ShockDoctor

Our county just picked up a new medic from the Los Angeles area (Mr. Hollywood as we country folks like to call him). We were talking about differences, and he mentioned the emergency lighting was a small thing that he adapting to. Apparently in Cali the color is red for everything (police, fire, EMS), and every emergency vehicle is required to have at least one red "steady burning" light (meaning not flashing). I thought this was a little weird, but I started paying attention to California reality shows, news, youtube videos, and so on, and I noticed he was right. There's always at least one steady burning red light on the setup. I have to say that I like the idea of a steady burning light (for tracking purposes). I think they look more professional too. I have since bought a new light bar for my Nissan that is capable of steady burning lights. I now have wig wag head lights and tail lights, a SuperVisor red/blue setup with two red and blue leds that go steady, Code 3 alternating red grill lights, a 36" amber LED light bar in the back window, and a driver side spotlight that is capable of gelling a solid red (just bought this from an ex CHP officer, really like this product).

It hasn't happened to me personally, but I've heard a few stories about it happening to other people. EMS doesn't have crazy shifts in my county, so sleep usually isn't a problem. We have 8, 10, and 12 hour shifts, and a minimum of two days off a week. I don't work on a fire rig, though.

Okay... not to open this can of worms again. But in that scenario would anyone be glad I was there with my gear? As for making an entry, I've kicked down a door before (life alert call) without PD help. Pt. was in the bathroom, unresponsive. All the doors were locked, and the windows all had bars on them. I cased the house and found a weak door in the back and made entry with just a few kicks.

I can't stress how important remaining calm is. The paramedic you were riding with had no business becoming "flustered". She can make suggestions and give criticism in a calm and constructive manner, but if you can tell that she's "flustered", she's not doing her job right. Dwayne gave you some excellent advice: don't rush. Whenever I'm riding with a tag-along, or new EMT, whenever I ask for something they'll usually fumble around, yank it out, then shove it right in front of my eyes while their hand shakes uncontrollably. Have a sense of urgency, but don't let it mess you up. If you find yourself loosing it, try to slow it down. You'll ride with many different types of people in your career. Some people have short tempers and are very emotional under stress. These people have no business riding with students or rookies. When you're new, your emotional state is highly dependent upon those around you. When your superiors are freaking out, you'll freak out too. It's their responsibility to stay in control. As for everything else: don't worry. It just takes a few days to master your ambulance. You'll soon know where everything is, how to get to it quickly and safely, and local tastes and procedures. Welcome to EMS.

We have a very large and active church that likes to do events (camping, day trips, hikes, ect). We're often far away from any help, so we formed a first aid team, which I lead. There's no official shifts, per say, we're all just on standby. My classes include anyone who wants to learn. The team consists of people who are 16+.

The BSA and AHA used to teach raised legs for shock. I don't recall them ever mentioning "internal bleeding" though. And I've noticed many guides no longer recommend the raised legs (I never thought it did much myself).

Honestly and realistically, I probably wouldn't do anything. If he has asthma, he's always wheezing; it's nothing new. I'd assume he'd have an inhaler with him, and I'd let him use that if he wanted. I wouldn't start pulling anything out for the short trip to the hospital.

I think it depends entirely on the maturity level of the kid in question. At 16 years old, I have to draw the line between "child" and "kid". I have no problem with 16 year olds going through entire EMT-Basic courses and getting their certs (finding work needs to wait, though). At that age there are kids I would trust my life to, and there are kids who I wouldn't want getting too close to the medicine cabinet. It's all case-by-case. In that story a lot of attention is paid on how young the kid was, sixteen. To me it's not that big of a deal; in just two years (provided he "just turned" 16) he could be working along side me in an ambulance. Teaching first aid to elementary school aged children is a different story, though. I actually do this frequently, I frequently volunteer to teach the local Boy Scout troop and Cub Scout pack first aid and CPR, and I also lead the first aid team at my church (where I also teach the youth first aid skills). I find that children can get confused really easily, and you need to focus on broad and simple concepts. For example, many of the younger cub scouts I deal with can't manage the thirty compressions then two breaths, thirty compressions, two breaths, all while remembering WHEN to do CPR (with the pulse check), proper hand placement, compression rate, ect. It's just way to much for them to remember, and the ones who can remember it will probably only remember it for a week at the most. So when teaching CPR, to children I have them skip the pulse check (I doubt many of them would be able to find a good pulse, anyways) and instruct them to do CPR if the patient is unresponsive and not breathing. I also teach them hands only CPR (no artificial respiration). It's much easier for them to remember, and I have a feeling most can "master" this and remember it if they ever need it. And the number one thing to pound into their head is to get somebody to call 911 ASAP. I'll actually take the time to teach full/proper CPR with the Boy Scouts (middle school and high school age). When it comes to other first aid skills, I make sure that whatever I'm teaching is age appropriate by making sure it's something that's unlikely to cause more harm if they do it incorrectly. I'm afraid when teaching smaller children that they'll do the WRONG thing in the emergency and make matters worse (all because of my training). With the younger ones, I teach them real simple things: Managing cuts, scrapes, ect... Applying pressure to stop bleeding (I don't cover pressure points) The concept of not removing impaled objects and immobilization Bites Poison Control (I give them info about the center and phone number) ect.... With the older ones, I might show them how to make some splints, ect. I NEVER discuss treatments for poisons because the wrong treatment for the wrong poison can cause way more harm than good. I guess the number one rule is make sure you're not teaching them something that they have a good chance of using and making matters worse.

I wasn't chewing him out, I actually think it's a good question. Yeah, the hard definition of "arrhythmia" is any abnormal heart rhythm, but I figured he meant something like v-fib or v-tach considering he's an EMT-B, not a cardiologist. All this being said, you should probably be doing something else if you suspect an arrhythmia.

Yeah, depending on the arrhythmia and if you know what you're listening for. It's way easier to EKG that stuff, though. This being said, why would you want to do listen for an arrhythmia? If a patient has an arrhythmia, you should be hooking them up and getting them ready for a shock (not sitting and listening for abnormalities in their heart beat). If you don't have a defibrillator, you probably should be doing compressions, not listening for abnormalities in their heart beat. So yes, theoretically you can, although there's no practical reason to do this. EDIT: Grammar.

^ Ditto, they're pretty much paying our bills. I find there are two types of B.S. patients: Lazy ones and ignorant ones. The ignorant ones honestly don't know when to call 911 and what's considered a medical emergency. For example, if a kid dislocates something and starts freaking out, I'd say most of the population would rather just hit 911 and let somebody else deal with it instead of thinking logically, realize that it's not life threatening, and figure they can just drive the kid to the hospital themselves. These people have very little or no first aid training, and they truly don't know what to do. So they call somebody who does. These are the ignorant ones, and I'm fine with them. The lazy ones are the ones who want to get into a room right away, and they know that if they go by bus they'll get there faster. I also include in here the ones who want to make a "point". They get into a little fender bender, and instead of taking themselves to get a quick checkup, they demand the flashing lights and sirens come. These people also routinely refer to me as an "ambulance driver", which pisses me off.

I sort of agree with you guys. I normally wouldn't have asked but I only brought in $10 (I figured the discount when I was counting my money in my rig). My bill was initially over that, so it was either get my discount or not pay. Plus, that wasn't even figuring the tip (which I wouldn't have been able to provide). I can understand drawing the line at giving the police a discount. There's a benefit to having a police officer inside your location (who in their right mind is going to rob you?). EMS and Fire is a slippery slope. As Dwayne said, why not teachers? Why not priests? Why not any other type of employee? Almost everybody works, so why not give a "worker's discount"? The answer is because it's advantageous to have uniformed first responders in your restaurant.

So, in my little cosey little rural area, the small town diners like to give us first responders breaks on our bills. Typically police, fire, and EMS get some type of break when they come and eat in their uniform. The local, family owned, doughnut shop gives us free doughnuts if we come in our uniforms. Coffee is also "on the house" sometimes. I guess this may be why police officers are associated with doughnuts, because they're also always hanging out there. Another family owned diner gives us a generous break when we eat at their place (around a third off). Some chain restaurants also give us breaks. Denny's gives us their employee discount, so does Burger King. However, today when I went into Denny's I didn't get my discount. My bill came and I noticed it was full price. I ordered a chicken fried steak, eggs, pancakes, and coffee, and I was being charged full price! I told the waitress (who was new), and she said that we had to pay full price (I knew from prior experience taking to the owner that we got the employee discount). I asked to talk to a manager, and she came out and apologized and gave us the discount. So this sparked my curiosity: what places give you free or discounted stuff?

It was about 2 AM and we were dispatched to a possible SCA, the patient was a 91 y/o male. When we arrived, the patient's wife (a bed ridden woman, 90 years old) was desperately trying to do compressions on the bed in between tears. She was very weak, and so were her compressions, but damn she was trying. I later found out that in her earlier years she had been a nurse, and he had been a physical therapist. We hooked him up and he was flat lined. I've never been able to get that image out of my head. A couple who had been together for seven decades, lived through major history, last physical contact with each other... It was very romantic and very sad at the same time.

Throw out your Littman II and purchase a Littman III. What are we living in? The olden days? A good TASER will take you far. Don't go cheap and just get a stun gun, invest in an X2 TASER that can shoot out prongs. OC is a must. Make sure it's at least 2 million SHU, no whimpy stuff. Some sort of Shotgun capable of firing breaching rounds is a must... in those cases you need to bust down a door. Benelli makes a nice shotgun that acts as a triple threat (buckshot, breaching slugs, and bean bags). A tactical flashlight that can attach to the end of your shotgun. An asp collapsible baton. A Kevlar vest with trama plates. Your own Motorola radio with a tactical headset. If you are missing any of that stuff you are clearly not somebody I'd want responding to my emergency. <end of sarcasm> Make fun of me all you want guys; I'm prepared. But, don't feel like you need to carry a lot on you. Your bus will be,nine times out of ten, nearby enough that you can grab whatever you need out of it. I have most of my patients come to the back of my vehicle anyway while I'm examining them.

What's your equipment? The monitors that we use don't advise the shock, we have to interpret that stuff. We might be old school, though. Not that's it's really a big deal or anything. In response to everyone giving shit for recruiting help out of the lobby, it's happens. In rural areas it's somewhat common. I've seen it happen a few times, but usually to people on duty. The compressions sounded futile. You had a patient who was in asystole for who knows how long. Pump him with some Epinephrine, do a few rounds of CPR, but he's probably not coming back. I'm surprised a doctor didn't call it over sooner that he did. Maybe the medic was simply saying, "I'm not getting involved compressing a corpse." That would explain why he initially accompanied you, then left when he saw the patient. All this being said, I've done CPR without gloves before. Unless the patient's bleeding, the risks are pretty low of contracting anything. I'm all for universal BSI precautions, but you shake hands without using gloves, how's this any different?

I didn't personally do anything out of the norm, but I was once dispatched to a haunted house. There was this very superstitious Mexican family who called the sheriff because the "ghost was getting angry". The father was feeling a little nauseous, and the family was blaming the ghost. I asked the father what he had done throughout the day and he claimed he had gone to work (construction in the hot summer sun). I asked the father what he had eaten (a few spoonfuls of Corn Flakes in the morning and he skipped lunch). I asked what he had drunk (a bottle of water in the morning). And they were blaming all of this on the family ghost... They wanted the deputy to force to ghost to leave. He was nice enough to go inside and give the ghost a trespass warning. I advised against encouraging them, but he defeintly went out of his way.

Medical school is hard & complex enough without this added annoyance. Unless you're planning to work in an ER, EMT training is going to be of little practical use. Granted, all students should know BLS & ALS practices, but why if somebody wants to be a dermatologist, then why should they have to ride an ambulance to do so? Hell, if somebody wants to be a general practitioner, why should they have to ride an ambulance? Remember when you guys jumped on me for carrying LE equipment and having combat training? This is similar to that. Doctors and EMTs have very different jobs, and I think it's silly to require that doctors learn how to be EMTs. Plus, I'd probably hate to ride with a med student. I have a strong feeling they'd be full of themselves.

^^ That brought a tear to my eye.

Wow, are you guys really this obsessed with me? I'm near NYC, but I don't live in NYC. I don't want to give my exact location/department, as I don't want my employer to easily identify my postings. All too often nowadays background checks involve internet checks. I like to keep myself anonymous. "Bus" is the slang term we use amongst ourselves here. RA is the way we refer to ourselves over the air, and outside agencies request an ambulance by asking for a "RA". And if you listen closely to the North Hollywood radio transmitions, they send the RA to the CP (which I believe stands for command post). I assume this is probably a few blocks away from the war zone.

This is a great question, and your answer is: it depends. There is something in the law called the "Emergency Exception" (relating to emergency responders entering private property without the consent of owners when there is a verifiable emergency). It depends on your state what the exact limitations and the statues, but I'm pretty sure every state has one of these. In addition, the facility may have some sort of Emergency Action Plan (EAP) with local emergency crews. It depends largely on where you are, and what kind of facility it is (is it large, prone to emergencies, ect), but many places will establish an EAP with first responders in case of emergencies. For example, in my area the local schools, malls, and assisted living homes have EAPs with us, so we'll know where to go in the event of an emergency, who can get us access into places, and so on. However, it's very possible (and unfortunately, probably also probable) that your facility doesn't have one of these, or is capable of getting one (not every facility is "worthy" of coordinating an EAP with local first responders, and most agencies would rather not bother). We can still find ways of getting into the gate. I actually carry a battering ram in my bus (laugh at me all you want, call me a whacker, whatever, I'm prepared). And btw, if there is an emergency, we probably won't be the first on scene. I'm sure somebody will be there calling 911 and holding the gate open for us when we arrive.

I think washing your hands correctly is more important than the particulars you use to wash them. Simply letting cold water hit your hands for three seconds before drying them doesn't cut it (this is what I see every lay person do in bathrooms, and it's disgusting). I stand there scrubbing for twenty seconds or so while three or four people use the sink next to me.

That was me (minus the Afgan part). I'd come up with an idea, ask questions to validate my idea, then diagnose. I think it's a natural way of thinking for most people (even in non EMS fields). You come up with a first impression, then everything that happens after it validates your impression. You see detectives sometimes do this, repairmen, and your average citizen when they make judgments about people. That's some good advice to ask questions to prove yourself wrong. Not just in EMS, but every aspect of life.

I had the same problem when I first started. A few times I jumped to conclusions, diagnosed the patient, passed it onto the ER, to later have the ER Doctor slap me in the back of the head and demand to know what my problem was (only happened once). I responded to a school for a sports incident. The patient had fainted and came back and was complaining about knee pain. After my initial check and interview, I formulated the opinion that his knee had dislocated, but it appeared to me that it had popped back. I told the school administrators and patient, gave him an ice pack, and transported him to the hospital assuring him that nothing would need to be done and that he was fine. Later the doctor told me that the problem was his kneecap and it WAS dislocated (I guess I missed that in the swelling), and he told me not to tell patients anything unless I was 100% sure. So I recommend using the "it might be" approach. Don't commit yourself unless you're certain. "It might be..." "Sounds like..." "It could be that..." That's what I call passing the buck onto someone who's more qualified to answer their questions.

Did you know, tap water is usually healthier than bottled water? Your local municipality uses a variety of methods to clean it's water, including filtration, reverse osmosis, UV, and chlorine. Government establish certain regulations about what bacteria can be present in tap water and at what levels. These levels are constantly monitored. Bottle water on the other hand has very few regulations governing it. Don't be afraid drinking tap water. It's perfectly safe. We were drinking far worse stuff for the thousands of years before filtration came about. That's a good point, although the deactivation time for most bacteria is way longer than the time the chlorine will be on your hand. Depending on the temp, E Coli usually takes one minute at 2ppm of chlorine (drinking water coming out of your tap usually has around 0.5 ppm of chlorine) to become inactive. Other bacteria, like the Hepatitis A Virus, takes around ten minutes at 2ppm of chlorine to become inactive (again, tap water usually has about 0.5 ppm of chlorine when it comes out of the tap). Other, more chlorine resistant bacterium, like Cryptosporidium can take up to a week at 2ppm to become inactive. There have been some high profile cases of mass crypto poisoning via water supplies. But crypto is only spread via fecal to mouth contact, so it's pretty rare. Unless feces is somehow getting into your water supply, you're fine. My point, don't rely on the brief exposure to chlorine to kill bacteria. But also, don't worry about the tap water giving you some sort of infection; it's safe.