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My partner and I were talking about this the other night. One of the BLS guys at our station is going to medic school. He's a pretty good, but not terribly experienced, BLS crew member. Solid BLS skills, and communicates well with us.
Or he did. As I commented the other night, paramedic school has ruined a lot of good EMTs. Sadly, this guy seems to be heading down that road. Not to worry, I have my rolled up copy of JEMS ready to smack him on the snout and put him back on the path of righteousness.
I'm going to re-read your post to see if you left me any material. If so, I'll still link back to yours since it's so good.
Looked around the web... can't find a copy of the book, but I found a few articles.
http://www.fireengineering.com/display_article/118329/25/none/none/Feat/The-Missing-Protocol:-Writing-A-Legally-Defensible-Report
http://publicsafety.com/article/article.jsp?id=2378&siteSection=11
http://emsresponder.com/print/EMS-Magazine/Motivation-for-Documentation/1$1992
I found an e-mail address and have written asking for information on ordering the book- will come back here and post if I get an answer.
15 minutes of "wait and see" is seldom harmful to a patient, provided good BLS is provided from on scene to destination. I promise you that I will work hard to never forget that when I get my fancy patch.
And I'm with Medic7. I have a feeling I'll be revisiting this post more than a few times over the next 12 months.
I must say, you have said it well. I have been thinking a lot about many of the things you have mentioned. I think some big changes are coming for me soon. I am struggling to understand and to make the right choices.
Mr Fixit
My paramedic partners at the paid gig ran the gamut from top-notch to piss-poor, and your observations about street smarts are right on target. The vast majority of the volunteer EMTs I had the privilege to serve with were (and in some cases, still are) a breed apart, demonstrating that compassion and common sense can and do have a greater impact on patient outcome than training hours and elaborate interventions.
Year before last, I suffered a severe bout of ennui (mostly due to organizational politics and BS, as opposed to actual burnout) leading to a lapse in my certification. But lurking here and reading (and enjoying immensely, I feel compelled to add) your trials and tribulations (and pithy observations.. :) for the last month or so, I realize I still have the desire to do the job, despite the current leadership (or lack thereof) in my former squad. I really miss it. So thanks for the nudge.
'Scuse me whilst I go hunt around for fall EMT refresher challenges in this neck of the woods. :)
Well done, friend.
Bravo AD, bravo (that's her above me)
I tried, about 2 years ago. Even input my credit card info. Never heard another word from them.
I've asked TOT if I can re-broadcase his post. I'd like to do the same with yours. Credit where credit is due, of course. It seems to me that there are many people that I work with that could benefit from this, and I'd like to try to see that happen...
Regarding that statistics course; I would also suggest that anyone who has to (or should) read medical research needs a copy of a book called HOW TO LIE WITH STATISTICS by Darrell Huff and Irving Geis. This gem of a book has been more or less constantly in print since the late 1950's, and for good reason. It will go a long way to immunizing ANYONE against statistical gibberish.
Over time I've learned that more knowledge serves primarily to make me more keenly aware of my ignorance, and that my last class or last experience is my worst enemy.
Since I have the attention of a group that knows about such things, I've always wondered why it's necessary to send out the 100-foot hook and ladder every time Grandma calls in with a hangnail. Wouldn't fire departments be able to reverse the national deficit by investing in some smaller vehicles? In the end, there's probably a reason, but I've never been able to figure it out...
Instead, they send them on EMS calls, so they can say, "Our trucks responded to 3500 calls last year."
Beside what happens if a fire comes in while they're tied up on the medical call? It COULD happen.
And due to the current economic situation in the big city just down the way- they've switched to squads- yes, just like Johnny and Roy's only they're Fords and the local FD is griping up a storm! They "need" the big rig for some reason even though they have what they need on the squad
great post.
William the Coroner
Hi AD - do you have some references for these statements? Believe it or not, we still have MAST suits on every one of our ambulances, and some management people still think they are the beez kneez...
The most often cited of these studies is the one performed by Dr. Paul Pepe at the Houston Fire Department in the early/mid 1990s.
As far as volume restriction in shock states, do a Medline search for Ken Mattox on the subject and you'll find plenty of hits.
Do a search for studies on spinal immobilization that demonstrate an improvement in neurological outcomes, and you won't find any. You will, however, find plenty that say it provides no benefit, including some that show a markedly poorer neurological outcome in the spinally immobilized patients.
Any chance I can re-print some of these gems in our department newsletter? (With appropriate credit and the address to your blog).
I found your blog while getting ready enter the world of EMS and start my EMT-B class. Now, as a rookie with his certification for only 4 months, I've had experienced EMT-B's and Paramedics tell me that I conduct myself very professionally and seem to keep a good head on my shoulders. It's also been mentioned that I seem to keep up on the current state of things and know most of what I'm talking about when I actually take a break from listening and open my mouth.
Believe it or not, I owe much of that to you. Already being the kind of person who learns a lot because he knows how to keep his ears open and his mouth shut when he's in new situations, I've also had many times that I've read something EMS-wise here on your blog that completely changed (and not for the worse) the way that I thought about things. Even when you write about things that I already had the same opinion about, you do so in a way that sheds it in a new light and adds to my opinion of it.
Thank you.
I think I'm going to look up some nice articles on PubMed and send that lecturer an e-mail ;) (if you'd like to suggest a few nice ones, please do so...)
2. I'm not responsible for you presenting in such a piss-poor condition that you called me to show up -- but I will do what I can to get you to the hospital alive.
3. If you don't want your elderly relative to be given a chance to continue life, don't call for an ambulance.
4. Amazing sights: the progression of right sided CHF, the effects of trendelenberg, and the rapid effect of Narcan.
5. Evil thrills: Not saving an asshole partner from a power puke.
6. We'll take you to the farthest hospital we can get away with for your terminal hangnail; you have to get back home on your own.
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