Miscellaneous

I like it when my preceptee beats me to work. It shows good work ethic. And I’m almost always 15 minutes early.

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There is a pro and con article in one of this month’s emergency medical services magazines about cell phone use on the job. I hate it when my partner’s phone goes off while we are assessing a patient and he answers it and says, “I’ll have to call you back.” I had a preceptee once who carried his cell phone on his belt and he had these ring tones that helped him identify who was calling. Right in the middle of a call, he gets a call, and he answers it and I’m thinking I am going to chew him a giant hole when we are done with this. Well, it turns out it was a family emergency and he had to go and I could hardly say anything considering the news.

I also hate it when a partner is driving lights and sirens and talking on his cell phone. Not cool.

I have a cell phone now — I’m probably the last person to get one in EMS. I admit it is very handy. I don’t have to beg anyone to borrow their phone. If a shift is paged out, I don’t have to wait until I get to the hospital to try to call in to get it. I admit I have answered it on calls — when I am transporting a transfer and my patient care is done. I usually just say I’m on a call, I’ll call you back. It raises the question if the non-emergency patient has dementia is it okay to yap on your cell phone during the transport. Probably not from an ethical standpoint.

I have lent my cellphone to accident victims on several occasions so they could call family members to let them know they had been in an accident. Hell, its only 10 cents a minute and they are thankful.

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Our new regional protocols are finally approved. We are set to start using them now at the one service I work for because we have all been trained in them. In the city, we will have to wait until July 1. I can’t wait to use them. Because I worked on them I feel a special pride every time I get to do something new. Wow, I raised this one up to the group and everyone went for it, and now it is making a difference. Or, hey I used to have to call the doc and now I can just go ahead and do it.

We also have CPAP and LMAs now, but I haven’t gotten a chance to use either.

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A number of weeks ago I wrote about missing a step when I was carrying a guy backwards out of a house. I have been having periodic knee pain when I go down stairs. I can run five miles pain free, or charge up the stairs of a third floor walk up no problem, but when I walk down from the third floor too quickly, I really feel it. I think I may have stretched a ligament or something. I found myself thinking what if I can’t climb stairs, then I’m done for. I told my partner this will be a good day if I don’t have to walk down any stairs. Last call of the day was to a motel for an overdose. Two sets of stairs. It turned out to be a refusal. I walked down the stairs with baby steps. No pain.

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A couple weeks ago I gave morphine to a large young woman who turned her ankle. The triage nurse mentioned she had a history of drug seeking. Well, she’s a drug seeker with a busted ankle, I said. I mentioned the case to a nurse at the other hospital in town and she knew the patient’s name and knew her as a drug seeker. She said she was always falling and complaining of ankle pain. Either that or having a really bad toothache. The nurse called me up yesterday and said, guess who’s here with ankle pain, claiming she fell and turned it?

I wonder if her ankle always look deformed.

I’m looking forward to responding to “the fall with ankle pain” and finding our friend sitting on the ground holding her ankle.

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I read an article the other day about an economist who claimed that plumbers were better paid than physicians. He came up with that by comparing all the years a doctor had to go to school and the cost of education and low pay as a resident and then all the costs of malpractice and setting up a practice. I told the wife of a resident how much money I made a couple years ago and she couldn’t believe it. They had so much debt and her husband’s salary was still minimal. He should have been a medic she said. (So what if when he finally has his loans paid off and has the dough to drive a Lexus, I’ll be eating cat food.)

I’m not saying medics are overpaid, but I don’t have a lot of costs. I don’t have to buy business suits or dine at fancy restaurants or go to charity balls. I wear my uniform at work and blue jeans off work. Some people work all day and hope to get a half hour of reading before bed. I read books on the job all the time. Sometimes I bring my bike to work and ride around the industrial complex where our base is located, doing .7 mile loops. If we get a call, by the time my partner has pulled the ambulance out, I am zipping into the garage. Other days I work out with dumbbells. There are some advantages to this job. Not that I would ever oppose a hefty raise.

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I’m glad its Spring.

5 Comments

  • Anonymous says:

    Do you have a copy of your regional protocols you’d be able to post or link to?

  • Medicmarch. says:

    As far as LMAs and ET Tubes what the plus side of using one from another? My company had evaluated them before I got hired on but they decided not to add them to our inventory. I may be wrong but if I remember correctly the LMA doesn’t protect against aspiration, right?

  • PC says:

    The new protocols aren’t on-line yet. i will post the link as soon as it is available.The new AHA guidelines say LMAs and combitubes are as good as an ET in an emergency setting. Their point is not that they are better — they’re not, but an LMA or a combitube is better than dicking around forever trying to get an ET tube in or not having an airway.You are right a big drawback of the LMA is it doesn’t protect against aspiration. On the positive side — it is a easy and quick airway that will ventilate most patients.Our new protocols will restrict medics to two insertions of a larengyoscope into the mouth. After that it is go to an LMA or combitube unless there is a second medic on scene who can attempt only one time.

  • Medicmarch. says:

    Our protocols are similar, except we get three ET tube attempts before switching the the combitube. I placed a combitube for the first time on an extremely difficult airway during a cardiac arrest and was surprised at how easy it was. I would definitely be more open to using the combitube in the future now that I’ve seen how easy it is. A fun toy we have at our company is the EZ-IO. I’ve drilled two patients already – a really useful tool that give you vascular access in a hurry if you can’t get a stick. I would highly recommend adding them to your inventory.

  • PC says:

    We should be getting the Easy IO in a couple months.

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