First, I f*ckin’ LOVE me some Special K (professionally - ahem; personally, when my partner gave it to me when I messed up my foot/ankle on duty, I found my spirit animal). We use it in myriad situations. Second, I recently transported a 30 yo who was 22 weeks pregnant. I put her on BiPAP as her room air sat was ~30%. She went on ECMO soon after she went up to ICU.

In Texas LE is required to provide a mental health evaluation on anyone who expresses any kind of suicidal ideation even if it’s hyperbole or said in frustration. The law can actually be a bit limiting in that way. EMS is also required to transport a patient who has voiced or attempted suicide. Either one (LE or EMS) can and are legally required to evaluate and usually transport such a patient. (Usually because bed availability- both ER & mental health facility - play into this.) LE can even transport someone directly to a mental health facility, though they generally don’t; EMS usually transports the person to an ER for medical clearance. Now, many large cities and counties (large by population and/or geography) also have CITs — crisis intervention teams which are usually LEOs which additional specific mental health training. Many places, including where I work, also have non-LE mental health teams. Both in the county I work and the one next to me, there are mental health crisis teams consisting of paramedics with additional mental health training, social workers, and other mental health crisis workers (the name escapes me right now). These aren’t perfect solutions and don’t help with bed availability. Sometimes there just isn’t a good solution to a mental health crisis, unfortunately, only a least bad option.

I just read this. I will in a bit. I’m running some errands right now.

Wait…Janeway, you’re in Texas, right? What you/your son was told is legally wrong. I deal with this all too often where I live in my line of work (also in TX). Anyone who overdoses and/or admits to wanting to kill themselves must be first medically evaluated. The only time someone might not be transported to the ER is if they have not physically harmed themselves, to include overdosing. The only time someone might not go to a facility, assuming there is a place with a bed, is if a safety plan that the patient, their family or friends, LE, and any other mental health crisis person agree on. And, no, in TX 17 year olds do not have the legal right to consent to or refuse medical care unless they meet a rather short list of exceptions (think emancipated minor or something like that). I’m sorry you and you son were given such poor and outright wrong information from the police.

This is my life right now, minus the anti-vax nurse family members. As sad as it this is to say, I’ve become quite proficient at spotting the patients who aren’t going to walk out of the hospital. I feel for your situation with your kids’ schooling. One of my colleagues found a TX ISD that has a fully online option and, apparently, has kids enrolled from around the country. Her son takes classes through them. I know you have other variables besides just worrying about kids at home. I’m sorry you’re dealing with this.

I’m actually not on duty today as this is a rare day where I’m not working a 48 hour shift. I realized this morning that there are very few of my colleagues who were even in EMS 20 years ago. There are even a few who were still in diapers back then. I think it’s hard because this is a big anniversary plus we’re living through another time when first responders are being directly affected by an event. The big difference, of course, is that 9/11 was a singular point in time and today is an ongoing and seemingly never ending pandemic. I, too, have known nurses and doctors who have died from Covid due to exposures at work. Several of my colleagues who caught it last May are still suffering. I think Fritz makes a valid point about the 20th anniversary coinciding with the withdrawal from Afghanistan. How could that not affect people regardless of one’s personal political/ideological beliefs or thoughts about that war and the withdrawal?

For HCWs who theoretically wear properly fitted N95s, we’re told we can wear them as long as they’re easy to breathe through. Which seem an odd standard to this HCW. Before I got my respirator I rotated my two N95s every shift (3 days). I imagine he can reuse them more than once. HCWs certainly are.

I finished a 48 hour shift on Thursday morning. In that time, I had 6 Covid patients at least half of whom are on vents as ICU holds in the ERs. None were vaccinated. I also had 3 CPRs - one COVID related, 3 trauma alerts, a couple of critical pedi calls - used our BiPAP on a kiddo for the first time, and myriad other calls. I gave up counting at hour 36. I’m right there with you.

You know, I have no idea. 20+ years ago I think we were able to drive the bridge “over the sea to Skye” and had to take the ferry to the Isle of Harris. Probably my comment is just irrelevant blathering. 🤣 Ignore me completely.

They are! Especially if they’ll be there over half-term holidays. My dh and I had to spend an extra few days on the Isle of Harris because we hadn’t made reservations back to Skye.

Blergh! Quoting error!

Yeah. Me, too. Utterly bone tired. I started in late 1996. Completely different world back then. My first eligible retirement date is next July. I honestly never thought I would punch out then. I mean, yes, it’ll be 25 years which is a good run for anyone but especially a field medic. I always planned on retiring at 30 years as that will max out all my retirement benefits — which in my system are incredible. I’m not sure I can do this another 5 1/2 - 6 years. Not physically, mentally, emotionally, or spiritually. I still love my job of taking care of patients and I’m damn good at it. But all the other crap I have to deal with? Not so much. I just don’t know.

We theoretically are capped at 48 hours straight and 96 hours in a pay week. Those maximums haven’t been adhered to since mid-May 2020. It’s called “emergency staffing rules” or “e-rules” for short in my system. But if every day has emergency staffing in effect then it’s just the new normal. Right. If we’re not on a call, restocking, completing run reports, and/or any number of other tasks, we can rest. But our call volume is only increasing as is the number of high acuity patients. I completely agree with your final paragraph. The pandemic didn’t cause these problems, though it certainly exacerbated them; it merely exposed the deep fault lines in health care and EM/EMS in particular.

I work a putative 24 hr on - 48 hr off schedule. Right now due to an extreme staffing shortage I and most of colleagues work 48-24 shifts or 96 hr shifts. You’re right; it’s not safe. Not at all. Yup.

QFT

Word. I’ll have worked nearly 150 hours by the end of the current pay week — NOT pay period. That’s, what, 54 hours over the maximum weekly hours worked. I’m certainly not unusual or special.

Yup. I’m on the last few hours of my shift and have transported patients to multiple hospitals in my area. All of them have bed delays for EMS; all of them are full; all have ICU holds; several ERs are having to utilize hall beds (not actually that unusual for ERs here), closets, showers, and - for one ER - the decontamination shower/room. The ERs, having been reminded that diversion is a request, not a mandate, and if two hospitals go on diversion then no one is on diversion, are now rotating 4 hour “full diversions”.

We have an annual ROT Rally in May — the Republic of Texas motorcycle rally. One of the local trauma centers used to have a tally board for the injured and dead (pronounced at the ER) motorcyclists. I once had a reporter try to crawl inside a vehicle with a pinned patient. Idjit managed to get past the county deputies (never really that hard- sigh) and was only stopped when the fire lieutenant and I stopped him. He proceeded to yell holy hell about freedom of the press and one of the state troopers introduced him to the charge of interfering with EMS.

Yup. Also, having a knife or gun pulled on you, having a patient suddenly have a psychotic episode in the back of the moving ambulance and attack you, etc.

In my area (2 heavily populated counties with multiple hospitals), the ERs are constantly on diversion. As I write this, one ER has 20 patients holding, one ER has turned ambulances away (which they technically can’t do), and in the past couple of weeks three of the local ERs have had charge nurses call for “Safe Harbor” due to extreme staffing shortages. Three. Absolutely unheard of in this area. The local EMS agencies, including mine, are losing paramedics at an unbelievable rate. All agencies are struggling to keep units staffed 24/7. I’ve worked in emergency medicine for almost a quarter century. I’m not sure how the health care system will survive or what it will look like if this keeps up. — signed one exhausted HCW to another

Although I agree with your post in general, for me post count is not an accurate way to judge how long I’ve been here. I read way more than I post. I’ve been coming to the boards over 20 years.

I don’t know of anyone in my area who can’t see their PCP for URIs. I’m sorry if the bolded is the case in your area. It is completely different in many of the areas in the US. Doctors are seeing and treating patients for a variety of illnesses, including various respiratory ailments, without issue. There may be additional precautions, but pts are being treated well prior to needing hospitalizations/ICU stays.

I don’t. They’re a bit brown, but as they’re going in a smoothie, no one in my family minds.

Ooh!! That’s a good point about smoothies! My kids love them, too. When my older girls were swimming competitively they would pack smoothies for after practices. Now, all my kids can make their own and I keep plenty of frozen bananas (sliced then frozen for greater ease), frozen fruit, milk, yogurt, etc available.

Or what about making bean burritos using refried beans? Or, really, burritos with any filling your son likes — shredded pork, beef, bean? I know there isn’t a microwave where he’ll be, but I don’t think that’s strictly necessary. Chilled/cool is fine for pre-cooked burritos. ETA: If you’re worried about cancer with deli meats, try roasting, smoking, whatever chunks of meat and slicing it yourself for sandwiches. You can cut the meat into thick slices which will help fill your boy up. We do this a lot even though we’re not at all concerned about cancer with deli meats in kids/teens. (Your calculus may be different based on your family’s particular health history. I’m not knocking your concern at all.)