. No chest pain no dyspnea. Im thinking ALS right off the bat as the jaw pain and nausea from my experience could be cardiac related. My rookie I was mentoring was asking the right questions but the answer he came up with in his head was bad tooth ache needs a dentist not a hospital. When we met ALS the ECG did show unusal rythems. After the call I was Q&A him and his reasoning was being her young age and no chest pain or difficulty breathing it couldnt be cardiac related. I had to explain its not always the elephant on the chest or the pale grey skin thats a heart problem and in females it can be down right wierd. It was my experience vs actual vitals or patient S&S that got the ALS ball rolling so the patient got to a higher level a care quicker. Thanks for the welcome back Richard. That was a good line to remember. Thanks again everyone for making me feel welcome. Now off to get involved in some discussions. Wow Captain you posted while I was typing this up. You basically hit the nail on the head as far as it is concerned. Not listening to reason and just making it toxic. Also changed my screen name a little as it was no longer fitting.

Kaisu yes the blinders are on certain people and I guess they are happy that way. I was trying to make it more mentor related but apparently "just follow the steps" was their idea of mentoring and when the new batch of rookies came aboard they were looked down on. Especially the newest batch before I left, my state recently revamped their protocols and added a few things to the EMTs protocols (nothing major but changes non-the-less) and the people not yet CEUed in the new protocols were fighting hard to keep them from being being added. I am doing the same with the hiatus. Went and did my recert courses, got some CEUs I wanted to do done, and working on my interests. Like I stated I would like to be back riding one day, hopefully it will be soon.

Hello Captain. Once the promotion happened the infighting started and at every turn I was fought against. I felt it was because I was promoted vs another person. Basically it got "cliqueish" and the back and forth was out of hand. I felt like resignation was the right course of action to stop the high school antics and get everyone focusing back on the patients. It was not an easy decision to make, I did try and fix things but it trying to bail the Titanic with a tea cup. Once I noticed the patient care dropping I knew what I had to do. From what I hear through the grapevine after I left the fighting stopped, the other person took over as Captain, and everything went back to the way it was. The patient care wasnt so much a physical thing to the patient as it was more getting responders to be on duty, fully staffing rigs, ect. The newer members had no problems but the more experienced people pushed back. I had tried to mentor the newer EMTs by placing them with experienced EMTs and not having two less experienced EMT on the same rig. I was hoping by doing this bad habits wouldn't be picked up or compounded upon. So when the infighting began in order to staff the rigs I had to pair up the less expeirenced people and thus my stating patient care suffered. Not that they didnt do good patient care but stuff could have been over looked or missed that a more seasoned EMT would have picked up.

Wow been a long while. Sorry everyone for droping off the face of the earth Its been a long bumpy trying road for me. Well, I think I am ready to be back. If you all will have me? I know you are probably wondering what happened. Well as you may or may not remember I became Captain of my squad. While almost immediatly I ran into major resistance and in fighting quickly insued. Well it got to the point patient care was going to crap and I lost it both mentally and physically. I resigned from the squad in an attempt to bring back patient care to the level it was before my promotion feeling I was the problem. Yes I basically fell on the sword. Because I was now no longer riding I became very depressed. It got very dark for me. I didnt want anything to do with EMS because I felt I had let everyone down and was looked at as a leper. I still am not riding currently but have recertifed hoping one day to get back on a squad. I guess this is a step in the right direction to getting back on the horse so to speak. Hopefully you will see me alot more around here again like in the past. I hope my lack of participation and disapearence hasn't soured anyone's views of me. If I am not wanted around, I understand, and I will leave. I hope everyone is well and good. Along with their families. See you around.... Ugly

Thanks everyone. Yea sorry for not being around much. Between work and taking the Captains test I had little time. Dwayne. Yea man can't wait to be back here and contributing. Even went and got a smart phone so I can post up when I can. Heard you were in Mongolia and visiting OZ. Nothing that exciting here except the promotion. Hope all is well with you and the family. As far as the medical goes. Wow! Didn't realize so many have done multiples like that. It was my first multiple fly outs. Done plenty of singles just never 3 at once and 5 in a 24 hour period. 2c4 congrats on the promotion as well.

Hey folks. Sorry been away awhile. Been super busy. Well as the title states I am now officially the Captain of my squad. Been a wild couple of days getting used to the position. Hopefully I will have more time to come back and talk more. Just a quick question how many Medivacs at once have you ever done? Had 3 at one scene followed by a 4th later that day and then the following morning... wild 24hr period. Be back soon folks...

Denny I skimmed through so if it was stated already i do appologize and to the others as well. I find plain speak to work best in your narratives. Ok using Pt instead of patient is fine but other than that try plain speak. Somtimes I think the shorthand version gets confusing. BP, GCS, PEARL are all fine as well because it is standard nominclature. Some of the others get garbbled from place to place sometimes. In your written narritive always start out with Upon Arrival _____ that gives you your starting point. Note position of patient and where found (ie sitting in chair in kitchen, laying in bed in bedroom). Move on to initial findings (Pt described moderate 6/10 abdominal pain, Pt stated crushing chest pain) usually there will be boxes for vital signs so not necessary in the written portion, what interventions you performed next (accultated abdomin, placed Pt on 15L NRB) state how you transefered the patient from found position to the rig (moved patient on stretcher, used stair chair to transfer patient) state what happened after the transfer (continued treatment until ALS arrived, no further changes in Pt) state that you transfered care (transfered care to ALS) note if any incidents happened durring transport (transported to ED w/o incident, pts became combative PD notified) finally end with transfered care to ED staff. Now for your radio narritive in route to the ED. KISS!!! Rig ___ to ___ ED. We are inbound with ___yr old M/F complaining of _____ latest vitals are _____ we have (explain any interventions quickly). ETA _____ Over Mine usually sounds like this (generic call here) Rig 48 to John Doe ED We are inbound with a 65 yr old male complaining of difficulty breathing. BP is 132/98 Pulse 89 Resperations 12 and labored. (sorry folks dont use O2 meters so no pulse ox given) We have him on 15L NRB ETA 5 minutes OVER. Short sweet to the point and the ED knows what to expect. On to reporting to the charge nurse or other ED staff upon recival. Be discriptive give your SAMPLE and OPQRST and any other pertanant information thats the key there pertanant. Noticing empty liquor bottles around an altered mental state patient is pertant (doc when we got him I noticed several empty vodka bottles on the floor near him) or on your difficulty breathing patient (doc noticed alot of mold in his appartment) what isnt pertanant? Things like he misses his grandchildren or nice drapes in her appartment. Don't laugh I have been in the ED and heard those things stated during the drop off. But remember one thing sometimes everything you say goes in one ear and out the other, don't take it personally. Making a good PCR comes with time, figureing it all out, what goes in and what doesn't. Best thing you can do to is sit down with your Crew Cheif, Captain, Lieutenant, QA Officer and go over PCRs with them. See what they concider good ones and sub par ones. When any of my members come to me with that question I usually sit them down pull out a few and review it with them. I try and keep a few great ones and a few poor ones in a file to pull out just for that. I have seen some stellar ones and ones that are shorter then one line. To this day my worst PCR I had seen.... Where the vitals go (no numbers) just the words Taken. Narrative actually read: found patient on floor transfered to rig transported to ED Needless to say that crew went in for some re-edamacation (lol). Remeber this: In your written narritive document, document, document. In your radio transmission KISS and in the ED SAMPLE OPQRST and pertanant info only. Any questions feel free to ask away

Ok I have reread all the posts, don't see name calling but the hammer HAD to administered! As for my thoughts.... First off, you say you have read the books, yet you helped the patient take a medication that was contraindicated on SO many levels. In case you missed them, they are, high degree of suspision of internal injuries (thus hypovolemia ie shock), blood pressure (was it taken?) needs to be ABOVE 100 those are the big two. Secondly, you state you put on the collar. Did you do a full trauma survey first? Did you asses the patients PMS (pulse, motor, sensory) functions before AND after? Did you continue to hold immobilization after administration of the collar? If you were maintaining immobilization how could you have monitored his vitals to see if they were stable? Next, which technically should have been first, was the scene safe? Were there wires down, able to come down? Do you know if electricity was flowing through said wires? If the possiblity existed of endangering yourself you should have waited until it was confirmed the scene was safe before entering it. On the first day of your EMT-B schooling it will be drummed into your head Scene Safety!! Getting beyond all that. The reason you were looked at like you were crazy by the actual responders is they realized you made their job harder and potentially will need to rush to get this patient stable, if they even can, all the while he is still trapped in the car and for an unkown amount of time. You made their job extremely difficult to say the least. As far as others stopping to help. You have to make decisions in your head based on the situation. You stated would I help someone get out their inhaler. Of course most if not everyone here would. Will I stop on a rain soaked road for a minor MVA? Probably not 911 will be notified and thats that. If it is a serious accident maybe, but I still think to myself how long is the response time for the guys with ALL the tools to do this properly and will I be a hinderence to the arriving crew or will me immediate intervention be benificial. These are the things you learn as you grow in maturity in the EMS field. Thats not saying your immature in general, its saying with time comes experience. I had a few 18yr olds in my EMS class when I went through, most got they way you were, gung-ho especially for that MVA with entrapment. Hell yea let me dive right in and do all the cool life saving things. Guess what? Not that glamorous, and after a while the adreniline wears off and reality sets in. Spend time in that car with the patient hanging on by a thread, all the ripping and sawing going on around you while your under a big blanket while the patient is in fear of the unkown. Do that at 3am when its pouring rain, your covered in the patients blood, and praying you might make the difference to this person and their loved ones. Or do it while a dead person is in the other seat and you have to keep your patient calm. Not that glamorous anymore. Its not TV its real life and peoples lives are in your hands. Glad to see you stuck around, shows you might be the real deal. But one thing I will say, grow a thick skin, noone here will hold anything back. We do not sugar coat our thoughts. If we think your a dick we will say it, if we like you we will say it, if we think you fucked up royally we definatley will tell you. BTW welcome to the City. ETA: this was typed while Herbie typed his response and posted afterwards, sorry for the similar posts.

Just found this topic LOL always slow on the uptake.... Websters defines cheating in this respect as sexual intercourse How WE define it is betwen us and our partners. I know a few people with "open" marriages and their defination is different then my wife's and mine. Why do we cheat (both men and women) I don't really think the sexual asspect plays a large roll initially. I know it inevitably ends up there but in the begining I think its about filling some hole you feel is there. I know one persons affair started over fantasy football. She was into it he wasnt and through her league found a partner and one night they played a little two hand touch between the sheets. It never started as that would happen but evolved from a shared interest. Of course under it all there has to be a deep issue with allowing it to happen. Why do people bed married people when they know they are married? Most likely the thrill of it. Just like having a quicky in a bathroom or dressing room. Would I cheat on my wife? Hell No she scares me LOL Seriously though I know it is a NO because I love her and more importantly I respect her. When it all comes down to it, you need to communicate with your partner, let them know what you feel or are missing in the relationship or are annoyed with. Might be a title fight when it happens but by morning you both will be better for it because you will know where each other stands and what to do about it.

Don't give my wife any ideas

Patients lie thats news to me LOL hope you saw the humor there

I can't say why, beyond my pay grade, but all the medics I have worked with pushed the Narcan once they heard Four was on-board and it seemed (at least to me) to have the same effect. A few minutes after the push response came up, then the agitation, then the vomiting. I never realized Narcan or its dirivatives were strickly opiode reversers. I have seen it used so much from drunks to crack ods I thought it was the cure all sober in 5 minute med. Time to read up.

As Doc said right arm it is and there isn't much else you can do in the situation. Need the BP to help figure out what we have going on.

I carry a jump kit thats pretty basic so it might give you a good starting point. I have used everything it it from time to time on scene when I pulled over off-duty. 4x4s, 2x2's, some roll gauze, band-aids,tape, one or two trauma dressings (some car accidents have big bleeders) a SAM splint, a couple of crevats, several pairs of gloves (amazed how many times a cop asks for a pair to help out),shears, a BP cuff, scope, I personally carry an airway kit because I needed one once and didn't have it so I have added it, a tube of glucose a pad and pen and finally an adjustable collar. Don't forget a rescue blanket. Sometimes I carry ice packs and heat packs if I remember to restock them after use. Anything more is overkill and the rig responding will surely have it. Its just in a samll bag with a star of life on it. It really is basic considering what I have seen some folks pull out of their trunk. I think of it this way, what are you going to see on the side of the road? MVA so the collar and bleeding control is handy same for the SAM, blanket and ice pack. Possible cardiac related so having your scope and cuff beyond that pray for a quick response from the rig. Possible diabetic emergency so there is your glucose. Beyond that anything else probably wont be getting used. Almost forgot my reflective vest with EMS on it. Just want to be safe LOL As for how to act on scene, the same way you would on duty. Calm, collected, polite. When the LEO arrives or the rig gets there give your report the same as you would to the ED Nurse (well maybe just identify yourself to the LEO). If you get a hot shot its my scene kind of person just let them know your level of training and explain why (politely) you are going to stay with the patient until higher care arrives. As for what to carry on your person. Scope, shears, pens, pad, reference guide if your so inclined. I also carry a small flash light (about 2 inches long runs on a AAA). I do carry a pen light because it always seems like the one in the bag is dead or dying. In the winter I do add a pair of Mechanics Gloves just so my hands stay warm and don't stick to the stretcher. I have had my PPE gloves stick and rip so I usually just pull them off switch to the gloves for the lift then reapply fresh PPEs. (Im wierd so take that with a grain of salt if you like). As far as the cargo pockets, it has been said good for the wrappers and stuff to keep your area and even the back of the rig clean and clear (please nothing with blood or fluids on them). Keep it light and remember the rig should have it if you need it. Hope this helps and welcome to our little world here.

I would go for the arm in the usual spot. Everything else is basically irrelevant and just a distraction.

It was asked wether or not you will bust out laughing or start crying. It happens. It goes with this line of work, we see people at their worst times yet are expected to be the rock for them. It will depend on your personality, current life situation ect ect. There have been times I went outside and punched my rig, threw things in the back when alone, cried like a baby and laughed uncontrollably. What will get you is when your away from the job and it happens. I have been walking with my wife and noticed a nice sunset and busted out in tears, I have been at the beach and started laughing at nothing. I feel letting the emotions out is one of the things that needs to be done to stay sane and empethetic in this line of work. Check out some of my threads in the personal section and you will see what I am talking about. As for how to deal with the Parents? I don't know, I haven't had to do that yet so I do not feel any info I give would be genuine.

Exactly my point on the tox screen. I have seen too many of the same reaction and from "drinkers" as well that says to me something else is in there causing this reaction. I look at it this way I haven't seen this reaction from RedBull and Vodka drinkers at parties from just one or two drinks yet most of my Loco patient either finished one started number 2 or didn't even get through the first one. Something tells me some ingediant is making the ETOH to metabalize in the system much faster then normal. Just as Herbie's patient didn't have vitals too out of wack 140/90, Sinus at 108 (there is your caffine/guarana mix ), sugar at 137 (taurine plus the sugar content) yet this person was unresponsive but reacted to the Naloxone push. Would like to see the BAC that turns up too. If it isn't too bad then something in these drinks are causing an overdose like effect without the person realizing it till it happens. Best example I can think of is one of my FFs that I know can clean a bottle of Vodka straight and still function tried ONE of these and won a trip to the ED. Looked at us when he came around and said never again and what the hell was in that thing LOL I for one think it plus its variants should be pulled from the shelves, nothing good comes from these things.