ems,

anonymous asked:

How do ambulances get through insane amounts of traffic? Like, Los Angeles/New York/Houston-Texas-at-rush-hour-gridlock-on-IH-10-with-shoulder-lanes-full-of-debris traffic? Especially with patients in critical condition who maybe weren't in critical enough condition to justify a helicopter ride. Do ambulances ever have to go off-road or hop curbs if the shoulders are too messy to drive on?

The short answer is, we get stuck in traffic like everybody else. Medics and EMTs will do our best to get around traffic, but if it’s gridlocked, it’s gridlocked. Nobody can move over because there’s no space to move over.

Also, there’s a phenomenon that will repeatedly happen where 99% of the people pull to the right and one idiot pulls over to the left, completely blocking our way, and then get very confused when we keep hitting the air horn telling them to just move forward. It’s extremely frustrating. I actually asked for a reassignment away from my city center in part because driving lights and sirens in bumper-to-bumper traffic was making me tense and agitated all the time. (I then transferred to a high-crime, low-income area and my patients’ acuity stresses me out, so it’s a trade-off…)

Generally speaking, when traffic is that bad I personally try to stick to large streets (where there might be more room), and especially to two-way streets without a physical divider, because I can zig and zag across the double yellow to make use of road space.

There’s actually an interesting mindset shift. Before EMS, I thought of a double yellow as a wall. Now I simply see it as paint on the road, a suggestion that I am not bound to (if I need to get somewhere while at work). Similarly, we can go the wrong way down a one-way street if we need to.

Highways can sometimes be better than surface streets, because if there is a shoulder, we can abuse it; even if it’s a half-lane shoulder on the left side of the road, we can generally get people in the left lane to squeeze closer to cars in the middle lane and give us enough room to invent a lane on the far left. But that’s not always possible, especially on elevated highways that were built on the cheap with limited (or no) shoulders.

As for surface street driving, sidewalks may seem like a good idea, but they’re usually rife with obstacles like telephone poles, lampposts, street trees, or pedestrians. Street signs that a car would slip right under might smack an ambulance as it goes past; the same with awnings and overhangs.

So typically we simply do what we have to do, put our heads down, push as much as we can, accept what we cannot change. The medic attending the patient will do what they can for them, and often times for critically ill people we try to get a second unit (so that two medics can take care of the patient while an EMT from a separate crew drives the vehicle).

One thing to understand about critical patients dying en route to hospitals: most of them were going to die anyway, no matter what we did. We’ll do what we can for them, but in the end many were beyond saving to begin with, no matter how quickly they got to a hospital.And it can be extremely frustrating to have someone crash on you, even if you know they’re going t

I hope this helps your storytelling!

xoxo, Aunt Scripty

disclaimer    

Cardiac distress symptoms in women

In the wake of Carrie Fisher’s death four days after she suffered a massive heart attack, one thing that was reported by some news outlets was that she had been in “significant distress” on the flight. We don’t know the exact details of this, but in my experience as an EMT, it often means “hysterical woman having a panic attack and thinking she’s dying…*woman dies* …oops, guess she really was dying.” 

It is SO IMPORTANT to remember that many women present in what medicine considers an ‘atypical’ manner for heart attack, but it actually IS typical…for women. Women are more than twice as likely to die from cardiac emergencies, not because our physiology is that much different than men and thus gives us a worse chance at survival (it’s actually better if treated promptly and adequately), but because our symptoms are more likely to go unrecognized or to be dismissed entirely.

Thus, please take a moment to review and pass on this list of cardiac distress symptoms as seen in women: 

Shortness of breath - This is the most common one. If a woman, especially one without prior history of respiratory issues or shortness of breath, seems to be having trouble catching her breath and/or complains of such, pay very close attention. If she continues to feel winded after sitting or laying down, it’s probably time to call for help.

Feeling of impending doom - This can range from a sense of general unease to a full-blown panic attack. This one is extremely important, and is the symptom most commonly disregarded by doctors and hospital staff. If a woman tells you that she feels ‘not quite right,’ or like something terrible is about to happen, or that she’s about to die, LISTEN TO HER FFS. 

Nausea and “indigestion” - Also common. Heart attacks frequently present as a feeling of vague nausea or indigestion, but unlike typical heartburn, antacids and other OTC treatments will not alleviate the symptoms.

Hiccups - Unexplained hiccups, especially if seen with any of the other symptoms listed above, can be indicative of heart muscle that is being acutely or chronically starved of oxygen.  The exact mechanism isn’t known, but it’s thought that the enzymes released by the dying muscle irritate the pericardium and adjacent diaphragm, causing spasms in the healthy muscle. 

Fatigue - This is another commonly seen symptom, and is often overlooked or ignored as just transient tiredness. Many women having a heart attack will complain of feeling “flu-like” symptoms of nausea, sweating, fatigue, and shortness of breath, and they’ll lie down for a nap and never wake up. 

Lightheadedness - A feeling of being lightheaded or about to faint isn’t terribly uncommon in many benign conditions, and many women experience it on a monthly basis. However - be aware when it appears unexpectedly or unexplainedly, and/or with one or more of the other symptoms on this list. 

Sweating (diaphoresis) - Heart attack does funny things to the sympathetic nervous system, which is behind reflexes such as sweating and hiccups. If a lady is experiencing unexplained or excessive sweating, pay attention to anything else that might be going on with her. 

Tingling or numb extremities - A feeling of numbness or “pins and needles” tingling in the extremities can be an important sign that cardiac function is being impaired and those body parts aren’t receiving enough oxygen. 

Peripheral and/or central cyanosis - Often accompanies tingling or numbness, and is considered a later-stage symptom of cardiac distress and heart failure. Finger and toe tips will turn pale or blue first, and lips and gums after that. Important to remember that darker-skinned women may present cyanosis as ashen, grey, or darker purple rather than pale or blue. 

Back pain - Pain between the shoulder blades, in the cervical spine, or even further down in the torso or lumbar region can be a symptom of heart attack. Alone, it isn’t that suspicious, but if it’s unrelenting and presents with any of the other symptoms above, keep a watchful eye on things. 

Classic “crushing” or “tight” chest pain or pressure - Women DO experience this classic pain, too, just not as frequently as men do. This may be due to our higher pain threshold, or differences in blood volume, or maybe we’re just not sure because nobody’s bothered to really study it. Whatever the reason, some women do still experience the crushing or tightening pain, and others may experience less painful pressure or tightness that doesn’t seem to be relieved by anything.

Arm and jaw pain - Another “classic” heart attack symptom, and a bit more common than central chest pain. Unexplained pain in the left arm or shoulder, and on the left side of the neck or jaw, should not be ignored by anyone.

The louder you are in the ER waiting room, the more the staff is convinced that you are not having an emergency.

I mean it. You’re getting the attention you think you want, all eyes on you. Except ours.
“Isn’t there anything you can do?” Your fellow waiters ask us, concerned. Behind the triage window, you can’t hear our teeth grinding.
You’re in pain, i understand that. This might even be the worst pain you’ve ever felt.
But you’re probably not dying.

Dying isn’t loud.
A patient having a heart attack does not scream and thrash and gasp for air. It’s a whisper, a tightness, with slow flexing fingers.
A stroke happens in a fraction of an instant, and never makes any sound. More whispers, halves of sentences and muscles that don’t quite match up anymore, a puppet with a few of the strings cut. Alarmed and wandering eyes, maybe, but never yelling.
Or the more common killers, infections that shut down organs or the pipes of blood that sever. Cardiac or respiratory failure. If a person can talk they are, in fact, breathing just fine.

Remember this, the next time you come to an emergency department. Remember this when you’re sitting in the waiting room, while a sleepy-looking person in a wheelchair is whisked away without a word.

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

Somewhere

Somewhere someone is having the worst day of their life.
Their child stopped breathing.
Their spouse is not waking up.
Their brother was in an accident.
Somewhere someone is crying out for help.
An abused wife.
A neglected child.
A drug addict.
Somewhere someone is counting the seconds until help arrives.
A single mom who’s house has been broken into.
A daughter watching her dad hold a gun to his head.
An aunt not knowing what drugs her niece is on.
Somewhere someone is in shock.
The 30 year old that just became a widow.
The once happy parents of a 6 month old.
The sister who found her sibling after losing to cancer too soon.

Somewhere. Someone.
Is throwing on boots, and running to the squad.
Hitting the emergency lights while pulling out of the bay.
Hoping a car will stop so they can pass the red light.

Somewhere. Someone.
Will see the blood left on the wall from that dad.
Will hold that baby knowing he’ll never breath again.
Will listen to the screams of family members in heart break.

Somewhere. Someone.
Woke up at 2am to save that drug addict for the 8th time this year.
Skipped dinner to go help a man with a stubbed toe.
Missed holidays, birthdays, soccer games to answer the call of duty.

Somewhere. Someone.
Worked 25 years just to get ptsd and lose their job.
Finally passed all their schooling and tests just to have a career ending injury day 1.
Mixed paths with someone in such a hurry they didn’t stop for the flashing lights.

Somewhere. Someone.
Left at 7am for their 24 hour shift.
Made it till 3pm without lunch.
Was hit head on at 7pm by a car not paying attention.

Someone. Somewhere.
Answered a call for a suicidal male.
5 minutes later was looking eye to eye with the man that would kill her.
A mayday. Shots fired. Is being echoed on radios.

Someone. Somewhere.
Makes 16 cents more then minimum wage.
Works 100 hour weeks to pay the bills.
Gives their life to others, to be paid less then fast food workers.

Someone. Somewhere.
Will see their partner more then their spouse.
Will skip more meals then they can sit down for.
Will wake up more times then they get to lay down.

Someone.
Somewhere.
Won’t.
Go.
Home.

FATRAT - Resp. Distress Acronym

There are a few signs you’ll see when it comes to sever respiratory distress. This is an acronym I use to know what to look for and I will help you by showing what this just might look like to!

F - Flaring (Nasal)

A - Anxiety

T - Tachypnea

R - Retractions

A - Accessory Muscles

T - Tracheal Tugging

These are a few signs of severe respiratory distress. If you have a patient with any of these, you might want to pay attention to them. This means they need help NOW.

One more time the acronym is:

F- flaring nasal

A - anxiety

T - tachypnea

R - retraction

A - accessory muscles

T - tracheal tugging