Why do we rant in EMS? That's what I want to write about. I want to write about it in a way that is not a rant, and I want to write about it in a way that will help to stop me from ranting because I don't think it is a particularly attractive quality.
Yesterday after I wrote my ranting anti-rant which on reading seems still like a ranting rant, I had quite a day to rant about, which I will try to avoid ranting about here. I did spend much time thinking about why we rant, and may have some answers but will need more time to write it up because I don't want it to be a rant.
I will mention one call where I had a chance to atone for my ranting, but I did not.
The short of it was a patient who slipped getting out of bed, hurt all over, and was ordered out to be evaluated. He had a constant history of pneumonia, and recently had MRSA, but evidently didn't have it any more according to the nurse. He coughed all the way to the hospital -- coughed up thick mucus -- enough to fill a bowl of oatmeal. His eyes watered as he coughed and you could see how fatigued he was. His nasal cannula had dried secretions all over it. He was also covered is what I initially thought was shit because he said he was covered with shit, but then qualified it as the chocolate milk shake he was holding when he fell out of bed, probably from coughing so hard. I didn't even want to touch him he was so nasty. Now, I'm not admiting I just copied his vitals off the nursing home W-10, but I did the bare minimum on the call. On the way in, he asks me "Do you think they'll brush my teeth there?" He asked it almost like a little boy, who is hopeful, yet used to disappointment.
"They don't brush your teeth at the nursing home?" I asked.
He shook his head and said "No, they never do."
"They probably will if you ask them," I said. "They have toothbrushes in all the rooms, the disposable kinds."
He nodded, but I saw nothing but fatality in his eyes. "I just want to die," he said.
In the hospital room, I found one of the toothbrushes and said to him, "Here's the toothbrush. I'm going to leave it here so you can remember to ask the nurse when she comes in."
He muttered thanks.
It wasn't until I was back out at the ambulance that it occurred to me I had had a chance for a gesture of kindness, a chance to break through and in the smallest of ways make the world a better place. "I should have brushed his teeth," I said aloud -- not to anyone because I was out there by myself. I just said it to the stretcher, to the ambulance, to the graying sky.
Saturday, October 27, 2007
Friday, October 26, 2007
Weak
My plan today was to write a response to Baby Medic’s rant Bad Day -- a rant I have had myself on too many a day, week, month and year -- but in order to write what I really feel -- about the privilege of this job despite all the bullshit -- I need not to be having a bad day myself.
The small stuff is getting to me.
I hate coming to work and finding half used drug vials in the med kit. It says right on the side of the vial “Discard any used portion.” Multidose doesn’t mean multi-patient. How would you like to get 1.2 mg of narcan injected into you from the same vial that maybe an AIDS infected heroin addict received two injections from? Maybe another medic drew up 1.2 mg and gave an IM injection to the addict, and when that didn’t work, drew up another .8 from the same vial with the same syringe, and now you are lying unresponsive – maybe from a head injury -- and your medic draws up the narcan from the same vial that either he or his EMT partner put back in the med kit because they either didn’t know you were supposed to dump the vial or they were too lazy to restock.
And I should talk about leaving the ambulance a mess because while I do my best, I am not a rubber gloves up to the elbows, bleach and toothbrush in hand scrub everything till it isn’t there anymore kind of guy, but what happened to the hospital gowns I stock and how about a blanket? I have to climb my tired ass out of the ambulance, back to the laundry rack, grab a couple gowns and a thick blanket and instead of climbing back in to the ambulance, I just open the back door and toss the blanket and one gown on the stretcher and toss the other gown on the bench. I can put it on the shelf later.
And who designed the houses in this town? Every one I have been to today is a split level. You have to walk up stairs to get in the house where you come in on a landing where you either have to go up more stairs or down stairs to get to your patient. And if they are in the back bedroom, you can’t get the stretcher in because the hallway is too narrow, and there is no turning radius. Let’s not even get into the size of the patients and their lifelong diet and eating habits. Or bathing habits for that matter.
The Red Sox won a great game last night and now lead the World Series 2-0, yet I am angry that the game started so late and lasted so long that I got to bed way past my bed time and so I am tired and irritable this morning, instead of being grateful.
And hey old Parkinson’s guy feeling a little weak with your companion a little too demented to give me any kind of rational history, why did you spend the night on the floor? And your batty doesn’t know she has Alzheimer’s yet companion didn’t call us to help you until this morning? And damn, even though you are not hurt, I can’t rightly leave you here and go back to my disturbed nap, my cheek pressed to the pillow, the blanket tucked up to my neck, me all curled up like a middle-aged baby. So I guess we have to take you in. If my partner can only get the stretcher in here.
I am sorry I am apparently too tired and tangled with my own gripes to take in the awfulness of where life leaves once fierce vibrant people.
Let's get you up. Here's my hand.
The small stuff is getting to me.
I hate coming to work and finding half used drug vials in the med kit. It says right on the side of the vial “Discard any used portion.” Multidose doesn’t mean multi-patient. How would you like to get 1.2 mg of narcan injected into you from the same vial that maybe an AIDS infected heroin addict received two injections from? Maybe another medic drew up 1.2 mg and gave an IM injection to the addict, and when that didn’t work, drew up another .8 from the same vial with the same syringe, and now you are lying unresponsive – maybe from a head injury -- and your medic draws up the narcan from the same vial that either he or his EMT partner put back in the med kit because they either didn’t know you were supposed to dump the vial or they were too lazy to restock.
And I should talk about leaving the ambulance a mess because while I do my best, I am not a rubber gloves up to the elbows, bleach and toothbrush in hand scrub everything till it isn’t there anymore kind of guy, but what happened to the hospital gowns I stock and how about a blanket? I have to climb my tired ass out of the ambulance, back to the laundry rack, grab a couple gowns and a thick blanket and instead of climbing back in to the ambulance, I just open the back door and toss the blanket and one gown on the stretcher and toss the other gown on the bench. I can put it on the shelf later.
And who designed the houses in this town? Every one I have been to today is a split level. You have to walk up stairs to get in the house where you come in on a landing where you either have to go up more stairs or down stairs to get to your patient. And if they are in the back bedroom, you can’t get the stretcher in because the hallway is too narrow, and there is no turning radius. Let’s not even get into the size of the patients and their lifelong diet and eating habits. Or bathing habits for that matter.
The Red Sox won a great game last night and now lead the World Series 2-0, yet I am angry that the game started so late and lasted so long that I got to bed way past my bed time and so I am tired and irritable this morning, instead of being grateful.
And hey old Parkinson’s guy feeling a little weak with your companion a little too demented to give me any kind of rational history, why did you spend the night on the floor? And your batty doesn’t know she has Alzheimer’s yet companion didn’t call us to help you until this morning? And damn, even though you are not hurt, I can’t rightly leave you here and go back to my disturbed nap, my cheek pressed to the pillow, the blanket tucked up to my neck, me all curled up like a middle-aged baby. So I guess we have to take you in. If my partner can only get the stretcher in here.
I am sorry I am apparently too tired and tangled with my own gripes to take in the awfulness of where life leaves once fierce vibrant people.
Let's get you up. Here's my hand.
Tuesday, October 16, 2007
Room
I’ve been doing a serious garage and house cleaning. I do it a couple times a year. I always manage to throw a good bit out, but never quite get control. I’m no pack rat. Paramedics won’t find my rigored body underneath a collapsed stack of yellowed newspapers, but I have stuff.
A month ago I cut my book collection in half – loaded up about fifty boxes and took them to the library. I still have way more books than I could ever read again. I have my best books on the bookshelf in the living room -- Moby Dick, The Great Gatsby, The Catcher in the Rye, Don Quioxte, On the Road, and others. The rest are piled high in plastic bins in the garage.
I have other bins too, but instead of books inside the bins are jumbled messes of old letters from past girlfriends, photos, concert tickets, records, magazines, momentos, souvenirs, old baseball gloves, sports equipment and trophies, and journals and papers and stories I wrote in grade school and high school and college, and then articles and speeches and more stories I wrote as an adult. They probably aren’t all worth saving. But I feel if I throw them out, I am throwing out a part of myself.
I go into the houses and apartments of old people – some piled high with junk and barely navigatable, others barren – not much more than a couch, a TV on a stand, a bed, a table with two chairs, -- and I wonder what my home or apartment will look like when EMS comes for me on that hopefully far off day.
Sometimes I think I’d like to weed my stuff down to only what I could fit on a dresser in a one room elderly apartment. What would I bring? A sperm whale tooth I got as a child, a baseball card of my first hero Red Sox Tony Conigliaro, a cloth bookmark a girl sewed for me with the stitched words “Wise Madness is Better than Foolish Sanity,” two small Indian stone carvings one of a buffalo, the other a wolf, a few photos of close family and friends. What more do I really need?
Years ago, a friend of mine said I would one day end up like the old man in the Robert Frost poem, An Old Man’s Winter Night.
All out of doors looked darkly in at him
Through the thin frost, almost in separate stars,
That gathers on the pane in empty rooms.
What kept his eyes from giving back the gaze
Was the lamp tilted near them in his hand.
What kept him from remembering what it was
That brought him to that creaking room was age.
He stood with barrels round him -- at a loss.
And having scared the cellar under him
In clomping there, he scared it once again
In clomping off; -- and scared the outer night,
Which has its sounds, familiar, like the roar
Of trees and crack of branches, common things,
But nothing so like beating on a box.
A light he was to no one but himself
Where now he sat, concerned with he knew what,
A quiet light, and then not even that.
He consigned to the moon, such as she was,
So late-arising, to the broken moon
As better than the sun in any case
For such a charge, his snow upon the roof,
His icicles along the wall to keep;
And slept. The log that shifted with a jolt
Once in the stove, disturbed him and he shifted,
And eased his heavy breathing, but still slept.
One aged man -- one man -- can't keep a house,
A farm, a countryside, or if he can,
It's thus he does it of a winter night.
-Robert Frost
"A light he was to no one but himself."
But I am not alone now. I share my house with a woman and two children, and another one on the way. I need to make room.
A month ago I cut my book collection in half – loaded up about fifty boxes and took them to the library. I still have way more books than I could ever read again. I have my best books on the bookshelf in the living room -- Moby Dick, The Great Gatsby, The Catcher in the Rye, Don Quioxte, On the Road, and others. The rest are piled high in plastic bins in the garage.
I have other bins too, but instead of books inside the bins are jumbled messes of old letters from past girlfriends, photos, concert tickets, records, magazines, momentos, souvenirs, old baseball gloves, sports equipment and trophies, and journals and papers and stories I wrote in grade school and high school and college, and then articles and speeches and more stories I wrote as an adult. They probably aren’t all worth saving. But I feel if I throw them out, I am throwing out a part of myself.
I go into the houses and apartments of old people – some piled high with junk and barely navigatable, others barren – not much more than a couch, a TV on a stand, a bed, a table with two chairs, -- and I wonder what my home or apartment will look like when EMS comes for me on that hopefully far off day.
Sometimes I think I’d like to weed my stuff down to only what I could fit on a dresser in a one room elderly apartment. What would I bring? A sperm whale tooth I got as a child, a baseball card of my first hero Red Sox Tony Conigliaro, a cloth bookmark a girl sewed for me with the stitched words “Wise Madness is Better than Foolish Sanity,” two small Indian stone carvings one of a buffalo, the other a wolf, a few photos of close family and friends. What more do I really need?
Years ago, a friend of mine said I would one day end up like the old man in the Robert Frost poem, An Old Man’s Winter Night.
All out of doors looked darkly in at him
Through the thin frost, almost in separate stars,
That gathers on the pane in empty rooms.
What kept his eyes from giving back the gaze
Was the lamp tilted near them in his hand.
What kept him from remembering what it was
That brought him to that creaking room was age.
He stood with barrels round him -- at a loss.
And having scared the cellar under him
In clomping there, he scared it once again
In clomping off; -- and scared the outer night,
Which has its sounds, familiar, like the roar
Of trees and crack of branches, common things,
But nothing so like beating on a box.
A light he was to no one but himself
Where now he sat, concerned with he knew what,
A quiet light, and then not even that.
He consigned to the moon, such as she was,
So late-arising, to the broken moon
As better than the sun in any case
For such a charge, his snow upon the roof,
His icicles along the wall to keep;
And slept. The log that shifted with a jolt
Once in the stove, disturbed him and he shifted,
And eased his heavy breathing, but still slept.
One aged man -- one man -- can't keep a house,
A farm, a countryside, or if he can,
It's thus he does it of a winter night.
-Robert Frost
"A light he was to no one but himself."
But I am not alone now. I share my house with a woman and two children, and another one on the way. I need to make room.
Sunday, October 14, 2007
The Gear
I've pretty much been a stickler over the years about carrying gear. You get a call -- whether its chest pain, a fever, or a fall -- you bring all your gear in. Monitor, house bag, 02. You never know.
Many years ago, I was working with a partner named Steve. Good partner. We had lots of fun together. We get called to an assault in the north end. This is a pretty common call. Someone gets punched in the face or scratched -- the cops call us, we go. The patient is giving a statement. We either get a refusal or we walk the patient to the ambulance. No problem. Most of the time they are sitting on the front stoop. Anyway, we get called, and the cop coming out of the apartment building says nonchalantly, "he's up on the 2nd floor." We walk up there nonchalantly. See a cop writing up a report. He nods down by his feet where a man in laying prone with a pool of blood around his head. "He got the shit kicked out of him," the cop says -- "steel toed boots." "Uh-o," Steve says to me. "Go get the gear," I say to Steve.
We work together the next week. No "uh-o" moments we both agree. We'll bring the gear in on every call. First call of the night is for a "woman drunk wants to go to rehab." This is a call we do all the time too. We walk in, meet the patient, who says, "I want to go to rehab." And we take them to the rehab place. Piece of cake. But this time, a man meets us at the door -- also up on the second floor. "My daughter is an alcoholic," he says. "She needs to get cleaned up. I don't think she's breathing." Uh-o. Go get the gear.
My partners hate it because I insist we carry all the gear in and out of every call. What bothers them is insist on bringing the gear even though I am generally a work-them-in-the-ambulance-not-on-the-scene-medic -- unless they really need to be worked on scene. Why do I carry everything in since I never use it? they ask. You always have to be prepared, I say. I make all my preceptees do the same thing. Same deal. Carry everything.
But I am slacking off a little of late. For the late year I have been training for triathlons -- swim, bike, run -- I am in excellent cardio shape -- good for going up stairs -- but my upper body has suffered a little bit for the all the aerobics activity at the expense of weight-lifting. I've lost some muscle. The gear is getting a little heavy. Plus we have medical dispatch in one of the towns I work in so I get a fairly detailed report on what I can expect to find. I confess to sometimes leaving my gear in the ambulance. Not on every call, but a little more than I used to.
Sixty-year old lady with abd pain. Alert, etc. Sounds like a put-them-on-the-stretcher-take-them-to-the-hospital call. Let's just bring the stretcher in, I say. We'll leave it outside and then go in and see what's up.
We find her sitting on the toilet. She says she feels a little nauseous and dizzy. Just get the stair chair, I tell my partner. She has a pulse. Skin is a little clammy. She's talking to me. We get her on the stair chair, strap her in, tell her not to reach out. Just as we are going through the front door, she starts waving her arms. "Stop! Stop!" she says, and then her head drops onto her chest and she speaks not another word in this lifetime.
The other day we got called for an overdose. There are a couple cop cars there. A few family members standing around outside. No one looks too distressed. The address is deep at one end of a town and we had to cross two towns to get there. Not once were we updated or asked for our ETA. I expect to find the person sitting at the kitchen table, telling officers she took more pills than she should have. One cop comes out of the house, and smiles at us as we step out of the ambulance. We apologize for the late response. He says, "No problem. She's inside." Another cop meets us at the door as we enter. "What's up?" I ask. "Overdose," he says. "Some Tylenol and benadryl." "Where is she?"I ask. "Over there," he says.
I walk past him and look to where he pointed. She's on the floor. She looks like she's dead. There is some chest movement, but her GCS is 3. No response at all. Vomit all over her face and hair. "Get the gear," I tell my partner.
Many years ago, I was working with a partner named Steve. Good partner. We had lots of fun together. We get called to an assault in the north end. This is a pretty common call. Someone gets punched in the face or scratched -- the cops call us, we go. The patient is giving a statement. We either get a refusal or we walk the patient to the ambulance. No problem. Most of the time they are sitting on the front stoop. Anyway, we get called, and the cop coming out of the apartment building says nonchalantly, "he's up on the 2nd floor." We walk up there nonchalantly. See a cop writing up a report. He nods down by his feet where a man in laying prone with a pool of blood around his head. "He got the shit kicked out of him," the cop says -- "steel toed boots." "Uh-o," Steve says to me. "Go get the gear," I say to Steve.
We work together the next week. No "uh-o" moments we both agree. We'll bring the gear in on every call. First call of the night is for a "woman drunk wants to go to rehab." This is a call we do all the time too. We walk in, meet the patient, who says, "I want to go to rehab." And we take them to the rehab place. Piece of cake. But this time, a man meets us at the door -- also up on the second floor. "My daughter is an alcoholic," he says. "She needs to get cleaned up. I don't think she's breathing." Uh-o. Go get the gear.
My partners hate it because I insist we carry all the gear in and out of every call. What bothers them is insist on bringing the gear even though I am generally a work-them-in-the-ambulance-not-on-the-scene-medic -- unless they really need to be worked on scene. Why do I carry everything in since I never use it? they ask. You always have to be prepared, I say. I make all my preceptees do the same thing. Same deal. Carry everything.
But I am slacking off a little of late. For the late year I have been training for triathlons -- swim, bike, run -- I am in excellent cardio shape -- good for going up stairs -- but my upper body has suffered a little bit for the all the aerobics activity at the expense of weight-lifting. I've lost some muscle. The gear is getting a little heavy. Plus we have medical dispatch in one of the towns I work in so I get a fairly detailed report on what I can expect to find. I confess to sometimes leaving my gear in the ambulance. Not on every call, but a little more than I used to.
Sixty-year old lady with abd pain. Alert, etc. Sounds like a put-them-on-the-stretcher-take-them-to-the-hospital call. Let's just bring the stretcher in, I say. We'll leave it outside and then go in and see what's up.
We find her sitting on the toilet. She says she feels a little nauseous and dizzy. Just get the stair chair, I tell my partner. She has a pulse. Skin is a little clammy. She's talking to me. We get her on the stair chair, strap her in, tell her not to reach out. Just as we are going through the front door, she starts waving her arms. "Stop! Stop!" she says, and then her head drops onto her chest and she speaks not another word in this lifetime.
The other day we got called for an overdose. There are a couple cop cars there. A few family members standing around outside. No one looks too distressed. The address is deep at one end of a town and we had to cross two towns to get there. Not once were we updated or asked for our ETA. I expect to find the person sitting at the kitchen table, telling officers she took more pills than she should have. One cop comes out of the house, and smiles at us as we step out of the ambulance. We apologize for the late response. He says, "No problem. She's inside." Another cop meets us at the door as we enter. "What's up?" I ask. "Overdose," he says. "Some Tylenol and benadryl." "Where is she?"I ask. "Over there," he says.
I walk past him and look to where he pointed. She's on the floor. She looks like she's dead. There is some chest movement, but her GCS is 3. No response at all. Vomit all over her face and hair. "Get the gear," I tell my partner.
Saturday, October 06, 2007
D'oh
I consider myself on the cutting edge of pain management. I have worked within the state and region to increase the amount of morphine paramedics can give patients on standing order and I am very aggressive with my use of morphine. You have pain, I want to take it away. Instead of screaming with pain, I want you singing "The Farmer in the Dell." Recently, I helped our region get Toradol so we have an alternative pain med for patients allergic to Morphine, in addition to being able to give toradol to patients with kidney stones for which it is particularly good for pain relief.
So it is with some embarrassment that I make the following confession.
But first a bit of blame.
Many years ago another paramedic told me if a patient is allergic to sulfa, you can't give them Morphine. Why? Because Morphine is in fact Morphine Sulfate.
Okay, makes sense.
So for all those patients, I said, sorry I can't give you any morphine because you are allergic to sulfa, I am profoundly sorry.
I had a patient with a hip fracture the other day who was allergic to sulfa and to NSAIDS. I told her I couldn't give her any pain meds unless I talked to the doctor first. We put her rather painfully onto the scoop stretcher and got her out to the ambulance, where pained by her distress, I decided to call medical control and ask if it was okay if I gave her some morphine. She was unable to tell me what happened when she took sulfa drugs, so if she had a reaction, well, I do carry the full complement of anti-allergic reaction drugs -- epi, benadryl, solumedrol, albuterol, 02, fluid.
After describing her injury, pain 10 of 10, vitals, and history, I said, "I'm calling because the patient is allergic to sulfa, but she can't tell me what happens when she takes sulfa. She is in a terrible amount of pain. 10 of 10 and I was calling to consult whether or not giving her morphine is appropriate."
Give her the morphine was the answer.
Later I talked briefly to the doc, and told her I had been told long ago, you couldn't give morphine to a patient with sulfa allergies. She smiled and said, "You can," and then went back to her charts.
Further research and questions confirmed this. The sulfa in a sulfa allergy is different from the sulfate in Morphine Sulfate.
D'oh.
***
This all brings up the issue of how we learn in EMS. We are taught certain things in class, but much of what we learn comes from the street, from calls, from conversations. Much of the information we learn is good, some of it is conflicted, and some of it is plain wrong. And some stuff changes.
When I started as a medic before every shift I used to grab a handful of ammonia inhalants. We get called for a drunk or an overdose, an ammonia inhalant goes under the nose and the patient is roused. One day -- quite a number of years ago -- our clinical coordinator was reviewing the run form of one of my preceptees and discovered a passage in the narrative about rousing the patient with an ammonia inhalant. He wanted to know what was going on. I explained. The guy was drunk. We couldn't rouse him. We stuck an ammonia inhalant under his nose. He woke up. Do it all the time. Been doing it for years. Then the coordinator said, "That isn't done anymore." He explained that it is, in fact, a dangerous practice (see links below).
I have long stopped using ammonia inhalants, but I still occasionally see them show up in the supply room or hear of someone telling about using them. Once even at the hospital, an older nurse woke up my unresponsive patient with one(just like I used to), and said, "he's just a drunk."
"You're not supposed to use those anymore," I said.
"You're a funny man," she said.
***
One common practice that is apparently passed from EMS person to EMS person is the use of the blue duct tape strap that comes with the popular "head-beds." People attach one end of the blue tape to the board by the patient's head at ear/forehead level, then loop the tape down under the patient's chin, and then crank it back to the board by the other side of the head, often hyperextending the patient's neck. When a partner of mine does it, I undo it, and if necessary resecure it straight across the head over the soft white strap. Sometimes I will get out the instructions and show it to my partner and explain how it hyperextends the neck when done improperly. The instructions allow for the tape to go either straight across the head or straight across the neck (c-collar). When I started as an EMT in the late 1980's, I would have been crucified by our then medical director for putting any thick tape across the neck, so to this day I don't tape the neck.
The use of the tape across the neck then back up to the head is so prevalent, I have almost given up trying to correct people. Another medic who shares my views on the device said he was in the ER the other day and a new EMT looked at his c-spined patient (he had placed the tape over the white strap across the head), and the EMT made a remark about how some idiot had taped the head instead of hooking it down under the chin.
Stuff just gets passed on.
Anyway, a second apology to all those sulfa allergy patients with broken bones who had to suffer through my ignorance. And another apology out there to patients past and future who may be the victims of any other misinformed information I have but am as yet unaware of.
***
Ammonia Inhalants:
Not to be taken lightly
This Procedure Stinks
Head-Bed Video
So it is with some embarrassment that I make the following confession.
But first a bit of blame.
Many years ago another paramedic told me if a patient is allergic to sulfa, you can't give them Morphine. Why? Because Morphine is in fact Morphine Sulfate.
Okay, makes sense.
So for all those patients, I said, sorry I can't give you any morphine because you are allergic to sulfa, I am profoundly sorry.
I had a patient with a hip fracture the other day who was allergic to sulfa and to NSAIDS. I told her I couldn't give her any pain meds unless I talked to the doctor first. We put her rather painfully onto the scoop stretcher and got her out to the ambulance, where pained by her distress, I decided to call medical control and ask if it was okay if I gave her some morphine. She was unable to tell me what happened when she took sulfa drugs, so if she had a reaction, well, I do carry the full complement of anti-allergic reaction drugs -- epi, benadryl, solumedrol, albuterol, 02, fluid.
After describing her injury, pain 10 of 10, vitals, and history, I said, "I'm calling because the patient is allergic to sulfa, but she can't tell me what happens when she takes sulfa. She is in a terrible amount of pain. 10 of 10 and I was calling to consult whether or not giving her morphine is appropriate."
Give her the morphine was the answer.
Later I talked briefly to the doc, and told her I had been told long ago, you couldn't give morphine to a patient with sulfa allergies. She smiled and said, "You can," and then went back to her charts.
Further research and questions confirmed this. The sulfa in a sulfa allergy is different from the sulfate in Morphine Sulfate.
D'oh.
***
This all brings up the issue of how we learn in EMS. We are taught certain things in class, but much of what we learn comes from the street, from calls, from conversations. Much of the information we learn is good, some of it is conflicted, and some of it is plain wrong. And some stuff changes.
When I started as a medic before every shift I used to grab a handful of ammonia inhalants. We get called for a drunk or an overdose, an ammonia inhalant goes under the nose and the patient is roused. One day -- quite a number of years ago -- our clinical coordinator was reviewing the run form of one of my preceptees and discovered a passage in the narrative about rousing the patient with an ammonia inhalant. He wanted to know what was going on. I explained. The guy was drunk. We couldn't rouse him. We stuck an ammonia inhalant under his nose. He woke up. Do it all the time. Been doing it for years. Then the coordinator said, "That isn't done anymore." He explained that it is, in fact, a dangerous practice (see links below).
I have long stopped using ammonia inhalants, but I still occasionally see them show up in the supply room or hear of someone telling about using them. Once even at the hospital, an older nurse woke up my unresponsive patient with one(just like I used to), and said, "he's just a drunk."
"You're not supposed to use those anymore," I said.
"You're a funny man," she said.
***
One common practice that is apparently passed from EMS person to EMS person is the use of the blue duct tape strap that comes with the popular "head-beds." People attach one end of the blue tape to the board by the patient's head at ear/forehead level, then loop the tape down under the patient's chin, and then crank it back to the board by the other side of the head, often hyperextending the patient's neck. When a partner of mine does it, I undo it, and if necessary resecure it straight across the head over the soft white strap. Sometimes I will get out the instructions and show it to my partner and explain how it hyperextends the neck when done improperly. The instructions allow for the tape to go either straight across the head or straight across the neck (c-collar). When I started as an EMT in the late 1980's, I would have been crucified by our then medical director for putting any thick tape across the neck, so to this day I don't tape the neck.
The use of the tape across the neck then back up to the head is so prevalent, I have almost given up trying to correct people. Another medic who shares my views on the device said he was in the ER the other day and a new EMT looked at his c-spined patient (he had placed the tape over the white strap across the head), and the EMT made a remark about how some idiot had taped the head instead of hooking it down under the chin.
Stuff just gets passed on.
Anyway, a second apology to all those sulfa allergy patients with broken bones who had to suffer through my ignorance. And another apology out there to patients past and future who may be the victims of any other misinformed information I have but am as yet unaware of.
***
Ammonia Inhalants:
Not to be taken lightly
This Procedure Stinks
Head-Bed Video
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