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How Paramedics function


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#1 Corin.Hamelton

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Posted 03 January 2014 - 11:13 PM

I thought I would speak to my profession since paramedicine has been badly distorted by the media and television.  First off, I'm a paramedic and we NEVER leave a patient unattended in the back of the ambulance.  I've seen tv shows where they put someone in the back and then both paramedics go sit in the front... preposterous!!!

 

We're not ambulance drivers either... we are either EMR/EMTs or Paramedics depending on license level.  Paramedics have a medical license and have to go to college, but in most areas they start as EMR/EMTs.  In places where both partners are the same license, they take turns attending and driving, but some areas only have an EMR/EMT and a Paramedic, so the Paramedic usually attends.

 

The ambulance is a tool and a mobile hospital bay.  We are trying to make people aware of the distinction between an ambulance and Paramedics... so be kind and mention us by our profession, not the ambulance.

 

 

Anyway.  9-1-1 is activated.  A call is received by a call taker at a 911 center and a series of questions are asked in order.  The answers given determine the following questions, like a choose your own adventure.  While the call taker is asking those questions, the call is being assigned to the closest ambulance by a dispatcher.  Many services use a CAD (computer assisted dispach system) where paramedics can see the same info that the dispatcher is getting from the call taker.

 

In some areas, Fire has ambulances.  In Canada, it is a separate service but Fire Depts often attend for certain types of calls because they have more stations and can get to a scene quicker.  This is only useful for cardiac arrests, choking/difficulty breathing, and serious trauma where first aid may be helpful.  They also attend on auto accidents to control traffic, manage fuel leaks, disable air bags and to free trapped patients using the jaws of life or other power tools.

 

Paramedics go straight to the call.  We don't stop for coffee on the way or finish eating our food... it's go go go right from the jump.  Not all calls are lights and sirens, but that doesn't change the response... on the air and to the call in less than 90 seconds regardless.

 

When we go lights&sirens, we don't put the hammer down... those ambulances are heavy and don't stop quickly or corner well. People that don't pull over to the side of the road are jerks and are a constant headache for us... but in fairness, they usually can't hear the siren until we're right on top of them.  We drive a little over the limit and we stop for red lights and signs to sure it is safe to proceed... t-boning a vehicle is our fault.  We also shut it all down if we get to a crowded intersection and can't get through.  We don't push people through red lights because that's unsafe.  We just wait till we can get through and then we light it up again.

 

When we arrive, we pay attention to scene safety.  It's a dangerous job.  Sometimes we have clues and are directed by dispatch to wait out of sight until the police can clear the scene and sometimes we make that determination for ourselves.  Suicidal patients, assaults, stabbing/shootings, etc. are dangerous scenes so we don't enter without the police... we're useless to the patient if we get injured too.  Lots of times there are dangers like dogs and neighborhood gangs and stuff we also have to deal with.  And not everybody wants to go to the hospital... drunks, junkies, head-injured people... they never want to go... but when they are injured, they HAVE to go because their considered vulnerable... so they often want to fight instead.

 

If the scene has been cleared or was safe and no police were needed, we enter the premises and begin with asking what is going on here... we also note the environment of the area.  Is it dirty? Crowded? Empty alcohol containers? Drugs? Weapons? etc. for a general impression.  Same for car accidents, etc.  We need to understand all the forces that could be a part of the mechanism of injury or illness.

 

We don't move patients that have injuries.  Even if it is a little old lady that fell off the couch and says she just needs back up.  We assess them first to make sure they don't have a broken hip or something so that we don't make it worse.  If they have a medical complaint, we ask them to remain seated or to sit down so we can assess.

 

typically, the attendant will ask a lot of questions and physically assess the patient.  This includes listen to lung sounds and inspecting/palpating areas of the body where there is a complaint.  During this time, the driver will have asked for identification and a care card/ insurance, medications, and then began to take vital signs.

 

If the patient is unconscious, the attendant will ask a few questions and usually do some of the vitals with the driver's help.  Once they have an idea, they work together... so for a diabetic call, the attendant will take a blood glucose reading and if the sugars are low, start an IV.  The driver will spike a bag of dextrose with a drip set and let it run through to prime the line to get it ready for the IV... that is, if it is within the attendant's scope of practice... scopes vary by license and service.

 

There's lots of different equipment and the driver usually has to decide how to get a patient safely out of a house to the ambulance.  The cot is brought as close as possible without going up or down a flight of stairs.  We also have stair-chairs for this purpose, or we may just carry the patient if it is necessary on a spineboard, clamshell, or just fore-and-aft in our arms.  It all depends on the condition of the patient.  We don't walk people that are having a STEMI (heart-attack) and patients having a triple-A get moved VERY carefully.

 

Patients that are stay and play are stable patients.  This may be asthma or a broken bone.  In which case we may nebulize some ventolin and let the patient breathe it for 10 mins before doing another pulmonary exam and then leaving, or we may spend time to stablize and give paiin control, etc... again as per license scope.

 

In the ambulance, we have all of our gear found in the jump kits and more.  The attendant rides in the back and sometimes we'll take along a police officer or fire fighter or another paramedic if there was another car at the scene, if the condition warrants it.  Unstable patients get a lights&siren response to the hospital... otherwise we just drive there routinely (which is what it is called: going routine).

 

We re-check our initial interventions and treatments with a head-to-toe exam.  We may improve on those if necessary or given more medications, or consult with a doctor over the phone for advice on giving another dose per protocol, etc.

 

Except for trapped patients, or cardiac arrests, protocols, or something that will confine the patient to the scene, we don't usually start IV's until we're in the ambulance.  It's about using our time wisely and there is no sense in wasting that time for salty water.  We can just as easily do it en route to the hospital in most cases just by preparing everything and then getting the driver to stop the ambulance for 5 seconds while the attendant pokes.  Once the catheter is in, GO again.

 

The ambulance goes where the patient needs to go... so we may need to get the patient to a helicopter with critical care paramedics to take the patient to an appropriate hospital that is too far away.  By ground, we prefer to take cardiac patients to hospitals with a cath lab, stroke patients to hospitals with CT scanners, etc.

 

Once at the hospital, we hand off most of the patients as described in my other thread... or we may need to stay and help the ER staff while giving the report... they get short handed very quickly.

 

 

Okay, this is a brief description because every situation requires its own response and treatment plan... but this is basically the foundation of any call.

 

Then there's the dark humor of Emergency Services... we see things that we laugh at as a coping mechanism or we would have PTSD in no time at all.  So we are quite dark and perverse in our humor... we also have a lot of fun.  Cops and Paramedics get along quite well.  Fire fighters are kind of their own group because there are so many of them together... it's a lifestyle more than a job too, and we're all under paid and under appreciated.

 

 


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#2 Corin.Hamelton

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Posted 03 January 2014 - 11:21 PM

Oh.  A few no-no's that I've seen.

 

We don't shock patients that are flat-lined... that's an Asystole rhythm and there's nothing there to shock.  Defibrillating is all about resetting a chaotic heart rhythm... crazy wavy lines that are Ventricular Tachycardia or Ventricular Fibrillation.  And we don't beat on the chest with our fists... that's a precordial thump and is only performed ONCE if we witness the arrest... and not all services do it.

 

 

Spinal immobilization... okay, a patient with a hard collar is immobilzed to a spineboard or a clamshell... never without or to the stretcher... the collar doesn't do anything but remind a patient not to move their head.  If we suspect a spinal injury or the mechanism of injury is suggestive, then we collar and immobilize.  It's an all or nothing intervention.  So if your character has been in a car accident or fallen down a flight of stairs, they will be immobilized so that they can't move around.  The head-neck-body... all restricted from movement until xrays can be done at the hospital.


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#3 Corin.Hamelton

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Posted 03 January 2014 - 11:26 PM

Here's a picture I took from a call on my CAD a week ago... it's been edited to remove information that could identify anyone.

 

Attached File  shitty call.jpg   29.98KB   11 downloads


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#4 SC_Author

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Posted 05 January 2014 - 01:04 AM

Amazing info; and that image  you posted sounds like something out of a horror novel!


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#5 Aightball

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Posted 05 January 2014 - 11:08 AM

Was there a dead body? That's creepy...

 

This all valuable information! I used to work on a cardiac floor and you NEVER shock a flatline...at that point, the patient is gone. It's rare that they come back from astyole. I remember watching shocks to V-fib and V-Tach...that was scary the first time it happened. I also remember the first time a patient's heart rate shot up over 200 and they had to be given...the name of the drug escapes me now, but it stops the heart for a few seconds to slow it down. Glad they sent down a nurse to sit with me for that one =). Atropine, maybe? Anyway, scary stuff.

 

Your posts will definitely help me as I start editing. I want to make sure my research and knowledge is good for my characters (an EMT and a Paramedic) and that I'm doing things correctly! Thank you for posting this stuff!


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#6 Corin.Hamelton

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Posted 06 January 2014 - 12:19 AM

My pleasure.

 

No, the guy wasn't dead... however, if he had been, he would have smelled better.  This patient was using his bed as both a bed and a toilet for a few weeks... it was nasty.  There were rats jumping around the cupboards in the kitchen and the place was a hoarder's nightmare.

 

Dead bodies are a common part of a paramedic's job so they aren't creepy after the first few.  I guess after awhile, nothing phases us any more.  I use it to my advantage as a writer because I have actually seen the things that other people have nightmares about so I can describe it very well and with my warped imagination, I can go even further with it.  :D


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#7 tinesy05

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Posted 09 January 2014 - 05:25 PM

Thank you Corin. I too am an EMT and it irks me when things are misconstrued in the main stream media. In fact, I took extra care to carefully explain a wreck scene in my novel Running Out of Days. (Shameless plug I know.) Thank you for posting this here. More people need to be aware.

#8 Aightball

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Posted 09 January 2014 - 05:42 PM

Of course, now I'm chewing my nails wondering if I got two of my big scenes right in my book...either of you willing to read two short scenes and let me know if I bungled anything? I like to think my research is solid but you never know...


Most girls are made of
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#9 Corin.Hamelton

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Posted 11 January 2014 - 05:58 PM

I don't mind.  Send me a PM with your email.


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#10 tinesy05

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Posted 11 January 2014 - 09:16 PM

Aightball, I'll read too.. PM me and I'll take a look.




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