OLD: CENTRAL ARIZONA REGIONAL EMS GUIDELINES (Latest ed.: 2-21-2020)
AZ DHS PARAMEDIC DRUG PROFILES
NREMT-B & P Patient Assessment Sheets w/ Follow-Along Script
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Universal Resources provided by Redditor: u/__Holocene__ (Who is a badass PCP in Canada):
EKGs
6 Second EKG Simulator
Life in the Fast Lane - Literally a wikipedia of everything you need to know about EKGs
Dr. Smith's ECG Blog - Hundreds of walk-thru 12-lead interpretation/explanations of real clinical cases
EMS 12 Lead - Again, hundreds of case studies of 12 leads and lessons
ABG Ninja More than just ABGs. Also has self-assessment tools for ECG and STEMI interpretation.
ECG Wave-Maven motherload of EKG case studies, diagnostics with lengthy explanations.
Youtube Channels/Videos
[ADDED 12/22/2020] Medic Junkies - One of my paramedic instructors run this Youtuber channel. He reviews our ems protocols and other things such as patient assessments, NREMT stuff and more.
Master Your Medics - lots of videos on drug profiles, disease patho, treatments.. etc, also has a subscription based website for more content
Medzcool - quick 2-3 minute "refresher" videos on drug profiles, case studies, patho, misc stuff like crainial nerves, ACLS.. etc
MedCram - mainly aimed at Doctors/Nurses but is obviously useful to Paramedics. Their DKA Lecture is easily the best one out there
Emin5 Great, short videos for Emergency Medicine; geared for the ER but still helpful.
EMTPrep Q few bits of A&P, and some diagnosis stuff. It also has examples of NREMT/Paramedic tests
Sciences
Khan Academy - two words, gold mine. THOUSANDS of free videos on anatomy, physiology, pathology, pathophysiology, chemistry, biology, pharamacology, organic chemistry... they'll even teach you calculus!
Straight A Nursing - again, lots of pretyped notes in PDFs on anatomy, physiology... you get it
Free Quizes/Tests
Smart Medic - 538 multiple choice questions - pretty decent variety of questions, basic explanations
~50,000 NCLEx Questions - I know it's for nurses, but it is still relevant to paramedicine
Podcasts
EMCrit[awesome podcast about Critical Care Medicine by Dr. Scott Weingart. A lot of the topics are geared more toward Physicians, but there's a lot of topics that pertains to Paramedicine and EMS]
ScenarioVille Interesting stuff, giving you a full scenario from dispatch and navigation, through to assessment, treatment and disposal. Probably best for newly minted EMT-Bs
WikEm Wikipedia of Emergency Medicine
Added 6/11/20: Mastering Ambo Vents by EMCrit
Apps
Figure 1 - Instagram for healthcare professionals. Health care providers around the world post pictures/stories about ongoing cases seeking advice, or just to show the world.
Books
Dale Dubin's Rapid Interpretation of EKGs - a very simple, easy to read book that walks you thru the process of understanding and interpreting EKGs, very well known book amoungst all healthcare professionals. Although the author has done some shady stuff, I still highly recommend
Nancy Carolines Emergency Care - WHO hasn't heard about this book at some point in their schooling/career. Frequently referred to as the "Mother of Paramedics". Good book, easy to understand and pretty basic overall, will need supplement material for some topics.
Tintinalli's - found a PDF of this book online and it is GREAT, caters to a more "advanced" person, however still an appropriate textbook for paramedics who want to learn more than what Nancy Caroline all taught us ;)
James & Bartlett EMT-B book 2011 ed - 40 Chapter powerpoints from the James & Bartlett EMT-B book 2011 ed. Good study tool for new students and for the refresher.
Another couple I've heard great things about are Rosen's Emergency Medicine and Goldfrank's Toxicologic Emergencies, although I have no experience with them.
Hope this helps fellow EMTs and Paramedics (and students :P)
Suicide Prevention Resources:
I was in the same position once, but seeking help really helps. Don't suffer in silence, please speak to someone and pursue professional aid.
http://www.befrienders.org/ (has global resources and hotlines)
ADDITIONAL RESOURSES (Thank you reddit for the info!):
What to Expect When Calling a Hotline: We maintain an FAQ about hotlines and what usually does and doesn't happen when you call one.
Worldwide Directories
We know of three international lists that are maintained by reputable agencies; try these if you don't find what you're looking for below:
The International Association for Suicide Prevention maintains a Global Crisis Centre Directory..
The Befrienders maintain a hotline database; use the "Find a Helpline by Country" control at the top of their page.
Do be aware that most global hotline lists are maintained privately by members of the public. Although these people usually mean well, the information on their sites is usually outdated and/or incorrect.
United States
National Suicide Prevention Lifeline: 988 or 1-800-273-8255 (TALK) Veterans press 1 to reach specialised support. Press 2 for Spanish-language support
(The older number, 1-800-SUICIDE, is no longer published by the lifeline agency and will probably stop working in the near future.)
Online Chat: https://suicidepreventionlifeline.org/chat/
Crisis Text Line: Text "HOME" to 741741.
Youth-Specific services (voice/text/chat/email) from the Boys' Town National Hotline: http://www.yourlifeyourvoice.org/Pages/ways-to-get-help.aspx
Trans Lifeline: 1-877-565-8860
EU Standard Emotional Support Number 116 123 - Free and available in much of Europe
Argentina
Centro de Asistencia al Suicida: https://www.casbuenosaires.com.ar/ayuda 135 (CABA & GBA), (011)5275-1135 (Todo El País/Nationwide)
Australia
13 11 14
https://www.lifeline.org.au/crisis-chat/
Austria
142, Youth 147 Online: http://www.onlineberatung-telefonseelsorge.at
Belgium
Dutch: 1813 https://www.zelfmoord1813.be/
French: 0800 32 123 http://www.preventionsuicide.be/fr/lesuicide.html
Brasil
141 changing to 188 effective 30 June, 2018 Chat, Skype and Email also available at: https://www.cvv.org.br/
Canada
National Crisis Line from Crisis Services Canada (Pilot Project, phone only at present): 1.833.456.4566
Other Crisis Lines by Region Alternatively, 211 works in most of Canada, and they can advise regarding local resources.
Nationwide Kids Help Phone (Up to age 18): 1.800.668.6868 or text HOME to 686868
Deutschland
http://www.telefonseelsorge.de/
Tel: 0800-1110111 oder 0800-1110222
Chat/Email: https://online.telefonseelsorge.de/
Denmark
70 20 12 01
Fiji
Lifeline Fiji: 132454
Finland (Suomi)
Kriisipuhelin 09 2525 0111 (suomeksi, 24/7)
Kristelefon 09 2525 0112 (på svenska)
Crisis Helpline 09 2525 0113 (in English and Arabic) / خط مساعدة الأزمات (باللغة العربية)
France
Suicide Écoute - http://www.suicide-ecoute.fr/ 01 45 39 40 00
sos-amitie - réseau de 50 postes d'écoute Téléphone: Numéros divers, carte ici
Chat: Disponible de 13h à 3h, 7 jours ici
Greece
1018 or 801 801 99 99
Greece - http://www.suicide-help.gr/
Iceland
1717
India
91-44-2464005 0
022-27546669
Iran
1480 6am to 9pm everyday
Ireland
Samaritans Ireland - https://www.samaritans.org/how-we-can-help/contact-samaritan/ 116 123
Test 50808, Text-based crisis service operated by HSE - https://text50808.ie/ Text Hello to 50808
Childline Ireland - https://www.childline.ie/ Phone 1800 66 66 66, Text 50101
Israel
1201
Italia
Telefono Amico: http://www.telefonoamico.it/ 02 2327 2327
Samaritans onlus Italia: http://www.samaritansonlus.org 06 77208977
Japan
Tokyo - Japanese: 3 5286 9090 befrienders-jap.org
Tokyo - English: 03-5774-0992 telljp.com
Osaka - Japanese: 06-6260-4343 spc-osaka.org
The above sites maintain links to related resources in other cities and other formats like chat and text.
Korea
LifeLine 1588-9191
Suicide Prevention Hotline 1577-0199
Lebanon
Embrace: https://embracelebanon.org/ Phone 1564
Lithuania
Emotional Support Service for Adults: https://www.viltieslinija.lt/ This is the agency that's reached through the EU standard emotional support number 116 123
Additional phone, in-person, and online options for adults and youth available here: https://tuesi.lt/noriu-bendrauti/
Malta
179
Mexico
SAPTel: http://www.saptel.org.mx/ (55) 5259-8121 Currently offline as of 2020/10/08 We're looking for an alternative but haven't identified one yet.
IMSS Covid-related crisis line: http://www.imss.gob.mx/prensa/archivo/202010/683 800 2222 668 opción 4 M-F 8am-8pm
Netherlands
0800-0113
https://www.113.nl
New Zealand
0800 543 354 Outside Auckland
09 5222 999 Inside Auckland
Norway
Kirkens SOS offers phone support and chat: 22 40 00 40 and http://www.kirkens-sos.no/
Directory of additional resources here: https://www.psykiskhelse.no/hjelpetelefoner-og-nettsteder
Osterreich/Austria
116 123
Portugal
SOS VOZ AMIGA: 21 354 45 45 or 91 280 26 69 or 96 352 46 60 (Daily, 1600-2400h) http://www.sosvozamiga.org/
Telefone da Amizade: 22 832 35 35 or 808 22 33 53 (Daily, 1600-2300h) http://www.telefone-amizade.pt/
Romania
0800 801 200
Serbia
0800 300 303 or 021 6623 393
Singapore
Samaritans of Singapore: 1800 221 4444 https://www.sos.org.sg/
South Africa
LifeLine 0861 322 322
Suicide Crisis Line 0800 567 567
Spain
Teléfono de la esperanza, 914 590 055 or 717003717
Sverige/Sweden
mind.se phone: 901 01 chat: https://chat.mind.se/ Both available 0600-2400 daily.
Directory of other services here
Switzerland
143
UK
Samaritans (www.samaritans.org)
Voice: 116 123 (24/7 Free to call, will not appear on phone bills, formerly 08457 90 90 90)
Email: https://www.samaritans.org/how-we-can-help/contact-samaritan/write-email/
Shout - Crisis Text Line UK (https://www.crisistextline.uk/)
- Text: SHOUT to 85258
Helplines for Men from thecalmzone.net:
Voice: 0800 58 58 58 (5pm to midnight nationwide, also 0808 802 58 58 London and 0800 58 58 58 Merseyside)
Text 07537 404717 (5pm to midnight, start your text with CALM2)
Online Chat: https://www.thecalmzone.net/help/get-help/
ChildLine (childline.org.uk), for those 19 and under:
Voice: 0800-11-11 (Free to call, does not appear on phone bills)
Online Chat: http://www.childline.org.uk/Talk/Chat/Pages/OnlineChat.aspx
Papyrus HOPELINEUK, suicide prevention specialist service for children and young adults (under 35)
Hours are 9am – 10pm weekdays 2pm – 10pm weekends 2pm – 10pm bank holidays
Voice: 0800 068 4141
Text: 07786209697
Email: pat@papyrus-uk.org
Directory of suicide-related services: http://www.supportline.org.uk/problems/suicide.php
Uruguay
Landlines 0800 84 83 (7pm to 11 pm)
(FREE) 2400 84 83 (24/7)
Cell phone lines 095 738 483 *8483
RESOURCES FOR FAMILY AND FRIENDS WHO ARE CONCERNED FOR A LOVED ONE WITH SUICIDAL THOUGHTS OR TENDENCIES
Again, thank you user SQLswitch from r/Suicidewatch and r/SWresouces for typing this out, here it is copy and pasted from the page itself:
Concerned but don't know what to say? Here are some simple, proven strategies for talking to people at risk.
Suicidal people typically don't feel change is possible. Anything that can be prefaced with “you should” can make them feel even more powerless. They often feel unworthy of help. “Fixing” or “advising” will reinforce that and make things worse.
This gets tricky because suicidal people often don’t see all the options they actually have. If and only if they've indicated to you that you've achieved a solid rapport (see below), it could be of real benefit to point these out, but there is a vital difference between “you should do <action>” and “you could do <action>”. “Have you thought of doing <action>?” or “What do you think about doing <action>?” are other good phrasings. It’s fine to mention something that worked for you, but frame it as an example of something that they may or may not want to try.
If they ask for advice, you could reframe the conversation as working through the “pros” and “cons” of various options together.
If you're worried that someone is at immediate risk, take action yourself, don't tell them to do it.
If they say harsh things about themselves or others, this can be the truth of their experience even if it doesn't match objective reality. Consider the emotions embodied by the self-loathing or the tales of woe. You can connect with the person on a feeling level and simply set aside any questions of "fact".
Examples:
If they say: “I’m a useless waste of skin. The world would be a better place without me,” simply disagreeing can make them feel even more “intrinsically wrong”. Instead, you might say “It worries me to think of you feeling so bad about yourself. I wish I could help you feel better.” This respects their emotional experience and shares your sympathy and concern, without getting into whether their self-assessment is accurate or not.
If they say: “Everyone is mean to me”, you could respond with “It must be so hard when every interaction hurts.” This tells them that you hear their pain, but you have not judged (i.e. you have neither supported nor challenged) their assertion about how they’re actually being treated.
Don't disagree with suicidal people about how bad things are. It’s not about their circumstances; it’s about their suffering, and you can’t measure that from the outside. A message that in any way tries to tell or show the suicidal person that “it’s not so bad” is just another way of saying “I don't understand what you’re going through”.
Describing suicidal behaviour as “selfish” is even worse. The suicidal mindset usually includes a firm conviction that “I can improve the world by taking myself out of it.” Telling them how much their deaths will hurt others reinforces their sense of personal failure.
Never use any kind of “tough love”. If you think they’d be fine if they just stopped feeling sorry for themselves, putting up with abuse, or staying stuck in the past, then you are not the right person to help, even if you’re correct. Chances are they’ve tried to do exactly that, over and over again, and failed. Everything you say to suicidal people needs to be grounded in the belief that they are doing the best they can to help themselves. If you don’t believe that, find them someone else to talk to.
The greatest gift you can give a suicidal person is the experience of being truly heard and understood. At most suicide hotlines, rapport-building takes up the bulk of the communications training.
It seems natural to try and pull a suicidal person out of whatever dark place they’re in. That almost always fails. What works, consistently, is simply to join them in the dark place and offer a non-judgemental, supportive presence. This is so simple that it can seem like doing nothing, yet it can also be so difficult that we can’t imagine how we can ever get it right.
Sometimes suicidal people can be reluctant to talk. Say that you just want to understand, and that you won’t try to suggest anything unless and until they are satisfied with your understanding of their experience.
Your questioning style can make a big difference: asking open-ended (“How do you feel?”) versus closed-ended (“Are you sad or mad?”) questions will ensure that they feel able to express whatever need to. If you ask if they’re “sad or mad” and they’re actually something else (anxious, numb, etc.), you may not get the information you need, and they may feel invalidated.
Help them by naming the emotions that you hear in their story, but which they may not be expressing, nor fully aware of.
Active listening, which demonstrates and refines your understanding, is a powerful rapport building technique. People in a suicidal state of mind usually feel profoundly alone. Saying “I understand” without proving it will often reinforce this sense of alienation. Some ways you can “actively listen” effectively are:
Ask lots of open-ended clarification questions. This shows that you care about getting it right.
Summarise, paraphrase and interpret what you’re hearing. This shows what that you’re taking in what they’re saying, and thinking deeply about it. It also offers them the chance to correct anything that you got wrong.
DO respond genuinely and supportively. If you feel a strong empathetic response to what someone is telling you, share it. This shows that what they are going through matters to you, and that they’re getting through to you.
DO NOT react with expressions of panic or urgency. This doesn't demonstrate a high level of concern or empathy, it telegraphs "I can't deal with what you're thinking and feeling". If you're unable to remain calm, refer them to trained resources and get out of the conversation.
Suspend your judgement and listen. Remember that you’re just building your understanding. You may hear some ugly truths, or even ugly untruths. The point is to understand, to go to the dark place with them, and those dark places are often dirty, smelly and full of evil things. Be ready for that.
Sharing your personal experiences can be a great help in building rapport, but it should be done only with the idea of establishing your “street cred” as someone who’s been in a dark place too. The danger is that they can feel like you’re assuming too much, not listening enough, or devaluing their pain.
You may need to ask tough or personal questions. Your goal is to “map” the dark place as well as you can. You can frame sensitive questions with: “Do you mind if I ask you about <subject>?”
If, and only if, they indicate to you that they feel “heard”, you might try some gentle re-framing of their view of the situation, or exploring options for change. While continuing to stress that you agree with them about how bad it is for them, you can try offering a hopeful perspective, if it's totally genuine. If they reject it, go back to active listening.
Deep rapport with someone who’s suicidal can leave you feeling sad, frustrated, hopeless, or disoriented, even if you’ve really helped. This is why suicide hotline responders are typically required to debrief regularly. Be sure to talk to someone you trust if you find the conversation is weighing on your mind.
Keep your expectations realistic. Even with the best training and resources, sometimes conversations with suicidal people will take a wrong turn. Reaching these people is a tricky business, and not even the experts can get it right every time. Remember too that the immediate response isn’t the outcome. It’s not uncommon for callers to a suicide hotline to tell the responder that they weren’t very helpful, then call back days or months later to say “Thanks, you saved my life”.
It comes out of what has been proven to work at suicide hotlines, and what has been discovered in the latest research into suicide, especially the groundbreaking work by Thomas Joiner's group at Florida State University. Joiner’s model uses three necessary and sufficient factors for suicide risk, and these can help us identify strategies that will and won’t help:
Desensitization to pain and death. We can’t fix this in the short term; it’s acquired by life experience and extinguishes slowly, if ever.
Perception that one is a burden. We can prevent this from getting worse by avoiding solutions, advice, and judgements. We can sometimes improve it by reflecting back to the person things that we genuinely value or appreciate about them, but it has to be utterly sincere. If you can't find something specific, positive, and accurate to say, just move on to the next strategy. By building a strong rapport you may discover some genuine positives that you can reflect back to the person.
A deep sense of alienation. We can always do something about this one by making a deep interpersonal connection, and since all three factors are necessary for high risk of suicide, it's only urgently necessary to fix one. This is why it’s “all about the rapport”!
The "Friends and Family" category at speakingofsuicide.com has a lot of great content, including their best-known post: 10 things Not to Say to a Suicidal Person.
Active Listening Tips for Difficult Conversations from the Samaritans, who are the Jedi of suicide intervention worldwide and another listening tipsheet from PsychCentral, which has a useful list of all-too-common "Conversation Blockers".
If you need to expand your own vocabulary of emotion words so you can help the person you're supporting to name them themselves, the "Emotion Wheel" is the best-known tool to label and categorise feelings.
Classic 1946 paper on what kinds of conversation really help people, by Carl Rogers, the "Father of Active Listening". An easy read even for non-specialists. The list of 6 factors for helpful interactions apply both to professional therapy and peer support, and have truly stood the test of time.
Thomas Joiner's books Why People Die by Suicide (2005) and Myths About Suicide (2010) at Google Books.
By far, the best source of suicide-intervention training available to the public is LivingWorks. A variety of programs are available; the basic level is available online.
Remember, you're never alone. It's tiring, I know, but you got this. You've made it this far, so please continue fighting. I wish you the best. - Vincent
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