Fox800

+1 for Big Shears.

Pt.'s saliva > milk > saline > water.

I'll be moving up to Fort Worth in late June/early July to start graduate school. Can you guys recommend any good places to work as a paramedic? I've got four years of 911 experience as a medic.

Places I've currently got my eye on:

-MedStar (not currently hiring paramedics)

-AMR Arlington (ditto)

-CareFlite (ditto)

-Cook Children's

Thanks!

I really applied for Pridemark, which is owned by Rural/Metro so it's a moot point (same application). Pridemark has the 911 contract for Arvada, Wheat Ridge, Edgewater, and Fairmount.

I think Northern CO may be too much of a drive. I've thought about Colorado Springs AMR but I've heard mixed things from my two friends who worked there. CSFD goes on every call and I don't want to deal with that drama.

I submitted all of my paperwork yesterday, hopefully I'll get my certification in a few weeks.

Do you guys know of any Colorado agencies that are currently hiring? I'm moving to Colorado between now and July and I'm looking for a 911 paramedic job. I've already applied to Denver Health, Pridemark/Rural Metro, Northglenn, and Platte Valley Medical Center EMS. Currently working on Clear Creek EMS. I'll be living in Parker so I'm looking for something within a reasonable driving distance. I don't want to primarily do IFT and I don't want to work in a system where EMS is subordinate to ALS fire first respondse.

Any other ideas?

I'll be moving to Parker, CO (20 minutes from Denver) next summer to start graduate school. I'm looking for a decent spot to work a medic shift here and there for extra cash. I have four years of paramedic experience on a 911 ambulance so I'm not entirely brand new.

Can anyone recommend any decent agencies that don't require fire certs and hire part time folks?

Thanks!

I've found ammonia inhalants to be a safe and effective tool for determining responsiveness when used appropriately. Intentional misuse should be grounds for serious disciplinary action/termination (crap like dropping them in a nonrebreather and putting the mask over their face, putting them in the pt.'s nostrils, putting them in a syringe and depressing the plunger to shoot fumes up their nose, etc.) If I ever see someone doing that, there's going to be a come to Jesus moment ricky-tick.

My typical continuum of testing to establish responsiveness:

Loud verbal > Painful stimuli (nailbed pressure, pinch trapezius, no sternal rubs) > Ammonia inhalant held next to nose > NPA/OPA (judgment call)...after that, they're likely to get an ET tube if I can't find something to do to wake them up (i.e. D50 or Naloxone).

We used Entonox at a prior job of mine, with pretty good success. You can't really overdo it, when the pt. is good and lit up, they will no longer be able to make a seal with the mask. When used in conjunction with fentanyl (for paramedic providers), we had some pretty awesome results. I miss having it.

Working a service with both large urban/surban and rural areas in the same district, I'm starting to favor dual paramedic transport units in the larger rural (county) areas, and dual-EMT transport units in the urban/suburban areas backed up by dual-paramedic squads.

Feel free to PM me if you have any questions. I went through the academy in 2008.

I can't fathom the idea of an ambulance without an AED. But then again, NYC isn't known for being a model of EMS...more like fail central, along with Fail Jersey, Maryfailand, Failiowa (for calling NREMTP-99's "paramedics"), and who can forget Failifornia.

What Spenac said was pretty much spot on. Our website is at www.atcems.org, check it out. If you're about to be certified as an NREMT-P I'd apply for Austin as soon as you get your card in the mail. You won't be able to apply for an ambulance position until you are certified as either an NREMT-Paramedic or Texas paramedic. If you have to wait for whatever reason, I'd recommend Marble Falls Area EMS (not sure how easy it is to get on as a basic) or San Marcos/Hays County EMS for a little 911 experience.

Search and Rescue...we have three "rescue" trucks, the people in rescue are trained in swift/still water rescue, land rescues, high-angle/low-angle stuff, trench rescues, cave rescues...all of that stuff. We also have a tactical paramedic ambulance that gose on all APD SWAT calls, and a HAZMAT truck for all of the methyethyldeath scenarios. There's a testing process to get into rescue after you've finished the academy and cleared to independent duty. The bike medic stuff is all run by ATCEMS paramedics, unless a special event chooses to contract out to a private company like First Medical Response, AMR, or S.W.E.A.T.

Let me know if you have any other questions.

I rarely run hot to the ER unless the patient is crashing.

I see more and more in cities I visit a disturbing trend.

Case in point. I have spent time in a town in florida and our office is right above the ER. I spend time day dreaming at times and looking out the window.

I one time this week counted 18 ambulances coming to the ER with patients. Of those 18 ambulances in that hour 11 of them came emergently, lights and sirens. Did they have 18 critical patients? NOPE as a matter of fact I went down to the ER and asked about the patients in the past hour. I asked how many were critical. They said 2 which were the trauma alerts that came in.

So why the emergent transport?

I also spent some time a number of years ago in New York at the New York Hospital Queens and every ambulance that arrived to their ER came with lights on, rarely with sirens.

What is this trend I'm seeing. It occurred in Jacksonville when I was there, I saw it in Springfield Mass, I saw it in Detroit and also in Patterson New Jersey.

Are these isolated places that just do this to do it or is there something else going on? Is it to save time because we on this forum surely know that running hot does not save time.

Just some observations. Nothing more.

Ooh they rolled their SUV! Now I get to practice my EVOC driving, yo!

Our new protocols will have a 1.25mg IV dose of enalapril for CHF/pulmonary edema with a systolic BP >140 after NTG paste/tab administration.

Looking for advice/suggestions/all the above: I work for a private ambulance service in Florida where the 911 service is fire-rescue. Often times my service is called to a residence where fire-rescue has already responded and deemed the patient non-urgent and in no need of ER care. So the patient calls us and even though we are under the same impression as fire-rescue we take the patient to the ER because that is what we are told to do. Upon arrival to the ER the staff usually shakes their heads and asks us why we thought the transport was necessary.

And of course I am not trying to dodge work....but I feel that through my training I can tell that a scratch and bump on the elbow does not require adding to the deluge of patients to the ER's in my city. I agree that most patients should go to the ER just to be sure there are no additional problems, i'm not a doctor just an EMT-B but shouldn't there be room for discretion?

So, the patient calls your company on the phone directly? Is fire allowed to tell people they're not transporting them/deny transport, or are they obtaining legtimiate refusals of transport? If the patient has no legitimate medical complaints, I understand the frustration. If you are consistently getting bad attitudes from ER staff, it sounds like it's time for your supervisors/medical director to have a talk with hospital administration. It's not your fault that the ER is poorly staffed. They have an obligation to evaluate and treat your patients, no matter how minor the complaint.

Congrats. Florida seems to be a great source of EMS entertainment lately, what with Dr. Tober over in Collier County...

As stated before, there are many variables to consider. One being transport time, another being how your patient presents, and the third being the mechanism itself. Should you be running to the trauma hospital hot just because your patient rolled their SUV and presents with neck pain? Probably not. Now the game might change if you're an hour+ from the trauma center and there are other factors to consider (alcohol, bystanders report they were unconscious prior to your arrival but are awake now, etc.) Use your best judgement. Don't hall butt based on mechanism alone, but make a smart decision. There's no need to run code 3 to the hospital with someone involved in an MVC above 40MPH because their arm hurts.

Of course, there are always those gray areas...do what's in your patient's best interest.

Things to think about...

You mentioned peds calls. One of my favorite pieces of equipment is a specialized pediatrics bag. We have one that's a medium sized bag, with a Broselow tape and a separate, color-coded ziploc bag for each patient color/class. Each color-coded bag has an appropriately sized OPA, ET tube, and suction catheter. The color-coded laminated insert in each ziploc bag has dosages, volumes, and defibrillation/cardioversion energies calculated for that weight range. The bag also has pediatric blood pressure cuffs, IV catethers, airway management tools, etc.

Do you guys have CPAP?

On laryngoscope sets...if you can have enough on-hand to restock your truck, the plastic disposable ones are fine. No worries about sterilizing the blades. If ordering supplies might take a while due to your location, you might want to consider the metal blades.

What kind of rescue airway devices do you guys plan to use? I've used the Combitube and the King LTS-D. We currently use the King, which I am partial to.

Your service needs to provide gum-elastic bougies for airway management. No exceptions. They are cheap, and will save your butt in a difficult airway situation.

Do your LP12's have ETCO2 built in? Will you be ordering the ETCO2/O2 nasal cannulas? They are AWESOME, probably the most valuable piece of equipment on my truck.

I can't comment on ventilators, but I used a Pneupac at a previous job.

We use EZ-IO's and I really like them. We carry pediatric, adult, and large adult needles. They are very fast to start, you can have a line in place before your partner finishes flushing the IV drip set.

What about IV infusions? Do you want an IV pump, something simple like a Dial-A-Flow, or are you just going to count the drops with a metronome (OK I've only heard of London paramedics doing this)?

I don't have the document in front of me, but I know that we will be getting IV enalapril with the latest revision of our clinical guidelines. We also utilize NTG paste and tablets, Lasix (hopefully this will go away) and CPAP. When I get a copy of the new guidelines, I'll post them up.

tskstorm: Are you in EMS long enough to remember the Federal "Q" siren? Loudest vehicle mounted electrical/mechanical siren I know of, and actually needed a brake to stop it. I had one on my first ambulance, itself a Caddylance.

We have an electronic version of the Q in our ambulances. It doesn't sound as good, but it sure is loud. Works well for heavy traffic.

On our newer units, all of the emergency lights are LEDs. They are brighter, use less energy, and last longer.

We use diazepam as our first-line drug for adult and pedi seizures, with midazolam as a back-up if diazepam doesn't work or you can't establish an IV. It's up to the provider's discretion as to whether diazepam or midazolam are administered for sedation for anxiety/cardioversion/etc.

Our protocol is to maintain a MAP of 70 for TBI's. For noncompressible hemorrhage, we allow permissive hypotension and do not bolus until SBP drops below 70mmHg. Compressible external bleeds do not apply to that. We titrate our boluses to skin color/condition, pulse rate/location, capillary refill, and improvement in BP.

Agree with the majority of previous posters. You should have transported. In my service, this would fall under implied consent and the pt. would have been unable to refuse transport due to suicidal gesturing/demonstrated self harm because he took 20 aspirin + ETOH. My agency/medical director has a very low threshold for implied consent when it comes to suicidal patients.

As you have seen Princess, I have not slammed this service. I simply have expressed distrust in this style of management. You seem to have a great deal of personal experience with this service, why don't instead of you blowing off the handle and calling us out, why don't you come to us and tell us why that service CANNOT survive without letting someone who is CPR trained only drive the ambulance. Before you say they get to run calls with a veteran driver what happens when they are in the front of the ambulance and a patient crashes. The medic needs help and all that CPR certified driver can do is go back and look pretty.

Plus, I don't believe that the state of texas would allow this but without you citing sources and just telling us that "Texas made it that way" you need to cite a source because this is just a BAD IDEA.

I await your reply. IF you wish to reply privately I'm game for that.

Just don't come back here with your opinions or unsubstantiated claims.

ok, I was just on the department of EMS in Texas website. Did some quick research on their statutes/rules.

Here is what I found

An ECA is defined as the following:

(24) Emergency care attendant (ECA) - An individual who is certified by the department as minimally proficient to provide emergency prehospital care by providing initial aid that promotes comfort and avoids aggravation of an injury or illness.

Sounds like a EMT or First responder.

AS for minimum staffing of an ambulance is listed here

(g) Minimum Staffing Required.

(1) BLS--When response-ready or in-service, authorized EMS vehicles operating at the BLS level shall be staffed at a minimum with two emergency care attendants (ECAs).

(2) BLS with ALS capability--When response-ready or in-service below ALS two ECAs. Full ALS status becomes active when staffed by at least an emergency medical technician (EMT)-Intermediate and at least an EMT.

(3) BLS with MICU capability--When response-ready or in-service below MICU two ECAs. Full MICU status becomes active when staffed by at least a certified or licensed paramedic and at least an EMT.

(4) ALS--When response-ready or in-service, authorized EMS vehicles operating at the ALS level shall be staffed at a minimum with one EMT Basic and one EMT-Intermediate

So is an ECA someone who is CPR certified only? IF that's all that it takes then WOW. Plus the drivers that this volunteer service is going to allow to drive, won't they need to be certified by the state of Texas

Gotta love those rules.

Interesting. I was under the impression that the minimum required staffing for a Texas BLS ambulance was two EMT's.

ECA is actually a condensed emt class. Believe it or not they condense that 110 hours even further. They are trained really all skills that a basic is but with even less education if you can believe it.

Texas fails in that it allows 2 ECA's to staff an ambulance with no higher level. Worse yet it allows 1 ECA with an non trained driver to staff ambulances with a waiver and no additional help. I speak from experience as I started in EMS as a volunteer ECA then actually became a full time paid ECA. I made nearly $30000 a year as an ECA that was often the highest trained on the ambulance. Scary isn't it. The public really has no clue how little actual medical care they are going to get when an ambulance comes gets them.

As to not being able to pay because to much area and to few people. Bull crap. I used to work in a service with over 2500 square miles of primary and more than 6000 square miles of response responsibility. That total 6000 square miles has no hospital and fewer than 10000 people, with one of the highest poverty levels percentage wise in the nation yet it staffs paid ambulances 24/7. So any place says they can not pay for ambulance is a liar.

It's not even close to an EMT class. It's based off the NREMT First Responder curriculum.

My concern would be interoperability- these trucks couldn't use somebody else's stretcher if that became necessary for whatever reason.

My service used to have older model Ferno stretchers, with a track system instead of "horns." It was actually a really solid locking system, but the chief replaced it with Strykers (not that I complained about that) with horns for that reason- interoperability.

Only true if your previous stretchers weren't Strykers. They will work just fine with the old Strykers if need be.

I've used the Stryker powered stretchers in my current job and my previous job, and they're just awesome. Especially with that hefty 300+ pounder. Make sure you stock at least one spare battery (goes without saying). Some of the batteries are a little wonky and will go from green (charged) to red (recharge needed) after only one call, so that's something to keep an eye out for. The cost of the stretchers is still less than the cost for workman's compensation for a serious back injury from lifting. At least that's the way my last two employers saw it when they decided to buy them.