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Riblett

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Everything posted by Riblett

  1. So we have been in Florida for 1.5 years now. I have really tried to give it a chance here, but I just hate it. There are NO jobs for paramedics who aren't firefighters and even if you are dually trained you spend years trying to find a job. Unless you want to kill yourself and your back running your ass off for 10-12 bucks an hour for a taxi.. er I mean private ambulance service...you are out of luck. Thanks to a recent episode of SVT (new onset) I am completely disqualified from any fire job or even fire academy. I have been passed over for even the ER tech jobs, despite a medic license in two states, a nurse aide cert, and five years of EMS experience. We have no hopes of leaving any time soon because my other half can't find a job anywhere else. And despite a 3.5 GPA and healthcare experience, I have been rejected from nursing school three times. What the hell more do they want? I truly get angry when I see the fire department pass by on the roads. I am sure there are some good medics down here, but all of them I have had any interaction with so far are a bunch of mouth breathing corn-fed testosterone factories that don't seem to know their ass from a hole in the ground, but by God they are fucking firefighters so they have a job. Never mind the fact that there are practically NO structure fires in S. Florida, since it is all stone construction and few ignition sources since it stays eighty degrees plus year round. I have seen more true structure fires and a medic in Carolina than many of these people do in their whole careers. It is just sickening. Someone please give me some advice.
  2. Great replies. You oversee the lead placement yourself and you take a second one just for good measure. It is identical to the first one. There is no cardiac history in the family that the father is aware of, but the paternal grandfather has HTN and IDDM. The father denies any recent illness, not even a cold. The child rates the pain as 9 of 10 on the pain scale. No exacerbation with positioning, but the child flinches when you press down on the sternum. The child has no medical history except for ADHD, for which he has been taking lower dose Adderall for 3 years. He has no allergies. He doesn't really understand when you ask him to describe the pain other than the fact that "it hurts." You can draw blood, but you gotta tell me which tests you want. Finger stick BGL is 86 and he skipped breakfast this morning because he was feeling bad. You can't take an x-ray, despite having the radiology department in the clinic. The radiology tech doesn't arrive until 9 and the physician usually shoots any emergency x-rays if she isn't there. Visualization of the chest is unremarkable. Lung sounds are clear and equal bilaterally. Auscultation of the chest reveals normal heart tones, clear S1/S2, no murmurs, rubs, or gallops. Pulsus paradoxus not present. What do we think is going on here? Is there anything else you want to ask the father about? Any other tests you want to run?
  3. Can't think of any duh moment off hand. But I definitely remember my first pucker moment. I had been a paramedic for 3 months. Up until that time I had been riding with a seasoned medic and it was my first shift with an EMT-I as my partner. The entire shift was uneventful, a few BLS transports, a couple of should-have-called-a-cab runs, and a diabetic given IV dextrose who signed a refusal. It was about 4am and we had been soundly sleeping for a couple hours when the pagers go off for sick call. The dispatcher gave us no further information and the residence was only a few blocks from the station so we got there before the call was fully EMD'ed. I stumbled into the residence with my eyes half open expecting someone with the flu. I found a 70 something year old man lying side ways across the bed, semiconscious, and doing that guppy fish breathing that you can see is pulmonary edema from down the hallway. His 02 sats were in the low seventies, cool, clammy skin. In the words of Kelly Grayson, aka AD, you couldn't have "shoved a knitting needle up my ass with a sledgehammer." I kinda stood there for a second like a deer in headlights. Finally gaining my composure, for some reason I asked him what wrong (as thought it wasn't obvious!) He replied, "I-am-f*ck-ing-dy-ing." I made a grab for my radio to summon some help and ended up flinging it across the room, breaking several ornate objects. After calling for back up I managed to get the CPAP on him, get a line, and have my partner get a 12 lead. He had ST depression in nearly every lead, but after 5 minutes on the CPAP his sats were low nineties. A volunteer EMT showed up to drive us to the local ER and I thought it was all over. I was sitting behind the nursing station trying to catch my breath when the ER doc (who happens to be the medical director) comes over. He very nonchalantly says, "Oh by the way, the MICU unit is tied up. You gotta take this guy to Duke. Right now." An hour away. That was my first FML moment in EMS, as well.
  4. Lets have some fun. This was my patient yesterday morning. I have attached an EKG and will give you some information to start. You get to ask questions and I'll provide assessment information as we go... Some background: You are a paramedic working at a small clinic and have two very new LPNs with you. You are the only clinician. It is 08:05 and the physician for the day is running late, but your first patient has already arrived. They will arrive in about another 15-20 minutes. You, as the paramedic, can act entirely within your scope at the clinic for the purposes of this scenario. You have all ALS drugs and cardiac monitoring. If you want a transport unit, you have to call for it and they will arrive in about 7-8 minutes. An eleven year old male is brought in by his father. The child is in obvious pain, very anxious, but is completely awake and oriented. His father states that he has been complaining of chest pain since late last night. Father states that he has observed what he believes to be intermittent respiratory distress. You direct one of the LPNs to acquire a 12 lead. See attached image. The other LPN gets the following vital signs: BP 104/73 HR 70 RR 22 %SPO2 97. What would you like to do? What would you like to know?
  5. Everyone please take a moment to say a prayer for Lt. Harry Kissinger of Raleigh FD. He came of shift this morning when his POV was struck head on by a school bus. He was trapped for 45 minutes and sustained serious head trauma. He is presently in the Trauma ICU at Wake Med of Raleigh. Please pray for his recovery, for his family, and for his fellow firefighters and EMTs who responded to extricate and care for him. He has been on the department for 12 years and is also an EMT.
  6. I think that from a system status perspective, transport and 911 should be kept completely separate even if they are part of the same department. I am not an advocate of 911 trucks being taken out of service for non-emergency calls, especially when a medic level truck is taking a BLS run. That was a major problem in the last agency I worked at in NC. Allthough we had a private service with both BLS and ALS units, if their ETA was not convienent for the hospital they would call 911 and demand an ambulance. Some of these runs were BLS, take granny back to the nursing home from the ED. Never mind the fact that she has been in the ER for 17 hours, we decided ten minutes ago that she is being discharged and thirty minutes is too long for us to wait for the private service to get here! For whatever reason the county 911 service just could'nt say no. Many patients suffered negative outcomes, because another 911 unit had to come from as far as 15-20 minutes away. When there are no more transport ambulances available, hold the calls until they get in service. Now if it is something that is actually time sensitive transport, like a trauma patient or MI going to a trauma center or cath capable facility, that is different. But direct admits and nursing home returns do not fall into that category. Also, if there is a major disaster or a extreme system status overload, transport units can be pulled off non-urgent transfers to help ease the burden by doing lower level transports or providing more immediate assistance while waiting for a 911 unit from a long distance, especially in areas where there are few first responders. I can definitely see a big advantage for having integration of personnel, particularly at the ALS level. Even so, I have to disagree with the idea that transport experience is not applicable to the BLS techs. I spent about 4 months on a BLS transfer truck before becoming a volunteer at my first squad and found the experience extremely valuable, particularly for someone with zero medical background. It was a great way to become familiar with equipment, learn to interact with other healthcare providers, gain a lot of practice taking vitals, reading H&Ps/charts, and transition into the completely new role of being a patient care provider. Many people will say, oh well you can teach a monkey that stuff. Sure you could. But you can't teach a monkey to do it well or comfortably, and certainly not in a 120 hour basic EMT course. I can only speak for my own EMT class, but we all lifted a strecher once, and briefly practiced vitals on our healthy, 20-something year old classmate, in a quiet classroom. I would go as far as to recommend 3-6 months on a transfer truck for EMT-Basics before entering the 911 sect, especially in high call volume area. It just makes for a more well rounded, fine tuning of skills before jumping on a 911 truck. Clumsy green EMTs have no business on a 911 truck, and certainly not as a primary crew member. (I am ready for the storm of EMT blasting now...) As I went on to attend EMT-I class and college as medic, I found the interfacility even more valuable. As we learned about conditions like CHF, A-Fib, COPD, etc, I actually got to see and assess these patients in non-emergent environment. I learned what these patients looked like, saw their H&Ps, read their charts and their meds lists, learned what groups of medicines are used to treat these conditions. I carried a drug guide with me and and looked new meds up. I saw patients with diseases not covered in paramedic school and saw how diseases came in combinations. Combined with an elective pathophysiology class, it gave me a huge advantage over many of my coworkers when it comes to knowlege of pharmacology and the disease process. I suppose a lot of it is about what you put into it, but I truly believe that interfacility transport can be very valuable to all levels. EMT education certainly should be teaching these things better, paramedic school should include an in depth pharmacology class besides the drugs we carry, plus a 4-5 credit hour pathophysiology course, but the reality is that most of them don't. Realism vs idealism here, because if things in EMS were ideal we would all be paramedics, with bachelors degrees and salaries comparable to RNs. Our agencies would all be able to afford a complete and well paid paramedic staff (and hospital diversion would be illegal...while we are dreaming) Some of the smartest paramedics I have met (most of them much smarter than me, with double or triple my experience level) have either worked in or still work in interfacility and critical care in addition to 911. Where I am from, 911 tech of all levels like to scoff at transport trucks, thinking they are somehow better than them. That sort of divisive attitude has no place in EMS. As I approach the 4 year mark in EMS and 1 year mark as a medic, I am actually considering taking a Critical Care class and getting back on a transport truck or spend some time as an ED or ICU medic. Hoping to get rid of my "special needs patients and pediatrics scare the hell outta me"-itis case.
  7. I passed and am now officially a dual state certified paramedic. I am super medic, hear me roar...ok maybe meow. Thank again for all your advice and to Medic829 and Vent for the study materials.
  8. Most of us seem to agree that the officers behavior was way out of line. If you feel that more severe disciplinary action is in order, as I do, you can email the Chief of Patrol Van Guillotte. His email address is choffice@dps.state.ok.us After reviewing the dash and cell phone footage several times, as well as the written reports, I believe there is no question that this cop has no business with brass and badge of any sort. His behavior was unprofessional from the moment he stepped out of the truck and only got worse. He has no business as a police officer. We can discuss this until our fingers bleed, but we need to make our opinions known to those in charge. An email or letter of support for White to his superiors would also be a good gesture. The Creek Nation EMS director is Scott Randall; his address is below. I could not find an email. Link to OHP site http://www.dps.state.ok.us/ohp/tngrct/default.htm Creek Nation EMS Scott Randal, Chief 309 North 14th Street Okemah, OK 74809-2028 I didn't see any previous posting of this info, but if there was sorry for the repeat.
  9. I have been called a numbers Nazi many times, border line cook book paramedic because I am still green enough to see mostly black and white. But even to me this seems to be a gray area. I worked two of Orange's neighboring counties when this incident occured. The paramedic involved resigned after he received numerous death threats regarding this incident. Secondly, Dr. Brice the system medical director suspended his right to practice as a medic in the system before NC OEMS ruled on the case. First of all, his right to practice was suspended based on failure to follow protocol. The OEMS report details seven Orange Co protocols he did not follow. Some of them are valid. But he couldn't hold the guy down to take and EKG or orthostatics if he refused. I mean, he weighed 250+ pounds and there is that little detail called assault and battery. If Fraley refused to sit down for the orthostatics or EKG then what was he supposed to do? That is not a protocol breach. So Brice can bitch about him not doing that all she wants, it just shows that she has not concept of prehospital medicine besides what she sees from behind a desk. It cites that he didn't follow the refusal of care protocol. on the refusal form because he didn't check the box stating the recommended time frame for him to follow up with a physician, immediately vs four hours vs 24 etc, but the Orange Co protocols does not specifically list age requirements for signing a refusal form. These details can all be read in the NC Office of EMS findings report referenced below. Secondly, the news writer either didn't read the autopsy report he wrote about or didn't have any concept of what it meant. Fraleys autopsy report states that there were no indications or clinical signs of dehydration and that his post mortem electrolyte panel was within normal limits. Perhaps Doczilla could chime in on this one for us, but it doesn't seem like a fatal massive electrolyte imbalance would return to completely within normal limits post mortem. It could, I don't know. The autopsy findings seem more suggestive of a fatal asthma attack considering the findings of the pulmonary structures. If he did experience a fatal asthma attack after they left, that was a tragic coincidence which was not predictable based on the paramedics clinical findings. You can't blame a medical provider for letting you sign a refusal form for one complaint when you later experience a negative outcome from another that wasn't present at the time. Given that if he had been taken to the hospital for the possible dehydration and happened to experience an asthma attack or cardiac arrhythmia he might have survived, that makes this a sad situation but still not the fault of the medic. Even if he had been taken to the ER when his vitals, EKG, and labs came back normal they would have simply sent him home with a prescription for a muscle relaxant and instructions to increase PO intake, maybe even before the incident occured. Additionally there is the issue of consent. The protocols don't specify age requirements to refuse treatment and transport. But if you make the determination that he was a minor and not able to refuse treatment, then according to the NC minor consent laws, he would not be old enough to consent to treatment and transport either, for a nonemergent condition. Since he was complaining of muscle cramps and all his vitals were within normal limits, it probably would not cross into the threshold of what the law defines as being an emergency condition that delay in care to contact parents for consent would have negative outcome. All that aside, being that most of us are not doctors or lawyers, we have a phone or radio to contact medical control for this issues like this, which he should have done. How do you spell medical control...C-Y-A.....ok rant finished. Autopsy report: http://www.wral.com/asset/news/local/2009/...195/Autopsy.swf NC Office of EMS investigative findings report: http://www.wral.com/asset/news/local/2009/...5961/fraley.swf Orange County EMS protocols link is in Mateo's earlier posting
  10. I'm going to schedule the exam for a few weeks from now. I have been here for a week and a half and the mountain of boxes is slowly being climbed. Many thanks so medic829 for the practice exam for Sunstar and trauma protocols from Vent. I haven't had a chance to look at them yet. I'll let you all know how the exam goes.
  11. I wouldn't go as far as calling it a cop bash fest, as much as I would worthy criticism for both parties. If the HP approached with a very high rate of speed, the driver of the ambulance may not have ever seen the warning lights until the patrol car was too close to the unit to be seen by the rearview mirror, especially if his vision was focused on the car in front of him. If the patrol car did have audible warning devices on, the driver did not hear them, which would not be so far fetched if his radio was screeching. If there was no safe and appropriate shoulder for the ambulance to pull to, they may not have safely been able to do so, especially considering how large and top heavy the vehicle is. From looking at the video, it seems that they belligerence of the officers was completely unnecessary and not in the best interest of the patient. But until we see the dash board footage we won't know if there was additional behavior on the part of the ambulance crew that provoked it.
  12. As some of you already know, I have moved to Florida from North Carolina and am having to take the Florida exam. I just had to fill out some paperwork and I can schedule the exam any time in the next 12 months. I just got my medic cert 9 months ago, and have only been out of school for ten months. So I was wondering, should I try to study or will that possibly make me freak out and do more harm than good? If there is anyone who has taken the FL exam, is there any particular points you would brush up on?
  13. Dust, I am closer to a special place in hell? That's news to me! I was worried about the nursing theory problems and time management stuff. I have applied for five NA jobs for that very reason, to get more experience with multiple patients. Matt, come anytime. You'll love it. Miss everyone in Raleigh. I went to my first A&P class last night. My professor is a doctor from Ukraine who barely speaks English.
  14. Vent, My A&P was not the quick one for paramedics. It was called General Anatomy & Physiology (BIO 163), which was 5 credit hours and had a lab. But the nursing programs require the two course sequence that are 3 credit hours each plus a 1 credit hour lab. Blah! I am hoping that most of what you are testing out of is basic nursing skills. I think you still have to take some of the nursing theory courses. I am hoping that my paramedic training (since it was an associates degree) had a little more foundation to it than many con-ed or certificate programs would. There was a lot of public health, health care theory, psychosocial, life span, in depth lab values, etc. Stuff that at the time I thought was pointless
  15. I have a chemistry and A&P class lined up starting as soon as I get there at Palm Beach CC. Unfortunately none of the nursing schools down there will take my A&P from here. There are two EMT-P to RN bridge programs at the community colleges, which are about a year long. You just test out of some classes if you are an EMT-P or LPN. Since I have an AS already, I had most of their general ed stuff done. But I have to take another A&P. I am a little concerned about doing this, because I might miss some of the nursing theory stuff which could hurt me when it comes time to take the NCLEX. I checked with the FL BON and they are fully accredited and everything. If anyone is familiar or knows someone who had done them, chime in. There aren't many full time jobs at the hospitals right now, but several part time ones. I applied for an EMT-P ED tech, but my FL certs are still pending. So I put that on the app. I also applied as a medic at the local prison. I'll have to start somewhere. We'll see what happens. I think I'll sign up for the con-ed Spanish for the health care provider class too.
  16. Hello everyone, A bit of news on the personal side. My partner and I are moving to Ft. Lauderdale FL on Monday. He recently got a job down there after the huge round of lay offs here in Raleigh. We have known for a few weeks, but it has sort of sneaked up on me. We are going to be living in Sunrise, and he is working in Ft. Lauderdale. I just got my application to state test as a medic in FL approval letter, so I will be taking 'the test' less than a year after I got my paramedic cert. I don't have a job lined up down there yet, since no one will even talk to me without a FL medic's license. Plus it is mostly fire based and I am not a firefighter. At this point, it looks like I am going to have to dust off my Nurse Aide certification (which transfers readily) for a while. Yay! I am really nervous because I don't know a soul there. We went down there to find an apartment and sign our lease. The area seems nice, but totally foreign. There are lizards there bigger than my cat.
  17. I think this definitely depends on the nature of the gift. We frequently receive small gift baskets containing fruit, chocolate, etc. Many people have baked cookies or a cake and brought them to the station. I think refusing a clearly personal gift like small baked goods is very rude. Especially when it is a little old lady or a kid making it. In that case, it should be graciously accepted and shared with the department. (Before partaking, I always look at which crew received it. Sometimes I worry if the crew could have somehow pissed the patient off, and granny could have added a little Exlax to the banana pudding. ) Larger gifts or monetary gifts should not be accepted. If they want to make a donation or something, I usually recommend the county EMS fund. With a $60 annual donation, everyone in their household will pay no out of pocket expenses for any EMS service. Their insurance still gets billed, but they are not charged any co-pays or expenses beyond what their insurance covers. If a patient refused to take no for an answer, donate it in their name. Maybe ask them to donate some new stuffed animals to the agency instead, or use the money to buy them. We carry them for comforting children during their ride in the ambulance, but rely on donations since the agency does'nt actually budget for them. If a patient left a cash gift that could not be identified or returned, I would suggest that it be donated to the county EMS fund or some stuffed animals.
  18. Ha ha, hiermit bin ich einverstanden. I am a 21 year old paramedic. I spent one year as a EMT-B, and two as an EMT-I. I graduated with Mateo with an Associate's degree in EMS.
  19. Really? So what is their reasoning behind it? Physical agility? Personal/psychological weakness?
  20. I have been reviewing these sites for paramedic positions down there. Apparently you have to sign an affidavit for the application, saying that you do not smoke cigarettes and have not smoked them for the past year. What the heck is up with that?
  21. I will likely be moving to Ft. Lauderdale in May, from Wake Co. NC. My other half got laid off up here and we are thinking of moving down there for him to work for Citrix Systems (he is tech guy). The catholic university in Miami has a good nursing program for me. I have been checking out paramedic jobs down there, it looks like Medics Ambulance Services runs ALS, BLS, and wheelchair. I can't figure out who does 911 ALS service down there. I could probably get hired as an ER Tech at Broward Health Hospitals, but it really isn't ideal for me. I emailed Medics, but they have not responded. I have been paramedic for 7 months, so still want some good call volume. Is anyone more familiar with this area?
  22. The lady had a history of skin cancer, which had been treated with at home chemo by pill. She was no longer doing the chemo. Also a history of high cholesterol and hypertension for which she took HCTZ and a cholesterol drug (I don't recall which one). No diabetes, cardiac history or heart problems. I looked at the nurses' paper work which indicated that it was a stage 2 ulcer. I am not sure what surgical intervention was required for the foot, but she wanted to go to the ER because she had a fever. Not for the foot. The home health nurses were there as part of her regular biweekly wound care. The nurses told us that we could not assess or transport her until they were done. When I was told that, I did not attempt to force by them or anything. The BLS transport ambulance could take anywhere from 30 minutes to about three hours if they are really stacked. But that is really the exception rather than the norm. She is able to stand and walk to the bathroom and around the bedroom with her husband's help. I think she really could have gone by car, especially with a wheelchair. It is of course possible for her to have a terribly drastic change in her condition and need an ambulance, but with that logic one could argue that all headaches need a brain surgeon and all every sniffle needs an ENT doc. As far as the hospital choice is concerned, we deal with that sort of thing all the time. Our local ED is pretty basic. The expectation from the family and nurses that we should wait thirty plus minutes for them to get her ready, and take her on a BLS taxi ride 40-something miles away, and then getting mad about it was what I took issue with. What is the PC way to tell them no?
  23. You are called for a sick person, dispatcher advises "fever". You are a ALS EMS service in rural area. Upon your arrival at the residence you are made to wait outside for a few minutes until someone comes to the door. Once inside, the patient's husband very casually leads you upstairs to a bedroom. You see a 54 y/o lady sitting in a chair in no apparent distress. There are two RN's (home health nurses, affiliated with the local hospital) doing a dressing change on a foot ulcer. The husband tell you that she has a fever and needs to go to the ER. One of the nurses tells you that they still have to finish doing wound care and then have to put her wound vac on. You'll have to wait. They won't even let you access the patient to assess her or take vitals until they are done and they say it is going to be a while. The lady is alert and oriented, in no apparent distress, advises that she has no complaints except for her foot hurts, but that it hurts all the time. She wants to be taken to the ER in the neighboring county (an hour away.) You are the last ambulance in service in the south part of the county. How do you proceed? This was a call from last week. We had to wait 35 minutes for the nurses to finish before transporting her to the ED an hour away. When I suggested that a convalescent scheduled transport ambulance service might be a better option, considering she was not ready to go and her low level of distress. I don't think a 911 ALS ambulance was appropriate, and when I tried to explain that to them, her husband became irrate. I think my view is tainted, but I don't think most people would expect a 911 paramedic-level ambulance to wait over thirty minutes for you to get ready for a non-emergency BLS transport to a hospital in another county. I would think that the nurse at least should know better. I am not saying that she did not need to go to the ED or at least be seen by a doctor. She is probably septic, but she has had the fever all day and has no complaints. Even though she did need some assistance getting down the stairs, but a BLS transport ambulance and/or RN's could definitely handle that. How would you handle this situation? Does the service you work for have any policies for this type of call? Would you wait 30 minutes for this lady to be 'ready' to go on her medical taxi ride in your ambulance with you service area already stretched thin?
  24. I think that t-shirts can be appropriate attire, especially in extremely hot and humid environments (like Florida). You look more professional in a well designed and not faded/stained t-shirt than a thick hot uniform shirt with sweat pouring down your face and perspiration stains under your arms. During sleep hours t's are good because you can just throw them on straight out of bed and they don't look overly wrinkled like uniform shirts with brass and badge. I certainly would not expect doctors and nurses who work in the controlled environment of an office or hospital to be examining and treating patients in a t-shirt. But at our local ED the RN's wear scrub pants and t-shirts with the hospital name and logo.
  25. I carry a stun gun on and off duty. I have an hour drive to work at 5am and often have to walk a long way to and from my vehicle into my apartment. It is very much a defensive-only weapon. You must make physical contact with the person in order to use it. It incapacitates the person for about thirty seconds, which is enough time to safely remove myself from the situation. I also serves as a flashlight and fits right on my belt, so no one is the wiser. It has a safety switch and takes two steps to fire, so it is not likely to be accidentally discharged. I think it is the perfect weapon for EMTs. I originally had it just for personal protection off duty, but then I started working in a rural county with no first responders and slow PD response times. With no first responders it is just the two of us on calls in these really rough areas. If things do take a turn for the worst it takes a while for PD to get there. I know we are not allowed to carry firearms or even knives that are greater than 4 inches in length. But I don't think the policy specifies stun guns, and I would rather ask permission than forgiveness. I would not use it unless I thought that myself or my partner was in serious danger, and in that situation possible disciplinary action would be the last thing on my mind. Like Fox said, I would rather be judged by 12 than carried by 6.
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