DFIB

An old mantra I was taught, and still follow is, "If a child is quiet, something is really wrong".

I have been known to respond with a personal kit for stuff I see in the street while just driving my personal van, hense, I've been solo on scenes awaiting the on duty crews. And even in a city, where the nearest ER is usually 15 minutes or under away from load and go, yes, it can be frightening when one is flying solo, no matter what the local geographics.

The scariest thing to responding as a civie is that there is no possibility of transport. What you walk up on is what you got until the bus arrives. Scary.

All emergency calls will wait until you begin to eat, regardless of the time.

Any patient, when given the option of either going to jail or going to the hospital by a police officer, will always be inside the ambulance before you are.

In any accident, the degree of injury suffered by a patient is inversely proportional to the amount and volume of agonized screaming produced by that patient.

Always assume that any Physician found at the scene of an emergency is

a Gynecologist, until proven otherwise.

11. Not all doctors graduated at the top of there class, and many ER Docs are not ER Specialist, but may be a dermatologists who is working part-time (especially the more rural you get), sometimes you have to step up and be a patient advocate.

What do you call the student with the lowest GPA in Med. School?

Ans. Doctor

If I know the patient is there and needs immediate help I go get 'em. Don't care about the door, window, pet or even the potted plant. It is always good to have LE and FF on scene, LE to watch and shoot the dog and FF to do bust the door and break the plant.

Going solo is risky but probably cleaner.

Edited for spelling

Ash,

We;come to the forum. It is good to see you are considering studying EMS. It is a grat profession both exciting and compassionate.

Are you in Cleveland, Texas? My son is studying EMT near there and I could give some pointers.

Vote for Pedro!

Ruffiens posted in another forum – “Two quick sprays of Nitro dropped the dog in about 5 seconds. I did hear from the cops that the dog did come around, not sure of long term issues but it was truly a matter of time on that call before the dog attacked.”

Has anyone else used Nitro on dogs?

In a medical call the patient is my primary concern after the safety of me and my crew, If the 160 lb vicious monster the patient calls a "pet" is in the way ... feed 'em rice. just not all that interested in the animal. If it is a poodle called Fifi that can easily be controlled it is a different story.

Welcome to EMS City.

You will find this forum to be stimulating and informative. I agree with Dwayne that if you want to be an RN there are more direct and better ways to achieve that goal. If you want to do Paramedic with your new hubby that is cool and should be a lot of fun to do together, although I would recommend being realistic about your options and your reasons for training and your expectations as well as his. I am not saying that you are not being realistic but your post raises questions.

As far as watching TV to get a feel for the job ... nothing on TV can prepare you for what you will encounter in real life emergencies. Real life is better and worse all at the same time. Regardless of your choice or your reasons, the medical field is exciting and gratifying. Love your wedding picture.

Inter personal relationships are always difficult. I have found that "waiting and watching" is a technique that works for me. It could be that the person giving you grief is simply having a bad day and is pretty cool the rest of the time. It could be he/she had a fight with their spouse/partner before leaving home, they could have financial problems, cyclical hormonal spikes or they simply might not like you. Who knows why people act the way they act on the first day.

I someone has a lot of bad days, everyone else notices as well and you gain esteem among coworkers by being cool. If it is just an isolated incident you gain esteem by being cool. Most people with bad attitudes are well known by their co-workers and don't necessarily need the new guy to confirm. Most people with unprofessional behavior fall under their own weight.

Another technique to diffuse a situation similar to yours is to ask for a post-call discussion with the crew. If your in charge or proctor has a chance to voice "what we did well" "and what we can improve" it often diffuses the lousy written reviews. Be ready to accept criticism with an positive attitude. In these sessions the offending person will probably have to eat crap, but often talking it out helps.

Finally we can only control our selves. We cannot control others or their attitudes. They only have the power over us that we allow them to have. Take the good and use I, ignore the useless and negative. So study hard, learn the equipment and the protocol, take a step back and enjoy EMS. It is worth the effort.

ems is dispatched to a local supermarket for a patient with shortness of breath. ambulance paramedics arrived to locate a woman seated complaining of swelling to the face and trouble breathing. this patient has no known allergies and the only medication she is on is motrin with she took this morning without problems. patient also reports feeling light headed and dizzy.

physical assessment is as follows:

respiration rate elevated at approximately 24 to 30.

pulse rate is 100 and weak in the extremities.

blood pressure is low and 70 over 40.

no significant ortho static changes noted.

no cyanosis noted to the distal body or lips

no hives or itching sensation noted anywhere on body

airways open and self maintain

skin is pale cool diaphoretic

no bite marks or insect scars on body

lung sounds are clear in all fields throughout treatment

treatment is as follows:

Ekg twelve lead nsr without ectopy.

Spo2 low 80s room air

02 via nrfm 15lpm

Pt placed trendelenburg on stretcher.

I would be interested in what areas of the supermarket she had been through. The potential for allergens in supermarkets are great, fruit from all over the world, cleaning products and packages that have been stored in warehouses all over the country. The absence of hives and itching is troubling but shouldn't exclude an allergic reaction. Did the hospital run a tryptase level or ELISA panel?

I have been watching shsrk week with my 14 year old daughter. Every time someone gets bit a will ask her: "So what would you do? Most of the time they need a touniquet since they are shark bites. Yesterday I asked her the same question as we watched TV and she said "That guy doesn't need a doctor, he needs a priest!

The point is that we can take every day occurnces and turn tham into learning oportunities,

Other than the fear that I might shoot my foot off, I have no interest in training to kill people

See the inherent problem is that we doubt "other" EMTs judgement and ability to handle a firearm in a rescue situation. There are many who carry all the time and would not shoot themselves in the foot.. Most good citizens who carry don't train to kill others but to preserve their own wellbeing. I have no problem with any trained, licensed person carrying at any time. I am also sure that EMS services will probably never let non tactical EMTs carry.

Is it time to go back to wild west vigilantism ?

Defending yourself and the innocent is not vigilantism. It is humane. It is just. If someone had a weapon in Norway or Virginia of Columbine the death count would possibly have been diminished. Who knows maby the bad guy wins, but at least the prospective victims have a chance. Just because a man is armed doesn't make him a wolf, more like a guard dog in my oppinion but he definitely ceases to be a sheep

This is not confined to EMS, though.... if we are to be armed to "protect ourselves" in our work, the same should be done for everybody, including postal workers, teachers, social workers, ER nurses... well, you get the picture.

Why not let law abiding citizens who are licensed to carry do so in their work place. Are americans constitutional rights suspended soley because they choose to be postal workers, students, teachers, social workers, nurses or EMT's?

,

I would be inclined to lean toward intracraneal pressure (blown L pupil) The rapid onset makes me think of a bleed. Although the proggressively worsening behavior could indicate a tumor, cisticercosis or some other rapid growing intracraneal mass.

I like the idea of medics attached to tactical teams being armed. It only seems reasonable since they could be in situations where they would have to defend themselves or their patient. A law that protects them is promising. Personally I wish CHL holders could have similar protection although it seems very unlikely anywhere. CHL holding school teachers have tried to be able to carry to work and failed except in one case that I can remember. (I can't remember where but I think it was in Texas). The topic gives much food for thought.

" I know it's your job to get the story, but part of mine is trying to protect the patient's privacy. Can we find some common ground so we both get our jobs done?" He backed off several yards, and resumed filming. Common ground was achieved.

Where I live the news agencies put the patient’s faces and identities in the paper and on TV. They try to take pictures of the trauma victims and diseased to run them on the front page. We are in the news a lot and I really hate it. Often folks will be at the funeral and pictures of their loved one, lying in the middle of the road are circulating in the local paper. We have to treat the news guys decent because they can twist the story however they want.

It' sounds like a neat group of people. Creating a first aid culture within a church community is an interesting concept. Great for the community. Good idea.

I'm afraid I can't help you with the cascade of hormonal effects that may begin with pain and end with abortion my friend...But I'm confident that chbare's ears are burning as we speak, or maybe one of the docs.

I was reading an article on the hormonal cascade of pain and injury and realized it was way above my pay grade but very interesting. I began to wonder if it had any effect on pregnancy. Maybe one of the Docs will chime in.

Have you spent much time around pregnant women? Mean as snakes I tell you!, and twice as tough! Why...I....once saw a pregger chick get hit by a truck! She flipped it over, ate the drivers sack lunch, and went about her way, all the time mumbling that she was pissed that the truck pushed her belly and made her have to pee...again....Just sayin'...

They have to be tough, I get tired carrying 8 lbs in my backpack.

Thanks guys for your replies and the ones so far have been helpful as it shows how we have vultures around causing a scene or being intrusive. Dwayne I'll pass on your comments to Rob. Thanks again guys you all rock

Scotty

There were some reality shows in the USA that followed paramedics arround I have seen. They look like they were filmed in the 80s. I think one was in LA but I specificly remember a show done Nashville,TN. If you can find who did them some of those guys might still be arround and would have an educated opinion.

1, yes

2. I start IVs on all trauma patients...and, depending on the situation, I try to start the two large bore IVs as you will be taught in your next round of education.

3. I'm curious to see your thought process on why you think you wouldn't...especially for the pregnant patient.

I think all pregnant trauma patients are at risk of miscarriage and should get at least one IV line and should be treated as high priority patients, It is an idea I am forming and wondered if I was on the right track.

I was thinking that simply the adrenergic effect of pain could possibly be sufficient to trigger labor through catecholamine production and it's general systemic interaction, but catecholamines inhibit the production of oxitocin I know it doesn't always occur but heard of a pregnant patient that sustained an ankle dislocation without direct abdominal trauma, and miscarried hours after. I am not sure what the mechanism is but think pregnancy and the prospect of new life merits extreme care.

I haven't figured out the mechanism .... any thoughts?

I have three questions.

1, Do any of you guys consider pregnant patients with any level of trauma as a risk for miscarriage?

2. Do you start IVs on all pregnant trauma patients?

3. If not why?

Edited to check spelling.

I never had a film crew although the local paper and TV hand around like vultures trying to get a shot with a little blood in it. Jerks. Most of the time they tic me off although i try not t show it.

Once I was in the rain packaging a head trauma patient with AMS and Cheyne-Stokes breathing that had bled at least 500ml from the scalp laceration. About 6 LEO were on the scene. As I was assessing the patient someone behind me kept asking how to spell my name, I thought it was the police. It was a reporter. I don’t like them at all, a bunch of vultures.

As far as putting a film crew on the bus with you, I don't know. I would hate to face a lawsuit with film! Lawyers could turn that into a nightmare.

EMS is an wonderful adventure. Enjoy the ride! Welcome to the City.

So ,,, What was her actual pulse rate?

Good job tcripp!

I caught and removed a snake from a patient's bathroom once. That has a hoot!

I think the actual geography has an effect on people's behavior. Greater distances make for longer response time. Also sometimes the ambulance can't find the house in areas where they still have PO Box addresses.

Most everyone has some form of transportation or someone who can give them a ride.

Unless it is really serious you can probably get to the hospital sooner by driving yourself.

Another important factor is EMS services diffusion and promotion. Since folks don't see ambulances that often they don't think to dial 911 in an emergency.

Cost is also a factor; why pay for an ambulance if you can drive yourself?

Also the odds of Joe lunch bucket the volunteer showing up first are pretty good and not necessarily what you want or need.

Let put a C-collar on him, no board as the cost benefit isn't there. I know the ER is likely to laugh/bitch at me for having a patient with a collar and no board, but I want to remind him not to move his neck.

Edited because I missed the diagnosis. Deleted coments.

When it comes to other first aid skills, I make sure that whatever I'm teaching is age appropriate by making sure it's something that's unlikely to cause more harm if they do it incorrectly. I'm afraid when teaching smaller children that they'll do the WRONG thing in the emergency and make matters worse (all because of my training).

So the developmental stage of each individual child would be key. Maturity does not come with age but with the acceptance of responsibility. We could teach all the same and expect that some simply won’t have the maturity to get it. But hey, some knowledge is better than no knowledge. Or do an introductory "test class" to identify kids that are interested and able to learn more.

Teaching first aid to elementary school aged children is a different story, though. I actually do this frequently, I frequently volunteer to teach the local Boy Scout troop and Cub Scout pack first aid and CPR, and I also lead the first aid team at my church (where I also teach the youth first aid skills).

First Aid team at church is very interesting. Do you include children, youth and adults? What church is it at? Do you have shifts during the services or is everyone just on standby?

I taught my eight year old how to make a sling last week. She's okay at it. If my three year old could tie knots, he could do it.

Basic first aid can be taught as early as elementary school and expanded on as a child grows older. Bleeding control, splints, slings, CPR with AED, even spinal precautions should be common knowledge by high school.

I dont believe in being greedy with the knowledge. Put it out there. People can handle it and should have it.

Yes, teach first aid to the kids. Make it an elective they can take in school. What a fun thing to teach!

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It is really cool to teach our own kids. My 14 year old is pretty good with the areas she is most interested in. She likes the Rapid Trauma Assessment but is less interested in interventions. My 19 year old will take his NREMT next month. I got to teach them both and it was a blast!