Fox800

In certain situations (standby work, rescue operations), t-shirts are acceptable. For normal ground transport personnel, a polo shirt is really the minimum. And for the love of God tuck your shirt in. Nothing raises my BP faster than seeing firefighters or EMS crews wearing untucked polo or uniform shirts. Looks like sh!t.

You can find another job. Better to be judged by twelve than carried by six.

I'm sure you have a different spin being in a country with draconian gun control laws. Do I carry on the box? No. Do I wish that I could carry concealed? Yes. However, my job takes me many places where I cannot carry anyways under a concealed handgun license even IF my agency allowed it: schools, bars, jails, hospitals, churches, courts, etc. Even if my employer allowed it, I'd still be committing a felony by carrying there. In the aftermath of Hurricane Katrina, MANY EMS providers that traveled to LA to help out were armed. Law and order didn't exist in some areas for a significant length of time, you were on your own. I'd like to see a bigger emphasis on defensive tactics, self-defense, and the opportunity to be certified to carry OC. Yes we need to wait for police, but they won't be there 100% of the time when you need them, and you won't always be able to predict when you need them before all hell breaks loose. Sometimes you're just on your own.

I hear good things about Conterra's products. http://www.conterra-inc.com/index.php?cPath=1

Lifepak 12: all the monitor crap, + a nasal cannula w/capnography capabilities Primary Bag (Statpack): BP cuff, steth, thermometer, glucometer, vomit bags, King LT's, advanced airway gear (laryngoscope, blades, tubes, NG set, ResQPod), BVM w/C-collar wrapped around it, controlled medications, small IV start pack w/250mL bag, small bandaging pack w/enough for most minor injuries (gauze, Kerlix, petrolatum gauze, Coban, tape, triangular bandages), front-line medications (Epi 1:10,000, Atropine, Lidocaine, Epi 1:1,000, Benadryl IV, Benadryl PO, Naloxone, ASA, NTG tabs, NTG paste, Glucagon, Oral Glucose, D50%, Ondansetron, Amiodarone, Albuterol, Ipratropium), a few syringes and needles, NRB, nasal cannula, nebulizer. It looks like this (except blue): http://www.statpacksstore.com/PhotoGallery...roductCode=2024 IV/Meds Bag (Statpack): Dopamine, 50mL bags, 250mL bags, 1000mL bag (all NS), Dial-a-Flows (wish we had pumps), alligator clips, medication labels, drip rate charts, all of the aforementioned drugs + Bicarb, Mag Sulfate, Adenosine, Lasix, Solu-Medrol, pre-mixed Lidocaine drip, 2-3 IV caths of each size, 2-3 syringes of each size, needles, saline locks, IV drip sets, a small bandaging pack, and the EZ-IO. It looks like this (again, blue): http://www.statpacksstore.com/PhotoGallery...roductCode=2025 We also have separate pediatric, OB, and trauma bags. On most seemingly simple calls we just bring in the primary backpack and LP12. Anything cardiac/respiratory/AMS/arrest/unknown/potential to be bad we'll bring the IV/meds bag + the suction. Any hemorrhage/penetrating trauma/bad injury call gets the trauma bag (duh).

Do you stash a bag with personal items on the truck? What do you keep in it? What kind o' bag is it? Ex. Food, toiletries, batteries for things, interesting EMS supplies that your service doesn't stock so you acquired over the years, etc etc. My protective gear bag has all of my issued PPE items + a spare uniform + other doodads. That's bunker gear, a winter/rain jacket, helmet, work gloves, ballistic vest, spare station boots, spare shirt/pants/belt/undergarments, and a small toiletry bag with deodorant, contact lens fluid, toothbrush/toothpaste, Tylenol, Pepto Bismol, Tums, etc.

At my gig we decide where the patient goes as well (ER vs. triage) but that isn't anywhere near the level of autonomy that the Alberta paramedics have in this case.

My current service last service have gone "all Fentanyl" when it comes to pain management, no more Morphine. My last gig did carry Nitronox. Throw that on and add some Fentanyl and you have one happy pt. Diazepam for muscle spasms, midazolam for severe anxiety.

We are expected to be at the patient's side in the vehicle, providing ALS assessment/care as needed. The fire department will also have an "inside firefighter" who's job is to support you while you are both in the car with the patient. We are issued wildland turnouts (wish they were structural gear), helmets, goggles, work gloves, and firefighting boots. At the scene of an entrapment, we are expected to be in the vehicle with the patient assuming that the scene is safe enough to permit this. As far as high angle/low angle/conspace/water rescue goes, we have specially trained Rescue Paramedics who carry rope rescue and water rescue equipment on their units. They will run the show as far as getting to the patient, stabilizing them, and working with the FDs to extricate the pt. Basically, our service has the capabilities to deliver ALS care to the patient in virtually any rescue environment (including HAZMAT).

Now that I think about it, it's true that most of EMS in Texas is provided by third services (government agencies, public utility models, or private companies). Most of the major cities have EMS run by the fire department (Dallas, Houston, San Antonio, El Paso). Austin is the only major city I can think of that has true third-service EMS as a government agency. Fort Worth has MedStar, which has had a lot of problems with recruitment/retention lately. A lot of counties have their own county-level EMS service, or just contract with privates.

This patient needs benzodiazepines and may very well have paralytics and an ET tube on the horizon. None of which you can do at the BLS level.

Pulse...maybe. HR and SpO2 by finger probe? Sure. Blood glucose level test? That's expected...the standard of care. BP? Very funny. Try getting an accurate auscultated BP on an actively seizing patient. Tell me that heartbeat you felt wasn't his arm flailing around. And don't tell me that the NIBP your monitor gives you would be accurate. As a BLS provider, the fact that there's not much you can do makes this situation pretty straightforward and easy. He's been seizing for 20+ minutes prior to EMS arrival, so he's hypoxic as all get out. NPA, BVM @ 15LPM, whatever initial vitals you can get, backboard, prompt ride to the hospital.

Wow, that's a lot of questions. I will try to answer them one by one. The EMS system in Texas varies greatly (duh). The quality of care fluctuates depending on where you are. We have urban systems that run their butts off and rural volunteer services that rarely turn a wheel. The majority of EMS agencies are fire departments. With that said, there are a good number of third services and private companies that provide 911 response. Texas is one of the states that allows a medical director to specify your "scope of practice", the state sets minimums but doesn't explicitly forbid other procedures. This can create gray areas where rural BLS/ILS providers are authorized to perform procedures that are typically reserved for paramedics. You'll find the standard assortment of paramedic procedures/medications, lots of services have protocols for RSI, the more progressive ones are inducing hypothermia for post-arrest patients, the really spoiled places have things like transport ventilators and IV pumps (cough MCHD EMS cough). You'll find that the vast majority of paramedic ambulances are set up as medic/EMT or medic/EMT-I, it's truly a luxury to work in a system with medic/medic trucks with both paramedics cleared to the same level (I'm spoiled). The only agencies I know of off-hand that do this are Austin-Travis County EMS and Williamson County EMS. Most services don't wanna cough up the $ to pay for that. As far as "thinking on your feet" goes, it really depends on the agency. The ones I've worked for give you the ability to think for yourself and apply our clinical "guidelines" as you see appropriate. Other agencies make you call for orders for practically everything. Hospitals depend on the area you work in. Obviously, the closer you are to a major metropolitan area, the better your choices will be. Some rural agencies may be hours from a basic hospital. Texas does not have a true "trauma system" compared to other states. This is just my opinion, but I'd recommend taking your paramedic course here in Texas. Doing it in California will instill that fire-based, kick-it-to-AMR, call-for-orders-for-everything EMS mentality. Here you'll have the opportunity to ride with some kickass third services and learn to think for yourself.

Has anyone from abroad gone on an observer shift with the London Ambulance Service? I plan on re-visiting the UK in the next year or two and would love to ride along and see how the LAS works.

Somehow I figured that comment would come quickly I was kinda thinking about the difficulty of having to A) assist ventilations if this lady's sats and skin color are going to crap attempt more IVs/do an IO to get D50 on board vs. waiting to get to the hospital...with one set of hands.

Here's the scenario: Female patient 80+ years old, called out for a fall. Fire crew (4 EMT's) arrives 3-4 minutes ahead of the ambulance, finds pt. on her knees facing away from the toilet, pt. had defecated on herself. Fire crew lifts pt. off her knees into a wooden chair. We arrive and find pt. with altered mentation (GCS 14, slow to respond, repetitive questioning), diaphoretic. Pt. released from a small hospital yesterday for a UTI. Hx: HTN, CAD, no hx of diabetes Meds: Levaquin (for UTI) NKDA Initial VS: HR 66, VS 130/90, RR 30, SP02 90% on room air, lung sounds clear, temp 98.6 temporal, BGL 43. 2 or 3 unsuccessful IV attempts, pt. says she can't swallow anything so oral glucose is a no-go. 1mg Glucagon goes in IM. O2 via NRB @ 15lpm. Sinus rhythm on the monitor. Move pt. to stretcher, move to ambulance. Get pt. in the back of the ambulance, SPO2 is now 72% with an NRB @ 15lpm, RR of 40, ETC02 of 25, 2nd BGL (~10 minutes after 1st one) is 33. Fingers are now cyanotic. With better lighting in the ambulance, you can now see that the pt.'s abdomen looks mottled. Closest (appropriate) hospital is 8-10 minutes away. What would be your next move? Go ahead and transport? Take some of the fire guys with you to help? Just wanted to hear some different thought processes.

Bringing a large backpack and a separate trauma pack and digging through them for supplies in a confined space/vehicle rescue situation, while not spilling the stuff everywhere.

To the rest of the United States, that's known as a RIT team.

We use them as our primary packs. Each ambulance has two bags. The first (primary) bag carries BP/steth, glucometer, thermometer, King LT's, surgical airway kit, chest decompression kit, intubation stuff, BVM, bandaging stuff, and some first-line cardiac/anaphylaxis/ACS drugs, also has a small O2 tank and a small IV start kit (250mL bag). The second bag is for IV/med supplies. It has big bags o' saline, the EZ-IO, a bunch of syringes/needles/catheters, and a ton of drugs. They work fairly well. Seem pretty durable in the 1-2 years we've been using them.

What do you think of it? Did you get it stocked or empty? I usually carry some stuff on a duty belt but our rescue turnouts negate that. I could clip one of these pouches onto the nylon belt of my turnout pants and at least have some basic stuff with me.

Anyone use one of these in the field? Interested in getting one for trauma calls/rescue situations. Something to have to stash some of the more useful trauma accessories (tourniquet, long IV caths, NPAs/OPAs, bandages, petrolatum dressings, shears, etc). I've found a few different models and I'm wondering if anyone has any experience with them. Call me a whacker, but our bags can be a huge pain to get through tight spaces, much less fish things out of them without spilling the entire bag into a wrecked car/tight space. North American Rescue CCRK: http://www.narescue.com/Combat-Casualty-Re...Ind--P28C4.aspx Pro Med Kit ALS Leg Pack: http://promedkits.com/als_leg.html CUF Tactical Medic Thigh Rig: http://www.hsgear.biz/ProductInfo~productid~36-CUFTHIGH.html I think I'm going to just order an empty pouch and stock it myself.

What's a "choper"? Your "choper" doesn't have portable CT, you're thinking of portable ultrasound. How can I get set up with AUTO LUNCH? It's hard to find time to eat around here lately... Spell check is your friend.

Holy sheep I step away from this thread for a little while and it blows up :shock: Let me clarify the following: -The patient WAS transported -The transport unit was ALS (all units in our system are ALS) -The patient was experiencing a considerable amount of rectal bleeding -The paramedic in question was in an evaluation phase for independent clearance and was "dinged" by his Field Training Officer, not by a supervisor -A supervisor was never called to the scene or involved with this incident

We have protocols for the following IN drugs: Fentanyl 1-2 mcg/kg Versed 5mg Naloxone 2mg Glucagon 1mg I've had mixed results with the fentanyl and versed. Haven't given naloxone or glucagon IN yet.

There are services that still use EOA's? Yikes :shock: