"Warring Ideals in One Dark Body"

"...The mark of experience is knowing when to duck."

First of all, there is no international sign for "What gives?". I made that up. I didn't mean to, I was just tired and trying to wrap up that sentence/sentiment. My bad. I went outside my scope of practice.

The EMT-B scope of practice:
Basic Life Support, CPR, airway management, splinting, longboard, shortboard, transport...

"It takes skill to be real. Time to heal each other." -2Pac

I always sit up front in classes. It's the only thing I remember from, "Where There's a Will, There's an A."
Probably, I should have done the reading ahead of time (when?). I got as far as, "There was a time before EMS when the only pre-hospital care was handled by the mortuary." But the best stuff isn't in the book. Oh no.
The Best Stuff comes from the Lead Instructor, starring in EMS: The Way Shit Is.

• Judge the condition of the patient, not the merit of the call. For many calls, the only information you'll have is an address and, "Unknown medical." That could be cutting off a stuck ring, delivering a baby, or bullets flying overhead. You decide whether or not it's lights and sirens vs. stay and play. Sometimes you walk into a scene that is, as we say, "In the Way of Things." You'll walk into a 106 year old cardiac arrest with the family screaming for you to resuscitate and you will do compressions unless there's a signed, dated DNR in hand even though inside you may be like, "Are you kidding me?" Judge the condition of the patient, not the merit of the call.
• EMS walks. EMS does not run. Running equals mistakes, and you risk losing control of the scene.
• Do not treat anyone until you have express, implied, or minor consent. If there's a comunication barrier, you still need consent until they pass out in front of you. Be sensitive to everyone's culture and religion.
• While treating everyone with dignity and respect, do act as if the people you encounter have HIV, Hep B, TB, MRSA, E. coli, and toe jam. That is to say, use personal protective equipment and universal precautions (gloves, goggles, and if appropriate, mask and gown). Wash your hands vigorously and clean your equipment.
• Do not say, "Everything's going to be okay."
• Do not ask, "Do you want to go to the hospital?" Ask, "What hospital do you go to?" which will put you in the realm of consent.
• Do not administer medication. Don't so much as give an aspirin. If aspirin is needed, document, "Assisted patient with meds."
• Do not accept refusal of treatment until you are sure the patient is competent to refuse. Competency means ability to understand possible consequences of refusal of treatment against medical advice (AMA). Drunks and people under the influence of drugs aren't competent. People who got hit on the head aren't competent. People who can't tell you their name what day it is, who the President is aren't competent. Ask them again anyway. Try to get witness statements (from someone other than your partner), if they still refuse. Give the patient specifics of what a worsening condition looks like and advise them to call again if those signs start to manifest. Don't say, "YOU COULD DIE!" Say, "You may permanently lose the ability to do things you are presently able to do such as walking, seeing, sexual function, feeling, going to work, or going outside." Then ask them again. If they still refuse treatment, try to get them to sign off on a Refusal of Treatment form. CYA.
• Do not cut through bullet or knife holes in fabric as there may be evidence there. Do not undo knots in ties or rope.
• Do not use the phone at a crime scene without the permission of the police.
• Do not breach duty to act unless there is a scene safety issue. Or there is documented refusal to accept treament. Or a physician and patient signed DNR dated within the last six months at the scene. You first priorities are to yourself and your crew, then to the patient. Whatever you do, be prepared to justify your actions to your EMS peers and elders. "Here, Doc. Here's the DNR. Here's why I didn't do my job."
• Do NOT try something because you saw it on ER. They don't even know how to wear a stethoscope correctly. No pen tracheotomies.
• Do NOT get your standards of care from WebMD. That's the wikipedia of medical advice.
• In your career, you will encounter scenes where the whole medical team is running around frantic, and then someone walks in--a doctor, a nurse, and, in the field, certain medics--and you visibly see everyone ratchet down a notch or two. It's not always age and experience. It's how you carry yourself.

"I'm knowing how it goes when the nigga with the purple heart of courage ain't the oldest. It's cold shit." -T-KASH


We stayed a half-hour late before class was dismissed. There was some yawning and baggy eyes, but nobody said a thing about it, and nobody got up to leave. It's not a hazing, but it's a bit of a stress test--no regular breaks, 5 minutes here and there, always at different times and intervals, just like the real thing. Complaining is a no-no, so mostly we all have a light-hearted affect as we snatch two bites of a sandwich or beans and rice in the 30 steps from the bathroom back to the classroom. I walked home from BART in the rain, slept 5.5 hours, got up and did some weight training.

Miscellany of possible interest:
www.epocrates.com has drug interactions, pill identification, medical news--and that's just the free stuff.

California's Good Samaritan law is under threat. This past holiday season, the California Supreme Court upheld an appelate court's ruling regarding a lawsuit of one woman by her friend. Woman B saw her friend Woman A get into a bad car accident. There was some smoke from the wreckage. Woman A was trapped in the car and Woman B acted to extricate her from the car because she thought it was going to explode. Whether because of being pulled from the car or the accident itself, Woman A is paralyzed. So she sued her friend saying that being pulled from the car caused the paralysis. (The smoke was from the airbags deploying. "Cars don't burn unless they're Ford Mustangs or BMWs," says Lead Instructor.) The Supreme Court in a 4-3 decision said the Good Samaritan law doesn't apply in this case because rendering aid doesn't include "rescue."

There's been a lot of publicity about this, but dialing 9-1-1 from a cell phone anywhere in Northern California gets routed to a CHP dispatch center in Vallejo. First, you get put on hold. Then they figure out where you are--if you know to be able to tell them and can talk--and route your call to the appropriate police department. If you need to call 9-1-1, try to use a landline. It's free from pay phones. Cell phones without service will still call 9-1-1 though so if your phone gets turned off, you can still make emergency calls from it in a pinch.

If you happen upon someone needing CPR who is covered in vomit or otherwise unappealing to make mouth to mouth contact with, just do the chest compressions. That person had oxygenated blood until they fell out, and circulating it is much more important than the breaths. The rate for compressions should be about 100bpm--use the Bee Gees tune "Stayin' Alive" to keep time. Or "Another One Bites the Dust" by Queen. Probably shouldn't sing aloud while doing compressions.