Posts Tagged ‘ emergency ’

To stay and grow or change and evolve?

I want to tell you all how much I appreciate each and every one of you. I consider our interactions here a conversation that I hope will continue for many years to come. 

I have not been as active on both Tumblr and my WordPress pages recently. I have been debating with myself. I want to start my podcast and have been researching just how I should go about doing it. It is a lot more involved than I initially knew. I have now come to a very serious question and I need everyone’s input. Please feel free to comment below, email me to ouremssite@gmail.com or private message me. 

My question is this: Should I continue OurEMSsite or should I rebrand the whole thing and begin fresh?

My goals have not changed:

1. To provide support for EMS providers everywhere.

2. To advocate for EMS providers and EMS as a career. 

3. To educate the public about EMS.

4. To grow EMS from within. To make it better.

Unfortunately I see a limit to where Ouremssite can go. Will the brand be accepted at a state level? On a lobbying board or helping local elected officials when they are pushing for legislation? That is what I don’t know and I think I need to know this before I begin the next stage of my journey. 

Any information, feedback, both good and bad is welcome.

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.

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. 

Final Destination?

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Improving EMS Part 1

I’ve said it before, and I’m probably going to say it again many times before my career with EMS is done, we are a young field in the grand scheme of things. I believe some mistakes were made at the inception of EMS and now we are having growing pains.

The first thing I’m going to talk about is education.

We do more on a full arrest than nurses with 4 year diplomas. I’m serious, depending on the service, you can do intraosseous establishment, intubation, ventilator use (something that requires a respiratory tech in most ERs), rhythm interpretation and appropriate treatment. Some systems have the ability to do rapid sequence intubation, tracheostomy, needle decompressions, and very potent narcotic use. Yet we are still not considered a profession.

I have been studying some online classes for my RN degree and have learned something. At the very inception of nurses there were groups of people that were thinking of the future. They were planning and they understood what was going to be needed for future growth as a profession.

Where EMS grew out of direct profit and has for a long time been considered a step child to the fire department, nurses were developing guidelines to establish bare minimums. Some of their guidelines included:

  1. The minimum education required for a technical nurse was a 2 year degree. Associates. This was developed for registered nurses and could be considered the foot soldiers of nursing. They can do the technical aspects of patient care and even supervise others in patient care.
  2. The minimum education required for professional nurse a 4 year degree. Baccalaureate. They can climb the ladder in different facilities and can take more managerial positions.

Now I’m not saying this would instantly benefit all involved in EMS, I’m not even saying that it wouldn’t hurt some systems that have horrible paramedic retention. I am saying that we cannot be a 2 day a week class for 9 months field anymore. We can’t be certificate paramedics. We need to provide routes for currently certified individuals to become nationally certified. We need to guide new students in learning that this field should entail a lifetime of education. We are not fire fighters, we are not police officers. We are EMS and we have the potential to do things medically to people that have far reaching and long standing consequences.

I believe that this is a first step in vastly improving our career. I will be posting other steps I believe will help EMS continue to grow and develop into the profession I believe it can be. Now before you completely disagree with me please take a moment and think, could more requirements in education really hurt?

Any thoughts? Send them to me below or visit my twitter account @ouremssite. I am eager to hear what some of you think.

Anaphylaxis

Here's a story:

Me and my partner get sent out for an emergency, chief complaint: sore throat. Now for the most part I am pretty good with dumb calls, I don't like them and do think they are a tax on our system, but until laws change we have to deal with them. My partner is another matter, he is quick to point something like this out to the patient, doesn't usually have any effect other than making a patient upset at him but I guess it gives him some satisfaction.

As we approach the scene we see a female patient walking towards the unit and looking panicked. Hives present on her face, neck and chest, that sore throat is actually anaphylaxis. The patient is a 50 year old female with no past medical history, no known allergies, no current medications. In fact when I try to explain an allergic reaction to her it seems she has never heard of it.

We begin treatment and start taking some quick vitals and place patient on an ECG monitor. This turned out to be a very necessary step. I know for my system it is standard practice to place any patient on ECG monitoring whenever any medication is being administered. I also know of many systems that run in BLS or intermediate systems that will administer benadryl and use the Epi pen without cardiac monitoring.

We administered benadryl and oxygen. As we administer epi at 0.3 mg the patient initially reacts as expected, she goes a little tachycardic, she says she can feel the medicine working and it makes her feel anxious. What surprised us was when the patient goes into a run of ventricular tachycardia followed by bigeminy pvcs. It was self limiting and as I took a 12 lead of the patient all ectopy was gone.

 

As we entered the ER the nursing staff put us into a cardiac room and immediately ordered blood work looking for cardiac markers.

Why?

Was it because of the run of ventricular tachycardia? Of course, but why?

Fact of the matter is the patient has just failed a stress test. We, I always say we in my unit, saved this patient not only from the anaphylaxis but we may have also clued her in to a cardiac condition that could have led dormant until it became lethal. This is one of the reasons we should always be monitoring ECG when administering any medications.

Now this I print with a big emphasis towards paramedics. Obviously if you are running a BLS unit or with just an intermediate you should treat anaphylaxis as per your protocol. Epi and benadryl should never be withheld on the basis of no ECG monitor available. I am a big advocate of quick and effective treatment for anaphylaxis as I have seen some patients deteriorate rapidly. As paramedics we should use all of our tools at our disposal, cutting corners on patient care should not become part of our protocol just because we can get away with it.

I added a few pictures of bigeminy pvc's I found online, I do not own the rights to them.

Combat Medic, true story.