Part 1: The Pulse
There are few things that EMT’s should claim as their domain. There are certain skills that the EMT provider should simple dominate. Vital signs are one such 
skill. No medical provider anywhere should be able to hold a candle to the EMT when vitals signs are the name of the game.
Vital signs are, to the EMT, what sharp shooting is to the sniper; what the fast ball is to the closing pitcher; what swordsmanship is to Zorro. It’s the EMT bread-and-butter skill. And yet…so many EMTs fumble through vital signs like it’s amateur hour. No more. Over the next few weeks we’re going to break down vital signs here at The Spot and make every one of our trusted and loyal readers a vital sign virtuoso.
Are you ready? Carnegie Hall awaits. Let’s start with the pulse check.
Some EMT’s can take 30 seconds to a minute to check a pulse. When they’re done they have one single piece of clinical information to pass on, the heart rate. Others can feel a pulse for 3 seconds and tell you much, much more about the patient’s cardiovascular status. What’s the difference? Practice and focus. If you’d like to be the second EMT, here’s how.
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A Guest Post By Jim Hoffman
“The EMS Professional,” “The Paramedic Mentor,” Today’s guest author, Jim Hoffman has more nicknames than a retiring prizefighter and he’s earned 
every one of them. From the streets of The Big Apple to New Jersey and now the secluded mountains of upstate New York, Jim has been a paramedic for the better part of two decades.
In his down time, Jim runs EMS-Safety.com, a one stop shop for low cost EMS training resources. He’s also part of the team behind The EMS Boot Camp series. After a little cajoling I talked Jim into letting me post his Handover contribution as a guest post. So this is me, stealing all of Jim’s literary goodness for you. (Thank me later.)
And now Jim:
As an EMT in a large EMS system I found myself becoming burnt and indifferent to the patients I was responding to and treating; all too often being annoyed at the calls that obviously just didn’t require an ambulance and more often didn’t even require a doctor.
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April is a promise that May is bound to keep.
- Hal Borland
I can’t make any promises about May, but I can venture a guess that the world of EMS will be every bit as interesting as it was in April here at The Spot. I started by telling you about the hydrogen peroxide, blood stain trick and then moved on to a few thoughts about assessment and scope of practice. Then we spent a few suspenseful days on the EMT liability pop quiz followed up with some thoughts on failure and a request to tell The Discovery Channel about The Chronicles of EMS. I ended off with a little observation about bringing yourself to work and that brings us here. *Deep breath.*
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There really is a dizzying array of stuff we can do to get ourselves in legal hot water in EMS. I was considering a few this afternoon and I got this idea.
Let’s play a game. I’ll give you a whole list of scenarios and you match the legal transgression to the act. OK, that was a really boring and overly technical way to describe my game.
I’ll say what they did; you tell me what they did wrong. Sound like fun? I agree. Let’s begin.
Here are all the possible answers:
- Sounds OK to me
- Negligence
- Battery
- Abandonment
- Assault
Jot your answers down on a scrap of paper. I’ll be back on Thursday with my answers and the rationale behind them.
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I’m so sick of hearing this phrase. If I could banish any phrase from the EMS lexicon this would most certainly be the one. I heard it today when I posted a question on Twitter, “How much do you really know about ACE inhibitors?”
I asked. The first reader reply, “Not much since I’m only an EMT Basic.” Ouch. I get stomach pains when I hear that.
I want to make a bonfire out of all the worthless phrases in our vocabulary and throw, “I’m only a …” right on top.
Since when was an understanding of out patients medications an advanced skill? Since when is medical knowledge of any kind an advanced skill?
Somewhere along the way we started giving EMT Basics the idea that anything that isn’t contained in their EMT textbook is somehow beyond them. It’s patronizing. “Here you go little EMT dude, here’s the basics. Don’t move on to anything more complicated, you could hurt yourself.” That’s just ridiculous.
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“Success is to be measured not so much by the position that one has reached in life… as by the obstacles which he has overcome while trying to succeed.”
- Booker T. Washington
With multiple premiers of The Chronicles 
of EMS and a wave of enthusiasm from the EMS Today conference in Baltimore, the future of EMS looks bright, blindingly-bright. I’m incredibly optimistic about where this crazy experiment in EMS is headed, but I also see some big hurdles in our path.
Put on your shades and let’s talk about what I feel are the five biggest challenges to EMS reform.
1.) We’ve been talking a lot about unity and standardization, but individual EMS systems are unique in every way. How do you influence standardization and still allow for the tremendous leeway required for EMS agencies to be optimized for the communities that they serve? Can EMS agencies be different in geography, financial resources, administrative structure, culture, call volume, compensation and certification/education level and still find enough unity to advance the profession together?
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In the coldest February, as in every other month in every other year, the best thing to hold on to in this world is each other.
– Linda Ellerbee (American Journalist)
And what better way to bring the EMS world together than the Internet? February was full of news and fun at The Spot. I hid inside from the Colorado cold and wrote about how to set up an IV line firefighter style. I asked you if you knew what was in the last issue of Splatter. (If you subscribed you’d know!) We discussed tips for mastering the head-to-toe assessment and getting people to hang up their cell phones. The premier of The Chronicles of EMS was the coolest thing is the blogging world. And we explored credibility and redundancy before launching into two posts on hypothermia. (Specifically how to assess it and how to treat it.) Then we wrapped up with a few musings about what it means to be passionate and what it’s like to be a firefighter. My fingers bleed for you.
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You probably practiced your head-to-toe assessment a bunch in your EMT
class. Maybe more than any other skill in the EMT curriculum. If your class was or is anything like mine (as a student or a teacher) you performed the head-to-toe assessment again and again.
As much as we practice this skill in EMT class, I often wonder why so many EMT’s have such bad head-to-toe skills out on the street. It seems that, once we get out on the street, the systematic, thorough head-to-toe assessment falls out of favor and quickly gets replaced with the faster, more direct focused assessment.
That works just fine most of the time. If it didn’t, I figure it probably wouldn’t be such a universal phenomenon. (For the record, have you ever worked somewhere where this wasn’t the case? Neither have I.) The downside is that when the patient arrives who really needs a, honest-to-goodness, rapid, complete head-to-toe, we’re not up to the task.
I happen to believe that patient assessment skills are one of the defining qualities of a talented EMT. Here are seven tips to keep your head-to-toe in top form.
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OK, I can’t keep this to myself any longer. It’s time for the big
announcement. With the final draft still in the mail from my editorial team and the final design still lacking a few details, it would probably be best to just keep this under wraps for a few more weeks, but I can’t wait.
My first E-book is scheduled for release on January 21st, one week from today. The e-book will be free and it will be available right here at The Spot.
The Book is called The Non-Conformists Guide to EMS Success. This book is the culmination of two decades of EMS experiences, mistakes, failures, trials, and errors that lead to my ultimate success. My goal was to write something that would be useful to EMTs at any stage in their career. And I didn’t hold anything back. This is my road map to finding true success and fulfilment in EMS work.
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I would surely rank the nasopharyngeal airway (NPA) as one of the most under-rated / under-utilized pieces of equipment in the EMT bag of tricks. They’re useful, simple and versatile. As a group, we tend to do a pretty good job 
oxygenating our patients, but I think we drop the ball on BLS airway adjuncts.
Most of our unresponsive or semi-responsive patients should be arriving at the ER with an NPA in place. If you’re bagging a patient they should have one … maybe two NPAs in place.
They’re fast, they’re friendly, they work much better on the semi-conscious and they don’t stimulate the gag reflex quite like their cousin the oropharyngeal airway. They also stay in place better, leaving the mouth open for examination and advanced airway techniques.
I’ve often had EMTs explain that they didn’t drop a basic airway adjunct because they knew I was right around the corner and I’d be intubating. That’s a poor excuse. When I arrive on scene I’d like to see that the EMT at the head has managed the BLS airway aggressively.
So let’s bone up on our NPA skills. Once you’re comfortable with these little beauties, they only take a few seconds to drop. You don’t need to make it a big production. Grab the right size, squirt a clump of KY on the end and go.
So let’s break it down and make you an NPA, quick draw, master.
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