Suburban/Rural Medic

I think the safety discussion is something that we in EMS have far too infrequently. Most of us, afterall, are still providing care to our patients in the back of speeding ambulances from a side facing bench-seat position without a seatbelt on. The backs of our ambulances have sharp edges and head-strike hazards everywhere, non-latching cabinets and inadequate means of securing our heavy equipment. Our stretchers don't stay put during collisions, nor do they do a good job of containing our patients on them when they become projectiles. We never gown up, rarely wear our eyewear, and almost never put our N95s on when we should. We go to car accidents and leave our helmets and vests hanging up inside the ambulance. The only thing we do well is diligently wear our steel-toed boots and nitrile gloves. I don't have statistics to prove it, but I feel that psych patients and belligerent drunks are far less of a threat to us than our industry's lack of concern for workplace safety. For years, fire departments have preached the message of fire safety and fire prevention at home and at work. It's about time the EMS industry got serious about safety in the industry and started preaching the home and workplace safety message to the public. As for me, I'll do as much care on scene as possible to minimize the amount of time I spend in the back of the ambulance with my seat belt off. I'll put the cardiac monitor in its mounting (that we're lucky enough to have) every time. I'll secure all my patients to the stretcher as well as possible, using all the straps. I'll wear my helmet, face sheild and vest at every car accident, even if it makes me look silly. I'll use safety IV catheters (once again, that we're lucky enough to have) and make sure a sharps container is always close at hand. I'll keep an N95 in my pocket, and continue to use it often. As for the violent patients, I'll continue to do the same thing; rely on my police counterparts for their expertise. Also, I will continue to ask for police response on calls I don't feel right about, and wait for police before I enter places I don't get a good feeling about.

Don't get me wrong. I know a show will never be an accurate portrayal of EMS and still be successful. A show can be sensationalized and still be somewhat accurate. Deep character plots, internal dialogues, off-ambulance politics; of course there's a place for all that. I don't even care if all we're seeing is MCI's, multi-system trauma, complex cardiac events, respiratory emergencies requiring ventilatory assistance, etc etc. You know, the type of calls that you learned how to run in school. I don't expect to be seeing 3/4 of all calls done by the cast of the show to be: general weakness, back pain onset 10 years ago, drug seeking pt that had a car accident 2 years ago, poor food/fluid intake for a week, stuff like that. This show wouldn't be half bad if the assessments and the medicine were accurate; that's all I'm getting at.

theotherphil, can you post a link to that journal? It seems worth reading. To the original poster; in reference to landmarks and placement. Don't be afraid to actually palpate the ribs to ensure you are over the proper intercostal spaces. Place V4 before V3 and place V6 before V5. Be sure to shave the men well when necessary and do your best to dry off the clammy or diaphoretic patients. As far as privacy goes, there's nothing I can think of that hasn't been said. Most important is to explain to the patient where you're going to touch before you touch it, and to use the back of your hands to gently lift the breasts when necessary.

I'm only done watching half of it, and it fails. An EMT-B diagnosing STEMI with a view of only one lead on the monitor, giving a triple dose of Nitro and the patient is in asystole within 3 seconds of receiving the killer dose. Didn't see him actually check the blood pressure either.... ...or was the placement of the 12 lead, printout, interpretation, and vitals check all off camera :confused:

Here in Newfoundland and Labrador, EMR's (two week course) can administer 160mg ASA for Ischemic Chest Pain and Cardiogenic Shock, Oral Glucose for Symptomatic Hypoglycemia (can't check blood sugar) and can only assist a patient in administering their own Epipen for moderate or severe allergic reaction (Epinephrine is not carried by EMR's). In a perfect world, we could say that no medication would be administered by anyone who doesn't extensively understand how it operates at the cellular level in various types of patients, all of its side effects and potential complications, indications, contraindications and precautions. Fact is, it will continue to happen as long as there is a lack of fully trained providers (or money) and where the pros of administration outweigh the potential cons.

Mine was a trip and fall on an icy driveway. Compound ankle fracture. She was not in much pain surprisingly, and said it had nothing on child birth. That was actually the only compound fracture I've ever seen, I tend to be a white cloud for all my calls.

+1 for docharris. EMS in general is far behind most other industries in terms of provider safety. There has to be some sort of low profile helmet out there that has the capability of protecting paramedics in a collision while still allowing use of a stethoscope. EMS professionals are already getting used to wearing helmets with face protection at MVC's and construction scenes, etc. Here in Newfoundland, there is nothing of the sort for providers working for community based and privately owned services. Hospital based services are a different story of course. Even as a student in Ontario, there was a proper helmet marked 'Observer' for me to use. For goodness sakes, stairchairs still aren't required equipment here on the rock. We're also using used ambulances up to 10 years old or up to 500,000 kms; so rest assured there are more sharp edges in the patient compartment then there are adequately padded surfaces. I'm no engineer, but I fail to see how it can be so hard to design a safe patient compartment. What do we really need the squad bench for anyway? All that's underneath mine is a prybar, axe, small toolset, rope, jackstand, traffic triangles, bedpan and poorly located sharps container. Really only a couple cubic feet worth of gear that is hardly ever used. This could all easily be relocated to allow for a single attendant seat or sliding chair on rails, possibly even with an extendable 5 point harness that allows the paramedic to reach for gear from the cabinets. Cabinets could easily all have latching mechanisms, instead of the standard sliding door type that are only held closed by friction. Air bags can be deployed from a multitude of places, padding can be much thicker and more absorbent. Handsets can be located in a position where they can be accessed from places other than just the rear facing attendant chair. Sharp edges can be completely eliminated. Stretchers can be mounted much more securely than they are with 'antler and hook'. Stretchers designed so that shoulder straps come through the mattress at the point of the patients shoulders and not from the top of the headrest. Grabrails can be brightly coloured and well padded, and all protruding objects recessed into the wall but still accessible. Just some ideas, and my two cents.

You're right there. It's not the place for me, nor will I ever be fluent in French. Labour mobility can at this point, take me almost anywhere else in Canada quite quickly, except there. (Fine with that though).

I am actually in the province of Newfoundland and Labrador, on the Newfoundland (island) portion. And there are only a few handfuls of Paramedics in this province who have also come from Ontario, so I won't get much more specific on where exactly I work. Here we have private services, community-based services and hospital-based services. All have the exact same protocols, but the pay and equipment vary greatly. I work for a private operator. I have noticed the vast knowledge here as I've 'stalked' these forums, haha. And kiwimedic, Newfoundland is about the only part of Canada where people don't generally say "toque" or "eh". Its mostly us immigrants to the island, haha. And I've learned never to make the mistake of pronouncing 'Newfoundland' like it looks, but rather as 'new-fun-land'. Anyway glad to be here, and I'd be glad to explain to you guys about some of the many recent changes we've undergone here in terms of protocols/ patient care etc. Cheers

Hey all. I've been on these forums for a while, but this is my first post. I've only been reading existing topics thus far. I'll say a bit about myself. I completed my Paramedic training at a college in Ontario, a 2 year program. Due to the lack of job prospects in Ontario, I elected to move to a different province. I have close to two years experience now. For those unfamiliar with the Canadian system, a Primary Care Paramedic is typically capable of performing: Defibrillation, Cardiac monitoring, and administration of Epinephrine, Salbutamol, Nitroglycerin, ASA, Glucagon. In the province where I reside, we also have 12 Lead application and interpretation, intravenous cannulation and fluid therapy, as well as D50 Administration. I love this job, and I love talking about it with other people who do.