noahmedic

Pretty accurate!

***You Are an Iced Coffee***

At your best, you are: hyper, modern, and athletic

At your worst, you are: cheap and angsty

You drink coffee when: you're out with friends

Your caffeine addiction level: medium

What Kind of Coffee Are You?

http://www.blogthings.com/whatkindofcoffeeareyouquiz/

Well this is from another website where we had this stuff come up, so I'll just copy my response to that here:

I've never gotten comfortable writing on tape on my leg. I still use gloves. I had a new RN on a flight with me the other day looking at me like i was crazy for it. She'll catch on to all the strange things medics do here soon!

A few things I've learned:

-Keep your EKG electrodes attached to the leads, it'll save you one step

-If you have a patient who is leaking large amounts of bodily fluid onto the floor, keep your feet on the cot undercarriage and be sure to warn your partner to be careful opening the doors when you get to the ER. You don't want them to get hit with a tidal wave of nasty.

-A BP cuff makes a great tourniquet when you need to do an IV

-If the adapter keeps coming off your ET tube take it off and wipe it with an alcohol prep, it'll make the plastic a little bit tacky and keep it in place

-Always carry 3 or 4 pens with you, it is very embarrassing to have to steal the firefighters all the time. Pens always seem to disappear. Also keep a pen just for patients to use when they sign the forms.

-Always use the restroom whenever you have the chance. You never know when a call will come in.

-In the winter time keep a few bags of IV fluid on the dashboard over the defrost vents. It'll get them nice and warm for your patients. Heating pads work much better for this, but not everyone has that option.

-Emesis basins are never big enough, use a trash can instead. I don't know who designed those things, but they are pointless. Puke hits the curve and flies right at your face.

-Hydrogen Peroxide takes stains out of white uniform shirts, just apply with a 4x4 and your good to go for the rest of your shift

-Tap the cot frame against the back bumper to make sure its locked. I only forgot once thank god we were just arriving on scene.

-Always be extra nice to nurses and dispatchers, they can make your life a living hell. Bring food to them whenever you get the chance.

-Always look professional, it will instill confidence in your patients. Always bring an extra uniform to work, you never know when you're gonna need to change!

-Never run, its not you're emergency

-Keep around 10 pairs of gloves in your pocket. When you have multiple patients you'll be changing gloves alot! Also wear two pairs and only change the top one, stops the problem with sweaty hands.

-Scoop stretchers are COLD! If you have the time turn on the patient's shower and leave the scoop in the bathroom. The steam will warm it up a bit while you get a quick history.

-Never, ever, cut a down jacket. You'll only do that once!

-50 lbs=23 kgs, the easiest way for me to convert..

-Not quite sure how to explain this one, but if you can't hear the BP/lung sounds in the back of the box try biting down on your back teeth and putting your feet on the cot. It helps me out.

Well can you tell I was bored? I haven't had any calls for 8 hours.

I'm still trying to get a job in the field. I'd be in heaven at 9.50/hr. The 2 services here pay CRAP $6.75/hr. The very sad thing is this. The service here owns EMSA in Tulsa and OK City. The governing group for that company is called Paramedics Plus. It's sad that right now I work on cars all day long in a fast lube and make more than an EMT-B who within reason has a part in life or death actions for patients. (whether it be driving rig or cpr or whatever.) I'd have to take 3.50/hr paycut to start here.

Well technically Paramedics Plus is the private contractor for EMSA. EMSA is just a trust fund/admin board set up by the city governments'. Anyways, $9.50 seems on par for Tulsa. If a remember correctly EMSA/Paramedics Plus starts out around $9-$12/hr for basics, depending on experience, not too sure about transfer services. I'm curious what type of position this is too, if you're able please fill us in.

If you are just comparing m-series and the LP12 then I would take the LP12, but that's only because I "grew up" on that machine and know most of its quirks. I agree the LP12 is not the most user friendly device, and I hate that stupid rotary knob and 12,000,000 menus to walk through. The m-series I only used with one service and they did not train me very well. I always felt like I was fighting the machine to make it work for me, and we had serious problems with the batteries on the Zoll.

At my current job we use the Welch-Allyn PIC 50. They have really grown on me and I love the color screen. I can't stand the small paper that it prints onto. I haven't seen an EMS service using these yet, but it's pretty common in the critical care transport realm.

I think you did a great job.

could keeping a patient, who has COPD and had difficulty breathing, on high flow O2 even AFTER he felt and looked better be harmful for the patient?

In the prehospital world, no. In the long-term or critical care world, maybe.

The bottom line in this case is to treat the patients acute distress. More O2 will not harm them so if they are having respiratory difficulty start will a NRB, you will not hurt them during the short transport time.

Well you could tell who the "advisors" were...

Be safe,

R/R 911

They have advisors for that show?

I have to say that I watch this show every week, but certainly not for it medical reality, just because my partner makes me. In all seriousness we were sitting at base joking about the doctor showing her how to bag the patient. That and them calling it an "ambu-bag", maybe it just local vernacular, but we always call it a BVM. Anyways, it's just a tv show, I'm sure that the AMA hates them showing attendings sleeping with interns, and I say an article last week about the a nurses association complaining about their outlook on nurses. I guess real life wouldn't make good tv.

I believe an easier question would be, what am I NOT anal-retentive about. Let's make a quick list of some of the things that bother me:

-Cleaning: quarters, ambulance, plane, comm center, whatever! I like it clean and organized.

-Paperwork: Sloppy charts just bother me, do it right

-People who complain about doing their job. We are on-duty for 2 weeks solid and then off for 2 weeks. I LOVE it but some people find the need to complain when we have a flight in the middle of the night. Get up and do it, this is your job, we don't pay you to sit on your ass all day. While you're at it, why don't you help me with equipment check and for godsakes CLEAN YOUR SHIT UP! Can anyone tell I'm having problems with my new partner?

-Listening: this should be tested as a practical skill, you have to listen to your patients, nurses, docs, partners, pilots, drivers, firefighters, dispatchers, and whoever else is talking to you

-Safety: actually my whole company is really anal about this

-MANY OTHER THINGS!

"Noah was killed by a mob boss"

You can do that? Sweet!

Sort of. I pretty much told my supervisor that is what I am going to do, if we need to alter our insurance then so be it. I feel more comfortable with my EMT partner, I know what their limits are, and I know they are committed to EMS, not just a tag along who became an EMT so they could get on with the fire dept. With a random FF/EMT I really have no clue what to have them do, other then CPR, and even that is hit or miss most of the time.

It's pretty much the same here. The idea is to spread ALS resources as wide as possible. The only thing I disagree with is a medic attending all calls. We have the same rule here, and it really is a disservice to the EMT's. Most of them want to learn and when possible I try to get a firefighter to drive so we can both be in the back, but you can normally only pull that on true emergency calls.

I think its a good idea. The community supports its EMS service and gets a good return on their investment at the same time. My only concern would be making sure that it still appears to the vast majority of people to be an ambulance. I've personally never seen or heard of this, but I think its a good idea!

The following is taken from the DOT-NHTSA EMT-Basic National Standard Curriculum Instructor's Course Guide

If anyone is interested the weblink is http://www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pdf

Clinical/Field Rotations

In addition to the required 110 hours of instruction, this course requires that the student

have patient interactions in a clinical setting. Ideally, areas that have access to an

Emergency Medical Services system should send students into the field with

experienced preceptors. However, in low volume systems or systems with legal

considerations, the training program may utilize emergency departments, clinics, or

physician offices. The program director or medical director must establish appropriate

relationships with various clinical sites to assure adequate contact with patients.

The student should interview and assess a minimum of five patients. The student

should record the patient history and assessment on a prehospital care report just as

he would if he were interacting with this patient in a field setting. The prehospital care

report should then be reviewed by the Primary Instructor to assure competent

documentation practices in accordance with the minimum data set. Regardless of the

clinical educational system, the program must establish a feedback system to assure

that students have acted safely and professionally during their training. Students

should be graded on this experience.

Students who have been reported to have difficulty in the clinical or field setting must

receive remediation and redirection. Students should be required to repeat clinical or

field setting experiences until they are deemed competent within the goals established

by the Program Director.

In extreme cases, when students are not able to obtain experiences in a clinical or field

setting, it may be necessary to utilize programmed patients. All variances must be

approved by the state EMS office or licensing agency.

If I understand correctly the states were encouraged to adopt this curriculum, and it is required for National Registry testing, but each State has the right to develop their own curriculum. I could be wrong however.

Personally I had 36 hours of ambulance time, and 24 hours of ER time for my Basic clinicals. I also had a month long academy with my first job.

If you are taking a class that will allow you to test for the I-99 why would you want to limit yourself to the protocols and skill set of an I-85? That would be my take on it anyways. I don't care if the 85 is easier, I would go for the 99.

They already have a level that includes only intubation (why can no one seem to spell that word correctly!), and I.V. skills. In most states its called EMT-Intermediate, National Registry calls it EMT-I88.

Since you asked for some idea of what I mean when I say increased educational requirements:

GENERAL EDUCATIONAL RECOMMENDATIONS- ALL TO BE COMPLETED PRIOR TO ENROLLMENT IN PRECLINICAL OR CLINCAL COURSES

-Biology (w/ labs) 8 sem hrs (general biology and microbiology)

-General chemistry (w/ lab) 8 sem hrs

-Organic chemistry (w/ lab) 8 sem hrs

-Biochemistry (lab optional) 3-4 sem hrs

-Human A+P (w/ lab) 8 sem hrs

-Pathophysiology 2-3 sem hrs

-English composition 3 sem hrs

-Public speaking 3 sem hrs

-General psychology 3 sem hrs

-Physics (w/ labs) 8 sem hrs

I'll post my ideas on preclinical and clinical education requirements later. I have errands to run at the moment.

I just wanted to add that this is very close to what a B.S.N. requires. It is a very good start, and very managable for a basic transitioning to medic. It might take more than 4 years if they have to go part-time, but if we want to increase the education and professional image of our field I think it's a great move.

We use the LP12's here, but I do have a few complaints about them. #1 is the scrolling knob, and the multiple menus. The other is the weight, these things can get heavy! I really want to try out the Phillips MRX. Does anyone have any thoughts on these? I love the ability to see the entire 12 lead view at one time on the huge screen.

Man, as a biology major reading this thread makes me laugh.

"You might as well put them on Carbon monoxide instead of O2

lol."

And I always thought we exhaled carbon dioxide. One little oxygen atom can make all the difference in the world

"If you read the full article you would also know that the reasoning is that

the cells needed to actually get the heart to start

pumping on it's own (ATP) aren't being activated until about compression

15, and then quickly die off when compressions stop."

This one might have just have been a typo, but as someone else said ATP is a chemical within the cells, not a cell itself.

I realize that a bachelor's degree in science is not required to do this job, but how much better caregivers would we all be if we knew the background science of our jobs?

As zippyRN said blankets and especially pillows work wonders when splinting at odd angles. The idea is to hold it still, the item does not have to be rigid, you just need to immobilize the joint above and below.

frac straps above, below , figure 8 round the ankles pad with pillows and blankets?

7-10 am with no calls? Why do I have to work in a "high-performance", 'system status management" system! WHY!

(Funny note: The first time I signed up to ride along I sat there from 7:30am till 11:00pm. The first call of the day for my truck came in at 10:00pm.)

It is hard to treat EMS or any medical career as just a job that you go to and leave. We do have classes, conference, CEU's, and many other things.

As for holidays, my immediate family (parents, brother, and sister) is very willing to work with me, and we've even done Christmas @ midnight just so I could be there. My extended family is not so understanding, I get comments every year as to why I have to work on this holiday or that holiday, and then am shunned because I don't show up for family functions. I missed my cousins wedding last month because I couldn't get anyone to cover for me, and my family's reply was to "call in sick". I always tell them that emergencies happen 365 days a year, but they don't understand.

As a side note, what do your services do about holidays? We have to work on of the following:Christmas, Thanksgiving, or New Years, and we get the other two off, so its really not that bad.

Driving seems like a major part of being an EMT, at least in my system. We don't have stations so we post all over town. Our crews are one basic and one paramedic so the paramedic doesn't drive much, but they are still required to take and pass EVOC, and keep a valid drivers license. You could work in an ER, or at a summer camp, and not have to drive I guess.

I was a very nervous driver at first, but my problem was confidence, I had just gotten okay with my medic skills and I was having to learn to drive a 2-ton ambulance. My problem worked itself out in time, the more I drove, the more confident I became.

Getting down to the root of your problem may help you decide. If you are nervous, then practice will help. If you just don't like it, then maybe you need to ask yourself if you would be willing to endure it while you work. We all have aspects of EMS that we don't like (mine is smelly feet, YUCK!), I guess you have to decide if the pros outweigh the cons.

We carry them in Tulsa, OK, but I've never seen them used on a patient. They sit under the bench seat, I wonder if they would even inflate. Our protocols allow them for pelvic/lower limb instability, and for shock with extended transport time, but our times almost never exceed 15 minutes. The last time I even saw them laid out was in EMT class when we were being shown how to use them (and at the same time being told we never would).

This may be way more than what you wanted, but hope it helps! I can't take complete credit for the following I learned it from my Basic instructor and still use it.

Since we use paperless charting I've learned to shorten my narrative section down quite a bit but it is still the most important part of charting. I use the CHART-E method as follows:

C-Chief Complaint This is why you are there at the patients side, i.e., chest pain, SOB, MVA, gunshot wound L knee, etc.

H-History of Present Illness This is a brief, but complete description of the chief complaint...OPQx3RST for pain, pertinent questions for medical, respiratory, etc. Then, pertinent negatives.

A-Assessment From head to toe, broken down into the following sections:

General - Age, sex, approx. weight, level of distress, level of

consciousness and orientation. Visible trauma, approx. blood loss.

HEENT(Head, Ears, Eyes, Nose, Throat)

Chest and Thorax

Abdomen and Pelvis

Extremities and posterior

R-Rx or Treatment

T-Transport In addition to what happened during transport i put Med Control orders here, and transfer of care information here.

E-Exceptions Any deviations from protocol and why, this is also where I document patient refusals, or any communication troubles with dispatch or hospital, or any other problems

For radio reports(I had to sit down and think about the order i say things in) I tend to use the following info, I don't really have a mnemonic for this one:

1)Unit Identification

2)E.T.A.

3)Patients age and sex

4)Chief Complaint

5)Brief(very brief) pertinent history of present illness

6)Major past illness/history

7)Mental status

8)Baseline vitals

9)pertinent finding of exam

10)Emergency care given

11)Patients response to care given

12)Questions for medical control

Well, I am dramatically younger than you, but almost half of my class was people over 30. It seems like this is a very popular 2nd chance career.

There is some gender bias, but it seems to reign more in the fire service, at least in my area.

Don't worry about how much you can lift, you should learn lifting techniques in class, and you can probably lift more than you think you can.

One ride along seems a little on the low side, I was required to do 36 hours with the ambulance, and 12 hours in the E.R. during my Basic class. You should be able to get more time third riding, but you might have to go a little further from home to do it because of the competition from schools for time slots. In my area we have to fight, esp. for our E.R. times.

I had no problem finding employment as a Basic. I believe your desire to go to Paramedic school could be a plus, services are always looking for Paramedics, and most of the time they will pay for your schooling too.

My education is a little strange, my medic classes are at a vo-tech school, but I am receiving college credit at a local private university. They allowed me to design my own degree program in EMS Management, it is based on their standard Management program, but most of my elective/internship time is taken up with my medic classes. All I have left to do is 10 months of medic school. The only complaint I have about the tech school is the number of high schoolers and the rules that we have to follow because of them(no gum in class, I.D. badges must be worn at all times,etc.).

Hope you enjoy your class!

Noah, EMT-B(soon to be EMT-P)