Clinicals are still eating my life. I think I'm putting in more hours/week than if I was actually working.
Anyway, reading Rogue Medic's post about HEMS, I got to thinking about a call I ran over the summer or last spring, or sometime like that. Mutual aid to the next county over, I ran with a firefighter driver (ie, the guy is an EMT, but never rides the box, leaving that to lesser mortals such as me), and a woman who has been an EMT before, but let it lapse and doesn't ride much anyway. The call was for a MVC, we were the second ambulance.
If I remember right, there wasn't much damage to either vehicle. Our patients (there were two of them) were in the same car. Both had been out of the car walking around until the cops or firefighters or whoever told them to sit back down. Patient 1 was complaining of knee pain in one knee. Patient 2 was complaining of lower back pain.
So the first thing that irritated me was that while I went over to assess my patients, the other two immediately got out the cot and 2 backboards with all the trimmings. I believe totally in being prepared, but seriously? You just can't tell with car wrecks these days, the way cars fall apart at the littlest hit.
So I assess my patients. Patient 1 was the driver, c/o knee pain in one knee, no loss of consciousness, no neck or back pain, no tenderness (except on the knee). Speed was nothing, as they were stopped at a stoplight and were rear-ended. Patient was wearing a seatbelt, and is now out and about, walking around.
Patient 2 was the front seat passenger, c/o knee pain and lower back pain. No loss of consciousness, no neck pain, lower back pain is lateral to the spine, just above the hips. Patient denies midline spine tenderness. Patient was wearing a seatbelt, was out walking around the scene, and was told to sit back down in the car by a firefighter. Patient bent over to indicate where the leg pain was and did not have any problem moving. The patient has no extremity numbness, and neither patient was suspected of drugs or alcohol.
So my driver brings over the backboards and such, and I mention that I don't think we'll need them. After all, neither patient meets the criteria in our state protocols for the need for C-spine immobilization. He asks what the patients are presenting with, and I tell him. His response is that the hospital will be upset with us for bringing in a back pain patient from a car wreck who isn't on a backboard. He says that the hospital has threatened multiple providers with their license for such things.
I'd like to say I stuck to my guns and didn't backboard the patients, but I caved. I backboarded the passenger and the driver rode in the captain's chair. I don't know the hospitals around here well enough to argue with them. I didn't get a chance to ask them, since as soon as we got there, they took the patient off the backboard (left the collar on), and we left (this hospital doesn't take report from us generally).
I have to say I'm disappointed in myself. I should have stuck up for my patient and not backboarded the passenger, because there really wasn't a need. Per our state protocols, we are to backboard and collar a patient if they have "experienced a traumatic mechanism which couls cause a cervical spine injury and meets ANY of the following": loss of consciousness or history of such, altered mental status or disorientation, distracting injury, midline cervical spine tenderness, EtOH or drug use suspected, focal neurological deficit, or a child less than 8 years of age. I very easily could have argued my case successfully. But I was afraid, and feared for my license. I can say that I hung my head in shame (metaphorically) and rehashed the situation for days afterwards. I am better than that.
I will be better than that in the future.
Sunday, October 3, 2010
Monday, September 20, 2010
Really? That's it?
Papers are eating my brain.
In other news...patient with moderately severe eye injury, to be taken to eye center at Big Fancy Hospital. Patient is in a lot of pain. Hospital says "Vitals are stable. Go ahead and drive the 1-1.5 hours up here." (This is the first WTF, as it pulls a medic unit out of the area for a minimum of 4 hours).
Medic says "Uh, ok. Oh, patient is in a lot of pain. Request permission to give 2mg morphine."
Patient is about 85-90kg. Granted, patient did admit to 'a few drinks' but still....2 mg morphine? For an EYE INJURY???? For a 1.5 hour DRIVE??????
You might as well spray that morphine in the air for all the good it's going to do the patient.
OYE! And I can't say or do a damned thing, as I have my NREMT-I, but cannot get licensed in this state because I am not a member of a dept that has ALS volunteers (a rant for another day).
I was reminded of Rogue Medic's take on pain management in the prehospital (and sometimes hospital) setting (well, one of his takes, at least).
In other news...patient with moderately severe eye injury, to be taken to eye center at Big Fancy Hospital. Patient is in a lot of pain. Hospital says "Vitals are stable. Go ahead and drive the 1-1.5 hours up here." (This is the first WTF, as it pulls a medic unit out of the area for a minimum of 4 hours).
Medic says "Uh, ok. Oh, patient is in a lot of pain. Request permission to give 2mg morphine."
Patient is about 85-90kg. Granted, patient did admit to 'a few drinks' but still....2 mg morphine? For an EYE INJURY???? For a 1.5 hour DRIVE??????
You might as well spray that morphine in the air for all the good it's going to do the patient.
OYE! And I can't say or do a damned thing, as I have my NREMT-I, but cannot get licensed in this state because I am not a member of a dept that has ALS volunteers (a rant for another day).
I was reminded of Rogue Medic's take on pain management in the prehospital (and sometimes hospital) setting (well, one of his takes, at least).
Friday, September 3, 2010
Right then....
First of all, a huge CONGRATS!!!! to Epi on passing her NREMT-P and becoming a full-fledged medic! So proud of you, girl, and I hope to be able to write the same thing next June.
School is back in session. Classes started this past week, though things don't really get rolling for another week or so. This year is all about clinicals and paper writing. All my my actual classes are management-type classes, and thus the paper writing. One class, Senior Seminar, meets 3 times this semester, and is all about case presentations.
This year's exciting clinical roster includes the cardiac cath lab, 2 different ER rotations, peds ER rotation, a turn with Big-Name-Hospital's critical care transport team (either in-house transports or inter-facility, we have yet to find out), a rotation in the OR with anesthesia for intubations, L&D (something that NO ONE is looking forward to), ICU, and perhaps a psych rotation. All this and ambulance too! We are scheduled to do 3 clinicals/wk, which means that we do one 8 or 12 hour clinical on Mon, Wed, and Fri. This is much better than last semester when I struggled to cram in all my clinical time on Fridays, Saturdays and Sundays. And it's a good thing we have our weekends free this semester, cause those papers are going to be a PITA. Luckily, The Man is back in town for the foreseeable future, so I don't have to stress about the dogs. Plus, it's really really nice to actually have him around. We will finally be able to spend a consecutive year together for the first time in 3 years! Clinicals don't actually start till 9/13, so I have next Friday clear as well. Wednesday is ACLS class (we did most of ACLS last semester, so it's really just a refresher).
My volunteer station has been something else. I've gotten maybe 3 or 4 calls over the summer, because while I didn't do much this summer, every day seemed to be busy. When I was at the station, I was The White Cloud. Not just A white cloud...THE WHITE CLOUD. The last few times I've slept in, we haven't turned a wheel. Once I slept in and the medics ran all night, but the BLS truck didn't turn a wheel. I'm helping with training, and found out this week that our training officer was in the hospital with chest pain, and in testing they found multiple masses on her liver. Obviously, this is putting a crimp in training. Next week is no training due to the business meeting, but I'm hoping she's ok and ready to go week after next, cause I don't have the time to take over.
Triathlon training is also going. The last 2 days have been a wash, thanks to some lingering knee pain and a migraine. No clear weight loss, but I suspect that has to do with my poor eating habits (mostly clean eating, but either too much or not enough). I can definitely tell a difference in my bike riding though. Endurance, both muscular and cardiac, is slowly getting better, which is the primary goal of this month's program.
I'd post more interesting stories and tales of the glorified cab, but nothing's been going on. Hopefully once clinicals start, I'll have some good stuff to write about. For now, it's about finishing laundry and heading to the station for a good heavy bag workout and some duty before dinner with friends this evening.
School is back in session. Classes started this past week, though things don't really get rolling for another week or so. This year is all about clinicals and paper writing. All my my actual classes are management-type classes, and thus the paper writing. One class, Senior Seminar, meets 3 times this semester, and is all about case presentations.
This year's exciting clinical roster includes the cardiac cath lab, 2 different ER rotations, peds ER rotation, a turn with Big-Name-Hospital's critical care transport team (either in-house transports or inter-facility, we have yet to find out), a rotation in the OR with anesthesia for intubations, L&D (something that NO ONE is looking forward to), ICU, and perhaps a psych rotation. All this and ambulance too! We are scheduled to do 3 clinicals/wk, which means that we do one 8 or 12 hour clinical on Mon, Wed, and Fri. This is much better than last semester when I struggled to cram in all my clinical time on Fridays, Saturdays and Sundays. And it's a good thing we have our weekends free this semester, cause those papers are going to be a PITA. Luckily, The Man is back in town for the foreseeable future, so I don't have to stress about the dogs. Plus, it's really really nice to actually have him around. We will finally be able to spend a consecutive year together for the first time in 3 years! Clinicals don't actually start till 9/13, so I have next Friday clear as well. Wednesday is ACLS class (we did most of ACLS last semester, so it's really just a refresher).
My volunteer station has been something else. I've gotten maybe 3 or 4 calls over the summer, because while I didn't do much this summer, every day seemed to be busy. When I was at the station, I was The White Cloud. Not just A white cloud...THE WHITE CLOUD. The last few times I've slept in, we haven't turned a wheel. Once I slept in and the medics ran all night, but the BLS truck didn't turn a wheel. I'm helping with training, and found out this week that our training officer was in the hospital with chest pain, and in testing they found multiple masses on her liver. Obviously, this is putting a crimp in training. Next week is no training due to the business meeting, but I'm hoping she's ok and ready to go week after next, cause I don't have the time to take over.
Triathlon training is also going. The last 2 days have been a wash, thanks to some lingering knee pain and a migraine. No clear weight loss, but I suspect that has to do with my poor eating habits (mostly clean eating, but either too much or not enough). I can definitely tell a difference in my bike riding though. Endurance, both muscular and cardiac, is slowly getting better, which is the primary goal of this month's program.
I'd post more interesting stories and tales of the glorified cab, but nothing's been going on. Hopefully once clinicals start, I'll have some good stuff to write about. For now, it's about finishing laundry and heading to the station for a good heavy bag workout and some duty before dinner with friends this evening.
Friday, July 30, 2010
Slow times
Not much has been happening. I am leaving for a 2 week camping trip tonight, and when I get back, I have 2 days before I leave for a 3 day camping bike trip. I'm very excited.
I've been trying to work out more lately. I'm tired of being tired, and I would like to lose weight before my wedding next October. I am short and round, and I'm tired of that shape. My problem is that I often start going to the gym, and in a few weeks, maybe a month or two, I lose my motivation to go. I think the problem is that I have no goal. While it may be sad to say that losing weight and getting in shape and being healthier should be goal enough, it's not.
My fiance loves to run. He ran cross-country in high school and college, and occasionally runs now. He's one of those lucky few that is tall and thin with a high metabolism (though it is starting to slow down). A good friend of ours, who is also working on losing weight, has discovered that he also likes to run, and is training for 5K races. His wife, who hates running, will be entering a body fitness competition next fall (Fall of 2011) at the ripe age of 54.
So I decided I needed a goal. Something to train for. A specific item to work towards, rather than the more nebulous finish line of 'lose 'X' pounds by 'Y' date. I thought back to the activities I like to do. I do like to lift weights, but there is no way I could be ready for any kind of body competition in less than 2 or 3 years. I like to bike ride, and I love to swim (I am a fish). I remembered that in the early days of my pre-teen and teenage years, I would spend the summer in the pool and on my bike, and when I saw my first triathlon on TV. I would swim several laps in the pool, then jump out and hop on my bike and ride around the neighborhood a few times, then drop off my bike and run the same route. So, I decided that next summer I would run a triathlon.
Now, I have no doubt that I will not win. But that really isn't the point. The point is to finish, be in good enough shape that I won't die on the route, and be happy when I finish so that I want to continue. In the future, should I continue, I am sure I will start competing to place, given my competitive nature, but for the first one, I just want to finish.
And before anyone thinks I'm totally off my rocker, triathlons come in various sizes. There is the Ironman, the half-Ironman, Olympic distance, and sprints. The sprints are the shortest ones, consisting of about a half mile swim, a 13 mile or so bike ride, and a 5K run. If I work hard on training, I should be more than ready to do one by next summer.
My one concern is school. This year, I only have classes twice a week, with clinicals the other 3 days. I'm concerned with how the clinicals will affect my training, given that the hospitals do not have workout rooms, nor do some of the fire stations I'm in. Time is another factor, as clinicals don't exactly have time built in to work out. But, it doesn't take long to knock out some push-ups and sit-ups, squats and lunges, and there are always pylometrics to bust your ass some. Nutrition will be a challenge too, but I think that eating properly will almost be easier than working out. I just have to say 'No' when the medics go out to eat.
So that is my plan. I've already started the past 2 weeks, by doing some interval training, circuits, and other fairly intensive workouts. Spinning is now playing a large role, and I am going once a week. I'd like to bump it to twice a week, but my schedule will not allow that once school starts. I have a good beginning cycling program that I will be starting when I am home from all my trips, and I will likely add swimming in the mornings twice a week before classes.
My goal is a sprint triathlon in July next summer. I probably won't be posting too much of my progress here, because I have a workout journal on Livejournal. If you happen to have an account on Livejournal and want to be added, let me know.
Anyway, that's the plan. I have some EMS related posts swirling around in my head, and I will probably work on them during my 3 week of relaxation.
I've been trying to work out more lately. I'm tired of being tired, and I would like to lose weight before my wedding next October. I am short and round, and I'm tired of that shape. My problem is that I often start going to the gym, and in a few weeks, maybe a month or two, I lose my motivation to go. I think the problem is that I have no goal. While it may be sad to say that losing weight and getting in shape and being healthier should be goal enough, it's not.
My fiance loves to run. He ran cross-country in high school and college, and occasionally runs now. He's one of those lucky few that is tall and thin with a high metabolism (though it is starting to slow down). A good friend of ours, who is also working on losing weight, has discovered that he also likes to run, and is training for 5K races. His wife, who hates running, will be entering a body fitness competition next fall (Fall of 2011) at the ripe age of 54.
So I decided I needed a goal. Something to train for. A specific item to work towards, rather than the more nebulous finish line of 'lose 'X' pounds by 'Y' date. I thought back to the activities I like to do. I do like to lift weights, but there is no way I could be ready for any kind of body competition in less than 2 or 3 years. I like to bike ride, and I love to swim (I am a fish). I remembered that in the early days of my pre-teen and teenage years, I would spend the summer in the pool and on my bike, and when I saw my first triathlon on TV. I would swim several laps in the pool, then jump out and hop on my bike and ride around the neighborhood a few times, then drop off my bike and run the same route. So, I decided that next summer I would run a triathlon.
Now, I have no doubt that I will not win. But that really isn't the point. The point is to finish, be in good enough shape that I won't die on the route, and be happy when I finish so that I want to continue. In the future, should I continue, I am sure I will start competing to place, given my competitive nature, but for the first one, I just want to finish.
And before anyone thinks I'm totally off my rocker, triathlons come in various sizes. There is the Ironman, the half-Ironman, Olympic distance, and sprints. The sprints are the shortest ones, consisting of about a half mile swim, a 13 mile or so bike ride, and a 5K run. If I work hard on training, I should be more than ready to do one by next summer.
My one concern is school. This year, I only have classes twice a week, with clinicals the other 3 days. I'm concerned with how the clinicals will affect my training, given that the hospitals do not have workout rooms, nor do some of the fire stations I'm in. Time is another factor, as clinicals don't exactly have time built in to work out. But, it doesn't take long to knock out some push-ups and sit-ups, squats and lunges, and there are always pylometrics to bust your ass some. Nutrition will be a challenge too, but I think that eating properly will almost be easier than working out. I just have to say 'No' when the medics go out to eat.
So that is my plan. I've already started the past 2 weeks, by doing some interval training, circuits, and other fairly intensive workouts. Spinning is now playing a large role, and I am going once a week. I'd like to bump it to twice a week, but my schedule will not allow that once school starts. I have a good beginning cycling program that I will be starting when I am home from all my trips, and I will likely add swimming in the mornings twice a week before classes.
My goal is a sprint triathlon in July next summer. I probably won't be posting too much of my progress here, because I have a workout journal on Livejournal. If you happen to have an account on Livejournal and want to be added, let me know.
Anyway, that's the plan. I have some EMS related posts swirling around in my head, and I will probably work on them during my 3 week of relaxation.
Monday, July 12, 2010
Wednesday, June 30, 2010
At least there's catchy music...
Having been reminded that the state protocol updates take effect tomorrow, I realized that I really should waste 30 minutes of my life and view the 'update rollout videos' before I'm taking off riding status. I suppose I should be grateful that they've put it up online so we don't have to go through classes face to face, wasting a whole day.
New in this year's update for BLS providers is the permission to give more than one tube of oral glucose to a diabetic patient who does not respond to the initial tube of glucose (prior, we had to call medical command to give a second tube of glucose), and the clarification that a medical director can allow BLS providers to use glucometers, rather than having the family do it, or wait for an ALS provider to get on scene (thankfully, the medical director for the region I'm in currently has faith that his BLS providers are intelligent enough to use a glucometer). Also new is the removal of the option of intubation for patients with an EMS DNR-A. The belief of The Powers That Be is that this will cause a swing in the number of DNR-B patients to DNR-A patients, as many patients only selected DNR-B because of the intubation issue. My personal belief is that it'll only make a difference to patients who aren't in nursing homes (most of whom do not have DNR's anyway), as those in nursing homes won't get the appropriate information to make the change. Not that it matters anyway...in my experience, ALS turfs all DNR patients to BLS, regardless of the level of DNR, and the hospitals generally disregard the EMS DNR's, and do everything short of intubation and CPR anyway.
Continuing the state's obsession with helicopters, this year's protocol update also included a review of the medevac protocol, with a couple of updates on just who is allowed to fly (though the little provision at the end of the 'trauma decision tree' that states 'paramedic discretion' is used as a catch-all). We were also treated to a safety discussion on creating landing zones and where it is dangerous around the helicopter.
But the most interesting change in the protocols is that BLS units now carry acetominophen, and can administer it to patients for pain control only. Which gives me a huge WTF, personally. While I would like to say "Who the hell doesn't have tylenol in their house?" experience has taught me better. What I will say, is that if tylenol is sufficient to control your pain before I get you to a hospital, did you really need 911? And if you have tylenol in your house, do you really need someone else to tell you to take it? And if your pain is sufficient that you called 911, you should require a paramedic with morphine.
And yes, I know all the arguments about 'they don't know it's not an emergency' and all that, so please, save me your speeches. I know common sense is not so common, but I am really starting to believe that there should be a class in high school on what constitutes an emergency.
*sigh* No wonder I feel as if I am constantly surrounded by the dregs of EMS. Don't get me wrong, there are spectacular people that I've worked with and that I've attempted to model myself after. But when we continue to dumb down our protocols so that we are covering every little tiny issue that may happen, we are removing the ability of the providers to exercise their brains, and making sure that all we really do have are ambulance drivers, not EMT's and paramedics.
At least the protocol rollout has catchy music...
New in this year's update for BLS providers is the permission to give more than one tube of oral glucose to a diabetic patient who does not respond to the initial tube of glucose (prior, we had to call medical command to give a second tube of glucose), and the clarification that a medical director can allow BLS providers to use glucometers, rather than having the family do it, or wait for an ALS provider to get on scene (thankfully, the medical director for the region I'm in currently has faith that his BLS providers are intelligent enough to use a glucometer). Also new is the removal of the option of intubation for patients with an EMS DNR-A. The belief of The Powers That Be is that this will cause a swing in the number of DNR-B patients to DNR-A patients, as many patients only selected DNR-B because of the intubation issue. My personal belief is that it'll only make a difference to patients who aren't in nursing homes (most of whom do not have DNR's anyway), as those in nursing homes won't get the appropriate information to make the change. Not that it matters anyway...in my experience, ALS turfs all DNR patients to BLS, regardless of the level of DNR, and the hospitals generally disregard the EMS DNR's, and do everything short of intubation and CPR anyway.
Continuing the state's obsession with helicopters, this year's protocol update also included a review of the medevac protocol, with a couple of updates on just who is allowed to fly (though the little provision at the end of the 'trauma decision tree' that states 'paramedic discretion' is used as a catch-all). We were also treated to a safety discussion on creating landing zones and where it is dangerous around the helicopter.
But the most interesting change in the protocols is that BLS units now carry acetominophen, and can administer it to patients for pain control only. Which gives me a huge WTF, personally. While I would like to say "Who the hell doesn't have tylenol in their house?" experience has taught me better. What I will say, is that if tylenol is sufficient to control your pain before I get you to a hospital, did you really need 911? And if you have tylenol in your house, do you really need someone else to tell you to take it? And if your pain is sufficient that you called 911, you should require a paramedic with morphine.
And yes, I know all the arguments about 'they don't know it's not an emergency' and all that, so please, save me your speeches. I know common sense is not so common, but I am really starting to believe that there should be a class in high school on what constitutes an emergency.
*sigh* No wonder I feel as if I am constantly surrounded by the dregs of EMS. Don't get me wrong, there are spectacular people that I've worked with and that I've attempted to model myself after. But when we continue to dumb down our protocols so that we are covering every little tiny issue that may happen, we are removing the ability of the providers to exercise their brains, and making sure that all we really do have are ambulance drivers, not EMT's and paramedics.
At least the protocol rollout has catchy music...
Wednesday, May 26, 2010
PASS!!!
I am officially an NREMT-I!!!
Now I don't have to worry about it till next year with the NREMT-P test.
By the way, what the heck is with the security for the written test? ID, fingerprint, palm print, photo, signature. Can't take anything into the test area with you, not even chapstick. What the hell? How is my chapstick a security concern? I mean, really? I know that they administer tests for people other than NREMT, but is there really a need for all this? I thought they were going to ask for a DNA sample next!
Now I don't have to worry about it till next year with the NREMT-P test.
By the way, what the heck is with the security for the written test? ID, fingerprint, palm print, photo, signature. Can't take anything into the test area with you, not even chapstick. What the hell? How is my chapstick a security concern? I mean, really? I know that they administer tests for people other than NREMT, but is there really a need for all this? I thought they were going to ask for a DNA sample next!
Subscribe to:
Posts (Atom)
