As we end 2018 and head into the New Year, Dan shares what he’s learned about moving into a command-level position…and what the pitfalls are for those of us who choose to take the path.
We’ve all been there. The cardiac arrest that may or may not have a positive outcome depending on what we do as providers. We know that walking into an arrest, our goal is to help the patient in any way that we can, and to get them to walk out of the hospital and home to their family. On paper, this is an easy thing to do. Hell, it’s our job. It’s what we do every day. But with the mountain of data that’s been coming out over the past year or so, it can be difficult to know what “the right thing” actually is. Sure, we always tryto do the right thing, but how can we be sure? What if I intubate someone and find out a week later that it wasn’t the right intervention? When do we use an endotracheal tube, or a supraglottic airway? What about a BVM? Should I RSI this patient? What about a DSI? If I do either of those and I fail, what’s my back up? These are all questions that are certainly valid and worth exploring. Let’s dive in.
We’ve all been in those classes where we phone it in. Someone is going to stand in front of the class, power point slides glowing behind them, and preach about a topic we haven’t heard about since our initial classes. The slides will be lightly animated, maybe there will be a video clip that highlights the point of the lecture (like salt makes sugar taste a little sweeter but in a weird way), and the bullet points will be read out word for word. You don’t even have to make the effort to read. Someone in the back of the room is balancing a checkbook, the co-worker who has been there for 20+ years is knitting a baby blanket, the rest are on their phones in a group chat trying to figure out where to go and get a drink at lunch. The class is required, and man does it feel that way.
Why should you spend your hard-earned money and time off at a conference? Dan breaks down why he goes, and why you should, too.
The current role of mostprehospital stroke care for a majority EMS providers is a rapid diesel bolus or an IV line, with the occasional intubation if the patient is imminently ill. With the recent podcast discussing what the current stroke care is out there and the differences in what we can do better, we wanted to ask the question: where is stroke care going, especially for us out in the field? I think this question is best answered by three major literature advances within the last year!
“Empathy is a requirement, sympathy is the price we pay.”
Let’s dissect that statement here. Empathy, specifically affective empathy, is what we need to possess in order to properly and completely care for out patients. “’Affective empathy’ refers to the sensations and feelings we get in response to others’ emotions; this can include mirroring what that person is feeling, or just feeling stressed when we detect another’s fear or anxiety.” In order to treat the whole patient, and not just the monitor, we need to be able to sense their pain, fears, and anxiety. They teach this in nursing school, often called a holistic approach, and it’s something we do not do a good job teaching pre-hospital providers.
Thomas Jefferson wore the first pedometer
Yes, that Thomas Jefferson. While walking through the streets of Philadelphia, and later at his home in Monticello, Thomas Jefferson never stopped his pursuit of knowledge. Jefferson was someone who loved to measure things. So, after the tools were available to make a measurement device to track his steps, Jefferson went about making the first pedometer. He took so much pleasure in this device that he sent one to James Madison in 1788 with instructions on how to customize it.
This series so far has focused on clinical applications and knowledge gaps between the classroom and the application of medicine in the pre-hospital environment. Certainly, these are important topics, and it’s something we at The Overrun will continue to explore; but I wanted to take a slightly different approach to this entry. I’m going to take about the social aspects, and indeed the life changing aspects that medic school had for me.
On this first installation of The Overrun’s What I Wished I Learned in Medic School, I’m going to discuss topics I was introduced to during my Obstetrics and Gynecology clerkship in medical school, or those that were refreshed from my medic school time. I chose topics that I think can either have a direct impact on your prehospital care, or that you can recognize and understand what is going on in your patient while you’re with them before you transfer care at the Labor and Delivery unit or the ED. I tried to steer clear of topics that are normally covered routinely during classes or refreshers (except a couple) – to give you all something new and exciting!
“We could fist fight in the parking lot of a “coffee with an officer” event and then wonder why no one takes us seriously…”
What’s the big deal with the Paramedic2 study?
· 8014 patients enrolled in a UK study of out-of-hospital cardiac arrest
· Randomized, double-blind, placebo controlled study
· 5 centers in the UK from December 2014 to October 2017
· 30-day survival was higher in the group receiving epinephrine than placebo
· Patients who received epinephrine had worse neurologic outcomes
There has been debate in social media about personal behavior and cultural issues in medicine, some that would surprise you when you see how much people will share with others they barely know. This has led in some cases to problems as social media posts have gotten people into hot water with their respective departments or agencies.
In a previous podcast we discussed career mobility. What we found was that there is truly very little opportunity for someone to work as an EMT or as a paramedic for the length of a career without needing a second job or changing careers entirely. We tend to bring people into the industry, train them for the equivalent of five weeks, and then send them on their way hoping that they’ll find whatever vague destiny awaits them. You see this romanticized in movies when a character is placed on a sheet of ice or a small boat and sent away from their village to live a better life. In the movies, of course, this tactic works well. But this career, this profession, is not the movies.
My entire EMT class was a blur. The lessons were quick, the skills stations were chaotic, we had two chances to pass a test and if you didn’t pull off that magical 70% you were out! Go sell shoes! You don’t belong here with the road dogs. You’re not part of the elite. Before I knew it, 3 months had gone by and I was ready to sling and swath with the best of them. I was going to save lives, snatch grandma from the jagged jaws of death with nothing but a non-re breather and tube of glucose; I. WAS. READY.
We’ve all had that call come across from dispatch that you know from the start is an overdose. “Man in car in abandoned parking lot, unresponsive and possibly not breathing.” The opioid crisis being what it is, the likelihood that we will be responding to a patient who has had just this side of too much is more likely than not. We go screaming down the boulevard, lights and sirens, and dispatch comes back and tells us that one Narcan has been deployed. Great!