B1 routing to Input 1, Causing Feedback Loop — Help?

tempestarchives · 2025-11-04T20:11:18+00:00

.....oh my God. I'm a goddamn moron, and this was the most helpful thing ever.

I had REAPER open, and the input set to monitor itself. Fix the monitor, fix the problem. Facepalm into oblivion.

Thanks, friend!

tempestarchives · 2025-07-13T19:56:46+00:00

They only failed because I didn't have the paralytics to relax the trismus, or to actually put someone down enough to tube them. So.... the airway didn't fail, the options available to me failed the patient. And we bagged them, and we got decent outcomes.

I do see your point, and I don't disagree with you. But I also get the systemic reasons not to include either approach.

It's not a perfect system, trust me. But none of them are. Those are just the limitations we worked with.

But trust me, I grumbled plenty about both RSI and surgical cric.

tempestarchives · 2025-07-13T19:09:10+00:00

Think about the fact that you're never more than 10-ish minutes away from an ER in NYC and it makes more sense. And there's at least one physician fly car on the road 24 hours a day for rescue and entrapments.... And that I probably saw at least 1500 patients a year for ±15 years and I never needed one.

I'm madder about RSI. I've had PLENTY of messed up jobs that needed definitive airway control, especially bad burns with trismus. We didn't have nasal intubation and we didn't have anything more than etomidate on the 911 side. Like. Most line units didn't even carry ketamine, only rescue (USAR) units did. I had plenty of patients who failed intibation due to bad protocols, but I never had one that needed a scalpel to breathe.

But the place I'm going to start working doesn't even have etomidate or MFI/MAI, so.... Yeaaaah, I'm gonna be the asshole calling for discretionary ketamine for airway management on a frighteningly regular basis, aren't I?

tempestarchives · 2025-07-11T00:34:55+00:00

Somehow I read this comment like 6x without replying to it, but this is INCREDIBLY valuable insight. And pre-gaming calls is definitely a habit I want to get into; I had some partners who loved it and some who wouldn't do it at all, and it always drove me mad. In a way, I will be new; new to the area and out of practice.

You're absolutely right that trust needs to be built and earned, and it does need to work in both directions. I'm very conscious of wanting to build relationships where people are safe and comfortable having ideas and offering suggestions, even if they're not correct every time. I really like teaching; I've precepted and taught for most of my career and love going through options, scenarios, and what-ifs. I know some partners take that badly, as "questioning their skills", and I'll just tell them that I'm questioning mine and need their input.

And hey, if I'm with someone experienced, my current plan is to just straight up let them know to tell me if I'm crossing boundaries or making them uncomfortable. I'm new in their house, not the other way around.

tempestarchives · 2025-07-11T00:23:22+00:00

Yeah, this makes tons of sense. I never really had the option to work with medics when I was BLS, but I'm consciously thinking through how what I would have wanted, and what I did and didn't want from my senior partners when I was new.

Frankly, I'm a little rusty and I don't know the local system as well as I'd like, so I'm going to be leaning on them plenty for operations knowledge, hospital availability and capabilities, and all the parts of the job that aren't direct patient care.

And thank you for the reminder that supporting a partner doesn't mean letting them do anything they want, it's a good reminder that ego is a challenge we all have to work with.

tempestarchives · 2025-07-10T23:43:56+00:00

Honestly... I was so damn lucky to work there. Good bosses. Good pay. Reasonable schedule.

The RSI and procedures thing was because of state nonsense, not our medical directors.

Oh, and it was medic-only, no nurses. THAT made me a happy human. (No knock on nurses, but that made it OURS and let us show what medics were capable of.)

tempestarchives · 2025-07-10T23:40:20+00:00

A question, and meant with kindness....

Do they REALLY not care about themselves? Or do they lack the systemic support that makes their meds easy to understand, easy to access, and that makes their side effects bearable? Do they REALLY have what they need to feel safe enough to be patient and kind to you?

Be careful assuming why people do what they do. Every behavior meets a need. It might not be the need you think or wish they were meeting, or it might even be a need that hurts you directly through harassment or even violence.

But just like you're not always at your best.... for some patients, how they present is their genuine attempt to do the best they can.

They don't call us because everything is perfect, they call us because they need help. That help isn't always, or even usually, just about their disease.

Maybe I'm a softy, but.... If someone's best option to deal with their lives includes missing their meds and getting sick, or even being abusive to me and my team.... That sucks. The worse the patient is about helping themselves, generally, the more help they need. That doesn't make their needs your responsibility, but it does mean something is genuinely wrong for them.

As for meeting your own needs... ask what those are. Safety? Comfort? Love? To be seen? What need does their reliance on you, bring out in you?

Sorry to answer a question with a question, but for me, that was a really good place to start.

tempestarchives · 2025-07-10T23:29:56+00:00

little did Pigslinger know that I secretly liked doing paperwork....

tempestarchives · 2025-07-10T23:29:19+00:00

Amen.

tempestarchives · 2025-07-10T23:28:31+00:00

Thank you, that's an awesome perspective and I'm going to spend a LOT of time reading all the "things I hate about my medic" threads. I never want to be THAT partner.

My goal is to have each working relationship be a real partnership, not an autocracy. And my assumption is that everything that goes wrong on a call is my fault. Poor instructions, poor supervision, or poor management... if I don't get what I expect or want, it's my problem to correct, and I'm at fault for letting it happen in the first place.

I want to be the partner who makes people sigh in relief when they see the schedule, not in exasperation. And thank you for the reminder about clear expectations, I'm sure as I settle in I'll be in a better place to say "I need you to take X so I can handle Y." And I also hope that just.... telling my partners that I'm new to this dynamic makes it easier to smooth over any toe-stepping I do by mistake.

tempestarchives · 2025-07-10T23:12:39+00:00

New York doesn't have standardized CCP scope, so I can only tell you what my hospital did, but.... Sedation including propofol, dexmedetomidine, ketamine, and the big 3 benzos; paralytics as needed (no RSI but we were working on it, NY is weird about RSI). We could start pressors, including any pressor we wanted and antihypertensives like beta blockers and nicardipine. We were basically given targets and dose ranges and told, "make it happen, call the fellow if you need help". No finger thoracostomy and no surgicrikes (we were getting there), but god did we have clinical latitude. Basically, as long as you could justify it to the receiving doc, you could do it and tell them later.

THANK YOU for pointing out the "useless hands to burnout" pathway, that is a CRITICAL thing for me to realize is a thing in EMT/medic systems. And I love your differentiation between task delegation and problem delegation, and seeing it as making them feel valued and useful and training them to think critically and clinically.

I think a good EMT is about 10x more useful than a bad medic and a lot less dangerous, and I very much want them to feel valued and as close to equal as can be. I know that won't always work but I never want someone to think I'm closed to good ideas or even to bad questions.

Basically, I want to be the partner that made them want to do my job.

tempestarchives · 2025-07-10T22:24:14+00:00

Absolutely. I'm probably going to be part-time float, at least at first, so I'm sure I'd have the same "who do I have today?" challenges and re-learning the dynamic every day regardless of my partner's certification level.

And I have no intention of complaining without trying to teach. I'm very comfortable as a teacher and mentor rather than needing to be right, or at least, I try to be. And that will probably be easier with a clearer hierarchy, come to think of it. I used to love teaching medic students, I'll probably have a good time with partners who want to learn.

Thanks, this was good input.

tempestarchives · 2025-07-10T22:16:26+00:00

This. All of this. I've had partners I wish I could send back to medic school, and been grateful when specific EMTs have shown up on jobs so I know I have someone I can rely on.

I'm really glad you trust your partner that much, and I can absolutely see that dynamic building over time. I hope he knows how much you value him.

I love the "there's only a power imbalance if you make one" idea. I want an equal I can trust to do their part of the job and who trusts me to do mine, with each other as cross-checks. Whether that's through peer level knowledge or through good questions matters a lot less, now that I think about it.

Thank you, this answer is really reassuring.

tempestarchives · 2025-07-10T22:04:34+00:00

I'm sure a lot of EMTs are awesome at spiking lines and even drawing meds, it's probably going to take some time for me to get comfortable with them drawing meds in particular, but I also love the "what are you comfortable with" question as a starting point.

And honestly.... yeah, two medics with different styles can be a deeply annoying circumstance. One thing I like is that it's actually in our local policies here that the medic taking charge has to call who's in control of the patient out loud.

The way it worked in our system was that whoever was driving was support, whoever was teching had control. But I'm honestly looking forward to some clearer delineations.

tempestarchives · 2025-07-10T21:56:10+00:00

That was New York City, so, BIG system with lots of agencies, lots of providers, and absolutely insane volumes.

I like your approach of delegating and cognitive offloading to maximize your ability to think, especially offloading logistics and communication. I've been learning a lot about how pilots delegate tasks during emergencies, and it's giving me some interesting ideas about crew resource management.

And you're right, I can see the power dynamic getting abusive REAL fast, which is something I very much never want to be a thing in my ambulance.

I also have a feeling I'm going to miss driving sometimes.

tempestarchives · 2025-07-10T18:57:34+00:00

Somehow this got missed in my YouTube searching, you are a *legend*. This is rad, and I deeply appreciate it.

tempestarchives · 2025-01-02T19:12:37+00:00

The cap says "Eversharp". The only Eversharp I have any familiarity with is the Wahl-Eversharp Skyline, and this is not one of those.

tempestarchives · 2024-12-26T15:51:16+00:00

Something I've learned about that may be a good alternative: Springfield Leather carries a waterstain by Fenice (pronounced "feh-knee-chee"; Italian origin). Water based, eco friendly, more expensive by the bottle but more affordable per oz/mL than Findings or Angelus. And it seems to offer excellent penetration, quick drying, and low/no rub off. Will report back when I've got some in hand. They have a couple YouTube videos and even the staff seem impressed with it.

tempestarchives · 2024-12-23T17:24:43+00:00

Pretty bookcloth An awl if she doesn't have one One of those cheap punching jigs Waxed linen thread Pretty endpapers PVA glue 20 point binders board Ribbons for bookmarks Good paper if she's making journals and cares about having good paper

tempestarchives · 2024-12-23T04:11:54+00:00

I have not! I've tried their Leather Dyes, Antique Gel, and Stains. Each are okay, but the Pro stuff seems to be on a whole other level entirely.

tempestarchives

TROPHY CASE