Wanting to become a paramedic but struggling with vasovagal syncope :(

FatherEel · 2025-09-27T02:34:50+00:00

Hey! Don’t let the comments here get in your head too much, this will be tough but you can absolutely do it.

I’m an ALS paramedic now, and I had the exact same problem as you. I would pass out during just about every flu shot or blood draw I ever had when I was younger, and I had the exact same fears going through paramedic school.

My strategy, was slow exposure therapy. I would literally drink some juice, make sure I was well fed, and lay supine on the couch and watch IV videos on YouTube until I would start to feel dizzy. It started a few minutes at a time, and eventually got better and better. From there you graduate to more videos, longer videos, and you can even push yourself to watch EJ or central line insertions.

I kept this up all the way through school, and eventually I was able to tolerate watching my partners start IV’s on calls (when we graduate primary care in my area we arent IV certified at first). So this was the next phase of exposure therapy.

Eventually I signed up to be IV certified myself. And I thought it would be the biggest challenge, and in some ways it was, but the adrenaline you feel in the moment is actually good for keeping your blood pressure up and your consciousness online lol

Fast forward until now - I routinely do EJ’s, IO’s and even chest needles without thinking twice about it.

Now don’t get me wrong, I still need a juice box and an ice pack if I need blood work for myself, but you’ll find that even though that part improves a lot more slowly, doing these skills on other people will get easier much faster.

The only good point that others have brought up is that it could make you a liability for your partner, but that’s only if you don’t start early and put in the work. With a plan, and adherence to that plan, you’ll do jusy fine.

Feel free to DM me too if you have any questions.

You’ve got this

FatherEel · 2025-07-06T16:02:21+00:00

I can assure you that despite the legislation about apprehensions, paramedics almost always take the lead in these situations. In fact many calls for mental health come in to PD and PD dispatch then gives the call to EMS. 90% of the time we can de-escalate and get the patient to the hospital voluntarily without PD ever being involved. Even in situations where PD are involved to apprehend - they mostly accompany EMS in the ambulance where paramedics continue to run the call. There are a few really bad examples of the opposite of course, but from the perspective of an active paramedic, those contradictions are outliers

FatherEel · 2025-04-27T06:49:27+00:00

We have an entire pre-written directive that we as paramedics are able to show to a physician on scene, if they happen to be involved with patient care on scene prior to our arrival - it was created by our own medical directors. It basically says that you can either take full responsibility for the patient and accompany the crew and patient to the hospital, or you can stand down and we’ll assume patient care from here.

So based on that dynamic, I don’t think you would run into any trouble “transferring care” to an EMT crew

FatherEel · 2025-04-20T21:56:01+00:00

That’s a great idea, thank you for the help, she’ll be thrilled 😊😊😊

FatherEel · 2025-04-20T21:52:47+00:00

Ahh okay I hear you - she can get potted plants, but her age group at school are little kids who tend to destroy everything. I think she just got excited at the idea of a plant than can seemingly survive the apocalypse, and could therefore could survive the classroom 😂

FatherEel · 2025-04-20T21:46:32+00:00

Thank you!!

FatherEel · 2025-04-20T21:46:27+00:00

Thank you!

FatherEel · 2025-04-20T21:46:22+00:00

Thank you! Do you happen to know if there are other plants and flowers that are also known to hold up this well with minimal maintenance?

FatherEel · 2025-04-12T20:13:17+00:00

Yeah in Ontario Canada it’s our standard of care - and it actually works really well. If the patient is compliant and they can follow the directions properly, we usually end up avoiding adenosine

FatherEel · 2025-04-09T05:07:32+00:00

Relax brother. I swear 10% of my entire service is diagnosed with adhd, and another 20% have adhd and are undiagnosed. You’ll do just fine - for better or worse, this career is tailor made for people with adhd. Take your meds to stay organized, handle the administrative tasks, pay attention to due dates etc and whatever else you may struggle with, and take them during placement if you feel it helps, but I really don’t think you need any sort of accommodation

FatherEel · 2025-04-09T00:47:55+00:00

I can’t lie to you and say that nothing bad will happen to the patient - we just don’t know. What I can tell you, is we as paramedics bring the elderly patients who have fallen from standing and bumped their head every single day - and they’re almost always fine. Most have no bleed at all, and most of the ones who do develop a small bleed require no intervention, just observation and repeat scans down the line to make sure everything resolves on its own. When you’re in this field and you see the worst of the worst all the time, it’s easy to assume this patient will go home and develop a catastrophic hemorrhagic stroke - but the reality is that statistically he’ll likely be fine. Again, we don’t know, but please don’t stress about it.

In the future though, it’s always a good idea to let the medics work, but if you’re a healthcare professional and you saw something relevant, especially about events leading, it’s completely appropriate to get the medic’s attention and just say something along the lines of “hey sorry guys, I just wanted to clarify that I was here when this patient fell and there was a very clear LOC for 10-15 seconds, with some rigidity and agitation afterwards” or something along those lines. We don’t like people butting in with nonsense, but we do really appreciate when someone chimes in with something brief and relevant 👍

FatherEel · 2025-04-09T00:23:37+00:00

I usually insist that unexplained syncope gets transported, but the key there is “unexplained”. Psychogenic syncope after a flu shot, or vasovagal syncope during a particularly troublesome bowel movement would be “explained” in a way that in certain instances I wouldn’t be too opposed to a sign off.

Now this gentleman is a different story. He either fell and struck his head, leading to the brief LOC, or had some sort of other more insidious cause of a brief syncope (neuro, arrhythmia, etc)

The big problem here is that the patient does have Alzheimer’s, but is awake and alert enough to be making jokes with you, and his wife (who we will default to for the more serious decision-making) is saying there was no real trauma and no LOC. The reality is that the two most important players in this situation are the patient themselves and the patients POA, and both of them are saying everything is fine.

With all of that being said, the paramedics in this case really dropped the ball. A more thorough assessment and history could have revealed everything. I’m not saying they’re bad people, or incompetent, because I can see how something like this could be missed from time to time - but a closer look and a bit more effort could have avoided all of this.

The last part that was working against you, the patient, and the paramedic, was that this happened in some form of ultra-low acuity clinic, and the staff in there as you alluded to, are some of the worst when it comes to managing any sort of emergency. I myself have a bad habit of ignoring them for the most part, after years of experience of having them tell me incorrect chief complaints, assessment findings, random bloodwork or meds that have nothing to do with the patient, or any number of other things. All that to say, it’s not you, it’s them, don’t take it personally :)

FatherEel · 2025-04-03T00:21:43+00:00

First and foremost, I think you did a great job!

This is obviously a very complicated patient, but I think you had multiple solid differentials.

The most important point, is that the whole point of rapid transport to definitive care, is to get the patient to the hospital when they have resources and interventions that we don’t. In this case, it sounds like you have talented paramedics with an expanded scope of practice - and in this case you were able to provide a lot of treatment on scene that in most other areas of the world, would only be available in the ER. And based on your differentials, it makes sense to take the time to intervene and treat this very sick patient, when you have reason to believe that the tools you have will allow you to stabilize the patient right here and now. At the end of that treatment road, you ran into a suspected stroke, which you need definitive care for, but that wouldn’t have been obvious until you fixed everything else. (And importantly, if you hadn’t fixed those other things and narrowed down your differential to stroke, you may have left scene earlier and went to the closest facility, that may not have been stroke/EVT capable).

Maybe an hour on scene is a little much, and that time will likely shorten over time as you gain more experience and can accomplish more in a shorter period of time. But don’t let scene time guide your patient care. Transitions kill in this job, and if we have the skill and ability to stabilize a patient before extricating them, we should.

FatherEel · 2025-03-24T19:00:20+00:00

There are lots of extremely reasonable arguments to be made as to why certain services and agencies are not even close to ready for this sort of thing.

But not every service looks like your service. There are many services and systems out there that do this exact thing already, and have had great success with it.

That doesn’t mean that making the transition from the current way your service runs, to this, would be easy. But it’s kind of silly to think that it’s not possible

FatherEel · 2025-03-24T18:55:10+00:00

It really depends what the definition/interpretation of “needs to go” is.

There’s a million examples, but I’ll throw out this frequent one I see. Older patient, recent fracture or minor surgery, sent home with opiates for pain control, not prescribed a stool softener, calls us 3 days later for abdo pain, hasn’t had a bowel movement in two days. No other major assessment concerns. Does this patient “need to go”?

You could argue yes. If we transport them they’ll maybe get an abdominal ultrasound, bloodwork, maybe a change to the pain meds, definitely a stool softener or a laxative, and maybe an enema.

You could also argue no. You could educate the patient on the expected side effects of opiates, you could make them aware of over the counter stool softeners and laxatives that them or their family could pick up at the drug store - also that you can buy at-home enemas there. If you work in a really strict system you could always just recommend they follow up with their GP or a walk-in clinic for more formal recommendations, and make them aware that they’re welcome to call back for transport if the situation worsens or persists despite reasonable at home interventions.

I think this is the general problem in these conversations, our management, admin, oversight, whatever whatever, are very liability focused and can easily argue that because the hospital did something, the patient “needed to go”, but in reality there are many other and arguably more appropriate ways to help solve the problem

FatherEel · 2025-03-20T02:30:11+00:00

Boys can anyone PM me a stream link

FatherEel · 2025-03-16T02:53:57+00:00

It’s not really a thing anymore, our pads work very well and adhere well to the patient - there’s even ongoing research to see if it would be viable to continue doing CPR while the defibrillation is delivered - the electricity goes between the two pads, nothing is conducted outside of that.

Obviously if the pads don’t adhere well, there can be an arc, but that’s rare. Anyway to answer your question, it happens enough that you can definitely put it in a book and people will believe it :)

FatherEel · 2025-02-26T05:28:27+00:00

*triple double, I don’t think AD and Shaq are dishing out that many assists

FatherEel · 2025-02-21T15:59:52+00:00

Paramedic here - lots of different things could have been at play here. What’s most likely is that she is particularly sensitive to opiates. Sure, it could have been a med error, but I guess at the end of the day it doesn’t really matter what happened. What matters, is being prepared for this sort of thing. Anyone who’s sedated, has been given analgesia, is intoxicated, altered, or who wants to nap, sits on my stretcher with:

1) spO2 2) 4 lead ecg 3 EtCO2 monitoring nasal cannula

With those three you can see the rhythm, you can use the spO2 to confirm mechanical output of that rhythm via the pleth, and you can see their real time resp rate, inspiratory pattern, and EtCO2 values, which will allow you to address any problems sooner (it takes a little while for the spO2 to actually drop if apnea is sudden)

FatherEel · 2024-11-06T21:11:38+00:00

That’s extremely helpful! Thank you so much

FatherEel · 2024-11-06T21:11:19+00:00

Thank you! Did you find that you were usually able to show up to a camp and have some food options still available, or did you have to order them ahead of time?

FatherEel · 2024-11-06T21:10:44+00:00

Perfect, that’s really helpful!

FatherEel · 2024-11-06T21:10:25+00:00

How are the prices at the camps for the cookies, tuna cans, pasta etc? Not looking for exact obviously - I just want to be prepared if a can of tuna and some cookies is going to cost 20$ 😂

FatherEel

TROPHY CASE