Tag: life

  • Firefighters, Only Good for 3 Things

    Running with firefighters is a daily part of our job and it’s important to know how to utilize them as a resource. Now, before we continue too far, let’s get one thing straight: fire medics are not real medics. It’s kind of like Velveeta being called cheese; it’s not cheese. It’s a processed ‘cheese product.’ And that’s kind of what firefighters are: processed paramedic products. Non-organic and not nearly as good as the original.

    That brings me to my first point, which is the things firefighters are NOT useful for. And that’s advice. Treat each and every single firefighter you run across like a child, as that’s basically what they are. For example, the other day I was working a cardiac arrest when some firefighter thought he should correct me just because he had twenty years on the job. He had audacity to say “I don’t think think we should shock PEA.” Well, it wasn’t PEA. It was an organized V-Fib!

    Without further ado, the three things firefighters are actually useful for:

    One: CPR.

    As a medic, you should never be doing CPR. Even if you’re alone in the back of the ambulance, it’s more important to start an IO and get amiodarone on board as soon possible. Once fire arrives, they can begin compressions. And if you’ve been doing your medication properly, the patient should already be pre-loaded with life-saving epinephrine.

    The most important way firefighters can help with CPR is by attaching a LUCAS device. After that, return firefighters back to the station so they can eat chili and grow fat.

    Two: Lift Assists.

    I work in Oklahoma, which means about 60% of my patients and 75% of my coworkers are morbidly obese. I am a small, petite woman that mostly eats grass and grapes, so I’m not built to lift heavy things like our patients. Or stethoscopes. I’m always on the radio on the way to any EMS call, requesting fire beforehand just because I know we’ll need them for any sort of lift assistance.

    It’s important to know that, as a paramedic, it’s not your duty to lift or assist lifting the patient in any way. Your hands are too valuable to risk. Let other, lesser people like EMT-Basics and firefighters handle that burden.

    Three: Dating

    Let’s all us girls be honest: when a balding, pudgy middle-age man flirts with you, it gets your pulse racing. Especially when he’s in uniform and has an under-trimmed mustache. Firefighters are the ultimate relationship goal for any paramedic. And the best part about them is that it doesn’t matter if things don’t work out, you can always find another! Some people say that there’s plenty of fish in the sea, but I say there’s plenty of hunks at the station.

  • Bias in EMS? There’s no such thing.

    I was reading the national news, as any good paramedic does on a daily basis, when I encountered this AP News article here.

    An ambulance is called to the scene of a police shooting. The patient they were called for has been shot in the torso by police. Upon arrival, another police officer reports trouble breathing and she’s covered in blood. There’s no reported injuries from her and she states that she is feeling better. So, which do you transport? The penetrating gunshot to the trunk or the resolving anxiety attack?

    That’s right.

    The anxiety attack.

    Police officers are the most true heroes of first responders, even more so than paramedics. And definitely more so than firefighters. And 200% more so than EMT-Basics. Think about it. Who do we call for help when we need it most? That’s right. Police. They’re the 911 for 911.

    So it only makes sense that we honor our brothers in blue by placing their needs above the needs of others, including gunshot victims. I know that sounds extreme, but truth is often the most extreme to those blinded by propaganda. Besides, there’s nothing we as paramedics can do for a gunshot patient anyway. You might as well throw them in the hosebed of a fire engine and make them transport while we deal with actual, real patients.

    In the end, I applaud this ambulance crew for making the correct decision in a stressful situation. Where others may crews may have fallen to peer pressure and transported the gunshot patient first, this crew stood their ground in the face of the hive mind and made the correct call. For that, you get Paragoddess Amber’s star of the week!

  • EMT-Basics can be treated like cattle. And that’s okay.

    I’m sitting outside a Chief’s office, about to have another of my ‘Emergency Mandatory Trainings’ after an interesting call I ran a few hours ago. And I can’t help but think, after having so many of these throughout the years (I’ve had them at my last five jobs in EMS!), they’re really the only kind of EMT I am used to. Or that I can stand.

    Yes, I know EMT-Basics are supposed to be considered professionals. But are they? Really? Are you telling me that their semester of training is anywhere equal to the eleven-months of school I went through to become a paramedic? That practically makes me a doctor. The only difference between me and a doctor is I still have some common sense.

    But I’m tired of these rugrats getting onto my truck and trying to tell me about their day. Or get to know me. Sometimes they’ll even try to correct me on MY practice. Do you think I have time to worry about a sharps container, *Susan*? Why don’t you just watch where you put your hands when you’re cleaning *my* truck?

    Let’s face it: the average EMT-B only lasts a few shifts of working with me. Some don’t even make it a whole shift before quitting the field entirely. They just can’t take the pressure. And that makes them easily replaceable. So imagine my shock when one just happened to mention how much they’re getting paid.

    You’re telling me that paramedics are struggling to make ends meet and pay off our various debts (school, mortgages, gambling, etc) and these freaking Basics are getting paid?!

    I know how we can fix EMS and improve paramedic retention: stop paying the cattle. People will line up for their job. Trust me. I used to teach EMT students and it’s absurd how many of them I simply rubber-stamped through school. And none of them had any idea what they were doing, even after graduating!

    If we reallocate those funds to paramedic pay instead, we’ll keep more quality medics like myself. You know, the people who actually save lives and don’t just drive the ambulance? EMT-Basics will still work for us, of course. But they can volunteer. And then the company can call itself a charity and even save money on tax dollars.

    I’m going to mention all this to my Chief once he’s done screaming about his usual bit about not using co-workers as pincushions.

    Or whatever he’s on about. I haven’t really been paying attention.

  • 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.