EMT Martin

Speaking as a non-paid EMT...yes, that's right, a volunteer: Take her out of the system. ...not all of us are motivated to serve biased on what we can and can't get. And some of us don't even earn money to motivate us; some of us just do our jobs because we have high hopes that when we're in trouble, someone will come to our aid. My department still hasn't recieved H1N1 vaccinations; we've had them going out around us, just not to us. You don't see me throwing down my stethescope and refusing to answer calls. I have N95's if I feel in real danger. We've also had more than just one confirmed case in our area, thanks to the county fair. :/ Thank MFRI for keeping us up with that...

With an eighty year old male on my squad running day crew at a volunteer EMS squad, I say go for it! You're never too old unless you make it so. Welcome to the City!

He signed. He just didn't accept the canary copy that was supposed to be his. He -almost- walked off without signing. We do have officers document it when we can't get the patient to sign, per protocol.

Very unsure. The cops basically wanted him to just go about his business. The more and more I sat and stewed on it, the more I couldn't agree more. If I had to load him onto the ambulance and deal with him for a whole 25 minute ride to the hospital, I'm 99% certain someone would've pissed him off and we'd have had to break out the restraints. Which, honestly...isn't a fun night for me. I'm the 'big guy' on everyone's crew, and ergo, the de facto one who's supposed to contain a patient when they get violent. God knows I didn't want to be bashing on a hippy (should be noted he was wearing an awfully shagadelic tie-dye shirt and had long, I'm-the-son-of-God hair).

So I just got in from an...oddball 911 call. Ambulance 68 was alerted to the report of someone jumping from a car into a roadway. At the time of the dispatch, police had been alerted since the subject in question had run into the woods. When we got to the scene, we find the guy sitting on the hood of the deputy's car. No cuffs or anything, and the only visible injury is a small scrape on his arm. The patient's awfully beligerant, won't sit still while I'm attempting to auscultate his B/P, and is more concerned with saying he's just going to leave than anything else. Apparently, he and his girlfriend got into a fight and she'd hit him. After a half mile of being hit, he jumped. The last I saw before we cleared, deputies were simply advising the girlfriend not to go home with him as he walked away. Without his copy of a refusal, I might add. Guy wasn't ETOH either, ergo there was no reason for them to keep him. So here's the $25,000 question. Should we have taken him? I continue to think that it was better we didn't, but given that we had no idea the speeds at which he jumped, nor the police taking him, I wonder if we should've. Thoughts?

This issue has started to recently show it's nasty head in my squad. EMS workers are all for getting the piss tests. The fire guys aren't. Guess which side is doing more weed than the other? Why get high when there are so many other ways of achieving a false sense of smug superiority? That's the way I've looked at it. We already have a no-tolerance on boarding and manning any piece of apparatus while intoxicated to any degree. There's a specific command in our SOPs that states that if you drink, you turn your pager off and do not come to the department until you've slept it off. This says nothing for the installation party every year, though.

Take advantage of every free bit of training you can get. Period. It will help you in the long run of things. Also be prepared to go from highschool to college when you take those classes: things won't be easy, but the rewards are tremendous.

Agreed, wholeheartedly. I've got a repeat offender in my jurisdiction, who consistantly 'tries' to kill himself...but we take him everytime. I just make sure that the state and local law enforcement officers know that I want him cuffed or that I'm going to restrain him myself if they won't do it. It'll be that one time I think he's 'okay' that he'll flip out and attack my crew... But, yeah, I find most suicide attempts to be someone's attempt to get help because they need it. Best to let them go to the hospital for an overnight evaluation.

Definately a transport. As everyone's said; alcohol really throws out the red flags as far as mental capacity to make the conscious decision to sign a refusal. Furthermore, an attempt at suicide really is an altered mental status sort of area, isn't it? In that regard, there's no capacity to sign a refusal, at all. Add on top of that an altered mental status with the suicide attempt...and you've got grounds to transport. Would've asked the PD to assist and document what happened, as well...for legality's sake.

We use Strykers on all three of our ambulances, with a charged battery in the cot, a spare in a compartment, and a spare in the station on charge. This enables all ambulances to constantly have a charged battery, one way or the other. They are definate back-savers, as I've used some of the Ferno manual crap in neighbouring jurisdictions and hated them. As for stair chairs, we've yet to get an electric one. However, in one of the responses I made with a friend's squad on a 911, I got a chance to sample Stryker's version. It's a backsaver as well with the nice treads-instead-of-wheels business.

We have one of those neat, confangled auto-pulses. I've watched the EKG's when the medic shows up, and it's got a very consistant compression set down. Every spike shows up neatly as the last. But we tend to use a combination of EKG, femoral pulses, 12 leads, SpO2, and the old saying "if you're not breaking ribs, you're not doing it right." ...should be noted I haven't been on very many codes, though. Three.

Unfortunately, as a young guy, I can't really comment on the sleep routines. Some people, it gets to them...others, it doesn't. Of course, this is from the volunteer-side of things; four duty nights a month, 2100-0500 served time, et cetera. However, I do know that both vollies and paid have a lot of heavy lifting. In America, at least. With obesity on the rise and people unwilling to do much but laze about in their 'off' time, you often get the big people with chest pains/trouble breathing/et cetera that need you to lift them. If you're working on the volunteer side, no problem: call the fire department for hose jockies to come out and assist. Not sure what the poor, paid guys do...

Many thanks. And something did throw me for a loop today: a call to the nearby airbase for the pilot ejection from a crashing plane. Never seen that before...

The median range of age in the department as a whole is roughly 32. That's taking into consideration fire side, which has no interaction with EMS, usually. If we take EMS, the median age goes up to 47. Myself at 23, that crew chief at 19, and one other EMT at 17 are the youngest EMTs. Myself and the 17 year old are not in a crew chief position, and thusly, can't even run a call without one even if challenged by Fireboard dispatch (IE- "Any response out of Company 6 for the ambulance?"). It's as if the state recognises me as being an EMT...but my department does not. I agree, wholeheartedly, that I should've done more. I really look back and kick myself in the ass for it. I knew the procedures but didn't do them because someone who has a title and a few more months experience told me not to. I shouldn't have allowed for that. As for the reason I wanted to do a rapid trauma assessment: The patient fell backwards from a small stoop, thus increasing the height at which she fell (hence why I noted it was a fall from roughly four feet). Further, our classes are taught that all trauma situations should call for a rapid trauma assessment, if but to catch internal injuries we may pass up. Afterall, nothing like feeling crepitation or hearing it to illcit a response. This isn't, by far, my first trauma call. Though I may still be a bit new in the field, I have docked up around 120 calls; which, for my area, is astounding. I've seen first hand what passing up the smallest things can do to a patient. The bottomline is this. I thank you guys for showing me the ways in which the call was handled incorrectly. I apologise for not having a full detail of everything in the original post, as I didn't complete the report for that particular run. I can only tell you that the baseline vitals I personally assessed on the scene were a BP of 135/92, pulse thready at 67, Oxygen stat of 85%, and that her CAP refill rate was less than two seconds. This was all I got before I made the decision to step on the crew chief's toes and make her call the medic for chest pains, then package the patient. I just wanted to get it off my chest before I go getting whacked on the head for not stepping up when someone's in charge and I'm not.

ERDoc: Per new stipulation put out by the state medical director, units who's drive times are greater than thirty minutes to a trauma centre are not to leave their county/jurisidiction during consult. Ergo, since the nearest hospital is a basic level and has no ability to treat the trauma of this level, we're told to consult online with the local hospital and the trauma centre. Since the drive time to the latter is overwhelmingly long (2 1/2 hours one way, on a good day where I-95 isn't backed up), running it priority two with lights and sirens the entire way (in my opinion) puts as much risk to the patient as does flying them out. Yes, we all still have the loss of Trooper 2 fresh in our memories when we fly anyone out. But the bottom line is, the state's medical director basically tells us in the rural areas to expect flyouts from Cat A and B's. I'm really glad someone found the trauma decision tree, too; that's helpful in illustrating what I'm trying to say. I personally see no problem in consulting with the trauma centre as a safety net, period. We're not doctors. Well...those of us who're EMTs, only. We're told to have a high index of suspicion, and that's what I was undertaking. But the fact that this young upstart (who is allowed to be a crew chief only because she's been with the squad for a year) didn't know what to do and I did illustrates only that my squad's inner-workings needs to be reconsidered. I think it's sad that I knew the protocol, knew the procedure, and this crew chief (should be noted, crew chief is in charge of care on the ambulance) didn't! Bottomline, I sort of suspected it would be a penis-measuring contest...which is what I'm trying to avoid. As the new guy, my EMS-Peen doesn't measure up to theirs; and though I may be in the right, this doesn't necessarily mean that I'm going to be considered much in whatever preceedings come of this. I hate that. While the young gal simply shrugs off another suspension, I'm possibly going to get my first and put a permanent scar on the beginnings of my EMS career. Yay! Another MIEMSS-y. Actually, I'm not referring to long bone fractures. Nothing in the leg at all. Rather, pelvic fracture. From what I was told on the follow-up, there was a good fracture in/near the Illiac Crest or something of the nature. Sadly, our driver that day was not an EMT, so he doesn't understand anatomy as well; he just understood that the woman was flown out of the hospital we took her to, due to skull fracture and pelvic injury. I have since brought it up with one of our two captains. Her outlook on the situation is more that I need to 'step up' more and that weather may not have allowed the chopper to take off anyway. Like you, I feel that if trauma has occurred, a RTA is absolutely necessary. As you said, I could easily miss something life-threatening. This is why it's on our practicals, afterall. It's a necessary step in patient care; period. Why this crew chief couldn't understand that...is beyond me. I tend to discredit my methods and not question the 'authority' until after the situations. Bad, I know. But my thoughts are that I'm still too young to understand all the reasoning, and I tend to get overlapped by other EMTs. Nice guys finish last, et cetera. I'm working on improving that, as best as I can.

Not insulted at all, I know that I've got a lot to learn, yet. To attempt to give you a background, and at the same time avoid the confusion of local codes: My state's requirements through trauma decision protocols state that "open or depressed skull fractures" be flown out. This is due, in no small part, to my unit and any unit in my vicinity being able to 'safely' transport a patient to the nearest trauma centre within the 'golden hour'. By default, that statute is considered "Category A" in a tree that decends in line to "Category D". Since this was on the highest point in the scale, it's considered an automatic flyout, as is any hip injury (the one I was unable to assess, due to being told not to). For the chest pain: it began after the fall, from what I was informed. Our state does not have our EMTs question whether it could or couldn't be an MI, but rather, call the medic unit by default. From my anatomy classes as well, we were taught that falls, injuries from accidents, et cetera could all constitute a heart attack, due to it's anchoring in the spine. Ergo, since she fell backwards, I would've thought it a good call to make. In all, my overall look at the situation was that it was multiple traumatic injuries; the focus on the head only made because it was the only injury site I was 'allowed' to palpate and physically see. Regardless, the hip and head both constituted a fly-out and high traumatic injuries, as far as my protocol states. This was why I felt the need to commit online consult with the local trauma centre, first and foremost. Further, considering that the patient was flown out hours after we dropped her off...I would've thought I was in the right on that call.

Greetings! I come foward today to post a story that happened to me approximately a week ago, which is now making repercussions in my department. Of course, all names are withheld to protect the innocent, blah-blah-blah. I happened to be in-quarters at my department when Fireboard set off our tones to notify us of a 70-ish year old female who'd attained injuries from a fall. There was no further information, as the caller was too hysterical to get past saying that there was some bleeding and that the subject couldn't move. I attended the call as a simple technician with one other EMT-B/IV Tech who was my crew chief and our driver. Upon arriving at the scene, we found the female outside. She'd fallen from a standing position, less than four feet backwards. She was stating that she couldn't move because it hurt too much. My crew chief (recently promoted) simply took a knee beside the female and asked her what happened. She then listened to what the patient had to say...and pretty much did nothing else. This discouraged me, because I knew a rapid trauma assessment was needed, immediately. Therefore, I stepped up and stated to her "would you like me to start a rapid trauma assessment?" I was told not to. It wasn't severe enough. I didn't like that answer, so I stepped up again and took over patient care. I began asking the lady what was going on and found that she'd stated she was suffering from pains in her chest. I asked her to describe them, and feeling that it was a risky situation, dispatched for a medic. It should be noted that our medic units are chase units; paramedics who board when called for, et cetera. So our medic unit is responding, and our driver comes over with the stretcher, long spine board, headblocks, collar, et cetera. With still no idea how extensive the injuries are, I'm told to step aside and help log roll the patient. I figured during the roll, the 'chief' would finally take it upon herself to check the backside of the patient. She didn't. We roll the lady aboard, and by now I know we've broken a lot of protocol. The patient's loaded onto the cot and taken into the ambulance, where I begin to take vitals and assess her breathing. Before I get a good set of vitals, the medic arrives. Unfortunately, she is by herself, and since my crew chief is younger than I am and has no license, I'm advised to drive the unit behind the ambulance until we get to the hospital. It was a largely uneventful trip for me from then on out, but I had advised the paramedic before she boarded that besdies chest pains, there was blood in the back of the woman's head. Upon arrival to the hospital, I parked the medic unit and turned it off, meeting my crew and the medic inside. I hand her the keys, she thanks me, I wash my hands off after taking all BSI precautions, et cetera. Now I'm back in the unit and we're headed home. After the crew chief calls us back in service, I turned the command chair around to talk to her (both she and the driver are in the front, I'm the only one in the back of the 'box'). I asked her if they'd consulted with the online trauma centre, since there was at least a Category A and D consideration for this patient. She told me they did not. A few days later, the driver approaches me and tells me that the hospital ended up transporting the elderly lady to the nearby shock/trauma centre and have kept her for a near week. Indeed, as I thought, the patient had fractured her skull. She also had a hip injury (a second category A consideration) that I couldn't have known about due to no rapid trauma assessment. Now...the call is under investigation. So here's my question. What can I expect from this call? I did everything that my crew chief told me to, while being unable to do what I felt was necessary. Furthermore, a seasoned paramedic never initiated a call for fly-out (my area having only one hospital and being too far removed for ground transport to be effective). Should I make some sort of statement to my EMS Chief? I want to know what you guys think.

I have some insight, but this comes not from the private, paid field...more toward the 911 side. My department doesn't employ a day crew. There's just a ragtag lot of us who work daytime hours and respond to the calls that come in. With my state's medical system being what it is, our medical director feels that 'if they're sick enough to call 911, they're sick enough to go to the hospital'. We have urge our patients to go, even if it's just a BS call (read- "Obvious priority 3"), like you've hinted you get a lot of. So, yes; we wind up with grandma who's had influenza for the past 150 years and suddenly needs to go to the hospital, like...RIGHT NOW. Ergo, lots of drama over the risk of letting a patient move themself versus bringing the cot/stair chair right up under their ass to move them. Now, toward your livid partner... I'm the only young guy on the day crew. With none of my local private transport companies getting back to me, I'm sadly out of work for the time being. Ergo, when I'm not putting in my 1796th application, I'm responding to calls. At only 23, most of the 70+ Day Crew Club think I haven't the slightest idea of what I'm doing. And, being the "veterans" of the field that they are, and all the high-up positions they held in the past, they tend to like to throw around powers they don't have anymore and keep a very short temper with me, personally. Incidents such as yours have happened to me; the bitter old man decides he would rather deride me in front of a patient than hold his tounge and squibble when we get back in quarters, or the patient's care has been transferred to whatever emergency room nurse has signed off for care. My suggestion is simple. Bite your tounge in front of the patient, but feel free to address the situation when you're not actively transporting. Yes, this may cause an arguement...but in the long run, I've yet to meet the EMT-B, I, A, P, CRT, et cetera who doesn't appreciate a fellow responder voicing up their concerns. Simply put, take this lady aside and simply state: "Listen...I appreciate you trying to correct my technique, but could you be less invasive about it? Especially in front of patients? And maybe drop the attitude a few notches toward me? I am, afterall, your partner. I go through much of the same BS as you do, and I'd really appreciate it if we could be civil in our arguements." ...or something to that effect. A little kindness and a little civility toward even the most irrate and irrational EMT can go a long way. Not to mention, it eases your own personal stress levels. You can safely look back and say "hey, at least I wasn't the one acting out irrationally or blowing my top off over nothing."

Many thanks! Yeah, thanks to the great state of Maryland and the EMAIS system with our many, many necessary narratives, my grammar, punctuation, et cetera all have to be keen and on-target.

Greetings to all my fellow EMTs out there! As a new member of EMT City, I thank whomever for making this site. It's wonderful to be able to connect to more EMTs than just the local jurisdictions! I, myself, am a rather new EMT-Basic. I'm hoping to work my way up to Paramedic and hopefully work my way into a private transport company so that I can finally be paid, since I intend to do EMS as a career. I'm looking foward to being able to hear some stories from some of you guys who've been working the field probably longer than I've been alive. And, being so brand new to the field, I hope that I can put some of the things I hear into function on my calls and make sure my patients don't fall into harm!