AMESEMT

I get a manual set of vitals first, then once in the unit I will use the automated if it comes to close to what I think it should be based on what the patient looks like. I have had times where it is different so I take a manual set and it does not even come close. It is a nice tool for when you want another blood pressure and you have a few other things to do. That way you can do several things simultaneously.

I didn't vote, but here are our options where I work as an ALS provider. We carry for pain: Nitrox Fentanyl Morphine Demerol I personally like to give the fentanyl. It seems like it is more effective as easing the pain versus the morphine, and without the drop in BP. Two days ago I had a patient that slipped on the ice and had obvious deformity to the left wrist. I gave her fentanyl and her pain went from 9/10 to 4/10.

Thanks but I have already accepted the position in Iowa and have already done all the paperwork and state licensing already. Plus I have already signed a lease. Thanks anyways! Hope you guys find people to fill those positions! Ames

Too bad I didn't know sooner! I am in KC right now but accepted a position in Iowa since no one in KC is hiring.

I say it was a good call on immobilizing her. Her bones are fragile with her hx and the possibility of a fracture are higher. The KED board though..... By the sound of it she was unstable and spending the extra time to put her in a KED is not warranted. Fiznat - According to ACLS pacing is necessary immediately, but atropine, epi, or dopamine can be used while waiting for the pacer. Since Nifty had help with the pacer I think it was a good call on the atropine and dopamine. I have transported people on a LBB with the head of the cot up some to elevate the head. You just have to make sure you loosen the straps on the cot before you do it.

Thanks for all the advice. I found out Friday after Thanksgiving I got the job!!!! I start December 22nd.

Thanks for all of the advice. My roommate and I talked to the agent this morning and we have worked it out. The apartments are in high demand and if they can get someone in, our lease is null and void once someone rents our apartment. The downside (or plus side) is that it is possible to move out very quickly. We are going to tell them the soonest we can move out and go from there. There is potential to move out without any problems (just forfeiting the $100 deposit).

So I have my first job as a paramedic. I am a little nervous. Going from student to the one in charge in the back is a little nerve racking. My preceptors say I know my stuff and I will make a great medic, and the National Registry says I am knowledgeable (since I passed the test). But I am still a little nervous. Maybe because for the past month I have been looking for a job and have been working part-time at a grocery store and have not been in the field, the other part of me says it is because I have had someone looking over my shoulder before and now I won't. Any words of advice to a new medic? Ames

Hey All, So I got my first paramedic job in Iowa. Right now I am in KC and thus have to move to Ames. Right now I am in the middle of a 12 month lease and will have to break it before I can move. My management company is not that nice and the lease only covers transfers (within a company) to another location. Anyone have any advice on how to get the rental company to allow me to break the lease at only 6 months? I tried to find a job in KC (applied at 5 different companies in the KC area) and no one was hiring. I have student loans coming due soon and I can't afford to stay on my meager hourly wage at the grocery store I work at, so I would not be able to pay rent as well if I stayed in KC. So I applied in Iowa thinking it was way out in left field that I would get the job. But here I am. I was going to explain it all to them and see how nice they will be. Any help would be greatly appreciated! Thanks Ames

Yea...I might scare them away. Unless they like hair, then they would probably hire me in an instant. LOL.

Not exactly sure which category to post this but since I was just a student not too long ago I will post it here. On Monday I have my first interview for a paramedic position. Besides looking nice (i.e. wearing a suit), what other things can I do to make myself more desirable (not sexually.....jeeze)? I want to give myself the best chance of being given an offer. Any suggestions would be greatly appreciated since I am new to the job hunt on the EMS side. I do have the ABC soup of certs (PALS, PEPP, AMLS, GEMS, ACLS, BLS instructor, PHTLS, and NRP). Thanks for the help! Ames

I PASSED!!!! You have to choose either A, B, C, or D for each question........

I wouldn't do just an NRB, bag them. If the person was able to protect their own airway stay basic. I ran a dude that was very intoxicated and was unconscious and unresponsive. Gag reflex we assumed intact. He was on the line of possibly needing to be intubated, but we did a NPA which worked. The only time I have seen anything even remotely like just doing the NRB on the tube was in the OR. They kept the person on the vent, but allowed them to spontaneously breath on their own without any mechanical help. This was after the surgery was finished and were waiting for the person to be conscious enough to protect their own airway.

um, the answers are.....A,B,C,D....... LOL

So I just got done with my test. WOW. There were a couple of questions on there that made me scratch my head. I answered like 80 questions in 45-60 minutes. I am sure hoping I passed. We will see in the next 24-48 hours. From what I have heard people say about getting done early it is typically a good thing. I hope that holds true!!!

So on Monday I take my NREMT-P test. I am nervous about it. I have read other posts by people saying just relax and think basic then go to paramedic skills if needed. I am still nervous. All the time and money put into it, I don't want to fail. I have been reviewing my book to brush up on stuff I have already learned but maybe forgot or got rusty on. I took my EMT-B on the CBT so I know how it asks questions. My program director has written questions for the NREMT and asked questions the same way for our exams. But I am still nervous!!!! Any words of wisdom or advice? Ames

Wow, spenac you are doing a great job on being kinder and gentler. I agree with all that and am happy now!!!!!! Laura Anne- All I can say is GOOOOSSSSS-FRA-BAAAAAAAA, or something like that......... *Amesemt is now calm, cool, and collected*

Vent- I understand the RN's there have many patients with lots of information about each patient and cannot memorize it all. But when the RN calls 911 for someone unconscious and cannot supply information about when they noticed this, the last time they saw them conscious, a blood sugar since they are diabetic. Most other LTC facilities I have gone to will meet you at the door and give you their paperwork and show you to where the patient is, and give you some information (as much as they know), and any treatments they have done prior to EMS arrival. For me, I always take my own vitals and assessment and form my own opinion. I realize what the RN's have to go through at LTC facilities. But when you call 911 and don't meet the crew at the door or have someone meet them at the door, don't have any paperwork to at least see what the meds., allergies, etc. are, and tell them they have no idea what is going on, that causes me to form a negative opinion on that person and their care. Don't get me wrong, there are bad apples in every profession and each profession will bad mouth another. Most of the time it is because the other party does not know the other sides story. I am sure you have had a bad day and something sets you off and you need to vent your frustration, even with the knowledge of what the other side goes through. I am sure when you where an RN at a LTC facility you complained about the EMS crews sometimes. Am I right? One bad apple can ruin it for all, and we need to keep in mind that the one bad apple is not representative of all in that career.

Easy there vent and John. Vent- You have valid arguments that patients from a nursing facility have the potential to be very sick patients and that we need to be alert for such things and that we might not know everything about the patient. Not all nursing facilities are quality or have quality and educated RN's staffing. You pointed out it is the RN that calls the doctor about potential problems, thus they are the first line where a mistake, possible laziness, or a true emergency is seen. Keep in mind that john is just venting, probably about those few nurses or facilities, that do call 911 for a patient who does not have a complaint, or even the nurse who has supposedly taken care of the patient or quite some time but does not know a single thing about them and what is going on. John- I understand where you are coming from. I did my ride time in a large city where I saw both the good nurses and facilities and some of the worst the city had to offer. One call we got called to an unconscious. We get there and fire is waiting in the hall by the room we were told to go to. They told us there was not anyone in the room. So we look for a staff member and did not find one for about 1 minute. Finally, a staff member tells us (a CNA or RN) tells us that it is the next room down. This is after fire had been standing there for 3-4 minutes and them trying to find out where the patient is. We tried getting info from the RN and she did not know a single thing about what was going on, what happened, hx, meds., nothing about this patient who she had been taking care of for awhile. So we scooped and left, grabbing paperwork as we were wheeling the pt. out. With regards to what vent is saying, there are health care providers who are undereducated and do treat these patients like there is nothing wrong with them, despite some subtle signs there is the potential for the patient to become very sick. And there are EMT's, paramedics, other EMS workers who are undereducated with regards to the geriatric population and those important lab values for them. I saw you said you don't have the qualifications to interpret lab values, at least you recognize that and can possibly correct that or at least get a pocket guide with normal values (the paramedic pocket guide has them in there). I am with spenac on this one. There are facilities out there where they call EMS for something the RN or staff can do in house. As a student, I can see the potential for students to be influenced to think a certain way about nursing home runs. I always kept an open mind about what I see, hear, experience with the facility and staff. I treat the patient on what I get from them and what is going on with them. A compromise between facilities and EMS needs to be established, as well as more education on lab values (maybe during a GEMS course). Hopefully someday this could be established.

I have seen both dual paramedic services, and an EMT/Paramedic service. When I did my field time for my medic, I was with the service that had an EMT and a paramedic on a truck. From what I experienced that is the best I have seen. You arrive on scene and the EMT does what the medic wants (i.e. vitals, hook them up to the EKG, prepare IV bag, etc.) while the medic determines what is going on and the appropriate treatment. The EMT is operating in their scope of practice without wasting skills (like with a dual medic truck, will explain in a minute) and the medic has someone there to help them. This gives the patient immediate ALS care, and the EMT experience. With the dual medic truck it seemed like the one who was driving at the time was basically a glorified EMT. Yea, they helped the other medic (i.e. starting IV's, preparing medications, etc.) but the one attending did the vast majority of the ALS skills. The plus side is the one attending had someone to help them when the c%&p hit the fan. People complain about wasting a ALS truck on a BS call, but sometimes those BS calls do need ALS care. Someone mentioned a broken ankle earlier, and how a BLS truck could handle it. Yea, they could but how comfortable would that patient be going down the road when it is bumpy? If there were a medic on the truck they could start a line and give morphine or fentanyl or some other analgesic to help make the patient comfortable. While doing my ride time for medic we did our fair share of BS calls but each call presents a new challenge and sometimes does end up being a good call. Another person brought up the point that sometimes what the patient presents with may be considered BS but turns out to be something quite serious. I am all for having an EMT/Paramedic truck. Just my 2 cents worth.

Paramedicmike- I have heard of the Difficult airway course. I have thought about taking it. Who offers it and do they do it fairly frequently? Is there anyone else that does a difficult airway course of the same caliber as The Difficult Airway Course? I would love to go do it but most of the site a quite a way away from where I am.

Well, I took my practical on Saturday. I passed! That was a long day (12 hours). I am glad to have that over with and next is the written. As soon as I am approved I am going to schedule it.

Hi everyone! Sorry it has been so long since posting. I did not realize how extensive clinical and field time really was. But I had an AMAZING time! By far the ambulance time was the best. So I take the practical (paramedic) on October 18th, here in 2 weeks. Anyone who has taken it recently have any words of advice. I understand there are a lot of ACLS type stuff like static cardiology, dynamic (similar to mega code), and IV and medication station, a trauma, and a medical station. Thanks for any advice.

The service I am riding with right now (as a paramedic intern) uses the Zoll E series. The metal bracket thing (to mount in the unit right?) sucks. It makes a lot of noise when you are going down the road. But otherwise the unit is good and rugged. Sometimes the NIBP can't get a reading but it is rare. When I was riding for my EMT-B the service I rode with used the Phillips MRx, and my program introduced me to the LP 12. The LP 12 is a beast. Like everyone else, I like the knob. I would personally recommend the Zoll E-series.

Can you go elsewhere? I have seen medic students from programs in other states come here.