When will we change?

If we, EMS as a whole, were right less than 15% of the time there would be a outcry among Medical Directors and Managers for remedial training and a plethora of terminations happening.  The study results Rogue Medic has posted are not new.  Looking at the following numbers makes me wonder why are we not changing our ways.  To summarize, the accuracy of the indicators of major trauma are (percentages based on the number of patients entered into the trauma systems in each catagory vs. the confirmed number of major traumas):

Vital Sign changes - 2.8%
Injury only - 4.7%
MOI - 8%
Vitals Sign changes + Injury - 15.4%
Vital Sign changes + MOI - 14.6%
Injury + MOI - 10.6%
Vital Sign changes + Injury + MOI - 50%

There will always be the patients entered into trauma systems based on altered mental status on scene that were over triaged because of a concussion along with the ones that we are given no choice because of abdominal pain or percieved chest trauma. 

I was pleased during my recent PHTLS update to find out they have taken assessment and added it to MOI for the criteria of admission into a trauma system.  I have seen some of the worst trauma that can be experienced while deployed for Operation Iraqi Freedom and seen how much the body can really take.  What we classify as major trauma here was normal, everyday injuries for us there.   It has given me a whole new perspective of "major" trauma.

This does not even begin to address the overuse of HEMS, that is a whole other post...

WOW

Captian Chair Confessions stirred it up.  I agree 100% and if you have a problem with that I offer this to you:

Available at Power Point Ranger and an Army Supply Point near you...

Bring it on

I am released to work solo, bring on the nausea every time the tones go off.  Years of experience at the BLS level help but, still nervous as hell...

Been There, Done That

I was having a conversation with one of my fellow students from the Paramedic class today and the conversation turned to experience.  I was lucky enough to have the BLS skills mastered and have years of experience at assessments prior to going to Paramedic School.  He had zero experience and landed a job at the BLS level prior to class being completed.  He is still waiting to finish testing for his Paramedic and was struggling to train into a job at the BLS level in a large urban system.  He related feelings of not being comfortable on runs and being frustrated.  I tried to encourage him in the fact that all of us have been there and the only difference between him and I was experience prior to taking the Paramedic class.

He is lucky in the fact that he did get a BLS job, having an opportunity to learn and  begin to master the BLS side of pre-hospital care, prior to taking his Paramedic written test will make him that much better when he transitions to the Paramedic level.  If there is one thing I could stress to anyone who would like to pursue a career in the EMS field it would be to become an EMT and find your place first.  I have many reasons I say that:

1)      If you do not feel comfortable assessing and treating a patient at a BLS level there is no way you will feel comfortable learning it at an ALS level.

2)      How can you be sure that BLS treatment will be appropriate when you have not had the time in the box doing it?  This prevents over treating your patients possibly creating problems with long term care.

3)      There are a number of skills you need to master at the BLS level.  Spinal immobilization, knowing how to effectively and efficiently immobilize patients is a core skill and the class room training and skills practices are just the tip of the iceberg.  Airway control, knowing when it is appropriate to control the airway using BLS means vs. ALS is a skill that you cannot be taught in a classroom.  Mastering those BLS skills on real live patients will build your confidence and give you some assurance when it comes time to intubate your first live patient.  Starting IVs, an IV on a training arm and a few live sticks for an Advanced EMT class vs. starting an IV on a patient that has a BP of 60 is a huge difference.  I firmly believe that I have gotten IVs based solely on having the confidence to stick them.

4)      BTDT, been there done that.  Being able to walk in and see a patient having a problem that you have seen in the past is something that a year and a half of class cannot teach.  No two patients are the same but, there are similarities.  Distinguishing between COPD, Pneumonia, and CHF can sometimes be so subtle that, experience and making the mistake in the past is all you have to draw from to decide.  Taking the BLS patient into the hospital for COPD that you find out later was CHF from the ED doc will leave you with a lasting impression and you did no harm at the BLS level.

These are just a few of the reasons and it is time that the National Registry and individual States start to require experience as a prerequisite to Paramedic School.  A few hundred hours of clinical time in an ambulance is not enough and the level of training would be better with more time spent on the ALS in school producing better medics.  Medics coming out would have a higher confidence level and better understanding of the disease processes that they will encounter.  My friend would have been better prepared for school and would not be so overwhelmed now.  He will do fine because his attitude and desire to learn is there and he is now using the BLS skills every time he gets into an ambulance.  Even he admitted that he would have done better in class at this point than he did.

Politicians...

Not only am I a Paramedic I work a full time occupation outside of EMS that is Union.  I am very proud to be Union and am disappointed in the partisan politics in the state if Indiana that has forced the Right To Work legislation onto the people and workers here.  Not that I really want to discuss politics with anyone I am just saying that the partisanship politics in this state and country needs to stop.  We need representatives that represent the people not the lobbyists and those with more campaign money than the rest.  That is the change I can be behind.

Gone and done it.

After more than a decade in EMS I have obtained my National Registry Paramedic certification, and as of today I have held it and my state certification for one month.  I am a lucky one around here having a job waiting for me to transition into from being an Advanced EMT and I am completing my third week of orientation, and it has been as experience.

It has been weird from the standpoint that I do not feel like a medic yet.  I still have another medic sitting in the back of the truck, critiquing everything I do and giving me a safety net if I get in trouble.  That gives me a sense of confidence and even possibly a false sense of security.  The only aspect that has changed is I get to make the decisions and treat how I feel is appropriate.  I still stop myself from asking if I should do something or if the medic wants something from time to time like I am still doing clinicals but, that is where the reality sets in.  I do not know if it is a privilege or a burden to have this responsibility, probably a combination of both.  One thing still remains true, I love this job. 

I have had a RSI and a full arrest within the first two weeks.  That was a huge confidence boost to know I could control the airway and manage difficult patients outside of clinicals.  I have gotten to use CPAP and manage multiple respiratory distress patients.  I have treated the standard chest pain patients and even had a transfer to the cath lab, starting and managing multiple drips.  The years of experience and the year and a half in school are really coming together.  One big lesson I have learned through this is, the year and a half in school and the certification has not made me a Paramedic.  It only earned me the right to learn how to be a Paramedic, the real learning comes after the certification.  It has been fun and challenging and that is why I love this line of work.  It has been awesome to have a preceptor that was in EMS exactly one year after I was born over thirty years ago, someone that encourages and corrects but, lets me be myself with how I treat patients.  I am looking forward to the next few weeks and in earning the right to my first shift as the only medic on the truck.

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