This is hilarious. Didn't quite almost make me pee in my pants...but funny nonetheless.
We need something like this for EMS.
4 hours ago
08 February 2010
07 February 2010
Sunday and such, ready to go home...
Well, it has been an eventful few days. Actually, I worked 12 hours on Wednesday, 24 on Tursday, 12 on Friday, and then 24 more on Saturday. I am off today and go back to the main gig tomorrow for 24 more.
I have seen some pretty silly crap over the past few days, as well as the past few weeks. No doubt, a blog entry or two is brewing....
But since it is Sunday, I'll end this on a lighter note. No, I ain't talking about the Super Hype that is the Super Bowl. Big deal.
No, I'm talking about hockey. Specifically, the Carolina Hurricanes. The season has not been good this year, but what the heck. Last night they took on the New York Islanders on the road and, well, the final score was 3-1 Carolina. But the best part was watching Justin Peters (#60) in his NHL debut, turning away 34 shots from the Islanders. Good job!
I have seen some pretty silly crap over the past few days, as well as the past few weeks. No doubt, a blog entry or two is brewing....
But since it is Sunday, I'll end this on a lighter note. No, I ain't talking about the Super Hype that is the Super Bowl. Big deal.
No, I'm talking about hockey. Specifically, the Carolina Hurricanes. The season has not been good this year, but what the heck. Last night they took on the New York Islanders on the road and, well, the final score was 3-1 Carolina. But the best part was watching Justin Peters (#60) in his NHL debut, turning away 34 shots from the Islanders. Good job!
05 February 2010
Unacceptible risks and such...
Many of you know me. A lot of my co-workers (and some former supervisors) read this blog. As you can tell, I am somewhat opinionated.
I posted this on this blog, so here it is here-
Interesting comments. I have to say that riding in the back of a moving ambulance is not a safe thing to do if you are not restrained. And there is no excuse. I know, I have been riding ambos for 34 years. We are expected to do the stupid things we think we have to do because the ambulances are designed the way they are. In most every unit I have been in, the primary care position is the bench. So why is everything placed in a way that requires you to do something stupid like get up?
Chest compressions? Well, there is a mound of evidence that proves that if you do not get them back on the scene, they don't come back. Period. Of course there will be someone who says "well, a friend of mine heard from this other guy who used to work at..." In 34 years of working in some pretty busy places, I have NEVER seen a patient brought back to life that was not resuscitated on scene. EVER. So why do it? You are taking an unnecessary risk. We have been doing that (working in place) here in my metro service for several years. There has not been any of the headlines like "Patient dies so EMTs can buckle up". No, because we are doing the right thing in that we are following the science that proves that you cannot do effective CPR in a moving vehicle, and that the interruptions in good CPR that you have to make to get them to the truck (anything of 20 seconds or more) are almost certainly fatal, and working them in place produces the best results. And we have PROVEN that over and over and over again.
How about the concept of doing stuff en route to save time, like the Golden Hour? Well, again, a lot of evidence out there now suggests that maybe, just maybe, that Golden Hour is a bunch of hype. Do we need to get them to the ED? Sure. But how fast is the right fast? Is two minutes to start an IV, if we in fact need to start that IV, going to make a clinical difference? I doubt it.
Don't take my word for it...look up the peer-reviewed research on the topics.
We're doing stuff like riding around unrestrained in an ambulance, and thinking it is OK why? You are telling me that firefighters cannot ride on the back step, cannot ride in a fire truck without being restrained, cannot enter a building without adequate back-up outside, etc, etc, etc, but we routinely expect our EMS personnel to routinely undertake risks that no one else is expected to do!
Check out the numbers (if you can find them) on how many EMSers are killed and injured every year, then try and find out how many were in the back and were tossed around, or tossed out.
No, it is not an acceptable risk in any fashion.
There is nothing we cannot do for our patients that cannot be done sitting down and restrained, that is going to make a clinical difference in outcome.
Ambulances can be designed safer without a lot of costs added. My old company did it, and if that penny-pinching organization managed to do it, for sure that anyone else can.
As to those that say you cannot treat a patient belted, baloney! I do it every day, day in and day out. And my patients lack for nothing. They are well treated, well cared for, and not one of them has missed out on anything because of my 'selfishness' of ensuring that I return home for my family. If they need IVs, they get it. If they need an ALS airway, they get it. In a stationary vehicle. If I have to do this, and get up, I tell my driver to stop? And the fallout? Kudos for patient care, general public care, partner care, and self care.
Meds, ventilations, anything. And I do it routinely from a seated, belted position, and all of my equipment is strapped down as well.
You can do it. You just have to stop believing the excuses that we can't. Those are the same excuses that were against SCBA, enclosed fire apparatus, better PPE, ICS, etc.
If we had listened to such logic, we would be using horse drawn apparatus, rubber coats, bleeding evil spirits off of our patients with leeches, and burning witches at the stake.
I posted this on this blog, so here it is here-
Interesting comments. I have to say that riding in the back of a moving ambulance is not a safe thing to do if you are not restrained. And there is no excuse. I know, I have been riding ambos for 34 years. We are expected to do the stupid things we think we have to do because the ambulances are designed the way they are. In most every unit I have been in, the primary care position is the bench. So why is everything placed in a way that requires you to do something stupid like get up?
Chest compressions? Well, there is a mound of evidence that proves that if you do not get them back on the scene, they don't come back. Period. Of course there will be someone who says "well, a friend of mine heard from this other guy who used to work at..." In 34 years of working in some pretty busy places, I have NEVER seen a patient brought back to life that was not resuscitated on scene. EVER. So why do it? You are taking an unnecessary risk. We have been doing that (working in place) here in my metro service for several years. There has not been any of the headlines like "Patient dies so EMTs can buckle up". No, because we are doing the right thing in that we are following the science that proves that you cannot do effective CPR in a moving vehicle, and that the interruptions in good CPR that you have to make to get them to the truck (anything of 20 seconds or more) are almost certainly fatal, and working them in place produces the best results. And we have PROVEN that over and over and over again.
How about the concept of doing stuff en route to save time, like the Golden Hour? Well, again, a lot of evidence out there now suggests that maybe, just maybe, that Golden Hour is a bunch of hype. Do we need to get them to the ED? Sure. But how fast is the right fast? Is two minutes to start an IV, if we in fact need to start that IV, going to make a clinical difference? I doubt it.
Don't take my word for it...look up the peer-reviewed research on the topics.
We're doing stuff like riding around unrestrained in an ambulance, and thinking it is OK why? You are telling me that firefighters cannot ride on the back step, cannot ride in a fire truck without being restrained, cannot enter a building without adequate back-up outside, etc, etc, etc, but we routinely expect our EMS personnel to routinely undertake risks that no one else is expected to do!
Check out the numbers (if you can find them) on how many EMSers are killed and injured every year, then try and find out how many were in the back and were tossed around, or tossed out.
No, it is not an acceptable risk in any fashion.
There is nothing we cannot do for our patients that cannot be done sitting down and restrained, that is going to make a clinical difference in outcome.
Ambulances can be designed safer without a lot of costs added. My old company did it, and if that penny-pinching organization managed to do it, for sure that anyone else can.
As to those that say you cannot treat a patient belted, baloney! I do it every day, day in and day out. And my patients lack for nothing. They are well treated, well cared for, and not one of them has missed out on anything because of my 'selfishness' of ensuring that I return home for my family. If they need IVs, they get it. If they need an ALS airway, they get it. In a stationary vehicle. If I have to do this, and get up, I tell my driver to stop? And the fallout? Kudos for patient care, general public care, partner care, and self care.
Meds, ventilations, anything. And I do it routinely from a seated, belted position, and all of my equipment is strapped down as well.
You can do it. You just have to stop believing the excuses that we can't. Those are the same excuses that were against SCBA, enclosed fire apparatus, better PPE, ICS, etc.
If we had listened to such logic, we would be using horse drawn apparatus, rubber coats, bleeding evil spirits off of our patients with leeches, and burning witches at the stake.
03 February 2010
For your afternoon enjoyment...
I was trying to think of something worthwhile to say about, well, something. But instead, I searched YouTube and found this.
02 February 2010
More about doing the right thing...
Remember the other day when I wrote about "doing the right thing"? It is an easy concept that so many of us have a hard time with, yours truly even. The subject on 1/28 was a story from Dekalb County, GA, where firefighters responded to a house fire, and for whatever reason, decided that there was not a fire and cleared. Around five hours later, a fire at the same residence was delcared a "working fire" and a resident was found dead.
Now comes this story that four personnel fromn the fire department have been terminated.
I wasn't there, so I cannot say what happened. And there are two sides to everything.
But one thing to consider is this- the resident is the one who made the call.
So did not anyone knock on a door? Did they not try to make phone contact with the caller? I don't know about Dekalb County, but around these parts entry would have been made.
So, let's talk about "doing the right thing". If what seems to have happened actually did happen, then obviously someone did not make the right call in doing the right thing.
Let's say you arrive on scene of a 'pedestrian struck' incident. As you get out of your ambulance a police officer is already stringing crime scene tape and another tells you "It's OK, they're dead". So what do you do? Hopefully you will go over and check for a pulse, check for breathing, and attach a monitor. Why do I say that? I know of at least two incidents just like that over the past five years in which the dead pedestrian was actually a live patient.
Or how about you have been dispatched to some sort of medical emergency, and then been cancelled by 'the caller'. Was it really the caller who cancelled? You don't know. Shouldn't you go ahead and check things out, kind of like the 9-1-1 hang-up call? I would, and maybe with a police check-in.
It only takes about 5-10 extra minutes to keep your career from becoming the fodder of the blogs.
Now comes this story that four personnel fromn the fire department have been terminated.
I wasn't there, so I cannot say what happened. And there are two sides to everything.
But one thing to consider is this- the resident is the one who made the call.
So did not anyone knock on a door? Did they not try to make phone contact with the caller? I don't know about Dekalb County, but around these parts entry would have been made.
So, let's talk about "doing the right thing". If what seems to have happened actually did happen, then obviously someone did not make the right call in doing the right thing.
Let's say you arrive on scene of a 'pedestrian struck' incident. As you get out of your ambulance a police officer is already stringing crime scene tape and another tells you "It's OK, they're dead". So what do you do? Hopefully you will go over and check for a pulse, check for breathing, and attach a monitor. Why do I say that? I know of at least two incidents just like that over the past five years in which the dead pedestrian was actually a live patient.
Or how about you have been dispatched to some sort of medical emergency, and then been cancelled by 'the caller'. Was it really the caller who cancelled? You don't know. Shouldn't you go ahead and check things out, kind of like the 9-1-1 hang-up call? I would, and maybe with a police check-in.
It only takes about 5-10 extra minutes to keep your career from becoming the fodder of the blogs.
01 February 2010
The trials and tribulations of paramedic school...
Something I have heard over the years is that we in EMS need to remember from where we came. I try, every chance I get, to remind my younger co-workers of this, but for the most part, I don't know, I just don't think they get it, or even care sometimes.
A lot of folks I work with these days are also going to paramedic class. Up until recently, the only places you could go to EMT-P school, unless you wanted (or could) to do the full AAS thing at the local community college, were some other community colleges that are pretty much and hour away in either direction. And then those options pretty much lead to some more problems. And even the new option at the local community college, well, leaves a little to be desired, from where I sit.
So I hear a lot of, well, whining. Having to take days off. Having to drive to class. Having to work a full time job. Having to buy books. Wah. Wah. Wah.
And it doesn't help matters much since in my home state, if you are affiliated with an EMS agency, your tuition is free. Yes, that's great, but I just don't think the new students appreciate what they have done as much, or what they have have achieved. And it just makes it harder for them later to go out and get some good CE because they might have to pay for it. In one state, for example, I had to pay $1,700. dollars or so up front to take medic school, plus buy uniforms (two shirts, two pairs of pants, and a jacket) that included special shoes to meet the college's specs, and patches, and my first chrome Cross pen (yes, it was required, and I still have it), and books, and an ECG caliper, a stethoscope (Littman Classic, I still have it, as well), and something called malpractice insurance. Thank goodness for an understanding first sergeant, company commander, and the purse strings of the US Army.
So anyway, I came across this jewel and linked to it. I think I am going to print it out and post it at area EDs, as well as stations.
And one of AD's statements says it best- "Pull up your big girl panties and get to work".
I thought I had it bad when I went through, being on active duty and having to make some pretty hard deals with my fellow soldiers in order to get my class time. Some pretty hard deals indeed. I pulled a lot of late night and all night dutyshifts, and wound up pulling a lot of weekend details as well. I remember plenty of 96 hour straight runs- class, work, class, work, class, clinical, work... Oh well, you have to set your goals.
So this is required reading for all of you students and potential students. And it is also required reading for all of the preceptors and FTOs out there. The reason is obvious for the students and all, but why the preceptors and FTOs? First, to appreciate what your students may be having to do to get to and through class. And second, so that you do not cut them any slack for doing so. Don't let them slip on their assessments and skills 'just because they may be tired'. Don't let it slide because they are late or have to go home early because they are tired. Pull up your big girl panties and get over it. You had it just as bad, maybe worse. And a lot of others before you had it a lot worse.
And I will say this to the employers out there-.with all that the students are going through, and even though you should not cut them any slack for it, you owe it to them to make sure they ride with your very best, not just any open spot on the schedule. If you are not doing that, then you are letting the students down. Not everyone can take a student and work with them. A lot of paramedics don't want to, and that, to me, is OK. Maybe they know that they are not a teacher. And they just shouldn't have a student placed with them. I have seen that way too much. And just because someone has a title, maybe they are not cut out for it either. I've seen way too much of that, as well.
9E1
A lot of folks I work with these days are also going to paramedic class. Up until recently, the only places you could go to EMT-P school, unless you wanted (or could) to do the full AAS thing at the local community college, were some other community colleges that are pretty much and hour away in either direction. And then those options pretty much lead to some more problems. And even the new option at the local community college, well, leaves a little to be desired, from where I sit.
So I hear a lot of, well, whining. Having to take days off. Having to drive to class. Having to work a full time job. Having to buy books. Wah. Wah. Wah.
And it doesn't help matters much since in my home state, if you are affiliated with an EMS agency, your tuition is free. Yes, that's great, but I just don't think the new students appreciate what they have done as much, or what they have have achieved. And it just makes it harder for them later to go out and get some good CE because they might have to pay for it. In one state, for example, I had to pay $1,700. dollars or so up front to take medic school, plus buy uniforms (two shirts, two pairs of pants, and a jacket) that included special shoes to meet the college's specs, and patches, and my first chrome Cross pen (yes, it was required, and I still have it), and books, and an ECG caliper, a stethoscope (Littman Classic, I still have it, as well), and something called malpractice insurance. Thank goodness for an understanding first sergeant, company commander, and the purse strings of the US Army.
So anyway, I came across this jewel and linked to it. I think I am going to print it out and post it at area EDs, as well as stations.
I thought I had it bad when I went through, being on active duty and having to make some pretty hard deals with my fellow soldiers in order to get my class time. Some pretty hard deals indeed. I pulled a lot of late night and all night dutyshifts, and wound up pulling a lot of weekend details as well. I remember plenty of 96 hour straight runs- class, work, class, work, class, clinical, work... Oh well, you have to set your goals.
So this is required reading for all of you students and potential students. And it is also required reading for all of the preceptors and FTOs out there. The reason is obvious for the students and all, but why the preceptors and FTOs? First, to appreciate what your students may be having to do to get to and through class. And second, so that you do not cut them any slack for doing so. Don't let them slip on their assessments and skills 'just because they may be tired'. Don't let it slide because they are late or have to go home early because they are tired. Pull up your big girl panties and get over it. You had it just as bad, maybe worse. And a lot of others before you had it a lot worse.
And I will say this to the employers out there-.with all that the students are going through, and even though you should not cut them any slack for it, you owe it to them to make sure they ride with your very best, not just any open spot on the schedule. If you are not doing that, then you are letting the students down. Not everyone can take a student and work with them. A lot of paramedics don't want to, and that, to me, is OK. Maybe they know that they are not a teacher. And they just shouldn't have a student placed with them. I have seen that way too much. And just because someone has a title, maybe they are not cut out for it either. I've seen way too much of that, as well.
9E1
31 January 2010
The Ice Shift is over...
...and it is time to go home. A rather uneventful period of time in The Peak, it was. Well almost. Five calls, two during daylight, and those were real calls. One of them related to the snow. But it was the calls after dark that, well, made you scratch your head...
No, not really, as I have come to expect them. When I get home my wife will ask me about the shift, and I will no doubt mention the two calls after dark that, of course, have come to typify why people call 9-1-1. One was to get their blood pressure checked, and the other, later on, was to get their blood sugar checked. Two calls, two different patients.
Of course neither one had any intention of going to the hospital when they called and with the roads (and their apartment complex's parking lot) covered in ice and snow, I was not going to force the issue. And looking back, I think it was the right thing to do. One of them just didn't want to go, and the other, well, if an older person with other chronic health problems does not want to get out in the cold and snow and ice, well, I think that is a good idea. Especially if they are stable and comfortable with their condition.
But, our state is now requiring a 100% audit of patient refusals, so someone now has to read over these, and in our particular EMS system, phone calls are made to the people who don't agree to go to the hospital to find out why, if transport was offered, and, for simplicity, if we were nice and courteous.
OK...time to go home.
Later ya'll.
No, not really, as I have come to expect them. When I get home my wife will ask me about the shift, and I will no doubt mention the two calls after dark that, of course, have come to typify why people call 9-1-1. One was to get their blood pressure checked, and the other, later on, was to get their blood sugar checked. Two calls, two different patients.
Of course neither one had any intention of going to the hospital when they called and with the roads (and their apartment complex's parking lot) covered in ice and snow, I was not going to force the issue. And looking back, I think it was the right thing to do. One of them just didn't want to go, and the other, well, if an older person with other chronic health problems does not want to get out in the cold and snow and ice, well, I think that is a good idea. Especially if they are stable and comfortable with their condition.
But, our state is now requiring a 100% audit of patient refusals, so someone now has to read over these, and in our particular EMS system, phone calls are made to the people who don't agree to go to the hospital to find out why, if transport was offered, and, for simplicity, if we were nice and courteous.
OK...time to go home.
Later ya'll.
Subscribe to:
Posts (Atom)