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steve_emt_68

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About steve_emt_68

  • Birthday 02/18/1968

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  • Occupation
    Paramedic

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  • Gender
    Male
  • Location
    Nebraska

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  1. In my case, the fact that the regional trauma center wanted to give steroids and the patient had a good outcome would lead a reasonable person to believe that the use of steroids was a beneficial treatment. I believe the initial question asked if anyone had any experience with Solu Medrol and what were they. I gave my opinion and then kicked in the nuts for expressing my opinion. I am to the point of giving up on this site as there seem to be a group who only want to blast anyone who doesn't share their burnt out attitude. Unfortunately those who want to use this site to grow as providers end up getting shot down. Why don't those of you with your bad attitudes go start a new site like crappy EMS providers.com and blast each other!!!
  2. I have personally been involved in giving Solu Medrol for suspected spinal cord injury. I was called for a diving accident where the party was still in the pool and completely flacid. Pt. was removed from the pool and flew him to regional trauma center. When we made contact with the Trauma center, we were given orders to administer 2 grams of Solu Medrol. We only had access to 750mg to administer but flight crew administered what they had and the patient got the balance at the trauma center. Turns out patient had C3 and C4 fracture with pressure on spinal cord. 2 days later patient was walking and today has made a complete recovery. Our service now carries 2+ grams of Solu Medrol on all trucks. This incident made a firm believer out of me for use on spinal injuries in the field.
  3. I personally encourage family members to ride with me. My department performs interfacility transports that last 70 to 100 miles. Having a family member riding in front (seatbelted in) has a calming effect on the patient, eliminates family members from riding our butts for the 100 mile trip, keeps false complaints from being filed against our crews and in the rare case allows family to be with their loved one if they should pass on. I have nothing to hide and therefore have no concerns about "the family" seeing what is going on in the back of the unit. I always size up the family member wanting to ride with us, I inform them of where they need to ride and that they must maintain control if things go wrong. I took a patient from a local hospital to the regional specialty facility. The patient had a 9cm AAA and this was last ditch effort to save the patient. WE allowed the spouse to ride with us so she was at the hospital when her spouse was. She was involved in lifesaving decisions as soon as the patient arrived. Had our patient expired en route, she could have said her goodbyes. We hid nothing and she appreciated the extra time with her loved one. The spouse knew the risks of the trip and was prepared for her husband to pass. Overall, I would not change a thing and I would hope that this would encourage others to review all benefits of having family with you.
  4. If a patient is already using a daily 75mcg Fentanyl patch wouldn't you want to continue with Fentanyl IV for pain control of a long bone fracture versus giving Morphine IV or am I missing something? It just seems like going back to Morphine would be like putting out a forest fire with a syringe.
  5. I am looking for some insight on what other services use as an orientation period for new medic's. We operate a EMT-B/Paramedic crew and we do a combination of Paramedic intercepts and ALS interfacity transports. In the past we have based our orientation on how the medic progresses and how comfortable we feel with the medic. As budgets get tighter, it seems like there is a need to rush medics to the street. What does your organization use as a guideline for orienting new medics?
  6. Trama shears, bandage scissors, stethoscope, forceps, field guide, personal cellphone, work cellphone, alpha-numeric pager, voice pager, wallet, gloves, at least 2 pens, folding knife, carabiner (great for controlling multiple bags/bottles of fluid), and a Tide stick
  7. One of the things you have that you need to keep handy is being scared. What we do as Paramedics is scarry stuff. The first time you take a conscious person and paralyze them to insert an ET tube and you know that their life is in your hands, thats scarry. I have found that having a healthy respect for the skills that you learned will keep you out of trouble. I am not saying that you won't become comfortable with the skills, but rather you need to be respectful of the consequences of using those skills. Someone said it earlier, don't be in a hurry to use everything you learned unless it is necessary. I knew a flight medic who had been in EMS nearly 20 years before she decompressed a chest. When she needed it she used it, but only when it was actually needed. Best of luck to you and congratulations. You seem to be off to a good start as you know you don't know everything.
  8. How about when you mention a patient name, you know you will see them within days. I also have found that every time I have on a new piece of clothing I will get blood or vomit on it.
  9. One of the things that I pushed for and helped make happen was EMS run reviews presented by a nursing clinical manager. We invited all area squads to attend. We also asked squads to volunteer cases for review. We always provided a dinner at no charge and asked at least one physician to attend to give physician insight into the case. We would follow the case thru from dispatch to hospital disposition. We tried to present 3 or 4 cases a night and we did this each quarter. We would have anywhere from 25 to 35 people attend and we gave continuing ed credits. This was a great program, the squads learned from their mistakes but the also got to enjoy what they did right. I don't know too many EMS providers that don't like to know how a patient did after they brought them in.
  10. I personnally like to explain dead as: Dead: just dead DRT: Dead right there, for the moments when someone just drops dead DRFT: Dead right F****** there, for those times when someone is shot dead DRFT & T & T & T: Dead right f****** there and there and there and there, and for those times when they get hit by a train or a semi
  11. In my experience rural EMS forces you to know your protocols better, know your medications better and know the disease process better. Transport times are long, response times feel longer. In the big cities you can practically spit and hit a hospital. Out here in the rural areas, you might be 30 minutes to 2 hours from a hospital. You really do get to see medications work. It is not unusual to work a code on the way to the hospital to have the physician call it when you hit the door, not because you weren't doing it right, but because after 4 or 5 rounds of meds there is nothing left to do. You balance the short term good effects with longer term consequences of the meds (Lasix is a prime example). You have a chance to develop friendships with the physicians and nurses. You earn their trust, they know you by your first name and you know theirs. I also believe that we see more true emergencies and less taxi work. Patients seem to really appreciate what you are doing for them and they regret having to get you out of bed or keep you up late. The best part of rural EMS is getting to know your patients. It is not unusual to pick them up on the 911 call and then transfer them out later the same day. Then in a week or two, you see them downtown. They remember you and you remember them. I can't tell you how many times a patient I transported 6 months ago will seek me out in a store to tell me their story and thank me for the care I provided them even if it was just sitting and visiting with them en route to the city.
  12. I agree that your class only gives you the basics and that you need to research areas where you have questions. As a new EMT, you need to keep it simple. It is not your job to diagnose what is wrong with the patient, you are there to treat the signs and symptoms. I applaude you in that you realize you don't know it all as a new grad. I made it a point to become friends with physicians and nurses that would take the time to explain things to me that I didn't understand. I read alot and asked questions. I have been in EMS for 12 years and still ask questions. A good resource is the American Heart Association website, keep studying and asking questions.
  13. I was very reluctant about the stryker power cot at first. I have come to love it now. Our service is primarily critical transfers so the extra 40lbs is not a big deal. We recommend that both partners lift the foot end to load in the ambulance with one person operating the controls when you have a larger than average patient. I have had a 600lber on the cot and it worked great. I would not want to use it for 911 calls as the additional weight of the cot will catch up with you at the end of the day.
  14. The dispatch center dispatched EMS to a rollover accident with ejaculation. How bad is it when you actually get ejaculated from the vehicle and I guess we know what was on the dispatchers mind.
  15. Why are you embarassed? is it because you can't carry on an intellegant conversation with your partners or because of the care they provide? I have worked with college educated paramedics who scare the hell out of me. They only get the minimum required hours of continuing education. They have the attitude about new things that "I don't know anything about that because I didn't learn it in school". Are these college educated paramedic's PROFESSIONALS? I don't believe they are. Is the guy who took 2 years to take night classes to get his paramedic license less of a professional? What if he goes and takes every extra class possible? How about once he gets his CCEMT-P? Does that make him a professional? I ask all of you, Where exactly in your ambulance do you hang your college diploma? I have never had a patient ask me if I went to college or which college I went to. My point is that the public judges us on our actions. The ER judges us on our actions and dress. Try walking into a busy ER in jeans and a t-shirt and have your EMT-B partner come in with dress white shirt and EMS pants, see who the nurses talk to for report. I will not disagree with you that the more knowlege we have about the human body the better off our patient's will be in the long run, does taking a class in art history really help you in the field. Education is the foundation of our professon, a college degree is not the answer. Professionalism amoungst our providers is the key. We both have differn't approaches to professionalism, mine being personal responsibility. As a profession, we must weed out those who are lazy, carefree and only in it for the money. I would consider this to be the first step in becoming a profession. As far as belittling the nurses whom I work with, I don't belive I belittled them. I stated facts, In the field if a patient needs Adenosine I give it, If they have pain, I can control it. If my patient needs RSI, I do it. I don't ask for permission, I evaluate, assess and act. In the ER if my patient needs Adenosine, I call the on-call Doc, inform him of what is going on and wait for his orders. If they need RSI, I call the Doc and when he tells me I call the CRNA. If you would take the majority of nurses and put them in a cold, dark and wet ditch in an upside down car they wouldn't know where to begin. Try having two nurses run a code and see how that goes. Most nurses will tell you that they wouldn't want our jobs which is fine, I don't want theirs.
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