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  3. Richard B the EMT

    Paramedic vs. Firefighter/Paramedic

    I'm retired from the FDNY EMS Command. There, I was mission specific EMS, as were my brother and sister EMTs and Paramedics. We didn't fight fires. The Fire Fighters had to be CFR-D (Certified First Responder-Defibrillator) trained, as per the dispatch matrix, some calls also automatically had an Engine company sent along. The Truck (Ladder) companies.would be sent for motor vehicle collisions. Now, numerous Fire Fighters, outside the paid FDNY, are members of Volunteer Fire Departments, both inside and in nearby counties to NYC, that also run Ambulance/Rescue, and are crosstrained FF-EMT or FF-PMs. In the FDNY, however, they are only utilized as FF/CFR-Ds. In the FDNY EMS, again, even if the personnel came from one of those VFD-EMS/Rescue agencies, they're only utilized as EMTs and Paramedics. We do, however, have a small group of "Rescue Medics", trained in several rescue techniques, such as high angle rope rescue. All FDNY EMTs and Paramedics are trained ("Haz-Mat Awareness") to operate in Haz-Mat "Warm" zones, with specially trained members ("Haz-Mat Technicians and Instructors"), including the "Rescue Medics", as operators within Haz-Mat "Hot" zones. Within the FDNY, it is considered a "Promotion" to go from any level of the EMS, to being a Fire Fighter. Pay is actually higher than Paramedic Lieutenant, as a rookie Fire Fighter. To the original poster, this probably won't help your situation, but will explain the world I operated in from 1996 to medical retirement in 2010. Good luck in overcoming your Acrophobia.
  4. Just Plain Ruff

    Assaulted on the job?

    too many times to count, only once did the prosecuting attorney do a damn thing about it. The rest of the time was told, the guy was drunk, on drugs, a psych patient or myriads of other reasons why he wouldn't be charged. But assault a cop or a firefighter and they get the book thrown at them. NO WAY am I discounting those charges against the officers or firefighters. If you understood my history and family history of assaults on police officers you would understand why I have NO problem with throwing the book, digging a hole and burying the suspect 6 feet under with as much fucking cement that the 6 foot deep hole can hold. ruff
  5. emt2359

    Assaulted on the job?

    I was reading the article about the Woman sentenced to prison for biting paramedic and it made me wonder how many of you have been assaulted so I created a poll. Share your story below.
  6. Just Plain Ruff

    second line seizure medications

    so we have to dumb it down for people in 2018????
  7. Arctickat

    second line seizure medications

    Why do we use a verb for aggressively grabbing something to describe someone who is having a seizure? To Seize is to grab something. To Seizure is an active convulsion due to illness or trauma. I have actually had doctors confused when I stated the patient was seizing because their interpretation of the word was that the patient was grabbing for stuff. Now we use "Seizuring" to avoid further confusion.
  8. I really didn't mean to poke the walrus.  His post was confusing and he left a lot to be interpreted to guesswork.  I think I hurt his feelings.  No offense was intended in my post.  

  9. Spock

    second line seizure medications

    Recently, one of our crews responded to a 30 year old female seizing. Upon arrival, they found she was one week postpartum and they called me for backup. We worked her up as eclampsia and gave six mg of magnesium and ten mg of versed but she never stopped seizing. They had initially suctioned her and assisted respirations with a BVM but when I arrived she was breathing and I had the paramedic student keep the BVM sealed and do a jaw thrust. Sat was 100% and ETCO2 was 40. I did not want to intubate her without RSI drugs so we maintained her for the 15 minute transport. Turned out she had a brain tumor with a malignant biopsy result. Sad in more ways than one. Remember what Doc said: Paralysis does not stop the seizure, you just can't see it. Good second line drugs are keppra and propofol. Of course keppra isn't found prehospital and if you use propofol, you better intubate. Spock
  10. DFIB

    Paramedic vs. Firefighter/Paramedic

    It has been a few years but I used to do both Fire and EMS. I was in the third world and and hate smoke but Fire was the best way to do high angle rescue. I always volunteered and absolutely love EMS . If you love medicine, go for it,
  11. I know the feeling. I quit posting here about the same time I quit practicing. I might try posting a little just to see how much I have forgotten. Enjoy your class friend.
  12. Oh this one of those forums. Hey asshole don't worry last time I ask a question here. Btw if this is the way you respond to your patients you should go back to class learn how to talk to people.
  13. Your post is confusing, how are you going to get better as a driver except to drive? I don't know of many EMT jobs that don't require driving as part of their duties. Plus, what medical knowledge are you not keeping sharp while in nursing school. If I were you, I would concentrate on learning the nursing school part and leaving EMT behind because in Nursing School you will be learning so much more than what an EMT will learn. CEVO/EVO is not a bad thing to take, it will make you a better emergency operations driver but if you really are that crappy of a driver in real life, it won't make up for the lack of you being a crappy driver. I would personally start out with maybe a drivers education course to begin with. Of course this depends on why you have such a bad driving record - is it tickets or speeding or wrecks or what exactly is your issue? If you are going to come back with DWI - don't bother responding.
  14. I don't have a good driving record but I have a friend who told me the company he works for has him as an EMT with a driving restriction since he also didn't have a great record so I've decided to just not drive anymore and gave up my car so to clean up my record. Anyways, I digress. I still have an active driver's license and would like to know if going through the CEVO/EVO training would be worthwhile. In general, I'm just very interested in learning the whole process. I'm also a nursing student so I like to keep my medical knowledge sharp so decided doing EMT while in nursing school. Thank you in advance for your input!
  15. 1EMT-P

    The aggressive methamphetamine patient

    I am starting to see more & more Meth related calls. It’s not uncommon for the patient's to have elevated temperatures with altered mental status and they can and do become aggressive.
  16. Arctickat

    Back braces for the job?

    The four point box is a fantastic back exercise. I used to always tweak my back until I started doing these. Here is what it looks like: http://jennfit.ca/blog/four-point-box-exercise/ Try to hold the pose for 15 seconds at a time, then switch sides.
  17. yakc130

    Back braces for the job?

    Maybe try doing some weight training. I think deadlifts might be the exercise that you want to do. That motion is similar to lifting the cot.
  18. emt2359

    Truth

  19. rock_shoes

    The aggressive methamphetamine patient

    We're essentially walking the Ketamine path right along with you. Big dose IM Ketamine for this indication is starting as a trial in one of our urban zones now and will likely be extended to the rest of the service by the end of the year. We've used Ketamine for all kinds of indications in air-evac for a long time. It's new to street level ALS practice in BC.
  20. rock_shoes

    Discussion: top 5 medications

    1) Ketamine 2) Epinephrine 3) Ancef 4) ASA 5) Benadryl If I only get 5 they better be flexible in their use.
  21. emt2359

    MAAH, GET MY BAGS!!

  22. What are we supposed to get from an abstract? I couldn't read the whole study so all I can say is that the authors are saying that mask ventilation isn't inferior to intubation. Unless someone has passed the pay wall for this journal, no one else can make any coherent statement either. "Not inferior" is being used as a a statistical term here and does not have the same significance as a conversational "just as good". Abstracts are useless, really.
  23. Off Label

    second line seizure medications

    Paralysis.
  24. rock_shoes

    second line seizure medications

    Ditto regarding the maintenance of paralysis in our service. We avoid it if at all possible with these patients. I've found Ketamine/Propofol for maintenance of sedation (plus or minus a loading infusion of phenytoin) really give any further seizure activity the old one two punch.
  25. rock_shoes

    FENTANYL AND CARFENTANIL

    Working in the Vancouver area I've seen a number of these overdoses. Management isn't really any different than any other opiate overdose. The only real differences are how long it takes to get the correct amount of naloxone on board and the probability the patient has aspirated. There are two main issues to keep in mind. 1) Always oxygenate and ventilate before naloxone to prevent wildly swinging hypoxic patients who come up angry (they probably still won't like that you've ruined their high but at least they're not taking a swing at you). If you're unable to get the patient oxygenated with good quality BVM ventilation and an FiO2 of 1.0 within 5-10 minutes of treatment, naloxone is no longer your friend. In these cases the patient has likely aspirated significantly and you're typically better to leave the patient down for intubation/ventilation. 2) If you're dealing with fentanyl or carfentanyl it will take boatloads of naloxone compared to what you typically expect. Instead of 0.4mg to 0.8mg IM or IN it may take in excess of 8mg IV. If that's the case setting up an infusion after bringing them around may be your best bet if you have the option. Expect to need roughly the amount it took to bring them up per hour immediately post rousal.
  26. This particular study tells us absolutely nothing about inferiority/superiority. I don't see any confounding factors accounted for such as intubator skill level or cause of arrest, nor does the study have sufficient overall numbers to draw any conclusions. The study arms are broken in to "initial management with ETI" and "initial management with BVM". What's the time scale here? Does initial management with BVM mean the first 10 minutes of the arrest or the entire arrest management period? Does initial management with ETI mean at some point early on when other more important interventions have already been started or essentially when the crew first walks in the door? This study leaves far more questions about it's own validity than it does about the harm vs. benefit of early ETI in cardiac arrest.
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