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Three days ago I had my first clinical experience. The first patient of the day was a transfer to a nearby hospital. I didnt learn anything from it except I hate transfers. We were just pulling back into the ambulance station and we got dispatched to a house fire. You could hear in the 911 operators voice that it was no joke. Turns out, there was a 4 year old boy in the house. We got there and the smoke was just pouring out of the windows and even standing 40 feet away it was very hot. We didn't know that there was a child in the house until a firefighter started frantically yelling for a medic as he emerged from the flames. The paramedics I was with grabbed the boy and took off running for the ambulance. They were joined by two other medics and the boy was rushed to the hospital. He was in PEA and one medic administered cpr while another was giving him Epi via IO and another medic suctioned his airway and intimated him. There was nothing for me to do except grab things from bags and cabinets when they were needed. When he got to the ER I couldn't really understand what was going on. Everyone was gathered around him talking over each other. When he went 7 more minutes without a pulse they called it. Not a single person in that room left with dry eyes. I walked out to see both of the paramedics I was with crying. My mom (a nurse in the ER) looked at me from across the room, and I just broke down. I'm having a really hard time dealing with this. I can't stop thinking about him, his family, the paramedics I was with. I've been trying to spend time with family and friends to take my mind off it but it's so hard. I'm not sleeping well and I've completely lost my appetite. I'm only really eat so my parents don't worry. It's so hard for me because everyone in my life is just going about business as usuall and I'm sitting here feeling like this and I just don't know how to deal. Does it ever get better? Or will I always have him in the back of my mind? I'm supposed to start a fire recruit program in a few weeks but I'm starting to question if I'm cut out for EMS. I handled the situation well while it was happening. And one paramedic said that they were impressed with how cool and collected I was especially considering it was my first patient. I don't feel so cool and collected anymore.
How does your agency deal with the topic of safely transporting children (5-99lbs) in your ambulances? Do you have policies in place (share them)? Do you do training over equipment for this purpose? Do you even think about it?
Hello folks I wanted to start a discussion about ambulance safety, specifically about transporting pediatric patients in ambulances. This should be a safe space for EMS workers to discuss this topic and be free to admit what you do not know. I have learned so much in the past 3 years on the topic, from US ambulance operations to similar issues in other countries. I have access to the top experts on the subject from NIOSH, NHTSA, Pediatrics researchers and professors, equipment manufacturers like Ferno, Quantum, and IMMI. Lets talk! I will start with something I didn't know, that I know now. 1. There is no "standard" in the United States that measures whether or not a product designed to restrain a child in an ambulance actually works as intended. The only thing close is FMVSS-213 which sets requirements for car seats in passenger vehicles.... which does NOT include ambulances. This means that no device on your ambulance has ever been scientifically proven to reduce death and disability in a similar way to how car seats have been tested.... scary huh? I attached some guidance from NASEMSO on the topic (I was one of the authors). Safe Transport of Children by EMS- Interim Guidance 3-8-17 final.pdf
This is gonna be a little different than a normal scenario, as I do not have the final diagnosis. I just thought this was an interesting case, and it was fun going through the differential diagnosis. A 16y/o 155lb male was shoveling a bin of old oats at 1400hrs. There was some mould in the bin, as well as rats/mice. He was not wearing a mask. At 1800hrs he had sudden onset pleuritis and SOB. His mother gave him an advil (500mg) and told him to lay down. At 1830 the pleuritis became worse (9/10) and he was notably tachypneic due to splinting his breathing. He was quite lethargic and generally weak. His mother brought him to the ER: HR: 140 BP 90/42 Temp 39.8 RR 36 Sp02 98% room air Skin diaphoretic & flushed A&O X4 9/10 chest pain midsternal nonradiating pleuritic in nature. Auscltation= quiet on the left, but clear. Right apex clear but some crackles noted in the base. Overall, very hard to hear bases as patient will not take full breaths. Pt was given 1G Tylenol, and fever was gone within 30min. A 500ml bolus was administered and vitals changed to: HR 110 BP 100/44 Temp 36.4 RR 36 Sp02 98% What would you do for this patient? What kind of hospital would be most approprate? Differential Diagnosis?