follow up q&a to my wemt/emt+w post

A friend of mine asked me some questions about my last post (finished my WEMT) and I thought the answers might be helpful for others out there.

What was your favourite part of the course?

Having people in it who had some serious experience. Two guys were heli-ski operators, one guy was a mine rescue technician, several were guides, one guy got shot in the chest point blank, and the instructor is a paramedic who has patients she can’t transport for up to 48 hours because of weather and general Alaskan-remoteness.

In a normal world I’m the most outdoorsy-medical guy around, so it was really humbling and level setting to be around others who experience near daily horror stories and handle them with grace.

What was your least favourite?

I think from an annoyance prospective it was dealing with state and local protocols which are basically always a little out of date with current research. You learn and get tested on some things that aren’t in the best interest of your patients because it takes years for medicine to change (great example: back boards and traction splints, medieval torture devices that are still on most rescue inventories).

At a personal level it was going through scenarios that I had never considered. Like a pediatric with multiple gunshot wounds or a woman who just had a miscarriage, sitting on a toilet, and you being the person who’s going to manage that scene and bring calm. I think everyone has situations that hit them hard in the emotional department, and you never really know what they’ll be until you’re in it or perhaps after the fact.

What surprised you the most?

How quickly a talented person can burn through a primary assessment, establish an airway, stop major bleeds, and prep for transport. It’s like less than a minute (tops) if you’re good, complete with all the gore/mayhem/ppe/bsi/safety.

Going back to the last one, it was also the scenarios that I hadn’t considered. Using a plastic model to practice sticking your hands into a vagina to push a baby’s face off a prolapsed cord and keep the airway patent. Or how to deal with excited/agitated delirium. They’re not scenarios I really signed up to handle, but if you’re functioning as an EMT in an urban setting you can’t pick and choose your patients.

Also, how easy it is to get a bp via a pedal pulse and a cuff on the thigh on a neonate now that I know what I’m doing.

Have you done the NREMT yet, and was it different than what you learned in class?

I’m an Alaskan EMT-1, and have applied for my NREMT course but haven’t taken the test yet. If you’re taking a state’s written and practicals I would really focus on that (which is different than wilderness protocols, which is different than NREMT) because you need to pass it to move on and remembering multiple protocols is rough. It’s a bit dumb because I had to memorize Alaskan procedures I’ll never do in California, but conflicting and head-scratching protocols seem to be the name of the game with medicine in general. Most things are right, but some protocols are bad and just haven’t been fixed yet.

But in general Alaskan and NREMT protocols overlap probably 90%. Dyspnea is dyspnea, a biphasic AED is a biphasic AED, and COPD is COPD. The differences are more subtle like: emphysema patient with a 2LPM nasal cannula complaining of difficulty breathing. Do you crank up the flow a bit or swap her out for a NRM at 15LPM? Either way you’re increasing their O2 but  what’s the specific blow-by-blow protocol? Did you need to use pulse oximetry and if so how? Stuff like that.

My sample tests I’ve taken for NREMT are going well; there’s a few items that are new but nothing mindblowing.

Are you planning on working as an EMT, or did you just do the class for the knowledge?

I think like sailing you suck unless you do it so I’m going to try to work at the local hospital maybe 20 hours a month covering other people’s shifts. My neighbors are trauma surgeons at the local hospital so if I’m lucky I can work with them, or try to hang in the ER in general.

I studied vital sign ranges before the class but from taking literally over 100 blood pressures from various people I actually learned way more about the ranges and concreted in the numbers. Ages and sex matters it seems but I learned that a skinny 14 year old girl probably just has a really low BP and that for little pediatrics I’m high as a kite if I think I can get them to sit still. So the practical application seems to be part of the knowledge to me, if that makes sense.

Do you plan to register in California by county?

So after I get through NREMT I’m going to hit up the hospital in town and just say “Hey, I’m a NREMT EMT-B, what else should I do and what other training would be helpful?” I think there’s ancillary stuff they’ll want too like phlebotomy, probably some blood borne pathogen training, etc. It’s a super rural county so I’m expecting some hoops but probably not a million.

What extra study materials would you recommend?

I was based out of the “Brady Book”, it was the major text we used in conjunction with our wilderness stuff. I bought the workbook along with it and burned through those chapters doing the work before the class. It was probably 100 hours of my life I’ll never get back but the pathophysiology really helped and I liked learning why a pulse oximeter sucks for CO poisoning, as an example.

My learning style is that I need to understand the whole circle and then I can branch out so I felt like (for me) I really need to go ham on the textbook and know underlying health-nerd stuff that there just isn’t enough time in a lecture to cover.

Also, really knowing a lot of the abbreviations and medical terms help. Writing tx is way faster than treatment, ditto pt for patient, hx for history, etc. Sometimes people toss out things like npo and it sucks to have to stop and say, “Huh?”. Yeah, they should speak in normal English but around hospitals they don’t and it’s pretty available info.

In class I made flashcards of things I didn’t understand.

Are there any extra non-study materials you’d recommend?

I made good use of 3×5 flashcards (in addition to pre-made NREMT ones), highlighters, a notebook, and rite-in-the-rain for outdoor stuff. For field scenarios and on actual sar callouts I have WMA’s field guide. It’s 4″x6″ (same size as my rite-in-the-rain book), and both fit in my radio chest harness pocket. On real ops I thumb through it for whatever the suspected injury is to remind myself what the hell I’m doing. There’s also some dope stuff in the back on litter tie-ins, chopper stuff, and medical terms. For whatever field team I’m in I’ll read it out loud (before we get to the patient) and we can discuss what to look for, who’s doing what, what gear we’ll need, what complications we might see, etc.

I just have the boring rite-in-the-rain 4″x6″ because I end up jotting down notes from witnesses, cops, other teams, etc. I’ll write a SOAP and try to format it well enough. In sar land I hand it off to the chopper/ambulance and ask them to give it to the receiving facility as well.

Anything else?

Just because I took so many damn blood pressures I’ll add that quickly being able to ballpark the systolic on a patient, rapidly getting there, then rapidly getting down to the diastolic then rapidly deflating completely is the difference between pro bp readings and torturing a patient by keeping what is essentially a tourniquet on their arm whilst futzing around trying to find their brachial artery for a minute solid.