Wrong Medicine

Some of the stacks of trip reports were nearing four feet high and they filled the musty closet. Dividing them up, we started sorting through them in earnest. The dates indicated that the calls had been run between 1972 and 1978. Most of the narratives were as brief as the treatment lists.

Hall Ambulance’s station one was an older house in an early residential area of Bakersfield, California. It had been, at one time, the residence of the company’s owner, Harvey Hall. In the early days of the ambulance service, Harvey had both lived in the home and run his fledgling ambulance service out of it. 

One of the crews stationed at the home had gone digging in the dusty storage closets and struck EMS history gold. Stacks and stacks of old trip reports from the Mother, Jugs and Speed days of EMS. That’s where we found it. A call run by our medical director back in his days as a paramedic for the service. A cardiac arrest, no less. The total list of treatments given; CPR, BVM, Epinephrine 1mg, Sodium Bicarbonate 2 amps.

The year was 1991. We found this hilarious. We were still in our ACLS infancy. There was no CPR first or AEDs or Amiodarone. Nobody had heard of capnography and there was nothing therapeutic about hypothermia. Yet we felt very advanced looking at our medical directors run report. The massive Sodium Bicarbonate doses of the seventies had long since gone away. 

More than happy to reminisce about the call, our doc read the report with a bemused sort of faraway look and announced, “I remember this guy.” He told us the story of the overweight, mid-sixties male who had collapsed in the parking lot across from the hospital. And then he made an observation that has stuck with me my whole career.

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Posted 7 months ago at 9:37 am.

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What Is Epinepherine?

A quick inside tip on field instructors; we all have our favorite questions to ask new riders. Those questions that help us get a more firm understanding of where our students knowledge base rests. What kind of practical knowledge are they carrying out into the field? Some of them are fair questions. Some of them aren’t. That’s life.

One of my favorite questions to ask that new rider early in the ride along is, “So what is epinephrine anyway?” (For the record, this is an extremely fair question.) I’ve found this to be a telling conversation because the scope of the question gives the student a lot of rope. This is a question where the student can choose to be shockingly simple or impressively complex. The choice is theirs.

I ask this question regardless of the students experience or training. I’ve had brand new EMT students knock the question out of the park and I’ve had experienced paramedics strike out miserably. All baseball metaphors aside, it’s a telling question. It speaks to a care givers understanding of the drugs we are able to administer. (Yes, all of us.) It’s revealing about ones understanding of the autonomic nervous system and it exposes an individuals understanding of basic pathophysiology.

 

When I ask the question, the answer I’m looking for is something like this:

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Posted 10 months, 1 week ago at 6:00 am.

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