Ep 10 I Don’t Know Nothing Bout Birth’n No Babies

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[audio:10_Babies.mp3] (42:41)
This week Ron covered behavioral Emergencies and started talking about delivering babies in class. How many do you think Kelly has delivered? Find out on this episode.

Ron also passed my Patient Assessment Trauma skill on Wednesday and will attempt Patient Assessment Medical on Monday. So he asks Kelly for tips on doing that exam.

You’ll also get a complete list of books a paramedic student should be reading.

Listener Questions:

This is Cameron from Colorado. I was wondering what Kelly thinks is the best way to prepare for paramedic school? Do you think you should ready ahead as much as possible? Such as, ACLS protocol, and drug memorization or do you think there is adequate time in the class to learn this material? Also, how much experience do you think an EMT-B needs before attempting P school?

Ken – besides reading Kelly’s book (which is very expensive on amazon), is there anything I can read / watch that can help me start my learning – getting ahead of the curve??

Kelly’s Book List

Anatomy & Physiology for Emergency Care by Bryan E. Bledsoe, Frederic H. Martini, Edwin F. Bartholomew, William C Ober, Claire W. Garrison

Emergency Medicine: A Comprehensive Study Guide 6th edition by Judith E Tintinalli

Rapid Interpretation of EKG’s, Sixth Edition by Dale Dubin

Taigman’s Advanced Cardiology (In Plain English) by Syd Canan, Charly D. Miller, Mike Taigman

The 12-Lead ECG: In Acute Myocardial Infarction by Tim Phalen

12-Lead ECG for Acute and Critical Care Providers by Bob Page

Goldfrank’s Toxicologic Emergencies, by Neal Flomenbaum, Lewis Goldfrank, Robert Hoffman, Mary Ann Howland, Neal Lewin, Lewis Nelson

Paramedic: On the Front Lines of Medicine by Peter Canning

Rescue 471: A Paramedic’s Stories by Peter Canning

Rescuing Providence by Michael Morris

Street Dancer by Keith Neely

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  • Ken Reed

    Ron & Kelly

    Just in case you didn’t get my phone message, Thank you for answering my question. But to correct one thing, I start EMT-Basic class on on 9/2/10 not next year. I have one of the books on the list. I have it installed on my I-Pod. I will work on the others as finances permit. I have to save up to get Kelly’s book. It’s still expensive no matter where I’ve looked. It looks like a great book from the excerpts I’ve read.

  • Ken Reed

    Ron & Kelly

    Just in case you didn’t get my phone message, Thank you for answering my question. But to correct one thing, I start EMT-Basic class on on 9/2/10 not next year. I have one of the books on the list. I have it installed on my I-Pod. I will work on the others as finances permit. I have to save up to get Kelly’s book. It’s still expensive no matter where I’ve looked. It looks like a great book from the excerpts I’ve read.

  • Ken Reed :Ron & KellyJust in case you didn’t get my phone message, Thank you for answering my question. But to correct one thing, I start EMT-Basic class on on 9/2/10 not next year. I have one of the books on the list. I have it installed on my I-Pod. I will work on the others as finances permit. I have to save up to get Kelly’s book. It’s still expensive no matter where I’ve looked. It looks like a great book from the excerpts I’ve read.

    Ken, the paperback version is $12, and you can buy an electronic version readable on your Kindle or other e-book reader (or your computer) for only $8.

  • Ken Reed :Ron & KellyJust in case you didn’t get my phone message, Thank you for answering my question. But to correct one thing, I start EMT-Basic class on on 9/2/10 not next year. I have one of the books on the list. I have it installed on my I-Pod. I will work on the others as finances permit. I have to save up to get Kelly’s book. It’s still expensive no matter where I’ve looked. It looks like a great book from the excerpts I’ve read.

    Ken, the paperback version is $12, and you can buy an electronic version readable on your Kindle or other e-book reader (or your computer) for only $8.

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  • Ken Reed

    Thanks Kelly. maybe I can get you to autograph my copy when I finish my Basic class this fall.

  • Ken Reed

    Thanks Kelly. maybe I can get you to autograph my copy when I finish my Basic class this fall.

  • Lisa O’Connor

    Ron – Do any of the students in your class have tattoos?

    Kelly – How are tattoos responded to in EMS?

    I have been told that I will not ever be hired since I have a small cherry tattoo on each forearm. I have 9 total, but those are the two that “show”. Some have said its no problem, wear a long sleeve under shirt, while others say patients are offended and it makes companies look dirty.

    I start school in January, and honestly, am a little nervous about my ink. I just want to know if I should be?

  • Lisa O’Connor

    Ron – Do any of the students in your class have tattoos?

    Kelly – How are tattoos responded to in EMS?

    I have been told that I will not ever be hired since I have a small cherry tattoo on each forearm. I have 9 total, but those are the two that “show”. Some have said its no problem, wear a long sleeve under shirt, while others say patients are offended and it makes companies look dirty.

    I start school in January, and honestly, am a little nervous about my ink. I just want to know if I should be?

  • Katie

    Ron, you’re going to P school without any experience as a basic? That’s very…interesting. That will pose some very interesting challenges for you since (I assume) you have little to no experience treating patients compared to what your classmates are probably going to have. Care to comment more on that? Why did you choose to dive right into medic school fresh out of emt-b school instead of gaining some experience first? Just curious.

    And I assume the podcast will continue through p school, right? I hope so, because I’m already excited to hear about your adventures in p school!

  • Katie

    Ron, you’re going to P school without any experience as a basic? That’s very…interesting. That will pose some very interesting challenges for you since (I assume) you have little to no experience treating patients compared to what your classmates are probably going to have. Care to comment more on that? Why did you choose to dive right into medic school fresh out of emt-b school instead of gaining some experience first? Just curious.

    And I assume the podcast will continue through p school, right? I hope so, because I’m already excited to hear about your adventures in p school!

  • Ron

    Katie, I’m just going to P school to keep the podcast going. 🙂

    I didn’t really think anything of it. I thought that was why they put hundreds of clinical hours in Paramedic programs. I don’t expect they put shiny new paramedics in charge on ambulances anyway.

  • Ron

    Katie, I’m just going to P school to keep the podcast going. 🙂

    I didn’t really think anything of it. I thought that was why they put hundreds of clinical hours in Paramedic programs. I don’t expect they put shiny new paramedics in charge on ambulances anyway.

  • Katie

    Ah I see….Well, that’ll be interesting on your first day when everyone goes around and says why they want to be a paramedic and you’ll say “Well you see I have this podcast…..” I’m not saying that’s not a legitimate reason, but it is funny…and different!

  • Katie

    Ah I see….Well, that’ll be interesting on your first day when everyone goes around and says why they want to be a paramedic and you’ll say “Well you see I have this podcast…..” I’m not saying that’s not a legitimate reason, but it is funny…and different!

  • “Ron, you’re going to P school without any experience as a basic? That’s very…interesting.”

    Translation: “Greeeeeaaaaat, another Zero to Hero.”

    But thanks for not saying that outright, Katie. 😉

    I am ambivalent about the importance of experience. On the surface, one would think that experience practicing your EMT-B skills is essential in becoming a decent medic.

    Problem is, that view fails to consider the great variable – the partner. Experience is valuable only if it’s good experience. All too often, what passes for experience is nothing more than bad habits learned from some burnout whose only meaningful learning experience on the street is the location of all the fast-food joints that offer EMT discounts.

    As a paramedic instructor, give me the green EMT-B every time. They have less bad habits I have to break.

    Ultimately, it all boils down to attitude and maturity. Give me an older medic student like Ron, one with maturity and a wealth of life experience, and I’ll have no problem making him a good medic and a lifelong learner.

  • “Ron, you’re going to P school without any experience as a basic? That’s very…interesting.”

    Translation: “Greeeeeaaaaat, another Zero to Hero.”

    But thanks for not saying that outright, Katie. 😉

    I am ambivalent about the importance of experience. On the surface, one would think that experience practicing your EMT-B skills is essential in becoming a decent medic.

    Problem is, that view fails to consider the great variable – the partner. Experience is valuable only if it’s good experience. All too often, what passes for experience is nothing more than bad habits learned from some burnout whose only meaningful learning experience on the street is the location of all the fast-food joints that offer EMT discounts.

    As a paramedic instructor, give me the green EMT-B every time. They have less bad habits I have to break.

    Ultimately, it all boils down to attitude and maturity. Give me an older medic student like Ron, one with maturity and a wealth of life experience, and I’ll have no problem making him a good medic and a lifelong learner.

  • Katie

    Haha…well that is SORT OF what I meant….thanks for pointing that out Kelly! 😉

    I was trying hard not to judge because I’m a newbie myself–who am I to say that you shouldn’t go to P school right after basic school? I guess I was under the impression that you’re “supposed” to work as a basic for at least a little bit before going to medic school, and I had never heard of anyone doing differently. That’s why I find it…..interesting, for lack of a better word!

  • Katie

    Haha…well that is SORT OF what I meant….thanks for pointing that out Kelly! 😉

    I was trying hard not to judge because I’m a newbie myself–who am I to say that you shouldn’t go to P school right after basic school? I guess I was under the impression that you’re “supposed” to work as a basic for at least a little bit before going to medic school, and I had never heard of anyone doing differently. That’s why I find it…..interesting, for lack of a better word!

  • Mike

    Gloves question for childbirth from a First Responder:

    Why is it that you need sterile gloves (I.e. sealed packaging) and you can’t use the ones out of the box of gloves marked your size? If your gloves are clean (assuming you haven’t touched the patient(s), the truck door, or whatever with them), why not?

  • Mike

    Gloves question for childbirth from a First Responder:

    Why is it that you need sterile gloves (I.e. sealed packaging) and you can’t use the ones out of the box of gloves marked your size? If your gloves are clean (assuming you haven’t touched the patient(s), the truck door, or whatever with them), why not?

  • Good question, Mike.

    First of all, your exam gloves are clean, but by no means sterile. And they are for your protection, not the patient’s.

    In the case of a childbirth, there is greater potential for co-mingling of mother’s and fetus’s blood. In some cases, like infectious disease of the mother, that poses a risk to the baby. Now, sterile gloves may not do much to prevent that, but at the very least you will limit the chance of outside contaminants reaching the baby.

    Gloves that are expressly expected to come into contact with open wounds are sterilized for the same reason your bandages and gauze are sterilized – to protect the patient from infection.

    The gloves we wear on every call are expected to protect you, and the vast majority of the times they’re used, they don’t come into contact with open wounds. When they do, it’s expected that you have more pressing problems on your hands than preventing a potential infection.

    In the case of preparing for childbirth, you’re expected to assess the patient and know whether delivery is imminent. If it is, you should have time to set up a sterile field to protect yourself and the mother and baby.

    Does that make sense?

    On a historical note, much of what we know about asespis and infection control came from Dr. Joseph Lister’s experience in delivering babies. He discovered that, if he washed his hands with 5% carbolic acid solution between deliveries, the incidence of infection in the mother’s decreased dramatically.

    Lister had read the writings of Simmelweis years before, who discovered that mothers of babies delivered by midwives had much lower incidence of infection than those delivered by surgeons.

    Lister hypothesized (correctly), that since the midwives typically dealt with only one delivery, and the surgeons many, that the surgeons were spreading an unknown infectious agent from one mother to another.

    He ordered his surgeons to wash their hands thoroughly between patients and to wear clean cotton gloves for each delivery, and thus the modern practice of antisepsis was born.

  • Good question, Mike.

    First of all, your exam gloves are clean, but by no means sterile. And they are for your protection, not the patient’s.

    In the case of a childbirth, there is greater potential for co-mingling of mother’s and fetus’s blood. In some cases, like infectious disease of the mother, that poses a risk to the baby. Now, sterile gloves may not do much to prevent that, but at the very least you will limit the chance of outside contaminants reaching the baby.

    Gloves that are expressly expected to come into contact with open wounds are sterilized for the same reason your bandages and gauze are sterilized – to protect the patient from infection.

    The gloves we wear on every call are expected to protect you, and the vast majority of the times they’re used, they don’t come into contact with open wounds. When they do, it’s expected that you have more pressing problems on your hands than preventing a potential infection.

    In the case of preparing for childbirth, you’re expected to assess the patient and know whether delivery is imminent. If it is, you should have time to set up a sterile field to protect yourself and the mother and baby.

    Does that make sense?

    On a historical note, much of what we know about asespis and infection control came from Dr. Joseph Lister’s experience in delivering babies. He discovered that, if he washed his hands with 5% carbolic acid solution between deliveries, the incidence of infection in the mother’s decreased dramatically.

    Lister had read the writings of Simmelweis years before, who discovered that mothers of babies delivered by midwives had much lower incidence of infection than those delivered by surgeons.

    Lister hypothesized (correctly), that since the midwives typically dealt with only one delivery, and the surgeons many, that the surgeons were spreading an unknown infectious agent from one mother to another.

    He ordered his surgeons to wash their hands thoroughly between patients and to wear clean cotton gloves for each delivery, and thus the modern practice of antisepsis was born.

  • Mike

    Kelly, that does make sense.

    On another note, what do you & Ron think about a First Responder third-rider in the back of an ambulance? And what should they assist with?

    I’m currently an explorer with a suburban FD that does EMS, as such, I’m allowed to ride along in the big red truck or the ambulance. Since 99% of what we do is EMS, I usually pick the ambulance. Before I was a first responder, I was only carrying a CPR card, and a Heartsaver one at that, and I was still in the back of the box with an EMT or Medic and the patient. Most times I was a giant fly on the wall, others equipment gopher (I.e. “Hey, grab me a set of gloves” or “Toss a Nasal Cannula over here.”)

    Now that I’m a first responder, I’d like to be assisting with patient care a bit more. How can I help the EMTs & Medics in the back of the ambulance and provide the best care I can within my scope of practice?

  • Mike

    Kelly, that does make sense.

    On another note, what do you & Ron think about a First Responder third-rider in the back of an ambulance? And what should they assist with?

    I’m currently an explorer with a suburban FD that does EMS, as such, I’m allowed to ride along in the big red truck or the ambulance. Since 99% of what we do is EMS, I usually pick the ambulance. Before I was a first responder, I was only carrying a CPR card, and a Heartsaver one at that, and I was still in the back of the box with an EMT or Medic and the patient. Most times I was a giant fly on the wall, others equipment gopher (I.e. “Hey, grab me a set of gloves” or “Toss a Nasal Cannula over here.”)

    Now that I’m a first responder, I’d like to be assisting with patient care a bit more. How can I help the EMTs & Medics in the back of the ambulance and provide the best care I can within my scope of practice?

  • Don’t underestimate the value of a equipment gopher. MANY are the times when I wish I’d had someone to hand me something, someone who knew their way around the cabinets on my rig.

    There are plenty of things you can do as a first responder on the rig, things that are often done en route to the hospital, for example: simple splinting, wound care, oxygen administration, CPR, etc.

    None of those things require even EMT-B certification to do, and they’re all important things.

    Simple answer: know where everything is in your rig, and do everything your scope of practice allows. I’d never turn down another trained pair of hands.

  • Don’t underestimate the value of a equipment gopher. MANY are the times when I wish I’d had someone to hand me something, someone who knew their way around the cabinets on my rig.

    There are plenty of things you can do as a first responder on the rig, things that are often done en route to the hospital, for example: simple splinting, wound care, oxygen administration, CPR, etc.

    None of those things require even EMT-B certification to do, and they’re all important things.

    Simple answer: know where everything is in your rig, and do everything your scope of practice allows. I’d never turn down another trained pair of hands.

  • Tommy

    One other possibility is to get thrown into a BSL ambulance with another EMT-B partner who doesn’t want to do much more then just drive. This has been my situation since starting as a new EMT-B seven months ago and the experience has been great. Most of our calls are general transport calls but every once in a while we get a really good call where someone calls the ambulance company directly when they should have called 911. This experience has given me hundreds of calls to practice patient care and grow my knowledge in the realm of EMS.

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