SF medics at Duke

[TLDR20]

As @Muppet said, we rotated through almost every department with a heavy emphasis on EM and critical-care areas. To this day I STILL say if I ever did nursing school it would only be to practice in an ED or ICU.

The only unit I didn't feel welcome in was L&D. The nurses really didn't like us being there; the physicians were great but the nurses killed the experience.

As a student nurse my best experience was in L&D, as a paramedic that shit sucked. Even female paramedics and critical care transport people get the cold shoulder. A lot has to do with the fact that L&D nurses are fiercely protective, like mama bear protective. L&D is also a place where nurses truly work to the top of their license. If I wasn't a guy I would go down that path.

 

[Devildoc]

I disagree. Maybe new ED nurses need that, but there is no reason for an ICU nurse to ride a rig.

I agree, unless an ICU nurse is trying to get into critical care transport, if that transport does scene runs. Then it would be beneficial. But outside of that, I don't know how beneficial it would be.

 

[Muppet]

I disagree. Maybe new ED nurses need that, but there is no reason for an ICU nurse to ride a rig.

OK. Agree on that point.

M.

 

[Red Flag 1]

I disagree. Maybe new ED nurses need that, but there is no reason for an ICU nurse to ride a rig.

 

[policemedic]

Yup, I can agree with that.

I do think undergrad nurses could benefit from a few weeks running calls with a busy EMS squad. It will be eye opening, and they will have a much better prespective regarding front line medicine, in the field. I' d go so far as to suggest ER nurses run a few EMS calls too.

I've encountered a number of nurses, who through no fault of their own, are blissfully clueless about paramedics. A wee bit of ride time would fix that. I actually blame some of this on the idiots some companies choose to put on trucks (the old transport vs. 911 argument).

ICU nurses may benefit from riding critical care trucks a time or two. I've had a few disagreements with nurses about why I needed to see/know the pt's labs or other values, why I refused to take them until the staff did a 12-lead (yes, I can do and read one but then he's mine...), invasive monitoring numbers etc. Perhaps riding with us might solve that issue.

ED nurses are a bit more in tune with us, but ride time would help them understand the challenges we encounter. It would also help them understand the care we can provide.

 

[Red Flag 1]

I've encountered a number of nurses, who through no fault of their own, are blissfully clueless about paramedics. A wee bit of ride time would fix that. I actually blame some of this on the idiots some companies choose to put on trucks (the old transport vs. 911 argument).

ICU nurses may benefit from riding critical care trucks a time or two. I've had a few disagreements with nurses about why I needed to see/know the pt's labs or other values, why I refused to take them until the staff did a 12-lead (yes, I can do and read one but then he's mine...), invasive monitoring numbers etc. Perhaps riding with us might solve that issue.

 

[Red Flag 1]

I've encountered a number of nurses, who through no fault of their own, are blissfully clueless about paramedics. A wee bit of ride time would fix that. I actually blame some of this on the idiots some companies choose to put on trucks (the old transport vs. 911 argument).

ICU nurses may benefit from riding critical care trucks a time or two. I've had a few disagreements with nurses about why I needed to see/know the pt's labs or other values, why I refused to take them until the staff did a 12-lead (yes, I can do and read one but then he's mine...), invasive monitoring numbers etc. Perhaps riding with us might solve that issue.

ED nurses are a bit more in tune with us, but ride time would help them understand the challenges we encounter. It would also help them understand the care we can provide.

.

 

[policemedic]

I think your practice of holding out for labs and a 12 lead is good practice. It is smart and logical to check how you did in he field. I can see that the hand over of the patient to the ER ends your part in the continuim of care. That is how the ED people will look at things. I believe you are spot on to await the information about your patient.

Doc,

I probably wasn't clear.

When I bring in patients from a 911 run--pure prehospital medicine--I have the capability to run 12- and 15-lead EKGs and interpret them myself. I always do pre- and post-treatment EKGs when indicated. Labs are a different story; 911 trucks generally don't have iStats or the capability to do labs apart from glucose testing. In our area, taking the time to obtain, measure and interpret a CBC, cardiac enzymes, or 'lytes would delay us too much due to short transport times. By the time we got results, we'd probably be pulling into the ED. In other areas, obtaining this information may be vital and may be the basis of a flight vs ground decision.

However, when I did critical care transports, I would never accept responsibility for a patient from the unit until I had read the entire chart, interpreted lab values/ABGs, Swan-Ganz, etc. If the chart didn't include a recent 12-lead I made the staff do one. This caused some consternation but I wasn't willing to accept an ICU level patient without knowing all the facts.

 

[Red Flag 1]

Doc,

I probably wasn't clear.

When I bring in patients from a 911 run--pure prehospital medicine--I have the capability to run 12- and 15-lead EKGs and interpret them myself. I always do pre- and post-treatment EKGs when indicated. Labs are a different story; 911 trucks generally don't have iStats or the capability to do labs apart from glucose testing. In our area, taking the time to obtain, measure and interpret a CBC, cardiac enzymes, or 'lytes would delay us too much due to short transport times. By the time we got results, we'd probably be pulling into the ED. In other areas, obtaining this information may be vital and may be the basis of a flight vs ground decision.

However, when I did critical care transports, I would never accept responsibility for a patient from the unit until I had read the entire chart, interpreted lab values/ABGs, Swan-Ganz, etc. If the chart didn't include a recent 12-lead I made the staff do one. This caused some consternation but I wasn't willing to accept an ICU level patient without knowing all the facts.

s.

 

[TLDR20]

As a soon to be full time ICU nurse, with considerable pre-hospital time under my belt, I can honestly say there is almost no reason for a new/student nurse to have any time on a rig. First off licensing would be a huge pain in the ass, so much so that it is a hindrance to any possible benefit. For a new hire ED nurse however I think it would be beneficial. It is easy to sit in the ED and criticize a paramedic for shotty care when you have never picked up a violent drunk who was just in an accident who you literally have to hold down to keep him from further injuring his C-spine. As a CVSIVU nurse I will never be receiving patients from point of injury/illness. At the level I will be at(highest acuity level) I will also never hand them off to a CC transport team. I have an interesting perspective having seen it from both ends of the spectrum though.

 

[Devildoc]

As a soon to be full time ICU nurse, with considerable pre-hospital time under my belt, I can honestly say there is almost no reason for a new/student nurse to have any time on a rig. First off licensing would be a huge pain in the ass, so much so that it is a hindrance to any possible benefit. For a new hire ED nurse however I think it would be beneficial. It is easy to sit in the ED and criticize a paramedic for shotty care when you have never picked up a violent drunk who was just in an accident who you literally have to hold down to keep him from further injuring his C-spine. As a CVSIVU nurse I will never be receiving patients from point of injury/illness. At the level I will be at(highest acuity level) I will also never hand them off to a CC transport team. I have an interesting perspective having seen it from both ends of the spectrum though.

My first nursing gig was in the surg-trauma ICU at Chapel Hill. When I started I had 13 years of EMS experience, with some of that critical care transport (air and ground). Once, one time, we did hand off to CC transport who was being transported to a hospital closer to the patient's home (Emory if I recall). I will be interested to hear your observations after working for a bit, having seen it from both ends of the spectrum.

 

[Red Flag 1]

As a soon to be full time ICU nurse, with considerable pre-hospital time under my belt, I can honestly say there is almost no reason for a new/student nurse to have any time on a rig. First off licensing would be a huge pain in the ass, so much so that it is a hindrance to any possible benefit. For a new hire ED nurse however I think it would be beneficial. It is easy to sit in the ED and criticize a paramedic for shotty care when you have never picked up a violent drunk who was just in an accident who you literally have to hold down to keephim from further injuring his C-spine. As a CVSIVU nurse I will never be receiving patients from point of injury/illness. At the level I will be at(highest acuity level) I will also never hand them off to a CC transport team. I have an interesting perspective having seen it from both ends of the spectrum though.

 

[Devildoc]

I think your observations about student status on rides is a valid point. The real life example you sited is perfect, and all too common. Not many hospital based providers have had to intubate a patient with kneeling on blacktop as your only option.

Sir, have you seen the literature? ETI is no longer en vogue, I don't know too many pre-hospital providers who do this any more.

 

[Red Flag 1]

[Q

 

[Devildoc]

Airway access beyond Miller and Mac rigid blades has been around for a long time. Fiberoptic endoscopes , and other methods of securing a protected airway were standard for in hospital use even when I stepped away. Just how far into the field that has evolved, I was not aware. My point was to illustrate some of the extremes between in house, and pre hospital challenges. The one that always pops into my head was more than a few years ago.

Generally I was called to the hospital ER/ICU/Patient care floor. While at Base "X" in Ca., I was called to a mile post marker on a highway. Single car mishap with the driver face down in a four foot deep culvert. Those who never get out much, need to know what squads face everyday before passing judgement on how the patient appears coming through the ER doors.

Yes, sir, I was talking mostly tongue-in-cheek, which rarely comes across on the interwebs. In EMS the pendulum swung from intubating everyone with a GCS less than 8, to intubating almost never. I have seen prospective paramedic curricula suggesting ETI be taken out. Which is weird because they still advocate crichs.

At the pinnacle we could do RSI, retrograde, fiberoptic laryngoscopy, nasal intubation (my personal fave) along with needle and surgical crichs. We weren't there long before one-by-one those skills were being abandoned. Now largely the protocol is blind insertion airway device and proper ventilation with BVM.

 

[Red Flag 1]

Yes, sir, I was talking mostly tongue-in-cheek, which rarely comes across on the interwebs. In EMS the pendulum swung from intubating everyone with a GCS less than 8, to intubating almost never. I have seen prospective paramedic curricula suggesting ETI be taken out. Which is weird because they still advocate crichs.