AMESEMT

Adam- I can relate. Really pay attention to when the medic/EMT asks questions. They will ask everything you have learned but in a different order. They have adapted what they have learned (the book way) to fit them and to fit the situation. You also have to remember that in the field if you are the medic, you might have an EMT-B partner who will take the vitals for you at the same time you are getting a history of what is going on and the SAMPLE and OPQRST. Or you might be the EMT-B for the medic so you will be doing vitals while he/she asks questions. When you do your ride-time, listen to the person asking the questions and when they ask each part, as well as how they ask in each different situation. Good Luck Ames

BEorP- I have seen several services (including the one I am doing my paramedic ride time with) that have protocols for unconscious unknown to give narcan and D50. The medics I have seen, and what I would do as a medic student is to get vitals first (BG included) before administering any medications.

I don't have an answer for what an exception is. When I was taught the method in basic I just followed what they taught us. I have started to not use the E for CHARTE. Ames

So my documentation (the narrative) is what I think is horrible. I am using the CHARTE method but for the life of me I cannot think of what all to include in the sections. I know what each area is: C=Chief Complaint H=History A=Assessment R=Treatment T=Transport E=Exceptions I just don't remember all the little things you need to include. Does anyone know of a cheat sheet for this? Since good documentation is important, I want to get my documentation skills up to par before going into the field. Any help would be greatly appreciated!! Ames

Dwayne - Thanks for the advice. I like the paper idea, I may have to borrow that from you! Sounds like you suffered through and persevered and you ended up on top! From what I have seen in your posts you will do great as a medic! Do you have a job already lined up or are you already working for a service? Good luck and thanks! Ames

CONGRATULATIONS!!! I am following in your foot steps! I start clinicals on Monday at 3pm! Any advice from the now official paramedic to the paramedic student? Again, congratulations! Ames

I had a long post in response do your post Dust, but I am going to have to say we disagree on things. I acknowledge I am still a student and don't have a fraction of the experience you do Dust (which I hope to get in time), but I am looking at things from the other side of the track and from a completely different geographical location. I disagree with you on the idea that the competent medic from a 4 month program is just a facade. Like any program, it highly depends on the quality of education and the devotion of the student to make sure they are learning and understanding everything, as well as the quality of instructors and facility. Being a graduate from a 4 month program (technically is more like 9-10 with clinical and field) I am biased, but the program I am from is known for turning out quality and educated medics. Maybe where you are from, the shorter programs turn out not quality and educated medics and the longer courses do, I don't know. I agree with every medic should have a degree (I am assuming that is what you are alluding to with the 4-year program). Personally, any degree that could be applied is good (i.e. business, psychology, biology, chemistry, etc...). The saying that all 2-year or less programs are bad is what gets me. You need to look at each program and what they do teach. Thats my 2 cents. We can't all agree on everything. Ames P.S. Dust, can you name all 206 bones in the human body by chance?

People blame the "quick programs" quite often. However, both 2-year and 4-year programs have their downsides as well. We need to look at are these programs accredited? What sort of qualifications are needed to get into a program? What standards do the programs have of the student, while the student is in the program? I know of a program that gives you your AAS but is HORRIBLE at educating paramedics. The doctors and nurses in the hospital they do their clinicals in (the same hospital has the school) complain that the medic students are unable to do the simplest of skills that are required of a paramedic. Whereas the program I went through, is a "quick program" of sorts. We don't get an AAS. We went 3 1/2 months of full-time schooling. We had tests weekly which we must get at least an 80%, and quizzes daily to test us to make sure we were retaining what we were learning. Then after a practical test and a comprehensive final we are sent to clinical and field time. From the people I have talked to that know both medics that went through my program vs. another program, they take the medics from my program due to them being competent medics that know their stuff. We need to focus on the programs that are not turning out quality medics, part of that could be mandating all paramedic programs need to be accredited. From my understanding (showing my ignorance of how they become accredited, sorry) there is a fair amount of monitoring of the programs that have and maintain an accreditation. Having more monitoring of paramedic programs, the poor programs could be weeded out, thus hopefully increasing the quality of medics produced by any length of program. Just my 2 cents Ames

In my limited time around crews, the only time I have heard them say truck, bus, rig, etc...is around fellow EMS workers. Around patients, non-EMS workers, they said ambulance. I have to agree with people who have said there are bigger and better things we need to worry about than what we call our mode of transportation. You may argue that it is the image it projects but what we call the ambulance is not nearly as important as how we present ourselves, how we act professionally, and the quality of patient care. People are not going to care what we call our ambulance if we arrive and are clean and well groomed with clean uniforms, act professional, and provide high quality patient care. People are concerned with the care they receive. Those things need to be looked at before we worry about what each area/person calls their ambulance. I feel we have bigger things to worry about that need to have our attention. Just my 2 cents. Ames P.S. Tinman that was great, an ecnalubmA!

Iowa?! That is where I am and went to school for both EMT-B and Medic. Where at? Like Dust said, just remember your ABC's and you will do fine. That is what I did and I passed. Even as a paramedic student right now, we are taught to do the ABC's first on every single call, you can't do anything else unless you are able to get past the ABC's and don't move on until you have the airway, got ventilations or breaths, and you have circulation. I am sure you will do fine and don't stress. Remember what you have been taught and review the patient assessment. Good Luck! Ames

Thanks for the words of advice! You guys reaffirmed what I was already planning to do and was advised to do by our clinical/field coordinator. I am going to go in there ready to learn, ask questions when I have them or don't understand why they might have done something a different way, do the scut work IMMEDIATELY, be prepared, and be nice. I am a little nervous because it is not like doing your field and clinical time as a basic where all you are doing is vitals and SAMPLE. As a medic student you may possibly doing invasive procedures, like IV's (the thing I am nervous about doing), as well as being held to a higher regard due to the knowledge and skill set I posses. I am ready but nervous and hope my preceptor understands that the first day. I got my bag packed, forms ready (with extras!), and am ready to start. Hopefully they will have the schedule done by Monday or Tuesday. Thanks again! Ames

So I start my paramedic clinical internship soon and am a little nervous. Does anyone have any advice for me before starting? Thanks Ames

In my medic class we just got done with AMLS last week. Like MSDelta said, it just teaches you assessment skills that help you come up with field dx and a list of differentials utilizing vitals, chief complain, and other tools a paramedic has. I actually found it very informative and would recommend it. For me it was a 2 day course with both lecture and lab time. The labs are scenarios designed to make you think and go through the assessment process from initial scene size-up to when you make your field dx. If you have any questions just give me a pm and I can try and answer them. Ames

THANK YOU!!!!!!!!!!!!! That was extremely helpful and a pretty cool site. Thanks scaramedic!

Anyone have access or know where to find the price of IV amiodarone when it first came out vs. the cost now? I tried searching online but nothing, just tablets. Thanks! Ames P.S. And if possible the cost of lidocaine at the time amiodarone came out and the cost now. Thanks!

It helps a lot. Thanks for the info/ideas. USAPride2004 - Is this before it started to come in premixed glass (forgot the true name for them) syringes?

I am doing a paper on Amiodarone for my paramedic class. I wanted to include some of the reasons services do not or did not carry amiodarone. Links to sites would be great so that way I can cite them (if there are any). Any help would be greatly appreciated! Ames

Ventmedic - No, you didn't offend me, I felt like I was being attacked a little bit with the first few questions. All is good though. A few classmates where being a.......s earlier so I was a little ticked when I read the post. Yea, the tip about using the adapter from an ETT we were told by our instructors. Great idea! tniuqs - My grandfather got his trach out after a month of having it. He had issues after a surgery that required them to put it in, since they didn't want to have him tubed for a long period. I did get a chance to look at his and it didn't have the inner sleeve. That one they had to just suction since it was stitched to his neck. We have been told stories by our paramedic instructors about calls where they respond and the nurse or family member panicked and called 911. So I have come to understand that even though someone is trained or educated in something doesn't mean they won't panic and call for the ambulance, as I am sure you have seen for other situations. It's too bad we didn't get anymore info for the scenario. These are fun and a good learning tool for me! Be safe Ames

Vent = easy there. No I have not changed any trachs yet, seeing as I am in medic school and as a basic I would not feel comfortable doing that even if I could. Also, yes there are quite a variety of brands of trachs and I was taught that if you don't know how to use it ask. The caregiver usually has more knowledge on that technology than the Paramedic and we should not be afraid to ask...I am not afraid to ask if I am not sure about it. Even better, I would have the caregiver change it instead of me since they have done it more times that I have. You refer to anatomy...I have some knowledge about it seeing has I have had a family member with one. Each person is different so things can be a little different. I don't claim to know all. Did I say to needlessly pull it out or have it changed without someone who can do an advanced airway present? Nope. Each situation is different. If you can't ventilate through the trach after suctioning, common sense would be to try something different (e.g. cover the trach and try the BVM, or removing the trach, etc.). Yes false cannulation can happen, but if you use a bugie (sp?) or flexible suction cather as a guide through the old one the chances of false cannulation are decreased because you have that guide. I guess a few misunderstood what I was saying. If someone posts something to do as a suggestion and it falls outside of your scope, then don't do it, follow what you are allowed to do and use common sense. Seeing that there is a variety on where people come from we have to take into account that you need to just follow your protocols and common sense when using them. Ames

tniuqs = I don't think Doczilla is saying to go out of your scope of practice. Seeing as the vast majority of the individuals responding to the scenario are from the US, it is in the paramedic scope of practice, he is saying what to do in general. If it is something you can't do in your scope of practice then ignore it and follow what is in your scope. shannon710 Did removing pt from the vent and bagging, suctioning, replacement of the trach. (or insertion of ETT) solve the airway and breathing problems?

From a diabetics point of view now........ Taking a glucose = easy and can be done in less than a minute by anyone. I have had my mother do it for me once and she never has done it for me and it took her like 45 seconds. I would expect most basics (depending on the machine) could manage that in less time. I do it in about 10 (since my personal machine is quick and I do it at least 4 times a day). Depending on if they have to wait for ALS or are meeting them in route you can do it while waiting or en route to the hospital/where you are meeting ALS. All it does it provide a means for ruling out hypoglycemia and not necessarily how you are treating the patient. Like Backinboston said, it is a tool of assessment.

I kind of agree with Dust on this. But I see both sides of the debate. Yes it is a good idea with the proper training on its use. The medication could and probably has saved lives by being in the AED box. I think that you need strict guidelines on its use and protocols on what to do if it is needed. Someone brought up the point that if epi is given then EMS should be called. I would be curious to see what guidelines and protocols they have in place for its use and ensuring it is still in date. Dust brings up a good point about someone thinking an adult is having anaphylaxis when they are actually having an MI, due to the cookbook S&S for its use. It could, and probably would kill them. Also, don't most kids who are allergic to something carry it? The people I know that have that bad of an allergy do carry the epi pen with them at all times. Yea, you can have those that have been exposed but have not had the reaction yet (this is where the pen would be good in the AED box). Like most people I think it is a good idea, but needs some strict guidelines to go with it if you are going to have it in the school. Just my 2 cents. Ames

Anyone know of EKG software (free) for practicing EKGs? Ames

Okay, I see what you mean. But not all accelerated programs are the same. Not only is the program I am in based at a teaching hospital (University of Iowa) but our medical director is the main guy for the ER residents and does the flight service as well as teaches us every Thursday. We have experts in the fields of burns, trauma, pharmacology, etc. that come in to the class to teach us in depth about the field and what we need to know about procedures/knowledge both prehospital but what they expect from prehospital providers in patient care. We are taught pathophysiology, physiology, and A&P (of course not as much as a med. student who has 4+ years). The vast majority of the students are people that have gone to college who have the english and math at the college level (actually, all the people in my class have gone to college and have taken those classes at minimum, 3/4 have a degree in something). I see where you are coming from, but I don't believe we can generalize all programs. There are quality programs out there the do provide a vast majority of the points you are looking for (minus grant writing, management or the very in depth physiology, pathophysiology, and A&P) and do require the college level math and English or be proficient in both (HOBET testing). Personally, I think it would be great if there were a four year degree that prepared you for not only being a paramedic but also gave you a degree in management with a focus on medical systems (EMS/Fire/Hospital). But right now, we need to support those programs that are quality, while we work to bring the four year program around. Thanks for your input! Like you, I believe we need paramedics out there that are not just in it for a quick education but for the vast amount of knowledge to bring better care to patients in the field. Thanks again for the post. Ames

Stcommodore- Don't take what I am about to say the wrong way. I have talked to people who have gone through the accredited and long standing accelerated version (like myself) and to those who have done the long (1 1/2 to 2 year) accredited versions, people like yourself seem to accept. My question is, what is the difference between the two? Keeping in mind I am talking about an accredited and long standing/well known accelerated program and not a non-accredited accelerated program. From what I have seen and come to base my opinion on is that the shorter version you don't have the A&P as extensively as the long version, plus the long version, most seem to include the EMT-B in it (that is what I have seen) as part of the curriculum. Both programs do offer the same core material (National Standard Curriculum) a paramedic should know (both knowledge and skill). Don't get me wrong there are both good and bad programs on both sides. The place where I got my EMT-B does the longer version for the paramedic and they are HORRIBLE. Whereas the program I am going to now (the accelerated through a University Hospital, University of Iowa) is well know for their quality education and turn out of well educated and knowledgeable entry level paramedics. My opinion is neither for or against the accelerated or non accelerated versions, but the quality of education you get and if you are a competent, individual thinking (not robot line of thinking) entry level paramedic. The public and others in the medical field see how competent you are and base their opinions on that, not on if you went to an accelerated or not program. To be viewed as a profession we need programs that do turn out quality paramedics that have received a great education (which I believe some accelerated and non accelerated) provide. Please don't take this the wrong way, but I am just wanting to know why you are against accelerated programs and give you what I have encountered while looking at programs and talking to individuals before choosing a program to go with. Ames P.S. Sorry to hijack the thread. And now back to your regularly scheduled program......