EKG's You Can Text!

1. So I texted a bunch of EKG rhythms on Twitter. Feel free to peruse my work, repost it on Twitter or on your blogs. I got like a dozen new followers from it! The basic ones are at the bottom; work your way up the page to the more advanced rhythms. Or do it the other way; I don't care. This is the best way I could find to write EKG's via keyboard. Enjoy. (Sorry, but I doubt you can get continuing education hours.)
   Torsades des pointes (French accent mandatory): VVVvvvVVVVvvvvVVVVvvvmmmMMMmmmMMMvvvVVVvvvVVVmmmMMMmmmvvvVVVvvv
   
2. Cardizem:V~V~~VV~V~V~~V~VV~~V~V~V~~V~V~~~~V~~~~V~~V~~~V~V~~~V~~~~V~~V~~~V~~~~V~~~V~~~~V
   
3. A-fib with RVR: ~~V~~V~V~~V~VV~V~V~~V~V~~V~VV~V~V~~V~V~V~~V~~~V~V
   
   SInus pause: --~-V~--~-V~--~-V~----------~-V~--~-V~--~-V~--~-V~-----------~-V~--~-V~--~-V~--~-V~--~-V~
4. 
   
5. Epinephrine: -----------------------------------------------~-V~--~-V~--~-V~--~-V~--~-V~--~-V~--~-V~--~-V~--~-V~
   
6. Asystole: --------------------------------------------------------------------------
   
7. Atropine: ----------~-V~----------~-V~----------~-V~--~-V~--~-V~--~-V~--~-V~--~-V~--~-V~--~-V~
   
8. Synchronized cardioversion: `V`V`V`V`V`V`V`V`V`V`V`V`V`VCLEAR<>BLAM<>--~V~--~V~--~V~--~V~--~V~--~V~--~V~--~V~
   
9. Defibrillation w/ conversion: MmwVwMmwwvvVWMCLEAR!<>BLAM<>------~V~--~V~--~V~--~V~--~V~--~V~--~V~
   
10. Ventricular fibrillation: wWwWWWwwWwWvVVvwMMwMMmmmvvvMM
    
11. Pacer rhythm w/ capture: --|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~
    
12. 3rd degree heart block: ~V---V-~-V--~V---V~--V-~-V--V---V~--V-~-V--~V
    
13. 2nd degree heart block, Type 2: --~-V~--~-V~--~-V~--~--------~-V~--~-V~--~-V~---~---------~-V~
    
14. 2nd degree heart block, type 1 (Wenkebach): ---~V~--~-V~-~--V~~---V~~-----------~V ---~V~--~-V~-~--V~~---V~~-----------~V
    
    • Delete
15. 1st degree heart block: -~---V~-~---V~-~---V~-~---V~-~---V~-~---V~-~---V~-~---V~-~---V~-~---V~-~---V~
    
16. Atrial Flutter (3:1 conduction): :vvvVvvvVvvvVvvvvVvvvvVvvvVvvvVvvvVvvvVvvvVvvvV
    
17. Atrial Fibrilation: ~~~V~V~~~~~~V~V~~~V~~~V~~~~~~V~~V~V~VVV~~~~V~V~
    
    
    1. Premature Atrial Complexes: --~-V~~V~--~-V~--~-V~--~-V~~V~-~-V~--~-V~-~V~-~-V~
       
    2. Ventricular Bigeminy:--~-V~M--~-V~M--~-V~M--~-V~M--~-V~M--~-V~M--~-V~M--~-V~
       
    3. Unifocal Premature Ventricular Comlplexes: --~-V~--~-V~M--~-V~M--~-V~--~-V~--~-V~M--~-V~
       
    4. Multifocal Premature Ventricular Complexes: --~-V~--~-V~--~-V~W--~-V~M--~-V~W--~-V~M--~-V~
       
    5. Adenocard: ~V~V~V~V~V~V~V~V~V~-------------ohshit---------~V~--~V~--~V~--whew
       
    6. Paroxysmal Supraventricular Tachycardia: --~-V~--~-V~--~-V~V~V~V~V~V~V~V~V~V~V~
       
       Supraventricular Tachycardia ~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V
    7. 
       Ventricular tachycardia: VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV
       
       Sinus tachycardia: ~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~
    8. 
       
       Sinus bradycardia: --~-V-~--------~-V-~--------~-V-~-------~-V-~--------~-V-~-------~-V-~-----
    10. Sinus rhythm: --~-V-~--~-V-~--~-V-~--~-V-~--~-V-~--~-V-~--~-V-~--~-V-~--~-V-~
        

Hospital Clinicals - A Million Hours of Misery Or A Million Chances to Become an Excellent EMT?

Hospital Clinicals - A Million Hours of Misery Or A Million Chances to Become an Excellent EMT?

You remember your hospital clinical hours, right? Maybe you're doing them now. They never seem to end. Back in the dinosaur days of EMS when I was in paramedic class, the only place we did clinicals was in the ER, because the emergency room is the most like EMS, right? And back then, EMS wasn’t exactly taken very seriously. Appreciated, yes, maybe even commended, but seldom taken seriously. Most of our clinical time (two hundred forty hours!) was spent watching the nurses start IV’s and push drugs, watching the doctors intubate patients and helping fetch and carry things thither and yon. Few of the nurses trusted us enough to actually stick a patient with an IV. We only practiced intubation after the patient was pronounced dead. 12-lead EKG’s took the same place as Egyptian hieroglyphics in our curriculum. At best, we might inspire enough confidence in the staff to allow us to give a pill or rub some ointment on a rash.

Nowadays, the curriculum includes over four hundred hours of hospital clinicals spanning not just the emergency department, but the ICU, med-surg floors, labor & delivery and surgery. On the surface it seems like the ways to be bored have increased exponentially. And if you’re looking for something to do, you may find yourself in the same predicament we did back in my class, when the Tyrannosaur was the king of the earth, and go look for an empty patient room to nap in.

One thing is for certain, when you take your hospital clinicals you’ll be a newbie. A “lowly” EMT (actually, you’ll be worse- an EMT student!), so judged by the nurses and doctors on the floors who don’t know you from Adam. You may be able to run circles around any other EMT, but there’s no way you’re going to prove that to crotchety old Nurse Ratchet. And she won’t care if you did.

So is there any benefit to the spectrum of torture your instructors are putting you through? If you want to be an excellent EMT, there most certainly is!

Maybe, just maybe, you’ll get to stick an IV. The CRNA or anesthesiologist might let you intubate a real, live person. Good, you need that. But it’s no big deal. Why? Because you can teach a monkey to intubate or start IV’s. All that takes is training. As an excellent EMT, you need to seek out education. And the hospital environment provides you with multiple opportunities to do so. Training teaches you how do do stuff: “Is my scene safe? I put on universal precautions. How many patients do I have?" Blah blah blah. What to do on every scene you’ll ever have. What education does is teach you how to think critically about your scene, especially when your scene is one of those “what if...” situations that EMT class can’t prepare you for. A great deal of education can be gleaned in the hospital.

Let’s look at some examples. One thing you’ll have to do on every call is write a run report. “Nobody’s gonna read this thing besides a lawyer,” you say to yourself. On the contrary! Many, many times the very first thing a physician or nurse will do when initially encountering your patient is read your run report. Your run report stays in the patient’s chart until he or she is discharged. It is referred to nearly every time a new doctor or nurse has any interaction with your patient. Even if they’ve been in the hospital for months and you’ve long forgotten about the call, your words are still being read and taken into consideration. If you are doing clinicals, try to take note of how often EMS reports are read. Now imagine those are your words being read. Is the report clear? Is the mechanism of injury and pertinent history accurate? What did you do for the patient? Why or why not? And be assured, your spelling, grammar and penmanship are under keen scrutiny. It is those words that will make the difference as to whether we EMT's are to be taken seriously by the medical community!

Speaking of what you did or didn’t do for the patient, another valuable lesson you can learn from hospital clinicals is the concept of continuity of care. Though your responsibilities may end when you hand over the patient to the emergency department staff, the patient’s care does not. More importantly, what you did while the patient was in your care has repercussions long after you’ve gone home and forgotten about the call.

Did you intubate the patient? Once your patient is intubated, you’ve assumed responsibility for the airway & breathing - two of the cardinal aspects of the ABC's. By intubating them, you’ve effectively made them vent-dependent. Once the body realizes it doesn’t have to breathe, many times it doesn’t start again. In your hospital clinicals, take a look at the patients who are intubated, particularly by EMS. A week or two after you’ve patted yourself on the back for “getting that tube” while hanging upside down in an overturned car in a ditch at night, that patient may well be getting a tracheostomy. That sweet grandma with CHF might not ever be able to speak the words to thank you for “saving her life” because she’s dying of ventilator-acquired pneumonia. Are you SURE you absolutely NEED to intubate that patient? Is there anything you can try to prevent an intubation and subsequent vent-dependency? The chest decompression you performed, the perhaps-less-than-aseptic IV and the hypotension you induced by walking your patient to the ambulance also all create a huge change in the continuing course of care for the patient.

The drugs you push have effects beyond the ER doors, too. Educating yourself about them can make the difference between an EMT who can pass his test and an excellent EMT. If you’re in clinicals, take a look at how the course of care is altered by drugs the EMT’s gave. Did EMS max out the patient on Atropine? The care changes. When EMS pushed labetalol on the hypertensive crisis, did the patient’s asthma kick in and now they have to be intubated? Another detour in the path of care. That patient with eclampsia - why is the ER giving them levophed after EMS pushed the magnesium sulfate? All those drugs have side effects, some of them deleterious. What may make you seem like a hero at the moment may cause an unnecessarily extensive hospital stay for the patient, added expense for insurers or taxpayers and a negative outcome in general.

In the hospital, you’ll encounter equipment that you’ll believe you will never have to think about again. Wrong! Many patients are discharged to home care with a variety of medical devices. As was stated earlier, the emergency room is the most like EMS right? Well, that’s no longer the case. A huge part of EMS calls nowadays have to do with ongoing care. That’s right- home health. People call EMS when their home oxygen machine breaks or their premature infant’s feeding tube is clogged. Imagine going to the home of a chronically ill patient who’s receiving tube feedings. The feedings are still running to the PEG tube and you have to disconnect it to package them for transport. How do you disconnect it? How do you flush it? Use your hospital clinical time to find out. Some patients go home with a Wound-Vac device to remove exudate from a surgical wound or pressure ulcer. When and how should you disconnect it? How long can it safely remain off? What should you do if it is accidentally dislodged? Again, pay attention and ask questions in the hospital. Some patients have a PICC line (Peripherally Inserted Central Catheter). Can you use that for IV’s? How should you access it? If it starts coming out, what should you do? There is a cornucopia of devices that you may not feel you need to know about, but in reality you will have to deal with frequently. Quinton cathers, Foley catheters, suprapubic catheters, colostomies, home ventilators, home CPAP and BiPAP machines and tracheostomies are only a few of the things you have a golden opportunity to learn about while doing your hospital clinicals, and you will be glad you did when you encounter them on scenes.

You can take note of other things too. True, cleaning a patient isn't a priority in EMS. But try to assist the nurses to turn and bathe that 600-pounder in the ICU. Help them keep the combative head bleed still for a minute during the CAT scan. Feel the soreness in your muscles the next day. The nurses will acquire a newfound respect for you and you will appreciate what they do when they have to do it without your help.

Use your hospital time to really learn about patient care, not just the bare minimum of EMS training. Understanding that what we do in the back of the ambulance has a lasting effect on our patients’ outcomes will make the difference between you being an adequate EMT and an excellent EMT. Remember, any trained monkey can start an IV and memorize ACLS algorithms. Being an excellent, educated EMT is not only what makes you stand out, but is also what truly makes a difference. And making a difference is one of the reasons we all started in this field, isn’t it?

Chronicles of EMS - An EMS Reality Series That Tells The Truth!

I know you tell war stories. I certainly do. And the questions that your non-EMS audience ask sometimes make you laugh. "How do you deal with death all day, every day?" "Do you have to cut cars up all the time?" "What's the worst call you've ever been on?" If you've spent more than twenty minutes in the back of an ambulance, you know all too well that such calls, while memorable, are the exception rather than the rule. Instead, on a typical shift we wonder about which frequent-fliers we'll be transporting, how many drunks we'll be scraping up, if it's nursing home Dump Day and where we're going to try to eat lunch. And we try not to think about who's footing the bill for our services. Sometimes we long for someone to tell our story- our real story, not some overly dramatized spectacle.

Your wish has been granted.

With Chronicles of EMS, Thaddeus Setla and Chris Montera have created an EMS reality series on the web that tell the REAL story in EMS. You can follow along with San Francisco paramedic/firefighter Justin Schorr and Mark Glencorse from North East Ambulance Service in the United Kingdom and see American EMS as it really is. No explosions, no Code 3 club, and every patient isn't dying from some unlikely scenario. Mark & Justin run actual EMS calls in San Francisco and show what it's really like to be an EMT - dealing with the chronic bullshit, the homeless, the drunks and occasionally even a real patient ("Trauma" on NBC, are you listening?). Also of note is Justin's warning to Mark - no meal breaks!

It's interesting to see Mark's reaction to the way EMS is run here; he's a paramedic in England. Compare his comments about U.K. EMS with the way it goes in the States. It was a long time in the making, as Justin explains in the first part of the video. Facebook, Twitter and blogs played a key part in CoEMS' creation, and I'm happy to have had a miniscule influence in it. The guys have done an outstanding job illustrating what we really do.

Watch episode one of Chronicles of EMS here.

And if you'd like to follow everyone on Twitter-

Follow Justin Schorr here.

You can follow Thaddeus Setla on Twitter here.

Follow Mark Glencorse on Twitter here.

And follow Chris Montera here.

And don't forget to join the Facebook page of Chronicles of EMS!

CoEMS is sponsored by Zoll (still my favorite monitors).

Looking forward to Episode 2 and more!

Sticky Situation

OK here's an interesting scenario and I'd like to hear from you. According to this story  http://bit.ly/bzSYxz a Jefferson Parish deputy recorded on his cell phone the dying testimony of a gunshot victim while in the back of the ambulance. 

My question: Is this OK or not OK? We all know HIPPA law prevents any of us medical people from recording images, voice or any specifics about patients, particularly if they will be made public (as this recording surely would be). Even our conversations must be tailored so as not to divulge such information. Does HIPPA include such informal legal testimony? If you were the paramedic, would you prevent the deputy from recording your patient? If there were no police around, would YOU record the patient's testimony?

The legal implications seem frought with peril. A video is far more convincing evidence in court than the debatable memory of a paramedic who was distracted with patient care. On the other hand, remember the trial of the shooters at the Louisiana Avenue car wash? They were acquitted despite there being a video of them shooting. How much of a risk would it be to your job if you knowingly allowed a police officer to video record your patient?

Oh, and if you are the paramedic who was on this scene, I'd love to hear from you about any backlash or issues that may have come up with this.

Write your comments using the link below. Thanks!

Military Allows Facebook, Twitter, Other Social Media

Apparently the benefits of social media outweigh the security risks. Hmmm... Where have I heard that before?

http://www.reuters.com/article/idUSTRE61Q07G20100227?type=technologyNews

At the risk of sounding bitchy...

Many of us loved the shooting game on Facebook. It was a bit of diversion that only a small group of Facebook friends could see. Guess the time of the next shooting. Closest guess won. No private information was given, no one got hurt, there was no national media attention. The game died because I was ordered to cease & desist for, at best, unclear reasons.

This very blog has been a bane to the EMS hierarchy. Apparently it has the reputation of "stirring the pot," a pot which apparently needs to remain unstirred. In reviewing the past dozens of articles written on here and the comments in the tag-box, I can't find any stories that might be considered "pot-stirring" (this current article notwithstanding). It's been a place to encourage others for professional improvement, point out a job well done, post photos from the Times-Picayune of us in silly poses, and cite links to other helpful EMS-related websites. How any of this is "pot-stirring" eludes me.

Therefore I find it fascinating that social media websites such this one exist unmolested: http://www.facebook.com/ProjectNOLA/posts/341940306666#!/ProjectNOLA. It is not my Facebook page and I have no idea who is involved with is creation or maintenance. It details crimes in the city as they happen, by someone who obviously has a radio scanner, with very specific information on who, what, where & when, etc. It also clearly has a large base of followers from the general public. Nowhere in the many comments and updates on it do I see a cease & desist request from any city entity. Further, it is just one of a myriad of similar online sources for the gory emergency responder details of the city in which we live and work. Here's another one, and another, and another, and another.

I was informed in one of my many cease & desist meetings that the internet is not the proper medium for letting out frustrations. It was recommended to go to a bar and bitch about work with my co-workers over a drink. Alternatives to such "therapy" were not explored. I must ask, is drinking & complaining the only approved method of stress reduction? After Hurricane Katrina I explained my own methods of decompressing to the CISD psychiatrists. One doctor called two other doctors so I could repeat my coping methods to them, namely writing about my experiences and channeling my frustration, sadness or joy into a productive medium. They were fascinated and encouraged me to continue doing so, saying "You obviously have a very effective way of coping with stress."

So, sorry for stirring the pot once more. Since websites such as the Facebook page above continue unbridled in their haste to inform the public with raw, unfiltered information for anyone to read and comment on, I will continue to feel justified for posting my own take on my EMS experiences. Until such public websites and social media are stopped from their own "violations," please do not single ME out as a troublemaker for my methods of dealing with stress and creativity by simply telling war stories.

There. I've said it.

-Fitz

Mid-City Shooting

Night of Endymion, Palmyra & S. Gayoso.

(Via NOLA.com)

Don't Kill the Messenger...

Below is an excellent article why the rampant paranoia surrounding social media, blogging and the Internet is unfounded, particularly in the EMS field. There is nothing wrong with using the internet or social media to decompress or let the world know that we are indeed plain ol' human beings after all. I didn't write it, so don't get all out of sorts because I agree with it.

http://michaelhyatt.com/2010/01/five-reasons-why-your-company-doesn’t-need-a-social-media-policy.html

Social Media in EMS

Here's an intersting article about using social media at EMS. If the PIO's were able to use facebook or twitter to update the public about the goings-on such as mini-press releases, Community Outreach projects or CPR classes, it could be a valuable tool in making a positive impact for EMS in the city. Since social media on the internet is a worldwide phenomenon, EMS could have a positive image of community involvement and responsibility that extends all over the world. Might be worth considering.

http://www.ems1.com/ems-products/technology/articles/601956-Using-Social-Media-at-Your-EMS-Agency/

EMS 2.0: An Inconvenient EMS Truth

An excellent, thought provoking look into the reality of EMS and it's
necessary future.

http://ambulancedriverfiles.com/2009/10/ems-2-0-an-inconvenient-ems-truth/?utm_source=twitterfeed&utm_medium=twitter

- Sean Fitz

Funny Ambulance Commercial

Check out this video on YouTube:

http://www.youtube.com/watch?v=sao-uEKgJ6Q&feature=youtube_gdata

- Sean Fitz

Worth Following

Here's an EMS website that I find very interesting. They post EMS news, research and pilot programs. You'll find it useful!

http://www.ems1.com/

You can also follow them on Twitter:
http://twitter.com/EMS1

MVA I-610 & Canal Blvd.

Car flipped over. 9,000 people on scene. Patient ok. Photo from
nola.com. Fitz' best side.