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No amount of training can prepare you for what happened that night. We pulled over at first thinking someone got hit by the car sitting on the side of the road and next thing you know we see her being dragged across the road. All I could do was yell for him to let her go and watch his hands to make sure he didn't have a weapon. Once he got her into the car we knew our best action was to alert the police and keep track of there location till police arrived. It's nice to be reconized for doing something like this but we must remember how many other great deeds were done by our brothers in EMS and Fire that night there are many of us that stand the line and do whats right and perform heroic acts 24-7 and to all you I'm proud to stand next to you all.

So I'm hoping for some positive involvement in this topic. This is not a hate thread as I love what I do and at the same time I hate going to work. The frustration stems from working in private ambulance for the past 5 years. I realize we are not all Rhode Scholars in EMS, (I have met many truly brilliant people in my career) but we are paid horribly and treated with even less respect by our employers. How many of you go to a station that the health department would condemn in any other situation yet our employers continue to allow to deteriorate? How many of you have supervisors that are not there to help you do a better job but are there to wait for you to make a mistake and discipline you? I know this sounds like venting but it's not really. I want to make a change in EMS. I still hold on to ideals that one person can start the ball rolling for change. So here are the issues that are important to me. See if you have the same or want to add some. Let's get together as a community and start to support one another. Issue #1: We may not spend 4 years going to school to be an EMT or Paramedic, however we do have to treat the sick, injured, and yes stupid with a smile and the best effort. Sometimes we even take part or are a major factor in saving someone's life. So why not pay us what we are worth? I mean I'm not talking $100k incomes but $8-9/hour for an EMT, $10-12/hour for a Paramedic...seriously? Issue #2: Public perception is a huge one. The west coast has glamorized being a firefighter...mostly after 9/11. Firefighters in the LA area often make more than $125k per year and rarely run fire calls. 90% of emergency calls with fire departments in the LA area are medical, yet private ambulance is who transports these patients and provides care are not acknowledged. I love my fire brotheren as I was also a reserve firefighter/paramedic. However, I will have to say this, not to be hateful, but the LA area has some of the poorest quality paramedics of any system I have ever worked in, yet the EMTs are some of the hardest working. So how do we change the public perception of us? How do we change how our employers perceive us?

Hey guys, I finally got permission to release a case report of a quite interesting case my former service had. I really would be happy to hear some opinions on this one. DISCLAIMER: THIS IS NOT AN AUSTRLIAN CASE ALTHOUGH I USED AUSTRALIAN QUALIFICATION NAMES. I simply could not find better names for the real "non-english" qualification of the people involved. Caller Statement: Young female, breathing difficulties. An ALS Truck, staffed with one Intensive-Care-Paramedic(10 years total expierence, 5y as graduate paramedic, 1.5y as ICP) and one advanced-care paramedic/EMT(5y expierence, in traning for ICP-paramedic) is dispatched to a remote country hotel. The service operates a "clinical decision model" where only a few guidelines (for resus&trauma) are established, there are no mandatory protocols. The weather is 32° Celsius, no clouds, the next basic care hospital is 22 min away from the scene, the next trauma-center 45minutes. The travel time to the scene is 17 Minutes. On scene the team is awaited by hotel staff and brought to the third floor of the hotel where they find a approx 30 y/o female sitting on the ground of a hotel room with a normal skin color who is remarkably agitated and extremely hyperventilating. A verbal approach/ "talk-down" to the patient seems not possible, the patient reacts with increased agitation to that. Therefore getting a direct patient Hx is impossible. The accompanying spouse informs the team that the patient had a recent miscarriage with a highly traumatic curettage 10d ago, no further medical history, allergies or medication is not known. The spouse suspects a psychotic episode as the psychological situation of the patient was degrading during the last days. The attached pulsoximetry shows 98% SpO2 and a HR of 100, getting a BP is impossible due to the patients movements. The auscultation of the lungs shows no abnormal diagnosis. There is no evidence of a further neurological problem visible, the patient is moving all 4 limbs with similar force, is able to identify persons, the pupils react PERL, the speech appears normal and the patient is speaking complete sentences, although not being orientated to person, situation, location or time. There is no evidence for a intoxication, the spouse was with the patient for the last 24hours and packed the bags of the patient. After further attempts by the spouse and the team to establish verbal contact with the patient failed the decision is made to sedate the patient, as a working diagnosis a presumed psychotic episode following the miscarriage is used. One arm is fixated and a 18G placed on the forearm without any problems. After securing the IV access and confirming the placement 4mg of Diazepam are administered. After awaiting the onset the patient appears to be a bit less agitated but still confused. Now taking a BP (110/70mmHg) and establishing a 3 Lead ECG (no abnormal diagnosis beside mild sinus tachycardia) is possible. As the patient still appears to be too agitated to securely transport her another 2mg of Diazepam are administered. After the onset of this dose a first attempt to transport the patient is done but due to the confined spaces (extremely small staircase, transport only in the carry canvas) and the fact that the patient is still trying to jump of the carry canvas the attempt is cancelled another 2mg of Diazepam is administered. After the onset of this dose the patient is now sleepy but opening eyes to pain (GCS9), has intact protective reflexes and a SpO2 of 98% on room air, HR90, BP as above. Another auscultation still shows no abnormal diagnosis, the hyperventilation has decreased, the RR is normal. A short palpation shows no abnormalities beside a small haematoma on the elbow. The patient is now again put on a carry canvas and carried the flights down, with a stop after each flight to recheck the airway and breathing. On the ground floor the patient is brought into recovery position and the airway and breathing is checked again. The patient now has a SpO2 of 95%, takes 8-10 deep breaths per minute and is maintaining her own airway. Now the patient is brought into the ambulance and is there observed by the advanced care paramedic while the intensive care medic is trying to get further medical history from the spouse and inform the receiving hospital, observing the patient thru the open door. After a few moments the advanced care paramedic notes a change in the skin color of the patient and immediately asks the ICP to join again. The SpO2 is now degrading rapidly, to 80% at the moment. Now a bradyarrythmia is noted with a frequency of 40. The patient is now rolled on her back and ventilated with bag valve mask with is no problem at this stage but within 20 seconds the patient goes straight into asytole. CPR is started by the ICP from the "over the head" position to allow the ACP to attach defib patches and to call for air-ambulance backup. Directly after this the patient receives the first dose of adrenaline (1mg) IV thru the IV-Line placed before. While doing CPR within the first minute the ICP notes increasing ventilation pressure and tries to place an oropharyngeal airway (Guedel). After two further ventilations (by now the ACP has taken over compressions) light-red blood comes out of the OPA, a minimal airway trauma from the insertion of the OPA is suspected and the OPA is removed. By now a large amount of light red blood is noted and the airway is first cleared manually and then my electrical suction. Another 30 seconds later the ventilatory situation degrades again and another huge amount of bloody fluid has to be removed from the airway, the patient at this stage lost approx 400ml of fluid thru the airway. Now the patient is intubated conventionally with ongoing CPR and without any problems.(7.5 ETT). Deep endotracheal suction produces another 100ml of bloody fluid and (increasingly foam), the capnography still shows 35mmHg. The auscultation shows wet rales on all four quadrants. The SpO2 under compression gives a value of 88% back. After the second adrenaline the patient goes into ROSC with a slightly tachycardic sinus rhythm. A good peripheral pressure of 130 to 90 mmHg can be taken, the ventilation is continued and a PEEP of 5 is started. After another 20-30 seconds the patients starts breathing against the tube and to bite on the tube. After another 40 seconds the patient goes into bradycardia (HR of 30) for about 30 seconds, after that directly into asystole. CPR is resumed and another 1mg of adrenaline is given. The ventilation has to be stopped soon as the airway again is again soiled with a massive amount of foam and fluid, almost 1l of fluid are now taken out of the airway. After another 90 seconds the patient goes into ROSC again, the situation is similar to the previous ROSC. The attempt to battle to onset of the bradycardia with continuous adrenaline administration and atropine IV failed, the patient goes into asystole after a short time. Within the next 3 minutes of CPR another 2mg of adrenalines are given (2x1mg), the airway is cleared two times of smaller amount of foam/fluid and a exjug is placed. Following this the patient again goes into ROSC for another 60 seconds. After the onset of the bradycardia pacing is attempted and remains successful for about 1.5 minutes (with good peripheral pressures) before the reaction is degrading and even increased energy does not show any results. CPR is now continued again. At this stage during CPR the patient has good peripheral pulses with a SpO2 of 87% and a CO2 of 30mmHg. Within the next 4 minutes the air ambulance doctor takes over the lead. He increases the PEEP pressure to 15. Further adrenaline is given, the airway is again cleaned from smaller amounts of fluid a few times. To reduce the chance of equipment failure the monitor is changed to the monitor of the air ambulance as the good SpO2 and especially CO2 parameters appear not logical. A further "all body examination" is done with no results. A few smaller episode occur but after further 30 Minutes of resus the patient is declared dead on scene. As the dead is treated as suspicious the dead is investigated by the authorities. The coroner's report later on states that more than 50 small size pulmonary emboli where found in the patients lung with another huge embolus in the uterus. Further investigation of the treatment by the local control boards and the coroner where done but no obvious mistake can be found. The use of intra-arrest- lysis is discussed but two different coronial experts state that even if administered (lysis was not available at any stage) when arriving at scene the patient would have nil chance of survival.

I have almost no experience with the west coast area, not in the last 5 years anyway. Are you sure about the firefighter wages? I live in the midwest and while firefighter are making at least triple what I make 125k a year is a bit shocking. My company went out of business this saturday and one of the reasons they cited in their "don't let the door hit ya" letter was the fact that the state was simply not paying them for any public aid runs we did. They were cutting costs for the last month, most notably when we were told to purchase our own gloves. Gloves are cheap but when you're making less than 10 bucks an hour it is a little frustrating. BSI or a non ramen noodle based dinner? Decision, decisions. Alas, such is life in this decadent age. Regarding issue 2 I understand your frustration. Personally, all of my coworkers were pretty amazing, particularly the paramedics. I LOVED working the ALS shifts. Not just because we tended to get the more interesting calls but due to the opportunity of working with and learning from some really great medics. As far as fire fighter glamor, well.... Just to get the ball rolling, let's consider the Hollywood perspective (In honor of your location *stage bow*). Best firefighter movie? Many would say Backdraft. I certainly enjoyed that movie and it did portray firefighters as serious hero types. Best EMT/EMS movie? Probably Mother, Jugs and Speed. A bitter EMT packing a big gun while hilarious hijinks, most of which portray the private ambulance folks as idiots, ensue. FF's 1, Privates 0. How do we change perceptions of the public and our employers? First, we get educated. As soon as I find a reliable job so I can avoid cardboard box living, I'm signing up for medic school. I'm still hoping to start before the end of the year. *fingers crossed*. Obviously EMT's who are happy with their current level of training and treatment options won't like that answer. It's a shame but it's about the only realistic chance I see at improving our value. Frankly, our class was extremely condensed at around 200 hours (with clinicals) and some states use classes that are half that. Fully half the class revolved around anatomy and physiology and I'm willing to bet that almost all of that is omitted from some states requirements. I'm looking at you Illinois! I'd love to see the basic emt requirements go up to, say, a 12 month course. Include phlebotomy and expand our protocols to include, oh, how about BGL testing? I can do it to myself twice a day but not a patient? How about some pain management beyond "bite down on this here plastic stick and we'll drive real fast mkay?" Why not take the current 10-12 month medic course offered by hospitals into the basic course and have the medic program stretched to 2 years like it is at Ivy Tech and most other colleges? And no grandfathering. EMTs who don't want to deal with it can be reclassified as EMRs. EMTs who take the new class can get paid a livable wage. Medics can take their associate of paramedicine degree do a 6 month nursing bridge if their back or knees go out or they just get sick of the rig. Now I admit this isn't a perfect solution. EMT's who feel happy with their treatment options will resent being dropped to EMRs. Employers will be enraged at needing to pay more than $9.50 an hour. Hospitals will be furious that... hmm. I dunno, they'll probably be mad at something . Anyway, I'm just brainstorming here. Let's hear what everyone else has to say. I'll check back on this tomorrow. Gotta get some sleep. Interview at 1100!

I had always considered myself on the side of those who oppose physician-assisted suicide, until I cared for my father when he was in end stage cancer. I wouldn't wish what he went through on my worst enemy, and if he could have moved to take his own life, he would have. The pain he endured was horrible. The stress it put on my mother, and my sisters and brother, were horrible. He hated every second that he stayed alive the last few days. It was all I could do, to not fill him full of every med I had at my disposal, to put him into a deep sleep that would allow his escape from his pain-filled life. He was very adamant that he did not want any life-saving interventions but it was unfortunate that he was not allowed to make the decision to end his life how he chose once the pain and suffering became unbearable. Some of the posts here express concern about ending one's life like this becoming a casual event, that patients and doctors will make this decision like they decide whether they want an extra shot of cream in their coffee. It has to be the decision of the person who is ill, not the family, not the doctor. I don't believe that it will ever be a casual event, or that we have to worry about doctors using it as a regular form of treatment. With proper education, most people are smart enough to make their own decisions. We try to educate our patients on the treatment options that they have. Why can we not do the same in this situation? People with debilitating diseases are generally informed about the progression of their disease, the signs and symptoms that will appear, and the deterioration of their quality of life. With that information, why do we not allow them to make the decision that will allow them to escape that pain and suffering in the way they see fit? My personal opinion is that by withdrawing treatments eg feeding tubes or medications, and then allowing the person to starve, or allow a slow organ failure, and accepting that as a more appropriate treatment than the person deciding to have a quick, less painful death through some other means, is merely a way of splitting hairs to distance ourselves from the negative connotation of "suicide." By allowing the slower, more painful, less dignified death, we can comfort ourselves that the person "died naturally" rather than "suicide." But who did this truly benefit? Definitely not the patient. And in the grand scheme of things, isn't the patient our first priority? Isn't patient comfort supposed to be one of our basic treatments? If or when that day comes that I have such a debilitating illness that I cannot care for myself, that I am a burden to others, and that there is no quality of life, I will do my very best to take those steps to ensure that I do not linger.

http://articles.mcall.com/2012-07-19/news/mc-c-emts-intervene-in-rape-at-marriott-hotel-20120719_1_emts-bethlehem-township-police-marriott-courtyard-hotel Couldn't post a link Dwayne?

Do not ever say " holey shit what the hell happened to you" They tend to get a bit up tight after that And yes I have said that once

This is really common, in fact I'd bet that we all had the same issue... I'm willing to bet that you're freezing up from overload. "What do the protocols say?" "What do I believe I should do?" "What does my preceptor think that I should do?" "What does Fire think that I should do?" "What do people think that I look like when I'm doing it?" "What if I'm wrong?" "What if I make a mistake?" "What will the ER doc think of my decisions?" Sorry Brother, but you have to say fuck all to all of the internal dialog. You're pushing to be a medic now, no longer a student. You're fear is very self indulgent and you've lost the right to such frivolity when you're faced with a patient. Only only line of thought above applies, can you guess which one? I had a hell of a time for a bit because I wanted the very best for every patient. I'd think, "Holy shit, they're bleeding and in terrible pain! You've done this before, you should take care of this patient, I'll get the next one until I get more comfortable..." There are no 'next ones' now Brother, every, single, one, is yours and you either step up and care for them or you don't. Those around you will keep you from running off into the ditch. Unless they step in, just do your thing. If they step in, learn from it and get better. But you MUST stop playing the "What if/what are they thinking" game. Accept that you are going to fail sometimes in front of all of those people. It's going to happen, I guarantee it, just as they've failed in front of others. But if you don't limit your line of thinking you're going to continue to fail every time instead of sometimes, right? You no longer have the right to play the, "I can't do it" game. You CAN do it. Now stop screwing around with all of the nonsense, focus on being A MEDIC, not a timid cog in the machine, and get amongst it my friend... It's not going to get easier and give you your opportunity to be a medic. Like me, like everyone else, you're going to have to choose to step up and take it. Until then everyone around you is going to see that you're trying to pretend to be a medic instead of choosing to be a medic. See? You've got it Brother....

You know Brother, it may seem that folks are just bagging on you, but they're not. You want to run IV fluids, right? The problem that arises as you begin your new medical career is that you see people run them all the time on TV, and you see medics starts lines and run fluid all the time on scene, so it appears that anyone can run fluids. I get that, but it's really a false view of what's going on. You did well by coming here for advice, but then you stopped participating after you didn't get the easy answer. But you know what? There isn't an easy answer. There is a short answer... The saline is added to try and match the electrolytes in the fluids to the electrolytes in the body in an attempt to approximate a homeostatic relationship to try and prevent radical fluid shifts into or out of the vascular/interstitial systems. Do you think that I tried to make up big words and make that as complicated as possible? Truthfully, that is the simplest explanation that I can think of. And I'm easily one of the dumbest people here. If that is all that you know about running fluids, or why there is salt in the water we push into people's veins, then you have to stop pretending that you want to do medicine and admit that you're simply an ignorant whacker that wants to look like a hero in front of the chicks and his buddies. Be better than that. Show that you actually have the balls to participate in EMS instead of simply pretend to participate. Come back and explain the paragraph above to the best of your ability after doing a bit of Googling. Not cut and paste, but in your own words....we'll walk you down the path, help you all that you need and more...but you've gotta pay to play man... We're not jerking you around because it's fun, but because it's good for you. If you really want to be an EMS provider prove it by doing the real work on this subject as it is vital. Of course, you've probably already gone to one of the other sites where they gave you the answer and told you what a hero you are for wanting to help people...If so, I'm sorry for that. They lied to you, and cheated you out of an opportunity to be better today than you were yesterday. If being better is not your goal then get out now my friend because you'll always be ashamed of yourself when you work around people that are truly dedicated. Because those people have been trying to be better today than yesterday for weeks, months, years, some here, even decades. That is what makes them really good medical providers. You want to knock the socks off of your teacher? Show the class that you came to play and that they'd better amp up their game if they want to keep up? Then understand this presentation when you give it instead of just parroting a bunch of crap you found online like everyone else is going to do. I look forward to your thoughts and I hope that you stay to participate. There is nothing at all foolish or stupid about your question. Many here can learn from this discussion. Show that you have a true EMS spirit...don't cheat them out of it... Dwayne Edited for poor grammar and typos. No significant context changes made.