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Next generation EMS

May 25, 2010 By 2 Comments

So there I was, sitting in the back of the ambulance cleaning up after running a combative patient that was under the influence of meth-amphetamines. My partner and I were wading through the wreckage that this outstanding citizen caused. Kind of like people do when their homes get demolished by tornadoes. I looked at my partner – who happens to be brand new – and told him that he did a good job on the call. He looked up at me with a confused stare and replied, “are you being scarcastic?” I explained to him that he stayed calm and did a great job with getting the restraints placed on the patient in a timely manner.  ”Um….thanks, nobody ever gives me feedback so I don’t really know if I’m doing a good job or not”, he replied.

After speaking with him for a while, I realized that he is afraid to ask any senior medics or EMT’s for advice. This really troubles me for many reasons. For starters, the majority of my family lives in this town and if a new EMT wants to better himself and learn from the more experienced medics, then I want that opportunity to be available to him. If he runs my family, I want him to be competent and comfortable with his skills.

Back in my night-shift days – before giving in to the call to promote to middle management – we used to all sit around the crews quarters and talk about our calls while finishing up our PCRs. Everyone talked about scenarios, asked questions and offered advice to the new guys. Nobody was afraid of being perceived as an idiot or a bad medic. We were all there to learn from each other and grow as professionals.  Nobody was out to be the “best medic”.

We owe to our newcomers to flood their brains with tips and information, whether they ask for it or not. Every time I see a teaching opportunity, I jump on it. Likewise, I take advantage of every learning opportunity that comes my way. Just remember, in time our “FNG’s” will become the senior providers. At some point in time, my health will get the best of me and I will require EMS. The same “new guy” that nobody wanted to bother with may end up coming to my aid. I don’t know about you, but I want him to have the benefit from learning from all our years of experience.


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Why my daughter doesn't play with balloons

May 6, 2010 By 2 Comments

I was en route to a call for a child choking. We are typically canceled on these calls before we arrive on scene as the parents either relieve the obstruction, or they realize that kid wasn’t really choking. Not this time. We made it all the way across town and arrived on scene to see a firefighter waving us into the house.

My partner puts the ambulance in park and gives our “on scene” traffic as I walk around to the back to get the gurney out. The firefighter walks up and says “Sean, the kids really choking…..not sure on what but we can’t get it out”. We get our equipment and head inside, doing our best to stay as calm as we can.

Sure enough, an 8 month old girl is on the floor with firefighters trying desperately to relieve the obstruction. They inform me that they are unable to ventilate with a BMV and back blows and chest thrusts are not working. I take a second to assess the child and realize that the kid now has no pulse. I quickly grab my laryngoscope and magill forceps and insert the blade to try and spot the foreign body that has deprived this poor child from oxygen. Seeing nothing but emesis, I grab the portable battery-powered and suction the airway. I go back in a see a blue object in the child trachea. I manage to grab the object on the first attempt and remove it. I place an ET tube and begin ventilating the child.

It was a balloon. A blue balloon that the child was biting before it popped, being sucked into the child’s airway as she probably gasped from being frightened.

The child is placed on our gurney, secured, and we are off to the nearest hospital. A quick look for IV access appears hopeless so I place an IO. After 1 round of EPI and Atropine, the child’s pulses return. No spontaneous movement, no spontaneous respirations…..just a pulse.

We get to the ER and the child is placed on a ventilator. Before clearing the hospital, I hear that the kid is now starting to breathe on her own. The ER staff was able to get a stable blood pressure and subsequently flew the child out to the nearest children’s hospital. I called that hospital every day for a week in hopes to hear good news. Unfortunately she died after a week of ICU.

Balloons are an infants worst enemy. They are possibly the worst thing a kid could possibly swallow. BLS methods of relieving balloons that are stuck the airway are next to useless. Unfortunately the parents of this child learned this the hard way. This is quite possibly the most mentally draining call that I have ever run.

If you have an infant or a toddler, be very careful when letting them have balloons. Please keep an eye on them, or just keep balloons away from them. Remember, we can’t all carry laryngoscopes around with us at all times.


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A few tips for passing National Registry

April 12, 2010 By Leave a Comment

I recently received an e-mail asking me about study material for the National Registry exam. It has been a number of years since I tested, but I would like to share some tips I learned while studying for the test.

Written Exam

The written is probably the most stressful part of the whole thing. At least now you get your results within a day or two. I had to wait 2 weeks for my results! Anyway, on to my advice….

I used “Barron’s Nation Registry Study Guide” for pretty much all of my studying. The book comes with a bunch of practice tests that are very similar to the National Registry questions. As a matter of fact, I remember quite a bit of them being nearly the same as the questions I came across on the test. I would take the practice tests, grade them, and then highlight the areas I either missed or had to guess on. I would take notes on the subjects that I needed to brush up on and then go back and study them in my textbook. Worked like a charm. I passed on my first try!

The book is a great tool to ensure success on the first try but you need to remember a few things. The test isn’t as complicated as people make it out to be. I hear people say crap like “if you see oxygen as one of the answers, pick it”. That’s 100% BS. Go with the answer that you KNOW is correct. I also remember someone telling me “if you see mast pants as an answer, pick it”. More BS. Yes I saw a couple questions with mast pants and an option, but I know for a fact one of them was absolutely wrong. Carefully read the questions and answer accordingly.

Pay attention to the wording on the questions as some people will read the question too quick and get the answer wrong because they misunderstood. For example; if they say things like “initial treatment”, it probably refers to a BLS treatment (BLS before ALS!). If they say something like “priority treatment”, it’s probably referring to something more definitive like intubation. Read the question twice to make sure you didn’t skip over words like “not” or “don’t”.

I used to tell people to go back and read over the test and answers again to make sure they didn’t skip any questions or mark on the wrong spot. This of course changed with computer-based testing. Just remember, pick the answer you KNOW is correct.

Skills Testing

I HATED practicing for skills tests. It feels redundant and boring. Trust me it’s worth it. All those stupid things like “c-spine” and “scene safety” WILL make a difference. Practice with some other paramedic students, and some seasoned paramedics. Memorize those skills sheets. Remember your proctor will be following one while you make a fool of yourself trying to get your license.

Something to consider is what kind of people are doing your test. Do some research and find out what kind of system the proctors work in. Read up on their protocols and try to get into their mindset. Remember, what works for you may seem stupid to others. You are in their playground. Adjust accordingly. I know a bunch of people are going to e-mail me telling me that I’m stupid because regardless of their local protocols, the testing remains the same. I agree. However, they are humans and think and act like humans. They are naturally going to respond to what they are comfortable with. Run your scenario just like they would run a call in real life. Trust me, it will work wonders.

As always I welcome suggestion, comments, hate mail and questions. I hope this post can be of use to someone. Please let me know if you have any other advice to offer!

Have a great week everyone.


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Teach them while their young

February 25, 2010 By 16 Comments

I just finished reading a great guest post on “Everyday EMS Tips” by Steve Lichtenberg about teaching CPR to kids. He gives some great advice about teaching to a younger audience. But more importantly, he makes it clear that kids can be taught to save lives. This post really hit home, as I am living proof on how teaching kids to perform CPR or First Aid can really make a difference.

When I was 12 years old, I took a health class in school to get out of having to take Spanish. For 2 weeks, we learned CPR and first aid. We were also certified in the skills once we showed our instructor proficiency. To me, it was more of an excuse to goof around and pretend to make out with the CPR dummy and make people laugh. It still didn’t change the fact that I had to learn the skills in order to pass that part of the class. I actually did find the first aid part of training to be interesting. So after I passed the class, I had 2 neat cards to put on the refrigerator and show off to my parents. I never thought I would use any of those skills, especially as a child.

A couple days after I completed that class, I was riding bikes home with a couple of my friends. One of the kids that was riding with us decided to take off across traffic and was hit by a pickup truck. I watched him fly over the handlebars, hit his head on the windshield and fall off the side of the truck to the street. After a couple seconds of watching him lay motionless, I ran over to him to see if he was ok. He wouldn’t respond to me and basically laid there limp.

The lady driving the truck got out and started screaming at me to get out of the road so that she could pull him off to the side. I knew that we shouldn’t move him, although I didn’t exactly know why. I just remembered that we should keep the head still. I held his head and told the lady to call 911. This was before cell phones were popular, so there was really nothing she could do. I yelled at my friend to ride to his house that was only a block away and call instead.

Several people stopped to help, and pretty much everyone wanted to pull him out of the road. I was adamant that we couldn’t move him and I tried my best to convince the adults on scene that I was doing the right thing. It basically came down to the fact that I refused to let go of his head, so they really had no choice. I had one of my friends hold pressure with a towel on a large laceration that he sustained from the accident in attempt to control the bleeding. He too had just taken the same class.

The ambulance (the same one I work for now) arrived on scene first and took over care. I don’t remember much of what they did, but I do remember one of the crew members thanking me and saying that I did the right thing by holding his head. A couple months later, the kid returned to school. He suffered minor brain damage and a spinal fracture. He had no lasting neurological deficits and pretty much made a full recovery. I’m sure his helmet probably did more of the life-saving than anything, but It’s nice to think that I may have actually made a difference in his outcome.

So yes, I do think that kids can and should be taught to perform life saving interventions. Image how many victims of cardiac arrest would survive if we taught all high school students to perform CPR? We make them learn to use a computer and type properly on a keyboard. Why not teach them how to react in a life-threatening emergency? They may never take another CPR class for the rest of their life, but they will always have at least some of the knowledge in the back of their head. Bad CPR is always better than no CPR. I wonder if the American Heart Association has tried to approach programs that would teach young adults CPR before graduating high school?

If anyone knows of such programs, I would love to hear about it.


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HIPAA vs EMS Bloggers

January 22, 2010 By 15 Comments

Yes I’m bringing up the much feared “H” word…..but for a good reason!

I read various EMS-related blogs and Twitter posts every day. Most come with some pretty interesting stories about calls ran. Unfortunately, some are a little too detailed and have the potential to get some people in trouble. I know this because I speak from first hand experience.

Being guilty of sharing my calls for the day with the world, I have been known to give out a little too much information. On one occasion, my boss actually called me into his office because he received a complaint about a story I posted on my blog. Luckily it just amounted to me pulling the post off my blog and no real damage was done. However, had it have been pushed any further, I could have easily been fined thousands of dollars. My employer would have also been fined, which would have probably translated into me being unemployed.

Many EMS bloggers violate HIPAA and don’t even know it. There is a huge misconception that leaving out patient names protects us from privacy laws. The truth is, you have to pretty much leave out any details that could even remotely link the story to a patient. For example; if the patient can read your blog and identify the story as being their incident, then HIPAA has been violated.

So how do I HIPAA-Proof my blog?

The only way to make your blog 100% compliant is to just not reference calls without a patient’s permission. If you read my blog, you obviously know this is not how I practice. I do however, take several steps to minimize my risks.

First and foremost, NEVER use patient names, addresses, pictures, etc. Anything that directly links your story to the patient is just an attorneys payday waiting to happen. Making up fake names or not using names at all is an easy way around this.

We all like to brag about who we work for right? Well don’t do it. Don’t even mention what agency or company you work for. Doing so places yourself and your employer at risk. This goes for the entire blog, not just the story.

Don’t talk about where you work, or even where you live.  Be vague when discussing your location. Use terms like “Southern California” rather than “Los Angeles California”. This also applies to the entire blog.

Don’t get detailed when discussing call locations. Describing your scene as “Chili’s Restaurant on 4th street”, is a bad idea. Instead either make up a fake establishment or just don’t even mention any business names.

Blogging is like journalism, so aren’t I covered under the “freedom of the press?”

No, no and hell no.

Sure Geraldo Rivera can pretty much say anything he wants on TV and be covered under the constitution, but Geraldo isn’t a paramedic (thank god). We are healthcare providers and we sign HIPAA agreements when we go through school and start employment. As a matter of fact, posting protected information on the internet is about the worst way you can violate privacy laws.

Don’t get me wrong people, I love reading about how you intubated 2 people at the same time or successfully stuck an IV in someones earlobe. Just please be careful and protect yourself!

If anyone is interested, more HIPAA information can be found at http://www.hhs.gov/ocr/privacy.


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Do snake bite kits really work?

December 11, 2009 By Leave a Comment

You have seen the movies and heard the stories. Someone gets bit by a Rattle Snake in the middle of nowhere. Their life is almost at it’s end. That is, until their buddy pulls out his pocket knife, cuts open the wound and sucks out the venom.

Obviously, this scenario is not likely to happen as the majority of snake bites occur within reasonable distance of civilization. Also, people who frequently work or live in these areas carry commercial snake bite kits. The question is, do they really work?

Most snake bite kits come equipped with suction devices, a scalpel, and a tourniquet of some sort. They typically direct you to cut and suction the site and lightly apply the tourniquet to reduce the spread of the venom. The majority of the bite kits that I reviewed recommend that this only be done if the nearest medical help is greater than 30 minutes away.

Every medical textbook that I posses, including “Essentials of Paramedic Care” actually discourage such treatment. The common theme in textbooks includes splinting the affected limb, keeping the limb at a neutral position(at the level of the heart) and rapid transport. Supportive measures include establishing IV access, high-flow oxygen, ECG and sp02 monitoring. Packing the wound with ice, applying tourniquets or cutting the puncture site can actually cause more damage.

The only treatment that is actually going to make a big difference is anti-venom. If you are in an area where snakes are prevalent, then chances are the nearest ER will be equipped with the necessary antidote for your snake bite.

The idea of a snake bite kit sounds good to most, but not to the “experts”. So in conclusion, if you are bit by a snake, your number one priority will be to seek definitive care. Immobilizing the affected limb, keeping it at even level with the heart and keeping the victim calm will all help to slow the process. Obviously the best thing you can do, is to avoid getting bit in the first place.

If you have any questions or comments, please feel free to e-mail me.


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Want to Become a Paramedic?

December 1, 2009 By Leave a Comment

13paramedicSo you have been working the field as an EMT-Basic or EMT-Intermediate for some time now and you feel it’s time to take the next step in your career. Making the decision to become a paramedic takes a lot of time and consideration. Working as an EMT is fun, rewarding and exciting, but are you ready to take on the responsibility of being a paramedic?

As a paramedic, you are ultimately responsible for all aspects of patient care on the scene of any medical emergency. You are in charge of proper documentation, radio reports, treatment, transport destinations and mode of transport. You will be held legally responsible for all interventions performed on the patient in your presence. In many cases your closest help will be miles away at the nearest hospital. As you may have heard many times before, great power comes with great responsibility.

Scared yet?

With all the responsibilities and stress associated with becoming a paramedic, the job has still proven itself to be rewarding. After a hard days work, the satisfaction of knowing you made a difference in one or many peoples lives, makes it all worth it. People will look to you in their greatest time of need and place all their trust in your training and expertise to save their life. Parents will hand you – a complete stranger – their child and trust that you will make them better and give them a safe journey to the hospital. Some people will life a long and fulfilling life as a direct result of your life-saving interventions, and some may die regardless of the amount of effort you and your crew had put forth.

Anyone who has been working in the EMS for a while knows that the job isn’t all about saving lives. On many occasions the 911 system is flooded with non-emergent calls and in some cases, strait out abuse. Sometimes you sit in a station for 24 hours and never turn a wheel on your ambulance.

So now you might be thinking “so how do I become a paramedic?”

To obtain certification through the NREMT (Nation Registry of Emergency Medical Technicians), you must pass six to eight months of didactic training, approximately a month of hospital-based clinical training and a minimum of 400 hours of field training. You must then pass a series of skills-based tests and a written or computer based exam. For more information on certification requirements, visit the NREMT website as http://www.nremt.org

Didactic (classroom) training typically lasts about 6 to 8 months. You will extensively cover many subjects such as anatomy, physiology, cardiology, pharmacology, pulmonology, trauma emergencies, medical emergencies, scene control, OB/GYN, geriatric emergencies, pediatric emergencies and ECG interpretation. You will also practice several ALS (advanced life support) procedures such as starting intravenous lines, administering IV medications, needle decompression, surgical airways, oral and nasal intubation, NG tube placement, IO placement, manual defibrillation and external pacing. This is a general list of skills taught. Skills may vary from state to state, depending on the allowed scope of practice.

Once you finish your classroom time, you will move on to hospital-based clinical training. Here you will get the opportunity to practice your newly learned skills on live patients in a controlled environment. Most programs include rotations through the ER, Operating Room, OB/GYN, ICU, NICU and sometimes psychiatric hospitals.

Now that you have practiced your newly learned life-saving skills, you will move on to field training. You will be placed with a paramedic-preceptor as you learn how to apply all your acquired knowledge and skills to a pre-hospital setting. This can the hardest part of paramedic training, especially for those who have little to no experience in a pre-hospital setting. This will last a minimum of 400 hours, but typically lasts 500 to 600 hours depending on your progress.

Once you get signed off from field training, you are now eligible to take the NREMT exam and apply for certification as an EMT-Paramedic. Skills testing will usually consist of stations including verbal scenarios, mega codes, pediatric emergencies, trauma and even some BLS stations as well. The written (or sometimes computer-based) tests are difficult and consist of questions covering everything you learned in your didactic portion of your training.

The whole process can be stressful and can quite possibly be the hardest course you ever take. Taking classes in anatomy, physiology and ECG interpretation prior to starting the program will make the class significantly easier. Some other quick classes offered by the American Heart Association like ACLS and PALS can also make paramedic school easier. For a list of AHA classes, visit http://www.americanheart.org

Good luck in your journey towards becoming a paramedic. I hope this article will serve a good reference or starting point. Please feel free to e-mail with any questions or comments.


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Want to Become an EMT?

December 1, 2009 By Leave a Comment

Ever considered starting a career in EMS? Being an EMT can be a very rewarding job and open up many opportunities to further your career in the future. Many EMT’s move on to become paramedics, firefighters, and police offers. Now several colleges offer EMS Management degree programs for EMT’s or paramedics that want to promote to management or get jobs at the state or county level.

Before we discuss the steps to becoming an EMT, lets talk about what an EMT is.

EMT’s are a vital link in the health care system, as they are typically the first to arrive at the scene of any medical emergency. EMT’s provide life-saving interventions at the basic, intermediate and advanced (paramedic) level. For the purposes of this article, we will focus on the “basic” or entry-level EMT.

EMT-Basics perform basic airway management, bleeding control, splinting, oxygen administration, spinal immobilization, and suctioning. In some cases EMT’s even administer some medications and are trained in childbirth.

In most settings, EMT-Basics typically work with a paramedic. In some cases ambulances will be staffed with two EMT-Basics in volunteer, rural or inter facility transfer settings.

Now for the big question, “how do I become an EMT?”

To achieve certification through the NREMT (National Registry of Emergency Medical Technicians), you must take a semester long class and pass a written and skills test at a licensed testing facility.

Many community colleges offer EMT-Basic training and testing. Some companies and fire departments also offer in-house EMT-Basic training. For more information on the requirements for certification as an EMT-Basic visit http://www.nremt.org

For someone with no medical or emergency services background, EMT-Basic school can be difficult. The semester-long class is a crash course in anatomy, physiology, pharmacology, airway and breathing emergencies, cardiology, trauma emergencies, pediatric emergencies, patient assessments, OB/GYN and much more.

If you are new to the medical field, I would recommend studying or taking a class in medical terminology. This will relieve a large majority of the challenges associated with EMT-Basic school. Researching basic anatomy and physiology prior to class will also place you ahead of the game.

Unfortunately I can not cover everything that is expected in EMT training as classes may vary from state to state. For information about becoming an EMT-Intermediate or Paramedic, please refer to my article titled “Want to become a paramedic?”.

I hope this will help serve as a starting point in your new exciting career in EMS. Please feel free to e-mail me with any questions or comments.


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911 – What to expect when you call

December 1, 2009 By Leave a Comment

So your loved one has suffered a heart attack. You fear for their life and feel helpless. You have no medical training and you are in desperate need of help. So what do you do? Like any other person in a time of emergency, you call 911.

Now what?

Activating the 911 system for first time often scares people. The thought of loud sirens, bright lights and several strangers entering your home can make you nervous or even hesitant to call in a time of need. For these reasons, I decided to create this article in hopes that you will know what to expect and what you can do to help in the event that someone you know or love takes a turn for the worst.

Unfortunately you can not plan or schedule emergencies. They often occur when you least expect it. Staying calm and taking control of the situation will be your key to a smooth transition from the panic of the incident to definitive medical care.

If you are at home, work or a place of business, always try to use a land-line telephone. In a state of panic you are likely to forget your address. Using a cell-phone makes tracing your location difficult for 911 dispatchers.

The 911 dispatcher is going to ask you several questions. Some of which may seem time consuming or ridiculous. Just remember, be patient and answer all of the questions clearly and accurately. Your answers will assist the dispatchers in assigning a priority to the call and give the paramedics valuable pre-arrival information. Try not to rush though the conversation. There are several dispatchers on duty at all times. While one is talking to you, another is dispatching the closest ambulance.

Once you know that help is on the way, you can perform several tasks to minimize the amount of time that the emergency workers have to be on scene.

- Make sure your lights are on.

The emergency crews will be looking for signs of activity. This will make locating your house easier.

- Leave your front door open.

This will also aid in spotting your house in the event that your address is not clearly visible.

- Clear a path.

Move cars out of the driveway, unlock any gates and move items that might prevent the paramedics from moving a gurney to the scene.

- Gather medications, identification and insurance information.

Have all of this ready in a bag. By doing this, you will cut several minutes away from the time the paramedics must stay on scene. This translates into a quicker transfer to definitive care.

If there are several people standing around, assign these tasks to others. Keeping people busy and out of the way will benefit your loved-one and make the responding paramedic’s job easier.

The paramedics will likely ask several questions. Some of which you may have answered when you spoke to the 911 dispatcher. Although this may seem like wasting time, be patient. The paramedics must have a clear understanding of what is wrong so they can determine the appropriate treatment and transport destination.


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