DwayneEMTP

I think that I'm challenged in some way where EMS gear is concerned... I have no idea who makes our ambulance, what kind of chassy it has, what brand of caths we use...I just recently discovered that my monitor doesn't do 12 leads... How do you guys know all of this stuff? Or does it come from staying at the same service for a long time? I tend to grab a cath, tear it open and say, "Ah, it's that kind...". In case it's not obvious, in no way is this rant supposed to be trying to show me in a superior light...I've just never paid attention to such things, and maybe I should?

To tell the truth, part of it for me is smudging the lines between humans and non humans. We, in only rare locations, have the ability to care for humans well in emergent situations, do we really want to begin to make things even more complicated? How about if we solve the problems that we have now, and then worry about adding patients to the waiting list? Of course, fire, nationally speaking, is rarely concerned with such things... Should we show compassion to all living things? I believe that we should. But the whole, "animals are people too!" stuff makes me a bit crazy. And honoring police dogs as "heroes"...I really hate that. Not because they're not valuable, but because once again it ignores the incredible things that they are by trying to infuse what they do with human characteristics. Does the police dog attack because he sees a gun, and sensing the danger to his human partner selflessly risks his life out of love and ultimate sacrafice? Of course not. The dog has been trained to enjoy his naturally aggressive instincts (those that all of us have) and has been taught that when he sees a gun he can then exercise and fulfill those instincts without getting into trouble. He's excited because he gets to enter into a gnarly cool dick measuring contest that ultimately ends up with a reward. That's not heroic, that's basic canine behavior. The other is akin to considering two highchool jocks, and when, immediately following being called a 'fag', one boy beats the other to a pulp. Does it make sense to say, "Mike, having recognized the homosexual slur was offended on behalf of all of those that continue to be repressed based on sexual orientation and in a rage fueled by his love and respect for his gay brothers and sisters put himself at great risk, to include his own LIFE, to speak for those unable to speak for themselves.." Bullshit, right? One kid called another kid out, they wanted to see who had the biggest weenie, and that is as far as the internal intellectual debate continued. Do I have an issue with someone that, upon finding a gasping kitten on a fire scene when no humans are present gives blowby O2 to help it out? I don't really. Do I have an issue when we begin stocking emergency ambulances with pet supplies? Yeah..I do. This is just the beginning...fire will soon be taking Animal EMS courses, etc, for the photo ops if nothing else, and people will continue to call (it's already happening) and that volume will increase...or so I believe. We have a broken system that wants to add volume and variety...Hmmm...what could possibly go wrong?

DFIB, that cracked me up... Welcome Jayme (Is that a girl's or boy's spelling?) Not important...Just curious. I'm guessing that a girl wouldn't have mentioned the dog along with the kids... :-) Good to have you man...the secret to getting mentally stronger is to participate in the threads instead of just reading them...We could use your thoughts.. Dwayne

Yeah, it's always exciting to have new grad medics... It helps old guys like Kat and DEFIB stay current...

LMMFAO

Uh oh...someone is about to get really unhappy.... If he was a fireman he'd be ok...but a paramedic and a cop? He is so screwed....

I guess that is my gripe... They are masters of creating change, and presenting it in such a way that the people that they are meant to serve don't see that they're actually giving them a big 'fuck you', creating a weaker system, yet all the while be seen as more heroic. Do I mind that they use the media to their advantage? I don't really, as that's good business, and fire is certainly more of a fantasy/media business than a service. But do I mind that they use it to keep causing EMS to take giant leaps backwards in terms of higher quality of medical care and it's delivery? Yeah... I guess I was just bitching....I don't have the answers...

It's a blog, not a book, but I truly, truly believe that it should be required reading for all paramedic programs.... http://babymedic.blogspot.com.au/2006_11_01_archive.html

Welcome!

Firefighters lead the charge to take over EMS when their jobs peter out..and succeed... Lead the charge to retard educational standards in EMS so that it has to stagnate in 1975...and succeed... Now they want to lead the charge to make sure that 911 is flooded with calls for people's sick pets, guaranteeing that humans will have to wait for care...and I have no doubt that they will succeed... Yeah man...The fire services have been awesome for EMS...

I hear you Moebes, but this isn't a monitor from someone's attic, it's an LP15! Do you guys know, as we can see all 12 leads individually, if they are filtered the same as the 12 lead? This is probably horribly stupid, but can you have 12 unfiltered "rhythm strips" if the machine isn't running the 12lead algorythms?

I agree...this incident shows that the entire dept is defunk'd...the "officers" weren't there, probably had other plans, a "JR. Officer", likely another kid, was in charge. They didn't follow protocol, threw a bunch of gas on the bushes so that they could hear the kids say "Wow! You're so brave and crazy!", without making sure that everyone was clear, or had their bunker gear on.... Obvious fix to this situation? Two choices, per Fire history. First option, do nothing. This accident was obviously unavoidable..no one is at fault. Pencil whip a training session to show that you've taken it seriously and have inproved because of it. Second option, Don't let 16 year olds on scene. The only unacceptable option? Hold people accountable, send them down the road, and make positive changes.

It was much better than I expected... It's unfortunate that the medic bailed on his responsibilities and left the cop to care for his new patient instead of doing it himself, as he should have. The prounouncing of death at a scene most often begins the care for more patients, not less. Good start Brother...though the questions asked of you above are important. You should be brave enough to respond to them. Dwayne

You know, I hear a lot of excuses from a lot of medics about why they don't choose to mitigate pain, but in my experience it most often comes down to fear. They are just simply afraid to push the drugs and then manage the patient. On another project that I'm familiar with a man tried to jump out of his vehicle while it was rolling over and ended up with both of his lower legs trapped by the frame at the top of the window. When I asked the medic about the call he said that he thought that "both legs were broken, but not bad.." When I asked about pain management he said, "He didn't need any....he was managing ok." This medic had this patient for 7hrs before he was transfered to a hospital. I later looked at the medical reports as this patient was going back to his site and saw that he'd had bilat /angulated tib/fib fractures, each fracture requiring plates and pins to repair. Do you think that he was in pain for that 7 hrs? I really, really hate pussy medics. As far as drug seekers and deciding when a person is in enough pain to be medicated, someone posted some studies that gave strong evidence that non of us is good at calling bullshit on either.... And truly...for most of us...how many drug seekers do you see in a month that catching them should be so high on our priority list?

Like Kat said, they're splitting hairs. You'll find this very often when riding with people that aren't really qualified to be preceptors. They don't really know what to do, so they try and find obscure, unimportant things to illuminate to try and make themselves look smarter and more experienced than they are. I spent a day a long time ago doing this on every patient. In this clinic we saw about 20 pts each per shift, so I had a lot of practice. I'd get an initial B/P, then reinflate the cuff and get the systolic again, and again, and though sometimes I'd see a few points difference, it wasn't significant, at least that I could find. And wrmedic makes a good point. Taking B/Ps is a skill that takes practice. You're never going to learn to do it and then just be awesome at it for ever. Any time that you have time to take a manual pressure you should understand that you're just being lazy when you choose not to. (Have I been to lazy sometimes? Yeah, many times, but we should try and avoid it when we can.) You'll get better and better at it with time. The same is true with taking a pulse. Pulses have 'character' (unlike most medics that I know...ha. ha.) but it takes quite a while before you've felt enough of them to be able to see it. And once you can, it takes practice to be able to continue to get more information than just a rate. Manual B/Ps, pulse quality, lung sounds....do them often, and most important, often on people that are healthy-ish for comparison, not only when they're indicated...it will serve you well in your career.

Thanks all... Yeah, I was surprised. I've not worked in a hospital based system, so I guess I've never really thought of a monitor as not being able to do a 12lead. You can view all 12 leads, just not print them out together. I wonder, is it really a 12lead then? Are the leads still filtered the same as if it was a 12 lead? I'm not opposed to moving a lead around to get the information that I need, but if they don't have the advanced filtering, then I've not really gained much, right? Not sure...probably talking out of my ass. DFIB, I hear you. Though I do go to some pretty primitive places, the company that I work for, normally, has a pretty interesting way of setting things up. The client is responsible for all costs of the clinic. They write my company a blank check and my company builds them the clinic that they want. As many of the clients are really big oil, gas, and gold producers, the clinics are often really, really nice! Staffed with docs and nurses...unfortunately, I've only worked in one of the nicer clinics, in Mongolia, but have passed through many on the way to the dumpy, dirty, single man clinic that I'm assigned to. :-) And for the record, for the last nine months I've been putting on the little brass bells with the suction cups for a 12 lead, but at least I had friggin' 12 lead capabilities!

Isn't it amazing how we have all of these heroes that filed complaints afterwards, which is good of course, but none stepped in to stop the assault? The fireman that stood by and videoed but did nothing to intervene should be subject to discipline also, as should anyone that allowed the assault to continue.

Little Johny was sitting at a bus stop. Next to him he had a stack of candy bars which he was unwrapping and eating one after the other. And elderly gentleman sat down next to him and said, "Son, you know it's not healthy to eat so much candy all at once.." Johny said, "My grandfather lived to be 94 years old." Old man, "Did he eat as much candy as you?" Little Johny, "No, but he minded his own fucking business..."

So yesterday a patient comes into the main Komo clinic as I'm passing through. It has doctors and nurses and such so I have only emergent responsibilities. He complains of chest pain and they decide to do a 12 lead using their Life Pak 15 monitor. I'm just sort of hovering when I hear one doctor explain to another that to get a 12lead you need to go to each lead and print it separately and then compare them. That there is a way to print three leads at a time, he says, but he can't remember how. I butt in and say, “No doc, this will do a 12 lead, just hit the 12lead button.” He argues, so I push on, to make my point.....but there is no 12 lead button. I have them keep the patient in place while I search the entire monitor, as if the 12lead button my have somehow been placed back by the batteries...but there isn't one. I keep the patient in place longer still while I Google the issue, but the only reference that I can find is the instruction to “Push the 12 Lead Button.” No reference for a unit without 12 lead capabilities. There just isn't a button where the button belongs. This completely blew my mind. How is it possible that a company that makes such sophisticated equipment would create one of their machines without 12 lead capabilities in this day and age? There are all of the appropriate 12 lead cables, you can view and print each lead individually (or in threes if you bring up three leads, the max, on the screen) but you can't run a 12 lead? Has anyone run into this before?

I man, c'mon, who hasn't, after a few too many shots of teqila, done such a thing? It's not really a party until someone gets bit on the head....