uglyEMT

Captain that was my shift as well. Mine started wed afternoon though. Only had two IFTs on that shift. Very mixed bag of calls which was nice.

I love night shifts, its a world most folks don't get to experience. You can keep the critters though.

I would even venture to say the people themselves are different in their attitude.

scubanurse beat me to it. Take the First responder and /or Rescue Diver course. Both are great dive based emergency courses that will deal specifically with what you are looking for. I just completed my SDI Rescue Diver course and found my EMT skills came into use well as an adjunct to what the diver's emergencies were. Plus as an added benifit with those courses and your EMT or Paramedic card you can treat the patient from the bottom to the ambulance without having to wait for that level of care to arrive.

As for the medic course there are alot of members here that can help you with that.

Good luck

I am well aware of what I'll be facing as an EMT/Paramedic. As I made clear, it wasn't the "doing the job" part that had me worried. I am confident in my abilities. It's the accumulated stress and how it will affect me. And why would I listen to the advice of someone who gives me a "better quit now" and "people with your problems can't do this job" response?

Seth first off let me say good job on asking the questions! Thats a big step alot of first timers don't do. They feel it would be a "stupid" question or a "beat a dead horse" question. When in fact they are not. Each person is different and asks the question for different reasons.

About the part of why would I listen to detractors. Well sometimes hearing or seeing things from a different perspective helps. You might not like what the person says but sometimes its the content of the response that needs to be looked at. Not saying you are not doing that but just dismissing all negative feedback, IMHO, is a disservice to yourself.

About your situation with the S&S you described. You will have to get that in check first and foremost. Double guessing yourself or nit picking every small detail will do two things, first drive you insane literaly and secondly prove a disservice to your patient. Some times in this profession you go on instinct and not just what the book says. You need to be confident in yourself and your decisions during times of high stress thus you need to remove the double guessing from the equation.

I will try to give you an example to show how double guessing could lead to problems. Say your dispatched to a gym for a female complaining of upper back/shoulder pain. Asking her your questions you also hear she has some tingeling in her jaw and after a hard workout is still having some trouble slowing her breathing down. All the while half the gym is staring at you and talking amongst themselves about you and your patient. What are you thinking is wrong? Strained muscles from a strenuous workout or heart attack? Are you walking the patient to the rig or possiblely not wanting her to exert herself too much more and calling for the cot or stair chair? Realize your doing all this in the first few moments before you even begin moving to the rig. For the sake of this example the women was having a heart attack and calling for the cot or stair chair was the appropriate call. See where second guessing and/or scrutinazing every detail might have had a detrimental outcome?

Now if you can handle something like that confident in your decision making skills and with the OC under control to stop the overanalysis then i don't see a problem with you being a good provider. If not then maybe wait until you do have things under control either chemically or mentally or some combination of the two.

As for after action stress and life. You MUST find a way to cope. This profession will eat you up and spit you out if you can't get the a handle on the emotional side. I am not saying you can't be emotional or that it won't happen even with the best coping mechanisims in place (just check out some of the threads in this forum to see even the best of us break down) what you need to be able to do is cope with the coping. You need to have a way to release the stress day to day but also have a way to handle it when you have reached the breaking point. If something as minor as say forgetting your favorite pen will throw your whole shift off and eat at you for days then it may be an indication that you need to find a better way to cope. It also helps to have these mechanisms in place outside the EMS community and before things start. Sometimes you really need to disconect from what we do to be able to decompress. Some say it doesnt matter as long as it is in place but I personally feel having it outside EMS helped me out alot.

Keep asking questions and hopefully you will get constructive responses that will better help you in your decision as to wether or not to become part of your great family we call EMS.

Also now that I thought about it, see if you can do a ride along or two. I know some services and squads do allow ride alongs so that may be an option so you get to see exactly what needs to be delt with and also if you can handle it. Not just during the calls but afterwards. See if you can go home and let it go or if it stays with you for a long time and if so how you handle yourself.

Got onto this one late int he game. I did read everything so Im pretty caught up on it. Please remind me not to get sick in NYC

OK from my BLS perspective... (keep in mind I have a 40 min transport time by ground) (I would love to fly this guy actually)

I am droping an NPA and starting with 15l NRB. I dont think CPAP would be a good idea because of the subQ air already. Might think about a VERY gental BVM.

ALS would be called and meeting enroute. This is a lights, sirens, airhorn call and telling my driver to open the diesel bolous. I want this pt to get to the ER as quickly and safely as possible.

Taking vitals every chance I get.

I want him sitting up to aid in the breathing but looking at the shock side I am going to ease the back down slightly and get a pillow under his legs.

Watching the secreations and suctioning if necessary. Definatley saving some for the Dr.

Depending on his temp I would put ice packs under the arm pits to try and bring it down if its very high. If its not danerously high I would just monitor it to see if its going up.

Other then that I am at the end of my protocols until ALS arrives and I assist them with whatever they need.

Medic hang in there. We all have "those" calls. Its amazing why we get that way after a call. Sometimes its a benign call that hits us.

Check out this post http://www.emtcity.com/topic/19206-something-that-got-to-me/page-1#entry250036 +

We all have emotions if you hold them in for too long they will eat you up and make life miserable. I am glad to see you still have humanity left inside. What you now need is to find a release. Find something outside EMS that will let you let go. I wish for you that your peers realized what had happened and offered professional help. Talking to someone is a good thing.

Don't feel bad or embarassed that you broke down. Its human. We all do it and ANYONE thats says they don't is flat out bullshiting you! Hang in there and if you need a strong shoulder to cry on feel free, mine is always there for anyone that needs it.

While I can't speak for the other poster from NJ but in my neck of the woods.. NO we do not lie to the patient. If we are transporting to a psych hospital or substance abuse facility we tell them. They might not like it, might get violent over it, or simply shut down but we let them know. As far as communication to the facility we usually let dispatch do that over the telephone (One for patient confidentiality. Two to let us deal with the patient not make radio calls)

Our Medical Director lets us transport to the appropriate facility be it 10 min away or 10hrs away. We have a few options in my area for these kind of patients. The hospital we normally use has a psych ward but not a secure ward. Another hospital farther away has a secure facility we use if LEO requests one.

I will say the hospital we normally use is pretty good when it comes to EDP cases. I have yet to get push back when I request an eval.

As far as the poster that sedates and boards EDPs, please tell me this was a joke?!? Besides the ethical issues what you are doing, at least in NJ, is patient abuse, assault, battery and pushing gross negligence. Do restraints need to be used sometimes? Yes they do. But if soft restraints (ie crevats or specialized cuffs) aren't enough then hard restraints should be applied by law enforcement and said LEO should ride along with said patient.

Here is the NJ EMS Field guide if you need a reference source.

http://www.state.nj.us/health/ems/documents/ems_fieldguide/nj_ems_field_guide.pdf

To the OP. You should try and contact your State's Dept of Health and start a dialog with the psych board to see if you can get the protocols at least looked at. Sometimes it takes a voice for a problem to be known. They may believe everything is working fine because they haven't heard a complaint about it. hearing from one of their front line workers vs a lawyer might be just what the system needs. You're bringing attention to a deficency not a claim sometimes that will help get through the wall of red tape otherwise encountered when money is on the line.

Dwayne you bring up a good point. The grey area.

I know if I had a drink or two and it was a life or death situation more likely than not my instinct would kick in before my brain said hang on a sec. I do know it has happened to me in the past. Would I be playing with sharp instruments probably not but to render no care? I don't think I could. (yes I know in my previous post on this thread I said drink = off duty but I didn't think of the grey area just the drunk area)

I do have two examples from real life that I did use my skills even though I did have a drink. One was while on vacation I did the heimlich after a few glasses of wine. Don't think there was any harm there (treatment wise I mean). The second was a near drowning 5yr old that the parents were way in over their heads with. A rescue breath got the child coughing the water up (yes I checked the pulse first LOL) then told the parents to take the kid to the ER for follow up care because of the dry drowning potential. (no ambulance call due to zero cell service in the state park we were at). Again this one was after some beers with the family and friends at a BBQ.

Both instances it was more instinct then thinking. Did I open myself up, yes but I think I did do the right thing and I wasn't invasive with the patient.

If your two sheets to the wind stick to the band aids. You know yourself and how you feel at that moment.

I would like to through a nugget or two out there for you. It may not be true for everyone but hope it helps.

First dating someone inside EMS sometimes makes it easier for them to understand what we go through (bad shift hours or days, the stuff we see and do, ect ect) but I think it may come with a price. That price is you never get away from it. They will tell you there stories and you tell yours so even in downtime getting "away from it all" might not happen and that can lead to burn out. If you have someone outside EMS you have that chance to shut it off and not think about it. I know with my wife (non EMS) when Her and I go out or stay home our conversations never turn to what I do (other than hope your day was OK, glad you're home safe). It gives me a chance to decompress and in some ways keeps me sane. Like I said not for everyone but it worked for me.

Nugget two: Don't shit where you eat!! If it goes to hell then its so very ackward for everyone not just you two. Everyone becomes part of the train wreck and it will strain and sometimes sever friendships or workships. Also some places outright don't allow it.

Ah OK NJ is Blue for VAC and VFD didnt know NY was Green. I guess thats why NYers never yield right of way to me LOL Time to get a green light LOL

ERDoc thanks for the extra info on the area. I guess once you throw the politics into the mix then its a no win situation. Still think with all that apperatus it would go better. I understand with the travel times the response time gets stretched out, we have the same thing here sometimes. Usually if we know the member is coming from a distance and we have someone on the rig already we roll and just notify the late commer to meet on scene. This of course depends on the call severity.

Tough case to crack, seems as though no matter what the patient is suffering in that area. So much for do no harm.

I will attest THAT is a crappy system!

Ok burn the whole thing down, pick up the ashes, and scatter away. Then bring in the paid serviecs and make it work as a normal system. A system that entrenched that the actual County Medical Director was run off and the interm told to sit in the corner After reading the blog I was just assuming it was a duty crew slash protocol issue. I didnt realize it was a freaking school yard clique regime.

ERDoc I don't know what to say but I will say if any place needed a paid service it is that place. Remind me never to get sick up there or if I do at least I hope to be AO enough to turn on my blue lights so my wife can get me to the hospital in time

The complexity is definatley the issue. What they need is to sit down with all dept heads, oem, dispatch and get it figured out. First is duty crews. You have the man power avaialable 24/7 by assigning shifts, coverages, and times. You sit down and logical look at the coverage area and break it up accordingly. You base you dispatch times from there, if there are longer times second tone and mutal aid times are shortened to get the man power moving sooner.

The Department heads and/or Squad Captains need to sit down and hash it out. If anything get a mediator in there and put the BS to the side and get it done. It can be done and has in many municipalities. I know NJ isn't the bastion for EMS in the country but we do have an extremley large volunteer based system and it works. Usually the cities are paid services because the call volume and the population warrant it. Most of the suburbs and rural (yes folks NJ has rural areas) are soley volunteer based due to the above mentioned reasons.

I know that in my area we sit down at the end of the year and review our logs and make recomendations for the upcoming year. This is usually a few day process of review and discussion with everyone (FD,PD,Dispatch,OEM,EMS) and things get worked out. Then the squads work out their scheduals for the upcoming year to have 24/7 coverage and mutual aid agreements. Then during the year any big events that get planned we work out accordingly for the extra coverage even if we need to bring in outside municipalities to have enough man power. Also every quarter all the Squad Captains in the county have a meeting where we discuss issues and make recomendations that way surrounding municipalities are all on the same page.

I agree.

Booze = I become a civilian.

Beyond a Heimlich or CPR I wouldn't be doing much if anything. As ERDoc stated, if I am out of my service area or area of responsibilities I keep it to call 911 and apply simple first aid.

Your partners seem to be of the kind that want the world to know they are medics any chance they get even if it means doing so while under the influence. THAT is a bad combo that can be disasterous to both them and the victim. I do want to state I dont believe they would do this while on duty just that in the off duty times they don't shut it off.

Welcome. Congrats on passing.

Now the real work begins when you hit the streets.

Dont be shy around here, pull up a chair and ask away. In my experience here there are no dumb or bad questions. You have alot and I mean ALOT of truley wonderful, intellegent, and experienced folks around here. Pick our brains!! Remember we were all where you are now at one point (although some my never want to mention it hehehe lol)

Enjoy the site.

Doc I wil agree that a paid service doesn't get to pick and choose. You show up for your shift and answer the call what ever it may be.

I will say though that from my experience even in a volly squad once you set up duty crews the coverage is the same as a paid. Basically its your shift you work it. I paint with a broad brush with my 3am example but we still get the man power, it just seems that the MVA will get everyone calling in vs the stomach pain which will get just the dedicated people calling in. The duty crew responds no matter what unless they are already on a call.

I think if the proper procedures are in place and everyone is on the same page volly does work well.

Im not going to comment on the paid vs volley. horse meet stick. But I do want to comment on something I noticed in the blog and with my own eyes in my area.

Could it be more of a procedural issue moreso then a paid vs volly issue? What i am getting at is the way in which calls are handled not who handles them. The area I am in is fairly large 85 sq miles covered by two squads that are not fire based. The local procedure is night duty crews responding from home (one crew for each service rig) then any aditional help would be called up as necessary. Dispatch tones out the crew and if not 10-23ed within 5 minutes are retoned. 2 minutes later if no 10-23 recived the other squad gets toned and usually by that time the other squads crew is ready because they heard the retone and started getting ready. So we usually have a rig rolling within 7 minutes most times alot sooner. Some crews with far travel times usually stay at the station for their shift so response time is immediate. During the day we are most general calls, no dedicated duty crews, and I would say 99% of the time a rig gets rolling within a few minutes, usually the retone is to notify responding parties that the crew is filled or if additional support needs to call in. Very rarely has a mutual aid gone out. If it does it usually means all rigs are out on other calls or we are dealing with something big.

The dispatchers procedure is cut and dry as to how EMS calls are handled and coverage is good. They dont keep punching out time after time hoping someone calls in. I would think thats how it should be once twice mutual aid and depending on travel times for mutual time limits for the call up should be looked at.

I think from reading that blog it seems like the procedure is flawed. The dispatcher keeps trying for far to long, then on the other end the mutual aid seems flawed by not making it a priority to respond. I think the fire based issue here isnt so much of an issue as is the procedures put in place is.

I think it is time to sit down with department heads, oem, and dispatchers and work out a new set of procedures and response time variables.

As to the side issue brought up about the "good calls" vs "ugg calls" getting man power I think every service has that problem. Tone out a stomach pain at 3am vs an MVA and see which gets the ants crawling. Same goes for a fire based service. Its the nature of the beast I guess. A fire fighter I know once said their version is call out for a possible smoke condition vs full envolved structure fire and see which gets more guys to turn up.

Looks like it was just an EDP. No passengers are known to be ill. Passenger led away in handcuffs to an awaiting ambulance.

Mods if you want you can delete this thread as it is currently a non event.

http://abclocal.go.com/wabc/story?section=news/local/new_jersey&id=9141962

Story is just breaking so few details right now. I work directly across the runway of Newark Liberty and so far flights seem normal. I can see down twords the Safety building alot of activity. Trying to get the scanner tuned in right to listen. About 24 minutes until touchdown. Will try and keep everyone informed from an eye witness prospective.

Hopefully this is just an EDP and everyone is OK.

mods if this is the wrong forum please feel free to move. Felt if this is an actual MCI it would fit here.

For the fellow who said bag her or put 15 LPM NRB- dude, she just got a neb tx, of course her resp rate will be elevated (along with her heart rate). Ever had one? She's fine. Her sats are fine. She's compensating well. We just need to support her and watch her carefully lest she decompensate on us, in which case we've got a mess on our hands.

Wendy

CO EMT-B

RN-ADN

Thanks Wendy. Didn't realize the neb treatment did that. No I have never had one nor a patient that had one. Most I have had was handheld inhalers. I did say i would be ready to bag, as you said in case she decompensates I want to be ready thats all. The 15 NRB was because of the shallow resperations but again I didnt realize the neb would do that. I was just going by my inhaler treatment protocol which is after treatment if patient doesnt respond with normal full breaths give 15 lpm NRB, call for medics, meet in route, load and go. Just fell back on my stuff thats all.

Thats why I love this place, I get exposed to things I haven't had before and get to know from others experience what to look for and what treatments are advised.

.

That's a very simplistic way of looking at it, and not accurate. When a local does something, generally they are acting for themselves. It's that simple. There are things that all locals are expected to do and follow, but generally they act as they see fit. This isn't to say that support may not filter down from the the international, or that the international does not do it's share of stupid stuff. But just because one local does something/takes a stance on something/whatever does not mean that it is being done by the IAFF as a whole, or that the official policy on that issue (if one even exists) is being followed.

I didn't mean the municipality. What I mean was that when one local does something it shouldn't be said that the IAFF as a whole is doing it, but that the local chapter of XXX city is doing it. Clear?

While I am not going to comment on the IAFF union thing. i do want to point out something about unions in general. Triemal is pretty much spot on with this comment. The union I am in just went through our big contract negotiation so this is all still fresh in my mind and the resources are close at hand. The Internaional had certain conditions during the negotiation that were for all the locals (pay, benifits, ect) then it came down to local negotiations that delt with "local" issues (by "local" I mean area specific) those were about company agrements and stuff affecting the local unions. It wasnt until all the issues both international and local were resolved was the master contract ratified.

So I can see where one local or city negotiated something that wasnt done somewhere else but it is still sanctioned by the international in general.

One comment I do want to make is about the shake and bake medic courses (my term for them). Most are specifically for the benifit of fire based ems systems. In areas where ems is not fire based you dont see them much. In my area all the medic services are through the hospital system and all medics are required to get sponsored by a hospital which then sends them through the actual college program with them then staying on for at least 2 years riding before finally being able to switch hospitals or go into the private sector. The area adjacent to me is fire based and most medic programs are course based and not through a college program and after the course is completed and certification issued they find employment where ever they can. Some depts in that are will "sponsor" a medic and have them stay at that specific fire house for a specified amount of time just to get a return on investment and not much more.

We sometimes get these medics due to call location or distances involved and can say that I would rather have my normal areas medics then the course medics. They (local area) just seem to be more knowlegable and comfortable doing their thing. The shake and bakes seem to know the procedures, follow an algorythem, spike a line, add diesel bolous, and get to the ED.

Just my two cents.

Dwayne excellent post man! I think its good to get that stuff out there. I think sometimes we all fall ill to the wanker bug not because we want to or desire to but because we forget that we treat human beings and not just a bunch of S&S. I read your post a couple of times to really make it sink in and to reflect on it. It made me think of a call I actually did a post on. I had that "moment of enlightenment" right in the back of the rig where I went from wacker to professional. http://www.emtcity.com/topic/19206-something-that-got-to-me/?hl=%2Banother+%2Bfeelings+%2Bpost

I figure the link would be better then a wall of text.

Wow rereading that post brought it all back up.

Done. Glad to help out and good luck

My feelings for the NRB is because of the 94 sat would like to see it up around 96 or 98.

Bagging if necessary due to the shallow respirations and wheezing sounds. This Pt may need help soon especially if the tidal volume continues to decrease.

The pale skin, that was my bad last night I was thinking cyanosis not pale skin. Now thinking about it with the hx of this Pt. any number of things could be causing it. So it really isn't indicative at this point.

The other things I mentioned are more of me thinking out loud. I usually think worst case until its ruled out through assesment.

1. Haven't experienced this kind of reaction.

2. No

3. 22 RR.. I would think 15 Lpm NRB because of the pale skin and depending on tidal volume... bagging.

What was the change with the Epi?

Sounds like a blood transfusion from someone that has bad seasonal allergies. If the Pt is in/from the Northeast we are currently in a very bad allergy season. Cold spring has led to both a tree and weed/grass pollen season happening at the same time.

Zofran is leading me to Chemo. Also said unknown treatment?!? I would find out the treatment due to the fact you may be looking at a side effect. Might be looking at a drug interaction. Has the patient vomited recently? Could be an aspirated Pt with onset pneumonia.

If nothing else I would be monitoring tidal volume and RR, sounds, and transporting. If the area has a dedicated hyperbaric and/or asthma center that would be my choice.

No problem Dwayne. You didnt give that impression at all, I just wanted you to know I went out swinging. I remember a few conversations we had about leaving places that were bad and everytime it was about the patients and fighting for them. Yes once my health went down and my wife didnt like who I was becoming or how I was feeling I knew it was time for a change.

Speaking of family I hope all is well with yours.

Many times it's because they are afraid of change.

Thats all it was.

They hated the State's new protocols (able to take blood sugar, standing orders for epi and nitro, and able to give ASA). Yea seriously those were the changes they didnt want, said it would be to involved and what if they make the wrong call. Plus the mentoring program. Hell they even bitched when I formed a comittee and got us a new rig through a grant. They bitched the rig was bigger, had a few different compartments, no cup holders, and the air horns were too loud, there were too many lights and finally the stripes on the back made us look like the fire deptment.

It was what it was. Its over and I have moved on.

No problem Artickat. Dont mind a seide track now and then. Yea it was just an example thats all, having had the jaw pain present on 3 female cardiac patients with the stomach issue (2 females called it upset stomach, one said heartburn) with no other S&S I kind of drew the conclusion. That was the point I was trying to make there the experience got the ball rolling vs vitals. In the rig the rookie did ask why he was having such a hard time getting the pulse right. During Q&A the rookie did tell me if he was alone or with someone else he would of called ALS at that point because he felt the pulse was "funky". So the patient would have gotten the proper care but just a little later in the process.

It was something I was pushing for in my squad, a great mentoring program. As Dwayne probably remembers I was a huge patient care advocate, something he helped instill in me, and we chated about mentoring and possibly making a thread or something about it to help new EMTs along. That was the biggest resistence I got, the more experienced members not wanting to "babysit" when in reality I was trying to make us stronger as a unit by helping the rookies think critically, make connections between different patient's S&S based on experience, and to do good medicine. Thus more people that can be paired together to help with scheduling and other things that come up so we can be flexible as needed but with the best in patient care as possible.