RocketMedic
Californian, Lost in Texas
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To start, a few bad ones, with context:
When discussing treatments for a deep neck laceration with arterial bleeding, from a system-cleared paramedic.
"I would put a Halo (circular chest seal) over it and continue my assessment."
"...the Halo will control bleeding and keep the blood in. All we need to do is get them to the trauma center. That's why we keep 10-minute scene times." (Yes, he made the case that crappy care is excusable because "it's different than the Army, we're not being shot at, you have to worry more about C-spine" and "we have short transport times, so they won't bleed out."
(This is in a system that does have protocols and even combat gauze for packing nontourniquetable hemorrhage.) To this medic's credit, he did go ask Education and was set on the right track.
When discussing the same thing, a fellow paramedic-orientee: "I don't want to have this argument, but I'd just put a pressure dressing over it and tape it down. That's going to control arterial bleeding. You can't put pressure on the neck because you'll cut off bloodflow to the brain. You'll kill half of their brain." (Yes, she thought that controlling hemorrhage was more likely to be fatal than allowing exsanguination).
Sadly, this medic did not educate herself, and I hope she never gets a call like this.
From another (experienced) medic: "It doesn't matter if they have a hemothorax, you can ventilate the lungs open anyways. Don't worry about barotrauma, they're ICU's problem after we drop them off." (in response to the potential of sitting patients with suspected hemothoraces up (IAW TCCC guidelines) as opposed to C-spine, supine, with Trendelenberg for shock.
"Dude, you're a wuss on intubations. I've never used a flex-guide (bougie) and I've never missed a tube." -from a very young, brand-new medic. (I use a bougie on almost every patient I intubate, and generally find it easier and faster than trying to fight with a short stylet.). Same young medic also seems to think that "Kings are for people who don't have skills" and not understand that some patients simply don't need to be intubated at all, much less left hypoxic from multiple attempts to intubate a difficult airway.
These are a single day's snapshots of what needs to change in this field. We have many people who are professionals, who strive to improve and learn, and who are not, for lack of a better term, willfully ignorant. We also have a lot of people who should probably find alternate employment.
To round it out, here's a family quote of wisdom.
"I'd rather be a wuss with 100% success rates on dangerous interventions like intubation, good assessments, and a solid grasp on the situation than a stud with 50% success rates, poor assessments, and a load of hot air. We have training and tools for a reason. Use them right or don't use them at all." -Dad.
When discussing treatments for a deep neck laceration with arterial bleeding, from a system-cleared paramedic.
"I would put a Halo (circular chest seal) over it and continue my assessment."
"...the Halo will control bleeding and keep the blood in. All we need to do is get them to the trauma center. That's why we keep 10-minute scene times." (Yes, he made the case that crappy care is excusable because "it's different than the Army, we're not being shot at, you have to worry more about C-spine" and "we have short transport times, so they won't bleed out."
(This is in a system that does have protocols and even combat gauze for packing nontourniquetable hemorrhage.) To this medic's credit, he did go ask Education and was set on the right track.
When discussing the same thing, a fellow paramedic-orientee: "I don't want to have this argument, but I'd just put a pressure dressing over it and tape it down. That's going to control arterial bleeding. You can't put pressure on the neck because you'll cut off bloodflow to the brain. You'll kill half of their brain." (Yes, she thought that controlling hemorrhage was more likely to be fatal than allowing exsanguination).
Sadly, this medic did not educate herself, and I hope she never gets a call like this.
From another (experienced) medic: "It doesn't matter if they have a hemothorax, you can ventilate the lungs open anyways. Don't worry about barotrauma, they're ICU's problem after we drop them off." (in response to the potential of sitting patients with suspected hemothoraces up (IAW TCCC guidelines) as opposed to C-spine, supine, with Trendelenberg for shock.
"Dude, you're a wuss on intubations. I've never used a flex-guide (bougie) and I've never missed a tube." -from a very young, brand-new medic. (I use a bougie on almost every patient I intubate, and generally find it easier and faster than trying to fight with a short stylet.). Same young medic also seems to think that "Kings are for people who don't have skills" and not understand that some patients simply don't need to be intubated at all, much less left hypoxic from multiple attempts to intubate a difficult airway.
These are a single day's snapshots of what needs to change in this field. We have many people who are professionals, who strive to improve and learn, and who are not, for lack of a better term, willfully ignorant. We also have a lot of people who should probably find alternate employment.
To round it out, here's a family quote of wisdom.
"I'd rather be a wuss with 100% success rates on dangerous interventions like intubation, good assessments, and a solid grasp on the situation than a stud with 50% success rates, poor assessments, and a load of hot air. We have training and tools for a reason. Use them right or don't use them at all." -Dad.
