Sunday, September 28, 2008

NSR Week 15

Welcome back to NSR... We've been... Going through a slight reorganization of sorts, but we're back! This week is unthemed, so you'll see posts on a variety of EMS topics. Give them a visit and let them know what you think!

First up we have Rogue Medic with Respiratory Therapy: 101 - What?
From Respiratory Therapy 101: Just Keep Breathing comes this not-so-shocking description of apparent misbehavior by a doctor - What?:

I was reading a patient's H&P the other day when I came across the following gem from one of our pulmonologists, who has a history of ordering thousands of dollars of useless therapy for no reason:
"There is no clinically significant bronchodilator response, which does not preclude the use of bronchodilator therapy."

Next up we have Peter with Out of Time:
The room in the nursing home is sparse. The patient, a large man in a hospital johnny, is pale and diaphoretic with a low grade fever and edema in his abdomen and extremities. His eyes follow me slowly as I assess him.
This week we have a guest Anonymous poster who wants to tell her story:
Its amazing what a little time will do to resurrect old dreams and longings. Take me for instance, I am comfortably stuck in being a full time employee, parent and general flunky when a job change suddenly gave me ample time to sit back and think about things and I suppose the fact I was about to turn 40 had a little something to do with it.
Epijunky tells us how not to do Medic School:
Two of the longest days of my life. This is how NOT to do it.

Friday, August 15, 2008

NSR Week 8 (late)

Welcome to Normal Sinus Rhythm, Week 8! There is no theme for this week, so please enjoy a veritable mix of topics! Posted with each link is an excerpt of the original post; head over there and leave a comment if you have the time.

If there is a theme you would like to see in a future NSR, leave a comment here or send an email to We would really appreciate input on this project.

Gertrude reminds us that That Only Works in the Movies. Have you ever wanted to ask your patients that?
When stopped by the police and you want to get away, jumping off the overpass to the ground below is not the way to go. It looks very cool in the movies and the bad guy gets away.

Sam talks about the Lights and Siren.
I love driving with my lights and siren going. There's nothing quite like the rush I get from seeing the lights bounce back at me, ricocheting off of an infinite number of facades. The sirens scream higher as we drive under a bridge, wailing, urging me forward. Children standing with their parents look at me with smiles plastered on their faces, waving as they jump up and down.

Not So Rapidly, Rogue Medic warns.
D50W is given to people who have had their blood sugar drop and are experiencing confusion, that appears to be due to the low blood sugar. I was taught, and still use this method. I look for the largest vein that looks good for an IV site. The label recommends a small needle in a large vein. I prefer a large needle. If you have ever pushed D50W through a 20 gauge catheter, you understand part of the reason. It takes a lot of effort. If you have ever pushed D50W through a 22 gauge catheter, you are insane (or management).

Witness responds to Sam with Woo-woo Wow.
In general, there are two types of areas- rural and urban, with some mix in between. In my opinion, in both situations our timeliness in responses depend on different things. In an urban area, with many stop lights and intersections, our fast response comes from the ability to cut through stop lights we would normally wait for. In a rural area, our speed literally comes from that, the speed of our response, mostly because traffic is lower in rural areas, as are lights and intersections.

EpiJunky tells us about A Little Flutter...
We were perfectly comfortable sunning ourselves on a beautiful July day. On of those days where the sky is a gorgeous blue, dotted with puffy white clouds. One of those days where you really wish you weren't working.

Monday, August 11, 2008

NSR Week 8

See what happens when Medic 61 asks me to put the post together?

I'll be late to my own funeral, folks. The post will be up tonight. I promise :)


Sunday, August 3, 2008

NSR Week 7

Welcome to Normal Sinus Rhythm, Week 7! The theme this week is "kids." Posted with each link is an excerpt of the original post; head over there and leave a comment if you have the time.

If there is a theme you would like to see in a future NSR, leave a comment here or send an email to We would really appreciate input on this project.

This week, Rogue Medic starts us off with Not Successful Resuscitation.
I have always hated the phrase, "I'm sorry for your loss." It sounds like a Hallmark card for a stranger you've never met. What happened? "Passed on," "Sorry for my loss," "No longer in pain," "No longer with us,". . . . We ask too much of the family member when we provide vague descriptions of what is going on. Unless we use the words "is dead," or "has died," we aren't helping them to recognize what has happened. These are attempts to say the right thing, but they just seems so far from adequate, at least to me.

Peter brings us a piece from his archive, I'll Be At Your Side.
What I like best about this job are the moments you observe between people, moments that show the bonds that life creates, that show the love in people's hearts, particuarly the love of a parent for a child.

Mom? Epi brings us a story of her own children.
It had been four months since I started at the Evil Green Empire. I had just started working a new schedule that gave me my nights and weekends off, but effectively kept me away from home during the day on weekdays.

Gertrude tells us about Asthma.
The engine officer meets me outside the school stating he needs a refusal form for dad to sign. I walk into the nurse’s office to see a small girl in a chair. She is crying. She is in the classic tripod position working hard to breath. Little accessory muscles at work. Before I even talk to dad I put the stethascope to her back and hear nothing but wheezes and rhonchi, everywhere.

Sam tells us about Gracie.
A tech is carrying her in. She's seizing in his giant arms, her little hands hitting his chest, her tiny feet kicking towards his neck. She can't be more than 3. He puts her down as gingerly as he can, and I realize that other than the doctor, I'm the first one in.

Friday, August 1, 2008

NSR Week 6

Welcome to Normal Sinus Rhythm, Week 6! There is no theme for this week, so we hope you enjoy a mix of ideas and stories. Posted with each link is an excerpt of the original post; head over there and leave a comment if you have the time.

If there is a theme you would like to see in a future NSR, leave a comment here or send an email to We would really appreciate input on this project.

Side Note: This week's was very belated due to the fact that we only received one entry. Apologies!

Rogue Medic brings us National Security Roulette, yet another in his fantastically titled series of posts!
"Judgment might be wrong. The only thing worse than an ineffective laughing stock of a government agency is allowing someone to make a decision without going through a bunch of committees. None of us is as dumb as all of us."

Sunday, July 20, 2008

NSR Week 5

Welcome to Normal Sinus Rhythm, Week 5! There is no theme for this week, so we hope you enjoy a veritable slew of ideas and stories. Posted with each link is an excerpt of the original post; head over there and leave a comment if you have the time.

If there is a theme you would like to see in a future NSR, leave a comment here or send an email to We would really appreciate input on this project.

Gertrude brings us a story of Recognition.
Something about her seemed familiar to me. A whisper of recognition. Where do I know that scar from? The mole on her arm and way she wears her wrist watch?

Sam tells us to Bleed, Everyone's Doing It.
Eric is in the back in seconds flat, and he sits on a shoulder as he calls for ALS. We need something to put this guy out, but we can't do it.
The deputy runs back to the medic, jumping in with handcuffs ready in hand. She restrains him somehow, but I'm not really paying attention.
I look down at our patient. He's bleeding. I don't know where from, but there's blood on his face.

Stretcher Jockey tries to remind us that Sometimes Good Things Do Happen.
These types of calls will more than likely always be a part of the job for as long as many of us are in this profession. It's frustrating and a waste of precious limited resources. These types of calls tend to wear us down. I sometimes feel like a part of my EMS "soul" is sucked right out of me whenever I get one of these calls.

When Are You A Competent Medic? Peter helps us out with the answer.
I think it took me about a year before I started feeling competent. This came from starting to handle the routine calls ( the 02/NTG/ASA chest pain, the breathing treatment dyspnea, the D50 hypoglycemia) well as I developed a rhythm and system that seemed to work. But then every now and then a call (asthmatic arrest, pedi struck by car) would come along and kick my ass, and I would go through the whole "Am I fraud?" "Am I going to kill someone?" agonizing, which I think all medics go through.

Monday, July 7, 2008

NSR Week 3 (Late)

Welcome to Normal Sinus Rhythm! This week, Gertrude over at Ridin' The Bus gave us the prompt, "You might be a _____ if..." Posted with each link is an excerpt of the original post; head over there and leave a comment if you have the time!

If there is a theme you would like to see in a future NSR, leave a comment here or send an email to We would really appreciate input on this project!

Peter tells us, You Know You're A Paramedic When...
You ask the phlebotomist at the doctor’s office if you can stick yourself (after she has already missed twice).

You can sleep soundly in an ambulance and only wake up when your ambulance number is called.

Lucid brings us You Might Be an ARP If...
7. Lacking a window punch, you've gained access to an MVA victim using an avalanche shovel.
8. You've directed traffic before you could legally drive.
9. You've gone for two hour hikes at 3 am... sometimes to look for a missing person, sometimes just for fun.

Gertrude brings us a different side of things with You Might Be A Junkie If...
4. You might be a junkie if you deny using but are covered in powder and little broken capsules.

Stretcher Jockey reminds us that You Might Be A Wacker If...
10. You wear two wristwatches while you're on-duty in case the first one goes dead while you're checking a pulse.

9. You carry more varieties of hemostats in the pouch on your belt than they carry in the local hospital's central supply.

Witness tells us what a Sad Life it is.
6. You go to sew up a hole in a pair of clothes, and when reaching for the needle you feel an overwhelming urge to wear gloves.

5. You're driving your personal vehicle, but can't quite find the address... so you reach over to the console to turn on your left scene lights, only to quickly remember that you are in fact driving your own car and not an ambulance.

Rogue Medic continues his expanded abbreviation of our very own "NSR" with Not Sedated--Restrained.
Well, I don't consider anyone to be much of a paramedic/EMT, unless one is a Jack of all trades. Part of that is the ability to keep a patient from harming himself and from harming crew members and still transport the patient to the hospital. This is the amateur wrestler/rodeo clown part of EMS, so:

You might be an amateur wrestler/rodeo clown if...

EpiJunky brings us Ten Signs that it's time to get off the transfer truck.

You can map a path past a good coffee shop to any Hospital/Nursing Home/Wound Care/Pain Management Clinic/Dialysis Clinic in the city, and do it efficiently.

You're on the local Wound Care clinic's Christmas card list or you get an invitation to the Dialysis Annual Memorial Day Picnic.

And finally, Sam tells us How You Know.
And when we're done, away from patient and family, that's when I think. That's when the emotions hit me, the thoughts of my parents and my friends. That's when I sigh deeply and get a little misty eyed and I'm silent; that's when it hits me, fully sinking in.

Sunday, June 29, 2008

NSR Week 2

Welcome to Normal Sinus Rhythm! This week, we've posed the topic of relationships of EMS with others for our writers to consider in their posts. Posted with each link is an excerpt of the original post; head over there and leave a comment if you have the time!

If there is a theme you would like to see in a future NSR, leave a comment here or send an email to We would really appreciate input on this project!

Peter brings us Countless Many.
My EMT friend takes great delight in passive aggressively blocking a hallway to transfer a patient from the stretcher to the newly found ED bed. He sets the transfer up so that there is only the narrowest passage for a person to get through, but like a miniature golf windmill whenever a nurse tries to get by, a slight adjustment in body position or stretcher and the passage is blocked. If the nurse says excuse me, I need to get through, he'll smile and ask her to help with the patient's legs. If a doctor needs to pass, he'll courteously point out to the doctor that passage can be effected by a quick short cut through the soiled laundry room that opens just around the corner.

Next, we have a story of Relationships In EMS from Witness
Laura was not your typical college sophmore. She was a bookworm, and studied hard - too hard, almost. She got good grades, of course, but there was always a repressed side of her that wanted to be one of the wilder girls. Perhaps it was her apparent innocence that originally attracted me to her, or maybe her intelligence, or perhaps it was just that she was pretty, but she was a fun person to be with.

Lucid tells us who The Real Heroes are.
Although a music industry studies major with absolutely no interest in science or medicine, he pretended to be interested when I selfishly recounted my passionate interest in the pathophysiology of hypertrophic cardiomyopathy and commotio cordis.

CrzeGrl writes about impressions in The C Team and Impressions: Medic and Nurse
Here I am, transporting a ATV + ETOH = trauma and I have to interact with two separate EMS crews, ride in their ambulances with my equipment and have to function. It is a bit like a duck out of water.

So, during my patient transport, the part of my brain not involved in what I was doing, was thinking about the post I wanted to write regarding the interaction between EMTs and Nurses. I was able to remove myself and see the impressions they were leaving me and I was leaving them.

Verrrrrrrry interesting.

Epi reminds us that They Don't Want to Know.
“So, Epi... How's work going?”

My family is sitting around the dining room table. The chatter has stopped as they wait with baited breath. My one drunk Aunt even sets her wine glass down.

Sam ponders the plausibility of EMS Couples
I have three jobs. I get paid for two of them, but I have three jobs. I'm a private transport EMT, I'm an ER tech, and I'm a 911 EMT. At the present time in my life, I am surrounded by more EMS providers than I am anyone else. It's a blessing: EMS workers understand each other better than most, and our sick senses of humor keep me incredibly entertained. It's a curse: I'm a nineteen year old college girl; I date.

In his post Nearly Silent Respirations, Rogue Medic discusses the difference between the care given by hospice and EMS workers.
Few things are as frustrating as dealing with other health care providers who do not see things the same way we do. One area where we are especially short sighted in EMS is in dealing with hospice patients and their care givers. The misunderstandings are similar to those between the doctors and nurses in the hospital on the one side and EMS on the other. We have little, if any, training in dealing with hospice patients.

And finally, Gertrude brings us Profesionalism, Medic X, and ED Relations.
I have heard people talk about ED staff who “ hate medics, don’t care or don’t listen.” I have even seen it in action. Many EMS providers feel the same way about doctors, nurses and techs. This attitude has the potential to damage interpersonal relationships with the ED staff and more importantly interfere with our patient care.

Sunday, June 22, 2008

NSR Week 1

Welcome to Normal Sinus Rhythm, week 1 of what we hope to be many more. In this post you will find links to several blog entries by EMS bloggers from all over. Included are snippits of the original post, so head on over to the original entries and leave a comment if you have the time!

Gertrude writes about The Job.
People always want to know what the worst thing I have ever seen is. It is a question people in this business get everyday. The public has a romanticized vision of the life of a medic. They also have a morbid curiosity about other peoples lives. I never tell them the worst things I have ever seen. They wouldn’t understand and I don't want to field the questions.

Sam tells a story this week of Tongues.
Sitting next to her on the bench seat, I watch her tongue. It flaps pathetically in her mouth, trying to remember the form it should take, but failing. It flickers up and down like a tiny flame in the breeze. I get lost in its movements, willing it to take shape and tell me she's okay, that it was all just a big joke, that she could run a marathon now.

Stretcher Jockey writes about Apathy In EMS.
By my observation,the degree of apathy these days amongst my fellow EMT's and Paramedics seems to be growing at an alarming rate. I can't pinpoint an exact time frame of when this first started, but I can say, however, that this attitude of indifference has definitely become more prevalent over the last few years. I've tried to correlate this with some major event or change within EMS, but I can't. It has the feel of a cancer that has been growing silently within us, metastasizing while we sat idly by. We ignored all of the early signs and symptoms, hoping that they would just resolve on their own without any interventions - we have been in denial.

Rogue Medic shares his thoughts with us on Needle Stick Regrets.
The protocol can be your friend, when it is well written. Most of all, the protocol is supposed to be the patient's friend. Somebody needs to change this protocol. This is not easy to do in most places. It is not fast, but it can be done. One way is to go to the protocol committee and sit in on meetings, if it is permitted. Talk to the doctors who are most open minded about good patient care. Present them with research supporting the change you are attempting to bring about. Pay attention to the response. Learn from it. Come back with more research and a possibly modified plan. Doctors tend not to respond to the, "In such and such place, they are doing this," approach.

Epi teaches us a Basic Lesson.
Without warning the taillights I've been watching disappear. I'm now seeing the headlights. Without warning the car goes off the road and into the trees of Suburbia State Park.

Peter shares, an anecdote about online ordering.
We're called for a woman unconscious. I recognize the address. We have been there many times before. Two sisters. Extremely co-dependent on each other. The younger sister has chronic pain and is a known drug seeker. The older sister is just plain crazy.

And finally, Witness explains "Why I Do This".
Annie's face was beginning to match her red hair. My medic partner grabs his scope and takes a listen to her lungs while I set up a nebulizer treatment. The pulse oximeter the FD has helpfully attached is showing 94% saturation... enough to be concerned with. Vitals are all a little elevated. Mom says she wants to go to Pretty Important City Trauma and Children's Hospital - a 30 minute haul. My partner says alright, but I can tell he's thinking perhaps the closest hospital would be best. I know he'll tell me if we need to divert.