JonathanGennick

When you say "patient assessments", do you meant that you have trouble remembering to get a SAMPLE history, and to ask the OPQRST questions? I carry a small notepad with me when I'm on duty. On the inside covers of that pad, I write details such as pediatric vital-sign ranges that I haven't yet committed to memory. You might be able to do the same sort of thing.

I remember my first few MVAs. First was an older-middle-aged lady who was "tunked" in a parking lot by an SUV that was backing out of a parking spot. I rode third on that call, and I almost think it doesn't count. For my next MVA, I was the EMT in charge. My partner was a first-responder (far more experienced than I, but lower certification). I was scared to death riding out to that call. And then when we get there, wow! The book did not prepare me for what I saw. All the patients were up and walking about, and chatting on their cell phones. You'd have thought it was a Sunday picnic in the park :-). I was pretty nervous, and probably had that deer-in-the-headlights look when I first hopped out of the rig when we got on scene. That was the call that really drove home to me the importance of running the call, and not letting the call run you. When you're in charge, it's important to actually take charge. That was a lesson-learned, and I've gotten my act together since. I look back on that call as a bellweather call just because of how much it helped me grow as an EMT.

Thanks, but I only deserve a sliver of the credit. I give a lot of credit to that ten-year-old girl, who had the presence of mind to crawl out of the wreck and walk barefoot through the snow (it was less that 12 degrees out that night) to a nearby house to get help. Otherwise, who knows how long it would've been before another car came by. That road is not really busy even in daytime, much less at night. Then, one of our most experienced EMTs, a specialist of 20+ years experience, and also an instructor, was called out. He got on scene before the rigs did. Let me tell you, I was *real* happy when he got in the back of the rig with me with that one patient having airway troubles. If I made any difference, it's because he was there taking the lead on patient-care. My partner helped with the extrication and then drove us safely in to the hospital. (Roads were slick and hadn't been plowed yet). Then my partner helped in the E/R -- she's in paramedic training, and she's been doing her clinical time at that hospital. Oh, and give credit too, to the two e/r doctors and the nurses and everyone else at the hospital. They had to kick it into high gear pretty darn fast. Things are usually pretty slow at our hospital. And lots of other people were out there on scene helping with extrication and scene control. I eventually lose track of who all did what, but there were no snafus, and everything came off like clockwork. That might be the best part. We all worked together to make all the right things happen.

Careful what you wish for. Being a boss ain't so easy. I used to work for a computer consulting firm. My goal was to get into project management. One day my dream came true and they made me a manager. Oh, my, but did that suck. Managing people is non-trivial, and I seem to be a better doer than manager. After awhile, I managed to work myself into the position of still being a manager, but with no one under me. That was the best thing. I had a nice title that impressed clients when I went out to see them. And it was a helpful title to have, because often I had to interact with various levels of client-management who were non-technical themselves. The best thing was though, that I really didn't have to manage anyone. Actually, I would often coordinate various activities, but to coordinate a bunch of people who are self-managing is not really the same thing as to be their boss. A manager of no one. That's what I was :-). And I liked it! Politics is everywhere too. Inescapable. Good attitude is the solution. Stay focused on the job to be done (or on the patient to be helped). Bottom line though, and despite all I've just said, if you have a new job that you're excited about, then that's a good thing. That's a really good thing. Go for it.

MedicNorth, believe it or not, your exception just happened to me this Monday night. Very bad car wreck that thankfully came right about at shift-change, so we could field two crews straight-away. Three patients though, and us two crews had our hands full with two who were critical. Turned out that the wreck was just a short walk from someone whom I'd gone to Basic class with. She hasn't been running calls much since class, but she came down and stayed with the non-critical patient, a 10-year-old girl. My partner and I had to make two runs to the hospital that night to get all the patients brought in. My classmate (who is licensed, btw) rode in the back with me to help care for the girl. It might have been a moral support sort of thing, but I really appreciated a second person in the back with me that night. She did help w/care too, and between the two of us we got things done faster than had I been alone, and we got that girl brought in. Then my classmate spent the next almost two hours standing next to the girl, comforting her, while she was treated on the cot in the hallway, because the ER was full--and in seeming chaos--with the two critical patients. Now I was there with the girl too, but my classmate is a very motherly lady, and I am sure she was far more comforting to that little girl than I could have been. She did great, and I was happy for the help. Could we have gotten by without this EMT who came walking down the street? Sure. There were plenty of deputies on scene who were MFRs and EMTs themselves. But it was good to have this lady along, and I know she was a great comfort to that little girl. Having said all the above, I live in a very rural area with a low population, and most of us EMTs all know each other. We've either gone through class together, or we've taken other trainings together, or we run together. We tend to become a fairly tight-knit group. So it's not like this lady that helped us out was a random stranger or anything. My partner and I had gone to class with her. Anyway, this has been an interesting discussion, and I just wanted to throw out one example where having someone step in to help turned out to be a good thing. P.S. Want to know one of the best parts about that call? My first patient that night was the girl's father. I didn't know it at the time, but found out the next day when I read the account in the paper. We did battle to keep his airway open all the way in to the hospital. It was touch-and-go. We got him there though, by golly. He survived. And so did his daughter. And that's a wonderful outcome.

Nokian makes great, studded bicycle tires too. I bought a set for my mountain-bike this winter. I've been having great fun w/them. I do get a lot of "looks" when I'm out riding about town, but I don't care. Anything that gets me outdoors and active is a good thing. They hook up very well on glare ice and on hard-packed snow.

20. I remember directly encountering 20 of the listed items. Oh my. I've grown old :-). When did that happen?

(JPINFV, the ellipses (...) show where I've elided some of your post that I'm quoting. Just FYI on that.) Amen! I couldn't agree w/you more. I'll only add that I wouldn't limit what you've just said to codes. If there's more than one responder on a call, then one needs to be in charge and the others need to be good followers.

Of course. You're absolutely correct here. We can trust the AHA website. You've motivated me to go look :-). I found an issue of the AHA magazine "Currents" that describes the delta between the old and new guidelines. I've only given the document a quick review so far, but there's enough in there that I'd be reluctant to implement the new guidelines by simply telling everyone in our system to just go read them. The result would probably be a coordination nightmare. I can envision a clusterf--k on scene as we debated whether to go with 30:2 or 15:2 compressions to breaths, whether to give two minutes of CPR before shocking, etc. And that's not to mention that not all would read up on the new guidelines at the same time, and so everyone on scene might be in a different "place" knowledge-wise. The guidelines themselves seem to be presented in an issue of the journal "Circulation" (Vol 112, Issue 24 Supplement; December 13, 2005). There's quite a bit of reading to be done there. Putting on my management hat for a moment, would I expect our group of mostly EMT-Basic volunteers to sort everything out for themselves? I would not. Some training and coordination is needed, because, when the stuff hits the fan, everyone on the team needs to be working from the same playbook, know what to expect from each other, know they can depend on each other. Changing the way that a large group of people operate can be teeth-grindingly difficult :-). I do see the wisdom in planning and then training. (and I'm eager to get on with the training). Hey, JPINFV, at least you've motivated me to get off my butt and download the new guidelines. I've got a nice small pile of bedtime reading now. Thanks for that. I'm still not going to implement the new guidelines unilaterally in my system, but I will read up on them, to get a head-start in preparing.

I'm not sure it's all that simple. Were I a physician, then sure, I could look at the evidence and change my treatment. But I'm not a physician. Rather, I answer to one. Where I am, we've been told to stick with the method that we're certified for until we can schedule a new training session. (And we are planning to schedule training soon) This order comes, I believe, from our medical director. I agree that the CPR changes are fairly simple, but I would not want to ever find myself on the stand in a courtroom trying to explain why I chose to go with a procedure on which I had not been trained, for which I had not been certified, and which I'd been told explicitly not to implement until such time as I became certified. I don't believe that "because I read it on the Internet" would be all that good of a defense. I will say though, I would like to get the traning done so that I can move up to the current best practice. p.s. I'm a basic. Perhaps if I were a medic, I'd feel differently. Seems like what I said above would still apply though.

I'm a very new, volunteer EMT-B. I can't speak from much experience, yet my observation so far is that holding the proverbial hand is a large part of what the profession is all about. A recent call of mine was to transport an 80ish-year-old heart patient from one hospital to another that could provide better care. Patient had been given Lasix at the source hospital. During the 40-some-minute transport to the other hospital, patient developed the strong urge to urinate. My job was to help this man urinate into a bottle, and, when he missed and went all over the floor instead, to cheerfully reassure him that it was perfectly fine to go on the floor, and that we had lots of towels to clean up with. To work in the ambulance, I think it helps to see "holding the bottle" and cleaning up afterwards as a valuable service to your fellow man. Does your brother want a career in EMS? Are there any practicing EMTs whom he could talk to, to find out what the career path is like in South Africa where you're at, what sort of education is needed?

LOL! I had actually thought about skis. They'd take to long too mess with though, and I'd look silly sking down the alley towards the courthouse complex. Probably I'll just jog the two blocks in winter. I will note though, that there is a Finnish company named Suomi that makes some wicked-cool studded mountain-bike tires for use in snow and mud. Here's a link: http://www.suomityres.fi/bike/winter/index.html I was so tempted to pick up a pair of those last fall. Maybe this year.

I live two blocks from the ambulance garage. When I get paged out, I hop into my 2003 Specialized Expedition SE and race to the station! I usually just have to peddle for a bit to get started. Then it's a downhill coast the rest of the way. The hard work is in peddling back home, uphill. Here's a link to my ride: http://specialized.com/bc/SBCBkModel.jsp?a...3&spid=5874 When I'm feeling especially brave, I'll shortcut across about 10 feet of county courthouse lawn :-). I do always wear a helmet, btw. It's red with white striping. I used to have gloves, but my neighborkid borrowed them for a mountain-biking class and never gave them back. Not sure yet what I'll do when winter hits.