Riblett

Well, lots of my co-workers had to quit smoking this year because the medical director outlawed smoking at all hospitals and EMS stations. Lots of people have had great luck with the Chantix, with minimal side effects. They were handing scripts for it out like candy over the summer for EMS workers. Another one of the female paramedics went to a chiropractor for smoking cessation treatment and she stopped cold turkey, after smoking for five years. I don't understand how or why that works but she swears it worked. Good luck with your efforts....if nothing else take a trip to the nursing homes and visit the COPDers. That might provide some good motivation. It keeps me from even trying it.

I guess it would depend if the patient had told the police that he was unhurt and did not need an ambulance, and if I was the cop I would make darn sure someone else witnessed him and document that. That versus the cop deciding the patient did not need EMS rather than asking him. If the patient has no complaints prior to EMS arrival and it was called in by some passing cell phone jockey then I don't see why they could not be canceled by PD or FD. They do it where I work.

I know that sometimes it can be hard to tell the different between Braxton Hicks contractions, or "false labor" and actual labor. From just my own experiences nulliparas have higher instances of false labor, particularly younger ages. Perhaps women who have given birth previously are just able to tell the difference. I have transported every patient with labor pains, and there have been a lot over the last few years. But there have been patients that I have taken three or more times for false labor before they finally had the baby.

Well, I don't know of any real prehospital treatment other than supportive care. The baby will need a special formula and probably won't be able to be breast fed. Maybe sodium bicarb to combat possible metabolic acidosis.

Maple Syrup Urine Disease aka Phenylketonuria

Well, since you said she is passing something on...could it be Listeria? Mom does live on a farm and mom has probably been eating soft cheeses, especially if made with unpasteurized milk. Listeria has been found in breast milk, but is rarely passed from mother to baby through milk. It is usually passed through the placenta during pregnancy or through vaginal bacteria during birth. Newborns can develop the disease a few days or even a few weeks after birth. So if that is the case it could just now be developing listeriosis and the baby is experiencing the n/v, diarrhea, and convulsions, and decreased LOC that occur when the bacteria starts affecting the nervous system.

Lets try an End Tidal CO2 reading and see what we get. Also establish IV and NRB. I am also going to try putting the baby on the stretcher with his knees to his chest. Possibility that the baby is suffering from Tetralogy of Fallot, and the knee-to-chest should provide temporary improvement by increasing systemic vascular resistance and encouraging deoxygenated blood into pulmonary artery rather to systemic circulation. The decreased PO intake fits with early symptoms progressing to current state. Intermittent persistent fetal circulation is another possibility.

As far as history goes, the medical history I wrote in the original post was taken off her chart from the clinic. There was no medication list and the patient did not know what medical problems she had, much less what medicines she takes. I asked her if this had ever happened before. She said that sometimes she gets "a little winded" when she was doing housework but never like this. That was all I was able to get out of her. She denied any chest pain, n/v, or any other symptoms. I asked her was there anything else wrong and all she said was " I am tired, I am just tired."

I had an unusual respiratory case today...not sure what was going on with this lady. Any ideas as to what it was or how it should have been treated are welcomed. Dispatched to a local health clinic for SOB. UOA found 73 y/o female pt seated in w/c in no obvious distress. RN at the clinic tells us that she was there to have her toes checked as part of diabetes care plan. She also states severe dyspnea upon exertion. Otherwise normal. Only known medical hx is 5 prior MIs, HTN, IDDM, ESRF and PVD. Nothing particularly respiratory in nature. The patient's BP is 115/70, and for all her medical hx that is a good darn BP. RR 16. HR 88. 12 lead sinus rhythm with obvious RBBB, q-waves in II, III, and AVF, T wave inversion in V1-V4. Lung sounds are clear and equal bilat with good air movement, 100% on 2lpm NC. So at this point she seems fine to me, and I am bit annoyed that my beef and broccoli was sitting in the truck. The patient operates the controls on her scooter w/c to move herself out to the hall (using one hand on the controls, and nothing more) and her respiratory rate shoots up to 40+. She started looking like a CHFer does when the are full of fluid, the guppy fish breathing look about her. Lung sounds still clear, 10-15 beat HR increase, and still 100% O2 sats. This continued for the duration of the call. She would be fine one minute and the next she looked like she was fighting to breathe, with the dyspneic episodes lasting no more than 2 minutes and maintaining good sats and clear lungs. So with her good sats, normal vitals, and clear lung sounds I thought maybe it could be psychosomatic. Or maybe related to an ESRF induced acid/base imbalance somehow manifesting itself as a respiratory presentation. I also entertained the idea of a pulmonary embolism, but the fact that it was drastically intermittent was really throwing me off. So I did what any good medic does when they are clueless....IV, O2 w/NRB, and 12 lead and high tailed it for the ED. Any ideas?

And what do you call these badge bunnies with badges of their own?

Ausgezeichnet!

I am about to graduate from my local community college with and Associate of Applied Science in Emergency Medical Science and state test for EMT-P. I am looking into Western Carolina's 4 year EMS degree program, the online option specifically. You already have to be a medic, have a certain number of liberal arts credits, you take chemistry and other gen ed classes at local college/university, and do clinicals with local hospitals and squads. Has anyone here done this program, or know anyone who has? What was the work load like? How difficult was it? How were your clinical experiences? Was it valuable as far as what you learned, rather than just getting the degree? Would you recommend it to others?

In my area so few 911 agencies staffed Basics, and the ones who do pay less and want two or more years of experience most of the time. When I was a new EMT I decided to work doing IFT because I needed a job and felt that $10.50 an hour was better than what I would make doing the common college student jobs like working at a restaurant, mall, or fast food joint. Plus I would be using my EMT cert and getting some type of experience while I worked on my medic at the local community college AAS program. Many would disagree with me, but I found the experience of working IFT quite valuable. It gave me the opportunity to become familiar and comfortable with ambulance equipment and do lots of hands on patient assessment, in a non-emergency environment. But you can make it as valuable or invaluable as you choose. I assessed every patient, took full vitals signs (which you should do anyway, but lots of IFT EMTs don't) , did mental status assessments, and even listened to lung sounds and heart tones. I looked at the patient's medical history and medication list, which was provided to our service mandatory for every transport. I learned about trends, common medications, medical conditions and corresponding clinical findings. While in paramedic school I got to see and assess people with the medical conditions I was learning about...a-fib, dementia, parkinsons, a flutter, sepsis, spinal cord injuries, and various neuro disorders, to name a few. This was a benefit that no one else in my classes had. Aside from the clinicals (during which the medics we rode with let you little more than observe anything more than a basic or stable patient) they all took vital signs and assessed their classmates, all healthy young adults. I rode as a volunteer a few shifts per month with the local 911 service also. This gave me the benefit of experience in the emergency environment with ALS personnel. If you can work 911 or at least volunteer a bit while in medic school you definitely should. But don't rule out IFT just because it is not lights, sirens, and glamor. I think everyone who goes to paramedic school should do at least some IFT while in school. It is a needed service, the pay is better, and it can be valuable it you make it. Just my own opinion.

A friend of mine, is a long time paramedic, posted this on myspace and I think it is very moving. I am not sure whether he wrote it or not. Maybe ABC news writers ought to get a copy. Standing in chest deep water, freezing rain falling and stinging as it hits the exposed parts of my body. Holding her head above water to keep her from drowning until rescue could get there to cut her free --- BUT I'M JUST AN AMBULANCE DRIVER Comforting a 89 year old woman who just watched me and my partner cover the face of her husband of 64 years as he lay dead in their bathroom floor --- BUT I'M JUST AN AMBULANCE DRIVER On scene at an MVC with mom trapped upside down in her car and her son's dead body laying on top of her. Without a second thought for my own safety I crawl into the wreckage to take C-spine control and calm the frantic lady --- BUT I'M JUST AN AMBULANCE DRIVER Called away from my just prepared meal to respond to the middle of B.F.E to a house with no house numbers, no porch light on, nobody waiting to signal us in and they bitch because we took too long only to find out the patient left P.O.V ten minutes ago...so we smile and walk away from the verbal lashing only because we are ...JUST AMBULANCE DRIVERS Standing in the middle of the street at midnight on the wrong side of town trying to patch the holes and stop the bleeding of a 19 year old shooting victim with the occasional bullet whizzing past our heads. We never break stride because this kids life is in our hands --- BUT I'M JUST AN AMBULANCE DRIVER Doing chest compressions on a 16 year old girl who decided this life was more than she could take. Her family screaming at us to help as though we are the ones who did this to her. Her lifeless body flailing about as the tube goes in and IV's being started, my arms and back burning from the pain of 30 minutes of CPR, never once giving up, hoping she would make it through and over come whatever lead her to this bad decision ---- BUT I'M JUST AN AMBULANCE DRIVER Death is all around me and still I go home to live my life I get kicked, hit, spit on, bled on, puked on... I look into the eyes of a lifeless child at 7am and by 8 am I'm holding my own child a little tighter and they know nothing about what happened. I have hundreds of hours of classroom time, years experience in the field... I have challenged death and won I've helped the helpless I've neglected my family for yours I find comfort in complete chaos I eat cold meals if I eat at all I work with no sleep for days at a time I miss birthdays, holidays, and school functions I put myself in harms way for a total stranger on a daily basis ALL BECAUSE I AM JUST AN AMBULANCE DRIVER I AM AN AMBULANCE DRIVER!!! I DRIVE 90 MPH THROUGH CONGESTED TRAFFIC FULL OF PEOPLE WHO REFUSE TO YIELD RIGHT OF WAY WHILE MY PARTNER STANDS UNRESTRAINED IN THE BACK OF THIS SCREAMING LAND MISSILE SAVING YOUR LOVED ONES LIFE!! NEVER ONCE DOES HE QUESTION MY DRIVING. HE KNOWS THAT AT THE END OF THIS SHIFT HE WILL GO HOME TO HIS FAMILY SAFELY, BECAUSE I AM AN AMBULANCE DRIVER....

When I drop the ammonia inhalant in NRB, I don't leave it in there. Drop it in and within 1-3 seconds they 'wake up' and jerk of the mask. If they did not wake up, which has not happened yet, I would remove it immediately. I don't see that causing any more damage that when people hold up under their noses for thirty seconds or stuff them in the nostril.

Spenac, Definitely agree with your post. In some ways, I feel that I may be contributing to the decline of the profession (or at least compromising progress) by continuing the 120 hour EMT class. I myself am in my last semester of an A.A.S. Degree paramedic program and believe it should be the minimal requirement for medics. However, the class is being taught through a 4 year college and most of these students are biomedical engineering and pre-med students doing this as a stepping stone into something else or taking it just for the experience. Just some thoughts.

I have looked for information on this topic, and my findings have been minimal. Perhaps I am not looking in the right place...but here is the question. In neonatal resuscitation, which is the preferred route of drug administration if you are unable to establish peripheral IV? Intra osseous or umbilical vein cannulation? Which provides the most effective access? Anatomically speaking I would think that, if done properly, the umbilical vein would be the most effective. However, I do not think the difference would be highly significant, and IO would be significantly easier to perform in a neonatal resuscitation. But this is just my opinion. What does everyone think? Is there any literature supporting one method or the other? Has anyone's experiences favored one over the other?

I have found a better, and less law suit likely approach. Put on a nonrebreather on them, and drop an ammonia inhalant (or two!) in the hole in the side. I have never seen anyone sit through that one.

Ruff, Is your article online that I can access?

I am teaching part of an EMT-B class soon and am working on lesson plans. I pose the question to field personnel and other instructors: Within the topics of SAMPLE, baseline vitals, and physical exam is there anything you find especially important? For the seasoned providers, is there anything you consistently see EMTs not being taught that you think they should? Is there anything you wish you had learned in class, etc? Opinions from all levels of providers are welcomed.

Hmm....good topic. Well just in what I have seen and done in the field over a three year period as a Basic, Intermediate and student Paramedic I think I have given and seen given more narcotic pain killers to white patients. Typically in my response district most of the callers have been white and the black callers are what you would call frequent flyers. I am not giving morphine or toradol to a cut finger or stubbed toe, period. I don't care how much you scream or what age/sex/race you are. I am actually pretty pain killer stingy, not really sure why. Now if I think the patient needs it, like for an MI, previously diagnosed kidney stones or significant traumatic injury they will absolutely get morphine. But back pain, abdominal pain, headaches, no...you might get some toradol if there is no bleeding danger. 99% of my decision is presentation based. I am hesitant to give narcotics to Hispanic patients because they often do not speak English well enough for me to feel that I have accurately assessed them and there is a demonstrated need for the medication. Same thing for some other minorities with linguistic differences. Not being judgmental or racist, but if I don't know what is wrong with you or what medical problems you have I am hesitant to medicate you at all. Black patients that I encounter are often frequent flyers. So no, if you call every few weeks for sickle cell crisis and want pain medicine, you are not getting it.

I took the EMT-B class in high school and I am not a very focused person, in fact I think I have the attention span of a two year old sometimes. I think you will be fine, but you will have to STUDY. If you have meds for ADHD, take them. Watch what you eat, get lots of sleep, and let your energy out at the gym; believe me it helps. Don't let what you already know make you too laid back and think you know it already. If you ride with a rescue squad already you have some great resources at your fingertips. You co-workers can be great to help you study, since they have been through this once ( but please pick competent ones) . If nothing else you can make index cards with question/answers on them and have them quiz you during down time. Read your textbook, BEFORE you go to lecture. This way you won't be seeing the information for the first time. You should read the information the night before, make some notes and come up with any questions you have or things you don't quite understand. Listen to lecture, take more notes and ask questions if needed, and then skim over the chapter again after you have heard the lecture. This is really helpful.

"Trauma Junkies" and Street Work Occupational Behavior of Paramedics and Emergency Medical Technicians C. EDDIE PALMER Paramedics and emergency medical technicians develop a need for role validation associated with ambulance runs that call forth advanced lifesaving, rescue, and medical skills. Metaphorically, this need turns paramedics into "trauma junkies," because answering calls involving multiple casualties, physical trauma, and fast-paced action becomes the "real" work of emergency medical services personnel. Calls evoking less sophistication of response behavior are devalued. Within an occupational milieu of excitement, danger, and public attention, paramedics perform a variety of roles constituting street work similar to that documented for police officers. Playing the roles of authority figure, lifesaver, information specialist, partner, grief manager, and counselor, paramedics are immersed in a work world replete with teamwork demands, conflicts with medical and nonmedical personnel, vaguely defined legal standards, and occupational uncertainty due to the newness of their medical niche. Journal of Contemporary Ethnography, Vol. 12, No. 2, 162-183 (1983) DOI: 10.1177/0098303983012002003 © 1983 SAGE Publications What does this mean to you and how does it apply, or not?

I am hoping to get lots of different responses to this. When is okay to have a family member help you on a cardiac arrest? There are so many sides to this issue. I read an article about it in JEMS not so long ago that suggested letting family members be there. In training a few months ago we were taught that it actually helps the grieving process along for some people, because they feel like they did something to help even if they person ends up dying. I never thought I would be faced with the situation until this past Thursday. I guess there is a difference in letting someone who asks help, and giving a 15 second CPR lesson because you are in dire need of an extra set of hands. And if the family member works in the medical field that throws a whole different dynamic into it. Read my bit and share your stories and opinions, good, bad or indifferent... A little background first...I work in two different counties and they are night and day different. The metropolitan area one is a huge system and our medical director is known around the country. If you have a code in that county you get a responding ambulance, a QRV supervisor, and engine company and at least one other transport capable ALS ambulance will check in on you most of the time. In the rural county, much of it is still volunteer and if you need help you gotta ask for it.. and you may or may not get it. Most of the time the nearest ambulance or even QRV supervisor is at least 10-15 minutes away. Most of the fire depts do not run first responder. You can request an engine company if you need them, but they are 10-15 out and are unavailable about 75% of the time. My partner and I are called out for a sick call. Nausea vomitting with some breathing difficulty. We get about a block away and dispatch comes back on and says that the caller advised the patient has had a seizure is now lying on the floor unresponsive and not breathing. We find a 24 y/o female lying on the living room floor with eyes wide in that blank death stare. I opened her airway and she had no respiratory effort but she did have a brady carotid. So I started bagging her and my partner ran to the truck to get a few things. I checked her pulse again right as my partner was putting her on the monitor and sure enough she had coded. I started chest compressions. In addition to the five other adults there was a three year old kid standing there watching that I had not noticed before. I asked them to please get him out of the room. A couple minutes later the family was on the phone with the pastor of their church and I could hear them in the background crying and praying. There was a lady sitting on the floor next to us in a pair of scrubs. We were struggling to start our IV, give any meds, work the monitor, get end tidal on, bag and eventually intubate the patient and still do chest compressions. And being able to try correctable causes...dream on. We kept calling for help over the radios and none came. I finally got desperate and gave the lady in scrubs a little BVM lesson and had her bag the patient. Turns out she was a nurse aide at a local SNF and the patient's mother. She was talking to her daughter while she was trying to bag her, which I feel bad about in retrospect. We could not get an IV and had resorted to giving Epi and Atropine down the tube, she was in asystole the whole time. I had to go to the truck and get the EZ-IO but had no one to do chest compressions. So I gave another 15 second chest compression class to her 20-something year old brother and had him do chest compressions. So mom is bagging, brother is compressing, my partner is trying to take blood sugar and start some correctable causes. We were able to get an IO and start pushing drugs and I resumed my chest compressions. Finally after 25 minutes on scene a QRV medic supervisor shows up. He puts a collar on to secure our tube and we finally get the patient out of the house and enroute to the hospital. The family followed us to the truck carrying our bags. The ER worked her too and she had ROSC. Even in the ED my partner and I were still rotating compressions with staff because the community hospital only has 14 beds and limited staff. When it was all over and the adrenaline wore off I thought I was going to fall over and die. A few hours later I came back on another call and stepped into her room. There she lay on the bed, chest tubes, lido drips, pacer spikes on the monitor and on a ventilator. With the c-collar removed her head lay lifelessly to the side and there was blood oozing from her nose from failed NG tube attempts by the ED staff. She had that same wide eyed blank death stare she had when I found her on her family's living room floor. I looked down at my "save". But what had I really saved? And what impact did what we did have on her family? I am not sure if she made it or not but just as I was about to leave the room her family members walked in. Not a word was spoken as I gave her hand a quick squeeze and left the room. It was a day that her mother and brother will never be able to forget. Will they remember it as the day they did everything they could to help save her? Or will it be remembered as the horrible life-scarring day that she died on their floor and in their hands? I don't know.

I attended my EMT class and state tested at 17. The state of NC held my certification until I was 18. The date on my first EMT-B certification is my 18th birthday, so I guess I woke up that morning as an adult and an EMT. I rank my EMS milestones by age... Age 18: Ran my first code. Started my first IV. Age 19: Delivered my first baby. Pulled my first bad trauma out of an upside down SUV. Age 20: Did my first intubation. First death notification. I essentially grew up in EMS, but I know that everyone is different. Some can handle it and some can't. I have been able to do it so far, but that is not to say that I won't be in a psych ward at age 30.