(Transcript is automatically generated)

Matt: [00:00:00] If loading and going is what's best for your patient, then do that. If you need to stay there and do a few skills first to stabilize them, then maybe that's the best thing to do. 

Erik: Early identification and early, early treatment on, on these patients is what saves lives, and that data is clear.

Narrator: You are listening to EMS with your hosts, Erik Axene and Matt Ball. 

Matt: Alright, so I know I [00:00:30] get this question all the time. Uhhuh as a preceptor, as a captain, and I'm sure that as a medical director, you get this question all the time. Yeah. Is the, the, the decision of when to stay and play and when to load and go, and I don't think it's quite as black and white as everybody would like to think there's no way you can simply say, okay, every one of these patients you need to load and go, or every one of these patients you need to stay in play. 

Erik: Yeah. 

Matt: It's not that simple. [00:01:00]

Erik: Yeah, it's not. It's not like you might think they're not that six. You can stay in play well in some ways. We've taught it actually where when they're not that sick, you can stay in play and get a full history and kind of do your thing.

Matt: Yeah. 

Erik: And then there's some patients where you better be on point Yeah. To do something. 

Matt: Yeah. 

Erik: Life saving 

Matt: Somebody bleeding out, like Yeah. 

Erik: And that might mean loading in, you know, alone. Go, mate. Yes. But it also might mean stay in play. Yes. 

Matt: So it's, yeah. I think stabilization is the word, [00:01:30] uh, that I think of most off.

And when I think of do I need to, and staying in play, like maybe staying, stabilize is a better word, uhhuh right? That my patient is too unstable if I don't do anything now to, to try to stabilize them. Mm-hmm. Bad thing. They're just gonna continue to deteriorate in route. Yeah. And that's not helping the patient, which is the overall goal, right?

Yep. And so, but I get, I think a lot of it from [00:02:00] my perspective is kind of an old school mentality where it's just like, well, 20 years ago, you know, we just, well bro, I've been doing this over 20 years too, and things have changed. Right? We don't fight fire the way that we did 20 years ago. EMS is not the same as it was 20 years ago.

Yes. And we have to keep up with the times that's mm-hmm. Part of it. And so 

Erik: pediatric resuscitation, I think is a, is a prime example. Prime example. Yes. Yeah. You, you really need to take care of what you can take care of there on scene that's best for the [00:02:30] patient. Yes. And, and uh, there's certain situations, obviously there's always exceptions.

Matt: Yes. 

Erik: Um, but if there's something you can do now, you know, effectively within your protocols 

Matt: Yeah. 

Erik: Uh, that patient emergently needs, you gotta do it. Yes. And some stuff can wait to do en route. And some stuff we can't do. We have to get into the hospital and that's part of the reason why load a load and go is sometimes the answer.

Absolutely. Yeah. So 

Matt: yeah, it's not as cut and dry as you know. It's not all or none, you know, like [00:03:00] trauma patients for example. Trauma patients, we cannot fix. Something going on in the body. We can't fix it. We can put a bandaid on it. The proverbial bandaid. We can do that, but we cannot fix it. They need a trauma hospital, right?

Yep, that's right. No. And so you gotta get going and I think a lot of it has to do also with what's your transport times. Mm-hmm. Are you using air medical or are you five minutes from a, you know, do you work in Dallas, Texas and you're five minutes from multiple level one trauma centers? 

Erik: Yeah. 

Matt: Uh, [00:03:30] that has to play into the decision.

Erik: Do you have blood? 

Matt: Do you have blood? Yeah. Yeah. Uh, do you have tourniquets? Do you have TXA, do you have blood? Do you have Yeah. I mean, there's so many factors that play into it. 

Erik: Um, well, the more and more that we're held accountable to the, the, I guess the, the, the more capacity that we have in the prehospital environment to treat patients, the more the responsibilities we have, the more ways we can deliver care, the more complicated these decisions are Yes.

Are becoming. Yeah. And [00:04:00] it's only gonna get more complicated there. There are so many things. That we can do now that we weren't doing just a few decades ago. 

Matt: Oh yeah. 

Erik: That, uh, you know, it used to be just a transport service. Yep. It was far more complicated than that now. Yes. So when you're, when you're making that decision and you're looking at your patient, you gotta ask yourself, is there something that I need to do right now that's gonna save their lives?

And that's why we have these algorithms. Mm-hmm. The March algorithm, uh, the ABCs, the C ABCs, all of these things [00:04:30] we have. To, we have to treat the most life-threatening things first. 

Matt: Right. 

Erik: And sometimes I think, and we talked about this in our airway lecture, we get so focused sometimes on the airway Yeah.

That we, you know, forget to resuscitate our patient first. 

Matt: Yeah. We don't notice their blood pressure is 90, over 40 or, or 60, over 40 or something. Yeah. 

Erik: And then, then some of the literature out there doesn't show any mortality benefit, uh, for outta hospital discharge. For example, with sudden cardiac arrest with intubation.

There's 

Matt: with intubation. Yeah. [00:05:00]

Erik: Um, so really the, the resuscitating our patients and doing those emergent things first Yep. Is, is key. And that might mean having the wisdom to know we can't treat 'em here and we gotta get 'em out. Mm-hmm. And time is money at times. Time is money, time is brain time is hard. I mean, all those things.

Strokes, heart attacks. 

Matt: Right. And strokes. Strokes is a big one too, is it's like there's really not much I can do for a stroke patient on scene. Yeah. You know, I can maybe get their blood pressure down a little bit if it's super [00:05:30] high. But I can do that en route. I can get an IV en route. I can give them, you know, whatever medication I carry in my toolbox to bring their, I can do that en route, right?

I don't need to spend 30 minutes on scene doing that. That is a waste of time. That patient needs to get to a primary or a comprehensive stroke center quickly 

Erik: and every minute you delay care, reperfuse 7 million, seven and a half miles, seven and a half miles, probably more than millions, but yeah, seven and a half miles of neuro myelinated fibers we lose.

So the [00:06:00] situation. Again, like a stroke load and go Right. Identify it, obviously. Right. And do what you need to do. What's, you can have a huge bad stroke that may need airway. Uh, that's true. Yeah. So, so everything is complicated. There are always exceptions. Yep. Um, but using your brain and using your understanding of the pathophysiology of all any disease process you could be handed 

Matt: mm-hmm.

Erik: A, identify the correct pathophysiology. Right. And then, and then work to save that patient's life by doing what needs to be [00:06:30] done now. Right, 

Matt: right. Like we, you know, in my system we just recently went to antibiotics. Same, same with your departments. And a lot of guys have asked like, why are we giving antibiotics?

We're not doctors. You know, this is ridiculous. You know, can that, that can wait till we get to the hospital. Like can it wait? Sure. It could wait till we get to the hospital. But the data shows that there could be a benefit to those patients if they're in septic shock. Yeah. If they're sick. If they're in severe sepsis.

Yeah. Not just for the big, but if they're really sick mm-hmm. You are decreasing their mortality by [00:07:00] giving them antibiotics now. Earlier you get it on board, the better for them. 

Erik: Yeah. I think it was every, every minute delay was an increased mortality. 7%. 7%. Yeah. Yeah. So for the sick ones, 

Matt: yeah. For the really sick septic patients.

Yes. Right. So like you said, identification is is key. 

Erik: Yeah. 

Matt: You know, to get those, to identify what we're dealing with. 

Erik: Um, and, and, and if you can, if you do have antibiotics or, but, but even if you don't, early identification and early, early treatment on, on [00:07:30] these patients is what saves lives. Right? Right. And that data is clear.

Yes, that data is clear. And if they're really sick, septic patients, the, the, the delaying antibiotics can actually increase mortality rate like we talked about. So there may even be evidence that, uh, the antibiotics delays bad things. So, and that's why in our departments, I went with the antibiotics. 

Matt: Yeah, 

Erik: there's a lot of data both ways.

Yep. But I decided, uh, under my medical license, we're gonna try to identify the sickest of the sepsis patients and start those [00:08:00] antibiotics early. Yep. Open fractures too. Yep. Yep. 

Matt: Yeah, I think it's, uh, one factor that we would look at is, or when I would teach our new paramedics is 'cause we all miss things, right?

Mm-hmm. Like, I probably should have taken that guy's airway or, Hmm. I probably should have done this. Right. And usually my indicator for that is. And I would teach my young paramedics this, that if they do it in the first five, if it's something that we had the capability to do pre hospitally, uhhuh, and you do it in the ER [00:08:30] five minutes after I get there, I probably should have done that pre hospitally.

Yeah. That's kind of my indicator for it, and that's how you learn. Right. Like, okay, next time if I have this kind of patient, I remember as soon as I got there, Axene dropped a tube on the guy, or Axene did this Right. And I could have done that. Yeah. And so use, that's where experience comes in, right? Yeah. And, and that's why, you know, experience is good in combination with education, but like heart attack patients.

Mm-hmm. I, I hesitate to say STEMIs because it's [00:09:00] not just STEMIs anymore. 

Yeah. But a patient having an acute mi. Right. That's right. Time is of the essence like a stroke patient. I, once we identify it, so I think we've talked about stroke, sepsis, and heart attacks. Get him to the guy that could fix it. Well, you gotta identify it, right?

You gotta identify it first. Yep. Right. Once you identify it. Then, okay. We don't, unless there's that rare septic, well septic, cardiac or stroke patient that may need an airway other than that Uhhuh, let's get 'em to the box and let's get going where we need to get going. Yeah. I can [00:09:30] start IVs en route, which I think is kind of a little bit of a lost start these days.

Yeah. Um, but start IVs en route. You can give meds en route. I can give Nitro, I can do all those things in route. Right. Take repeat 12 leads. But at the end of the day, they need a hospital. 

Erik: Yeah. And I would say, uh, you know. If that airway. Uh, emergency arose in in certain situations. Yeah. Doing it in route, you know?

Yeah. You don't delay. Yeah. 'cause really what they need is the interventionalist to reperfuse that that blocked [00:10:00] artery in the brain or the heart, or wherever it is. That's, that's the key. Is the problem fixing the underlying cause? 

Matt: The problem with innovating en route, like say you have a stroke patient, most of the time I'm not taking somebody with me.

Right. You know, I mean even it's, if it looks like a big LVO, you know, like somebody's totally gorked, then I might take somebody with me because if they looking a little unstable, yeah. Yeah. But for my run of the mill stroke, I'm probably not taking somebody with me. So I'm not gonna be RSI somebody by myself.

That's not safe. Right. I can't be drawing up [00:10:30] meds, pushing meds. Mm-hmm. You're right bag. I can't do all that by myself. So again, you have to look at that. Who's on the call with you. If you're in a rural agency or you're in a private event and you're by yourself, you might not be able to do that. And so there's so many factors that play into the decision of whether we stay and stabilize.

I'll say, let's change the play, but staying stabilize or load and go. 

Erik: Yeah. 

Matt: Lots of factors involved. 

Erik: Yeah. That's a good, that's a good, a good point you bring up. I, I think that, um, most of the, the stroke patients I've had, [00:11:00] um, even, even the vos mm-hmm. They're, they're, they're not an airway emergency initially, but they can become one for sure.

'cause of that large area that's ischemic, you get, um, increased risk for, for the, the swelling. That's right. I've actually, I feel like, uh, this is my experience, this is anecdotal, the, the hemorrhagic strokes. Mm-hmm. The, those, those, the subarachnoid, the sudden hemorrhage of an aneurysm or whatever it might have been.

Yeah, those are a little bit, those 35-year-old females or males that come [00:11:30] in like that, those are the ones I usually intubate. 

Matt: Yep. Yeah. Yeah, they're a little bit more altered. They're not usually with it. Yeah. They're a little bit more unstable as far as vitals and things like that, because it's more of an acute and there's actual bleeding going on.

Right, right. So you've got that factor going, 

Erik: but in the ambulance, you don't really know that. No. In the ambulance you've, 

Matt: well, there's things you can look for that can point you that direction. That's true. But you don't have definitive. 

Erik: You know, that's actually one of the things that I, I see too. Just, just as a side note, if you see pupils dilated [00:12:00] or like a bing pupil Yeah.

That patient should be intubated. Yes. At that point. Yes. I mean that, that patient's herniating. Yes. And uh, that's, you know, when you're looking at somebody's eyes and they're talking to you. Unless you're looking for syphilis or some other pupilary Yeah, yeah, yeah. Abnormality or something there. Um, you're not gonna, you know, the, the whole head trauma thing, I feel like, kind of, I feel like sometimes I, I gotta do the, the show.

Oh, okay. Oh, looking in the pupils? Yeah. [00:12:30] Like, 'cause Oh are there Mom and dad 

Matt: eyes appear pearl. Yeah. Yeah, yeah. 

Erik: If the parents are looking at me examining their kiddo and I don't look at the eyes, it almost,

Matt: what does this guy know what he's doing?

Erik: But I don't wanna explain myself right now that, you know, you could have a traumatic Sure. Iritis or, you know, there's certain things that can happen with like a traumatic pupil. You can actually mess things up, like bar fights, you know? Anyway. Yeah. But, um, if I'm, I'm really, it's just an act. Yeah. When I'm looking at, at the pupils, uh, 'cause the, I know it's a late finding and, and, uh, 

Matt: yeah. It's kinda like [00:13:00] tracheal deviation. Like you're not gonna see a tracheal.

Erik: I've never seen it. I've had a be tension new authorities, but I've never seen tracheal deviation.

Matt: Yeah. I, that would have to be really bad before it's pushing. But at any rate. Yeah, it's, yeah. I've never had to intubate. I've personally never had to intubate a stroke patient, but I've had numerous septic patients Yeah.

That I've had to control. We actually just had one recently in my department where they had to take the airway on a, a, a really bad septic guy. Um, yeah. But, uh, but yeah, it's, so it's, again, I get this, my, these [00:13:30] guys, oh, we're staying on scene too long. Well, things have changed. Things have evolved. Mm-hmm.

Right. And like you said, they're going to continue to evolve. Right. They're gonna continue. To give us more things, but I think it's important for people to understand that. Medical directors mm-hmm. Are not putting things in their protocols, I would think, for the most part. Mm-hmm. Are not putting things in their protocols just to put things in their protocols.

They're doing it because it can have an impact on patient outcomes. Right. That's why it's in there. And so if [00:14:00] you do a protocol revision and your medical director, you know, gives you new medication or starts antibiotics or starts a blood program, uh, it's because you can save lives by doing that. 

You know, there's benefit. There's a huge benefit 

Erik: and a lot of it has to do with the boots on the ground, identifying the right patient population to receive the therapy. Yeah. So we have to be on point with identification, like you'd mentioned. We also have to be able to, um, if you're, if you're ever going to have any sort of treatment, it doesn't matter what it's, you've gotta be [00:14:30] prepared for the complications too.

Matt: Yep, yep. What could go wrong? Right. Dope. 

Erik: That's right. 

Matt: I'm about to intubate somebody. I got my dope acronym in my head. Mm-hmm. Right. These are the things I gotta watch out for. Right, 

Erik: exactly. Yeah. Uh, there are complications to blood transfusions, you know, it's a good place to be within, you know, a paramedic, because we could treat those emergencies.

Exactly. But, uh, these are, these are things we need to prepare, be prepared to deal with. Uh, but back to the, the, the whole heart of, I think the podcast here is, uh, you know, when do you determine. [00:15:00] You're gonna stay and play or load and go. Yeah. And I, I think, I think that it's, it's complicated. There's no simple answer.

Matt: There is no simple answer. It's an art form and it takes experience to build that. 

Erik: Yeah. 

Matt: But I think that if you're. If you're staying on scene, there is a thing where you stay on scene too long. Yeah. And it's like, okay, like we're not doing surgery here, let's go. No, you could be killing your patient. Yes.

If it's a trauma situation potentially. For sure. Yeah. So you can definitely stay on scene too long, but you can absolutely also go the opposite side, and I think this is the more prevalent one. [00:15:30] Yeah. And if I'm being honest, I think most of the time, and I think if most paramedics are honest with themselves, yeah.

The reason why they wanna rush off to the hospital is 'cause they're scared to do something. Hmm. And that's okay. Like we're humans. Yeah. Some of the things that we're at, like taking somebody's airway, pushing paralytics on. Yeah. That is a scary thing that you should respect, but if you're scared of it, you need to go train more on it.

Oh yeah. Get with your FTO, get with your medical director, get with a senior paramedic on your. Crew and say, man, I just, I've never taken an [00:16:00] airway before. Could we go through this? Yeah. You know, could we, could we just practice airway? Could we practice going through the med math and all the things Right?

Yeah. And get comfortable with it before you get that call. Yeah. And then when the moment hits, you're gonna be like, oh, I've done this a hundred times in training. I got this. You, you know. But it's like Dr. An Tevye created the p the hand Tevye method. Yep. And he, because he saw these guys were rushing to the hospital and patient's kids.

We're dying because of it. Yeah. And how do we change that? Slow down. 

Erik: Yeah. 

Matt: Do this on scene. How do we do that? Let's [00:16:30] simplify it. Make it simpler. 

Erik: A systematic approach. Yes. I gotta have that. Yeah. Here's a story. I, I, I had a, an agency I was working with and, um, they rushed the trauma assessment and we discussed it later on because they missed something, life threatening.

Mm-hmm. But a lot of it was, the scene was stressful and chaotic and there were multiple patients and they knew this. Patient, there's a lot of blood. 

Matt: Mm-hmm. 

Erik: Couldn't really find the source of bleeding. Figured it was probably a headlock somewhere in her hair [00:17:00] and, but what she had was a brisk arterial bleed in her scalp.

It was a bad scalp plaque I've had. 

Matt: Yeah. 

Erik: And they couldn't see it. They didn't visualize it. But if they would've spent just another 30 seconds looking for that school. Order. 

Matt: Yep. 

Erik: And then having, you know, that gloved finger 

Matt: Yeah. 

Erik: Uh, to stop that blood quick clot works really well on that. I wouldn't have had to have activated a, a massive transfusion protocol.

Um, and, and we did for a patient that really shouldn't have had [00:17:30] it. 

Matt: Yeah. 

Erik: Because they, they had let her bleed out through that scalp black. But by knowing things like that, those pearls where how bad a scalp black can bleed. Yeah. Or how much blood you can get in a thigh, or those signs of bruising, signs that you know that are signs of blood in your belly.

Matt: Yeah. 

Erik: These life threatening signs and and injuries by knowing that they're there and identifying them and treating them in place. Mm-hmm. Right? 

Matt: Mm-hmm. 

Erik: You don't just throw 'em in the ambulance and go, yeah. And then, and then they got to the hospital on [00:18:00] a backboard full of blood. Yeah. Um, really being careful and knowing that, hey, I know there's a scalp black there somewhere, so we'll just go know what kind of scalp black is it?

Yeah. 

Matt: Where is it? 

Erik: Because if you've got pulsatile flow, you need to get a finger on it. Gotta give it style. We can leave, we lose a. Of blood out of a scalp line. Yep. 

Matt: Yep. 

Erik: That's just one example of many where it would be good to just take some time. 

Matt: Mm-hmm. 

Erik: Fully assess that scalp. Yeah. And find that lack, um, come into the ER with, with, you know, a head, head [00:18:30] dressing and a stack of four by fours over hair and stop in a, uh, an arterial, but you gotta use your finger.

Matt: Gotta have pressure. 

Erik: Yep. Yeah. Which is, I think just one of many examples we could give. We could tell stories all day about what the important life saving things, whether it's a. Tourniquet or a, you know, in a pediatric resuscitation, you know, going through all of, all of the differential with blood sugar and all that stuff, really resuscitating that kid before you get 'em outta there.

Right? Super important stuff. [00:19:00]

Matt: And in those calls, like with airway stuff, like train on it, run scenarios with pediatric patients, get a pediatric airway mannequin if you can, and run through those scenarios. You don't want your p your first pediatric cardiac arrest to be the first time you've. Ever gone through that, right?

Yeah, yeah, yeah. You know, we train extensively on fire and stuff and that's great, but we need to do the same thing for EMS because that will alleviate all this mindset. Like we get a structure fire, we're not running away from it. No. Which a lot of [00:19:30] times when we're loading and going, it's running away from the problem.

Yeah. If we're being honest with ourselves, that's what it is. Yeah. You know, but that structure fire that's there, and I have said this and some people like it, you know, some of the fire guys get it and some of them don't. Mm-hmm. But to me, if. You are running to the hospital on a patient that you should be doing something on that is equivalent of me going up to the door of a structure fire and fire's ripping over my head.

And I say, and I know there's a victim in there. Yeah. Well, I'm, I'm not going in there. [00:20:00] Yeah. Let's, let's just wait for the next crew to show up. Yeah. It's the same thing. And guys don't wanna necessarily acknowledge that that's really what's happening, but that's really what's happening. But things are, take care of it.

Exactly. I, well, we're not doctors. Take him to Dr. X. He'll fix 'em. Okay. Well, he's not. Be alive by the time we get him to Dr. Ine. 'cause he is bleeding out right now. Right. Right. So we need to do something right now. 

Erik: It it really, and you can't prioritize these things unless you've accurately assessed your patient.

That's, and to act accurately assess your patient, you have to have a [00:20:30] systematic approach. Yes. Something you do, an evidence-based, systematic approach you don't deviate from. 

Matt: Yeah. It's your, well I call it your flow. 

Erik: Yeah. 

Matt: Right. It takes medics a while to figure out their flow. Yeah. Right. So, you know, when you come outta paramedic school you use, so when I get somebody in.

Do their mega code uhhuh. I'll tell 'em like, when the doctor comes in here, you're gonna get nervous. Yeah. So write down O-P-Q-R-S-T, you know, A-E-I-O-U, tips, sample history, all the things, right? [00:21:00] Because you can have those on there. Because I said, I guarantee you when he walks in here and he starts giving you scenarios, you're gonna go blank and not remember what you're supposed to ask.

Yeah, that's true. And the other thing I tell 'em is don't rush. And again, like on scene sometimes if there's an obvious. Thing. If I see obvious bleeding, I'm gonna put pressure on that and stop that bleeding. Mm-hmm. But when you're doing your assessment, take your time. Yeah. Get the information. Or maybe if you're a good officer, a good partner, get that information for your paramedic.

But yeah, you gotta start with a good, full assessment to [00:21:30] get a good picture of what's happening before you start treating things. 

Erik: Yep. That's right. Yeah. And know, know what your capabilities are and the limitations. Yeah. What your scope is there. There are certain things you just are never gonna be able to do in an ambulance that a trauma surgeon's gonna do in the or.

Matt: Correct. 

Erik: You don't want to get in the way of that happening. Right, right. 

Matt: Yeah. Trauma surgeons don't like it when you do that. No. And again, too, I think so I, I, you know, early a good assessment, identify what the problem is. I then think about, again, we're thinking about patient [00:22:00] care. Is this something that I need to get to the hospital now for?

Is this a stroke? Is this a heart attack? Is this a really sick septic patient? Or a trauma where, man, there's really not much I can do for this patient. We need to go and anything I can do, I can do it in route. Hmm. Or. Uh, you know, if I've got a 30 minute transport time, that's what I'm thinking, or I'm thinking about calling a helicopter, 

Erik: it is more complicated.

Matt: Or I'm like, ah, I'm five minutes from a level one trauma. Let me take some time here. Let's call the blood guys out. Or however [00:22:30] your system does it. Yeah. And let's get blood going because I don't know if this guy can make it five minutes to the trauma center. He needs blood now. Yeah. Or they need blood now.

Erik: And that's, and that's usually what kills people in traumas is blood loss. That's the number one loss by having blood. 

Matt: Yeah. 

Erik: You can really do a lot of good potentially with the right patient. Penetrating traumas shown the benefit, but you get anybody bleeding. It could be a medical costume, GI bleed, o GI hemorrhage, postpartum, whatever.

Um, getting, getting people what they lost. Save lives. Saves [00:23:00] lives. Yeah. Saline doesn't carry oxygen. No. And that's again, a great example of something we can do on scene. 

Matt: Yeah, for sure. Yeah, for sure. Yeah. So. Again, it's not black and white that we can always stay and play and we can always load and go.

Sometimes there's people that are staying on scene too long and messing around too much. Yeah. But there's also, and I think this is probably a little bit more prevalent, is that too often people are just rushing off to the hospital when there's something that they should be doing and they're not doing it.

Whether they are don't wanna do it, they [00:23:30] don't wanna document it, they don't wanna go through the hassle of narcotics documentation or they're scared of the procedure. And I've never r aside somebody before. I'm terrified to get. In somebody rock. Right? Yeah. We'll get comfortable with it, right? Yeah.

Because the problem is if you take that guy to the hospital, like firemen are always worried about getting fired. I'm gonna get fired, I'm gonna get in trouble. It's like, we'll do the right thing and you won't get in trouble. Right. If that's all you do, you'll be fine. Yeah. And, uh. Sometimes you might attempt to do something.

We're not always successful in doing something. Yeah. But if [00:24:00] you're, if you can prove why you were trying to do something, your intent was correct, Uhhuh, you went through the proper stages of trying to do it. And you didn't get the tube. Yep. You didn't get the tube, but then you put an IGEL in, you bagged the guy back up.

Whatever the case is, whatever it is. There was no bad outcome and you were trying to do the right thing, you're gonna be fine. Yeah. You're gonna be fine from a medical director standpoint, would you? Yeah. 

Erik: Yeah. I agree. I think that if your, if your heart is in the right place, even legally speaking, um, you're, you're not being negligent.

You're doing the [00:24:30] best you can. You have an intent to deliver care to your patient. 

Matt: Right. 

Erik: Not to cause harm. Right. And you're doing things within the scope of your practice. Right. For good reason. You're, you're, you're, you're fine. Yeah. Now there, if there is a bad outcome. There may be some investigation and 

Matt: Yeah.

Oh yeah. 

Erik: Um, and you may have to go through some stressful Oh yeah. Periods of time, but Yep. Um, but you can, you can rest on the fact that you did the best you could mm-hmm. With an intent to heal, followed your protocols not to cause harm. Non negligent. [00:25:00] Yep. Um, but I think one of the best ways to prepare for those situations before they happen is to practice.

Yeah. You've got to be over prepared for the unexpected so you could be prepared. Yeah. I think that's, that's. Key. Uh, in fact, that's something we've talked about before. Oh, yeah. Um, you know, think about what is expected and over prepare for that. Mm-hmm. That way you'll be prepared for the unexpected.

Matt: Prepare for the worst case scenario. That way if that happens, you're ready. And then everything else is gravy. Yeah. Right. Every other call is gonna be easy. If [00:25:30] you're ready for the mass casualty, I gotta end up, you know what? Yeah, you're gonna be ready, you're gonna be ready to go. Like, okay, I got this. And the only way you get to do that is by, like you said, practicing.

Erik: Well, I'll tell you a story where this didn't work out for me. Training you didn't? Well, no, I, I thought that I was preparing for the worst possible scenario. I remember in residency, and I walked into my first day in the cardiac ICU and what was given to me was far worse than anything I had imagined or heard of.[00:26:00]

I, I mean, it was so incredibly stressful and overwhelming. I couldn't do, it couldn't function. I absolutely couldn't. Like I was able to cognitively function on what I was doing, but I had so many patients and so many things that came in at the same time. Yeah. I was just so overwhelmed. I had to ask for help.

Matt: Yeah. 

Erik: I had to go to the attending physician. I say, Hey, listen, I know that normally this doesn't happen, but, uh, I need help and I'm, I'm concerned about these patients. I'm just a resident. I need you to step in and help me. And it was hard for. Me to do that. But asking for [00:26:30] help is so important. Yes.

Especially when you're, you've got some skills maybe you're not a hundred percent comfortable with. I know you, you've been checked off and you're good to go. Right, right. But when you have maybe a mass casualty event or something like that, 

Matt: now it's not a mannequin. You're actually cutting, doing a thing, 

Erik: knowing to ask for help is really, really key. Yeah. Don't be too proud. Yeah. To call for backup.

Matt: How did the attending react?

Erik: You know what he, no joke. My attending in medical school, he, we had to push him around in a throne. 

Oh, that's right. On wheels. It was [00:27:00] this guy. Yeah. 

Yeah. I, I really loved him. Uh, but he was, he was tough and, and, uh, um, he, uh, he's really nice.

Yeah. And he, he, I think he appreciated the fact that I had the guts to ask for help. Yep. And so he said, well, let's see the, um, we'll go see the ones that you've seen now, and then why don't you take your notes and go see the other ones you haven't seen yet. And so we split it up and 

Matt: Okay. 

Erik: It, it ended up going well.

Yeah. Um, and, but, uh, and I never saw that many patients, that many [00:27:30] sick patients ever on an ICU shift. But my first day, it was so funny. Oh. Murphy's Law, you're like, what 

Matt: did I get into here? This is crazy. 

Erik: Is this the beginning of the end or what it this every day of my life. I guess asking for help though.

Yeah. I think that's really, really important Practice. Yep. If not comfortable with something, Hey, you know Mr. FTO? 

Matt: Yeah. 

Erik: Matt, can you help me? I'm really uncomfortable. If I got a pediatric resuscitation today, cardiac arrest, I'm not a hundred percent comfortable with everything. Can we run through a scenario?

Yeah. [00:28:00] I'm not a hundred percent confident with my airway skills. If, if, um, if I had to. You know, if there's vomit and I couldn't use the video. Yeah. Can we work on some direct, gimme some tips. Yeah. These are the types of things where you've recognized the deficiency and that's probably one of the most important tools you could have is knowing what you need to know.

Little humility. Yes. Yeah. Yeah. Being, being able to be aware of what you don't know is a huge skill. Mm-hmm. What's scary is not knowing what you don't know. That will make you really [00:28:30] freaked out. Yep. So practice, practice, practice. Yep. 

Matt: Yep. Well, it's, I don't think it's ever going away. That'll, it'll be the age old debate, stay and play or load and go, 

Erik: yep.

You 

Matt: know, and there's people that are hard one way or the other, and that's fine. But, you know, make, do what's best for your patient. Yeah. Do 

Erik: what's best for your 

Matt: patient. If loading and going is what's best for your patient, then do that. If you need to stay there and do a few skills first to stabilize them, then maybe that's the best thing to do.

Ultimately, if that's what your goal is, what's best for the patient, you're doing the right thing. 

Erik: I think if you treat your patient like they were a [00:29:00] family member, as long as you love your family. 

Matt: Yeah. 

Erik: Uh, you, you, you, uh, you're doing, you're doing the right thing. 

Matt: Yeah, yeah, exactly. It's, yeah. 

Treat your patient and then you're gonna be fine.

So, yeah. Anyway, it's a neat topic. See you on the next one.

Narrator: Thank you for listening to EMS, the Erik and Matt Show.