Sunday, December 27, 2009

Pre- Hospital Airways and Oxygen Made Simple

You know, the City has hired a lot of new and by new I mean NEW Paramedics recently, and I’ve been seeing some really glaring gaps in their knowledge base.

Used to be only a select few candidates made the cut. Now, if you have a paramedic patch and proof of City residency you are half way home. Put those folks out on an ALS ambulance with another inexperienced Medic and the crazy good times roll.

I don’t want to get into the Medic who desperately wanted to give his bradycardic inferior wall MI patient Atropine, the numerous knuckleheads who give walking/ talking dopers Narcan, the idiots who treat, then assess, or the crew that does absolutely nuttin’- except scream and hop- in order to expedite transport.

No- let’s back way up and talk about pre-hospital airways and oxygen administration.

Very simply folks- if there is a mechanical impediment to your patients respiratory function, throwing oxygen at the problem will not help.

So, that guy with the half pound of Christmas candy stuck in his trach- the non rebreather won’t help. Oh, I know he’s purple- everyone was hoping you’d maybe do something about that…and the lady who can’t (and proves it) breathe laying flat? Yeah, a cannula at 2 liters will not change things at all.

Nope. Fix the problem- this is EMT class stuff. We shouldn’t have to give this little lecture to Paramedics.

But we do. We do.

Sunday, December 13, 2009

Pedro- Where the Hell Have You Been?

... working, just workin'...

First, let me say- if I owe you a phone call, text message, Tweet or lunch- I'm sorry. Been working a goofy schedule- every time the schedule straightens itself out, someone else quits and the chaos begins again. Crazy.

Second, to my dear friends and family- thank you so much for helping with the dogs. But- who ever taught the "little" dog to poop in the front yard is in very serious trouble.

Third, I know you're just dying to know- where the hell was I last night? Working. Working out in the freezing rain.

Folks- if you look out and the streets all shiny and every conceivable surface is coated with a layer of ice- stay home. Just stay home.

Had the honor of transporting a nice elderly gentleman to the ER in the middle of the storm- Complaint? Runny nose- "it just keeps running..."

Then the crashes started and didn't stop- oh, thanks for the OT folks. Your driving prowess is paying off my house and keeping my garage filled with two wheeled toys...

My partner and I responded to a 12 car smash up- it looked like one of those made-for TV crashes. Cars everywhere, at all kinds of crazy angles. Just one injury though.
Could have used those chopper guys from NBC's Trauma- or Lassie. Could hardly walk on the street because of the ice.

The ride to the ER was crazy- five miles in one hour and ten minutes. The last half mile is a curvy up hill- we had to turn around at the bottom and go up in reverse. Could not go up "the right way".

There were at least two City ambulances involved in crashes. One occurred not far from the crash I worked- they sheared off a utility pole and dropped the wires on the top of the truck.
The other that I know of the Medics commandeered an SUV and transported their patient in it. Now that's Old Skool- or Old West...
All of our peeps are alright...

Around 0700 we ran out of trucks- too many calls and it was taking too long to respond- and Dispatch was holding the low priority calls.

Ever call your ambulance a "bus"? One of our ambulances in another district started picking up the E3 (low priority) calls by stopping at each location, putting the patient on the bench seat and driving to the next patient. They'd load four or five and head for the closest ER.

Finally Police, Fire, and EMS all stopped responding to calls that didn't involve an immediate life threat.

But it's good to know we were able to sneak the dude with the dribbly nose in under the weather.