Thursday, May 7, 2009

Conversation With an Athletic Trainer

I work as a Paramedic in a major metropolitan area- for some Medics one of the perks of the job are the overtime details at professional sports contests. Baseball season is here and with football fast approaching we had our annual meeting with the local pro football team trainer- afterward his assistant had this brief exchange with me:

I don't know what the big deal is- I can do all the same stuff you Paramedics do.

Huh- can you intubate?

Well, no I... I can't...

Give intravenous drugs like Amiodorone, Verapamil, Atropine, Morphine, Fentanyl- can you even give Benadryl?

No, I-I-I...

Can you interpret a cardiac rhythm? How about a 12 lead EKG?

We ahh, we never ahh...

How about CPAP, pulse oximetry, capnography- you ever do any of that stuff?

No, no I mean ahh...

So pretty much the only thing you can do that I do is hand out band-aides right? You look like you're really good at handing out band-aides.

Yeah, whatever man, I just thought we ahhh....

Look- you can't do anything a Paramedic does. So next time just keep your mouth shut.

Life in the big city folks.

Monday, May 4, 2009

Why the Big Three Aren't Selling Cars...

... or- how I tried to buy a 2009 American truck and failed...

Ok- I read the papers, I know the Big Three Car makers are in trouble. Being a conscientious American I thought I would help out by purchasing an "American" truck this time around.
I started my search on-line- it is after all the 21st Century. So, right off the bat I eliminated all Chrysler products- they make junk and I don't buy junk, GM- just didn't have what I wanted... so I settled on a Ford F-150 pick-up. I already knew how I wanted it so I clicked the box on Fords web site to get an "Online Quote"- that was my first mistake.
Why? Well, Ford doesn't give online quotes- nope- that's just a thinly veiled scam to collect your contact information.
I'll save us all some time here- I soon received about 15 e-mails from my local Ford dealer. The General Manager wrote, the Sales Manager wrote, a Salesman wrote... but no one sent an online quote.
Then the phone calls started- again, the General Manager, the Sales Manager, a Salesman and finally the Sales Manager again. Come on down so we can give you a quote they said...
Ahh, I've checked the inventory you've posted on YOUR web site- I'd like my quote on #123456 please...
I told them that one (or more) of us has mis-understood what an on-line quote is... it's, it's ONLINE right?
Now I'm pissed, but I went anyway. I met with Chuck at the Ford dealer.

Let me show you some trucks! Chuck was all happy and ready to go!
I know what I want Chuck- how much for this one?
Well, what are you trading in?
I'm not.
What...ahh, well, how much did you want your payment to be?
One dollar.
You must be putting down one hell of a down payment.
Nope, not puttin' anything down- how much for that truck- the one right there, 10 feet from us.
Well it's $*** per month.
What's the total Chuck?
Ahh, well, umm...

Hey- you get the idea- round and round we danced till I grew weary of the game and left... and went straight down to the Toyata dealer and bought a brandy- new Toyota Tundra.

Saturday, May 2, 2009

EMS Swine Flu Guidelines

... just on the off chance anyone would be interested- below are the EMS Swine Flu guidelines sent to us by our EMS administrators- yours are probably similar. There's no mention of resource allocation or other "tactical" considerations. But- they did give us the standard; gown, mask, gloves, stay six feet away and wash your hands... I think we all know, some of these are impractical for EMS and, most will be absolutely ineffective in the face of a wide spread outbreak.
Yea, we all know that.
So please- Do not panic- there's no need to... but again, a little pre-planning would go a long way.

The memo:

In response to confirmed cases of swine influenza in Mexico, California, Ohio, New York and Texas, all personnel should be aware when responding to calls for patients experiencing flu-like symptoms including fever, cough, sore throat, body aches, headaches, chills and fatigue. Swine flu is a respiratory infection caused by Type-A influenza viruses that regularly does not normally infect humans. At this point we do not know how easily this particular strain can be passed from humans or the severity of the illness. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions. Every ambulance should be equipped with additional supplies to enhance your protection while treating patients with cough and sneeze symptoms.

The City of __________ EMS Medical Director and EMS Admin are releasing the following recommendations with respect to the potential Swine influenza outbreak. This aggressive approach will help us limit the spread of influenza to pre-hospital care providers, our families, and our patients.

The Swine flu - just like the seasonal flu - is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. Some people are at high risk for serious flu complications, such as elderly, young children, pregnant woman, and people with chronic health conditions.

Influenza transmission occurs by large respiratory droplets that are expelled from the respiratory tract during coughing or sneezing. The patient compartment of ambulance should be considered an area at risk for transmission when transporting a suspected influenza patient.

To keep you and your family healthy during this period, please follow theses guidelines when responding to patients with potential flu like symptoms. For our purposes, symptoms of the flu will include a cough and fever but also may include any of the following sore throat, body aches, headaches, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu.


Ø To reduce the spread of respiratory droplets patient's with flu like symptoms that are not in respiratory distress should be asked to wear a surgical mask (this is not an N95 mask). Patients with respiratory distress should be placed on oxygen via a non re-breather mask.

Ø Personnel should enhance the patient interview to include specific inquiry as to recent travel, with an emphasis on Mexico, or contact with someone who has recently traveled to Mexico. Additionally, personnel should also establish if a relationship exists with anyone who has been at or in contact with a known high risk location. This information shall be passed on to the receiving hospital.
Offer tissue and advise patient on cough etiquette.


Ø To reduce exposure during treatment and transport EMS crews are suggested to wear appropriate BSI.

Ø Maintain an initial three (3) to six (6) foot standoff distance from the patient as possible with one Paramedic conducting the assessment when possible.

Ø Gloves must be worn for all patient contact.

Ø While interacting with the patient, crew members should wear an N-95 mask.

Ø Wear a gown if soiling of clothing is likely from secretions

Ø Use of eye protection when working within 3 feet of patient recommended

Ø Cough-generating procedures should be avoided inside the ambulance (e.g., nebulizer treatments). Contact command if these procedures are medically necessary.

Ø Prior to arrival at the hospital, notify the receiving hospital that you are transporting a possible influenza patient.

Ø Wash or decontaminate your hands frequently, avoid cross contaminating surfaces or equipment.

Ø Avoid eating, drinking, application of cosmetics, and handling of contact lenses in the patient compartment area.


Ø Patient-care compartments (including stretchers, railings, etc.,) should be cleaned using an EPA-registered hospital disinfectant.

Ø EMS crews should wash their hands as often as possible before patient contact, after patient contact and before returning in service from the Emergency Department