cotjockey

Any time my family and I are sitting in the drive-thru line at Dairy Queen, the pager goes off...same with any time I have plans with my grandmother. Mentioning the name of most of our "special friends" (our chief HATES the term"frequent flyer") will cause them to call us within 24 hours. If our assistant fire chief goes out of town, his father-in-law is certain to suffer some sort of cardiac or diabetic emergency....we see him so often that I don't need to ask his birthday or allergies any more. Any time I teach a class for the community (CPR, first aide, etc) or am giving a tour to the Girl Scouts or Boy Scouts, we are certain to get a "good" call. If one of my husband's coworkers is the patient, I almost always miss the IV. If I have no plans for three or four days and hope to spend all of my time responding with the fire department, the pager will be silent.

This is one advantage of having an active volunteer department...we almost never only have one EMT in the back of the ambulance. We also get law enforcement on most of our calls so if the EMT is ever uncomfortable being alone with a patient (or the patient is uncomfortable), the police are more than happy to ride along. The EMTs who actually do harm patients deserve to be punished, but the innocent ones shouldn't have their lives ruined by false accusations.

We have law enforcement on about 99% of our calls. For the calls where we don't, dispatch does a status check after 10 minutes. If we don't respond to the status check or if we say a certain phrase (similar to "Yes, we are fine" but not "Yes, we are fine") law enforcement shows up. It isn't a perfect system, but it works.

Well...I'm female and I'm confused. How do people come up with ideas like this? BTW...has anyone ever tried alcohol via nebulizer? I've heard it is a good time.

I can relate to how EMTs can be frustrated by nonsense calls at LTCs. I’ve responded to calls where the patient has been dead for a long time and had nurses wanting me to do CPR. I’ve also responded to “needs transport for x-rays” to find a patient who is cyanotic and breathing less than 5 times a minute. I’ve also been told a patient is “in his room” when asking where the patient is and watched a C N A kiss a resident good-bye (on the mouth!) while her boob popped out because she was leaning over so far. I know how they feel about the nonsense calls and calls where inadequate information is given to dispatch. I was not aware that I had to specify that calls were emergent…I thought dialing 911 indicated that already. I also know that the dispatcher that was on that morning once paged out a “transport” for someone who was unconscious and not breathing. I honestly dread responding to the nursing homes here and I equally dread calling 911 when I am at work. I really wish there were a way for all of us to have a better understanding of how and why we do what we do, but I know that it isn’t something that could be fully explained if we shadowed each other for a shift or two. (That is what my administrator suggested). I still don’t like this EMT…I think she has attitude and a half and I know she is really burned out. I feel bad for her. I talked to my medical director at lunch today (saw him in the local burger joint) and he is going to talk to their medical director and see if they will let me help out a bit. I’m in their town more than I am in mine and would be happy to run with them between shifts if they are agreeable. I don't want them to think I am being pushy or trying to play the hero or anything, but it when I am sitting in their apartment doing nothing between shifts, it might be fun to respond with them.

Well...I have some information that I didn't have a week ago. According to the EMT, the reason for the long response time is that dispatch paged it out as a "transport," which apparently means non-emergent, so according to the squad's SOP means they have up to an hour to respond. I took for granted that calling 911 meant that I had an emergency. From now on, we have to specify that we need an emergent transfer. The squad has been called to our LTC for complete nonsense more than once, so they have a bit of attitude about responding there. The EMT admitted this when my administrator talked to her. (Yeah, I was supposed to talk to her, but the administrator called her first). The EMT said that she was upset when she came in because the resident was still on the floor and because no one was holding her hand or trying to comfort her. I thought about moving her back to bed, but really didn't want to move her without appropriate splinting. No one was holding her hand because this lady isn't the type that would put up with it. We could have held her hand for about five minutes before she would say something like, "OK...you can find something else to do now." There was a CNA in the room with her the whole time. The EMT didn't know I am a nurse. I didn't have my name tag on...it was on my jacket, which was hanging over a chair at the desk. My fault completely. The EMT also said she was upset because she has "never seen an RN" there. We are required to have an RN there 8 hours out of 24...and that is about all do we have. I don't really think it is the best thing not to have RN coverage 24/7, but that is how it is...I don't make the rules. The squad only has four EMTs and two were out of town. The two that were available both had to work that morning and both hoped the other one would respond. The closest mutual aid is 15 miles away and protocols don't allow paging them out until 15 minutes without a response. So...it sounds to me like their squad needs to make some changes…so does our LTC. Our LTC needs to be more careful about what we call 911 for...we need to be more assertive when the doctor tells us to transport when we really just need orders for an antacid. We also need to specify to dispatch that we have an emergency. I need to make sure I am wearing my name tag. We're supposed to have a meeting with the fire department officers and our department heads...we'll see what happens.

I’m not really sure how I should handle this…or if I should just shut up and smile. Wednesday night, I worked night shift…not my normal shift (I am a pencil pusher with an office with a view), but I know the residents and the routine well and I still have pretty decent clinical judgment. Anyway…it was a wonderful shift and things were smooth sailing until 0430. One of our alert and oriented residents, who has a history of pathological fractures started screaming for help. Well…there she was on the floor. She denied pain, but is a very stoic lady. I can honestly see her chopping off her leg and rating her pain at a 2 or a 3…while smiling and patting the nurse on the hand and telling her how sweet she is. So…there are no real deformities, but her right arm just didn’t look right. No bruising, no swelling, nothing that looked like it shouldn’t look. We positioned her for comfort,made sure pulses were still there, and placed pillows to position (but not immobilize) the arm. I called the doctor (seven times before he picked up instead of the answering machine) and got orders to transfer to the 10 bed hospital across town. I called 911 and forty minutes (and two phone calls to dispatch) later, one EMT and a police officer showed up. I met the EMT at the door and gave report as we walked down the hall toward the resident’s room. I told the EMT that this resident is very fragile and that we handle her like eggshells because of her history of pathological fractures. The EMT said, ”Well, I think I know how to package a patient and I don’t even know what a patho-whatever fracture is.” I then said, she fractures really easily…and without known cause…she broke her wrist just picking up a water pitcher last year. The EMT rolled her eyes and sighed. She went into the resident’s room and asked me why I hadn’t put her back in bed. I again stated that she fractures very easily and because her arm didn’t look right that I didn’t want to move her without proper splinting. The EMT then informed me that she hadn’t brought any bandages in and that I needed to get her some Kling or something to immobilize her arm with. I could find any Kling, so I suggested using a pillowcase to splint. The EMT then informed me that pillowcases are not appropriate splints and that she would just splint her in the ‘bus.’ When I was in paramedic school, we learned to splint with all kinds of “inappropriate” things like pillowcases, magazines, duct tape, etc, so I said…”Oh…they taught us how in paramedic school.” She asked me if I am a paramedic and I admitted that I am. She informed me that I am “not a paramedic here, so it doesn’t count.” The EMT and the police officer then rolled the resident onto a sheet and lifted her onto the cot, letting her right arm flop to the side. I stepped up and tried to move her arm and the EMT held her arm up and told me to let her do her job…she then said, “I really don’t think there is anything wrong…you people call us all the time for nothing.” The EMT took her O2 off and the EMT and the police officer wheeled her out head first and with the cot flat, despite her extreme kyphosis. She resident had three fractures…one to her humerus, another to her ulna, and the last to the pelvis. The resident reported to me (when I took her glasses to the hospital) that the EMT was rude to her in the ambulance and that she told her that there was no way she was fractured because she had very little pain. So…my DON told me that she wants me to handle this one…I was there, I am a department head, and I have the EMS background to really know what was done wrong. They are a volunteer squad (and this EMT is their rescue captain and is married to the fire chief), so there is really no one above her to go to. Should I just call her and ask if we can talk or what? I really feel like I should have been more assertive about it when the patient was still there...I dropped the ball there for sure. The patient didn't have any additional harm done, but the potential was certainly there. I just don't feel good about the way the thing played out, but I'm not sure what to do about it.

I'll admit that I have complained a time or two when we go to the same house for the same minor complaint five out of seven days...but hey...that's part of the package. Every job has customers or clients or whatever you want to call them that no one likes to deal with. Besides...the non-emergent patients give newbies some good assessment skills without the urgency of having to find and correct things emergently. They get a lot of practice assessing healthy patients, so they are more comfortable saying that something isn't normal. It's part of the job...plain and simple. If people are so burned out that they are complaining about the BS calls, maybe it is time to find somewhere else to volunteer their time.

I just don't see how they can enforce any kind of rule against calling 911 when it isn't an emergency. For things that are very obviously not an emergency, maybe, but I've seen people call for things that were really stupid but, they were convinced that they were about to die. How can someone prove that they didn't know it wasn't an emergency? I wonder how long it will take for them to get sued because someone is so afraid of being in trouble for calling for something that isn't an emergency that they end up dying.

http://www.doubleqcountry.com/artman/publi...icle_8981.shtml I understand the point, but how are they going to enforce this? How are they going to determine what is an emergency and what is not? Are they only going to punish repeat offenders or will the do it the first time? Are they going to take a person's mental capabilities into account? I know where they are coming from...I would bet that more than half of what we respond to is non-emergent, at least according to us. I would also bet that a lot of the non-emergent calls seemed emergent to the person who called.

This is very true...I volunteer for a small, rural squad that is about 50% funded by tax $$$. Any time the city gets in a crunch, they take a little more away from us. We are forced to struggle to buy equipment, pay for most of our own training, and bust our tails having fundraisers. We're also expected to help the police with crowd control, SAR, etc. I know we do a lot of it to ourselves, but I wonder if the city council even realizes the contributions we make. I work in a nursing home in a small town about 30 miles from where I live and I have been asked to leave work to respond with their volunteers...I about fell over the first time my supervisor came running up to me and told me she was taking over because EMS couldn't get an EMT, so I was going to respond to an MVA with their 80 year old driver. For a lot of us out here in the middle of nowhere, its all about the love of the game...I don't disagree that it shouldn't be that way though!

One of our instructors always told us to start the big ones on people who don't need them so we'll have plenty of practice when it comes to the people who do need them. He was a pretty good medic...a bit aggressive at times, but he knew his stuff.

If you have a PDA, epocrates is a really good one to download. The free version is adequate about 99% of the time and if you pay one of the paid versions, it has a lot of features like dosage calculators, herbal meds, narcotic conversion charts, etc. My favorite print version is either Davis (which I'm not sure is updated yearly...it didn't used to be) or the Physician Drug Handbook, which apparently isn't updated yearly either...but, most that I have found that don't update yearly, do it every other year, so this might be the year they update. Sorry to ramble on...I have a cold and the cold medicine make me a bit dippy. Ooops...you wanted to know why. I like epocrates because it is quick and compact and it updates almost daily. It also has a "Multi-Check" feature that you can use to see how drugs might be interacting, has a dosage calculation feature, and it lists a ball park figure for how much drugs cost, which is something a lot of my patients are concerned about when something new is ordered. If a drug isn't covered by insurance or costs too much or isn't available, it has a list of alternatives. It doesn't list nursing implications and interventions, which would be nice to have. Davis is the one we used in nursing school. I think I just got used to it and since I haven't seen one in several years, I don't even remember what it is like. The Physician Drug Handbook is the one that the ER here used. I think maybe I was just used to it too because nothing really stand out that I liked about it. Not a lot of help, am I?

When I was a student, we got diaptched to a "man down...unknown if conscious or breathing." We responded to the address and were directed to the shed in the back yard. We go to the back yard and find a shed, about 6X6, made of fancy bricks to match the house. There are extension cords going from the house to the shed. We opened the door to the shed and find a naked man on the floor...unconscious, not breathing. An empty bottle of Benadryl (100 tablets) and a stack of porn magazines is lying next to him. He had been dead for a while. There was a refrigerator, a space heater, and a tv plugged into the extension cord. This man lived in the shed becasue his parents were scared of him, but didn't want to make him move out, but also didn't want him in their house.

Well...I have to agree about the c-spine technique, also it looks like the cot isn't covered completely with a sheet or blanket...up at the head, it looks like she is lying on the bare plastic. Her clothes are awfully clean looking considering she was involved in an explosion...and she's still wearing her shoes, if they didn't come off in the blast, I would think flip-flops would have fallen off by now.

Our paid firefighter/EMT responds from the station as soon as the page goes out. The volunteers respond from home to the scene. If there is a fire or MVA, we respond from home to the station so our engines, crash trucks, etc are manned.

Usually I just call it an ambulance or call it by the unit number. After it died in the middle of the street at 0300 today, our EMS captain called it the big old rolling turd...

Amen to that! :wav:

Nurses bash us quite a bit...LOL. Sometime when you're bored, check out allnurses.com...do a quick search for paramedic and you'll get quite an education...

I'm not sure what you mean by "better nurses." We have some really good nurses at the NH I work in...however, we are limited by lack of resources, scope of practice, state regulations, etc. Personally, I am willing to treat residents emergently as far as my resources will let me...I have no problem putting on O2 or increasing O2 or whatever. I won't however do anything invasive, like an IV without an order...in the first place I am an LPN and LPNs here don't do IVs without taking an extra semester long class...my facility doesn't allow LPNs to do IVs anyway. Sure, I can do all IVs when I am not at work, because then I am a paramedic, but I have to stay within my LPN scope of practice when I am on the clock. It takes a pretty good nurse to recognize that something is up with a resident when they say they feel fine, their vital signs are normal, and their symptoms are as subtle as refusing breakfast once...

At the basic level, you might be out of luck. Most places I know of either use basics as drivers or if they are a basic service (yep, they exist) then they run with two basics and they alternate who drives and who does patient care. Not fair to your partner if you aren't allowed to drive and they never get to work in the back. If I were in your shoes, I would look into either joining a volunteer squad where you don't need to worry about driving while you gain some experience or go back to school to work on your paramedic while your record clears up. Even then you might have trouble getting a position. I was in an accident involving a fatality...since legally I was at fault, it still affects my record...and eight years later, I still don't drive anything except my private vehicle. I'll be cleared to drive the ambulance in December.

We had the same problem...for some reason paramedic students were at the end of the line after CRNA students and medical students...we just kept showing up until we got our tubes in. Your instructors should be able to help you out and find out what days there aren't going to be other students there or what days are going to be busy enough that there will be more tubes to sink. Also...even if there are other students, if you get in on the first case of the day, there are usually several procedures starting at once in different rooms...other students can't be in every room at the same time, so that is a good time to go. It also helps me to get in the good graces of one of the anesthesiologists or CRNA...if they like you, they'll help help you out.

I think it would help a lot to know more about what the nursing homes do too. A lot of my coworkers don't understand that they don't have access to high flow O2 or splints or dressings other than 4x4s and ABDs...they also don't understand that the nurses there can't put on O2 without an order or give D50 without an order or start IV fluids. Also, a lot of times our residents don't tell us they aren't feeling well until they are REALLY not feeling well...we don't check vital signs and do head to toe assessments every shift (or more) like they do in the hospital. The nursing home is supposed to be a HOME, not a hospital. Most of us try to keep a good eye on our residents...sometimes we can tell when something is going on by their behavior (we have a lady who stops eating when she has a UTI...another who gets confused when her B/P is high), but too often if something gets missed is it because there are no outward signs and the resident doesn't say anything to us. But again there is NO excuse for not providing at least a brief report and letting EMS know that normally the resident is alert or confused or that she doesn't have feeling below her waist...I have never worked on a unit where there isn't at least one staff member who has been there a while. Even when I have done agency nursing, I knew who was confused, combative, independent, etc...I usually had to ask, but I knew.

When I worked in the ER, I made a point of helping the students who helped us...if you were willing to clean a room or run to the lab, I was more likely to seek you out or make sure you got to be involved when there was an interesting (or even a boring) patient. The students who walked in with an attitude were left on their own a lot more...if they got in on a procedure they did, if they didn't oh well. I fully believe that students are there to learn. I wouldn't dream of asking them to run to lab or clean a room if there was something else that they could be doing or learning. Students are not there to be staff's gophers...that is what techs or LPNs or CNAs are there for (at least in the ER I worked in). Techs, LPNs, and CNAs should not be standing there watching a procedure or helping out while an EMT or paramedic student misses out...there will be plenty more things for staff to do some other day...students have limited time. Running to lab and cleaning rooms is all part of the package, but not at the expense of missing out on something educational. Ooops...didn't realize how old this post was...should be more careful!

I work in a NH and I honestly have horrible experiences almost every time I respond to a 911 at one (the one I work at isn't in our fire/rescue district, so I never have to go there). I know that the nurses' hands are tied as far as giving more O2, splinting, some dressings, etc...they just don't have the supplies or the doctor won't give orders since 911 is supposed to be en route. Also with limited staffing, it can be really hard to get paperwork done in the brief time between getting orders to transport, calling 911, and arrival of the ambulance. We've managed to remedy the paperwork problem by having ready made transfer sheets with appropriate names, addresses, and phone numbers, med lists, treatment lists, and diagnosis sheets...we up date them once a month and are ready to go at any time..just have to pull them out of a book. There is NO excuse for not knowing at least a little bit about the residents you care for...if the nurse doesn't know because she is new or whatever, there should always be someone they can ask. There should always be a chart available with a summary of the resident's mental status, habits, abilities, etc (we do them monthly and PRN when there are significant changes). Nurses need to take time to figure out important information about the people they are caring for. It really frustrates me when I show up as a paramedic and still have the nurse trying to direct care...she called 911 because there was something going on that could not be handled in the nursing home...once we are there, it is time to back off and let us do our job. I think it would make me very uneasy if I were the resident and had a bunch of strangers (EMS) trying to put O2 on me while the nurse (who has been caring for me for years) stands in the background yelling "Don't do that, he has COPD!" Who do you think the resident is going to trust more? I always want to go to all of the NHs we respond to and do an in-service on how they can best help us when we show up and explain some of the logic in what we do...our rescue captain doesn't think it's a good idea. She thinks we just need to show up and do our jobs and leave things as they are...no need to hurt feelings or make people feel bad...I don't totally disagree with her, but... It would be nice to just let them know what kind of training we have, what our scopes of practice are, how our protocols work, how they can help us by having someone to show us where the patient is, clearing obstacles out of the way, giving us a little background, etc...it would be nice to feel like we are all on the same team instead of them feeling like we are a bunch of idiots showing up for the adrenaline and us feeling like they are a bunch of incompetent nurses who can't cut it anywhere else. I've been on both sides, and I know a lot of times, those feelings are there. I think it would help if we all knew a little more about what the other ones do.