In my previous post 2009 A Year of Paramedicine I gave a breakdown of the medicine I gave over the course of 12 months.
Below are my medicine stats from my first three years as a full-time medic in the 1990's, working in a one medic per ambulance urban system with some responses to suburban towns. (Also at that time, there were fewer medic ambulances than there are today). The numbers includes only calls where I was the primary medic and wrote a run form. Does not include calls where I backed up another medic on cardiac arrests or respiratory distress. Each number represents a unique patient. A patient receiving 3 doses of NTG counts as 1 NTG. Does not include ALS transfers. ALS calls were any call that I either put the patient on a monitor and/or put in an IV and or gave medicine, and of course, saved the run form.
I had been meaning to get rid of these old run forms for years, but quite enjoyed going through them and revisiting old calls. My memory of the old days and the actual facts of them were interesting. I recalled having more intubations and having done more traumatic arrests than I actually did. I thought I had given narcan far more than I did.
When asked by newer medics to talk about the city "back in the day," my tales would always begin: "There I was in bullet proof vest, largynescope in one hand, narcan syringe in the other, two bags of fluid ready to run wide open, hanging from my teeth..." (For the record, I have never worn a bullet-proof vest).
My memory of more traumatic arrests (besides the exaggeration of years) was likely more a case of the number of times I would have jumped in the back of another medic’s ambulance to do CPR on the fly than actual calls I was directly dispatched to as the primary medic, as well as the number of calls where the patient did not arrest until the hospital or was simply presumed at the scene (after the PD let us through the yellow tape).
Some of the drugs I have given are remarkably consistent between the decades such as ASA and NTG. Even the number of cardiac arrests is fairly constant. The biggest discrepancies are where the medicine has changed. Compare my use of Lasix between the 1990’s and the present day. I gave it 21 times in 1996, 0 last year. I cringe on reading my clinical impressions on calls where I gave Lasix, ?CHF/?pneumonia, ?CHF/?sepsis. It was still before our protocols contained the caution:
CHF vs. Pneumonia: If the clinical impression is unclear and transport time is not prolonged, consider using
Nitroglycerin and withholding Lasix or Bumex or contact medical control.
Even my narcan usage seems excessive in light of today’s protocols, which call for its use only in patients with hypoventilation/ depressed respirations related to likely opiate overdose.
The most shocking to me is how little I used morphine. At the time it required on-line medical control. When I did use it, it was more likely for CHF than for trauma. And when I did use it for trauma, I never gave more than 2 mg. Ouch! I read through all these old run forms documenting trauma and I did nothing for them. Worse, most of the fractures I likely encountered I BLSed, thus no run form was saved. In my first three years doing a much higher volume of calls than I do today, I gave morphine for trauma twice. Last year alone, I gave morphine 37 times.
Other observations:
1. As a new medic most of my intubations were on dead people. (We have never had RSI). A few years ago and before we had CPAP, half my intubations were on living people. Last year, I only intubated 1 living patient. I think that was a bit of an abberation.
2. For all I sweated learning about lidocaine and dopamine in medic school, I really didn’t use them very much.
3. The popular image of medics putting paddles on the chest and shocking isn’t much of a reality, although, I did use the gel and paddles in those days when I could, even though we had the option of hands off patches.
4. There was nothing I could give to all the patients I had in rapid afib. Today I can give them Cardizem or Metoprolol.
5. The higher rates of breathing treatments would have been a function of the high rates of asthma in the city, as the higher rate of D50 today is a function of an extremely high obese diabetic problem among the elderly population in our town.
6. I don’t see as much serious trauma in the town I work in as when I was in the city full-time.
7. I wish I knew how many BLS calls I did in the 90’s. Even though medics were reserved for the “better” calls, I am sure I still BLSed a higher portion of my calls then than I do today.
8. My traumas from the 1990's almost all have IVs wide open despite normotensive blood pressures.
9. All Cardiac Arrests that were worked then were transported, whereas today we have the ability to work and then presume on scene if the rescusitation is unsuccessful.
***
1997
376 ALS Calls
12 Cardiac Arrests (10 Medical, 2 Trauma)
14 Intubations (1 Nasal)
2 Defibrillations
1 ROSC
?0 Survival to Hospital Discharge
NTG - 38
ASA - 37
Ventolin - 37
Atropine - 18
Lasix - 17
Epi 1:10,000 - 12
Dextrose - 11
Narcan - 10
Benadryl - 4
Adenosine - 4
Epi 1:1000 - 3
Glucagon - 3
Lidocaine - 2
Morphine - 2 (1 for chest pain, 1 for ankle fracture)
Valium - 1
1996
512 ALS calls
12 Cardiac Arrests (11 Medical, 1 Trauma)
11 Intubations
1 Defibrillation
1 ROSC
0 Survival to Hospital Discharge
NTG-45
Aspirin-44
Ventolin – 42
D50-21
Lasix-21
Atropine – 12
Epi – 1:10,000 - 10
Benadryl- 6
Adenosine-5
Morphine-4 (3X for CHF, 1X for burns, gave 2 mg with permission of med control)
Narcan-4
Epi 1:1000 – 2
Valium-2
Lidocaine-1
Glucagon-1
1995
361 ALS calls
9 Cardiac Arrests (8-Medical, 1 Trauma)
7 Intubations
2 Defibrillations
2 ROSC
1 Survival to Hospital Discharge
Ventolin – 36
ASA – 32
NTG – 27
Lasix – 11
Benadryl – 10
D50- 8
Atropine – 9
Epi 1:10,000 – 8
Epi 1:1000 – 7
Narcan – 5
Adenosine – 4
Lidocaine – 2
Valium – 1
Glucagon – 1
Dopamine - 1
Morphine - 0
Other drugs we carried for all or part of these years: Bretilyium, Procainimide, Pitocin, Sodium Bicarb, Calcium, Isuprel, Thiamine, Dramamine, Allupent, Verapamil
Results are limited by run forms saved.
