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Cougar

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About Cougar

  • Birthday March 4

Profile Information

  • Gender
    Not Telling
  • Location
    Northern New Mexico
  • Interests
    Scuba Diving, Horses, Writing, Adventure

Previous Fields

  • Occupation
    EMT
  1. Wow! What a terrific attitude you have! I'd like to box it up and feed it to my students. From your willingness to listen to what people are saying to you, to your recognition of your weaknesses, you demonstrate that you have the qualities to become good at this. I stipulate to what has already been said. We aren't only EMTs. We are social workers, psychiatrists, strategists and depending on the day and the hat we are wearing, a lot of other things. We are the eyes and ears of the doc and in rural areas like mine, we see things no one else will see. Our interpretation of what we have observed may make an enormous difference in not only the outcome of our patient's current problem, but sometimes in everything that comes after. The experience you gain in learning about all aspects of life is what enables you to be good at making sense of that observation of the scene and patient as only you will ever see them. Study, learn everything about all that you can and then apply it. Good luck and I'd love to have you in northern New Mexico.
  2. Wow, 10 hours for a call! ...and I thought my part northern New Mexico was the tules. I'm impressed. We have had three hours to be able to meet a helicopter.
  3. I am with a volunteer squad in a VERY rural area (read frontier). After almost 17 years, we know the populace pretty well and have fairly accurate spidey senses for when a call could have safety issues and when it's not a problem. Our area is is used as a training ground for state police and the nearest paid ambulance service has been going through a few years of very heavy turnover so although we know our patients and our district well, they don't. They are forever having us hold for law enforcement to clear scene that we would be comfortable going into becuase we know the folks. Mind you we are a minimu of 40 minutes for them to get up here and sometimes much longer. Last night we had a call that came out as a 19 year old female who had possibly OD's on prescription antidepression meds. Enroute we hear she has left the house and is heading for the river (no bridges here). We get within a quarter mile of the scene and are told to stage and wait for LE to to arrive and clear the scene. After 20 minutes I am really worried about whether this could be tricyclics and we could end up working a code so I get central on the radio and get them to repeat exactly how the call came in. I ask them if there is ANY reason to suggest this pt has a weapon or iffers any specific threat to my crew. They tell me law enforcement is an estimated 20 minutes out. After hearing what they have to say about no weapons and how the call came in, I have decided we are going to head in anyway when law enforcement comes screaming by (I guess the 20 minutes was the wrong estimate) They clear teh scene immediately because it is a frantic teenager who has had a miscarraige a couple of days ago and is pretty missed up , but dangerous to no one but herself. My question is, since this keeps happening up here because the staters are all new and shiney and the paid service doesn't know the area and our drunks scare them, should we just listen to our own risk assessment? There are places here we aren't going into without law enforcement. Domestic violence situation with the shooting nutjobs....we aren't crazy....but we have a way better idea than the the law enforcement people and paid service from 40 miles away what situations are threatening and which ones aren't. I don't want to be explaining to a judge and jury someday why I sat on my ass in my comfy warm truck while someone died when I had a pretty good idea my crew would not have been in any danger if we went in promptly when called. Can law enforcement stop us. Who has jurisdiction here?
  4. The famous exploding belly button attached to a patient that certainly was uninsured. On the other hand, there certainly was medicaid. All I could figure is that they thought the alcoholism would kill him before a possible infection. It didn't seem rational to me. I've been searching the net since this call happened. I haven't been able to find any reference to hernias that burst though the skin. It was one of the weirder things I've seen. On the way to the call, I recall thinking that there was going to be a knife wound or bullet hole. Nope, [ressure from inside tore open skin and begain to force out viscera. I am really looking forward to talking to someone who has even heard of this phenom.
  5. We had a rather odd onel one last night. The call came in from a panicked party saying that someone's "belly button" had exploded and there was blood everywhere!." This is an EXTREMELY rural service and getting to the patient took us over 30 minutes. On the way we talked a bit about what might be going on. We heard on the radio while enroute that now the pt was bleeding from his genitals. Hmm, lets rethink this. As we were talking we discussed the idea that what was "a lot" of blood to a layperson might or might not truly be a lot. We were thinking something ugly was coming up. Instead we found a 62 Y/O male in semi-fowlers position with his daughter holding a towel against his umbilicus. There was only perhaps 20-40 CC of blood and fluid. Under the towel was what appeared to be intestine bulging through a tear in the skin. It appeared to be a spontaneous rupture and not the result of trauma. There was no bleeding from the genitals, the family had mistaken urine for blood when his pants became wet. Pt. was quite thin with a distended abdomen, probably ascites. As far as management of the protruding intestine, we used direct pressure on an AB pad. Coughing or any movement on the part of the patient caused the extrusion to creep out more. Although I know the umbilicus is a weak spot and people with ascites are obviously at risk, I have not read of a hernia actually tearing through the skin. I was most surprised at the treatment in the hospital. I was told this morning by a family member that they "shoved it back in and put a bandage on it and told him he should get surgery some time and sent him home." I would have thought that once viscera was extruding through the skin tear that it would need more immediate treatment. Has anyone else run into this sort of thing?
  6. You guys are wonderful! Keep going! They never told me that kidney dialysis could tank blood sugar. I was very confused by my first dialysis patient back in my basic days who had eaten beans and steak an hour ago (yes, he kept it down) no diabetic hx and a BGL of 12. I act as a volunteer in an EXTREMELY rural area. The other day I am first on scene by ten minutes with 4 pts. A screaming one yr. old in a car seat. A bloody, sobbing unseat-belted 8 year-old, a too quiet curled up 5 year-old complaining of right LQ pain and a shocky adult. Damn, that magic jump kit is lacking a lot. I elected to put the only O2 on the 5 year-old and prioritized her as #1 with adult #2, 8 y/o #3 and baby #4. When we met with the pros they sent the adult out by copter, took the rest to the local ER and ended up airlifting the the 5 year old out with a liver lac. I hate quiet kids. Bless the screaming ones! You city dudes don't know the luxury you have of having hospitals close by and never being alone at a scene. Sometimes the wild west is scary.
  7. I am working on a class regarding the things you learn in the field that they don't always teach you. An example would be my agitated, obnoxious, sweaty and pacing patient with no pulse...not even at the carotid. (alcoholic with a rate over 300...he lasted 25 minutes before he crashed) You can't feel a pulse if the heart rate resembles a hummingbird's wings. I have a few other examples, but I would REALLY love to have some input from the forum. The things you learn from experience that weren't part of you education. Sometimes I find myself thinking, "Why don't they teach us that?" Please share your experiences. Thanks in advance.
  8. I am in Mexico and between getting my teeth fixed and getting a bit of diving in, I am trying to get the fund act application in for our volunteer agency in the states which is due the day I get home. I spent a lot of time in the ICU last year and haven't spent as much time teaching as I like. I fear I've let things slide a bit as far as riding herd on the herd. Putting in this application means I am in putting runs that someone SHOULD have been put in through out the last year and a half half (hey, I was in the hospital trying to die). Anyroad. As I put in these old reports I see see some major weakness in our volunteer department Basic EMTs. "Did a head to toe assessment and everything was OK." No specifics! If I see vitals at all they say things like, "respirations=regular"! Eek! You paid guys have to understand that in a volunteer service where no one gets a thin dime to slide out of bed in the wee hours it can be really tough to find anyone, but I'm ripping my hair out here. How do I gently beat the holy &&*% out of these guys and say something like, "Just because you aren't getting paid doesn't mean we don't act like professionals. Vitals don't consist of WNL (we never looked) The narrative reports are touchy, feely community reports on the state of the village but I would hate to hear what a good lawyer would say about some of this. Does anyone have any recommendations about how to whip them into shape without having them all quit, which would spell disaster. This is a really good bunch of people and they work hard. They have some good skills, but 5 calls a month can make report writing a lost art. They do the work with the patients, I've worked with them at scenes, they just don't write it down afterwards. On the other hand, describing a year and a half old baby (yes not months...I have reports that don't even give me the date it occurred on let alone an accurate pt. age) "good color, warm, soft, moist skin" Just picture a really vicious lawyer with that one had anything untoward happened. (This baby was just fine....but my legal background says that kind of report writing can come back an bite you.) As an aside, someone also used something I don't recall seeing and couldn't find on the net. Has anyone seen HNNEE as part of a narrative? I'm not familiar with it and I can't ask the author right now. Anyone, does anyone have a technique for getting these volunteers to write these reports in a timely fashion while they still remember what happened. Using notes at the scene. Getting them to realize that galloping in on the white horse is all well and good but horrid reports are written with permanent ink. We can't afford to loose any of these good people and I wouldn't hurt them for the world, but this REALLY needs to be fixed. Suggestions PLEASE.
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