Starting ride-alongs...

[JJR512]

Tomorrow night I should be starting my ride-alongs as part of my EMT-B class. In MD, students in EMT-B classes are required to do five pt. assessments after the pt. assessment mod and before the finals. One of the instructors of my class (a county-wide class) also happens to be the EMS Lt. of my station, and he runs on Friday nights, which is the main reason I picked then to start. I'm looking forward to it...Hoping I don't screw up in front of my own lieutenant/instructor, of course!

 

[Jon]

Good luck.


Where I run, Friday and Saturday are "Busy" - because we are a college town, and the college is a state school system "party school"

That's why I run Saturday evenings and overnights.

Jon

 

[Wingnut]

Awesome, I hope you enjoy it half as much as I did. We didn't have that kind of requirement, just a sheet to check off any skills we had the opportunity to practice and an evaluation from the medic we rode with.

 

[MariaCatEMT]

Good luck and have fun! The requirement for my class was 12 hours ambulance and 12 hours ER, with a skills checklist. You'll have the advantage of knowing your EMS officer, so take comfort that you're not with a total stranger. Come back and tell us about it!

 

[JJR512]

It's just occurred to me...Today being St. Patrick's day, by the end of the night I could easily have all five assessments done, what with all the drunk drivers that are sure to be out tonight. :sad:

 

[JJR512]

Well, I went out at last night on four calls.

The first was what my instructor called a classic example of the real world vs. the book/classroom. Pt. was a 58 y/o woman who was found unresponsive on the floor of her house by someone else who lives there. She was lying on her side, partially in her room and partially in the hallway. It was a tiny house. The bedroom door was only opened 45° due to crap behind it. The hallway was tiny. Throughout what we could see of the house, there was only barely enough empty floor space available to walk around in. The tiny house was extremely cluttered, but at least somewhat neatly cluttered. Anyway, pt. was unresponsive, the other person there was an older woman who had some condition that kept her head bent down (my instructor told me what that was called but I forgot), and she had her coat on and buttoned all the way up, so she's talking into her coat. She seemed a bit daft and it was difficult to get any information from her. Eventually we discovered she is the pt.'s mother. The other EMT-B with us discovered a bag of prescription bottles but they all had someone else's name, which we determined was the mother's name, but they were in the pt.'s room (not the mother's). The only name I remember was Lortab, but I understood the others (about half a dozen) were other kinds of pain killers. So we figured this pt. probably took too much of something, whether accidental or not could only be guessed. A paramedic unit also got on scene after we had been there a few minutes (they had been dispatched at the same time). Because she had fallen down, we took c-spine precautions first thing, then the paramedics got there and took over, putting her on a cardiac monitor and on a backboard, which they carried out to the stretcher. They also put her on oxygen (NRB). They transported her, but that wasn't the last we saw of her...

Back to the station, then out to our next call. A two-car MVC. We get on scene, an engine and medic unit are already there. A Honda Civic t-boned a minivan. The paramedics there had taken a 17 y/o female, collared and put on a backboard, and all assessments were done by the time we got there. The mother was still in the driver's seat, she was refusing any treatment. I never saw the driver of the minivan; apparently, he/she was fine. Anyway, there was no serious injury to the girl, no bleeding, but she did hit the back of her head on the seatrest on the rebound from the crash. She was complaining of pain in her head (6/10) and neck (7/10). The paramedics transferred care of her to us, we loaded her and went priority 2. I got her vitals. My instructor was in the back with me, he looked at her head and saw no bruising. The trip was uneventful. Later my instructor told me that she probably wasn't really hurt enough for an ambulance trip to the hospital, and that her pain ratings were probably somewhat exaggerated, but of course that doesn't matter in what we do or how we do it. At the hospital, though, I did get an even better education. We walk in through the ambulance-bay doors wheeling our stretcher in, then just stand there and wait. And wait. Probably about five minutes before someone from registration showed up. Then a nurse came over and care was eventually transferred. (This hospital only required pre-notification of priority 1 patients, which they'll be waiting for and will take in right away.) I later said to my instructor, "So at the hospital it's more about the beauracracy than patient care," and my instructor just laughed and the other EMT-B said, "Congratulations, you pass!". Anyway, when we first came into the hospital, we saw the paramedics who took the pt. from our first call. They told us that when they got there, she became somewhat combative and had to be restrained to her bed. We did see her in her little room. That was the last we saw of her.

Our third call was cancelled ten seconds after we rolled out.

Our fourth call was for a woman with difficulty breathing. When we got there, there was already an engine and paramedic unit. I saw the place looked like some kind of nursing home, and I remembered the term "SNF" that I learned here. Inside, out of earshot of anyone else, I said to my instructor and the other EMT-B, "So this is an SNF, huh?" And the other EMT-B said, "What's an SNF?" I told him "skilled nursing facility", to which he replied, "No it's more like an USNF". We get to the pt.'s room, there's a woman there probably 45-50 y/o. I estimated her to be about 400 lbs., but the other EMT-B put her at 450. She was using some kind of nebulizer, and a paramedic had determined he could hook it up to his oxygen supply (I heard him say the thing there had a "venturi"), but he needed to know what the supply was supposed to be. He asked an attendant how much oxygen was the machine putting out, she went to go ask someone at a nurse's station, and came back with the answer of "40%". The pm said that's not what he needed to know, he wants to know an amount, how many liters, and the attendant said "3". So after a little fumbling around they get this thing hooked up to their oxygen bottle and it seems to be working fine, and I get to learn that people working in this type of place don't really seem to know what's going on. The paramedics took her out of there (of course with the lifting help of the engine guys) and left, and we left.

So out of four rides on the ambulance, we transported one person, and I got one assessment. But I'm glad it turned out that way. I didn't want to go out and get all five done on one night. I think I learned a lot of other, more useful stuff than what I got out of taking real vital signs on a real patient.

 

[natrab]

Sounds like you had some fun times. That condition with the curved back is called Kyphosis. A lot of older females get it when the calcium depletes from their bones. You have to be careful as some of them have it so bad you can't c-spine them on a board. Doing so causes them extreme pain and can even break their back. I do a modified c-spine on the gurney with rolled up sheets and tape.

Good experience. When I did EMT school, the local services weren't allowing ridealongs for insurance reasons.

 

[Chimpie]

JJR it sounds like you're having fun out there. Hang in there... it only gets better.

 

[Wingnut]

I love reading the ride a longs. Sounds like your doing a great job and learning all you can, keep up the good work!

 

[Jon]

Sounds like you had fun - I'll try to go over some stuff in detail for you tomorrow.

 

[JJR512]

Went out again tonight. It was slow, only went out on one call, for an assault at a KFC in a neighboring station's first-due area.

I learned some more interesting real-world stuff tonight. I knew that if a pt. was under arrest by the police, that a police officer had to ride in the back with the pt., but was not allowed to be armed. No police office likes to be separated from his weapon. So to get around this, they'll try to avoid formally arresting a pt. at the scene, and let him be transported with no officer accompanying. Then, at a later time, if they determine the pt. does need to be arrested, they'll get a bench warrant issued.

Another interesting thing that happened was apparently the police did not feel they got a good enough "pat-down" on the pt. prior to him being packaged for transport. Paramedics had arrived on scene prior to us (we are only BLS), but this was not a critical situation so they transferred care to us. One of the paramedics there was a Lt., and at the request of the police, the Lt. PM asked my preceptor (the instructor I mentioned earlier) to perform a detailed trauma assessment. Essentially, this detailed assessment was really a wink-wink, nudge-nudge pat-down for "anything that might happen to fall out of his pockets" that would be of interest to the police.

 

[MMiz]

See, you can learn a lot on the slowest shifts!

For us PD regularly go in the back of our rigs and carry weapons. If they feel we have the situation under control they'll cuff 'em to the cot and follow us. We radio dispatch "Unit 123 transporting with PD in tow".

I had one call at 2:00 am for a possible ankle fx at the local jail. We get there, get a hx and assessment, and load her for a trip to the hospital.
She had been arrested earlier in the night for resisting and fleeing. The cop cuffs her to my cot, and we begin transport. She pulls her skinny hand out from the cuff and says "What would happen if I ran?" I replied "As a teacher I'm supposed to say there are no stupid questions, but that may just be the dumbest question I've heard all night." She put her hand back in the cuff and made it a bit tighter.

 

[Jon]

See, you can learn a lot on the slowest shifts!

For us PD regularly go in the back of our rigs and carry weapons. If they feel we have the situation under control they'll cuff 'em to the cot and follow us. We radio dispatch "Unit 123 transporting with PD in tow".

I had one call at 2:00 am for a possible ankle fx at the local jail. We get there, get a hx and assessment, and load her for a trip to the hospital.
She had been arrested earlier in the night for resisting and fleeing. The cop cuffs her to my cot, and we begin transport. She pulls her skinny hand out from the cuff and says "What would happen if I ran?" I replied "As a teacher I'm supposed to say there are no stupid questions, but that may just be the dumbest question I've heard all night." She put her hand back in the cuff and made it a bit tighter.

I had a local, umm, non-perscription drug abuser (nice way to say crack-head) do that to me once...

As for cuffing the patient to the strecher and following.... NO! If the patient needs to be in cuffs becuase they are a flight risk or a risk to me, etc.... PD needs to be in my ambulance, with keys.