Things I Learned on the Ambulance . . . .

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If I come to the ED to take you to the nut-hut at oh-weird-hundred please don’t ask me to stop at your car & unload your 17 kilos of pop, smokes, twinkies & sundry worthless crap you picked up at Kroger on the way to the ED. When my 5 foot tall pixie partner turns out to be more accommodating & sympathetic (she must have gotten more sleep) & asks me to do it with a smile, do NOT get all bent out of shape when my 6’2” 250# weary self growls there’s no way I’m putting bags of crap filled with roaches from your car in my bus. Don’t ask my partner either; now she’s serious too!

Originally Posted by DNP student

A paramedic friend of mine learned that whenever you get a call for a cardiac arrest at an ice skating rink, get the pt off the ice BEFORE you defib; or be prepared for multiple pts (bystanders, partner, self, etc)

Bovine scatology. First of all, the paddles/patches most often represent the path of least resistance which the electricity will follow. Ice (unlike water) has high resistence. Even if we leave that bit of physics aside, electricity is NOT like sarin gas. A (relatively) little whiff is NOT going to create "multiple pts (bystanders, partner, self, etc)". Having been in the unfortunate position of being grounded and in contact with a patient who was defibrillated, I can tell you that, while uncomfortable, the incident did not make me a patient, and that was direct contact.

Simply put, your "paramedic friend" was trying to impress you with a "war lie" that simply isn't true.

- H

Originally Posted by Pemigewasset

REMEMBER: everything you do must be in the patient's best interest & have a demonstrable benefit. eg: Splint & sling a humerus fx. Ergo, sternum rubs are out; no benefit to the pt. However, your average BS GOMER playing at being all gorked out can NOT sue you for 1)D stick 2) 16ga AC NS TKO & my fave 3)The NPA. I've yet to see someone remain "unconcious" when I thread that puppy! It's especially effective!

Establishing responsiveness to pain is an accepted part of an assessment provided that the patient does not already demonstrate a higher level of alertness. BTW what is an NPA?

- H

Originally Posted by FoughtFyr

BTW what is an NPA?

Nasopharyngeal airway - the "nose hose".

Originally Posted by FoughtFyr

Establishing responsiveness to pain is an accepted part of an assessment provided that the patient does not already demonstrate a higher level of alertness. BTW what is an NPA?

- H

Certainly. But how you establish is important; sternum rubs can cause pain & injury but provide no benefit... seen it sued brother, trust me! If someone wants to go to court it can & has been successfully argued that a sternum rub is not beneficial- but no one can argue about securing an airway! Let MDs with deeper pockets & better insurance do stuff that's hard for Joe Dumbass Public to understand.

Originally Posted by Apollyon

Nasopharyngeal airway - the "nose hose".

AKA the "nasal trumpet".

Originally Posted by pm2do

5) Going by ambulance DOES NOT guarentee you being seen faster in fact, more cars in driveway, the quicker you go to triage.

We call that "Positive Good year sign". When you get niside the only light comes from a 60" TV & nobody gets out of your way. Really pisses em off when I break out my 5w LED torches & shine as many eyes as possible. "Sorry, where's the patient? Don't bother with the lights, I've got my own."

No matter how good your intentions, speaking Spanish to Spanish speakers is a mistake unless the 1st phrase out of your mouth is “Talk to me like an idiot child” or “Speak slowly & use small words”. I have to laugh the way they rattle along while I understand one word in 10!

Originally Posted by Pemigewasset

Certainly. But how you establish is important; sternum rubs can cause pain & injury but provide no benefit... seen it sued brother, trust me! If someone wants to go to court it can & has been successfully argued that a sternum rub is not beneficial- but no one can argue about securing an airway! Let MDs with deeper pockets & better insurance do stuff that's hard for Joe Dumbass Public to understand.

Well, I am an MD. And I have 10+ years as a EMS instructor, with more than 8 years on the streets as a firemedic and 1.5 years as a Municipal consultant specializing in EMS. I have testified in court regarding national practices in EMS and standards of EMS education and helped prepare congressional testimony on the same. A sternal rub IS valid. The likelihood of actual injury (as opposed to producing the noxious stimuli as called for) is almost zero. OTOH, there have been well documented cases of turbinate damage (even avulsions) from the NPA. Likewise, clavicle rubs / pressure have produced fractures. But the force needed to fracture a sternum (and produce a tortable injury) is significant. I teach (and will continue to teach) sternal rubs. Using an (albeit minimally) invasive airway where not otherwise indicated is far more legally risky IMNSHO.

- H

Originally Posted by FoughtFyr

Well, I am an MD. And I have 10+ years as a EMS instructor, with more than 8 years on the streets as a firemedic and 1.5 years as a Municipal consultant specializing in EMS. I have testified in court regarding national practices in EMS and standards of EMS education and helped prepare congressional testimony on the same. A sternal rub IS valid. The likelihood of actual injury (as opposed to producing the noxious stimuli as called for) is almost zero. OTOH, there have been well documented cases of turbinate damage (even avulsions) from the NPA. Likewise, clavicle rubs / pressure have produced fractures. But the force needed to fracture a sternum (and produce a tortable injury) is significant. I teach (and will continue to teach) sternal rubs. Using an (albeit minimally) invasive airway where not otherwise indicated is far more legally risky IMNSHO.

- H

Point taken. I guess y'all had better lawyers... everybody being all sue-happy (aggregiously letitigious society we live in yay) is half the reason I quit running municipal & just do rural & private. After seeing a guy get hosed in court AGAIN because of a wreck in which his bus was struck by someone who dam near drove on the sidewalk to get past all the cars stopped for him... it just really sours one on the whole compassion & humanity thing.

Speaking of waking people up, we got called to a bar at about 4pm for a guy who was drunk and starting to strip. He talked to us for a bit, was definatly altered, keep speaking to people and about stuff that wasn't there. We get him on the bed and he passes out. No response to pain, no response when we put in an NPA. We take him in emergent, IV 02 monitor etc. We move him to the hospital bed, and I start helping the staff strip the patient. I pull down his pants and the patient sits up in bed wide awake, grabbing his pants. I turn to the doc and say "patient responsive to pants removal."

Wow....lots of lol things here to read. Not sure how I found my self on these boards, since I'm a nurse, but I'm here and reading.

I've read alot of posts on the stupid/funny/ weird things you all have seen from LTC and nursing homes and not sure what I want to say.
Yes....it happens, put please dont' think its like this everywhere. I've seen alot of the stuff you all have posted happen. Most of the times, I feel like a piece of crap when I need to send a pt out to the hospital and can't even put the appropriate O2 device on them because I can't find a feaking mask, etc.
Yes, nursing homes are the worst places to send a loved one, but just remember, they do serve a purpose. As a RN with my BSN and EMT training, I know that when I go to work, I make a difference.

My point in this post, instedad of getting nasty about the idiot nurses, have you ever gone over their heads and reported them to the administrators or department of aging for their neglegece etc. Ignoring the atrocities that you see just perpetuates the problems that do occur.
Where I am, we are very fortunate that we have an EMS service that will actually come in and educate the nurses on what they expect during a transport emergent or non. No they shouldn't have to do this, the nurses should have some bit of common sense, but it has made a whole heck of a difference.

Originally Posted by Pghgirl

Wow....lots of lol things here to read. Not sure how I found my self on these boards, since I'm a nurse, but I'm here and reading.

I've read alot of posts on the stupid/funny/ weird things you all have seen from LTC and nursing homes and not sure what I want to say.
Yes....it happens, put please dont' think its like this everywhere. I've seen alot of the stuff you all have posted happen. Most of the times, I feel like a piece of crap when I need to send a pt out to the hospital and can't even put the appropriate O2 device on them because I can't find a feaking mask, etc.
Yes, nursing homes are the worst places to send a loved one, but just remember, they do serve a purpose. As a RN with my BSN and EMT training, I know that when I go to work, I make a difference.

My point in this post, instedad of getting nasty about the idiot nurses, have you ever gone over their heads and reported them to the administrators or department of aging for their neglegece etc. Ignoring the atrocities that you see just perpetuates the problems that do occur.
Where I am, we are very fortunate that we have an EMS service that will actually come in and educate the nurses on what they expect during a transport emergent or non. No they shouldn't have to do this, the nurses should have some bit of common sense, but it has made a whole heck of a difference.

I understand that there are a lot of good nurses/nursing homes out there (I used to volunteer at a good one back in high school), but where I live right now that's not exactly the case. Two nursing homes have been shut down by DOH in the past 3 years for violations of all sorts of stuff, as well as inappropriate care. Two others are on "probation," and the reason the one at least hasn't been shut down yet is because they had such a hard time finding places for all the patients they had to take out of the most recently closed facility, and all the other nursing homes in the area are still overcrowded. There are also a few more in the area that have been on probabtion from Medicare for violations of their regulations.

I've reported nurses to the administrator (about the LPN to the one of very few RNs actually in the building), and as a result she called our office to complain that the crew was being "disrespectful" in front of the patient, when in fact my partner was taking care of the patient, and when the head nurse showed up to make sure we were treating the right one, I took her out into the hallway to talk to her. I've filed reports at the hospital and by written documentaion about some of the stuff I've seen (ie: dining room of 50 residents with nobody from staff there to watch him, and therefore nobody to tell me how the patient had fallen, when he had fallen, or if he lost conciousness, since I don't speak German and couldn't ask him myself).

As far as educating the nurses go, we've tried to tell the nurses at one nursing home that when a patient falls and is complaining of head/neck/back pain, it's not a good idea to pick them up and move them, but is better to just leave them on the floor to minimize injury. The LPN's response (because nobody could find either of the two RNs that were in the building) was "but the patient isn't comfortable lying on the floor" and to walk off. At one of the nursing homes that every time we go, we have to explain to the same nurse every time that we need the paperwork for the hospital, and each time she's walked off in a huff saying "nobody's ever told me that before." The time we had an arrest there, we told her to just fax the paperwork over, since we weren't going to wait 10 minutes again for her to finish copying it. Our agency has in fact tried to talk to the administrators at some of the area nursing homes about teaching them what they need to do in certain situations (falls, hip fxs, etc) and each time have been turned because "we teach our staff everything they need to know."

So basically, even though I know there are some nursing homes out there, since I have been working in EMS, I have yet to see it.

After my first two gsw's in the field in three weeks I must wonder...is everyone really that bad and trying to kill themselves?

"Were you trying to hurt yourself?"
"yea"
"well you missed"
....
"I can't breath"
"ya dude you have a hole in your chest."

Originally Posted by Aurora013

I understand that there are a lot of good nurses/nursing homes out there (I used to volunteer at a good one back in high school), but where I live right now that's not exactly the case. Two nursing homes have been shut down by DOH in the past 3 years for violations of all sorts of stuff, as well as inappropriate care. Two others are on "probation," and the reason the one at least hasn't been shut down yet is because they had such a hard time finding places for all the patients they had to take out of the most recently closed facility, and all the other nursing homes in the area are still overcrowded. There are also a few more in the area that have been on probabtion from Medicare for violations of their regulations.

I've reported nurses to the administrator (about the LPN to the one of very few RNs actually in the building), and as a result she called our office to complain that the crew was being "disrespectful" in front of the patient, when in fact my partner was taking care of the patient, and when the head nurse showed up to make sure we were treating the right one, I took her out into the hallway to talk to her. I've filed reports at the hospital and by written documentaion about some of the stuff I've seen (ie: dining room of 50 residents with nobody from staff there to watch him, and therefore nobody to tell me how the patient had fallen, when he had fallen, or if he lost conciousness, since I don't speak German and couldn't ask him myself).

As far as educating the nurses go, we've tried to tell the nurses at one nursing home that when a patient falls and is complaining of head/neck/back pain, it's not a good idea to pick them up and move them, but is better to just leave them on the floor to minimize injury. The LPN's response (because nobody could find either of the two RNs that were in the building) was "but the patient isn't comfortable lying on the floor" and to walk off. At one of the nursing homes that every time we go, we have to explain to the same nurse every time that we need the paperwork for the hospital, and each time she's walked off in a huff saying "nobody's ever told me that before." The time we had an arrest there, we told her to just fax the paperwork over, since we weren't going to wait 10 minutes again for her to finish copying it. Our agency has in fact tried to talk to the administrators at some of the area nursing homes about teaching them what they need to do in certain situations (falls, hip fxs, etc) and each time have been turned because "we teach our staff everything they need to know."

So basically, even though I know there are some nursing homes out there, since I have been working in EMS, I have yet to see it.

Okay...permission to bang head on the wall
I guess, I'm lucky to work where I do. Yes occasionally we get some bad nurses, who shouldn't be permitted to take care of thier dog, let alone a person, but for the most part...I think we give damn good care. I know....the exception to the rule.

Originally Posted by niko327

When treating the Acute pulmonary edema patient found lying supine in a filthy diaper on 1LPM O2 via simple face mask, it may be construed as bad form to throw a pillow behind the nursing station and say "use this next time, it's much faster."

Almost peed my pants on this one!!

K, I need to stop reading this thread and read my text if I ever plan on finishing school. So quit submitting such entertaining stories!!!

So we had a patient last night with 9/10 abd pain who kept saying:

"Oh my god, it hurts. Why can't you give me anything for the pain? Don't you have phenergan or something?"

I learned that I have the crappiest luck. Last night running on the volunteer fire department (I'm moving in a couple of weeks so I resigned), and I wind up on an accident scene with three victims- two intubations, three IV's and a crike (which if anyone asks the medic did since I'm "only" an EMT-I *whistles* ) in less than 20 minutes.

Even though the grass is the same height, the ground under is not always.

Never make eye contact with fire personal on scene of an MVA after taking a tumble in a ditch, you will most likely see a smile on his lips and his eyes will twinkle a little.

While doing a trauma assessment on a drunk after an MVA don’t ever use the words “tell me if you feel anything” you may possibly get the answer “it feels good when you do that”

Give Alzheimer’s patients something to hold onto other than your body parts.......oh yeah and never lean over Alzheimer’s patients.

All of your experience and skills on the monkey bars as a child will come back to you when moving around the back of a moving ambulance.

When typing a report I know where to find candy in the office at 3:00 am.

I have learned that firefighters absolutely loooove to play with toys, and will disasemble a car just because they can.

Tape is the great equalizer, nobody is exempt from having their hair taped to the backboard.

The first thing I learned is that when you put Armor All on the seats in the back of the ambulance you can and you will fly off them when the driver (who waxed them for you so they would look nice) hits a right turn on a country road.

I have learned that nobody has a more wicked sense of humor than police, fire and ems, they also have a stronger bond between them than I knew.


Note to nursing home staff….when caring for a patient who has fallen in the shower room, move them from behind the door, secondary injuries from head wounds makes our jobs a little harder.

The other night, I met the patient everyone knows.

Originally Posted by Wackie

The other night, I met the patient everyone knows.

We saw a patient lying in the street the other night, who happened to be completely and totally plastered. Everytime we asked him his name, he kept slurring out "you know me," and didn't trust the fact that I had never seen him before in my life. Well needless to say, somebody else must have called 911 before we got there, because when the FD showed up, the first words out of the medic's mouth were "oh, it's you."

Category: WTF.
See all previous posts regarding Nursing Homes.
Now, read......

Page: my ambulance number, you are needed at X nursing home to transport a patient complaining of a cough, non emergent.

K, out the door we go.

At Nursing home, after talking to three different aids/nurses.

Me: "Did anyone call the ambulance?"

Finally, Nurse X pipes up.......

Nurse: "Yeah, Resident X has had a bad cold for a few days now, and we thought he should have it checked out".

Me: "OK............. where is the resident?"

Nurse: "Down the hall"

Me, looking at several halls filled with residents: "Would you mind showing me?"

Nurse: "(exaggerated sigh) I guess"

Me, after talking with patient and determining that I am not going to get a reliable history, asks the nurse: "So, what's going on with patient x?"

Nurse: "I don't know, not my patient" and walks away leaving myself and my crew in patient x's room, and NOT returning.

So, to spare you more of my horrible scripting, after tracking down the charge nurse, we find out that pt x's nurse is no where in the building, and low and behold, the charge nurse has no clue about this pt. either. This pt's nurse, called the ambulance, then clocked out. Only telling the other staff that she called us and that she was going home. We ended up transporting the pt, then had to wait an hour, per protocol, only to be told that the pt. had a cold, and should be returned to the nursing home. DUH. I want to wring the little twits neck who called in the first place. Talk about a waste of money. Let's hope that this lazy nurse ends up in a nursing home left to rot in a soggy depends, with all kinds of painful ulcers.

(Before anyone starts complaining, please understand that this is ONE nursing home, and ONE lazy nurse that I am complaining about, and that this patient was in no obvious signs of distress and could have waited until the morning to see his primary physician if so needed, but the lazy nurse wanted to leave early and could only do so if the facilities census complied.)

I remember calls like that...and the endless nursing home to dialysis and return calls....I would rather transport someone with a cold before they were at deaths door than the frequent"pt with a cold" who is actually basically dead with chf/sepsis/etc/doesn't know it yet/has a dnr so no als interventions.....I worked in a single ambulance county so we did it all: 911, critical care tyransports/benign interfacility transports/grandma to the doctor's office, etc
not enough real 911 calls and too many middle of the night bs calls so went back to school(pa) and never turned back....still teach medic students but glad that I don't have to do odark30 bs anymore.

Originally Posted by emedpa

odark30 bs

I gotta remember that one.

We get a call to a nursing home for a patient in the post dictal state. We arrive to see said patient sitting in a wheelchair, being supported by a CNA. According to the RN who's standing there, her seizure was ~30 mins ago, she's normally completely oriented, and isn't coming out of it as fast as she usually does. She now just kind of stares blankly at us drooling and unable to support her own head. Looking at the paperwork, she has diabetes. So...

Me: "Have you checked her sugar recently?"
RN: "Yeah, it was 87."
Me: "What time was that?"
RN: "5:00"
Me: "So before the seizure?"
RN: "Yup."
Me: "And you haven't checked it since then?"
RN: "No, why would we do that?"
Me: "Because chances are it dropped since then. Can you get me a glucometer?"
RN: "It wouldn't get too much lower in only an hour."
Me: "Normally no, but she just had a seizure."
RN: "Well that doesn't explain why her sugar would go down."
Me: "Can you please just get me the glucometer?"
RN: "I still don't see why it's necessary."
Me: "If her mental status isn't what it normally is, I'd like to check to make sure. Can you please get me the glucometer?"
RN: "I still don't see why it's necessary."

However, she does go off to get it. And the result is...that's right, 49.
RN: "Well it was 87 before. I don't see how it could drop so much in only an hour. You must have done it wrong."

And even with the number being clearly visible, she insisted on taking it again, with exactly the same result. Her conclusion? It needs to be calibrated.

Originally Posted by Aurora013

We get a call to a nursing home for a patient in the post dictal state. We arrive to see said patient sitting in a wheelchair, being supported by a CNA. According to the RN who's standing there, her seizure was ~30 mins ago, she's normally completely oriented, and isn't coming out of it as fast as she usually does. She now just kind of stares blankly at us drooling and unable to support her own head. Looking at the paperwork, she has diabetes. So...

Me: "Have you checked her sugar recently?"
RN: "Yeah, it was 87."
Me: "What time was that?"
RN: "5:00"
Me: "So before the seizure?"
RN: "Yup."
Me: "And you haven't checked it since then?"
RN: "No, why would we do that?"
Me: "Because chances are it dropped since then. Can you get me a glucometer?"
RN: "It wouldn't get too much lower in only an hour."
Me: "Normally no, but she just had a seizure."
RN: "Well that doesn't explain why her sugar would go down."
Me: "Can you please just get me the glucometer?"
RN: "I still don't see why it's necessary."
Me: "If her mental status isn't what it normally is, I'd like to check to make sure. Can you please get me the glucometer?"
RN: "I still don't see why it's necessary."

However, she does go off to get it. And the result is...that's right, 49.
RN: "Well it was 87 before. I don't see how it could drop so much in only an hour. You must have done it wrong."

And even with the number being clearly visible, she insisted on taking it again, with exactly the same result. Her conclusion? It needs to be calibrated.

GRRRRRRRRR...........
These are the situations where I bang my head on the wall. While (briefly) working in a Nursing home a resident had aspirated a pill and needed oxygen, what does the nurse do? Puts her on 2 liters NC, her sats are in the low 80's and she is normally high 90's. I tell the nurse that this resident needs a NRB with high flow oxygen, Nurse looks at me and says "what?" I had to describe the mask to her. She finally finds one, puts it on the patient, then delivers ONLY 2 LITERS VIA NRB!!!!!
Some of these "nurses" should get out of the game. It is hard not to hate nursing home RN's, I know there are still some good ones out there, but the ones around here leave much to be desired.

Originally Posted by Aurora013

We get a call to a nursing home for a patient in the post dictal state. We arrive to see said patient sitting in a wheelchair, being supported by a CNA. According to the RN who's standing there, her seizure was ~30 mins ago, she's normally completely oriented, and isn't coming out of it as fast as she usually does. She now just kind of stares blankly at us drooling and unable to support her own head. Looking at the paperwork, she has diabetes. So...

Me: "Have you checked her sugar recently?"
RN: "Yeah, it was 87."
Me: "What time was that?"
RN: "5:00"
Me: "So before the seizure?"
RN: "Yup."
Me: "And you haven't checked it since then?"
RN: "No, why would we do that?"
Me: "Because chances are it dropped since then. Can you get me a glucometer?"
RN: "It wouldn't get too much lower in only an hour."
Me: "Normally no, but she just had a seizure."
RN: "Well that doesn't explain why her sugar would go down."
Me: "Can you please just get me the glucometer?"
RN: "I still don't see why it's necessary."
Me: "If her mental status isn't what it normally is, I'd like to check to make sure. Can you please get me the glucometer?"
RN: "I still don't see why it's necessary."

However, she does go off to get it. And the result is...that's right, 49.
RN: "Well it was 87 before. I don't see how it could drop so much in only an hour. You must have done it wrong."

And even with the number being clearly visible, she insisted on taking it again, with exactly the same result. Her conclusion? It needs to be calibrated.

"Muscles burn glucose as fuel, or were you too busy studying which way to wipe for your nursing exams to pay attention to A+P?"

This is the reason why I don't hesitate to document my calls and file complaints for incompetence with the state nursing board. I've always said that we should be allowed to wear recording devices like cops do on traffic stops to back up our statements.

Note: You can't put "Nurse in question is really f--king stupid" as the reason you're filing the complaint.

What I want to know is how these nurses pass their examinations.

From my experience it is the Nurses who are just biding their time till retirement that are the culprits here. When I did work at the Nursing home the Nurses did nothing more than pass pills (most of the time just leaving the pills on the patients bedside, eek) and sit at the desk to chart. Very seldom did I see a Nurse actually physically take care of a resident.

Taking a nursing position in a LTC facility is a sure-fire way to lose all those skills that were learned (maybe) while in nursing school. When you see an RN or LPN badge on someone's uniform, you naturally expect a certain level of competence. For those of us who work with emergent/CC patients we have the opportunites to hone our skills every day/night when we show up to work. Are those nurses getting those opportunities? Nope.

I am not defending poor nursing decisions/care. One of the earlier poster's EMS was doing an excellent service by having scheduled sessions to teach the staffs of the various nursing homes how to prepare for the transport of a resident. Personally, I think that nurses who work in LTC facilites should have to complete twice the amount of continuing education hours required of part time nurses. (which is already twice that of full time nurses in my state) Also, a minimum amout of those hours should be dedicated to assessment, O2 delivery sys., facilitating EMS pick up and departure, and calling report to the hospital. 1 nurse : 50 residents w/ polypharmacy makes it hard to do any real nursing care. Unfortunately, LTC facilities aren't as gung-ho about these things as they are about having all the day to day paper work completed.

Originally Posted by EMT2RN2MD

Taking a nursing position in a LTC facility is a sure-fire way to lose all those skills that were learned (maybe) while in nursing school. When you see an RN or LPN badge on someone's uniform, you naturally expect a certain level of competence. For those of us who work with emergent/CC patients we have the opportunites to hone our skills every day/night when we show up to work. Are those nurses getting those opportunities? Nope.

I am not defending poor nursing decisions/care. One of the earlier poster's EMS was doing an excellent service by having scheduled sessions to teach the staffs of the various nursing homes how to prepare for the transport of a resident. Personally, I think that nurses who work in LTC facilites should have to complete twice the amount of continuing education hours required of part time nurses. (which is already twice that of full time nurses in my state) Also, a minimum amout of those hours should be dedicated to assessment, O2 delivery sys., facilitating EMS pick up and departure, and calling report to the hospital. 1 nurse : 50 residents w/ polypharmacy makes it hard to do any real nursing care. Unfortunately, LTC facilities aren't as gung-ho about these things as they are about having all the day to day paper work completed.

Very good thoughts. I do agree, there needs to be more continuing education. Correct me if I am mistaken, but isn't there a national standard to uphold when you become an RN? I know I have a standard of care to follow, and if I fail to uphold that I could find my arse in a sling. It is an unfortunate situation, not enough money to go around to get, keep, and educate good staff at Nursing Homes. Not enough staff either, very very sad.

A comprehensive "nursing standard of care" is kinda hard to find. I have taken several courses that refer to these nursing standards of care. I recall one CCC instructor talking about international standards of nursing care. Yet, I haven't been able to find the whole document. There is a national "model" nursing act provided by the national council of state boards of nursing. (https://www.ncsbn.org/312.htm)

This non utilization of a universal standard of care may be due to the fact that each state board of nursing governs the scope of practice of their own nurses. Plus, hospital policies are usually much more restrictive than the state's nurse practice act. If you get reported to the state board, they decide your fate.

1) Trailer parks are the shallow end of the gene pool.
2) If you're drunk, in handcuffs, in the back of my ambulance, you DO have a drinking problem.
3) The difference between paramedics and migrant workers is that we have nice navy T-shirts. (how many jobs do you have????)
4) The difference between paramedics and janitors is that we get to stop cleaning to make runs.

The question I can't answer: why "drunk & stupid" isn't a valid chief complaint.

and

"No matter what problem,
no matter how small.
Always remember our motto:
if you call, we haul."

"4) The difference between paramedics and janitors is that we get to stop cleaning to make runs."

and then we get to clean up the runs.....
I had a deal with a former partner that was mutually benefiical:
vommit I clean
crap you clean.
worked out well.

uh,oh I feel a haiku coming on:
vomit on the bus
why did you call us for this
no one who loves drives

if you call, we haul

Not if you can find a reason to get them to sign a refusal. "Look, we'll help you into the car and your friend can transport you"

1. Q. What do you call a young unconsious female?



A. Sweety

drunks are always fun

before EMT school, when I was a lowly lifeguard, I had to fight a drunk guy in a splash pool wile another lifeguard saved his unconsious friend from the bottom of the pool. Why did I have to fight this drunk in 10 foot water, his friend was find and he "didn't need no sav'in." Beer and waterparks do not mix.

A call to the worst NH in the area (see my above post about seizures and glucose levels...) for a patient with "decreased responsiveness and no apical pulses."

According to the nurse, the patient has been breathing noisily for the past couple of hours, and when they just checked her again, couldn't find an apical pulse. After my partner tries unsuccessfully to find one, I go right for the carotid.

RN: "Why are you doing that?"
Me: "To see if she has a carotid pulse. Which she does, but just barely."
RN: "Really? I couldn't find an apical pulse, so didn't think it would make a difference looking for the carotid."


I know apex usually means top...so does anybody know what an "apical pulse" would be? Since to me, "apical" would imply carotid (the highest pulse in the body), but that's evidently not what he was talking about.

He was probably talking about listening for heart sounds....or feeling for the impulse of the heart in the chest. But you're right....sounds like his head was crammed up his ass.

Originally Posted by Aurora013

I know apex usually means top...so does anybody know what an "apical pulse" would be?

The apical pulse is that measured directly over the heart.

as soon as you buy food you get toned out. it's an ambulance law.

I work rural EMS and working 24 and 48 shifts is normal...and to continue on the previous post:

- As soon as you take your boots off and get in bed for the night after an afternoon movie marathon without a call...you get a page.

- Or you decide to get a quick shower...your 1st truck gets a page - they head out. This is followed shortly by second a page....you're up now, wet head and all!!! Fun stuff!!

- When you are called out for a "Vehicle vs. deer"...it doesn't matter how fast you get to the scene of the accident - you will NEVER get there before the deer "disappears". Somebody's brother, uncle, cousin, mother, etc. has already carried it off. (Seriously...I've worked 5 of these and never actually seen the deer!)

- When you are called out for a "Vehicle vs. deer"...it doesn't matter how fast you get to the scene of the accident - you will NEVER get there before the deer "disappears". Somebody's brother, uncle, cousin, mother, etc. has already carried it off. (Seriously...I've worked 5 of these and never actually seen the deer!)

Or the volunteer firefighters have.....we've carted a few home tied to the top of the hosebed. We learned to tie them down after one fell off the back of the truck when we hit a bump going up a hill.....it hit the road and our junior firefighter (16 y/o) yells out: "Stop the engine! It's trying to make a break for it!"

Originally Posted by DropkickMurphy

Or the volunteer firefighters have.....we've carted a few home tied to the top of the hosebed. We learned to tie them down after one fell off the back of the truck when we hit a bump going up a hill.....it hit the road and our junior firefighter (16 y/o) yells out: "Stop the engine! It's trying to make a break for it!"

We had a call where the car hit and killed two deer. The FD was trying to figure out how to smuggle one of them out with out their assistant chief, who's also the head of the local DOT branch, noticing that one went missing. According to him, the deer needed to stay for when the DOT inspectors came to the site the following day. They told us that because we weren't transporting the patient, we could join in the barbeque if we put the deer on the stretcher and transported it back to our station.

Thought I'd share this list I made before I left the field. I'm sure everyone's experience is different but in general I have found these to be true.


101Things I’ve Learned as a Medic (In No Particular Order)
1. Usually the most important decision on a call is where to bring the patient.
2. Intubating people in the ambulance is almost always a bad idea.
3. Intubating people using only versed is always a bad idea.
4. Treat pain and nausea early and aggressively.
5. Do everything you can to avoid back boarding people who are vomiting.
7. If there is one piece of equipment you leave in the truck that will be item you need the most.
8. Dispatch information is almost never correct.
9. Take the time to grab a pillow and blanket on every overnight.
10. Eat off of actual plates whenever possible but have a to-go container ready in advance.
11. Know the location of the nearest emesis basin at every hospital triage area.
12. You can never have too much linen on the stretcher for man down calls.
13. Hand-titrating a Diltiazem infusion is not practical.
14. EMS continuing education is stupid. Go to the physician conferences.
15. Old people with vague complaints should go ALS.
16. People on Coumadin with minor trauma are usually bleeding somewhere, often the brain.
17. Doing a 12-lead is never a bad idea.
18. Difficult IV access sucks up time. Accept defeat early and move on to what you can do.
19. Keep the patient talking; no matter what they talk about it usually has some relevance.
20. Get rid of excess people at the patient side.
21. The more you do, the more that can go wrong.
22. Common things really are common.
23. A patient with CHF and COPD is a potential disaster. Use CPAP.
24. Sometimes you will do the right things but the patient will get worse.
25. If something isn’t working, change something or stop doing it.
26. Know how to reverse every intervention you do before you do it.
27. Only use narcan if you absolutely have to.
28. Don’t pretend to know about something.
29. Know everything you are supposed to and relearn it every 6 months.
30. People who look sick are almost always sick.
31. People who don’t look sick and become sick very quickly.
32. Always consider the worst possible diagnosis first.
33. Suggesting the Mass General to people who look sick saves lives.
34. People will try to convince you to do the wrong thing constantly.
35. Nobody needs a 14G IV.
36. Trauma patients don’t need fluid. Get them to blood.
37. Never touch a patient, or their linen, or their stuff without gloves.
38. Knowing about common medications is hugely useful.
39. Ask the patient/family what they think is going on; they are right a lot.
40. Some of the people working at the hospital are angry at baseline. Don’t let it get to you.
41. If you don’t think a patient should go to “triage”, say so.
42. If you give report to a doctor, they will almost certainly not convey that information to the nurse.
43. Think about what you’re doing and how it will affect the patient 24 hours later.
44. Machines do a poor job of assessing your patient. Hands-on assessment is critical.
45. Just because it says to do something in the protocol doesn’t mean you should do it.
46. Ativan is better than valium in all respects.
47. 50mg of Benadryl is better than 25mg.
48. If a medication can be given IV, give it IV.
49. Glucagon doesn’t work that great.
50. Magnesium works awesome for respiratory cases.
51. Fentanyl wears off really quick.
52. Morphine makes people puke.
53. Everything besides adenosine and atropine is better if diluted and given slowly.
54. If there is one piece of equipment you check, it is the defibrillator.
55. As soon as you give sedation, get on the phone for more sedation.
56. Anticipate all the orders you will need before you need them.
57. Most people with chest pain aren’t having a heart attack.
58. It is always better to take your time except in STEMI, stroke, trauma, and severe abdominal pain.
59. Giving pain medicine after moving someone is stupid.
60. Always have a change of clothes with you.
61. Manually checking a radial pulse gives you a lot of information.
62. Take vital signs before taking someone BLS.
63. Sometimes homeless people get really sick.
64. People who seem drunk are not always drunk.
65. General weakness can be caused by very bad things.
66. Ask for the police before you need them.
67. Sometimes doctors do the wrong thing.
68. Sometimes you have to convince the hospital your patient is sick.
69. You can learn a lot by following up on your patients.
70. Getting report from a nursing home is usually a waste of time, but not always.
71. If you’re going to a cardiac arrest, bringing in the suction is a good idea.
72. If your patient is fat, get extra help before doing anything.
73. Sometimes lift assists turn into cardiac arrests.
74. Lecturing people on proper use of the EMS system is a waste of time.
75. Take people to the hospital who want to go to the hospital.
76. Use needles sparingly.
77. Working more than 80 hours a week is not safe.
78. Never plan anything for at least 3 hours after your shift ends.
79. Taking 5 minutes and having a cup of tea is a good stress reliever.
80. If you drink coffee, you will get GERD and it will feel like an MI everytime you lay down.
81. Eating after 10pm is usually a bad idea.
82. Sleeping past noon after an overnight makes you feel crappy.
83. Liability insurance only costs 100 dollars. Just get it.
84. No matter how unusual the call, you won’t remember it a year later.
85. You have never seen everything.
86. If the hospital asks you if you want to take the infusion pump, take it.
87. You will never be as good as a ventilator at ventilating.
88. Tipping well at restaurants you go to at work benefits you.
89. The ring cutter works, you just have to twist it for a really long time.
90. Never assume something that should have been done was done.
91. Practice giving every medicine you carry before giving it to a real patient.
92. No matter how good you are at something you can always be better.
93. Blood glucose should be a vital sign.
94. Oxygen saturation has very little significance.
95. Waveform capnography can be very useful.
96. Jumping calls for people who are eating is a nice thing to do.
97. If you think of a better way to do something, do it.
98. Driving to and from calls is the most dangerous thing you will do.
99. It makes sense to be nice to people even if they’re not nice to you.
100. You need a good stethoscope to hear what you need to hear.
101. It is very easy to do this job, but very difficult to do it well.