emt322632

I had never seen, let alone heard of ANYTHING this bad until yesterday... 2 college kids went on a drinking binge, one was totally unresponsive without a gag reflex and around 6-8 resps/min, the other was singing and having a jolly time. The unresponsive kid ended up having a BAC of .53, now on a ventilator... Anyone else ever run into BACs that high before? If so what was the patient outcome in the long run? I'm thinkin if this kid survives, he's having permanent brain or liver damage...

Shira Emt... Most people do appreciate volunteers, however most people in the public do not know anything else other than what they are given by their public leaders. I do not agree that volunteers are the answer, nor should they be. They are just that, volunteers. In order for EMS to be taken seriously as a profession, having people around willing to do this for next to nothing, severely limits the ability of those of us who wish to do this for a living to argue for our jobs. True, people do not care who comes to their house to help them, they only expect an ambulance to be out the door the minute they hang up with 911. With volunteer companies, there is no guarantee that an ambulance will be out the door every second of everyday, staffed with the best crew that can be found. An example of this...One day a volunteer squad in my area got paged for a male having chest pain. 4 pages later, they were still not out the door, 2 pages for the next closest volly squad ended up with nothing, and the same thing with the next. They ended up paging a squad that was 20 miles away to come to the guy's aid, who by then was unconscious, apneic and pulseless. He died, leaving a wife and newborn daughter behind. The reason the volunteers didn't respond, was because everyone was attending a training at the EMS center about 40 miles away. That is just unacceptable in my opinion, call it poor planning, call it stupidity...it's unacceptable. With a paid organization, you are guaranteed a response, within a certain amount of time, with a full ALS crew...no additional pages for ALS, no ALS from a department 20 miles away, heck no ambulances from 20 miles away... I have no doubt that you volunteer because you love to do it...but that doesn't mean that those of us that are paid do not love our jobs either...we aren't forced to be there just as you aren't... As the system stands, it is built for volunteers...less education time so we can churn out techs so we can fill trucks...less time spent on the why more spent on the how... Sorry for the rant...

I'm going on to Paramedic school in the Fall after being an EMT for 1 1/2 years, and then getting my AEMT-CC (equivalent to NREMT-I99). My reasoning was I didn't know what I wanted to do with my life...now I know...so here I am, 4 years later and 30,000 in debt for my B.A. in history lol... Wish I would have found out what I wanted to do earlier, but in the end...whatever makes you happy... I'm glad you found the spark that lights your fire faster than I did!!!

Everyone has to have the biggest, shiniest truck...The newest, most sophisticated equipment... It's oneupmanship at it's finest. Volunteer services around here anyway seem to think that by buying the shiny new toys, they're doing everyone a favor... But honestly...it's no good if the time it takes to get out the door to the call exceeds 12 minutes on average...Or worse if there is no one is there to staff the rig...

I agree with everyone here as well...In the past I've been stuck on a volly ambulance with people who can't lift half of their own weight. It does no good to you, your crew, or the patient to have a person on the bus who can't help lift in some way shape or form. Relying on mustering the correct amount of manpower each and everytime is just wishful thinking.

Speaking of drunk colleageus and other volly squad nightmare scenarios... I got dispatched to a bar one evening for a drunk woman passed out ( no surprise eh?) to find one of the girls that volunteers with the squad at the patient's side attempting to take a pulse. She was almost as drunk as the patient, the cops had told her to step back, but she refused to listen, believing she was the ONLY person on scene this woman would talk to. Granted, this type of individual exists in all systems, but you have to know when to be on duty, and when to leave your stethoscope at home... Another volunteer nightmare, the one that made me disgusted with volunteering, occurred when a call went out for an 80 year old female, fell the day before, now experiencing knee pain. One of those calls where, yeah, it's B.S. and you know it, but it's still a call, still a patient in need... 15 minutes later....after paging 2x for the department and 1x for fire department mutual aid for a driver...I told dispatch to turn the call over to the closest available department, and miraculously got a driver...go figure? When someone is going to step into their sandbox, they can't stand it... No volunteering for me thanks...

I would have to agree that the whole "Volunteer vs. Paid" argument definitely hurts EMS professionalism, mostly because we're all so busy arguing amongst ourselves that most of the time we forget why we're here: the patient. Example: The volly squad that serves in the area where I work is grossly understaffed when it comes to ALS. When I work, they generally do not have ALS available, but refuse to dispatch us because they have a problem with 1 person on our staff. We don't suffer because they won't call us, they don't suffer...ultimately the patient does because a higher level of care could have been delivered quicker, and wasn't... Volunteer squads really do, in a way, hinder EMS...after all, if you're selling something, and someone else can come along and do it for next to nothing, wouldn't you accept it? I've seen the same suggestions to improve U.S. EMS here that I would have made... Increase education requirements :move away from teaching "technicians" and move toward training "clinicians". Increase pay : a happy employee is more than likely going to love their job, and show it when they work their job. Decrease volunteers: Volunteers are great, but hey, sometimes they can't get out quickly or at all... Just my .02

It also depends on the patient as to whether or not you can actually see the outline of the pacemaker...if the patient is relatively large you may have a hard time seeing it in my experience...

At work we only carry NS...at the volly squad (last I knew anyway) we carry both LR and NS...

In my world, sticking a thick gel into an unconscious person's mouth is ALWAYS a bad idea...always;-)

The company I run for now does alot of business in non-emergent transfers, we also do emergency calls. Currently, if a transfer comes in, and it is a stat trip (as defined by the ER docs) the emergency crew is required to go, no matter what time of day or night. I've found myself on a number of these after already working a 12-13 hour shift, and it's kinda brutal. My advice to you is to try to convince your boss to have someone on call with the car. That way, if a run comes in, the car is available, though not at the station. This way, someone is on their way in with the car, and your 911 crews are free to run their calls without the worry of taking granny home at 2 am.

[align=left]Your teacher should know better. Feeding an unconscious person a sticky gel is not really conducive to a patent airway. I had one call at a nursing homes for an unconscious diabetic, to find out that when I got there they'd given not 1 but 3 tubes of oral glucose to the guy. Suctioning that stuff is hard. In short, no you are not supposed to give oral glucose to an unconscious patient, only if the patient is awake and alert enough to swallow. Sometimes though, people feel they need to do SOMETHING to help the person, and feel helpless. My advice is to ask your teacher about possible airway problems that could result from giving oral glucose to an unconscious patient, see what she says.

Just need some input on a case I recently had that's been kind of bugging me. Recently had a 21 y.o. male involved in a car v. pedestrian accident (the car won), low speed 20-25 mph. Pt A&O x 3, no syncope, no neck or back pain, c/o only R leg pain rated at a 7/10. Full physical exam revealed no bruising, no obvious deformity to the leg or any other body part for that matter. Fully immobilized the kid, backboard, collar. Stated the pain in his leg was worse around his knee, nowhere else. += PMSx4. Leg was slightly rotated laterally, but when I pulled gentle traction, he stated the pain increased more. Immobilized the leg by fixation. IV, O2, etc.... So here's where I need either vindication or someone to tell me I'm an idiot.... A colleague of mine works in the particular hospital we took the patient to, and later called me to tell me I "completely missed" a huge femur fracture. The doctor on call didn't even think the kid had broken his femur, until they moved his leg to assess him, and it began to swell and bruise and the pain worsened. Question is, how could I have missed the fracture if the physical exam I did, which I believe was as thorough as could be, examining the limb at least 3 times enroute to the hospital with no change from the initial assessment...I could only go on what I found at the scene...the fact that the doctor and the ER staff didn't believe the femur was broken also says that maybe I did right... Any thoughts? Title adjusted to reflect content..AK

Aspirin Atropine Albuterol Atrovent Benadryl D50 Dopamine Epi 1:10,000 Epi 1:1,000 Etomidate Furosemide Glucagon Lidocaine Bolus and Drip Mag Sulfate Narcan Nitro spray and tabs Sodium Bicarb Toradol NACL

I'm hearing alot of the same things from other people that I went through in my OR rotations. Docs or RNs fearful of giving the opportunity to a student due to fear of a lawsuit or damage to the patient. This doesn't seem like an isolated incident, which to me says something about the state of EMS education in the US. I did have a rotation with an RN who allowed me the tube without any hesitation, but this was one day out of 5 or 6 mind you. Also, the hospital I went to for OR time, (the ONLY hospital in my area that would allow EMS students in the OR), was and is currently moving away from ETT in favor of LMA. I have been told that the class now going through clinicals have had very few attempts at intubations, or none at all. Something needs to change, practicing on mannequins is not enough.

Top Gun is great... Also gotta love this part... Maverick: Goose....she's lost that lovin' feelin'... Goose: Wha? No she hasn't... Maverick: Yes she has.. Goose: God da...I hate it when she does that... lol

Correct!! +5 to Wakkoemt!! lol

From Kingdom of Heaven: "What man is a man who does not make the world better?" and "Holiness is in right action, and courage on behalf of those who cannot defend themselves..." and from perhaps the greatest movie ever made...+5 points for anyone who names it... "Are you the police?" "No m'am, we're musicians..." (also a nice one if someone asks the stupid question, "are you the paramedics?" :wink:

Notsobrite, I've had the same problem. The squad I currently run in, and the surrounding area actually, is full of people who seem to really only care about promoting themselves rather than quality patient care. I could go on at lengths about how this subject bugs me, but it has probably been talked about ad nauseum. My advice, don't quit a squad simply because of a few bad eggs. Go there to do what you came to do, help people. If others seem to be using it as a stepping stone, it's unfortunate, but as long as it doesn't effect you or your care, then good for you. The people who are simply in this for the ego boost, usually die out fairly quickly. In my experience, you hardly get a thank you from anyone, and those who are in it solely for the boost will probably fizzle or burn out quickly.

When I interviewed for my job, I laid out my plans for the boss as best I could. I didn't give BS (other than the usual pleasantries) and told him exactly what I wanted to do for the company and for myself, i.e. going to Paramedic school eventually after completing college, and gaining more experience as a provider. During training, I didn't pretend to be anything other than myself. I'd like to think I've turned out alright, and I've been with the same company for almost 2 1/2 years. Remember everything is a learning experience, not one person knows everything, there are just people with more experience and more training. As others said, go on to Paramedic school, it shows the company you're interested in EMS as a career and informs them that you're a driven individual. As for the tests, expect perhaps a trauma scenario, maybe a full arrest or some such thing.

I agree with Timmy, not having control over something as potentially lethal as electricity scares me, especially if this is going to be used in a PAD program. I would go for the semi-automatic AEDs over the fully automatic, less potential for an accident. Granted the human aspect is still there, but at least then you have someone pushing the button before you shock.

Granted most protocols state that a patient with a low D-stick buys themself an IV of D50 or IM glucagon, but like Rid said, if they're alert enough to speak and swallow, why waste the time searching for a vein or readying the glucagon when it's so much easier to administer a tube of glucose or a glass of OJ. As for the tablets vs. gel, everything I would have said has already been said lol...gel faster acting than tablets...I myself prefer the cherry flavored vs the lemon though lol...

It's true that we've broadcast to the terrorists the problems that apparently litter the railway and chemical industries, but this may also be the only way to get the attention this issue truly deserves. Look what happened in the 1900s when Upton Sinclair published The Jungle, about the meatpacking industry, vast sweeping changes in regulations governing food, it lead to the creation of the FDA even. Granted we're airing our dirty laundry, but sadly maybe this is the only way to get the laundry cleaned.

Hilarious! lol

I would have done the same thing in your situation. Sad situation, but in the end like everyone has said you put the patient above your own ego. Too many people that I know would be unwilling to "give up", and would have ran it despite there having been a previously valid DNR. Hard situation to be in, but you did well.