Treating patients: "By the book"

[Cookie]

Whats a cookbook

Protocols, or steps are to me a basic outline, or framework to follow, they give you the gist of what you need to do, the rest is up to you and how well you perceive your patients problems and how well you treat your patients problems.

In any case the above responses have pretty well covered your questions. You will, as you gain education and experience, be able to see the difference in every partner you have. Never stop learning, and never stop asking questions or seeking answers.

[1EMT-P]

Protocols are like maps they are there to help guide your decision making, but keep in mind that there are always alternative routes that you can take.

PS: As a new EMT, I would encourage you to find an experienced EMT mentor to help you learn the ropes.

[tskstorm]

Something not as safe as what is suggested here, if you feel your partner is skipping important steps and offers no explanation, ask a nurse, doctor, or even your supervisor.

Never feel embarrassed or out of place for being a advocate for your patient. If your partner is doing an incorrect thing, you will have to pay the price as much as he does, unless you speak up, and ask questions. Never blindly follow anyone!

I'm not telling you to be a snitch, always discuss things with your partner first and most likely there will be an explanation.

[whit72]

I would repeat that steps are not being skipped with experienced provider, they are just not being addressed as they were learned. There is class room application and there is real world application of said steps.

The EMT is taught to detect a pt is short of breath, not necessarily why. Education and experience will hep you determine why they are short of breath. Is it COPD, CHF, pneumonia, asthma. Being capable of performing a competent assessment of both pt and surroundings will help you narrow down the possibilities. Can you make a definitive judgment? Sometimes, other times you cant. Will that change your treatments at the BLS level. If you administer medications it will.

I have seen just as many ALS providers flash a pt, because they cant adequately asses a difficulty breathing pt as BLS providers. Actually the fact that the EMT cant treat the pulmonary edema they are usually a little more leary about giving the treatment. Albuterol can be dangerous in the hands of anyone who cant effectivly asses a pt.

I had a call to assist a pb transfer truck with directions to the hospital. They had picked a non emergent pt from a nursing home, being transfered for an eval of pneumonia.

We arrive to find a parked ambulance with both attendants in the back, with approximately 85 yof in acute distress, ancillary muscle use on a NRB at 15 liters, spo2 of 78%. Medic states he administered two breathing txs to pt. with no relief. I immediately call for an ALS intercept, lungs sounds are bilateral rales to the apecies. I note a 1000 bag half full, running wide open. I ask how much lasix does the pt take daily, I turn the bag off, take pts vitals, they are 192/70 hr 136 resp of 36. I state it isn't pneumonia its CHF. He states she had a temp orally of 99.1 I state thats not considered febrile. I lay the pt down drop an NPA and begin to assist ventilations. ALS arrives administers their treatments. We clear up

I am not sure if she was treated with lasix or morphine, I believe she got nitro spray before I left. On arrival at the hospital the pt has a spo2 of 94% on 4 liter nasal cannula, is responsive, and lungs are clear bilateral. She avoids the tube and probable death in ICU.

The intercepting medic asks the medic if he would like some remediation and offers him some ride time. The medic pleasantly declines and walks off into the sunset to save another life. The EMT is useless, and cant stay off his cell phone, long enough for me to figure out what the pts condition was before they transported. Keeps telling me to hold on a second. If I hadn't just finished anger management classes that finger would have been broken off and shoved up his ass along with his cell phone, and probably the end of my foot.

These two were dangerous because they had know Idea what they were doing and had know idea they had know idea. This call began as a fairly easily manageable. It turned into cluster f@#k, because a couple retards, couldnt adequately assess the needs of their pt. and almost sealed someones fate.

If your going to do this job make sure you have the information, education and experience to competently handle it.

[Just Plain Ruff]

Whit I think this saying that an old doctor once told me would fit the two yahoo's that you met

When you really don't know that you really don't know, Then you really don't know.

He also told me about marriage (after 5 failed attempts on his end) "Michael, Marriage is a fine institution, it all depends on what kind of institution you want to live in. "

[whit72]

Ruff wrote:

"Michael, Marriage is a fine institution, it all depends on what kind of institution you want to live in. "

I will have to remember that one as my D day is fast approaching

[Richard B the EMT]

Almost sounds like someone is being institutionalized.

[ERDoc]

This whole "by the book thing reminds me of a noob back in my EMS days." She was a fresh EMT (card was still wet) who took the class through the local community college and joined the vollies after the class. She had been riding for about 2 weeks when we get a maternity call. As we jump in the ambulance she starts freaking out saying that we need to get a textbook so that we do it right. It was a good laugh. This was the same girl that when we told her to jump on the bottom rail of the strecher and continue CPR as we wheel the pt into the ER decides to jump all the way up on the strecher, straddle this dead 80 y/o 350lb guy and continue CPR. You should have seen the ER staffs faces. Priceless. Yes Dust, she was hot.

[Dustdevil]

Yes Dust, she was hot.

Eager, hott n00bs is actually one legitimate reason for keeping EMTs around in EMS.

I have seen just as many ALS providers flash a pt, because they cant adequately asses a difficulty breathing pt as BLS providers.

I'm guessing this is a system where the medics are allowed to wear skirts? :shock:

I had a call to assist a pb transfer truck with directions to the hospital.

A lead transfer truck? Does the EPA know about this?

[Richard B the EMT]

If this new EMT felt the only way to do proper CPR was to jump all the way up on top of the stretcher, instead of riding the rails, this EMT was simply trying, what at the time seemed the best way for her, to do the task at hand.

I once had a patient fell down the basement stairs, found face down, and head lower on the stairs than the rest of him. I suggested, and we accomplished, after c-collar application, laying the long backboard on top of him, and fastening him to it with the 9 foot straps "underneath" the patient. A fire fighter, under our direction held manual stabilization on him until we were able to flip him, already on the board, to a face up position, use the sandbags (didn't have the "head bed" devices then, kids) for additional stabilization, brought him upstairs, and put him on the wheeled stretcher, and removed to the ambulance.

Is not a part of the job to mitigate extenuating circumstances? I've used rolled newspapers for splinting! Improvise! Overcome!