Archive for February, 2010

Teach them while their young

I just finished reading a great guest post on “Everyday EMS Tips” by Steve Lichtenberg about teaching CPR to kids. He gives some great advice about teaching to a younger audience. But more importantly, he makes it clear that kids can be taught to save lives. This post really hit home, as I am living proof on how teaching kids to perform CPR or First Aid can really make a difference.

When I was 12 years old, I took a health class in school to get out of having to take Spanish. For 2 weeks, we learned CPR and first aid. We were also certified in the skills once we showed our instructor proficiency. To me, it was more of an excuse to goof around and pretend to make out with the CPR dummy and make people laugh. It still didn’t change the fact that I had to learn the skills in order to pass that part of the class. I actually did find the first aid part of training to be interesting. So after I passed the class, I had 2 neat cards to put on the refrigerator and show off to my parents. I never thought I would use any of those skills, especially as a child.

A couple days after I completed that class, I was riding bikes home with a couple of my friends. One of the kids that was riding with us decided to take off across traffic and was hit by a pickup truck. I watched him fly over the handlebars, hit his head on the windshield and fall off the side of the truck to the street. After a couple seconds of watching him lay motionless, I ran over to him to see if he was ok. He wouldn’t respond to me and basically laid there limp.

The lady driving the truck got out and started screaming at me to get out of the road so that she could pull him off to the side. I knew that we shouldn’t move him, although I didn’t exactly know why. I just remembered that we should keep the head still. I held his head and told the lady to call 911. This was before cell phones were popular, so there was really nothing she could do. I yelled at my friend to ride to his house that was only a block away and call instead.

Several people stopped to help, and pretty much everyone wanted to pull him out of the road. I was adamant that we couldn’t move him and I tried my best to convince the adults on scene that I was doing the right thing. It basically came down to the fact that I refused to let go of his head, so they really had no choice. I had one of my friends hold pressure with a towel on a large laceration that he sustained from the accident in attempt to control the bleeding. He too had just taken the same class.

The ambulance (the same one I work for now) arrived on scene first and took over care. I don’t remember much of what they did, but I do remember one of the crew members thanking me and saying that I did the right thing by holding his head. A couple months later, the kid returned to school. He suffered minor brain damage and a spinal fracture. He had no lasting neurological deficits and pretty much made a full recovery. I’m sure his helmet probably did more of the life-saving than anything, but It’s nice to think that I may have actually made a difference in his outcome.

So yes, I do think that kids can and should be taught to perform life saving interventions. Image how many victims of cardiac arrest would survive if we taught all high school students to perform CPR? We make them learn to use a computer and type properly on a keyboard. Why not teach them how to react in a life-threatening emergency? They may never take another CPR class for the rest of their life, but they will always have at least some of the knowledge in the back of their head. Bad CPR is always better than no CPR. I wonder if the American Heart Association has tried to approach programs that would teach young adults CPR before graduating high school?

If anyone knows of such programs, I would love to hear about it.

Do as I say, not as I do

I was teaching a CPR class a couple days ago to a group of EMT students. While I was explaining the 30 compressions to 2 breaths ratio, a student raised her hand and asked me if I actually count or even follow the AHA guidelines when working in the field. Believe it or not, this is the first time any student ever asked me that. I was honest and told the group that I do not always follow compression ratios. As a matter of fact, I probably never do. As you can imagine, the class was full of comments and questions after that answer.

Of course, I explained the science behind the AHA guidelines and why they recommend fast and hard compressions. The hard part was explaining why me and most of my coworkers don’t follow them. Being a paramedic, It’s easy to explain that my focus is around ALS interventions. Being that I have plenty of BLS providers on scene with me, I don’t typically have to worry about doing CPR. However there isn’t really a good excuse as to the large number of EMS providers that just “pump and blow”. It kind of makes me wonder how much of the Heart Associations studies actually included pre-hospital cases. More importantly, it makes me wonder if it really makes a difference.

….which brings me to my next point.

It seems like every time I teach a class, whether it be CPR or an EMT class, I always find myself having the “when you get into the field” talk. There seems to be this big separation of what you learn in the classroom and what you learn on the streets. I get that there are many things that experience teaches you that a textbook just cant. But why can’t our education be more realistic? It almost seems that we do everything BUT prepare our EMT and Paramedic students for real life scenarios.

We don’t tell people in CPR classes that bagging patients for any period of time usually leads to abdominal distention and regurgitation. Sure if you “properly ventilate”, that shouldn’t happen. But throw in the “bouncing ambulance” factor and the “2 people trying to do five things” factor and you got yourself a gurney caked with used hot dogs.

We don’t seem to tell our paramedic students that Mr. Homeless on 4th street only calls 911 complaining of chest pain because he knows you will give him Morphine, a bed and a hot meal. Is it that the people writing the books are so far disconnected from pre-hospital medicine? Or do we just think it’s too “politically incorrect” to tell our students that our patients lie to us?

All I’m trying to say is that we as EMS educators and providers need to put more emphasis on teaching our students the reality of working in this field. I would like to see us try and close this gap between classroom and field learning.

Anyone beg to differ?

A Boy Named Sue

Once upon a time lived a boy named Sue. He was well known as the bully around town. Sue was quite the perfectionist. It was understood that when you are in Sue’s territory you play by his rules. One wrong look and you better hold on to your lunch money for dear life, because Sue would have you roughed up and broke before you even knew what hit you.

On the other side of the neighborhood lived a boy named Doc. Now Doc was quite the opposite. He spent his days helping people with their various issues. A problem solver if you will. As a matter of fact, other kids were willing to pay Doc to help them with their problems. He was good at what he did and had a heart of gold. Unfortunately Doc wasn’t perfect. Sometimes he made mistakes, and that often made the other kids mad.

One day came and a kid named Pat had a problem that Doc just couldn’t solve. Pat became very upset as he paid Doc all of his lunch money and didn’t get what he wanted. Pat decided to track down Sue and see what he could do to help. Sue assured him that he would get his money back, as long as he got to keep half. Pat couldn’t resist the offer and decided to take him up on the deal. So Sue tracked down Doc, roughed him up and took all his money. As a matter of fact he took more money than Pat gave him to begin with. Pat ended up getting all of his money back and Sue kept the rest.

Now Doc eventually recovered and went back to his business of helping people. That is until one day Pat returned and requested his services again. Not really sure what to do, Doc agreed to help him. Once again Pat wasn’t very happy with the service he received. Pat once again called upon Sue to get him his money back. Only this time Doc called upon his friend Sharky to defend him in his time of need.

Sharky stood up to Sue and saved Doc from losing all of his money again. This continued until one day Sharky realized that he was providing a valuable service for Doc. A service this good was worth some form of reimbursement. After all, if Doc didn’t have Sharky to help, then he would lose all of his money every time Sue came around. Eventually it got to the point where it cost more money to have Sharky help, then to just give Sue what he wanted. This of course made for hard times with Doc.

More and more kids were getting the idea that they could just call Sue to get what they wanted out of Doc. Of course Doc couldn’t stand to lose all of his money as he had to have something to buy his lunch with. So Doc decided to ask for more money in exchange for solving peoples problems. As the cycle continued, many people couldn’t afford to pay Sue anymore and therefore would not seek his services. Even with the small number of kids that were actually paying Doc for his services, his high prices still provided for enough money to buy lunch.

Times were tough, but Doc managed to eat everyday. That is until the kids that didn’t have enough money to pay Doc called upon Sue to help them with their problems. Sue then told Doc that whether or not the kids had money, he was going to help them unless he wanted to get roughed up and robbed again. Unfortunately it got to the point where Doc was helping every kid in the neighborhood and only a couple kids were actually willing to pay him for his service.

Eventually Doc just couldn’t keep helping people. The constant fear of Sue coming around finally got the best of him. He had no choice but to quit trying to help people and find another way to earn his lunch money.

Chronicles of EMS Episode 1 Review



Chronicles of EMS – The Reality Series (Season 1 Episode 1) from Thaddeus Setla on Vimeo.

The wait is over. The much anticipated first episode of “Chronicles of EMS” is now available for viewing. I must start off by saying that I am very impressed with the quality of work done by the group. I am very excited to see more episodes as they arrive. Just watching the first episode really opened my eyes to many differences and similarities between the system in San Fransisco and system that I currently work in.

For starters, I noticed that Justin walked many of his patients to the ambulance. In the area where I work, that is against our policy. We aren’t supposed to walk patients at all. Obviously what he is doing is working for him and we do works for us. It’s just one example of how we all take different approaches to achieving the same goal.

Another thing I noticed was his short radio reports. I’m not sure if this was a result of cuts in the video during the edit, or just how medics give report in that system. We typically try and keep our reports under 30 seconds, but we also include a lot of information that isn’t exactly needed “right now”.

I guess it doesn’t matter if you live in San Fransisco, New York, Texas or anywhere for that matter. We all run the same patients. The system, protocols, equipment, and colors on the ambulance all change. The only thing that remains the same is the patients and the emergencies. This is why I believe that the Chronicles of EMS will be a huge success.

If you are reading my blog and haven’t checked it out. DO IT. It’s a great piece to watch, and I’m sure that it will continue to grow and improve. The concept of EMS 2.0 is growing right before our eyes thanks to the hard work of this group. I really hope to see more people become involved and interact to share their stories and maybe even bring Chronicles of EMS to their home town.

Take the time and check it out. You wont be disappointed! http://www.chroniclesofems.com

Also feel free to join the discussion about #CoEMS on twitter. Follow Chronicles of EMS on Twitter!

What do I look like?

Let’s rewind back a number of years to the first week of my paramedic internship. I thought I had it all figured out. 400 maybe 500 hours and I was going to be off to take my registry test and get my license. The first call of the day is a motorcycle down. My preceptor informs me that I am running the call alone. Its sink or swim time. “No problem, I got this” I say through the window tha seperates the cab from the patient compartment.

We get on scene to find an intoxicated biker standing in the roadway talking to law enforcement. They don’t want him to go by ambulance as they are arresting him for dui. The officer asks me to evaluate him and make sure he is ok to go by squad car. I walk up to the man and ask “what’s going on?”

“I got bit by a shark” he replies.

Sean – “very funny, are you hurt?”
Patient – “you tell me”
Sean – “are you having any pain?”
Patient – “am I getting billed for this?”
Sean – “only if you are transported”
Patient – “then I’m not going”
Sean – “do you know where you are?”
Patient – (he tells me the cross streets)
Sean – “what is the date today?”
Patient – (tells me a date that is off by a couple days)
Sean – “what does that man look like over there?”
Patient – “a cop”
Sean – “what do I look like?”
Patient – “a dumbass”
My preceptor – “well sounds like he’s alert and oriented to me!”

Can you call a bluff?

Your ambulance is dispatched to a scene for a complaint of seizure activity. You are arrive on scene to find a young male in his 20′s shaking violently on the floor. Your initial reaction is to protect his head and place him on high flow oxygen. You instruct your partner to place him on the ECG monitor and get your narcotics. Your just about ready to start your IV when you glance at the ECG and see a rate of 60 beats per minute. “Wait a minute, 60?”.  You then tug at his arm and pull it towards you with little effort. He then pulls it back with a few second delay. Having a pretty good idea of what’s going on, you stand back and say out loud “well I can’t find a vein, looks like we have to give rectal valium!” Suddenly his “seizure” stops and he immediately starts talking.

Obviously the patient above was not having seizure. Luckily you were able to figure this out. Had you have just assumed he really was seizing, you would have administered a controlled substance for no reason. Sometimes knowing when a life-threatening illness is not present, is just as important as knowing when one is.

Emt and paramedic school is great at telling you what to do when a patient complains of chest pain or has a seizure. Unfortunately, nobody really tells you the reality of treating patients in a pre-hospital setting. The fact is, people lie. People want drugs and people want attention. I really think that we need some some emphysis on teaching paramedics to detect when someone is “faking”.

In my opinion, part of doing a thourough assessment is determing whether or not the patient’s complaint is ligitiment. I wouldn’t give atropine to a patient in SVT, and I wouldn’t give nitroglycerine to a patient that was hypotensive. So why would I want to give valium to someone that wasn’t having a seizure?

Any seasoned emt or paramedic knows when a complaint is real or not. But this comes from experience in the field, not from training. At some point, we all had to learn our lesson from the one guy that fooled us. Why can’t this be taught as part of our detailed assessments?

I really think that we need to start training our paramedics the reality of working in the field. We need to promote having an open mind and realizing that things aren’t always as they seem.

EMS – Bad for Relationships?

It’s probably no surprise that public safety work from all aspects can have negative effects on relationships. Long hours, mandatory overtime, irregular work schedules and work-related stress can certainly wear on your partner over time. Does this mean that our line of work makes it impossible to maintain a healthy relationship? Absolutely not.

Yes it is true that most ems jobs come with long hour shifts. But let’s not forget that it usually includes more time off. For example, people working 48 or 24 hour shifts usually get stretches of 6 or 8 days off. It’s all of the overtime that we pick up that causes problems in the household. Now I live on private ems pay too and I truly understand the need for extra money. But it must come in moderation. Try not to live outside of your means and make what time you have with your spouse quality time. Being apart from each other can actually have positive effects if it’s not excessive.

We all get irritated when we get held over to run “late calls” or support a busy system. Trust me, your partner feels the same way. The last thing your significant other wants to hear after you have been away for 2 days is that you are not coming home on time. Not to mention the fact that you probably just want relax or sleep for a few hours to recover from your shift. Rather than fight over this, try talking about it and come up with a set of agreements. For example, you can set rules like not making plans immediately after your shift or designating some time for rest when you come home. Now on the occasions that you do come home well rested and on time, you can surpsrise your partner and do something special.

Everyone knows that our line of work comes with its share of stress. High work loads, financial trouble, critical incident stress and desicions concerning promotion or relocation can take its toll on a person. Unfortunately, most of the time we keep it inside. Trust me when I say that it shows, and it can negatively affect your behavior. Always make sure to talk to your partner about stress in your life. Try including them when it comes to important decisions abour your job or your life. Call your partner throughout the day to tell them about your shift and talk about stressful calls. This will keep you on the same page and will allow your partner to have a better understanding of what you are going through. Let your loved one support you. Don’t let your work issues become home issues.

Working in ems doesn’t mean the end of the world for your love life. It certainly isn’t easy. It’s no surprise to me that many ems professionals date and marry nurses, firefighters or other ems professionals. Communication and quality time are going to be your best friends when it comes to maintaining your healthy relationships.

I would love to hear about your stories or experience with relationships and the ems field. Please feel free to comment below or email me.

Field Guides – Crutch or Tool?

Before I even begin this discussion, I am going to come right out and say that I carry an EMS field guide with me on every single call. Now I’m going to spend the rest of this article defending my position on it!

I heard many people argue that field guides or “cheat sheets” are crutches. I can certainly understand how someone could become dependent on having the information in their back pocket. I have heard plenty of stories of medics flipping out after getting on scene only to realize that they forgot their field guide.

I will say that I have been that guy. The first time I forgot to pack my guide, I ran an infant cardiac arrest. Even though I got nervous, I was still confident that I knew my dosages. I treated the kid without delay and the call ran as smooth as it would have if I did have it.

Even if you carry a guide, it shouldn’t replace your core knowledge. You should have no problem figuring out a dosage or doing drug math. Carrying the guide should be a way to double check your work. You shouldn’t have to rely on it 100%.

The popular field guides that are on the market now have tons of useful information. Poison information and prescription drug information are just 2 examples of things that are nearly impossible to accurately keep in your memory bank. Having the information in your back pocket will be extremely beneficial.

My personal favorite guide is the “ALS EMS Field Guide” by Infomed. I never leave home without it. I also carry a nurses drug reference book and a medical dictionary in my backpack. If nothing else, they can be used to research a patient’s medical history and medications during long transport times and learn something new.

In conclusion, I feel that the field guides are a great tool, but can easily turn into a crutch if you don’t stay on top of your core knowledge. The guides should be used to add to your existing knowledge, not replace it.

If anyone knows of any good field guides that I didn’t mention, please let me know. I’m always looking for new tools to use at work.

New downloads section added

I recently added a new downloads section to the blog. Right now it includes a radio report index card and an adult GCS scale card. I am going on vacation tomorrow, but I plan to upload more EMS related cards and a free copy of my e-book when it’s finished.

If anyone has any suggestions or requests for items to add, please let me know.

Sign here please

As I sit here reading through Happy Medic’s Blog, I came across a very interesting post regarding billing, and refusal of treatment. He made some very valid points when it comes to fraudulent practices seen amongst many EMS providers. For the purpose of this post I am going to focus on legal issues when it comes to having patients sign AMA (against medical advise).

The Scenario:

You arrive on scene of a 26 year old female complaining of abdominal pain that started 2 weeks ago. After you start your assessment, she asks you if the ambulance ride is really necessary. You respond by telling her that her vital signs are all stable and that she looks fine. You explain that abdominal pain that started 2 weeks ago is non-urgent and that she should seek care with her primary care physician as soon as she can.

She accepts your advise and decides against transport to the hospital. You then ask her to “sign here” to release you from any liability SHOULD anything happen after you leave. She signs the form, apologizes for calling you out and wishes you a good day.

Here’s the problem with this scenario. You just had her sign a form that states that she is “refusing treatment” against medical advise. Well your medical advise was to stay home and seek care from her physician at her convenience. I’m sorry but Larry H. Parker is going to eat you alive in the court room.

Just because you got someone to sign a piece of paper, doesn’t mean your legally off the hook. Someone signing out AMA must give you Informed Refusal in order for the form to actually be legal. Just like Informed Consent, the patient must verbalize that they truly understand the risks from REFUSING TREATMENT. Tossing them a piece of paper and saying “please sign this” isn’t going to meet that criteria.

As EMT’s and Paramedics, we should not be giving medical advise unless it is in the form of convincing a truly ill person to go to the hospital. The proper way to address the “do I need to go” issue is to explain that it is not your decision to make and that if they want to go to the hospital, you would be more than happy to take them. I’m not saying force everyone to go, because that will get you in trouble too. Just be very cautious when expressing your opinion on their condition. We are not physicians and we cannot truly rule out a life threatening illness.

If you felt so strongly that the patient didn’t need to go, then why did you have them sign an AMA? Why not just leave them and call it good? There shouldn’t be a need to “cover your ass” if they really don’t need medical attention right?

If you want to play it safe, then don’t advise patients that their condition doesn’t require medical attention. That old lady with the stubbed toe just might have broken loose a clot from the DVT that you or her didn’t know she had (a stretch, I know). I’m not saying that you have to force everyone to go, but rather be careful of what you “advise” people before you have them sign a refusal of treatment. Lets try not to give the lawyers any more money than we have to.

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