Eydawn

No swollen lymph nodes, no fever, no signs of infection, no complaint of distress other than a tiny bit of a sore throat and nauseous. Am I 100 percent sure she didn't have an infection? No. Can you ever be 100 percent sure that the patient you see isn't about to die of a sudden, random coronary? No. The medic also visualized the area pretty well... he saw a *tiny* bit of surface bleeding, looked just like she had popped a clot from the surgery site. She wasn't in any distress, mom called because she freaked out at seeing blood in the kid's puke. I didn't make the final call, my medic did... and there is nothing we could have done for the kiddo in the back except for stick her with a needle (which she might not need) and give her a ride. I happen to agree with the medic's evaluation of the situation. Mom was strongly encouraged to take the kid to the ED for evaluation by an EENT doc (which mom really wanted to do, she wanted us to take the kid to the kid's specific EENT doc's hospital), and as we were packing up, they got going. There's the knowledge that any refusal might have something you missed, but there is also the application of good evaluation skills and common sense. The trick is to approach every call with an open mind, rather than assuming "it's just another drunk" and seeing what you expect to see. If you do that, I feel strongly confident that we as prehospital providers can adequately determine when and when not to transport. You didn't answer my question. Is it appropriate, in your mind, to inform any given patient that ambulance transport is excessive for their condition? Or should we always operate on a "you call, we haul" system? Wendy CO EMT-B

Where exactly do you draw the line on "workplace appropriate" vs "keep it at home"? Is a historical movie containing violence, like American History X, inappropriate? Is it inappropriate if it has the potential to offend anyone who may wander in? I am offended by spongebob.... so does that make spongebob workplace inappropriate? Just curious. Wendy CO EMT-B

Well, it is in the best interest of some patients to not ride by ambulance. Take for example the 6 y/o female who had a little tiny bit of bleeding post- tonsilectomy (1 week prior) who hurled because her pain meds made her nauseous and had a little red streak in it. Not vomiting blood, no real active bleeding, just tired, not dehydrated, good vitals, no history of anything... Is it worth it to stick her with the stress of an ambulance ride and a large bill for mom just because we got called by an overreactive parent? She's perfectly fine to go by POV with a puke bucket (even though she's not nauseous anymore, but just in case) with her mom to the ER she wants to go to instead of the closest one we normally transport to. We offered the option, showed pros and cons of both, and mom chose to go POV. Do we suck? Question for you. Is it appropriate, in your mind, to inform any given patient that ambulance transport is excessive for their condition? Or should we always operate on a "you call, we haul" system? Wendy CO EMT-B

HUH? I'm confused. And why muddle a perfectly good thread about workplace appropriateness by dragging the whole race issue in? Never mind. I had hopes that you would be a productive poster, but you're well on your way to establishing yourself as a troll. Good luck with that. Wendy CO EMT-B

Discussion is the exchange of information from varying perspectives in a civil manner with the intent to educate or simply enjoy different viewpoints. All you've done so far, no offense intended, is bitch that we try to get out of treating low acuity patients and then insist that you're "discussing" something. Why don't you get your coffee, sit and think for about 10 minutes before you hit reply to my post, and see how you might view your last few posts if you hadn't written them. Remember on the internet we don't have the benefit of body language or vocal inflection to help soften our points- right now, as I'm imagining a voice saying what you're saying, you seem like the underwear shrunk in the dryer, someone puked on your shirt, and the last thing you want to do is try to persuade, but rather bitch about your day (life, career... substitute here). Best Regards and NO OFFENSE INTENDED, Wendy CO EMT-B

Are you part of the fire department? Or do you just share the house a bit? If you just share quarters, might be time for you to approach your management and theirs in an attempt to negotiate for workplace appropriateness. I don't know if this is a universal, and it sounds like a FD problem, not necessarily an EMS problem. Sorry to hear that your workplace is like that! Wendy CO EMT-B

Yes, you have a duty to the patient in front of you. No arguments here. You also have a duty to ensure that you provide proper feedback both to your patients and to your management in order to provide ground-level intelligence as to how to provide the best coverage. If you're consistently tied up with one frequent flier, or 7 frequent fliers, and care of acute patients is suffering in your area, you shouldn't just shut up and deal because you have an obligation only to the patient in front of you. I agree that we spend way too much time bitching about or not providing adequate care to indigents, lower acuity level calls... but it's because on some level, many of us are frustrated with being tied up when our care is needed elsewhere. Any suggestions for solving the problem? More staffing in your area? A "hobo" van to transport them somewhere? Wendy CO EMT-B

Is it that you would prefer a V-chip to ensure proper station environment? Or is there a discipline problem and improper treatment of women occurring in your workplace, and you feel that this is contributing to it/emblematic of it? I agree that inappropriate materials have no place in the work environment... but I'm curious as to where this particular outburst came from, as it's not been a problem where I've ridden/worked. Wendy CO EMT-B

I'm sorry... what I am about to say may offend some people... and no offense is intended. Bear in mind I write this *saddened*-- not angry. Newspaper articles like that are what feed into the guts and glory mentality that gets so many of us killed, fire and EMS alike. I have often heard it said that the line between stupidity and bravery is a very thin one; I would like to posit that true bravery is having the skills and training to master your adrenaline response and utilize your judgment and critical thinking skills when faced with a dangerous situation. Cody Renfroe ran into the fire. I agree, those last four words speak volumes. Doubtless the man was of stellar character and well loved by his community. But running into the fire is not heroism, it is not martyrdom, it is ignorance. Had he been confronted with the "one shot" at getting out the kids he could see and knew that there was no time save for that one chance with his partner, it might have been viewed differently. But he ran into a house fire without knowing if there were any victims at all, and instead of being a hero, he severely damaged several hearts in his community. Unfortunately, it's often the younger members of departments that buy into the guts and glory mentality. While true to a certain extent, it is far better for one to realize that the MYTH of firefighting or paramedicine is much shallower than the rewards gained by operating within the REALITY of those fields. Until we learn to teach our younger, more headstrong men (and women, but you see men getting killed far more often for some reason) to abandon the myth and adhere to training, we will continue to see people die needlessly. A needless death is a tragedy, and I pray that Renfroe's community and family heal from the loss they have sustained. I also hope his department and other departments everywhere heed the clear warning given by his death. Wendy CO EMT-B

Chocolate eaten by one while one is floating in the bathtub... Better? Speaking of which, I could really use some damn chocolate, lol. --Wendy

Man, I don't know how I missed this thread. First of all, I would like to say that I believe that guns are not nearly as dangerous as those with the judgment holding those guns. A gun by itself, whether an assault rifle or a BB gun, has no more damage and malice in it than a pencil. Or a baseball bat. Now, the question becomes, do we trust the general American public, capable of acquiring firearms legally or illegally, to handle a gun with higher capabilities for mass damage? I think AK is siding with "no" on that question. MY question is, do we force those who have obtained said guns in the mindset that it may be necessary to defend oneself from and forcibly overtake our civil government to relinquish that right? Do we force them to turn to illegal avenues to acquire weaponry that would allow them to challenge a corrupt government? I say we allow the public to arm themselves with this in mind. Before anyone jumps all over me, read on below... The shock at the arsehole from the original article having a gun as a felon is quite laughable. You can put as many restrictions on guns as you like, you can outlaw certain types or certain days on which they can be carried and require proof of 7 generations of citizenship to purchase a gun, but you will just make it harder for normal citizens to own guns with which to defend themselves. The less savory elements of society will *always* be able to procure whatever it is they need to keep their illicit businesses running, whether that be drugs, guns, bribe money... so don't be shocked if a ban on guns doesn't result in removing them from the criminal pool. As far as AK recognizing that he is responding emotionally to this issue, kudos to him. I would caution those reading that admission about making sweeping judgments on AK's character or ability to operate in the medical field, however; all of us as human beings are bundles of inconsistency and idiosyncrasy. For example... I respond very emotionally to certain issues, I listen to gut feelings and weird feelings that come out of nowhere, and I don't always make consistent sense on any given issue; but I do interpret many things logically and without emotion. One can, for example (to steal this from a movie) believe that any chocolate eaten while floating in the bathtub has no caloric value and still teach high-schoolers with no aberration from normal curriculum. AK can definitely respond emotionally to the issue of the legality of assault rifles and still approach medicine with the clarity necessary to do his job well. To say that one's idiosyncrasies in one area eliminate one's ability to be logical in another area is a non-sequitir. Wendy CO EMT-B

If she is pre-code-looking, there's good odds that she may be fixing to join her husband. Take the ashes, tell her that there is a chance the urn may get broken because the ambulance isn't good with bumps, put it in the front seat, seatbelt it in with a pillow or extra blanket. Many of us take patients' personal belongings, like a purse, an overnight bag if they're a frequent flier and know there's certain things they need to bring with them, etc.; how is this any different? A little odd, yes, but a huge leap? Nah. If it is going to benefit the patient's condition by calming them down, who are we to say no way in hell am I taking responsibility for your stuff? Sometimes the best medicine isn't really medicine at all.... Wendy CO EMT-B

Even though the full story may not be true, the truth of human emotion and integrity is what really matters. And one can easily see an interaction like that between two young people in a horrible time, so... I'm going to believe it, whether it's totally true or not. Wendy CO EMT-B

Anthony, you make some very good points. I appreciate the feedback, and take no offense to it. How would you approach watching and imitating when you are pushed to the front of every single call to begin assessments as the initial lead? I keep being informed that I need to come up with a system, and then I'm not given much opportunity to just watch a team and learn how their system works. My first chance to watch someone run a call was my last shift, and I got to watch one fairly simple psych pick-up and transport that didn't need anything more than a set of vitals. I also think that being told to verbalize assessments and possible treatment modalities and then receiving chastisement when I do so and mention a drug that might be in the patient's future is confusing. Not necessarily wrong, but I'm telling you, it needs to be one or the other. Either we're encouraged to think and cross check what we're thinking to show that we're clued in to patient care, or we just do the monkey skills and shut up. For now, I'm going to try to shut up. I also would beg to differ that asking a question mid-procedure is not learning, or that it's always inappropriate. I didn't tell the medic I wouldn't stick that vein until it was explained why it's ok to stick there; I did, however, raise a question that I thought was important for patient welfare based on what I had learned. It's like double checking that they're SURE they want you to do that when the medic tells you to put the combivent together for that asthmatic but the patient said they were allergic to peanuts, so Atrovent might not be a good idea unless there's a different thought process going on that I am not aware of. Regardless of the fact that the medic is ultimately responsible for actions in the ambulance, I am also ethically responsible for any actions I do, so I'm not going to just do something (especially something invasive) because I've been told to if I'm not comfortable with it. On the IV thing, I got it now, I know better. Easy mistake to make, now fixed. But we've been told over and over again to ask questions, to get in there and get involved and try to learn... and it's not serving me well in terms of learning how to be an effective paramedic's bitch, because questions are taken as challenge and I'm always following the medic and what they're doing- not what the BLS guy is doing while I'm distracted with watching the medic. You see where I'm coming from, Anthony? --Wendy

I'd read about this as an adverse effect of anti-convulsants before, but never this much in depth. Great article, doc! Here's hoping he makes it and recovers, Kaisu. Isn't it amazing what can happen to the human body for no apparent reason? I think this would be fascinating to study in some sort of mammalian model... I bet it has something to do with cell death pathways (just my uneducated Monday morning guess). Wendy CO EMT-B

Thanks, folks... I really appreciate the feedback. I feel like I'm not crazy anymore. I'll keep you posted on where/how it goes... Wendy CO EMT-B

I like how people also bought the "ultimate Porsche" game. Dreamers... dreamers... always dreaming..... Wendy CO EMT-B

Work, and "field instructor" three person team phase, to answer your questions. Here's the problem though. They want us to discuss what we're doing and not "Just do it." It's *uber* wierd. I tried doing the whole thing just like I was actually running a call... but every call turns into student-teacher discussion type dynamic. I do my assessment in my head... and then get reminded that I need to assess.... *_* So I keep my mouth shut when I'm thinking about meds and treatment lines from now on... but what if I have a legitimate question like that and don't want to do something just because the medic said so, and I've been taught otherwise? Do I just dodge aside and say hey, you better get this line on this particular patient? Do I just do something that doesn't sit well with me? Not sure how to handle that without pissing people off. I was taught that IV access there is a no-no because it is an unnecessary risk. WTF? Here's the real rub. Instead of being taught to be the paramedic's assistant, I'm being pushed up front to assess and run calls, while the other EMT sets things up, go-fer, gets the cot ready, etc. I feel like I'm sort of learning how to BLS a call without learning how to assist an ALS call. Also... when they say "what are we going to do for this patient" and I respond with something about the monitor, because I know the event warrants a look see by the medic, is that overstepping my bounds? Some think it is. Dunno... I thought syncope/near syncope in the elderly indicated possible cardiac even w/o chest pain... You see where I'm stuck? --Wendy

Alright folks, I got the pen thing licked fairly quickly. The tape did the trick. I have a much stickier problem now. I've had one field instructor tell me that I come across as a know it all and argumentative. Scenario: Verbally started talking about the Narcan and its possible use in a potential oxycodone OD before I physically started taking BP. I understand that I need to focus on my basics and making my part of the call run smoothly, but when we're told to think along the same lines as the medic and really think about assessment and anticipate what might happen... I'm confused as to how that was a screwup. Maybe because I jumped to the treatment before getting everything else put together? We did get a first set of vitals from the FD (pretty reliable 90% of the time from what I hear) so it wasn't like I was thinking cold without any objective data. I also expressed confusion about an IV site selected by this particular instructor... I was taught never to stick right under the thumb due to the potential for stabbing the radian nerve and REALLY pissing your patient off... and apparently I said "yea but what about the radian nerve?" instead of what I thought I said... "but what about the radian nerve there?" I hope you guys can read the tone difference there right... One is apparently challenging while the other is questioning. I can see how my FI would have felt it was a challenge- they told me to stick a vein and I asked a question instead of doing what I was told, but due to my confusion from my instruction from my recent class, I thought it was a question of potential patient welfare. How can I phrase something like that where I genuinely have a question and don't want to screw up through my relative inexperience, without seeming to challenge the medic's authority? I had no intention of doing so... So what I did on my shift today as a result of the discussion I had earlier in the week with one FI was approach my new field instructor and tell him what the previous one said. He was very helpful on ops and mapping today... I feel much better than I had previously and was totally comfortable on a shift for the first time since getting here. I warned him that I was blunt and that I had come across as a know-it-all or otherwise and asked him to let me know if he got any of that so I could figure out to fix it. At the end of the shift he said it wasn't so much a know-it all as much as I seemed slightly abrasive (and believe me, today I tried to be super polite, worked my ass off at studying protocols and maps etc.) but he couldn't put his finger on why I seemed that way. Anyone been in a similar boat or have any ideas on how I could figure out how I, a normally blunt and honest woman, can cease to piss off my new coworkers by just being myself? My FI today did say that perhaps they just need more time to get to know me and get used to my personality... but I'm really confused by it all. Any feedback would be greatly appreciated! --Wendy

My thoughts and prayers are with the fallen man's family, friends and department. However, I think this really needs to be seriously examined to keep any of his brothers from falling victim to the same fate. It sounds like someone, not knowing the full story I shan't guess at who, screwed up. Sucks, no matter how you look at it. Wendy CO EMT-B

Hey Michael? I got a question for you. What the hell *is* that? I prefer Dove milk chocolate promises, truth be told, but if it is chocolate and not laced with melamine, I'll eat it. It'll be a miracle if that wedding dress zips come June. --Wendy

Anything chocolate. MMmmm..... Wendy CO EMT-B

Those lanyard pens aren't a bad idea. We'll see if taping the ick pen works. I have a shift tonight, so we'll put it to the test. I don't want to completely stop chewing on pens, because it's something that helps me study. Chewing gum doesn't do the same thing for me... so I only want to break myself of nibbling on the ick pen I use at work (strangely enough, I had no problems not chewing on the pens I used in the cadaver lab this summer... go figure lol.) Yes, I know everyday pens have germs too... but it's unprofessional to take a pen from a patient who I just brought in puking/coughing/otherwise ick and put it in my mouth not 5 minutes later when I'm doing paperwork. Wendy CO EMT-B

I like hot sauce. Not a good deterrent lol. But thanks for the suggestion! Coon ass indeed.... As to washing my hands FOR dealing with patients, of course you wash your hands as much as practicable before patient contact. But it's even more important to me, at least, to want to wash my hands after patient contact before I touch my pen and other items in my possession.... Wendy CO EMT-B

ROFL at Mateo and Michael! Thanks for the suggestions. I think I'll try the tape trick. That, or have a pen I use specifically for patient stuff and a pen specifically for paperwork that I only touch if I've washed my hands. Wendy CO EMT-B