Monday, September 1, 2014

Adventures in online Medical Control

"Hey this is Paramedic Survivor from Rural Ambulance in the back hills of Town-with-plenty-of-Sick-People, who is this?"

"This is Dr. White"

"How do you spell that?"

"Like the color"

"Oh...We are currently doing CPR on a 67 year old male for over 20 minutes now, unknown down time, the patient is intubated with etc02 of 20s-30s. We've given 5 rounds of epi, half an amp of d50, an amp of sodium bicarb, and the patient has been in asystole the whole time. I'm looking for permission to terminate efforts"

"Um, okay...hold on a sec"

Pause.

Pause.

Pause.

Pause.

Probably a minute and a half goes by.

"What do the patient's pupils look like"

"Fixed and Dilated."

"Is there family there, what do they want you to do?"

"I've spoken to his wife, and she is comfortable with us stopping"

"Okay...um...I think...yeah you can terminate efforts....you've done everything you could...I....it's appropriate....There isn't anything else you could have done"

I appreciate the (somewhat unnecessary) caring and empathic tone. It's 1:30 in the morning.

It's always fun to figure out whether the Doc that picks up the phone is an attending or new resident.

Like the one time the Doctor told me "Do whatever you need to make him comfortable" when I called after I used up all my standing order pain meds.

We call a line that is recorded, I think it would be fun to listen to some of the conversations.

Thursday, August 22, 2013

Understanding Program Accreditation

Full Disclosure: I chose an expensive fully accredited Paramedic Program 

Right now, Paramedic Education is somewhat in flux, because recently the National Registry has required Programs to be accredited for students of those programs to test the National Registry.

Here is more information about that...

In my experience there are two camps when it comes to education in EMS.

There are those that see it as a barrier to working, and those that see it as a benefit.

Not to be cliche, but lets say you have a child or a parent that needs EMS. When the paramedic shows up, they are wearing a t-shirt that says "I chose to be educated at a program because it was the fastest and/or the cheapest!"

Would you trust that Paramedic?

The opinion of anyone who doesn't think that accreditation of Paramedic Education is a good thing should be questioned. Once we can be held to higher standards, we can start asking for what we are actually worth. Look into the history of Nursing.

But anyway, if you read the article in the link above, it talks about the Commission on Accreditation of Allied Health Education Programs or CAAHEP.

This group does accreditation for a bunch of different education programs, the list is here.

So how do you know if the program you are looking at is fully accredited? Just search your program here

That is a neat website, because you can search for programs that are newly accredited, recently lost accreditation, as well as programs that have something called a "Letter of Review".

Here is what CAAHEP has to say about that...

Letter of Review is NOT a CAAHEP accreditation status, it is a status granted by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) signifying that a program seeking initial accreditation has demonstrated sufficient compliance with the accreditation Standards through the Letter of Review Self Study Report (LSSR) and other documentation. Letter of Review is recognized by the National Registry of Emergency Medical Technicians (NREMT) for eligibility to take the NREMT's Paramedic credentialing examination(s). However, it is NOT a guarantee of eventual accreditation. 


Now I understand money is money, but I remember calculating it out. When I started school, the company I worked for would foot the bill for Paramedic School if you were in good standing. They called it a "scholarship" but really they would deduct funds from your paycheck until you had paid them back. But if you worked for them for 3 years, you would supposedly get your money back.

But here is the kicker. The bump that I would've gotten in pay, not including any overtime, would've have been more than enough to cover the cost of school within the first year of working as a Paramedic. So the 3 year commitment made no sense.

So anyway, the point to this anecdote was to show that money really shouldn't be much of a consideration when it comes to Paramedic School, because that money will be made back pretty freakin' quickly. If you think $10000 is a lot of money, go ahead and ask your friendly local intern at the Emergency Department about student loans. Obviously doctors make a lot more money, but it takes a significant amount of time to pay off their loans, even at the higher paycheck.

I don't know if I've already told that story here.

But anyway, I remember hearing some guy on NPR talk about the "Student Loan Crisis" and he said that your total student loan load shouldn't be more than your expected annual salary getting out of school.

I hope that anyone reading this is going to be making more than $10000 a year.

Granted, the only experience that I have is my own, but it was nice to here from preceptors "Yeah, students from (my program) are usually really good. Some students from other places didn't have a f**k'in clue"

Wait a minute....what did they mean by "usually"?

Leave your comments below...

Thursday, May 16, 2013

I once...

I once met a fellow in a hospital.

He was a patient transport tech. He was the guy that moved folks around the hospital.

He could tell the liters per minute setting on an oxygen tank by listening to the hiss it made.

Sunday, April 7, 2013

White Cloud

Haven't posted in a while because nothing particularly exciting has been happening in these last few months...really.

I work in a fairly rural system, so going an entire shift without a call isn't unheard of.

I am considering applying for a part time job at another service. I have a few choices.

One service is somewhat familiar to mine, but with a Community Access Hospital as it's Medical Resource Hosptial.

One service is the most busy in the area by far, but in terms of protocols is fairly behind the times(calling Medical Control for benzos for a patient actively seizing).

One service is a Community Hospital Based 911/Intercept Service. The Paramedics work in the ED when they aren't on calls.

In terms of possibilities I guess things are pretty varied. I know folks who work at all three services, so I guess we will see what happens.

I've probably lost 30 pounds since finishing Paramedic School, finally able to do the things outside I like doing and not eating crap all the time probably has something to do with that.

Still haven't worked a code yet as a medic, but I'm sure there will be plenty of those.

 

Monday, January 28, 2013

A few months...

So it has been a few months since I last posted. It feels like things have calmed down since I started, I don't know if we get more calls in the Summer, but I have been sleeping through the night more on shift, which isn't bad.


I can already feel the effects of skills and knowledge decay(Flowers for Algernon anyone?). I was thinking about ways that I can keep this from happening. I intend to apply to work part time some where that has a little higher call volume, as well as in a place that there is teh opportunity for discourse about patient treatments at the Paramedic level.

Being the most knowledgeable provider all the time has it's ups and downs, and I have seen among other Paramedics that have worked longer that if you assume your knowledge is infallible, eventually you will be wrong, and no one will be around to speak up and tell you as such. So I operate under the conditions that I continue to look for signs that my treatment and diagnosis is wrong, as much as I look for signs that my treatment is right.

Is it V-Tach?


I never work on the same truck as another Paramedic, and rarely are there 2 on shift at once. I keep in mind that getting though the Paramedic School gauntlet only allowed me to begin this journey, by no means was it an end.

I underestimated how widespread the "Para-God Ego Asshole" attitude is among other Providers.

To be fair, from the stories I hear there were some truly terrible Paramedics that have come (and gone) before me, so I guess the attitude is justified. Sometimes I feel like the unvented frustration towards them are directed at me but whatever.

While working, I try to be fair to my co-workers, as well as doing what is best for our patients, but oftentimes it feels like I am going to get shit from somebody no matter what decision is made, but I guess that is my burden to bear, earning the extra $2 an hour and all.


I have yet to kill anybody (that I know of).


I have given plenty of Fentanyl.

I have had calls that what I did was all the patient needed(see above 12-leads).

I am researching Critical Care Education programs, they seem really interesting.

I have learned that sometimes the best treatment is Diesel Therapy. I know this because the treatment that the ED made once I was there was a bolus dose of waytanzee.

Sunday, September 16, 2012

Just one thing...

Dispatched to 37 yo female who has fallen...

On scene, first responders are administering oxygen and getting information from the patient's family.

Allergic to Penecillin/Amoxicillin, took sulfamethoxazole 5 minutes before passing out in the bathroom.

And she is flushed...like really flushed, lobster red flushed...pressure soft, pulse tachy, lungs wheezing and unresponsive.

No urticaria but I guess you can't have everything. Her lower lip is swollen, but it is also bleeding, she probably knocked it on the way down.


0.3 mg IM epi 1:1000, Abuterol nebulizer in a mask, another epi shot. Her sp02 is high nineties with high flow 02.

On the board and on our way. She starts coming to, and her pressure/pulse improves. Once in the back of the ambulance, she has the old 'Eau de Etoh'.

She says she had 2 glasses of wine before going to bed. Her repeated questioning leads me to believe she is concussed. She doesn't remember anything, she said she had gone to bed(it was 6:00 pm in the afternoon).

Oh, she is on Lovenox and Warfarin as well, prone to clots apparently. Did I mention she had an -ostemy bag?

She was somewhat evasive and confrontation about how much she had to drink. She chased that with Flexiril and Oxycodone, she takes that to sleep.

Jeez, maybe the allergic reaction wasn't causing the altered mental status.


Her color improved, her vitals got better, we made it to the hospital.

I'll have to keep this one in my head for training purposes.




Wednesday, August 29, 2012

Fentanyl

So, we you are administering pain medication to a patient whom you are also administering fluid, especially through a large gauge catheter that flows really well. It doesn't really matter much how slowly your push your 1 ml of medication into the extension set. Because it probably won't get to the patient until you start running the fluid again.

That being said, don't open the roller clamp full bore right afterwards. It might end up in someone in the ambulance vomiting from getting pain meds too fast.

Not that this happened to me, I'm just saying.