Practical EMS

We meet our new panel: Eric (EM Physician) Shelby (EMT) Nate (EMT) and returning guest Sam (Prior EMT, ER RN) DeTessa (ER RN)   Part of the fun part of the ER is getting to start from scratch and figure out the puzzle Stories do change as the patient talks with different providers We are not equipped to diagnosis or resolve chronic problems in the ED, we can’t provide every answer for every sympto...

Chris and I talk about my background and motivation for my podcast.  I talk about a pediatric arrest I ran that had a huge impact on me.  We tend to dehumanize patients in this job to keep our distance, but that is not always the best technique. Emergency standards are standards I have developed working in the ER. One of those standards is to walk slowly through the department . Become mindful . B...

Chris and I talk about my background and motivation for my podcast.  I talk about a pediatric arrest I ran that had a huge impact on me.  We tend to dehumanize patients in this job to keep our distance, but that is not always the best technique. Emergency standards are standards I have developed working in the ER. One of those standards is to walk slowly through the department . Become mindful . B...

Wrapping up our conversation with Brian and Kristina (PA’s and prior paramedics) and Casey (paramedic) Shadow PAs in different specialties so you really know what the career looks like practically.  Use this to find out what specialties you like , school doesn’t always give you enough time and you may not get a job in your desired specialty every time. You must know WHY you want to be a PA . Have...

We jump back into our conversation with Brian, Kristina and Casey  Advice for newbies   Reflect on the calls that you run.  What went well and what went poorly?  Are there providers that did a great job that are worth emulating?   Find those mentors that are worth emulating. Also make note of those that are worth avoiding . Keep in mind there are multiple right ways to do things.  All of us in eme...

We meet our new panelists Brian and Kristina (PA’s and former paramedic’s). Casey is back!   Transitioning from paramedic to PA   Professionalism is a big emphasis in PA school.  This was something I learned as an EMT from a great paramedic partner early in my career as well.   Professionalism in EMS is a cultural and personal aspect to strive for.  PA school also wants you to keep in mind you are...

We discuss what things we want others to know about our careers. In EMS we can tend to jump immediately to being confrontational , even when the other person isn’t meaning to be confrontational. We all have different scopes and different levels of knowledge. Casey wants people to know that paramedic’s get extensive training in 12 lead interpretation . Lucas wants people to know that doctors are no...

Meaningful patient interactions – Hold on to them . The mundane calls, the rude patients, the horrible things we see -  those are the price we pay for the one call where you save someone or have a meaningful interaction. It is an honor to take care of patients that can’t get help in any other medical setting except the ER.  Find one thing every shift that you find fulfilling. Be intentional. Find...

Our new panelists: Lucas- ER Physician, Micaela- Paramedic, Alex- Paramedic, Rebecca- ER RN, Casey- Paramedic We discuss struggles with caring for patients that have perpetrated violent crimes. Recognize your own bias and your personal history that may affect patient care.   It’s important to have a good self-care plan because you can’t pour from an empty cup. Pediatric calls will stick with you....

Struggles in emergency medicine Casey struggles with keeping up with the changes, especially the technological changes.  If you worry about keeping up, put yourself in a position to teach the new people. They will force you to learn as well. Micaela talks about her personal struggle with burnout and the significantly high acuity calls she has run She ran a ton of high acuity in a short amount of t...

We welcome our new panelists.  Micaela (paramedic) Simone (former ER RN and now ER NP) Paramedic’s Alex and Casey returning.  Simone gives us a glimpse into the tough transition from ER RN to ER NP.   You need to love the medicine.  Having to know so much of so many things was one of the toughest parts.    You must be second best at every specialty.  Alex talks about the transition from EMT to par...

Emergent Standards I address a comment about how we mentally handle the patients we care for that have committed violent crimes. We still care for them to the best of our ability; in fact we often learn the whole story after we have finished caring for them. We don’t judge because that is not our role. We find ways to move on from the horrible situation. Emergency standard: Take care of yourself b...

Confidence in EMS: Nate talks about how he was reaffirmed when learning ALS meds and a physician agreed with his treatment plan.  School does not make you confident. As a provider , give the crews feedback because it helps them grow and confirm their plans and treatments were accurate. Don’t just give negative feedback. Some students do need an extra push to make them uncomfortable enough to progr...

Random stories episode! We often don’t want to talk about the “craziest” call we’ve ever seen . I tell a story about a fireplace fueled by batteries and no real medical reason for the call.  We talk about things that surprised you about emergency medicine Dealing with drunk people is a challenge. Other great random stories: Thoric dissection’s, triple A’s, rhythm changes, driving lights and sirens...

Jumping back into our discussion on alcohol abuse in EMS . Everyone is susceptible to overuse of alcohol so abstaining can be powerful even without it being your vice.  Interpersonal communication skills are key to developing in EMS. We need to connect with our patients. Patients care more about being understood and listened to than good medicine. Advise for newbies: It’s hard to admit when you ha...

New panel! We welcome Alex, paramedic and Kate, EMT. Welcoming back Sarah, paramedic and Nate, EMT.   What makes a great paramedic? Treat your EMT’s like a partner. Talk about calls. Teach your EMT’s. Educate without belittling.  Create an environment where your partners can question the plan if they don’t understand it. Learn from those that have been doing this for awhile. What makes a great EMT...

You guys ever see a dead family member in a patient? Like they look similar, act similarly? No? Maybe it’s just me. Nate talks about his life experiences and how it helps him talk with patients that are struggling with mental health. He talks about a patient experience where he really connected with a patient and how the patient was seen years later having changed his life.   We talk about God in...

Leadership in emergency medicine Good nurse to patient ratios is very important to good patient care and allowing those little moments where you can spend some extra time making sure the patient feels cared for .  Management doesn’t always equal good leadership.  Part of being a good leader is being the calming presence in a chaotic scene or situation. Walk, don’t run. Be mindful. You can be freak...

Is burnout moral injury? Is it out of your control? ZDoggMD talks about burnout being moral injury .  Link here: (30) It's Not Burnout, It's Moral Injury | Dr. Zubin Damania on Physician "Burnout" - YouTube We jump back into our discussion on the video. Casey says one of the great things about this job is that we have the privilege to be with people on their worst day. Nate tal...

Jumping back into Principles in Emergency Medicine Nate- People lie. Despite the fact that we are not judging them, and just need to know accurate details to provide the best possible care.  Casey- Expect the unexpected.   EMS is long periods of boredom punctuated by moments of sheer terror .  Adam- the job is always out to get you. We see the 1%, it is a self-selected population. So, if you are g...

We meet our new panel and some returning guests! Kiley – ER RN and new NP Sarah – Paramedic in EMS for 8 years Welcome back Adam ( ER MD), Casey (paramedic) and Nate (EMT). Nate talks about the transition from field EMT to ER EMT . It’s a new world with new things to learn. Sometimes a change in environment can get you out of a rut. Sarah also worked in the ER but as a paramedic and loved learning...

We revisit the question “Where is God is emergency medicine? Doug- I’m a believer in science and a believer in God.  There are some occurrences that we can’t explain with modern medicine. He tells the story of a cardiac arrest that woke back up an hour after pronouncement.  Sarah- God has given us the science to learn and be able to use.  We often see the victim of a horrible tragedy as well as th...

Crazy stories episode Delivering babies!  Not something most of us look forward to but it happens, nonetheless. Casey talks about a breech presentation birth that, thankfully, turned out just fine despite delivering at 28 weeks in an ambulance as well as a prolapsed cord case. Stabbing victims! In a sex shop, in their homes, we run them everywhere. Butt stories! Stuck vibrators with full batteries...

Pronouncing in the field is a difficult part of EMS. In a lot of ways, the ED insulates us from some of the aspects of this that make it challenging when you are in the patients actual home.   The ED is mentally taxing in other ways. High volume, high acuity, multitasking, consulting etc. Nate talks about how “you’re just an EMT” gets thrown around a lot. Just because it’s a lower-level of educati...

Challenges in emergency medicine Burnout can creep up on you and can occur even in one shift. Nate got burned out working nights and started drinking heavily and almost got into blows with his partner. He went through a tough period and came out the other side. Substances will become an easy outlet and a way to avoid dealing with real problems if you allow them. Everyone has their coping strategie...