Manual VS Automatic B/P

I came across this article on JEMS where a study was done on the differences between a manual and an automatic B/P reading and it reminded me of a conversation I had recently with a paramedic. In my county we use the Lifepak 12, ours are set up to be a BLS and an ALS tool as we can use it for pulse ox, B/P, capnography, Congreve, ECG and 12 lead ECG and as our AED. The paramedic and I were discussing the fact that most providers rely only on the information they obtain through their Lifepak now. We have both witnessed the look of panic on the newer members faces when the Lifepak beeps, alerting them that the pulse ox is not found because they put that on the same arm as the B/P cuff. When I first started I remember working with medics who insisted on at least one manual B/P, when going through my Enhanced class last year I had a few teachers who still felt the same way. Most people in my class rolled their eyes at the thought of taking a manual B/P, including myself, but after reading this article it definitely makes me take a step back.

Since the contributors and readers of this blog cover many states and protocols I figured we could get a good mix of opinions on this subject. So tell us, do you prefer only manual, only automatic, or a mixture of both?

P.S., When doing spell check on EMS related blogs you receive some interesting "suggestions." Instead of "capnography" spell check suggested that I use "pornography." Our Lifepak doesn't provide that, maybe it's an upgrade option?

dealing with the drama

As with any group of people you always have a certain level of drama or politics going on, I've always believed that I could go to any fire department or rescue squad in the country and find basically the same kinds of people. There are roles to be filled and while the names and faces may change deep down it's all the same. You can always find the know it all, the rookies, the ones who have been there done that, the ones that haven't been there or done that but feel that they know it all, the overachiever, the one who overextends them self and the ones who majored in trouble stirring in college.

Over the years of moving up the ranks from the "wet behind the ears rookie" to "in charge of more things than I can even remember on a good day" I have learned the two step shuffle that is required to survive. It's a tough step to learn, you have to know how to talk to this person and that person without upsetting them or sometimes, stooping to their level. Sometimes it is exhausting. Scratch that, most of the time it is exhausting. You can only please so many people per day and my quota sometimes fills up by 9am. (and believe me, I am NOT a morning person) For the past few years my two stepping hasn't been all that bad but we had a major shift in operational officers a few months ago and I feel like I am stuck in one of those horrible techno dance clubs where the songs supposedly change but you can't tell where one ends and the next one begins. (and you can only chant "only 9 more months, only 9 more months, only 9 more months" so many times before your significant other starts to look at you funny)

What I have never understood is why some of the trouble stirrers spend so much time upsetting people. I am in a volunteer organization, we're not collecting a paycheck to be here every day so WHY do they come by, normally at the worst times, to spread lies and rumors? Why not find something that truly interests them? I am told that obviously stirring up trouble IS what interests them but I can't wrap my mind around that. Maybe the problem is I can't shove my head that far up my butt?

Tell me your department has these people and please tell me I am not crazy since I can't understand their game.

My Introduction

I can honestly say I was rather flattered to be asked to contribute to a project like this. I see what I do as just that - what I do, it's my job. I don't take it well when called a hero, I get uncomfortable when people tell me how awesome my job is or ask me if it's exciting or tell me how amazing it is I get to save lives. I love what I do, don't get me wrong...it's way more than a pay check. I can't imagine myself anywhere but on an ambulance. I just don't see it as something so special like the "outsiders" do.

I took an EMT class at the suggestion of a friend. Every other job I tried just left me bored and uninspired. The class was $75 and gave me something to do for a summer. Even if I hated it, it was no huge loss. I started running on trucks as a student once I got my CPR card, even though the program I went through didn't require it. I have a fear of failure and I didn't want to be a gung-ho EMT, fresh out of school, who freaked out on my first call. Before even carrying a state EMT card, I had been on all types of calls - psych emergencies, cardiac emergencies, strokes, traumas, pediatrics, and even a cardiac arrest one Sunday morning in church. The more I ran on the truck, the more I got comfortable, the more I liked it, and the more it became my life.

Two years later, I'm on the payroll with 3 different ambulance providers. Corporate EMS, and two municipal EMS agencies. Both have their pros and cons, and some people are better suited for one as opposed to the other. There will always be little things that irritate me, be it management decisions, stupid policies, or useless partners. However, I can say that every day when I come home from work, I feel like I accomplished something and maybe made someone's bad day a little better. My father tells me all the time that he wishes he had a job where he truly got to help people every day, and how proud he is of me for committing myself to something and truly enjoying it, and in the process, learning that money isn't everything.

I don't have many great war stories. Funny ones, sure...but few that everyone hasn't already heard before. I'm just doing my thing out there on the trucks, getting my ducks in a row so I can move on and be a paramedic, and making the choice to make a career out of this crazy little job.

The Influence of an Instructor

Jennifer's post made me think about my new EMT class starting in just one week. I've lost count, but, in 25 years, I've trained a lot of people and sent them into the EMS world as EMTs. I enjoy teaching EMTs even more than paramedics. They're a clean sheet of paper and are ready to learn, then, go out and save the world.

I'm proud of the way our class is run. When we started 12 years ago there was also a fire and police academy which held a rigid posture and high standards. We adopted it and still maintain it which is a departure from how most EMT classes are managed.

Kids right out of high school have a hard time wearing uniforms and realizing they will get locked out of a quiz if they're late from a break or don't have thier ID badge. Only when they leave do they understand why we do what we do to prepare them for the world of EMS. Some have become lifelong friends, and many I see again in the recert classes in subsequent years. They send me
e-mails to tell me they're at the top of their fire academy class and felt it was the discipline we gave them that got them there. I had a student who went to a disaster assignment during hurricane Katrina and was thrown into an experience that was way over his head. He told me later that the constant memorization we made them do on ABCs, CMSTP, AVPU, OPQRST, SAMPLE etc. came back to him when he needed it. I've watched my students become RNs, PAs, public health administators and ambulance company executives. One is a medical writer for a hospital system.

One of my most profound memories was walking into my class on September 12, 2001 to 50 wide-eyed and confused people. I realized most of them were too young to have ever had any threat to their basic sense of security. The age range was 18-62 and their reactions were all over the map. I had to wonder how the death of 300+ firefighters in New York was going to affect their career goals. Some left, most stayed. My critical incident stress management training kicked in and that day was about sharing our feelings of fear, and violation, and anger. Six weeks later my Disaster Medical Assistance Team was deployed there. Myself and one other student, a police officer, were gone for two weeks. It was years later before I realized the huge impact that had on my students. They were proud that we made that contribution and it gave them even more incentive to become one of the special ones who are part of the solution rather than part of the problem.

Do I get tired sometimes. Yeah. The "deer in the headlights" first night, the "high maintenance" individuals; the ones that have a tired excuse for always being late; the "minimalists"; the ones that always seem to know more of my lecture material than I do ... Out of each class, though, there are always a few shining stars. They are the ones I feel good about, the ones I know will make a difference. There are also the ones I watch struggling through the semester, but want it badly enough to fight for it. They have perservence and motivation. They come back 2 or 3 times, but are ready for the world when they eventually succeed.

Sometimes I'm lucky enough to learn where my students have gone with their lives, or that they were the ones to step up when a child was drowning, an old man went into cardiac arrest, or they need to triage a fatal head-on collision on Vasco Road. I can take pride in thier accomplishments. That makes it worth doing all over again.