Chief1C

Welcome to the city; for both above..

The local preacher was a Marine sniper.. Everyone loves a preacher that isn't afraid to curse!

I could use a banana bag right now. I swear, I just went in for 1. I'm gonna hurt in the morning.

Poconos - Ugh! Full of, and or too close to them damn Jersey-ites.

I fail to see how this makes all volunteers look bad.

My favorite new toy, Rehab wise, is the KoreKooler Chair. I'd recommend one for every 10 firefighters, if that's what you're serving. We have two on hand, with several camp type chairs. Crew Boss makes a nice Rehab trailer, kinda pricey. I developed a rehab program a couple years before one was required. I'd say the only item I want, but couldn't get, was a Rad57 CO Pulse Oximeter.

Don't waste money on fans that blow water, it just pisses people off. A case of the typical towels available for ambo use in ER's are good, just long hand towels.

And a couple army cots, b/c sometimes people just have to lay down, and it keeps them away from things that crawl on the ground.

Well, it may cut down on the unnecessary EMS calls and ER visits.

The patient initially didn't have much going in their favor. As you warm a severely hypothermic patient, without vascular access, you're setting the stage for cardiac arrest. You can manage that, if appropriately equipped. But it all depends on the patient, the degree of exposure, medical conditions and general health. Despite the patient being elderly, and diabetic - which is bad in the recovery of the extremities, as far as pre-existing poor perfusion. The patient was in relatively good health. Without intervention, the patient would have succumbed silently; with it, the patient came close to dying anyway. The potential for vasodialation, which causes hypotension, poor perfusion, arrythmia, arrest; was there.. In fact, the hear rate dropped off relatively fast, with the occasional PVC. However, the patient never arrested, I don't know what meds were pushed into the IV line, but the HR did stabilize.

Continuing...

Didn't know how the person came to be laying there, and the snow did have several inches of solid ice on top from an ice/sleet storm.. So, we immobilized, and carefully placed on a big fluffy blanket on a spine board. Now totally nude; covered with another big fluffy blanket and then a Ready Heat blanket. Wrapped heat packs in pillow cases we butchered and put them in all the common areas for transport out on foot. Got the cocoon thing all wrapped up and carried. Our hands were now white and painfully cold, b/c gloves certainly don't help on a cold day. Put the monitoring device in place....rectally. fun fun. It's a wired device with a probe, slip a probe cover on it, lube it, and gently...yanno.. Core temp was 88.1F (31.1C).

Patient was not responding, pupils were constricted and non reactive. Could not obtain radial or femoral pulses, the skin was too stiff to obtain a good carotid pulse, so I listened w/ scope. HR was 66 and very irregular. Initial NIBP was 167/120. GCS was marked as 1-1-1. As the patient warmed up, the patient began furiously scratching at the neck area, and the hands were wrapped with towels. Otherwise there probably would have been no skin left. Respiratory rate was 20 and and lung sounds were clear, the patient was maintaining the airway fine (I'm using general terms to avoid mentioning a sex), had "warmed" oxygen flowing at 15 by mask.

We sat at a field awaiting an aircraft, as the nearest ER that could handle such was at least 2hr by ground w/ road conditions and as far out in the boonies as we were. Took maybe 5min from the time the patient was out and loaded up; till the chopper was on the ground. In that time, the pulse dropped to 48, BP was 60/44, and respiratory rate was now 10 and shallow. Placed an NPA, and began bagging.. and then the chopper staff took over. Had to do an IO, as they couldn't get IV access after a couple attempts by the PHHP (prehospital health professional) - a doctor and PHRN - you all know what that is.

We always get a follow up report on bad cases from the medical director of the aircraft service. Patient was placed on a new system they had for warming the blood in bypass. With in two hours, the patient was conscious, and by the next day, the patient was talking and in good condition. There was significant frost bite, and several toes had to be amputated. However, the patient developed multiple organ system failure, and died from kidney failure about a month later. But the important part was, IMO, the patient got some lucid moments to spend with the patients family, and got to say goodbye. So, there was closure.

So... Anyhoo. I just got some time to myself, b/c I really don't want to do the CQI forms, they're a couple weeks overdue anyway. What will an hour hurt? (I'm not the one that is supposed to do them - but I am - so that should count for something, right?)

My first patient, where the only problem was hypothermia. The reason that hypothermia came to be the problem, was unknown. Patient was walking from a parking spot, to a cabin in a wilderness area, no phone service, but was supposed to walk back out and call family from a seasonal place near by. Phone call never came, family got worried, sent someone to check. Said bystander located the victim in about 15" of icy snow, about a mile into the woods.

Timing, I could figure the person may have been exposed for 8 to 13 hours. A little bit of SAR expertise, and you look for signs of recent activity. The foot prints and tire tracks were all frozen solid, so they were not recent imprints, and the ice was clean, not muddy. The snow around the victim, was also frozen, and not disturbed, so there had been no movement for some time as well. Temperature at the time was 18F (-7C), with light wind, sun and of course snow cover. There were no barriers to obstruct the wind. The forecast temperature for the preceeding evening, was to be around 10F (-12C).

The patient was clothed in blue jeans, a long sleeve, light shirt and a hunting jacket; and the clothing was wet or frozen solid. Skin that was in contact with clothing, which rested upon snow or ice, was bright red and frozen (like - yanno - firm/frozen). Extend your hand flat, and the fingers back, and press on your palm.. Now picture it excessively cold and moist, that would be how the skin felt. Clothing was of course removed.....

Do you like suspense?

Because I have a call. I'll get back to you.

If it's a busy station, and they're poor - they're doing something wrong. Bill those taxpayers. That's what they're there for!

First. Welcome to the city. Second EMT/Medic, not the same thing, on the fence over whether it's okay to call ones-self the other.

Third.. Good on you for making a positive impact.

What would you spend $$ for personal equipment to own?

I would buy a CPR mask, a small/simple first aid pouch and a box of whatever size gloves fit you. That's all. It may cost you around $35. We're training a shit load of newbies, we're not strapped for cash, but that's all they're getting. Then after you become certified, maybe replace the CPR mask with a BVM. Why? You'll find out the first time you use the mask on a real patient, if you ever do.

What type of bag should I really carry v. what the salesguy tells me to carry.

I have yet to find a salesman pitching for a trauma bag, in person. When they see a wanker, they butter you up to squeeze the most money out of you by reinforcing your thoughts and/or fears. I would just buy a generic pouch type deal from your local chain retail store's luggage department. Put stuff in it, from their health & beauty section. Some kerlix, some conforming gauze rolls, 4x4's, some tape.. the gloves.. small note pad and a pen.

Footwear & Pants, what holds up, comfortable, and is what you wear?

Any sort of comfy work boots, or shoes - doesn't matter, I usually wear sneakers and jeans. Everyone has their own style of tactical emt pants.

What should I start with and what web-sites do you think sell quality and what are the quality gear companies?

Go right over to your neighborhood Wally World or chain drug store, and you can get everything you need. Add on a good watch, and maybe a "Nurse Scope". Best starter scope possible, and it costs like $6 maybe.

I'll add some next time I get a chance to log into my trip sheet bank. Had a call, true holy shit how are you alive, type deal. Marked with multi organ failure in the month afterward. It was a good learning experience call. I can't remember the nitty gritty details, so I'll wait till later to post it.

Fudge bar? Because that would be so ironic. No thanks. Honestly, I don't even check my bgl unless I feel sickly. My problem is low, and I'm sure I'd know why if I followed up. It started in the low 200's.. Then abruptly began to always be around 70. Varies from the 60's to 80's anymore. I've had a few "incidents" after fires, or searches where I had to scramble to treat. Only lost consciousness once, and it was treated appropriately. But again, I didn't go to the ER. Now if they strapped me in, and got on the road, I wouldn't have had a choice. But, stay and play, and I get to choose.

As a person that is not exactly compliant with meds, and diabetic... If it were to come to either choking to death on thick gooey cherry gel.. or having the same squeeze up my back side.

PLEASE, LET ME DIE! Clearly, it was meant to be.

Protocol states not to put anything into the mouth of someone unconscious. I tend to side with that, instructors always said go ahead, what can it hurt?

Well, we made a hell of a mess one evening, to prove a point to the instructor. The punishment? I bet it was a bitch to get that stuff out of Resusci-Anne's mouth. Glucose that is, sick bastards. I squeezed that thick ass cherry Instaglucose gel in, and squeezed another tube onto a paper plate. I said, there is "THAT" much in there, the patient is choking, suck it out. The suction unit kept getting clogged, or it just wouldn't siphon the glucose globs.

Point was given, point was shoved down her throat, and point was well received.

I prefer Glutose 15, in the grape flavor; or Dex4 GlucoShots (lemon/lime liquid) for myself. And I eat the tablets like candy.

We don't use anything that could cause burns, when warming a patient. I have the separating layer rule; which applies to heat or cold. Heat or cold therapy should be neither uncomfortable nor harmful, if done properly. If it's too warm or too cold on MY skin, I quickly improve the barrier before I place it on the patient.

Nexium and a few hundred 10mg diazepam would work... b/c 2mg just doesn't cut the edge off. Just sayin'

My new "doctor", is an NP.. She. is an NP. Thorough, uncomfortably.

Because it's prolly not cut with anything impure?

Can I get a prescription for medical marijuana?

Is creating an account good enough? Because I really don't want to download anything. But I did create an account.

I'm gay... And if Ben is "a gay". I'm gonna go out to the nearest bar, pick up the loosest woman I can, and go straight again.

Do you know what annoys the piss out of me? Patients who make me look like an idiot; and providers that don't recognize "Pain" as something that needs to be treated.

Take Patient A. Patient A has a fracture, and both Patients A's vitals, and their demeanor points to them being in a significant amount of pain. 10/10. Patient A is trying to be strong, but crying through it. Patient A had no significant mechanism, and no other injuries, and probably could have gone POV. But Patient A's parent called 911, because Patient A appeared to have a syncopal episode, while splinting the fracture.

EMT A calls an ALS unit, to manage Patient A's pain. What does patient A do when the paramedic gets on board? Patient A is suddenly pain free, and doesn't know what EMT A is talking about. Then, after the ALS unit releases care to BLS... Patient A is crying again, and in severe pain. EMT A wanted to scream "if you didn't want help, what the fuck did you call us for", but didn't. Thought it probably increased EMT A's BP ten fold.

Then, you have Patient B. Patient B is in a severe amount of pain, and is a hospice patient with a certain form of Cancer in the abdomen, and Patient B is dying. Patient B told the hospice nurse to shove it up her backside, and decided that since there were no meds to help, that 9-1-1 was the best choice. Patient B is okay with death, but would rather not lay in bed, in agony. Patient B is clearly shocky, and vitals show it; Patient B is in tears, and gripping EMT A's hand, screaming like there is no tomorrow - which there might not be. ALS boards, and won't give the patient any meds for abdominal pain... Because abdo pain is too hard to diagnose.. and releases care. EMT A calls medical command, and states the obvious, that the patient doesn't need a diagnosis, the patient needs pain management. Which brings Paramedic B... another ALS unit, who gives the patient enough MS, so that EMT A can feel his fingers again.

Those are the sort of things that annoy me.

Denial is a disease.

What were his vitals? >jk

Welcome to the city, I guess.

Our ePCR can do graphs and such.. About 47% of our dispatched calls are life-threatening emergencies, based on chief complaint; while 43% are life-threatening based on "provider impression". About three years ago, we saw a sudden drop in "junk runs", or bullshit complaints. Perhaps because so many frequent fliers passed on? Who knows. But I'd say 3 in 5 calls are emergencies which could end a life, without intervention.

Folks really don't abuse it that much anymore, but yeah, some do; however call volume has definitely dropped as compared to say ten years ago.

An EMT Certification and an EMT Instructor course.. But I'd recommend several years experience as an EMT, before teaching the course.