Thursday, February 15, 2007

A plethora of information for the new E.M.T.

A plethora of information for the new E.M.T.


Contained here is the vast accumulated wealth of stuff they don't teach you in EMT class. You always seem to hear that "It's a little different on the streets than it is in the classroom." Well, that's like saying a 7.5 earthquake is a little different that a train passing by. Here are some jewels of wisdom I've gotten from my own experience, those of my co-workers and that sent in to me via e-mail from around the world. Also, if you'd like to send me one of yours, I'd be happy to put it up here. Just e-mail me at medicman@bellsouth.net.
Getting Started
Your first day on the job is going to be a stressful one. You're all gung ho, and come in to your new job with your crisp, brand-new uniform, your duty belt bulging with gear, some of which your not really sure what it's for. Of course everyone will notice all your scissors, shears, hemostats, window punch, oxygen key, flashlight, tourniquet, multi-function tool, buck knife, beeper, glove keeper and fanny pack and you will immediately become self-conscious. Especially when you go to sign out your equipment and realize that while squeezing all that other stuff onto your belt, you forgot to bring a pen. Don't worry, happens to all of us.
When you go to load your equipment, you'll realize that you have no idea where all your stuff is supposed to go. You also won't know where all the stuff you learned about is, such as non-rebreathers, 4x4's, kerlix or spineboards. You'll find it eventually. Expect to feel that you've just spent hundreds of dollars and months of your life to learn this stuff, and you have no idea what's going on.
Your first partner will be the crustiest, most burnt-out paramedic in the company who you'll find out was on the scene when Cain killed Abel. He'll have had a bad night with no sleep, and is even more grouchy to find out that he has to orient the "FNG". Since no one will tell you what FNG means, it means the F*****g New Guy. Don't worry, it happened to everybody.

Your First Day
Of course, your first inclination will be to turn on your radio, in case the city has been blown up and you're called upon to rescue it. Don't worry, it hasn't. When you first listen to the radio, more likely than not it will be a Babel of numbers and obscure codes. "10-4, 10-97, mileage 4286..." and so on. "Whoa, we never went over this in class!", you think to yourself. Welcome to the streets. It'll take a few days to figure out what all those codes mean, but eventually you'll find them sneaking into your personal life as you tell your wife "Ten-four" or, when asking someone to repeat themselves , you tell them to "Ten-nine".
Well, let's say you've mastered the codes ( or you will eventually ), and you get your first call. Dispatch calls your radio number and you anticipate your first emergency. Will it be a shooting? A train wreck? An airplane crash? Maybe a cardiac arrest? Let's listen...
"Unit 12, respond to 1234 Main St. on a medical emergency, 101-year-old female complaining of generalized weakness."
"Hmm", you think, "I wonder what this could be. You'd think that a 101 year old would be expected to be a little weak, wouldn't you? Well, I guess I'll find out."
So you respond with your lights blazing and your sirens blasting to the location. You leap from the unit and begin choking! What's wrong?! Oh yeah, oops... better unfasten the seat belt. That's better. You leap again from the unit (more carefully this time), grab every bit of gear you can carry, including the OB kit, and race into the house. You locate the patient who is lying in a hospital bed with a tube running from her belly to a bag filled with what looks like a milkshake. The patient's eyes are closed, but she is making strange groaning noises. Her limbs are twisted in the most bizarre angles that you think she's been dragged a few miles behind a truck. She seems about to die any minute, you think. Yet oddly, your partner seems quite unconcerned about the whole thing. Your partner is over there writing down information, copying names of medicines (all eighty-six of them) and seems unperturbed at your vital signs findings - pulse 120, pressure 70/50, respirations 30... aren't those consistent with shock? Isn't this an emergency? Finally you load the patient on the stretcher and take her to the hospital. The ER staff also seems mysteriously unconcerned. Why?
Well, before you get too outraged at everyone's callousness, let's think about this a bit. The patient is a HUNDRED AND ONE years old! Of course she's a little weak! No you don't need every bit of gear on your ambulance every time you respond to a little old lady who's a bit under the weather. That tube in her belly is a feeding tube. Lot's of bedridden people have them. In fact, people call ambulances a lot to bring patients to the doctor or ER to have them changed. The milkshake stuff is liquid food. It's gross, try not to fool with it. And don't worry about her twisted limbs, it's called contractures, it happens when people lie in bed for months or years at a time. Just don't try to straighten them or you will have an emergency on your hands. As for her vital signs, yes she's sick, but obviously she's been this way for a LONG time. Don't get all worked up over it. Just take her to the hospital and get it over with.
Well, how did you like your first call? Not too exciting was it? I have news or you - most EMS calls are like that. You study and prepare and practice for those major adrenaline-rush scenarios with critically injured patients where with your every move the patient's life hangs in the balance, but to be honest, it's just not like that all the time. In fact, those dull, little old lady calls are the order of the day most of the time.

Some hints
You will eventually get used to what equipment will be needed on what scenes. If you have to go up an elevator and it will take a while to get between your patient and your unit, bring all your resuscitative equipment. This will prevent your patient from being in cardiac arrest. Believe me, dragging all that gear up and down is much better than going up with only a stretcher and finding an arrested patient. If you don't bring it, I promise you you will need it.
If you run out of straps for a spineboard, tear some sheets up into strips about three inches wide and use those to secure your patients. Torn sheets also work well for restraints.
Speaking of restraining a patient, when you're trying to transport a psychiatric emergency, don't give them a choice of whether or not to go. Don't say "Why don't you let us take you to the hospital?". Tell them "Sit on my stretcher." If they really get out the box and you need to restrain someone who is violent, try and get some gung-ho cops to help you if they're there. Otherwise you'll have to do it yourself. My favorite method of holding a violent patient down is a knee on the side of the face at the head of the stretcher. That way I can hold down the head & chest with my knee and hold the patient's wrists with my hands while my partner gets the legs restrained. Some prefer to apply upward pressure with both thumbs just beneath and inward to both temporomandibular joints. This an effective control mechanism. Of course if it is not practical to get into such close proximity, then an oxygen cylinder or heavy flashlight, properly applied, can have just as satisfactory results. After all, they are going to the hospital anyway. It is also helpful to secure on arm above the head and the other to the side. That way the patient can't launch his head your way and take a bite out of your anatomy. If he spits, a facemask or sheet over the head will solve the problem.
You will find that three-inch tape solves a multitude of problems. I have seen it used to hold the siren emitter onto a unit, to hold wiring and hoses in place on an engine, to keep a broken stretcher together, to write notes on, to hold broken cabinets closed, to secure patients, to make cup holders, and even to fashion a crude oxygen regulator. As long as problems arise, the list of uses for tape will continue to grow.
No matter how slow a day it has been, you will get a call just as you try to get something to eat or sit down on the toilet.
Don't leave food around in your ambulance. Patients bring in roaches with the crust that's accumulated on their unwashed bodies and the roaches will set up house in your ambulance if they find food.
KY jelly, defibrillator gel and nitro paste (if your really nervy) stuck under door handles on the unit make great practical jokes. Just don't do it to your partner, you have to work with him.
Turning on all the lights, sirens, radio, windshield wipers, etc., while a coworker's unit is turned off so that they all come on when he starts up his unit is another good one.
Don't abuse places that offer you free drinks or food.
Tell your dispatchers what they want to hear and everyone will be happy.
If you get in trouble with your boss, don't try to justify yourself, even if you're right. Just say "You're right, I'm sorry, it'll never happen again."
Put seizure patients in your ambulance while they're still postictal and can't fight.
If a seizure patient is combative and really needs to go to the hospital, shine your penlight in their eyes a few times. This will often make them have another seizure, during which time you can place them on your stretcher and go en route to the hospital.
The more patients screech and holler that they're hurt, the less hurt they actually are.
Adapt, improvise and overcome.
I don't advise going on murder scenes without the police, but if you in yourself in that situation and it's safe, then it can be really cool.


** LANCE'S LAW OF EMS TRANSPORT **
- Don't waste your precious time trying to convince the public of why they are abusing
911 by calling an ambulance for this B.S. problem - you may as well be talking to your
O2 cylinder.
- Corollary #1: Your blood pressure is directly proportional to the amount of
hot air you waste trying to convince them of why they shouldn't have called 911.
- Corollary #2: Whenever you say "There's a city full of dying people who need
this ambulance more than you," take a listen to the other calls coming out on your radio
(weaknesses, seizures, drunks who fell, babies with fever, etc.) and realize the
alternative is no better.
- Corollary #3: If you haul *** on a scene to get a refusal so you can jump a
good call nearby (like a shooting or stabbing) it will be unfounded because they
probably went to the hospital in a car anyway.
- Corollary #4: If you accept that you are nothing more than a cab driver with
a siren and 90% of your patients expect nothing more from you than a ride you will be
well on your way to erasing job stress.

- Corollary #5: It's that 10% of the time where you must step up, perform
flawlessly, and save a life that keeps you coming back day after day.
- Corollary #6: When in doubt, transport.
(In case you didn't notice, my friend Lance is a little cynical.)

Well, that's about all for now. I'm sure I'll think up more.

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