Author: Amber

  • Education: Leave It To the Professionals

    I’m tired – sick and tired – of these medics with ten, fifteen, or even twenty years of experience trying to teach younger EMS professionals about our profession. Let’s be honest: medical knowledge evolves quickly. And so many of these older medics haven’t seriously paid attention to new studies in years. Meaning their knowledge of medicine is severely limited.

    I’m going to say something not everyone will like: if you’ve been a medic for more than ten years, your license should be revoked. And yeah, I know, ‘continuing education units’, blah blah blah. But if you’re like me, then you actively avoid those classes. And if you ARE forced to attend one, you sit at the back and take a nap. Or it’s an online class and you watch YouTube videos about how to fix a bad dye job while Jimmy from some no-name fire department explains how albuterol works. We get it – it’s a beta 1 antagonist.

    But the worst is when these so called veterans try to teach younger members their knowledge (and I use the term “knowledge” loosely).

    I remember being a young paramedic, still in my third attempt at getting through medical school, when an older male medic sat down and tried telling me that IVs shouldn’t be inserted at a 90 degree angle. Like, how else are you supposed to feel the vein pop? It’s even more gross when a man is trying to teach me. Like, I get it, you’re just hitting on me. Gross.

    Anyway, once I’m in charge of my own agency, I’ll make sure to not hire anyone over the age of 40. That’s just too old to be useful.

  • Intubation: We’ve Been Doing It Wrong

    We’ve all been there. A 56 year old female, chief complaint of chest pain, with a history of anxiety and diabetes. Her skin is warm and pink with rapid respirations in the range of 38. Irregular and shallow ventilations and with clear lung sounds. If you’re a decent medic (and if you’re reading this, you are) then you can tell one thing just from what I’ve mentioned above: this patient in unable to control her own airway and is a candidate for rapid sequence intubation.

    Here’s the problem with the scene: time is limited. One thing other fields of medicine don’t understand about paramedicine is that our scene time, legally and morally, cannot be more than ten minutes. So taking time to push sedatives like ketamine or etomidate ()both of which are incredibly lethal drugs even in small doses) is a waste of time and resources. But for too long we’ve tried to accommodate the opinions of so-called ‘doctors’ and ‘medical experts’ and ‘the court of law’ just because they’re the ones in charge. But it’s not their patient. And it’s not their life to save.

    I think it’s time us paramedics really buckle down and focus on what we are: life-saving heroes. And life saving heroes don’t have time for Delayed Sequence Intubation (an oxymoron if I’ve ever heard one). Instead, it’s paralytic time.

    In the above scenario, the patient shows all the traditional signs of imminent respiratory collapse: rapid respirations, an inability to stop crying, and a recent breakup with her boyfriend of three years. (His name was Marko and he had shaggy blonde hair and a smile like a sunrise.) The traditional way would say to administer a sedative like versed or etomidate first. That’s wrong. If we waste anymore time, the patient could crash on us. Not to mention all the dangerous side effects we could be introducting. So, what’s the correct way?

    We skip straight to the Succs.

    A proper dosing of Suchsinocholine (.3 – 5mg/kg) will have the desired effect of controlling the patients airway and decreasing their respirations while we prepare for ventilation. By reducing their respiratory rate, we allow a proper build of carbon dioxide to help reset their respiratory drive. We can even supply 4 ppm of O2 via a non-rebreather to help support ventilation efforts in this time.

    After preparing for intubation (remember to forego the flex-guide or stylet as these will damage the airway 70% of the time), we immediately intubate the patient. We’ve now controlled the respirations and ventilations and have saved yet another life. This is the new way we should be operating and the which that modern science actually teaches us.

    So next time you go out into the field and run that chest pain call that turns into respiratory distress? Remember this simple phrase: intubation before relaxation.

  • It’s Time For A Voice of Reason

    Let me start off with the basics: this is a site for Paramedics. If you’re a EMT-Basic, it’ll be too complicated for you. (And God forbid you’re an EMR). If you’re a nurse, you won’t understand the pressures of a real, dangerous career. We’ve seen things you just won’t understand. If you’re a doctor of any sort, your knowledge isn’t applicable to us. I’m sure it’s all well in good in your fancy hospitals, but in the streetz? We don’t have time for sterility.

    Now that that’s all been said: let’s get down to what this blog is about. I’m a paramedic, the highest echelon of medical care available in the real, out-of-hospital setting (where 98% of the world actually exists, fyi). But our field is plagued by inexperience, ignorance, and incompetence. I call these the four I’s (the fourth I is inconsistency) and it’s my responsibility to correct them.

    Recently I was promoted to a field training officer at my prestigious ambulance agency, and it definitely wasn’t because of a lack of staffing and they’re desperate to push out as many bodies as possible. It was because of my expertise in all subjects of paramedicine. After all, I have been a medic for nearly two years. That’s the equivalent of two decades of nursing, so I’ve conquered many subjects. And in this blog I’ll be discussing those subjects to help illuminate my fellow paramedics on the actually correct way of doing things.

    So sit back, grab a Monster, put on your Vipers, and buckle up, kiddos; Amber’s about to learn ya.

    I also provide diet advice.