When I was a precepting medic, I had a young boy as a patient. I heard a rumbling sound and my preceptor said “Look out!” Not a second later, the boy vomited all over me. “You’ll learn to recognize the signs,” my preceptor said, handing me a towel. The mark of an experienced medic is…
I try to time my calls so that I have everything done that I need to have done by the time the ambulance backs into the hospital ED bay. I know some medics are taught to do everything on scene. If a patient is sick and needs immediate care, I will absolutely treat them on…
Thirty three years I’ve been in EMS now and if there is one line of advice I have for people starting out in the field, or just for life in general for that matter it is: Don’t Be an Asshole EMS is stressful and we are constantly in situations that may put us in conflict…
I came to work the other day and saw a chilling site in the parking lot. Ambulance 911 — the ambulance that was assigned to me for many years when I worked the 5:30-17:30 shift, the ambulance that had been my EMS home — sat battered and wrecked in a line with other battered and…
In 2012, I wrote a series called Street Lessons, but I could just as well call it any of the following: Things They Didn’t Teach Me in Paramedic School Things They Might have Taught Me in Paramedic School, but I Was on a Bathroom Break. Oh Shit! Things I Learned The Hard Way Trial and…
I was a new paramedic. The senior medic briefed me. They took two guys out of a basement apartment with high carbon monoxide readings after a dryer caught on fire. Ones already on the way to the hospital for evaluation. Your patient is the guy over by the building door arguing with the police officer. …
With all that is going on these days, I thought of Kevin Andrews, one of my first partners in EMS. I first posted this in January of 2011. *** In EMS, we cannot help but be shaped by our earliest partners. They are the ones who show us the way. I was lucky in that…
I have been a full-time paramedic for over twenty years and a part-time hospital EMS coordinator for over six years. Over the years my ideas of who the best paramedic is have changed markedly. I used to think the best paramedic was the one with the swagger, the one without fear, who never hesitated to…
You should never have been precepting. You did not have enough street experience, not to mention you were not even old enough to buy a drink when you started. But these days like too many of your peers, you go from EMT school to paramedic school without putting in the time on the road. Sure…
This post is inspired by a book I am reading – Antifragile: Things That Gain from Disorder by Nassim Nicholas Taleb. In this fascinating book Taleb discusses risk. Take this example which I am modifying from his book: Would you get on an airplane if there was only a 5 percent chance that the plane would crash?…
Here is a question that I recently considered. If you have a critical patient who you are worried may crash, when do you do the IV? At the patient’s side, on scene in the ambulance, or en route to the hospital? The key is that you need to have the IV when you need it….
The number one treatment change in EMS in the last twenty years is the increased emphasis on painmanagement and comfort care. Albert Schweitzer said, “Pain is a more terrible lord of mankind than death himself…. We must all die. But that I can save him from days of torture, that is what I feel as…
I pride myself on my assessment skills, my finely tuned senses — the ability to see, hear, touch, smell, taste, and whatever the sixth sense is – I do that one well too. But lately, I must confess I have been having some issues with the hearing. I auscultate the patient’s lungs and hear nothing….
I was in a parking garage over the weekend when my exit was held up by a woman in a SUV who took about five minutes to make all he turns necessary to back into a parking space. I was thinking why not just drive in straight? Why do you have to be parked for…
It never ceases to amaze me when it happens. When routine saves you. I was talking with another EMS Clinical Coordinator recently, and he said he did not understand why some medics seem to check the blood sugar on virtually everyone. Why don’t they do it only when it is indicated? I argued that medics don’t do…
Your patient is unresponsive. They are also cool, and diaphoretic. You are thinking they are diabetic. You have pricked their finger to get a capillary blood glucose. This is the moment of truth. You are actually hoping for the reading to come back LO or at least less than 50. If it does, you relax,…
Doing calls in doctor’s offices can be tricky. “Do you start working the patient in the office or wait till you get out to the ambulance?” Here are the assumptions. You are a transport medic so you have the stretcher with you. The patient is not in cardiac arrest or so sick that they will…
It’s your first day here. You might be a new volunteer, a paramedic student, or a fresh hire. This may be your first time in an ambulance or maybe you worked ten years for a service in another state. You might be nervous or you could have so much confidence you had trouble fitting your…
Back in 1995 when I started working fulltime as a paramedic in the city, paramedics got to choose their own partners. This was great for the paramedics and could also be great for the EMT partners. You worked three twelve hour shifts together and you always knew what to expect. You picked someone you were…
In EMS, we cannot help but be shaped by our earliest partners. They are the ones who show us the way. I was lucky in that regard. Kevin Andrews was one of my first partners. This was back in 1989. I was a spanking new EMT — so fresh I didn’t even have my certification…