By: Kate Pula, Captain, 2013-2014
As EMTs we do not provide official diagnoses for our patients but in EMS care it is important to differentiate between call types. In this spirit, each month I’ll present a short scenario and either ask you to provide a treatment plan or tell me what’s wrong. So, without further ado…
You are dispatched to a residence hall for an 18 year old female with difficulty breathing. When you arrive on scene you find the patient on her bed, breathing with shallow breaths. She reports she had a cold for the past week, but when she went to the gym today her chest started hurting during her workout.
Your patient is allergic to dust and pollen. She takes allergy medication seasonally. She also reports a history of asthma, and has an inhaler prescribed to her. However she has already taken two puffs on the inhaler, and her breathing has not improved. She also reports that this does not feel like an asthma attack. You put the patient on a non-rebreather set at 12 lpm and take your first set of vitals. You get 120/70 bp, 80 bpm, 22 resp/min, patient feels warm to the touch, and during lung sounds you hear crackling sounds in the top of both lungs.
The patient confirms that the oxygen is improving her breathing; however she still has pain in her chest when she breathes. She also mentions that with the pain in her chest, she has also had a deep racking cough today. Patient asks your opinion on whether she should wait to go to Baldwin in the morning, however with all these symptoms adding up, you know this shouldn’t wait.
What is wrong with your patient? Send your thoughts to email@example.com.
By: Peter Florio, Equipment Officer, 2013-2014
The New York State Department of Health recently approved the use of Naracn (also known as Naloxone) for use by Basic Life Support (BLS) ambulances. Previously, it was only used by paramedics and hospitals to counteract the effects of drug overdoses, specifically of opiates (heroin, morphine, etc). It is very fast-acting (typically within only a minute or two) when given via IV, however the version BLS has been approved to use is a nasal version (BLS can’t use IVs). The nasal spray won’t act quite as fast (about 5 minutes), but will get the job done just as well as an IV. Narcan has also been approved for trials with agencies other than EMS. Some Police Officers are also being trained on Nasal Narcan, namely on Long Island (go LI!). They’ve been able to save dozens of lives this way.
If you ever need to use Narcan, your patient may not be too pleased with you right after. Narcan will almost immediately “kill the high” that the patient was on from his/her opiates and sends them into withdrawal. Possible side effects include vomiting, dizziness, fainting, and it may also block certain endorphins that are responsible for reducing pain, so be prepared.
According to the Department of Health, state certification is not a requirement to become certified to use Narcan. It is possible that we could use it at Vassar relatively soon, we would just need to get approval from Baldwin and go through the proper training (so stay tuned!). If anyone is interested in the New York State Narcan protocols, feel free to contact Kevin Lee or look them up on the NYS Department of Health website.
By: Kevin Lee, Training Officer, 2013-2014
For the EMT, cold weather sucks. There is nothing good about freezing temperatures. The equipment stops working because the batteries freeze, your ambulance does not start because the engine is frozen and even if you do get it starting again, ambulances are rear-wheeled drive with a huge top, disproportionate weight and have light truck tires that are too small to put chains on. So imagine how ambulance drivers feel when they have to respond to high priority patients in the snow. To make matters worse you have to carry three or more huge bags of equipment and something to carry the patient on, all potentially in a snowstorm. The result is a very unhappy, cold and wet patient being loaded on an ambulance with a slushy, slippery, wet and disgusting floor that you will have to clean out again after your call.
Thankfully here at VCEMS we do not have an ambulance to take care of. Unfortunately, we still have our own problems that we need to deal with when responding to calls in cold weather. The lack of an ambulance means we have to walk at the time of day when the weather is the coldest. Therefore it is extremely important that you take the time to bundle up before responding. Layers, gloves, hats, scarfs, earmuffs and more layers should be a requirement and boots are a strong encouragement. If you see the EMS truck heading your way, start waving your arms frantically and jump up and down in order to get the driver’s attention. The best way to travel to a call during the winter is in the comfort of heated seats. Remember to walk briskly and know where you are going before leaving the building. Watch out for bright spots on the pavement because chances are it is ice and falling while responding is never a pleasant sight nor experience. These tips will help you shave precious seconds from your time being exposed to the cold and minimize your chances of arriving to the scene with completely frozen and numb fingers.
If you can picture an intoxicated individual walking down a dry surface and compare that scene with the same person walking down an icy surface, you can very accurately predict what the change in surface will do to the results. While you may think that you only need to take care of the trauma and intoxication, you actually first need to take care of something different that is exclusive to the weather: hypothermia. Stationary, injured patients will use more energy than healthy individuals, while the body uses more energy in the cold in order to maintain temperature. So an injured patient that cannot move in the cold will use a significant amount of energy in order for the body to maintain itself. Therefore, after stabilizing your patient, your first order of business is to get the patient inside, otherwise, you will be fighting a losing battle with hypothermia. Remember that there are a number of devices in the EMS truck that are designed to safely transport patients from place to place, so do not be afraid to use them. Once you get a patient inside, use passive warming techniques such as layers and sitting next to a heater to warm up your patient.
Despite your personal opinion on the beauty of winter, EMTs despise winter because it slows down operations and does a number on your patients. But fighting Mother Nature never seems to work so we end up adapting to the conditions presented to us. Dress correctly, work smart, pay attention and hopefully you will survive the season nice and cozy.
By: Dana Convissar, PR Officer, 2013-2014
Sarah Cheng graduated from Vassar last year with a major in Biochemistry. She served as PR Officer for VCEMS during her senior year and is currently in her first year at UCSF School of Medicine.
VCEMS: What made you decide to join VCEMS and what was your favorite part?
Sarah Cheng: Vassar’s EMT course was actually too full my first-year, so my path to VCEMS was a bit delayed than most. I was interested in medicine and wanted to learn more about taking care of patients. VCEMS also was an opportunity to be more involved in the Vassar community. The very best part of EMS are the friendships you make and the people you meet. You really get to know the crew you’re on call with, the patients you are taking care of, and of course your classmates (and Ed!) on Tuesday and Thursday nights.
VCEMS: What is the most important thing you learned from VCEMS?
Sarah: Learning how to maneuver school and life while balancing my backpack and EMS duffel was SO helpful during my carry-on bag adventures between California and New York.
VCEMS: How has your experience volunteering with VCEMS influenced your current work or future career plans?
Sarah: I was a biochemistry major and spent a bit of time contemplating whether to apply to graduate or medical programs after Vassar. Through my experience with VCEMS, I realized how much I enjoyed interacting with and taking care of people; it was one of the confirming factors in my decision to pursue medicine. I’m currently studying at University of California, San Francisco (UCSF).
VCEMS: Do you think your experience with VCEMS has helped you in medical school? If so, how?
Sarah: Knowing how to take an accurate blood pressure is an amazing life-skill to know.
VCEMS: What’s your spirit animal?
Sarah: Squirrels. Just kidding, they terrify me. Probably the hummingbird because I like to keep myself busy.
VCEMS: Words of advice to current members?
Sarah: I was plenty scared during my first calls of messing up vital signs or letting my crew down if I blank on something. Don’t be afraid to make these mistakes; it’s really just part of the learning process. VCEMS is fantastic because it provides a peer-teaching environment with two sets of eyes also watching and supporting you along the way.
VCEMS: Anything else you would like to add?
Sarah: VCEMS was a big part of my life at Vassar and I would be more than happy to be a resource. If you have questions about being pre-med at Vassar, medical school, or questions unrelated to squirrels (I’ll refer you to Jess and Moby Dick instead) feel free to get my contact through the officers.
By: David March, Training Officer, 2013-2014
EMS at its core is about two primary tasks: 1) rapidly responding to patients in order to provide time-critical life-saving interventions, and 2) transporting patients quickly and safely to a higher level care facility (usually a hospital of some sort). Some times we lose sight of these central components since we have the luxury of staying on scene for longer than most organizations, giving us more flexibility in our triaging operations. However, these remain our most critical operations. The first is achieved with quality ABC’s (airway, breathing, circulation), while the latter is largely a matter of hand offs.
The earlier you make a transport decision, the sooner our patients get the care they need, and the sooner you get to go back to bed. If you arrive on scene for a patient who is having difficulty responding appropriately to simple questions, who has suffered serious trauma, has had an unusual medical episode, or otherwise seems to be fairly clearly hospital bound, go ahead and make the call then. Our training and experience allows us to fairly reliably size-up a scene and determine what interventions are going to be necessary. Of course, without more time with the patient, you can’t be certain a trip to the hospital is going to be necessary. I’ve arrived on scene to find a patient that was almost entirely unresponsive and immediately called AFD (Arlington Fire Department), only to lead them to a fully cogent and ambulatory patient ten minutes later. If you’re unsure and the patient doesn’t face any immediate life-threats, take the time to asses them properly, but for most extreme situations, you should be able to make the call as soon as you arrive on scene and be reasonably confident in your decision. Worst case scenario, AFD is dispatched and you have to meet them at the door to explain the confusion.
Many of us are also so used to dealing with somewhat uncooperative patients that strongly do not want to go to the hospital, that we forget that many patients do. It doesn’t hurt to start off your patient assessment by asking them if they would be interested in going to the hospital. Many patients, particularly those who have just gone through a disconcerting medical episode, or who have a chronic condition, will already know they want to go. Calling AFD at that point shortens their wait time, and reduces the amount of repeated medical history the patient will have to go through.
Once AFD has been dispatched, you have a short window of time to get everything ready for the hand off. If your patient requires continued care and attention, that is obviously all you should focus on. However, if the patient is fairly stable, it is helpful to have a PCR (pre-hospital care report) prepared by the time the ambulance gets there, as well as an up to date set of vitals if there are enough crew members. The form you hand off will likely not be the complete write-up we will keep for our records and submit to Baldwin. For this skeleton report, it’s most important to note the patient’s name, birthday, medical history, allergies, and the critical details from the incident that lead up to EMS being called. Press down hard, as the report we give AFD is a carbon copy and will be illegible if you don’t.
If your patient is ambulatory and able, you can assist them to wherever AFD will be arriving. If they aren’t, at a minimum try to ensure that they have shoes, ID, and their health insurance card. If their friends are with them, encourage them to decide if anyone is going to ride along in the ambulance and figure out how the patient is going to get back from the hospital. When the CRC informs you that AFD has arrived, go meet with them and fill them in on what you’ve learned and what has happened while you’ve been on scene. Give them the pink sheet and make sure they’re able to read the patient’s name and birthday. Don’t let the ambulance leave without finding out which hospital the patient is going to be transported to.
Handing off a patient transfers responsibility for their continued care to the EMTs in the ambulance, and releases you and your crew from liability for future incidents that night. However, it is only appropriate to make this transfer when you can be confident that your patient is going to receive the care they receive. The EMTs and Paramedics you will be handing patients off to will likely have much more experience and training than you will. That does not, however, absolve you of responsibility in ensuring that your patient gets the attention they require. If the ambulance crew is not taking your patient’s condition as seriously as you think it deserves, it is your responsibility to convince them otherwise. Be polite and professional, but be firm. Our first and foremost responsibility is to our patients and it is well-worth some awkwardness and bruised egos to make sure they have their concerns adequately addressed.
Most of the time, hand offs will be easy and hassle free, and you’ll get to go home knowing that your patient has been transferred to someone with the necessary experience, training, and resources to give them the care they need.