mcmikeguy

I usually use mine to find medicines I am not familiar with but I have used it occasionally on runs help me remember a point or two. I don’t regularly use all my skills. The longer I do this less reminding I need. Crutch is an awful harsh way of saying: putting your ego aside for accuracy. I participate in CE and audits, I ask questions, and bone up on topics during down time. I do, however, think it arrogant and foolish to expect I will remember everything all the time. I’m a not FDNY medic who sees everything there is to see twice a week, so at 3am I might find something obscure, just plain uncommon, or maybe I can’t recite all the H’s & T’s in the asystole algorithm at the moment. I have been around for about 8 years (medic about 3yrs) and have seen every imaginable position a car can be in but I don’t hang a drip more than once a year so I might double check my work. When I have down time and nothing to read, I have a book it my pocket. Finally, if you are a lousy medic there is no field guide in world that will help that. You have to decent to get use out of the book, and you have to be smart enough to know when you’re beat and not at 100%.

I have forced entry several times, sometimes I have found a patient, sometimes a body, sometimes no one home, and one time a vacant house that was about to go on the market. I kicked doors in, had fire or PD force their way in, I even took out a window a/c unit and climbed in the window (trick for later reference, just don't push it in and have it land on your patient). Not once have I ever heard "Well why did you have have to break the door?" Nor have I ever had boss say "Did you have to break the door in?" and they would have said something if it cost them a single penny. Has any one ever gotten in to more trouble than they couldn't handle for breaking into home with good intent after looking for an alternative, especially with PD present? Isn't all the forced entries you have made and were wrong worth the times you needed to do it? I always thought that was part of the job. It seems it was more trouble to not kick the door in.

The boy might be screwed. The lawyer wants to take a "not viable" approach, then why was he working the patient. Apparently, he didn't see obvious signs of mortality and can't "call it" .I doubt the complaintant's counselor will let that slip past. We all have had absolutely hopeless patients with a 0.0001% chance, we gave it our all "just in case" you're wrong and they will at least give the family the chance for closure by saying "bye" to them and "pulling the plug". ( And you were right every time and they don't make it, I'm guessing) I don't know if this guy just got excited and tossed the "not working" suction down and didn't notice the bright red tip was now yellow. I couldn't tell you why he didn't find out why it wasn't working. I think it's easy to see this case and put it in context of a substandard performance that one has witnessed in the past. It sounds like he wasn't seasoned enough to override his own adrenaline with a young person in full arrest. I have had a time or two where I had noticed something not right and said: Glad I saw that, it could have been bad. This one slipped past him for whatever reason and went unnoticed. I want to know if the doc fished it from the mouth or pulled it out of the trachea. That seems more definitive. Let this be a lesson to us all. Instead of looking at it and saying "dumb ass", think of any close calls you have had that could have been seen as your fault if you didn't catch it, esp. if when you where new, and count your blessings. The lawsuit is not about if it was an accident or not. It is whether it's his fault or not. The word "mistake" makes it his fault. That has not been decided yet. Learn and be proficient with everything. Demand instructions- even is you 'already know how' who knows what you might get as bonus information. I have found many things being miused as standard practice. Know 'the motions' in your sleep, just in case you have some adrenaline or emotion get in the way. It will leave room for noticing an oops. (that last thing was more for the newest people).

What is so great about LEDs? Did I miss a memo? Okay, I’ll admit the light bar thing was a good idea. Strobes are great but the faster they flash the less bright they are. LEDs are just on or off, and with very little amp draw, you can’t beat them. But I don’t read by light bar. Nor do I ever rely on a light bar to give me a good idea of what is going on. If anything I am apt to turn it off to see better. No, my complaint is focused at the belt ornament that someone is showing me every week that resembles a flashlight except is emits a bluish, sometimes purple, light that distorts the very thing I am having trouble seeing. Am I alone? Am I the only one that gets an annoying head pain from trying to read under a blue book light? What are these people thinking? “They are new so they must be cooler than your old Mag-light”. I hear the following when someone talks about their LED flashlight, and I quote: baaaaaaaaaaaaaaah! Get off the wagon already. How is a light that you can’t see with an upgrade? You get more battery life. Sure, if it isn’t worth turning on the batteries should last forever. Extended battery life is great for my kids’ toys. I’ll change the batteries in my tools; I HAVE TO see out here.

In my service, which is private, we can release (we use SOR) just about anyone. I had a buddy of mine SOR a full arrest. The patient was in his 90's and just got his steak at a local restaurant when he went into v-tach. He was successfully defibrillated and on the way the the squad he didn't want to go to hospital, he wanted to finish his steak. I am more reluctant than that to release a patient. I used to, for instance, SOR diabetics I treated with D50. I kinda got away from that. I thought about it and people don't need much reason to sue anymore. Even if something else happens and you did everything right. I prefer to just get them in the truck and on the way to hospital before I wake them up. Its the easiest thing we do usually, raise a blood sugar. If you are already on the way to the hospital they won't SOR. I would just prefer the doctor to release them. Some cases I tell them "I can help if they'll come with me to hospital". I do that because I don't want to give a guy NTG then he feels better and less like going to the hospital when he really needs long term treatment and not just relief for now. I keep it BLS o2 v/s monitor, EKG, until I can get him to go. Less of a factor to me but still in the back of my mind is the company doesn't get paid when I release patients. If they have to spend a lot of money of meds, diesel fuel etc.... and don't get it back that doesn't leave much left for me. God knows that the bosses don't need anymore excuses to not pay me what they should be.

I am glad to see that there are people left in the field with compassion. I don't know why it is so difficult to help employees with stress. the Best thing I have ever been offered was to talk to a peer that was trained in CISD. A peer was the last thing I wanted. The problem I have is being judged by police, fire, EMS people. I agree that their needs to be another look taken at the mental health of public servants. Its become traditional to drink, get divorced, have nightmares, get PTSD, and die young of heart trouble. IT'S BULL. We are delaying our own progress. Medicine evolves constantly but are we, are our employers?

I would like to add that I am a stable, level headed guy. I been doing well for a long time. In fact the few people I have told where surprised, even those who knew me then. I learned some limits and what it looks like to approach them. The insight I gained, though painful, is a rare perspective that, fortunately, few healthcare professionals get. It hits a sore spot when I see a lack of compassion for serious mental complaints. I try to keep that in mind before I speak-up, but there is a need for some professionals to reconsider their position on the subject, from first responders to MD's.

I, at first, was influenced greatly by my big EMS siblings. The common consensus, in a nutshell, was that suicide attempts got what they deserve and that it is only the great intangable governing body Ethics that causes one to set their opinions aside and treat the attempt. As I have gained my own experiences I feel I have earned an opinion of my very own. Excluding the B/S suicide attempts, you know the chicken scratches on the arm or the threat over the phone to mom, girlfriend etc.... the 3rd party call to EMS that don't amount to any distress what-so-ever. Those burn a person out I agree. I mean the guy you find that is really dying and doesn't want you to stop it. There must be something big going on there. Think about all of the impending doom expressions you have seen. That is a fear like no other. In general, humans have the same drive to survive when it comes down to the wire that all other animals do. Mice don't give up when the cat has obviously won. Yet, in a small percent of people a drive stronger that sex, stronger than pain is bypassed, or overridden. How does one lose the will to survive? Its a bigger picture than sad, pain, or weakness. How many cancer patients have you seen hold on to the very end? What a horrible why to die. So pain isn't it. Long before the the life experiences that EMS has bestowed, my dad attempted suicide. It didn't work and he recovered to return to his existence as a very depressed alcoholic. Their was the opinion proposed to me that it was for attention. Maybe. I'll never know. He had passed about 10 years ago from ETOH abuse. I was taught that having a parent that committed suicide increases the risk in that person. A long time ago I too had to be treated for ideations. No attempt, I was close, but it was real to me. I have made great strides in treating depression, I even gave up alcohol before it was a problem. To this day I cannot fully understand what was happening in my head. I can give you a first hand account of what its like, but answers I don't have. I know that attention was the last thing I wanted. I don't recall any behaviors that could be considered a "a cry for help". I was obviously depressed, but not obviously social. I had a counselor at the time, I knew how to avoid a 72 hour hold, and I did. I went to the hospital on my own accord. But what if there was some hang up about going to the hospital. I know I had a lot more excuses to not go than to go. I'm not sure how that day went but I ended up treated. The point is, its old and out dated to say one has right to kill themselves. I am telling you from experience that, if you have a patient that is a serious case there is something as wrong as an MI. Psychology has progressed far enough to show as that it is possible to have a mind so disrupted that one can kill themselves despite will to live. At that the moment just before they end their life there is no "impending doom" no fear. I reconsidered but was not afraid. I don't know why. I challenge every EMS provider to ask themselves if they haven't "what if I'm looking at this wrong". Illness can be psychological as well as physiological. There is something that I can not explain that goes beyond selfish or weak.