As I mentioned in a recent post, we have a process for instituting a STEMI alert to, in consultation with an ED doctor, activate the cath lab prehospitally based on clinical assessment and a 12-Lead ECG. The coordinator at the hospital that I transport most of my patients to told me so far EMS is…
What follows first is fiction: “482. Lawrence Street. 2nd Floor, unknown on a one. PD on the way. Advise when you get there.” We were around the corner having just cleared Hartford Hospital. “Shouldn’t we wait for the cops?” I said, as Troy grabbed his house bag and monitor from the side door. “No, it’s shift…
I did another nursing home code this weekend. We have five nursing homes in our town. Two are very nice and are the final stop in larger retirement communities where residents start off in the own cottages or apartments, move to their own rooms and then go to skilled care before they pass on. The…
I’m back at work today on the ambulance after four days working the desk job, reading run forms, working on education presentations, and entering trauma data. There are good and bad things about each job. Here’s a brief run down. Desk job: The Good – I can sleep until 7 in the morning. I don’t…
Every now and then I marvel at how far EMS has come, I did three calls on Sunday that had they happened fifteen years ago would have gone quite differently. The first was a CHFer. Obese woman, filled up with rales, felt like she was suffocating with the nonrebreather on her. I strapped on the…
So I have been talking to many people about this hip fracture issue and it is quite a dilemma. I want to change the dispatch protocols to send ALS to fall with hip pain. They don’t have to go lights and sirens. They can go “cold,” but they should at least be on the way….
A hip fracture is not a prehospital emergency. Let me repeat that. A hip fracture is not a prehospital emergency. I couldn’t believe it. But there is was written in bold. Not just a stray sentence by listed as “an axiom.” A hip fracture is not a prehospital emergency. For those who know this or…
We’ve been here before to pick the woman up. 99 years old, lives in a second floor apartment, uses a walker to get around. Once she hits the deck, she lacks the strength to get up. Tiny little white lady with severe kifosis ( a hunched back). The last time we were here the fire…
Dispatch: 8:07 Chest PainEnroute: 8:08On Scene: 8:14At Patient: 8:15 66-year-old female with 3 out of 10 chest pain X 2 hours. Periodic chest pain for last week. Skin warm and dry. No prior heart hx. Initial 3-lead strip: 8:16 Vitals, 02 by cannula. 324 ASA PO. Patient shirt removed, put in hospital gown Initial 12-Lead:…
I’ve been doing this a long time — 15 years as a medic — and it amazes me how often I find new ways to do things or think about things. I did another cardiac arrest yesterday. Fairly routine. Yet another nursing home hospital bed one legged diabetic dialysis patient pulseless, apneic, CPR in progress,…
I was talking with a hospital management person the other day about how much I love being a street paramedic, and how I didn’t think I could do my new job – a part-time position as a clinical coordinator at the hospital if I wasn’t still working in the street. The manager’s response was I…
My old partner Arthur once said I was too nice — that I believed everything my patients told me. I didn’t really agree with him. I was actually sort of torqued he said it because he told it to a newspaper reporter who was riding along with us that day to do a story. I…
Well, for the last month now we have been using electronic run forms. For the most part, I like them. I like most being able to type out an extended narrative, instead of trying to scribble it all into a confined space. (I know you could always attach a supplemental page, but I rarely did.)…
Difficulty breathing at the nursing home. The officer who arrives on scene tells us to keep coming lights and sirens. The room in the nursing home is sparse. The patient, a large man in a hospital johnny, is pale and diaphoretic with a low grade fever and edema in his abdomen and extremities. His eyes…
Elderly man. Alzheimers. DNR. No history of seizures. Had a witnessed seizure at the nursing home. Started with his eyes twitching, progressed to a full gran mal. Now the patient who is normally verbal, isn’t saying anything, and has snoring respirations. His pressure is 200/110. I stick an oral airway in after a slight gag,…
A fundamental tenet of the street medic is that you do not criticize another medic if you were not there on the call yourself. Countless times I have had people come to me and tell me what so and so medic did on a call and can I believe how stupid they were. But most…
I may have mentioned recently that I started a new part-time job. I’m an EMS coordinator at a local hospital. I’m still keeping my full-time medic job, only I won’t be working so much overtime. I haven’t written yet about the new job — I need to think more about the proper way to write…
A young doctor I know, who used to be a street paramedic, says the reason paramedics have standing orders is because no two doctors can agree on anything so they let the medics decide based on written guidelines. Otherwise there would be chaos. Where I work I transport patients to any of eight hospitals, but…
Yesterday my preceptee didn’t come to work. He told me he might not come in. That was okay because he is pretty much done. We’re just waiting for the hospital coordinator (who officially cuts him loose) to come back from vacation and sign the paperwork. The truth is it was great being the medic again….
You call in for orders and medical control asks “What’s your ETA?” That’s an interesting question. There are several answers. I am fifteen minutes from the hospital grounds. I am eighteen minutes from my back door opening. I am twenty minutes from arriving at the triage desk. I am anywhere from twenty-five to fifty minutes…