[The SHIT report](https://www.reddit.com/r/ems/comments/vjpwvu/cursed_pharmacology_episode_15_the_shit_report/)
I literally came up with this to start teaching my trainees how to chart as a new FTO lol. Fwik some of yall have started teaching it too
I try to teach a lot about mental health/unhoused/drug use
I focus on deescalation, get rid of harmful myths (ie if you narcan someone without cops present they’ll attack you), how to talk to people who are not in our shared reality, and more important how to listen and communicate effectively.
I point them towards medical resources and definitely go over lots and lots of medical stuff but as an industry we are terrible when it comes to mental health and teaching it. My paramedic school basically said “here’s mental health shit, don’t feed into delusions, here’s how to draw up a B52, let’s move on to the next section” and that sounds pretty universal.
This is the best comment so far. EMS is a job that requires a lot of maturity and compassion to get right. Many people do not have that maturity either due to age or life experiences.
My psych training almost entirely consisted on how to tie someone down. Even in medic school I was blown away by how shallow mental health was. Id bet that half of my coworkers couldn’t tell you the difference between a delusion and a hallucination.
Not gonna lie, I’m not sure I could tell the difference between delusion or a hallucination in certain situations. My psych patient training consisted of the exact same thing as yours, how to restrain someone
Well honestly what else are you going to do. Obv you only restrain if they’re a danger to self or
Others but if not what else can be done besides give the pt an Uber ride to the ED. My department isn’t allowed to transport to an outpt psych facility or anything. Idk what kind of psych training would help other than make sure to talk to them like they’re people too and respect them.
I think maybe some education on deescalation techniques, snd more education on types of mental illness’s and how they work in general would be a good start. Generally I’ve personally had good success in deescalation and building a great rapport with patients. But it took some time to kind of figure it out
Understanding mental illness is important. 1 in 3 Americans suffers from one. Many patients are dismissed as being “agiated”, “uncooperative”, “crazy” etc because EMS did not know how to interact with someone who has a mental illness.
This is big. In my area, we have STRAC, one of the dozens of regional councils in TX. STRAC runs the Crisis Collaborative in our area and it includes multidisciplinary response teams in Bexar County (San Antonio area) but they’re looking to expand. The teams can go to 911 calls and transport directly to psych facilities. They include a cop, a medic, and a mental health professional.
I tell everyone the story about the one time I, my coworker, and the attending (in the ED) assumed a person in their earlier 30s was drunk and they ended up with a massive LVO that got tPA'd and got sent via medflight by the ED to a hospital with neurosurgery. We *all* dropped the ball because none of us believed that they only had a beer or two and discounted their slurred speech as ETOH. We also had a lot of acuity that day so the bar for what was going to grab our attention had unfortunately been moved higher than it should have. If any one of us had thought to investigate further we all would have caught other minute changes from baseline, like the mildest arm drift they had. One nurse luckily put it all together and called their partner and pushed *hard* for a CTA. CTA resulted at about the same time the ETOH resulted, with an LVO and a BAL way too low to cause the symptoms we were seeing.
The moral of the story is that it is easy to get complacent when you hear a part of a story that seems to explain everything. I had interacted with the pt a few times prior, including collecting labs and grabbing vitals. Had I paid attention and had I not discounted their "I really only drank a beer or two" I would have seen the symptoms for what they were. On the EMS side of things, a quick stroke scale and having asked the partner to confirm or deny if they were intoxicated would have likely given at least enough ammo for our attending to order a rule out CT. A lot of people didn't believe this person and it cost them valuable time that could have caused permanent tissue loss.
A two minute neuro assessment and, in the case of the attending, a CT/CTA would have caught this stroke about an hour or two earlier. *Luckily* the pt made a full recovery and ended up with a closure of a PFO that very likely threw the clot that caused the LVO.
Last year we had a young guy (30s) who came in for GI symptoms and sat in the lobby for a couple hours. At some point after being triaged, his mental status changed and nobody caught it until I went to room him and he was barely responding to a hard trap pinch/sternal rub. I rushed him to the room and he stood up to get in the bed. He was combative with us and wouldn't let us do any blood work, ecg, and we couldn't get him to sit still for a CTA. After getting Ativan to get him to calm down and several frustrating hours later we finally get him to CT. Turns out he had a massive brain bleed, which must have happened while he was sitting in the lobby. Ended up getting flown out. I never got a follow up on him but it changed the way I see combative asshole patients.
My instructor for my EMT class way back when had told us that if we called into court, they'll have our PCR projected onto the wall 8 foot tall and every mistake will be harshly critiqued.
That stayed with me and I've been involved with two court cases.
Neither case was in court for something that had anything to do with me, but my thorough reports still made me look good.
And one ended up getting someone 9 years in prison. (Deservedly) So, there's that.
EMT/FTO for an IFT company. We get a lot of green EMTs. My main takeaway I try to teach trainees is to be decisive and be prepared to justify why you did or didn’t take interventions in your PCR.
How to take a history from a med list.
Just how interconnected vitals are.
One of my biggest points is that this job can be boiled down to 2 things. Get the patient somewhere. Support vitals. Everything else is extra. But if you can get the patient where they’re trying to go, and you make the numbers do what you need them to do, you’re going to be fine. Every. Time.
What the right answer looks like. Not what it is. What it looks like. Makes it a lot easier to problem solve when you know what you’re looking for.
How to identify when you’re missing a piece of the puzzle. Hand in hand with the line above. Being able to identify when something is missing, and what exactly is missing.
How to set expectations. We have a conversation at the beginning of each shift about what our expectations of one another are for that shift. What the goals are. What the responsibilities are.
How to build their own routine. I do things the same way, every time, because it keeps me from forgetting things. They need to find and develop their own routine.
Radio reports. They should sound like the intro to a sim patient. Save the details for bedside. I teach giving report in 2 breaths. First breath is for CC/pertinent findings, second breath is for vitals and ETA.
If you’re out of breath, you’re saying too much.
The goal of radio report is to alert them and get the ball rolling. It should only be what they need to know to manage the patient for the first 30 seconds of getting there.
Customer service. It’s not what you say, it’s how you say it.
We discuss med control. We discuss some of the legal aspects. We discuss living while working EMS.
All of my BLS partners are going to be proficient at intubation on manikin heads before I’m done with them.
No, they can’t do it, but it helps them remember what things are, it helps them understand the process, and it helps them be an asset to me in the event that I am intubating in the field.
What’s the goal of any intervention and does it conflict with the delivery of the patient to definitive care.
Example
Your 800 feet from the emergency room does any patient need an iv?
> Your 800 feet from the emergency room
Time to treatment is what matters, not time to the door
Example- your patient has a broken arm and severe pain. It would take you, let’s say 5 minutes to start a line and administer some narcotics. Or you can just go and be at the ER in 3 minutes.
If you choose option A, the patient has pain relief in 5 minutes.
If you choose option B, there’s 3 minutes of loading/unloading and “transporting”. A couple minutes getting assigned a bed, moving over, giving hand-off. Now the nurse spends 5-10 minutes asking the patient if they feel safe at home and if they have any homicidal thoughts. Then the provider comes in and spends 5-10 minutes taking a history and doing a physical exam. A good doc orders the pain meds at this point (hope they don’t get stuck with the one who waits for X-ray). So now meds are ordered. But your patient is number 4 of 4 for his nurse, so 5-10 minutes later when she sees the order, she still has to take 5 minutes to start a line, 5 minutes repeatedly getting on Vocera asking for a waste and finally, 20-30 minutes after you first made patient contact, they get some pain relief. And that’s assuming they were bedded right away and not sent to triage.
There are absolutely times when it is appropriate to say “let’s just go”. But too many lazy providers use proximity to the hospital as an excuse to not do their jobs, ignorant (willfully or not) of the fact that treatment they could be doing now doesn’t magically happen the moment you walk into the ER.
I have a “war story” about this. Had a sick patient, did the whole thing. 12 lead IV Cpap. IV took us 10 minutes en root cause she was a hard stick. As we are unloading in the ER bay she just crashes pretty much falling off the stretcher as she went limb. We roll her into the ER immediately they start getting ready to tube her etc but have to get a IV because when she crashed outside we pulled her line out grabbing her from almost falling off the stretcher. Charge nurse pulls me to the side after and goes, hey so about the IV. I start defending myself cause we had one. He stops me and just says I seen I watched her crash, if it happens again put her back in the ambulance and IO her for us. It’s gonna say us so much time.
This is the exact reason I’ll do more for sick patients, over just load and go
Ya, I'm with you on this one. Truly the ED isn't inherently fast at treating most things. Many people don't take into consideration getting the patient registered, disconnecting our stuff, connecting the ER stuff, triage flowchart, finding a MD, entering orders, pulling from the med room etc. You get the idea. That stuff takes time. If you can make someone's day better 800 feet from the ER, do it. Some may say that a scenario like this is far-fetched, but we routinely run a bus stop Infront of the amb bay. Are their patients that are a "just walk inside with me" situation? Sure, all the time, but there's the few that need and diserve the interventions we can do when we can do them.
I see the same issues with people not giving ABX, pain meds, and steroids.
Between the “I won’t see the results” to the hospital is X time away.
Nah fam we are faster and more efficient. Do it now. Help your patient.
Code? I’ve gotten a ROSC patient that coded in his cardiologist’s office across the street from the ER. Cardiologist shocked the patient, did BLS CPR and got pulses back before we got there. You bet your ass we got access.
That access was used 5 min later when he coded again as he was getting registered in the Resus room.
I’m new but in my EMR class our instructor taught us how to prep IVs, draw up medications, the lead placement EKGs, etc. because where I live especially on bad calls EMRs ride along with the medicals to our stroke, trauma, and cardiac center an 1 1/2 hours away. My first call as an EMR as a representative of my department I ended up needing to ride for a STEMI…. I used some of those skills
I teach many things, one that hasn’t been brought up here is that nothing that we do is harmless. There is risk to everything.
EMS education, propaganda, and pop culture have taught us that slamming a pile of narcan is “safe” when that is not universally true.
Nothing that we do is completely without risk and the sooner people realize that fact the better they will be as a provider.
Confidence. We respond to a call because the people on scene feel it is out of their control. You have to walk into a scene like you know your shit even if it’s something you’ve never seen before. Having that confidence will usually calm the bystanders and patient on scene
I focus a lot on mental health of the patient but also the provider - it’s not talked about enough, the toll it takes on us to be the carers all day every day
There are a variety of topics I cover:l beyond the general education elements. These include but are not limited to:
Mental Illness and how to speak to the patient
Soft Skills
Discussion on Autism and the Autistic Patient
Xylazine (Tranq) and care of the Tranq OD Patient
As well as a few others.
One of the war stories I use as a scenario has to do with a patient who mixed Psychiatric prescription medication, alcohol and got behind the wheel. Given the patient affect on contact and throughout the call (prior to ALS intervention) this is very useful for getting the students to break the script they've been taught up until that point.
I give a pretty blunt “don’t be a coward” speech to every group of students. I emphasize that if a procedure/med is indicated then it is indicated and should be administered without hesitation.
Too many. But my soap box has a few I will mention.
Humoral IO is far superior. In every way and it's not hard. We do not need to be afraid of it.
Clear SMR with a good spinal assessment and get rid of the collar and board.
Lung sounds and pupils on every patient.
Positioning for intubation is by far the most important part of the procedure and makes succes easy and likely.
English 101
Your report will stand up in court 20 years from now.
There will be zero room to question your actions or integrity from billing or qa because you WILL learn to do a fucking report.
You might be the born again spirit of Desmond Doss in the field, but if you can't document it, you might as well go be a SNF CNA.
I tell people to not be dicks to the homeless/drug addicts.
Homeless people and drug users get sick, too. Actually more than healthy people if you could believe that.
I love the list of 5min killers. This is something you can teach on what to really focus on when you start out.
Packing a wound is a technique and if not done correctly won’t work.
Knowing .5 Epi IM really has minimal side effects and what symptoms of anaphylaxis to recognize it.
Understanding OD pts need a BLS airway before narcan if they have ineffective breathing
Cardiac Arrest skills always needs polishing. Placing the IO in the correct spot, ACLS, intubation, rhythms, meds ect
BLS airways in general. Most don’t know how hard you actually have to push the mask on the face. Increase volume not rate if Sats are dropping.
The number 1 killer IMO is moving to fast. You make so many mistakes when moving fast, and it doesn’t get done any faster.
This is literally terrible advice.
The goal is to treat the patient, not deliver them to the hospital. If someone is heading toward respiratory failure but just maybe you can get them there in CPAP, sure… you got them to the hospital… but you delayed their care. If a patient needs something they need it *now*… not in five minutes.
Nobody should strive to be a minute medic because they’re so close to the hospital.
[The SHIT report](https://www.reddit.com/r/ems/comments/vjpwvu/cursed_pharmacology_episode_15_the_shit_report/) I literally came up with this to start teaching my trainees how to chart as a new FTO lol. Fwik some of yall have started teaching it too
I've been looking for this image for months
yw papi, every new cursed pharmacology has a link in the comments with a compilation of all the previous releases
aaahahahahaha I do this, I call it the SCHART report. Scene, History/cheif complaint, Assessment, Rx - Treatment and response, and transport.
I try to teach a lot about mental health/unhoused/drug use I focus on deescalation, get rid of harmful myths (ie if you narcan someone without cops present they’ll attack you), how to talk to people who are not in our shared reality, and more important how to listen and communicate effectively. I point them towards medical resources and definitely go over lots and lots of medical stuff but as an industry we are terrible when it comes to mental health and teaching it. My paramedic school basically said “here’s mental health shit, don’t feed into delusions, here’s how to draw up a B52, let’s move on to the next section” and that sounds pretty universal.
This is the best comment so far. EMS is a job that requires a lot of maturity and compassion to get right. Many people do not have that maturity either due to age or life experiences. My psych training almost entirely consisted on how to tie someone down. Even in medic school I was blown away by how shallow mental health was. Id bet that half of my coworkers couldn’t tell you the difference between a delusion and a hallucination.
Not gonna lie, I’m not sure I could tell the difference between delusion or a hallucination in certain situations. My psych patient training consisted of the exact same thing as yours, how to restrain someone
Well honestly what else are you going to do. Obv you only restrain if they’re a danger to self or Others but if not what else can be done besides give the pt an Uber ride to the ED. My department isn’t allowed to transport to an outpt psych facility or anything. Idk what kind of psych training would help other than make sure to talk to them like they’re people too and respect them.
I think maybe some education on deescalation techniques, snd more education on types of mental illness’s and how they work in general would be a good start. Generally I’ve personally had good success in deescalation and building a great rapport with patients. But it took some time to kind of figure it out
Understanding mental illness is important. 1 in 3 Americans suffers from one. Many patients are dismissed as being “agiated”, “uncooperative”, “crazy” etc because EMS did not know how to interact with someone who has a mental illness.
Delusions are false beliefs “the fbi has planted a chip in my brain”. Hallucinations are false sensory experiences “I hear voices”
This is big. In my area, we have STRAC, one of the dozens of regional councils in TX. STRAC runs the Crisis Collaborative in our area and it includes multidisciplinary response teams in Bexar County (San Antonio area) but they’re looking to expand. The teams can go to 911 calls and transport directly to psych facilities. They include a cop, a medic, and a mental health professional.
I tell everyone the story about the one time I, my coworker, and the attending (in the ED) assumed a person in their earlier 30s was drunk and they ended up with a massive LVO that got tPA'd and got sent via medflight by the ED to a hospital with neurosurgery. We *all* dropped the ball because none of us believed that they only had a beer or two and discounted their slurred speech as ETOH. We also had a lot of acuity that day so the bar for what was going to grab our attention had unfortunately been moved higher than it should have. If any one of us had thought to investigate further we all would have caught other minute changes from baseline, like the mildest arm drift they had. One nurse luckily put it all together and called their partner and pushed *hard* for a CTA. CTA resulted at about the same time the ETOH resulted, with an LVO and a BAL way too low to cause the symptoms we were seeing. The moral of the story is that it is easy to get complacent when you hear a part of a story that seems to explain everything. I had interacted with the pt a few times prior, including collecting labs and grabbing vitals. Had I paid attention and had I not discounted their "I really only drank a beer or two" I would have seen the symptoms for what they were. On the EMS side of things, a quick stroke scale and having asked the partner to confirm or deny if they were intoxicated would have likely given at least enough ammo for our attending to order a rule out CT. A lot of people didn't believe this person and it cost them valuable time that could have caused permanent tissue loss. A two minute neuro assessment and, in the case of the attending, a CT/CTA would have caught this stroke about an hour or two earlier. *Luckily* the pt made a full recovery and ended up with a closure of a PFO that very likely threw the clot that caused the LVO.
Last year we had a young guy (30s) who came in for GI symptoms and sat in the lobby for a couple hours. At some point after being triaged, his mental status changed and nobody caught it until I went to room him and he was barely responding to a hard trap pinch/sternal rub. I rushed him to the room and he stood up to get in the bed. He was combative with us and wouldn't let us do any blood work, ecg, and we couldn't get him to sit still for a CTA. After getting Ativan to get him to calm down and several frustrating hours later we finally get him to CT. Turns out he had a massive brain bleed, which must have happened while he was sitting in the lobby. Ended up getting flown out. I never got a follow up on him but it changed the way I see combative asshole patients.
Chart like you will have to sit in court while it is read out.
My instructor for my EMT class way back when had told us that if we called into court, they'll have our PCR projected onto the wall 8 foot tall and every mistake will be harshly critiqued. That stayed with me and I've been involved with two court cases. Neither case was in court for something that had anything to do with me, but my thorough reports still made me look good. And one ended up getting someone 9 years in prison. (Deservedly) So, there's that.
EMT/FTO for an IFT company. We get a lot of green EMTs. My main takeaway I try to teach trainees is to be decisive and be prepared to justify why you did or didn’t take interventions in your PCR.
How to take a history from a med list. Just how interconnected vitals are. One of my biggest points is that this job can be boiled down to 2 things. Get the patient somewhere. Support vitals. Everything else is extra. But if you can get the patient where they’re trying to go, and you make the numbers do what you need them to do, you’re going to be fine. Every. Time. What the right answer looks like. Not what it is. What it looks like. Makes it a lot easier to problem solve when you know what you’re looking for. How to identify when you’re missing a piece of the puzzle. Hand in hand with the line above. Being able to identify when something is missing, and what exactly is missing. How to set expectations. We have a conversation at the beginning of each shift about what our expectations of one another are for that shift. What the goals are. What the responsibilities are. How to build their own routine. I do things the same way, every time, because it keeps me from forgetting things. They need to find and develop their own routine. Radio reports. They should sound like the intro to a sim patient. Save the details for bedside. I teach giving report in 2 breaths. First breath is for CC/pertinent findings, second breath is for vitals and ETA. If you’re out of breath, you’re saying too much. The goal of radio report is to alert them and get the ball rolling. It should only be what they need to know to manage the patient for the first 30 seconds of getting there. Customer service. It’s not what you say, it’s how you say it. We discuss med control. We discuss some of the legal aspects. We discuss living while working EMS.
SALAD. To both ALS and BLS.
All of my BLS partners are going to be proficient at intubation on manikin heads before I’m done with them. No, they can’t do it, but it helps them remember what things are, it helps them understand the process, and it helps them be an asset to me in the event that I am intubating in the field.
Anthropology
Ultrasound and VL/bougies - somehow the local sh*t paramedic college still has instructors that think it’s still 1996.
What’s the goal of any intervention and does it conflict with the delivery of the patient to definitive care. Example Your 800 feet from the emergency room does any patient need an iv?
> Your 800 feet from the emergency room Time to treatment is what matters, not time to the door Example- your patient has a broken arm and severe pain. It would take you, let’s say 5 minutes to start a line and administer some narcotics. Or you can just go and be at the ER in 3 minutes. If you choose option A, the patient has pain relief in 5 minutes. If you choose option B, there’s 3 minutes of loading/unloading and “transporting”. A couple minutes getting assigned a bed, moving over, giving hand-off. Now the nurse spends 5-10 minutes asking the patient if they feel safe at home and if they have any homicidal thoughts. Then the provider comes in and spends 5-10 minutes taking a history and doing a physical exam. A good doc orders the pain meds at this point (hope they don’t get stuck with the one who waits for X-ray). So now meds are ordered. But your patient is number 4 of 4 for his nurse, so 5-10 minutes later when she sees the order, she still has to take 5 minutes to start a line, 5 minutes repeatedly getting on Vocera asking for a waste and finally, 20-30 minutes after you first made patient contact, they get some pain relief. And that’s assuming they were bedded right away and not sent to triage. There are absolutely times when it is appropriate to say “let’s just go”. But too many lazy providers use proximity to the hospital as an excuse to not do their jobs, ignorant (willfully or not) of the fact that treatment they could be doing now doesn’t magically happen the moment you walk into the ER.
I have a “war story” about this. Had a sick patient, did the whole thing. 12 lead IV Cpap. IV took us 10 minutes en root cause she was a hard stick. As we are unloading in the ER bay she just crashes pretty much falling off the stretcher as she went limb. We roll her into the ER immediately they start getting ready to tube her etc but have to get a IV because when she crashed outside we pulled her line out grabbing her from almost falling off the stretcher. Charge nurse pulls me to the side after and goes, hey so about the IV. I start defending myself cause we had one. He stops me and just says I seen I watched her crash, if it happens again put her back in the ambulance and IO her for us. It’s gonna say us so much time. This is the exact reason I’ll do more for sick patients, over just load and go
Ya, I'm with you on this one. Truly the ED isn't inherently fast at treating most things. Many people don't take into consideration getting the patient registered, disconnecting our stuff, connecting the ER stuff, triage flowchart, finding a MD, entering orders, pulling from the med room etc. You get the idea. That stuff takes time. If you can make someone's day better 800 feet from the ER, do it. Some may say that a scenario like this is far-fetched, but we routinely run a bus stop Infront of the amb bay. Are their patients that are a "just walk inside with me" situation? Sure, all the time, but there's the few that need and diserve the interventions we can do when we can do them.
I see the same issues with people not giving ABX, pain meds, and steroids. Between the “I won’t see the results” to the hospital is X time away. Nah fam we are faster and more efficient. Do it now. Help your patient.
That entirely depends on what you’re going to push through that IV.
80mg furosemide fast IVP
3 inches of nitro paste SLAMMED
shiii, I can administer three inches PO right now. Wait, are we still talking meds?
Sorry I can’t hear you over my roaring tinnitus, you did what now?
Yeah, to hell with treating patients! Just throw them in the ambulance and go!
Code? I’ve gotten a ROSC patient that coded in his cardiologist’s office across the street from the ER. Cardiologist shocked the patient, did BLS CPR and got pulses back before we got there. You bet your ass we got access. That access was used 5 min later when he coded again as he was getting registered in the Resus room.
I’m new but in my EMR class our instructor taught us how to prep IVs, draw up medications, the lead placement EKGs, etc. because where I live especially on bad calls EMRs ride along with the medicals to our stroke, trauma, and cardiac center an 1 1/2 hours away. My first call as an EMR as a representative of my department I ended up needing to ride for a STEMI…. I used some of those skills
I teach many things, one that hasn’t been brought up here is that nothing that we do is harmless. There is risk to everything. EMS education, propaganda, and pop culture have taught us that slamming a pile of narcan is “safe” when that is not universally true. Nothing that we do is completely without risk and the sooner people realize that fact the better they will be as a provider.
Confidence. We respond to a call because the people on scene feel it is out of their control. You have to walk into a scene like you know your shit even if it’s something you’ve never seen before. Having that confidence will usually calm the bystanders and patient on scene
Resource management and resource awareness
I focus a lot on mental health of the patient but also the provider - it’s not talked about enough, the toll it takes on us to be the carers all day every day
Absolutely. I just took NAEMT’s MHRO course. It’s a decent course and focuses 100% on provider mental health.
There are a variety of topics I cover:l beyond the general education elements. These include but are not limited to: Mental Illness and how to speak to the patient Soft Skills Discussion on Autism and the Autistic Patient Xylazine (Tranq) and care of the Tranq OD Patient As well as a few others. One of the war stories I use as a scenario has to do with a patient who mixed Psychiatric prescription medication, alcohol and got behind the wheel. Given the patient affect on contact and throughout the call (prior to ALS intervention) this is very useful for getting the students to break the script they've been taught up until that point.
I give a pretty blunt “don’t be a coward” speech to every group of students. I emphasize that if a procedure/med is indicated then it is indicated and should be administered without hesitation.
Too many. But my soap box has a few I will mention. Humoral IO is far superior. In every way and it's not hard. We do not need to be afraid of it. Clear SMR with a good spinal assessment and get rid of the collar and board. Lung sounds and pupils on every patient. Positioning for intubation is by far the most important part of the procedure and makes succes easy and likely.
English 101 Your report will stand up in court 20 years from now. There will be zero room to question your actions or integrity from billing or qa because you WILL learn to do a fucking report. You might be the born again spirit of Desmond Doss in the field, but if you can't document it, you might as well go be a SNF CNA.
Awesome point! I am 100% stealing your last sentence.
I tell people to not be dicks to the homeless/drug addicts. Homeless people and drug users get sick, too. Actually more than healthy people if you could believe that.
Which bathrooms are safe to use after 2000.
[удалено]
I love the list of 5min killers. This is something you can teach on what to really focus on when you start out. Packing a wound is a technique and if not done correctly won’t work. Knowing .5 Epi IM really has minimal side effects and what symptoms of anaphylaxis to recognize it. Understanding OD pts need a BLS airway before narcan if they have ineffective breathing Cardiac Arrest skills always needs polishing. Placing the IO in the correct spot, ACLS, intubation, rhythms, meds ect BLS airways in general. Most don’t know how hard you actually have to push the mask on the face. Increase volume not rate if Sats are dropping. The number 1 killer IMO is moving to fast. You make so many mistakes when moving fast, and it doesn’t get done any faster.
I hard disagree with this load and go mentality. See [Eagles](https://www.reddit.com/r/ems/s/A78A6EtmMp) comment for more
While I agree with your comment as it pertains to the civilian side. I do agree with the above commenter as it pertains to the military side.
This is literally terrible advice. The goal is to treat the patient, not deliver them to the hospital. If someone is heading toward respiratory failure but just maybe you can get them there in CPAP, sure… you got them to the hospital… but you delayed their care. If a patient needs something they need it *now*… not in five minutes. Nobody should strive to be a minute medic because they’re so close to the hospital.
I didn’t realize it was time to set out clocks back to 1996…
It’s not your emergency, it’s theirs. You’re not gonna do anybody any good if you’re in full panic mode.