WolfmanHarris
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Everything posted by WolfmanHarris
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This is one of the longest shifts I can remember. Our first call feels like a week ago. It's way too hot and way too MOH-ey today.
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We're taking up a hall bed at PRHC. Takes to the crew from 4532; sorry I didn't catch your names.
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What a crappy morning. Julia woke up with severe joint pain and we're not sure why. Might be the DCA, but the Doc hasn't seen anything like that before. Couldn't make it to Kingston for her appointment because she was in agony in the car so we turned around after a few minutes. Now we have to figure out how to get blood work done, so we can get her chemo and get that started. Thankfully some respite, both her and Carter are down for a nap and I might try for the same. Only gets better from he...
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Recently the EMS Chiefs of Canada (EMSCC) and under them the Association of Municipal EMS Services of Ontario (AMEMSO) adopted standardized titles and insignia for Paramedics and specifically management. As a result services have been slowly but surely moving from the mix of Directors/Managers/Chiefs/Grand Poomba's of before to a management structure like this: -Chief - Deputy Chief - Commander - Superintendent Only our Superintendents currently work in a field supervision role. Each day has a Deputy Chief on call that is available for any big issues but they're off site outside business hours. Within HQ we have two Deputy Chiefs assigned to Operations (one covering the busy south districts, the other the north district and Special Operations), one assigned to Performance and Development and one to Logistics. For Commanders we have one assigned to Fleet and Facilities and one to Supply and Equipment. For Superintendents we have one assigned to each district per platoon (12 total) plus acting Superintendents which are are nine month secondment from the road to fill in for vacations, sick time, etc. We have Superintendents assigned to Clincal and Community Programs, Performance and Quality Improvement, Scheduling and Deployment, Special Operations and The Office of the Chief. Captains are a fairly new title and used to be called Lead Paramedics. They're so far only assigned to education and community programs but there's been some talk of seeing them take on non-management, field leadership roles. As for crews on the road, there is no rank on a regular truck. Certainly and ACP may pull clinical rank if the call warrants their taking over, but it's a team effort and shouldn't come to that. For new hires, they spend their one month orientation and one month riding third as "Recruit Paramedics." They are fully qualified to practice but as part of their intake they are eased into full duties. After those two months though they can be partnered with any other medic. Frankly I'd like to see this expanded so that no one with under a year on the road can be partnered with someone else with under a year. But maybe that's due to the stupid mistakes I made in my first 12 months.
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Pefferlaw and Aurora are both first response; who gets the up staff to make a full truck? Did you guess Aurora? Wrong!
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What equipment do you bring with you on calls?
WolfmanHarris replied to Bieber's topic in Equiqment and Apparatus
No IV supplies on the monitor. The IV kit is in it's own bag within the backpack. It could be brought in on it's own if need be but chances are if I'm starting a line, but didn't bring in the backpack than it's probably not a particularly emergent line and can wait a moment while I go grab the bag or can be done in the back of the truck. In the monitor we only carry the adult NIBP. The different sized cuffs in the O2 bag are all manual. We didn't sacrifice space for the meds, we've never carried multiple NIBP cuffs. The rear pouch that no holds our symptom relief bag used to just hold extra paper and a lot of junk that can be just as easily left in the truck. (Who needs a half dozen spare razors on the call?) We usually beat fire or arrive at the same time since our station's co-located with them. I bring the O2 bag in since I'll clear FD as soon as I know I don't want the hands so I don't want to rely on it. I only bring the O2 bag in on chest pain, SOB or decreased LOA calls and only put it on when warranted. We also don't have a D-tank on the bed and usually the bed is outside the house. The O2 bag usually comes in "just in case" based on call details. But since apparently everyone is short of breath at the time of the call is more often than not put back in the truck unused. -
Two new personal records today. Max Watt Row of 557 (old record 485) and 1 rep max back squat of 265 lbs (old record 185).
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What equipment do you bring with you on calls?
WolfmanHarris replied to Bieber's topic in Equiqment and Apparatus
Last year they took a few of our folks on modified duty and had them ride around with various crews to observe and record equipment use. They watched what bags were taken in on what calls, what was used most frequently, and other data points which were then collected and used to help design our new bag layout. Our new bag layout is really practical. Monitor: LP15 has the defib supplies, monitoring cables, ETCO2 via nasal and also carries our basic drug bag in the back pouch. Symptom Relief Bag (carried on monitor): ASA, NTG, Glucagon, Ventolin, epi, gravol, benadryl, glucose, glucometer. We can get away with carrying just the monitor into a great deal of our calls while still having our meds handy if we misjudge. Oxygen Bag: O2 in a sleeve on top with labeled pouches at the head of the tank for masks, nebs, etc. Main bag opens up into subdivided compartments with CPAP, manual BP cuffs (all sizes), BVM (adult and child), aerochamber and loops holding OPA's and NPA. Exterior compartments hold V-vac suction (back-up), sharps container and a small pouch with supplies for minor trauma (one roll kling, one ab pad, a couple of gauze pads) so we don't need the trauma bag for small wounds. On most calls we bring the monitor and the oxygen bag. Back-pack: Contains ACLS drugs, narcs (only if ACP on the truck), suction, King LT's and airway supplies, intubation kit, IV kit. This bag is designed for high acuity calls and is left in the truck on most of our calls unless distance from the vehicle would make retrieving it impractical. Trauma Bag: Top pouch holds gloves. Front pouch dressings. L-side pouch back board straps. R-side pouch triangulars. Main pouch hold two adult and two peds select all collars, two towel rolls, one litre bag, one disposable blanket, splints. ACP Reserve bag: Rather than keep perishable stock in the vehicle drugs and the like are kept in a back-up bag to be restocked from. This helps ensure that when crews switch into or out of a spare vehicle that supplies aren't left to expire or inadvertently parked outside where they may freeze or overheat. It really doesn't come out of the truck though in a pinch it could fill much of the role of the main bag and back pack. With our bag redesign the thinking was to only carry what was needed for one call into the call. There are essentially no spares in the bag but it makes for a fairly lean and light set-up. -
NASA has such cool stuff on their website. Now should I build a pinhole solar viewer or go buy some welder's glass?
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This is the problem with the mentality of "part of the job." What it should mean is to be aware that patients and circumstances are unpredictable and to be prepared for things going awry. It doesn't mean suck it up and it doesn't remove the obligation of a service to protect it's crews. For us, if the patient is under arrest we not only have PD follow, they are required by their own policy to be in the back with us since the patient is their prisoner. (This may even be a legal requirement in Ontario for all I know.) Once at the hospital two Police officers must guard the prisoner at all times. If the patient is a mental health case and Police are involved they may ride along or they may just follow. Often times the Mental Health Act (MHA) apprehensions are attempted suicides where they'd initially attempted to refuse but were informed they wouldn't be given that option and come along without incident and Police are accompanying to do their duty under the law which requires them to have custody of the patient until the physician confirms the hold and hospital security can take over. If the patient required restraint and is cuffed, PD comes in the back.
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After five years of faithful service my Macbook may be on it's way out. The battery won't take a charge at all anymore and shuts off as soon as the cable comes out. Might be time for an ipad.
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Torturing the poor VON Nurse with Julia's awful veins. Four failed attempts and we sent her packing and went next door.
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We see cellitis fairly regularly. Usually presenting as chest pain secondary to a DUI arrest. Haven't really done too many fake seizures though.
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Transport Ventilators usage for 911 response
WolfmanHarris replied to FireEMT2009's topic in Patient Care
I'm appreciate the intent of introducing a transport vent onto the Ambulance for freeing up hands during hot calls, but I wonder if the better, easier, more adaptable solution is to allow crews the personnel resources they require (for some services)? For example, where I work we have more than 40 vehicles on the road at a given time covering about 1 million people over 680 mi sq (1760 km sq). We have been granted essentially carte blanche by our management to request additional resources when required and are not questioned by them or dispatch on the why. If I want another pair of hands in the back I can take a medic off another unit (transport or RRU) and/or take a FF. In contrast, a friend of mine working at a rural county service with 6 vehicles covering 134000 people (~72k urban, rest rural/remote) over 1485 mi sq (3840 km sq) they can't request ALS back-up until they make pt. contact regardless of dispatch information and back-up, if available can be an extended period of time away. At my service, even in the more rural areas with transport times of ~45 minutes, back-up is still only ten minutes away and FD closer than that. With crews having the ability to bring whatever resources they need a ventilator is a hard sell, especially with the manpower freed up by the LUCAS 2. At my friend's service, a transport vent might make way more sense than attempting to coach two Volly FF's with first aid and variable knowledge and experience with critical patients. I don't have any familiarity with transport vents or respirators though so I'm only able to speak to the logistics side. For those like Chbare with the RRT or CCT background, if you had to pick a device, place it on the 911 trucks of a large service (20+ trucks), provide effective education to the crews and be the best choice in reliability and ease of use for a low frequency high acuity skill, what would you choose? -
There aren't a tonne of traditions within EMS in Ontario but that's starting to change. In 2000 when the Province downloaded responsibility for EMS onto the upper tier municipalities (Counties and Regions) the hodge podge of provincial, hospital, private, municipal was mostly ended and services were moved to a local level. Since then it seems more traditions are starting to be formed. Honour Guards are becoming more common; even smaller services are starting to develop them for ceremonial functions and that role is starting to expand. The Honour Guard at my service now attends the graduation ceremony when new recruit medics finish their probation are issued their badge wallet and pose for photos for family with the Chief and big-wigs. The Honour Guard also attends remembrance day ceremonies, the annual awards ceremony and unfortunately funerals. Honour Guards from across Canada are starting to meet and try to reach consensus on protocols, symbols and the like and as a result a common tradition across EMS will start to develop. Symbols and insignia have started to standardize in some areas of the country. The EMS Chiefs of Canada (EMSCC) met a couple years back and agreed to support the adoption of standard epaulets with a symbol for EMS in Canada and standard titles for front line staff and Command Staff. While the details of the change have been contentious, the idea of choosing one standard seems well accepted. Funerals. It's unfortunate that we've had so many medics die recently both on and off the job, but it has lead to some Paramedic specific traditions. One started in Peel Region that I think is incredibly poignant is at the funeral Paramedics line up to view the casket one by one, removing one epaulet and placing it on the casket (Honour Guard members are to bring an extra in their pocket so as to not alter the uniform). A more obvious one is the using of an Ambulance in the procession either has the hearse or just part of the procession draped in black over the emerg lights.
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I accepted that I've become a beer snob and a coffee snob, but I may be a fitness snob? Watching a group do some boot camp style work out in the park my thoughts were: 1) those are some weak ass cheater burpees and they're on their first set. 2) why aren't they just going to Crossfit? 3) I need a good WOD. Thanks CFK!
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Self cleaning the oven worked so well it self cleaned the wiring for the control panel. Now we have no oven.
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IV fail! IV was blown. No DCA tonight and unfortunately I have neither caths of my own to restart it or a wife who's willing to let me do. Will reformulate a plan tomorrow.
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Great WOD today! Felt the week and a half away on all those wall balls but it only enhanced my sweat angel making skills.
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Theme of EMS Week is "More than a job. A calling"
WolfmanHarris replied to BEorP's topic in General EMS Discussion
Guys, we're over thinking it. The week is for public consumption, not our own and it's about time we started trading on some of the bravado utilized by our friends in the fire service to promote their own profession. It's like those license plate covers North City Insurance gives away "Paramedics Save Lives"; it's a heck of a lot catchier than "Paramedics Provide Competent Professional Medical Care and Improve Clinical Outcomes Within a Certain Subset of Patients." -
For the first time Carter is in the playpen in our room and we're downstairs with the baby monitor. Julia's coping okay with it.
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Rolled, aerated, patched and overseeded the back yard today. Fingers crossed it actually makes a difference, I don't want to resod next year to fix it.
