This is episode 2 of Confessions of an EMS Newbie where we talk about Love, Sex, Relationships, and the EMT as well as Anatomy, Physiology, and those cool EMT Pants. The show begins with a discussion of Ron getting ready for clinicals and the trials of getting all his shots. We learn how Kelly does 200 mile, one way critical care transports, and why Hurricane Katrina is to blame.
Through number of comments Ron gets the idea is is easier to get laid in EMS. Kelly gives him the real scoop. And while EMS may get you married, it is hard being married to someone else in medicine and it hard being married to someone outside of it. Ron is already beginning to see a separation where he doesn’t want to tell his wife stories from EMS to protect her.
Talking from his book, Kelly explains how ambulances are staged, or positioned and what an ambulance station is like. And don’t get him started on System Status Management, but Ron did.
In the gear you really need, it is time for Ron to get his uniform, so we talk boots and pants. Do EMT’s really use those cool trauma shear straps? What is the biggest give away of a sparky new EMT? And what is in Kelly’s pockets?
I wanted to tell you about all the money I’ve been spending that wasn’t mentioned when I signed up for my EMT-B course. It wasn’t really completely hidden, but it is starting to take me by surprise. Plus if you started some of this stuff earlier it would be cheaper.
CPR for Health Care Providers
One of the things you have to have before they will send you out for your clinical is your CPR card. I looked around locally and it was going to cost about $40 for a 2 hour course. I looked online and found the American Health Care Academy offering it for $20. I contacted my clinical supervisor and she said she didn’t care where I got it as long as I got the card. This isn’t the AHA’s place, so you might want to check before investing in it. I think she didn’t really care because we’ll be doing CPR on dummies in class anyway. You need to take an AHA approved CPR class, and this one isn’t one. I had to retake CPR as a result. The cost was $40.
Good. Fast. Cheap. Pick Two.
Obviously you always want good with a vaccine that can save your liver, or your life, so that leaves fast or cheap. If you have time, you can go to the county health office and get most of the shots for like $5. If you have shot records from when you were a kid, you can also bring those in.
My required shots were Measles Mumps Rubella(MMR), a TB test, Diptheria-Tetanus-Pertussis, Chicken Pox and Hepatitis B.
Since I had no records I needed titers – tests to see if you have the antibodies for something you are now immune to. But remember the MMR shot – which is one shot – is 3 titers. Since 2000 all children are getting Hepatitis B shots, but back when I was a kid they didn’t do that. I got the test anyway.
The titers were $224. I was immune to MMR and Chicken Pox, but not HepB.
Here’s where I got bit in the butt. I put off getting my shots until the beginning of class thinking I might learn something in class that would effect how I got them. HepB normally takes 6 months to get. It is 3 shots and they are give at 1 month and them 6 months later. But we have to show we’ve got all our shots before we can start clinicals and the deadline is 2 weeks after the start of class.
Luckily the CDC does allow an accelerated schedule – I think mostly intended for travelers who need to go out of the country fast. That schedule is day 0, 7, 21-30. I found a place that would do it in 4-6 weeks over the phone. When I got there I was able to talk them down to 4. Got shot one today, will get shot 2 in 7 days, and the last shot 2 weeks after that.
Still too late for my paperwork deadline, but my clinical supervisor is being cool and said if I turn everything else I can wait till after I get the last shot to start my rotations. BUT I won’t get to pick my schedule, I’ll have to take whatever is available even if I’m suppose to be at work. Lucky for me my boss if pretty loose on missing work.
Got the TB test – which I have to go back in 2 days to check – and the Tetnus at the same time as the first Hep B shot.
That bill was $296. Each Hep B shot is $140.
They say I must have these three things:
Pen and Paper
Blood Pressure Cuff
Which agrees with Kelly’s minimum. Especially because one teacher said you don’t really need the BP cuff. I’ll probably still get one so I can practice on my friends and family. I already have a pen or two and a watch that shows the seconds.
But after reading Kelly’s Essential Gear post I need a new watch. Looking for metal or plastic, water proof and with a glow in the dark second hand. But that is surprisingly cheap if you aren’t worried about impressing the ladies. Under $20.
We have to wear a specific uniform for doing our rotations. Blue shirt with a Lone Star College EMS patch ($4.95), a navy blue t-shirt underneath, blue or black EMT pants, black boots. Looking online the pants run around $30, the shirt $20, boots from $50-$250. I may have a blue T-shirt.
So around another $150.
I have to pay for and get a background check as well. $45. If you have a felony on your record you cannot do clinicals. Which means you can’t be an EMT. I’m a CHL holder which means I’m squeaky clean.
Here’s the costs I know about:
Now you could probably find this stuff cheaper if you weren’t rushing to get stuff done. And I’m not trying to go the cheapest with everything. But still there are going to be costs they don’t mention when you are signing up at school.
Welcome, Newbie. Throw your gear in the rig, sign out a portable radio for yourself, climb in the back with me and we’ll get our supplies inventoried.
I’ll point to the cabinet, call out what we’re supposed to have, and you count. Why? Because I have to do it every shift, and doing it this way helps you figure out where to grab stuff when we ask for it. Don’t ask silly questions, Rookie.
How do I know you’re a rookie? Well, partly it’s that endearingly eager-to-please look on your face, or the fact that you are disgustingly chipper at 0530 in the morning, but mainly it’s that Batman utility belt you’re wearing. The more stuff you have on your belt and in your pockets, the less experienced you are.
Write that down, kid. It’s an EMS axiom.
What’s that? Hey, don’t apologize. The whole eager-to-please and chipper thing is rather endearing, actually, kinda like puppies and baby ducks and Lolcat posters. We expect you to act like a newbie. What you don’t want is to look like a newbie.
So ditch the window punch and the EMS holster and the glove pouch and the oxygen cylinder wrench and the CPR collar pin and the trauma shears and the seat belt cutter and the penlight and the pocket EMS notebook with write-on/wipe-off waterproof pages, and… holy crap, kid, you’re carrying a lot of stuff! What’s in the backpack, a midget doctor for consultations? Just shed all that crap for now. Some of it I’ll let you have back later.
For now, all you really need is a watch, a pen and a stethoscope.
Hold on there, Hero. Not so fast. Not just any watch, pen or stethoscope. Let your friendly Uncle Ambulance Driver offer some guidance on which ones to purchase. Let’s start with the easy one first:
Yes, I said pens. What’s that? You’ve got one of those fancy tri-color medical pens for more efficient charting? Good for you. Now ditch it. You need one pen color – black. No red, no green, just black. Blue will do in a pinch, but black is better.
And you need more than one, because invariably you will lose one, or break it, or you’ll hand it to a patient to sign something when his hands are covered with their own civilization of yet-to-be-discovered harmful bacteria or cooties, or your partner will need to borrow one…
… which reminds me, can I borrow your fancy tri-color pen? Thanks, I forgot mine this morning.
Avoid felt tip pens, no matter how fine the tip, because the ink tends to bleed through the paper and smudge. Roller balls are okay, but gel tip pens work best. You want something that can easily write on the back of a glove without snagging or tearing through that protective cootie barrier you’re wearing. You’re going to jot lots of little notes on the back of your hand, and gel point pens tend to work best for that.
Buy a pack of those retractable gel-tip black pens, and keep the spares in your backpack.
The only thing you need to remember is transcribe those notes onto paper before you step out of the rig, because you’re going to strip off those gloves and wash your hands as soon as you end the call, which brings us to the next item…
Never come to work without a watch. Without a watch, you can’t count a pulse, or respirations, or even tell what freakin’ time it is, and don’t tell me you’ll use the clock on the cardiac monitor. That’s a cop out.
Your watch needs either a back light or luminous hands, because you’re going to be reading it in crappy lighting conditions. It needs to have a second hand, or be a digital watch that displays seconds.
And since you’re going to wash your hands many, many times a day, it needs to be a waterproof watch. Avoid watches with fabric or leather bands, because those materials tend to catch and grow all sorts of nasty bacteria.
Your watchband needs to be metal or plastic, and ideally, you need to take your watch off and wash it just as thoroughly as your hands. After every shift, take it off and scrub it thoroughly with antibacterial soap. Use a toothbrush to get into every nook and cranny.
Um, don’t use your regular toothbrush for that, okay? I know it should go without saying, but you never know with newbies.
If washing your watch all that often seems like too much of a hassle, you might try a fob watch or one that attaches to your stethoscope tubing.
If you’d rather have a stethoscope watch, let’s talk about what you’re going to attach it to. It is the most important and most expensive purchase you’ll make:
When it comes to stethoscopes, cheaper is not better. If you’d rather have a cheap stethoscope that you can’t hear anything with, just use the one on the truck. Most EMS agencies use cheap, poor quality stethoscopes because a) equipment like that tends to disappear and cheaper is easier to replace, and b) they know you’re going to use your own anyway.
If you want a quality stethoscope, be prepared to pay good money for it – upwards of $100 dollars. You may find a bargain here and there in the $50-$75 range, but it’s not likely. My stethoscope was a gift, and it cost over $250 new. I guard it with my life.
Relax, you don’t necessarily need a $250 scope. I have to have one, because my ears suck, and acoustical clarity in stethoscopes does not come cheap. If you have no issues with hearing deficits, a mid-range stethoscope purchase will suit your needs nicely.
The EMS supply catalogs are full of choices, and they all claim to enable you to hear a gnat fart through a down comforter and a foot of cellulite. Caveat emptor, Rookie.
You’re not going to be able to give every stethoscope a test run, so you’ll have to rely on word of mouth and testimonials from other users. For most health care professionals, Littmann scopes set the standard for acoustical quality. You may find cheaper, off-brand scopes, but if you go that route, go for a Littmann clone. Avoid the cheap stethoscopes with hard plastic eartips and thin-walled tubing, and avoid Sprague-Rappaport style, twin-tubed scopes.
A good choice is the Littmann Cardiology III scope:
I purposely didn’t include a purchase link. Shop around for the best price. Sure, at $150 it’s a bit pricey, but it’s a scope you’ll use for your entire career.
My personal preference for stethoscopes are the Puretone scopes made by Doctor’s Research Group (DRG). The acoustical quality seems to be a notch above (in my opinion) of the comparable Littmann models, but you’ll pay a bit more for it. In my opinion, it’s money well-spent.
This is the stethoscope I carry every day:
That’s a DRG Puretone Ti Lite Cardiology stethoscope. It has a titanium head and DRG’s patented External Noise Reduction (ENR) tubing, which really helps filter out the road noise you hear when using a stethoscope in the back of a moving ambulance.
For a comparison, stick a Littmann scope in your ears, and rub the tubing with your fingertips. You hear all sorts of noise. When you do the same thing with a Puretone, you hear next to nothing, because instead of thick-walled tubing, Puretone uses neoprene coated stainless steel springs. It makes a big difference in reducing ambient noise.
Regardless of which brand stethoscope you choose, there are two modifications you can make to any stethoscope that will drastically improve its acoustical clarity.
First, replace your old stethoscopes ear tips with a pair of Gelseal tips by DRG Puretone. They’ll seal better, and you’ll hear better.
Second, replace your stock diaphragm with a disposable, antimicrobial diaphragm. Puretone makes them, but so do many other companies. Heck, they give ’em away as freebies at EMS conferences. Buy yourself a dozen or so (they cost only a few bucks each) and replace them every month.
Remove the chill ring from your stethoscope (that’s the retaining ring that holds your diaphragm in place). It may be a threaded collar, or it may snap into place like an O ring. In any case, remove it, and your stock diaphragm. Put your old diaphragm someplace safe.
Replace the chill ring, and stretch the new, disposable diaphragm over the bell of your stethoscope. You’ll find that the sounds are much louder, but you may have to alter your technique a bit to notice it. Soft diaphragms are more sensitive to pressure, so you’ll have to use a lighter touch to notice the improvement in acoustics.
Be sure to change that antimicrobial diaphragm every month, because there are few things in an ambulance that come into more frequent contact with harmful bacteria than the head of your stethoscope.
What’s that? You feel naked without all your extra gear? Relax, kid, you’ll get used to it, and you’ll never miss half that stuff. If it helps your confidence, I’ll let you keep your trauma shears. Or even better, try a pair of these:
That’s enough advice for now, Newbie. We’ve got calls to run.
But before we do, be a pal and fetch me a cup of coffee. Black, three sugars. I’d appreciate it.