Still moping about not going to EMS Today.
Still hoping to go down to the exhibit hall for a day.
Not to meet Randolph Mantooth, although I hear it will be possible.
I'm not interested.
Johnny Gage is real. Meeting some actor will make him "not real," and I'm just not going there.
I spent part of today going through some of the stuff I picked up from the exhibit hall last year.
It's a lot.
I went through it because I was looking for my samples of QuickClot. I found them.
Came across the sample Hurl-E. This was one of the new products showcased last year. Fortunately, I haven't needed to use mine yet.
There was a lot of information handed out. From seizure care, to the national field triage protocols from the CDC. An entire program on improving CQI. One on blast injuries.
In other words, even if I didn't get to go to any of the classes (whimper), if I went through all the information and training material I could get from the show floor, that would easily equal more than the number of class hours provided.
No CME credit, though. Which is too bad, but really, I'm more interested in the information, than in getting "credit" for it.
So I think I'm going to try to do it, as long as the weather allows.
It's going to take a lot of Red Bull.
Tuesday, January 31, 2012
Monday, January 30, 2012
Will I, or Won't I?
Way back in November, I posted about trying to decide whether I want to take the EMT-CC class or not.
It finally came to the time when I had to decide, and I've decided to take the class.
Trouble is, there may not be enough people for them to run the class. Meaning all that deciding may well end up for nought. I'll find out tomorrow.
In the meantime, I'm still checking out various sources of training, and trying to keep up with things on my own. If this class runs, I'll need to do a lot of studying on my own, as well as start more ride time and clinical time, so it's a good thing these are things I like to do.
It finally came to the time when I had to decide, and I've decided to take the class.
Trouble is, there may not be enough people for them to run the class. Meaning all that deciding may well end up for nought. I'll find out tomorrow.
In the meantime, I'm still checking out various sources of training, and trying to keep up with things on my own. If this class runs, I'll need to do a lot of studying on my own, as well as start more ride time and clinical time, so it's a good thing these are things I like to do.
Sunday, January 29, 2012
All Strokes Are Not Created Equal
Strokes have made the news a lot in the past couple of years. There are organizations like Power to End Stroke who are working to increase people's awareness of stroke symptoms and risk factors. I have three or four different refrigerator magnets that list stroke symptoms, from a variety of places.
I think it's great. The more people know about it, the better, and the more likely someone having a stroke will get the help they need.
Interestingly, though, the strokes I've heard about and/or seen have not followed these lists very well.
My first experience with strokes was when I was a teenager and my mother had a stroke. I did not live with her at the time. She was at work when it happened, and she described it as "the wrong words came out." Clearly some sort of aphasia. She said that at first, she didn't know what had happened, and it wasn't until a coworker told her that her face was "crooked" that anyone, herself included, thought to get her any help. Both of these are well known "stroke symptoms"- difficulty speaking and an uneven or drooping face. But she didn't have ALL the symptoms that are usually listed. No one sided weakness, no difficult moving or walking or gripping, no "slurred speech."
I know now, of course, that people don't always have all of the symptoms, since where, exactly, the stroke occurs and what it might impair will vary widely. But at the time, she and her co-workers didn't really consider a stroke until the symptoms had been present for quite a long time, because it didn't match the image they had of "a stroke."
Another experience was when my sister had a stroke. I don't know what her symptoms were. In her case, I only know a couple of details. One is that when the other people in her family went to bed that night at about 11:00pm, she was fine, and they found her, unable to move, the following morning. She said later that she had been lying there unable to move, and unable to get help, for several hours before anyone woke up. When I heard that, it worried me, since what I had heard about strokes was that if you "caught them early" the person had a good chance for recovery, but if it was longer than about three hours, there wouldn't be anything that could be done. She had not been found for at least six hours.
She recovered extremely well. I believe there is a little residual weakness in one of her arms, but that's it. Walking, talking, no problem.
Since then, I've had a number of patients present with symptoms of a stroke, some very obviously so, others more subtle, and others, still, with a confusing combination of symptoms that probably included a stroke AND some other things going on.
So if the symptoms may not match the image people generally have of "a stroke," and if how well someone recovers can't be predicted, then what do we really know about strokes?
The answer is not very much. And a lot. At the same time.
Much of it comes down to people all being individuals.
Some of it is a better understanding of a wide variety of possible signs and symptoms, instead of only three or four, not all of which might be present every time.
It's definitely interesting.
How the brain works is right up there with how the heart works, as far as being totally fascinating.
I especially find it fascinating to see how people recover, and how they don't. What heals, or what does the brain or body find ways to adapt to, and which things seem to be more difficult?
Clearly, another case of not enough hours in a day, or days in a year, or years in a life to learn everything.
Maybe some day we'll have better ways of diagnosing a stroke in the field, and better ways of treating them. Medical science has made a lot of advances, but sometimes, with this, it comes down to "wait and see."
I think it's great. The more people know about it, the better, and the more likely someone having a stroke will get the help they need.
Interestingly, though, the strokes I've heard about and/or seen have not followed these lists very well.
My first experience with strokes was when I was a teenager and my mother had a stroke. I did not live with her at the time. She was at work when it happened, and she described it as "the wrong words came out." Clearly some sort of aphasia. She said that at first, she didn't know what had happened, and it wasn't until a coworker told her that her face was "crooked" that anyone, herself included, thought to get her any help. Both of these are well known "stroke symptoms"- difficulty speaking and an uneven or drooping face. But she didn't have ALL the symptoms that are usually listed. No one sided weakness, no difficult moving or walking or gripping, no "slurred speech."
I know now, of course, that people don't always have all of the symptoms, since where, exactly, the stroke occurs and what it might impair will vary widely. But at the time, she and her co-workers didn't really consider a stroke until the symptoms had been present for quite a long time, because it didn't match the image they had of "a stroke."
Another experience was when my sister had a stroke. I don't know what her symptoms were. In her case, I only know a couple of details. One is that when the other people in her family went to bed that night at about 11:00pm, she was fine, and they found her, unable to move, the following morning. She said later that she had been lying there unable to move, and unable to get help, for several hours before anyone woke up. When I heard that, it worried me, since what I had heard about strokes was that if you "caught them early" the person had a good chance for recovery, but if it was longer than about three hours, there wouldn't be anything that could be done. She had not been found for at least six hours.
She recovered extremely well. I believe there is a little residual weakness in one of her arms, but that's it. Walking, talking, no problem.
Since then, I've had a number of patients present with symptoms of a stroke, some very obviously so, others more subtle, and others, still, with a confusing combination of symptoms that probably included a stroke AND some other things going on.
So if the symptoms may not match the image people generally have of "a stroke," and if how well someone recovers can't be predicted, then what do we really know about strokes?
The answer is not very much. And a lot. At the same time.
Much of it comes down to people all being individuals.
Some of it is a better understanding of a wide variety of possible signs and symptoms, instead of only three or four, not all of which might be present every time.
It's definitely interesting.
How the brain works is right up there with how the heart works, as far as being totally fascinating.
I especially find it fascinating to see how people recover, and how they don't. What heals, or what does the brain or body find ways to adapt to, and which things seem to be more difficult?
Clearly, another case of not enough hours in a day, or days in a year, or years in a life to learn everything.
Maybe some day we'll have better ways of diagnosing a stroke in the field, and better ways of treating them. Medical science has made a lot of advances, but sometimes, with this, it comes down to "wait and see."
Saturday, January 28, 2012
Things I Want but Likely Won't Get
I keep a list of things I want, or things I'd change, if I was the one who had the authority to make the changes.
Top on my list today is a portable, personal CO detector.
One of those that clip onto something would be great. We could clip it to the bag we carry in to every call.
I was just looking for information on them, to see the pricing, etc. The ones I saw would need to be turned on for each call, and we'd need to learn to do that.
I also saw some disposable detector cards. They last for 90 days, and change color in the presence of CO. Nothing to turn on or off. You can get them for about $3, so replacing them every 3 months would not be expensive. However, they don't have an audible alarm, so we'd need to look at them to notice the color change.
All it would take is one call that comes in as "sick person" and turns out to be "CO poisoning" to make either option worth it. Word is, our dept had such a call not long before we joined. Fortunately, everyone turned out okay, but it easily could have turned out differently. I might just get some of the cheapo disposable ones for myself, and go with that.
For a long time, a new KED, perhaps the K.O.D.E. 2, was on my list of things I want. The old KED we have is in desperate need of replacement, but right now, what I'd like to have even more is a set of good, clear, scientifically valid protocols for spinal immobilization.
I made my original list last year, at EMS Today.
Yep. Still moping that I can't afford to go this year.
Still... maybe I COULD go down for the day, check out the show room, get more ideas for things I want but won't be getting. Tempting. Very tempting, indeed.
Top on my list today is a portable, personal CO detector.
One of those that clip onto something would be great. We could clip it to the bag we carry in to every call.
I was just looking for information on them, to see the pricing, etc. The ones I saw would need to be turned on for each call, and we'd need to learn to do that.
I also saw some disposable detector cards. They last for 90 days, and change color in the presence of CO. Nothing to turn on or off. You can get them for about $3, so replacing them every 3 months would not be expensive. However, they don't have an audible alarm, so we'd need to look at them to notice the color change.
All it would take is one call that comes in as "sick person" and turns out to be "CO poisoning" to make either option worth it. Word is, our dept had such a call not long before we joined. Fortunately, everyone turned out okay, but it easily could have turned out differently. I might just get some of the cheapo disposable ones for myself, and go with that.
For a long time, a new KED, perhaps the K.O.D.E. 2, was on my list of things I want. The old KED we have is in desperate need of replacement, but right now, what I'd like to have even more is a set of good, clear, scientifically valid protocols for spinal immobilization.
I made my original list last year, at EMS Today.
Yep. Still moping that I can't afford to go this year.
Still... maybe I COULD go down for the day, check out the show room, get more ideas for things I want but won't be getting. Tempting. Very tempting, indeed.
Friday, January 27, 2012
Customer Care: series of articles
About a year and a half ago or so, I attended an area training day that included a presentation on Customer Service. It was based on a handbook called Quality Improvement for Prehospital Providers. Click on that for a link to an earlier pdf version of the handbook.
"Everyone knows" that it's important to provide good service. Not everyone agrees on the priority of that service, how to provide it, or how to measure it.
I created a training session on the topic (with some help), that I've also written a blog post about. Since then, I've looked for other ways to improve our level of service.
Today, I came across a series of articles being reprinted by EMS World.
Here are the links to them:
EMS Revisited: Customer Care, Part 1 What is Customer Service?
EMS Revisited: Customer Care, Part 2 Making a First Impression
EMS Revisited: Customer Care, Part 3 Let Your Patients Know What You are Doing and Why
EMS Revisited: Customer Care, Part 4 Conducting a Patient Interview
EMS Revisited: Customer Care, Part 5 Why Do So Many Responders Dislike Nursing Homes?
EMS Revisited: Customer Care, Part 6 Are You a Professional Driver?
EMS Revisited: Customer Care, Part 7 Looking and Acting Professional
EMS Revisited: Customer Care, Part 8 Implementing Changes: Share Your Vision
Don't forget that EMS World is searchable, so there's always more.
"Everyone knows" that it's important to provide good service. Not everyone agrees on the priority of that service, how to provide it, or how to measure it.
I created a training session on the topic (with some help), that I've also written a blog post about. Since then, I've looked for other ways to improve our level of service.
Today, I came across a series of articles being reprinted by EMS World.
Here are the links to them:
EMS Revisited: Customer Care, Part 1 What is Customer Service?
EMS Revisited: Customer Care, Part 2 Making a First Impression
EMS Revisited: Customer Care, Part 3 Let Your Patients Know What You are Doing and Why
EMS Revisited: Customer Care, Part 4 Conducting a Patient Interview
EMS Revisited: Customer Care, Part 5 Why Do So Many Responders Dislike Nursing Homes?
EMS Revisited: Customer Care, Part 6 Are You a Professional Driver?
EMS Revisited: Customer Care, Part 7 Looking and Acting Professional
EMS Revisited: Customer Care, Part 8 Implementing Changes: Share Your Vision
Don't forget that EMS World is searchable, so there's always more.
Thursday, January 26, 2012
EMS Today Show Floor
I'm considering going down to Baltimore just for a day, to visit the exhibit hall. There are several interesting looking free CME classes, and a lot of new stuff to check out.
You can find a list on their website.
http://www.emstoday.com
The list of exhibitors is here. Each has a description of what they have, and most of them have links to their websites. There is a symbol to show which are new exhibitors.
There is a list of free classes in the exhibit hall here. The whole list of sessions is searchable.
I'll come back and note what I find most interesting when I get a chance.
You can find a list on their website.
http://www.emstoday.com
The list of exhibitors is here. Each has a description of what they have, and most of them have links to their websites. There is a symbol to show which are new exhibitors.
There is a list of free classes in the exhibit hall here. The whole list of sessions is searchable.
I'll come back and note what I find most interesting when I get a chance.
Wednesday, January 25, 2012
Spinal Immobilization: Nothing But Questions
If you haven't already read any of the various articles and blog posts about whether or not we should be immobilizing patients, or what research there is or is not, supporting such a thing, go read this article from EMS World.
I have a lot of thoughts on the subject, and many questions, but no answers.
It is clear to me that with elderly patients, who may have fallen from standing, or from a chair or bed, backboarding them may well do more harm than good.
It is clear to me that we have a lot of patients from MVAs who are unhurt, due to the improvement in car construction, safety belts and airbags, or just plain luck, who are backboarded due to "mechanism" but don't really need to be. It probably falls in the "neither harm nor good" category for most of them.
Where I'm not clear is this: patients who are injured, who have a mechanism that protocols say we should immobilize... what then? Does it really help? If it doesn't, then what WOULD? What SHOULD we be doing? How can we help the people who NEED some sort of protection because of a spinal injury?
I have not had a patient who was demonstrably harmed from either being immobilized, or from not being immobilized, that I am aware of. Still, I'm not satisfied that we're doing the best we can for them.
I'm intrigued by the full body sized vacuum splints. How does this change the effects of being backboarded? Is it safer? How about those pads they make for backboards? Any real difference?
Mostly, I want to know when there WILL be actual research on all of this.
I confess, it scares me. It scares me that we might be causing harm to patients. That I have protocols I have to follow- but don't know what they are based on, if anything.
I know medics who sometimes choose, under certain situations, to override protocols, when they are sure that it is in the patient's best interest. I am way too new at this to feel comfortable doing that, so I'm left in a very awkward position.
I got in this to help people.
I don't want to do things that harm anyone, and I want to know, for sure, or at least as sure as I can be, that what I'm doing actually helps.
Is that too much to ask?
I have a lot of thoughts on the subject, and many questions, but no answers.
It is clear to me that with elderly patients, who may have fallen from standing, or from a chair or bed, backboarding them may well do more harm than good.
It is clear to me that we have a lot of patients from MVAs who are unhurt, due to the improvement in car construction, safety belts and airbags, or just plain luck, who are backboarded due to "mechanism" but don't really need to be. It probably falls in the "neither harm nor good" category for most of them.
Where I'm not clear is this: patients who are injured, who have a mechanism that protocols say we should immobilize... what then? Does it really help? If it doesn't, then what WOULD? What SHOULD we be doing? How can we help the people who NEED some sort of protection because of a spinal injury?
I have not had a patient who was demonstrably harmed from either being immobilized, or from not being immobilized, that I am aware of. Still, I'm not satisfied that we're doing the best we can for them.
I'm intrigued by the full body sized vacuum splints. How does this change the effects of being backboarded? Is it safer? How about those pads they make for backboards? Any real difference?
Mostly, I want to know when there WILL be actual research on all of this.
I confess, it scares me. It scares me that we might be causing harm to patients. That I have protocols I have to follow- but don't know what they are based on, if anything.
I know medics who sometimes choose, under certain situations, to override protocols, when they are sure that it is in the patient's best interest. I am way too new at this to feel comfortable doing that, so I'm left in a very awkward position.
I got in this to help people.
I don't want to do things that harm anyone, and I want to know, for sure, or at least as sure as I can be, that what I'm doing actually helps.
Is that too much to ask?
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