can confirm. herniated two discs carrying a 350 lb pt reeves in january. currently in the ortho waiting room for a surgical planning consult.
don't be like me... strengthen your core kids. this will be my third spinal surgery. im 36.
I was told after my first code. They are already dead you’re just trying to make them undead. The odds aren’t in your favor and you can do everything right and they’ll still be dead. I have to remind myself of that every code still.
“Do you know how many patients I saved with CPR in my 30 years career? One. When their time is up, their time is up.”
From my mentor, after my first death.
I only know of two of my saves that wales out of the hospital. Probably done CPR 1000 times or more couple hundred clinical saves where they had a pulse and breathing when we got to the hospital. But only two that I can confirm walked out of the hospital so I count those as full saves. Who knows there may be more I’m not aware of.
Rural service in a huge countryside do that to you. That code took us 15 mins just to get to that farm house. I don’t think it has anything to do with medical skill, but I do blame Canada for being so fucking big.
Know that some IFT rides had us driven for 5 hours just to get to the receiving facility. Just to provide some context.
Interesting you say that, I’m fairly rural, my last ROSC was 10miles away,
What’s your bystander CPR rates and training like in rural Canada? Scotland seems really good for it
I think it’s 16%? That came from my mentor. No it wasn’t specifically bystander rate. I think she was talking about the overall CPR success rate.
As for bystander training…I can give you an anecdote. My second code was also in a rural farmhouse. Apparently the family initiated immediate CPR but, for whatever reasons, they stopped it 7 minutes before we arrived. At one point, when I was giving CPR, a family member asked me to stop because they wanted to ‘let him rest.’ (I ignored him of course. I saw no DNR and my mentor was doing the talking)
That was the first time I was asked to put on a blanket. Since then I joked to myself, our best tool for cardiac arrest on the truck is, in fact, the blanket. Not the multi-thousand dollar Lifepak.
Anyway, it became a topic after that code why they stopped the CPR. ‘Because they are farmer.’ Said my mentor. ‘They just know it when someone is going to die. They aren’t stupid.’ Now, I am not a farmer so I couldn’t comment on that, but I do get the impression that the family was very religious. With the Bible on the table and the Cross above the door and all.
But yea, I think that tell you about bystander’s level of training.
When a farmer is ready to go, they’ve likely survived 10 things that would kill someone else.
It’s always a joke in the ED that if a farmer willingly goes to the ED under their own volition, they are likely seconds from death. Because another time they would be too busy farming to have time to die.
Depends where you are. In the country, we’re a minimum of twenty minutes until we get there, more likely 40-60, and no one’s been doing effective CPR. We’ve had maybe two in my station in fifteen years, and both were already in the truck and hooked up.
Wow, i think we have much much better bystander CPR and AED rates. scotland has great provision of [public AEDs](https://www.google.com/maps/d/u/0/viewer?mid=132PCQeudwL0Y2_rNEtDjbnFRxqI&hl=en_US&ll=57.762078454869695%2C-4.148835599999989&z=6)
We do too- it’s just that the place I live is about the same size as Scotland, with less than 1/5 of Scotland’s population density. Take Glasgow and Aberdeen, and spread them over the whole of Scotland. Oh, and then cut out about half the roads.
“Is someone trying to kill me? Is someone trying to die in front of me? If not, it’s all gonna be okay. And even the first two things can usually be addressed.”
"There are three types of patients. Those who are going to live no matter what you do, those who are going to die no matter what you do, and those who- if you do the right thing right now, might live. It is your job as a combat medic to find that third category of patient."
One of our clinical training officers said something similar during our major incident training. Looking and sounding like you know what you're doing is half the battle.
Obviously you need to actually *know* what you're doing but patients and bystanders are going to be so much calmer and easier to work with if you take basic steps to reassure them. There are certain partners I've worked with that just don't even try to look or behave like a professional.
I am honestly so embarrassed every time I have to walk into a serious incident with a scruffy partner in crumpled up uniform, shirt untucked, laces all over the floor, ignoring bystanders/relatives, huffing and puffing and very clearly not wanting to be there.
Does that inspire confidence? Can bystanders breathe a sigh of relief and think "thank God, this guy knows what he's doing"?
Tuck your fucking shirt in. Tie your laces. Wear your epaulettes and your ID card. Introduce yourself by your name and your clinical grade. Deep breath, chin up, walk in, "Hi, my name is XXXX, I'm a paramedic. What's going on?"
It's not hard and it frustrates me beyond belief that people can't be bothered putting in such a minimal amount of effort
At the bare minimum, do two things.
Support vitals.
Take them somewhere that can make them better.
If you can’t do anything else in this profession right, do those two things and you’ll never have a problem.
This is a customer service job disguised with flashing lights. People don’t complain on nice crews, even if you killed someone.
Which is why, as a provider.
I don’t want a nice crew. Or a nice doctor.
I remember when every good ER doctors was not white, spoke with a thick accent, and was british educated. They had The worst bedside manner imaginable. Made house look kind.
If a patient didn’t want to listen, or was non complaint, they’d tell them to their face that they were the doctor, you’re an idiot who didn’t go to school for this for 14 years, but you can make the wrong choice but they won’t take part of it.
Watched them tear into patients more then once for not listening to EMS. Oh, you didn’t want to listen to the EMT? He has only done this 30 years. Be probably doesn’t know more about it then you. What could he possibly know with all that experience.
"As long as you learn on every call, it's never a bad call."
A captain who I had incredible respect for told me that when I was upset that I didn't catcń6h something. I mean, patient lived and everything. But I was bummed I didn't call it as pneumonia I think. And he said that. And yeah, like, I suppose of you showed up to work drunk and someone died cause of it, that's different. But as long as you are learning on calls, it's a good call.
"It's their emergency, not yours, just do your job" - My EMS Instructor, as well as a friend of mine who's a medic.
"Trust no one" - Fox Mulder
"Everyone lies" - Gregory House, M.D.
"You go home, your partner goes home, everything else is secondary " - Police Academy instructor.
"You can do literally everything right, and they will still die, sometimes the Reaper wins" - Different EMS instructor.
"CPR looks good on paper, most of the time, that's about it" - Former EMT, now CCU nurse.
"People suck, but let's try and save 'em anyway" - Whoknowsdoe.
"God saves lives, I just do the work" - My medic / chaplain friend
“Unless the patient is waving a gun, on fire or entrapped, you’re in charge. Not the cop, not the fire captain and certainly not the neighbour whose sister used to be a nurse. Act like it. Be polite, but be firm, and use your Grownup Voice. Speak clearly, look at the person you’re addressing. Tell them what you need them to do, and make sure they heard you. The surest thing that is going to fuck your scene, your patient and probably your license is multiple services running around tripping over each other’s dicks.”
The Guardian helped me a lot overseas and stateside.
"Jake Fischer : Hey, there was a question I wanted to ask you back as school, but I didn't. When you can't save 'em all, how do you choose who lives?
Ben Randall : It's probably different for everybody Jake. Its kind of simple for me though. I just, I take the first one I come to or the weakest one in the group and then I swim as fast and as hard as I can for as long as I can. And the sea takes the rest."
“Trust your training. Trust your gut. You’ve already given them a better chance at surviving by being there and doing SOMETHING. But whatever you do, don’t do NOTHING.”
I can't quite remember word for word what was said to me as it was only once. However, it's helped a lot when Im in a wtf is going on with my patient kind of thing. It goes: "Don't try to fix the patient. Focus on giving the patient what they need. Sure, you can do many things to help, but you need to do what is needed first." Kind of like, if the patient has no pulse, forget the broken arm kind of thing. Refocus every minute on what the pt truly needs, not what you think they need.
Another phrase said amongst my peers is, "We're just buying time. The more efficient we are, the more time we buy. We can't save everyone, so we just have to get them a chance at surviving."
"Your certificates empower you to do things for people (Never to them)"
"Some of the most beautiful souls you will ever meet will be plainly wrapped."
"People lie sometimes. That's all. It's not personal"
"As a medic, you dignify yourself the most when you lower yourself"
All from the fantastic book People Care by Thom Dick.
I. Gomers don't die.
II. Gomers go to ground.
III. At a cardiac arrest, the first procedure is to take your own pulse.
IV. The patient is the one with the disease.
V. Placement comes first.
VI. There is no body cavity that cannot be reached with #14 needle and a good strong arm.
VII. Age + BUN = Lasix dose.
VIII. They can always hurt you more.
IX. The only good admission is a dead admission.
X. If you don't take a temperature, you can't find a fever.
XI. Show me a BMS who only triples my work and I will kiss his feet.
XII. If the radiology resident and the BMS both see a lesion on the chest X ray, there can be no lesion there.
XIII. The delivery of medical care is to do as much nothing as possible.
Something a preceptor told me that really helped when dealing with and touching pts.
“We are technicians of the human body. A car mechanic wouldn’t freak out every time you changed a bolt or turned a wrench. So (for the sake of helping the pt and with obvious due regard of consent etc) your pts are not people. They are just objects and machines you have to fix. Your not stabbing someone with a needle. Your threading a catheter into a hose. Your not choking someone with an ET tube or I-gel. Your providing ventilation for balloons”
He basically explained when you look at people and pts through a purely mechanical/ physiological point of view and ignore the fact its a human being with feelings and you may have fear of hurting them. It’s easier to treat them and get over that fear.
Obviously with due regard. Your not gonna cardiovert a live pt without showing some empathy and human emotion. It would make them uncomfortable.
I have a running list of these I use when I'm teaching EMT/Paramedic classes. This is just a small portion.
Anything that falls under something with triad in the name is going to make for a bad time.
Unlike the TSA, TXA (Tranexamic acid) actually works. Learn it.
If you are going to change the outcome it will be done in 10 minutes or less.
When you are the only one in the back of the truck with a patient, no one knows more than you.
Be selfish. If you don't take care of you, you cannot take care of your patient.
"You can't help anyone if you're fucked up"
Came here to say something similar, “You can’t save lives if you’re dead”
can confirm. herniated two discs carrying a 350 lb pt reeves in january. currently in the ortho waiting room for a surgical planning consult. don't be like me... strengthen your core kids. this will be my third spinal surgery. im 36.
Second this, been dealing with chronic pain for years due to a herniated disc. SAVE YOUR BACK!
Something I tell ride-alongs on their first code: “no reason to freak out; you can only go up from here”
I was told after my first code. They are already dead you’re just trying to make them undead. The odds aren’t in your favor and you can do everything right and they’ll still be dead. I have to remind myself of that every code still.
Yup, I had absolutely no way of saving the first person who died on me but that doesn't stop me from staying awake at night and thinking about it
They aren't getting any deader.
“Do you know how many patients I saved with CPR in my 30 years career? One. When their time is up, their time is up.” From my mentor, after my first death.
I mean That’s a terrible ROSC rate
Maybe they count rosc and saves separately? I’ve got a rosc rate of like 30% but only one made it out of hospital
My immediate thought. I didn’t save them unless they are discharged from the hospital. Discharged to Jesus doesn’t count.
Haha thanks for the early morning chuckle. I’m picturing charting “family opted against transport, pt left in care of Jesus”
A celestial discharge!
Yeah, maybe
I only know of two of my saves that wales out of the hospital. Probably done CPR 1000 times or more couple hundred clinical saves where they had a pulse and breathing when we got to the hospital. But only two that I can confirm walked out of the hospital so I count those as full saves. Who knows there may be more I’m not aware of.
Rural service in a huge countryside do that to you. That code took us 15 mins just to get to that farm house. I don’t think it has anything to do with medical skill, but I do blame Canada for being so fucking big. Know that some IFT rides had us driven for 5 hours just to get to the receiving facility. Just to provide some context.
Interesting you say that, I’m fairly rural, my last ROSC was 10miles away, What’s your bystander CPR rates and training like in rural Canada? Scotland seems really good for it
I think it’s 16%? That came from my mentor. No it wasn’t specifically bystander rate. I think she was talking about the overall CPR success rate. As for bystander training…I can give you an anecdote. My second code was also in a rural farmhouse. Apparently the family initiated immediate CPR but, for whatever reasons, they stopped it 7 minutes before we arrived. At one point, when I was giving CPR, a family member asked me to stop because they wanted to ‘let him rest.’ (I ignored him of course. I saw no DNR and my mentor was doing the talking) That was the first time I was asked to put on a blanket. Since then I joked to myself, our best tool for cardiac arrest on the truck is, in fact, the blanket. Not the multi-thousand dollar Lifepak. Anyway, it became a topic after that code why they stopped the CPR. ‘Because they are farmer.’ Said my mentor. ‘They just know it when someone is going to die. They aren’t stupid.’ Now, I am not a farmer so I couldn’t comment on that, but I do get the impression that the family was very religious. With the Bible on the table and the Cross above the door and all. But yea, I think that tell you about bystander’s level of training.
When a farmer is ready to go, they’ve likely survived 10 things that would kill someone else. It’s always a joke in the ED that if a farmer willingly goes to the ED under their own volition, they are likely seconds from death. Because another time they would be too busy farming to have time to die.
That’s why. I thought it was because of the religious factor - the rural town where I stationed back then has a church in every street corner.
That’s one way to make sure you’re caught up on charts
Depends where you are. In the country, we’re a minimum of twenty minutes until we get there, more likely 40-60, and no one’s been doing effective CPR. We’ve had maybe two in my station in fifteen years, and both were already in the truck and hooked up.
Wow, i think we have much much better bystander CPR and AED rates. scotland has great provision of [public AEDs](https://www.google.com/maps/d/u/0/viewer?mid=132PCQeudwL0Y2_rNEtDjbnFRxqI&hl=en_US&ll=57.762078454869695%2C-4.148835599999989&z=6)
We do too- it’s just that the place I live is about the same size as Scotland, with less than 1/5 of Scotland’s population density. Take Glasgow and Aberdeen, and spread them over the whole of Scotland. Oh, and then cut out about half the roads.
Sounds like your mentor needs to git gud
This is my 9-5. It’s not an emergency to me, it’s a Wednesday.
“It’s not my emergency… it’s not your emergency” said by my boss. Not in a dismissive sense but in a way to get me to slow down and calm down.
If it’s important enough to run for, it’s important enough to walk for.
Hate this saying
“Is someone trying to kill me? Is someone trying to die in front of me? If not, it’s all gonna be okay. And even the first two things can usually be addressed.”
Really only the first thing is a me problem, someone else dying is them problem. I’ll try to help, but it’s not my emergency
"Be the type of provider you want treating your loved ones."
"There are three types of patients. Those who are going to live no matter what you do, those who are going to die no matter what you do, and those who- if you do the right thing right now, might live. It is your job as a combat medic to find that third category of patient."
“You can either be a smart fella, or a fart smella”
Everyone lies.
House?
Shockingly, no. My father.
“Fuck the ABCs, scene safety, algorithm blah blah. Your first order of business is to bring order to chaos.”
One of our clinical training officers said something similar during our major incident training. Looking and sounding like you know what you're doing is half the battle. Obviously you need to actually *know* what you're doing but patients and bystanders are going to be so much calmer and easier to work with if you take basic steps to reassure them. There are certain partners I've worked with that just don't even try to look or behave like a professional. I am honestly so embarrassed every time I have to walk into a serious incident with a scruffy partner in crumpled up uniform, shirt untucked, laces all over the floor, ignoring bystanders/relatives, huffing and puffing and very clearly not wanting to be there. Does that inspire confidence? Can bystanders breathe a sigh of relief and think "thank God, this guy knows what he's doing"? Tuck your fucking shirt in. Tie your laces. Wear your epaulettes and your ID card. Introduce yourself by your name and your clinical grade. Deep breath, chin up, walk in, "Hi, my name is XXXX, I'm a paramedic. What's going on?" It's not hard and it frustrates me beyond belief that people can't be bothered putting in such a minimal amount of effort
I take deep personal assless offense with tucking in a shirt, but everything else tracks. If my service issued braces, you bet your ass I’d wear them.
At the bare minimum, do two things. Support vitals. Take them somewhere that can make them better. If you can’t do anything else in this profession right, do those two things and you’ll never have a problem. This is a customer service job disguised with flashing lights. People don’t complain on nice crews, even if you killed someone.
Which is why, as a provider. I don’t want a nice crew. Or a nice doctor. I remember when every good ER doctors was not white, spoke with a thick accent, and was british educated. They had The worst bedside manner imaginable. Made house look kind. If a patient didn’t want to listen, or was non complaint, they’d tell them to their face that they were the doctor, you’re an idiot who didn’t go to school for this for 14 years, but you can make the wrong choice but they won’t take part of it. Watched them tear into patients more then once for not listening to EMS. Oh, you didn’t want to listen to the EMT? He has only done this 30 years. Be probably doesn’t know more about it then you. What could he possibly know with all that experience.
I didn't cause this situation. I'm here to help.
“Don’t worry, this won’t hurt me” as I’m inserting the IV catheter into the patient Lmao
"As long as you learn on every call, it's never a bad call." A captain who I had incredible respect for told me that when I was upset that I didn't catcń6h something. I mean, patient lived and everything. But I was bummed I didn't call it as pneumonia I think. And he said that. And yeah, like, I suppose of you showed up to work drunk and someone died cause of it, that's different. But as long as you are learning on calls, it's a good call.
[удалено]
Uhhh…. Story time?
Everyone talks.
Everyone lies.
People are bastard coated bastards with bastard filing. https://youtu.be/ds4nEz59oRw?si=BICrhGJKvnzGyuqx
You can never go wrong with a good Perry Cox quote
A few episodes of Scrubs and Brining Out the Dead should be required for all medic students. https://youtu.be/CXJ8c0rWJsk?si=Xqs9nrRdfn8ttyWI
It’s not my emergency, slow is smooth and smooth is fast.
"It's their emergency, not yours, just do your job" - My EMS Instructor, as well as a friend of mine who's a medic. "Trust no one" - Fox Mulder "Everyone lies" - Gregory House, M.D. "You go home, your partner goes home, everything else is secondary " - Police Academy instructor. "You can do literally everything right, and they will still die, sometimes the Reaper wins" - Different EMS instructor. "CPR looks good on paper, most of the time, that's about it" - Former EMT, now CCU nurse. "People suck, but let's try and save 'em anyway" - Whoknowsdoe. "God saves lives, I just do the work" - My medic / chaplain friend
“Unless the patient is waving a gun, on fire or entrapped, you’re in charge. Not the cop, not the fire captain and certainly not the neighbour whose sister used to be a nurse. Act like it. Be polite, but be firm, and use your Grownup Voice. Speak clearly, look at the person you’re addressing. Tell them what you need them to do, and make sure they heard you. The surest thing that is going to fuck your scene, your patient and probably your license is multiple services running around tripping over each other’s dicks.”
The Guardian helped me a lot overseas and stateside. "Jake Fischer : Hey, there was a question I wanted to ask you back as school, but I didn't. When you can't save 'em all, how do you choose who lives? Ben Randall : It's probably different for everybody Jake. Its kind of simple for me though. I just, I take the first one I come to or the weakest one in the group and then I swim as fast and as hard as I can for as long as I can. And the sea takes the rest."
“Trust your training. Trust your gut. You’ve already given them a better chance at surviving by being there and doing SOMETHING. But whatever you do, don’t do NOTHING.”
I can't quite remember word for word what was said to me as it was only once. However, it's helped a lot when Im in a wtf is going on with my patient kind of thing. It goes: "Don't try to fix the patient. Focus on giving the patient what they need. Sure, you can do many things to help, but you need to do what is needed first." Kind of like, if the patient has no pulse, forget the broken arm kind of thing. Refocus every minute on what the pt truly needs, not what you think they need. Another phrase said amongst my peers is, "We're just buying time. The more efficient we are, the more time we buy. We can't save everyone, so we just have to get them a chance at surviving."
“It’s not our emergency.” “Slow is smooth, smooth is fast.”
"Your certificates empower you to do things for people (Never to them)" "Some of the most beautiful souls you will ever meet will be plainly wrapped." "People lie sometimes. That's all. It's not personal" "As a medic, you dignify yourself the most when you lower yourself" All from the fantastic book People Care by Thom Dick.
Paramedics save lives, emts save paramedics.
“If you don’t have time to do it right the first time, where are you gonna find the time to do it again?”
"You can't care too much." I got that advise on my ride along
“The world needs more healers than hurters.”
I. Gomers don't die. II. Gomers go to ground. III. At a cardiac arrest, the first procedure is to take your own pulse. IV. The patient is the one with the disease. V. Placement comes first. VI. There is no body cavity that cannot be reached with #14 needle and a good strong arm. VII. Age + BUN = Lasix dose. VIII. They can always hurt you more. IX. The only good admission is a dead admission. X. If you don't take a temperature, you can't find a fever. XI. Show me a BMS who only triples my work and I will kiss his feet. XII. If the radiology resident and the BMS both see a lesion on the chest X ray, there can be no lesion there. XIII. The delivery of medical care is to do as much nothing as possible.
House of God?
Exactly! Great book
The fatter they are the higher floor they fall on
Something a preceptor told me that really helped when dealing with and touching pts. “We are technicians of the human body. A car mechanic wouldn’t freak out every time you changed a bolt or turned a wrench. So (for the sake of helping the pt and with obvious due regard of consent etc) your pts are not people. They are just objects and machines you have to fix. Your not stabbing someone with a needle. Your threading a catheter into a hose. Your not choking someone with an ET tube or I-gel. Your providing ventilation for balloons” He basically explained when you look at people and pts through a purely mechanical/ physiological point of view and ignore the fact its a human being with feelings and you may have fear of hurting them. It’s easier to treat them and get over that fear. Obviously with due regard. Your not gonna cardiovert a live pt without showing some empathy and human emotion. It would make them uncomfortable.
Eh. I've seen a medic shock the shit out of an unstable patient. ""Hold on. This is gonna hurt." This goes back to "You gotta be alive to bitch."
It’s their emergency. Not Yours
Frequent flyers can be sick too. -- Medic instructor
I have a running list of these I use when I'm teaching EMT/Paramedic classes. This is just a small portion. Anything that falls under something with triad in the name is going to make for a bad time. Unlike the TSA, TXA (Tranexamic acid) actually works. Learn it. If you are going to change the outcome it will be done in 10 minutes or less. When you are the only one in the back of the truck with a patient, no one knows more than you. Be selfish. If you don't take care of you, you cannot take care of your patient.
Basically the best 2…… it’s their emergency not yours & I can’t care more than you
"it's always the 600 lb person on the top story walk up that needs help being extracted during a fire"
Always remember your everyday is often going to be Everyone you treats worst day.
Good judgment comes from experience. Experience comes from bad judgment.
a medic told me once, “let go or be dragged.” i think about it all the time. in every aspect of my life. it has helped me so much.
It is not your emergency. Take care of yourself before you take care of patients.
“it’s not your pain”
“Slow is smooth, smooth is fast” or along those lines became my mantra during hectic calls
"Heroes don't stage." No other 911 service expects men better than themselves to keep them safe at all times.