This week we had a training session to introduce us to the new CPAP machines we are getting, as well as to review intubation and surgical crichs.
It all set me thinking about the changes I have seen since I became an EMT in 1989 and a paramedic in 1993. (I'm sure people who have been in EMS longer than me have an even longer list.)
Here’s what we had:
Wide open fluid for trauma
EOAs as backup airway
Old CPR
On-line Medical Control required for any controlled substance, including valium for status epilepticus
Isoproterenol and bretylium
MAST pants (We actually still have them but they are buried so deep we rarely bother to look for them much less ever use them)
LifePack 5s (10's were on some trucks)
hands on paddles with gel
paramedic certification
separate pacing pads
syrup of ipecac
demand valves
Stokes baskets for large people
dopamine and lidocaine we had to mix ourselves
two straps on the stretcher
wood long boards
ammonia inhalants for drunks
chemstrips to check sugar
lots and lots of patients with CHF
towel rolls
tape or oxygen tubing to tie ET tubes
We did CPR on and transported everyone except complete stiffs
we c-spined everybody in an MVA and everyone who fell
two man stretchers
What we have now:
CPAP
New CPR
Continuous Wave Form Capnography
LP 12s with 12 Lead ECGs
paramedic licensure
standing orders for controlled substances
bougies
glucometers
combitubes and LMAs
bulb syringes to check tubes
commercial tube holders
100% hands off defibrillation (we have no paddles anymore)
Combi-pads
HIPPA
restricted fluid for trauma
commercial surgical crich kits
Cardizem
Ativan and Haldol for violent psychs
amiodarone
selective spinal immobilization protocol
permissive hypotension
field termination of resuscitation
atrovent
phenergan and raglan for nausea
stair chairs with tracks
one man stretchers
solumedrol
Morgan Lenses
mandatory seat belts
black box technology
safety nets
bariatric ambulances
three straps and shoulder straps on the stretcher
needles syringes
protective catheters
Easy IO (coming soon)
I may be missing more -- I'm sure I am. Here's my votes for the three best changes over that time span.
#3 Field Termination of Resuscitation
There is so much more dignity in dying at home, even if it means an ACLS workup.
#2 Selective Spinal Immobilization
Again, anytime we can stop doing anything pointless like immobilizing everyone regardless of whether or not they have neck or back pain is a good thing.
#1 One-Man stretchers.
I can't help but think that at some point I would have injured my back doing the old two man dead lifts where we had to lift the patient and stretcher up and then toss it in the back of the ambulance. Now we just load the head end, squeeze the handle while our partner manually lifts the wheels while most of the weight is supported at the head. Easy as can be.
(And the thing of it is, many of us resisted the one-man stretchers when we started to get them. I'm strong enough to do my own lifting!)
I wonder what we'll have new another ten years down the road?
