Ask the Paramedic

My mid-70s mother-in-law (recently diagnosed with Alzheimer’s) had an episode of “hospital dementia” when she was admitted post-heart attack, needing a triple bypass - or stenting, which is what they did. Her second night there, pre-stents, she decided she was going to check out of the “hotel” she was in. It took 4 people to restrain her. :eek:

Ferret Herder, I didn’t mean to sound callous in my post.
Usually, with Alzheimer’s patients, talking to them calms them down. I’ve taken a lot of older patients who are very confused, and just want someone to talk to. Most of the time they repeat the same questions over and over, and all I can do is reassure them.
We had a patient just tonight - she’d been taken to the ER for a fall, and we were taking her back to the nursing home. The nurse was getting her ready to leave, and the patient kept asking for a donut. The nurse was just brushing her off, saying she didn’t have any donuts. I told her I’d make sure she got a donut when she got back to the nursing home. She asked me several times if she could get a donut, and I just told her we’d try to get her one when we got back. It seemed to help. She kept patting my leg and telling me how nice it was that I was going to get her a donut. And yes, she got a donut when she got back to the nursing home.

St. Urho, can you elaborate on how command and control at the scene works, please? Who controls the scene of, say, an auto crash? Maybe it’s a potential DUI that the police responded to first, then called for medical assistance. Who takes over at the scene? One might think law enforcement has clear control, but that doesn’t make sense if the injured is critical or nearly so. Who overrides whom at the scene? And is this a touchy point among first responders and law enforcement?

Thanks for the thread, BTW. I’ve more than one question about protocol and such… :slight_smile:

sangfroid- the short answer is that in most states the senior fire officer is the overall incident commander.

Long answer, it really depends. Where I work, I’m responsible for the patient or patients medical care. I’ll determine what treatments need to be started, what hospital the patient is going to, and if any additional ambulances are needed I’ll coordinate that. If the patient needs to be extricated from the vehicle, the fire department runs that. They also stabilize the care and clean up any fluids that might be leaking. The police will investigate the accident and handle traffic control. There’s not a whole lot of overlap- I’m not going to tell fire how to extricate someone, nobody’s going to tell me which hospital to go to, and so on.

The DUI thing isn’t a huge deal where I work. If the patient is critical, we just go to the hospital and the police can work with the hospital to get a blood sample. If the patient’s not critical, we can do a legal blood draw on scene or at the hospital if the patient consents. We also do the legal blood draws for people who don’t go to the hospital, as well. There’s generally not a lot of conflict where I work because everyone usually has something to do. That’s not the case everywhere, though. For example, in New York City, both FDNY and the NYPD have units that can do auto extrication or heavy rescue, which often leads to heated turf battles.

For a straightforward medical call, the medic that is responsible for patient care is responsible for managing the rest of the scene, too. These scenes have more potential for conflict because there’s often a bunch of firefighters standing around with nothing to do.

Do you sleep well? What you do is little different from combat, and I don’t sleep well. I have a hard time sometimes getting any sort of good sleep. How about you?

I work a 12-hour night shift 1900-0700, and I actually sleep well coming off a night shift. It’s my days off when I have a tough time sleeping. I started taking clonazepam about 9 months ago and it’s been a godsend.

ETA: He posted at 050 Mountain Time…

Do you find that built-up areas cause more suckage? I was at an intersection just recently when I heard a siren, so I looked around. The sound seemed to be coming from in front of me but I could not see flashing lights there. Suddenly the ambulance was right behind me! The sound had evidently reflected off the buildings in front.

Here’s a blog by a U.K. EMT that may interest you.

Not that I’ve noticed, but I’ll keep my eyes open to see if it makes a difference.

You didn’t sound callous - I was just saying you can’t necessarily discount them as a potential threat.

I’ll chime in. I’m still new enough that I don’t have any stress-related sleep problems.

I’ll only do duty on weekends, so any sleep deprivation won’t interfere with my day job. Probably the worst is trying to sleep at the station, and you don’t get any calls. You lay there half asleep, waiting for the page tones that never come. On duty, I sleep my best when there’s a run or two.

Yay! I was hoping I’d see this one pop up eventually…

  1. What’s it like getting started? Taking the initial classes looks pretty easy, but I can’t imagine the first rotation through the ER and ride-along program are exactly low-stress. Can you give me any insight on what your actual experience what like?

  2. What are the lifting/lugging requirements like? What sort of physical requirements do you run into day-to-day?

  3. What are the questions you really wish people would ask you about your job - civilians, newbies, newsies, whatever?

  4. From the reading I’ve done in the last few days, I see there’s a lot of debate over the whole “hero” mentality that seems to come in with a lot of new recruits. It seems quite unlikely to me that anyone in the average entry-level age range (18-22) would not have at least some desire to be the “hero on scene,” even if they have other motivations as well. What’s your take on why folks come in, generally? What kind of people do you like having on crew with you? What kind of people really chap your hide? (I presume it’s the same general stuff as in other occupations, but every job has its own quirks that are not easily seen from the outside, so I ask.)

I’ve been discussing things with my husband in the last few days, and we’re talking seriously about my applying to the local tech college and getting my EMT-B this fall. If there’s anything you have to add that I haven’t asked about, I’d love to hear it! :slight_smile:

As an EMT, I didn’t have to do any ER rotations, but paramedics have to do them here in Maryland as part of their field training.
I took EMT through my firehouse, and its accreditation is through the University of Maryland and MFRI (Maryland Fire & Rescue Institute). I didn’t have to pay for the class, but I did have to pay for the books. I also needed Dickies work pants and leather steel-toed boots when I did my Ride-Alongs. Once I was finished and cleared to ride at my firehouse, I got my blue EMS gear and boots from the firehouse. I did the summer crash course. It was five weeks of class, plus a week of Haz-Mat Operations. It was pretty intense, but I preferred that over six months of two-night-a-week classes. I just did my re-cert, and that was four Saturdays, all day.
My Ride-Alongs were pretty tame. Lots of little old ladies, feeling faint. I didn’t have anything very exciting for those. My very first call after I finished class was a roll-over car accident with four patients, one of whom was flown on the Med-Evac. That was a scary way to start.

At the firehouse, it’s not too bad. We usually have firefighters along, and they can do some of the heavy lifting, and it’s always nice to have extra hands.
At work (private ambo), we do a lot of bariatric transfers. We have two regular bariatric stretchers, and one electric bariatric stretcher. The ambo with the electric stretcher has a dedicated crew, meaning bariatric calls are pretty much all they do.
We (me and a partner) are supposed to be able to lift a 250-pound patient on our own. This means transfering the patient to the stretcher, and then lifting it into the back of the ambulance. If they’re much heavier than that, we can call for another crew to help us. The heaviest I’ve ever done on my own was a 300-pound patient - we had help in the hospital, and knew we’d get help at the nursing home, but we had to get him in the ambo on our own. You slide the upper end of the stretcher into the back, and lift, so your partner can raise the legs. You’re not lifting all the weight, but a good part of it. The stretcher weighs about 75 pounds by itself.
You have to squat and lift, so you’re using your legs - not always very lady-like, but otherwise you’ll hurt your back.

Yup. It’s your fault. :wink:

I found the actual classes for EMT to be pretty easy. I did do ER clinicals for EMT, which mostly involved taking patient histories and taking vitals signs. There’s not a whole lot of procedures that EMTs can do.

Paramedic school was harder. In addition to the paramedic classes you have to take 2 semesters of anatomy and physiology. The more challenging parts were pharmacology and cardiology. Most schools also give certifications in Advanced Cardiac Life Support (ACLS), either Pediatric Advanced Life Support (PALS) or Pediatric Education for Prehospital Providers (PEPP), and either Pre-hospital Trauma Life Support (PHTLS) or International Trauma Life Support (ITLS- used to be BTLS).

I found the in-hospital clinicals to be pretty low-key. People asked me lots of questions and I got to see a lot of patients, but I didn’t have to do a whole lot of decision-making. We hit pretty much every part of the hospital- all the ICUs, the cardiac cath lab and electrophysiology lab, psych ward, surgery (mainly for intubations), 2 different ERs, and detox. We also did some rides with the police and spent time in the county 911 dispatch center.

The pre-hospital rides were very challenging, though. I rode with 3 different ambulance services in 3 different states. I ran a lot of calls, and the expectation was that I would do everything. The patient needs an IV? Great, start one. We had to be able to run a call from start to finish, give a report to the hospital and document it. It takes a lot of time and practice to get comfortable with this, and it’s somewhat stressful even when you’ve been doing it for a while.

On 911 calls, we typically bring in our jump kit, our Lifepak 12, and a D-tank of oxygen. Probably about 50 pounds of stuff, split between 2 people. At a bare minimum you’re usually lifting the stretcher up to the loading height and unloading it from the ambulance. The harder part is getting people on to the stretcher, that can take some work.

We have a bariatric ambulance, too, but no dedicated crew. If we get a bariatric call, someone brings it out and we become the bariatric crew. We don’t have a power stretcher, but we do have a winch mounted in the ambulance (look at the pictures). That’s because the stretchers can hold significantly more weight when they’re all the way down.

I really wish people would ask questions about what we do. A lot of people still think we’re just “ambulance drivers”- throw 'em in the back and haul ass to the hospital. We can do a lot more than that, and people don’t seem to realize it. I also hate it when people call us ambulance drivers :mad: I also don’t like being asked what the worst thing I’ve ever seen is, and I won’t answer it.

In my opinion, it doesn’t matter what your reasons are for joining the field. My current partner went to EMT school on a dare and found out she loved it! She’s the best EMT I’ve ever worked with. What matters is your attitude when you hit the streets. If you expect people to treat you like a hero, you’re in for a surprise. On the other hand, if you have a good attitude, want to learn, and want to help your patients you’ll do well and you’ll be fun to work with. The biggest thing is wanting to learn. There’s so much that goes on in emergency medicine that you can’t possibly hope to learn it in an EMT or paramedic class. The biggest pain for me is people who got into EMS because they wanted to be firefighters. The first question I always ask students is “Why do you want to be an EMT/paramedic?” I’ve had a bunch say, “Oh, I don’t. I want to be a firefighter.” Okay, great, thanks for devaluing everything I do. It seems to be more a means to an end for these people, and they don’t really care about providing good patient care.

That’s great! Good luck! My advice would be ask as many questions as you can and don’t wear 5 million things on your belt.

I’m usually the guy in any group of people who thinks of the stuff everyone else has overlooked, but such a thing never even occurred to me.

They’ve gotten more common since medicare began paying for them at the “speciality care transfer” rate (= more $$$). It’s actually a really great thing to have, because the alternative was trying to shove a large person on a little stretcher into a little ambulance. Or even worse, not being able to fit the patient on the stretcher.

I wish we had a bariatric rig. We have one lady in the county that takes 6 of us to load.

The PTB says no, we have lots of firemen instead. :rolleyes:

Do you have any stories that you found amusing? Any absurd non-horrible accidents or weird people?
I can understand not wanting to talk about the worst cases you’ve seen. I was a vet tech for a while and some days when I went home after a sad euthanasia or a failed resuscitation (in vet medicine it is rare to successfully revive a dog or cat after trauma) it was just impossible to share that feeling. I still don’t like to think about or mention some of the sad cases I’ve seen. It’s partly why I’m no longer in that business.

So let’s hear about the weird and wild instead.

Forgot I had a question.

How common is it to have a third party on the scene who can be of no help to you whatsoever, but whom you can’t ask to leave?

I ask because about a year ago a workman who came out to my house suffered some sort of cardiac incident: his heart rate got very high and he asked me to call 911. The paramedics came and started treating him, and thank god he was conscious and lucid, because I couldn’t have begun to answer any of their questions. I was just the guy who lived there.

EMS stands for Earn Money Studying, what does paramedic stand for?

I broke my arm 2 years ago. The paramedic that showed up was a guy I knew. I had a bone sticking out. Now, he says that he usually doesn’t see that kind of gore. I call BS. I live in Saint Paul, not some podunk little berg. So what is your take? Does an open compound fracture elicit a “meh” or is it more of a “duuuuude, that is gnarly”?

Third parties who are of no help whatsoever can stick around, no problem. In your case, we probably would have asked you a few questions and let you go about your business. In the cases of parents or family members/friends, we’ll usually put you to work- gathering medications, finding medical paperwork, that sort of thing.

It’s the third parties who are actively NOT helping or interfering that can be a problem. I ran a call about a month ago where the patients two adult sons were continually yelling “She needs help!” and wouldn’t shut up. I eventually had to ask him, “Sir, do you think it’s helping your mother for you to be yelling at the paramedic?” before he finally wandered off. We’ve had other scenes where people have been interfering where we’ve had to call the police in to help.