Riblett

Ah the pet peeve of nearly every EMSer...stupid people. And it should come as no surprise that they make up a disproportionately large number of our 'customer base'. I guess all is fair in love, war, and any job where you are fighting the process of natural selection on a daily basis. Two nights ago I had a lady call 911 that was EMDed as a respiratory distress. Okay so we get up from our dinner (good chinese, by the way) and run lights and sirens. We are met at the front steps of the trailer by a 24 y/o woman saying that she needs to go to the hospital. She looked fine, no obvious distress, six year old daughter underfoot. When asked why she says that she thinks she may have pneumonia or something. She seemed to have the same damn cold that my partner did and he had even less sympathy for her than I did. She also proceeds to tell us that her daughter was sick too and needed to be seen also. She told my partner enroute that she KNEW she would get seen "like, much faster" since she came to the ED on an ambulance. Plus her husband was inside asleep and did want to have to drive her. I hate people.

Phenergan has been replaced by generic Zofran in our protocols as well. I think a lot had to do with the cost, because shortly after the generic was released the change occurred. The rational explaination given by the powers that be was that phenergan was being given improperly and in too high dosages. This resulted in patients being obtunded and groggy while at the ER and making the ED docs job too hard.

Well, there may be a moral question here depending on one's personal values. More concerning here is the legal question that is raised by her being a minor. Depending on which state you are in he could be committing statutory rape, and that is definitely something that you would not want making the evening news. If you decide to do anything about it, check your squads SOGs. Many smaller or rural agencies still have rules that deal with things that fall under the "conduct unbecoming" catagory. If there is anything I have learned, it is that relationships among co-workers and other relationships that could be considered inappropriate are going to happen in this profession. Scandal and drama are a daily occurence almost anywhere you go. It is best to keep your head down and stay under the radar.

So on scene at a code blue, with a very green EMT-B. Fresh out of the state test and just out of high school. So folks from several units are working this lady, got her intubated, pushing tons of drugs, shocked a few times, the works. After we move her onto the stretcher one of the medics thought that the tube may be dislodged since the ETCO2 reading was dropping. So he looks at he new recruit and yells, "Give me some ears"(which in my neck of the woods means a scope). This kid, wide eyed and looking like a deer in headlights, has no idea what to do. So he slams his head down on the patient's chest actually trying to listen for breath sounds! Guess he never heard the term ears before.

After the last time I used the device I started thinking that maybe it could be being occluded with bone matter. Everytime it was used it was hooked straight up to a line of fluid, so next time I think I will try a saline flush that I can push a lot more volume a lot faster to try and clear the line. By the way Doczilla and Shane, thanks for the actual advice rather than bashing disagreement. The lines were placed on four different patients, on four different calls, by three different medics. I don't think it was placed wrong every time, but every time it was more difficult to push the drugs and get the bolus in.

I don't think that most prehospital personnel are trained in the insertion of central lines, and I do not know of any systems in my area that have them in the protocol. They would be really nice if we could use them, especially for long transport times when there would be time to establish the line. I have found it more difficult to start lines on peds that adults, maybe because of smaller vein structure and high stress. Some people can be pretty aggressive when working with pediatric traumas and puting in the IO is quick and easy access in comparison to even a peripheral line. I asked a similar question of an ED nurse as to central line usages and she said that they are difficult to insert in the absence of a fairly controlled environment, particularly when the patient has no palpable pulse.

No, we did not have a pressure infusion bag. I thought about using a BP cuff, and probably will next time.

In response to the comment that I should 'do my research,' I have. I have used the device in the field several times and personally found out how difficult it was to give fluids and push rapid push drugs. Of course the articles from the manufacturers and the studies are going to say that it works just great and is just like and IV. If you can get past the majority of those articles you will find plenty of field personnel who will tell you that yes it is an easy insertion, but delivery is significantly slower. I have used the EZ IO four times on a code, pushing multiple drugs and a bolus through it on each. No I would not call that a lot, but it is more than a lot of providers. The first time I did it was much more difficult to push the drugs than with an IV and the bolus was a slow process. I thought that maybe my partner did not have it in the right place, but was assured that marrow had been aspirated and it was normal to meet significantly more resistance. Three more times I had the same experience. Maybe what I should have said is that makes it sometimes ineffective if you can't get the drugs in at the appropriate time. And by the way, some of you should spend half as much time posting helpful information rather than degrading people for their posts (questions or answers) for any reason you would think of.

Definitely see where you are coming from with that Dusty. It seems that our dispatchers (and the whole county really) are so afraid of a lawsuit that they will send a medic level ambulance to anything. As far as talking to them goes, we all try to be as professional as possible and hope that eventually something will be done about it.

In my experience the IOs have been helpful in the fact that we were able to get an IV established through which to push our code drugs. But I have never had ROSC on a patient that it was used on. Not because it caused harm, but usually the patient had been arrested for a while and was far into circulatory collapse, making a periphral IV nearly impossible. Combined with the fact that it is much harder to push drugs through and delivery is ineffective.

We have tourniquets in our protocols in the larger system I work in. They are a new addition and I have not been able to use them yet. They are military style 'CAT's and are really nice. They are to be used only as a last resort or in MCI. Most folks used to say that they did more harm than good by resulting in limb loss and other complications. But newer studies have shown that they can be left in place for up to 2 hours (or more depending on other factors) without significant risk and they are being put back into more and more protocols. We are fortunate because you can be at an ER from just about anywhere in the county in under 15 minutes going emergent traffic. While this amount of time is unlikely to cause limb loss with a tourniquet it is certainly enough time for the patient to bleed out. In any case, if the bleeding is so significant that you are considering the tourniquet then hemodynamic compromise is far more risky than limb loss.

We get called to a local nursing home (which happens to be a block from our station) for IV starts. The dispatchers actually say on the page, "EMS 1, IV start, at ......, code one." Bear in mind that this is a 'skilled nursing' facility with RNs and LPNs on staff 24 hours a day and they call EMS for an IV start. Sometimes I think that they just call us before even trying because the nurse is busy or on break, not because the patient is a hard stick. I have been there when there were no signs of prior attempts. In that rural county if we are tied up the next ambulance has a minimal response time of 10-15 minutes even going code three. 'Sorry your husband died of that MI ma'm, but we were busy doing the nurses jobs.' Hmmmm....quit wasting resources and call your contracted ambulance service for a routine trip to the ER so that the IV team can do it. Or call your convalescent-only contracted agency that has intermediates and paramedics to do it rather than taking a 911 truck out of service.

I work in two different counties, both are very different in the way they handle DOAs. One of them is a metropolitan area containing the state capital. The other is a smaller rural county to the north. In the larger city/county if EMS finds a DOA, as defined by our protocols and determined by the highest level on scene provider, then police are notified. Police are also dispatched to all pediatric codes and most other codes. In a DOA or resucitation discontinuation EMS will request police to attend the body and make arrangements. If it was an attended death, meaning patient had a primary care physician and they are willing to sign the death certificate the police can release the body directly to the funeral home as long as the death was not of a suspicious nature. If this is not the case, or the death was suspicious in nature then the body is transported to the morgue by as special unit known as WC-7, staffed mostly by moonlighting police officers and EMTs. In the smaller rural county police are not dispatched and come only if requested. Police will still release the body to funeral homes if it is a natural death with an attending doc. But if not, the body is transported to the morgue by EMS. Fun stuff.

Manufacturers recommend that RL, RA, LL, and LA be placed on their respective limbs. Instructors should be teaching you this in school and while precepting in the field. However, if you spend any time on a truck you will see that the majority of medics, especially those who have been in for a while, will place them on the torso. When the leads are placed on the torso you tend to get significantly less artifact. But the view can be skewed by improper lead placement, particularly when doing more sensitive diagnostics such as axis deviation and ventricular hypertrophy. However, if you are doing just dysrhythmia monitoring it is probably okay to place them on the torso. Personally I place them on the limbs, but as close to the torso as I can. I put the arm leads on the deltoid area and limb leads on the thighs (clothing permitting). This way you should have minimal artifact caused by limb movement and the accurate view that limb placement provides.

Dustdevil, I thought it did have to do with the topic. Tough love and objective interventions are not reserved for drug addicts and alcoholics. It can apply to anyone whose continued actions are posing a danger to themselves or others, particularly when EMS service is being abused. It may not be on the same level as those who tie up units for repeated drug usage, drunks who have passed out in public, and repeated attention-wanting half hearted suicide attempts, but the end result is the same. It seems that people have spent more time arguing that I am off topic than posting anything on original topic.

To all of you who have felt the need to attack me about this, go back and read the post as to my real concern in the matter. Sure, I do not like getting these calls, and no it is not my job. But other patients could be seriously harmed by them continuing to do this. They are in a part of the city that is served by a municipal service with county run units in surrounding areas with extended response times. And if she does indeed have dementia, as EMTlady suggested, and he is to weak to even move himself to the toilet, then it is dangerous for the two of them to be living alone. Despite your smart a** comments about me wanting to look good in a uniform, being a big bad paramedic, and not wanting to do "my job," no one with a shred of common sense can say that it is not a valid point. EMS is not a service that you call a few times a day to come help you use the toilet, and it should not be used as one. I have no problem picking someone up of the floor if they fall, and will do it with a smile and a call us back if it happens again. But when the only ALS unit in the area is getting called out there several times a day and tied up for thirty minutes at a time for this then there is a problem. They are in need of a little 'tough love' in the form of an intervention and be told that they cannot keep doing this and need to make other arrangements. While I sympathize with their situation they should not be allowed to continue putting other patients at risk by tying up a paramedic level ambulance for something it is not intended. They have been refered to case management several times and nothing has changed. So if anyone has any real advice about how to intervene or if it would even have a point, please post, otherwise show yourself a little 'tough love' for being too much of a bleeding heart too look objectively at the widespread implications of their actions. The phrase, 'don't be so open minded that your common sense falls out,' comes to mind.

"Where are the family members for these people, did you ever ask, probably not. Did you ever THINK to ask, probably not. " Hey WendyT, back off! Actually many responders have asked many times. They have a daughter who lives out of state and no other family to speak of. The lady gets really mad and rude when we ask, giving us the whole speech of how they have paid taxes for however many years their family or lack thereof is none of our GD business. We have also referred them to social services many times to no avail.

More bashing, eh? Allright, here goes! If there is anything that I cannot stand, it is a smart-ass nurse. They get on my nerves more than anyone in this field, for the simple fact that despite the fact that their paycheck doubles or triples that of a paramedic, but most of the ones I have dealt with have been total morons. The ER ones screw with the medics and are lazy. The hospice ones are just plain stupid. And the nursing home ones are the crap of the crop-I'll save bashing them and telling horror stories for another post. Nurses are trained like monkeys and are overpaid a** wipers. They are taught exactly how to do things and then are told by a doctor exactly when to do them and on what patient-99% of the time. They only push drugs when told, don't have to know their indications or mechanisms because they just give them as ordered. They don't think because they don't have to. The majority of them can't even do a simple assessment without their computer screen telling them what questions to ask and what assessments to do and the predetermined responses. And by the way, their IV skills suck, with the rare exceptions here and there. But they are quick to bash medics and EMTs for what they do. Had one get really mad at me not too long ago for bringing a hypoglycemic diabetic in without an IV. Well, for starters the patient was bedbound and had contractures, limiting my selection and eliminating the ACs. Several technicians tried and were unsuccessful so I gave IM Glucagon. The blood sugar went from reading 'lo' to 46 by the time we got to the ER. Since we were 3 miles from the hospital I gave the Glucagon and got enroute. She was pissed and starts yelling at me that it is 'unacceptable' for me to bring in a hypo with no IV. My nurse hatred and immaturity got the better of me and I said "Bitch, the day that you have Paramedic after your name is the day that you can critique my patient care!" I know I am terrible. But my number one rule when dealing with nurses, if it felt good to say you probably should not have said it.

I think it depends on who is making the trauma decisions. If it is an MD who is significantly informed on the patient condition, then okay. In my county most of our medics are highly competent and have excellent assessment skills. We have a Level 1 trauma center (recently upgraded from a Level 2) and have very specific criteria for initiating a trauma one or trauma alert. Unfortunately we have some idiot nurses who will screw with us. They will downgrade our traumas or make patients trauma based on their own opinions and not established criteria. Two times they have done this to me. Once was a 49 y/o f who fell down a flight of stairs, had blunt trauma to the head in addition to multiple lacerations, had significant LOC, and had a GCS of 12. Because of the AMS post traumatic injury she met criteria for a trauma alert (lesser of the two.) The nurse took our report as usual. We arrive at the hopital and roll our patient into the trauma room, expecting to see the usual gowned cavalry of the trauma team. The room was completely empty. We went back out to the triage area and find this snotty little fresh-out-of-school nurse sitting there by the radio eating a bagel. When we asked her why there was no trauma team she replies that she did not think it met criteria so she downgraded it. My partner rather angrily jerked out his protocol book and shoved the trauma criteria section in her face. Second time was a low speed roll over MVC. According to witnesses the car just kinda slid off the road slowly and rolled on to its side when it hit the ditch inside the subdivision. Patient was alert and oriented, no LOC, normal lung sounds, and no complaints other than a laceration on the forearm from glass Vitals signs within normal limits %100. We call in report and the nurse tells us room assignment on arrival. We get there and they take us to the trauma room and there is the trauma team. As soon as she heard roll over she upgraded it with no criteria and cost this patient several thousands of dollars before he ever got to the hospital.

Well, I try to tread lightly on these types of subjects with my patients, but sometimes my lips loosen after three or four calls in the same week all after midnight. We have a patient who has a major problem with alcohol and we get called to their apartment several times a month. I have been called to this patient for drinking mouthwash, rubbing alcohol, and hairspray so far in the last few months. I always try to be nice, but sometimes I just get really irritated, especially when it has involved me getting out of bed or up from dinner. The patient is always really nice to us and never snappy or rude, and it is usually a friend or family member who calls us because they found out what the patient drank. Patients who abuse the system are the ones that tend to get a rise out of me. In the county I work in there is one individual who calls 911 two or three times a day because she needs help moving her husband from wheelchair to bed or bed toilet, etc. The two of them live alone. This may sound mean or cruel, but get a home health aide or go to an assisted living facility. I am getting sick of being paged to this address for "assist invalid" three times a day. Helping grandpa to the toilet is not our job. This paramedic level truck is tied up moving this man while another unit that is 15 minutes away from the neighboring district has to respond to codes, chest pains, and shortness of breath calls. To top it off, the county cannot bill Medicare for this call, but it is tying up an ALS ambulance. The county has not done anything about it. It makes me mad. I can certainly sympathize with her not wanting to put him in a nursing home, but what about when serious call comes out in that district and another ambulance that is far away has to respond, and the patient dies?

Unless you consider the bathroom a changing area, no we do not have specified changing areas. And many people do not sleep in their full uniform, especially if it is a same sex crew. Management has not come out and said that there are cameras, but it has been rumored. If they wanted to put them in there, then fine...but notify the employees. I will make sure I sleep in full clothing and change in the bathroom only from now on. But if they are there, then how long have they been there? There have been many cases of employees being videotaped at work and lost suits because it was concluded that in the workplace there is no reasonable expectation of privacy. Exception being inside the bathroom, which is an established expectation of privacy almost anywhere. But I suppose that EMS/Fire are the only civilian professions that have bedrooms so they may be new ground.

At my squad our bedroom at our secondary station has three beds, but there is usually only two people on the crew unless we have a student. Managment is suspicious that certain individuals have been having sex while duty at night. There have been some rumors flying around lately about there being cameras in the bunkrooms to try and catch this. I have nothing to worry about as far as any inappropriate behavior is concerned, but my concern is that I have changed clothes in there, even my underwear, on many occasions. The idea of someone having video of me undressed makes me very uncomfortable. Wouldn't they be legally required to notify employees if they are being filmed in an area that there is a reasonable expectation of privacy, like in a bedroom or bathroom? It is very common place for members to change uniforms in the bedroom because we only have one bathroom.

Wow, thank you all so much. I am starting with the uniform jackets Erica found with Galls. I am glad to know that I am not the only person who has this problem. I will keep you posted with what I find. For as much as us in EMS are taught about the adverse health effects of being overweight, the rampant onset of heart disease in middle aged women, and the fact that we see them everyday, one would think that we would take heed. However, it is sad to say that there are probably hundreds or even thousands of women in EMS who actually wear a men's size large or extra large. This has become the norm. Supply and demand=few normal sized EMTs/Medics, few normal sized uniform apparel for the rest of us.

Okay, still waiting for an actual answer if anyone knows. This really is a serious question. But in reply, we have several high speed highways in this area like 401, 40, 95 and so on. High speed=bad accidents and potential for long extrication times. It is also the season for 4 wheeler and hunting accidents that always seem to be way off the road and in the middle of no where.

I live in Wake County, NC and it has yet again decided to turn really cold really fast. I am trying to buy a duty coat to wear this season, cause the agency-issued sweatshirts and pullovers just aren't enough. Here is the problem: I am five feet tall and weigh about 115 lbs. (and no, I am not a kid or cadet) Everywhere I have looked all the jackets are too big. Most of the jackets I found are for men, and the smallest womens conversion size is an 8-10. I need a womens size 4. This is an ongoing problem for me, I guess there are not many EMTs/medics my size out there. If anybody knows where I can buy one please post.