Kaisu

A lot of the problems with lack of professionalism, I believe, stem from the root of this profession as an offshoot of paramilitary public safety as opposed to medicine. Gungho git 'er done attitudes are fine and good when axing structures and/or tearing apart cars; not so appropriate for medicine. The same old lack of formal education, easy entry into the field and poor wages and shitty hours discourage the professional minded and medically driven from either entering or staying in the field. It makes me crazy. I have noted that one individual can make a big difference in the culture of a place. Lead by example. Express dismay in a non-confrontational manner at anything you see in the field that reeks of whacker. A dedicated professional, especially as the leader of your crew, can make your crew, then your shift, then the entire organization better. Believe it or not, most management wants the same thing. Those that don't really have no leg to stand on in this day and age.

Excellent topic. It is worth checking this site on a regular basis for the things that I learn. I was not aware of ACE inhibitor induced angioedema. Had I run on this patient, I would have been loath to take any aggressive measures. The key here is the history - 3 hours to develop a swollen tongue does not in my way of thinking, an airway emergency make. I would certainly provide oxygen (nc 4 lpm at this point). Being ignorant of the pathophysiology before reading this post, 25mg of diphenhydramine would probably find its way into this patient, as would a corticosteroid. Other than that, rapid transport to the ER. It is wonderful to have ERDoc chime in with the statement that prehospital, really nothing to be done. I am probably a day late and a sandwich short coming in at this point, but I wanted to express my deep appreciation to the OP and the other posters. I have once again learned something.

AZ still requires MAST As for the linens.. never reused them.... never have.. never will. This includes pillows, pillow cases, blankets and the gurney sheet. The gurney is disinfected after EACH patient with special attention to rails, buckles and straps. Anything less is irresponsible and unacceptable.

Just to ensure that there is no misunderstanding, AK, I am one of those "religious" that subjects my beliefs to rigorous scrutiny. I appreciate your comments and certainly respect your worldview. Mine is ever evolving and you help me with that.

My brother killed himself 40 days ago. 35 days ago, the brother of a good friend was shot to death by the cops. (he was drunk, wouldn't put down the pipe). 20 days ago, my daughters school chum OD'd.... And then Rob died. I have the same regrets about Rob that I do about my brother. I did not take the opportunity to tell them what they meant to me. I so much want to believe that they know now.,, that afterlife that AK so eloquently debunks. Really tho, how else to deal with these horrid losses? How else to comfort ourselves and go on?

Now there is the difference between men and women... From a female perspective, if the important things are good, then the sex is good. If I am being treated with respect, feel heard and valued, then sex is great. If my husband ignores me, tries to force me to do things his way, calls me names, negates my opinions etc... guess what happens when he wants sex?

I am so saddened. I knew he was ill and I should have known that only something life threatening would take him out of the profession he loved. As a newbie, he scared the crap out of me. As I gained experience and knowledge in the field, Rob was the touchstone I used to make sure I wasn't deluding myself. A compliment from him meant the world to me. I will miss you Rob. Rest in Peace.

quitcher braggin

Easy... cheating is anything you don't want your spouse or mother to find out about.

In regards to cheating, especially "serial" cheating, it is almost invariably a distraction from the real issues. By that I mean, problems with your marriage and problems with yourself. The amazing thing about being in a marriage is that sooner or later, all the weaknesses in your own personal character are exposed; whether these are issues of self esteem, dishonorable ways of dealing with others, addiction issues, etc. etc. As we all struggle with these issues, we use a myriad of methods to avoid exposing ourselves in those dark secret places where we are the most vulnerable. People fight tooth and nail over the placement of the furniture, whats for dinner and other seemingly insignificant issues that are representative of the deeper issues between the couple. As a serial monogamist, ;-}, I have learned that the personal and relationship problems of one marriage tend to follow me into the next. The excitement, ego stroking and initial gratification of an affair are a great way to avoid dealing with what needs to be dealt with. At the conclusion of the affair, and there always is a conclusion, you are left with the same shit you were avoiding in the first place, as well as the inevitable and complex fallout of the affair. Pretty stupid I think.

Best place I ever worked at stated in the mission statement (and demonstrated by living it) employees first, clients second and the company third. It was an amazing place to work and extremely successful I might add.

I have an extremely long fuse, with a major explosion at the end of it IF I do not carefully monitor my emotional responses and take steps to eradicate stress. For me a real give away is when I get angry at a patient. I don't mean irritation or mild frustration, I mean anger. I am very careful not to let my emotional responses to patients show, but I still critique myself after every call. If I get angry at a patient, I know I need some PTO time. I take a set off and I return good to go. I would imagine that if I let too much time pass before getting that time off, recovery of my usual caring self would be much harder.

Amen to that brother. PS.. can you change the size of your font. You have great things to say that are really hard for us old people to read. :-)

Oh please Asys... intelligent, thoughtful consideration of consequences? This is US health care we are talking about. Wade into this mind field through all the special interests and we really do live in Bizzaroworld, where good things occur only as unintended and unforeseen by-products.

I don't carry snacks. I have drank sterilized water in the back of the rig coming back from a 4 hour transport feeling like I'm going to blow away. I grab what I can when I can, and spend my 4 days in the gym fighting the dreaded ambulance ass.

Hey Doc... they look different from us right? so they must be bad.

More useful to this thread is the understanding that untrained people cannot be expected to know that there are differences between a trainer AED and a working one. Institutions just don't get it when it comes to health and safety issues. I once ran on a 17 year old unresponsive for 8 hours because the minimum wage personnel entrusted with their safety didn't realize that unresponsiveness (albeit with pulse and respirations) is a life threat. The economic downturn and people expecting to do more with less has resulted in a lack of funding for a lot of programs. Health and Safety looks like something that can be cut when bean counters sit down to balance the budget. Without a strong advocate for these things, stuff like this happens. Pretty bad news for the person that has a witnessed arrest with a shockable rhythm and a non-functioning AED. Unfortunately, unless risk management personnel are aware of the issue; or if the financial repercussions are not clear, then someone has to die before something like this is rectified.

That would suck big time.... run for the AED and its a trainer.... I often think of that in airports when I am not on duty... without my lifepak...

The thing that really got to me out in the field was that because the vast majority of EMS providers in this area are in fact highly trained but poorly educated, the main source for valid information (experienced providers) for others was not an option for me. Make sure the person giving you the info is reliable. I overcame this particular deficiency by doing my own independent research, including but not limited to, running questions by some of the truly smart people on this site. When I finally got into a station where I wasn't run off my feet with call volume, I could actually do follow up with doctors and hospitals too. I am currently in a quandary. I know enough to know that large areas of my medical knowledge are sadly lacking. What do I do? Do I get more medical education (real education btw - not bullshit refreshers)? and if I do that, then do what? I love the field. I wish our system was more like Canada, where you HAVE to have a minimum of 2 years of college level to even ride on the ambulance and a 3rd year for ACLS.... BUT I am beating a dead horse Cheers

OOOOOOHHH.... I saw the topic, and then I saw the poster... and I thought "What fun!" *** pulls up a chair and some popcorn ***

Thank you so much for your responses. At the time, I needed to reach out and hear what you had to say. You never let me down. I am doing well... exhausted from all of the hubris that surrounds an unexpected death... drained with my attempts to care for the family and friends that have been affected by this. The estate matters feel almost overwhelming. My remaining brother is executor and I don't envy him the task. The last year of my brother's life degenerated into chaos. His surroundings reflected his pain and confusion. I have been in some pretty bad places but nothing prepared me for the filth and squalor that he had been living in. It hurts me to think of him there. My brother managed to take himself to his job every day. He worked on Monday and no-one noticed anything except that he seemed happy, relaxed and peaceful. His boss closed the business down for the day of the funeral and they all attended. It was a moving tribute. The funeral was huge. People came from all walks of life and the things they had to say about my brother were heartwarming, allowing us to see him in a totally different light. He was a helper guy, assisting anyone above and beyond their needs. Never a traditional Christian, he was a true one in that he literally would give others the shirt off his back. The lesson to those of us in EMS? We run on the suicide or suicide attempt and we see squalor and filth - a lonely, past his prime unkempt fella with cases of beer and pizza boxes surrounding him. He looked like the homeless dude we pass on the street. His life had value. He touched hundreds. We loved him and will always miss him.

I am posting news of almost unimaginable sorrow. My twin brother, the person that was with me before we were born, put a pistol to his parietal and pulled the trigger. He died yesterday. I am shepherding my mother, 82 years old, through one of life's most excruciating tests.. the death by suicide of her baby. My brother killed himself because he could never come to terms with the childhood sexual abuse that we both suffered at the hands of our father. Ironically, I had taken a leave of absence from my job to help my granddaugher through similar issues and was in Canada for the first time in years. I never did get a chance to tell him him that I loved him. Treasure your moments with the people you care about. Don't let a single grudge stop you from calling those you love. I have always turned to this page for comfort, solace and understanding. This community, although I have not posted in a while, has always been there for me. Thank you Kaisu

I am saddened by this news. My thoughts and prayers for family and friends.

That BP is pretty worrisome. I would transport for evaluation. So.. good job. As far as what else you could have done.. more detail on medical history and history of present illness. Has she ever felt like this before? What did she do? Any change in life circumstances? diet? Dysuria? Constipation? Does she live alone? What does her house look like? Is she in a well ordered "healthy" environment, or does she seem overwhelmed by things? Ovarian cancer is usually a bad one. How long ago was it diagnosed? What treatment did she get? The more you find out about this patient, the better it will be for you to come up with a clinical picture, if for no other reason than to make yourself a better provider. Can you follow up with the ER and find out what if anything was going on. Think of it as a puzzle that you need to figure out. Do this for every patient. Some people have 1 year of experience 5 times. Be one that has 5 years of experience. All the best

So this homeless guy had made his way 40 miles up the road in the 100 degree plus heat of the Arizona low desert summer. He was headed another 45 miles North East, to one of the few places in this part of the country that had a homeless shelter. We were toned out for unspecified illness. He was as you would expect for a dehydrated sun baked guy not in the best of health to begin with after a day in Hades. The problem ? Nearest appropriate facility and the hospital we transport to is 20 miles back in the opposite direction. The man flat out refused to go back there. He said "I've been through hell to get this far. There is no way I am going back." I told him to sign this piece of paper that said he was aware that insurance (which he did not have) would not cover transport to where he wanted to go and that he was personally liable financially. He said "I have no money". I pretended not to hear him and had him sign. I transported him the 45 miles. I started a nice line to hydrate him, he had a nice nap, and the ER doc kicked my ass. (Not the first time and won't be the last)