Skip to content

Archives for ems-topics

See all posts in the network tagged with ems-topics

BLS; remembered.

1 comment

BLS providers can make or break you. The opinion they have of you as a medic, usually negative, is one you’ll own through your entire career, unless you make an effort to change it.

I want to relate a few BLS/medic stories. There are instances when I’ve been in the EMT’s shoes working with a medic and others where I’ve been the Medic working with a BLS provider. It seems nobody ever talks about the calls that go smoothly, we all focus on the ones that went sideways with a quickness.

I was a new medic, but working as an EMT back in Washington as I waited for a full time paramedic spot to open with an agency that I had applied for. My partner and I were dispatched, along with fire and a county medic unit to a trailer park for a 60 something female with shortness of breath. When we arrived, there was a fire engine and a county medic unit parked in front of the house, so we walked up to the door to see if we could offer a hand, help with patient movement or fetch any equipment. As I stuck my head in the door, I saw an obese woman on a Rascal scooter, working hard to breath, with chugging and sloshing respirations that sounded like a washing machine from across the room. The paramedic looked up at me and said, “You can bring your bed to the door and we’ll walk her out.” Excuse me? This is a BLS call how? I looked back at him and said, “Really? She sounds ALS to me from across the room.” The medic gave me the stinkeye and sighed. It was obvious he wanted to turf this CHFer on me. No way. Not now, not eva. So, I sent my partner out to the medic unit to fetch the medic’s stretcher and watched the lead medic squirt 7 or 8 shots of nitro into this woman’s mouth. Oh yeah, his partner was digging around in the woman’s arm trying to get a line, without much luck. I asked him if he was going to start CPAP. “We don’t have CPAP” he said. He asked me if I could help them get her out to the medic unit. “Sure,” I said. “How about a stairchair?” Nope. Instead, he wanted to drive the patient on her Rascal scooter over to the door and have her walk down the short hallway and the 5 stairs to the carport to the waiting stretcher. Now, you should realize while this is going on, there are 3 firefighters, me and my partner, two medics, and a couple of family members in the living room of a single wide mobile home. It’s tight. It’s getting warm and I knew that we needed to get some people out to make room. I asked a couple of firefighters to grab the stairchair off my truck in case we needed it and help us move the patient to the stretcher. The patient’s daughter looked at me, “Ain’t no way mama gonna be able to take no steps.” I looked at the medic and he just said, “We’ll help her down.” Okay, your call. I’m just the EMT. As it turned out, the Rascal wouldn’t fit down the hallway, the patient was too fatigued to stand and we did need my stairchair to get her out. As we navigated the stairs, we needed to tilt the chair back a little to make it down. As we put the patient on the stretcher, it was obvious that she was even more fatigued, getting ready to quit breathing and was full to the brim. The medic looked at me and said, “Damn, you guys tipped her back, now I have to intubate her!” This is my fault? This medic was behind the 8 ball from the get go. We got the patient out into the the medic unit and as the lead medic started setting up for an RSI, the daughter came charging out of the house. She ran up to the side door of the medic unit and cried, “Mama! You okay in there?” The medic sitting at the head pushed her out of the truck and slammed the door. She looked at me and I realized I was going to have to explain what the medic was doing, how he was “going to make her sleepy and put a tube in her throat to help her breathe.” Now, remember, I was working for a private BLS service that was (and I’m sure still is) routinely treated like shit by the county medics and the fire department and I was the one that was having to explain to the hysterical daughter why the medics were tubing her mom.

I lost any respect I had for that medic system that day. I’d seen them do some shady BLS turfing in the past, and I’d been the victim of a few ALS turfs, but nothing as blatant as a frothy CHF patient. The customer service sucked. The patient care sucked. The whole experience left an awful taste in my mouth and I swore that I’d never be that kind of medic.

Here I am, a couple of years later, working in a busy, county based third service, having to deal with BLS providers every day, on every call. I look back at that call, and I still remember how disgusted I felt when I looked at the medic and watched his shoddy patient care. Was he having a bad day? Did he fight with his wife before the shift? Was he on overtime? Whatever was going on, it was not good and it will always be the memory of that service I take with me.

As a medic, I’ve been the guy that has ticked off a few BLS providers and I’m still learning how not to do that. I’ll tell you about a couple of my recent experiences as a medic dealing with BLS in the next post.

Posted by on October 1, 2011 • Filed under: EMS Topics

Looking…

6 comments

I’ve been thinking about new opportunities.

Taking on new challenges in a new place.

My gypsy soul is ready to settle and put down some roots.

It’s got to be a great place to live, in a warm climate, with outstanding private or third service paramedics. I’m not really interested in a fire/medic system. A forward thinking MPD and liberal protocols are a plus, too. Oh, if there’s a chance to get involved in EMS research and education, that’s an even bigger bonus.

Anyone have any ideas? Thoughts? Reviews on their own dream service? Let’s hear ‘em!

Posted by on February 17, 2011 • Filed under: EMS Topics

New Blogroll addition

1 comment

I’ve been rather remiss in adding new blogs to my reading list.  Hell, I’ve been busy, and I don’t get enogh sleep, the dog ate my laptop…

All excuses and none of them good.

So, I’m adding some new blogs to my reading list. First on the list is EMT-Medical Student. Good stuff. If you’re a newbie EMT or Medic and need healp writing SOAP reports, there’s some GREAT examples here, as well as other cool tips and tricks. the best line on this blog is this: “Act like a technician, be treated like a technician. Act like a professional, be treated like a professional.”

Nice work Joe!

I’ll be adding more in the near future, as soon as I can get the dog to hork my computer back up.

Posted by on February 8, 2011 • Filed under: EMS Topics

My Johnny and Roy moment

2 comments

Back in the early 80s’, when I was just a kid, I would rush home after school, grab some Chips Ahoy cookies, a glass of milk, and turn on Channel 38 from Boston to watch reruns of Emergency! After the crew from Station 51 wrapped up the day’s adventures, my friends and I would hit the streets to play paramedics in the neighborhood. Our bikes were shiny, red, two wheeled versions of Squad 51, my dad’s old fishing tackle box  the med kit. I always played Johnny and my partner in crime, Mike Petroski, took the role of the more stoic Roy. Mike’s younger brother Joey was invariably pressed into service as the patient. Our favorite “rescue” involved Joey, feigning unconsciousness, on the roof of the the Petroski’s garage. Perched on that roof in a raincoat and plastic fire helmet, in my mind I was far above the ground on an oil drilling rig, getting ready to rescue a roughneck that had a bad day. As Mike was busy strapping Joey to a chaise lounge lawn chair, our version of the stokes, I would yammer about “Sinus Rhythm” and “Ringer’s Lactate” into an old telephone handset that we carried in a lunchbox that my dad had spray painted orange.

One of the best parts of Emergency! was that all of the medical problems were quickly solved with an IV of D5W or a defib shock. “Rampart, we shocked the victim, he’s in sinus rhythm.” The guys showed up, worked as partners doing some paramedic stuff and BAM! The patient was better. These guys were super medics. Plus, they had a bitchin’ refinery fire or chemical plant explosion in every episode! But I digress.

Who knew that yesterday, almost 30 years later, I would have my own, real Johnny and Roy moment.

My partner and I were watching an amazing TV show about amazing wedding cakes on A&E when the tones dropped for an “unconscious and unresponsive” patient. We arrived at a nice house in an upper middle class neighborhood to find a 72 year old female who had suddenly become unconscious during a canasta game with her husband and another couple.

When I walked in, a couple of fire fighters were attempting to obtain a BP on a very gray, diaphoretic woman who was half slumped in a kitchen chair. Holy shit. This lady looked sick. Her husband, standing behind her, holding her up in the chair, looked scared to death. The woman could be aroused only with painful stimuli and would only answer yes or no questions with a mumbled “yuhhh” or “nuhhh”. “OK,” I said, “Let’s get her lying down.”

A couple of firefighters quickly got her on my cot, took a pressure, which was 50 over nothing, and hooked up the monitor. Sinus brady at 42. My partner got a line established and I pushed half a milligram of Atropine. I started a fluid bolus and about 4 or 5 minutes later she was pink, dry and alert, wondering why there were so many people in her kitchen and wondering why we were making such a fuss.

Yeah, that was the stuff. That was my Johnny and Roy moment. It was smooth and pretty. Like an Emergency! episode. Everyone worked as a team. The treatment was fast and appropriate, the patient improved, the family saw some efficient EMS, and we did it all in about 7 minutes before we were on the road for the hospital.

Thanks again to my partner. Unfortunately, you’ll never read this, but you are the reason I was able to be a good medic yesterday. I’m new and still learning and almost unconsciously, you worked as my right hand, doing the things I needed before I could ask you to do it. You helped me more than you’ll know.

I’m not Johnny. He’s not Roy. We’re not super medics by any stretch, but, we work pretty damn well as a team and we do good stuff. It’s not a man trapped in a well or a 5 alarm refinery fire, but I’ll take it.

I’ll take it.

Posted by on January 30, 2011 • Filed under: EMS Topics, paramedic, Partners

Cut loose

4 comments

The MPD finished looking over my last few PCRs and then stood up and shook my hand.

“You’re cut loose. Try not to kill to many people in your first few months.”

He was kidding… but he really wasn’t, if ya know what I mean.

That phrase, “cut loose”, still scares the hell out of me.

Let’s be honest. My paramedic course is far from a “patch factory”, and I finished at the top of the class, but I still feel woefully inadequate when it comes to dealing with complex patients. And I’ve been seeing a bunch of them at the ALS IFT job. My downtime is filled with looking up drugs, researching medical conditions and making notes on scratch paper and photocopying strips so I can buttonhole the doc and ask him about that something strange that I saw on the monitor.

There is still so much to learn. And it never ends.

And that’s pretty damn exciting.

In other news, I start a new full time job as a first out 911 medic tomorrow morning at 0800. Am I a little nervous? You bet. I’m going back to the busy service where I rode my last quarter of paramedic school and while I’ve got an advantage because I know the system and the docs, I’m still a wee bit nervous that I’m gonna screw up, and screw up big.

Luckily, I’ve got 240 hours of preceptor clearance time to work out the kinks and then I’ll be once again cut loose. On my own to sink or swim.

Unfortunately, I had to leave the full time resident position at UNFD to take this full time paramedic slot. All of the places I’ve been interviewing had told me that while volunteering at UNFD was a great thing, they would rather see full time experience in a high volume system. Alright! Ask and ye shall receive! You want me to run a lot of calls? You got it! I miss the fire stuff already, but I’m testing at several departments and with luck, I’ll land one of those coveted career firemedic slots. Fingers crossed.

My personal life is still a mess. I’m trying to get through it, but the holidays are rough. I hear a Christmas song in the mall and just fall apart. I know, it’s tough all over and I hate to write about it, but because you are here as my anonymous reader, I can say things here, in the privacy of blogland, that I just can’t bring myself to say to my friends or family. Frankly, it sucks. I miss my life, I miss my wife and home and dogs and I’d do anything to rewind a year and get it back.

Friends, I really miss the times when I’m able to write here. I miss the opportunity to spill my thoughts out onto a blank screen and I appreciate the comments and positive reinforcement that readers leave. Although, at times I feel like I’m screaming into a phone with no dial tone. Please let me know if you think I should keep doing this. I know I’ve been sporadic as of late, but I also know if anyone reads this, it’ll be motivation to stick with it and keep pouring it out on the keyboard.

Thanks for letting me vent.

Posted by on November 30, 2010 • Filed under: EMS Topics, paramedic

Learning…

2 comments

I’m a new medic. I’m still learning.

I learned that, contrary to what they taught us in medic school, you CAN push Adenosine through a 20g in a patients hand and convert SVT with only 6mg. Crazy stuff. My instructor told us that 6mg “never works”.

Guess what? It worked like a champ.

I also learned that I should be a little more aggressive with sedation when I manage vented patients. The 3mg/hr of Versed that was dripping into my patient when I picked him up at the ED to transfer him to another hospital wasn’t enough to keep him comfortable. Once I bolused him with another 2.5, he stopped bucking the tube. His son thanked me over and over at the ICU. “He’s been fighting that tube for hours. Thanks for giving him something.”

I learned that just having a Paramedic patch on my uniform doesn’t mean I know anything, even though people think I do.

I learned that really sick patients can scare me, and I need to be on my game.

My education is just beginning. The paramedic course was only scratching the surface. I will continue to learn.

I’ll never stop.

Posted by on October 25, 2010 • Filed under: EMS Topics

Lessons learned.

4 comments

Lesson #1- ALWAYS have that bougie out and ready! Lesson #2- Cric pressure is your best friend. Lesson #3- Suction, suction, suction.

I wake with a start when the red light in my bedroom flicks on and the tones blare from the overhead speaker.

“Medic 22 with Medic 11, upgraded ALS response for a traumatic fall…”

I hop from my warm bunk and stuff my feet into my still warm boots and walk out to the bay and climb in the medic unit. I settle in the back and put on my headset. The captain turns to look at me through the pass through.” This is for you, ya know. 11s doesn’t need the help, but they know we have a student so they called us in.”

As we speed down the quiet streets, the radio mutters updates in my headset. “Bagging the patient.” “We need your C-Spine gear.”

We show up to a mess. The patient is a 50ish year old guy who had either been assaulted or had a standing ground level fall. Either way, it doesn’t matter. He’s in bad shape. A mushy occipital fracture, decorticate posturing and an airway full of blood means he is getting a tube.

The medic on scene finished starting the IV, lookes up at me and asks, “Can you go set up my truck to RSI this guy?”
“He looks to be around 150 pounds?” I guess.
“Sounds about right.”

The firefighters get to work packaging the guy on a board while I run over to Medic 11 and grab the intubation roll. I set out a 7.5, a mac 3, and  pull the bougie from the airway cabinet and lay it within reach on the bench. Then I start drawing up the drugs. 140mg of Sux, 20 of Etomidate, the Vec, the Versed. I label all of the syringes and carefully place them in order on the counter next to the head of the stretcher. Suction? Set. Vent is out and plugged in. I am as ready as I’ll ever be.
The stretcher comes crashing and rolling into the back of the rig. The Captain is bagging, the guy is seizing. A firefighter I don’t know is holding the man’s arms to keep him from pulling the mask from his ruined face. 11′s medic asks me to get a BP as he pushes some benzos. As I pump up up the cuff I hear the medic tell my preceptor, “No, you can go, I’ll just take your student.”
Monitor on, pulse ox, capnography showing a good waveform.
Down the road we go. Blood everywhere. The suction thrums, slurping in the guy’s mouth.

The medic asks if I think I can get the tube. I tell him I’d give it a shot.
“This is going to be a hard one,” he says. “He’s got a bunch of facial trauma, his airway is full of blood, he’s in a C-collar…” He trails off, looking at me expectantly.
“Well, no time like the present,” I say.

He smiles as he pushes the Etomidate and Sux while I pick up the laryngoscope in my left hand.

Posted by on January 17, 2010 • Filed under: EMS Topics, paramedic

The prep for medic wanna-bes.

1 comment

I wrote a post the other day called “For future paramedic students” and made an offhand remark about acetylcholine and how important it was to know what the hell it is and what the hell it does.

A reader, Mistie, asked in the comment section, ” I’m a basic going to medic…any tips?”

Oh Mistie, do I have tips. Enough that I felt it warranted it own post, rather than just a reply in the comment section.

So, here’s the stuff you need to think about before you even apply to medic school.

Pre-education:

Unfortunately, today’s prerequisites for many medic programs are pretty lax. If you really want to succeed at paramedic school, and in turn be a well educated medic, you really need to go beyond the bare minimum of what is required.

If your paramedic program only requires that you complete a 5 credit A&P “survey”, you’re doing yourself a disservice. Take a FULL 10 credit A&P series. Of course, you must take a college level Bio prior to A&P. And here’s a big tip: Keep those books for reference. Don’t sell ‘em back! If you have time, take a chemistry and microbiology course, too. It’ll help. Trust me. And hey, if your college offers it, Pharmacology is a safe bet, too. (I didn’t take Pharm, and wish I did. I do plan to take Pharm as soon as medic school is finished.)

One item that often gets overlooked. Study skills. If you haven’t been at school for a while, your study skills may have gotten rusty. It’s vitally important that you have a good grasp on college level study techniques,  have good writing skills, completion of basic composition (English 101) and solid test taking skills.

Also, make sure you have a good grasp on basic math skills. The medical math portion of the paramedic program isn’t difficult, but many people have trouble with it. If you need remedial math help, get it now and get comfortable with multiplication, division, addition and subtraction. It’s really just basic algebra for drug doses. Conversion of weights and volumes and decimal conversion to fractions are essential. Practice it every day until it becomes second nature.

If you have poor study habits, now is the time to fix that. Get some help. The sheer volume of information that you’ll need to take in is amazing. Medic school isn’t like  a foreign history course, where you can cram for the exam and forget it all in a few weeks. This is information that you’ll need for the remainder of your career. It’s stuff you’ll put into practice every day on the job. It’s important stuff. You’ve got to comprehend the material when you study, and you need to remember it.

EMS Skills

There is a lot of debate about the time that you should work as an EMT before taking on medic school. I believe the length of time as an EMT should be dependent on the individual and vetted through scenario testing. If you’re a competent EMT, have good, solid BLS skills and are comfortable around patients, you’ve got a great foundation on which to build your paramedic skills and education. If the idea of simply talking to patients scares you, if you still fumble when you backboard or C-Collar a patient, maybe you need to spend more time building confidence and basic skills. I think a year on a busy BLS truck is a good foundation for “getting your sea legs” in EMS. But, that’s me. Everyone has a different opinion.

Balance/Wellness

This may be the hardest element to include in your “pre-paramedic” prep. It’s vitally important that you still have a life when you’re in medic school. Time with friends and family will allow you to decompress and keep you grounded. The wellness aspect should be an ongoing lifetime commitment. Make time to exercise, really focus on eating healthy and remember that YOU are number one. Without a well functioning body, you’re just going to be another broken down Paramedic with a sore back that wishes he or she worked out and focused on core strength before that devastating career ending injury.

I’m sure there more I could add to this, but I’ve got a cardiology quiz on Tuesday to study for, I’m still trying to fit more ER clinicals and work into my busy schedule then there are free days and the dogs are barking to go out.

If you’re planning to pursue a paramedic education path, I wish you the best of luck and I hope some of these tips help.

Posted by on November 14, 2009 • Filed under: EMS Topics, Training & Development, Uncategorized

A collection of thoughts, muddled.

5 comments

Not a collection of a muddled thoughts.

Instead, on display is a random collection of things that I’ve been noodling around for the last few days.

  • We made the decision. My wife took the job. We’re moving again. (Anyone want to buy a house in Seattle?)
  • Moving sucks. My wife is giving notice at her current job today. She is planning to be at the new job in mid November. Aggghhh. Lots to do. I will stay here, in the PNW, until June when my medic program ends. With luck, I’ll get hired at the new place. Yeah, that thought isn’t stressing me out at ALL. Neither is the idea that my best friend will be 2000 miles away for the next 8 months.
  • I think EMS 2.0 is a great idea, but I’m sick of all the chest thumping and dick swinging. “My idea for EMS reform is better than YOUR idea.” The truth is, EMS needs are different in every area, and not one model will be a universal fit. It’s going to take a long time for change to come about and the priority should be on educating the public about what EMS is and, more importantly, what it is not.
  • I did worse on that last quiz than I thought I did. I missed 12 questions. WHAT? Yep. 12. That sucks. The only light at the end of the tunnel? All of the quizzes in total are only worth 15% of the grade. And I’ve aced all of the others. Not something to stress over. So why am I stressed?
  • I picked my 3 choices for ALS ride time. The first choice is an agency that’s 80+ miles from home, but one of the buisiest. Go big or go home.
  • I hate flying. I’ve decided that airline travel, which used to be somewhat enjoyable, is now akin to riding an overloaded school bus in a third world county. Never before have I fell more like a sheep than I did on one of the flights I was on over the weekend. I hate being crammed in and treated like cargo.
  • Some of my classmates need to be smacked. The bravado and ‘supermedic mentality’ is starting to grind on me. I want a t shirt that says, “It’s less about the skills and more about the relationship.” Most of the fire monkeys that are in my class simply for the patch would look at me with disgust and call me a hand holder.
  • The is a person in my class that is on her THIRD run through the medic program. Why do they keep letting her in? As my Dad used to say, “You can’t polish a turd.”
  • I don’t know how I’m going to find any time to work between class, studying and clinicals. How do people do this?
Posted by on October 28, 2009 • Filed under: EMS Topics, paramedic, School

Busy, busy, busy.

3 comments

I’ve been swamped with school stuff, so here’s the quick update for all 3 readers.

1) I was checked off for field/OR intubations. Only 4 out of the 24 people in my class had technique good enough to be checked off this time around. Kinda scary. On a rubber “Fred the Head” it’s not all that difficult. It all changes out on the street. Feel free to read this blurb on Airway Management and some thoughts on medics NOT being allowed to intubate.

I don’t understand why some medics let their Ego eat their Brain. Frankly, if there’s something better and easier … I’m all for it. I don’t care if it’s an ETT or a King or a Combi. If it gets me a patent, secured airway, I’m all over it. Who I am is not tied to the skills I can perform. And yes, I feel if endotracheal intubation is going to remain in my scope of practice, I must be competent. If that means I need to get 12 good tubes a year, or continuing education, so be it.

2) I’m flying to a beautiful part of the country this weekend with my wife. She has a great job opportunity and the head honcho from company that wants to hire her wants to meet me, as well. So, they’re flying us in, putting us up and doing everything they can to make sure we like the place. Having been there before, I think we will. If she takes the job, I’ll stay here and finish school and sell the house.  By the way, the place we’re visiting has an outstanding Third Service EMS agency, and they’re looking for medics. So, that’s a BIG positive.

3) As part of the airway discussion mentioned above, the EMS 2.0 thing is fired up again and everybody in the blogoshpere is weighing in with their opinion. Where is EMS as a profession going? Some say MORE medics, some say fewer medics. Some say fewer skills for basics, others say more skills for basics. Up the educational requirements or keep them the same. Christ, it all makes my head hurt. I will, at some point soon, fully weigh in with my take on where EMS should go … after all, I am one of the “soon to be new medics that will be working to drive the process forward.” I just don’t have the time to do it now. I’m working on committing drugs and dosages to memory, and that’s a little more important.

4) I’m picking my agencies for ride alongs next week. I’ll let you know how that goes, too.

Posted by on October 23, 2009 • Filed under: EMS Topics, Patient Management

Well, here we are!

4 comments

Ahhhh. Smell that? It’s the scent of a fresh blog. Mmmmm. Smells delicious.

Welcome to the new “Medic 22″, formerly “Medic 7″. (But, you knew that.)

I’m stoked to be here. It really is pretty cool to have been invited to move to FireEMSblogs.com along with some of the other folks that will be publishing here. Lots of the people I respect and read everyday are now part of the family over here. Firegeezer, Happy Medic and 999Medic especially. It’s going to be a great, vibrant community of bloggers. I’m excited to be a part of it.

Anyway, what’s going in in my world? Glad you asked.  Medic School is non stop. And by that, I mean it’s full on, no holds barred information overload. You may have read my post below extolling the virtues of flashcards. They have really paid off! Three quizzes in, I’m kicking ass. I haven’t missed more than 2 or 3 questions per quiz, and that’s significantly better than most of my classmates. Some of the guys in my class now study with me and my cards at lunch everyday. It’s really amazing how well you can soak up information when it’s in little bite sized chunks. And that’s the best way to deal with pathophisology. Small bite sized chunks.

We’ve put a lot of tubes in Fred the Head. Like 150 each. There’s many training heads, and the instructors want us to learn perfect technique so we don’t walk into the OR and fumble through our tubes. Every moment we’re not doing something else, we’re supposed to have a laryngoscope in our hand, putting tubes in. Our partners watch like hawks. Every now and then, from across the room, you’ll hear a whispered, “You’re on the teeth!”

small digitalThis is my lab partner, digitally intubating Fred. He was not happy.

As far as life on the ambulance, I haven’t worked much in the past few weeks. I’ve been busy studying and trying to spend some time with my wife when I can. Luckily, the scheduling folks at OAC understand and they’re very cool with me working when I can. I’m on a 13 hour day car tomorrow, so I’m sure I’ll be working an interesting mix of IFT and fire calls. If anything groovy happens, I’ll make sure to blog about it.

In the meantime, it’s back to my pharm flash cards and the memorization game of dosages, names and contraindications.

Posted by on October 16, 2009 • Filed under: EMS Topics, Training & Development