A Day In The Life Of An Ambulance Driver - Latest Comments in What Every Paramedic Student Should Know

Re: What Every Paramedic Student Should Know

Carlos R — Fri, 25 Sep 2015 17:15:00 -0000

Somehow, this kinda reminds me of militia infantry training. To wit, there is nothing taught in class you would not be able to learn in less than twenty minutes into your first day. The really useful stuff, like knowing how to conduct a good patrol, can be taught by book, but you won't understand it until you've done it. Truly important skills, like contingency planning, having situational instincts, and being able to suck up misery, can't be taught in school, and if someone does try to teach them, the inevitable universal reaction is "yeah yeah yeah of course", but nobody will actually understand or internalize unless they've been in a situation where they've had to.

The thing about the Pharmacologist rings true in a surprising number of situations. Being able to understand something and being able to teach something are two entirely different skills. I once went to some kind of some security seminar taught by a former police officer. What they didn't tell us was he was a desktective with a voice like Ben Stein -- the guy with the hyperboreian voice (pun intended) who just drones through everything. We got all these wonderful little details like the correct wattage for motion detector lights, who makes the toughest doorknobs, and what kind of windows are the hardest for burglars to get through. Thank God I forgot all of it; I ended up using the majority of my notepad to invent various alphabets and scripts mostly to compain about how bored I was -- I ended up creating a writing system that can be written in half the space as English, condense all the dipthongs into single characters, turn any word into a ligature, and also write German and Russian without need for approximation. Another super boring guy was some dude from the Texas Air National Guard who tried to teach about tactical fieldcraft. Virgins teaching sex, anyone? By far the best instructors were guys who'd been in long enough to get practiced, but not long enough to think of themselves as patriarchs. Protip: If an instructor fails to make a joke within the first two minutes of class, you will not have a good time. If your istructor rebukes a student for their sense of humor, chances are you are going to come away worse for wear. That's a learning experience, too -- not all teachers can teach and not all experts are experts.

I love your comment about the difference between stupidity and ignorance, but I'd argue that there's a third category, Thoughtlessness, which is for when smart people do otherwise dumb things. Ignorant is assuming there are five gospels in the King James Bible on account of not getting much information about Christianity. Stupid is deciding it'd be funny to turn your hands into flamethrowers by holding onto a couple of lit roman candles. Thoughtless is not making sure you have all your stuff before you get off the plane.

Now in gunfighting, there's some more consistency as to what is correct and wrong. People tend to disagree on some of the finer points. And a lot of stuff about gear and techniques are subject to changes more often attributable to fashion than conditions. For example, it used to be fashionable to run weapons stock, then it became fashionable to strap on every accessory you could physically streamlined rigs. Likewise, the AR family as represented by the M16 was the future of small arms in the 1960's, then it became a jammomatic, then it became accepted, then it was meant to be replaced at some point around the turn of the millenium, then then it was a jammomatic again thanks to the sandbox and the next gun of the future was the XM-8, then the ACR, then the SCAR, then the HK416, and now the M4 is the way of the future. 5.56x45 used to be the weak round, then it became respectable, then 7.62x51 was the way of the future, and now 5.56x45 is a death ray. Gunfighting instructors disagree on stances and grips. Some tell you to try to be squared so if you take a round, your armor is more likely to catch it. Some tell you to be bladed so you're more likely to be missed altogether. Handgunners oscillate between advocating Cooper style sighted shooting and advocating Applegate style point shooting. Essentially, if you learned it from someone competent within the last twenty years, it'll suffice.

Being able to legally account for yourself, or just write in general, is a rare skill. The number of times I've seen reports from comrade troopers for firefights which were shorter than Twitter posts is too damn high. Your explanation for engaging a cartel patrol should not be "We swa some shade guy's in SUV's and tehy diddint like that so we shotted them." If that's your report, I'm going to have to waste a few hours going around to everyone involved and wheedling stories out of them so I can write up a nice report which actually tells something useful. The following are absolutely unacceptable for grown men to write: Teh, their/there/they're confusion, its/it's confusion, because x, ain't no/didn't no/ain't none/ain't nothing/don't got/etc, thru, lighted, bended, blowed, buyed, choosed, digged, drived, freezed, keeped, leaved, lighted, losed, rided, ringed, sended, sinked, speaked, spended, standed, stealed, sticked, swimed, taked, thinked, throwed, writed, missing Oxford commas, misplaced capitalizaton, misplaced punctuation, we was... I'm more patient with ESOL types, whom I should just be grateful for being able to speak English at all. Right after the evasive fourth grader reports come the reports written like a temper tantrum. If you have a problem with anyone on your team, don't save it for the AAR, which is confidential and will likely only even be seen by your superiors. Your teammates do not get magic telepathic powers when you express all angry thoughts in an AAR. And it is not my job to "take a hint" and do something about some guy who bugs you -- talk to him if you have something to say, or get your squad leader to mediate; I'd be one of the last people to have anything constructive to say in your squabbles. Please refrain from writing nasty things about superiors in your AAR's, especially if they happen to be the one who has to read your AAR's. While I do make genuine efforts to be professional and impersonal, referring to your immediate CO in colorful terms is going to make me feel a lot less like coming through for you when you want something. Last come the obvious coverup AAR's where the writer botched something and is trying to pin the blame on someone else, because nothing says not your fault like an irate diatribe about how it's not your friggin fault because it's some other dude's fault. These only get better the more guys try to pin the blame on each other in their AAR's for the same incident. Keep it up and you just might reach the zen of bureaucracy, where it's not really anybody's fault because the office takes the blame and nobody can decide who in the office to pin it on.

I absolutely love you final point about skills being easy and judgement being hard. It is so much easier to do something than it is to think things through, especially in a tense scenario. It's the odd man who can think before acting instead of acting before thinking. I've never seen a lesson taught that says when you should decide against doing something instead of teaching when to do something. Contraindications are just as important as indications. A brilliant officer can come to the same conclusion as a clueless officer -- the difference is how the clueless officer will see the first five things to cross his perception and order immediate action based on that while the brilliant officer will start his assessment by establishing what is not and then order action based on what least constrains his tactical flexibility. For example, two officers each see a small party of enemy troops. The clueless one decides it's an easy kill and moves to neutralize. He neutralizes the party, but failed to account for the possibility of being observed, resulting in being wiped out by the wrath of nearby reinforcements who heard the gunfire. The brilliant one decides to observe and note their movements. He soon spots other elements moving nearby. He takes note of this information and then sends it back to command, who then know about the enemy movements and can then advise him to do what will be optimal at the higher level he is unable to perceive. Result: Enemy movements at least discovered, friendly casualties minimized, possible employment of fire support inflicts casualties on enemy force. But now I'm just rambling.

Re: What Every Paramedic Student Should Know

chloe — Fri, 14 Nov 2014 17:38:36 -0000

I'm' Chloe Manouaskis be a paramedic my life for forever and and we working in the ring wood at there and in' very exceeding study 16year old and im great blogging thanks Chloe

Re: What Every Paramedic Student Should Know

Jon — Fri, 25 Jul 2014 12:18:56 -0000

I'm not sure there is one concise linear thought in that long winded topic

Re: What Every Paramedic Student Should Know

ThatOneEMT — Wed, 29 Jan 2014 13:30:58 -0000

So a little behind, but...

Those are some interesting points, especially the last one. The fact we are trained as 'Technicians' versus professionals would be a prime reason we do and don't always think why. Imagine where this profession could go if we were taught to think.

Re: What Every Paramedic Student Should Know

Amandalemt — Thu, 04 Aug 2011 15:55:30 -0000

I was lucky to go through an excellent university based paramedic program that did teach the reasons for doing things.We were constantly told to "think outside the box" vs "this is what the algorithm says".Having a good understanding of acid/base disturbances helped me recognize an ASA OD that others missed.I admit that many of the changes make me feel like a dino but I fight the urge to say things like "in my day we had to walk a mile in the snow, w/ 0 shoes to save our mastodon vs pedestrian pt's."As far as NCTI, I'm inc the link(in case you're curious).Had an ex that went through them & in my op they stunk.They often gave incorrect info & weren't good @ answering ?'s

Re: What Every Paramedic Student Should Know

Kelly Grayson — Thu, 04 Aug 2011 12:45:54 -0000

Not sure what "NCTI" is, but if you're telling me that your son's college paramedic education program has no preceptor agreements set up with nearby EMS systems, that is a serious breach of educational ethics, and may even be enough to land them in hot water with your state EMS agency.
I'd contact the state EMS office in California for guidance.

Ambulance Driver

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Re: What Every Paramedic Student Should Know

Vanessa D. Flores — Thu, 04 Aug 2011 00:32:18 -0000

Can anyone here tell me what agency conducts a training in EMT just in Manila. For how many days? And how much is the expenses all in all? pls

Re: What Every Paramedic Student Should Know

Anne_meline — Thu, 04 Aug 2011 00:17:06 -0000

PLEASE, PLEASE GIVE A HINT, A BIG HINT, ABOUT HOW AND WHERE TO FIND A PRECEPTOR FOR A PARAMEDIC STUDENT FROM COLLEGE OF THE SISKIYOUS WHO FLEW THROUGH DIDACTIC AND CLINICAL BUT NOW IS INDEFINITELY STALLED AT THE INTERNSHIP PHASE BECAUSE NCTI SEEMS UNABLE TO HELP, HAS NO CONTRACTS, SAYS GO DO IT YOURSELF, ESSENTIALLY OFFERS NO SUPPORT AFTER GOD KNOWS HOW MUCH MONEY HAS GONE INTO THEIR POCKETS. MY EMAIL: anne_meline@yahoo.com cell 916=798=3007 this is critical because my son, for whom I am writing, wants to be ready when CDF starts offering ALS. He's a 4 year CDF firefighter and has been trying to break into the business full time for 8 years. Any words of advice would be appreciated and if you ARE a preceptor, where are you, how much do you cost, how many students have you had, what do you like to see in your potential students? Thank you.

Re: What Every Paramedic Student Should Know

Dave — Wed, 03 Aug 2011 21:32:31 -0000

Dang, alrite ill keep an eye out. thanks for the reply

Re: What Every Paramedic Student Should Know

Kelly Grayson — Wed, 03 Aug 2011 21:16:30 -0000

Dave, it's apparently out of print, and the company is out of business.
Excellent book, though, if you can find it on EBay or elsewhere for a decent price.

Ambulance Driver

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Re: What Every Paramedic Student Should Know

Jeff Zaffino — Wed, 03 Aug 2011 21:15:15 -0000

corrected link to TOTWTYTR's post
http://tooldtowork.com/2009...

Re: What Every Paramedic Student Should Know

Jeff Zaffino — Wed, 03 Aug 2011 21:13:11 -0000

EXCELLENT POST Kelly, and timely as well - Paramedic school starts for me in a couple of weeks - Keep up the great work!

Re: What Every Paramedic Student Should Know

Jeff Zaffino — Wed, 03 Aug 2011 21:12:13 -0000

Excellent post Kelly - and timely as well... paramedic school starts next month

Re: What Every Paramedic Student Should Know

Dave — Wed, 03 Aug 2011 21:08:27 -0000

Where do I find a copy of The Missing Protocol: A Legally Defensible Report. its going for 1,000 dollars on amazon, a bit pricey for my library

Re: What Every Paramedic Student Should Know

Matt Spille — Mon, 11 Jul 2011 12:24:38 -0000

Thanks so much for this lecture Kelly. I'm currently in a paramedic program that has combined didactic and clinical and is still working and currently taking an accelerated A&P class. Everything you said makes sense and gives me motivation. Not trying to be a kiss a#$ but I'm grateful that our facebook friend in common Rocky has sent me this link. I am going through doubts but being reminded I'll always be ignorant strangely helps motivate. Thanks again.

Re: What Every Paramedic Student Should Know

Anon — Wed, 22 Sep 2010 18:50:25 -0000

As someone in EMS education who struggles daily with the age old question of "how do we get people to attend classes," I truly wish this piece would be required reading for all EMT's and paramedics. I found this blog via a post on facebook from another friend in EMS, and it absolutely rings true - thanks for sharing. By the by, do I have your permission to copy the portion on narrative writing and share it with the new employees I teach narrative writing to in orientation?

Re: What Every Paramedic Student Should Know

james — Mon, 07 Sep 2009 03:07:57 -0000

Thanks for the sharing this website. it is very useful professional knowledge. Great idea you know about company background.
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Re: What Every Paramedic Student Should Know

Anonymous — Wed, 02 Sep 2009 21:21:01 -0000

1. In a situation where it's me or nothing I'm much better than nothing.

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.

Re: What Every Paramedic Student Should Know

Anonymous — Wed, 02 Sep 2009 17:26:53 -0000

I'm a second year med student and today I had a lecture by a trauma surgeon. He told us all about the Golden Hour etc. etc... so I immediately thought of this post. Apparently, over here in the Netherlands, everyone still adheres to the concept of the golden hour (and also c spine immobilisation etc.).

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...)

Re: What Every Paramedic Student Should Know

NJ Public Servant — Wed, 02 Sep 2009 01:59:44 -0000

AD, you've done it again.

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.

Re: What Every Paramedic Student Should Know

Ambulance Driver — Tue, 01 Sep 2009 16:50:39 -0000

By all means, Bob!

Re: What Every Paramedic Student Should Know

bobball — Tue, 01 Sep 2009 12:39:52 -0000

Yo, AD

Any chance I can re-print some of these gems in our department newsletter? (With appropriate credit and the address to your blog).

Re: What Every Paramedic Student Should Know

Ambulance Driver — Tue, 01 Sep 2009 02:17:07 -0000

Flobach, a number of studies have disproven the assertion that PASg application displaces any significant amount of blood from the lower extremities. None of them have shown a measurable improvement in outcomes, and several have shown worse outcomes with the PASG group.

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.

Re: What Every Paramedic Student Should Know

flobach — Tue, 01 Sep 2009 00:26:45 -0000

"that spinal immobilization was beneficial and rarely harmful, that volume resuscitation in trauma patients saved lives, that the Golden Hour was based on scientific research, and PASG could auto-transfuse blood from the lower extremities to the trunk."

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...

Re: What Every Paramedic Student Should Know

William the Coroner — Wed, 26 Aug 2009 18:29:07 -0000

I stole some of this, esp you are what you write and you don't know shit for my first lecture tomorrow. Thanks.

William the Coroner