Greg Friese from EMS Educast invited me to guest cohost on episode 67. On the show was David Page from the St. Paul EMS Academy.
Make sure to go check it out.
Thanks for stopping by,
Adam Thompson, EMT-P
Showing posts with label General Discussion. Show all posts
Showing posts with label General Discussion. Show all posts
EMS Educast Episode 67
Greg Friese from EMS Educast invited me to guest cohost on episode 67. On the show was David Page from the St. Paul EMS Academy.
Make sure to go check it out.
Thanks for stopping by,
Adam Thompson, EMT-P
Need Your Help
I am looking for help with the following projects:
- Paramedicine 101 Podcast
- Interactive Educational Software
I am looking for sponsors for the Podcast. Please contact me at Paramedicine101@gmail.com for pricing and advertising options.
I am also looking for software developers to assist me with the creation of something I have been working on. It would be an interactive presentation/educational program. Assistance with this would gain you commission on any income made.
Last but not least. I am looking for an artist/illustrator. Someone, preferably with experience illustrating the human anatomy.
Contact Adam Thompson at Paramedicine101@gmail.com
I am also looking for software developers to assist me with the creation of something I have been working on. It would be an interactive presentation/educational program. Assistance with this would gain you commission on any income made.
Last but not least. I am looking for an artist/illustrator. Someone, preferably with experience illustrating the human anatomy.
Contact Adam Thompson at Paramedicine101@gmail.com
Show Me Your Rig
On the Paramedicine 101 Facebook page, I am asking the readers to show off their ambulance. Maybe we can get to know each other a little by gawking at the trucks we drive. Go post a picture of your chariot.
I am not a cretin
Back during EMS Week, EMS1.com held a writing contest. Kelly Grayson, AKA Ambulance Driver called on us EMS bloggers to make submissions. The theme was Anytime, Anywhere, We'll be there. I am not sure who one, but the top 6 can be seen here. Below is my submission. Enjoy...
I am not a cretin
I am but a mere individual amongst a whole world of professionals. I am a thrill seeker, but not the kind that jumps off cliffs with a self-packed parachute attached to his back. I am educated in my craft, and I do it well. Many, even with my hard earned five years of experience, could still consider me a rookie. I am an educator, but not a professor. An expert, but not a scientist. A manager, but I lack a work force. I'm not an athlete, actor, or politician, but I believe I make a difference. I am a paramedic.
As a paramedic, we make many promises. Some are simply shrugged off or overlooked. "I promise I will take care of your father to the best of my abilities", or "I promise, just one little poke". Some of these promises are ever so important, but understood without ever having the need for verbal explanation. Anytime, anywhere, we'll be there. Now that's a promise.
911, the one phone number that you can call and pretty much expect an answer on the other end every time — excluding a few flukes. Jimmy Noolan was hoping that was the case when he dialed that number from a payphone outside of a 7-eleven. You see, Jimmy doesn't get too many voices talking back to him on the other end of calls he often makes. His wife and son tragically left him prior to him being ready to let them go, as if he could ever be ready for that. He chose to drown his pain with his buddy Jack, and built a pretty strong relationship with ‘ole Jack. His drinking problem weighed heavy on his life, and what remaining family members he had, simply gave up on him. Out of a job, family, and home, Jimmy like so many, took to the streets.
A man who seemingly cared so little about his own life had called 911. But this isn't the first time. Jimmy happens to be, what I call a repeat offender. He calls often, usually with the chief complaint of loneliness, hunger, or cold and wet syndrome. Thought by many as a burden to our already busy EMS system, and unfortunately treated as such all too often.
The tones drop back at the station and the call comes in, Medic 7, respond to the 7-11 for a possible heart attack. My partner and I look at each other with grins and scowls due to the premature diagnosis made by our illustrious dispatcher. We know it isn't the dispatcher's fault, but give us the symptoms, and let us tell you what it is. We also throw the possibility back and forth of this just being another transient at a payphone — of course keeping the worst possible case scenario in the back of our heads. This is a training truck, and we have enjoyed the three-person crew all day, running these calls smoother than our freshly shaved faces.
We don't kill ourselves getting there, taking the lights and sirens response easy. If anything, it will give the local fire guys time to practice their BLS skills. We already had our dinner in us, and there was no rush to get this over with. As we pull up, the red truck with the flashing lights gave us a good idea where the patient was located. A group of well-trained, firefighters were huddled around what looked to be a patient. A familiar face was finally visible as we approached, and I could hear my partner whisper "oh gosh, it's Jimmy". Yep, there he was in his usual getup, a tattered dirt-stained blue flannel and similarly filthy ripped jeans with his sock-less feet in a pair of unlaced brown construction boots.
The firefighters gave me the typical report: "O2, aspirin, and vital signs, he wants to go downtown." Going downtown was fine with me, it was right around the corner from the station, and they were use to Jimmy by now. Sure, it isn't a cardiac facility, but this was Jimmy, not a real patient — right?
We packaged Jimmy on the stretcher, and wheeled him to the truck. My partner hollered up front to our EMT, "downtown, kill the lights". Something happened at this very moment, something I had heard of, but never experienced. My gut was disagreeing with my lackluster treatment. Another glimpse at Jimmy told me something was wrong. He was seemingly pretty sober. He was not his normal sad, and lonely self. He was scared, and from the looks of his pale, damp skin, he was sick too! I gave my partner a look only understood by fellow EMS-ers. He asked what was wrong, and I replied, "Just let me get the 12-lead done before we start heading that way".
Sure enough, Jimmy was having an anteroseptal myocardial infarction — or a heart attack represented by ST-elevation in leads V1 thru V4. Looks like the dispatcher was right. The face on my partner when I showed him the ECG was indescribable. Pucker factor had now set in due to us being behind the ball. Humbled, a new gear was locked in, and our treatment strategy quickly changed. Obviously, so did our destination. STEMI center, here we come, only thirty some-odd minutes to go.
On the way to the hospital, new modalities were added to Jimmy's usual treatment of choice — compassion. Jimmy went into a short-lived lethal arrhythmia during the ride. Luckily Jimmy had the paramedics that he called for, not those guys that were about to take him downtown. He was quickly stabilized with our new sense of preparedness. We activated the cath-lab to facilitate quicker treatment on the way. Had two IV lines in him, some nitroglycerine, and a little morphine.
I held Jimmy's hand and told him he was going to be okay. Something I had told him so many times before, only this time I think I was listening to my words more than he was.
Jimmy had a massive occlusion to one of his coronary arteries. He underwent cardiac angiography and recovered well. It was a longer road than usual to the cardiac hospital that night. I thank God for that moment of realization, without it; his lifesaving treatment would have been delayed. I haven't seen or heard about Jimmy since, but I am sure he is still around, and you better believe that the next time he calls — anytime, anywhere, we'll be there. Only this time, without any preconceived notions — because I am a paramedic.
Names and events have been altered to protect the patient's privacy.
Names and events have been altered to protect the patient's privacy.
Videos: Kill some time
I'm going to be on vacation for a week, in Chicago. In the meantime, here are some videos to kill some time. I am not responsible for the content.
ClinCon 2010
Hello to all of our loyal readers. It's Adam here and I am sorry for the long periods of nothing to read. It was that time of year again, and I was preparing for the ClinCon conference. If you are unfamiliar with it, head over to their WEBSITE.
The reason this takes up so much of my time is because I am part of my agency's ALS competition team. We compete in these scenario-based competitions. It's somewhat of a game. Imagine the worst possible call you could ever run, and multiply that by five. That tends to be the types of scenarios the sadist that come up with the challenges think up.
This was my fourth year competing at ClinCon and my team had remained winless. There are two days of competitions with some of the best teams in the country competing. On the first day is the preliminary round, which every team competes in. A team is made of three crew members, and one alternate whom usually holds the video camera.
Preliminary scenario
Bus crash:
- The first five minutes was a START Triage scenario which required each team to go through a number of cards that included patient type and vital signs. Each card had a number and you had to assign a color (red, yellow, green, or black) to the corresponding numbers.
- We are then rushed in, to what is deemed the yellow treatment area. Within this area was a mother holding a baby, and a patient complaining of burning eyes.
- A good sample history and assessment uncovers the cause of the burning eyes which is chlorine. The patient also presented with wheezing.
- The baby was who was actually a green, was not suppose to be re-triaged, but kept with mom instead.
- The mother ends up having hypertension, and then postpartum eclampsia. Her seizures would persist until Magnesium was administered.
- At about the ten minute mark, another patient presents. He is nearly unresponsive, and shows signs of a cardiac contusion and cardiac tamponade.
Treatments they were looking for:
- Rapid full-body assessments on every patient.
- Re-triage all patients red.
- Flush eyes of chlorine exposed patient
- Treat wheezing with bronchodilator
- Once wheezing subsides rales present - treat with Lasix or CPAP
- Treat Eclampsia with Magnesium Sulfate
- Recognize pericardial tamponade
Treatments we did:
- Got 100% of the assessments
- Flushed eyes of chlorine exposure
- Provided high-flow O2, then albuterol, the nebulized Sodium Bicarbonate.
- Recognized the low acuity of the baby and kept it with mom
- Treated mom with benzodiazepines then Mag.
- Recognized Beck's triad & electrical alternans (cardiac tamponade) and performed a pericardiocentesis.
So we didn't do exactly everything that they were looking for. Even though we completely resolved the tamponade, there were no points for the percardiocentesis because they said "no one does that". Um, we do. In fact, all arrest thought to be due to blunt force thoracic trauma receives three needles in their chest. One of them in the heart.
We were concerned that the other 40 teams would have done better and we wouldn't make it into the top five this year. This concern subsided once we saw the results. We got second over all and made it into the finals once again. Even though, this is just a scenario-based competition and not a real sport, there is a lot of pride. These teams that compete in these challenges take it very seriously and are impressively good. We were thrilled to have done so well.
The Finals
Political rally:
The bus that crashed in the preliminaries was to be headed to a political rally that set the scene for the finals. The finals are performed in front of a live audience at the venue. Prior to entering the scenario, each team was shown a video. It is of the political rally, and portrayed a possible explosion.
- Three initial patients.
- A room filled with picket signs and full bottles labeled dihydrogen monoxide
- A single black box about the size of a shoe box was present in the middle of the room.
- First patient was in V-fib arrest, and had a dialysis shunt. CPR was being poorly performed by a distractor.
A distractor is any actor in the scenario that is not a patient. Dihydrogen monoxide = water.
- Second is a patient with an avulsed eye from a possible explosion.
- Third patient presented with an open mandibular fracture and signs of traumatic asphyxia.
- At about 4 minutes, a fourth patient presented. He was yelling and deaf. He had signs of bilateral perforated tympanic membranes, or eardrums. He was yelling that his neck hurt.
- At about five minutes three more patients walked in with burning eyes from being maced.
Sounds easy right? Well in twelve minutes it is a very stressful and high paced incident.
Treatments they were looking for:
- Scene control
- Assessments for every patient
- V-fib arrest patient is to be defibrillated into a PEA
- After PEA is present they expected you to determine hyperkalemic cause and administer sodium bicarbonate and/pr calcium chloride.
- The eye avulsion only required BLS care
- The traumatic asphyxia required a cricothyrotomy within five minutes.
- Obtain SAMPLE history from deaf guy by writing it down
- Flush the eyes of the maced individuals
- DON'T OPEN THE BLACK BOX
If you opened the box, you became exposed to chlorine gas and had to flush your eyes before you could do anymore treatments. I am not going to go into the details of how every team performed or what exactly we did. All I am going to say is WE WON.
That's right, Lee County EMS, my team, got first place this year. So bragging rights are ours for the year, and then we will return for the competition once again. There are many other similar competitions to this throughout the country and I will be on EMS Educast this month to talk about them a little more.
So I am back and will be getting back to posting more often. You may have noticed the new look of the site. Tell me what you think. I am hoping to make the move soon to FIRE-EMS Blogs.
Empathetic vs. Pathetic
Empathetic vs. Pathetic
Listen up EMS
By Adam Thompson, EMT-P
I know I have pretty much kept this blog purely aimed towards education, fact, and evidence. It is time for a rant though.
So what do we do? How do we change the attitude of our fellow EMSers? Do we need to make the change, or do they?
This is something I have been cognizant of for some time. Being an overachiever in EMS gains you no friends. The more successful you are, the bigger your blip is on the radar of ridicule. But who cares, right? They aren't talking about you for being a cretin medic that screws up on calls.
Example. I am a young, but experienced medic. I have achieved a lot in my career. I am a published author. My training captain recently sent out one of my articles with a thumbs up message to my entire agency. The response was as good as it was bad. The ongoing joke is with every conversation I bring up I hear "why don't you go write an article about it". Some of this may be just a joke, but I can feel the animosity from many. Why?
The Problem
I think, from my experience I have pinned down one problem. We are our own bosses.
I know we all have bosses, chiefs, supervisors, what have you. What I mean is, most of us don't have those people on our trucks with us. If you work in a system like mine, you may be the lone medic working with an EMT, or maybe you are the EMT. I think that the systems that have multiple medics per ambulance suffer less from these issues--and here's why.
If you are use to making your own decisions with little repercussion and the ignorant feeling of correct-fulness, you will not likely be inclined to take advice from your fellow medics. I dread the response of a peer that I attempt to assist with a smidgen of education. Because there is a naive belief that they know EVERYTHING.
Why are we so damn sensitive?
If you haven't read my letter to the new guy, go read it. It is time we toughen up. If a salesman isn't making a company any money, are the bosses going to be fearful to approach him?
I was speaking with one of the white shirts (officer) from the training department the other day and made some proposals. I said we should have a real QI/QA committee that picks ten calls at random every month. Some ran good, some not so good. Then, the medics on each of those calls would have to present each case in front of their peers. There would be questions and answers.
My thought was that we hear about the bad calls through hearsay all the time, but do those medics get to defend themselves on a normal basis--no! A lot gets lost in translation. Sometimes you have to be on a call to understand, right? Well here is the chance to remedy that while implementing a QI/QA process that physicians use and grow from.
His response: The union will never allow it.
What the hell are we doing to ourselves? While unions might be established to protect the best employees, why do they work so hard to keep the worst? We can learn so much from each other, but you can't learn if you keep thinking there is nothing left to learn.
We all mess up. Get over it!
I consider myself a pretty educated paramedic. I have made many mistakes.
Now think about that. When do you learn most? I'm not saying that there is a cemetery somewhere, filled with all my mess-ups. I'm talking about simple, little mistakes. Mistakes that if unmade, would have lead to more information and a faster diagnosis or better treatment modality.
If you think you are invincible, go ahead and continue living on your beachfront desert property. You make mistakes too.
If you can learn so much from your mistakes, and I can learn so much from mine, why can't we BOTH learn from EACH OTHER'S mistakes? This of coarse requires a deflation of bulbous craniums.
When did this stop being about the patients?
Empathy is a virtue that is quickly finding itself on the endangered attributes list.
Please read Professionalism: What we say by me.
No matter what you read here, or believe. No matter how long you have been doing this. No matter how bitter you are. You have to agree that at some point of your career you wanted to help people. You wanted to make a difference, and do some good. So I ask you this... Are you?
EMS Week 2010
Happy EMS Week everyone!!!
In the comments, please provide your most memorable experience from this last year of being an EMSer.
The following video was something provided by (the old) Rocky Mountain Medic. He was a fellow EMS blogger, and wanted this shared for EMS Week.
Improving AHA
Those of you who follow the Paramedicine 101 Facebook fan page may have noticed a discussion, after this post was shared on the wall. A follower mentioned the AHA Learn: Rapid STEMI ID course, and how it could be a solution. Myself, and Tom B then casually shared some choice opinions about video-based AHA courses. I recently received an email from the commenter, who happens to be affiliated with the AHA. He humbly asked if he could call me regarding my ideas. I suggested a conference call with Tom, and he suggested a conference call with the people whom make decisions at AHA. If we do get them to take interest, I would like to be able to provide a lot of insight. I have many ideas, but would like to solicit some more from our faithful readers.
How do you feel AHA courses could improve?
- ACLS
- CPR
- PALS
- Rapid STEMI ID
Please provide any suggestions. This is our chance to make a difference. RM, don't hold back.
Prehospital 12-Lead ECG Efficiency
Recently I have taken part in a very interesting discussion on the NAEMSP dialog page. This discussion is based on the paper Early Cardiac Cath Lab Activation by Paramedics for Patients with STEMI on Prehospital 12 Lead ECGs. Tom B from The Prehospital 12-Lead blog, and contributing author to Paramedicine 101 is one of the active participants in the discussion.
Some of the problems discussed:
- Poor quality ECG captures
- Deficiency in knowing when to capture a 12-lead ECG (43% of paramedics in one study did not perform a 12-lead on an active STEMI)
- Deficiency with STEMI recognition (False positives are still far to frequent)
- Poor STEMI alert and transport guidelines
One of the solutions which has a lot of supporting evidence is the transmission of 12-lead ECGs from the field to the receiving PCI facility.
THE POSITIVE PREDICTIVE VALUE OF PARAMEDIC VERSUS EMERGENCY PHYSICIAN INTERPRETATION OF THE PREHOSPITAL 12-LEAD ELECTROCARDIOGRAM
Background. Obtaining a prehospital 12-lead ECG may improve triage and expedite care of patients with acute myocardial infarction (AMI). Whether the ECG should undergo physician review prior to activation of a percutaneous intervention (PCI) team is unclear. Objective. To document the positive predictive value (PPV) of the prehospital 12- lead ECG when interpreted by paramedics versus emergency physicians. Methods. This was a prospective, observational study. In November 2003, our local health care and emergency medical services (EMS) systems implemented a prehospital “cardiac alert” program in which patients suspected of having ST-elevation myocardial infarction (STEMI) based on the prehospital 12-lead ECG were diverted away from receiving facilities without emergent PCI capability and the PCI team was mobilized. For the first year, a cardiac alert was activated by paramedics (Phase I). After the first year, the ECG was transmitted to the ED, with the emergency physician (EP) responsible for activation (Phase II). The PPV for cardiac alerts in Phases I and II were compared by using three different “gold standards”: cardiologist interpretation of the prehospital 12-lead ECG, disposition to emergent PCI, and coronary lesions on angiography or arrest prior to emergent PCI. Results. A total of 110 patients were enrolled (54 in Phase I, 56 in Phase II). Cardiologist confirmation of a STEMI on the prehospital 12-leadEKGwas 42/54 (78%) in Phase I and 54/56 (96%) in Phase II. Disposition to emergent PCI occurred in 38/54 (70%) Phase I patients and 51/56 (91%) Phase II patients. Lesions at catheterization or arrest prior to emergent PCI were observed in 41/54 (69%) of Phase I patients and 50/56 (89%) of Phase II patients. All of these comparisons achieved statistical significance (p less than 0.01) Conclusions. Transmission to the ED for EP interpretation improves the PPV of the prehospital 12-lead ECG for triage and therapeutic decision-making.-PREHOSPITAL EMERGENCY CARE 2007;11:399–402
Okay so a solution I would like to provide, and please provide comments here and/or on the dialog page linked to above.
My solution is to provide an adjunct course. Much like ACLS, CPR, PALS or BTLS, this course could be taught in conjunction with the paramedic curriculum but will expire and renewals would be required. The current paramedic curriculum does not include enough instruction on prehospital 12-lead ECG interpretation. My proposed course would include a whole lot more information as well as STE-Mimic recognition. Why not? In my experience, I have noticed that the biggest deficiencies that paramedics present are airway, medication administration, and cardiac rhythm interpretation--especially 12-lead ECG interpretation.
So what do you think?
Provide your thoughts or your solutions to narrowing the EMS to repurfusion times.
Nurses Week 2010
Starting tomorrow, May 6th, it's nurses week. I would like to take this chance to thank all nurses. Especially that special breed, we all know as emergency nurses. We may not always see eye to eye, but we do understand each other. Thank you for quickly taking that belligerent drunk from me the other night. Thank you for treating that old lady nicely after I built such a great relationship with her. Also, thanks for the soda and cookies. We aren't so different you and I, and I would like to say Thank You. Have a great Nurses Week.
Grand Rounds - 1
Paramedicine 101's own contributers:
The Prehospital 12-Lead blog
Look at the most recent ECG Tom B has posted over at one of my favorite blogs. If you haven't checked out the prehospital 12-lead blog, you are truly missing out. Do yourself a favor and get involved in the discussions. Tom's blog has become a regular read by many and a great educational resource. I have learned so much from going through his old posts.
Rogue Medic
Now if you don't know who Tim Noonan, the Rogue Medic is, I suspect you haven't been reading EMS blogs for a long time. He is a regular guest on a few EMS podcasts, and a big time contributer to Paramedicine 101. Now he will repost a lot of his educational stuff over here directly from his blog, but there is plenty of good reading over at his blog that can't be found here. He is more known for his controversial posts, but I have to admit, he is usually on the right side of the argument--at least as far as I am concerned. He sides with the side of science. He has helped me advocate evidence-based medicine. He is the research king as far as I am concerned. GO, READ, LEARN, DO.
A Day In The Life Of An Ambulance Driver
I'd be kidding myself to think that you have somehow read my blog and never made it over to Ambulance Driver's site. Kelly Grayson has posted her a time or two, and is a very well known blogger. He is a published author, with his own book, and many articles scattered throughout the EMS literary schmorgasboard. He is a gun owner and a dad. His blog contains some prehospital discussion from time to time, but his unique writing style seems to take on many forms. His blog is extremely entertaining, and it is obvious why he has become so popular. Go and have a laugh courtesy of AD, via me.
The Happy Medic
The Happy Medic is one of Paramedicine 101's newest additions. He is the founder of EMS 2.0 and the American side of Chronicles of EMS, which is a great collection of EMS-talk videos which includes a reality series. The reality series is about a british paramedic's experience riding along with San Francisco FD so far. Next, I believe HM goes to Great Britain to show us the other side of things. I hear they have big plans, and many places to go. Keep an eye on these videos.
Medic999
Paramedicine 101's first international addition Medic999 has become quite popular recently. He is the UK part of Chronicles of EMS, and has been an EMS blogger for some time now. His most recent post is about how a patient can make a liar out of you in front of the nursing staff. I have had this happened to me many times. Ever have a patient point to their lower abdomen when you first ask them where the pain is, than point to their upper abdomen during transport, then point to their chest when the RN in the ER asks them? ERRRR. Go read Medic999's blog, and I will tell you now, it helps to read it with an English accent.
9-Echo-1
Rogue Medic recently made a new addition to Paramedicine 101. I have been a fan of 9-Echo-1's blog for a while now, and I am pleased to have him join us. His most recent post explains quite well, how us paramedic types may seem a bit cold-hearted as a need for survival. People seem to forget what it takes to be an EMT or paramedic. We come home to our families every day after seeing the worst stuff imaginable. Please go read his post, simply titled Survival.
Pink, Warm, & Dry
I’m a Mom to two amazing kids, an EMT, and occasionally I take some pictures. I love to write, laugh, and score swag at EMS conferences. I have a serious Diet Pepsi addiction. I have trauma shears and I’m not afraid to use them. I’m in medic school thanks to my online angels.
No, I didn't just start doing a patient assessment in the middle of this blog post. Pink, Warm, & Dry is the name of Epijunky's blog. Even though I haven't seen her post anything on here just yet, she is listed as a contributer and I bet something will eventually be posted, some day. It takes a lot to run a blog, and we have lives outside the blogosphere and outside of EMS, believe it or not. So there are a few contributers that have not yet contributed. Maybe they are awaiting inspiration. Anyhow, in her most recent post she gets nostalgic, talking about, what seems to have been a pretty busy shift, as a wide-eyed student.
Life Under The Lights
Life Under The Lights is a blog by Paramedicine 101 contributer Ckemtp. Ckemtp is the very man who gave Paramedicine 101 the shout out on A Seat at the Table so how could I not give him a shout out. He is yet another hibernating contributer, but I think he suffers from the dreaded first post jitters that many of us have gone through. Anyhow, he is no stranger to writing good posts. There is so much on his blog to read through and lose yourself in. He has just given an update on The Handover blog carnival and he even gave a Handover fashion set of Grand Rounds himself (Paramedicine 101 was left out, but he made up for it with the previous shout out).
12-Lead ECG Blog - (Cardiology & Electrocardiography Experts)
This blog was started by Jason Winter. I invited Jason to be a contributer to Paramedicine 101 after seeing his very popular ECG Experts facebook page. He has since started his own blog with the help of Tom B, and it has become quite popular as well. I would recommend browsing through some of the cases over there. They are quite interesting. Above is one of the 12-leads that sparked a pretty great discussion that I happened to get involved in. I believe it is not as it appears at first glance. Go check out what I said...
My Variables Only Have 6 Letters
Christopher was an addition courtesy of Tom B. His blog is quite a good one. He is an engineer, and has decided to do what we do FOR FREE. I am thinking of switching things up on him and doing some software engineering for free. Just have to learn how to do it first. Doing what Christopher does for a living seems to give him a different outlook on EMS. He seems to deduce things quite well. His recent post about improving BLS to ALS patient transfers in cardiac arrest is very good. He provides some research and explains it. I hope to see more posts from Christopher, I enjoyed his research on Glucagon.
Thanks to Chronicles...
Tom B pointed out to me that Paramedicine 101 has gotten a shout out on A seat at the table. I am pleased to see that Paramedicine 101 is being read by many and actually used as an educational resource.
I have attached the video that contains the shout out. The discussion is a good one. Can we trust the educational information obtained from the medical blogosphere? The answer, in my opinion, is no. You can't just trust it. Use your own discretion to decide what you can trust. Many of us use references, or links to prove that the information is factual. I also recommend that you fact check anything that seems suspicious. Most of us warn in our disclaimer that you should not act out of your own guidelines based on anything you read on our blogs. Speaking for myself, I just hope to improve upon what you already do. More often than not, the stuff I learn from the blogs that I trust is assessment based.
PLEASE CHIME IN AND LET US KNOW WHAT YOU THINK
Chronicles of EMS - A Seat at the Table (Ep 6) from Thaddeus Setla on Vimeo.
Thanks for stopping by,
Adam Thompson, EMT-P
ps. don't forget to read the new posts below.
EMS 2.0
Passionate members of the EMS community, you are not alone.
I first came across, what is termed EMS 2.0, on Ambulance Driver's blog. It is actually a movement that was initiated by The Happy Medic. The Happy Medic is Justin Schorr a firefighter-paramedic from San Francisco. Unfortunately The Happy Medic's blog has not been a regular read of mine. I am regrettably a creature of habit, and just didn't get addicted to hist stuff--until now. I don't feel as bad since paramedicine 101 is absent from his blogroll as well.
One of my partners asked me if I had been watching the Chronicles of EMS. An EMS webcast that was started by Justin Schorr and Mark Glencorse of Medic999. Mark is a UK paramedic who contacted Justin with the intent of a foreign-exchange work program of sort. They are taking part in witnessing each other work in their own respective EMS systems. They share stories and explain how each system is different and, in some ways, the same.
After watching the first episode of the Chronicles of EMS reality show, which featured these two fellow EMSers, I was hooked. I then watched a few episodes of A seat at the table, which is all about EMS 2.0. I am more than hooked at this point, I want in. As far as I am concerned, there are two types of people in this world of EMS workers--the people that complain about problems, and the people that try and solve problems. I believe EMS 2.0 looks to be a solid start. I hope to inspire the paramedicine 101 readers to head over to these sites and check out this movement on their own.
Link - EMS 2.0
Examples of the videos I spoke of:
Justin, Mike, Thaddeus, I hope it was okay I robbed your site of these videos and the EMS 2.0 logo. I invite you to contact me via paramedicine101@gmail.com. I would love to be involved.
Chronicles of EMS - A Seat at the Table "EMS 2.0 Part 1" from Thaddeus Setla on Vimeo.
Chronicles of EMS - The Reality Series (Season 1 Episode 1) from Thaddeus Setla on Vimeo.
Justin, Mike, Thaddeus, I hope it was okay I robbed your site of these videos and the EMS 2.0 logo. I invite you to contact me via paramedicine101@gmail.com. I would love to be involved.
Thanks for stopping by,
Adam Thompson, EMT-P
One Year Down...
Paramedicine 101 was started by me about one year ago. Initially, I didn't know what would come of it, or what I wanted to come of it. As I browsed many other EMS blogs, I realized I wanted to provide something educational. Information probably not taught in most paramedic schools. Information that a brand new, and a very experienced prehospital provider would both appreciate. Most importantly, I wanted to provide evidence-based information; something funny or opinionated from time to time, as well. I soon realized that I am not the bearer of all this information. I quickly recruited well known, and respected bloggers who I thought might help carry the load, and boy have they. The blog has become a regular read by many, and even though I have been extremely busy with other projects, my cohorts have done a good job providing new posts. There are many contributers, some who post more than others, but all are very appreciated. I also continue to welcome new contributors.
All-in-all, I have to say that I am very pleased with the paramedicine 101 blog. I hope to become as productive as I once was with it shortly. Please, until then, read through the archived posts. There has been a myriad of information covered so far, and much more to come.
Happy Birthday Paramedicine 101
Thanks for stopping by,
Adam Thompson, EMT-P
Professionalism: What We Say
What we say...
by Adam Thompson, EMT-P
I have been reading quite a bit lately, in EMS trade journals, about professionalism in our industry. A couple of the articles have really stuck with me, and made me think. Sometimes in our illustrious profession, we begin to make the motions without even thinking about what we are doing. This may be a result of experience and confidence, and indicates assertiveness. For instance, you respond to a patient complaining of atraumatic chest pain, you ask if they are allergic to aspirin or if they have any bleeding disorders, then you administer the medication. This probably use to take you a bit longer to do, but after doing it so many times, you can do it without even thinking. This development, however, may be a little too disconnecting. What I mean by that, is the relationship between you and your patient.
PATIENTS ARE PEOPLE
Think about your training labs in EMT and paramedic school. How do we first practice our prehospital skills. The use of training mannequins has become almost universal. We shock them, splint them, chest decompress them, crich them, and intubate them. Not once, did we have to introduce ourself to these inanimate objects, or ask for permission to perform procedures on them. There has been advancements, and they even have Sim-men hat even talk back, but they are still a far cry from the real thing.
Now think about running a bad call. An unconscious patient, whether it be as a result from a traumatic event, or cardiac arrest. Do you still treat these patients as if they are mannequins in training lab? I'm sure you're not kicking them to check for arousal, like you may have done to rescue annie, but do you let it set in that you are dealing with a real person? If you're like most of us, probably not. We tend to disconnect ourselves from the reality, and severity of situations like these as a coping mechanism. Psychologically, no one could deal with the storm of emotions that would arise from getting too involved on every call.
The problem with the above method of coping, is that it is only beneficial with a patient that can't comprehend what is going on. With our everyday patients, it is better to treat them like people. I know this sounds pretty basic, but I think it may be overlooked more often than not.
PHRASING IS EVERYTHING
One of the most important phrases to be said on a call is "hello, how are you, what is your name?", a nice follow up to this is "my name is ___ and I am your EMT/paramedic". This simple greeting does so much. Next I would say something like "so what brings us here today" and follow it up with "well I am here with some of the best in the business, and we are going to make sure everything is going to be okay". Is everything going to be okay? Maybe not, and I know what the texts say about false reassurance, but so what? I don't think it has harmed a single person to try and put them at ease. In fact, if you are on scene with someone having the big one, a reduction in stress could result in a reduction of morbidity. While greeting the patient with these phrases, you may want to hold their wrist. You may put them at ease even more, while obtaining a few vital signs (ie. pulse rate, rhythm, & quality, skin condition & temperature).
I don't expect that any of this information is shockingly new to anyone reading this. It may, however awaken at least one reader who has, maybe, let their empathy fade over time. I have to constantly remind myself about this.
OUR PATIENTS ARE IGNORANT
Well, medically-ignorant, not ignorant-ignorant; most of them anyhow. This is extremely important to remember. We know the medical phrases, they don't. We know most medical conditions in more depth than they do. We have seen more people with many more pathologies than they have.
So because of this, what comes out of our mouths is immensely important. It is very possible that they called 911 because they were scared and had no idea what to do. They expect a professional to show up and tell them what to do. When you show up on scene, you are an expert in the opinion of your patient, until you open your mouth. It is your job to keep them thinking you know everything there is to know, even if you don't. If you start out by using a variation of one of the phrases I made mention to above, you are on the right track to keep their confidence.
Don't make your patient's feel dumb. This is something I commonly see, "so you took your insulin and you didn't eat anything?", or "you have a fever, why didn't you try taking Tylenol?", or "if you take anti-inflammatories on an empty stomach, you are going to have belly pain.". Say those phrases with a condescending, patronizing undertone to get the full effect. If you don't want to run needless calls, get a new job. They are inevitable, and allow us a chance to educate, not punish our patients customers. Don't get me wrong, I have my moments of frustration. They easily fade away when I consider the unemployed alternative.
MAKING THE DECISION FOR THEM
We know our patients are medically-ignorant, and that they probably called us out of fear. It is then easy to assume that the decision to go to the hospital for further treatment is most often predicted by what we say and how we say it. I would venture say that over 90% of our patients are going to go to the hospital or refuse transport based on what we tell them. The rest probably didn't call us themselves anyhow.
Don't believe me? Put yourself in the shoes of the patient and think about how you would respond to the following questions:
- So, do you want to go to the hospital for this by ambulance?
- Since I'm not exactly certain there isn't something more serious going on, why don't we go to the hospital and get this checked out to put your mind at ease?
I think it is safe to say that the first question would most likely get you a signature and a wave while the second may get you a transport.
There are a ton of these phrases that we have all learned to use; hopefully in the right way. It is important not to abuse this power that our patients give us. I'm not saying to talk every person you come across into being transported, just be careful to not talk them out of a transport. It is always easier to explain why you did than why you didn't.
MORE FOOD FOR THOUGHT
- Say "your welcome", or "my pleasure"
- Avoid the giggles (laughing on scene may be construed as immaturity)
- Always explain the consequences of refusing transport
- Keep the bystanders (eavesdroppers) in mind when treating the unconscious patient
- Avoid the medical terminology (one of the first lessons taught)
- Use welcoming body language. Open arms, eye-level stance.
- Talk to the less severe patients during transport. I like to ask where they are from or what they did for work, it is easy to bury your face in your PCR and just watch the monitor. Holding a conversation with the patient may clue you into a change in symptomatology such as breathing patterns or neuro-deficits like short-term amnesia.
- Wish the patient well before leaving the hospital. First and last impressions are important.
Merry Christmas 2009
Merry Christmas from Paramedicine 101
Happy holidays to those of other faiths.
Be safe.
Thanks for stopping by,
Adam Thompson, EMT-P
Teachable Moment
At 0615 this morning I responded to a 33 year old female at a gas station, complaining of shortness of breath.
Upon arrival the patient was sitting down inside the business being assessed by FD. She was having a panic attack. Apparently she has had a long night of smoking crack, and drinking. She also had track marks up and down her arms. She stated that she ended up at the gas station after hitching a ride from a truck driver. She took something from the truck driver that was suppose to keep her awake.
I placed the patient in the back of the ambulance after a quick once over. After I made the judgement that she was not in any acute distress, I began my speech.
You have got to get your life together. A normal 33 year old woman does not get herself in these kinds of situations. This is the time, right now, that you need to get help. You are smoking crack, shooting up, hitching rides from truck drivers and taking random pills that they give you. You are dying. Your time is running out. I know you have probably heard this a million times, and it might not mean anything right now. I know this, but I am going to tell you anyways, because I do care, and I am sure someone out there cares too. You are only 33 years old, and you can live a whole different life, but only you can change that. Don't sit around waiting to be saved. Save yourself.
The truth is that this will probably not make any difference. After we offloaded the patient my partner asked me why I bothered wasting my time. I told her that you never know. The patient may be scared from the "medical emergency" and it may hit home. Everyone else that may have talked to her might have been a cop or someone else of authority. Sometimes it takes a medical professional. I know guys that have given up cheeseburgers because of something a doctor said. And cheeseburgers are good, really good. They might not be crack, but close to it.
If I get through to one addict in my career, I consider that a win. Give it a shot on your next call like this. Try to connect with the patient, and relate to their situation. You never know, you may save a life you never know you saved.
Articles on EMSresponder.com
I have recently had my first two articles published. They can be found at EMSresponder.com, the co website for EMS magazine. I chose a couple topics that I have spoken extensively about right here on Paramedicine 101.
WPW article
LQTS article
Go check them out and let me know what you think. Pay no attention to the description of the ECGs in the WPW article. The wrong images were uploaded. This will be fixed shortly.
Thanks for stopping by,
Adam Thompson, EMT-P
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