Just Completed my Ride Along

[EDAC]

I did my ride along last week and it was quite a learning experience. The first thing I learned is nothing in the field is done like we are taught in class. We ran 10 calls and during each and every dispatch I would go over in my head what to expect based on the information. Every call went something like this: Dispatched to 123 B st, chief complaint, and directions. We would get there and carry the equipment into the residence, hook the Pt. up to the monitor ask a couple of questions, give O2 via a nasal cannula, and ask if PT wanted to go to the hospital. Only one time that I remember did the Medic or EMT wear gloves, the whole thing seemed like it was robotic for the most part. No matter the call whether trauma or medical did the approach change. For the most part they were leaving as I was still going through pt assessment in my head. Is this pretty typical of what to expect? I was kind of dissapointed, I was hoping to get to practice my assessment skills out, but it seems that it is all automated. We had one PT who was as white as a sheet of paper and cold to the touch. The pt was put on 6L nasal cannula, I asked after if high flow O2 would have been appropriate and was told no, the O2 sat was good, even though the skin signs said something different. I feel as though I am a bit lost now, I was feeling confident, but now not so sure.

 

[Shishkabob]

If skin is not cyanotic, pt isn't complaining of SOB, and O2sat is ok, there's very little reason to go above a NC, let alone 15lpm NRB.


As for if all calls are run like that, you'll eventually get to a point where you're methodical in how you run your calls, every call, as to not miss a thing. You get a system down that you're comfortable with and you go with it.




Too bad they didn't give you more leeway to do your own assessment, as the crew I rode with in EMT would push me at the forefront to do the assessing.

 

[Ridryder911]

Sounds like you had sh*ty medics. Sorry, no gloves no oxygenation for possible shocky patients. Sorry, pale possible shocky patients still get higher level of oxygen (yes, there is a reason for this). If they were robotic, then it is time for them to leave the business!

In regards to you not assessing, sorry but most basic clinicals are really considered more of an observation than participation in majority of EMS services. The reason is that we see literally hundreds of EMT students and we are still responsible for the patient.

Keep a + attitude and demonstrate your knowledge and ask to perform one if possible, chances are they will accommodate you.

Good luck,

R/r 911

 

[Shishkabob]

^^^ Forgot to add the shocky part in as well. I read "only one pt on a nc" Darn 15 minute restriction >_<



Better question is WHY was the pt shocky looking?

 

[EDAC]

^^^ Forgot to add the shocky part in as well. I read "only one pt on a nc" Darn 15 minute restriction >_<



Better question is WHY was the pt shocky looking?

He had LOC and fallen 3 times in a 90 minute period. Rid, I may have worded my post wrong, I did not want to provide the pt. assessment, just be a bit more hands on, in no way did I want to get in the way of them performing their duties. Part of our observation is to have 4 BLS contacts during the shift.

 

[Shishkabob]

You only have to do 1 shift on a rig?

 

[EDAC]

You only have to do 1 shift on a rig?

Yeah, but I have scheduled 3 more. I'm also trying to get a rotation in the ER at a hospital that may allow it with a letter from my school. I have found many ambulance companies or hospitals do not accomidate EMT students. But I have over a dozen calls out to various companies and hospitals, some as far away as 60 miles, I just don't feel 12 hours is enough for me at least.

 

[Shishkabob]

You're right, it isn't, and shouldn't be, for anyone. The more ride time you get, the better.


Good to see you're going beyond the bare requirement.

 

[rhan101277]

I did my ride along last week and it was quite a learning experience. The first thing I learned is nothing in the field is done like we are taught in class. We ran 10 calls and during each and every dispatch I would go over in my head what to expect based on the information. Every call went something like this: Dispatched to 123 B st, chief complaint, and directions. We would get there and carry the equipment into the residence, hook the Pt. up to the monitor ask a couple of questions, give O2 via a nasal cannula, and ask if PT wanted to go to the hospital. Only one time that I remember did the Medic or EMT wear gloves, the whole thing seemed like it was robotic for the most part. No matter the call whether trauma or medical did the approach change. For the most part they were leaving as I was still going through pt assessment in my head. Is this pretty typical of what to expect? I was kind of dissapointed, I was hoping to get to practice my assessment skills out, but it seems that it is all automated. We had one PT who was as white as a sheet of paper and cold to the touch. The pt was put on 6L nasal cannula, I asked after if high flow O2 would have been appropriate and was told no, the O2 sat was good, even though the skin signs said something different. I feel as though I am a bit lost now, I was feeling confident, but now not so sure.

These folks sound sub-par and I wouldn't want them treating any of my relatives. There should be more detail in this information to make you feel more confident and that maybe these guys just don't care. Good O2 sat is not the end all, my patient is ok. I don't know all the details but these patients should get a complete work up, if there are in bad shape then get them onto the ambulance and do as much as you can for them.

Pt's with ALOC, CC, should be asked questions to verify like what day it is, do you know where you are, who is president etc., if you fell confident you can ask math questions like what is 2+1 or whatever.

Sorry to ramble. We don't give high flow 02 here unless there are respiratory issues, dyspnea, tachypnea etc.

 

[EDAC]

These folks sound sub-par and I wouldn't want them treating any of my relatives. There should be more detail in this information to make you feel more confident and that maybe these guys just don't care. Good O2 sat is not the end all, my patient is ok. I don't know all the details but these patients should get a complete work up, if there are in bad shape then get them onto the ambulance and do as much as you can for them.

Pt's with ALOC, CC, should be asked questions to verify like what day it is, do you know where you are, who is president etc., if you fell confident you can ask math questions like what is 2+1 or whatever.

Sorry to ramble. We don't give high flow 02 here unless there are respiratory issues, dyspnea, tachypnea etc.

We have been taught to never rely 100% on the O2 Sat, watch the skin signs, as the skin signs don't lie. The Pt never regained good skin color but his BP did return to a normal range and the pulse & respirations were normal. Again there was no respirtory distress and no Hx of any medical condition, he was not on any medications either.

I am not far enough along to second guess the treatment, and I was not doing so. Based on the general impression upon arrival, we all felt it was poor. The skin was cold and clammy, he had a GCS of 15 and the vitals were normal except BP which was low at first. I have personally never seen anyone that white in color, and according to his family he is normally a more reddish color. His head, face and fingers were ice cold, but assessing his ABC's, airway was clear, breathing was normal, circulation(?), did not look normal to me.

We start our bleeding and shock module tomorrow at school and this is something I want to go over in class, as to why or why not high-flow O2 is appropriate in that particular case, aside from the monitor said O2 sat was good.

 

[Level1pedstech]

It really is a disservice to you as a future provider not to have the benefit of at least 24 hours in the ER. Like many of the others I think more not less when it comes to ER clinicals, I am a firm believer in hands on education especially at the basic level. Some things are learned by power point or in a book but others require hands on training, I put most EMT-B skills in that category. Having your hands on as many SICK patients as you can is the only way to get a good foundation for a future in patient care at all levels. If you set up your own rotation time be sure that you have approval to provide care at your level, you don't want to show up and find out your just acting as an observer. One of my duties as an ER tech is to work with EMT and medic students on their clinicals. When you arrive show your willingness to jump in and be a part of the team, grab warm blankets, get those hourly or post med vitals and even dump a urinal or two. You will know from the start what your boundaries are so keep it simple and have fun.

Being at the basic level as a provider means just that and you should not worry about wanting to second guess a higher level provider, a provider which seems to me has a good amount of time in the field. It is not our place to pass judgement on another provider based on your observations, we should only put in our two cents and leave any second guessing to those he will answer to at the ER. There are alot of piss poor medics out there that's a fact. Your duties and responsibilities as an EMT-B are real simple ( BSI,scene safety,ABC's,package and transport) I know there are some that think the basic is alot more but its just not so and until the education improves that's the way it is. I think new EMT-B's get a little ahead of themselves and forget what little they actually are given in the way of knowledge when it comes to dealing with complex medical problems. I have see many people in the field and the ER that look like hell with cold distal extremities but with a GCS of 15, a good airway, in range BP, in range RR (an O2 sat would be nice) seems like a stable patient. I'm going to follow the basic ABC's, transport the patient and get a higher level provider to make a more educated call on what treatment path to follow. I'm sure I will get second guessed on this but it will be mostly by higher level providers which proves my point.

 

[EDAC]

It really is a disservice to you as a future provider not to have the benefit of at least 24 hours in the ER. Like many of the others I think more not less when it comes to ER clinicals, I am a firm believer in hands on education especially at the basic level. Some things are learned by power point or in a book but others require hands on training, I put most EMT-B skills in that category. Having your hands on as many SICK patients as you can is the only way to get a good foundation for a future in patient care at all levels. If you set up your own rotation time be sure that you have approval to provide care at your level, you don't want to show up and find out your just acting as an observer. One of my duties as an ER tech is to work with EMT and medic students on their clinicals. When you arrive show your willingness to jump in and be a part of the team, grab warm blankets, get those hourly or post med vitals and even dump a urinal or two. You will know from the start what your boundaries are so keep it simple and have fun.

Being at the basic level as a provider means just that and you should not worry about wanting to second guess a higher level provider, a provider which seems to me has a good amount of time in the field. It is not our place to pass judgement on another provider based on your observations, we should only put in our two cents and leave any second guessing to those he will answer to at the ER. There are alot of piss poor medics out there that's a fact. Your duties and responsibilities as an EMT-B are real simple ( BSI,scene safety,ABC's,package and transport) I know there are some that think the basic is alot more but its just not so and until the education improves that's the way it is. I think new EMT-B's get a little ahead of themselves and forget what little they actually are given in the way of knowledge when it comes to dealing with complex medical problems. I have see many people in the field and the ER that look like hell with cold distal extremities but with a GCS of 15, a good airway, in range BP, in range RR (an O2 sat would be nice) seems like a stable patient. I'm going to follow the basic ABC's, transport the patient and get a higher level provider to make a more educated call on what treatment path to follow. I'm sure I will get second guessed on this but it will be mostly by higher level providers which proves my point.

Thank you for your input and advice, I do want to stress that in no way was I second guessing or critizing the medics I rode with. Just making some observations in the diferences in the way i was instructed and how things were carried out in the field. We did discuss it in class today and I was told that our medic instructor would have given high flow O2, but each individual will make their own call. She also said tha me as an EMT if that were my call, should have used high flow O2, because I don't have the luxury of the education the medic has and in that case I would need to provide more rather less care. Everything we discuss in class is hypothetical and field experience is going to have many variables. The Pt was going down the road to shock, I believe, and I do not how he came out as he refused transport to the hospital. I just want to emphasize I am here to learn, and not be judgemental, if thats how it sounded I apologize, it was not my intent. I was just asking why, you may have felt the treatment was appropriate or not. Like I said it jus differed from my classroom learning and I am just trying to take in as much as I can and learn from my experiences in the class and in the field.