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  2. 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.
  3. 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
  4. Just Plain Ruff

    second line seizure medications

    so we have to dumb it down for people in 2018????
  5. 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.  

  6. 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.
  7. 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.
  8. 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.
  9. emt2359

    Truth

  10. 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.
  11. emt2359

    MAAH, GET MY BAGS!!

  12. 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.
  13. 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.
  14. Violyn

    Blast Medics

    Hahaha. That is exactly why I did it that way. I'm glad someone noticed!
  15. Just Plain Ruff

    24hr Shifts - Do they need to go?

    I think a lot depends upon the system you work in. if your ambulances are running non-stop all day and all night like many urban systems are - then yes I think they need to go for that system. You cannot have your medics/emt's fresh and alert running 16 calls a day. You just can't. If they cannot get at least a couple hours of good sleep at a time then you are doing your crews a grave disservice by making them work 24 hour shifts. if you have your crews running 8 calls in a 24 hour shift then theres room for discussion. It also depends on how many units you have on the street at one time. If you have enough crews running so they only will run 8 calls in 24 hours then don't get rid of the 24s but if all your crews are running 16 calls in a 24 hour period, then it's time to add more crews. The dynamics are fluid in any staffing situation. there is no guarantee that your crews will only ever run 8 calls in 24 and there is no guarantee that they will run only 16 calls in 24. But the risk of sleep related crashes or drug errors or just plain human related issues that can be directly related back to 24 hour shifts I believe are too great to keep 24 hour shifts unless you have other safeguards in place. Some of those safeguards could be 1. a number of swing shift crews/trucks that are put on the road on the heavy hours of the day (6a-6p, 3p-3a, 11a-11p those types of hours) 2. When you see that your 24 hour trucks have met in their first 12 hours a certain number of calls let's say 6 calls or so, they get a mandatory down time of 3-4 hours and are only pulled out for calls such as major trauma, cardiac arrests and major life threats and only if they are the closest unit. There should be a swing crew covering their area for their downtime. Depending on the type of area they cover this might not be feasible. 3. 24 hour trucks should not be used as transfer trucks if there are swing shift trucks available. And better yet, staff some BLS transfer crews to take grandma and grandpa jake and jane home from the ER. An ALS unit should not be utilized for a BLS transfer, this is a waste of resources. No offense to the EMT's on this forum but that's what they staff BLS transfer units with EMT's for. Again, no offense. 4. NO MORE SSM and sitting at the corner QuikTrip. I worked under SSM for a large portion of my career and I can say 24 hours in the cab of an ambulance SUCKED BIG DONKEY BALLS. I'll never do it again and I hope that no one here ever does it again either. I blame my permanent sciatica partially on sitting in the VAN ambulance at 23rd and Noland Road in Independence MO. I have more to say but if my bosses see me on this website, I'll get my ass handed to me and then I won't have to worry about sciatica anymore.
  16. Just Plain Ruff

    last post was Feb 22

    my brother in law in honor of showing off who we think will be his fiance very soon bought all of us floor seats for the Eagles. I would never look a gift horse in the mouth but I would much prefer a seat up off the floor area because they pack you in like a sardine and my sciatica was fired up after an hour. Thank goodness for coor's light to lighten the pain of the past sins of lifting wrong in EMS.
  17. Just Plain Ruff

    It happened again - same town - 7 months later

    well it turns out that they have charged the woman who told the officers that there was no-one in the home and allowed them to go inside. the prosecutor said that had she have said that there was someone inside then the officers would have gone in in a entire different approach. She is charged with 2nd degree murder. The guy was a felon who should never have been out but he was, his 2nd address basically was the missouri prison system. Both of those pillars of the community deserve what they get and got. The funeral and the outpouring from the community is simply incredible. 900 officers attended my brother in laws funeral in some sort of capacity or another(50 officers patrolled the city and county allowing every county officer to go to the funeral) and the same happened this time. While both officers lied in state, there was not a single minute where Gary's or Ryan's body was not without a honor Guard standing by over their casket. 24 hours a day every day till they were laid to rest. Humbling to say the least. After time to reflect, I'm no longer angry, I've forgiven both the men who did this, I'm more looking to see what can we do to end this all out assault on our law enforcement, public safety and correction officers lives. Yes they know that this can happen but it SHOULD NOT. What can we do as a society to decrease this? I don't really know.
  18. Haha this is an impressive undertaking, you're a stronger one than me for doing it. Great idea, and thank you for doing it! I work in a busy urban service. We'll get between 50 and 70 thousand calls per year with 13 ALS units on during the day, 3 BLS units on from 0700-2300, and 10 ALS units at night. I'm not one to gripe about dumb calls, I appreciate the easy tripsheets, but the level of EMS abuse we see is astronomical. i.e: Tooth Pain, Broken Toes, my kid has a cough and fever, and we were at the hospital today, and it's still there and I want him checked out again. Everyone deals with this stuff, I get it. In an 8 hour shift, it's not unlikely for us to get 6-7 calls for just my ambulance (what a lot of services get in 24 hours for 2 ambulances), and there are days were that's all of our calls, forcing our also high number of truly truly ill patients to wait another 15 minutes for one of our other ambulances to get there. This is some thing, very obviously, NOT specific to my service, but shows a serious lack of education on what's ED appropriate and what's not, and when I try to explain that there's not much the ED can do, they get mad, tell me I'm lazy, blah, blah, blah, totally unaware of how much they are clogging up the system and hurting sick people. I think it would be cool to develop an app with common non-emergency complaints, and the person can select it, and be given more appropriate solutions, or, at what point with them (if there is any) that the patient should go to the hospital. The only big issue I see here, is I'm sure a lot of investors could be cautious with the liability aspect...but it never hurts to throw it out!!!
  19. cekuriger

    Abandonment Question

    That was well-put, good job!
  20. Just Plain Ruff

    Uganda EMS Pilot Project - Comments?

    Your program is inspirational. I so want to get involved.
  21. Inf

    CCEMTP

    So I've been thinking of dipping my toe back into this madness of a field and taking a CCEMTP course - is it even worth it? Not trying to troll but I'm currently making 2x whatever the highest medic salary is, and its purely for the satisfaction of making a difference in someone's life that I would even bother attempting this. Is there such an agency that does inter-facility critical care transport on a regular basis whether its fixed-winged or rotary that does not feel like a regular 'grunt' ALS work of 911 EMS?
  22. jwiley40

    Old folks Still here?

    Been away for four long years. For some reason, an email popped up and reminded me of the site. I totally forgot about EMTcity! I'm back and plan on checking in more often.
  23. Morning all, from cold and icy Missouri! The service I work for has shifted in the last year from Broselow to Handtevy for treatment of pediatrics. In a nutshell, it cuts back on the need to do all of the calculations, especially if you're in a very stressful situation. It works more with milliliters than milligrams. Volume over dosage. With the addition of the app for our phones, I can have a pretty good idea of how much of a specific medication I would need to give BEFORE I arrive n scene. If anyone else is using it, how do you feel about it? Has it helped you? I have been off EMTcity for a few years so if it has been addressed, sorry to bring it back up. Thanks!!
  24. Just Plain Ruff

    NREMT Test

    congrats to you. and NEVER NEVER NEVER Let your national registry lapse for any period of time. I did and I regret it to this day. No way is this old fart going to go back and retake it, and thank god Missouri doesn't require grandfathered in medics to go back and get registry. I can still work in missouri at least until they get a wild hare and decide to make us all go and take the registry if grandfathered in. That will be the end of my having a missouri medic license.
  25. yakc130

    Bariatric Patients

    If they have no desire to take care of themselves, there isn't much that you can do for them no matter how hard you try.
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