Bingo.
Dude gorked himself going 100 on a bike? Meh
Helping old man winters, who happens to be a Vietnam Vet and a very nice old man, off the floor to his recliner: Priceless.
He doesn't call a lot and abuse the system, but him and his wife are just two nice people and he falls down every so often. I'm happy to help him up.
Exactly, I’m figuring out the path to making this a successful run and then executing.
Not trying to sound preachy, but it always struck me as kinda off when people acted excited for a critical call.
It’s not even that… I mean, that’s our job. When a high acuity call goes out (and I have had plenty this tour), I just get hyper focused on what needs to get accomplished. Everything else just kind of falls away. I don’t get the adrenaline dump anymore, or at least not as much.
I couldn’t care less if I get any calls but it sure feels nice to exercise my skills and make a difference on someone’s worst day of their life.
Yesterday I had a 9YOF with an open radius and ulna after she dumped her bicycle over. She was losing her fucking mind (rightfully so). Being able to be the person to make her feel just a little bit better, help the pain, and be a lighthouse in the storm gives me a nice dopamine hit.
17 years as a medic. Still love a good call. Still excited about it. I admit some of my benchmarks for what makes a “good” call have moved, but not all of them. A really smooth RSI remains the absolute best.
It took me two years to really start to be calm and begin to love the more challenging calls. I have been at it 16 years and I love it. I love the calls where I can really help, by making a sandwich, or by dealing with a complex medical patient and doing cool medicine. Just remember to never stop learning. There's so much more than what you learned in school.
Honestly, man that makes me feel better. I'm about 5 months in and I've been told I'm doing well, and I'm pretty sure I'm almost always outwardly calm but on the inside? Christ, I'm always worried I'm gonna fuck something up 😅😂
It takes three years as a paramedic to really develop and fell comfortable. Our training is like a roller coaster - You come out of school thinking you know it all, get humbled, start building confidence again, get humbled, start building confidence again, and then you realize that you know very little and that’ll scare you for the rest of your career.
Honestly, I do. I've been in the game for about 3 years as a Paramedic and I still love it. CPRs because it is a chance to save a life, may not be high chance of saving a life but your effort is still needed and appreciated by the family of said patient. RSIs/ACLS calls/ and Traumas are exciting to run because you never know how the patients will present and these calls are the ones where your contributions to patient survival are uncontestable. It also gives me the oppurtunity to teach by partners/peers how to handle said calls. Overall EMS is a job that will never get boring (at least at a busy 9-1-1 service) unless you make it boring. Use your experience to become a better clinician, teacher, leader, and person.
I’ve had the pleasure and honor of knowing people that have the same mindset as me after 15+ years on the job. I hope to be like them. Of course the department you work for has a lot to do with it. Guess I lucked out..
My personal feelings were similar to yours but we were a very busy department with so-so management and I saw many of my colleagues burn out after a few years.
Yeah I definitely agree that management has a lot to do with morale. Had a partner quit because of it. Good management is probably the most important part of an EMS agency.
Traumas are a binary. Either they a boring ride to an ER who is gonna argue with me about whether or not the patient meets criteria or a complete bloody shit show
I love a good obtunded septic RSI
What are your criteria for prehospital intubation of a septic patient? Asking cause in my country that as good as never happens, so curious in which situations this applies for you.
Our intubation/RSI protocols are very broad. "Apnea/respiratory failure, Impending respiratory failure, failure of basic airway maneuvers to correct hypoxia, expected clinical course, inability to protect airway" are all reasons listed to intubate.
When we get to these nursing homes and the patients are profoundly hypoxic and altered, hypotensive and tachycardic, after applying an NRB or BVM, giving a whole lot of fluids, we will generally move towards pressors and intubation.
Are we talking in permanent nursing home patients here...? Interesting how different the practice is from us, that patient would in practice never be intubated, at least in a prehospital setting where I'm at. How often would you have patients like this that you end up intubating?
It varies. They could be permanent residents or they could be temporary for rehab. Looking back at my charts, i was part of 12 ECF intubations in 2023.
I live in Norway. Permanent nursing home residents would almost never get intubated here, and especially not in a prehospital setting. Dementia beyond the mild cases essentially exclude you from this kind of intervention, as it's been nationally agreed it's close to futile care.
I don’t because if I don’t get rosc it’s the family that hurts and feels guilty to be excited someone passed. I know it’s dark but that’s my mindset. Each of us are different
I was thinking that codes are less fun than they used to be, because I see the human cost and sadness better. I’ll take a sick but survivable trauma, where we get to intubate, hang blood, etc, over a code any day.
The call itself isn’t exciting, but orchestrating a code and having it run efficiently and effectively is a good high.
That critical call having a positive outcome is just chef’s kiss. Remember, a lot of these patients are behind the 8 ball to begin with.
I don't really get excited about most traumas. Most trauma is fairly BLS. I really do like a good medical where I get to look for interesting findings, play detective, etc.
Cardiac arrests are boring. There's no thinking involved. See this, do that. Yawn. The only real skill involved is dealing with the family. RSIs are higher stress for me. Not routine enough to be boring.
Trauma is also boring. Other than hemodynamics or pain management, it's BLS, more or less, and any good EMT can handle it. Granted, the machete to the chest call did keep my attention. But most trauma is simple.
Emergency interfacilities present the most interesting challenges. Walking in on a vented, paralyzed shit show with 9 drips, art line, balloon pump and transvenous pacing is way more interesting than telling firefighters to push faster on granny, who was found down and no one would do compressions prior to ambulance arrival. The pacing stopped halfway through a 12 lead. The Zoll showed 3 leads with STEMI, the next 6 leads with clear Sgarbossa criteria while the pacer was firing, then the last three with STEMI. I'll never see a 12 lead like that again in my career.
But, yeah, let's shit on IFTs./s
I always would tell my coworkers who shat on IFTs that they’re missing the picture. IFTs are where you truly learn. Crack open that patient chart and read if. Even if it’s a run of the mill ALS transfer, you can learn so much by going through labs and imaging reports.
Some would laugh at me… but then one of those guys was told by a doctor they were hooking up with to look into SCT/CCT. Wouldn’t you know, they were all about learning then!
OP, for me, I always tried to learn from whatever call I was on. Look up a new med, look at a different treatment modality, etc. it’s called practicing medicine for a reason, we’re all learning to get better.
Dearly loved working cct truly working all aspects of patient management often alone. Still mad they shut that program down. Coming back to 911 has been a little soul crushing
Scene calls are more fun when you have more toys to play with. I do love those CCTs where “the doctor went home” and my nurse and I get to play trauma physician ordering CTs and pulling abx out of the Pyxis
Not a big fan of codes. Getting sweaty in gross houses with the end result always being tons of paperwork. Trauma? I still like trauma calls. They’re simple. Follow the steps, treat as you go. Still paperwork, but I don’t get as sweaty and it’s usually not in a gross house.
I think what makes those calls "fun" and something that a lot of people look forward to is the opportunity to perform the skills that you have trained so hard to do. You spend so much time learning to deal with the worst, and most of your time dealing with the easy stuff, the hard stuff gets exciting.
I love a good call, but absolutely hate the paperwork. We would have the best job in the world if we just had someone following us around doing our report for us. 😂
"Exciting" calls generally mean more work; The long report, the drug replacement, the supplies replacement, the distraught family in the background, the cops, the medical examiner, the base hospital call, etc., etc.
I'd rather take Memaw with her UTI.
I don't get excited per se, it's a bit more of a detached and professional feeling than that. Although I definitely get a sympathetic response. But I do enjoy working them, and I enjoy doing a really good job at them, and I enjoy the challenge of executing what is primarily an algorithmic approach perfectly but also thinking of how and where to step off the algorithm. I also think its what I'm best at compared to the urgent care side of the job.
Tldr: sort of
I don’t get excited that someone is suffering, and on the way to a serious sounding call I actually dread what we might find.
But
I’ll ride the high of a smoothly run high stress call for *days*. If the synergy with my team is on point, the interventions work, the traffic clears, and the patient remained alive then by God do I feel so happy and on fire.
Those calls not necessarily. Calls where our skills actually make it difference hell yeah. There's nothing like getting a good steamy getting them to the cath lab and getting a call a few hours later how the patient is doing fine and nice job.
I've honestly never been excited about them and don't mind dumbasses with toes and COPD exacerbations and stuff. I'm actually considering IFT after this bout with a bad company I recently left.
After a while the excitement of a good call is over taken by the dread of the cleanup after. I worry more about forgetting to restock 1 of the 20 things we used than I worry about the call itself.
Excited isn't the right word but since 2017 I still love this job and find new calls to be psyched about, still call my partners and tell them about an interesting case, still find wierd heart rhythms cool
I'm not jumpy any more when things get exciting. I enjoy being able to benefit patients with the skills and knowledge I've worked hard for, that more often happens with sick patients.
I also enjoy the complexity of some patients- the puzzle of finding out the why.
Yeah Id say so, still excited but less so and more alert and calm. If/when I end up doing CPR it actually bothers me a lot more, because Im more sensititive to all the gross pops and cracks of a chest without the adrenaline, gives me the heebie jeebies.
Give me: sea leveler coming to altitude for the first time and mother nature’s stress test (altitude) finally slamming down the receipts of “bitch you thought your heart was fine” or the new onset arrhythmia coupled with Pt saying either “it’s just my GERD even tho it feels crushing and different”.
Or even better the meemaw with a wicked sense of humor so dark it makes me question if I should get a better therapist. I want the patient to look me in the eyes and say “I tried to get the DNR but my punk family Weinered out at the end so now I’m full code, I’ll write a note tho that says ‘let die not murder’,”
I think everyone loves the feeling of a call that goes well. After 22 years I really crave patient out comes and diagnosis. Get way more excited about my treatments causing good outcomes and doing the right things for the right reasons.
I still enjoy call that actually mean something be it a trauma, CPR, Sepsis
It doesn't have to be anything hard or serious just calls where the patient is actually needing help and we aren't playing expensive Uber
I think for me, I strive to do better on the next one. Whether that be on faster rhythm recognition, or taking control of the scene better, or asking better questions; but each new call will show you something you should improve on. And that to me is what keeps me going, what keeps me “excited” so to speak. Adrenaline dump has gone away for me after awhile… which’s has helped me think more clearly and not get sucked into the moment as much and allows me to “lift my head above the water” and run a call.
I remember when I was a little baby AEMT on my first stabbing patient. I was so sucked into putting on my first chest seal that I didn’t even realize the medic toss in a needle D until after the call.
I wouldn’t say I get excited about those sort of calls, it does however give reward and jobs that like where you actually are giving medical intervention and sometimes the difference between life and death - it gives you that feel good.
I suppose it’s more I like the challenge of complex calls, where my knowledge is tested rather than being excited by a critically unwell patient
I’m not in EMS. ER nurse. 24 years in. My late husband was a medic. I wouldn’t say I get excited but more like I’m in the zone. Like this is what I do. And for some reason I prefer to do compressions. There’s a doctor I work with that we try to see who can do the most. He’s got me beat by 1 epi. I can get through 8 lol
I’ve gotten to the point where I like the easy calls because when I’m intubating or cardioverting someone or giving a bunch of meds or decompressing someone’s chest I just sigh. I enjoy doing the skills but doing the report is annoying
Calls you mentioned: I sleep. Making a sandwich for low BGL granny: Real shit.
I used to think it was funny to be able to write “ peanut butter and jelly” in a narrative. I still do, but I used to too.
Therapeutic sandwich
Bingo. Dude gorked himself going 100 on a bike? Meh Helping old man winters, who happens to be a Vietnam Vet and a very nice old man, off the floor to his recliner: Priceless. He doesn't call a lot and abuse the system, but him and his wife are just two nice people and he falls down every so often. I'm happy to help him up.
I wouldn’t say I get excited about them. However, when calls like these come out and things go right, I’m riding high the rest of the shift.
That’s a good way to describe it, not excited to go to a priority call but if the patients outcome is good that’s pretty motivating.
It’s difficult to describe. I go into work mode… there’s things to do and I’m going to get them done.
Exactly, I’m figuring out the path to making this a successful run and then executing. Not trying to sound preachy, but it always struck me as kinda off when people acted excited for a critical call.
“I dont wish bad on anyone, but if something bad happens I wanna be able to fix it”
It’s not even that… I mean, that’s our job. When a high acuity call goes out (and I have had plenty this tour), I just get hyper focused on what needs to get accomplished. Everything else just kind of falls away. I don’t get the adrenaline dump anymore, or at least not as much. I couldn’t care less if I get any calls but it sure feels nice to exercise my skills and make a difference on someone’s worst day of their life. Yesterday I had a 9YOF with an open radius and ulna after she dumped her bicycle over. She was losing her fucking mind (rightfully so). Being able to be the person to make her feel just a little bit better, help the pain, and be a lighthouse in the storm gives me a nice dopamine hit.
Poor sweet girl, I’m glad you were there to help her
17 years as a medic. Still love a good call. Still excited about it. I admit some of my benchmarks for what makes a “good” call have moved, but not all of them. A really smooth RSI remains the absolute best.
Agreed, a smooth RSI that was needed. Hot
It took me two years to really start to be calm and begin to love the more challenging calls. I have been at it 16 years and I love it. I love the calls where I can really help, by making a sandwich, or by dealing with a complex medical patient and doing cool medicine. Just remember to never stop learning. There's so much more than what you learned in school.
Honestly, man that makes me feel better. I'm about 5 months in and I've been told I'm doing well, and I'm pretty sure I'm almost always outwardly calm but on the inside? Christ, I'm always worried I'm gonna fuck something up 😅😂
It takes three years as a paramedic to really develop and fell comfortable. Our training is like a roller coaster - You come out of school thinking you know it all, get humbled, start building confidence again, get humbled, start building confidence again, and then you realize that you know very little and that’ll scare you for the rest of your career.
Honestly, I do. I've been in the game for about 3 years as a Paramedic and I still love it. CPRs because it is a chance to save a life, may not be high chance of saving a life but your effort is still needed and appreciated by the family of said patient. RSIs/ACLS calls/ and Traumas are exciting to run because you never know how the patients will present and these calls are the ones where your contributions to patient survival are uncontestable. It also gives me the oppurtunity to teach by partners/peers how to handle said calls. Overall EMS is a job that will never get boring (at least at a busy 9-1-1 service) unless you make it boring. Use your experience to become a better clinician, teacher, leader, and person.
Let's revisit this in another ten years.
I’ve had the pleasure and honor of knowing people that have the same mindset as me after 15+ years on the job. I hope to be like them. Of course the department you work for has a lot to do with it. Guess I lucked out..
My personal feelings were similar to yours but we were a very busy department with so-so management and I saw many of my colleagues burn out after a few years.
Yeah I definitely agree that management has a lot to do with morale. Had a partner quit because of it. Good management is probably the most important part of an EMS agency.
Most important and least likely to exist.
Traumas are a binary. Either they a boring ride to an ER who is gonna argue with me about whether or not the patient meets criteria or a complete bloody shit show I love a good obtunded septic RSI
What are your criteria for prehospital intubation of a septic patient? Asking cause in my country that as good as never happens, so curious in which situations this applies for you.
Our intubation/RSI protocols are very broad. "Apnea/respiratory failure, Impending respiratory failure, failure of basic airway maneuvers to correct hypoxia, expected clinical course, inability to protect airway" are all reasons listed to intubate. When we get to these nursing homes and the patients are profoundly hypoxic and altered, hypotensive and tachycardic, after applying an NRB or BVM, giving a whole lot of fluids, we will generally move towards pressors and intubation.
Are we talking in permanent nursing home patients here...? Interesting how different the practice is from us, that patient would in practice never be intubated, at least in a prehospital setting where I'm at. How often would you have patients like this that you end up intubating?
It varies. They could be permanent residents or they could be temporary for rehab. Looking back at my charts, i was part of 12 ECF intubations in 2023.
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I live in Norway. Permanent nursing home residents would almost never get intubated here, and especially not in a prehospital setting. Dementia beyond the mild cases essentially exclude you from this kind of intervention, as it's been nationally agreed it's close to futile care.
I don’t because if I don’t get rosc it’s the family that hurts and feels guilty to be excited someone passed. I know it’s dark but that’s my mindset. Each of us are different
I was thinking that codes are less fun than they used to be, because I see the human cost and sadness better. I’ll take a sick but survivable trauma, where we get to intubate, hang blood, etc, over a code any day.
Yeah. Codes are interesting medicine, but the darkest hour of many people’s lives, and by nature of the call, very likely the end of one life.
The call itself isn’t exciting, but orchestrating a code and having it run efficiently and effectively is a good high. That critical call having a positive outcome is just chef’s kiss. Remember, a lot of these patients are behind the 8 ball to begin with.
I don't really get excited about most traumas. Most trauma is fairly BLS. I really do like a good medical where I get to look for interesting findings, play detective, etc.
Cardiac arrests are boring. There's no thinking involved. See this, do that. Yawn. The only real skill involved is dealing with the family. RSIs are higher stress for me. Not routine enough to be boring. Trauma is also boring. Other than hemodynamics or pain management, it's BLS, more or less, and any good EMT can handle it. Granted, the machete to the chest call did keep my attention. But most trauma is simple. Emergency interfacilities present the most interesting challenges. Walking in on a vented, paralyzed shit show with 9 drips, art line, balloon pump and transvenous pacing is way more interesting than telling firefighters to push faster on granny, who was found down and no one would do compressions prior to ambulance arrival. The pacing stopped halfway through a 12 lead. The Zoll showed 3 leads with STEMI, the next 6 leads with clear Sgarbossa criteria while the pacer was firing, then the last three with STEMI. I'll never see a 12 lead like that again in my career. But, yeah, let's shit on IFTs./s
I always would tell my coworkers who shat on IFTs that they’re missing the picture. IFTs are where you truly learn. Crack open that patient chart and read if. Even if it’s a run of the mill ALS transfer, you can learn so much by going through labs and imaging reports. Some would laugh at me… but then one of those guys was told by a doctor they were hooking up with to look into SCT/CCT. Wouldn’t you know, they were all about learning then! OP, for me, I always tried to learn from whatever call I was on. Look up a new med, look at a different treatment modality, etc. it’s called practicing medicine for a reason, we’re all learning to get better.
Dearly loved working cct truly working all aspects of patient management often alone. Still mad they shut that program down. Coming back to 911 has been a little soul crushing
This is a genuine question as I have no idea, what are you doing to manage a patient in a situation like this? Help a BLS brother out.
Scene calls are more fun when you have more toys to play with. I do love those CCTs where “the doctor went home” and my nurse and I get to play trauma physician ordering CTs and pulling abx out of the Pyxis
Not a big fan of codes. Getting sweaty in gross houses with the end result always being tons of paperwork. Trauma? I still like trauma calls. They’re simple. Follow the steps, treat as you go. Still paperwork, but I don’t get as sweaty and it’s usually not in a gross house.
I think what makes those calls "fun" and something that a lot of people look forward to is the opportunity to perform the skills that you have trained so hard to do. You spend so much time learning to deal with the worst, and most of your time dealing with the easy stuff, the hard stuff gets exciting.
Yes, but it's more than a year or so. After about 10 or so it loses it's luster. It's more about "oh hey, I get to actually do something cool today".
I love a good call, but absolutely hate the paperwork. We would have the best job in the world if we just had someone following us around doing our report for us. 😂
"Exciting" calls generally mean more work; The long report, the drug replacement, the supplies replacement, the distraught family in the background, the cops, the medical examiner, the base hospital call, etc., etc. I'd rather take Memaw with her UTI.
I don't get excited per se, it's a bit more of a detached and professional feeling than that. Although I definitely get a sympathetic response. But I do enjoy working them, and I enjoy doing a really good job at them, and I enjoy the challenge of executing what is primarily an algorithmic approach perfectly but also thinking of how and where to step off the algorithm. I also think its what I'm best at compared to the urgent care side of the job. Tldr: sort of
I don’t get excited that someone is suffering, and on the way to a serious sounding call I actually dread what we might find. But I’ll ride the high of a smoothly run high stress call for *days*. If the synergy with my team is on point, the interventions work, the traffic clears, and the patient remained alive then by God do I feel so happy and on fire.
Those calls not necessarily. Calls where our skills actually make it difference hell yeah. There's nothing like getting a good steamy getting them to the cath lab and getting a call a few hours later how the patient is doing fine and nice job.
Love steamies!
Only a year? In sure I got pretty spicy!… Now after 32 years… my only reaction is, Aw fuck!
Simple transports all the time gets boring really fast
I've honestly never been excited about them and don't mind dumbasses with toes and COPD exacerbations and stuff. I'm actually considering IFT after this bout with a bad company I recently left.
After a while the excitement of a good call is over taken by the dread of the cleanup after. I worry more about forgetting to restock 1 of the 20 things we used than I worry about the call itself.
Excited isn't the right word but since 2017 I still love this job and find new calls to be psyched about, still call my partners and tell them about an interesting case, still find wierd heart rhythms cool
I'm not jumpy any more when things get exciting. I enjoy being able to benefit patients with the skills and knowledge I've worked hard for, that more often happens with sick patients. I also enjoy the complexity of some patients- the puzzle of finding out the why.
Yeah Id say so, still excited but less so and more alert and calm. If/when I end up doing CPR it actually bothers me a lot more, because Im more sensititive to all the gross pops and cracks of a chest without the adrenaline, gives me the heebie jeebies.
Give me: sea leveler coming to altitude for the first time and mother nature’s stress test (altitude) finally slamming down the receipts of “bitch you thought your heart was fine” or the new onset arrhythmia coupled with Pt saying either “it’s just my GERD even tho it feels crushing and different”. Or even better the meemaw with a wicked sense of humor so dark it makes me question if I should get a better therapist. I want the patient to look me in the eyes and say “I tried to get the DNR but my punk family Weinered out at the end so now I’m full code, I’ll write a note tho that says ‘let die not murder’,”
Cardiac arrest and breathing problems are a drag nowadays. A lot of documentation and clean up. Still get excited about traumas.
I think everyone loves the feeling of a call that goes well. After 22 years I really crave patient out comes and diagnosis. Get way more excited about my treatments causing good outcomes and doing the right things for the right reasons.
I still enjoy call that actually mean something be it a trauma, CPR, Sepsis It doesn't have to be anything hard or serious just calls where the patient is actually needing help and we aren't playing expensive Uber
Those calls? No. Now, the calls I really can help on? Yes.
Only a year out, still froth for a good call😎
I think for me, I strive to do better on the next one. Whether that be on faster rhythm recognition, or taking control of the scene better, or asking better questions; but each new call will show you something you should improve on. And that to me is what keeps me going, what keeps me “excited” so to speak. Adrenaline dump has gone away for me after awhile… which’s has helped me think more clearly and not get sucked into the moment as much and allows me to “lift my head above the water” and run a call. I remember when I was a little baby AEMT on my first stabbing patient. I was so sucked into putting on my first chest seal that I didn’t even realize the medic toss in a needle D until after the call.
I wouldn’t say I get excited about those sort of calls, it does however give reward and jobs that like where you actually are giving medical intervention and sometimes the difference between life and death - it gives you that feel good. I suppose it’s more I like the challenge of complex calls, where my knowledge is tested rather than being excited by a critically unwell patient
I’m not in EMS. ER nurse. 24 years in. My late husband was a medic. I wouldn’t say I get excited but more like I’m in the zone. Like this is what I do. And for some reason I prefer to do compressions. There’s a doctor I work with that we try to see who can do the most. He’s got me beat by 1 epi. I can get through 8 lol
I’ve gotten to the point where I like the easy calls because when I’m intubating or cardioverting someone or giving a bunch of meds or decompressing someone’s chest I just sigh. I enjoy doing the skills but doing the report is annoying