r/ems

I ask because I've seen a couple posts about it recently.

For context, where I'm based a verbal order from someone close to the patient is enough for us to not even put the pads. Be it a friend or family member.

It just seems crazy to me to try reanimation even if the family doesn't want it just because they don't have a paper.

I didn't think this would bring such a big discussion. Seems like we are pretty unique in Quebec for how we do it. It is explicitly written in our protocols that "anyone with a significant link" can ask us to stop cpr. What is significant is a bit vague but it's left to our judgement.

Hey guys, I been in EMS for almost 2 years now. I work 24 hours on Sunday and then Tuesday, and up until a massive influx of new hires, I would pick up OT like no one's business. Minimum 70 hour weeks and I really enjoyed it, however for now there's scraps. So I'm trying to find new hobbies on my 5 days off a week and I was just wondering what everyone else does in their free time. Video games are already locked in, but I want to try new.

Thanks guys !

So, I recently had a cardiac arrest on a patient over 80 years old, down for minimum of 10 minutes before we got there, cyanotic and pulseless, initial rhythm of PEA, worked her for 17 minutes with a LUCAS, gave one round of epi, gave 50 of sodium bicarbonate, intubated, and we got a pulse back with sinus tachycardia as the 12-Lead showed. BP was good and pulse stayed present until after we got to the ER (patient coded before we cleared the hospital and family did not want her resuscitated).

Anyway, two weird things happened:

1. Family did not want her resuscitated which makes sense, she was over 80. However, when asked about an OOH DNR, they said they didn't have one but that we still shouldn't resuscitate because she's a DNR in hospital. Obviously, no OOH DNR means resuscitation efforts must be given.

2. When we got to the ER, we still had the LUCAS on in case pulse was lost and we needed to start it back up again which, thankfully, pulse stayed steady for the 10 minute ride to the hospital and as we rolled her into the ER, I called out that we fot ROSC at 1149. However, my partner overheard a nurse say, and I quote, "they dont even have the LUCAS turned on" which, why would we? Patient has a pulse right now and I literally called that out as we rolled in. Then, as I was giving report and stating the meds given and everything else, they realize they know this patient (I have personally picked her up twice and I know others have, too) and that she has a DNR in place and they start acting like I broke the law by bringing her back at which point, I said that the patient's family could not produce and did not know what an OOH DNR order was. And, apparently, they didn't believe we got a pulse back because RT in the room said "Oh, shoot, she does have a pulse," like, yes, she's pink now rather than blue. Anyway, I didn't get to finish giving a complete report because they started questioning me not about interventions and down time but like they were planning an inquisition into my competency and were already heckling me before they even got the full story like receiving the story wasnt their job. Heck, the doctor was asking questions like I was too stupid to understand what a DNR is when she was the last doctor the patient saw and like she shouldn't know whether the patient has an active OOH DNR if she recognized the patient so easily.

I guess the point of this long rant is to ask whether anyone has experienced something similar while bringing in codes to the ER? Or is this a particularly niche situation I experienced?

My supervisor thought it went great, at least, and the firefighter we brought for assistance and my partner, a brand new EMT, thought it went smoothly and like I had everything under control as lead medic.

Edit: regarding my state, OOH DNR with a stamped seal and doc's signature is required to deny resuscitation and an in hospital DNR is not good enough and family saying "no" is not enough, either. As for my company's medical control, they are there as a placeholder, really. I have the number but there is an understanding with our company that we're not supposed to call him. I know, stupid, but that's how it works in my are with all EMS companies: don't call the doctor.

Throwaway account for obvious reasons. I had a psych interview for my dream EMS department recently, and during it I confessed to something that I did as a young adult. Basically, I had a sexual relationship with a 16 year old girl while I was 19. I live in a state where this is technically not illegal (due to the romeo and juliet law), but it was still a mistake and I've regretted it every day since it happened.

I found out yesterday that I got a permanent disqualification based on that interview. Am I unhireable because of this? And is appealing this decision a good idea?

edit: yeah it was really stupid for me to admit to it. I'm just going to move on, apply elsewhere, and not mention it again. thanks for the helpful advice.

With the new changing DEA laws our service is looking to upgrade how we manage and store our controlled narcotic medications. We have looked at several new safe options for the trucks but thought I would reach out to see how other services handle their narcotics.

How are you currently exchanging narcotics with oncoming crew members? We have looked at several new RFID tracking options along with manual tracking with schedule2IT.

How are you handling waste of controlled substances after the call is complete? Are you filling out a DEA form after each call is complete? Is the waste form integrated in your ESO or similar patient care report? Does your partner sign for the medication waste?

How are your narcotics stored? Do you have one box that stores multiple vials for multiple calls or do you have multiple pouches but can only be used one time each? We currently carry three boxes of identical loadouts but they can only be used for one call each and then black tagged. Have been questioning the option to move towards a multi use box for less crew fatigue having to swap after a call.

Thanks for this input and any other ideas that you have would be great!

I joined a private ambulance company two weeks ago. I was monitored by a FTO for a week, who had to clear me on driving after I took the EVOC. My second day after I was cleared, I backed into a parked ambulance at a hospital. I had a spotter, but I heard her late. Luckily, we didn't have a patient. We filed an incident report and I had to meet my supervisor the next day. I accepted responsibility and she put me on non-driving status. There were visible damages; the repair cost was $2500, which seems a lot. I asked my supervisor if I could eventually drive again, but she didn't give me a clear yes or no. Honestly, I feel stupid because I didn't even finish a month and the incident was avoidable. Has something similar happened to anyone and were they able to drive later in their career?

We have traditionally got the shittiest EMS week gifts. Last year was a soft munch box that everyone ditched (the director at that time sucked).

This year I got the opportunity to design an EMS week shirt. I got some input and designed something that I felt was pretty cool. Our current director wants to continue the trend of designing a new EMS week every year that is unique.

With that said, what are some design ideas/slogans you would look forward to having on the back of a limited edition shirt?

Well, that was an interesting shift...

Birdstrike at 120 & my doee-eyed right seater almost fought a mating pair of geese with a wounded gosling on the freeway.

If I run into a moose in the next :40, I'm done. Just fucking done.

What's your wildlife story?

Hi, I would like everyone’s opinion on EMTs staffing QRV units and arriving first ahead of an ambulance, whether for lower-acuity calls or even high-acuity calls.

I’m in a busy metro area with several hospitals in very close proximity to our base and also we do respond outside the metro area into the suburbs . I brought this up to a paramedic friend once and was told rather bluntly that EMTs shouldn’t—and probably never should—run QRVs on their own because “their medicine isn’t good enough.”

However, I’ve read articles showing that strong BLS care can sometimes be just as effective, or even more effective, than ALS in certain situations. That got me thinking: why not get good BLS care to the patient sooner and then have a BLS or ALS ambulance arrive later if needed?

What are everyone’s thoughts on this?

Does anyone else hold multiple state licenses and their NREMT? I hold 8. Traveling feels different with the practice compared to when I use to travel all over the place in a general and research sense.

Hello /r/ems,

Ballston Lake EMS is putting out a short video on the struggles of local EMS services not only in upstate New York but across the United States. We are not asking for any money but to share this video and get the word out there. We are hoping this makes it to mainstream news to spread awareness of this issue. This video was produced by a Paramedic at Ballston Lake. If anyone has any questions feel free to reach out to me.

Not me, but one of my agencies in the past ran 911 in a pretty rough area. No idea what the call was for, but it sounded like standard BLS "load and go". I guess the patient had some enemies, because as they were preparing the patient to be transported, a third party jumped in the ambulance, shot the patient to death, and left.

Obviously nothing can really be done in that situation - they have a gun and I would not, so protect yourself and your partner. But it got me thinking about some of the DV calls I've been on.

Let's say I am rendering aid to someone involved in an altercation. Generally, I'd expected PD to secure the scene before I get there to avoid anything like this (in fact, that's usually what happens). What I was not sure about was a "pop up" incident where I wouldn't have PD right away.

I'll pose a scenario:

We are dispatched to a routine "trouble breathing" call. The patient wants to be transported. I load them in the stretcher, but as we are about to get them in the ambulance, a third party rolls up and either attempts to (or successfully) assaults the patient.

We would call PD of course and try to separate the fighting, but I am confused as to what ethical obligation -- or protections, more like -- that I would have in such a situation before those resources arrive. My gut feeling is that since this patient is strapped in my gurney, it's sort of an expectation that I would defend them from harm up to the point that I probably couldn't do anything to protect either of us (e.g. gun drawn), even if I may come to harm myself. But we're also trained to ensure scene safety, prioritizing our ambulance team -- no sense in creating more patients by inserting ourselves into a dangerous scene, and request backup where available.

The ethical issue I see is that if we step away to "ensure scene safety" and call for additional resources, we are also allowing this patient that is in our care to get the shit beaten out of them in the meantime. I do not know what protections or obligations EMS has, particularly as force escalates (say, if the assailant brings blunt instruments or sharp objects, etc).

Went to a hanging last night. Not my first, won’t be my last.

The majority of calls and call types sit fine with me, but I hate hangings. I hate seeing them, I hate getting them down, and I especially hate having witnesses or family on scene.