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Back in the day...

58 posts in this topic

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I was recently reminiscing with a friend about when we both started EMS back in the early 90s. He still rides and showed me his ambulance. Despite how much we bitch and moan about a lack of progress, the change over time is visible. I figured I'd start this thread so that we call a wax nostalgic about our early days and give the new people a little insight into what it used to be like. This is not meant to be one of those, "This is the way we used to do it so this is the way we should do it now," type of threads.

When I started my basic training in the early 90s, we still used MAST pants and were tested on them on our state exams. We only suctioned the oral pharynx for 10 seconds because that is how long it was comfortable to hold your breath. The ambulance had 3 VHF frequencies, dispatch, switchdown (unit to unit) and hospital. There was no CAD/MDT or whatever it's called.

The jump bag in the ambulance now has a portable, automatic CO detector. There were no CO detectors back then, much less ones that could be attatched to a jump bag. We had to go through 2 separate radios to get to medical control, now it's a simple phone call away.
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Yeah, reminiscing, I started EMS in 1993.

Lifepak 3, Tackle boxes for drug kits

wooden spinal boards

huge suction machines that if you ran over them with a pumper the damn things still worked.

hand operated hydraulic extrication tools

manual d-stick rather than machines that do it for you now

mast pants

no cell phones

did I mention no cell phones

UHF and vhf were it.

If you wanted medical control contact in a house or a building you just picked up the phone and called as long as you had the number memorized.
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LOL, calling medical control from the pts phone. That happened so often. I can just imagine what the families thought. We were still using Thumpers for the first few years. Those were always fun to play with but never used one on a call. We had reuseable cervical collars, infection control be damned.
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[quote name='ERDoc' timestamp='1355151441' post='291301']
I was recently reminiscing with a friend about when we both started EMS back in the early 90s. He still rides and showed me his ambulance. Despite how much we bitch and moan about a lack of progress, the change over time is visible. I figured I'd start this thread so that we call a wax nostalgic about our early days and give the new people a little insight into what it used to be like. This is not meant to be one of those, "This is the way we used to do it so this is the way we should do it now," type of threads.

When I started my basic training in the early 90s, we still used MAST pants and were tested on them on our state exams. We only suctioned the oral pharynx for 10 seconds because that is how long it was comfortable to hold your breath. The ambulance had 3 VHF frequencies, dispatch, switchdown (unit to unit) and hospital. There was no CAD/MDT or whatever it's called.

The jump bag in the ambulance now has a portable, automatic CO detector. There were no CO detectors back then, much less ones that could be attatched to a jump bag. We had to go through 2 separate radios to get to medical control, now it's a simple phone call away.
[/quote]

So glad you started this topic!
I received EMT-A training as a requirement of the LE training I completed in '91. I'm writing some fiction in which two of my important characters are paramedics. One began his career as a cop but switched when he realized that he lived for the medical calls.

I planned to use the application of MAST trousers in a scene. Are you saying they're not used anymore? Why not? What do you use instead? Is there ever a situation in which you'd use them?
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I remember hearing a grizzled old medic say that one form of extrication was taking one tow truck on one end of a car and another on the other and just yanking. C-spine be damned back then.
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[quote name='Roni' timestamp='1355164301' post='291316']
So glad you started this topic!
I received EMT-A training as a requirement of the LE training I completed in '91. I'm writing some fiction in which two of my important characters are paramedics. One began his career as a cop but switched when he realized that he lived for the medical calls.

I planned to use the application of MAST trousers in a scene. Are you saying they're not used anymore? Why not? What do you use instead? Is there ever a situation in which you'd use them?
[/quote]
They don't work. All they do is squeeze the blood out the open holes. The only good prehospital intervention for shock is diesel. You could use them to stabilize a pelvic fx if you can find an ambulance that still carries them. My professional consultant fee has been billed and is in the mail. Be sure to look for it. :showoff:


[quote name='Captain ToHellWithItAll' timestamp='1355164701' post='291318']
I remember hearing a grizzled old medic say that one form of extrication was taking one tow truck on one end of a car and another on the other and just yanking. C-spine be damned back then.
[/quote]

My uncle trained in the days before they were called EMT (think mid 1960s). They were taught how to do trachs and were taught to apply cervical TRACTION on all neck pain due to trauma.
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[quote name='ERDoc' timestamp='1355165168' post='291320']
They don't work. All they do is squeeze the blood out the open holes. The only good prehospital intervention for shock is diesel. You could use them to stabilize a pelvic fx if you can find an ambulance that still carries them. My professional consultant fee has been billed and is in the mail. Be sure to look for it. :showoff:[/quote]

Will do. Thanks for the help!
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[quote name='ERDoc' timestamp='1355165168' post='291320']
The only good prehospital intervention for shock is diesel.
[/quote]

And many times Diesel even won't work.
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When I started in 1971: [yes I'm old ] We were called Ambulance attendants. Our training was basic first aid and little else. We had pontiac station wagons with a raised roof. . only gave an additional 8 inches height. 500 cubic inch motors ,700-15 bias ply tires and sub par drum brakes.
We had an oxylator which was nothing more than a demand valve resuscitator and a first aid kit with some surplus military bandages, OPA's, along with some board splints. we had a jaw screw for siezure pt's and ice bags if we remembered to fill them up at the ice cream stand the family also ran . Every trauma Pt was placed in the mast trousers whether they needed it or not and put on a wood spine board.
Not much else for equipment.
I remember well when the owners bought a radio system for the base, [the family run Funeral home] and for the two wagons. They painted big letters on the side of the fender ,
""RADIO DISPATCHED"".
We no longer had to call in after finishing a run from the nearest pay phone. I know:: most of you youngsters have never seen or used a pay phone. :-}

We had the two man dead lift ferno stretchers, & a folding steel chair contraption that caused more broken fingers than anything else.

Oh how we have changed over the decades.

Now we run in 14000 lb. GVW trucks with boxes that are bigger than some of the apartments I've rented over the years. Fully outfitted with more equipment than the emergency rooms used to have at their disposal.
We do 12 leads as a matter of fact and IV's , intubation along with a myriad of medications at our disposal.

Where will prehospital care be in the coming decades??????

Added a couple sentences for clarification. Edited by island emt
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[quote name='island emt' timestamp='1355168900' post='291326']
Where will prehospital care be in the coming decades??????
[/quote]

That's a topic for another thread!! Which I will start.
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[quote name='Captain ToHellWithItAll' timestamp='1355164701' post='291318']
I remember hearing a grizzled old medic say that one form of extrication was taking one tow truck on one end of a car and another on the other and just yanking. C-spine be damned back then.
[/quote]

I saw that done a couple of months ago.
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[quote name='DFIB' timestamp='1355179581' post='291344']
I saw that done a couple of months ago.
[/quote]
but was there a patient inside? And was he dead or alive?

My bet he was dead.
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[quote name='ERDoc' timestamp='1355165168' post='291320']
The only good prehospital intervention for shock is diesel.
[/quote]

Doc you sure outdated diesel therapy doesn't work. Makes it hard to work and often leads to additional trauma patients.
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Started 1996. Many of the same things as above but I didn't even have an AED until 5 yrs into my career.
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[quote name='spenac' timestamp='1355184703' post='291349']
Doc you sure outdated diesel therapy doesn't work. Makes it hard to work and often leads to additional trauma patients.
[/quote]

Well, they aren't going to get to the hospital without it.
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[quote name='ERDoc' timestamp='1355186781' post='291353']
Well, they aren't going to get to the hospital without it.
[/quote]

If you mean drive safely to ER I agree. If you are saying driving like a bat at of hell I disagree. The few seconds to couple of minutes saved in city services will make no difference. In frontier areas like mine the 5-10 minutes saved probably won't make a difference if they are that bad. But if while driving fast, blowing intersection the ambulance crashes you have lots more patients and the one you were giving a diesel bolus to still dies.
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[quote name='spenac' timestamp='1355188624' post='291354']
If you mean drive safely to ER I agree. If you are saying driving like a bat at of hell I disagree. The few seconds to couple of minutes saved in city services will make no difference. In frontier areas like mine the 5-10 minutes saved probably won't make a difference if they are that bad. But if while driving fast, blowing intersection the ambulance crashes you have lots more patients and the one you were giving a diesel bolus to still dies.
[/quote]

But this is EMS, drive fast or go home. You are right though, a diesel bolus could be a bad thing, especially when used to ignite the pt.
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[quote name='ERDoc' timestamp='1355189413' post='291355']
But this is EMS, drive fast or go home. You are right though, a diesel bolus could be a bad thing, especially when used to ignite the pt.
[/quote]

Hard to explain how the minor trauma became a major burn.
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Started in 1996. MAST/PASG was a well recognised intervention, the EOA/EGTA's were not uncommon, trauma patients received aggressive fluid resuscitation, supraglottic airways were frowned upon, the AED had not proliferated, Carbon-dioxide monitoring was not frequently used or even talked about, bretylium was still around, one of the first paramedic programmes in my state was conducted around 1998-1999 and consisted of just over 800 hours of total training.
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[quote name='spenac' timestamp='1355189719' post='291357']
Hard to explain how the minor trauma became a major burn.
[/quote]

If you didn't document it, it didn't happen. :devil:
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[quote name='chbare' timestamp='1355190802' post='291358']

trauma patients received aggressive fluid resuscitation

[/quote]

That's still what's done around here...
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My favorite seatbelt PSA ever.

http://www.youtube.com/watch?v=v80Nfnc0fCA
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now that was awesome
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We didn't have shows like Turd watch and Grey's Anatomy, we had ER (in the beginning) and Rescue 911.
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[quote name='ERDoc' timestamp='1355254484' post='291395']
Rescue 911.
[/quote]

Where 99.9% of all people never died on that show.
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