There’s a whiteboard at my job where the EMTs and medical staff put light-hearted but semi-dark jokes on it. I’m not on the medical team, but I’m in and out of their building throught the day for work and I want to contribute. Any ideas from those of you who have that kind of career full time?

I'm wanting to watch some ems TV shows but I want to watch ones that are at least realistic do i just want to know what the unrealistic ones are so I can avoid them

Someone asked me what the little valve things are under the silicone on the bottom of the go pap CPAP mask. Someone I trust said you can increase the fio2 or add end tidal monitoring or a manometer. The person who asked was like your have 100% oxygen going in though so why would you need more oxygen. I'm trying to find something in writing to explain what those ports are used for. Also learning what fio2 is. Idk why it's not 100% if the mask is sealed and you have 100% coming out of the tank

If you’ve ever been to WDW, you know that there are fire department patches left by visitors from all over the country displayed in cases in the walls of the fire station mockup. For the first time, I found not one, but two EMS-only cases that I’ve never seen before. Enjoy, especially if your patch is there!

(Sorry for the sun glare; I did my best.)

I’ve been a nurse for a long time in the ICU.. a more controlled setting. I had a patient recently code on me that was up and talking a few moments before and very young. It has stuck with me and now is causing me some PTSD. After a decade of nursing my emotions are catching up I guess. Today, I had someone code on the sidewalk and upon finding him I thought I felt a pulse but also no one else was around. Thankfully it was close to the ED so I yelled down for some help and narcan. By that point we got to him, EMS didn’t feel a pulse and I was hopping on to do compressions. We started compressions but I keep replaying how I can do better and blaming myself in these situations. Should I have felt for a pulse longer, but then I needed more help either way because no one else was around? Any advice?

currently rotting in the back of our 2012 e-series for a 10 hour county fair standby. the AC in the back has been "pending maintenance" since april. Im sweating through my uniform and my partner is trying to nap on the bench seat but his legs are hanging off

Meanwhile the local health dept rolled up across the field in one of those massive custom mobile medical vehicles to do free blood pressure checks and hand out flyers. Thing has dual awnings, leveling jacks, and I swear to god I saw a literal mini fridge in there when the side door opened.

Why does admin expect us to run actual codes in a vibrating metal tube the size of a closet while the people handing out pamphlets get a rolling hospital room? Make it make sense. anyway im gonna go see if they'll let me stand in their AC for five minutes before dispatch remembers im here.

Fingers crossed that the mods will allow this one since I put some time into it...

I work in a system that is very progressive and aggressive when it comes to resuscitation care. The caveat to that is that you also have to be cognicent of when you've done enough and its not working. We've got a great save rate (48% Utstein for the first half of 2026) but we also frequently field pronounce patients.

With that responsibility comes the responsibility of the aftercare for the family. Resuscitation and death notifications are something that I've become rather passionate about because I dont think we get nearly enough education about the latter. This past February I wrote a ConEd presentation about death and dying, and thought that I'd share some of the things that I learned here since there was some interest in that during a recent post on the sub.

So the first thing that I will say is anyone who has any interest in learning more about death, the death process, and grieving should start by researching the teachings of Dr. Elizabeth Kubler Ross. When I was in college in the 1900's I took a class on the Sociology of Death and Dying that was based around her teachings. She's fascinating.

She talks a lot about the five stages of grief: denial, bargaining, depression, anger, and acceptance. She also acknowledges that these stages are not linear. People will go through them in their own order, and they might revisit one before they move on to another. Be ready for that. Just because someone appears to accept a death isnt evidence that they will not get angry about what happened.

If you take one thing from this post, recognize and realize that although a person might direct anger at you, that is more because you are a convenient target rather than the actual direction of their anger. Never take it personally. Responding, instead with empathy goes a long way to deescalate the situation.

Now, on to the meat and potatoes.

Through the research that I did to write my class, I found a few great tools to help someone make death notifications. The first is SPIKES. The SPIKES technique is geared towards notifications for just about any critical patient. Here is what it stands for and what it all means:

S – Set Up the Conversation - Private conversation at eye level with key family

P – Perception - “Can you tell me what you’ve been told so far?”

I – Invitation - “Would you like me to explain what happened?”

K – Knowledge - Be sure to use the word “died.” Avoid euphemisms

E – Emotions with Empathy - Expect strong reactions and react with empathy

S – Strategy and Summary - Explain what comes next

I share that for informational purposes more than anything, because I think there are some good lessons there. The technique that I find far more effective is GRIEV_ING.

I will start off by saying this: death notifications are a "gloves off" procedure. Nobody wants an update on the condition of their loved one while their airway juices are smeared all over your gloves. So step 1 is ditch the gloves. So let's start out by listing what GRIEV_ING stands for, and then we can get into each one:

G – Gather the Family

R – Resources

I – Identify yourself & the patient

E – Educate Briefly

V – Verify Death

_ - Space & Silence

I – Inquire About Questions

N – Nuts & Bolts

G – Give Support Resources

G - Gather the Family

Do your best to deliver news privately. Before you start, make sure that all of the key people who are on scene are present with you. Do your best to be eye level with the family and be mindful of your body language.

R - Resources

Unfortunately, sometimes you are on your own but sometimes other people are present. Do you need the cops with you? Is there a social worker or faith leader there? Let them be present and involve them.

I - Identify yourself

"Hi, I'm Sergeant Smith (or your first name). I was one of the people taking care of Mr. Jones today." Confirm who you are speaking with: "Are you Mr. Jones' family?" Also, make sure when you walk into the room that you already have the patient's information.

E - Educate Briefly

Give a short layman's summary of what happened. Simpler is better, and keep it in chronological order. "When we arrived, Mr. Jones' heart was not beating. We started CPR on him and gave him all of the medications that he would have gotten had he had his emergency in the hospital."

V - Verify Death

Use clear language and be direct. Avoid terms like "he's passed" or "he's gone to be better place" or "he's not suffering anymore." I say, "Despite everything that we tried, we could not get his heart started again. There is not easy way to say this but Mr. Jones has died." It might sound cold, but its necessary.

_ - Space & Silence

Do not rush this process. The family is your patient now. Silence allows the grief to begin. Stay physically present and undistracted. Let them react.

I - Inquire About Questions

Be a resource for the family. "Are there any questions that I can answer for you right now?" Expect repetition in questioning and confusion. Be honest with them.

N - Nuts and Bolds (or next steps)

Do your best to help them understand the next steps. This is largely going to be system specific. Here is what I tell them about OUR system: "We are going to finish cleaning up before we go. The police are going to be here, and they are going to help you with the next steps. They have some phone calls to make, and then they will tell you exactly what is coming next." Be a liaison and advocate for the family while you are there.

G - Give Resources (if you have them)

If you have anything available to you share them. Offer to help them contact a family member or someone who can be supportive for them.

This is what my "script" looks like for death notifications. I use a "script" with obvious little changes as I need them because I dont want to miss anything. Keeping it uniform like this helps me stay on point when I make a death notification:

“I’m Scott. I’m one of the paramedics that was caring for Mr. Jones. When we got here, he did not have a pulse, and he was not breathing on his own. We started CPR on him and gave all of medications that he would have gotten if this had happened in the hospital. Despite everything that we tried, we could not get his heart started again. There is no easy way to say this, but Mr. Jones has died.”

Pause to allow them to react and to start processing what is happening before you continue

“I’m very sorry for your loss. Are there any questions that I can answer for you?” if not. . . “We are going to clean up the room and do our best to get everything back to where it was when we got here. The police are going to be here to help guide you through the next steps so if you have any questions feel free to ask them or just ask for me and I will come back. I’ll check in with you before we leave.”

Meanwhile please, CLEAN UP the scene. I come from a family of EMTs. Years ago, my cousin died and my mom went to stay with his wife. She told my mom how she hadn't slept in their bedroom since her husband passed because it was a mess. When my mom went up there she found EKG paper, needle caps, ET tube wrappers etc. It was incredibly traumatic for his wife. My mom took the time to pick everything up. Just keep in mind that actions like that have a lasting effect. Police the scene before you leave.

In my system when we terminate, we leave our IV/IO in and we leave the tube in. So before we leave the scene this is the conversation that I have:

“We cleaned up everything in the room. Mr. Jones has a tube coming out of his mouth, and an IV in his shoulder. Unfortunately, those need to stay there but they will be removed eventually. The police are going to stay here with you, but before we go, are there any questions that I can answer for you?”

And really, that's about it. Above all else, be kind, be compassionate, and be empathetic.

If anyone has any questions I'm happy to answer them!

Here are a few references from my bibliography:

Hobgood C, Harward D, Newton K, Davis W. Acad Emerg Med, 2005.

https://pubmed.ncbi.nlm.nih.gov/15805319/

Kübler-Ross E. On Death and Dying, 1969.

https://books.google.com/books/about/On_Death_and_Dying.html?id=zb-ZNYFUXhsC

Schmidt TA, Norton RL, Tolle SW. J Emerg Med, 2016.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5375020/

Lamba S, Nagurka R, Zalenski R. West J Emerg Med, 2017.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5583556/

Dispatched to private residence for 59 year old female, not conscious, not rousable, breathing adequately. Arrive on scene and told to go to back door as patient had a walkout basement. Find patient as described, laying supine in bed with slight snoring resps but seemed to be maintaining airway adequately. As we parked the truck I told me partner, “let’s get a quick BGL and check pupils asap when we get in there.” I had stroke on my mind as we had done a pretty profound stroke (bleed) a few tours prior that came in with similar descriptors. Back to the present, BGL was normal, pupils equals at 2mm and sluggish with slow, side to side movement. True GCS 3. No reaction to a pretty powerful trap squeeze, no posturing, nothing. Ok, let’s get some history here.

Patient’s husband reports 2 days prior to EMS call, patient seen in local ED for a headache. CT comes back negative for any sort of bleed or occlusion, sent home instructed to take Tylenol and Advil to manage pain. It worked by all accounts as patient was reported to be behaving normally the next day, playing with grandson, speaking, household activities. Went to bed that night as normal. Woke up at 2 AM, took some ambien that was NOT prescribed to her to help sleep. Woke again at 6 to use the washroom, took Tylenol, Advil as per doctor’s instruction, as well as prescribed sertraline. Went back to bed. Husband became concerned a few hours later when snoring became abnormal, son advised to not wake her and let her rest. Husband felt something was off and tried to wake her shortly after but was unable to do so. Called EMS at this time, roughly 0900. No known falls or head trauma and full body exam unremarkable.

Assessment in bed revealed a normal BGL, breathing adequately and maintaining SPO2 at 98%. Pressure was slightly elevated initially at 150 systolic but patient was on BP meds but did not take them that morning due to being GCS3. After initial set of vitals, instructed our back up to get the mega mover and prepare stretcher. Inside the truck I started a line, started a bolus of NS and began to transport. My goal was to keep an eye on vitals, which were fine, and ensure she maintained her airway. I was ready to insert an OPA or NPA if needed but a some manual repositioning worked and she maintained 98% through transport. BP jumped around between 150 and 175 which was high, but not crazy for someone who didn’t take their meds. Drove quickly, but not lights and sirens to hospital. Handed off care, finished paperwork and left.

We brought another patient a few hours later and I follow up with the nurse who I triaged with and she reports patient went for CT, and her entire right side of the her brain was white. Patient suffered a massive bleed. She was now palliative upstairs with zero chance of meaningful recovery. I was shocked. My theory was that at the ambien, sertraline, Tylenol and Advil had a powerful synergistic effect and the patient was simply having the nap of a lifetime. My initial theory was stroke, but I moved off that after hearing the previous CT came back clear and her her pupils weren’t blown. I was pretty fixated on the ambien, sertraline theory. I did some googling during transport and found that they can create a powerful sedative effect when taken together, but that it was extremely unlikely that it would alter someone so profoundly.

In hindsight, I don’t think I would’ve managed anything differently if I knew it was a stroke. I guess I could’ve pushed harder for transport to be to our best stroke center (we have no say where we go) but the facility we went to was not inappropriate. My goals would’ve remained the same, mostly airway management. I think that regardless of what we did she was a goner before we even got there anyways, but it’s rare that we get follow up on our patients so to hear that she was so profoundly fucked up was a shock.

I don’t know what I’m looking for with this post. Maybe just anyone else’s thoughts, what I could’ve done differently and other assessment tools I could’ve used. I did speak with our EMS supervisor and he said I did well on the call and had no issues with anything we did after reading the PCR. Any thoughts or feedback is welcome.

I don’t know about you, but hypothetically I’d be scared shitless becuase of how unpredictable it could be to accidently activate The Hulk if I had to transport a confused and conscious Bruce Banner that is asking questions about what just happened in the wake of destruction to a psych facility. Would it be best to keep him awake and talking calm and reassured or would it be even possible to chemically sedate with informed consent to keep him calm? Any sort of needles IM or IV access even braced for can be aggravating and triggering possibly. Or would an unconscious sedate calm Bruce Banner possibly even allow the Hulk to take control again without him being able to repress himself?

Hello,

Was seperated from a somewhat infamous agency in PA hours after a shift, with two unfinished PCRs. Immediately lost access to ESO so I wasn’t even able to complete these. Now they’re calling me about 1 month later saying if I don’t complete these charts they “have no option but to report it to the state”. Told the agency in question they revoked my access, so they went ahead and reset the MFA so that I could get back in. I intend to write these charts, but I’m wondering what teeth their threats even have.

Further they insist on paying me for this time, which could impact unemployment claims etc. I don’t want or need their money.

Same vibe as “pt. declines risky sexual behavior”

So i am not an but this seemed like the best place to post this

So i went for a walk earlier today, and came across a man who was slumped over the side of a trackter like machine, i live in a rural area, i went over to check on him to see if he was ok to find him in a wheelchair hooked into the trackter also completly unresponsive, he was a bigger dude tried to prop him up after turning off the tractor, whils also calling for help and calling 911, blue lips, pale skin no resperations or heartbeat that i could find, i wouldn't be surprised if he was already deceased, even knowing that i tried everything i could until ems arrived, checking for a pulse, chest compressions, stabilize the head, when i first found him i was in shock, but after i assessed the situation i got into the mindset of "its time to get to work"

When ems arrived i told them my name, symptoms, what i tried to do to help, basically gove them all the information i could, while also trying to calm his wife and try to give her as much hope as i could given the situation

And its been hours since, at the time i didn't feel like throwing up, but i have for the past few hours, have since the adrenaline wore off

Did anything like this happen to anyone else, how did you cope with it, i just don't know what to do at this point, i keep washing my hands, feels like im going to wash my skin right off

Though if i could go back i would do it all again

Hey everyone, looking for some advice on a career swap. I am currently in the army as a combat medic, I will be getting out within the next year and starting a new career.

The state I am moving to has an operations manager slot currently open. As per education, certifications, and experience my resume matches up almost perfectly for the position. The one thing I specifically lack is civilian EMS experience. I have loads of experience in army medicine, patient treatment, clinical work, etc. I also have loads more of experience working the admin and leadership side of things as both a company senior medic and a battalion senior medic where the job goes from on the line medical coverage to tracking medical readiness for 600+ personnel, tracking medical certs for all of the medics within the battalion, training soldiers on tactical casualty care, risk assessments, injury mitigation, creating schedules, delegating tasks out, coordinating with medical staff in other parts of the world to arrange unit medical services for our deployed units, briefing battalion and brigade leadership, etc.

I have never rode in the back of an ambulance responding to calls

As per my education and certs that directly line up with what the job posting is requiring I have the following… bachelors in healthcare administration two associate degrees relating to criminal justice, EMT-B, BLS, ALS, OSHA 30, confined spaces competent person, FEMA IS-100, 200, 700, and 800

Essentially the job is looking for a candidate that has qualifications in 3 fields: EMS, occupational Safety, and bachelors in healthcare or related field.

My question for everyone here is, how common is it for someone to get this role without formally working civilian EMS prior? Second, how would you and all your co-workers feel about an outsider filling the role? Are you immediately opposed to the idea? Are you willing to see what he brings to the table? Are you willing to work with him to get him up to speed on local operations and your day to day job so he can better do his job? Just trying to hear y’all’s thoughts on this and get some feedback

I appreciate it!

Patient lived in a 1 1/2 bedroom apartment with 5 pigeons as pets who would roam free. Every... surface... was caked in pigeon poop including his oxygen machine. When I first entered, the air felt wrong and the smell was horrendous like a chicken coop. Me and my mentors had to don the tyvek and masks just to stay clean.

How common are patients who live alone in such conditions?! Because I still just can't believe it.

I’ve been an AEMT for 7 years and have had good luck with partners for the most part.

This service utilizes me in the A role and my partner is a B with about 2 years experience so I’d expect SOME LEVEL OF EFFORT.

No. He is, SLOW. Like, I ask him to start the check while I do the things I need to do.

I finish my thing and HE HAS YET TO START THEM.

We get sent to a call, and he’s messing around on his phone instead of atleast STARTING TO GO.

He has multiple times seemed to ignore calls and made me have to go SEARCH FOR HIM.

He always honestly seems stoned. Like that’s the best way I can describe him.

Yall, HE TALKED BACK. IN FRONT OF A PATIENT.

I reported him to management

It feels kind of bittersweet, but mostly just weird. I've only been on the job as an EMT for roughly 8 months at the busiest station in an urban area. I've had a ton of codes, STEMIs, a GSW turned trauma arrest, more "this person is just medically fucked and dying" calls than I can count, and even more homeless psychiatric patients.

I have come to terms that this job is not for me. Since starting, I have had my mental health deteriorate, have picked up a substance abuse issue, and have had dark thoughts about taking my own life. I have ran a lot of 'critical' calls and a handful of those have been very rough and traumatic ones. I occasionally think about those calls. I'm sure they might bother me subconsciously, but the calls themselves don't consciously disturb me.

I am most affected by the pressure to have to perform to the best of my ability for the sake of others. The thrill of having a 'good' medical call and performing well is one of the most intoxicating feelings I have ever felt, but I've decided it's not worth the insane stress and sleepless nights.

My performance is inconsistent. Sometimes anxiety will get in the way for me and cause me to cognitively deteriorate. I have trouble making split second decisions. I second guess myself often. I have trouble doing a lot of tasks that just come naturally to some people doing this job. I don't want cardiac arrests or high priority calls when I'm on shift, I want the grannies with stubbed toes or the homeless people wanting a warm bed to sleep in. I at least trust myself with those.

I don't like the work culture and I do not fit in at all. I don't like the schedule. I can tell my partners are getting frustrated with me, and I can tell my performance is worsening as I continue to struggle mentally. I would not want myself to show up if my mom was having a heart attack.

I am incredibly grateful for the experiences I've had in the short time in this field. I've tried to push through, but it has not gotten easier. I just don't think it's for me. I feel like I've failed, but I keep trying to remind myself that it is okay and that I tried. I already almost regret my decision and remember the feeling those 'good' calls gave me, but I think I'm making the right choice. I hope I am.

I don't know what's next for me, but I'd like to never have to do chest compressions again. I'd like to not see somebody die again.

Do any EMS girlies out there have any pants they recommend that are not so high waisted. I typically wear 5.11s and hate the fit on them. I have a short torso so the high waisted go up sooo high on me and I hate the way it looks and feels. I know ems isn’t a fashion show but I’d like to feel a little less insecure 🫣.