theotherphil

I work for North East Ambulance Service, previously TENYAS before the merger.

I tend to use the smelling salts on patients who are obviously feigning unconsciousness. You know the type....you can see their eyes moving. When you lift their hand above their head and release it, it conveniently doesn't hit them right in the face but flops to one side. I have never seen anybody resist smelling salts before.....they smell vile and make you wanna hurl at the slightest whiff. When concentrated in a mask the unsuspecting punter usually does hurl. But, there is an exception to every rule. I had a lady recently who had been arguing with her boyfriend. He disappeared down to the local shop for a packet of cigarettes. On returning 5 minutes later, he found her "unconscious" with an empty 20 packet of paracetamol close by. She was a big girl and there was no way I was carrying her down 2 flights of stairs when she was clearly feigning. I told her to sit up and stop messing about....paracetamol doesn't make you go unconscious. I could see her eyes moving, she was swallowing and her hand wouldn't hit her face when I released it above her head. She resisted a sternal rub, the pressing of a pen to her nail bed and a pinch of the ear lobe. This lady was good! I decided to use a nebuliser mask with a bottle of smelling salts jammed into the hole where the medication bowl usually goes. She took it without flinching. My colleague and I were gob smacked. She wasn't going to beat me though so I left the mask on and told my colleague I'd be back. I went to the vehicle to grab a size 8 NPA and some KY. I lubed it up and started to insert it down the lady's nostril. She screwed up her face but refused to open her eyes until it hit the back of her throat and she started gagging. Her boyfriend then started to wretch in sync with her. I told her to open her eyes or she'd be getting a bigger tube down her throat. She immediately opened them and went to GCS 15 in under a second. She went mental at her boyfriend for "putting her through all this". If she'd only opened her eyes when I told her to :roll:

We went to a 17yom last night, taken an overdose of 40x 500mg Paracetamol (acetaminophen) literally five minutes previously and living right across the road from the hospital. I knock on his front door and he steps out and locks his door and says "Shall we?" I reply, "Shall we what? I don't dance with other guys young man!" Another call last night to an elderly lady who had fallen out of bed in a care home. Obvious #NOF. She was covered in a blanket. Before removing the blanket to assess, I ask her if she is wearing any panties. She replies that she is. I said without thinking "You're obviously not from around here then." Cue funny looks from the female nursing staff.

We got called to a 20yof, 38 weeks pregnant, birth imminent. I casually walk up to the door and ring the bell. A large hysterical young lady meets us at the door. I calmly say, "Hey, stop jumping about like that and keep your legs together or you'll drop right there." She replied, "it's not for me - my mate is through there."

Yeah, our trust doesn't carry the Hydrocortisone yet but it is in the pipeline :wink:

Quite a few of us here carry personal dosimeters and are SORT team trained.

As an EMT in the UK, my basic is £25,500 pa (~$48,000 US) Paramedics earn £31,750 pa (~$59,800 US) Overtime is @ time and a half for anything over 37.5hrs.

I use them routinely on people feigning unconsciousness...you know the type - just taken 20 paracetamol 5 minutes ago and is now "unresponsive". They work great usually. For added effect, take one nebuliser mask and replace the bowl on the bottom with the opened bottle of smelling salts. Inform the patient you are going to give them a little O2 to "help bring them round" :twisted:

Pen and pen torch in L arm pocket Bottle of smelling salts in L shirt pocket L cargo pant pocket has 2 pairs of gloves R cargo pant pocket has my steth Belt has a Benchmade Rescue hook (cuts through any material like a hot knife through butter) Mobile phone That's it....we have a saying around here - never trust a medic with more kit on his person than on the vehicle

I use a Littmann Master Classic II

A lot of us NHS medical staff work privately in our spare time to cover events. This is a good way for private companies to utilise highly skilled staff that they would never otherwise have had access to. Some of us get to travel worldwide covering large sporting events like the World Rally Championship as medics for specific teams who are willing to pay for quality, experienced staff.

I love my job....from using my brain and skills at the real jobs to the entertainment of the idiotic British public

Some good points raised so far. We are switching to yet another priority based system on the 24th of this month which will see (hopefully) our workload drop. No longer will we be obligated to attend every 999 call. Our call takers will be triaging as usual but much more in depth. Any call identified as suitable for referral to other pathways, will be.....be it dentist, GP, Emergency Care Practitioners or even telling the punter to make their own way to hospital/ get a lift from friend or family. It seems we are heading back to being an Emergency Service, not a general health/ social service.

Yes, I agree. In remote places, first responder schemes are usually in place and sometimes in co-operation with the Fire Service. Where I work, we do have sattelite Stations and roadside standby points where crews standyby based on predictive analysis software in the control room. Lol, we haven't had protocols over here for a long time....they expect us to rely on common sense (dodgy at best ). Although we have these times to meet, it is supposed to be done by ensuring adequate vehicles are available in strategic points to respond to an incident in a given area.....not by driving accross the county at break neck speeds. When fully manned, the system works beautifully. If shifts aren't covered then we don't have the blanket coverage needed to reliably meet the targets. The onus of responsibility to meet the targets is on management having sufficient vehicles on the road. We certainly don't put ourselves at risk to meet a government time....far better us arrive in one piece than not at all.

That's great guys, thanks! Obviously it's easier to enforce a national standard when the size of the UK will fit into one of your states :wink: Over here, people make a big deal of a "postcode lottery".....they believe that you should have the same access to NHS resources no matter where you live. Waiting for 30mins + for an Ambulance doesn't go down too well, as was highlighted in the thread I mentioned in the first post. It is considered a failure if we reach a Cat A call in 9 minutes and the patient lives but a success if we reach a Cat A call in 7 minutes and the patient dies :shock:....it's all about targets nowadays with management not being bothered about patient care. Many thanks!

Hi there, after reading a post in the UK forums from a US medic critisising the response times of the UK Ambulance services, I thought I'd ask how things are done in the US? It'd be nice to compare and contrast the differences. Here in the UK, the government fund the NHS and as such, is free to set targets as it sees fit. Firstly, we have 3 main categories of incident: • Category A - Life threatening conditions where rapid intervention may positively influence the eventual outcome of the patient. • Category B - Patients whose condition is serious but not life threatening. • Category C - Patients whose condition is neither serious or life threatening. EMERGENCY RESPONSE STANDARDS (ORCON) The response standards are very much linked to the severity of patients’ conditions and specify that: - • 75% of all life threatening emergency incidents (Category A) to be responded to within 8 minutes. • 95% of Category B incidents to be responded to within 19 minutes. • 95% of Category C incidents to be responded to within 60 minutes. In addition to this, there is a 3 minute activation time (time from emergency call being made, to getting a vehicle moving) which needs to be met in 95% of cases. This 3 min activation time is included in the response time.....eg, if it takes 3 minutes to take the call and assign it to a vehicle, the crew then have to reach the scene of a Cat A call in 5 minutes to hit the required 8 min response. Fast response units (single manned Paramedic cars or bikes) can be used for Cat A incidents and they must be backed up by a regular ambulance within 19 minutes in 95% of cases. As you can see, these are quite strict targets to meet especially when you consider the type of terrain in the UK.....rural and urban with a lot of traffic most times. Is there any sort of standards in place in the US with regards to response times? Are they nationally agreed targets or local to individual states? Who monitors adherence to the standards and what happens if they are not met? Many thanks!

Call to a female Police officer, returned home from work to find dog has eaten her tortoise. The only thing left was a part of the leg.

I had a call to a regular diabetic who was hypoglyceamic and unresponsive, BM <2mmol/l. He was typical hypoglyceamic presentation and very clammy. Normally fit and well with no notable history. All vitals were within normal limits so we treat with O2, Glucagon IM and dextrose gel. He came round pretty quickly but the diaphoresis continued and he looked ghastly. He denied any pain but I wasn't happy. The guy I was working with looked quizically when I asked him the grab the monitor. I did a 12 lead and noticed ST elev in II, III and aVf with reciprocal changes in I and aVl....the patient was having a silent inferior MI! The patient is a regular hypo and we usually treat at home and leave him - I'm so glad I did that 12 lead. Treat with O2, Aspirin 300mg and GTN. Faxed the ECG to coronary care who arranged for the guy to go straight to the cath labs for Angioplasty.

During my brief reading of this site, I see a lot of referrals to protocols. Here in the UK, we don't use protocols in the strict sense of the word. We work to guidelines and are free to interpret and use them as we see fit. As long as we can justify our actions and that we work in the best interests of the patient then that is fine. I suppose the fact that we work autonomously gives us a greater freedom to act by using guidlines. As has been said above, we rarely use any advanced interventions unless it is truely needed. We don't even cannulate unless we are going to medicate or feel we may have to medicate. You won't go far wrong by doing the basics well and intervening where absolutely necessary.

I find 2 books invaluable.... 1)Rapid interpretation of EKG's by Dale Dubin 2) 12 Lead ECG - The art of interpretation by T. Garcia

Salbutamol 5mg nebulised with 6-8l/m O2, repeated as required until side effects become significant In acute severe or life threatening asthma, nebulised Ipratropium 0.5mg should be given concurently with the first dose of Salbutamol. In acute asthma unresponsive to Salbutamol alone, a single 0.5mg dose of Ipratropium should be added to the second or later dose of Salbutamol. Adrenaline 1:1000 for life threatening asthma with failing ventilations. 0.5mg IM initially, repeated after 5 mins if required. Try to take best peak flow reading from three before and after treatment (easier said than done in some cases)

Hi all, I'm Phil and am an Advanced Technician working for the North East Ambulance Service (NEAS) NHS Trust. I've been qualified 3 years and have recently passed my Paramedic entrance exams.....just waiting for a course now :shock: