EMS

My local EMSA has approved IV Tylenol for pre hospital pain management in trauma patients. Supposedly, studies show that there's little clinical difference in the efficacy of acetaminophen and opioids in acute pain management. I've attempted to find this alleged research, and the link above is what I found. I can't quote it exactly because I'm on mobile and it's being weird, but the relevant section is towards the end and compares the efficacy of IV Tylenol to IV opiates. It leads with saying that the relevant evidence is considered low quality before indicating that (this is a VERY rough summary) IV tylenol seems to have a very similar though slightly less effective/durable analgesic effect. I recommend you read it for yourself. The study also doesn't seem to be limited to trauma patients, and seems to make no distinction between visceral and somatic pain, both things I was hoping to see.

Overall, I can see the benefits: it's cheaper, not addictive, less strictly regulated, doesn't alter consciousness or respiratory drive, and doesn't induce a bunch of histamine to tank a patient's blood pressure. I'm wondering if anyone has any experience with it, and if it works as well as advertised.

EMS Expo 2024 is taking place in Las Vegas, September 9-13th.

I haven't been to an EMS Expo since 2010, and that one was pretty okay. Has anyone been recently / planning to go? Is it any good?

So, I wanted to have a level-headed discussion about this case. I've been loosely following it since it happened, and I'm curious to see what others think of it, perhaps hear from folks who followed it more closely.

For those out of the loop, here's the JEMS article on it: https://www.jems.com/patient-care/two-co-paramedics-found-guilty-in-death-of-elijah-mcclain/

The tl;Dr is this: Aurora fire medics are dispatched to assist Aurora PD with a combative patient they believe is in an altered mental state. Aurora FD EMS crews identify this patient as qualifying for their excited delirium protocol based on PD and patient presentation, and administer the maximum dose of ketamine allowed under their weight-based dosing (which was well over what Elijah weighed). Now, there's other details (this IS a tldr), but after the ketamine, the patient goes into respiratory and cardiac arrest and is eventually declared. The paramedics involved were found guilty of negligent homicide. The FD has stood by their paramedics, saying that they followed their policies appropriately.

Let me lead with this: it seems to me that McClain's case was a foreseeable (albeit low likelihood) and unfortunate outcome that was the cumulative result of many lesser individual poor choices on the part of both law enforcement and EMS. We lack the personal context to really appreciate those choices, I think, and we're left to armchair quarterback those decisions with only the information available to us. I do believe that Mr. McClain should still be alive, and likely would be under different systems-level conditions, such as training and clearly defined interdepartmental operations protocols. Personally, I disagree with the conviction based off of my current understanding of the situation. My current understanding of the facts does not persuade me of the presence of gross, nevermind criminal, negligence on the part of the EMS crew. There absolutely is a conversation to be had here about PD leveraging field sedation and integrating field emergency care as a compliance and law enforcement tool as opposed to a healthcare response to a medical emergency. There's another conversation to be had about systems-level choices that likely influenced this outcome. I think that just throwing these guys in jail fails to accomplish anything on those fronts, and, as such, is a false justice.

So, I'd like to ask you guys for your thoughts. Was it preventable? Was the conviction helpful? What can be done to prevent this in future, if anything, and what's your take-away?

I was wondering how many of you have experience using pre-hospital ultrasound. I've heard for a long time that it's the "next big thing", and I can see it for rural systems or maybe even community paramedicine, but I've not seen much in the way of it actually getting adopted. Do you find it to be a meaningfully useful addition to your skillset and protocols? If you were around when it was introduced, how do you feel about the introduction? What were some lessons learned by you or the system along the way?

Visited this icon the other day. An off duty FF was leaving shift and noticed we were taking photos. He made sure the on duty crew let us in for a tour. They're very used to visitors and have it all set up for guests.

Army medic '86-'93. BLS: '89-'00, ALS: '00-Current with NREMT.

During Army drills in Germany & Belgium I transported one patient in Belgium and 2 in Germany. Then in 2017, I was friendly with a Medic in Hammerfest, Norway and rode 3rd on their rig. That gives me 3 foreign countries of ambulance transport.

I've worked EMS in MA, RI, NH, FL with total state transports of 11 states.

I am still NRP, but, currently running "Uber" ambulance at BLS level (At Medic pay due to credential level). Woot!

I love & respect everyone that's still hustling the streets.

I wonder if I can keep it up doing the easy work for 13 more years. Giving me a grand total of 50 years on an ambulance.

Lift smart, protect your back! I strongly suggest good massage therapy!

One thing I've recently seen be a point of contention is whether it's appropriate to disrupt sleep hours of 24 hour units for non-urgent transfers. That is, should 24 hour units have a time in which they're protected from being sent on non-urgent transfers? When this came up in the past, the consensus of "no" seemed to be coming from people whose systems weren't mixed 911/transfer systems and didn't do 24s. On the other hand, most of my 13 years in EMS has been with mixed-service 24 hour systems, one system of which was also a system-status deployment model (yes, I know that system status and 24 hour shifts are supposed to be mutually exclusive, but that fact never bothered company leadership). So, suffice it to say, I've had my fair share of riding 2 hours at 0300 on 30 hours without sleep for what could be an outpatient consult or because the local ED doc really wanted some other doc to take the liability for the discharge. A small company that I work for (mixed service, consecutive 24 hour shifts) recently started turning down overnight transfers for non-urgent reasons. The local (rural) ED was pissed and threatened to call other ambulance companies, but all the other companies got a good laugh when they heard where the hospital is. And in all fairness, they've laid some real stinkers of transfers in their time, including transferring due to CT glitch and transferring an 17 year old to the children's hospital two hours away for uncomplicated strep throat.

To me, it seems clear that 24 hour shifts are still well-suited to rural EMS, and I don't think it's at all unreasonable to not gamble with the lives of your crew, patients, and fellow drivers for what essentially amounts to the convenience of the ED staff. I don't think you can even argue that it's about patient convenience, because if it's ed-to-floor, then the patient realistically isn't going to see the specialist until business hours anyway (and there's a decent enough chance that the transfer is urgent at that), and if it's ed-to-ed, then there's a good chance (in my experience) that they're just travelling 2 hours away for a discharge, and where's the convenience in that? Stranded two hours away with an extra hospital bill and an ambulance bill so that they could get an outpatient appointment; now that's what I call service. The industry has had a nasty habit of pretending that people can just choose not to be affected by lack of sleep for too long, and there's been a lot of unfortunate consequences because of that. I don't have a problem with formalizing it and making sure that it doesn't get abused, but I just don't see the benefit in rawdogging your crews on non-urgent transfers.

What do you guys think?

Coming to you live from San Diego

Everyone's got a favorite "war story" to bust out when it's story time. What's your go-to?

One of mine is the time I picked up some dude who slammed a brand new bottle of hydrocodone to try and keep from going to jail. They'd just picked up the bottle when he popped the lid off and just downed the whole thing in front of his family, who (rightly) freaked out and drove straight to the nearest fire station. By the time we got there, dude was on the dark side of the moon. We get the story, do an initial, take over bagging, drop 2 of narcan in his nose, load and go. I know this guy, he's going to be a jerk about it, and I don't to allow him the lattitude that he'll have at the scene. So, five minutes pass, IV's in, re-assess to find no change. Shocker. I dump another 2 in the line. Nothing. Well, shit. Re-assess to make sure I didn't miss anything, and opiates are still the best explanation. tl;dr we have a long transport time, so I end up making base contact a couple of times and finally dump the tenth mg of narcan in the line as we roll up to the receiving facility. We get inside, tell the hospital what's going on, transfer him over, and the dude jerks awake. He sits bolt upright, tells the doc "take your hands off me, {bundle of sticks}", grabs the NPA out of his nose, and then slings it into the corner of the room as hard as he can with an almighty "FUCK!"

Everybody piles out of the room and sort of awkwardly stands there, waiting for security to show up. While we were waiting, I remembered it was EMS week, so I asked the nurses if this meant I could have my shirt now. They said no :c

Those of you who left EMS, what are you doing now, and are you happy about your choices?

I left full time paramedicine after 12 years. I've been in software development for a little over a year now, and I still do some part time for shits and giggles. I don't regret my choice, especially seeing how hard the full time folks at my company get ran. It's fun to do this job again now that I'm not dependent on it for finances. I will say, though, programmer stories make a much smaller impact with friends and family.

Welcome to c/EMS, Lemmy's community for EMS providers by EMS providers. Most topics are permitted here, though this might get adjusted according to the kind of traffic we get. This is a space for:

-sharing industry-related news

-professional discussion and development

-sharing memes (allowed 24/7)

-getting professional feedback

and more.

Some quick and dirty rules: Don't share any PHI, just don't. Use good judgment. Let's build a community based on mutual respect and good faith discussion.