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People,


I am having trouble conforming to the medical procedures I have been trained to use as an EMT-B.

I follow the protocol for the most part but I have found myself confronted with situations that were deemed beyond the parameters and authority of an EMT-B.

I suppose I have trouble understanding that I am no longer in a battlefield situation when the injuries are extreme and so I find myself doing what is necessary to save a life, that is for the most part, the realm of lisenced physicians.

We were expected to do"what we can" and the conditioning never left me. I find myself going into "combat mode" ( if it is bleeding, make it stop!) and reacting instead of thinking about the law. There was no law there and the injuries were beyond what is typically encountered in non combat society.

Now I want to take the fire school course again and be recertified to start the process over as I stopped for along time because of my failure to follow the rules.


DO ANY OF YOU HAVE ANY SUGGESTIONS ON HOW TO LET GO OF MY FORMER TRAINING/CONDITIONING?


I have tried counseling but everyone I saw had the same reaction and suggestion. They all said they felt they were not qualified to deal with a person with my degree of emotional and psycological damage and suggested I see someone else. ( War situations seemed to be too intense for them).

I can only wonder if my problems are too difficult for a mature adult trained as a psychiatrist to cope with then how do they feel we 18 year old "children" of the killing fields are handling it all the years since, alone.. because they can not or will not help?

All told me that I was supressing my emotions and this was not good for me to do. I am at a loss to know what else to do that would be socially acceptable.

I feel acceptance is the key to cope with everything in this life. I love all living things too much to just look away when I can help, I am just not able to be that selfish.

The VA representatives I saw told me simply,... " what was necessary there is unacceptable here".

Respectfully,

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Comment by Lieutenant Frederick Georges on April 21, 2011 at 7:13pm

This Comment is simply the collective response of all who wished to help me with my question being this: "DO ANY OF YOU HAVE ANY SUGGESTIONS ON HOW TO LET GO OF MY FORMER TRAINING/CONDITIONING?"

I have removed the names of all of the participants to protect their privacy.
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If you have not been there then you should save your comments and pious attitude for yourself. Even if you served, and THANKS if you did :), if you were never in combat you do not fully understand what the front-line medic experience is like. As shocking as his admission is to you, he came here asking for advice, not attitude or judgement.

How many basics have started lines or intubated because their medics let them? More than you care to know. Maybe even you. They just don't speak about it publicly.

Fritz, I did operational/combat medicine for 23 years with 4 combat tours. When I came home from Iraqi Freedom I in 2003 after being wounded while evacuating my marines I had to take a 3 year break from emergency medicine. With a lot of pushing from my family I finally sought help and was diagnosed with PTSD and a severe case of burn out. I had also been a civilian Paramedic and Firefighter (paid and volunteer) for 20 + years while I was on active duty. I found my niche as an educator.

I am guessing that you are a Vietnam era vet, but it still works the same no matter what theater you served in. Get back to the VA! Do not confine yourself to individual visits with a counselor. Especially one with no military or combat experience. Get into a PTSD group where you feel at home with other combat veterans. No amount of schooling can replace the "been there, done that" experience you can identify with.

As far as your medical skills, you already know it's time to step back. I have done crichs and venous cut-downs in the field. I have removed shrapnel to maccess a bleeder. It is hard to have advanced training and the walk out the door and not be able to use it. It has always been an insult to military medics, especially those with the experience to back it up, but thats life and we must play by the rules or get out of the game.

Medic to Medic I do have to raise the Bulls*#% flag. Did you honestly do the procedures you listed in your reply to Joe P and if so, why? I have found in working with fellow combat experienced vets (and in PTSD groups) that we sometimes go for the shock factor to bring attention to our situation.

Going back to WWI, relieving intracranial pressure and arterial/venous splices have never been taught at any level of combat care and I doubt that any battalion Surgeon has ever taught his medics to perform those procedures in the field. I was taught a lot of advanced procedures in field surgical skills and tacmed/specops level courses over my 23 years. Those skills have not been taught at the PJ or 18D courses. First, these are not feasible while performing care under fire or when dealing with more than one casualty who is more than walking wounded or self-care. Second, those procedures in the field are more detrimental than a life-saving measure. How did you know that their ICP was elevated? More importantly, these could never be managed effectively for any length of time in the field if you have a delayed medevac.

If you, or anyone else for that matter, need to talk to a combat vet who understands what you have been through just drop me a line. I will not play shrink for you but I can empathize.

Semper Fi!
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Agreed ... this seems very dangerous and also unethical. What evidence do you have the procedures you performed beyond your scope of practice didn't increase mortality or morbidity or that the patient wouldn't have lived if you had simply transported?

I am at a loss as to what a "skull vent" even is ... I am assuming drilling a h*** in the skull for relief of increased intracranial pressure? Regardless, this is scary stuff.

You need to go to the VA where they are trained to deal with PTSD and then, when those issues are resolved, take another look at what you may want to do within the medical field AFTER proper education and licensure. You may find this field is not for you if you can't keep yourself from operating outside scope of practice.
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The post Vietnam era saw the PA begin as a profession becouse there was a recognized "learning curve" for returning medics and corpsman, esp. those at battalion aid stations who were preforming procedures and skills way above the accepted norm. Those soldiers and sailors paved the way for the mid-level practictioner. That being said, an EMT-B, or a paramedic, who would carelessly perform the procedures that you have listed would be a risk manager's worst nightmare. You have functioned so far out of scope that I am surprised that you havn't been civilly sued, or even placed in jail for assualt/battery (skull vent ?!?) Most trauma centers dont open the cranial vault until the neuro team is present, and in the OR... all I can say is WOW
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Are you an American MD or DO who has completed a residency? If you are not how would you know what advanced skills will necessarily save these patients lives? What it sounds like is you are an EMT Basic who is operating beyond your scope of practice. I'm not sure if you believe that being a Combat Medic or Hospital Corpsman in the military counts as being a military doctor, but they are also not a medical doctor. As an emt-basic you should not be intubating anyone with an ET tube, doing "vein splices", or "skull vents." I don't believe a licensed physician would even do some of these things in the field that you are suggesting. This is obvious malpractice and your license should be revoked. Depending on if you "vented" someones skull, you might even deserve to be put in jail. I'm quite appalled at how accepting everyone is about this simply because you mentioned being a combat vet. Being a combat vet does not give you the right to practice medicine without a license.
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Fritz - You obviously care about people and that is where the problem may lay. I think most of us had to reign in our enthusiasm and impulsivity when we started in the field. I know there were times when I would rush into a situation without thinking of the consequences first but thankfully my guardian angel was on duty. Although it will be hard I believe the best thing for you at this point is to take a break from EMS - and the health field in general. You have been extremely lucky so far that no complaints have been filed with your state agency. If that happens you could be prohibited from ever working/volunteering in the field again. And, although you are asking a question as to whether you should retake the EMS training class, I think you already know and stated that answer. For whatever reason, you are not in a place where you can operate within the limited rules of what is permited for an EMT-B. To repeat the class at a time when you are able to adhere to the limits placed upon you would not be fair to yourself much less, your service, partners or patients.

I am not a veteran so I do not know first hand the problems of getting help through the VA although I have heard the horror stories. You need someone who specializes in Post Traumatic Stress Disorder - preferably with a military background in order to help you get back into civillian mode. If that service is not available through the VA and you cannot afford private therapy, I have 2 suggestions. First, every state has an office that helps people with disabilities get services that will allow them to obtain employment. I know that they will pay not only for an evaluation but for therapy and job training as well. Look for an agency with a name like Vocational Rehabilitation or Vocational Services. The second suggestion is a little more unconventional. Approach a local TV station. Find a reporter that does investigative work and explain your situation. Tell him that you have not been able to get help through the VA and maybe by the media rattling some cages you can get the assistance you need. I have seen several programs that looked at specific cases where veterans have not gotten the services they needed and after the news media got involved the guys got everything they needed and then some.

You obviously have a lot to give but if you continue on the course you are following you are going to wind up in a situation where you will never be allowed to be of assistance to anyone.

Good Luck.
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If you take your own supplies, why don't you just take your own ambulance? What you are doing is dangerous. I do not care if you can slip a trach into a patient while stuffing their intestines back into their abdomen. All you need is for one patient to find out you are not licensed for what you did and not care if you saved their life (there are plenty out there) to sue you out of existence. You don't seem to care, though, and that may be even more dangerous. We all operate with due regard to public safety and treating citizens like they are combat wounded is not due regard.

I do understand where you are coming from, though. I know that in war, things are done without orders or without protocols and sometimes without proper training (infantry with catheters are scary). Coming home from war is probably the worst time I have ever spent in life. I was depressed, full of anger, and was afraid my own Toyota Corolla was going to explode and kill me (two years later and my legs still go numb occasionally while driving around because I'm afraid the road is going to explode and rip them off.) You need to get out of the medical field if you can't leave war behind. It's dangerous to you and to the public you serve.

$0.02

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Well, the full situation is needed to be understood to begin to offer suggestions. I understand and share your frustration since my education also greatly surpasses the requirements for EMT-B. That said, just because I have a BS in biology and am currently working on my MS in biomedical sciences doesn't give me the legal right to surpass my scope of practice as an EMT-B. I've been fond of saying 'It's EMT-B, not EMT-Joe or EMT-Frederick.' If we start allowing people to decide their scope based off of their view of their education (because you know someone is going to say "hey, my online 4 hour A/P course is just like a 4 unit college level anatomy and a 4 unit college level physiology course combined), then will have anarchy with everyone doing their own thing.

My second suggestion is to not carry any equipment that you wouldn't be supplied with otherwise. Sure, I carry my own steth and own BP cuff set up (I like the trigger grip set up and neither company that I've worked for used that style), but both of those would be supplied with otherwise. As I mentioned earlier, it's hard to go past your scope if you don't physically have the equipment to do so.

Finally, become a paramedic and most of the issues should evaporate since those procedures will now be in your scope of practice (location dependent on things like crics).

As to the military physician who isn't licensed to practice as physician but is licensed as a basic? I would hold him to the same standards for the same reasons. If we start letting people define their own scope of practice then we lose any reasons for having certifications and different fields/levels (MD/DO/RN/RT/NP/PA/EMT-P/EMT-B etc).

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