# Any comments on this one......



## emt seeking first job (Mar 10, 2011)

Your best guess. Was this senility or was this man always un-informed.

An 88 year old retired MD, an orthopedist. Must have been successful, nice house, clean, well maintained.

He complained of weakness, fainted twice, his wife reported his blood pressure was fluctuating all day, hi, then lo.

We responded and he was found in bed in a supine position. BP 140/88, pulse 42, we called for medics. The unwritten rule with the medics is when they arrive there had better be 02 already hooked up. 

So the patient was questioning why we were giving him 02 as he was not having any difficulty breathing......

He complied when three EMTs, his wife, daughter and grandaughter all agreed he should have it (mass suggestion).

So my question his, assuming he was not senile, wouldnt any MD know that it was appropriate to give 02 in that instance ?


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## CAOX3 (Mar 10, 2011)

My treatment is based on assessment, I don't care what the medics want or unwritten rules, if oxygen isnt warranted they don't get it.

What did his lungs sound like, was he in any distress, what are you basing the oxygen administration on?


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## usalsfyre (Mar 10, 2011)

Perhaps because in the absence of hypoxia, oxygen isn't appropriate?


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## Afflixion (Mar 10, 2011)

You did not obtain O2 sat levels? I would have to say provided he was saturating fine he would not need O2. Despite what is preached O2 is not some magical cure all drug, and in some cases can be quite detrimental to the patient, granted that was not the case here but there does not appear to be any reason for O2 other than something else to charge the insurance company that is.


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## emt seeking first job (Mar 10, 2011)

Afflixion said:


> You did not obtain O2 sat levels? I would have to say provided he was saturating fine he would not need O2. Despite what is preached O2 is not some magical cure all drug, and in some cases can be quite detrimental to the patient, granted that was not the case here but there does not appear to be any reason for O2 other than something else to charge the insurance company that is.



In NYS EMT-b do not obtain 02 sat levels.

In the EMT-b class the mantra was give 02.

The service I work in is 100% free. We do not even bill insurance. 

02 is considered theraputic, makes people more alert and aids in depression.


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## emt seeking first job (Mar 10, 2011)

CAOX3 said:


> My treatment is based on assessment, I don't care what the medics want or unwritten rules, if oxygen isnt warranted they don't get it.
> 
> What did his lungs sound like, was he in any distress, what are you basing the oxygen administration on?



Clear bilateral.

The two people I was with were senior to me and I was told to do it.

I will add that the medic who showed up told me to ride in his bus. He knows me and he knows I do what I am told. I also remain quiet. I pick up anything the medics discard to the floor.  He also knows without being told I, after the patient in transfered to the hospital bed, always wheel out the stretcher, wipe it down with anti-bacterial cloth, throw a clean sheet on it, and strap the life-pack, with an extra sheet tucked under it.

I ALWAYS get picked to ride with the medics.

I am over 40, I have no prior health care experience. I just got my emt card and have less than 50 patient contacts. My only virtue is that I shut up, do what I am told and my mobile phone stays in my pocket in front of other people.


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## CAOX3 (Mar 10, 2011)

Great it seems like your a team player and that's important, your also a patient advocate.  Oxygen isnt a benign treatment its a medication like any other and should be administered as such.  Trust me I'm not attacking you personally, it s a nationwide problem, they have shortned classed removed anatomy and physiology and moved towards a system where you just throw everyone on oxygen and call for a medic truck.

I commend you for keeping the medics coming the guys heart rate needs to be addressed but remember also this isnt apopularity contest either, you need to do what's in the best interest ofyour patient a medic its going to respect you more for doing a complete assessment and treating appropriately then one who follows blanket policies and unwritten rules.

There are some great threads here about the administration of oxygen and google is also a great resourceif your not able to take any traditional classes right now.

trust me you will get more satisfaction and respect out of being a competent provider then you will from being  the guy the medics want to ride because you will clean up their mess.


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## Shishkabob (Mar 10, 2011)

emt seeking first job said:


> He complied when three EMTs, his wife, daughter and grandaughter all agreed he should have it (mass suggestion).
> 
> So my question his, assuming he was not senile, wouldnt any MD know that it was appropriate to give 02 in that instance ?



Since when do 3 presumably non-medical people, and 3 minimally trained medical people know what is and is not appropriate insofar as providing medical care, especially when given the info provided, is inappropriate, and the doctor states as such?

I don't care what the "unwritten rule" is, I'm doing what's appropriate.  



If he was AOx4 and capable of making his own decisions, no reason to pressure him on such a minuscule procedure that most likely was not indicated... especially at 15lpm


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## John E (Mar 10, 2011)

*Hmmm...*

sounds like the alleged senile MD knows more about how to treat a patient with his symptoms than the entire group of EMT's and family members combined.

Did the O2 help alleviate any of the symptoms, did it make the patient more comfortable, was it continued after his presumed arrival at the ER?

Why is it your job to clean up after the Paramedics? 

Your candor about your own virtues is refreshing but you don't need to be a doormat to anyone.


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## usafmedic45 (Mar 10, 2011)

> Was this senility or was this man always un-informed.



I don't think he was the one who was misinformed nor senile.



> 02 is considered theraputic, makes people more alert and aids in depression.



Care to provide some proof for that? Better yet, just go kick whomever told you that crap in the groin hard enough that they can't spawn another generation of morons.


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## JPINFV (Mar 10, 2011)

emt seeking first job said:


> Was this senility or was this man always un-informed.











emt seeking first job said:


> So my question his, assuming he was not senile, wouldnt any MD know that it was appropriate to give 02 in that instance ?



Why is O2 indicated? In medicine there's very few instances of automatically administering oxygen to a eupneic patient, and even those are starting to be revised.


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## reaper (Mar 10, 2011)

While you may think it is cool to be picked by the medics to ride along, they are picking you, because you do their clean up. Not because they respect you as a provider. It is nice to help out, but why were you not in the ED learning what was wrong with the pt? instead of cleaning their truck.

As stated, assess your pt and treat appropriately. Not do something because the medics expect it. This pt has more medical knowledge then the entire cast of people sent to treat him. Why not listen to the man?


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## usafmedic45 (Mar 10, 2011)

reaper said:


> While you may think it is cool to be picked by the medics to ride along, they are picking you, because you do their clean up. Not because they respect you as a provider. It is nice to help out, but why were you not in the ED learning what was wrong with the pt? instead of cleaning their truck.
> 
> As stated, assess your pt and treat appropriately. Not do something because the medics expect it. This pt has more medical knowledge then the entire cast of people sent to treat him. Why not listen to the man?


BTW, was this in Kentucky by any chance?


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## fast65 (Mar 10, 2011)

Like everyone else has said so far, oxygen was in no way indicated for this patient. He was obviously AOx4 without any breathing difficulties or anything that would even make you think he needed oxygen. Despite what they tell you in basic class, oxygen isn't needed on every patient; don't get me wrong, I'm not trying to bash you, but I'm just saying that it's more important to thoroughly assess a patients need for oxygen before tossing a NRB on them.


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## emt seeking first job (Mar 10, 2011)

CAOX3 said:


> trust me you will get more satisfaction and respect out of being a competent provider then you will from being  the guy the medics want to ride because you will clean up their mess.



Remember, I work at a volunteer service in an area already served by paid EMTb responders. Nobody forces me to do it. On that one job the patient's family called us but on many we buff them off the radio.

Its like if I crash a party (which I have never done, just an expression) I would be sure to show up with a bottle of wine in each hand.

And on one call, which we buffed, the same paramedic told his own agencies EMTs that they could leave since we were there.

The way I see it, I am not cleaning up their bus for them, I am making it clean for the next patient and enabiling them to return to service quicker.

And more than once those medics have offered me food and beverage when they are running to the deli. Remember, I am not being paid and I have cut back hours at my paying job (non-emt) to spend time EMT-ing and have cut back my take out food purchases (among other exspenses).


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## emt seeking first job (Mar 10, 2011)

*Thank you for the replies.*

So the answer is o2 is not always medically indicated even while it is not harmful. An MD would only administer o2 in more limited circumstances. The EMT class mantra of always put them on o2 is not always agreed upon.

I think it should be noted here that this in in NYC where the ride to the Hospital is ALWAYS under 15 minutes and on average around 5.

And thank you for the advice about respect etc, but I am nobody's 'biotch', I am just being a good guest. The unwritten rule at my service is the newer person cleans up. People with a higher # with me, I always ensure they do it.

The biggest complaint the medics have about other EMTs in my service is they brag, don't shut up, or assume they have a closer aquaintance-ship they than they do.


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## EMSrush (Mar 10, 2011)

usafmedic45 said:


> I don't think he was the one who was misinformed nor senile.
> Care to provide some proof for that? Better yet, just go kick whomever told you that crap in the groin hard enough that they can't spawn another generation of morons.



My sentiments exactly.


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## emt seeking first job (Mar 10, 2011)

fast65 said:


> assess a patients need for oxygen before tossing a NRB on them.



In certain instances we do our assesment with the o2 on and as I said, as a service we are trying to either load an go and play on the way rather than stay and play. The hospital is a five minute ride and the patient really needs to be assesed by the ER staff more than us.

The patient in this thread, our crew chief did not want to move him because of the bradycardia.


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## JPINFV (Mar 10, 2011)

emt seeking first job said:


> So the answer is o2 is not always medically indicated even while it is not harmful.


Part of the problem is that supplemental oxygen is not *not* harmful. It might not be immediately harmful, but it's not benign either.


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## emt seeking first job (Mar 10, 2011)

http://nursingcrib.com/nursing-notes-reviewer/oxygen-therapy/






It's really OK, I am very thick skinned. Flame away.

I enjoy reading any response on this forum, even the opinions, right, worng or indifferent it is all good.

I respect every one's opinon here, however, when someone in my service senior to me directs me to put the patient on o2, or any lawful request that does not violate REMSCO protocols, I am gonna follow it without question.

Especially if it makes the patient alert and less depressed.

So flame away, and link up some good meme's.......

:wacko::wacko::wacko::wacko:

:unsure:B):unsure:B):unsure:B):unsure:B):unsure:B):unsure:B)


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## EMS49393 (Mar 10, 2011)

That's not an actual study, that's just some note for nurses.  You have to back up your information with facts, something that EMS is fricken horrible at doing.

And another thing, since you can take a flame, Stop being a doormat!

I clean up after myself.  I don't trash ambulances or drop crap on the floor if I can help it.  If all defecation hits the rotary oscillator, there might be a mess, and I'll at least help clean it up.  

It pisses me off that there are still lazy, archaic, knuckle-dragging medics out there that think everyone should clean up after them and be silent.  How the hell are you supposed to learn if you're quiet on calls?  Nevermind, you'll likely just get the same backwards 1972 answers paramedics just can't seem stop using.


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## emt seeking first job (Mar 10, 2011)

EMS49393 said:


> That's not an actual study, that's just some note for nurses.  You have to back up your information with facts, something that EMS is fricken horrible at doing.
> 
> And another thing, since you can take a flame, Stop being a doormat!
> 
> ...



Once again, they do not ask me. I just do it.

If they did tell me, I just might as soon not do it....


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## Shishkabob (Mar 10, 2011)

emt seeking first job said:


> So the answer is o2 is not always medically indicated even while it is not harmful.



Who said O2 is not harmful?



emt seeking first job said:


> The unwritten rule at my service is the newer person cleans up. People with a higher # with me, I always ensure they do it.



Your agency has too many stupid unwritten rules.

Everyone cleans the rig, regardless of length at agency or certificaion level.  I have no problems cleaning the mess I made.


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## JPINFV (Mar 10, 2011)

Small study in Norway looking at supplemental oxygen in stroke patients. If you read the discussion, note that one confounding variable is that some patients in the non-oxygen group received it prehospitally before being split into a cohort. 



> Background and Purpose—We sought to test the hypothesis that breathing 100% oxygen for the first 24 hours after an acute stroke would not reduce mortality, impairment, or disability.
> 
> Methods—Subjects admitted to the Central Hospital of Akershus, Norway, with stroke onset <24 hours before admittance were allocated to 2 groups by a quasi-randomized design using birth numbers. All patients with acute stroke admitted to hospital within 24 hours after a stroke were included and enrolled. Patients were allocated to a group that received supplemental oxygen treatment (100% atmospheres, 3 L/min) for 24 hours (n=292) or to the control group, which did not receive additional oxygen. Main outcome measures were 1-year survival, neurological impairment (Scandinavian Stroke Scale), and disability (Barthel Index) 7 months after stroke.
> 
> ...


http://stroke.ahajournals.org/cgi/content/full/strokeaha;30/10/2033


Markers for oxidative stress in non-hypoxic volunteers:


> Abstract
> 
> Supplemental oxygen is often administered to induce hyperoxia in nonhypoxic patients for indications such as chest pain, despite lack of evidence of clinical benefit. Induced hyperoxia is potentially toxic, since it may increase oxidative stress and peroxidative damage to deoxyribonucleic acid, lipids and proteins.
> 
> ...


http://erj.ersjournals.com/content/21/1/48.full


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## the_negro_puppy (Mar 10, 2011)

Study done in Australia, published in the British Medical Journey

*Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial *

http://www.bmj.com/content/341/bmj.c5462.full

*Conclusions* Titrated oxygen treatment significantly reduced mortality, hypercapnia, and respiratory acidosis compared with high flow oxygen in acute exacerbations of chronic obstructive pulmonary disease. These results provide strong evidence to recommend the routine use of titrated oxygen treatment in patients with breathlessness and a history or clinical likelihood of chronic obstructive pulmonary disease in the prehospital setting.


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## emt seeking first job (Mar 10, 2011)

*Thank you for the links.*

I am reading them all.

Thank you for the information.


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## Bullets (Mar 10, 2011)

man, dont clean up after the medics, its their mess, they clean it up. Ive been know to leave a bag full of their trash hanging on their door when they leave their stuff behind, just cause they are medics doesnt make them better people, just more educated providers. just like i dont expect medics to check the hopsitals cage for our LSBs and such

Also, 02 is not needed, and if the medics give you hell for it, expalin why it wasnt needed. and definatley not NRB, MAYBE a NC on like 4L. I rarely use the NRB anymore after i took the time to read up on oxygen delivery. I makes me wish we had more pharmacology in EMTB school


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## firetender (Mar 10, 2011)

*Just wondering...*

Isn't the administration of O2 all about start as low as you can get away with and then titrate to effect? Are you saying some of you automatically slap on a pre-determined flow SEPARATE from the immediate symptoms of the patient?


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## JPINFV (Mar 10, 2011)

firetender said:


> Are you saying some of you automatically slap on a pre-determined flow SEPARATE from the immediate symptoms of the patient?


Unfortunately, that is what is taught. NRBs for EVERYONE!


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## Sasha (Mar 10, 2011)

emt seeking first job said:


> http://nursingcrib.com/nursing-notes-reviewer/oxygen-therapy/
> 
> 
> 
> ...



That's silly. Don't follow without question when someone else is not being a patient advocate. You're doing patients a disservice. 

Where does it say the patient is less alert or depressed? I don't remember reading that in the OP (and I harbor a guess that half the crap in that picture is BS)

We don't do things because of unwritten rules, we do things because it benefits the patient. Oxygen did not benefit the patient, a hospital would have benefited the patient. Instead of getting his family to gang up on him and force him on oxygen while waiting for ALS, you should have put him on the stretcher and taken the man to the hospital instead of delaying definitive care.

He wasn't ill informed or senile, he was just not buying the BS!


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## Handsome Robb (Mar 10, 2011)

I understand the 'rookie' aspect of cleaning up, I am a rookie at my service. But there is a place and time for it, if someone makes a huge mess it's there responsibility. As for more educated providers, technically I am the highest educated provider at my service besides a few of our vollies who are around 1 or 2 weekends a year. I am an I everyone else is a B. It doesn't make me any better than the rest of them...


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## jjesusfreak01 (Mar 11, 2011)

NVRob said:


> I understand the 'rookie' aspect of cleaning up, I am a rookie at my service. But there is a place and time for it, *if someone makes a huge mess it's there responsibility*. As for more educated providers, technically I am the highest educated provider at my service besides a few of our vollies who are around 1 or 2 weekends a year. I am an I everyone else is a B. It doesn't make me any better than the rest of them...



Man, medics must hate running codes in your service if no one helps clean up.


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## fast65 (Mar 11, 2011)

emt seeking first job said:


> In certain instances we do our assesment with the o2 on and as I said, as a service we are trying to either load an go and play on the way rather than stay and play. The hospital is a five minute ride and the patient really needs to be assesed by the ER staff more than us.
> 
> The patient in this thread, our crew chief did not want to move him because of the bradycardia.



Well I can assume you went through your ABC's, so when you got to breathing, was there anything at all that indicated the patient needed oxygen? From what I've read, the answer is no. 

Why was he afraid to move the patient because of the bradycardia?


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## Aidey (Mar 11, 2011)

jjesusfreak01 said:


> Man, medics must hate running codes in your service if no one helps clean up.



I think it is the difference between a disaster and a mess. If you routinely leave the ambulance a disaster, and make no attempt to even pretend to contain or clean up the mess, be prepared to clean up after yourself. If you make a mess, but try and pile all the garbage together, and minimize the gross contamination people are going to be more willing to help you clean up. 

I try and minimize my messes when possible. At the very least I try and pile all the garbage in one or two spots. Often if we are at the hospital when someone comes in with a code or other nasty call we will start cleaning up their bus while they drop the patient. I am much more willing to clean up another person's ambulance if I can tell it was clean before and it isn't disgusting.


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## emt seeking first job (Mar 11, 2011)

fast65 said:


> Why was he afraid to move the patient because of the bradycardia?



They were afraid his heart  would stop beating if we did not maintain him in a supine position and since medics are available and in about 5 min, and the potential unstability of the patient, our crew chief deemed it an ALS job.


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## Shishkabob (Mar 11, 2011)

emt seeking first job said:


> They were afraid his heart  would stop beating if we did not maintain him in a supine position



Errrmmm...positional hypotension?  Did he do positional blood pressure readings or anything that would indicate his fear as, well... rational?


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## emt seeking first job (Mar 11, 2011)

Linuss said:


> Errrmmm...positional hypotension?  Did he do positional blood pressure readings or anything that would indicate his fear as, well... rational?



Patient's wife reported gross variations in blood pressure the entire day.

We took six reading, within 10 minutes we had a wide range as well.


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## EMS49393 (Mar 11, 2011)

emt seeking first job said:


> They were afraid his heart  would stop beating if we did not maintain him in a supine position and since medics are available and in about 5 min, and the potential unstability of the patient, our crew chief deemed it an ALS job.



You couldn't roll a transfer sheet under him and lift him on the stretcher?  Please, please tell me you all moved him to the stretcher and not that the magical paramedics had him "turn and pivot" or walk to the stretcher.


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## MrBrown (Mar 11, 2011)

emt seeking first job said:


> They were afraid his heart  would stop beating if we did not maintain him in a supine position and since medics are available and in about 5 min, and the potential unstability of the patient, our crew chief deemed it an ALS job.



Its things like this that make Brown a very worried Brown :unsure:


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## Handsome Robb (Mar 11, 2011)

jjesusfreak01 said:


> Man, medics must hate running codes in your service if no one helps clean up.



I'm not saying I wont help clean up. But If a medic runs a code and leaves a huge mess around and doesn't help clean it up, unless they are providing continued patient care, you can count on it that I am going to say something. I wont just leave a mess around, especially since I work outdoors and am environmentally minded, but I'm not gonna clean up after someone just because they are a medic and I am an EMT, I'm not a janitor...


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## Shishkabob (Mar 11, 2011)

I know that if I had a messy call, especially a code, that usually entails a lengthy PCR, and if my parter refuses to clean up the back during that time and chooses to "Have a talk" with me, I'll be having a talk right back... and I'll win.



I'll clean up what I can and have no problem cleaning up my mess... but there's common sense there too.  If my partner has just been standing around next to the rig the whole time while I handled the transfer of care and did the PCR, that's not right.


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## JPINFV (Mar 11, 2011)

Linuss said:


> I'll clean up what I can and have no problem cleaning up my mess... but there's common sense there too.  If my partner has just been standing around next to the rig the whole time while I handled the transfer of care and did the PCR, that's not right.










...and I'll add that I don't care if the paramedics are with my service or another service. They have a job and I have a job. Parts of that job overlaps, but sometimes not temporally.


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## emt seeking first job (Mar 11, 2011)

EMS49393 said:


> You couldn't roll a transfer sheet under him and lift him on the stretcher?  Please, please tell me you all moved him to the stretcher and not that the magical paramedics had him "turn and pivot" or walk to the stretcher.



Scoop stretcher.


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## abckidsmom (Mar 11, 2011)

emt seeking first job said:


> Patient's wife reported gross variations in blood pressure the entire day.
> 
> We took six reading, within 10 minutes we had a wide range as well.



If he lasted throughout the day, don't you think you could have moved him to the stretcher at least?

With his potential instability, I'd want to be making movement toward the hospital as soon as possible, especially considering the antiquated mentality your service seems to be bringing to the calls.

People sitting and talking to you don't typically stop being alive just because you slide them over to the stretcher.

I'm with the others, EMT.  You've gotta find a real agency to work with before you start thinking this is the standard way to do EMS.  The stuff you are learning right now, at the beginning of your career, is the stuff that will last forever.  You'll regret having this behavior in your muscle memory if you do go on to actually do some EMS.  

It really sounds like your agency is a branch of the Lions club or something.  Nice community service, sweet people, but dude, call in the real medics!


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## emt seeking first job (Mar 11, 2011)

abckidsmom said:


> It really sounds like your agency is a branch of the Lions club or something.  Nice community service, sweet people, but dude, call in the real medics!



I have no doubt in my agency whatsoever.

We have many paid medics, emts, nurses and PA's. Perhaps I left something out of the story ? Me with an emt card less than 1 year old....My agency had a person with 20+ vollie experience, the seconf person had 3 years volley and two years NYC 911 experience.....

I read everyone's input here but I am inclined to follow along in the field..


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## Shishkabob (Mar 11, 2011)

And that's the problem... you're following along blindly.


It's one thing to listen to experience, it's another to believe the experience being shown is the end-all be-all correct experience.  You need to be your own provider and need to do what YOU think is best for the patient (so long as science backs it up), even if it's counter-intuitive to what your 'superior' is telling you if they themselves are unable to explain why their way is the right or better way.


I've had my medic for a year now.  I work with medics who have had theirs since before I was born.  I'll listen to their wisdom, but in the end, it's my license and my patient care, so it's my decision.   The only person on this earth who can tell me what to do with my patient is my own medical director... all others are advisors.


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## abckidsmom (Mar 11, 2011)

emt seeking first job said:


> I have no doubt in my agency whatsoever.
> 
> We have many paid medics, emts, nurses and PA's. Perhaps I left something out of the story ? Me with an emt card less than 1 year old....My agency had a person with 20+ vollie experience, the seconf person had 3 years volley and two years NYC 911 experience.....
> 
> I read everyone's input here but I am inclined to follow along in the field..



I don't know, man.  Seems like something's missing if you decide to leave the patient lying in the bed instead of moving to the truck because his heart might stop if you move him.  Where did you learn that?  I've not had that lesson....

I'm just saying that you with your EMT card less than 1 year old should be working to acheive competence, and not necessarily venerating these people with their 20+ years vollie experience if these are the kinds of decisions they've been making all these years.  The people you learn from are the people you become.  Choose carefully.


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## abckidsmom (Mar 11, 2011)

Linuss said:


> And that's the problem... you're following along blindly.
> 
> 
> It's one thing to listen to experience, it's another to believe the experience being shown is the end-all be-all correct experience.
> ...



Amen.  And even the medical director can be wrong at times.  Ours is totally open to receiving well-though-out criticism phrased respectfully.  He was completely wrong on a med/legal issue we were talking about last week, and I got the state code, we talked about it, and we all learned a lot from the discussion.

And he's the medical director for the state OEMS!


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## emt seeking first job (Mar 11, 2011)

abckidsmom said:


> I don't know, man.  Seems like something's missing if you decide to leave the patient lying in the bed instead of moving to the truck because his heart might stop if you move him.  Where did you learn that?  I've not had that lesson....
> 
> I'm just saying that you with your EMT card less than 1 year old should be working to acheive competence, and not necessarily venerating these people with their 20+ years vollie experience if these are the kinds of decisions they've been making all these years.  The people you learn from are the people you become.  Choose carefully.



Well as I wote, the medics were 5 minutes out. They stayed on scene about five minutes assesing him, we scooped him, carried him carefly down the stairs, keeping him as level as possible, he was brought to the ER in the same condition we found him in.

I appreciate everyone's concern and input.


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## JPINFV (Mar 11, 2011)

emt seeking first job said:


> We have many paid medics, emts, nurses and PA's. Perhaps I left something out of the story ? Me with an emt card less than 1 year old....My agency had a person with 20+ vollie experience, the seconf person had 3 years volley and two years NYC 911 experience.....




To steal a line from Kelly "Ambulance Driver" Grayson, is that 20 years experience or 1 year experience repeated 20 times?


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## MrBrown (Mar 11, 2011)

JPINFV said:


> To steal a line from Kelly "Ambulance Driver" Grayson, is that 20 years experience or 1 year experience repeated 20 times?



Hey you cant steal that, Brown already stole it before you did!


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## emt seeking first job (Mar 11, 2011)

*Thank you everybody for your input.*

I have read all the replies and will conisder all of your advices.


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## EMS49393 (Mar 11, 2011)

Linuss said:


> I know that if I had a messy call, especially a code, that usually entails a lengthy PCR, and if my parter refuses to clean up the back during that time and chooses to "Have a talk" with me, I'll be having a talk right back... and I'll win.
> 
> I'll clean up what I can and have no problem cleaning up my mess... but there's common sense there too.  If my partner has just been standing around next to the rig the whole time while I handled the transfer of care and did the PCR, that's not right.



*THIS^*

I used to work with a guy that refused to clean anything.  He drove to the hospital, we unloaded the patient, and while I transferred care, he ran his mouth at the desk.  I'd get finished and have to make the stretcher and drive back to the station.  After we got back, he's go back to playing xbox and I'd get to do another hours worth of paperwork.

I'm usually really nice to EMT's but this "I'm not cleaning up after you" crap is starting to tick me off.  I never asked anyone to clean up after me, but you can make a stretcher since the only thing you'll be doing back at base is sleeping, eating, playing xbox, or pulling your crank while I get to do my favorite (sarcasm) part of the job - document.


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## Madmedic780 (Mar 11, 2011)

IMHO...Patient's always have the right to refuse even if it's going to bad for them in the end. Especially with his education it would have been easy to convince him of the good chance that he was possibly be having a cardiovascular incident and that  some 02 might make him feel a bit better. 

However that being said I think it was a bit unfair for you to jump to ignorance or senility for his refusal of 02 therapy...as he was obviously not feeling well.

Remember the most important part of the job is being an advocate for the patient, and that includes good clinical skills and judgement rather than just following protocol.

Would I have given 02 given the v/s and history? Yes. 15lpm via NRB? probably not.


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## emt seeking first job (Mar 11, 2011)

EMS49393 said:


> *THIS^*
> 
> I used to work with a guy that refused to clean anything.  He drove to the hospital, we unloaded the patient, and while I transferred care, he ran his mouth at the desk.  I'd get finished and have to make the stretcher and drive back to the station.  After we got back, he's go back to playing xbox and I'd get to do another hours worth of paperwork.
> 
> I'm usually really nice to EMT's but this "I'm not cleaning up after you" crap is starting to tick me off.  I never asked anyone to clean up after me, but you can make a stretcher since the only thing you'll be doing back at base is sleeping, eating, playing xbox, or pulling your crank while I get to do my favorite (sarcasm) part of the job - document.



At my service, the senior person presents to the ER triage nurse, the junior person can listen in, then while the former or the next in line writes the PCR, the later puts the stretcher back and sets everything up for the next call.

The next in line is getting experience in writing PCR's. 

One of my shifts is with two very seasoned people, one a full time EMS boss, they are both instructors. The other person with us has about 2 years in, but forgets their glasses. So I jump in and write the PCR. I ask them to dictate, but they force me to make a guess. 

I dont mind setting up the bus and I dont mind writing the PCR as I need experience in both.


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## Sizzlator (Mar 11, 2011)

*Confused*

Perhaps he was just confused because of all the excitement.  Or perhaps he did not want to make a big fuss over his situation and thought that O2 would just elevate the situation.  Denial perhaps.


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## reaper (Mar 11, 2011)

Sizzlator said:


> Perhaps he was just confused because of all the excitement.  Or perhaps he did not want to make a big fuss over his situation and thought that O2 would just elevate the situation.  Denial perhaps.



Or perhaps he has extensive medical education and knew it was ridiculous to give him O2, when it was not needed or called for.


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## usalsfyre (Mar 11, 2011)

Sizzlator said:


> Perhaps he was just confused because of all the excitement.  Or perhaps he did not want to make a big fuss over his situation and thought that O2 would just elevate the situation.  Denial perhaps.



The misinformation continues...


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## emt seeking first job (Mar 11, 2011)

reaper said:


> Or perhaps he has extensive medical education and knew it was ridiculous to give him O2, when it was not needed or called for.




Ok, however, arent the protocols for EMT's written by MD's ????


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## usalsfyre (Mar 11, 2011)

emt seeking first job said:


> Ok, however, arent the protocols for EMT's written by MD's ????



Written by MDs, but they're often out of date, and assume EMTs aren't educated enough to know when oxygen is indicated. 

Ask yourself, do you want to be "that guy" protocols like this are written for.


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## Aidey (Mar 11, 2011)

Protocols are written for the lowest common denominator. The protocols I work under probably cover ~500 paramedics, but when a couple of guys screwed up with the Lasix it was nearly taken away from everyone.


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## MrBrown (Mar 11, 2011)

emt seeking first job said:


> Ok, however, arent the protocols for EMT's written by MD's ????



Yes however it seems to Brown that many of them got their MD out the Weet Bix box and that many Paramedics got their Paramedic cert out out the same box.

There was no clinical indication for oxygen in this patient, let Brown repeat, there was no clinical indication for oxygen in this patient.

Try this on for size 



> *1.4 OXYGEN ADMINISTRATION*
> Few sections contain specific instructions on oxygen and clinical
> judgement is required. Oxygen does not necessarily provide benefit
> and should usually only be given if the patient has:
> ...


----------



## emt seeking first job (Mar 11, 2011)

usalsfyre said:


> Written by MDs, but they're often out of date, and assume EMTs aren't educated enough to know when oxygen is indicated.
> 
> Ask yourself, do you want to be "that guy" protocols like this are written for.



Well if god forbid, the patient has a bad outcome, I would want to be that guy who can defend his actions with the protocols.

I dont want to be that guy who has to explain why he did not follow the protocols.

Seven years in insurance claims left me with the impression that its best to follow what the standard procedure is.


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## emt seeking first job (Mar 11, 2011)

MrBrown said:


> Yes however it seems to Brown that many of them got their MD out the Weet Bix box and that many Paramedics got their Paramedic cert out out the same box.
> 
> There was no clinical indication for oxygen in this patient, let Brown repeat, there was no clinical indication for oxygen in this patient.
> 
> Try this on for size




The crew chief told me to adminster the 02.

The paramedics never told me to remove it.

There was no clinical indication that oxygen was detrimental to the patient.

We were < five minutes away from the ER.

It is hard to get obtain even an unpaid emt position in NYC.


----------



## MrBrown (Mar 11, 2011)

emt seeking first job said:


> Well if god forbid, the patient has a bad outcome, I would want to be that guy who can defend his actions with the protocols.
> 
> I dont want to be that guy who has to explain why he did not follow the protocols.
> 
> Seven years in insurance claims left me with the impression that its best to follow what the standard procedure is.



Brown is sure that those at Nuremberg thought whatever they did was a good idea at the time too or they were just 'following orders'


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## emt seeking first job (Mar 11, 2011)

MrBrown said:


> Brown is sure that those at Nuremberg thought whatever they did was a good idea at the time too or they were just 'following orders'






I was waiting for someone to write that.

:wacko::wacko:

If someone in charge ordered me to do something illegal or against the protocols I would refuse and report him or her.

By orders I meant lawful and valid orders.


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## MrBrown (Mar 11, 2011)

emt seeking first job said:


> The crew chief told me to adminster the 02.



And what makes your clown of a crew chief more clinically qualified than you?



emt seeking first job said:


> The paramedics never told me to remove it.



Probably because they actually know about 5% more than you do 

*Brown goes to look in the kitchen for an open box of Weet Bix



emt seeking first job said:


> There was no clinical indication that oxygen was detrimental to the patient.



Do you have a blood gas machine in your ambulance?

There is evidence that oxygen can be harmful to select groups of patients, while this patient may not be one of them there is good evidence showing hyperoxia and hyperventilation can be very harmful.



emt seeking first job said:


> We were < five minutes away from the ER.



And this makes a difference how?



emt seeking first job said:


> It is hard to get obtain even an unpaid emt position in NYC.


[/quote]

And this makes a difference how?


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## reaper (Mar 11, 2011)

emt seeking first job said:


> The crew chief told me to adminster the 02.
> 
> The paramedics never told me to remove it.
> 
> ...



Ok guys and Gals, 

Lets just drop all this education here. It is shown here that cookbook medicine is in play, just so a position can be kept.


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## Shishkabob (Mar 11, 2011)

emt seeking first job said:


> Ok, however, arent the protocols for EMT's written by MD's ????



To be technical, no.  Med director just signs them as if they were his.




Aidey said:


> Protocols are written for the lowest common denominator. The protocols I work under probably cover ~500 paramedics, but when a couple of guys screwed up with the Lasix it was nearly taken away from everyone.



We have I'm guessing slightly more than 100 Paramedics at our agency... we used to have liberal pain protocols (and technically still do compared to many places) where we could go 1-2mcg/kg Fent multiple times.

A couple of months ago, it was switched to 1mcg/kg Fent for patients between 10-70years of age with acute pain... a max of two times.

Apparently a couple of retards severely over sedated patients...


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## emt seeking first job (Mar 11, 2011)

I appreciate all these insights and I will keept them in mind.

I am just curious, next time, does anyone here as the junior person suggest I refuse to throw the NRB on the patient and prevent anyone else at the scene from doing so ?

The other people would order me to leave.

If I did not they would request the police respond.

I would be arrested, removed from the scene, and guess what....on goes the NRB mask anyway.


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## MrBrown (Mar 11, 2011)

We have over 3,000 Ambulance Officers be they Technicians, Paramedics or Intensive Care Paramedics working under one set of what are technically "standing orders" .... 

*Brown checks the drug bag, frusemide, yep, unlimited morphine, yep, suxamethonium yep thats there too hmmm ........

*Brown puts down the drug bag and goes to the kitchen to look for an open box of Weet Bix


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## Veneficus (Mar 11, 2011)

*can I just ask a question about all of this?*

In all of the protocols I have ever worked under, somewhere in them was usually written something along the lines of:

"Guidlines not meant to replace sound medical judgement," "Administer oxygen as appropriate," or "initiate or withold treatment as appropriate."

Are any of these items in the protocol book?


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## MrBrown (Mar 11, 2011)

emt seeking first job said:


> I appreciate all these insights and I will keept them in mind.
> 
> I am just curious, next time, does anyone here as the junior person suggest I refuse to throw the NRB on the patient and prevent anyone else at the scene from doing so ?
> 
> ...



You do not have to put everybody on an NRB, most people only need 2-3 litres on a cannula, if oxygen is even indicated at all.

Medicine is not a one size fits all process unless you are a barely homeostasasing looser cookbook medic with poor cerebral perfusion

*Brown goes to the kitchen once again in search of an open Weet bix box


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## lightsandsirens5 (Mar 11, 2011)

MrBrown said:


> Brown is sure that those at Nuremberg thought whatever they did was a good idea at the time too or they were just 'following orders'



That is the closest I have ever seen anyone come to breaking Goodwin's Law and still get away with it.


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## emt seeking first job (Mar 11, 2011)

MrBrown said:


> You do not have to put everybody on an NRB, most people only need 2-3 litres on a cannula, if oxygen is even indicated at all.
> 
> Medicine is not a one size fits all process unless you are a barely homeostasasing looser cookbook medic with poor cerebral perfusion
> 
> *Brown goes to the kitchen once again in search of an open Weet bix box



Once again, I thank you for the input and will bear that in mind for the day in the future when I am the crew chief.

In four months I worked my way up from the guy they tell to check over the rig to the guy they tell to show the newer guy how to check over the rig.

Does Brown want to come to Brooklyn, the South non-hipster part of Brooklyn and shake things up ?

Does he want to be that guy ?


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## MrBrown (Mar 11, 2011)

emt seeking first job said:


> Once again, I thank you for the input and will bear that in mind for the day in the future when I am the crew chief.



So you are somehow devoid of any clinical rationalisation or your opinion as an Ambulance Officer is null and void when you are involved in treating a patient?


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## emt seeking first job (Mar 11, 2011)

lightsandsirens5 said:


> "Goodwin's Law".




???


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## emt seeking first job (Mar 11, 2011)

MrBrown said:


> So you are somehow devoid of any clinical rationalisation or your opinion as an Ambulance Officer is null and void when you are involved in treating a patient?



One of the cardinal rules of the public safety professions is if you are the new guy, keep your ears and eyes open and your mouth shut.

Imagine if I had never joined the service. What would have happened any way ?

Remember, the doctors wife called US, the vollies instead of 911 for the paid people. These were people of means that could clearly have paid out of pocket (if they had no coverage). They had lived in their home for 50+ years. They had a good impression of our service....

Once again, does Brown want to come to Brooklyn and change things ?


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## Veneficus (Mar 11, 2011)

MrBrown said:


> So you are somehow devoid of any clinical rationalisation or your opinion as an Ambulance Officer is null and void when you are involved in treating a patient?



I think it is a cultural issue. Most of the people I have met from that neck of the woods live in some pseudomilitary, longevity = knowledge, never question the system because it works mentality.

It would be very difficult for any one person to suddenly challange that, especially on a scene.

Probably better to bring it up at the station. 

Brown,

The US EMS providers are digging in their heels to retain the laborer/tech mentality. They want nothing to do with being free thinking individuals. A free thinking individual is responsible and accountable for their decisions and actions. It is the only way to preserve the idea that people are absolved from their responsibility because they were "just following orders." 

Right or wrong, it is what it is.

Personally, if some healthcare punter/hobbyist came into my place and started coercing my family into letting them give me treatments that weren't indicated, I don't care if that person had 6 kids and a disabled wife to feed, I would make sure the next order they followed was: "clean out your locker and don't come back."


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## emt seeking first job (Mar 11, 2011)

Veneficus said:


> I think it is a cultural issue. Most of the people I have met from that neck of the woods live in some pseudomilitary, longevity = knowledge, never question the system because it works mentality.
> 
> It would be very difficult for any one person to suddenly challange that, especially on a scene.
> 
> ...



Just to clarify, he questioned the o-2, he did not refuse. We have had people refuse o-2, we have had people refuse back-boards, we have had familes call us and the patient refused. We get them to RMA, the family to witness, and withold whatever treatment was refused, or left entirely.

We get a lot of out of state sons and daughters call for their parents, the prents refuse, we state our case but if they still refuse we leave.

Had the patient in the original post flat out refused the o-2, we would have witheld. He mrely questioned it and was satisfied with our answer.


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## Shishkabob (Mar 11, 2011)

EMT--- next time something is done on scene you don't agree with (or as in this case, learn to not agree with), if it's not unsafe to the patient, bite your tongue, do it, and then after the call discuss it with the 'in-charge'.


Don't ever question the person running the call on scene if it's a technical difference... but don't be afraid to question them after the fact.   However, if it's a safety concern, question right then and there to your hearts content.


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## Veneficus (Mar 11, 2011)

emt seeking first job said:


> He complied when three EMTs, his wife, daughter and grandaughter all agreed he should have it (mass suggestion).



This does not sound like he was satisfied with your answer, it sounds like he decided that it would make his family feel better so he played a long.



emt seeking first job said:


> So my question his, assuming he was not senile, wouldnt any MD know that it was appropriate to give 02 in that instance ?



It was not appropriate to give o2 in that situation. But many doctors do not simply call somebody out as being wrong, often they listen to the reasoning and make a decision based on that.

I am willing to bet his decision wasn't that what you were doing was right, but that to comply with people who didn't know what they were doing was going to get him to people who did faster/with less stress than arguing.


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## emt seeking first job (Mar 11, 2011)

Linuss said:


> EMT--- next time something is done on scene you don't agree with (or as in this case, learn to not agree with), if it's not unsafe to the patient, bite your tongue, do it, and then after the call discuss it with the 'in-charge'.
> 
> 
> Don't ever question the person running the call on scene if it's a technical difference... but don't be afraid to question them after the fact.   However, if it's a safety concern, question right then and there to your hearts content.



Thank you.

I will add that everyone at my service is receptive to questions after the call and some even ask me if I have any questions. Some even go farther to quiz me as what to do on the way to the job, or ask me why we did something after it.


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## firetender (Mar 11, 2011)

*The REAL Paramedic Cookbook:*

Examine the patient.

Initiate accordingly.

Examine the patient.

Adjust accordingly.

Examine the patient.

Adjust accordingly.

Repeat.

Deliver.


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## JPINFV (Mar 11, 2011)

emt seeking first job said:


> One of the cardinal rules of the public safety professions is if you are the new guy, keep your ears and eyes open and your mouth shut.



There are a lot of things wrong with public safety culture, and that is definitely one of them. Old guys have experience, new guys (hopefully) have the most up to date knowledge. There's also a place for a fresh set of eyes or a new prospective. New guys should be asking questions, sometimes tough questions, and there should always be an answer that never includes "tradition" or "that's how I was taught back when I took EMT class with Galen." 

However, there's also a time and a place to question orders. Oxygen is not perfectly safe. Oxygen is, however, one of the most benign drugs that EMS administers. That doesn't mean that every patient should receive oxygen, but I'm not entirely sure if it would be worth getting into an argument on scene. It would be like getting into an argument about saline lock vs saline TKO on scene.


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## reaper (Mar 11, 2011)

No one is saying to argue it or refuse to do it. We are saying to question the "why" you are doing it. If the pt does not need O2, then ask the "crew cheif" why he wants them on it.

If all you are going to do is sit back and blindly follow orders, you will never be a very good provider. This is not the military, the police dept. or the Fire service. You have the right and justification to question why a treatment is being done, if it is not needed.

This man mostly likely gave in, to keep his family happy. The fact that an MD is questioning your use of O2 should have made you step back and think about why you were doing it.

We are not public safety. We are a medical provider. Please lose all that garbage that they are filling your head with.


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## volparamedic (Mar 12, 2011)

Seeing the age of the patient would make me think there is something more underlying going on. If the patient is senile then he is not dependable to give accurate information. Asking a few questions you should be able to see if he can be reliable. O2 can never hurt with just a couple of liters on a nasal cannula. 

They key being that his BP has been varying. I would be more suspicious of cardiac issues. I noted that his pulse is 42. Is he on beta blockers that may be causing the bradycardia since his BP tells us he's perfusing? Then again he could be fine while at rest but as soon as he moves around or walks the bradycardia may be much for him causing his bradycardia to worsen and the BP to drop and thus the syncope. There could be a chance he could be come hypoxic from poor perfusion and have seizures.


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## Sasha (Mar 12, 2011)

emt seeking first job said:


> Well if god forbid, the patient has a bad outcome, I would want to be that guy who can defend his actions with the protocols.
> 
> I dont want to be that guy who has to explain why he did not follow the protocols.
> 
> Seven years in insurance claims left me with the impression that its best to follow what the standard procedure is.



I'd rather be the girl who could defend her actions with education and knowledge rather than "Oh he told me too.." 

"Why didn't you put the patient on oxygen?" "Based on my assesment the patient was not exhibiting signs of hypoxia, and oxygen wasn't indicated."

"Just following orders" is not a good defense at all.


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## emt seeking first job (Mar 12, 2011)

Thank you for your reply. It was informative and interesing to read your views on this topic.


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## volparamedic (Mar 12, 2011)

Sasha said:


> "Why didn't you put the patient on oxygen?" "Based on my assesment the patient was not exhibiting signs of hypoxia, and oxygen wasn't indicated."



He may not exhibit signs while at rest. I would bet once he gets up and starts moving he may due to decreased cardiac output during exertion. It's not a respiratory problem.....it appears cardiac. My suspicion due to varied blood pressures with bradycardia. To know for sure you really need more info. I've had patients look fine and still code on me later...it's better to over treat than under treat. Just as long as you remember....Do Not Harm....you can never go wrong.


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## usafmedic45 (Mar 12, 2011)

> Seeing the age of the patient would make me think there is something more underlying going on. If the patient is senile then he is not dependable to give accurate information



Just because he's old, doesn't mean he's senile or that there's "more underlying going on".  I am working on a book about WWII veterans and a lot of these guys are in their 90s and in better health than a lot of 30 to 40 years old I know.  Apparently the patient in this scenario is sharper than the OP because he was able to accurately frame his concerns and bring up issues the young folks didn't know about. 



> Just as long as you remember....Do Not Harm....you can never go wrong.



Yeah....giving oxygen never does harm. *rolls eyes*




> There could be a chance he could be come hypoxic from poor perfusion and have seizures



Any idea how infrequent convulsions (true convulsions, not just twitching) actually occur as a result of hypoxia?  It seems like you're trying to piece together what little you know about cardiac and respiratory physiology to fit the need of the OP to justify the administration of oxygen to this patient.


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## JPINFV (Mar 12, 2011)

volparamedic said:


> it's better to over treat than under treat.




Over treatment is just as bad as under treatment.

"The delivery of good medical care is to do as much nothing as possible."
Law 13. The House of God.


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## usafmedic45 (Mar 12, 2011)

> it's better to over treat than under treat.



I love when people put that one out as a defense.  It gives me plenty of work as an expert witness.


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## usalsfyre (Mar 12, 2011)

usafmedic45 said:


> I love when people put that one out as a defense.  It gives me plenty of work as an expert witness.



But overtreatment makes US "feel" better...


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## usafmedic45 (Mar 12, 2011)

usalsfyre said:


> But overtreatment makes US "feel" better...


Rule #2 of EMS: Don't just do something, stand there.


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## Veneficus (Mar 12, 2011)

usalsfyre said:


> But overtreatment makes US "feel" better...



Big hearts are usually accompanied by little brains.


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## abckidsmom (Mar 12, 2011)

JPINFV said:


> Over treatment is just as bad as under treatment.
> 
> "The delivery of good medical care is to do as much nothing as possible."
> Law 13. The House of God.





usafmedic45 said:


> Rule #2 of EMS: Don't just do something, stand there.





Veneficus said:


> Big hearts are usually accompanied by little brains.



We should put these lists in the front of every protocol book.  Priceless.


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## JPINFV (Mar 12, 2011)

^
Make _House of God_ required reading for all EMT students. The Laws of the House of God are more widely quoted in EMS than many people realize.


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## Aidey (Mar 12, 2011)

I _finally_ red House of God earlier this year, and it is a little scary how applicable it is, all these years later. 

I rather liked the rule that you can't find a fever if you don't take a temperature. I think the EMS corollary to that is the pulse ox.


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## 18G (Mar 13, 2011)

That was 9 pages of interesting, head shaking reading! The entire BLS crew on that call sounded like a bunch of idiots who had no clue what was going on with the patient. So the patients heart rate was in the 40's.... was the patient symptomatic of the low HR? It sounds like the patient was pretty stable to me.

I had to laugh when I read that the most experienced EMT didn't want to move the patient out of fear that his heart may stop... really? 

Here is some more reading on the dangers of high-flow oxygen when not indicated: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1809170.

EMT Seeking... I get you want to be liked and you think your doing the right thing... but it sounds like you are being taken advantage of. Let the Medic clean their own mess. Its not your job! They made it, they clean it. 

So what did the Medic think was causing the Bradycardia? Did the Medic provide any ALS tx?


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## Sasha (Mar 13, 2011)

> So what did the Medic think was causing the Bradycardia?



Apparently, hypoxia!


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## CAOX3 (Mar 13, 2011)

You want to know what s wrong with EMS, you wouldn't have to look much further then the pages in this thread, name calling, degrading comments and unprofessionalism.  We all know the state of EMS education to hold someone personally responsible is ridiculous.  We like to blame everyone else for the problems in EMS however we create most of them ourselves.  Take a look in the mirror, are you doing your part to educate and guide less experienced providers or do you just scan these forums looking for your opportunity to pounce on a inexperienced provider.  Its a DBish move and really shines a light on the lack of leadership in this profession.

Everyday I'm faced with questions sometimes I have to ask new providers to repeat because I can't believe the words are coming from their mouth. Sure I could laugh, talk behind their backs to make myself look  smarter or I can take the opportunity to educate them. Maybe you should try the latter.  No I cant fix all the problems in EMS, I can't increase educational standards, I can't change the protocol mentality or any other of the billion problems that exist in this profession, what I can do maybe educate one provider on what better course of action may have been the maybe when he gets his oppurtunity he does the same.

Blaming others for problems that exist, them not doing your part to change them is weak.  Sometimes I want to throw up my hands and walk away, put in my papers and get a little place on the beach but I don't because that just makes me part of the problem.   I'm just an emt, nothing special, I got no fancy tools, no magic medications and I don't save lives on a daily basis not do I claim too.  What I have is a passion for EMS that I'm happy to share with anyone who is interested. 

So yeah I could knock his head off and jump down his throat to prove I'm better but I never have and I never will I choose to take a different path in changing EMS to share what ever I have with anyone who wants it.

Some times I miss the opportunity, I'm not perfect.  But nothing bothers me more then then a more experienced provider who belittles a new or less experienced one to make themselves appear superior, I don't care what level you are EMT, medic or whoever you are its unprofessional.  I been in this game a long time, I'm not impressed with titles, I'm impressed with actions


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## Veneficus (Mar 13, 2011)

CAOX3 said:


> You want to know what s wrong with EMS, you wouldn't have to look much further then the pages in this thread, name calling, degrading comments and unprofessionalism.  We all know the state of EMS education to hold someone personally responsible is ridiculous.  We like to blame everyone else for the problems in EMS however we create most of them ourselves.  Take a look in the mirror, are you doing your part to educate and guide less experienced providers or do you just scan these forums looking for your opportunity to pounce on a inexperienced provider.  Its a DBish move and really shines a light on the lack of leadership in this profession.
> 
> Everyday I'm faced with questions sometimes I have to ask new providers to repeat because I can't believe the words are coming from their mouth. Sure I could laugh, talk behind their backs to make myself look  smarter or I can take the opportunity to educate them. Maybe you should try the latter.  No I cant fix all the problems in EMS, I can't increase educational standards, I can't change the protocol mentality or any other of the billion problems that exist in this profession, what I can do maybe educate one provider on what better course of action may have been the maybe when he gets his oppurtunity he does the same.
> 
> ...



I think there is a very important distinction that is being missed. 

Every effort is made on this forum to guide and mentor new providers. Some have approaches harder than others. 

I do my best to educate the newer people, to share what I have learned. 

But when their reception turns into: "the cookbook says" or "following orders" without regard to the thought processes of patient care to simply justify that not thinking, knowing, or wanting to learn because it takes too much effort. 

Everyone in EMS claims to want to be more than a taxi driver. Some step up and prove it. Some just recess into excuses and wanting to be considered a hero.

The division between educated professional providers and trained laborers has been going on for ages. 

For every one EMS provider who tries to advance the profession, there are 10holding it back with excuses and laziness. You can even see it here on this forum. 

I think people are simply choosing their side. 

Those who want to learn and be better seem to get more slack for their mistakes here, even if there is a personality clash.

Those that tout following the traditions and dogma of yesterday seem to have a harder time. 

I expect that other healthcare fields experienced similar internal struggle when they decided they wanted to be more than the bottom feeders.


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## 18G (Mar 13, 2011)

Its exactly what Vene has said. I said they sounded like a bunch of idiots because they really did and the OP was defending them and playing follow the leader. I'm not a condescending person but there does come a time when you have to call it as it is.


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## emt seeking first job (Mar 14, 2011)

In my EMT class, they said always slap on o-2, and monitor the patient, if they refuse, can not tolerate, or have a bad reaction then take them off.

Once again, unless I am told to do something illegal or against the protocols, I will follow.

ALS did not say to take it off.

The ER staff put him on their own o-2 supply.

Maybe I left a critical part out.

Can anyone cite the NYC REMSCO protocl violated in this situation.

And my question was answered, the patient was unfamiliar with EMS protocols and his speciality had been orthopedics anyway.

As far as the comments, I dont care, I am the most thick skinned person you ever met.


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## usalsfyre (Mar 14, 2011)

Three thoughts here. 



emt seeking first job said:


> The ER staff put him on their own o-2 supply.


If I bring a patient in on O2, the ED usually continues it. If I don't they usually don't start it. 



emt seeking first job said:


> Can anyone cite the NYC REMSCO protocl violated in this situation.


As has been noted a dozen time in this thread, just because it's protocol doesn't mean it's not stupid/outdated/assumes your stupid. 



emt seeking first job said:


> And my question was answered, the patient was unfamiliar with EMS protocols and his speciality had been orthopedics anyway.


Depending on where his practice and if there was a specific are of ortho he specialized in, he was very likely extremely familiar with emergency and/or critical care.


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## 94H (Mar 14, 2011)

emt seeking first job said:


> One of the cardinal rules of the public safety professions is if you are the new guy, keep your ears and eyes open and your mouth shut.
> 
> Imagine if I had never joined the service. What would have happened any way ?



Thats the problem you need to overcome right now. I am relatively new on an ALS bus (7 months), but I still question my superiors (both rank and seniority) when its necessary. 

Like the time I was running with a sup who wanted to give nitro to a pt who had a sys BP of less than 100, before establishing IV access. In that case I was able to convince her to hold off, and IV access was never established, so if we ended up giving the nitro we would have been SOL.


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## 94H (Mar 14, 2011)

emt seeking first job said:


> In my EMT class, they said always slap on o-2, and monitor the patient, if they refuse, can not tolerate, or have a bad reaction then take them off.
> 
> Once again, unless I am told to do something illegal or against the protocols, I will follow.
> 
> ...



You didnt do anything wrong, other then perhaps initiating prompt transport when you decided ALS was necessary. As a general rule, wherever I was working (NYC, PA) we didnt sit and play while waiting for ALS (except with the QRS. Its a judgment call though, and its easy to defer to the senior person simply because they are "senior". 

What I found though is that many of the "senior" people are still working on the same mentalities they were trained on in the 80s. EMS has come a long way, just like new medics always wear gloves for any type of invasive procedure, and those "senior" ones usually dont.


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## emt seeking first job (Mar 14, 2011)

94H said:


> You didnt do anything wrong, other then perhaps initiating prompt transport when you decided ALS was necessary. As a general rule, wherever I was working (NYC, PA) we didnt sit and play while waiting for ALS (except with the QRS. Its a judgment call though, and its easy to defer to the senior person simply because they are "senior".
> 
> What I found though is that many of the "senior" people are still working on the same mentalities they were trained on in the 80s. EMS has come a long way, just like new medics always wear gloves for any type of invasive procedure, and those "senior" ones usually dont.



The explanation given to wait transport is (in our area) ALS i five minutes out and our crew chief wanted a full ALS evaluation before moving him.

(I didnt ask, but the person said that.)

Also, was not said, byt my thinking, there was a very narrow and steep staircase to negotiate and I felt better w/ five pairs of hands on the scoop.


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## Veneficus (Mar 14, 2011)

emt seeking first job said:


> And my question was answered, the patient was unfamiliar with EMS protocols and his speciality had been orthopedics anyway.



But he is still a doctor and knows more about medicne than any EMS provider ever will. 

Also remember that traumatology is originally and still part of orthopaedics. Trauma is one of the most complex parts of medicine, and the molecular and biochemical pathology is the same as any other illness. If he had cardiac insufficency I am sure he was more than aware of what the treatments are, what helps, and what doesn't.

Just because he was unfamiliar with the outdated ineffective medicine practiced by US EMS doesn't make him senile or inept. 

If any medical knowledge is lacking in this scenario it is that of the EMS providers. They could have been just as effective waving a dead chicken at him.


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## Veneficus (Mar 14, 2011)

94H said:


> Like the time I was running with a sup who wanted to give nitro to a pt who had a sys BP of less than 100, before establishing IV access. In that case I was able to convince her to hold off, and IV access was never established, so if we ended up giving the nitro we would have been SOL.



If I could just point out...

Nitro tabs or spray lasts about 5 minutes. People self administer it everyday without taking their BP or starting a line.

I know many female patients whos normal BP is less than 100 who are on nitro.

I think you might have been making this more dramatic than it really is.


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## abckidsmom (Mar 14, 2011)

emt seeking first job said:


> The explanation given to wait transport is (in our area) ALS i five minutes out and our crew chief wanted a full ALS evaluation before moving him.
> 
> (I didnt ask, but the person said that.)
> 
> Also, was not said, byt my thinking, there was a very narrow and steep staircase to negotiate and I felt better w/ five pairs of hands on the scoop.



You can fit 5 people on a narrow, steep staircase?  Swift work.   I thought you used the stair chair.  

Anyway, on stairs, the safest way to move a person is with the stair chair, bumping down one at a time, with one person on the top (or maybe two, but they need to be able to communicate seemlessly), and one on the bottom.

I wouldn't carry a scoop stretcher down more than 4 or 5 stairs.  The angle gets too steep.


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## usafmedic45 (Mar 14, 2011)

> I know many female patients whos normal BP is less than 100 who are on nitro.



My mother is a perfect example of this.  



> And my question was answered, the patient was unfamiliar with EMS protocols and his speciality had been orthopedics anyway.



Wow.....talk about misplaced confidence in one's very paltry knowledge and an inflated sense of importance in the world.


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## emt seeking first job (Mar 16, 2011)

usafmedic45 said:


> Wow.....talk about misplaced confidence in one's very paltry knowledge and an inflated sense of importance in the world.




Please do not be a "forum weenie"....(sigh)

I meant an MD might not be familiar with EMS particulars. The same way a Mechanical Engineer with a PHD defers to an auto mechanic with a tech school certificate to get his dead car to work.

I was just being objective, not putting myself on a higher plane.

Too many people online read into everything........


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## usafmedic45 (Mar 16, 2011)

> Please do not be a "forum weenie"....



I'll try being more saachrin so you don't get your feelings hurt, when you stop trying to defend you being blatantly rude and extremely disrespectful to someone who probably has forgotten more about medicine than most members of this forum- myself included- will ever know.  



> I meant an MD might not be familiar with EMS particulars.



Given the "EMS particulars" you're describing, chances are this guy was a junior attending about the time they were developed, so yes, I'm reasonably certain he knew about what you were trying to do and why you were trying to do it.  



> The same way a Mechanical Engineer with a PHD defers to an auto mechanic with a tech school certificate to get his dead car to work.



The better analogy would be a ASE certified mechanic who works for a Formula One team and the jack*** who learned by tinkering around in his driveway on his Datsun.  A doc knows how to get a person working just as well as an EMT does and then some.  Get over yourself. 



> I was just being objective, not putting myself on a higher plane.


I suggest you read the following.....:
http://en.wikipedia.org/wiki/Confirmation_bias
http://en.wikipedia.org/wiki/Attitude_polarization
http://en.wikipedia.org/wiki/Wishful_thinking
http://en.wikipedia.org/wiki/Overconfidence_effect
....before ever trying to argue that you're being objective.


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## Sasha (Mar 16, 2011)

usaf is a loveable forum weenie.


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## usafmedic45 (Mar 16, 2011)

Sasha said:


> usaf is a loveable forum weenie.


Thank you.  

Sasha, my dear, even you can see that he was rude and disrespectful to the doc right?  I mean, you'd be offended if he assumed you were stupid because you're pretty?  How is it any less offensive that he assumed that because the guy's a doc and not an EMT he doesn't know what is going on and that he's senile simply because he is old and does not immediately agree with what is happening?


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## Sasha (Mar 16, 2011)

Are you being condescending to me? Because if you are I'm going to kick you in your shins.


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## usafmedic45 (Mar 16, 2011)

Sasha said:


> Are you being condescending to me? Because if you are I'm going to kick you in your shins.


No ma'am.  That was a genuine "thank you" and an honest question.


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## Sasha (Mar 16, 2011)

Yeah, I think it was a jerk move to assume because the patient didnt agree and was old that he was senile. He just wasn't buying the BS and was bullied into taking a treatment that he didn't need.

Patient advocates they were not, and that makes me have a sadface.


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## usafmedic45 (Mar 16, 2011)

Sasha said:


> Yeah, I think it was a jerk move to assume because the patient didnt agree and was old that he was senile. He just wasn't buying the BS and was bullied into taking a treatment that he didn't need.
> 
> Patient advocates they were not, and that makes me have a sadface.



Thank you.  I figured if you saw it, then it must actually be there because you're always giving folks the benefit of the doubt. 


The persecution rests.


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## Sasha (Mar 16, 2011)

i find the defendant guilty of bad medicine. On to sentencing?


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