PCP

Why does he need supplemental oxygen?

Did he request pain control? Was it offered?

Can you do a 12 lead? If not, how were you planning on monitoring the chest tightness?

What underlying possible injuries do you think could have developed that you could have treated?

His SP02 stats where 93% and when he was put on high flow O2 they went up to 96 %. Patient was a heavy smoker, so 93% for him was acceptable to me. I feel that the O2 would just have helped him calm down a little and bring his SP02 stats up while being transfered. He may not have needed it, but at least I could have put a nasal cannuel on him. NOt going to hurt anything.

He did not ask for pain control, but I could have offered it to him again while in transport, if I felt that the chest discomfort he was feeling was due to him being a heavy smoker and had just finished climbing back up a side of a bank about 20 to 30 meters. Not saying I would give it to him, but at least I have on my ambulance if needed.

I can not do 12 leads, but I do have a AED with 3 lead capability so I could monitor him that way. I was not concerned about his chest as I questioned him about the soreness in his chest and it was not pointing towards cardiac. I should have mentioned I did hook up our three lead and he had a normal sinus rythm.

To be honest I was not really concerned about any underlying problems that may have developed, but more so about his pain in his neck. He did take a pretty big fall. My feeling is if something did happen like, decreased LOC, sudden abdominal pain, the injuries to his head bleed through my dressings. AT least I can deal with that when we are in the ambulance and not in some personal vehicle. I could have started an IV on him, even though there was really no indication for one.

I just feel the best place for a patient who has suffered trauma is in the back of my ambulance rather than a coworkers vehicle where nothing can be done at ALL!!

Do you not agree that a patient like that should be in the back of the ambulance?

While I'm right there with you on not giving oxygen unnecessarily, I would like to anecdotally say that oxygen does seem to have some therapeutic effects with regards to pain and (maybe especially) nausea. Don't know what the science says, but a little oxygen does seem to be relaxing for some of my patients.

I just don't see why not give a patient oxygen, sure they may not need it, but if it helps them feel comfortable, or help with nausea, bring there SPO2 stats up. I was taught that any trauma patient gets a non rebreather. So that is what I did, then I down graded to a nasal at 3 LPM.

I explained to him that there may be underlying injuries that I can't see or may develop while being driven to the hospital that could not be treated due to being driven by a coworker in a personal vehicle, but that did not work. It is hard to talk a patient to go to the hospital in the ambulance when the patient is the acting mine manager this week. I was hoping one of the other staff members might have spoken up and helped me talk him into being taken in by ambulance, but that did not happen.

I guess I could have kept trying, but I felt he needed to be seen by a dr. sooner than later. All and all it turned out okay, from what I was told. Only a few stiches in both wounds and no damage to the spine.

Main thing is the guy is okay and was able to go home without any major complications.

I agree with Bieber's comment on the complexity of the warning statement.

When you get to the point of having to say, "Sir, you do understand that you could possibly die from this?" and they still insist on an alternate means of transportation, just ensure you have a third party - non EMS - witness and ask him to sign here. There's not much more that you can do.

I did have a third party sign my form as a witness. The same as I do when I am working on car for the BC Ambulance. I documented everything that happened, as I enjoy working as a first aid attendant and do not want to be brought down in flames due to a patient refusal form.

I am very lucky where I work, we have a fully equiped ambulance on site. Same as what you would find in any ambulance service. I have access to everything I would normally have while working for the BC Ambulance service, plus a few extras like wooden splints and a few other wound care supplies. It is just hard for me to allow a coworker to transport a patient of mine who I feel needs to be monitored while being transported, not to mention higher care for the patient.

So, I had a worker today come to into my first aid office with head trauma from a fall. I treated the worker for his injuries to his head. The worker complained of a stiff neck, which is to be expected after being thrown off a snowmobile and falling down an embankment about 20 to 30 meters. The patient refused a hard collar and did want to be taken to the hospital by our onsite ambulance, but wanted a coworker to drive him to the hospital.

I told the injured worker and the other workers that came over to check on their fellow worker that I did not agree with him being taken to the hospital in a work vehicle due to the lacerations on his head and tightness in his chest. The worker still refused and managment backed him up on it.

My question is, how far does one go to try to talk the patient into being transported to the hospital by our onsite ambulance, rather than a personal vehicle? The hospital is an hour away from the work site.

I feel that the patient should have been transported by our ambulance where I could have monitored his vitals, gave him O2, been able to give the worker Entonox if wanted, as well as monitor the tightness in his chest, along with the injuries he sustained on his head.

I just don't understand sometimes!!!

Hawk eye welcome to the city!! Those are some great questions and as mentioned great answers! Feel free to ask questions and check out posts from other members as you will find some great information being posted on this site.

Brian

On our car, we have one pillow on the cot at all times, which gets switched out after every call or at least a new pillow case, as well as we have one extra pillow or two in our cabinets. Also we have a pillow with a trauma strap wrapped around it with a ice pack in it to be used as a pillow splint. In many cases I have used two pillows for my patient, so they are comfortable, especially on those long transfers.

Hey no problem

As mentioned before good luck and don't be shy, jump into discussions on the forum or post more questions. There alot of people on this site that can be very helpful.

Hello all, I'm new but from what I've read I think I'm going to fit right in. At this point in my life, I'm finding that my path in college isn't very much my thing anymore. I've wanted to be a Medic since I was little, but when it came time for college, I was pushed in the direction of higher pay, computers. Don't get me wrong, it's good work and it pays great. The only problem is that it is quite possibly the most boring way to make a living. The college that I'm going to now offers an EMT Basic course that takes 3 months. This is where I have some questions.

Firstly, there is an accelerated course. My question is whether or not someone with no formal training in medicine could feasibly do an accelerated course. My parents are both in medical lab jobs and I've grown up around blood and medicine all my life. I even passed an online practice exam.

Secondly, I'm not going in blind here. I've done a ride along with a local Private company. Capital Ambulance of Bangor Maine. It was the most fun I'd ever had. My question here is about my current work experience. I'm currently a supervisor at a local restaurant after 4 years of employment. I'm not at all squeemish. I've cleaned puke, crap and blood up so many times that I've lost count, and I've had people in my face screaming at me every day. That on top with a store open 24hours, I'm very used to working at 4am one day and 2pm the next. Would you consider someone who would do well finding employment seeing as I have management experience and stay with jobs?

Lastly, would you consider $12 dollars an hour a good starting pay for a Basic at a private company?

Thanks so much in advance for any advice.

Welocme to the City! IMO having management experience and staying with a job or having people screaming at you every day is not the reason you should do the job. I may be worng, but I feel with your work experience as well that it will not help you find employment in EMS. I can say for sure what each company is looking for when they are hiring somebody, but for the most part I would say it would be based on personality, how you answer their questions, and how well you do on their scenario based examination if they have one that is part of their hiring process. You have to be able to enjoy what you do and have the PASSION for the job and want to help people and treat them with respect and compassion. Sorry I can not answer your question if 12 dollars an hour is good for a starting wage for a Basic at a private company. The service I work for, the starting wage is 18 an hour for a driver only and that is someone who does not have an EMR, PCP, or an ALS license, so all they can do is drive. The pay goes up from there depending on what license you hold and how many years you have been in the service. Now with that being said, we are a union service so that does make a big difference.

I would maybe try and do some more ride alongs if possible and talk with the medics and find out what they enjoy about the job, as well as what they don't like about the job. It will give you more of an idea of what a day and a life of a medic really is like. In my experience, working as a medic, there are very few days where you are dealing with people vomiting, yelling at you, or even very little trauma. Most of the time you are dealing with sick people, so you need to have a good understanding of Anatomy and physiology . Possibly take a first aid course first before jumping into the EMT-B course, just because IMO the course can be very intense and there is lots to learn in such a short period of time, so having some basic skills will help you in the course.

It does not matter what people tell you, just remember it is your life so it is your decision! That statment comes from my own experience from people trying to talk me out of becoming a paramedic due to such low wages. I would not change a thing as I love going to work and helping people and learning every day.

Good Luck to you!

Brian

The service I work for I believe starting in June of 2011 are going to a dark blue dress shirts but no more buttons, but a zipper in the front. We currently wear a white dress shirt and have been since the service started back in the 70's. Not sure why the change, but I like the look of the new dark blue dress shirt.

I feel wearing a t-shirt would be nice during the summer time as it might be a little cooler.

When it comes to a uniform looking professional I feel that as long as the dress shirt is ironed and tucked in, pants are pressed, and boots shined that is professional or if wearing a t shirt it should be not wrinkled and tucked in.

As mentioned we wear white dress shirts (soon to change) and if we spill anything on it or if it is wrinkled before your shift. Our Unit Chief requires that we iron our shirt or change it if it has a stain on it. He will even shut the car down until we change our shirt. That even goes for students if they show up with a messy looking uniform, he will make them iron their shirt, polish their boots, iron their pants or change their their clothes before going out on a ambulance call with their preceptor.

Sounds anal, but in our profession I feel we need to dress and look professional at all times, that even goes when wearing a t-shirt in those hot summer days!

Welcome to the City! You will find some great discussions on this site, so don't be shy and jump in and put your two cents worth in.

Happy New Year!

Brian,

I have to say that I am impressed with your attitude throughout this thread!

You've posted a question, provided possibly damning information; and throughout it all, you accepted the criticism as well as the encouragement without copping an attitude and resorting to personal attacks.

You've owned your mistakes, and apparently have learned something from them. I see great potential here! I can see that you've got great empathy for your patients, and you're concerned about learning more. This is the precise attitude that is needed for EMS. There are far too many that become complacent after they get out in the field, because they mistakenly think that they now know it all. This is not the case with you.

EMS is known for its 'tough love' attitude, and there are many of us that strive to not only be the best that we can be; but work hard to advance EMS as a whole.

Being new on the trucks (regardless of your level of licensure) is a tough spot to be in! We've all been there and some of us will 'be there' again. Ultimately, it's what you do with it that decides if you're going to make it or not. I've seen people excel under the pressures, and I've seen people fold and quit. I don't see you as one to throw in the towel and walk away.

This site is a great learning tool, if you let it. There is quite possibly hundreds (if not thousands) of years of experience that is available to you. You've already shown that you're willing to speak up and ask questions.

Good fortune to you, sir!

LS

LS first of all Happy New Year to you sir! Hope you had a great New Years Eve and the hang over was not too bad. I am working unitl 1800 on New Years day, then I am heading home to see the wife and kids. Looking forward to spending a couple days at home with them before heading to work to my second job which is on the Ambulance.

I am working the transfer car again and looking forward to hopefully doing a another transfer with a Nurse escort so that I can use the knowledge I have gained from this post. Yourself and Dwayne both have mentioned that I have taken some personal attacks on this post, and I am blind I guess as I don't see that at all. All I see are comments towards me that I can either agree with or not. Life is all about learning and sharing information with others. I figure if I am going to be working in the EMS I best gain as much knowledge as I can by asking questions and learning from the mistakes I make out in the field.

The more I get to know certain memebers in the City, the more respect I have towards them and their comments either good or bad. .

So thank you for your all your comments in any of my posts as you are one of the members I respect and always look forward to learning from.

Happy New Year!

Yeah, like LS said, it speaks volumes about you that you continued in this thread after being treated poorly. Kudos brother.

EMS is known for eating it's young, but that's not completely what happened here. You were called to task to justify your position, but you were also banged on needlessly, and that's just poor form. EMS does demand cast iron balls/ovaries at times not only so you have the courage to look at yourself critically and accept when others do so, but also to spot assholes that are just trying to shore up their own egos and tell them to go and fuck themselves.

I was sure after the "I'm sorry I posted" comment that you were not coming back, happy to see that no one kissed your ass to make you feel better, and very impressed to see you posting again immediately after LS called bullshit on playing the sympathy card. We have a ton of ballsy young providers here that just simply refuse to be denied the opportunity to learn. You remind me every day that I'd better work to stay at the top of my game or be left behind...and I thank you for that.

Good call, good question, outstanding learning opportunities in this thread both on and off topic! It's going to be an awesome new year at EMTCity!

Have a great day all!

Dwayne

Dwayne,

The comments that are made by you in the post above about being banged on needlessly don't bother me one bit. Everybody has the right to share their opinion. I am not going anywhere and I am going to keep posting questions or jumping in on discussions that I feel comfortable posting on, even if I am wrong with what I feel may be the answer to the question and may get as you put it "banged on needlessly" I fully respect what you have to say and how you are willing to help and answer questions from new medics and posters on the City!

I am looking forward to 2011 as well and hope to learn lots from the City and while working on car.

Happy New Year!

Funny i always thought PCP was something you did when you were young and made poor judgement calls, live and learn lol

[/quote

LOL, After I picked that name, I did laugh at myself once I thought about the name as the drug. Guess I could have changed it, but oh well.

At least I did not call myself "crackhead" that could have turned out really bad!

cheers

You know I looked back at my post and I have to appolgise for my reply. My questions were ligit but I didnt need to sound so snotty, I'm on cold meds and thats the only excuse that I have. PCP just be aware that the Ambulance is your area and now matter who is in the back you the pt is just as much your responsibility as the nurses.

Enjoy learning about the job as there is much more to know and again sorry about the snotty reply

Happy

PS Squint is a good source of information even if he is alittle crast about it

Happiness, NO need to apologize for your post. I did not take it as being snotty at all. You were just pointing out a few facts that need to be addressed. Any comment or suggestion comming from a veteran like yourself especially from a fellow BCAS employee is alway welcomed by me.

If it was not for this website and the discussions I have had and the few friends I have made by joining this site, I would not have learned what I have learned in the past month which has helped me in my career as a BCAS employee, as well as helping me become a better paramedic which will help me give my patient the best patient care they deserve. So, as mentioned NO need to apologize for your reply. I understand what you have said about the back of the ambulance is my work space, and for now on I am going to treat it as so when doing transfers with a nurse escort or any time I am attending.

Hope you are feeling better soon

P.S. I received an email from my UC the other day, explaining that the local fire dept. and the wife of the patient I had last week that had a cardiac arrest contacted him and expressed how good of a job my partner and I did and that how respectful I was, and how I showed great empathy for her and how I showed great dignity towards her husband. The fire dept. said they were happy the way my partner and handled the call and they were impressed how I handled myself for doing my first cardiac arrest.

For me that made me feel proud to be part of the BCAS and that helped me know that I did everything that I could for my patient. As well as when I took some time to talk to the wife while at the hospital that my words did mean so much more than one can imagine to a loved one that was going through what she had to go through.

HAPPY NEW YEAR and STAY SAFE!

Lone Star, Thanks for your post and I do agree we all need to check the truck before leaving the station and I do that every time. You must have missed the part of the post to as where I mentioned that the monitor is not part of our ambulance and belongs to the hospital. I did learn from the experience and from talking to yourself and the others what could have been done better. For example, next time I am doing a transport with a nurse I am going to ask and confirm that they have fully charged batteries.

I don't feel that I am being blasted here or being knocked down at all. I was just making a point that I feel as a new medic that I made some mistakes and that I need to learn from them. In now way do I feel I am or need to play the "Poor Me Card" that is not my style and it never will be. I appreciate your comments and suggestions as I take every comment and suggestion from everyone who posts on a subject that I may have posted and I feel it is a good point I try to incorporate it into my assessment or treatment, as well as I attempt to gain more knowledge by reading others posts or comments to me.

Please don't take this post as if I am upset or pissed that you said I need to stop my poor me attitude. It is hard to tell how a person is feeling by just reading a post they typed out.

Thanks again for you comments and encourgments!

Brian

Well done Herbie1 It must have been a great feeling!

tniuqs,

Thank you again for your comments on my post. In no way did I take them personally. I admit at first I was a little shocked, but then I took some time and read your comments again and it made sense to me. As to me coming back and explaining myself to where I am in my career I guess I was just trying to explain myself a little better as to my level of experience in the EMS system and that I do have the passion to learn and as well as very little experience when it came to doing a transfer with a nurse on board or doing a call period.

I honestly love the job and really want to be the best paramedic that I can, which I feel will make me a better patient advocate.

Any how, thank you again tniuqs for your comments and your advice

p.s. I am open for any advice anytime from anybody!

HAPPY NEW YEAR EVERYBODY!

Happiness,

I now realize after reading your post and the one from Richard that there are things that should have been done and asked by me as the attending paramedic even when there is a nurse going on the tranport.

I am not sure why the patient was not on O2 from the beginning. It is my dumb mistake for not asking if and why the patient was not on O2 from the beginning and it was also my dumb mistake for not doing a better job at jumping in when the patient stated to the nurse she was having chest pain (angina). The nurse was taking care of the patient and I did what she asked me to do. I do know that giving Nitro is in my scope of practice and I would have administered it myself, but as mentioned the patient was being transfered with a nurse and she was in charge of the patient.

SO I THOUGHT!

I now know for next time that any time a nurse is along for the ride that I will do a better job of asking questions and making sure their equipment is in good working order, as well as if the patient develops any problems while in the back of the car I will not just let the nurse take care of it. I will do what I would normally do as if there was not a nurse escort.

I have only been working in a busier station now for 4 weeks and previous to the that I was in a station where I never did transfers and very little patient contact as I was a driver only for 2 half years and did only about 20 calls in that time.I am learning very quickly how things should be done.

Richard B the EMT I see a "Fail" here, but I can't point fingers. Yet.

Well I do and I LOVE NEW YORK CITY cause no BS !

Agreed and quite embarrassed actually, but why ? That is because I voted to re title EMT and/or the P1 (in BC) to PCP with Paramedics Association of Canada (that was 16 years ago) and here we are today and now a "PCP" cannot interpret a farking lead 3 ECG first degree block and admit to this on an international forum for EMS professionals ? <insert head slapping noise> Well I guess I failed so many years ago to believe that "what was accepted at that time in Alberta was the standard Nationally" so FAIL SQUINT bad, bad SQUINT ! And here and now the Ontario PCP are most likely better at interpreting a STEMI that I am.

I FAILED to recognise that the government(s) would prostitute this title to cause less confusion I was so wrong .. I have allowed the general public to be under an illusion that when a truck has "BC Emergency Paramedic Ambulance" on its side but does not have an ECG that can not display a rhythm is simply terrifying for the future of Paramedic profession, btw PCP "nitro" is in actually your scope of practice too ... you know just in passing.

Major link worth reviewing.

http://www.paramedic...ContentTypeID=2

Link to competencies.

http://www.paramedic...Diagnostics.pdf

Link to medications lists.

http://www.paramedic...Medications.pdf

rock _shoes: Sorry man no mercy here on this stupidity and bring on the negative reps from the politically I should be more correct crowd. I feel a complete shred just maybe tough love is what is needed here as a tune up, yeah think EH ? no LOL at all.

So Best Advice their BC PCP: READ and EDUCATE yourself before continuing to embarrassing yourself and MY country, YES see above rock_shoes is 100% correct, interpretation of basic ECG rythum's is a National standard for PCP, first degree block is a basic arrthymia, therefore logic dictates that you are sub standard please pull up your damn socks.

Agreed absolutely no excuses allowed, I believe some ripping is needed too ! This in Kanukistan is a legal responsibility called "due diligence" or in fact criminal negligence so FAIL HUGE besides as rock_shoes states there is an 110 inverter on board that truck, or was that broken ? ps BCAS is damn near completely standardized in every unit throughout the province.

Excellent point(s) Dwayne an unwanted and unneeded adrenergic response, (ie Adrenergic means "having to do with adrenaline (epinephrine)and can lead to a fast heart rate this is called tachycardia and increasing myocardial oxygen demand, btw Dwayne that explanation is not intended for a pararescue ninja. Now one shot of nitro pain resolved chest pain with elevation in STEMI and an elevated "TROPONIN" level, and transported with an RN, BC is such an interesting place.

No information provided in this senario indicates any life threatening distress, the patient is NOT in extremis and to pick it up L+S .. well this just increased your speed and statistical increased incidence 20 % for an MVC is that a good practice ... fill in the blank.

Disagree ... an absolutly Stupid Rhetorical question did PCP ever ask the RN if L+S was required ? PCP do some "thinking" and "personal research" on the terms you wish to quote BEFORE asking questions because this thread is exactly that, rhetorical. You have failed in every thread where I have taken my efforts and sometimes extensive amount's of my time invested in YOU to be polite and educational, unfortunatly you have yet to answer one basic question, don't believe for a second that this culmulative effect speaks volumes.

FAIL in legal knowledge and understanding of your scope of practice, and pure observation, that being that cold, clammy and pale says a lot about a DX when a patient is complaining of Chest Pain, you don't need a machine to tell you someone is circling the drain and needs diesel bolus.

.

So ok teaching point just what was the underlying ventricular rate ? You are trained in taking pulses as a PCP aren't you as that would be a vital sign or perhaps look at the pulse oximiter reading, also scope of practice, so normal B/P ? hmmm .. so why am I getting an impression that we are talking with an OFA level 3 ?

So If this patient died when under when your care and in your truck (no matter the RN present) you would look the fool @ fatalities enquiry, possible criminal negligence as well. Did you write a PCR report with no information on it too ? this is absolutely no joke, EH !

Wrong answer the RN stated and again you are as responsible for that patient's condition and knowledge of vital signs as the RN, you must perform to the level of your training, period, and only if you had an MD or ACP on board assuming responsibility written and signed would you NOT get slammed in a "shotgun legal suit" just saying.

Good job something learned, you can have a non STEMI and have elevated troponin levels as well, just because one has elevated ST segments does not "absolute indicate" that one is having an MI, a prior Bundle Branch Block would be one of the exceptions.

TROPONIN :http://en.wikipedia.org/wiki/Troponin_test

When chest pain via SL nitro relieves chest pain, this is typically be called angina, now if the call went well all in all then why generate a question ?

Should I mention I am trying to quit smoking, nah that would just be an "excuse" myself for being pointed and opinionated and have pride about my profession as a "PARAMEDIC".

cheers

Well, I am sorry I posted this question as I was just curious to know if we should have upgraded to code 3 that was all. I am not sure where you took your PCP training, but where I took mine part time course we where not instructed how to read the different rythms or placement of leads, sure we read about it, but it is alot different when a person spends a two weeks just on cardiac stuff compared a few hours reading a section on Cardiac.

Being a NEW PCP I learn something new every day and by reading your post it has made me realize that even though the patient was in the Nurses care I need to ask more questions before taking a patient. Also I did do a PCR including vitals before we transported. Thanks for pointing out that chest pain is called angina I did not see anything wrong with saying chest pain guess I should have said angina.

On another note I did ask the nurse if she wanted L/S and she said no.

Seems as though I have let you down with my posts and here I thought this site was for learning and that is what I am attempting to do. Thank you again for giving being so hard on me and pointing out where I have FAILED as a PCP and where I have failed by asking a simple question.

I do read my books still and try to learn on every call and while sitting in my first aid office Yes OFA level 3 that does not mean I don't have the smarts to be a Primary Care Paramedic.

Any how, I don't want to say something that I don't mean, so I am just going to leave it at this as I am taking your post towards me as a learning tool.

SORRY FOR MAKING YOU SOO UPSET THAT WAS NOT MY INTENTION AT ALL!!

OH, VITALS SIGNS BEFORE TRANSPORTING

BP 110/75 R-18 EASY P-72 REGULAR-SPO2 97 RA

If I had known that this post would have turned out like this I guess I would have mentioned as well that I did attempt to take a set of vitals while on route, but the attending nurse told me not to worry about at as she is stable and that the patient is in HER CARE.

I see a "Fail" here, but I can't point fingers. Yet.

Who's EKG machine was it, sent on a trip of that known duration, without sufficient power; the OPs service, or the sending facility? There should have been both a fully charged EKG unit at the transport's start, as well as a fully charged backup battery.

The event described took place in Canada, eh? (Sorry, couldn't resist) In the medical pecking order, who is higher medical authority, the tech, or the RN, riding this particular call? If it is the RN, the RN had the authority to elevate the call status, or not, and took such option. Otherwise, the Tech could have made the decision.

Original Poster, what was the outcome?

The EKG machine belonged to the sending facility, as we don't carry EKG's on our BLS cars. Yes the patient was under the nurses care so she had the authority to upgrade to code 3 at any time and she felt it was necessary.

Not sure of the outcome, all I know is we got our patient to the other facility safely and she was scheduled for surgery later that day or early next morning.

Yes this event did take place in Canada eh! LOL, I know it is hard to not make fun of us Canadians as we seem to say eh after every word!!

Here in BC at the PCP level we are NOT trained on how to read a 3 lead. I have done some of my own research, but no way I am able to diagnose anything or do I fully understand the different rythms.

Patient hx was the night before she woke up for a bowl movement and she developed chest pain. After the bowel movement the pain got worse and called EHS. She was transported to the hospital and was sent to the CCU due to having a first degree heart blockage.

No previous hx of any cardica issue. pack a day smoker and chronic fatigue was the only other medical hx we had. She was being transported by us along with the nurse due to having a STEMI which I just looked up to understand what STEMI stands for now. The patient was given a thrombolytic medication two hours before our transport time which was at 0600 am. Not sure the name of the Thrombolytic (sorry)

That is all the information I received from the attending nurse.

When asked, the nurse stated that her vitals where all within normal range before we did the transport. I am not sure what the vitals where when the patient experienced the onset of chest pain while enroute, as the patient was under the nurses care at this time.

I over heard the nurse talking to the attending dr. at the receiving hospital that the patient had elevated Traponine levels. When I asked, I was told that by having elevated Traponine levels it indicates the patient has suffered damage to the heart due to her having a STEMI.

That is all the information and hx I had on the patient.

All and all it went well and we did not go code 3 and the patients pain went away after the squirt of Nitro and the pain never came back.

My feeling is, if we did not have the nurse on board and since we do not have the capability of using a 3 lead we would have upgraded to code 3.

Okay, yesterday I was working on the transfer car and we were transporting a patient from the CCU down to the CCU in Victoria which is about an hour and half away from Nanaimo. I had a nurse on board with me in the back, the lady was hooked up to a 12 lead monitor, along with two 18g IVs one in the ACF and the other one in the right hand. No IV solution running at this time. The lady was diagnosed with a 1degree heart blockage.

I am the first one to admit that I do not understand the difference between a 1 degree and a 3rd degree heart blockage. But I can learn about that over time. Any how, when we were about 40 minutes from the hospital my patient started to experience chest pain again, the nurse gave the patient some nitro and asked me to put her on 3 lpm of O2 by nasal cann.

Also the monitor's battery was running on a low battery, when it died the nurse switched over to the back up battery which was reading low battery as well.

My question is would you have upgraded to Code 3 due to being about 40 minutes from the hospital due to the patient experiencing chest pain?

The nurse in this scenario did not, so I was just curious to know if we should have possibly upgraded to code 3?

Thanks,

Brian

OK I just got off the wierdest shift I have had to date. When i say just got off I mean 2 hrs ago (went home to shower and now at my day job). If I ramble I appologize I am on zero sleep since 4am yesterday and on about my umptenth pot of coffee.

Started even before my actual EMS shift. At my day job had someone had an accident that needed immediate attention. My boss calls my desk and I pick it up and all he can say is we need EMS NOW (screams now) I grab my bag (personal bag, nothing major) and he's already at the door with a truck running. Get to the scene and someone cut there arm open really good. Nothing arterial but loads of blood none-the-less. I grab my gloves and the few packs of combine dressings I have and apply pressure and elevate. Bleeding slows to a trickle so I start to bandage a little to free up a hand. In the background I hear the sweet sound of sirens. The rig shows up and 3 guys get out and take over. Congradulate me on a job well done and one hands me a few combines from their rig to replenish my bag.

One my way home I witness a MVA, nothing major but stopped anyways to check. Lady on a cell phone hit the rumble strips and turned into the divider instead of away. I get out and shes shaken but other then a bruised ego nothing. Shes in the left lane up against the barrier with a dead car, wouldn't start back up so i decided to use my truck as a shield and turned on all my lights (no not a wacker, now that I am 1st Lt they had me install rear emergency lights so I could be on scene with my POV if needed) few moments later PD shows up and takes over. I get another "good job" and am on my way.

Well I was supposed to pick up my wife's present from the engraver but that didnt happen because now I have 30 minutes to make a 40 minute drive to get on duty.

Ok Duty shift starts and all is well. Stays quiet the first few hours and I get a decent meal in with my wife. No sooner did I get up from the table to do the dishes then the Plex went off. I kiss my wife and get moving.

First call of the night was a slip and fall with possible hip fracture (as dispatched haven't been on scene yet). Get to the home of two little old ladies and ones in a chair and the other greets us at the door. Ok I am wondering where my hip fracture is. We are brough to the one in the chair and she starts yelling at the other that she should never have called and disrupted our night. Apparently 3 days ago she fell getting in the shower and has been in pain since. Her friend noticed her limp and finally called us. We package and transport and all is said an done. OK the wierd part is 3 days with a hip fracture and she just sat there like nothing was wrong. Hoping it wasnt fractured and was just really bruised.

On our way back, my crew and I are chit chatting when we get called over the radio to see where we are. Not usually a good sign. We call out our location and dispatch says "great". Oh brother, here we go. Divert to such and such address for possible OD. Man I hate geting these right before the Holiday (see my other thread) Get to the scene, we have another elderly lady that decided it was all too much and took all her meds, i mean ALL here meds. 4 prescriptions were filled only that morning. Pt is totally out of it. Ask her the time 1957 ask her the date Star Date 2112 ask her name Marylon Monroe. OK this is going to be fun. Ask her where she is Pee Wees Playhouse (these are her real answers I shit you not) We start transport to meet ALS in route. Well half way to the intercept ALS calls back and they were in an MVA!! OK no ALS. I ask for a diesil bolous and my driver agrees. We get her into the ED and the nurses are looking at us like what the hell (last time we were back to back there was last year). On our way back we hear over the radio that our other unit is doing the ALS MVA. We pass and wave.

Ah we made it. We are back at base and I head home. Been a long 4 hours. Get in bed and try to get comfortable, guess the dog figures since I wasn't home the bed was her's for the taking. My wife is sound alseep oblivious to the tug of war me and the dog are having. I finally win and close my eyes.

Tones go off.

I look and its been just 1hr since I got home. Well its after midnight so nothing good happens after midnight. I listen to the Plex and its an MVA with injuries.

I grab some extra gear figuring we will be out in the cold (it was 17 last night with a 20mph wind) while they extricate. We get on scene and there is no rescue rigs. Wierd I think to myself. I go to the first officer I see and ask where our patient is. He directs us to the back of the bar, thats right MVA happened in front of the bar and the patient goes inside. OK here is where we enter the Twighlight Zone and everything gets really wierd. PD is actually trying to conduct a field sobriety test INSIDE the bar. Well that didnt work. We go outside and ask PD if we can look at her before the test is performed. Looking at the car she might have some injuries. PD agrees and says what they have is enough, they will follow if we transport. Well our patient hears this and goes ape shit batty on us. PD helps hold her still and we calm her down with words. She asks if PD can exit the rig and she will be coopertive. They step outside and this girl gets all giddy. Next thing we know we realize 3 weeks ago we had her for a nasty fall down some stairs while intoxicated. She says, "Yes I remember, thats why I wait till now." Now for what? "well see I thought he (pointing at me) was cute, so I crashed my car to see hime again!" Holy Shit she crashes her car to see me. OK take the wacky juice away. So I kindly let her know my wife wouldn't like that very much. She starts sobing and during the sobs says if she knew I was married she wouldnt have drank 7 drinks, taken 4 Ambien and 2 Zanex. Nothing about crashing the car, just the drugs and ETOH. Anyways get her to the ED and she goes batty again, punched a nurse and security swarmed the room.

Heading back, get another call. Oh great now what. We are giggling though from the last call (both my partners are female so they were getting a really big chuckle) so maybe this wont be so bad. Another possible OD. Get there and its a frequent flyer so we know the deal. Well it must be the Moon or something because it gets wierd again. Hes in the back with me and my partner and starts giggling but not once looking at me. I dont think much of it until my partner motions with her eyes twords the guys feet. I look down and notice some "movement" under the blanket. I ask what was going on and the guy started laughing. Next thing we know the movement was pronounced. Holy Shit he's masterbating. I have a guy wacking off in my rig. I get a little loud and tell him to knock it off. He was like aw come on man Im not hurting anyone. Both my partner and I begin to tell him why its not appropriate to do that in public. Well it goes back and forth a while and he stops. Think its over? Hardly. His hands are above the sheet but he starts gyrating. Tries using the sheet to continue. My partner starts getting mad and I have to calm her down while trying to get this guy to calm down and stop. Only thing I could think of was talking to him about Bee Arthur, dont ask me why but its all I could think of at 3 in the morning, he starts to dry heave because of it and it stops. We get to the ED and the nurses are pissed. Bad enough here is patient 4 but our last one we can still hear flipping out. Well we proceed to explain this one and the nurse said "Oh Hell No" After a little convincing we get him to a bed (apparently they want us to deal with him a little longer) we transfer him and then comes time to remake the cot. Well I am not doing it, my partner is nowhere to be found (aka the coffee shop) and my other partner is busy doing the PCR. Great just what Iwant to do at 3am. Well I get it done and miraculously everyone shows up just as I finsh. No problem I say, they get the next "messy" one LOL

Well we get back and I look at the clock, I am off duty 2hrs ago, haven't slept in 24hrs and now have 30 minutes to shower and get ready for my day job. I walk in my door and get ready and here the tones again, oh well I'm off and heading to my job. I heard it was a puker (evil laugh)

OK I know to some that might sound like a typical night but not for me. Was definatly one for the books and I just had to tell someone. I couldn't believe I had a stalker and a wacker back to back and ALS was in an MVA on the way to one of my calls. We did find out it was minor, clipped a bumper apperently, but the other car seeing the shiny stickers figures it was a payday.

Anyways... hopefully I dont fall asleep at my desk now and hopefully I made some of you laugh a little.

Happy Holidays!

Stay Safe Everyone

I have to say that is one for the books for sure! I can not believe some chick crashes her car just so she can see you I just don't understand why some people wait so long to call for an ambulance when they have been injured???

Hopefully you are not on shift tonight and you can get much needed and deserved rest!!

All you can say sometimes after a shift is

Thank you everyone for your kind words and thoughts. The fact that I was unable to bring this patient back from his arrest does suck, but what sucks evern more is, that I can't help to think if he had just gone to the hospital earlier in the day when he was complaining of indigestion to his wife. The fire captain was on scene as well and was feeling the radial pulse while I was doing chest compressions and he said I was doing good. So my only thought was I must be performing the compressions properly.

I am a BLS provider, so I don't have access to the tools that the ALS crews have, and as mentioned in other posts we do not have ALS in our community which would have been nice to have. It MAYBE could have made the difference in this call. I feel that for my first arrest that I did everything in my power to attempt to bring my patient back.

I feel for the family more than anything being so close to Christmas and also having another family member pass away just three weeks prior. I wanted to stay with the wife longer while they were working on her husband, but duty called. I attempted to get a line on the guy as well in the back of the ambulance while the fire guys where doing CPR, but was not able to start the line.

Not sure if that would have made a difference or not?

I guess there is not much more I can say, besides I did my best and unfortunatley it was this guy's time to go and hopefully next time there is a better outcome.

Thanks again everybody for your kind words, thoughts, and sharing your stories. It is nice to know that I can share my stories here on the City knowing I can get feed back and support.

MERRY CHRISTMAS TO EVERYBODY!!

Brian

Hey Sean,

Thanks for your reply and sharing your thoughts and story as well. This guy had just turned 60. While at the home we received gave the patient 4 shocks and after the fourth one we loaded and transported with giving two more shocks in the back of the car. At the hospital the patient recevied three more shocks before the Dr. called it. I was hopeful that we may save this guy, due to having a shockable rythm. I do find it hard to believe that it gets easier as you do more arrests, due to the nature of the call and knowing that the person you are working on is someones father, mother, husband, wife, dad, mom, or grandmother, or grandfather.

As mentioned in my original post, I don't seem bothered by the call, as I am not having trouble sleeping. I am thinking about it pretty much 24-7 about how the call went and if there was anything else could have done?

I agree that when it comes to the family members that they also are experiencing a huge tragedy in their life at that moment and they are the ones who will need to be taken care of. While I was working on my patient I could not help but to wonder how the wife was making out and hoping my partner was talking with her and doing what ever she could do to comfort her.

Thanks again for your thoughts and comments. I am sure there will many more posts like this one in my near future.

Brian

Welcome to the City!!

No question is a dumb question. trust me I have probably asked a few quesitons that seem dumb to some members, but we all start off not knowing stuff and at the end we all still have to ask questions as we don't know everything!! There are some great members on this site who are very helpful and will answer any question you may have the best they can.

Welcome again and have fun!

Brian