Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Ride-Along as an EMT Student

http://www.thehandover.wordpress.com/

When I was in EMT school, we had to ride along with EMS for 3 shifts. The school arranged for us to ride with the San Francisco Department of Public Health. This was before the take-over by the fire department.

Friday evening 1600-2400 shift. I arrive and meet the crew I will be riding with. they check out their gear and we head out on the road. One of the medics asks me if I know what AEIOU TIPS[1] stands for. Golly. A chance to impress them with my ability to repeat something we memorized, rather than understood.

A is for Alcohol. And E is for . . .

That’s all you need to know. Alcohol is all we do. All night. Every night.

I don’t mention that they appear to be a pretty sober pair of medics. One of them seems to be reading my mind, and states that they are referring to alcohol consumed by the patients. We won’t be getting drunk on duty.

Well, there was some devastation at the lack of iterest in my ability to fetch a mnemonic that we had been told would be so important. Another Charlie Brown moment.

That was only the beginning of the Skinner Box effect.[2] Something to addict even the most resistant to the appeal of anecdote – the rogue EMT student – which I most certainly was not. Not yet. By the end of the shift, with 2 codes, 2 traumas, and a few other patients, I was ready to go audition for NBC’s show Trauma.[3] Mayberry EMS was not going to cut it for me. This was EMS. This is the way we set students up to become the Barney Fifes of EMS. Stress the emergency at the expense of the medical service.

The shift turned out to be one that could have been written for TV. 2 cardiac arrests (1 regained pulses – AEIOU TIPS = A – chronic alcoholic homeless person). Not showing any signs of mental function, but he had a pulse. A SAVE. Hazel Motes couldn’t have been prouder.

2 critical trauma patients (both were pedestrians crossing the street together, when struck by the same truck – AEIOU TIPS = A – most alcohol involvement in auto/pedestrian incidents is on the part of the pedestrians.[4] Drunk pedestrians do a pretty poor job of looking both ways before playing in traffic. Looking both ways is a simple technique, that is very effective at preventing all kinds of auto/pedestrian incidents.

Looking both ways helps the pedestrian to avoid a bad driver. The driver with too much whatever to pay attention to the road: Too much confidence in his/her ability to handle alcohol/other drugs and a motor vehicle at the same time; Too much confidence in his/her ability to handle text messaging and a motor vehicle at the same time; Too much confidence in his/her ability to handle a cell phone and a motor vehicle at the same time; Too much confidence in his/her ability to just plain handle a motor vehicle; And too much motor vehicle.

Do racoons look both ways before playing in traffic?

No. Raccoons are road meat/street pizza/speed bumps/. . . .

Do skunks look both ways before playing in traffic?

No. Skunks are more aromatic road meat.

Do deer look both ways before playing in traffic?

No. Deer are also road meat, but they occasionaly take a driver/passenger/both
along with them. Road meat and front seat meat.

The most effective way to reduce auto/pedestrian injuries/fatalities is to not walk in front of moving motor vehicles. Green light? Look both ways. Maybe you have never run a red light, but others are not so well behaved, or even so observant. A bunch of people are crossing the street at the same time, so no need to look both ways? No, but you may have company in the ED, or in the morgue. Won’t that be a consolation?

Meanwhile back at the busy shift, we had an odd drug reaction. He stated that he had taken something to help him relax. It was not his. There was no more left. It was not in a marked pill bottle. His heart rate is on the fast side. His neck is on the side. His tongue is on the outside. I had no clue. We did not cover anything like this in EMT school. One of the medics called command and asked for permission to give diphenhydramine (Benadryl), but medical command was uncomfortable with the idea and just wanted the patient transported. We arrived at the hospital and they gave the patient benztropine (Cogentin), which does the same thing that the medics could have done a while earlier with the diphenhydramine. The patient was having a dystonic reaction.

Then we had a surprise for all of us. None of us had met this guy before, even though he would go to the hospital every day for chest pain or difficulty breathing. The local newspaper even wrote about him in good old politically correct San Francisco. They called him the Million Dollar Man. Over a 3 year period, with daily 911 calls and full work-ups in the hospitals, they calculated that he had cost the city over a million dollars in unreimbursed care. And that was just the cost to the city. 404 pounds (according to him) and he wanted to be carried. One of the neighbors pointed out that he has no problem walking every time he calls the ambulance, so our backs appreciated that. He also does not want to go to the closest hospital, because They were mean to me yesterday. By the time we arrived at the hospital, he had alienated another 3 people. The guy has at least one talent and it isn’t charm.

Since then, I have not had many shifts that were as eventful as that. That was my first time working on an ambulance.

Footnotes:

^ 1 AEIOU TIPS
This is a mnemonic to help remember the causes of a change in mental function.

I have repeated several of the words, since there are several ways to use this mnemonic. You may eliminate the ones that are duplicates, that do not help you remember. Endocrine, Insulin, OverDose, UnderDose, and Pharmacy overlap. Infection, Sepsis, and Temperature overlap, too – but they get you to think about similar things differently. That may be helpful.

A – Alcohol

E – Electrolytes and Encephalopathy and Endocrine

I – Infection and Insulin

O – OverDose and Oxygen

U – Uremia/UTI and Underdose (not taking medications that should be taken)

T – Temperature (Hypo/HyperThermia) and Toxidromes (OverDose) and Trauma

I – Infection and Insulin, again

P – Pharmacy and Psych and Porphyria

S – Sepsis and Space occupying lesion and Stroke and Subarachnoid Bleed and Seizure

^ 2 Superstition in the pigeon
The root of many superstitious beliefs, such as full moons being busy in the ED, black clouds, white clouds, causing bad things to happen by saying, Slow or Quiet, . . . . Skinner’s experiments demonstrated that we behave no better than birds, when dealing with intermittent reinforcement. So, it is perfectly appropriate to refer to superstitious people as bird brains. The scary thing is that some are doctors, nurses, medics, et cetera. These bird brains are responsible for making decisions that affect patients’ lives. And these bird brains vote.

We should end this through education, but as TOTWTYTR repeatedly states, You can’t cure stupid.
Wikipedia (part 10 in contents if the link does not take you directly to this part of the page, or click refresh).
Article

^ 3 Trauma – New NBC Drama To Ridicule EMS
Rogue Medic
Article

^ 4 Age, sex, and blood alcohol concentration of killed and injured pedestrians.
Holubowycz OT.
Accid Anal Prev. 1995 Jun;27(3):417-22.
PMID: 7639925 [PubMed – indexed for MEDLINE]

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