Ventricular-Assist-Device

anonymous asked:

Do ambulance drivers need any sort of specific training or certification?

Okay. We’re going to talk about this. I apologize in advance if my tone comes off poorly, but this is a misconception that I really, really want to slaughter.

There is no such thing as an “ambulance driver” and the term is downright disrespectful.

As in, I had to take a good couple hours and vent to somebody before I could even approach this ask. That term makes my blood boil.

Ambulances are staffed differently in different parts of the US, but there are 3 main levels of certifications that EMS workers have:

EMTs (Emergency Medical Technicians) are trained to the level of Basic Life Support. They can splint, bandage, do CPR with defibrillators, give artificial breaths with a bag-valve-mask (AKA Ambu bag). In some areas they can give some life-saving meds, like EpiPens for anaphylaxis, and albuterol for asthma, and aspirin for a suspected heart attack. An EMT has about 3 months of training if they took a certificate course, which is common.

Paramedics are trained to an Advanced Life Support standard. We’re the ones who do IVs, EKGs, give drugs, shock patients, We intubate–put tubes down people’s throats. We make field diagnoses. Many paramedics use ventilators, give infusions. We use needles to reinflate lungs that have collapsed. Paramedics MUST be EMTs first. If they take a certificate course, this is 9 months to a year of training in addition to their EMT schooling. However, it is much better to simply get this as an Associate’s degree, with a solid A&P, microbio, and health sciences background.

Critical Care Paramedics are trained even beyond the paramedic level. We work with technologies like isolettes (AKA portable incubators) for neonates, work with Ventricular Assist Devices (VADs) and ECMO (Extracorporeal Membrane Oxygenation, essentially a lung bypass) and medications that are reserved for the Intensive Care Units. We get a lot of clinical latitude to treat our patients.

Flight Paramedics are a specialized type of critical care paramedic who have training that specifically relates to performing medicine in tight spaces at altitude. We study the way altitude affects everything from head injuries to vent settings. We learn about survival and a few more other tidbits specific to working in the aeromedical environment. Most flight programs pair a flight medic with a flight nurse, which is a whole other debate, though in other parts of the world it’s typically doctors with flight medics.

(For any EMT-Is or EMT-CCs or MVOs I left out: I feel you, I see you, you’re important, but I’m keeping it to these 4 just to keep things simple for writers.)

Unless they’re very special, ground ambulances are staffed either with two EMTs, one EMT and one paramedic, or two paramedics, depending on their service. (Volunteer units sometimes roll with a lot of people, but vollies are…. unique, sometimes.) One person drives, the other “techs”–attends to the patient. But while they’re on the scene, it’s a team effort. So the person driving the ambulance is not a “driver”. They are a medical professional. (Of course, in flight services pilots are dedicated to being pilots, because of course they are.)

Overall, I have over 100 college credits to my name; about half are medical, and half are liberal arts. My critical care course and flight medic certification–which is a board certification, by the way–aren’t even factored in to that number. And I’m starting a fellowship in February that’s intended for physicians.

So you have to understand, anon, when you say “ambulance driver” what you’re basically calling us are “medical taxi drivers”. And I know that, somewhere in our history, my predecessors were just that: they drove the ambulance. But EMTs and paramedics have existed as certification levels since the 1970s.

No other first responder gets called by their vehicle. No one points to a firefighter and says “The firetruck is here!”, or points to a police officer and says “the squad car is here!”. But people point to us routinely and say “the ambulance is here!”. I’ve had critically ill patients complain that we weren’t driving them to their hospital–not the closest hospital, but their hospital–while I’m doing interventions to actively save their lives.

There’s a whole set of issues as to how we are portrayed in media, and frankly I don’t want to bore you all with it. The bottom line is that I’m highly skilled clinician with a decade of experience. It hurts

If you have to refer to an EMS worker, and you don’t know our level of skill, just call us that: EMS workers. We’ll be okay with it. And we tend to write REALLY BIG on some part of our uniform what we are, so no one gets confused.

But also try to remember… we have names. Ask. I swear we’ll tell you. We’re people. Really-truly. We have feelings and everything. Call us “sir” or “ma’am”, or “Jim” or “Tara” or “Aunt Scripty”. Call us “Hey EMS”.

Just please don’t call us “ambulance drivers”.

xoxo, Aunt Scripty

A Failing Heart Gets A Hand

This image was made using a specialized computed tomography (CT) scan of a patient’s thorax in 2013. It shows an amazing piece of medical technology called a ventricular assist device

This implanted device was helping a patient with a weakened heart survive while the person waited for transplant. The machine pulls oxygenated blood from the left ventricle and pumps it out through a connection in the aorta, the main artery that distributes blood to the body.

The picture, which won the Wellcome Image Awards this year, was taken to ensure that the device was implanted properly. The blue parts indicate the pump and the white lines are cables connected to it and to an external control unit through a port in the patient’s abdomen. Anders Persson created the image from a series of X-ray slices taken with two different low-radiation energy sources in a process called dual energy CT angiography.

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