Paramedicine 1995-1997

In my previous post 2009 A Year of Paramedicine I gave a breakdown of the medicine I gave over the course of 12 months.

Below are my medicine stats from my first three years as a full-time medic in the 1990’s, working in a one medic per ambulance urban system with some responses to suburban towns. (Also at that time, there were fewer medic ambulances than there are today). The numbers includes only calls where I was the primary medic and wrote a run form. Does not include calls where I backed up another medic on cardiac arrests or respiratory distress. Each number represents a unique patient. A patient receiving 3 doses of NTG counts as 1 NTG. Does not include ALS transfers. ALS calls were any call that I either put the patient on a monitor and/or put in an IV and or gave medicine, and of course, saved the run form.

I had been meaning to get rid of these old run forms for years, but quite enjoyed going through them and revisiting old calls. My memory of the old days and the actual facts of them were interesting. I recalled having more intubations and having done more traumatic arrests than I actually did. I thought I had given narcan far more than I did.

When asked by newer medics to talk about the city “back in the day,” my tales would always begin: “There I was in bullet proof vest, largynescope in one hand, narcan syringe in the other, two bags of fluid ready to run wide open, hanging from my teeth…” (For the record, I have never worn a bullet-proof vest).

My memory of more traumatic arrests (besides the exaggeration of years) was likely more a case of the number of times I would have jumped in the back of another medic’s ambulance to do CPR on the fly than actual calls I was directly dispatched to as the primary medic, as well as the number of calls where the patient did not arrest until the hospital or was simply presumed at the scene (after the PD let us through the yellow tape).

Some of the drugs I have given are remarkably consistent between the decades such as ASA and NTG. Even the number of cardiac arrests is fairly constant. The biggest discrepancies are where the medicine has changed. Compare my use of Lasix between the 1990’s and the present day. I gave it 21 times in 1996, 0 last year. I cringe on reading my clinical impressions on calls where I gave Lasix, ?CHF/?pneumonia, ?CHF/?sepsis. It was still before our protocols contained the caution:

CHF vs. Pneumonia: If the clinical impression is unclear and transport time is not prolonged, consider using
Nitroglycerin and withholding Lasix or Bumex or contact medical control.

Even my narcan usage seems excessive in light of today’s protocols, which call for its use only in patients with hypoventilation/ depressed respirations related to likely opiate overdose.

The most shocking to me is how little I used morphine. At the time it required on-line medical control. When I did use it, it was more likely for CHF than for trauma. And when I did use it for trauma, I never gave more than 2 mg. Ouch! I read through all these old run forms documenting trauma and I did nothing for them. Worse, most of the fractures I likely encountered I BLSed, thus no run form was saved. In my first three years doing a much higher volume of calls than I do today, I gave morphine for trauma twice. Last year alone, I gave morphine 37 times.

Other observations:

1. As a new medic most of my intubations were on dead people. (We have never had RSI). A few years ago and before we had CPAP, half my intubations were on living people. Last year, I only intubated 1 living patient. I think that was a bit of an abberation.
2. For all I sweated learning about lidocaine and dopamine in medic school, I really didn’t use them very much.
3. The popular image of medics putting paddles on the chest and shocking isn’t much of a reality, although, I did use the gel and paddles in those days when I could, even though we had the option of hands off patches.
4. There was nothing I could give to all the patients I had in rapid afib. Today I can give them Cardizem or Metoprolol.
5. The higher rates of breathing treatments would have been a function of the high rates of asthma in the city, as the higher rate of D50 today is a function of an extremely high obese diabetic problem among the elderly population in our town.
6. I don’t see as much serious trauma in the town I work in as when I was in the city full-time.
7. I wish I knew how many BLS calls I did in the 90’s. Even though medics were reserved for the “better” calls, I am sure I still BLSed a higher portion of my calls then than I do today.
8. My traumas from the 1990’s almost all have IVs wide open despite normotensive blood pressures.
9. All Cardiac Arrests that were worked then were transported, whereas today we have the ability to work and then presume on scene if the rescusitation is unsuccessful.

***

1997

376 ALS Calls

12 Cardiac Arrests (10 Medical, 2 Trauma)
14 Intubations (1 Nasal)
2 Defibrillations
1 ROSC
?0 Survival to Hospital Discharge

NTG – 38
ASA – 37
Ventolin – 37
Atropine – 18
Lasix – 17
Epi 1:10,000 – 12
Dextrose – 11
Narcan – 10
Benadryl – 4
Adenosine – 4
Epi 1:1000 – 3
Glucagon – 3
Lidocaine – 2
Morphine – 2 (1 for chest pain, 1 for ankle fracture)
Valium – 1

1996

512 ALS calls

12 Cardiac Arrests (11 Medical, 1 Trauma)
11 Intubations
1 Defibrillation
1 ROSC
0 Survival to Hospital Discharge

NTG-45
Aspirin-44
Ventolin – 42
D50-21
Lasix-21
Atropine – 12
Epi – 1:10,000 – 10
Benadryl- 6
Adenosine-5
Morphine-4 (3X for CHF, 1X for burns, gave 2 mg with permission of med control)
Narcan-4
Epi 1:1000 – 2
Valium-2
Lidocaine-1
Glucagon-1

1995

361 ALS calls

9 Cardiac Arrests (8-Medical, 1 Trauma)
7 Intubations
2 Defibrillations
2 ROSC
1 Survival to Hospital Discharge

Ventolin – 36
ASA – 32
NTG – 27
Lasix – 11
Benadryl – 10
D50- 8
Atropine – 9
Epi 1:10,000 – 8
Epi 1:1000 – 7
Narcan – 5
Adenosine – 4
Lidocaine – 2
Valium – 1
Glucagon – 1
Dopamine – 1
Morphine – 0

Other drugs we carried for all or part of these years: Bretilyium, Procainimide, Pitocin, Sodium Bicarb, Calcium, Isuprel, Thiamine, Dramamine, Allupent, Verapamil

Results are limited by run forms saved.

5 Comments

  • totwtytr says:

    Things do change, even if you stay in the same system.

    Bumex. We never used it, but some of the hospitals did. No real advantage over Lasix, which is why you don’t see it any more. In fact, we use far less Lasix than we did back then. Soon I think we’ll use none at all as the science doesn’t indicate any benefit in the acute setting.

    Morphine. We use to use it a lot for CHF or chest pain not relieved by NTG. Now we don’t use it much, when we need pain control we use Fentanyl. Back then, we didn’t use it for burns, now we use Fentanyl for burns.

    CPAP. We didn’t have it at all back then, now it’s the primary treatment for CHF. Soon, I hope we’ll have IV NTG as well.

    Asthma. No more Alupent, but we do have Atrovent. Combivents are all the rage. Plus BLS crews can give Albuterol nebulizer treatments, which is a big benefit.

    12 Lead EKGs. Very rare back then, routine now.

    I can’t say that I’ve noticed that most or even many of our hypoglycemic diabetics are large. In fact, the opposite is my impression.

    I’m sure medics working 10 years from now will look back at the things we did in the 1990s, if not today, and laugh.

    Maybe I can work up a post about that.

  • medicscribe says:

    Thanks for the comment.

    We never actually got Bumex. There was a period where Lasix was difficult to order so Bumex was put in as a substitute, but it never reached us.

    We will soon be getting Fentanyl. The local services that have just gotten it, love it, and I have been hearing good things about it for years.

    I would like to see our BLS crews get CPAP and breathing treatments. CPAP is coming for some of them (medical control dependent), the breathing treatments aren’t in the pipeline yet.

    12-Leads. It was very interesting reading the old chest pain calls and having only the single lead to look at. I didn’t even know what a STEMI was back then. I did know ST elevation was bad, but if it wasn’t in the inferior leads, I didn’t know how to find it. Eventually I learned how to do modified 9-leads, then the 12s came and what an improvement they have been.

    Our town has large African American and Jamaican American section where it seems we are always going for unresponsive diabetics. The Jamaicans particuarly, many of them grew up eating very healthy foods and walking miles and miles every day, then they came to America, started eating our fast food and driving or taking the bus, and many packed on the pounds and developed diabetes.

    I wrote about this a couple years ago in “King Sugar” and “Snow.”

    http://medicscribe.com/2007/03/king-sugar/

    http://medicscribe.com/2006/02/snow/

    Thanks again for the comment. I’ll watch for your post.

    Peter C

  • Fergie97 says:

    You forgot the Bicarb from those 90s runs….

  • Murphy says:

    When did 2 amps of Bicarb, D5W and a call to Rampart stop curing everything?

  • medicscribe says:

    Bicarb, D50, calling rampart and of course, the double thumb flip of the bristojet tops, which I still require (the double flip) all my preceptees to do on their first code with me.

    Thanks for the comments,

    PC

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