AnthonyM83

We're BLS: -Extra sheet to cover patient -O2 tank secured to bottom of gurney -Clipboard for non 911 calls -Adult NRB If first on scene, jump bag with airways, BVM, BP cuff, trauma stuff. Wish we had a compartment to store extra stuff.

Personal Background 3rd day as EMT. 2-EMT BLS rig (answer 911 & routine transfers) My EMT class was 1 yr ago My unthorough EMT class relied on us learning a lot on the job b/c in San Francisco area, EMTs are usually with ambulance medics or FFMedics. My field training at this company consisted of only 5 transports, 1 of which was routine transport...I only participated in 2 of them. Hoping to post a lot of calls for review...since I'm on my own in the back of rig, I have no one to critique me. My driver is 1mo new. The Call On-Scene 91yro male, SOB, seems asleep, taking loud semi-short breaths. Attendant noticed 1hr ago, so put him on O2@4LPM via NC, checked BGL (at 435), so gave 10 insulin units. As we're leaving, he mentions fever of 103, 1hr ago What We Did On Scene -I'm still in IFT mindset, figuring these attendants know best whether it's an emergency since they know his baseline and must transport residents all the time when they get borderline needing to go to hospital. They know when to call for a transport versus calling 911. -But still concerned it's SOB, so let's just get him to hospital fast and make sure he's okay...still treating it seriously...but not as a "real call". Didn't start doing an assessment like taught in class. -Change to O2@15LPM via NRB -Nursing facility's O2sat goes from 91% to 96% During Transport: -Pulse 90 and strong -Try talking to him...unresponsive to pain -Take BP...won't extend arm...puts strong resistance...trouble getting BP -Attempt palpate...trouble finding pulse -Pulse now weak, very hard to track -RR increases, 44 BPM, shallower, weaker Treatment[ -Start assiting ventilations. Not sure exactly how to pace when "assisting"...so end up just doing 1 every 4 seconds...not sure if I should take over completely or keep trying to "assist". Decision Process -Do tell partner to upgrade to Code 3 (L/S)? -This is a call ALS (vitals unstable, SOB) would usually handle and ALS really only does things that need code 3 response (...least that I could think of?) -Thus, this justified code 3 response for us. -Additionally, medics on board have told us to go code 3 for more stable patients. -So if using them as reference point (though they're quite liberal in those decisions), code 3 okay At the ER -Walk in ventilating -They have me stop to check breathing -They remove mask completely from face and get O2 sat -Breathing has slowed and O2 sat in 90s -Transferred to room with no O2 ER Staff -ER nurse makes unintelligible comment -Another replies, "Yeah, I know....better they do that than bring him in not breathing or beating." -Later I tell her it's my 3rd day and want to know if what I did was okay. She says I did fine, and she'd rather I do something than nothing and risk the patient. -(This implies she thinks I went too far...but I'm not sure if it was on the ventilations or on the code 3 or what) Note: We didn't rush in the hospital doors yelling our report or anything. Calmly walked in bagging and explained what happened when asked. So, my question: What would have been best (not acceptable) responses to noticing pulse weaken and RR go to 44? Code 3 decision? Thoughts/Lessons Learned -I need to get into mindset of this is a real call for anything other than a routine, regularly scheduled transport -Be less timid. More aggressive checking things. Don't wait until back of ambulance to "do my thing"...even if partner looks at me weird or I get attention. -These non 911 hospital admits are great for practicing patient assessment, which we don't get to do often, b/c FFmedics are usually on-scene. -It's my patient. Be possive of him/her. Do whatever I think might be needed. Basically, more looking to myself for direction...self-confidence. Patient is expecting and trusting me to do this. -Get rid of old reminents of police explorer, where I was never to make the decisions except for minor stuff or exigent circumstances. It's my job to do this...don't put being scared of liability (like code 3 upgrade decision) over patient health -I did get into the right mindset on this call...but not right off the bat...so gotta push self in future. And final thought: It's damn hard to not be a dumbtard when you get that little field training. If you're with a medic, it's fine b/c they'll teach you. But when you have two new EMTs, there's no one to show you stuff...critique you after a call...you learn from trial and error...no one of higher title to emulate....and thus you look like a Gomer to the medics that ride with you and ER staff. Trying hard not too, but damn. And that's why I'm posting this here.

Low dose poisonings? Psych history?

Dustdevil!?!?!

Wrote them an email

I've worked at a few elementary schools and two of them had no-running on the playground rules. I was amazed since that's what I thought playgrounds were for. Everyone's worried about liability...how far can it go . . .

What's the appropriate way for a crew to respond in this situation? I've been told not to argue with nurses...much less a physician. "The doctor said, ___, but based on my EMT training, I believe he is wrong." ?

Follow-up Question: Is it appropriate for an EMT to stay in the trauma room when they start working on a patient you brought in? I had my first trauma yesterday (Shotgun pellet to pt's face) and they had a room full of doctors, residents, and misc. waiting. The FFmedic stayed in for awhile, but I stepped out after patient transfer because I didn't know if it was appropriate. Do people mind if the EMT steps to the corner and watches awhile for educational purposes? During my ride-alongs in a different part of the state, the ambulance medic said we could stay to watch medical, but I don't want to assume it's the same everywhere. I'll ask around at my company, but wondering how others worked.

It's a parody, making fun of the whiny tapes the real emo kids put on You Tube.

Thanks and very good advice. I felt it taught me how far EMS can degrade and I'll always remember never to be that way...in fact the opposite.

All I can tell you is our BLS ambulances that respond to all 911 calls (with ALS fire department squads arriving separately and usually 1 - 2 min sooner) must arrive withing 8 minutes to every call or file an incident report explaining delay. If dispatcher knows you're close to the location, they'll ask for your location or ETA anytime they feel you should have been there already.

Before I started my new job, I had to take a CPR course with my old job. They're really trying to change it to make it as easy as possible and as likely as possible that people will perform it. It'd be great to have a really widespread campaign on it...on the level of the "Slow for the Cone Zone" or "Don't Drink and Drive" campaigns the DOT is pushing.

I'm enjoying the thread on Paramedic suggestiosn for the EMTs. I'm a pretty new EMT. I'd like to get some suggestions on...I want to say "how to get the ER staff to like you"....but a more realistic question might be "how to get the ER staff to hate you as little as possible" So far I think I've been doing alright, but only because I had the excuse that it was my very first day...I showed it in my timidness. But that's really just going to last through my first day and not much further. I've seen some EMTs who are extremely professional and polite, yet are really blown off by ER staff. I've also heard of some guys who don't look that professional, but apparently are (reasonably) liked by staff. So, for anyone who has worked in the ER and interacted with EMTs, how can I best serve you? What stuff annoys you? What positive stuff do you like or will notice when EMTs do? And for any EMTs who get along with ER staff really well, any tips?

My ride-along with FD involved a medic cursing and making fun of his patient for complaining of severe chest pains, imitating his voice (in front of him). No monitor hookup. Homless guy was post-ictal with O2 sat in 60s and totally out of it...witheld oxygen and yelled and cursed and neck pinched him telling him to say his "F'ing name" trying to get him to become A&Ox4 before arriving at the hospital so he wouldn't have to get an IV going...i felt i was at my last job interrogating someone...after 5 minutes or so I finally worked up the guts to recommend O2 again, put some on, and his sat when up to 90s and suddently became completely oriented. A little more yelling at some non-english speaking transient and interrogating him on if he loved our country and if he wanted to be deported...a little pushing morphine all at once...little more holding back on O2 But I realized that's not the norm...and I'm working at a great ambulance company now. Things are very different and the FD medics are nothing like that ride-along. Find a work environment that's promotes the kind of style you want to be...best way to do that is to ask around at different places and talk to their employees...if you're looking to get hired somewhere that is.

Inadequate on-the-job training...often result of high turn-over

This always brings up confusion, even for some teachers who normally know their stuff...it's just easy to mix up what the hyper/hypo is in reference to. The key for me is adding the word "solution" after each term. People always forget if it's the solution that's hyper/hypo or if it's the solvent (tonic) that's hyper/hypo (later one is true). Think of tonic (as in tonic water) as something/particles you mix into water to make a specific drink (solution). A hypertonic solution will have a relatively hyper amount of tonic particles in the solution. (and of course it's all relative to whatever you're comparing it with) So remember: HyperTonic Solution - Higher tonic/particles in the solution HypoTonic Solution - Fewer tonic/particles in the solution IsoTonic Solution - Same amount of tonic/particles in solution

I think that's probably where people disagree. Not the rest of the stuff, rather on this point right here. I think I was just swayed by Asysin, in that it could be a protecting our youth thing, since they are technically minors. Just how we protect them (in theory) from rated R movies, drinking, sex with adults, driving past curfew in some states, etc.

There are some big ants out there...

Hmmm...I really don't like any shirts that come off as pretentious or asking the public to acknowledge them for their work....but I think THAT ONE, I might actually wear.... The "It's not nice to FIB" is okay, too...b/c it's not pretentious or showing off your career.

Best Code 3/LS song we've had is Weezer's Hashpipe song on the radio. It was perfect timing.

Yup...I've seen a medic withold oxygen for that reason...finally b/c he couldn't get an IV in before reaching hospital he gave him some O2...and within seconds of administering, hey what do ya know...the guy's LOC went from orientated x0 to x4...amazing! I guess you could say it could technically improve their LOC so they could give you an SAMPLE that might save a life? (I'm reaching here)

Measure from nose to chest? So, one does it by measuring from nose even with variances in head/neck/chest size? Wouldn't it be better to just do it a certain distance above the sternum or something like that? Also, what's the legalities of adding this to my toolbox if I didn't learn it in EMT class?

I was wondering: What's the deal with the heart thump? A few years ago, in high school, I was on a field trip where one of the kids collapsed. Apparently, he didn't have a pulse, but some other peers, fellow teenagers, restarted it with a heart thump. I didn't get to witness it, as I didn't know anything was wrong until I saw EMS arrive. I never heard this mentioned in my EMT school, so I'm guessing it's outdated or out of scope. If it's outdated, why? Something reminded me of it just now, so I thought I'd ask. PS Apparently, the victim had a pre-existing heard condition...don't know more details.

Jack Bauer is the new all-American hero (as well as my icon). We haven't had one in awhile since Chuck Norris retired. Yeah, sounds cheesy until you watch the show. http://en.wikipedia.org/wiki/Jack_Bauer

Someone's gotta ask Jack Bauer how he does it...