rat115

Good luck and welcome back to the City.

I would say that "fearless" is more knowing your limitations and knowing when and how to work within those. How many of us have been injured on the job and then walked back in knowing that we could be injured the same way again. Instead of being afraid and possibly causing problems for our coworkers, we deal with that fear and knowledge. Would you look at a coworker and say "now you know how it feels" because you'd been injured on the job? Would you be unwilling/unable to get take any position (driving or attending) due to something that's happened to you in the past? As for our patients, we've got to be knowledgeable about what can happen when we use interventions. We have to understand when to use them and when not to, so that we can do what we can for the patient.

This is where I'd ask the student if I could make a suggestion since he/she's training. I would suggest to ASK the pt to show that she can ambulate significantly to move around when left alone. If she is unable/unwilling to do so, I ask why and depending on the answer may tell her that it's my suggestion that she be evaluated at the ER. As long as the pt is AAOx4 and there is nothing telling us that self-neglect or possible self-harm is going on, there is nothing that can be done to force the pt to go. Often with the elderly, they will become upset (as you noted) when told "that if there were any changes (which we thought there would be) that we would take her to hospital for evaluation." I've found that when you talk to them, they've had so many of their freedoms taken away by their age and disabilities that they get defensive when they feel that EMS or medical providers are taking away their right of choice. We have to remember not to make a pt feel forced to get evaluated unless there is a reason such as altered mental status, ETOH/drugs, or threats of self-harm. In these situations, we need the area LEO to back us up and to make the pt feel that this is us caring for them and not forcing them. I had a pt who had attempted suicide by taking too many painkillers, but it wasn't enough to actually kill him due to his tolerance. He became irate to the point of telling our ALS provider on the call to get out of his home and not to come near him again because the ALS provider said similar to what you did and started giving orders. One of our volunteer Basics who's a minister was able to convince the man to let us take him in, get him checked out, and get him counseling simply by treating him with kindness and showing concern for his well being. It was a lesson in non-pressure for me.

I'm another person who took Physics in high school. While I wish I'd have had a better instructor so I could have learned more (unfortunately, I can write this as the teacher had a PHD but had been removed from a major university due to his student failure rate), I've been able to use a lot of what I did retain to help understand the effects of accidents. I think that a basic understanding of physics would help as much as algebra helps with drug dosage.

Glad to hear that ya'll and Kiwi are good. I've heard from a friend who's a counselor in Auckland, and she said the same thing. Prayers for those from the area and rescue/disaster crews who are working in the area.

I live in an area with a large elderly population per capita. I've seen similar a couple of times because of this. We are instructed to lean to a worse case scenario if there's doubt. The pt hx of having been into the doctor for x-rays late the previous week would have me thinking as you did on scene. (Any known hx of osteopnea or osteoporosis? Pt on Ca+?) I would be worried about a non-displaced fx. While I may not have used a reversed KED, I would have prevented the number of moves you had. Here, our normal practice is to use a scoop (if possible and no chance of other injuries like in this situation). This would have prevented movement of the pt's hips after initial placement on the scoop and allowed movement to the cot and ER bed without extra movement of the body. On scene, did anyone attempt slight manual traction of the pt leg? I've done this in the past and was able to relieve the pain and was later confirmed that it was a femur fx. I've also had a pt with a hip and lateral pelvic fx who's pain was relieved by a traction splint, the ER here told me to leave it off the pt on ground transfer to higher level of care due to the pelvic fx, and I had an ortho PA tell me there that I should have followed my gut and put it back on her because it lowered the pt pain level even though the ER here told me not to. Moral, don't take for granted with elderly pts that pain without visible injury means that nothing's broken. Finding a way to make the pt comfortable and not have to repeatedly move them is the best thing you can do to prevent displacement if there's a chance of fx.

Just wanted to update. It's been a crazy couple of weeks. I had surgery 2 weeks ago today. Turned out that I didn't tear the meniscus. I tore the cartilage on the end of the femur and back of the knee cap. Doc had to go clean out the joint and behind the knee cap and smooth both down to prevent re-injury. Stitches came out today and the GP liked the look of the knee. I go back to the ortho tomorrow, and I'll talk to him about PT to help strengthen it before I'm back on the amb since my boss isn't comfortable with me coming back without some rehab and strengthening after being down for as long as I've been. Things went well. The knee definitely didn't start hurting and swelling with the storm that came through this week. I'm a happy camper for now.

I think this doc tends to be a bit overly optimistic where the EMS field is concerned. The EMS director ended up with a rotator cuff tear (LODI) and he said that this doc expected to have him back on the job in about half the time it took. Remember, I'm on a compensated volly service with about 10 people taking call. There is only 1 "paper pushing" job on the service, and it's definitely not mine. It stinks since I can't work the ambo until I'm released by the doc.

I'll add my 2 cents worth. I think that working your way up is not a bad thing. It gives you the chance to get field experience and on the job training/knowledge. Now, to help you understand my stance. I work on a rural volly service. We had a gal who went through class and got her EMT-B at 18. She worked here through her senior year of high school (the school would actually let her leave class for runs). She graduated and went to college for her RN. She got a position with a major ER right out of college due to her experience on the ambulance and within a year and a half she was hired as a RN for a flight crew. Hope that helps you.

Welcome from rural Colorado, USA. Hope you enjoy and learn from the City.

While all services have different protocol, it seems that it's pretty consistent among the services that I've dealt with or talked to providers on. Most must contact their own dispatch and the dispatch sets up a number for the call and location in the computer. Dispatch also contacts the area law enforcement. Depending on the severity of the accident, fire and tow truck(s) will be dispatched too. I don't know why you're asking. If you're new to EMS, check with your EMS director or supervisor. If you're asking due to being involved in or having a family member involved in an accident, you'll need to follow proper channels to gain access to any and all information. If you're asking for some other reason, let us know.

Dude, I've heard stories similar to this and worse over the years that I've been in EMS. They are not funny. There are a lot of reasons why they aren't. Add me to the list of "Don't find this funny" people.

I saw the ortho last week. I'll be going in for arthroscopic surgery on the 19th in the Denver area. Richard, I'm on the plains, but I'm about 2.5 hrs out from Denver & Colorado Springs. I talked to the doc about the pain. He said it's normal with the injury. He told me to start some small exercises to start strengthening the knee before the surgery. He thinks that I'll be back on the rig 2 weeks after the surgery. My director said to plan a month (this doc did his rotator cuff surgery a couple of years ago). I'll definitely wait to see how things are going and where I am in rehab before I'll jump back on the rigs.

I'd like to see the basics covered. Let's start by getting everyone on the same page in the US. Let's get a national standard of training and care like other countries have. By standardizing practice levels and training levels, there is an increase in understanding within the profession of what each level can do. It also decreases the ability of people to fake certification. I agree with better training. Basics need better training before they're released to work in the field. We are professionals and quality training gives us a better chance to be seen as professionals. That also means that we must ACT like professionals and treat each other with respect. That means that nasty comments on a website or face to face shouldn't be considered ok by anyone. I think if we can start by getting those IN the EMS field to understand that we ARE professionals and must act like professionals. When we change our attitudes and get the training that allows us to work as a team with those in the hospitals and clinics, they will see us as health care providers and professionals like them. From there, things can only improve.

Medicgirl, do you live in a rural area? If you do, one of the most important things for you to know is the treatment for those who've been exposed to Anhydrous ammonia. This is a commonly used fertilizer in rural areas which is often stolen and used for meth labs. The extent of use of anhydrous is one of the reasons that meth labs hide so very well in rural areas. I speak as an EMT-B in a rural area. My husband works for the local Coop. I've seen times during periods where the farmers are fertilizing a lot of fields where just this one location (out of about 6 in the county) has gone through so much anhydrous ammonia that they had 2-3 semi tankers coming in with deliveries in a day and still couldn't keep up with the demand on what they need to send out. They also have to check over every tank that comes in to make sure it's not been compromised. They alert law enforcement (LEO) if there is damage that is indicative of someone trying to drill through the tanks or tamper with the valves so that LEO can start looking for active meth labs in the area. Ugly did a very good job listing off the basic treatment for anhydrous ammonia exposure. Water, water, water!!! Get the patient out of the contaminated clothes OUTSIDE of your ambo and have Fire spray the person down. You do not want to have to wash out the ambo after the call. (I've seen a crew have to wash Roundup out of a rig and it took about 3 hours to totally decontaminate it and them. We ended up with our primary rig and crew out of service for 1/4 of their call time that day.) This is basic decontamination. Wash the eyes and skin. If you're not ALS and do not have ALS that can get to the scene, support and monitor respiratory and head to the ER quickly (not necessarily emergent) and let the ED know what to expect. If you even think that a pt has been exposed to a meth lab, you'd do best to demand hazmat on scene and decontamination before you let the patient near your ambulance. You also don't want to go anywhere near the scene yourself unless you're in a "glow worm" suit. Remember, scene safety is number 1 because you can't provide care if you become a patient too.

Richard, sounds like I'm lucky to have the 2nd GP that I saw know me and know that I'm not one who c/o pain at the littlest thing. I'm glad this doc sent me in sooner for an MRI than you were able to get in. I agree about knowing ahead of a storm that something's coming. New question... I live on the plains in Colorado and had to go into the mountains in Wyoming. I had to go the weekend after I injured my knee, and thought the increase in pain was because of the time in the vehicle. I've had to go twice more and have had similar pain increase with the change in altitude (Pain got worse as my ears would block up and I'd have to pop them.) I'm going to talk to the ortho about that and the continued pain on the medial side of my leg just below the knee Thursday, but was curious. Have any of you that have had knee injuries ever experience that kind of increase in pain with the change in altitude?

Thanks, 105. I'm in the same boat that only heat helps the pain. I've been working with my doc and chiropractor together. (The work comp doc is actually my GP and knows that I've been seeing the chiropractor.) The chiropractor has a degree in sports medicine, so he's helping me keep from losing too much muscle. I've also found out that the ortho sends his patients to this chiropractor at a point post-surgically to ensure that everything is in proper alignment with the surgery and pt to help healing. I got lucky to fall into a good team, so I'm hoping that this will help things heal faster. Happi, we're already there and have been dealing with that off and on for a while. The ex is part of the issue on that, too. (If only.... Ok, I'll shut my mouth there.) I think that the kids are getting a clue after spending close to 2 weeks with their dad between Thanksgiving break and a week of Christmas break and they're realizing that their dad really doesn't stick to what he's said or stay consistent on what he wants. They've got that consistency here, even though kids seem to love to push against that and want it at the same time. Hate it, but glad it's not abnormal.

Co2... Thanks! 3~4 months more post-surgical is going to stink, but it's about what I expected. I've had injury to both a ligament and a tendon, so I had some idea. It's just not something I'm happy about. The report was filed. Our EMS Director was the ALS on the call, so he had paperwork going before I got into him to get the official paperwor after Thanksgiving weekend. He'd already given the driver a talking to about his heavy foot, too. You're right about babying the knee. I've found the slightest twist is a bad thing. (That was hard for me at first with having martial arts training.) Weather changes and uneven ground are bad too. Knee keeps trying to drop out on me. Pain is pretty much a constant even when they upped me to 800 mg Ibu. I actually do better most of the time using heat on the knee instead of ibu and letting my natural pain threshold stay strong (as crazy as that may sound). I'm actually kind of scared to try getting out in the morning with it snowing and blowing badly enough to form black ice tonight. Docs have me using heat instead of cold. 1st, I don't tolerate cold well normally and cold was making my muscles spasm. 2nd because of the age of the injury being over a month old now. Around the house, my hubby is normally really good. He's more apt to chew my bunz about something he thinks I shouldn't do and tell me to go sit down while he fixes dinner. Being my 2nd marriage, my kids keep pushing him and don't want to help. That's got me about to blow up at them. At the other job, there is NO elevator. I also can't work with the leg up there for 80%+ of the time. I'm actually supposed to stand almost all of my shift there (front desk at a hotel), and my boss is letting me break that rule and sit all the time. Thank Goodness!!!! Hmmm.... Maybe the SO down the street would let me borrow his. That or I could borrow a cattle prod from one of the oldest's scout leaders.

Great story and job, Herbie!!!

I'm having a rough time. I got my knee injured the day after Thanksgiving on the job. The partner who was driving (there were 3 of us on the ambo) got a heavy foot because for a pt with a GCS = 3. My boss was sitting in the captain's chair trying to raise the hospital and told me to use the independent pulse ox across the ambo from me instead of the one on the Lifepak. I was leaning across the pt when the driver hit the gas, stumbled and slammed into the back door of the ambo with the side of my knee hitting first. After we dropped the pt off, I sat at the station with a cold pack on for 20 minutes and then went home and continued RICE at home. I didn't get it checked out that night because it felt like a bruise and the knee was moving fine. I hadn't felt an actual pop because of the impact. By Monday, I was feeling pain. My knee never ballooned up because I don't swell normally. I went into one of the 2 clinics here and the doc did an x-ray. That came back clean...No fx. It did show some thinning of my bones, so the doc started me on CA and Vit D twice daily. She didn't attempt anything else at that time. I went to my chiropractor thinking that my knee was mildly dislocated. I've had similar happen with my kids and the MDs never even think about reducing them, so I had the chiropractor (who also has sports med training) take a look. He noted significant internal swelling immediately. (This is with me taking 400 mg Ibuprofin every 6 hrs.) Manually palpating around the knee joint, he told me that it felt like a meniscal tear and encouraged me to continue the current treatment of bracing it, heat applications and NSAIDs. He also encouraged me to get back in with one of the MDs at the clinic. I finally got back in with the head doc at the clinic. (Different doc than the one that ordered x-rays.) By the time he saw me, he'd looked at the x-rays and had read the radiologist report. In a 10 minute appointment, he had the scheduling department authorizing and scheduling me an MRI. The next day, he told me over the phone that I had a meniscal tear and that he rarely saw ones like this heal without surgery. When he called, I was on the road becuase 2 of my kids had appointments in the city so I couldn't ask a lot of questions about the exact nature of the tear. Scheduling couldn't get me in until Jan 6th with the ortho. For now, I can't work on the ambulance at all. My part-time non-EMS job has me limited becuase stairs or even vacuuming makes my knee lock up or hurt unbelievablly. Getting help around the house is like pulling hen's teeth with 2 pre-teens and a teen. My husband's been pretty good, but lately he's chewing me out for doing things he thinks is beyond what won't make me hurt but himming and hawing when I ask for help with what I know will make me hurt. Any idea on the come back post-surgically on a mensicus tear to being back on the rig? Any suggestions on how to get help around here without buying a cattle prod? I'm about to scream!!!! (And this is only the crap at home and not the crap I'm getting from some of the people on the ambo. That's almost another thread and definately its own post.)

LOL! That's a good parody.

Seen this one before, and it's still a chuckle. Of course you would be, Loner. Just kidding with ya!