r/ems

Ok, here's my unpopular take: Naloxone has a place in patients who are profoundly unconscious from a suspected opiate overdose even if they are breathing adequately and are not suffering from respiratory depression. I'm not talking about people who are a little "on the nod," I'm talking about GCS3, not protecting their airway type patients.

Given a choice between three alternatives:

1. Naloxone (dosed in the lowest appropriate dose you can) to the point they can protect their own airway, and likely wake up enough to have a conversation about their wishes. My personal dosing strategy is 0.4mg IM repeated every 5 minutes or so, usually 1 or two doses is effective. I would do less if I had IV access, but has most of my patients choose to AMA after waking up, I prefer to be as non-invasive as possible.

2. Essentially do nothing to protect their airway, beside maybe basic airway adjuncts, transport them, and then either have the hospital intubate them or wake them up with naloxone anyway.

3. Intubate them (inappropriately in my view), transport them to hospital and have them admitted to the ICU for a day or two.

I feel like option 1 is the least invasive, most ethical and the best use of healthcare resources. I think it's also what most patients would prefer. The downside is obviously precipitated withdrawal, but by choosing the lowest possible dose to achieve your desired goal, this can be minimized (but not wholly avoided).

While I think that option 1 is the best outcome for the patient, it is also the best option for the healthcare system. I'm based on the west coast of Canada, and quite frankly, if we brought every patient who had overdosed to hospital, the system would immediately collapse.

Anyway - I expect spirited disagreement, but that's what reddit is for. Discuss!

Edit: Oh well, glad to see it's not actually an unpopular take

Had a patient abandonment case 2 years ago and got suspended license. No injuries to pt or anything. What are rhe chances of getting hired

I’ve been in volunteer EMS for two years now. My friend from college called me parents out of genuine concern, saying it seems I’ve been devoid of emotion and am showing a lot less compassion than how I used to. I’ve been experiencing major depressive episodes for reasons not having to do with EMS; if anything EMS feels like an escape from my thoughts and fills me with a sense of purpose.

I had the worst DOA I’ve ever experienced the other day, and I am afraid that it might affect me without me realizing. I’m afraid all of this might be affecting me without me realizing it. In the moment and even now, I don’t really feel anything or get any intrusive thoughts about it, yet I’m able to recognize how sickening the nature of the what I saw was. I’m afraid I’m just emotionally numb at this point, and am not able to recognize what is fuelling it.

Context: I just finished my 1st year for my Associates in Nursing.

I’ve been running with my local EMS company as an EMT since August (2 weeks before my program started). I honestly love EMS, I love working on the ambulance, the variety in calls, and going on scene.

Once I graduate, I’m hoping to become an ICU or ED nurse. I thrive in high stress, constantly moving, busy environments.

Nursing is what I want to do, it is what I’m meant to do. However, I’m not sure if I’ll ever truly walk away from EMS.

From your experiences, how long do providers wait until they cross train to PHRN?

(I’ll also cross post into a nursing subreddit :). )

Hi everyone! I’m a pretty young EMT and i’ve only been doing this for about a year. I haven’t felt the need for therapy or counseling yet, but I hear a lot of conflicting opinions on it. Some people say you should start therapy early to build coping skills before the bad calls happen, while others feel it’s something you only need if you're actively struggling with your mental health. I'm curious to hear from seasoned medics and EMTs: Do you think regular counseling should be standard for all first responders or does it vary?

Does anyone else use PulsePoint or any other EMS Apps? As an EMT I have been using PulsePoint for a long while now, and to me it is an awesome app. It alerts you in your home town of all the different medical/fire emergencies in your area. Does anyone else use it also?

So I made a post recently about accidentally leaving part of my template in a refusal PCR that should not have been there. The patient refused vitals, but I left in lines like “vitals stable,” “lungs clear equal bilaterally,” and “abdomen soft and non-tender x4” from the template.

I’m planning to talk to my supervisor and figure out how to either edit it or add an addendum so the chart is accurate.

The only issue is this happened about a week ago, so I’m not sure how that usually works once a PCR has already been submitted and uploaded.

Can supervisors still reopen it for editing or add an addendum after that long? How does your agency usually handle situations like this?

I had a call recently where I could see the patient potentially ending up in court, and after I got home I realized I may have left part of my preset template in my PCR. I documented that the patient refused vitals, but later in the second paragraph it still says things like “vitals stable, lungs clear equal bilateral, abdomen soft and non tender x4,” etc.

I’m new and only have about 2 months on the job, so I’m worried if the patient ever ends up in court and I get called as a witness, lawyers would pick apart the inconsistency in my narrative. Has anyone dealt with something like this before? Just really paranoid about getting in trouble so if someone can ease my nerves I would appreciate it lol. Thanks in advance guys!

I keep hearing they exist but havnt found them. I have 8 points

Approaching 4 hours right now and can only refresh socials so many times

Hey all, quick bit of context: I work rural EMS and typically run w/ a 2 person BLS crew and call for ALS as needed. In my area its common that if ALS is needed on a scene to assist with a PNB or otherwise extra complicated call, we can spend a solid 30-45 minutes working on scene before advanced care arrives. I had a recent call that fit this description and my partner and I were the only trained responders there until paramedics arrived after we worked for about 22 minutes, patient needed constant airway management, ROSC was achieved early and maintained until we began transport. That said with 2 sets of hands we really didn't take quality notes and have been talking about ways to improve our on scene documentation when we are short hands.

Has anyone had any experience with any of the AI assisted voice recording hardware out there? It seems like a lot of them interface with smartphones, which we carry on our rigs so no ones personal phone is every being used. Plaud AI looks promising but I'm not seeing any examples of these devices being used successfully in a busy/ loud/ outdoor environment. Privacy issues are a concern too and I am unfamiliar with current guidance around AI and HIPAA since there would be data being transferred over unsecured networks. It seems like there are some talk to text solutions specifically for clinical settings that are HIPAA compliant but don't seem like they would fit into field work as well.

Any thoughts?

Dispatch
Ocala, Florida — The Night Before the Playoffs

The call came in at seven forty-seven p.m.

"Marion County Fire-Rescue, what is your emergency?"

Sloane's voice was not panicked. It had moved past panic into something more focused and more frightening. "My son. He's seven. He's just not right. He's spacey. He's breathing but I can't get him to focus."

"Ma'am, I need you to stay on the line with me. What is your address?"

She gave it. Her voice stayed even. She was standing in Wade's doorway, one hand on the frame, watching his chest rise and fall.

"Has he been sick recently? Any fever, vomiting?"

"He's been tired. The last few weeks he's been really tired. And thirsty. He's been drinking a lot of water." She paused. "I thought it was the heat."

"Units are on the way. How is his breathing?"

"Regular. He's just off."

"Stay with him and stay on the line."

----------------------------
Unit 12 arrived in six minutes. Two EMTs — a woman named Carver and a man named Delgado, both in their mid-twenties, both Basic life support certified. They moved through the front door with the practiced efficiency of people who had been in houses like this before, following a frightened parent to their sick child.

Carver went straight to the couch. She put two fingers on Wade's wrist, looked at her watch, looked at Delgado. "Skin is pale and diaphoretic, pulse is weak, respirations twelve." Wade weakly tried to push her away.

"Hey, buddy," Delgado said, leaning over him. "Hey. Can you hear me? Squeeze my hand if you can hear me."

Wade's fingers moved. Barely, but they moved.

"Responds to verbal," Delgado said. He looked at Sloane. "How long has he been like this?"

"We were watching TV and he just — wasn't right. Maybe twenty, thirty minutes ago."

"Ma'am, has he been drinking a lot of water lately?"

"Yes. A lot. And he's been going to the bathroom more than usual."

Carver and Delgado looked at each other. The look communicated everything and nothing — they both had the same suspicion forming, they both knew their training only took them so far.

"We're going to check his blood sugar," Carver said, pulling the glucometer from her bag. "Has he ever been diagnosed with diabetes?"

"No," Sloane said. "Nothing like that."

The fingerstick took ten seconds. The reading took another fifteen.

Carver showed the number to Delgado without showing it to Sloane first, which was the wrong call and she would think about it later. "Forty-one," she said. Critically low. Below the threshold where the brain gets what it needs.

"We need a medic," Delgado said, already reaching for his radio.

"What does that mean?" Sloane said. "What's forty-one?"

"His blood sugar is very low," Carver said. She was at the couch, turning Wade slightly, monitoring his airway. "We're getting a medic here. They can give him something to bring it up. He's going to be okay, but we need to move."

Sloane stood in the family room and didn't cry. She made a decision not to cry, the way you make a decision to hold a door closed against something pushing from the other side.

-----------------------------------------

The medic unit arrived four minutes later. She took the handoff from Carver in thirty seconds — glucose forty-one, altered mental status, pediatric, no known history — and was already drawing up dextrose before Carver finished the sentence.

"What's his weight?"

"Around sixty pounds," Sloane said from the doorway.

She did the math. She established the IV with the focus of someone for whom a child's arm was just another problem to solve, no different in kind from an adult's, only requiring more precision. Wade flinched but didn't wake up.

"It's okay," she said to him, though she wasn't sure he could hear. "This is going to help. You're going to feel better."

She pushed the dextrose slowly. Waited. Checked the glucometer again two minutes later.

"Coming up," she said. "Sixty-eight."

Another two minutes.

"Eighty-two."

Wade moved. His eyes opened — not fully, just a sliver, the unfocused squint of someone returning from a very long distance. "Mom," he said. His voice was the voice of a child who had been asleep.

Sloane made a sound. She crossed the room and took his hand.

"Hey, buddy," she said. "There you are. How do you feel?"

"Tired," Wade said.

"That makes sense. You're going to be tired for a little bit. We're going to take you for a ride, okay? To the hospital. Just to make sure you're all the way better."

Wade looked at his mother. "Is Dad coming?"

Sloane looked at her. She gave her a small nod.

"I'm going to call him right now," Sloane said. "He'll be there."

----------------------------------

She called from the back of the ambulance, sitting beside Wade's cot while the paramedic monitored his vitals and the unit moved through the Ocala night toward the hospital. The phone rang four times. Five.

"Sloane." Jackson's voice had the careful lightness of a man who had been hoping for a good call and was already adjusting.

"Wade and I are in an ambulance," she said. "He's okay. He's awake. His blood sugar crashed and they're taking us to Marion General."

A silence.

"I'm coming," he said.

"Tell him I'm coming."

She held the phone away from her face and looked at Wade, who was watching her with the careful attention of a child trying to determine how scared to be.

"Dad's coming, bud," she said.

Wade's hand found hers under the blanket. He held on.

In the front of the ambulance, Marion County moved past the windows in the dark. The paramedic checked the glucometer again — ninety-six now, and climbing — and made a note in her chart, and thought about the mother in the back who had not cried once, which was either strength or shock, and which she had learned, over the years, was sometimes both.

— from A Unifying Roar, by DGDean