Is ems worth it?

I was recently asked anonymously if I thought EMS as a career was worth it. I began to think about it. How to answer this question?

The truth of the matter is that the answer will be different for everyone. There will be some bad. Do not expect to get out on time, for example. Other jobs talk about the long hours, EMS relishes in making people get out of work late. You have plans right after a 12 hour shift? Here’s a cardiac arrest 20 minutes out of your area. There’s a concert or event you want to go to, you’re on shift. Accept this and you will be much happier, I still haven’t been able to do this.

There will be boring, regular calls. These can tire you out more than the real ones. Don’t let them get to you.

Sometimes we are not recognized for what we do. Belittled and called drivers. Us in EMS don’t do the job for the glory. At least not those of us who have been in it for a long time.

I have described EMS and a career in EMS like a marriage. Initially you are enraptured and in awe. You love all aspects of the job. You find little things that are annoying but you find them endearing. You’re tired, half lost as you learn the ropes, but you are happy. This is the honeymoon phase. This will end.

Next you start to feel the repetition wearing you down. You start to hate aspects of the job. The drunks, the regulars, the transfers, THE PAY. Some people stall out here. Some stay in this phase and don’t leave it or the field. The honeymoon is over. This is where some burn out. Their drive to learn is gone. They stop believing EMS does much good. They become paycheck medics. Most negative comments (pure negative) come from this group. Some can never get through this stage.

Then some grow past. These medics can see the faults in EMS but have learned to understand them. Like a long marriage you understand there is no perfection. There are things you don’t like but you stand them because you love the field.

There are going to be times you hate EMS and that hate can spill over onto people because of what you are going to see them do to each other. There will be greatness. There will be moments when you can’t see yourself doing anything else.

Is it worth it?

I can answer for myself and in my situation I can answer with a resounding yes. Will it be worth it for you? I think that at the minimum you will learn a lot, the rest you will have to answer for yourself.

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Consequences and repercussions

Funny story that happened a medic. Please, no one attempt to reproduce, you could get into a lot of trouble with the hospital staff.

Close to where I work there is an emergency room where the restrooms can easily be opened from the outside by just sliding the unlock mechanism and pulling the door open, it’s a safety feature for patients. Well one medic went into the restroom after delivering a patient and kept getting pestered by his partner from outside the door. We’ll call the medic inside Pete and the one annoying him Dick.

Dick would keep messing with Pete just outside the restroom door. This annoyed Pete. On the way out Pete triggered the emergency button in the restroom. Dick walked in and sat down to handle his business. Moments later there was a knock on the door, a nurse was asking if everything was alright. She was accompanied by a security guard and a tech. Dick of course didn’t buy it was a nurse, he was sure it was someone from registration Pete had put up for the job.

After a few knocks the nurse asked if he was ok, Dick answered he was in a lot of pain. Not even two seconds later the door was unlocked and open and somewhere, obviously not in my possession, there is a video of this classic moment. In all honesty Dick might have been telling the truth, he sure was straining as the door swung open.

The clean-up

I went to the hospital after one of the other ambulances on shift had just arrived with a pediatric arrest. I didn’t want to go inside, seemed a little overkill, the patient was already on the hospital bed I was sure and there was another unit assisting them. My partner wanted to go in and so I stayed outside the ER.

I saw the ambulance they had transported the patient in had their back doors slightly open and decided to clean up for them a little bit while I waited. Inside I found the usual, boxes of epi, narcan, vials of vasopressin, ET tube wrapping, suction tubing attached to the wall suction, the usual syringes, packs of ky to lubricate the tube as it is placed in the trachea. I saw all of this but I felt what had happened. The male and female paramedics had fought to keep this kid alive, had used narcan as some last ditch effort in case somehow this was an overdose. To breath for someone, to pump their chest in an effort to move blood through their entire body, to face the parents during the moment that will define the rest of their lives. This, all of this is, is not something that is easy to convey.

EMS is truly a job no one can understand until you live it. I can explain to you what I was feeling and thinking as I threw away the remnants of our weapons against death. You can read the words, try to empathize. If you have been in EMS you will know what I am talking about. If you have not there is nothing I can write that can adequately explain it.

They lost the battle. The patient was called in the ER.

The parents come outside and meet with the medics. The father shakes their hand and thanks them for trying, you can almost feel the emotions coursing through his hands. It’s tough to shake the hands of someone you have failed in the most profound of ways. The mother is hugged as she walks away and says, “you have the worst job in the world.”

She’s right you know, in that moment EMS is probably the worst job out there. Some people don’t recover from some deaths. I saw one of the best medics I ever knew leave the field after a bad shift. He said he couldn’t work in a career with so much uncertainty, in a job that showed you the worst of life. As the lady walked away after losing her daughter any words you say will be empty and useless. She can’t know the greatness that EMS can show you. The saves, the lives that are benefited by our work. The compassion that we can show, the ability to lessen someone’s suffering if only for a moment or two.

That medic, on her next shift responded to a female patient in respiratory arrest. They were able to intubate the patient and keep her from coding. The patient was found to be hypotensive and after a bolus she dropped the hammer and started a dopamine drip. The patient was stabilized and is still alive.

We can work in the worst job out there, but because that paramedic still decides to wake up and come in and do her best people are alive today that may not have been. Thank you to her and all of you that continue the struggle, a battle we can never truly win, but damned if we won’t give it a Hell of a fight.

Death of ER co-worker’s family member

This was submitted to me anonymously.

I feel bad every time I see her.

It’s been months since me and my coworkers had to try to save her husband’s life. We did everything we could but he had been dead for too long, whatever it was that killed him did not let him return. I know I tried as hard as I could, became very aggressive in my medication administration, made sure CPR was being done as we carried him down multiple flights of stairs. It was no use and while I think I know she knows we did everything we could, I feel empty in front of her. I can walk into the ER smiling but my smile disappears once I see her. Is it that I met her children and don’t know if they can smile like I can?

STEMI in the field

Submitted.

Excellent STEMI caught in the field.

Story goes the patient had an onset of severe chest pain 15 minutes prior to EMS being activated, tried his nitro but no change. Called EMS and was showing an inferior MI on 12 lead. Since an inferior MI can be affecting the right ventricle a reverse 12 lead was performed and V4 was examined. No elevation noted. Patient treated and transported, both 12 leads transmitted and STEMI alert issued to receiving ER. Patient treated during transport for the MI. Total time from onset of chest pain to patient being in the cath lab: under 40 minutes.

I think, from what I was told, the receiving doctor activated everyone as soon as he saw the 12 lead he received. I’m not trying to say doctors don’t trust the medics when a STEMI alert is issued without the ability to transmit, but it does sound as if the doctor lit a fire under everyone involved to get this patient in and out of his ER as fast as possible.Stemi 1st Stemi 2

Link to article about new fentanyl abuse spreading.

The new street drug to watch: Acetyl fentanyl

Be observant out there you guys, fentanyl seems to be catching on. This story was brought up to me by @itsjasonstark on Tumblr and it can very well be the beginning of a new go to drug in the streets. Fentanyl and Acetyl fentanyl will hit like an opiate but depending on the dosage and the mixture used can be extreme and sudden. I have personally already dealt with a few overdoses involving fentanyl and in one extreme case a teen was ingesting fentanyl patches. As you can imagine the overdose will look like any opiate overdose but narcan could be rendered ineffective depending on the dosage taken. Fentanyl patches will continue to release the drug for long periods of time. In some cases higher doses of narcan can be effective but may only be short acting. In the case of the teen ingesting fentanyl patches he had to be intubated and treatment didn’t bring him back until 24 hours later. 

Futile ICU Care Prevents Other Patients From Getting Treatment

Futile ICU Care Prevents Other Patients From Getting Treatment

 

Great article on the studies that are being carried out which could potentially change the landscape of when care should be given and when it should be withheld due to patient outcome prognosis. It sometimes amazes me that we teach triage everywhere in prehospital care but once the patient is admitted it stops, and as this study shows, sometimes with dire consequences.