emtannie

Wow – for once I disagree with Dwayne! (ok, maybe this is the second time). I think you DO have to suck it up and provide patient care…. If that means you drive, and your partner attends, or you get another responder to drive, you do it. As I said in a previous post, the dogs are trained for travel, and can easily be seatbelted into a seat…. Why couldn’t you put the dog in the front passenger seat for transport while you attend in the back? The dog is secure, the patient is happy knowing their dog is with them, and you, even though you have a fear, can attend, knowing the dog is secured close enough for the patient to know they are there, yet far enough that you should still be comfortable. As for emotional support, I will give a severe example as comparison…. Your son is ill, and in hospital. There are lots of hospital staff available to provide support. Is that the same as if you and Babs are there to give support? Somehow, I think not. The emotional attachment a person has for their service animal is one that you and I can’t quite understand, but it is a very strong bond, and I don’t think we can just make light of it and say “there are others who can give the same support.” Maybe I work in an area where we are just lucky, but our hospital has a number of arrangements in place for service dogs who need care if their human partner is in hospital. The hospital has people available day or night to come care for the dog, and in the interim, our city police department is always willing to take the dog and care for it. Let’s go back to the original post…. The patient is alert and oriented, and will not leave home without their service animal. We aren’t talking about a patient who is incapacitated. This person is still depending on their animal for support. In this situation, yes, I would take the dog with me. If I was doing CPR, or the patient was in critical condition and unable to make that decision, I would make it based on the situation. Once in hospital, then the hospital has to make the decision regarding the animal. Dwayne, how many times have you transported a family member in order to make the patient more comfortable? What makes this so different? That service animal is an extension of that person, and transporting the animal will make that person more comfortable. I will refer again to my example above. That service animal does provide a type of support that a hospital staff member cannot.

Service dogs are trained not to be aggressive - they know their job is not protection by aggression. I can't say "never will happen" but I do feel that the chances are incredibly slim. If the EMS provider has a fear of dogs, they should realize that their fear is exactly that - it is theirs,.... if it interferes with patient care, they need to address it, and if that means calling in a second crew to transport the patient and their dog, then do it. Your phobia, pride, or embarassment need to come second to doing what is best for the patient.

Absolutely. I have a hard time believing that someone would even consider separating the patient from their service dog. That just shows a complete lack of education, compassion, and empathy on the part of the EMS provider. My previous dog was a working dog - she was certified with the RCMP for Search and Rescue, and we would get called for both people and evidence searches. The training that we provided was very thorough, and I know it was far less than what a service dog would get. The training my dog received, and the competencies it was forced to prove in order to maintain certification every year, included being able to handle stressful situations without becoming aggressive. If there are providers who would consider not bringing the service dog along - please please PLEASE contact a local group who handles service dog training, and educate yourself. There is absolutely no reason to leave the dog behind. With regard to safety, most dogs have harnesses that have a seatbelt attachment, and will sit in a vehicle seat and allow themselves to be seatbelted in place (this was the only way my working dog travelled). As for the next patient being allergic to dogs.... that service dog is far cleaner than a lot of the patients we take... at least that dog won't have fleas or lice, and has been bathed more often than many of our patients. Clean your rig after, and you won't have any problems.

I agree with others - what about insurance? And, not knowing this area, I googled it a bit... Although Wikipedia isn't the most reliable source, it shows some statistics.. Population of just under 4700, with a median income of just over $78,000. It also states that this is one of the few volly departments left in NYC. Why is that? Given the income levels, I think that the area could support a paid service, or at least finance the new vehicle needed. Working with that 4700 population number, if every home donated $20 for every man, woman, and child in the home, most of the funds would be raised. That isn't a lot of money, given the median income for the area. PR and educating your community to the fact that they need your services and they won't have them if you can't get the financial support required is a major issue. Consider all the options, including possibly leaving the volly scene behind, and going paid, to get access to other funding. Remember - they pay for garbage pickup, street cleaning, and other municipal services. Educate your community - let them know that you are an essential service that they won't have if you don't get the money you need.

We have a specific protocol for firefigthter assessment at scenes. I have tried to attach the protocol as a gif file, but if you can't open it, let me know, and I can email it to you. The biggest problems I have had with this protocol aren't with the protocol itself, but with the firefighters.... it is hard to get them to hold still and allow themselves to be assessed, and harder to convince them to take a break when their HR or BP is too high. I agree with other posters that you need to talk to your medical director. And good for you for doing the legwork first! Your MD will be a lot more cooperative when you go to them and say "this is what I want to do, and here is what I think the protocol should look like, and this is why I think it should be like this." Good luck!

We don't have it in the rigs, but it is used a lot in our hospital, to work with specialists at other hospitals when it isn't efficient or in the patient's best interest to be transported 3 hours (one way) for a consult or followup. I am curious - how do the Baton Rouge medics like it? Do they use it often? I would like to hear some success stories about it.

There have been some great posts from others on this thread… good to see the positive contributions! Just a couple days before this thread appeared, one of the medics I work the same rotation with regularly referred to his partner as “my work wife.” We all laughed about it, but then discussed it in more detail. Working 12 hour shifts on a 4 on, 4 off rotation, especially if your spouse works a regular 8 – 5 job, means that you spend more time with your work partner than you do with your spouse/girlfriend/boyfriend. This can cause stress at home, especially if your work partner and you get along very well. I’m not talking you and your partner getting along well in that you have an intimate relationship, but you know how there are some people you work with where it just clicks – they know what you need, and what the patient needs, and you just seem to work calls smoothly, and get along in between calls too. Do you come home to your significant other and spend time telling them about your day, and every sentence starts with “my partner….” Even if unintentional, this can make your significant other feel like someone else is taking their place. Like many other jobs, EMS takes a lot of effort, and even during time away from work, many spend that time reading the latest journals, keeping up on their CEU’s, and heading to the gym. Is time with your fiancé coming in second to these other things? Others have said – make sure that you schedule specific times where you spend time with her. When you are off the clock, your home life should come first. For those that are passionate about EMS, this can be difficult, as loving the work you do can be so consuming. Remember…. You don’t live to work, you work to live…. Appreciate the time that you have away from work, and appreciate the time you have with her. …. In the long run, that is the important part of life – the time you spend with those you love. I am glad to see that you have gone to counselling – keep it up! Having an outside person who can look at both of your opinions and concerns objectively is a huge help, and the fact that you are willing to take that step is a good sign that you want your relationship to work. All the best to you!

Unfortunately, in my region, we have different protocols depending on the area you are in in the region. This is due to a couple of cowboy medics completely f***ing up some attempted intubations, so medics have to call OLMC for the ok to tube. In those areas, until we can recover from the stupidity of a couple people and renew the medical director's faith in the medics, the blind insertion airway is first choice.

Dang - I didn't get into this discussion quick enough to offer initial interventions, but I agree with those above - Is OPA and bagging maintaining the airway? If not, do we carry LMA, King LT, or Combitube? If those airways aren't available, and OPA isn't enough, intubation to maintain airway is indicated. Were we able to get a large bore line in and bolus fluids to try to bring BP up? Once glucagon and Atropine are administered, do we see any improvement? I want a second crew to respond, as my partner is busy bagging this patient, and I won't be lifting him by myself. I am curious - the call to the wife was 4 hours ago.... so she waited 4 hours before calling EMS? Was she hoping he would be successful? And, she doesn't feel this is important enough to leave work to come home? I can see if she works far enough away that she can't, but she could offer more information on history if she is still available to be contacted.

As some of you are aware, I am just starting my first practicum of the paramedic program I am in. The purpose of this practicum is to start thinking like a medic, not an EMT, and become proficient in assessment, history-taking, and differential diagnosis, learning to integrate paramedic skills and scope of practice. I had a call the other night, and I would like some opinions on it. I hope I can explain it well enough. We were called to an 85yo male, complaining of abdominal pain causing shortness of breath. We arrive on scene, and he is in his recliner, alert and oriented, no obvious distress, good skin color. Note he has a urinaery catheter bag at his feet, and tube coming from under his bathrobe. (also note a good collection of Playboy and Penthouse magazines under the end table next to him - good on ya, old guy!). Guy is deaf as a stone, so I have to yell (even though both his hearing aids are in) to get any information. He is complaining of abdoninal pain he describes as pressure, like gas "if I could just fart, I would feel better" kind of discomfort. He says that it feels like it is pushing upwards, and that makes him short of breath, especially when he lays down. He says this started 2 days ago, and was bad the night before, and he considered calling 911, but hoped it would just go away. On assessment: HEENT: skin pink, warm, dry, pupils ERL, patient does not appear dehydrated Neck: no JVD noted Chest: note bruising common to elderly, especially those on warfarin, no sternal scar, no medication patches. Denies chest pain or discomfort. Lung sounds have fine crackles in all lobes, and patient says he had pneumonia 2 months earlier, and still gets a bit of a cough Abdomen: distended, quite rigid, no bowel sounds noted (am thinking possible bowel obstruction at this point). Patient says discomfort is across entire abdomen, but at one point, when asked to point to the pain, he points to just above umbilicus. No pulsating masses.. Pelvis: urinary catheter, urine in collection bag is dark, like tea, about 200mL. Patient stated he had had a BM earlier in the day, but smaller than usual, no diarrhea or pain during BM. Legs: significant pedal edema, pitting, bruises, difficult to find pedal pulses, good motor function and sensation Arms: strong radial pulses, movement, and sensation, same type of bruises as on legs and chest Back: unremarkable Initial Vitals: HR 60, strong, irregular (patient states irregular HR is normal for him) BP 170/100 resps 22 SpO2 95% on room air Temp: 36.5C BGL: 5.8mmol Hx: No known allergies Meds: metoprolol, nitro patch (only wears for 8 hrs/day), lasix, flomax, diazepam, warfarin, prednisone MI 3 years ago, had 3 stents put in prostate cancer - hence the urinary cath denies CVA, diabetes, HTN, any other medical issues eating normally, no decreased level of consciousness, can recall all events Because of the SOB, and at one point when I was trying to get information, he pointed above his umbilicus, I ran a 3 lead.... Rate was irregular, between 60 - 130, with several PVC`s (4 -5 per minute). I did a 12 lead, which showed elevation in V2, V3, V4 and depression in V5 and V6. So, I showed it to my preceptor, and say my gut tells me this is an old cardiac issue, not acute, and that we are still dealing with a GI issue, not a cardiac issue, but I want her opinion on it. She looks at it, shows it to the other medic, and we discuss back and forth for a minute.... my argument is that he is pink, warm, dry, good SpO2, no cardiac complaints except the SOB, and is it possible that the 12 lead could be showing prior injury, not acute onset? But, I question my preceptor - should we be treating the cardiac findings as well, with ASA and nitro? I don't want to treat based on monitor findings only, when his symptoms appear non-cardiac.... They agree, and we transmit the 12 lead to the hospital (gotta love bluetooth technology) and call the ER doc. He says give ASA and nitro, and treat as cardiac until we get to hospital. So, we draw blood tubes, give the ASA and nitro, continue O2 via nasal cannula, continue monitor, and transport.... There was no change in patient condition, so I still think it was GI, but we never got back to the hospital so I could follow up.... It was good to see that my preceptors were as stumped as I was..... I was completely convinced it was a total GI issue, until I got the 12 lead.... but then when I saw the ST elevation, then I thought "Whoa, do we have more going on here?" And yet the only cardiac symptoms were the shortness of breath, and irregular heartbeat, neither of which were acute onset. The one ER nurse said she remembered him from a prior visit, where he had the same symptoms, and he was admitted, given doses of Lasix, and returned home within a couple days. So….. my questions are: - is it possible for a 12 lead to have ST elevation or depression that is from prior damage, not acute onset? - Would you have treated as a cardiac patient, or a GI patient, and why? I am hoping to be able to follow up on this guy my next tour – the ER docs where I work are pretty good about discussing cases so you can learn from them.

I am in the same program, just a year ahead of Neesie. Many programs do require A&P as a prerequisite. This program does not, but it is also a longer term program to allow for that. The program offered by this college is one of the toughest in this province, mostly because the didactic portion is done on line and distance learning, and you spend several weeks on campus every few months to do labs and skills work. There is a great deal of self-notivation required. Before anyone hacks this program to bits, part of the reason I chose it was because it fit into my schedule, and partly because it has an incredibly good pass rate with the provincial registry exam, which a number of the other colleges do not. Now, that being said, I can relate to Neesie on this one... A&P is difficult, and it is the foundation that a number of other courses depends on. Knowing how cells work, and then being able to explain how a drug enters or affects a cell is hugely important. If only I haad known how important acid-base balance was when I took university chem a hundred years ago, I would have paid more attention! Neesie, some things I did to assist me through the course were: - I bought the Anatomy and Physiology coloring book, and worked on the pages of areas that I was struggling with - I also subscribed to a site called audible.com, and downloaded the audio version of the A&P text. The downloaded version is like a Coles notes (or Cliffs notes, for those of you in the US), where each chapter is summarized into a short version, and then there are review questions.... I downloaded it to my iPod and every time I was in my car, I listened to it. That was a huge help to me, as wading through hundreds of pages in the text overwhelmed me sometimes. - there is a website called www.purposegames.com. If you go to that site, and search "anatomy" a number of simple quizzes come up... from "name the skeletal bones" to "name the bones of the skull" to "name the parts of the brain" to "put together the parts of the kidney".... it seems mindless, but it is a nice change from just reading, and is just a different way of testing your knowledge. You can do it! Annie

Finish your degree! You may feel now like it is 2 years that won't do you much good towards your career choice, but that just isn't true. Having your degree will open more doors, both in EMS, and elsewhere. Having a degree means you have more education, and are more marketable, when compared to the person who has their EMS education only. Having a degree is a prerequisite for a number of management positions, so years from now, when you decide your back has had enough of lifting patients, you will already have the degree, while others that you are working with are trying to get a degree while working so they can get into a management position. Having a degree makes you more appealing to colleges as an EMS instructor, or to instruct entry level science courses. Some colleges require a minimum of a Masters, but a number still are happy with a Bachelors for teaching entry level stuff. Keep your options open - and having a degree means more options! Wish you all the best!

Well, not being a US citizen, I read this with some interest. I agree with thrutheashes, who said that the general nature of politicians is similar everywhere, and it is not just US politicians who line their own pockets first and spend without making a difference to their citrizens. I think what NYCEMS9115 was trying to say is that everyone is responsible for their own success, and we can’t blame everything on the government. I think government corruption is alive and well in most countries. How many times do we hear that there is no funding for something that would benefit a large group of people, and yet there always seems to be funding for travel expenses, meetings in exotic places, extensive benefits, and retirement and severance packages for politicians? I am amazed and appalled at crotchity’s comments (why do I continue to be surprised at the dreck this person spews?) Thank God for the current government for saving the US from a depression? Really? US unemployment rates in 2009 and 2010 are higher than they have been since 1983 (US Department of Labor www.dol.gov) The only reasons the current economic situation in the US is not called a “Depression” is because that word brings back reminders of the 1930’s and people would prefer to think that things are not that bad. Although the financial situation is not as dire as the 1930’s, the US, and world economy is indeed in a depression, where there has been a longterm downturn of economic activity. Many economists consider the last 4 years to be the worst economic crisis since the 1930’s. This "recession" is a culmination of decades of poor management and policy-making by government, big business, and financial institutions. The current state of affairs did not come about because of the last 4 or 8 years of US goverment - this has been building for a long time. One of the largest failures of our time, is that we have not held current generations accountable for their actions. The mentality of “the government will provide” is so alive and well, and that is part of the drain of funds. Whether it is the stereotypical white trash or black ghetto neighborhoods, there are so many people that expect the government to care for their basic needs, rather than getting off their collective a**es and putting in an honest day’s work to earn their keep. At the same time, education levels are falling, the quality of education is falling, and as individuals, many are depending on the schools to provide what in previous generations was provided at home. Today’s schools are not just a place of learning. They are daycare centres, social services centres, food banks, and safe havens for those with no other place to go, providing the day to day needs that should be provided for at home. Add to that the decreased level of education and training that a teacher in the US needs today compared to some other countries (I will use Canada as my comparison) and no wonder education if failing. In Canada, to be a teacher in a secondary school (kindergarten to Grade 12) you are required to have a minimum of a 4 year Bachelor’s Degree in Education, which includes several practicum components. In the US, having a college diploma in any field is acceptable in many areas. Watering down the educational programs deteriorates an economy as a whole. We all know that in general, more education means higher incomes. Higher incomes means more disposeable spending. More disposeable spending means more demand for products which generates production, which further stimulates the economy. But I digress….. is all this the government’s fault? Mostly, yes. The government has told the average citizen that they will be well cared for in the “best country in the world.” It has become too easy to fall into that lazy “the government will provide” mentality and not take responsibility for one’s own actions. At the same time, the government, being government, has its corrupt decisions, and self-serving policies, which protect those in government, rather than those that they are to serve. The remaining fault lies with those who are too willing to blame everyone else for their problems “I’m not educated, so I can’t get a good job (but I dropped out of school),” “I am discriminated against (since I refuse to see that it is my actions that are preventing me from achieving my goals).” “My business is failing and the government needs to bail me out (even though I was a poor manager and refused to see that my spending was exceeding my income).” Back to Dwayne’s video – yes, funny, but sad too – it summarizes in a nutshell that the government does as much harm as good, and many citizens are doing little to take responsibility for themselves. Sadly, those that are working hard to ensure a good life for themselves are working for more than their own families – they are working to put dollars into a politician’s pocket, and a social assistance abuser’s pocket. That cycle cannot last without complete collapse eventually. Dangit, I forgot to add - if anyone gets video of AK dancing to this, can you please post it here? I would love to see that....

Cougar, I feel your pain. I was lucky to have the opportunity to get into EMS via the volunteer route, and realize that this is where I want to be, but in my many years since then, I have found the same thing that you are. Many volunteers feel that because they are volunteer, they shouldn’t be held to the same standard that paid services are held to. I agree with others, that a training session needs to be completed. You don’t have to beat them over the head to cover the issues you are seeing. Put together some examples of what you have seen without naming providers or patients, and then ask your crew “how would you handle this if it went to court? Could you explain what happened and justify your assessment and treatments?” Remind your members that this is in THEIR best interest, and it covers their a**es if something should ever happen that they end up in court. I work for a paid service in an urban centre, and continue to volunteer when I have time in the rural community where I live. More and more I find it difficult to support the volunteer crew, when I continue to see the mentality of “we don’t get paid, so we don’t have to meet the same standard.” I always come back with “the patient expects a competent provider; they expect someone who can provide the best care possible, not just a ride to the hospital.” I also reinforce that in rural and remote communities, we don’t just have to meet a minimum standard, we have to exceed it, because we have that patient for 30 minutes, 60 minutes, or sometimes more, before we can get that patient to advanced care, where in the city, there is almost always a crew to back you up, and the hospital isn’t that far away. Yes, they are providing a service to their community, but they need to be reminded that they have to provide competent service to their community, which includes good report writing. I think if you can show them that making these positive changes is not just something that is an administrative pain, but is something that will work to their advantage, and to their patient’s, they will be more willing to make the effort. I agree with Dwayne – you may lose the wankers, but really, that isn’t a loss. Those that are committed to quality will step up and improve. Good luck!

OMG mobey - that is incredibly sad, yet funny... I think you could make a Lego youtube video about that. Your sis should talk to her family doc about the treatment she received, and show her doc that pic. That is pathetic.

But Lone...... Firefighters spend their day playing with their own hose.... and cowboys think 8 seconds is a good ride....

I will take a shot at this… Symptomatic tachycardia at rate >250, lethargic, hypotensive….. definite candidate for cardioversion. As only medical hx is the SSRI prescription which matches the anxiety attacks, overdose is a possibility, but we can’t really solve that right now, unless she admits to it, we know time of ingestion, and we have charcoal and gastric lavage in our protocols (and I don’t want to do that in my ambulance – I don’t want to clean that up!). Going with Dwayne’s tx, so far, IV is in, monitor is on, O2 is being administered, we have hx andf vitals, she is still conscious, and I am assuming vagal maneuvers didn’t work…. I would explain to her and her family that I need to shock her heart to attempt to reset it to a normal rate, and I will give her an analgesic (fentanyl) and sedative (Versed) prior to welding her. Given the distance we have to travel, and I agree with others that getting the chopper is not something we want to stay on scene and wait for right now, I wouldn’t stay and play too long, but I would try to cardiovert on scene. Once I have attempted cardioversion, I want to move into differential diagnosis, but I have the feeling Ruff doesn’t want me to do that yet…..

I can see your point on this.... however, to defend my previous post, the book I recommended has a significant portion on cardiac anatomy, review of rhythms, and patient assessment, to ensure the reader has the background knowledge before getting into the algorithms. I too have seen the changes to the new guidelines, and if someone has the basic knowledge, I don't think it will be too confusing to transfer to the new guidelines. We had to make changes 5 years ago (especially instructors) and we will do it again. Most of the new guidelines have been in discussion forums on this site and elsewhere for some time, so none of the changes should be coming as a complete surprise. When I originally took ACLS, my biggest problem with the algorithms was that I was weak in rhythm analysis. Once I was more confident in my analysis, the algorithms were easier.

Ugly, I can see your dilemma. And, as much as I like to see everyone achieve the highest education they can, I can see why you aren't going for your medic. I like that you are still willing to learn more, so you can do more for your patients. And, although a la carte isn't a perfect situation, it is better than nothing. I teach EMR (which is our equivalent to your EMT- and one of the biggest frustrations I have is exactly what you have already stated.... students don't learn WHY we do the interventions we do. Your example of giving a patient oxygen is a perfect example. I think taking a Human Anatomy course is a very good start. If you do end up taking A&P, you may also want to consider purchasing the Anatomy coloring book. Sounds silly, I know, but it is a good learning tool. I don't know what meds your units carry, if any, but you may also want to consider a basic pharmacology class. If you can't access a class, a textbook that is very useful is Dr. Jeffrey Guy's "Pharmacology for the Pre-Hospital Professional." He also has podcasts on iTunes (they are free!) related to the book, but the podcasts make sense even if you don't have the text, so you may want to just listen to a few of those and see what you think before buying the book. Do you do 12 leads on your patients? Maybe consider more education in cardiac dysrhythmias - you may not be able to treat en route, but you may be able to give a clearer picture to the ER staff. There are a lot of good references on line for this. Just a few thoughts....

One book that was a big help to me was: ACLS Study Guide Author: Barbara Aehlert, RN, BSPA Third Edition ISBN 0-323-04695-9 I think it costs about $35 - you might want to check Amazon. It was worth it to me!

Thanks for sharing that video, croaker. What an excellent reminder of who the true heros are, and how much we can learn from the courage of those kids. That is a powerful video. Thanks again.. Annie

A young engineer who graduated with distinction, was leaving the office at 3.45 p.m. when he found the Acting CEO standing in front of a shredder with a piece of paper in his hand. "Listen," said the Acting CEO, "this is a very sensitive and important document, and my secretary is not here. Can you make this thing work?" "Certainly," said the young engineer. He turned the machine on, inserted the paper, and pressed the start button. "Excellent, excellent!" said the Acting CEO as his paper disappeared inside the machine, "I just need one copy." Lesson: Never, ever assume that your boss knows what he's doing.

I was sent this link from someone more nerdy than I, and thought it was pretty cool. The Merging World – a 4 minute presentation on life expectancy and wealth of 200 countries in 200 years…. Statistics for the inner geek in some of us… http://www.flixxy.com/200-countries-200-years-4-minutes.htm It is kinda neat to see it in animation, showing the changes in life expectancy and incomes. What is just as amazing, and scary and sad, is how some countries have hardly moved on that grid in those 200 years. I’m a geek, so I wanted to share this….

First, thank you Wendy, for reporting this post.... I would have done so if I had seen it before you. I would like to direct a few comments to emtpociets... You have been on this site for a very few days, and have shown yourself to be completely narrow-minded and uneducable. You have posted here and in other threads, based on opinion only, with no evidence to support your claims. As most here, I don't have a problem being involved in a heated discussion or debate, but your posts do nothing to encourage intelligent debate. Rather, they just show that you have no interest in expanding your knowledge or education, nor researching your current opinions to see if they are valid. As a medical "professional," as your profils says you are an EMT, you should be ashamed of yourself, as you appear to have absolutely no interest in expanding your views or improving your education.