“Armed” – Not “Dangerous”

I fully support our Second Amendment right to bear arms.

I own no less than 40 firearms, which include rifles, shotguns, muzzle-loading rifles, a few semiautomatic pistols, and a handful of bows.

Almost everything I own has been used to put meat in my freezer.

I am armed.

I will never use a firearm to take the life of another, unless that life is directly threatening me or someone else in my presence.

I will never open fire on innocent people in a post office.

I will never open fire on innocent people in a school, college, or university.

I will never open fire on innocent people in a movie theatre.

I will never open fire on innocent people in a parking lot.

I will never open fire on innocent people in a food store.

I will never open fire on innocent people, period.

I have been through countless instructional courses in firearm safety, handling, and firing techniques.

I have been trained/qualified by the U.S. Military on everything from pistols up through, and including, the Vulcan cannon.

I have been trained on weapons systems that the typical civilian and most LEOs will never come into contact with.

I have a great deal of respect for both human life and for the weapons that have been created to take them.

So, yes, I am armed, but I am not dangerous.

And I am not unique. 99% of gun owners are just like me – except for maybe the Vulcan, that is.

A Quick Lesson From The Grammar Nazi

When writing your run report, you whip out your handy-dandy dictionary, and maybe even your assorted pocket reference thingies. You want to make sure that the clinical words you don’t spell every day are spelled correctly so you don’t look like a doofus.

Good on ya, mate!

Why is it so hard to take that extra brain cycle to do the same thing with plurals and contractions? I cringe every time I’m reading an EMS blog/article, and while the content is great and I’m learning something while reading it, I want to smack the author for not going the one extra step to finish checking their work. It drives me ablsolutely bonkers!

So, here is a breakdown of the common ones I see the most. Pay attention here. The doctors, nurses, and even supervisors reading your reports might even thank you for it one day. They’ll probably think you took an extra class in English Grammar in an attempt to further your career.

Don’t laugh. It does make that big of a difference in the way people think about you. People DO judge you by how well (or poorly) you write. Making excuses for your poor grammar skills just makes you appear lazy or ignorant. Don’t give anyone the excuse to think of you as either.

OK, enough of The Lecture. On with The Lesson.

If something belongs to an EMT/EMT-B, it’s EMT’s/EMT-B’s.

I grabbed the EMT’s stethescope.

The plural of EMT or EMT-B is EMTs/EMT-Bs.

There are two EMTs/EMT-Bs on the truck today.

If it belongs to the Paramedic/EMT-P/MICP, it’s Paramedic’s/EMT-P’s/MICP’s.

The Paramedic’s/EMT-P’s/MICP’s assesment was spot-on today.

The plural of Paramedic/EMT-P/MICP is Paramedics/EMT-Ps/MICPs.

There were three Paramedics/EMT-Ps/MICPs yearning for a day off.

If it belongs to the patient, it’s patient’s.

I assed the patient’s vitals before loading him/her/them in the bus.

The plural of patient is patients.

We had two patients in the ambulance yesterday.

If it belongs to a nurse, it’s nurse’s.

I don’t know where that nurse’s charts are.

The plural of nurse is nurses.

There were three nurses complaining about a doctor.

If it belongs to a doctor, it’s doctor’s.

Don’t mess with the doctor’s golf clubs.

The plural of doctor is doctors.

All of the doctors are playing golf today.

I’m going to go back through all of my previous posts now, just so someone doesn’t flame me for making a mistake of my own :)

 

A Wrap-Up For The Past Few Months..

I apologize to my 3 readers. I haven’t been home very much lately, between weekends at the new part-time job, teaching various classes, at the range with my two new Sig-Sauer P226 (9mm & .40S&W), and, more recently, on the road with 2 new motorcycles. Before that, I was working on my DMT recert and trying to get everything together for my paramedic school application.

Yes, two new motorcycles. (No, I didn’t win the lottery. I’ll get to that in a bit.)

My new part-time job (working BLS) requires me to work a minimum of 4 weekend days per month, plus any mandatory large events. I won’t disclose the location or the company, but if you go to a concert, NFL football game, or any other large event near me, you know the place. (If you grew up in Northern NJ, you’ve been there at least once for a Springsteen or Bon Jovi concert.) You’d be surprised (or maybe not) at the amount of ETOH patients we get. I still don’t understand why someone would pay top dollar for a good seat, then miss the entire event because they get inebriated.

But, I digress…

My DMT recert was a PITA, mostly because the continuing hours required for the diving-specific lectures has to be NBDHMT-approved lectures. The 30+ hours of lectures I had weren’t approved lectures. Making those in time was frantic, to say the least..

As far as Paramedic school, it looks like that will have to wait yet another year, since the deadlines were different than last year. And thanks to the State changing the entire EMS tracking database, I couldn’t get verified for my New York EMT card by the deadline. I’ve also heard that the reciprocity for NY has changed recently, so that might not even be an option for next year. I’ll find out the details later on, and see if the Disco Patch will be in my immediate future or not.

Now, to answer your questions about the motorcycles, here’s the short version.

I’ve been wanting to get a Kawasaki KLR650 for years. Finally, with my huge truck payment coming to an end next month, that leaves an extra $600+ in my paycheck each month, so I figured now was the time. I went to a local dealer to see what they had, and, lo and behold, they had 2 in stock. I looked around to see if they had anything else on the floor, since I’ve also been yearning for a Vulcan for a little longer than the KLR. They didn’t have anything on the floor for less than $13,000, so that pretty much made the decision for me. I checked at the other dealer in the area, and they had even less.

So, pay stub in hand (to prove my earnings for the financing), I picked up a brandy-new 2012 Kawasaki KLR650 in black.

KLR650

After riding it for a few days, I realized that the bike was too high for me. Seat clearance on the KLR is about 36″ – my inseam is about 30″. I didn’t think it was too much of a dealbreaker until trying to navigate the numerous uphill turns from a stop, idiot drivers stopping short (because the person they were talking to on their cell phone had earth-shattering news that they just had to stop short for), and considering I live on a hill, just trying to get off the dern thing was an event you’d pay to see (without the kids, please!)

It just so happened that 2 days after I rode it home from the dealer, I had to go back there to pickup the owner’s manual, since the sales weenie forgot to give it to me when I picked up the bike. When I walked in, there were about 15 brandy-new V-twin cruisers waiting for me.

After taking a beating on the trade-in, and working out the financing for the new love of my life (as well as paying off the original $6k loan for the KLR), I drove home on a new 2012 Kawasaki Vulcan 900 Custom two weeks after I drove the KLR home. Seat hight is about 26″. No more circus act when I get home every night.

Vulcan 900 Custom

So, the next update will probably be sometime around October, or whenever the first snowfall hits.

Too bad I can’t take it to the range to play with my other Baby..

Sig Sauer P226 Elite Dark .40S&W

Oh, and if you follow me on Facebook, look for the pictures of what I look like on the bike. IN A KILT.  I might just post them here, as well.

Stay safe out there…

Patient Questionnaires – Are You Using Them?

Recently, an idea came up about sending out questionnaires to patients (or families of patients) we transport to the ED. The idea behind this is to gauge our performance, and use the completed forms as a “quick and dirty” QI process while we establish better procedures.

I would like to hear feedback from anyone who has implemented this, and how this had an impact (if any) on patient care, procedures, SOPs, or anything else.

We’re also in the middle of putting together a list of questions to include on the form, so if anyone wouldn’t mind sharing theirs, I would be grateful. If you don’t want to post it here, feel free to email it to me. I make it a point to keep my sources anonymous, so your name and/or department/squad/company will not be disclosed to anyone (I’ll just copy the questions down on a pad and shred the original at home.)

Thanks, and have a safe Holiday weekend.

Check Your Attitude At The Door: First Impressions Are Everything In The Field

This is a guest post from a good friend of mine. This is her first public post, and her new blog is over at http://ambolampcelady.blogspot.com. Welcome, Kimmie, to the EMS blogging community!

 

It’s a sweltering, sticky summer night with humidity so high every breath you take feels laborious and heavy. Your uniform clings to your body like a suffocatingly moist second skin. The only cup of coffee you were able to obtain spilled all over you just fifteen minutes into your shift, eight hours ago. You haven’t even had time to think about another cup of coffee, let alone food. Finally you crawl back into your ambulance to hopefully finish a few of the charts you are behind on. As if on cue, the radio crackles and you punch your clipboard as you hear your unit number called, yet again. This time your assignment is for “the twenty year old female with a toothache and possible syncope.” The patient is on the fourth floor of an extremely nasty apartment building. Instinctively, you reach down to your pocket just to make sure that you have your trusty flashlight, because this particular building has scarce to no lighting. As you pull up to the scene, the new song you have been raving about all night to your partner drifts out of the speakers mockingly. You sardonically chuckle to yourself thinking “REALLY!” After hauling all of your equipment up the four unlit, urine-drenched, seemingly never ending, flight of stairs, you rap on the door. Of course it takes five or six hard knocks before someone finally hollers “Who is it?” Your partner holds up their hand to stop you right before the words “the Tooth Fairy, who do think?” slip out and responds “the ambulance.” You take a deep breath and feel the flush creep away from your face. This is the very moment when what you say, the tone and inflection of your voice, your appearance, and body language form the first impression of you for the patient or their family member.

We are all human, and it is perfectly normal to be tired and frustrated. There are times when life and all of its accompanying stressors seem to form large concrete barriers, and cause us to lose sight of why it is that we do what we do. We can all be guilty of forgetting the real reason we got into EMS in the first place – which, by the way, is to help people! Despite being hypo-caffeinated, over tired, and hungry, it is important to remember that for better or for worse, you are the professional in this situation. Your attitude and the way you present yourself ultimately affects the patient, your safety, and dictates the flow of the assignment.

The “first impression” that is formed by the patient (or the patient’s family) strongly impacts how they are going to act towards you and your partner as their pre-hospital care providers. I am by no means delusional, neither; am I advocating for you to be poised and ready to enter a situation hugging patients, their families, kissing babies, and drying crying eyes. That is not what we are called to do as pre-hospital care providers, nor is it a reasonable expectation of our patients that we provide such a service. Yet, what is a reasonable expectation on the part of all past, present, and future patients is professionalism. We must strive to remain professional at all times. Be both conscious and contentious of what you say, and how you say it. It is not only the words you use that the patient hears, but also the inflection, and the tone of your voice. Your appearance and body language will also give away what you are thinking and how you feel about the situation. Is your shirt tucked in? Are you obviously wearing your coffee on the front of your shirt? Are your hands in your pockets? Should you be slouching over or holding up the walls by leaning on them? Did you make eye contact with the patient or are you scrubbing the dirt off the floor with your eyes? It is important to be mindful of these things and not put the patient or their family on the defensive, before you even get in the door. Putting the patient or their family in a defensive mode is not only counterproductive but dangerous. It can make you appear as if you do not care about the patient or their situation. Being uninterested or confrontational is different than being calm, yet confident and assertive as called for to manage or control the scene. Self-assuredness is acceptable; being unapproachable and unwilling to listen is not. What you say, and how you appear can even inadvertently make you seem as if you are a poor pre-hospital care provider.

There are a lot of “unknowns” and variables when initially entering a scene or assignment. In most instances we are not familiar with the house or scene we are walking into. We do not know where any guns, knives or other potential weapons may be hidden. Although it should be part of your initial scene assessment prior to any patient contact, you may not know all the means of ingress or egress. We
do not know the mental state of the bystanders or the patient. We also do not know why EMS was really called to respond.

The anxiety level on the scene of an assignment is usually elevated. When people call 911, their degree of control over a situation changes, the knowledge that they are no longer in control and have therefore called someone else to assume control over the situation can be a point of relief or a point of added stress for the patient and/or family members. As EMS providers the first words that come out of our mouths should be direct, to the point and respectful. Our focus is to quickly discover exactly who the patient is, where they are, and why the ambulance was called, all the while, assessing whether or not we are walking into to a violent or volatile scene.

“Yo, what’s going on?” is not the best approach even if you are in an urban area, where this type of language is common place and acceptable. Instead, try to incorporate more courteous and professional “opening questions” such as “Hi, are we here for you sir/ ma’am? Did you call the ambulance today, and if so, what can we do for you?” These questions show respect, attempt to identify the patient or patients and can clue us into what may possibly be waiting in the next room. If the first person you make contact with believes you are truly there to help, you may find that you have at least one ally if the patient proves to be uncooperative, combative or “difficult”. If you have unintentionally offended or upset this person of “first contact”, they will be less inclined to help you. This person may even stand in the way of patient care both literally and figuratively.

Upon approaching the patient try making eye contact with them, while simultaneously introducing yourself. Nobody likes to be touched uninvited, especially by a stranger in uniform. Your apparel or your presence in an official capacity can be intimidating. The patient may not have given permission for the ambulance to have been called to care for them, and EMS might have been activated by family, friends, a concerned third party, or law enforcement. To the patient you may simply be an unexpected or uninvited guest. Ask the patient what, if anything, is ailing them, and why someone has called for the ambulance (if the patient did not call for themselves.) If you take the initiative and demonstrate respect by asking the patient first it lets your patient know that you care about them despite the possibility that your presence was requested against his or her wishes. It is imperative that we somehow communicate to our patients that we do care what they have to say, how they feel and about their general well-being. Don’t make yourself or your partner the enemy by ignoring the patients concerns.

When the bystanders try and intervene respectfully let them know that the patient’s ability to answers question appropriately for themselves is part of your assessment. Bystanders can provide you with crucial information that the patient is unable or unwilling to communicate during assessment. You can always try and gather this information as well as other background and demographic information from the bystander on scene after you speak with the patient. Sometimes this additional information is best exchanged between bystander and provider out of ear shot from the patient.

As often occurs when speaking to patients, EMS providers are able to make some sort of basic interpersonal connection. It is this simple connection that lets the patient know that they can trust you as a provider. Your presence should be a calming one. If the patient is loud, hysterical or agitated try to coax them into speaking quietly. Explain to the patient that you are there to help them but that you cannot understand them and therefore help them if they are yelling at you. There are also physiological changes that occur when a patient is upset, angry, or anxious. These states will raise a patient’s blood pressure and heart rate and have the potential to exacerbate a patient’s current conditions or symptoms. Even if it seems that all you have done was calm the patient’s anxiety or fear you have ultimately helped the patient on many levels.

When patients trust that you are competent and have their best interests in mind, they are much more likely to comply with any patient care–related requests that you may have. The more cooperative and collaborative the effort between the patient and the provider, the more synchronized and seamless patient assessment, patient treatment, and patient transport can be. Simple actions such as a patient calmly allowing you to assess their wounds, the establishment of IV access, or even assisting the patient in walking to the ambulance when medically appropriate, are all examples of tasks that are better accomplished with patient trust and cooperation.

A patient’s perception of you as their health care provider will unequivocally determine the level of care they allow you to provide for them. Subsequently, a patient’s family’s perception of you will also determine just how much they are going to interfere – or help – with the care you provide. Your job will be easier, safer, and your patient care improved, if you remember to check your attitude at the door.

 

Kimberly Rundecker, EMT-B

A Note to EMS Providers on Hyperbaric Chambers

I don’t know about the rest of the country/world, but in my neck of the woods, EMT students are taught to bring patients involved in a diving incident, no matter how minor, directly to a hyperbaric chamber.

Can someone please put a stop to this nonsense?

First of all, HBOT (Hyperbaric Oxygen Treatment) is a treatment, and needs to be ordered by a physician.  Unless directed by medical control to transport the patient directly to an awaiting chamber, as can be the case with public safety and commercial divers, patients need to be in stable condition before being subjected to the pressures and stress of a hyperbaric chamber.  Literally.  If a patient is unresponsive, can’t maintain a patent airway, or needs immediate surgical intervention, they won’t be ALLOWED in the chamber.  Period.  End of story.

Secondly, most operational chambers are used for a growing number of non-diving related treatments.  Insurance and Medicare consider the following conditions for HBOT to be covered for payment:

  • Air or Gas Embolism (AGE), including cerebral (CAGE)
  • Carbon Monoxide Poisoning
  • Compartment Syndrome/Crush Injury/Other Traumatic Ischemias
  • Decompression Sickness (DCS) / Decompression Illness (DCI)
  • Diabetic and Selected Wounds
  • Exceptional Blood Loss (Anemia)
  • Gas Gangrene
  • Intracranial Abscess
  • Necrotizing Soft Tissue Infection
  • Osteoradionecrosis and Radiation Tissue Damage
  • Osteomyelitis (Refractory)
  • Skin Grafts and (Compromised) Flaps
  • Thermal Burns

The following conditions may or may not be covered by insurance or Medicare, but can also be treated with HBOT:

  • Autism
  • Cerebral Palsy
  • Lyme Disease
  • Migraine
  • Multiple Sclerosis
  • Near Drowning
  • Recovery from Plastic Surgery
  • Sports Injuries
  • Stroke
  • Traumatic Brain Injury

The staff operating a chamber are well versed in treating the above-mentioned ailments/indications, although they have a working knowledge of DCS/DCI/AGE and have been taught the basics.  The physician at a chamber site would sometimes need to call on another specialist for assistance if an ambulance pulled up with a bent diver looking for treatment, if they even let them get past the front door to begin with.

Other reasons you shouldn’t bring a patient with a possible DCS/DCI issue directly to a chamber include:

  • No available chambers (once a patient is under pressure and being treated, you can’t just yank them out for someone “worse”.)
  • Gas supplies on hand (oxygen and compressed “clean” air) are low and won’t last the required length of a table 6 treatment.
  • The facility may not treat diving injuries.
  • An injured diver needs to be “cleared” for hyperbaric treatment by a physician.  Contraindications for HBOT include pneumothorax (collapsed lung), tension pneumothorax, myocardial infarction (heart attack), and/or neurological and musculoskeletal injuries with symptoms similar to DCS/DCI, to name just a few.
  • The facility might be closed after normal operating hours.

If you encounter a patient that you think might be suffering from a diving related injury, the best thing to do is to provide high-flow oxygen via a nonrebreather mask (15lpm or higher) as soon as possible and transport to the nearest ED.  Gather and record as much information as you can pertaining to the patient’s diving profile, including:

  • signs and symptoms, chief complaint
  • deepest dive depth
  • number of dives in the last 48 hours
  • type(s) of gas used (Nitrox, tri-mix, heliox, air, etc.)
  • diving environment (fresh water or salt water)
  • ascent/descent/bottom issues (if any)
  • equalization problems during ascent/descent (if any)
  • equipment malfunction issues (if any)
  • name and phone number of the diver’s divebuddy
  • any pre-existing medical conditions

Provide the information gathered with your handoff report, preferrably on paper, along with any equipment they were using (if you picked them up at the dive site.)

Call Divers Alert Network (919-684-9111) and speak to a Medic, or have the receiving physican call and speak to a DAN Medic or physician for treatment options.  The phones are staffed 24x7x365, and they accept collect calls.

The single-most important treatment for a diver suspected of having DCS/DCI is a BLS adjunct: OXYGENLots of it, as soon as possible, for as long as possible.  Forget a nasal cannula at 4lpm.  Oxygen breaks down the nitrogen bubbles in the blood stream and tissue compartments.  Nitrogen is what causes DCS/DCI, so the faster you can apply SLO2 (surface-level oxygen), the faster you can begin the nitrogen breakdown, and the diver will have a better chance of recovery once they start the chamber treatments.

Whatever you do, DON’T, for the love of whatever you consider Holy, take them directly to a hyperbaric chamber.

 

We Done Good, but We Can Do Better!

Well, after a little over a month, countless odd looks, a number of random conversations, a few brain-bleach incidents, and a ton of great fun, Kilted To Kick Cancer 2011 has come to a close until next year.

Or has it?

Officially, September has passed us up until next year, which means Prostate Cancer Awareness Month is another 11 months off in the future, and now is the time to Save The Bewbs. But that doesn’t mean we should stop trying to spread the word about prostate and testicular cancer just because it’s no longer September.

Guys still need to know that they need to get themselves checked on a regular basis.  I don’t see myself donning my kilt in the middle of a Northeast snowstorm (well, I might, you never know), but that doesn’t mean I’m going to stop spreading the word on how important “checking your junk and your trunk” is until next year, either.

All in all, my fellow Brothers and Sisters helped raise a total of $8806.50 in ONE MONTH for the Prostate Cancer Foundation and the LiveStrong Foundation.  You can check out the breakdown on AmbulanceDriver‘s page here.  You’ll notice that the total on that page is $8,114.50 but that doesn’t count the last little bit my employer raised for the cause, which didn’t get submitted in time for the contest deadline.  Which would’ve put me in third place.  Oh well.  I’ll just have to outsmart Kelly next year, provided that doesn’t include anything about me being in drag.  Unlike Kelly, I have self-debasement limits higher moral standards better legs  OK, I got nothing.  If I have to promise pics of me in pantyhose and lipstick to raise money, so be it.

So, in the meantime, you might have noticed the pink background..

SAVE THE BEWBS!