there should be an ems gym with mannequins and equipmen t and various stations for practicing splinting and intubating and shit and then they can also advertise free vital sign checks to old people so we can also practice our vitals, and complimentary zyns, monsters and gas station food whos with me

Had a 70 YoF with CC of shortness of breath and chest pain. Pain radiated to epigastric and in between shoulder blades. Pt had smoked Marijuana prior to symptom onset. PMH of HTN, AAA, and lung & breast cancer. Pt DC'd HTN medication when it normalized thinking it was cured. Pt on Plavix and unable to tell the reason why she's was on it. Pt denied taking anything else. 12 lead was NSR. L BP 228/89, R BP 229/89, HR 70, RR 22, & O2 97RA. L BP 224/93, HR 70, RR 20, & O2 97RA, BGL 129. Chest pain improved upon our arrival. A&O x4. Pt refused transport. OLMC consulted with Doc siding with Pt. Pt was told that were concerned she could worsen her AAA due to the high BP. Pt signed refusal. etc, etc, etc was done to try getting pt to go to ED.

We clear scene and about 20 mins later get called back.

PT stated that she wanted to go to the hospital and wouldn't refuse transport this time. Chest pain returned and worse than before. We get back on scene. L BP 186/81, HR 60, RR 26, O2 95RA. PT was placed on cot and loaded. Immediate departure RLS. L BP 76/53, HR 87, RR 26, O2 95RA. Pt skin became pale and pt became lethargic. 6-7 min since first BP. I immediately start IV in L AC and bolus of NS. R BP 78/51, L BP 86/54, HR 90, RR 30, O2 94RA. 12 lead was NSR. Radio report given to ED. Arrived at ED.

I'm BLS and considered ALS intercept. In MN we EMTs can start IVs and run fluids. It was about 10 mins from hospital. 5 for ALS intercept but not considering intercept scene time. Plus there wasn't much they would do on the few minutes they'd be with me. Diesel bolus to ED I figured was best.

Recently (in the last 30 days), an ambulance in the area where I work was involved in a bad wreck. The 2 medics were injured, one of whom was entrapped and required extended extrication (45+ min). Fortunately, no patients or bystanders were involved.

Somehow, pictures of this wreck found their way online, several of which including the face of the trapped medic. Grapevine conversation suggests that the individual taking photos was the first arriving medic who also works for the same service.

Discussion Questions:

1. Do you have a moral/ethical obligation to report the taking/posting of photos?

2. Even if verbal permission was given and/or the proper channels followed regarding HIPPA, do you still post photos of the medic/persons involved?

3. What are your priorities when arriving on scene of a bad wreck where initially you are assuming both medics are DOA, only to discover one is critical and needs extrication?

4. Would you even consider taking pictures if there is no room to perform patient care while the FD extricates the patient?

Happy to answer any questions best I can, but I’m being vague for reasons…

I started going to EMT school when I was 32, and seeing all these young kids I’m like damn I really started late in my life. Imposter syndrome came strong on this one lol.

Hey yall. I was hoping to hear about some experiences working for the National Park Service as a seasonal EMT. Specifically, Sequoia and Kings Canyon National Park out in CA. Any insight into the following would be greatly appreciated:

- Housing situation

- Common activities when not on shift

- Culture!!

- Call types (No idea what to expect for this)

- Transport times

I'd appreciate any insight in working for the NPS at all, but if anyone has specifically worked for Sequoia/Kings Canyon and cares to share that would be amazing. If there's anything that I am missing that you think is valuable please add it in! Thanks :)

A neurosurgeon that I know at the hospital granted me some sanity on charting and attention to detail recently.

Everybody here brings different sets of experiences to EMS. Some of us grew up around people with certain medical problems, like maybe seizures or kidney disease or alcoholism, or we may have health problems ourselves. We may know more about some random aspect of EMS just because of life happening to us, and this may give us a leg up on helping certain patients better than others.

In both the hospital and on the ambulance, I used to make a point to repeat my patients' symptoms in detail to other people, especially if it was neuro, psych, or musculoskeletally related. An athlete broke their leg and has sensation in just their big toe but not the others? Cool, let's put that in that chart. A seizure patient is seeing red and blue swirls and hearing buzzing 2 minutes before their seizures? Put that in the chart. I would make a point to tell the nurses and docs at the hospital these same details on hand-off, even if I got a weird look. I figured that these kinds of things matter to their doctor, who has to call the shots on a near stranger's health.

I don't know about you guys, but some of the folks that I have worked with have treated me like I'm naive for caring about these details. There's a retort of, "Oh, you don't have to put that in the chart. It doesn't matter." Or, "You can just put 'toe numbness' down." More ER and floor nurses than I would have expected take this approach as well. The lack of care for detail is a bummer, because I know from my biology and neuro background that all of this shit is connected. The kidneys affect the heart affects the brain affects the immune system, and it goes on and on. Details matter, and putting them in the chart matters. Like, why even have this job or keep taking CMEs if I just to write on every little grandma's chart, "RLQ stomach pain x3 days," and then go fuck off to the station and take another nap? There's more to this patient's story, even if I am technically allowed to forget that they exist once I clock out.

Anyway, I was talking to one of the neurosurgeons at the hospital about one of their patients as they were reviewing the chart, and the reports from all of that patient's multi-physician team were insanely detailed. It was stuff like, "Experiences psychosis after eating bread," and, "Sees red and green blocks in upper left of field-of-view in morning only." It was unreal. Just wildly detailed things that were written exactly how the patient experienced them. No vagueness. No judgment or laughing about the patient "making things up" at the nurses' station. Just attention to detail and trusting the patient.

I looked at the doctor and asked, "You guys care about this stuff?" The doc said, "Yeah, absolutely. If a person usually hallucinates red and green shapes before brain surgery, but now they're seeing blue and yellow shapes after, we need to know. Maybe we have to go back in or change their meds." I told the doc that more folks in EMS than they would have guessed have expressed irritation about noting these kinds of things, but the doc said, "If I read something that detailed in an ambulance report, I would want to know where they worked, so I could give them a prize."

I don't know your experiences in EMS. Maybe you have worked at places that championed detailed charting and Michelin star medicine. I'm also no medical genius, and I have much to learn. The medics and nurses who chastised me about charting also taught me other cool things that my dumb-ass didn't know. Some medics and nurses were also just as jazzed about the details as I was. With that being said, this conversation with the neurosurgeon showed me how EMS and ED charts matter and that the details that our patients tell us can actually help their doctors fix them. It didn't feel like my extensive charting marked me as some greenhorn EMT grad at that point. Our charting of some seemingly superfluous symptom may actually change our patients' treatment weeks or months down the line. If some salty bastard is going to make you feel like a gullible child for caring about that and being curious about your patient, then that is their own prerogative.

Does this fit with your experience? What do you guys think?

Note: slightly changed details about the patient and the doc, because HIPAA/PHI.

Found this out through the NC state firefighter’s association email that goes out every so often. H0675 (which passed first reading in the house) will require NREMT for initial issuance and renewal and IBSC for specialty certifications.

NC providers, what do ya’ll think about this? From what I know most CCT agencies seem to use IBSC anyways.

Hey yall 👋🏼

I have a quick question I can’t really find an answer for after googling. I had to do CPR on someone a few years back before taking an EMT class and I remember that they were not breathing obviously but when we did compressions, they coughed up all kinds of lovely bloody goodness.

This one someone who got ejected from their vehicle and unfortunately they didn’t make it. (May he rest in peace) He had obvious head trauma when I stopped to help, bleeding a good amount from his skull. He had CPR started right after the accident and although his head was bleeding, I wouldn’t say it was enough that he bled out.

So in that situation, I didn’t have any way to suction and from the little bit I know - CPR with fluids in the throat is a big no no.

What I specifically have a question about is when you have no way to suction, do you still do compressions and mouth to mouth / bvm?

Do you still try and clear their airway without a suction? I’d think you’d roll then left and see what you can get out but would that even make a difference in clearing the airway for CPR?

I’m no medic or anything special but I’m trying to understand this in case this happens again. I don’t usually go out of my way to stop at car wrecks but I travel through remote areas fairly often where ems is a minimum of 15-30 minutes away. I only stop if there’s no one else to help or people doing something really wrong like moving someone with a broken spine. I prefer to mind my business but having a good kit can helps with peace of mind.

Thank yall for being awesome and doing that ems stuff every single day. Yall are a different breed. Be safe ❤️❤️

This post was inspired by an experience I am currently having.

Called for a 48 year old male asthma attack. We get there and the dude is on his bed, with his cat, very mild wheezing, joking about his very friendly "attack cat". In other words, mild distress. He's noy sure he even wants to go to the ER, as his uncle called 911 for him.

Vitals are fine, SpO2 93% room air, EKG fine. Said he's out of his inhaler, and his nebulizer wasn't working.

Give him a duoneb, after the neb he said he should probably still go to the ER because he wasn't 100% yet and he will need a doctor note to call off work.

We leave for 2 minutes to grab the stretcher, and come back to him diaphoretic, clutching his chest, screaming in pain, couldn't hold still for even a second. BP is now 240/120, HR like 140.

As he's screaming he can't breathe, he reaches between his legs and grabs another inhaler I hadn't even saw and takes 2 puffs before I can even see what's happening. I check and it's an epinephrine inhaler.

I ask how many puffs he took while we were getting the stretcher said he took 20 puffs... 2.5mg of epi total. He's screaming "I'm freaking out man".

Maybe just double check your asthma patients aren't trying to self medicate with epi before grabbing the stretcher.

Last night, my partner and I were called for an overdose code. While on scene, the patient's son told us that this was an intentional overdose by the patient in an attempt to commit suicide. We called our local med control, who told us to bring the patient in because he was only in his mid-40s. The ER was able to get ROSC, intubated the patient, and placed him on a vent before calling for a transfer.
I work in a rural area, and the next closest hospital is at least an hour away. When we showed up for the transfer, a nurse told us that the son had come by with DNR/DNI paperwork for his dad. We went to talk to the doctor in charge of the patient's care, and he told us that because it was not a natural cause of death, he didn't need to follow the patient's advanced directives.
My partner stayed to talk to the doctor while I called our supervisor for advice. Our supervisor told us to take the transfer because we weren't the ones who got ROSC, we aren't qualified to extubate, and the doctor is the one who makes the final decision. We took it, and when we arrived at the next hospital and gave them the DNR/DNI paperwork, a nurse asked me why he was intubated, and I didn't have an answer. I guess I just wanted to come on here and ask if this normal? Did we do the right thing? Any advice is appreciated. Thanks!

First of all I’m not here to spark a Covid/vaccine debate. I’m genuinely just curious…. Is it just me that’s noticing that in the years following covid, the incidence of otherwise healthy 40-50 year old men with STEMI’s and strokes seems to have gone way way up? It seems like I see it ALL THE TIME. It’s a very common theme… interfacility transfer from local hospital to larger facility, 47 year old male, no history, no allergies, no meds, STEMI. Or stroke. And I probably see 3 or 4 of these a week. Anybody else?

Over on r/clevercomebacks there is a twitter post from Bernie talking about the cost of ambulance rides and a response that stated the ambulance is not your taxi. I made a comment stating that agree healthcare in the US is of outrageous cost and the system is broken, but I felt like the post was missing a critical point in that ambulances are NOT taxis. They are a limited resource and should be reserved for life threatening emergencies. Well I got downvoted to hell and the amount of people defending the idea is mind boggling. I knew they were out there, we see them all the time, but I didn’t know the sheer number of people that honestly believe an ambulance should be free so you can use it for your 4 day old tummy ache at 2 am.

Almost every single role 911 BLS job around me is through AMR, the paramedic program I want to apply for in 2-3 years (Seattle/King County Medic One) wants 24 months of 911 experience. Does AMR make me look like a bad candidate? Anyone know of Portland/Columbia Gorge spots that might be better?

My medic partner and I (EMT-B soon to be finishing my own medic program) were on a call with a guy in afib RVR, HR consistently around 160-180, confirmed DVT R leg from knee surgery a month prior and on thinners as a result. Hour transport to the hospital. His blood pressures were below 100 systolic, and my medic ran fluids and called med control who said “cardiovert him at any time if you feel like he’s unstable”. The guy LOOKED unstable (I was worried he was gonna code before we got him out of his house based on appearances only) but I was driving so I don’t know what his BPs were like consistently. I didn’t get a chance to look at them in the report later.

My medic didn’t consider cardioverting him until his BP hit 76 systolic (after the call he told me he didn’t want to throw a clot), at which point he called med control and informed them he was going to go ahead and do it. He told me not to pull over so I kept driving. I heard him sync the monitor, and then I heard him cancel the charge and he came up and told me he wasn’t going to do it and to keep going. The hospital successfully cardioverted him within ten minutes of arrival.

After the call, he told me that whenever he goes to cardiovert someone, he pushes the blood pressure cuff button at the same time to get a final reading as a sort of Hail Mary to hopefully see if he doesn’t have to shock them. He did this and the patient’s BP was miraculously at 116 systolic, highest it had been the whole call, so he cancelled the charge and we proceeded to the hospital. The doc said the pt was likely fluid responsive, which makes sense to me. No other meds were given.

I guess my question to all other providers out there, would you take the time to get a second BP reading as you’re charging up the monitor? I guess it doesn’t take that long and we shouldn’t necessarily be in a rush to deliver that shock, but I feel that if someone is unstable enough for me to consider charging up the monitor in the first place and his rhythm is still unstable and irregular, I don’t know that I’d take the time to check? Does that make me lazy? He needed cardioverted regardless is my point. I’m new to this obviously, but I’ve never heard of anyone else using this method of his and I’m debating if I will be adopting it myself. I’d love to hear others’ more experienced thoughts.

EDIT for more info based on some comments I’m seeing: 1) when I say pt looked unstable, I mean he was blue/gray in the face like a pt is when we are doing CPR on them. Skin coloring was very alarming to me, and pt was incredibly weak, altered (only oriented to self and place) and diaphoretic. This did not change throughout the call. I am not sure of the initial BP because we got out of there so fast and I was driving so it may have been above 100 but I would be surprised based on presentation alone. He also asked halfway through the call if he was gonna die, which is always alarming, at least to me. There’s several comments saying treat the patient, not the monitor, and this patient looked and felt like crap. 😅 2) he was already on thinners for the known DVT.

After 17 years in EMS. I worked a 24 hr shift without a call. I’m gonna bring the lube tomorrow. 🤩

lets say if a patient come in with a dnr. He realize hes about to die but don't want to die. the patients tells you or the nurses to ignore it and save him. do you watch him die? or do their request even though it is against their dnr?