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Noobs

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Rookie Partner and I have a student, and because it is a female student she is “technically” under the control of RP. Not that I have any fears about RP not being able to do this. She’s smart. She’s good. But she’s sooooo impressionable. If I’m grouchy and want to do something wrong soon after, you’ll see RP doing the same thing! Screwing with drunk people! You bet! Asking dumb questions to obvious fakers…. she all over it. I’m corrupted her….

So what will happen with poor, no idea what in the hell-is-going-on-in-this-truck noob girl gets thrown into the masses? Well, we will see? We’ve given her a week of riding along, doing whatever. But next week the cord is cut. Time to run from mommy and be a medic!

Posted by on April 24, 2012 • Filed under: EMS Dispatch, ems-health-safety, ems-topics, partner, patient-management, Training, training-development

Damn it, Jim!

267 comments

Starting a story with a misquotation is likely a serious faux pas, but alas, I did it. Get over it.

We were called to Jim’s house by a 3rd party. Actually a fourth party. Jim had missed a lot of work so his boss called his next of kin–and estranged daughter–she called a neighbor and between the neighbor and his boss, made the decision to call the ambulance.

I was greeted on the rickety steps by a confused looking gentleman I learned to be Jim’s boss. As I walk past him he tells me Jim had fallen and was on the ground all night. Jim says he’s not hurt. He says he is fine. Every word he speaks is enunciated in booze. The fruity smell of cheap vodka and cheaper beer permeate through his pores. Even the feces he has all over himself smell of sweet, cheap alcohol.

But Jim is adamant that he isn’t hurt. He knows where he is, he knows what day it is, but he just can’t admit that he is hurt. He just can’t admit that he needs help.

See months earlier Jim lost his mother and sister in a week or two. Jim, already an alcoholic took these double crosses and stumbled back to the ropes. He bowed out and lost control. Now the alcohol has control.

See, Jim isn’t fine. You can see the cellulitis has eaten at his legs. He’s not eating. Not bathing. Not doing anything other than getting delivered in cheap booze. Intentional or not, he’s killing himself. He’s of sound, if not sane, mind. He by law, can make decisions for himself. People are allowed to let themselves die here.

But after I’ve spent a considerable amount of time trying to get Jim to go to the hospital today, with me in the ambulance, his family arrives. His estranged daughter, her husband, and the granddaughter he hasn’t seen in a year. I try to “prep” them for what they are going to see. This isn’t going to be the “dad” you’re use to. But she walks right by.

And the crying, and the begging, and fighting begin. PD tells me they have no grounds to hold him. No threat to self or others. See, Jim insists he’s in contact with his lawyer, who is going to take him to the doctor on monday. The problem is, he can’t tell me his lawyers name. If you ask Jim how much he’s been drinking he changes the subject. If you ask Jim to stand(knowing he can’t) he changes the subject again.

Jim wants to stay home and drink another day. I think he knows that if he manages to stay home and drink enough days his body will finally give in to his mind and end this all.

But just because someone thinks they want to die a miserable death doesn’t mean we SHOULD stand idly by. I had walked out, as the city around me is imploding with 911 calls and transfers, I’d given up. Nothing was working. I waked out, got my signatures and was getting into the truck when the daughter came up to me.

“Please help me”. I don’t want him to die here. I don’t want him to die alone”. I try to explain how little there is I can do. I’ll be honest, I don’t expend a great deal of energy trying to get people to go to the hospital. If people say they don’t want or need me, I send them on their way.

But not this time. I’d already spent 50 minutes on scene, a few more won’t hurt. I walked back inside, daughter trailing behind me. We walk past an unopened box of “Omaha Steaks” with a postmark before Christmas. What kind of man leaves a box of meat–tasty meat–on their front stoop?

Inside the front door Jim’s son-in-law and granddaughter are sitting there. Granddaughter is crying. I walked up to Jim and said flatly…. “if you can stand, I will leave you alone forever”. So he tries to stand up. And flails and fails miserably. Sad, but in a way, what everyone needed to see.

I kneeled down to his now low level. Firmly, but compassionately I said…

“Jim, look. Look around this room. These are all people that care about you. Your daughter. Your granddaughter. Your boss. Your neighbor. Even me and my partner. If we didn’t care, the easy way out presented itself 100 times or more. But we didn’t take it. I stuck around. WE all stuck around. Because I’m scared that we’re going to come back tomorrow morning and pick you up in a different way. In a black bag and instead of going to the emergency room we’l have to go to the morgue. I’m terrified that I’ll have to look at this little girl over here and tell her that her grandpa is dead because we couldn’t convince him to go to the hospital to take care of some moderate medical problems. I’m scared that I won’t be able to sleep if I don’t do right by you. You have a chance to go out with some pride. Go out on your own, not be drug out of area against your will or in a body bag. Do this for your pride, if nothing else. Your pride is going to kill you”

and all he said to me:

“Well I don’t wanna hurt your beauty sleep. You need all you can get. Lets go”

And so we went. Quietly and calmly. At first he was defeated, but then the relief swept over him and the fear faded away.

In my longest scene time ever(1 hour, 48 minutes) I actually did something. More than I do on every major trauma or code or stroke I go on.

When the powers that be wanted to talk to me about the scene time delays I told them to read the narrative. I wasn’t going to justify it any other way. I wasn’t going to say sorry. I got a sick person to go to the hospital.

THAT is my job.

Damn it, Jim.

Posted by on April 11, 2012 • Filed under: Crazy Calls, ems-health-safety, ems-topics, fire-rescue-topics, funding-staffing, Good Stuff, patient-management, Psych

Give away!

428 comments

I’ve got a review coming for the statgear stethoscope tape holder. They were generous and send out to extra. If we get to two hundred likes I will finish the review and ship out five of these great gadgets.

Get your friends on board!

Posted by on December 29, 2011 • Filed under: administration-leadership, ems-health-safety, ems-topics, firefighting-operations, Research, Review • Tagged:

Booze in the Nose.

357 comments

of “alcohol on her breath”. I’ve started a lot of charts like this. Seen PD run reports that said the same. I’ve seen it testified to in court….  And it is pretty interesting, in part because you can’t smell alcohol. Sure, you can smell booze–the other crap in the alcoholic beverage. But nope, you can’t smell “alcohol” on someones breath.

 

Smell of alcohol on the breath. There is a very poor correlation between the strength of the smell of alcohol on the breath and the BAC. Pure alcohol has very little smell. It is the metabolism of other substances in alcoholic beverages that produces most of the smell. This explains why a person who drinks large amounts of high-proof vodka (a more pure form of alcohol) may have only a faint smell of alcohol on the breath. On the other hand, a person who drinks a modest amount of beer may have a strong smell of alcohol on the breath.

 

This is hammered on by DUI lawyers, with mixed results:

“I Smelled a Strong Odor of Alcohol on the Suspect’s Breath”

Posted by Lawrence Taylor on June 23rd, 2006

You will never see a DUI case where the officer does not report an odor of alcohol on the suspect’s breath. Never. The officer expects to smell it and it is a psychological fact that we see, hear and smell what we expect to see, hear and smell. In fact, most police DUI reports are formatted for the usual symptoms: there will be a box for “odor of alcohol”, which the officer checks off. There are often three boxes, labelled “strong”, “moderate” and “weak”; there is no box for “none”, so that is not an option for the officer.  The ”strong” box is almost always checked.  Presumably, the stronger the odor of alcohol, the more intoxicated the person arrested.

There is only one problem with this:  alcohol in a beverage has no odor.

Assuming the officer actually does smell an odor on the breath, what he is smelling is not ethyl alcohol but the flavoring in the beverage. And the flavoring can be deceptive as to the strength or amount consumed. Beer and wine, for example, are the least intoxicating drinks but will cause the strongest odor. A much stronger drink, such as scotch, will have a weaker odor. And vodka leaves virtually no odor at all.

Consider a simple experiment. Have a friend drink a can of “near beer” — the stuff that looks, smells and tastes like beer but has no alcohol in it. Then smell his breath. You will smell an “odor of alcohol” — and maybe a strong one.

And, of course, there can be any number of causes of an “odor of alcohol” on a person’s breath: mouth wash, throat spray, cough syrup. Illness, indigestion or simple bad breath has been the cause of more than one officer’s trigger-quick conclusion that the suspect has an “odor of alcohol on his breath”.

The point of all this is that the odor of alcohol has very little relevence in a drunk driving case. It may or may not indicate that the person has consumed alcohol. It has absolutely no evidentiary value on the much more important question of how much the person has consumed — orwhat he had to drink, or when. Depending upon circumstances, a person with a single drink can have a “strong odor of alcohol on his breath”, and an extremely inebriated person can have a “weak” odor. And an experienced and honest DUI officer will readily admit this….if he is ever asked.

Unfortunately, evidence of the odor of alcohol on a person�s breath can have a significant impact on a DUI case. This is because most officers who pull a driver over for some driving irregularity at night are looking for further signs of drunk driving. When the officer approaches the driver’s window and smells alcohol, that confirms his suspicions. Since few can pass the “field sobriety tests”, particularly under the conditons in which they are given, an arrest is likely.

Are there any scientific studies to back up my claim that breath alcohol odor is largely irrelevant yet disproportionately weighted as “evidence” of intoxication?

In 1999, the same scientists whose federally-contracted studies became the basis of the so-called “standardized” battery of field sobriety tests conducted another study on the effectiveness of alcohol odor in detecting intoxication. These researchers used 20 experienced officers working with 14 subjects who were tested at blood-alcohol concentrations (BACs) ranging from zero to .13 percent. Over a four-hour period, the officers smelled the subject’s breath odor under optimal conditions, with the subjects hidden from view.

The conclusions of the study: Odor strength estimates were unrelated to BAC levels. In fact, estimates of BAC levels failed to rise above random guesses. Further, officers were unable to recognize whether the alcohol beverage was beer, wine, bourbon or vodka. According to the scientists, these results demonstrate that even under the best of conditions, breath odor detection is unreliable. Moscowittz, Burns & Furgeson, “Police Officers’ Detection of Breath Odors from Alcohol Ingestion”, 31(3) Accident Analysis and Prevention 175 (May 1999).

 

So the moral of the story is that we need to examine how we chart suspected intoxicated patients. Being highly suspicious of all medical conditions that could cause these symptoms is important too:

http://www.monkeydoit.com/medical-act-drunk.php

DIABETES
Symptoms of diabetes may make a person appear drunk or intoxicated.
A person with diabetes may exhibit abnormal behavior as a result of the many different signs or symptoms associated with the disease. The signs and symptoms listed here only relate to symptoms that mimic drunk or intoxicated behavior. Generally, these are warning signs that a person needs immediate medical attention and should be treated as a medical emergency. Police dealing with suspects often times mistake diabetes for drug or alcohol use during field sobriety exercises. 

Signs & Symptoms of Diabetes
-- The smell of acetone on the person's breath
-- A distinctive fruity odor on the breath (Police Officers often mistake the smell as alcohol during a field sobriety tests)
-- Dizzy, has trouble keeping balance
-- Altered states of consciousness
-- Arousal such as hostility or mania
-- Apprehensive with no obvious reason
-- Unusual nervousness
-- Disoriented in place or time
-- Confused when asked simple questions or confused in general about circumstances
-- Sweaty with clammy perspiration
-- Inability to concentrate on what you are telling them or on the tasks at hand
-- Sudden mood changes
EPILEPSY
Epileptic seizures generally happen without warning for most people. A seizure is a brain disorder of abnormal electrical activity in the brain. Seizures may be either partial or generalized and will present signs and symptoms that very among individuals. 
Signs & Symptoms of Epilepsy
-- May appear detached from reality
-- The person might be in a dreamy state 
-- Dizzy, unable to maintain balance
-- Falls down
-- Staring spells
-- Unresponsive
-- Walks away during a conversation
-- The person may have pupillary dilation
-- Sweating
-- Problems speaking
-- They may display an inability to answer questions
-- Contorted posture / limbs appear twisted
-- Flushing
-- Memory and time distortion (they may not remember what just happened)
-- May appear unrealistically fearful
-- May exhibit emotional signs of heightened pleasure
-- May exhibit emotional signs of displeasure
-- May appear aggressive or angry
-- Complete loss of consciousness
BRAIN INJURY
Brain injures will generally have signs and symptoms that relate directly to what part of the brain was injured. Here are just a few symptoms that someone could easily mistake as the person being drunk or intoxicated. These will vary among individuals and to what extent the brain was injured.

Signs & Symptoms of Brain Injury
-- The person may exhibit tremors
-- Dizzy, unable to maintain balance
-- Unable to make simple movements of various body parts
-- Inability to perform a sequence of complex movements
-- Unable to focus on tasks
-- Sudden mood changes
-- Inability to focus attention visually
-- Difficulties with hand and eye coordination
-- The person may suffer from hallucinations or visual illusions
-- They may have difficulty in understanding spoken words
-- They may show signs of aggressive behavior
-- The person may slur their speech 

Brain Picture -EpilepsyALZHEIMER'S
Alzheimer's or dementia is unique for every individual. Alzheimer’s is a progressive and fatal brain disease and the most common form of dementia. The signs and symptoms like the other medical conditions listed here may mimic impairment or drunkenness.

Signs & Symptoms of Alzheimer's
-- The person may show signs of paranoia
-- There may be drastic changes in mood
-- Confusion is quite common with people suffering from Alzheimers or dementia
-- They may have problems speaking
-- The person may exhibit aggressive behavior
-- It's common that there will be problems with remembering things
Posted by on November 13, 2011 • Filed under: administration-leadership, Changes, Code 3, Code 4, command-leadership, Crazy Calls, Dispatch, ems-health-safety, ems-topics, Failure, fire-rescue-topics, firefighter-safety-health, funding-staffing, hipaa, in-the-line-of-duty, news, patient-management, Pediatric, Protocol, special-operations, training-development, Wow.

The annual Bambi Slaying commences!

432 comments

Walking into the foothills of South Dakota’s badlands tomorrow morning…. If you don’t here back from me in a day or two just assume the deer won!

 

On EMS news, I ran my first call at “second job” today. 9 shifts, 1 call.   LOVE IT!

Posted by on November 12, 2011 • Filed under: ems-health-safety, ems-topics, Home, husband, news

Finally saved a life….

356 comments

Kohler. Or maybe “Sir Pterry(the Pterrydactyl) quackin duck.”

Posted by on November 3, 2011 • Filed under: administration-leadership, Cats, ems-health-safety, ems-topics, fire-prevention-education, fire-rescue-topics, firefighter-safety-health, firefighting-operations, fires, hazmat, news

The Mendoza Line

402 comments

Do you ever feel like we’re playing a losing game?

The other day I went through my cardiac arrest statistics. Dispatched to 91 cardiac arrests since I became a medic. ~30/year. I have worked approximately 50% of those. I have EXACTLY 1 cardiac arrest save.

ONE!.

If this were baseball, I’d have a batting average of 0.01098901098901099.  OOOH! If we call all of the no start calls “sacrifices” I’d have an average of 0.021739130434782608. If we only say that the ~45ish times I’ve actually worked an arrest count as “at bats”, then I have an amazing 0.022222222222222223.

In baseball the record for lowest career batting average for a player with more than 2,500 at-bats belongs to Bill Bergen, a catcher who played from 1901 to 1911 and recorded a .170 average in 3,028 career at-bats. I’m well below the “Mendoza Line”

What is YOUR batting average?

 

 

 

 

Posted by on October 25, 2011 • Filed under: administration-leadership, Coping, ems-health-safety, ems-topics, Failure, fire-rescue-topics, news, patient-management, rescues, special-operations, technology-communications, technology-communications-ems-topics, training-development, training-fire-rescue-topics, Uncategorized

Ambien made me post this…

345 comments

Seriously. It did. I take ambien for sleep(12.5mg XR), as the chances of me sleeping on my own are not so good. But if I am awake past that first 40 minutes it makes me do crazy crap. Like post on my blog. Or clean out the fridge. OR trim, cut and cure 40 lbs of deer meat for Jerky slices. I’ve rearranged my 75 gallon aquarium and not remembered. I’ve don a LOT of things and not remembered.

It is mildly terrifying to know how much can happen with so little control. MY wife sure like the cleaning version of me though, so I doubt I’ll be changing over soon.

Do any of you have first hand experience of the crazy things meds made you do?  We hear stories all the time from patients and coworkers, but I’d like to hear your own stories.

ON a clinical note, what do we need to look for with these odd situations? Can a patient sedated with ambien be reliable?

Drop me a line!

 

Ambien Side Effects

Ambien Dosage:

Dosage in adults

The recommended dose for adults is 10 mg once daily immediately before bedtime. The total Ambien dose should not exceed 10 mg per day.

Special populations

Elderly or debilitated patients may be especially sensitive to the effects of zolpidem tartrate. Patients with hepatic insufficiency do not clear the drug as rapidly as normal subjects. The recommended dose of Ambien in both of these patient populations is 5 mg once daily immediately before bedtime [see Warnings and Precautions (5.6)].

Use with CNS depressants

Dosage adjustment may be necessary when Ambien is combined with other CNS depressant drugs because of the potentially additive effects [see Warnings and Precautions (5.5)].

Administration

The effect of Ambien may be slowed by ingestion with or immediately after a meal.

Posted by on October 5, 2011 • Filed under: ems-health-safety, ems-topics, father, firefighter-safety-health, HELP, Home, husband, medic, news, patient-management, Uncategorized, videos

Mostly it’s the getting by thing…

419 comments

We all joke in ways our families, friends and patients don’t understand. See around the 3:20 mark of this video:

Godspeed, friends!

Posted by on October 5, 2011 • Filed under: administration-leadership, command-leadership, ems-health-safety, ems-topics, Failure, father, firefighting-operations, funding-staffing, Heart Strings, partner, patient-management, sleep, special-operations, TV

News Cameras…

104 comments

…Make me do stupid things.

Very stupid things.

Today during an extrication, in the middle of the city, just blocks from the newspaper office I stood by as FD was extricating our very obese patient from the SUV she somehow smashed into a parked car on a residential street.

I just stood there.

And picked my ass.

In front of the camera.

And imagine that, of the 350 pictures he took in those 20 minutes…. he chose the one of me picking my ass to be the lead photo for that section.

I can already sense how  my day at work is going to go.

 

So, this is the M3 PSA: If you think there are cameras around, don’t go digging for gold in your bum or up your nose. They’ll catch you and almost without doubt, they will run it.

 

 

Posted by on September 30, 2011 • Filed under: ems-health-safety, ems-topics, fire-rescue-topics, firefighting-operations, news, rescues, vehicle-operation-ambulances

Healthy Eating

345 comments

Harvard has a new “healthy plate” out to give guidance on how we should eat. Here it is:

Here is the MedicThree version of a healthy plate:

It’s ok. I’m sure Harvard will figure it out eventually.

Posted by on September 28, 2011 • Filed under: ems-health-safety, ems-topics, Home, husband, Life, news

Dropping a patient…

332 comments

doesn’t seem so bad now:

You could drop them from a moving ambulance.

Posted by on September 14, 2011 • Filed under: crazy, ems-health-safety, ems-topics, fire-rescue-topics, news, patient-management, training-fire-rescue-topics, videos

Repeating myself….

333 comments

Only because I think I said it right the first time.

<strong>WE’VE ALL BEEN THERE….

Sad as it may be, many medics spend a great deal of time trying to get out of doing their jobs. We’ve all been there: annoyed, over tired, and over worked. We don’t get paid any more to transport, so sometimes we seem to think that maybe the patient doesn’t really need an ambulance….

I can see how it plaid out in my head. I really can… and that is what scares me the most. In 2008, 39 year old Edward Givens died shortly after EMS saw him at his home. The medic that day told Mr Givens he was just having acid reflux and recommended Pepto Bismol. Two hours later Mr Givens was dead.

You can see it now, can’t you? Maybe the patient is being overly dramatic, or maybe it is the family. You’ve been working for 20 hours and this is your 30th call. You’re 8 charts deep and know that another refusal or no ambulance needed is less work than the transport…

But here is the problem…. it is our job to transport people to the hospital. It isn’t our job to determine whether they need an ambulance or not. If someone wants to go, we take them. Regardless of whether you think they are sick or not. We don’t diagnose. We don’t cure. We are in the business of transporting patients.

I don’t know what really happened that day in 2008, but I do know that we’ve all been there before. We’ve all spent a considerable amount of energy on not transporting someone. Maybe you’ve even had a close call. A stroke you thought was a diabetic… or an AMI that you thought had reflux… But until now you’ve skated by.

Well stop. Stop expending so much energy trying to get out of doing your job. If you’re no longer interested in transporting patients, find a new line of work. When it comes down to it, is it worth risking someones life, your job, and your family’s livelihood on it? The medics in question here were not found to have violated any policies or procedures by their employer…. but do YOU want to live with that on your shoulders?

What do you think about it now?

Posted by on July 13, 2011 • Filed under: administration-leadership, Changes, command-leadership, ems-health-safety, ems-topics, funding-staffing, hazmat, news, Research, technology-communications, technology-communications-ems-topics, Wow.

Think Thin.

1 comment

I took AD’s challenge, last week.I started at 183.4 lbs. Today… I am 179.4 lbs(up a little from a few days ago….). I am under 180 lbs for the first time in nearly 5 years. Mrs M3 is doing amazing, btw. While I am just conserving calories, she is busting her ass working out every day. Very proud of her for sticking with it. You’re amazing, baby!

Staying on the wagon is a little tricky this weekend. Home alone while the wife and little guy are at the inlaws… Pizza called my name, very loudly…. and that M3 Oktoberfest(or Februaryfest) is really starting to call my name…

Can you accept the challenge, too? Not many people in the EMS field can’t stand to lose a few pounds… So I challenge YOU to get off your well cushioned arse and do something about it. Today.

Posted by on March 5, 2011 • Filed under: administration-leadership, ems-health-safety, ems-topics, firefighter-safety-health, training-development, training-fire-rescue-topics

We’ve all been there….

408 comments

Sad as it may be, many medics spend a great deal of time trying to get out of doing their jobs. We’ve all been there: annoyed, over tired, and over worked. We don’t get paid any more to transport, so sometimes we seem to think that maybe the patient doesn’t really need an ambulance….

I can see how it plaid out in my head. I really can… and that is what scares me the most. In 2008, 39 year old Edward Givens died shortly after EMS saw him at his home. The medic that day told Mr Givens he was just having acid reflux and recommended Pepto Bismol. Two hours later Mr Givens was dead.

You can see it now, can’t you? Maybe the patient is being overly dramatic, or maybe it is the family. You’ve been working for 20 hours and this is your 30th call. You’re 8 charts deep and know that another refusal or no ambulance needed is less work than the transport…

But here is the problem…. it is our job to transport people to the hospital. It isn’t our job to determine whether they need an ambulance or not. If someone wants to go, we take them. Regardless of whether you think they are sick or not. We don’t diagnose. We don’t cure. We are in the business of transporting patients.

I don’t know what really happened that day in 2008, but I do know that we’ve all been there before. We’ve all spent a considerable amount of energy on not transporting someone. Maybe you’ve even had a close call. A stroke you thought was a diabetic…  or an AMI that you thought had reflux… But until now you’ve skated by.

Well stop. Stop expending so much energy trying to get out of doing your job. If you’re no longer interested in transporting patients, find a new line of work. When it comes down to it, is it worth risking someones life, your job, and your family’s livelihood on it? The medics in question here were not found to have violated any policies or procedures by their employer…. but do YOU want to live with that on your shoulders?

Posted by on March 3, 2011 • Filed under: administration-leadership, command-leadership, ems-health-safety, ems-topics, major-incidents, news, partner, patient-management, training-development

Mmmmm….

236 comments

How I love potato chips. And Mt Dew. Oh, and I love pizza, beer, cheese, hamburgers, and my personal favorite… the Butterburger from Culvers. (yes, they really cook it in butter)

But it is time to lose this gut. When I graduated high school in 2002 I weight 132 pounds. I was a distance runner… Now the distance I run is from the couch to the fridge–with two stops, ended with a beer….

Kelly over at www.ambulancedriverfiles.com has placed the challenge, and I accept. Time to lose the weight.

My goal is 155lbs by June 18 when we go to Vegas for a friends wedding. Any other takers out there?

Posted by on February 26, 2011 • Filed under: ems-health-safety, ems-topics, Uncategorized

The Speech

1 comment

“Mr Thompson…. Today when we arrived your wife was not breathing, her heart was not beating. We began CPR and hooked her up to our cardiac monitor. The monitor showed that your wife’s heart had stopped. It had no electrical activity.

At that time we continued CPR while administering heart-starting medications and inserting a breathing tube. After nearly 20 minutes, nothing has changed.  Her heart is still not beating. She is still not breathing.

I give you my most sincere condolences, but she is deceased and there is nothing more we can do. I’m very sorry sorry for your loss. ”

This is how it plays out in my head. Well put, accurate, somewhat concise…

But it never comes out as well and they never let you get that far. It is even harder in untimely deaths.

What do YOU tell people when their loved ones have died?

Posted by on February 19, 2011 • Filed under: ems-health-safety, ems-topics, Failure, Heart Strings, patient-management

Unnatural Fear

306 comments

Everyone who works in EMS knows the reality of death and dying. We make a living on the simple fact that people get sick, hurt, and die. Peoples stupidity, misfortune, and bad luck are my job security.

What makes that knowledge hard to swallow is not other people’s emergencies.  The sick and dying do not greatly effect me. Obviously some cases are more gut wrenching than others, but most of the time the dying do not have faces, stories or names. They are just another body on the bed. You have to think this way to survive in this field. You can’t take them all home with you.

But I do take home a very unnatural fear. That doing my job–the job I love to do despite crappy ours, management and pay–will take my life. Every single EMS and Fire Line of Duty Death scares the crap out of me. EMS is a dangerous line of work. Driving fast and hard through red lights, stop signs, traffic and weather is bound to end badly.

But I think I am too worried. I often think about my son growing up fatherless, my wife widowed… and I am not sure how long I can keep doing it. I LOVE my job. I love the occasional day where I can help someone and actually do more than be a glorified taxi driver…

But at what point am I worrying too much? At what point will that get in the way of doing my job? It is just hard to be another “warm body in the seat” when I know that the risks are so real.

Posted by on January 29, 2011 • Filed under: Coping, ems-health-safety, ems-topics, firefighter-safety-health

My Crutch

232 comments

Maybe I’m just superstitious. Maybe I’m a little insecure… But for over 3 years, every day I have put the same EMS pocket guide in my right cargo pocket every day on my out the door. Every. Single. Day.

It is worn and tattered, but not so much from use. I can only think of 2 or 3 times I have actually referenced it in the field. But still, every day I put it in my pocket and pat the pocket to make sure it is there.

Every single day.

Posted by on January 29, 2011 • Filed under: ems-health-safety, ems-topics

Merry Christmas, friends

1 comment

image

As I head into day two post sinus surgery and Christmas day, I realize I have much to be thankful for. So much I won’t try to list it all here.

So….. Merry Christmas, my friends. To those of you working the streets: be safe, warm, and come home in one piece.

Godspeed, friends.
M3

Posted by on December 25, 2010 • Filed under: ems-health-safety, ems-topics, fire-rescue-topics, Home, medic

May God Have Mercy…

11 comments

Today,  on the anniversary on one of the worst days in Firefighting history, 2 of Chicago’s Bravest perished during a building collapse. 14 others were injured during the initial collapse and subsequent search efforts.

May God Have Mercy on their Souls. May God Have Mercy.

Posted by on December 22, 2010 • Filed under: ems-health-safety, ems-topics, fire-rescue-topics, firefighter-safety-health, firefighting-operations, fires, in-the-line-of-duty, line-of-duty, LODD, major-incidents, news, rescues • Tagged:

Timing

323 comments

When we got in the cab after loading a particularly odoriferous and rotund body the irony couldn’t have been any stronger…

Apparently I had left the radio on the oldies station, as “Stairway to Heaven” was blaring away…

I’d be lying if I said things like this didn’t make me smile. Since lying is bad, I won’t…

I’m actually still smiling…

Posted by on December 4, 2010 • Filed under: Coping, ems-health-safety, ems-topics

Attitude is everything

1 comment

Amazing what a change of partners can do. A year ago my job was almost unbearable… today, I love it.

Ok, Love is a really strong word. I like my job though. I don’t have a hard time getting out of bed to do it. Do fakers and drama queens still drive me nuts…. yup.

But the best part is that instead of getting pissed at them… I just screw with them. Fun had at the expense of others is always the best kind.

Amazing how working with someone, a friend mind you, can really make work miserable. When someone else hates their job… it makes it hard for you to even bare going there.

I have a post planned for tomorrow, don’t forget to stop back!

Posted by on November 28, 2010 • Filed under: ems-health-safety, ems-topics

“Service”

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Are we “service” professionals? Do you view patients as “customers”?

I work for a corporate system and I am having a hard time wrapping my head around some of corporate nonsense they are using in employee publications as of late.

What do you think of calling “patients” “customers”?

My first impression…. I was under the impression “customers” “bought” things…. not took them for free?

Posted by on November 5, 2010 • Filed under: ems-health-safety, ems-topics, medic, patient-management

Reality Check

312 comments

As usual, the EMS blogosphere has found itself in yet another little tiff. This time Timothy Clemans and Medic22 are in a bit of disagreement about proper use of ALS, among other things.

Timothy seems to believe that ALS skills are wasted on patients that are not in risk of losing life or limb. While Medic22′s way of responding to him might be over the top, I can TOTALLY understand how and why that would happen. See here and here. We all take this pretty damn seriously, so I understand the frustration.

Because I agree with Medic22′s thought process on this, I thought I would chime in a little bit.

If it was up to me I would eliminate prehospital ALS except in cases where ALS care prevents the need for hospital/clinic care and in cases where evidence demonstrates that ALS saves lives. That said, Medic 22 did bring up an excellent point about prehospital pain management.

Is it really that simple? Simply put, I’m out of a job. All of us are. In a systemsign-realitycheck with 11,000 calls a year, we’d be able to pay one medic. Thats it. After the sob story of me being unemployed is over, we’ll address the real issue: why is it that you have to be dying to get compassionate, adequate, respectful care?

If you are sick or injured, but not dying, Timothy is saying that you should only get a taxi ride to the hospital(where you will wait in triage for an hour(or more) and then wait for a nurse to complete an assessment, then a doctor, then maybe get your treatment started).

Are there ALS skills that need to be reviewed? Absolutely, but until you have had to sit in a truck with patients puking their brains out(on your new, shiny boots) you will not understand the validity of our skills that are in between taxi driver and super hero. Pushing Zofran for that nausea not only helped to relieve the discomfort for that patient, it also helped prevent them from further dehydrating themselves (or like a patient a week ago… going into vfib every time she puked… Seriously).

Managing pain in patients is one of the best skill sets we offer(and either the most avoided due to paperwork or most abused by patients).  Allowing grandma some comfort for the 15 mile ride through my Wintry Mid-Western city riddled with potholes and ice chunks is the least I can do after she allowed my whiny ass to stay alive all this time.

I can’t agree more with you! I have been battling this topic for 7 years to no avail. At one point we had our agency MD on board yet the other program MDs in the county voted against it! Again, “nobody ever died of pain” was just one reason. Another was/is the potential abuse issue, especially with fentanyl compounded by the fear ketamine could be stolen off the trucks by youngsters for their Rave parties. Subsequently, our patients receive a proper induction via etomidate but very infrequently the administration of diazepam and morphine post intubation (only a few of us religiously use the agents). What you end up with is a patient who doesn’t remember undergoing paralysis and intubation but wakes up being paralyzed and intubated on a bumpy ride to the hospital.

All this says is that local MDs have zero faith in their medics. If you can’t secure your narcotics, you have no business being in this business. There are dozens of ways to secure them. This is simply an excuse for someone who is afraid to allow their medics the ability to treat.

Medic 22 a dehydrated girl with a low BP and tachycardia needs a line and a fluid blous. That’s ALS. Not an emergency… but something that a paramedic can, and SHOULD do.
Me: what’s the benefit of the prehospital als in that case? if it doesn’t save a life or shorten hospital stay what’s the point
Medic 22: It’s GOOD PATIENT CARE. Its what competent, caring prehospital care providers do.

If the care by paramedics could prevent the need for hospital then I’m all for it. Unfortunately in the case wouldn’t you just be delaying hospital care and doing something just to do it?

First of all, you are assuming we are delaying care. Like I said before:

My scene time consists of a brief primary assessment, possibly a 12 lead and loading the patient where I begin the rest of my treatment–unless the patient absolutely needs other interventions prior to departure. That being said, when I am 15 minutes away from the hospital with someone puking(and further dehydrating themselves) or someone who has moderate wheezes, why shouldn’t I begin treating them?

Again…. It seems that you assume there is some abundance of Life or Limb calls in EMS. Honestly, those exciting calls just don’t come all that much. What we get a lot of is sick baby boomers, indigents, drunks, and people who don’t know any better. Does that mean we shouldn’t treat them while we can?

It is our job to treat patients, and as long as I have time in the back of my truck, I am going to do everything I can to make them more comfortable, happier, and healthier–if at all possible.

Posted by on March 9, 2010 • Filed under: Blogroll, ems-health-safety, ems-topics, medic, patient-management, Protocol, training-development • Tagged: