Eydawn

Situation A: Phone number- unless he has photographic memory, and he took it home written with the patient's name, he's in bad trouble. We've been taught in nursing school that we can't even write patient initials on our case studies, especially if it's in conjunction with room number and hospital. Unless there's some facility appropriate reason for him to be given the number (not take it of his own accord) and follow up with the patient, he shouldn't have it. Situation B: Runs into someone in the grocery store- as long as they're two consenting adults, I have no issue with it. Is it skeezy? Sure, but a lot of ways people hook up initially are kind of skeezy. As long as he didn't stalk her and figure out what grocery store she goes to and it's totally coincidental, call it fate or something but I make no judgments on it. I've been treated by friends. Close friends. Does that mean I can't be their friend anymore, because they know what my lungs sound like when I'm buggered? Does that mean that our close friend relationship is somehow non-kosher? Not in my opinion... Wendy CO EMT-B

Keflex! Contraindicated in folks with allergies to cillins! Cillin allergy. Cross reaction to Keflex, perhaps... and lookie there in my drug guide! Adverse reaction to Keflex that is bolded under CNS is seizure! I wondered... mom's hint seemed kind of obvious to me... So this may be an allergic response or severe adverse reaction. Now, why was he taking it? Because we may have more than one horse here hanging out with yon zebra I may have just identified. URI? Progressed to meningitis perhaps? Or dehydration secondary to infection triggering his naturally occurring epilepsy... (Do y'all know how long that takes to type with a broken hand?? Don't punch walls is all I have to say...) Wendy CO EMT-B

You know me. I'm a tech geek. In my experience with digital textbooks, mostly on my laptop, I *hated* it. Yes, I hate carrying textbooks, and my PT/chiro hates me for it too... but nothing beats the original layout, with pictures, and the ability to flip to an index and flip around to skim for related things in that area of a chapter. I had a developmental psych text that was in digital form (having already had a different version of the class a few years previous with a paper version) and I *hated* reading the digital one. Would I like it better if it were an e-reader? Maybe... can't answer that. But I can definitely answer that the paper text is my go-to. Now, for things like drug references, the smart-device and app is where it's at. I wouldn't solely rely on the e-reader version; I'd have the paper version at home to work with. For portability during clinicals/class I could see having the e-reader. Sorry I'm not more help.... Wendy CO EMT-B

Then no, no way in hell I'm stopping. I take my eyes off that patient, they're going to crash. No thanks. Haul ass, call for help, hope for the best... Wow. Do they still use Nipride? Wendy CO EMT-B

Dude. It's your thread. ROFL. No response to my analysis? Sad me. Can someone at least clue me in to the risk of Nipride drips? It is a vasopressor, right? So... you need close monitoring to prevent tanking the patient and to keep good perfusion, right? Or am I off in the ditch with the nuns and hemophiliac orphans? Wendy CO EMT-B

I've got one for you. I'm on my local Search and Rescue team. Our uniform is orange vests or orange hunting shirts with the team patch and MRA patch (and medical patches as appropriate). Pants are up to you- hiking pants, BDU's, etc. We wear red jackets with the team patches as our outer layer. All our shirts and jackets have our last name on them (first initial as well if there are duplicates). Are we totally uniform in how everyone looks? No. Are we readily identifiable when we field? You bet. Do we all look professional? Absolutely. Is any of this provided for us? No, we're a non-profit, non-taxpayer funded organization. We run on donations (I'm currently in the middle of a giant pain in the arse fundraiser) and our members pay dues. The county sheriff, who we operate with, provides us with workman's comp insurance and fuel for the response vehicle- that's IT. We buy our own shirts, we buy our own patches (provided with our first set on graduation from training), and we buy the jackets. We take pride in our appearance, and understand that this is the norm for our group. We respond from work, home, social obligations... we keep our equipment in the car, and we change into our uniforms in our vehicle if necessary. Again- shirts, pants, boots... much like an EMS uniform. It doesn't slow us down, and often we are responding to very high risk situations (much more so, I would venture to say, than the run of the mill EMS call...) It's all about where you decide to put your emphasis. If you want to be professional, you will make it happen. Pride in appearance changes how your view yourself, and changes how you view professionalism. Can you be an excellent provider in your jammies? Sure. But I bet the receiving facility and everyone you interact with will view you ALL THE BETTER if you look professional too. Wendy CO EMT-B

Pros: I get to sound off and nobody will fire me. I get to use my brain, and nobody will fire me. (seeing a pattern here?) I get to learn from some of the most wicked smart people in medicine I've ever encountered- from RN's to paramedics to basics to MD's (how cool is that?!) I get to get inside different scenarios and see how different minds critically approach patient care, which allows me to integrate that information into my own fledgling practice as a student nurse... I've made some wicked cool friends who don't diss on me for being under 30 ;-) Cons: I should be studying... I get too easily distracted by the trollage Did I mention I should be studying? ;-)

I want to know more about the IFT ALS patient we're transporting. Obviously not necessarily stable, as they're being managed on drips, but perhaps manageable for a little longer period of time as you assess the other patient? I need to really know the status of my first patient before I make that call. And I don't know much about Nipride, tbh, which leaves me at a definite handicap here. I wouldn't leave a basic to watch the IFT patient for sure. However, if this patient is stable enough for us to delay transport for a few minutes, with me still managing care (aka we have enough resources to manage an increased transport time and the patient is maintaining well enough to do so), then we can pull over, drop the EMT-B to assess the car situation, and go from there. What I really need to know is can I safely manage the care of these two patients- is this cardiac patient stable enough for me to have divided attention on an unknown, possibly cluster-f*cked trauma patient? Since it's just me, I need to be honest about my capabilities, and I can't do that unless I know the status of my IFT patient. In the scenario where I can't manage both simultaneously, we stop JUST LONG ENOUGH to assess and treat immediate life threats and get that guy in the car more stable if we can (if the delay in transport of my original patient won't immediately kill him/her). Extrication if possible, airway if possible, cover with a blankets topped with a Mylar for hi-visibility, leave him in the best possible position we can given our time constraints. Then high-flow diesel to an area with comms, radio it in, and get another unit headed that way, using whatever resources are available (civvy, military, air, ground, etc). At the very least we can get a cop of some sort flying that way hopefully to provide some more basic level care until the cavalry arrives. Now, I can see some people saying well, isn't that patient abandonment? The same holds true for the catch-22 in Dwayne's original scenario- if I leave one kid with the goobery redneck first responders, and that kid dies, didn't I abandon that patient? At least in this situation, I didn't ignore a distressed human being entirely, and did the best I could with shitty parameters. I can't let my first patient die- that's neglect, and if I take on another patient and that causes me to be unable to keep my first patient alive, that's also neglect. However-- I can't, as a human being, pass by someone who I may be able to help (or at least provide some palliative comfort to, even temporarily) so I feel that I must at least try, if doing so will not immediately kill my first patient. I will not, however, take on the second patient as a transport unless I feel like I can safely manage the care of both (or at least not inadvertently kill one or the other because both require too much focused intervention on my part). If I feel like I can manage care until I get to a rendezvous with another unit, I may take that risk, because I can then decrease the time to definitive care for the auto patient (that's assuming I can get them out at all...) More info, plz! And thank you... Wendy CO EMT-B

Interesting. Thanks for posting this for us. Some of my timelines on what I knew were definitely off...

I'm in. Hubby says he'll pay airfare anywhere I need to go.

You're putting the cart before the horse, and that's why the FD wanted to ream you a new one. No attack from me- I used to be over-eager like you. The more I have learned, the more I am ashamed of how I used to be. I was ignorant, and I was a danger to myself and to my patients. I'm just barely at the point where I've learned enough to USUALLY not endanger my patients. People are not of a mood to re-orient you today because we lost one of our best and most respected posters to chronic illness. He tackled many of us when we were at the stage you are now, and we are all better for it. Unfortunately, there have been trolls lately "pretending" to be this naive... hence the suspicion. If you're really and truly this new, step back and look at our responses... we're trying to save you from the mistakes we made. Answer me these questions: What is the pharmacologic action of nitroglycerin? Why would that be a potential problem in a trauma patient with unknown hemodynamic status? What would your recourse have been if another vehicle had hit the vehicle you were in, while you were helping the patient- who would have paid for YOUR care? What are the legal limits of practice in your state? Who is the physician advisor for your local departments? What are their protocols? Put yourself in the shoes of the local department- and take a look at yourself on that scene. You don't know you from Adam. All of a sudden, you have some unidentified individual performing medical care (and not just nifty bystander CPR, but performing potentially dangerous interventions) and you're no longer assessing that patient at baseline... to boot, the patient has now been given medication... do you like you very much? Wendy CO EMT-B

I will miss him. Rob was incredibly intelligent, even if he was slightly whacko. I was one of the few whom he told about his diagnosis, and was sworn to secrecy. It grieves me to think of him fighting this cruel disease, and I am glad that he is free now... godspeed, Rob. He poked me, and prodded me, and pissed me off. He challenged me, and forced me to develop my thinking. It is because of him that I refused to be scared into being a half assed EMT. He taught me things that are immeasurable in value, that directly affect my approach to care in my job now and shape my views as I go through nursing school. I am only sorry we never met in person; I will never forget endless hours of angry forum posting and congenial video chatting... it's funny, I actually had a dream last night where I was talking to Rob... really weird, if you think about it. Maybe he came to tell me goodbye. Rest in peace, Uncle Dust. Wendy CO EMT-B

ASYS! You're back!!!! We missed you! Speaking as an asthmatic, yeah, if I'm severely screwed the MDI isn't going to do much for me, but it may buy me some time. At the very least, it's a psychological intervention that will quell the "panic response" that feeds the monster... If you can establish that an albuterol MDI is what the patient normally uses, I wouldn't administer it myself but I wouldn't prevent the patient from taking it from the person offering it (after verifying that it was in fact albuterol and not expired). My big question: why would you folks administer an expired epi pen, but not use someone else's MDI? What if it's not really anaphylaxis, but something like a niacin flush? Nobody ever died because of an albuterol administration (MDI form, at least... let's not think IV or continuous neb on altered mental status), but people sure as heck have died from epi pen administration. I may or may not have played the "oh look at what got dropped over there, it must be yours, yeah, you keep that now" game with someone in fairly good status, with an inhaler that expired within the month... is it risky? Sure. How risky? Fairly low, based on my assessment. Wendy CO EMT-B

Penn Jilette... what a character. And ferociously intelligent. High up there on my list of "if I could sit in a bar and shoot the shit" folks... I don't care if he's got a doctorate (since I can't figure out what's capitalized in phd) in anything, he's wicked freakin' smart and voices things very well. On the original topic: Yes, there are rescues that are too dangerous. Me, me, me, my team, those assisting my team, the subject. You must use good judgment, and you will catch flak from the media for situations they don't understand (wow, that NEVER happens with anything EMS related, right?) Now, to the nice diversion that AK set up for us... (thanks bro!) I am comfortable in my faith. I am also comfortable with others' non-faith, differing faith, agnosticism and so forth. It is my profound belief that God (or the higher power, or whatever you choose to recognize perceptually) speaks to each individual as they need to be spoken to. Some are meant to question, in my opinion. I worry for those who have never questioned their faith... who have never asked themselves the hard questions and examined what they really believe in. Do I really, really believe in God? Can I believe in God? Do I ascribe to any particular religion? Those are IMPORTANT questions. Those who never ask, who are raised in a religious manner, often shatter when something catastrophic happens to them... and they lose their faith. To me, that seems more traumatic than someone who has analytically approached their beliefs and decided that they do not believe. Do I, as a Christian, believe that those who question and wrangle with philosophical ideas and vehemently deny the existence of God at some point (or even until they die) will automatically be excluded from "heaven"? Negatory. Do I feel a need to "prove" the existence of God in order to justify my faith? Absolutely not. Do some people need to see that "hard evidence" to lend credence? Absolutely, and I don't think you will be faulted for that. God created the human mind, in all its complexity, with so much that we still don't understand... and God's perception of us, if you accept the omnipotence theory, must be vastly different than our "self-perception"... so much so that it is truly arrogant to assume ANYTHING about what, or who, God will deem worthy. I have had many experiences that have strengthened my perception of a higher power in this universe. The simple fact that so many millions of minute evolutionary chances had to occur for our existence is one logical thing that corroborates my understanding... (for others, it appears a definite proof AGAINST...) There are other experiences, for which you must know me better for me to share. There are things that I cannot explain, and there are experiences that I have had that demonstrate to me that I am here for a reason... in my understanding of that reason, God exists fundamentally. Ask me to prove it? I can't. I can't show you the inside of my heart and head... the subconscious and spiritual and conscious connections that allow me to hold the things sacred that I do... you just need to take my word for it that this is what works FOR ME. As I said before, that might not work for you. And that doesn't make you a bad person! It just makes you... NOT ME. Those who truly believe in God know that He works best when we get out of the way and quit trying to micromanage everything. Live your life well, carry love and kindness to others, and do not judge... and you'll be surprised at the experiences you have... walk around intentionally "showing how to proselytize" and you will turn people away from you and maybe from their own comfort in exploring theological ideas. And that's all I've got for now, since I should be studying for my fluid/electrolyte/acid-base exam at 8am. ;-) Wendy CO EMT-B

Kept the anime-ish theme... went for the nurse imagery (boy, do you know how hard it is to find a CLEAN nurse avatar?! Holy shit...) Whatcha guys think? :-) (Needed a diversion... been a really tough week and tough adjustment back to school and 30 hours/week work... I'm struggling over here.) --Wendy

Hospice usually figures it out in my experience. If you need to call, you need to call... What we do here at my facility is call hospice first, and they send us an on-call nurse or advise us on what to do next. If it's an issue that is seriously jeopardizing patient comfort/causing distress that we can't handle, and the hospice nurse can't get here to implement their interventions, they'll tell us to call 911. They then call the hospital to let them know a hospice pt. is enroute and what their care orders state. I've had the hospice nurse be here and call EMS themselves (pulmonary edema/fluid overload, difficulty breathing, needed CPAP) and then tell EMS where to take the patient (usually to the hospital that has the inpatient hospice wing). Sometimes it's a transport for direct admit, sometimes they go by way of the ER first- varies by situation. Occasionally, you can't get ahold of hospice, so you follow your best judgment. I've never seen someone get dropped or have non-payment for hospice services because they were transported by EMS. At least, I've never heard of it happening... doesn't mean it hasn't, but usually hospice services can document why the family/facility felt a need to call EMS for intervention so it's not a problem. Wendy CO EMT-B

Eh, I don't call anyone a whacko without a smiley-face to make sure that it's taken as tongue in cheek. *shrugs* I thought it was a jab and a nod all in one, wouldn't have really offended me but I'm not the person it was directed at. Mike, quit playing semantics. An epidemic and a crisis are not mutually exclusive. FOCUS... ~_~ I agree with Mike on the meat of the issue, interpersonal whoopsies aside... where's the data? OMG that page in the original post... what a nutjob this lady is. Has charlatan written ALL OVER her. I agree that the rise in autism is alarming, but so is the rise in so many other things. Like Alzheimer's dementia, for example. That scares the shit out of me, because there is NO PRAYER of normal coping for any given length of time. Once you've got it, you're going to die, and you're going to lose a great deal of what is important to you and be AWARE of the loss for at least part of the time. Back to the original topic of autism... the whole vaccine-correlation/causation link has been thoroughly disproven, and that British scientist who originated it hauled up for inquest over poor medical practice and crappy ethics. Until there's good data to indicate a link, that particular idea is dead as a doornail from the scientific perspective. From the anecdotal perspective, it will continue to hold water because people want SOMETHING to be the cause. Children go through massive neurodevelopmental changes at the same time as they receive many vaccinations. Ergo, it looks causative... but as stated before, the data doesn't back it up. The gut flora argument that we started with here really holds just about as much credibility to me as "the government is secretly poisoning all of us." Sure, every theory that's different than the norm could be valuable to investigate, but let's focus on the ones that actually may lead to USEABLE data that can help us change practice and understanding. Reading that web page was like reading the label on a bottle of Dr. Bronner's Castille Soap... (Please tell me someone in here gets this...) Wendy CO EMT-B

Man, I wish I had seen this thread before you gave the answer. That's totally where my brain went with the funny move and the "pop" and immediate diaphoresis/pallor. My brain went "uh oh. Vascular compromise." I would have listened for bruit on both sides. I also would have probably placed a C collar to minimize movement in case the vascular compromise was secondary to a busted something or other that could shift around and make things worse. I would not have given the odansetron. Too many unknown variables. I don't know enough about odansetron to give it when there's potential for this to be a neuro-based issue. If he pukes on me, so be it. 4/10 isn't bucket-worthy... anything above a 6 is where I'm shoving receptacles at you... What did they do to tx, do you know? Did it self-correct, or did he need some kind of graft/stent treatment? Wendy CO EMT-B

There's a reason I just flew to Michigan for a 3 day conference (I hate Michigan!). I'm now certified in Individual and Group CISM, which I did to help out with my Search and Rescue team (now there's two of us, instead of just one, yay!) If used properly, CISM techniques can help individuals identify the need for further counseling... especially when said certified person is helping to evaluate that need. PTSD happens. I don't think it makes you any more or less of a risk at your job, as each individual is different and handles different psychiatric diagnoses differently. There's great bipolar medics, medics with clinical depression, etc... there's TONS of medics with PTSD who don't even know they have it. Does stress affect how you do your job? Sure. Does it mean you'll freeze up, or that fear of freezing up is weird? Nah. All of us have that unspoken fear that we'll drop the proverbial soap at the worst possible moment. I don't think that's a PTSD thing. I'm bad about seeking help after calls that mess with me, because my hubby is also on the team and I just go to him with what's bothering me. However, I am good at identifying "bad ju-ju" signs in myself and in others. Between myself and the other gal on the team, we make contact with people after a call we knew was hairy to see how they're doing. If even ONE person asks for it, we will hold a debriefing or defusing, depending on the time table. Or we'll do 1:1 with the person if that's what they're more comfortable with. Sometimes, people just need the reassurance that they're not nutso for reacting the way they are. Sometimes, they need a little bit more. We have psychologists that we can refer people to if they're really struggling and need someone with the ability to help them work through deeper issues. We're hoping to establish a CISM response team for our area (closest one is a couple counties away), so we can help out other departments and such. It's a catch-22; if you're too close to what happened, you have your own emotions to deal with... if you're not part of the department/team you're trying to debrief, folks are less likely to open up. It's a complex issue, that's for sure. Especially so for those who are returning to civilian life from a military deploy. It's not just the stuff you saw while you were out there, it's learning to readjust to a "normal" life again. I think those who are the most honest about where they are struggling do the best, at least from what I've observed with folks I know. Those who try to put on the "tough face" end up suppressing, and suppressing, and suppressing, until they reach a catastrophic point of some sort. We discussed this in my conference with a police LT, who has had trouble with re-integrating his undercover detectives back into the main part of the force after they come off a lengthy undercover assignment... same kind of deal- you have to switch over your mentality completely from what you were doing to something that is much more mundane, and has its own challenges. Just my thoughts on the matter... also, disclaimer- I do not think CISM is for everyone, and nobody should EVER be mandated to go to a debriefing. Oh, and someone who's not trained shouldn't run one. And there should be backup with referrals to psychologists as needed. And nobody should be forced to talk during a debriefing if they don't want to. Thanks for posting this, Maverick! Wendy CO EMT-B

What gets me is that he walked into the room. If you're opting out because you're not on the clock and not covered by your employer's insurance, why did you walk into the room in the first place? However, I do like Dwayne's assessment of "Man, I want no part of that mess... quick, think of an excuse!" I could see that happening. Methinks, though, what would it hurt to help do compressions until the doc says "no mas." It's not like he killed the patient by refusing, though. It's not like they asked him to help get a difficult airway that nobody had been successful with... he just didn't feel like pounding on a dead guy's chest. Guy was still gonna be dead, help or no... so no harm done. Especially if he was in asystole. Does your AED tell you the rhythm when it advises "no shock"? And yeah, I'm talking JUST the AED, which is what I think may have been used here... not the fancy 10k Lifepaks that let you actually LOOK at what's happening... Wendy CO EMT-B

First of all, I thought we had disproven the concept of the Golden Hour? Second of all, it seems that the greatest challenge to this 30 minute response is resources. If your heli-go-flopter is not always available, and is coming from a distance away, you're going to have a hard time meeting this goal. Ditto for rural ambulances. Heck, a company I know of in CO provides for a mixed urban/rural county, and it can take upwards of 40 minutes to get to a scene. That's why local FD's have BLS crews... to provide immediate treatment... but they aren't allowed to transport, and seldom allowed to transport-to-rendezvous... so that county in my state would fail to meet that 30 minute criteria. It seems that the major issue they hit on is facilities contracting with private companies instead of using the fastest available resource... I know in some cases that a facility will contract solely with a private, but is mandated to call 911 in a life threatening situation... seems that isn't the case in Indiana? Hm. It's good to try to improve performance, but it looks like this hasn't been considered from very many angles yet. Wendy CO EMT-B

Oh Dwayne, even better is the poor unfortunate 12 year old soul who doesn't understand what's happening during testicular vasocongestion... and the camp medic (fortunately one of the dudes was around) has to explain that no, they're not going to fall off, and the solution is rather simple... Yeah. So glad I wasn't in on that assessment or conversation... Wendy CO EMT-B

Fella wasn't bright enough to pick a smart partner. If you're going to engage in any kind of risky "tie me up and gag me" play, you better have a damn good set of safety signals and a full understanding of what to do/not to do. Leaving someone bound and gagged in a sensory deprivation/dehumanization setup is grounds for unintentional manslaughter, way I see it. Accidental, yes, but directly contributed to by the fact that no one was there to make sure the moron didn't asphyxiate. I also want to know how a toy was lodged in someone's throat accidentally AND their mouth zipper closed. With all limbs bound. Did they telekinetically deep throat something? (I have a lot of friends with varied interests, FYI. I'm about as vanilla as it gets... but I have a lot of knowledge about various other proclivities... just in case someone was wondering based on what I said up there... ;-) Wendy CO EMT-B

I say this program is worth a shot. Any "alternative" approach that encourages learning to engage with your patient is beneficial; my guess is those folks who want to go be podiatrists aren't that interested in an EMS-centric program anyway, and will opt for the more traditional programs. Bet these future grads will be *bitchin* ER docs and medical directors! Is it the best idea ever? Nah. Is it unique enough that it could prove to be valuable? Definitely. I have friends that are babydocs of various stages and flavors... and the UNIVERSAL problem that I see is the inability to view things from the patient's perspective. It's all about being right, and figuring out the puzzle for these guys and gals... because that's what it takes to get through medical school. I had one babydoc acquaintance (who disabled posting to his Facebook wall soon after our little tiff...) who said that he would have to cede care of anyone stupid enough not to realize that high sodium intake means increased blood pressure. I jabbed him here and there about the role of physician as educator and the duty to take care of even the dumbkopfs, even when they resist your teaching or are noncompliant with important therapies. He didn't like that very much, because I rained on his little bitchy-parade. He said it was his right as a future physician to choose who to treat and who to turf to others. We haven't spoken much since (but he was kind of a prick in undergrad anyway, so... no giant loss there.) I sincerely hope he's learned some compassion along the way... Point being, with that story, is that EMS kind of forces you to think outside of the box if you're a provider who's at all interested in the bigger picture. Once you move past the "hero" stage, once you realize just how much you don't know, and once you start educating yourself and putting the sociological pieces together with the pathophysiology (not to mention a smattering of psychology here or there), your mental medical world opens up to a vast degree. A medical school program that has instructors willing to take the risk of flying in the face of "accepted" teaching holds a lot of promise... execution, however, means everything and it will be interesting to see how long this program lasts. If these babydocs are paired with jaded old nasty paramedics who don't give a damn about improving practice or empathetic care, then it's probably going to be a bust. Wendy CO EMT-B

Is that why you're an educator now and don't work the streets? What happened? If you don't mind me asking... Wendy CO EMT-B