Why I’m no good at CHFers

More than one “experienced” EMT and Paramedic emailed me after my post about EMS Anchors, each one reminding me that I am but a child in this thing called EMS and have no idea what it’s all about.

One email told me “Until you’ve been up to your ankles in pink frothy puke on a crashing CHFer don’t tell me how to handle my career.”

Well buddy, I have bad news for you…I don’t let my patients get that bad anymore.

The reason so few Paramedics are experienced in the truly crashing complex patient is because there are less of them.  I can’t even remember the last crashing CHF patient I had and since we adopted CPAP I barely even check the nasal ETT kit anymore other than to make sure it is there.

Treatments have advanced and, more importantly, EMS has become more recognized as an important public service.  More responders are in the community and able to respond quicker.  Education standards may be lower than we’d like (OK, ARE lower) but are still above where they were even just 15 years ago.

The grizzled old medic who rumbles on about how the kids today have never really seen it “go to hell” on a rough call actually are a dying breed.  They too see less and less truly critical patients because of the advancements in medical care, access to EMS and what passes for public outreach these days.  As annoying as all those medication ads are on TV, they at least tell people to call their doctors and ask questions, which is a plus in my book.

Does a Paramedic HAVE to be experienced at watching a patient far past therapeutic intervention die in their arms to be a good practitioner?  Certainly not, but it gets you the street cred doesn’t it?

Stories about patients crashing, infrequently used procedures having no effect and blood and guts still seem to be the metric by which many in EMS try to measure themselves.  It used to be how much blood was on your crisp white shirt, then how messy your boots were, and now we’re on to describing how our care and tools were inadequate.

Think about that for a minute.

Most folks in EMS are BRAGGING about how they failed their patients.  Nice.

Education is a wonderful thing and can never replace experience, but don’t forget that experience is also useless without education.  While that new kid on Medic 88 may know 100 different ways a 12-lead can go wrong, you give him crap because he hasn’t “been there” and “done that” the way you did.  He’s thinking the same thing watching you, only wondering when the last time you took a class that wasn’t a merit badge update was.

Things have changed.  Patients have changed.  I’d venture to say that the only thing that really hasn’t changed is trauma, and that’s easy enough to deal with regardless of your level of education or time on the streets.

I guess what I’m trying to say is this:

New People: Slow down and watch the folks who have been here awhile.  You think they’re avoiding taking a BP when really they’re reaching for the emesis basin just in time or anticipating what will come next based on experience.  If they’re not up to the second on the newest toys and techniques, give them time, learn from them.

Not so New People: Take it easy on the new kid and think back to your early days on the street.  The new kid isn’t being a jerk when they mention 100 different ways to read the 12 lead, just doing what he’s been taught.  Teach him.  Make him better without all the BS about the old days.  Teach him how to learn the instinct you now possess.

Everyone: Climb down off your ivory towers of years on the job and step out from behind the curtain of education and talk to each other about the call you just went on.  Exchange impressions, ideas and explain why you did what you did.  We can all learn from one another if we just try.

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9 thoughts on “Why I’m no good at CHFers”

  1. Word.

    I’ve noticed that the better I do my job, the less exciting it is.

    That’s tough on my green partners who crave excitement, but eventually they figure out that it’s better for the patients.

  2. Word.

    I’ve noticed that the better I do my job, the less exciting it is.

    That’s tough on my green partners who crave excitement, but eventually they figure out that it’s better for the patients.

  3. Treatment, both emergency and non emergency, of a lot of medical conditions has improved over the past several years. CPAP as you noted, 12 leads, better medications for SVTs, and so on. Which reduces the number of really sick patients we see, but doesn’t totally eliminate them. Instead of 5-10 acute CHFers who need to be intubated, we see maybe one or two a year. CPAP fixes the rest. Albuterol and Atrovent do a good job on Asthma and COPD patients.

    One thing that hasn’t changed is being able to recognize those patients and their conditions and picking the right course of treatment. Experience makes that a lot easier.

  4. Treatment, both emergency and non emergency, of a lot of medical conditions has improved over the past several years. CPAP as you noted, 12 leads, better medications for SVTs, and so on. Which reduces the number of really sick patients we see, but doesn’t totally eliminate them. Instead of 5-10 acute CHFers who need to be intubated, we see maybe one or two a year. CPAP fixes the rest. Albuterol and Atrovent do a good job on Asthma and COPD patients.

    One thing that hasn’t changed is being able to recognize those patients and their conditions and picking the right course of treatment. Experience makes that a lot easier.

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