What Did I Do Wrong ?

[FNGfirstresponder]

First of all, I did not administer NTG to the patient, he administered it to himself, I simply opened the bottle and gave him what he requested.  Had someone else showed up first, I am sure they would have done the same.  I did read up on it as you guys suggested, and I do see that I should have told him not to take it.  Thank you for that, but you did not have to hit me over the head with a hammer, or call me names to get your point across, this is not kindergarten, or at least I hope it isn't.I did see the banner about the death, but the first one did not say he was a member of this forum, I am sorry for the loss that all of you must be feeling.

Edited October 5, 2011 by FNGfirstresponder

[island emt]

. He was compaining of chest pain and difficulty breathing, his vital signs were stable. I put on a C-Collar and gave the patient two of the Nitro pills that was in his pocket (he asked me to). I held C-Spine until the Fire guys arrived, and then gave report. They looked at me like I lost my mind ???????? Then told me they wanted to talk with me when the call was over. I snuck away, but I can not figure out what I did wrong ? Can you help me figure it out ?

In reading your original post you might understand why we ALL responded the way we did. You state" you gave him two of the nitro pills that was in his pocket".

You""snuck away" when someone in authority wanted to speak with you.

Do not be surprised to find a knock on your door with a man offering you jewelry for your wrists.

`

Coming back after the fact and changing what you wrote does not excuse your actions.

Good samaritan laws will not cover your ass when you do stupid actions that are detrimental to the PT.

Edited October 5, 2011 by island emt

[ERDoc]

FNG, I'm glad you stayed and have toned it down a bit. Maybe the responses you have gotten have made you think harder and look inside a little more (but I doubt you'll admit it). We love new people here, especially when they are eager to learn.

As for the nitro issue, in your first post you gave everyone the impression that you gave the nitro. There is a difference between you giving it and you getting it for him (although it is a very small difference). I'm glad you looked up nitro and found out why it was a bad idea to give it to a guy like this. Honestly, you are probably right, most other laypeople probably would have done the same. The issue you are running into is you are trying to live in two worlds. You are trying to make yourself out to be a layperson, which is fine but you are also trying to make yourself out as a certified responder. You can't have it both ways, you either have to be one or the other. As for your issue with many that say they don't stop, you will come to see the reasoning as you get older and more experienced. Many have families and who is going to pay your mortgage if you are unable to work? In a utopia this wouldn't matter but in the real world it is a real fear. Who is going to be a mother or father to your kids if you are killed? To an 18y/o these things seem irrelevant but once you have these responsibilities the concern becomes very real. Google the term "first responder killed in crash" and you will find plenty of examples of how dangerous it is.

[HERBIE1]

First of all, I did not administer NTG to the patient, he administered it to himself, I simply opened the bottle and gave him what he requested. Had someone else showed up first, I am sure they would have done the same. I did read up on it as you guys suggested, and I do see that I should have told him not to take it. Thank you for that, but you did not have to hit me over the head with a hammer, or call me names to get your point across, this is not kindergarten, or at least I hope it isn't.I did see the banner about the death, but the first one did not say he was a member of this forum, I am sorry for the loss that all of you must be feeling.

Actually, we DID need to hit you over the head because you instantly became defensive- even after you allegedly asked what you did wrong. There's no way to sugar coat the potential trouble you may have caused yourself. Your EMS career could easily be over before it even starts. Just hope that crew does not wish to pursue this issue and the authorities start looking for you. Hopefully the patient was OK and all will be forgotten.

No, a trained, educated responder would NOT have done the same thing. That's the whole point of this.

We won't split hairs about WHO gave the NTG, but if you had the proper education and training, you would have been able to explain to the PT why taking that NTG would be a bad idea. If the patient goes against your advice, fine, but do you know what to do after that? How would you prove that what the patient did was against your medical advice? Here's a hint- it does not involve sneaking away from the scene.

A little knowledge can be a very dangerous thing- especially in this case, and the ironic thing about medicine is that the more you know, the more you realize how much you DON'T know. The fact that you had to look up WHY this was such a bad thing perfectly illustrates why folks were all over you.

As Doc alluded to, read up on some horror stories, or ask folks who have been in the business for awhile about legal issues they find themselves involved in. Did you know that many providers actually have their own malpractice insurance- just like physicians? Even folks who work for major companies or municipalities and are covered under a blanket policy. Why? Because even with the best of intentions, bad things can and do happen even to providers with years of experience and training.

Someone has a bad outcome from a situation- whether or not you were in any way culpable- and they SUE everyone possible. Can you afford the legal fees, court costs, potential monetary damages, or even jail time if you are found criminally liable?

You are young and have a lot to learn about life. You will also need to develop a much thicker skin because this type of criticism- and a lot worse- comes with the territory.

[uglyEMT]

First of all, I did not administer NTG to the patient, he administered it to himself, I simply opened the bottle and gave him what he requested. Had someone else showed up first, I am sure they would have done the same. I did read up on it as you guys suggested, and I do see that I should have told him not to take it. Thank you for that, but you did not have to hit me over the head with a hammer, or call me names to get your point across, this is not kindergarten, or at least I hope it isn't.I did see the banner about the death, but the first one did not say he was a member of this forum, I am sorry for the loss that all of you must be feeling.

Ok I have reread all the posts, don't see name calling but the hammer HAD to administered!

As for my thoughts....

First off, you say you have read the books, yet you helped the patient take a medication that was contraindicated on SO many levels. In case you missed them, they are, high degree of suspision of internal injuries (thus hypovolemia ie shock), blood pressure (was it taken?) needs to be ABOVE 100 those are the big two.

Secondly, you state you put on the collar. Did you do a full trauma survey first? Did you asses the patients PMS (pulse, motor, sensory) functions before AND after? Did you continue to hold immobilization after administration of the collar? If you were maintaining immobilization how could you have monitored his vitals to see if they were stable?

Next, which technically should have been first, was the scene safe? Were there wires down, able to come down? Do you know if electricity was flowing through said wires? If the possiblity existed of endangering yourself you should have waited until it was confirmed the scene was safe before entering it. On the first day of your EMT-B schooling it will be drummed into your head Scene Safety!!

Getting beyond all that. The reason you were looked at like you were crazy by the actual responders is they realized you made their job harder and potentially will need to rush to get this patient stable, if they even can, all the while he is still trapped in the car and for an unkown amount of time. You made their job extremely difficult to say the least.

As far as others stopping to help. You have to make decisions in your head based on the situation. You stated would I help someone get out their inhaler. Of course most if not everyone here would. Will I stop on a rain soaked road for a minor MVA? Probably not 911 will be notified and thats that. If it is a serious accident maybe, but I still think to myself how long is the response time for the guys with ALL the tools to do this properly and will I be a hinderence to the arriving crew or will me immediate intervention be benificial. These are the things you learn as you grow in maturity in the EMS field. Thats not saying your immature in general, its saying with time comes experience.

I had a few 18yr olds in my EMS class when I went through, most got they way you were, gung-ho especially for that MVA with entrapment. Hell yea let me dive right in and do all the cool life saving things. Guess what? Not that glamorous, and after a while the adreniline wears off and reality sets in. Spend time in that car with the patient hanging on by a thread, all the ripping and sawing going on around you while your under a big blanket while the patient is in fear of the unkown. Do that at 3am when its pouring rain, your covered in the patients blood, and praying you might make the difference to this person and their loved ones. Or do it while a dead person is in the other seat and you have to keep your patient calm. Not that glamorous anymore. Its not TV its real life and peoples lives are in your hands.

Glad to see you stuck around, shows you might be the real deal. But one thing I will say, grow a thick skin, noone here will hold anything back. We do not sugar coat our thoughts. If we think your a dick we will say it, if we like you we will say it, if we think you fucked up royally we definatley will tell you.

BTW welcome to the City.

ETA: this was typed while Herbie typed his response and posted afterwards, sorry for the similar posts.

Edited October 5, 2011 by UGLyEMT

[Quakefire]

Fun little story about Nitro, that I think illustrates a point. A paramedic in Ontario was attending to a patient with cardiac chest pain, and was going to admisiter a Nitro spray, to use a Nitro spray properly you spray it once to prime the pump to ensure a proper dose is admisitered to the patient, the paramedic primed the spray off to the side away from himself and the patient. Unfortunately the patients large dog came around the corner with its tongue hanging out of its mouth as the medic sprayed.

The dog dropped.

Disclaimer: no animals were harmed in the making of this post, the dogs blood pressure recovered by the time they left, unfortunately the medics shorts may never be the same.

I understand being excited (the scanner and supplies)

No holding c-spine is not rocket science, but without proof of proper training, that patient could turn around and say you were the reason he cant feel his legs (lawsuits suck).

If you were properly holding C-spine, how did you get him is pills?

I can forgive you giving the nitro, was it the right thing to give, no, did he ask for it yeah, did you know any better, no

The only thing that really irks me is that you ran from the scene when asked to stay, and I wonder why you would do that? Did you realize you did something wrong and wanted to avoid punishment? Was it lack of respect for the responding crews? Personally if I was one of the fire fighters you ran off on, and I saw you working a call even as a licensed EMT, I would have a chat with your supervisor. I dont think being a cowboy and then ducking responsibility for it would sound great for a future boss.

Everyone here has learned to take a spanking for doing (or saying) something less than bright, usually by one member in particular. Learnign to accept critique, even when harsh, is an important skill in EMS.

Listen and learn well young grasshopper

Dan

EMT

[FireEMT2009]

Firstresponder,

First off welcome to the city. I understand that it seems that everyone is out to tan your hide by their comments but it truly is not what it seems.

The reason they are being hard on you is because you practiced outside of your scope of practice and being in medic school I understand pharmacology and the human body and a mix of nitro and trauma is not a harmonious mix.

I would like to point out that I have been a firefighter for 4 years and an EMT for 3. I understand that you want to go help and save the world attitude, hell we all have had it. That attitude will give you a great drive in your EMS career and EMT school and I truly believe with proper training you will be a decent EMT.

Lawsuits, everyone is out for money, if this guy dies or has brain damage or something phyically or mentally wrong with him after this call due to your actions the family if not the patient will file a big lawsuit against you for doing something that is only done by trained personnel. And you will being paying them for the rest of your life. That being said, are you a certified first responder, or did you just place that as your credentials? I am not being sarcastic or smart ass just trying to figure out where your skill set starts from.

I understand that reading your EMT book earlier is a great way to prep yourself for class, but you still need proper instruction and training everything from C-Spine, to operations, to medication administration. Everything is done via building blocks. If you decide one day to become a medic you will understand how much of it is built upon your skills as an EMT.

In VA here you have to call medical control as a EMT-B to give any medication and you best know what it does, why you use it, what are the side effects, and what you can't use it with. Be careful with how aggressive you become, if you want to do some first responding, join a department and get some run time in with them as a observer and then work there through your EMT class ride time. It will help you become a better provider through the experience and street time that is ever so important.

Overall, learning the right way the first time is the best way, I would suggest next time to just listen into the call because I promise you that you will have some of these calls yourself where they are filled with adreniline or you will have a good samaratain come up and drive you crazy by their actions, its a part of this life.

Lastly, the people on this forum have 100s of years of experience combined and I trust their opinions and love to hear the inputs they have on my questions that I post, since I like you am still in school myself. Sit back and be able to let stuff roll of your back because somethings will be taken the wrong way by some people or it will not be meant like what it sounds like. Understand that the people here have more experience and knowledge than you do right now so they want to give you tough love so that when your an EMT you will fully understand why you shouldn't have done that. Its all for you and your patients best future.

I wish you luck on all of your EMS ventures and I hope to see you post further with better reports, updates on class, and other questions that we can help you with. We all want the best for you.

FireEMT2009

Edited October 6, 2011 by FireEMT2009

[HERBIE1]

Fun little story about Nitro, that I think illustrates a point. A paramedic in Ontario was attending to a patient with cardiac chest pain, and was going to admisiter a Nitro spray, to use a Nitro spray properly you spray it once to prime the pump to ensure a proper dose is admisitered to the patient, the paramedic primed the spray off to the side away from himself and the patient. Unfortunately the patients large dog came around the corner with its tongue hanging out of its mouth as the medic sprayed.

The dog dropped.

Disclaimer: no animals were harmed in the making of this post, the dogs blood pressure recovered by the time they left, unfortunately the medics shorts may never be the same.

I understand being excited (the scanner and supplies)

No holding c-spine is not rocket science, but without proof of proper training, that patient could turn around and say you were the reason he cant feel his legs (lawsuits suck).

If you were properly holding C-spine, how did you get him is pills?

I can forgive you giving the nitro, was it the right thing to give, no, did he ask for it yeah, did you know any better, no

The only thing that really irks me is that you ran from the scene when asked to stay, and I wonder why you would do that? Did you realize you did something wrong and wanted to avoid punishment? Was it lack of respect for the responding crews? Personally if I was one of the fire fighters you ran off on, and I saw you working a call even as a licensed EMT, I would have a chat with your supervisor. I dont think being a cowboy and then ducking responsibility for it would sound great for a future boss.

Everyone here has learned to take a spanking for doing (or saying) something less than bright, usually by one member in particular. Learnign to accept critique, even when harsh, is an important skill in EMS.

Listen and learn well young grasshopper

Dan

EMT

Dan- damn funny story about the dog! I'm also glad the pooch is OK.

I think I would have needed to change my drawers after that too. LMAO

[Asysin2leads]

FNG, I'm glad you came back and hope you'll stick around. I think you need a word of caution about this site. This site is fairly unique in that it has a high level of standards for EMS. Its really a collection of prehospital professionals, and we like to try and keep it that way. Our friend and colleague who recently passed helped to set that high standard.

You can Google a million and one EMS sites and find the same old pat on the back war stories that everyone has heard and everyone is sick of. They'll be the ones with the cool gear and the latest patches. This isn't that site and its why its the only EMS site I belong to. I even canceled my subscription to JEMS because I got tired of the nonsense on that site.

I read back the responses to your post and I really didn't see any name calling. Yes the responses were a bit harsh, but this real life. Every single profession in the world treats its subject matter with the same degree. If you don't believe me, go try arguing a point about structural steel with a group of ironworkers. It won't go well.

So you won't find anyone here who will tell you everything is okay when it isn't. But if you have a question, you'll get it answered. It may not be the answer you wanted, but I can tell you it will be right answer. So good luck and again I hope you'll stay.

[NYCEMS]

Actually the reason why we were hard on him is two fold.

he asked for criticism and we gave it.

He also gave 2 nitroglycerins to a trauma patient that if he was an EMT or even a first responder he would not have done that.

He opened himself up by putting himself on a pedestal of I've read the books and I know what to do. in Fact, he did not know what to do.

Giving the nitro's to the chest trauma patient may have cost that patient his life. So tell me why you think we were too hard on him?

I too believe that he's got some good years ahead of him with the enthusiasm that he shows but this also proves that a little bit of knowledge is a dangerous if not nearly fatal thing.

That's why we got on him, not because his heart was in the right place!.

Let me ask this question, if this was your father and he hit the tree, bent the steering wheel and a person came up who has read the emt books and has all that equipment in his car. He comes to your fathers aid and gives him two nitros when he has chest trauma, your father suffers an adverse effect from the giving of 2 nitros and either passes away or has lasting disability, would you just chalk his error to just being gung ho? Would you say "your heart was in the right place" or what would you say to this person?

I look at it this way. What's done is done now lets educate him to prevent him doing this again and possibly hurting himself or others not tear him down. He'll resent you for that and do whatever he wants. I'm not going to say " hey buddy good job". I'm going to say " you had good intentions but this is the proper way to do it". Then he'll know he can look for and accept help from someone who will listen. Is this a forum to trash those who respect and want to do what we do or are we here to advise with our experience and help each other out. I pray that all is well for that patient but one thing I'm sure off is that patient was happy to have someone with him during a serious situation and provide some comfort knowing he wasn't alone. You can't change the past but you can prevent it from happening again.