Archive for August, 2015

Why I became an EMT

I was recently asked why I became an EMT.

In reality I did not know how many people are in business trying to keep other people alive. I got to see first hand what EMS can be, my younger brother had asthma and on more than one occasion I saw how close he was to not being able to breath. I was there when, I assume now but did not know then, my brother was given Epi as multiple nebulizers were failing. The paramedics and emergency personnel were able to deal calmly and efficiently with what was a horrifying event for me and my family. How can someone be so calm in such a hectic situation?

Now I know that inside the medics were probably not very calm. I have been through emergency calls where children are basically gasping during particularly severe asthma attacks. I’m also telling them to stay calm, the oxygen is coming, the medicine is working, their lungs are opening. I know how panicking can send the patient into a worse path and so have to fake my confidence when the medicines are not working as quickly as I would like.

I remember thinking that as the medical personnel arrived our emergency was done. They were here to help. Sometimes I can save someone, anaphylaxis, hypoglycemia, drug overdoses, CVA’s where the people think it’s something completely different. We can slow the situation down enough to provide care and move them to a better, more definitive care location. Sometimes all we can do is tell someone how sorry we are that their loved one has passed away and try to console them as best we can.

Sometimes that’s enough. To try. That’s what led me to EMS, to be the person that tries right at the beginning. So far for me it has been a worthwhile endeavor.

Weekly Link Post 8/15/15

I’m a little late on posting this weeks links for interesting articles I’ve read, but if you’re off of work this can be an excellent opportunity to read some very good writing. Each of these articles brings with it a very unique take on a subject and they are all worth the few minutes they take to read. Hope you enjoy.

EMSWorld – Busting Trauma Myths

We all know some of these trauma myths, we all may have followed them at one point or another. Some of us still have to follow them due to protocol. This is a great article with tons of references for those wanting to delve deeper into a specific issue.

Medic Madness – How to not be that medic in 12 easy steps

Humorous but very honest and completely true. I find it hard to stomach that probably “that medic” is the only one that won’t be reading this post.

USA Today – Cities put nurse practitioners alongside paramedics

The growing problem of ER congestion for complaints that do not deserve to be there is causing EMS services with hospitals to come up with interesting solutions. This pilot program in Anaheim, California is aimed at reducing these problems and could be a catalyst for other changes around the country.

CNN – How doctors want to die

Zocalo – How Doctors Die

These last two links are on two articles describing how doctors are usually choosing no extraordinary measures in the case of their death. I found both articles very interesting and decided to casually ask around the station what most medics would prefer. I was amazed, though I shouldn’t have been, that most would immediately say DNR. Some would put in the stipulation that if it was a reversible cause that was easily identifiable to go ahead and try to save them, but if it was something like a stroke, heart attack or massive trauma that lead to immediate death then they did not want CPR or intubation done. Some of the reasons were just how vicious CPR is, how resuscitation attempts do involve a lot of trauma on a patient. A different reason that came to light was that there is a slim chance that the body will be saved, but the patient will become completely bedridden. This was very high on the list as to why they would not want to be brought back. The thought of being a permanent patient for the rest of their lives is horrifying.

What are your thoughts? Would you want everything to be done on you to bring you back from the dead? What if you were brought back but were now completely paralyzed and would never be able to move freely again?

I hope you found some of these posts interesting and informative. As always if you have any questions or want to share one of your posts feel free to send me message. Until next time stay safe out there.

A few questions about becoming an EMT I was recently asked

I was recently asked a few questions about becoming an EMT. I’m going to try to answer a few questions as best as I can. If anyone has any further insight feel free to let me know in a comment down below or message me. It can always be helpful.

How intense can EMT education be?
It all depends on the instructors and how much you know about anatomy. I have seen many people jump into an EMT class without much knowledge about human anatomy and physiology and have to learn both things in tandem. You also have to take into account how long the class is. I’ve seen some crash courses that require a lot of dedication in order to finish everything required in such a short time. For the most part I have seen this of some fire systems that require EMT cert for their first responders. That can be pretty rough. It is intense for most people without any healthcare experience because it is a different way of thinking. It’s no longer, call for help this is a horrible situation, you are the help. Anything that can happen to someone in a medical or traumatic way you have to be ready to at least help in. So I would say to question 2:

What, if any, other schooling should I look into before or after?
Anatomy and physiology. Those can be extremely helpful. Any classes dealing with health and the human body would be helpful. Knowing what some of the physiological responses our body has and what methods it uses will become very handy when your learning to treat someone. Yes they will go over most of it in class but if you already have a solid base it will make it that much more fluid a transition.

Another thing I would have done before going into Ems would have been to go out and buy a recent EMT or paramedic textbook. Recent doesn’t have to be the newest and biggest EMT textbook. Just something that isn’t 30 years old. Read it and study up on what you don’t know. It’s ok if you don’t know everything or understand it, a lot of things as I’ve said before are very weird to grasp initially. Protocol, acronyms we use, different steps we have to remember even in the worst of situations. If you keep it up it will start to make sense and then when the class comes around you will definitely have an edge to understanding.

There seems to be a lot of variances in tuition costs and program length, is there specific regulations/accreditations I should look for?
Yes there is a huge variance in the types of education programs available for becoming an EMT or paramedic. I would say definitely research where you are thinking of going. Ask around for what others have thought of the program and problems that may have come up. The main thing you want to make sure of is that the program will give you the ability to test for the NREMT. (That’s for here in America) As long as that is allowed you will be able to become a nationally certified provider and then get state certified where necessary most likely through reciprocity.

I hope some of this helped you. If you need anything else or have further questions feel free to let us know.

Weekly Link Post 8/6/15

I read a lot of blogs and posts about EMS. Many times I store the information on my computer and many times I don’t publish it because the post just gets too long, sometimes it just doesn’t get done. I’m hoping to remedy some of this by posting once per week about good articles, information or blogs that I see and take notice in. I will add a quick little description about what the articles are about with the hope that you can go and check them out on your own. If anyone has any articles or blog posts that you think would be good for us to read feel free to send us an email and let us know. I’m always eager to read good quality content.

Medic Madness – Why Paramedics are Going to Lose Intubation:

I wrote a little bit about this in my post about intubations, this is still a great read. Explains some of the major pitfalls that are still active in EMS education. Take a read and understand that it is truth he is saying, no matter how much I wish he wasn’t.

EMS1.com – EMT refused to respond; I can’t find a reason to withhold judgement:

The story has dominated a lot of social media. A medic is being sent to help in a pediatric cardiac arrest in a first response vehicle as an ambulance is sent from a longer distance away. The medic not only refuses to respond at that time, but never even arrives.

WHNT.com – New pilot program will increase the number of paramedics statewide:

Paramedic shortages are not new, new program is putting students done with their general education requirements into a straight to paramedic program. The first year is about to begin and I’m sure many are waiting to see what the outcome will be.

The Morning Call – Man overdosing on synthetic marijuana knocks out paramedic with kick:

Paramedic knocked out as overdose patient becomes combative. Synthetic marijuana is blamed and the problem is growing.

INDYSTAR – Paramedic fired for her diabetes wins disability discrimination suit:

I have been asked about this in the past. Does a disease such as diabetes prevent you from working in EMS? Recent court ruling would point to a resounding no. It wasn’t just that the medic was fired, but that the medical director had clear directions on how to proceed and what steps needed to be taken to allow the medic to work and were ignored.

Hope you enjoy some of these and remember to let me know if you have any articles or posts you have enjoyed. They can be recent or just very well written pieces you would like to share. Until then stay safe out there.

On intubations

The skill of intubations for first responders has been a controversial issue since pretty much it’s inception. I recently came upon an article that had many good points to it. The article did mention that it is their opinion that if certain things are not done soon EMS could face intubations being done away with for most.

Here’s the link to that post:

http://medicmadness.com/2014/08/paramedics-going-lose-intubation/

I’m going to say that I agree with a lot of what this post has to say. It is definitely a good read and everyone in EMS should check it out. The author of the article correctly points out some deficiencies in training that most paramedics suffer when it comes to intubations. Not only training before your a paramedic and going through school, but also after a paramedic gets licensure and begins working. I have a few items I would consider highly important to all EMS agencies and should be implemented as soon as humanly possible to mitigate litigation as well as assure patent airways for all our patients.

1. Its true intubation is a skill learned with a lot of time and you need many successful intubations to become proficient. Ongoing training should include mandatory quarterly checks on intubations in all age ranges and emphasis placed on proper technique. I sincerely believe that I was not adequate at intubations until at least 5 years into EMS. That will diminish if you don’t intubate regularly, that’s just a fact. You might be able to jump on a bike and know how to ride it after years of not riding a bike, but you will not be as good as someone who rides it all the time.

2. In line ETCO2 should be an absolute criteria for agencies that have the ability to RSI. Furthermore it should be implemented in all agencies where intubations are permitted. There is no better criteria for assuring an intubation has been done correctly. Yes, visualization of the vocal chords and watching your tube pass through the vocal chords is great and should be the top priority for the person inbutating, but that is only beneficial to one person. No one else will be able to testify that they also witnessed it. We need checks that everyone can see and since we don’t have the ability to shoot a chest X-ray in the field we should all be proficient in end tidal CO2 reading. Everyone should be shown how not only to establish in-line CO2 monitoring on their monitor but also how to activate waveform monitoring. Not all monitors do this automatically.

3. Reporting on out of hospital intubations should be better maintained and on a national level. We really don’t know how many intubations are being done correctly and how many are being missed. There is no definite guidelines on how to maintain records. In Texas, for example, agencies are supposed to maintain all PCRs for a period no less than 5 years. There is not a clear database for patient information, however, and most studies are done in select cities many times not even accurately describing all the systems in those cities. The same goes for those that are advocating against out of hospital intubations or attempting to advocate to keep intubations on our trucks. Both groups have very limited data and statistics. Local systems in our area have computer databases for this information but the systems don’t talk to each other in this aspect. (I am currently waiting for some definitive statistics about intubations from these companies.)

A major hurdle comes not only from EMS companies and what they think is cost effective or good for business but also from each of us in the field. I see it all the time when medics don’t push themselves to learn better techniques. This doesn’t just stop with EMS, I’ve seen personally some doctors that don’t practice and then fail in intubations that are vital for the patient. All I can say is don’t be that medic, don’t be that healthcare provider. Don’t be the one that leads us away from being respected with our skills. If something happens and you are not able to establish that airway know your alternatives and learn from that experience. I completely agree with the writer above that says nothing but constant practice and real world experience will get you to the competency level we should all be at.

If anyone has any further suggestions feel free to let us know. We would love to hear your thought on intubations and what could help guarantee patent airways for all our patients. Thank you for all you do out there and stay safe.