Who knew?

[Veneficus]

Actually I apologize ven, I wasn't really as verbose in my first post as I thought I had been. So to clarify, what's really getting me down is my company. I'm absolutely grateful to be able to volunteer when i want and have no quotas, but it's frustrating to work in what I consider to be a serious job (and we can agree to disagree) with people who are so lazy and apathetic.

I understand what you are saying. I am trying to point out most of EMS is like that.

There are a handful of extremely reputable places and a few more mediocre places.

What you are seeing is what is is.

 

[Veneficus]

Learning moment for me- can you explain this in layman's terms, Vene?

IMO, "dramatic acute rearrangement" of anatomy via high-energy events is far, far *easier* to manage than systemic organ damage. One gets you a surgeon. The other gets a shortened lifetime filled with medical visits, attention, and the gradual collapse of your body's capabilities.

There are 2 phases of trauma.

the first which most field providers see is the failure of delivery of o2.

Think of it like a train. There is the heart (the engine) the blood compnents (the cars) and the vessles (the tracks) What you see and are taught about here is a problem with this train and tracks.

However, anytime the body is disrupted, like purposefully cutting in surgery, accidentally getting shot, stabbed, crushed, etc, a systemic inflammatory response is initiated.

These 2 issues always happen. In septic and anaphylactic shock you start with inflammation and progress to failure of o2 delivery.

Inhemorrhage and neurogenic shock you start with failure of O2 delivery and progress to inflammation.

But they are 2 sides of the same coin. One does not exist without the other.

Following your high energy rearrangement, fixing o2 delivery is the surgical part of the treatment of trauma, but immediately and always following trauma then becomes a critical medical disease.

That is why it is one of the toughest (if not the toughest) pathologies in medicine. It is both surgical and medical.

Stopping bleeding is not enough. It is simply a part. The real game begins when you are trying to stop the inflamatory system from destroying the body organs after the o2 delivery is restored.

That is what kills truma patients days, weeks, or months later in the ICU.

This is what stops them from regaining full function.

This is what stops us from simply attaching limbs back on all the time and them working.

It is the exact same molecular processes as sepsis. If you can take care of sepsis, you can take care of trauma and vice versa. If you are not good at both, then you will never be good at either.

 

[the_negro_puppy]

Even though it may seem like the grass is greener on the other side, permit me to give you some perspective.

Even the "exciting 911" service gets really monotonous after about 2 years.

In all of EMS in the US and infact Emergency Departments (which see much higher volumes of patients than ambulances) only about 5% are life threatening emergencies on average.

In the modern developed world, we see more exacerbation of chronic conditions than acute conditions. Which means you are more likely to see "sicker" patients while doing interfacility work than 911 response.

Those patients will also be more complex cases. (I like complex cases)

The area you work in also makes a difference. The lower the socio-economic level, the more emergencies you will see. However, many providers don't like these populations because they call often for everything because they do not have the knowledge to know what is an emergency and what is not. They are generally non-compliant with treatment for a variety of reasons, and most of their problems are either preventable or socially unacceptable in middle and higher levels of society.

Very few have the fortitude to have long term careers in such an environment. They are usually very admired by most of their peers and colleagues.

If you got involved with EMS for the exciting guts and glory, I think you will be very disillusioned.

You cannot change what you have gotten into, but you can change your perspective of it.

Look for small victories. A great success is best measured by how much you help somebody, not what medicine you provide. The most amount of help doesn't come from a drug or a procedure, it comes from making people feel better. What you say, how you say it.

People never remember providers for their medical capability, patients remember and celebrate how the provider made the patient feel.

Welcome to medicine.

 

[RocketMedic]

Many thanks, Veneficus.