Arachne

It sounds like an investment in "bee suits" might be worthwhile for your department - y'know, those nets that go over your head, face, etc?

I've always wished that "when to call 911" was part of the health classes or "life skills" classes that are taught in middle and high schools. They taught me how to put a condom on a cucumber, and that alcohol and sex are bad, but they manage to leave out a lot of more useful things, like when to call 911, when to call your primary care doctor, why you should read the directions on OTC drugs, and all those things. (Not to heap more responsibility on schools, but if they're going to take the time to teach health class, why not include more than sex, drugs and alcohol?) The article mentioned this case: "In a Michigan case, EMS responded for a patient who had suffered an acute stroke.(3) The patient's wife requested transport to Spectrum Health in Grand Rapids, but EMS took him to Mecosta County General Hospital instead. After a CT scan, the hospital determined that the stroke was caused by an embolus, but failed to administer thrombolytics and failed to transfer the patient quickly to another hospital. The patient finally arrived at Spectrum after the three-hour window for administration of thrombolytics had elapsed, and he sued for "loss of chance," alleging that the failure of EMS to take him to Spectrum as requested caused him to lose the chance of recovery he might have had if the thrombolytics had been administered. He suffered paralysis and severe neurological damage from the stroke." It would be interesting to know if the lawsuit was only against EMS, or if they also sued the receiving hospital. It seems to me as if the hospital is to blame for delaying appropriate care as well (and would probably be a more lucrative target for the family).

I was always under the impression that they don't care what we wear, because "it's just going to end up on the floor anyways". :angel12:

I'd also like to see more emphasis on professionalism from employers. Who better to insist on it than the people with power over our jobs?

In addition to what's been mentioned already, I've found that addressing the patients' practical concerns can help to gain their cooperation and trust. Elderly people are afraid they won't be able to get home after release from the hospital, or they're afraid they'll be sent to a nursing home. Kids are afraid of needles. Teenagers are afraid that their parents or the police will find out they were drinking/using drugs. Some female assault victims are nervous about transport with a male EMT. People are worried about leaving their pets alone if they don't know how long they'll be in the hospital. It may not always be obvious what they're really afraid of, but if you can figure it out or ask something like, "Is there something else that's concerning you?", it can go a long way in building that rapport with them and getting them to work with you.

As a BLS provider, the only time I'd transport a patient who appeared to be having a stroke* without ALS is if the wait for ALS is longer than the trip to the hospital. All the good reasons to call ALS can happen waiting for them or transporting without them, so I may as well get the patient to the ER. Ideally, we intercept with ALS en-route so that we have -someone- who can take care of seizure or airway compromise or fluid loss as soon as possible. I've also found that most paramedics have no problem when you say, "Her vitals are good, her airway is fine right now, but I'm concerned because of X, Y, and Z". They tend to understand that I am doing what was discussed in earlier posts - I'm calling them for what they might need to do, not necessarily what they need to do right now. As I see it, they're being paid, it's not going to hurt them to ride in with me, and it may benefit the patient. Most areas that I have worked in have enough ALS available that taking one paramedic out of service isn't going to deprive someone else of ALS care. On a different note: We had a "just a headache" call about a year ago that turned out to be more. We were called around 6 am and arrived to find a woman in mid-60s, c/o headache (4/1-->10) on the left side of her head behind her ear. She described intermittent throbbing pain x several days, no radiation. COAx4. No other pain anywhere, no recent trauma, no dizziness, no vomiting, no nausea, no extremity tingling, no balance or coordination problems, no visual disturbances, no memory loss, no mental status change, no confusion, no etOH or recreational drug use. Equal and reactive pupils, equal grip strength, no slurred speech, no signs of trauma. Her only PMH was HTN, only prescriptions were to control the HTN. Vital were within normal limits. She'd recently had her eyeglasses prescription updated. There was absolutely nothing abnormal that she could think of or that I could find, aside from this occasional throbbing pain. She called 911 because she "had a feeling" that she shouldn't wait for her doctor's appointment a few hours later. We transported her BLS, gave the hospital the long list of everything that wasn't wrong, and went on our way. A week later we responded for her again, this time for seizures. She had a 9 inch curve of staples on the size of her head. She'd had a tennis-ball sized tumor removed from her brain two days after we transported her, and hadn't properly followed her post-op directions for taking dilantin. *Or headache with changes in mental status, decreased level of consciousness, "looks like crap" - anything that makes me think seizures or respiratory compromise are a concern.

:::blink, blink:::

Unless you're in nursing or in the military, you'll probably be paying for your education in healthcare. My brother's girlfriend is getting paid over $20,000/year to go to gradute school and learn about genetics, but I'm paying more than that/year to go to graduate school to be a PA. Figures.

I don't have that technology on my phone, so I can'te tell you about battery life... One of my partners has it, and it works fairly well. There's a bit of a lag as the phone sends and recieves signals, so sometimes if there are a lot of roads very close together it has trouble telling you exactly when to turn, but for the most part it's quite useful. If you were walking it would be fine, but becuase you're going a lot faster in an ambulance every so often you have to stop and turn around becuase the street passed between in one of theose "lag" moments. Someone else I work with has a dash-mounted one which is absolutely amazing - unfortunately they're quite expensive and aren't nearly so portable as a cell phone.

I'd rather feel a little stupid for being fooled by a faker than feel like a huge idiot (and possibly hurt someone) by assuming fakery and missing something real... As for the police situation...When we're called for someone who has acute onset of symptoms after being arrested, I just point out to them that I'm glad to take them to the hospital, but that they'll still be under arrest and still have to deal with the police after release from the ER. Quite often, their symptoms magically resolve, and they don't want to go anymore.

I would guess that venous blood, such as one would draw when starting an IV, could have a lower BG than capillary blood because some of the glucose in the blood has been extracted by the cells surrounding the capillary beds. Disclaimer: That's just a guess, I didn't research it.

I didn't miss it, I skipped it. It's been discussed to death. If you'd like to address it, however... 120 hours is minimal, as I'm sure you're finding as you go through paramedic school. You'll probably do more than that in ride time and clinical time. I'd hope, anyways.

I think there's one piece missing from this extensively explored topic, and I'm going to mention it even though I suspect I'm going to have people jumping down my throat... We're not viewed as professionals. I'd like to think that we are, and I like to think that someday we may be, but right now, I don't feel that as an EMT-B anyone considers me to be much beyond an "ambulance driver" or a "dialysis monkey". Even working full-time in a system that uses BLS for 911, this comes up a lot. Being viewed as the absolute bottom of the healthcare food-chain isn't exactly conducive to decent pay. Part of this is the limitations of BLS - we all know what they are and it has been discussed to death, so I'm going to skip that. The other part, I think, is how some of us act in facilities and in people's homes and when out and about in uniform. I do my best to be professional, to be polite and generally to present a clean, competent appearance to my patients and to hospital/facility staff. Not all of my co-workers make the same effort. I have partners who do not know the meaning of "clean shirt", and who do not make use of deodorant. I have partners who make no effort to not bang the stretcher and patient into doorways. I see some other EMTs being rude or indifferent to patients, rude to staff, and some who even take the attitude "Why should I do any interventions, we're just driving them". Some partners don't even consider it necessary to spell words correctly in reports or remove trash from the back of the ambulance between calls. I've even met EMTs who'd rather lower standards than get some extra education to deliver better patient care. Nothing says "we care" like the gauze wrappers from the last patient, mumbled replies, and smelling like a football player after the game. I don't want to generalize, because there are a lot of very good, very professional EMT-Bs out there, but what I've gotten out of working in this field is a general indifference and lack of awareness of the overall image we're projecting. Until we can get our act together and be more professional, I wouldn't expect much respect or the pay scales that come with respected professions.

I don't think you did anything wrong. But even if you had... the way she reacted is completely unprofessional and rude. If you are there as a 3rd rider, she should be teaching and explaining, not yelling at you. I hesitate to judge without having been there, but it sounds like this medic has more problems than oxygen administration. Pardon me if this has been mentioned already, but have you asked her to explain how high flow O2 is a problem for patients on blood-thinners? It would be interesting to see if she has an explanation and how plausible it seems.

It's too bad that "stupidity" is not considered an acceptable chief complaint. It is, after all, the underlying problem for many of our patients. Perhaps "hypoxia p/ near drowning"? "respiratory complications p/ water accident"?

It seems to me as if there are a few different issues here: 1) Should there be a national test and national standards defining what is an EMT-B/I/P and what each can do? 2) Should states be able to not use that national standard/test, such as NC and MA?* 3) How good/valid/useful is the National Registry's test? I've taken NR and the MA state test, and found both to be fairly inadequate at assessing knowledge and ability (And ridiculous - if you're going to make me answer via multiple choice, at least give me enough information in the question to figure out what you're looking for!) 4) How much of making someone a "good" EMT is the job of a test/course, and how much of it is the job of preceptors/ambulance services? *Which are the other non-NR states, anyways?