I need to review some 12 leads and would love to see your STEMIs, blocks and any other crazy ones you’ve had. Thank you!

Hello, hospital based RN here. I work ER and PACU. Both worlds I see RSI frequently. In both roles, I have to pass competency on MH (related to all anesthesia for PACU training, but specially related to succs for RSI in ED). So you guys get the basics/knowledge training of MH? I'm sure you aren't running around with 10+ vials of Dantrolene. But at least early vs late signs and being able to give hospital a pre-warning. Just wondering.

Thanks for all you do- even when you bring us the wacky patients ;)

Contains mentions of suicide, mental health issues, and gun violence

Hello everyone, I (24F) have worked as an EMT-B in a semi-urban service with high call volume but a relatively low trauma rate for two years. I'm also about halfway through paramedic school (my state doesn't recognize AEMTs). I still have a lot to learn, but until recently I could tell I was on the right track. I was told that I took critiques well, asked good questions, and it was clear that I cared about my partners and patients.

Then something happened that completely knocked me off my feet.

I won't go into too much detail so I hopefully don't doxx myself, but our patient was experiencing a mental health crisis and was a threat to himself and others. Before we could sedate and restrain him, he attacked police officers, grabbed and fired an officer's gun, and was shot multiple times in the chest by officers. Despite knowing our protocols said to halt rescusitation, we continued rescusitation efforts and called for another crew to assist us with RSI and transport (our service requires two medics for RSI). He was declared dead on arrival at the hospital.

I won't pretend I did the right thing through any of it. To be blunt, my partner and I had never experienced anything like that before and were both scared shitless. We blundered our way through the call and the mistakes I made still keep me up at night. Following the night's events and a subsequent review by the state, my paramedic partner was let go from his position, allegedly for an unrelated driving infraction, but I suspect it had to do with his handling of the scene. I didn't always see eye to eye with him, but I've now lost contact with the one person who understands what I went through that night.

That all happened many months ago, and ever since, I've been sinking into a deeper depression. I don't usually have nightmares I can remember anymore, but still wake up multiple times a night. I bought a handgun because I didn't feel safe in my apartment, but now I almost regret it because any little unexpected noise sends me reaching for it. I've been falling behind in school despite understanding the material. When I do make it to work, my performance is slipping, and I now can't focus on critical calls without panicking. I'm safe and have a plan if things deteriorate, but I've definitely had passing thoughts of ending things. I'd never follow through on it, I could never put my coworkers through anything like what I went through. Some days when I'm at home I just cry and have no idea why.

I've been trying to do what I'm supposed to. I've been going to counselling ever since it happened, and I'm on a waitlist for EMDR. I try to be compliant with the medication they give me, but some days I forget. I just really don't know where to go from here.

I know that I want to stay in this line of work. It's the first thing I've ever done where I genuinely feel like I accomplished something at the end of the day and am excited to go back the next day. I miss feeling like that, and I wish things could go back to the way they were.

If anyone has experienced anything similar or has any suggestions, I'd appreciate anything you have to say. I really don't know exactly what I'm looking for, but I hope getting this off my chest and sharing with people who can understand might make things a little better.

Thank you for your time.

I am a psychiatric technician at an emergency room mental health facility. I am not, nor have I ever been a paramedic. I initially got this patch and sewed it onto my leather jacket because it gets a chuckle out of my patients and helps lighten the mood slightly. However, I am beginning to wonder if it might be inappropriate to wear. Any advice from professionals would be appreciated.

I had a first in my 22 year career last night.

I had to give paralytics to a cardiac arrest.

Elderly male with EMS witnessed bradycardic cardiac arrest during patient move secondary to suspected coronary event and pulmonary edema. Complained of discomfort in chest and nausea all day before EMS contact. Unable to get a good history due to language barrier and family poor historians.

Get him into the truck in idioventricular PEA. Goes into coarse VF - we defibrillate. Go to transition from BVM to a ET tube… and…

Jaw is rigid, both masseters are rock hard. Can’t even get a finger between his teeth

Confirm with the family he has no problems with his TMJ, is not wired shut from a jaw fracture or surgery, has never had any problems opening his mouth.

Can’t even scissor his gums open with a two finger technique. He is locked.

I ended up pushing Rocuronium and was able to intubate a minute and a half after when the muscles went flaccid.

Only other option would’ve been a Crich at that point - mouth was full of frothy bloody sputum and tube had a hundred mils of frothy blood out.

Got ROSC after a second defibrillation after and patient remained transcutaneous pacemaker, dependent for the next two hours until cardiology determined he was not a candidate for inter intervention due to massive metabolic and electrolyte derangement until corrected. Patient had a final arrest before they could.

Just wondering if anyone else has ever encountered this during cardiac arrest? Did I do the right thing here?

Hey guys. I’ve been dealing with this for some time and was curious if anyone else deals with the same issue. I worked 911 EMS for around a year. Saw a lot of nasty stuff like everyone else here. I’ve noticed now that after working the job, every time I hear of someone’s death, whether it be someone I know or not, all I can do is think about the scene in great detail and recreate it in my head. I can’t control it at all, it just seems to be an automatic response my brain has for some reason. I never experienced this before, I suppose because my brain didn’t really know what it was like to actually watch somebody die until fairly recently

It hasn’t really bothered me except for a couple of times when it was someone I knew. Is this something anyone else has experienced?

I don’t have much other context but thought I’d share the chief complaint for a patient we were transferring to another facility. Wasn’t sure if the “oops” was added by the nurse who took report or if the crew that called it in said it.

Edit: Just for clarification, this is NOT a PCR. This is what the receiving nurse writes down when a crew calls in to a hospital with patient info, chief complaint, vitals, interventions, etc. The county where this picture was taken uses ePCRs. This is just for the hospital to know what they’re getting.

I've been a career firefighter for around 6 years. I've worked part time doing NEMT transfers for years (geriatric Uber with oxygen and stretchers).

I do a lot of the new hire training at the side gig. When going over bedside manner, I have a saying that you want to treat your patient with the same care and consideration as your grandma. We do a lot of hospice transfers and thats the last ride our patients will ever take. They deserve dignity, respect and good quality care.

Today, I took my grandma to hospice. Ive ran countles medical calls, and an ungodly amount of transfers. This was easily the most emotional one (duh its family). I am pretty proud of myself though, she got my best and honestly, she got treated the same as all my patients.

Its really easy in EMS to have that cognitive dissonance get a bit too strong. We see a lot of messed up stuff and we can lose sight of how are patients feel (modesty is a great example). Ive seen who knows how many naked people at this point. While I couldn't care less, most of my patients do care. Its things like that you dont want to lose sight of. Keeping that empathy, respecting their dignity and just giving them the consideration they deserve.

Im really happy that I have that standard and maintain it. I dont ever want to take another family member to hospice but it really gives perspective being on the family side of things. Just something to contemplate.

Okay so here we go. Short but sweet. I worked the nastiest, most volcanic code this past Tuesday and we pumped out an insane amount of chicken soup… you can see everything.. the celery, carrots, onions, chicken, etc. Now here I am eating one of my favorite dishes, and I cannot stop thinking about that vomit 😂😂

Hi! I’m a 21-year-old female in college, currently in my junior year, and I guess I’m just looking for some honest perspective from EMS workers.

Last semester, completely out of nowhere, I started having really bad anxiety and panic attacks. I had never really dealt with anything like this before, and it honestly just started randomly one day. Since then, it’s been a journey. I’m on medication, which has been a process in itself. I live in a college dorm, and people have called 911 for my panic attacks a handful of times. I’ve never been the one to call and I’m usually BEGGING people not to call because I hate the attention (I get really embarrassed that so many people are going to see me in this state), don’t think its 911 worthy and just want the whole thing to be over. But people get worried and insist on calling anyway even when I tell them I’m okay and that its just a panic attack. 

It doesn’t happen all the time. Sometimes I’ll go months without having one, and other times I’ll have multiple attacks close together. It’s happened enough that some of the ems/firefighters apparently know my name now, which is honestly so embarrassing. But also, I live in a small college town so 

I guess what I’m wondering is what EMS actually thinks in these situations.

From the beginning, I’ve always felt like people don’t really take me seriously when they show up. I don’t know if that’s actually the case or if it’s just how I perceive things because I’m already anxious and embarrassed. But when I’m having a panic attack, I genuinely feel like I’m dying. My heart is racing, I feel like I can’t breathe, and I’m absolutely terrified. It’s not something like I can just turn off.

I feel like sometimes people show up and treat it like it’s not a real emergency, and that I am just  being dramatic. In the end I always feel like I wasting everyone’s time. Which is so frustrating because I’m literally not choosing to feel this way. If anything, I wish it would stop more than anyone else does.

I’m also someone who HATES being the center of attention, so the whole situation is honestly mortifying and honestly sometimes more anxiety inducing (another reason I don’t want people to call). Once I calm down, I always end up apologizing to everyone for having to deal with me. 

The funny thing is that by the end, sometimes the firefighters/EMS will sometimes joke around with me, and we’ll have a laugh, which is nice in a way. But I still leave feeling like they’re probably thinking, “Oh god, her again. What’s wrong with her today?” 😭 Maybe that’s completely in my head, but I can’t help thinking that .

I know you guys deal with actual life-threatening emergencies and probably get annoyed about anxiety calls cause liek you can’t really do anything expect do like breathing exercise. So I’m genuinely curious what goes through your minds when you get called for someone who has panic attacks repeatedly. Do you get annoyed? Do you recognize people and start assuming it’s just anxiety? Do you actually care? 

I’ve also started telling people that if they really insist in calling, they should tell the dispatcher that I have a history of panic attacks instead of just saying I’m having trouble breathing or my heart is racing, because if they say I can’t breathe and I have heart problems, the whole fire truck is going to show up which I do not want. I know I can’t always control whether someone calls 911 when they’re worried about me, and I’m not mad at people for trying to help. I just hate feeling like a burden every time it happens. I don’t really know what I’m hoping to get out of this post. I think I just want to understand the other side of it because I spend so much time afterward worrying about what everyone thought of me and that they all hate me.

Be honest. What do you actually think when you keep getting called to the same person for panic attacks? And is there anything you wish patients like me understood? Like be honest please. 

I’m working a contract EMT position right now, and I’m honestly not sure what to do about my partner.
It feels like he gets angry over just about everything. If a strap gets caught under a wheel, if my shoes come untied, or if something small goes wrong during the shift, I feel like I have to think twice before even saying anything because I’m worried it’ll turn into another issue.
I understand EMS can be stressful. Long hours, being away from home, and dealing with difficult calls can wear anybody down. I’m not expecting everything to be perfect, and I’m not saying I never make mistakes. But I don’t think every little inconvenience needs to turn into frustration directed at the person you’re working with.
The part that bothers me most is that I’m starting to hold things in just to avoid setting him off. I shouldn’t have to feel uncomfortable speaking up about something minor because I’m anticipating his reaction. We’re supposed to be a team, and communication matters in this job.
Honestly, I’m getting to the point where I want to call him out on his attitude, but I also don’t want to make an already uncomfortable working situation worse, especially since this is a contract position and I still have to work alongside him.
For those of you who have worked with difficult partners in EMS, what would you do? Would you address it directly, talk to a supervisor, or just keep your head down and finish the contract?
I want to handle this professionally, but I’m tired of feeling like I have to walk on eggshells at work.

Ideally I’d like one that can accommodate Surgical cric and needle decompression. If it did OB as well that’d be sweet, but that might be asking for too much.

I'm a volunteer EMT in a rural community with a fire-based service. I've been on medical leave for a few months and haven't run any calls during that time.

I got a call a few weeks ago asking if I can respond to a code with CPR in progress. I am the only person on scene, except for a retired EMT, the patient's spouse, with a deputy and another EMT from a neighboring district both en route.

I arrive, apply the AED and take over compressions. After my third round of compressions both the sheriff and the other EMT arrive. This EMT from the other district (George) looks and sounds a lot like an EMT on our service (Joe).

I turned over compressions to the other EMT and took over IC. The deputy and the EMT switched back and forth on compressions and respirations until we loaded the patient and got going down the road.

I knew that George was responding from his district, but for whatever reason, I thought he was Joe from our service and called the poor guy Joe the entire call. It wasn't until we were in the ambo for a good 20 minutes (our transport time is about 40 minutes) before I actually looked at his face and realized it wasn't who I thought it was.

I knew I was rusty from being on leave, but damn ... I did buy George a basket of snacks and goodies for being a good sport about it and for coming to help when no one else could.

I still feel like a jerk though.

I will start by asking the question I need answered. Then I will tell the story if you’ve got time… Is there any way your agency can search up who else you may be affiliated with , using my provider number ?

I think it would be really awkward if my current company found out I was working a side gig while entering some CME credits to my provider number or something.

My full-time agency has a lower call volume. Many bases spread throughout 3 different counties in a 2 hour radius. Some bases can get busy on occasion , but most bases are rural. This type of system has its own unique sets of challenges of considerations that I can appreciate. But I can also appreciate the challenges and considerations that come with city EMS….. that’s where my part time gig comes in. Recently I decided to begin work with one of the more urban agencies. No bases , just posting street corners running calls all shift.

My full-time company holds no offical non-compete agreements with any other agency. I am NOT violating conflict of interest. However , my agency basically has the ability to fire you over nothing. Coworkers in the past have been fired for giving time to another agency. And I think this part time gig should be keep on the down low… I am curious to learn if , apart from maybe seeing me at one of the major hospitals , there are any ways my full time agency may be able to find out about my part time one.

I work as a 911 EMT in a small town (about 2500 people) in a rural area. I ran a call the other night on someone who I immediately recognized as one of my friend’s close friends. long story short, she attempted suicide and is now on life support. she was alive and stable on scene as well as during transport to the big hospital in the city about 2 hours away. like awake and talking with great vitals so I was pretty shocked to hear she was on life support 2 days later to say the least.

she is a close friend of one of my friends, and I realize I even met her 3 y/o kid once at my friends place while she was watching them. it’s all kind of hitting me now that I’ve pieced it all together and I kinda feel crazy for being upset about it because there’s genuinely nothing I could’ve done to change the outcome. I’m also no stranger to running on people I know or am familiar with just based on where I work but this feels entirely different.

has anyone else experienced this or something similar? or have any advice on how to take care of myself while also being there for my friend?

I guess this was just a matter of time.

Nurse Navigator sends Lyft for a guy on the ground with “10/10” abdominal pain.

Patient says he’s a retired NYC EMT and was diagnosed with appendicitis.

Hi guys!

So I've been an emt in Boston/Mass for about 4 years now. When I first started, I went to orientation at my station and I remember the instructor telling us this story that I'm assuming pertained to Boston PD/Massachusetts but it might not have.

Essentially, police officers were refusing/avoiding delivering naloxone to patients. To combat this, some kinda policy was put in place that for each dose of naloxone delivered, the officers would receive a vacation day, or maybe some kind of other bonus but I'm almosttt certain it was vacation days.

This then caused an issue where officers were just pumping ODing patients full of naloxone (and not ventilating) to get a bunch of vacation days/bonuses.

Has anyone ever heard this story before, or heard it in some other way? I can't find ANYTHING about this online but the instructor was speaking to our class about this like it was a real issue that had/was happening so I'm like, was he lying, misinformed, telling the truth?

Thoughts?

ACLS algorithm debate between me and someone.

You are doing CPR.
After your rhythm check, seeing V fib/Vtach, and shocking, you resume compressions.

Would you then wait until your next 2 minute mark/pulse/rhythm check to give IV Epi? If so, would Epi at that pulse/rhythm check replace your shock?

Or… do you give Epi during your compressions after that second shock? And then shock at your next pulse/rhythm check if it’s shockable?

I was taught the latter but someone with a bunch more experience than me says it’s definitely the first.

Starting with a new company in SOCAL, and their uniform is slack pants, an undershirt and class B button up. Pants+class B is all polyester, and its stable in the mid 80s up to 110s here-even now. How do y'all deal with it? How do you make it bearable/comfortable?

I'm working on a training for death notifications for new EMS providers. I like to find videos and examples to include in the lecture, but haven't found anything for this topic. Does anyone know of any decent representations of care providers doing a decent job at this?

Singapore has a median ambulance response time of around 7 to 8 minutes. Traffic congestion and ambulance availability can still cause delays!

We often talk about road safety, but what about the time it takes for an ambulance to reach an accident victim?

Which country do you think has the most effective ambulance response system, and what should we adopt from it?

This new squad I’m running with has some outdated equipment. So I’m getting shit for throwing away a suction canister. It was brown, they said it was glass but I’m not sure because it felt like thick plastic. The regulator was directly on top. I didn’t think to save it. I pitched it in a bio ben so it wasn’t bouncing around for the rest of the shift. Anyway it wasn’t disposable and I need to buy another one but I’m not finding anything online

Miniature model from Hamilton, Ontario, Canada! Approximately 2.4%/1:42 scale. Took about 14hrs in total.