Question on traction spints

[paramedicmike]

Classroom theory isn't the issue in question...it's applying it situation and figuring out which is a bigger risk (laceration/infection).

If you don't have the theory, you can't apply it in the field. Unfortunately, there are too many providers out there applying in the field information and eductional theory they don't possess. Is that the kind of provider you want taking care of you?

The largest issue facing EMS right now is lack of education. Having an education lends credibility to your position in an argument. "One time in band camp" stories are neither educational or authoritative by any means and should carry little, if any, weight.

I'm just a new (in EMS that is), so take it for what it's worth.

Which I think is part of the larger issue. It's not a matter of "how is all that book learning going to help me start that IV better?". It's a matter of, "I'm well aware of not only the infection potential that exists in this compound femur situation but also the surgical considerations once we get to the hospital. However, since I know that he has 12 bullet holes in his chest and belly, I'm going to ignore this compound femur for right now."

If you're not thinking about what you're doing and why, you're hurting your patient and the industry as a whole. The only way to get around that is education. What's more, field experience comes with time. It can't be learned by anyone out of a book. That goes for EMS, nursing and yes, even being a doctor. If you know the theory, the transition to the field will be much easier than if you're just trying to wing it based on training six hours a week for three months.

And yes, decaf is good. But maybe that's the problem here. Maybe someone switched to decaf and that's why the guy's so edgy!

I smell a closed thread coming on.

-be safe

[paramedicmike]

Good luck in future endeavors!! Remember my friend, we are all human, and nobody is perfect!! We need to learn from each other, leave your attitude back in the rear with the gear micro-boy!!

Wow! Now you've resorted to name calling and further derogatory comments. Isn't this the pot calling the kettle black?

Regardless, it's merely the sign of a defeated individual. Perhaps you can learn from what you've posted yourself.

It's great that you're passionate about your work and the care you provide to your patients. But if this is how you handle your industry level discussions I'd hate to see your bedside manner.

-be safe.

[akflightmedic]

I am still laughing at "the most horrifying death scream" comment. I find that overly dramatic and imagine it comes from someone who has NOT taken care of femur fxs. Yes it is painful and yes I have treated many including most recently an 8 year old girl that fx her femur on a trampoline, but never have I heard the horrifying death scream. All she did was whimper and cry a little.

[AnthonyM83]

If you don't have the theory, you can't apply it in the field. Unfortunately, there are too many providers out there applying in the field information and eductional theory they don't possess. Is that the kind of provider you want taking care of you?

Agreed. Refer to my posts where I acknowledge classroom theory, but say it's not the issue in this specific discussion or the quality to bring up about yourself in such a discussion. Of course you need theory, but I see application/common sense in the field as the rate limiting factor so to speak.

[paramedicmike]

Agreed. Refer to my posts where I acknowledge classroom theory, but say it's not the issue in this specific discussion or the quality to bring up about yourself in such a discussion. Of course you need theory, but I see application/common sense in the field as the rate limiting factor so to speak.

I disagree. If I contribute to a conversation with a "One time at band camp" moment and I'm countered by someone who can legitimately say, "No, in school I learned this..." I lose the debate. Why? Because education trumps hearsay. And if that card needs to be played in order to have correct information played into the discussion then so be it.

Can it come across as snotty (which sounds like more what you're concerned about)? Yes it can. But otherwise, you have a bunch of uneducated buffoons standing around telling stories about all the whacker calls they did back in the day before people knew any better. Unfortunately, too many people in EMS still fall into this category.

Is common sense important? Yes. I don't deny that. However, there is a difference between uneducated "common sense" and educated "common sense". Many times, especially in health care, the difference between the two can mean drastic differences in patient outcome. And if it takes someone pulling the educational trump card out of his wallet to get the idea across then more power to him (or her).

-be safe

[Asysin2leads]

Firefighter, good luck with your endeavours, and I'm glad you are going to school. I honestly think you do need a little therapy though, because you seem to be having some problems adjusting to civilian life. Relax. I'm sure you hold traction just fine, no one is saying you're necessarily wrong. I think you might have some issues that are far more complicated to work out then a busted leg, but its okay. You know, I could be my normal wiseass self and put in my $.02 about the "horrifying death scream", but the truth of the matter is I just don't have the heart too, because I really feel bad for you firefighter, just by reading your posts I can see you have some real issues. EMS will always be there, but if you continue to use it as a way to hide from your demons, its just going to get worse. Face your problems, deal with them, then approach EMS, you'll find you will be a much happier individual.

[Scaramedic]

I am still laughing at "the most horrifying death scream" comment. I find that overly dramatic and imagine it comes from someone who has NOT taken care of femur fxs. Yes it is painful and yes I have treated many including most recently an 8 year old girl that fx her femur on a trampoline, but never have I heard the horrifying death scream. All she did was whimper and cry a little.

Ummm I agree with AK on this one. I have never heard the "death scream" from a patient with real injuries, that tends to be the domain of the drama Queen or King. Patients with truly severe/critical injuries like an open Femur fracture tend to be too weak or in too much pain for a nice big dramatic television scream. People in severe pain tend to grunt and moan not scream at the top of their lungs.

Which brings me to another point, Firefighter dude you say your patients are in pain and need traction to ease the pain. Do you not carry analgesics on your unit? I have multiple forms of pain control available to me. My patients should never be in extreme pain unless they are shocky and I am unable to provide analgesics, even then their LOC tends to be down and they are not registering pain to the degree you specify.

As far as traction on an open femur goes I tend to agree that if their is good distal PMS I would leave it as is. There IS a risk of further infection if you drag "dirty" bone ends back into the body. The same theory applies to eviscerations, do you jam the bowel back into the body or do you cover it with moist sterile dressings? Once again this is a common sense issue to me, common sense what a concept.

Let me continue with a point someone else made, the issue of would you even treat a open femur fracture in the face of other injuries? The femurs are some of the strongest bones in the body, to actually fracture a femur requires a ton of kinetic energy. That does not even take into account the energy required to push those bones thru the muscles of the thighs and cause an open fracture. So if you are dealing with an open femur you probably have even more severe injuries to deal with, such as a pelvic fracture which would rule out traction anyway.

Finally, what is with all the anger Firefighter? DO NOT make me quote Master Yoda again, you know how he feels about anger. :wink:

[Ridryder 911]

Okay... I agree too of not hearing "death screams" with femur fractures; in fact I suggest if one wants to really hear "death screams" go visit a ortho ward of patients with osteomyletitis and post amputations.... then come and tell me about what screams are like. I agree with ER Doc and use local guidelines. Each case should be evaluated on individual basis.

I respect the military and the personal... but, it is not civilian nor are the standards the same. They are trained for specific tasks and do well at those tasks, but are trained not to question or divert from standards and protocols. The difference is as well is difference in patient make up, diverse medical care needed and as well as potential litigation which mandates most of our care.

Now, for experience it is nice and yes, needed. But, it does not matter what experience one has if they are performing it wrong or unaware they are and continue.

I am sure everyone will agree that EMS needs education, not training. Yes, collegiate level should be the entry level. One might remember even those with little or no experience are still called Dr. (physician) and can dictate what you can do or not able to do... no matter, what the experience one has. So yes, education is far more valuable than experience, and one can always get experience after obtaining their education level.

Experience, where and how is all relative. Twelve years in comparison could be substantial or little, dependent again on how it was obtained.

R/r 911

[ERDoc]

Experience, where and how is all relative. Twelve years in comparison could be substantial or little, dependent again on how it was obtained.

Experience is what you gain after a mistake is made (hopefully not yours).

-Heard during medical school

[Ridryder 911]

Experience is what you gain after a mistake is made (hopefully not yours).

-Heard during medical school

So True !!

Negligence is continuing or repeating to make those same mistakes again...

R/r 911