Where has commonsense gone?

mycrofft

mycrofft

Still crazy but elsewhere
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EMS needs its version of "Notebooks of Lazarus Long" or a serious "Murphy's Laws of Commonsense EMS" or some such. Things like:

1. Don't drive or ride with a co-worker who is high, drunk, or acting like they are. (It isn't a matter of HOW impaired; if they are acting impaired, just say no). By the same token, if it is anywhere NEAR a work shift, ABSTAIN.

2. If you are hurt, say so, don't keep working.

3. Don't work for a horse's ***, because when trouble comes, he/she/they will throw you under the legal bus.

4. If your assessment does not indicate a treatment, don't do it.

5. If you assessment does indicate a treatment, do it.

6. Keep reassessing and documenting.

7. If you have a selection of treatments, do what is needed to keep the patient alive right now, then consider how long you will be in transit versus the benefit of anything else you "want" to do. (See #4 above).

8. Remember, no one was ever discharged from a hospital to an ambulance for superior or equal care. The hospital has more tricks and doctors than you.

9. Don't get so busy doing things on scene before you can load that the patient runs out of time. That's called "Target fixation" or "getting into the 'coffin corner' ". (See #8 above).

10. Data gathering which does not support your immediate treatment or greatly improve hospital treatment distracts you from thorough assessment and immediate measures. Patients die while practitioners watch the monitors. Treat the patient. (See #9 above).

Seriously, anyone else have any contributions?
 
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11. Keep learning and do not be afraid to go to the next step. Why be an underpaid EMT hyphenated-stepchild (EMT-IV etc etc etc) when you can be a Paramedic or higher, make more money, learn more, and do more?
 
12. It's called "patient care" because it isn't about you. What an excellent opportunity to forget your problems, be your best, and "fill your karma cup"! (as someone once said here).
 
13. Remember, you are not repo man. (See #12 above).
 
14. Remember to learn and preserve the balance between going too fast (efficiency) versus taking too long (effectiveness). (Excesses on the first end are known as "carelessness", on the second "nitpickiness").
 
15. DO assessments right, then trust your assessment above all else. Weigh the history against the assessment then trust it too, but make sure the "Objective" part of SOAP doesn't merge with the "Subjective". You alone are responsible for the assessment, and must defend it when needed. Sometimes all you can say on patient turnover is "That's what I got, I can't change it. If you have a better way to do it, please teach me how".
 
16. You wouldn't accept a weapon without checking it yourself first. Don't accept a vehicle until you have inspected it yourself. Come early if you must, but hearing the last oxygen whistle down the tube or finding the airways are missing the most popular sizes has a unique feeling, and you have no excuse. (See #3 above).
 
17. Trust your spider sense. First impressions are often valid if you are using instinct and not buying their glitz or their theatrics. IF something feels wrong or dangerous, act on that.
PS: If you are prone to superstition or unscientific conclusion-jumping or protocol rupturing, get a second opinion.
 
18. Don't whine.
 
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18. That's right, do not whine.
(Thanks Achilles)
 
19. Remember without protocols and a sponsoring agency a paramedic or EMT is a first-aider with an inflated sense of self-worth and too much education and tools for what she or he is allowed to do. Ignoring or gratuitously going off-protocol is the same as not having them. They are there for a few reasons and none of them is to make you frustrated.
 
Don't be a lazy bum, do your morning rig checkouts.
 
Don't be a tool.

Sorry I had to.
 
I don't care if the baby isn't breathing, if your a diabetic, or you just lit your brother on fire, if I don't know where you are, I can't send help.

I don't care if the baby was just shot by a stray bullet, or the assault victim is no longer breathing, until the cops secure the unsafe scene, EMS should be staging. Even if it takes an hour for them to show up.

Make sure you go home at the end of your shift.
 
Good ones all.
Font size 4, font Book Antique, bold
 
26. The nice media people are not your friends. They are not your enemies, but you are their prey.

27. The media will publish it wrong, at least partly, every time, and you cannot change that even if you sit them down and draw a picture
 
28. The media will always be there, and if you ignore them, and pretend they don't exist, they will still publish content about you. It's always better to be proactive and have them on your side, and have media contacts so you can give your point of view, than to ignore them and hope they go away. At least that way when you draw them a picture and they still screw it up, at least you can say you tried.

29. We all make mistakes in our career. Anyone who says they never have, is either new to the field, or a liar. The most important thing is to not repeat your mistakes, and to learn from them.
 
The Patient will excrete their body's waste fluid at the most inconvenient time.

Wear gloves (and optimally a mask). If you dont wear gloves you are not a hard riding hero, you are just stupid.
 
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30. "That's someone else's job!" is NOT an acceptable reason to sit back while your colleagues labor.

Good thread
 
31: Keep checking vital signs; when you are doing 1 set at start of run, and the last set at the bed at the end of the run; and it is a 2 hour transport: DON'T be surprised when the patient is dead (and has been for awhile).

32: don't trust the machines: always do a manual set of vital signs
 
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