Keepin' it real on the road

Road Safety

We all think we practice it, we all think we are the best drivers in the world (at least those of us in EMS right?)

My company has just begun to install road safety devices similar to those in AMR ambulances. I guarantee, there are going to be a lot of high pitch tones for the first few months...the exciting thing is...we will be better drivers by the end of it (in and out of an ambulance).

How can one assess one's own driving safety? One needs to have an objective piece with proper parameters programmed into it to give an accurate account of good driving habits. Your partner in the seat next to you is not a good judge of driving. Individuals have different perspectives, but this black box by Zoll has one perspective that is repeated for every operator, creating a universal standard of driver safety.

While driving to a scene lights and sirens sounds, sometimes, like the best adrenaline rush you could have and gives you that feeling of being a superhero, just remember your state driving protocols and remember those who did not get so lucky.

"WRAL.com

FORT BRAGG, N.C. — A paramedic was killed late Wednesday in an ambulance accident at Fort Bragg, authorities said Thursday.

The wreck occurred at about 10:30 p.m. Wednesday at the intersection of Plank and Turkey roads on post, said Tom McCollum, spokesman for Fort Bragg.

An ambulance from Womack Army Medical Center was responding to a mutual aid call from another military ambulance when the driver lost control and slammed into some nearby trees after overcorrecting, according to Emergency Chaplains, a group that ministers to first responders and emergency personnel."

By Craig Crosby
Portland Press Herald
Copyright 2007 Blethen Maine Newspapers, Inc.
All Rights Reserved

TURNER, Maine — Allan Parsons' last act was helping someone in need.

Parsons, 46, a paramedic from Wilton, was treating a patient in the back of a Med-Care ambulance early Thursday when the vehicle collided with a pickup truck on Route 4 in Turner, according to Androscoggin County Sheriff Guy Desjardins.

Parsons was pronounced dead at the scene.

The unidentified patient was rushed to the hospital with two other people: Arlene Greenleaf, 68, of Bethel, who was driving the ambulance, and the driver of the pickup truck, Christopher Boutin, 29, of Turner.

The crash occurred at the intersection of Potato Road and Route 4 a little after 3 a.m., Desjardins said.

Greenleaf and Parsons, who were based in Mexico, were taking a patient from Rumford to Central Maine Medical Center in Lewiston when Boutin pulled his full-size Chevy pickup out in front of the ambulance, police say.

"A witness stated the ambulance's emergency lights were on and the pickup truck was crossing Route 4 from Potato Road to Lone Pine Road when the accident occurred," Desjardins said.

Greenleaf was removed from the ambulance with an extricating device. Boutin was ejected from the truck during the crash, Desjardins said.

Greenleaf was listed in fair condition at Central Maine Medical Center after undergoing surgery, Milligan said.

Officials at the hospital confirmed Thursday that Boutin was a patient there but declined to give his condition. Initial reports indicated he suffered multiple injuries, including head trauma, Desjardins said.

He had no information on the patient who was riding in the ambulance.

It was the kind of crash that could have claimed more lives, Desjardins said.

"It was a violent collision," he said.

(stories courtesy of ems1.com)

Cocoon

I have begun, recently, to practice a new technique with my stretcher at work. Keep in mind, this is just a small way of keeping me occupied when I am bored; however, the cocoon is a fantastic idea, especially in the winter or when dealing with an obese patient.


Here is how it works:

1) Take a sheet and tuck it in on the stretcher pad

2) Completely unfold a heavy blanket on the stretcher
3) Completely unfold another sheet on top of the heavy blanket

4) Grab both the blanket and sheet and fold a little on the top and bottom of the stretcher (this keeps the stretcher and sheets looking neat and fresh)
5) Take one side of the blanket (right or left) and fold to the other side of the stretcher, then fold back to the opposite edge of the stretcher. Finally, with the sheet/blanket looking like an S, take the end of the fold that is closest to the middle of the stretcher and fold it towards the same edge you just folded to prior to this move.

6) Repeat...

Magen David Adom

http://www.youtube.com/watch?v=ZE_zFPcMAaA&feature=related

אמת

As I pull into the base this morning, the sun is just beginning to shine it's first rays of light onto the earth, the still frigid air meets my nostrils, and a sigh reaches my throat. It is the start of my normal 10 hour shift of providing transport and emergency care to people all along the I-95 beltway and Metro-Boston. As I hop into the 55 this morning, the same musty, cleaning solution smell that exists in all of the ambulances thrusts itself at me. Soon, the engine is sputtering and roaring to life like a sleeping beast just rudely awakened.

Lights...check    Equipment...check  Computer...check

Sitting in the back of the ambulance, nothing jumps out at me anymore. I know where all of my equipment is, the quantity required by my check off sheet, and where to grab or discard extras. This is my office. Most people I know come to work, sit at a desk, have a desktop or laptop computer already prepared to be set up and ready for the day. Maybe they have stacks of paper, possibly reports they have to complete by the end of the day. A swivel chair, a desk, a calendar, maybe even a fun picture or post card dangles from a safety pin.

I look around my office. Tools crammed into every nook and cranny the truck has to offer. My desk is my lap. My desk lamp, the rear dome or Action Area light. My computer is a Tough Book. My reports come, sometimes, at a dizzying pace (I never know how many will be completed by the end of the day). My chair is a tech seat or bench seat. Diesel fume dust coats these seats and anything else it can cover in the back.

The radio crackles to life and then silences, another ambulance on its way for a transfer. My partner arrives and soon after, the phone rings. We have our first call of the day. The garage door opens with the crisp outside air rushing over me, the ambulance once again sputters and roars to life. The garage door closes and off we go.

Really?

I am at work tonight and I overheard another EMT saying to another group of EMTs, "what other job in the world allows for a non-college educated person to make a steady salary and have multiple days off?" He was saying this to explain why this job is so great. Tell me something, how many people say this about their jobs seriously? More importantly, how sad is it that this is what makes this job great?

Teamwork Part II

My last post on Teamwork was designed to give an idea of how two people working towards a common goal can come together to help an individual in need. That is what being an EMT is all about. Good physicians and nurses confer with their fellow healthcare professionals in order to complete the puzzle of a patient's illness and provide the proper care.

Recently I ran a call that I feel is fit to be used as an example in teamwork. I was working with a fairly new employee at my company out of a base that I am not very familiar with. This is a recipe for a bad shift as I have had a recent streak of partners who are new to the job and are therefore in the stage of feeling invincible and/or full of themselves; simply put, they do not like to listen, take criticism, or work as a team. This was a lucky situation for me, I ended up with a partner with some past experience with another company taking 911 calls. We immediately hit it off and by the time of our first call, we were already working well together. He knew the northern half of our response area, I knew the southern. Our first call went off without a hitch; we communicated well and got the patient packaged, transported, and safe at home without any problems, besides a malfunctioning radio. Our second call was for a cold response to a facility in the southern part of our response area and proved to be an interesting case.

Like I have said before, communication is key, if you can look at your partner and know his/her next move, you can function well as a team. If you can talk to your partner and confer on decisions, the patient is going to get the best care. Two heads are always better than one.

We get a cold response for a male with lower abdominal pain. On arrival, the nurse hands us a packet of information on the patient. We ask the nurse what is going on with the patient, the nurse seems to know very little about the situation other than he has had pain for 5 days and now it is getting worse. The patient is ambulatory in his room; we convince him to sit on his bed while I grab vitals and my partner starts an assessment. We find the upper right quadrant of his abdomen is distended with rigidity.

On the way over to the facility, my partner and I were discussing how we would go about handling the scene (who would do what, what we would be looking for, and what we might expect). This is another aspect of teamwork; bouncing ideas off your partner is NOT a bad thing!

After we find the patient's abdomen is distended and rigid we decide without more than a glance that we are going HOT to the ER, especially with the patient presenting with a fever. Long story short, we got to the hospital and found that the patient, among other issues, had an SPO2 stat of 91% (despite not reporting shortness of breath or difficulty breathing). The next day, I checked on the patient, he had been admitted, that is all they would/could tell me. I hope he did alright, but I know that if he is doing better, it is in large part due to the teamwork that my partner and I had and our quick decision making and assessment abilities.

Teamwork

This is a word that is seldom used in EMS, yet it is also an expectation. The AHA, in it's recent changes to CPR, made mention of utilization of teamwork in it's curriculum. This is mentioned as if this never existed in CPR, let alone pre-hospital care and this is not particularly surprising. In EMT school we are taught to work individually, whether it be in class or testing. Each of us must pass without the assistance of a "partner" on exams and in class. Unfortunately, this is not conducive to real-world EMS.

Here are some reasons why I disagree with the individualistic mentality placed on EMS providers:

1. Individualism breeds competition and while competition in theory is not a bad thing, it does not help EMT's function better. Remember, our common goals are to make sure our patients get the proper care they need either during a routine transport or during an emergency.

2. Communications lacks! A large part of our job is communication, whether it be through radios, to our patients, or to our partners, this is an area of our job that is fundamental.

3.  Patient Care is another area affected. Four hands are better than two, just as two heads are better than one. The more information you can get, the more life saving procedures can be performed, and the least amount of time sitting around without a clue...the BETTER!

There are other areas that are affected by our individualized education; however, these three categories are extremely important to our job. So how can we fix this?

1. More education. By changing the way we approach educating new and old EMT's, we can begin creating an environment of community and teamwork within the industry. This means learning as a team, practicing as a team, and testing as a team. This does not eliminate individual testing, but puts less emphasis on that individual mind set.

2. Emphasis on communicating on all levels. I recently had a partner who was near silent in the ambulance and while this is not necessarily a bad thing, it is when he/she could talk without issue with patients in a compassionate tone while responding to me in a harsh and dismissive tone. I do not take kindly to this. You or your partner may be having a tough day, but leave it at the door. You are a team. Without one of you, the team would cease to function.

3. Patient care can be looked at from a variety of angles; however, I like to look at how EMT's handle the patients once they are placed in the back of an ambulance. In my company, what generally happens is the Tech goes in back with the patient while the Driver goes to the front seat immediately to start the truck and get going. I want to propose another strategy. I would like to propose to EMT's, not only in my company, but elsewhere, to hop in the back with your partner and grab a set of vitals or help with some of the treatment before you run to put the pedal to the metal.

All of these basic tactics, while relatively small in the grand scheme of things, contribute to improving the way we function in an ambulance.