Help me cope with sharps

[CBEMT]

OK - the lady was in a lot of pain. She had been sent to a facility for treatment of the abscess but nothing had been done. I figured at the very least we could get some pain relief into her.

Ok, because you don't mention that in your earlier post about how the call went. In a three minute transport where you gave the pre-arrival report in the parking lot, I can only assume that you did not, in fact, provide the pain relief.

I'm not trying to be argumentative, but I will stand by the opinion that if you didn't give her anything, she didn't need an IV pre-hospital. Like I said- once you decide to start IVs based on what the patient needs before they get to the hospital, you'll drastically reduce the chances of a sharps error.

I just don't see the point in starting a lock for the hospital to use "for bloods and meds," because they won't. At BEST they'll use it for the meds AFTER they stick the patient again for bloods. Why not hold off on the stick in the truck, and save the patient some of the pain that you want to alleviate in the first place- let the hospital start the IV, draw their bloods, and use that access for medications UNLESS a significant reason to have established pre-hospital access exists. The fact that you want the patient to receive pain management after transport isn't one of them, IMHO.

[Kaisu]

Don't get me wrong CBEMT - It was a very good point. My confidence is so shaken by the stuff that has been happening here that I am trying to keep my head down and avoid any and all flack until I have my sea legs. To me, that means doing things THEIR way until I get out from under a microscope. The point you make is valid and demonstrates paramedicine at the highest level. What I really need is a service that will let me run with preceptors (good ones) until I gain the confidence to say "F--- you - this is best for my patient not for the recovery of costs". That puts things on a whole other level.

[AnthonyM83]

In some systems I've seen any sharp (retractable or not) treated like a bomb or those little green spheres of toxic gas from "The Rock". As soon as one removes the needle from patient, it's put into the sharps container. If there's ANY delay, even if you have to walk a single step or even turn around to the container, one yells "sharp out" and holds it up.

Nothing else happens until the sharp is disposed of. NOTHING. You don't take the tourniquet off, you don't control bleeding, you don't connect the IV tubing or lock. I guess what I'm suggesting is psychologically make it a colossal deal for yourself. The anxiety from it might force you to re-learn a habit that took you months to acquire...create an anxiety/fear response to prevent you from doing it.

Also, like Dust said, adding it into your IV procedure is a good idea. I can space out from time to time and forget things like giving dispatch mileage over the radio upon arrival at hospital...so I had to make a list. Turn off lights, use radio, turn off engine, grab gloves, open door. If one of the four is missing, I know I've forgotten something and won't open the door to get out.

[Arizonaffcep]

The employer does NOT use the retractables... This is Arizona Dust - I have no 12 lead, no CPAP, the only med for pain is morphine (if my patient is allergic then he/she is sool) - no drugs for N and V, the cheapest possible catheters, and supervisors think they are being generous because they will allow me to use a portable sharps shuttle to help lick this sharps problem. I am the only one that uses a NS lock, both paramedics and EMTs are convinced that because I did not run a year as a basic that I cannot possibly be ready for the field... the list goes on and on... Its a tough gig and a big adjustment for me.

where and who do you work for?

[Arizonaffcep]

Oh yeah... if you don't get the IV in, you are reprimanded for poor time management to the extent that I have been told that if the transport time is short I need to get the IV BEFORE we leave the scene. :shock: ( IV automatically ups the transfer from BLS to ALS.)

That's crap. I've never seen the "life-saving" IV before. Who told you that? If you're a 1/2 mile from the ED and there are other priorities...then tough. Those folks in the ED know how to start an IV. Sorry, not irritated at you...just that stupid mindset about wasting time o/s to get an IV. Now...if you need it for something like RSI or what not, then that's a different story. But then again IF you are 1/2 a mile from a trauma center/hospital, then who cares about RSI anyway. Just get them there. Suction the airway...BVM and/or dual lumen airway (way underused in MHO).

[CBEMT]

Don't get me wrong CBEMT - It was a very good point. My confidence is so shaken by the stuff that has been happening here that I am trying to keep my head down and avoid any and all flack until I have my sea legs. To me, that means doing things THEIR way until I get out from under a microscope. The point you make is valid and demonstrates paramedicine at the highest level. What I really need is a service that will let me run with preceptors (good ones) until I gain the confidence to say "F--- you - this is best for my patient not for the recovery of costs". That puts things on a whole other level.

Ok, that I understand totally. It sucks big hairy smelly ones, but I get it. I should have realized your position (rock/kaisu/bigger rock) earlier. Mea culpa. Good luck.