After doing some work with a paramedic class and looking at the way they studied it made me think back to how I studied when I was taking my first paramedic class back in college.  When I got to college my study habits were poor to say the least.  I was one of those people who always got it or I did not.  I can count the number of tests that I studied for in four years of high school on one hand, because I would just absorb information. I could have gotten better grades if I had applied myself more.  While I was a good test taker, I skipped a lot of homework assignments because I saw them as being busy work.  When it would come time to take a test my score would be solid.  When I would have to do a report I could research it and put something good down on paper.  Homework though, that was my downfall. Once I got to college the game had changed all together.  I went from not having to study to having to learn how to study because it was something that I had never done all that much.   I had trouble confirming for myself that I knew something without some concrete evidence in front of me.  That is why products like Dan Limmer’s Paramedic Review app were so important to me when I got my National Registry Paramedic certification a few years ago.  I could take a test, get immediate feedback on it and then have a score in front of me that gave me an idea of how well I was grasping the information. Once I got to my paramedic class I found myself having to study more and more, especially in the first semester.  While carrying a moderately high class load I had to deal with the Fick principle, acid/base balancing and pharmacology.  Oh yes.  Pharmacology.  My program brought in a doctor for a month who gave us his own four inch d-ring binder full of information.  We did not just have to learn each medication, its purpose and its dose but we had to also know contra indications, mechanism...

In response to a number of major incidents over the last couple of years, active shooter, WMD, and terrorism classes are once again all the rage.  I wonder sometimes though if we are putting our eggs in the right basket.  These are not the incidents that are injuring and killing providers in the field as often as altercations with a single patient, lifting injuries, and motor vehicle accidents. Maybe we need to shift our focus back to scene awareness (not scene safety).  Some of the incidents, namely the hostage incident in Georgia, was a response to a routine call that went horribly wrong when the crew arrived.  I wonder if they looked back at it though if they would identify any warning signs that they missed.  I wonder if they walked into the scene with the level of complacency that many of us do when responding to a ‘routine” emergency.  It is something every one of us have done, myself included.  We get tunnel vision.  We forget to really get a look at the room we are walking into, or ask where that vicious lhasa apso is when we see the “BEWARE OF DOG” sign on the door.  Or even something as making sure the keys are out of the ignition on the call for the unresponsive or disoriented person behind the wheel. We rely far too often on the police and assume that their presence alone means that a scene is safe when that could not be farther from the case.  I have had plenty of “we need to get out of here right now” moments on scenes that were deemed “safe” prior to my arrival.  Now that statement does not exist to take anything away from the job that they do, because personally I rely on the police for a lot.  They often are able to offer a lot of information, and while maintaining a scene is their prime responsibility, our own safety needs to be our responsibility regardless of who else is there, or what the nature of the call is. Sometimes it just takes a few simple approaches to our day to make a big difference in its outcome, and...

I recently read a story that came across the EMS wire about an EMSA paramedic in Oklahoma City who was assaulted by a patient and as a result, she lost her unborn child.  Last week, I read a story about a politician or lawyer (forgive me, I cannot find the actual article to reference it) who assaulted a medic and was not charged.  Over at Rogue Medic, Tim brought to light a man who assaulted a Chicago medic who got off easy. Our job can be dangerous.  Sure, for the most part, our calls are routine, and we are not at risk, but then there are those cases, like the ones referenced above, where we are put at risk.  When these incidents happen, I’d go as far as to say that paramedics and EMTs are more at risk than doctors and nurses who have other staff there who could potentially back them up, and police officers, who are trained to deal with such situations.  When a provider is one on one with a patient who could potentially become violent, or does become violent, there is not a more dangerous scenario that we as prehospital providers are put in. Some of these tips are my own.  Some of them I picked up from Mike Taigman and the street safety course he was teaching through EMS1.com a couple of years ago. First of all, each of us needs to remember that scene safety carries into the back of the ambulance.  Next time you’re in the back of your truck, take a look at your surroundings.  Where are the potential “weapons” kept?  Are there sheers or IV needles in the cabinet right next to the patient?  Are they accessible on the bench seat?  What do you keep on your belt, and how well is it secured?  Make sure your sheers are always fastened if you carry them.  And although I have not found much of a use for them in my years as a medic, make sure your knife is discretely tucked away. Work a “pat down” into your assessment.  It can be as simple as a head to toe assessment, and can be very discretely done. ...

I am sure that most of you have noticed that I have been wading my way through another bout with writer’s block.  It happens, right?  I’ve beaten it before, and I will beat it again though.  I’ve gotten some great support from some friends who have suggested topics, and offered ideas for future posts.  The one I am sharing with you today though is one I find interesting. Last week, I was complaining on my Facebook wall about my struggles with writer’s block, and my friend friend sent me an interesting question: “I saw that you had writer’s block the other day and was curious to know if you’d be interested in running an informal and non-scientific survey of your faithful readers. Here’s what I am curious to find out: I have the opportunity to watch hundreds of transfers by the various private services in RI take place at various hospitals while I am posting. It seems as though virtually all of the techs riding with their patients sit in the airway seat behind the patient, usually entirely out of view of their patient. About the only time that I sit in that seat is when I have a backboarded patient (so my patient can see me) or a patient with an airway issue, at all other times I am either on the bench or in the “captains” chair, in full view of my patient. I wonder if this is generational/experiential/company SOP, etc. and why so many EMT’s now choose to be out of view of their patients? Just a thought, I am sure you have your own feelings and experiences from Springfield, and maybe this will help break your block.” Personally, my answer is simple, but it comes with an “*”.  Although I often tell people that I am only 5’9” the truth is I am actually 6’5”.  When I am working on a truck, they are 99%-100% of the time, van ambulances.  With my long gangly arms, I can reach everything in the truck from the comfort of the bench seat.  When I say everything, I pretty much mean everything.  Its freakish.  The only time you will find me in the airway...

Over the years I have seen a variety of EMTs who carry a variety of equipment on their person.  I have seen everything from window punches to elaborate holsters with a round of soft goods to virtually nothing at all.  It made me think about my own personal compliment of supplies that I feel are vital to my job that I carry on my person every day. The amount of stuff that I carry on my full-time job in the city varies a bit from my old part-time job when I worked at an amusement park, and when creating your own supply list I suggest you keep that in mind as well.  Tailor it not only to what you need to have right by your side but also what will be close. 1.  Radio – I always have a means to talk to someone not only via phone, which in a pinch will take too long, but also by radio.  Also, how is anyone supposed to get a hold of me if they cannot get me on the air? 2.  Scissors – The trauma shears I carry at work (in my pocket, not in my belt) have a set of Rip Shears attached to them as well.  This way, I can get through anything I might have to on a scene with little difficulty. 3.  Two spare pairs of gloves – Usually, my first pair of gloves sits in one of my front pockets until I decide to put them on.  My second pair is in one of the leg pockets of my uniform pants, usually on the left side.  Why the left side?  Because that is where I have always put them.  I try to carry the same stuff every day in the same place.  It has become a routine of sorts for me. 4.  Handy wipes – In my other leg pocket, I usually carry eight or ten of our industrial strength individually packaged handy wipes.  They are not just for my crew and I but also for the police or fire department should they need them.  These things are really popular with our first responders, and I swear along with coffee,...

This past September, I attended my first “real” EMS Conference. Sure, I’ve been to a few small ones out in my side of Massachusetts, but I had never seen anything quite like what I experienced down in Dallas. It was amazing, and I was completely overwhelmed. Now, as I prepare to head off to Baltimore for EMS Today in just a couple of weeks, I think its time to share with you some of the lessons I learned at EMS Expo. 1. Wear comfortable shoes! – You are going to be on your feet and walking around a lot. A large conference isn’t the place for flip flops (I’m looking at you, April) or brand new shoes that haven’t been broken in yet. I was able to find some inserts down there that they were selling on the conference floor that made a huge difference, but I definitely wasn’t prepared for all of the walking that I had to do. 2. Carry a spare wall charger for your phone — I’m a social media addict. There were many times where I was chomping at the bit to get my phone charged, but my charger, of course, was on my desk in my hotel room. It would have been great if I had a wall charger with me that I could have plugged into an outlet somewhere to just get myself a little more juice. 3. Get a business card made up — You never know who you’re going to meet when you go to a conference, and having some way to identify yourself, and making a lasting impression after the fact is great. Conferences aren’t just about education, they’re also terrific networking opportunities. Not only did I make and strengthen some great friendships in Dallas, I met some people who have been valuable resources for helping to improve the place I work in. 4. Pack a couple of resumes — As I said, conferences aren’t just about education. You’re going to find services and recruiters there too. If you see someone you like, tossing a resume their way might not be a bad idea. You never know where it might take you. 5. Leave...

When I was in California, I had three similar conversations with three different crews. It went something like this: Paramedic/EMT — “So, you said you’re from Massachusetts, right?” Me — “Yes I am!” Paramedic/EMT — “How the heck do you work in the snow? What do you do?” My response at first was “What do you mean?” But I realized very quickly that in the Bay Area, dealing with a significant snow fall usually isn’t a logistical issue. I’m sitting in my truck right now writing this as I stare at a five and a half foot high snow bank, which is bound to get higher as in the next 48-72 hours, we might see as much as an additional twenty inches of snow fall dumped on us by Mother Nature. I’ve been in Massachusetts for almost fourteen years, and I can honestly say, I don’t remember a winter being that bad. Keep in mind though, that I don’t completely remember some parts of my college years! For those of you who live in warmer climates, I guess I should give you the rundown of what we do, and what we deal with when things get like this. . . right after I share an inappropriate hand gesture with you, and your “Its warm enough in January to wear short sleeves” weather. 1. Plowing, or lack there of. Over the last couple of years, my service has completely transitioned out of Box Ambulances. Our entire fleet of 35 trucks is now made up of vans, and let me tell you, I’m not that heart broken about that, especially at this time of year. Many side streets in our service area end up being very poorly plowed, and with cars parked on the streets, its very difficult to get a Box Truck down the streets. Even a not-so-experienced driver can park a Type II ambulance just about anywhere. 2. Hypothermia. The heat almost always stays on the back, so that all it takes is a flip of the “Master” switch to get that truck nice and toasty. Crews always make sure their IV warmer is stocked, and sometimes will even add a 1000 cc bag...

As I am writing this, its Tuesday afternoon, and my area is planning on spending much of Wednesday dealing with Blizzard-Like conditions.Predictions for my area are going anywhere from six inches of snow to a foot and a half.Only time will tell how much we end up getting. It’s Winter Time, and snow is a given where I live.We might not get as much as say, Tonawanda,New York, but we do alright here.So far this year, we have gotten pretty lucky, but all of that could change tomorrow.If a blizzard was to hit where you work, how ready are you for it?I’m not talking about your service, I’m talking about you personally. Do you have a Winter EMS Survival Kit?Maybe its time that you make one.I am fortunate enough that I live about a mile and a half from where I work, so the need for me to be “fully prepared” is not as great as it was, but when I lived farther away from work, I always had a kit in the trunk of my car that was ready to go if I ever needed it.Here’s what it had: 1.Spare clothes — I always carried a spare uniform with me, right down to the skivvies!You never know when you might need them, especially in the snowy, winter tundra ofNew England. 2.Two Pairs of Socks — As funny as it may sound, its always important to take care of your feet.One extra pair is good, but two will get you through for a while, if need be. 3.Shower Supplies — I always had an extra towel, along with soap, shampoo, and flip flops!While the towels in my service get washed, they’re also used to clean up the ambulances.Gross, right? 4.Toiletries — Always have a spare stick of deodorant, and a tooth brush and toothpaste handy.No one wants to sit in the truck with a stinky partner. 5.Extra Boots — Again, think about those feet!I usually go through two pairs of boots a year, one in the Spring and one in the Fall.Usually, my Spring/Summer boots are in good enough shape that they could still be worn if needed, so I keep them as a...

For the month of July, I was selected to host The Handover, an EMS Blog Carnival. The topic I chose to tackle? The Crisis Patient. Not a day goes by where I don’t have to deal with a psych crisis patient. They’re out there, we all run into them, and the training that we get to be able to deal with them is minimal. Focus moves towards ACS patients, strokes, respiratory patients, or trauma scenarios. While treatment of these patients is usually rather involved, it takes the focus away from our less acute crisis patients, which are viewed as more routine, and easy to care for. They are, however, far from either of those descriptions. Take a read through the blogs below. Chances are you’ll see a situation that you’ve been through in the past. The Insomniac Medic shares the story about an encounter with a patient where a special bond was created, and because of it he was able to get his crisis patient the help that he very much needed. The Happy Medic dug into the archives for his contribution to this month’s Handover. He’s asked by the Police Department to help remove someone that many of us have encountered: a horder. Physically, she’s fine. Mentally, she’s competent, but sometimes we are forced to make decisions in the best interest of our patients. Our friend over at Paramedic Pulp Fiction takes the time to talk to his already restrained crisis patient, and takes the easier, less forceful way out. Taking this approach not only made his job easier, but could potentially make things easier on the next crew that encounters this guy. Often times, its important that the provider takes control when dealing with a crisis patient. Over at Street Watch, we get to hear a story from 2006 about a rather large crisis patient with the potential to escalate a situation to a physical level. He remains in complete control of his scene and his patient, but he gives her the chance to feel like she’s in control with a few simple actions: letting her have a cigarette and giving her simple choices about how care is provided to her. Our...

Well, its July, and its my turn to host The Handover.I’ve done a lot of thinking over the last couple of weeks after I was given this task, and I feel like I’ve come up with a good topic. Throughout my schooling to become an EMT and a Paramedic, I received a lot of education and information about treating strokes, and traumas, and MI’s.I’ve learned how to read 12 leads, and I’ve tubed and cannulated my fair share of patients.There have been times though in my career where I might go a rotation without dealing with a critical patient.There is one patient that always has seemed to be present in my EMS Career as a Paramedic, and coincidentally, it’s a class of patient that was not touched upon as much by my Paramedic and EMT instructors: The Crisis Patient. These patients come in all shapes and sizes.Some are as young as 5 or 6, and some as old as 70 or 80.They all present differently.Some are suicidal, some homicidal, and some depressed.Some of them are very cooperative, many show passive resistance, and others, unfortunately, insist on being difficult. Recently in my system, because of a few incidents, techniques for dealing with these patients has been a hot button topic.Some crews are reluctant to go into scenes without the Police Department or a Supervisor present.Instead of blindly pushing people through the door of a residence, I’d like a chance to take from you, my esteemed, intelligent colleagues, some of the techniques that you use to deal with these crisis patients.So I was wondering: – How do you approach these patients?How conscious are you of your body language around these people – When a patient is resistant or reluctant to receive treatment and transport, how do you like to handle that? – In your time with these patients, how much do you dig into their history, and reasons for feeling depressed, suicidal or just “not right?” – Finally, when it comes down to it, what techniques do you use for subduing and restraining a patient? So how do you contribute? Just post a link to your blog as a comment to this post, and I will...