Ok, I may open a can of worms on this one - but here it goes. What happened to the quality of our patient assessments, and why aren't the students of today being taught the importance of the patient assessment?
The new breed of student that gets on the truck nowadays is VERY skill oriented. They want to do skills and get signed off on certain things - but they don't want to "run the call." They want you to figure out what is wrong and then let them step in and start an IV - or intubate? I have a HUGE problem with this.
I personally feel that we can train monkeys to start IVs and Intubate, so as good preceptors, we should NOT emphasize the skills, but rather should ensure they can accurately assess a patient. The shift should always start by asking the student what they're comfort zone is. When they begin talking about skills and IVs, you should redirect the conversation to go something like this. "So are you comfortable walking into a house and interviewing the patient with no assistance?"
I personally offer to assist them with skills and even do some of the skills for them - if they're willing to concentrate on the patient assessment and work on "getting the big picture."
Another thing - don't allow them to use the pulse oximeter and glucometer until they can tell you what THEY think the satuation level and glucose levels will be based on their physical exam of the patient. I say, "so what do you expect their O2 sat to be?" or "what do you expect their glucose to be - are they alert and mentating appropriately?" The good students will suddenly "get it" and think, "Wow, I figured this out without the machines!"
Also come up with a signal ahead of time that the student can use to ask for your help without having to embarrass themselves by asking. I always say, "you go in the house and begin your assessment. I will be standing off to the side. If you get stumped or need me to help you with your questioning, just look up at me and nod your head." This certainly is better than them saying, in front of the patient, "Can you come help me" or "I don't know what else to ask." You will also gain a lot of respect as a preceptor when you treat the student in this manner.
I do lay a lot of the blame with the instructors of today. My friend DJ (9-echo-1) has blogged about this recently. People fresh out of EMT or Paramedic school are now being allowed to teach and they don't have the assessment skills sharpened themselves. I would like to ask all of my fellow preceptors to consider my approach and take away the machines until the student can perform a quality physical exam and interview. Then allow them to confirm their findings with the machine - not base their treatment path on a machine.
Enough for now - keep reading and commenting! Thanks so much to those of you who follow my blogs!
Thursday, April 2, 2009
Monday, March 30, 2009
Ambulance Operation Tips
I feel compelled to blog about Emergency Vehicle Operations. I have some friends and co-workers who are just now operating emergency vehicles for the first time, so I offer you some tips:
1. Stop at all red lights and stop signs - and SLOW down for ALL intersections regardless, even if you have the right of way. Some fool will run a light and you'll still hit someone - but if you've slowed down, the impact may can be avoided or not be as severe.
2. Watch your speed and follow your department's policy regarding what is acceptable. In some places it is no more than 10 or 15 mph over the speed limit. Remember, just because your department allows that, doesn't mean you have to drive that fast - operate at a safe speed for existing conditions.
3. Do not park anywhere but on a hard surface when it is raining and/or the ground is wet. This includes grassy yards and dirt driveways - stay on the street if it is wet!
4. ALWAYS pass on the left. The general statute tells motorists to pull to the right and stop. If you start to pass someone on the right, and the person does what the law tells them to do, they'll pull in your path and you will hit them - and it will be your fault.
5. Do not stay so intent on staying in the lane if you are the only person on the road. The wind blows ambulances easily - if no one is beside you, it may be a good time to change lanes if this happens. The "jerky" movements trying to keep a unit in perfect alignment throws your crew around and makes the patient and crew SICK.
6. Drive around curves (and start/stop the unit) as if you had a full glass of water sitting in the action area in the back of the unit and you don't want it to spill. Start and stop slowly - you will make up your speed once you get going.
7. DO NOT use a cell phone when operating an emergency vehicle.
8. DO NOT drive to a call with the AM/FM/CD player blasting. This is a major distraction.
9. ALWAYS drive a clean vehicle. The public and fellow public safety agencies know when your truck is dirty and they also know that it is a reflection of you!
10. You SHOULD get upset if you get lost while transporting a patient to the hospital. You should consult the map book/computer for directions if you need them. Remember, the patient is paying by the mile and I would be HIGHLY pissed if I was following you to the hospital with my loved one and you went around your elbow to get there - or missed all of your turns. Place yourself in that family's shoes.
11. DO NOT leave the back doors open on the scene in the summertime!!! BUGS are attracted to those lights and your attendant does not appreciate having to swat bugs off of the patient the entire way to the hospital.
12. It IS your responsibility to know where you are going if you get in the driver seat.
13. Do NOT speed back from the hospital. You should obey the same traffic laws as anyone else. As a Chief I have instructed our local law enforcement to NOT have leniency on my folks who speed all over town when they're returning from the ER or are not on a call. Don't ask me to try to get you out of a ticket!
1. Stop at all red lights and stop signs - and SLOW down for ALL intersections regardless, even if you have the right of way. Some fool will run a light and you'll still hit someone - but if you've slowed down, the impact may can be avoided or not be as severe.
2. Watch your speed and follow your department's policy regarding what is acceptable. In some places it is no more than 10 or 15 mph over the speed limit. Remember, just because your department allows that, doesn't mean you have to drive that fast - operate at a safe speed for existing conditions.
3. Do not park anywhere but on a hard surface when it is raining and/or the ground is wet. This includes grassy yards and dirt driveways - stay on the street if it is wet!
4. ALWAYS pass on the left. The general statute tells motorists to pull to the right and stop. If you start to pass someone on the right, and the person does what the law tells them to do, they'll pull in your path and you will hit them - and it will be your fault.
5. Do not stay so intent on staying in the lane if you are the only person on the road. The wind blows ambulances easily - if no one is beside you, it may be a good time to change lanes if this happens. The "jerky" movements trying to keep a unit in perfect alignment throws your crew around and makes the patient and crew SICK.
6. Drive around curves (and start/stop the unit) as if you had a full glass of water sitting in the action area in the back of the unit and you don't want it to spill. Start and stop slowly - you will make up your speed once you get going.
7. DO NOT use a cell phone when operating an emergency vehicle.
8. DO NOT drive to a call with the AM/FM/CD player blasting. This is a major distraction.
9. ALWAYS drive a clean vehicle. The public and fellow public safety agencies know when your truck is dirty and they also know that it is a reflection of you!
10. You SHOULD get upset if you get lost while transporting a patient to the hospital. You should consult the map book/computer for directions if you need them. Remember, the patient is paying by the mile and I would be HIGHLY pissed if I was following you to the hospital with my loved one and you went around your elbow to get there - or missed all of your turns. Place yourself in that family's shoes.
11. DO NOT leave the back doors open on the scene in the summertime!!! BUGS are attracted to those lights and your attendant does not appreciate having to swat bugs off of the patient the entire way to the hospital.
12. It IS your responsibility to know where you are going if you get in the driver seat.
13. Do NOT speed back from the hospital. You should obey the same traffic laws as anyone else. As a Chief I have instructed our local law enforcement to NOT have leniency on my folks who speed all over town when they're returning from the ER or are not on a call. Don't ask me to try to get you out of a ticket!
Tuesday, March 24, 2009
Cancer
So today I got up a little early to go eat at the Pizza Inn at 40/42. Today from 3p to 8p a percentage of earnings were given to Relay for Life. I had a great meal and gave an extra donation for the cause. I also got to have luminaries placed in memory of my grandmother, and in honor of my sister (who is a cancer survivor). I would like to encourage each of you to participate in Relay for Life as the local events in your area are being organized at this time.
Cancer touches each and every one of us in some way and we must do our part to contribute to finding the cure.
Cancer touches each and every one of us in some way and we must do our part to contribute to finding the cure.
Kids in the Creek
I believe the year was 1997 - I will research soon to find out exactly.
While returning from another call, one of our neighboring agencies was dispatched to an MVC, vehicle in the creek, children pinned. Shortly thereafter, our agency was paged mutual aid. We were on the beltline enroute back from RCH (DHR now) and they called and asked us to respond as well. As we approached the scene, the incident commander said, "prepare to intubate upon arrival, we have 4 pediatric trauma codes." At this point, I remember driving down the center yellow line and cars falling off of each side of the road. We arrive and find my dear former preceptor Becky doing mouth-to-mouth on a child and another guy Terry doing chest compressions (there weren't enough BVM's to go around until more units got there).
So you ask, what happened? A lady and her children, along with a child she was babysitting, ran off of a winding country road into a creek. This was either January or February. So, did the 4 children retrieved from the creek suffer cardiac arrest from blount trauma - or was it cold water drowning? To be honest, I think it was a mixture. My patient had an obvious head injury. Some of the others did not have obvious injuries - so we honestly didn't know. We worked all of them until they were at hospitals and were warm and dead - or revived.
Now - what did we do? Well, remember back then, we did not have consistent paramedic coverage county-wide, so the first-in unit was an EMT-I level unit. Our agency was on the 2nd in unit and was Paramedic level, and I was returning from a 2nd duty call and was an EMT-I. Paramedic intercepts were dispatched from all over Johnston County to assist as well. Back then, trauma care and "appropriate facility" weren't nearly what they are today. 3 of the children were transported to a trauma center and one was transported to a community hospital. Guess what the outcome was? The one who went to the community hospital on an EMT-I level ambulance was the lone survivor! That child received warm NG lavages and aggressive warming - and survived. It was also likely that this patient was the victim of cold water drowning and not trauma.
Now - the heroism that day was ever so present! The first arriving EMT-I jumped into the water to begin rescuing kids, and 2 deputy sheriff's were in the water rescuing the kids who were trapped in the vehicle in the water. Several volunteer firefighters also jumped in this freezing water - including one firefighter who was transported for hypothermia.
Everyone on the scene that day pulled together and worked as a team. There were no boundaries, district lines, or arguments. I will never forget pulling up and seeing veteran EMT personnel doing mouth to mouth because there weren't enough BVM's to go around. This is what heroes are made of! I am proud to have been there that day. My patient did not survive, but the lessons learned were paramount.
That was one of the first times as a young ALS professional that I realized that superior BLS and non-paramedic care is what truly saves lives. I also learned that you can have compassion and be in EMS. I saw my heroes crying as they did mouth to mouth on lifeless children - yet they kept their composure and did an outstanding job. It is ok to care, it is ok to cry - but the show must go on. Remember, early rescue squads began as neighbor helping neighbor. My father knew at least 50% of the patients he transported if not 75% yet he did a great job and didn't break down on every call. It seems like today if a provider treats someone they know, it almost incapacitates them and becomes "dramatic." Think of our predecessors and how the principle of neighbor helping neighbor is one of the foundations of rural EMS. Always remember, this could be your next call!
While returning from another call, one of our neighboring agencies was dispatched to an MVC, vehicle in the creek, children pinned. Shortly thereafter, our agency was paged mutual aid. We were on the beltline enroute back from RCH (DHR now) and they called and asked us to respond as well. As we approached the scene, the incident commander said, "prepare to intubate upon arrival, we have 4 pediatric trauma codes." At this point, I remember driving down the center yellow line and cars falling off of each side of the road. We arrive and find my dear former preceptor Becky doing mouth-to-mouth on a child and another guy Terry doing chest compressions (there weren't enough BVM's to go around until more units got there).
So you ask, what happened? A lady and her children, along with a child she was babysitting, ran off of a winding country road into a creek. This was either January or February. So, did the 4 children retrieved from the creek suffer cardiac arrest from blount trauma - or was it cold water drowning? To be honest, I think it was a mixture. My patient had an obvious head injury. Some of the others did not have obvious injuries - so we honestly didn't know. We worked all of them until they were at hospitals and were warm and dead - or revived.
Now - what did we do? Well, remember back then, we did not have consistent paramedic coverage county-wide, so the first-in unit was an EMT-I level unit. Our agency was on the 2nd in unit and was Paramedic level, and I was returning from a 2nd duty call and was an EMT-I. Paramedic intercepts were dispatched from all over Johnston County to assist as well. Back then, trauma care and "appropriate facility" weren't nearly what they are today. 3 of the children were transported to a trauma center and one was transported to a community hospital. Guess what the outcome was? The one who went to the community hospital on an EMT-I level ambulance was the lone survivor! That child received warm NG lavages and aggressive warming - and survived. It was also likely that this patient was the victim of cold water drowning and not trauma.
Now - the heroism that day was ever so present! The first arriving EMT-I jumped into the water to begin rescuing kids, and 2 deputy sheriff's were in the water rescuing the kids who were trapped in the vehicle in the water. Several volunteer firefighters also jumped in this freezing water - including one firefighter who was transported for hypothermia.
Everyone on the scene that day pulled together and worked as a team. There were no boundaries, district lines, or arguments. I will never forget pulling up and seeing veteran EMT personnel doing mouth to mouth because there weren't enough BVM's to go around. This is what heroes are made of! I am proud to have been there that day. My patient did not survive, but the lessons learned were paramount.
That was one of the first times as a young ALS professional that I realized that superior BLS and non-paramedic care is what truly saves lives. I also learned that you can have compassion and be in EMS. I saw my heroes crying as they did mouth to mouth on lifeless children - yet they kept their composure and did an outstanding job. It is ok to care, it is ok to cry - but the show must go on. Remember, early rescue squads began as neighbor helping neighbor. My father knew at least 50% of the patients he transported if not 75% yet he did a great job and didn't break down on every call. It seems like today if a provider treats someone they know, it almost incapacitates them and becomes "dramatic." Think of our predecessors and how the principle of neighbor helping neighbor is one of the foundations of rural EMS. Always remember, this could be your next call!
EMS History and Emergency
So last night after trying lobster for the first time, my friend and I came to the house to watch a movie. He is fairly new to EMS and is currently in EMT school. When I turned on the TV, by habit I looked at my DVR recordings. Daily, I record Emergency!, Adam 12, and Kojak. So my friend had never heard of Emergency! I could not believe it. So I gave him a preview and we watched an episode.
I explained that they used true "online medical control" per the definition in his EMT book. I also explained the role nurses and doctors played in early EMS. I then explained how the treatments rendered in the series were extremely realistic and appropriate for that time period. I then explained what D5W and LR were! I also gave an overview of the EOA and compared it to our modern day KING, combitube and LMA.
He was HOOKED! I explained that I consider these "training films" and that ANYONE who is new in the EMS profession MUST purchase, own and view the series in order to know where we came from. One of the victims in this particular show was in a crop duster crash and had organophosphate poisoning. I explained the importance of the "excessive salivation" that was assessed and why high doses of atropine were ordered. The light bulb came on!
So if you are new to EMS, you really must purchase this series and learn about our heritage. For new EMTs you will actually learn a lot of helpful tips, teaching lessons and see excellent examples of injuries/illnesses. If you are a promising student and are in this line of work for the right reasons, and cannot afford it, I will assist you with the purchase if I can.
So, many of you are requesting war stories. I will start telling them shortly. Stay tuned! Thank you so much to each one of you who reads by blog.
I explained that they used true "online medical control" per the definition in his EMT book. I also explained the role nurses and doctors played in early EMS. I then explained how the treatments rendered in the series were extremely realistic and appropriate for that time period. I then explained what D5W and LR were! I also gave an overview of the EOA and compared it to our modern day KING, combitube and LMA.
He was HOOKED! I explained that I consider these "training films" and that ANYONE who is new in the EMS profession MUST purchase, own and view the series in order to know where we came from. One of the victims in this particular show was in a crop duster crash and had organophosphate poisoning. I explained the importance of the "excessive salivation" that was assessed and why high doses of atropine were ordered. The light bulb came on!
So if you are new to EMS, you really must purchase this series and learn about our heritage. For new EMTs you will actually learn a lot of helpful tips, teaching lessons and see excellent examples of injuries/illnesses. If you are a promising student and are in this line of work for the right reasons, and cannot afford it, I will assist you with the purchase if I can.
So, many of you are requesting war stories. I will start telling them shortly. Stay tuned! Thank you so much to each one of you who reads by blog.
Monday, March 23, 2009
Lobster
The weekend went by way too fast for me. I guess that is because I did 12 hours of EMS Friday night in Garner and 24 on Saturday in Clayton. Man was I asking for it. Luckily, we weren't too busy in either place. It's just the lack of sleep that hurts me. I generally sit up at night, so I didn't sleep either night.
So on Sunday, I rested. I slept until about 4pm. I then went to visit a friend who had a death in the family and later met another friend for dinner. We went to Red Lobster. Being the typical southern joco guy, I like fish and shrimp, but have not tried much else in the seafood world. So I was coerced into trying lobster. Let me tell you, it was a wonderful experience. I have a new appreciation for all seafood, not just my standard shrimp and fish. I used to be terribly picky as a child and would NEVER try new things. I guess as I've aged, I'm venturing out more. I will now make Red Lobster a regular trip, and male lobster a priority on my seafood menu the next time I go to the coast and go to a real seafood restaurant.
So on Sunday, I rested. I slept until about 4pm. I then went to visit a friend who had a death in the family and later met another friend for dinner. We went to Red Lobster. Being the typical southern joco guy, I like fish and shrimp, but have not tried much else in the seafood world. So I was coerced into trying lobster. Let me tell you, it was a wonderful experience. I have a new appreciation for all seafood, not just my standard shrimp and fish. I used to be terribly picky as a child and would NEVER try new things. I guess as I've aged, I'm venturing out more. I will now make Red Lobster a regular trip, and male lobster a priority on my seafood menu the next time I go to the coast and go to a real seafood restaurant.
Sunday, March 22, 2009
Heroes
Here are a few photos of EMS heroes of mine. Among them is my father who served citizens of our town with over 20 years of combined Rescue/EMS and Fire service.
This is Grady. He was an EMS pioneer, and later worked until retirement as a dispatcher of ours at the local police department. Notice the original Minitor pager - not the Minitor I, but the Minitor (the version before the square brick, this one had rounded edges and had no monitor function - it wouldu squelch until reset). Grady always started his broadcast with, "Attention Clayton Rescue Monitors go 10-8"
Marvin Parrish was my first Chief. He continues to serve our squad with over 20 years of service.
David Eatman and David Edwards were EMS Education pioneers in our County. The most prestigious EMS award given in our County is in their name.
My father and Art treating a patient from the motorcycle races.
Jerry, Eunice, Danny and Steve - the best of the 80's at Clayton Rescue
I consider this to be one of my favorite photos. It is of a husband and wife team, working together, sharing a passion for helping the community. I think all many of us could ever want would be to save lives along side the one you love and share the same passion for helping people.
Another two photos of my father in action.
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