Riblett

Peppermint oil works really well for me. Vicks Vapor rub works okay for preventing the gag, but for me it doesn't work if I have already started gagging. For some reason the smell and taste of it kills my gag reflex. You can carry as small bottle in your pocket. Just make sure you don't use undiluted peppermint oil on your skin, because it really burns. You can get a tin of lip balm (Carmex, etc) and mix in the peppermint oil. Then just rub it on your lips and under your nose. You will have to experiment with the strength (more or less oil mixed in) that works for you.

Thanks to everyone for their feedback so far. I would like to clarify a few things. I am not really sure why I feel this way. I have never been uncomfortable around the deceased on scenes (which was the limit of my exposure to them) before. It is not the same sort of childish fear you have of the dark. I am not laying there afraid they are coming out to get me or anything silly like that. It is not even really fear, more of an uncomfortable feeling. But I certainly think maturity is a factor here. And it is certainly not that I do not respect the dead. I can see your point AK, and why you might get that impression, but I disagree. I believe that I have the utmost respect for the dead and their families. I have many times tried to make a patient more presentable after death to make things easier on the family to view them. I had zero uneasiness and never thought twice about it. This uneasiness applies only to bringing them back to the station and sharing the facility with them for what is usually the rest of my shift. Perhaps separate myself was the wrong choice of words. I guess maybe having difficulty turning my mind off from the call is a better explanation. It is much more difficult to get away from the what-if's when the body is in the next room for the rest of your shift. The sense of uneasiness is exponentially increased it if was my patient. If I was not involved in their care, it is like I know they are there and I don't really like it, but I just try not to think about it. In the county I started out working EMS, once death was determined we turned the scene over to law enforcement and left. A separate service came in and bagged, tagged, and transported. For many of you older and more experienced medics, you have dealt with post-mortem issues since the start of your career. You knew from day one that it was part of the job. Like you said, some of you real Johnnies and Roys started out when EMS was breaking away from the funeral home services. This sort of thing was never really a part of my job until now. That is not to say that it should or shouldn't be, just that it wasn't. And all the sudden not only do I have to bag & tag, but transport them in my rig back to my station. So this is completely new to me. You are right with the fact that I am indeed not used to them in what I consider to be 'my space'. Perhaps I am trying to make this all about me when it really should not be. Considering my word choice of "I have to transport them in my rig back to my station." I am willing to entertain all possibilities. Perhaps a better dissociative mechanism will come with more experience. Throwing a hissy fit and say that I am not going to deal with this is simply not an option for me, personally or professionally. This is really my first real setback like this so far. Besides a moderate dislike for childbirth, I never had any aversions or weak stomach issues. When my fellow medic students were learning to deal with blood, needles, trauma, death, chaotic scenes, etc, I was happily waiting for graduation. As far as AK's question about why the trauma arrest incident from a few years ago bothers me, I don't really have an answer. I did not work there until a couple years later, but the stigma is harsh and lives on. For a long time after the incident when I told people where I work, there was the only half-joking question of "Did you put any live folks in body bags lately?" Maybe a factor, maybe not.

Our main station is a medium sized station with two bays, small living quarters, supply area, and two small offices. A few months ago the county added on to the building a temporary mortuary holding area. It houses a two body fridge. Bodies are placed there temporarily from the scene. They are later are moved either to the funeral home or the medical examiners office in the neighboring county. The two ambulance bays separate the living quarters from the morgue and the adjacent supply room. I am not trying to be funny, but I really find this disturbing. Maybe I am still immature, but I just plain don't like sharing my station with the mortuary. It creeps me out, for lack of a better description. I don't like going into the supply room or even the bays at night alone. It is not like being based at a big hospital with a morgue across the hospital or in the basement. It is especially psychologically disturbing to have a bad a trauma arrest, then have to bring them back to your station with you and stay there with the person. I don't feel like I have any real closure from these calls. I can't separate myself from them when the call is over. Sleeping on those nights just doesn't happen. I have never been afraid of dead bodies. I have been around them, worked on them in resuscitation efforts, and put them in the body bags. I have seen several autopsy videos in paramedic school, which did not bother me in the slightest. I can't explain it, but something changes (at least in my mind) after death is determined and resuscitative efforts have ceased. It just isn't the same as working a code on a newly dead person. I learned in my psych courses that most humans have an innate aversion to the dead, thought to be left over evolutionary programming to avoid the spread of disease. I have no other explanation for feeling like this. I really hate going to work at this station. I have nightmares about it. I may have to find another job because of this, and I have been working here for almost two years. To make matters worse, several years ago there was an incident with this agency where a trauma arrest was later determined not to be dead (no jokes or details please). Long story short it was very dramatic and completely changed the lives of the medics involved. I was not involved, but those who were have to deal with that every day and are still haunted by it. The mortuary facility here is especially disturbing to them, as they are constantly questioning if the body in the next room is possibly still alive while they are trying to go to sleep. Does anyone want to weigh in on this situation? Any advice or similar experiences? Am I blowing this out of proportion? Should I run off and get a psychiatric evaluation or something?

Age can be troublesome in this profession. Understand that not all EMS partners are like this, and most treat their partners decently regardless of age, sex, or experience level. I took the EMT-B exam and sat for the state exam at age 17. They sent me my cert a few weeks after my 18th birthday. I am now a 21 year-old paramedic, so I feel your pain. The good news is that most of your co-workers will respect you once they see that you know your stuff and can do your job. You might have to work a little harder to earn that respect than say someone 15 years older would, even with the same level of experience. So study as much as you can, and don't be seen at work in front of the TV even after all the station duties are done. Pull out your textbooks and read/study. And that should not change even after you get the EMT-P after your name. Hitting the gym helps too, because if you can't lift then you can't do your job no matter how smart you are. Everybody has difficult partners at some point in their EMS career. Take it as experience and try to learn from it. Not encouraging you to be abbrasive, but you could tell him that his closed mindedness and prejudice are exactly the kind of thinking that sets this profession back to blue collar.

Okay everyone, OP here. I appreciate you all entertaining the idea of emergency field cesareans. Some of the discussion was very productive and discussed some issues I don't think many of us had thought about. But in the rural county I work, MC won't even give us orders to hang a Mag drip for a severe asthmatic, despite the long transport times. Everyone (including the MC docs) is scared out of their minds since a few of our medics made national news for putting a trauma patient (who turned out to be alive) in a body bag a few years ago. They sure as hell are not going to authorize a field c-section. So lets get back to the original questions. Assuming the mother would be receivig full ACLS enroute, which hospital would be the best choice for both mother and baby? Is this patient a candidate for helicopter transport? How would you choices change if the arrest was traumatic in nature?

Great points ER doc. I was hoping you and Dust both would weigh in. So you would advocate a trip to the community ED (choice #1) I assume? Our protocols are not specific for this situation; they just say treat the mother per appropriate protocol, immediate notification to medical control, and immediate rapid tranport.

Option 1, the community hospital ED has basic neonatal resuscitaton capabilities. They don't have any more equipment than you have in your peds bag, except for Lab capabilities. Technically, since they are and ED they should be able to stabilize all patients while transport is being arranged. But what is stabilization for this patient? Can and will they do it. There is no apparent cause for the arrest when you are making your decision to transport. Which hospital is the best choice? This is nt a trick question...I really don't know.

Good question Fiz, The local community hospital is a very small ED with 14 beds and 1 MD. THey have always thrown a fit if you bring anything OB to them. There are no OB/GYN docs or dedicated facilities. They also transfer any and all pediatric patients if they have more than a simply stitchable lac, simple fracture, or the sniffles. They rarely if ever give any blood or blood products in the ED. Any remotely significant trauma gets transferred out. It seem to me that all they really need for an emergency c-section is a scalpel and an MD.

So I propose the following question regarding a sudden cardiac arrest of a pregnant female in the rural setting. Pt is anywhere from 24-40 weeks gestation in a witnessed cardiac arrest. You obviously do not spend anytime on scene working it, so it is time to make the hospital choice. You have three options: 1. Take her to the local community hospital ED that is less than ten minutes away. They have no OB capability, no NICU/PICU. 2. Take her to the hospital in the border county to the north, about 20-25 min drive hauling ass. Their ED is nothing special, they don't have a NICU/PICU, but they have full OB capabilities. 3. Take her to the hospital in the border county to the south, about a 25-30 min drive hauling ass. They are a level one trauma center, pediatric specialty ED, full OB capabilities, full NICU/PICU. Which hospital would you choose and why? How would your decision change if the arrest was traumatic in nature? Is use of a helicopter appropriate?

Very nice to have someone from another European country. We have some from Germany and the Netherlands. I think you are the only one from Switzerland. So could you tell us what roles the Notartzen play within the Swiss system? Also, please tell us more about the Krankenpfleger specialization. What can they do, what is their training, etc? http://www.emtcity.com/phpBB2/viewtopic.php?t=12370 These are some questions I posted about the German EMS system on another section.

Like I said in my OP, I very rarely encounter any problems. The closest thing to sexism I have experienced is the occasional tendency for some of my patients to talk past me to my male partner or the fire department while I am trying to interview them and trying to ask my male counterparts questions instead of me. I provided this example to get the discussion moving and it seemed to work pretty well. Personally, I hit the gym several times a week and can lift on the ambulance w/o any problems for all but the most obese patients (thanks to convalescent in my first year with just me and my partner). Sometimes if I am on one of the higher trucks (chest level for me) it is hard for me to lift a larger patient into the truck. As far as my paper is concerned, I am addressing Nurses, MD's, and EMS. I did an interview with a male ER nurse at our local ED, and a female doc I know. By the way, does anyone know how to properly cite postings on an EMS forum?

I am writing a paper on sexism in the healthcare field (I didn't pick the topic) and wanted to get some feedback on experiences from female providers, especially medics. Guys feel free to weigh in as well. I have rarely encountered anything direct. I have found that more often than not I have trouble getting a patient to talk with me initially. Most of them, especially among the older population will go right past me and try to talk to my male partner or the guys on the fire department. This could just be my perspective or it could be attributed to my age (21) and small stature. But I see the same thing with my older female collegues. Most of the time I just brush it off. But I have, particularly in my more abrasive days, been tempted to say "Hey, do you see my paramedic patch and badge? Yeah, I'm the medic (or intermediate in the past) so quick trying to explain your in depth cardiac history to the firemen or my green EMT partner, because their eyes glazed over a long time ago!" I have also noticed that this does not happen just among the older population, but even among the younger female patients. I see this even with college students; and you know those "Women's Studies" courses have been filling their head with the idea that sexism is rampant, women struggle constantly, every one is equal, etc. So everyone feel free to weigh in on your experiences, why you think this is, and how/if you try to combat it. If you would rather not post, PM me.

Anthony, I have noticed the same thing among my few frequent sickle cell patients. One in particular, a 23 y/o male calls very frequently and wants to be taken to Duke (over an hour away) instead of the smaller community hospital. He says that "they don't do anything for me" at the community ED. This kid is a chronic caller and usually when he calls it has been progressively worsening for several days. The local ED has the same docs all the time and most of them are old and well seasoned. I think they are kind of stingy with the pain meds. But at Duke, a well known university/teaching hospital, there are fresh white coats (interns/residents) who are quick to give drugs every chance they get. Maybe you can advise us on this ERDoc, but would there really be any harm having a family member drive him if he doesn't want to go to the local ED? I am thinking just from a system availability perspective, since we are out of service for a long time with this and this is not an acute thing. And the kid has a ton of narcotics at home. I can see him needing pain control, but if his codiene, oxycontin, oxycodone, phenergan, etc is not working, what good is my little bit of morphine really going to do?

Kick ass Matt!

We use the IN route for Versed and Narcan. I have given Narcan by the IN route one time and it did not seem to work very well for me. Also, a lot of it seemed to run out of her nose rather than staying in and working. I may have pushed the plunger too quickly. We finally did get an IV in this patient about 10 minutes after giving 4mg IN (2mg per nostril) and gave 2mg IV Narcan, which seemed to work. Does anyone know what sort of onset we should be expecting? I suppose it may have just been taking a while to work, and when I gave her the IV Narcan it worked right away so we did not see the actual end results. I can see how IN would be a great route on a seizing or psychotic patient, rather than risking an needle stick. A little aside here, I did shoot Sprite up my co-worker's nose using the atomizer during training just for fun. I thought I was going to have to give her some Versed, cause she freaked, despite the fact it was her idea.

Hi Matt, I think the focus for the APPs, as far as intubation is concerned, would be the ability to RSI. This is currently not part of the Wake Co EMS protocols. It has been my experience thus far (for better or worse), that the tube is always done by the newbie with the presumption that they need the skill. If they are unwilling or unable the more experienced tech will do it.

Ha Ha. No offense intended for the poster, but that "idiot" as he was so eloquently referred to, would be Dr Brent Myers. Dr Myers is, in my opinion, one of the greatest emergency physicians to ever carry the title. He also probably the most EMS-friendly, clinically and professionally supportive medical directors in this country. He is personally involved in the education of all technicians within the Wake EMS system, and I don't mean as a pencil pusher. He personally makes sure each and every ALS practitioner working in his system is competent to his standards, which are far above the state or even national level. As a Medical Director who absolutely abhors cook book paramedicine, he teaches his own monthly continuing education for those of us within the Wake EMS System. The man is so dedicated that he is out on his "MD-1" QRV unit checking in on calls and assisting his paramedics and EMTs. And he consistently shows us that he does not believe any task is below him in the field. I will admit that his APP program still has some kinks to be worked out, what new program doesn't? But from seeing the list of his 15 or so medics that he selected for this project, it already has a really good start. Just like the fact that all EMS practitioners should be Nationally Registered Paramedics, with 4 year degrees, and adhere to the utmost highest level of clinical competence, all paramedics should indeed be trained to this Wake EMS APP standard. But the reality is, we are not. Not here, probably not really anywhere. But give the man some credit for having a vision, reaching for a higher standard, and attempting to advance the profession.

We all need a change sometimes, and we would love to have you here in Wake County. My agency is looking for new paramedics. PM me if you want to know more about our county and area.

Full time at Wayne? Kick ass!

This is a regular day at this facility. As far as the staffing goes. And Ruff, the foley thing is true for like 90% of my patients in nursing homes, but the lady did not even have a foley. That was what was so fishy about it. How would the staff have even known her urine was cloudy? I don't understand why nursing homes are allowed to get away with using EMS as a taxi and using the ER as their patient dumping grounds. Is there anything that can be done about it?

Here is the scenario: You are called to the local nursing home for a sick call, emergency traffic. (You know the type of nursing home, where the residents can be smelled from the front door, no one knows anything about any of the patients, and every staff member just magically arrived at work even at three am. Every patient "just got der." Every nurse is "from dee odda hall." And every patient "ees not my patient." Ok I made my point.) So you stand at the front door for about 10 minutes. You are starting to wonder, if this was such an emergency that warranted a 911 call and an emergency response, why is no one waiting for you or even coming to the door? When you finally get inside the staff members are sitting around watching CSI Miami and don't seem to know who called you. Finally after a long phone conversation in what sounds like some strange variation of French, they tell you to go to room 303. You have been on scene for about 15 minutes and still have no idea who/where the patient is or what the problem is. You find a generally well-looking lady sitting in her room watching TV. The nurse aide (or whatever she is) tells you that the patient has had cloudy urine and needs to go to the emergency room. With your best attempt at a straight face you ask if that is why she called 911. Yes. No other symptoms/complaints? Nope, just cloudy urine. Ths little old lady says she does not need to go the hospital, and that she is "just fine thank you very much." In fact, she says she is down right not going and the nurse aide proceeds to tell you that the doctor ordered it "so she has to go." Great. Right about now you are wishing you were still had your icecream you were eating before this call went out. This lady is fully dressed, ambulatory, and seems to be pretty competent, but she can't seem to tell you the exact year. You look down at her paperwork under the medical history section finding little more than some hypertension, high cholesterol, and then you see the magic word: dementia. What now? Here is the rant: Ok, seriously, why are you here? I have no problem helping people who need/want my help. Gone are my days of wanting to run all the codes and traumas. But this seems ridiculous, especially when there is a shortage of units to start with. The lady has no complaints and the supposedly ambulance-worthy symptom is certainly not an emergency. Especially considering there are zero associated complaints, no fever, no mental status changes etc. This patient probably has a urinary tract infection. But what she needs is a urinalysis to confirm it, and some antibiotics. Why this can't be done at the nursing home I don't understand. Maybe someone can enlighten me. What exactly warrants an ER visit? Or even a 911 call? Do the primary care doctors ever actually see these patients? A urine test and phone order by the MD for some Bactrim or Septra seems like a logical solution. Or even a next day doctors appointment would do. If this lady is taken to the ER she will be using an ambulance that someone else may need. And she will be taking up a ED bed for several hours which is sorely needed by other patients. Then another ambulance will be called to take her back to the nursing home, even though she is perfectly ambulatory because there is no other way for her to get back in the wee hours of the morning. Maybe I have been reading my grad student co-worker's Healthcare Economics textbook too much, but this seems ridiculous. From a financial perspective this unnecessary ambulance ride is going to cost about $500. Then the ER bill will be anywhere from $3000 to $5000 or more. And the inevitable ambulance ride back will be at least $300. And Medicare will be footing the bill. With this being done around the country hundreds of times a day the country's health care debt is looking more and more like a black hole. Where does it end? When do we start telling nursing homes to stop using EMS as a taxi and the ED as a 24 hour patient dumping ground for even the most minute issues? EMS seems to be the first link in the chain. I won't lie and say I did not get irritated. I did try to explain why they should not have called 911 for this. I tried to explain to this very dense nurse aide that first off, if she needed a routine transfer done she should have called one of the several contracted BLS ambulance services serving the area. Her response, "a ambalanz be ambalanz." My response, "Um no, an ambulanz do not be an amblanz." and told her why. Secondly, sending this lady to the ER for this was probably a little over the top. A next day doctors appointment would certainly suffice. Some would say it is not my job to educate her about this, that I should have just taken this lady to the hospital (which I did). But what I want to know is, whose job is it? Because they are certainly not doing it.

Hi everyone. First of all let me say... I passed the paramedic exam! I am done with my degree and totally thrilled! Next stop is nursing school. I am still undecided about what branch of nursing, but I would really like to go to UNC Chapel Hill. At this point it appears I have a pretty good shot at getting in. UNC wants all BSN students to spend their last summer the program abroad. You can go anywhere, but you have to be working with RN's or their equivalent. I would like an internship where I could integrated nursing and EMS. At this point Germany is looking like a good choice. My understanding is that in South Germany nurses are part of the EMS system also. I guess it could be called MICN. Any European country would be great, but I only speak English and German. I would just need to do some ride-alongs for about 8 weeks. I would handle my own accommodations, travel, etc. If any of our European members could point me in the right direction. If any of the agencies you know would be able to participate in something like this. This would be Summer of 2011. Long ways away, just looking for ideas at this point.

I hope that SOB who did this burned to death slowly and very painfully. If not, string him up by his gonads, throw rocks at him, strangle him slowly. Tie him up and throw him in boiling oil. No judge, no jury, just kill him. What sort of low life could be capable of committing such an atrocity? No forgiveness, no mercy.

MAPLEWOOD, Mo. — Firefighters became victims of what appeared to be an ambush Monday when they were fired upon from a house as they worked to put out a vehicle fire across the street, police said. One young firefighter was killed, two police officers were wounded and the house where the shots were fired later burned to the ground. It was unclear Monday afternoon whether the gunman died in the house fire; authorities were searching the remains of the brick bungalow, St. Louis County police spokeswoman Tracy Panus said. Little was known about the man who lived in the house in Maplewood, a suburb just southwest of St. Louis. Neighbors described him as quiet and reclusive. Someone began firing shots from the house when firefighters arrived in response to a 5:40 a.m. report of a pickup truck fire. The city identified the slain firefighter as 22-year-old Ryan Hummert, son of former Maplewood Mayor Andy Hummert. Officials said he was shot to death as he got off the fire truck. The firefighter had graduated from paramedic training in August and from the fire academy in March. "He had been with the fire department for only 10 months but knew it was his calling," Fire Chief Terry Merrell said as he fought back tears. "It's impossible to say in words the emotion and pain we are feeling right now." A Maplewood police officer was treated for a shoulder wound that was not considered life-threatening, St. Mary's Hospital spokesman Eric Clark said. There was no immediate word on the condition of the other wounded police officer, who was taken to another hospital. Police evacuated some nearby homes - using armored vehicles in some cases - as dozens of officers surrounded the house. "They knocked on my door - bam, bam!" said neighbor Joanna Bedford, who was asleep when police arrived. "They said, 'Let's go. Go right now!'" The house caught fire later in the morning. Police rifles stayed pointed at the house as smoke poured from it, but authorities saw no one leave the building before it burned to the ground. By the afternoon, the house had collapsed, Panus said, and police were using heavy equipment to sort through the debris. A neighboring home also was damaged by the fire. Peter McCreary, a St. Louis County police chaplain, said his mother lives across the street. The burning truck was in her driveway, but it wasn't hers and she didn't know how it got there. McCreary said his mother, 81-year-old Julia McCreary, awoke to what she thought was a backfiring vehicle. It turned out to be gunfire. Soon thereafter, police arrived and took her out a back door, carrying her over a fence to safety. Julia McCreary told her son that in the two years she lived in the house she had waved to the man, but that he never spoke to her. Sanyoz Rai, who works at a 7-Eleven store nearby, said he heard three or four shots around 5:45 a.m., then saw a police officer go to the ground holding his shoulder. Rai said he then saw a firefighter on the ground behind the truck. He said the body remained there for an hour before authorities could get close enough to remove it. Black and purple bunting was placed around Maplewood City Hall, where people cried and hugged each other and the flag was lowered to half-staff. "I can't believe someone would do this," said 9-year-old son Nathan Manestar, who came with his mother and brother to place flowers at the base of the flagpole. http://www.wral.com/news/national_world/na.../story/3244130/

http://www.newsobserver.com/news/johnston/story/1117474.html