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Had a DOA on Christmas morning last year, 50 year old male, I can still hear his son begging me to help his dad.

Tumblr is back at it not notifying me about messages, I apologize for the late reply. 

I have personally always taken losses heavier around the holidays, I think it is natural to be a little more upset than usual considering the time of year being so family oriented. 

If you would like to tell me about it to vent or be told that you did all you could, my inbox is always open!

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Ain’t that the truth

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It’s hard to believe it’s been 17 years.

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Patient Assessment

In the field 

In-class scenario

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Insight Friday: Let’s Talk TXA

Insight Friday: Let’s Talk TXA

When you ask providers whether they have heard of TXA the responses tend to vary based on the region and the size of the service. I have heard every response from “Obviously, we have had TXA for a decade” to “TX-what?”

So what is TXA?

TXA has been used for decades, most commonly in operating rooms across the globe. Here are the pharmacokinetics of TXA.

Name: Tranexamic Acid (TXA) Class: Anti-fibrinolytic Route: IV (for our purposes) Indications: Hemorrhagic shock with traumatic mechanism Contraindications: Seizure history, renal impairment (relative), allergy to TXA, isolated head injury Dose: Typically 1 gram over 10 minutes Side Effects: Hypotension if rapid administration, GI issues from long-term use Provided: 1g ampoules

How does it work?

Everyone knows that when you have a tissue injury the body begins to form clots to control hemorrhage and begin the wound-healing process. However, as soon as the clots are formed the body begins breaking these down by emitting tPA (tissue plasminogen activator, and yes it’s THAT tPA). This tPA will activate the plasmin and begin the deterioration of the existing clots, but this is where TXA comes in. TXA blocks plasmin creation and keeps the clot from being broken down. It is also known to increase inflammation because plasmin typically acts as an anti-inflammatory.

What do the numbers say?

The most significant study that covered TXA administration was CRASH-2. This study involved administration of TXA or placebo to over 20,000 trauma patients suffering from hemorrhage. The results were very much so in the favor of TXA, with a survival increase of 2.1% if administered within one hour of trauma…in other words the way it would be used/is used in EMS. What is truly amazing is that the survival chances actually got higher as the criticality of the patient increased. With those percentages, it was estimated that TXA could have saved 4000 trauma patients in the US in 2016.

Cool numbers bro. What about the side effects?

None. Zilch. Zero. Negative. Nope. There were no adverse outcomes in this study and the only true known side effects come from either improper administration or long-term use (which is not recommended).

Summary

TXA is a fantastic drug with amazing results and no adverse effects. It is slowly growing in EMS and becoming more common among providers, as it should be. If we can save even one life with such an inexpensive and safe drug, it’s easily worth the measly $30 a dose. I hope that you learned something today, if you have ideas for next week’s Insight Friday, drop us a message!

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Great! If anyone is interested contact @time-and-trauma !

If anyone is in need of an NREMT Paramedic level study guide let me know.

Some folks asked me to make one so I did, and I’m all about sharing the love.

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Insight Friday: Confidence vs. Humility

Public service is a unique profession in many ways. One of which is the required balance between confidence and humility, where tipping the scale in one way or the other can hurt your skills and abilities. 

Confidence. You need to be confident in every skill on your belt. Our citizens do not call 911 expecting someone mediocre, they want the best and nothing less. Decision making under stress should not require a thought of “Can I do this?” There is no room for that, there is no time for that. When you are confident in your skills and abilities, you do not question, you decide and you act. Confidence can be a killer, too. You never miss an IV, you are a champ on the range, you are the best breacher on the team. Cool. Are you maintaining that? Or are you so confident that you neglect skill maintenance? Over-confidence can lead to neglect of skills, a bad attitude, and ultimately a mentality that can cost someone their life. You cannot properly make judgment based decisions when you have an overly confident mindset. 

Humility. Public service professions breed humility. Anyone who is worth their weight in salt lets this profession ground them, keep them on planet Earth rather than letting their ego inflate beyond control. The things we see on a daily basis are a privilege, no matter how awful. Whether in birth or death, these circumstances are truly special and being allowed to be at someone’s side during either of these and everything in between is absolutely incredible. Being humble lets us hone our skills, analyze ourselves and understand what it is we need to work on to become better. So what about too much humility? I like to call too much humility the punching bag. You are always down on yourself and your skills. You are so humble that you cannot see that you are good at things, you push yourself to a point that it hurts your mindset. You become depressed, you don’t see any value in yourself, and this causes more problems than you can imagine. You don’t go for that promotion because you don’t think you are good enough, you don’t go to that course because you think you will embarrass yourself. Now you are losing out on valuable additions to your character and professional skills.

Balance. Be confident in your skills, be confident in who you are as a person. Understand that you are not perfect, you are not a god, your skills can ALWAYS use practice, and that you will always be working to be better. In fact, for the rest of your life you should be working to be better. Most of you probably do not have issues with this balance, I believe public service somewhat naturally aligns us to be somewhere near the middle. If you are not though, you need to own that. Own the fact that you are too confident or too humble and fix it. Not for your own good, but for the good of the people you serve. 

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UPDATE

I have been trying to decide what to do with this page for some time now. I still check it weekly to make sure there are no followers in need or with questions, but the ask box has been dusty for some time. So I have ultimately decided to tweak the purpose of this blog just a bit.

This blog is and will always be prioritizing mental health awareness in public service, that will never change. The ask box will always be open for those who need to talk or want to bounce thoughts off on someone anonymously. However, I would like to start using this blog as more of a general purpose area for public service. It will now have a heavy emphasis on mental health awareness and EMS education, but will also include light hearted jokes and memes and such. 

What I am looking at doing is making weekly or bi-weekly (depending on how popular it is among you all) educational posts about topics requested or those which I believe are good to get out there. If you have any requests or ideas of educational topics to post on, please send us an ask! 

That being said, the blog will be getting tweaked appearance wise and I will probably change the name as well. It’s still us though, and we are always here for you when you need us. Thank you all.

[public-service-central]

I used to be a hero, now I'm broken

What’s going on, my friend?

[public-service-central]

UPDATE

I have been trying to decide what to do with this page for some time now. I still check it weekly to make sure there are no followers in need or with questions, but the ask box has been dusty for some time. So I have ultimately decided to tweak the purpose of this blog just a bit.

This blog is and will always be prioritizing mental health awareness in public service, that will never change. The ask box will always be open for those who need to talk or want to bounce thoughts off on someone anonymously. However, I would like to start using this blog as more of a general purpose area for public service. It will now have a heavy emphasis on mental health awareness and EMS education, but will also include light hearted jokes and memes and such. 

What I am looking at doing is making weekly or bi-weekly (depending on how popular it is among you all) educational posts about topics requested or those which I believe are good to get out there. If you have any requests or ideas of educational topics to post on, please send us an ask! 

That being said, the blog will be getting tweaked appearance wise and I will probably change the name as well. It’s still us though, and we are always here for you when you need us. Thank you all.

[public-service-central]

“Medical Alarm. 75yof, no answer on repeated callbacks. History of cardiac arrest.”

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Share your crazy calls!

Have a particular call you find interesting? Intense? Downright weird? 

Share it here! (Obviously adhere to HIPAA regulations and yadda yadda)

I want to hear some crazy calls from you all. I am trying to get some more interaction going between us and our followers!

Spread the word!

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It’s too late. They probably already stole all the good snacks and drinks from the EMS room and are going to go post the rest of the day. 

Ew! Shoo! Shoo!

Go on! Git!

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Today is National PTSD Awareness Day. The classic comic by Paul Combs needs no words. Please take care of yourselves and reach out if you need help. We all need a lift up every once in a while, but the deeper you get the harder it is to climb out. Be safe, everyone!

[public-service-central]

Thoughts and prayers out to Long Beach Fire Department today.

Captain Dave Rosa was shot and killed responding to an explosion at a senior living apartment. Another LBFD Firefighter was shot and transported to a nearby hospital with non life threatening injuries.

Rest easy, brother. We will take the next alarm.

[public-service-central]

Roc vs Sux

Any thoughts on the debate of Roc vs Sux, particularly in EMS/ED? Does your service carry Roc?

[public-service-central]

They Eat Their Own

This resonates with us in relation to our community. The question has always been there, do we eat our own? In an environment composed of extraordinary men who relentlessly pursue excellence, rising to the occasion at all costs, there is no room for weakness. 

If one were to admit they need help, he would acquire a black stain that is as irreversible as death. The pack would follow a new, stronger leader. We have had giants amongst men reach out to see if our products are a solution to their suffering, this is not an isolated request or feeling. There can be severe repercussions for seeking help with their issues while in service. For those who have experienced every aspect of war, and we are not referring to non-kinetic deployments, you likely have developed issues.

If you downplay your symptoms after seeking help through medical channels, you will likely go back to work with a few therapy appointments and a handful of pills. All persons involved will work to keep your situation in the shadows, no harm no foul. 

However, if you are completely honest, a drastically different scenario can occur. You are involuntarily told that you are done. You lose your purpose. A man without purpose, is a shell of a human. The summary of what happens next is determined by the network that individual keeps. 

Without understanding and support, the result is another brother buried. Do not eat your own gents, there are far more mentally destroyed individuals in the community than anyone will ever admit. We have fallen victim to standing in line for pills, and putting a barrel to our head. We have been there, it does not go away. No amount of therapy, alcohol and pills, or CBD will make it go away. You have to continue fighting to cope well, but this issue is rooted deep in our hearts and minds. Some coping methods are better than others. We prefer natural solutions, solid friends, and the outdoors. We will do everything possible to inform the community and make our voices heard across the channels that matter. 

- Via @Un_canna on Instagram. I highly recommend you go drop our brother a follow.