What you want?

[kecpercussion]

What do you guys expect your EMT partner to know about your preferences?

For example: What size needle you prefer and such...

 

[PapaBear434]

We don't have regular partners in our system, you just get random people depending on how the schedule works out. But as far as what gauge you want, the standard is 20 so that's what you get unless told otherwise.

 

[medic417]

No 20 is not the standard. There is no standard. Each patient must be evaluated and based on patient an educated decision must be made as to what size IV catheter to use or even if IV is needed, whether an EKG is needed, etc etc.

 

[medicdan]

What do you guys expect your EMT partner to know about your preferences?

For example: What size needle you prefer and such...

Are you talking about a basic partner or a medic partner? I have other things I like to know about my partner, that we cover before even intiating patient care... but I feel like that isnt what you are looking for...?

 

[kecpercussion]

Im talking bout what are the main things a basic partner should know about his medic partner's preferences?

 

[EMS49393]

I only have two standard preferences. First, I wear small nitrile gloves. I generally get the initial gloves for my partner and myself anyway because they're driving. Secondly, I like the trash bin next to me when I'm doing anything in the back of the ambulance. I HATE making a trashy mess in the truck.

Other than that, I don't have actual "preferences." Every patient is different, and I can't determine what I need until I make an assessment. I'd love a nice, big 18 anytime I'm giving D50, but I'm lucky to get a 22 on some patients, and I adjust my dextrose concentration accordingly. I'd love to intubate every patient with my favorite mac 4 blade, however I've had to change that up depending on how my patient is shaped and where I find them.

Most of all, I just want my partner to be professional, and if they don't know how to do something, I want them to admit it and let me teach them. I hate asking someone to do something only to look up several minutes later and see them struggling because they were afraid to tell me that they didn't understand the directions or do not know how to do something. I try to be good about letting my partner know as soon as possible what I'm going to be doing and what I need so they can be prepared.

 

[PapaBear434]

No 20 is not the standard. There is no standard. Each patient must be evaluated and based on patient an educated decision must be made as to what size IV catheter to use or even if IV is needed, whether an EKG is needed, etc etc.

I think you misunderstand. I meant in MY system, 20 is standard. It's what we're going to put in MOST people, because it's big enough for most meds but not so big to blow veins easily. Obviously, large bore for trauma, 22-24 for peds or extremely old/frail...

 

[ResTech]

Agree with the standard 20g... everyone gets a 20g unless a ped or trauma patient or some other special circumstance exist.

 

[akflightmedic]

Agree with the standard 20g... everyone gets a 20g unless a ped or trauma patient or some other special circumstance exist.

Please do not take offense but it is this kind of thinking that needs to be eliminated.

There is no "every" and there is no "never".

To say unless a pediatric or trauma they will get a 20 is impractical and reflective of cookbook methodology.

As someone said previously, every patient gets an assessment and a determination is made at that time.

If you have preconceived notions of what a patient will or will not get, you only limit yourself as you box in your thinking or tunnel vision your thoughts. This may eventually be harmful to the patient.

 

[knxemt1983]

What do you guys expect your EMT partner to know about your preferences?

For example: What size needle you prefer and such...

Me and my partner have worked together long enough that normally she knows what I want and has it ready for me when I need it. every pt gets largest practical bore needle to get it with as few trys as possible (18 is usually biggest unless I want a bolus etc, , but every pt is different). she knows, to get 12-lead cables out and ready for cp, sob, non-descript ABD pain or n/v (yes just last week we caught an inferior MI on a n/v after eating dinner a great door-to-needle time). theres still stuff we are working on, but you have to remember not all partners are the same, not all calls fit into a "recipe".

so to answer your question, I expect nothing more than to watch my back (especially on certain scenes, shootings, domestics, wrecks etc), to keep pt care a priority, and for teamwork. the rest of the stuff we'll work out together, and when she has stuff ready for me how I want it, then things are just that much better

 

[PapaBear434]

Please do not take offense but it is this kind of thinking that needs to be eliminated.

There is no "every" and there is no "never".

To say unless a pediatric or trauma they will get a 20 is impractical and reflective of cookbook methodology.

As someone said previously, every patient gets an assessment and a determination is made at that time.

If you have preconceived notions of what a patient will or will not get, you only limit yourself as you box in your thinking or tunnel vision your thoughts. This may eventually be harmful to the patient.

Seriously? I already stated the reasoning behind using the 20g. Why is THAT a big deal with you? Yes, I make an assessment based on the patient, their veins, their condition, whatever. Yes, I judge which gauge I will need. Most of the time, that happens to be 20g, because, as stated, it's big enough for meds but not so big to easily blow out veins.

It's kind of a silly thing to find fault with.

 

[akflightmedic]

Seriously? Did I quote you?

I think not...

 

[PapaBear434]

Seriously? Did I quote you?

I think not...

You quoted a guy who agreed with me. Who echoed what I said. And you proceeded to nitpick the methodology of preferring one gauge cath over another for perfectly logical reasons because you... I don't know why. Making a ruling on the rest of our patient care as "cookbook" simply because we use a "typical" item in most non-emergent cases seemed needlessly judgmental.

 

[akflightmedic]

Can you dispute anything I said in that comment...can you prove my words were wrong?

If not, then you have no debate other than to defend ego. The words he chose to use are exactly why I picked them apart and explained why I did so.

Learn from it and move on.

 

[Sasha]

You quoted a guy who agreed with me. Who echoed what I said. And you proceeded to nitpick the methodology of preferring one gauge cath over another for perfectly logical reasons because you... I don't know why. Making a ruling on the rest of our patient care as "cookbook" simply because we use a "typical" item in most non-emergent cases seemed needlessly judgmental.

Your treatment shouldn't be about preference. That's like saying "I prefer a mac blade over a miller blade for every patient" when they both have their uses based on the anatomy of the patient's airway.

It is based on assessment of the patient and their needs.

One must wonder if you cookbook IVs what else you cookbook.

 

[PapaBear434]

Can you dispute anything I said in that comment...can you prove my words were wrong?

If not, then you have no debate other than to defend ego. The words he chose to use are exactly why I picked them apart and explained why I did so.

Learn from it and move on.

I can't dispute it, because if you notice I said that yes, it's an assessment of the patient. But as far as the basic partner is concerned, you'll be using a 20 unless told otherwise. They are all in the box in front of me, so if he sets out a 20g, and I decide I want to use an 18, I just have to move the two inches over and grab it. But a 20g is assumed, because it's the most commonly used.

What I take exception to is you...

Your treatment shouldn't be about preference. That's like saying "I prefer a mac blade over a miller blade for every patient" when they both have their uses based on the anatomy of the patient's airway.

It is based on assessment of the patient and their needs.

One must wonder if you cookbook IVs what else you cookbook.

...and you, making these judgment calls on EVERYTHING people say here that doesn't conform to your own theology of EMS. I get it, every patient is different, every judgment should be made independently without bias or preference blah blah blah... But you know as well as I do that certain routines happen, and sometimes happen for good reason and not just laziness.

We prefer the 20g, the hospitals prefer the 20g, but we use something else when it warrants. Why exactly is that wrong with you guys, as it seems to conform to what you guys are saying in all but the philosophical zen aspect of your statements.

 

[akflightmedic]

I can't dispute it, because if you notice I said that yes, it's an assessment of the patient. But as far as the basic partner is concerned, you'll be using a 20 unless told otherwise. They are all in the box in front of me, so if he sets out a 20g, and I decide I want to use an 18, I just have to move the two inches over and grab it. But a 20g is assumed, because it's the most commonly used.

What I take exception to is you...



...and you, making these judgment calls on EVERYTHING people say here that doesn't conform to your own theology of EMS. I get it, every patient is different, every judgment should be made independently without bias or preference blah blah blah... But you know as well as I do that certain routines happen, and sometimes happen for good reason and not just laziness.

We prefer the 20g, the hospitals prefer the 20g, but we use something else when it warrants. Why exactly is that wrong with you guys, as it seems to conform to what you guys are saying in all but the philosophical zen aspect of your statements.

I know you could not or would not dispute it because of your previous statements, it was more rhetorical than anything; however the point of the statements was to remove those two words I quoted for exactly the reasons I stated. A tangent yes, maybe a bit too deep for some...a little too zen-esque.

Again what you prefer and what the patient requires are two different things, but at this stage you seem to be in a perpetual state of obstinacy, so it is of little use to debate this any further when you intentionally refuse to see the obvious.

Routines lead to complacency, complacency leads to...

If I am able to shake the tree from time to time and open the eyes or assist someone with exposure to a different line of thinking or procedure, then we are all the better for it...me being right or wrong is irrelevant as long as it gets others to think and/or challenge. (More zen for ya).

And finally, again you used "everything", please review my post history and tell me that 100% of my posts are judgment calls and in direct response to conflict with my own theology of EMS (which I didn't know I had); do I get royalties?

Have a zenful day...I am!

 

[PapaBear434]

I don't know, AK, you seem to do this a lot. You, Sasha, even Rid. Going after a legitimate screw up or disagreement, like going straight to IO without even attempting an IV or my previous statement from the dead thread about our system rarely using pain control protocols, I can see.

But in this, you are arguing a philosophy. You guys assume that since we use a 20g most of the time, we are just going to shut off our brains and just use it without due regard. Sasha took it the step further and evaluated our entire service ability as "cookbook" because we stated that the Basic providers, when setting up an IV for us, set aside a 20g without asking because that's most commonly used.

You're not shaking any tree, you are just looking down your nose and attempting to appear as so much more enlightened by spouting the concept everyone already knows: Every Patient is Different and Requires Different Treatment. We know that.

It's being practical, and it's so simple Goldilocks could understand. It's not too big, it's not too small, it's just right. I should be able to say that without putting a disclaiming on my post to satisfy the nitpickers out there. (some patients may vary, void where prohibited, the statements found here do not represent that of Virginia Beach EMS or that of anyone other than the poster, offer valid while supplies last, see rules to apply, do not read while under sun lamp or other artificial UV device, do not read post if you have a heart condition or are pregnant or may become pregnant, standard standards and practices apply...)

Oh, and Edit: The use of the word "everything" is hyperbole. Just the last couple days, this attitude is taking hold as everyone rushes to be holier-than-thou. Myself included.

 

[Sasha]

Sweetheart, I am just stating my opinion on the subject, you're the one taking it as a personal attack and in return attacking others.

 

[PapaBear434]

Sweetheart, I am just stating my opinion on the subject, you're the one taking it as a personal attack and in return attacking others.

Your "opinion" was that because we have a routine that says that while I am setting up the monitor and the Basic is laying out a 20g while setting up the IV before we even look at the patient's veins, that our service (and my patient care) is under suspicion of being "cookbook."

I wonder why I would take offense to that.

If you have an opinion about how someone provides care, that's fine. But as mentioned, you guys (and you in particular) are throwing the "cookbook" flag on the basis of the most commonly used gauge cath.