coolparamedic

I've heard that WA is going to fall in line with National Registry which, in my opinion, is great. It will make it a lot easier for reciprocity among other things. I do like how you left NCTI off your list of good schools. I am not a fan of them either. It's just a medic mill plain and simple. There are places that pay for paramedic schools. Generally it is hospital based EMS services though. My EMS service paid for my school, and another hospital based service will pay and has paid for their full time EMT's to go to medic school. I do know awesomeambo and excellentemt and ImpressiveIntermediate also. I've always gotten crap from this name. Just haven't ever figured out a new one lol.

I'll try and give you my take on WA. Having only lived in eastern WA my whole life, I can't really say how the west side is. However, if you want the rainy type environment, the west side is for you. I have spent quite a bit of time in Vancouver, WA in the past year and a half and it seems like it rains a lot. It seems like a pretty decent town. If you drive 15 miles north, east or west, you're out of the big city and into the country. Eastern Wa is, for the most part, pretty arid. We get snow during the winter and its hot during the summer. Where I live we get about 18" of rain a year. The cost of living is decent. There is no state income tax like there is in OR. AMR is all over the place. Vancouver, Longview, King and Pierce counties (BLS). They're also on the east side (Yakima, Tri-Cities, Spokane). There are several other private services I know of. There is also the fire service, if you want to do that. If you join a volly squad and have your EMT and red card, you can get called to state mobilization fires and make pretty good money from what I've been told. WA can be a pain to reciprocity in if you're an EMT-Intermediate. They have 5 different certification levels between Basic and Paramedic. One of my co-workers was an I-85 in Idaho but washington would only let him certify as an IV tech. You can look up WA's scope of practice for all of the certs available on the WA DOH website. As for the schools, I can't really tell you a whole lot. I don't have kids and I've only been to a few schools. I don't personally think they are bad, but maybe someone else can answer that better for you. If you're into outdoor type things, WA is a great place. We have mountain climbing, hunting, fishing, whitewater rafting, all that type of stuff. Hope that answered a few of your questions. Maybe some of the people on here from western WA can give you some better answers on the west side.

The stats are as follow from WA DOH: 563 IV techs 2 Airway techs 23 IV/AW techs 227 ILS techs 91 ILS/AW techs and it appears that they are pretty much all from the boonies

Another Top Gun qoute: Captain to Maverick, "And if you screw up just this much, you’ll be flying a cargo plane full of rubber dog shit out of Hong Kong!” True Lies: “Kids - 10 seconds of joy, 30 years of misery.” Superbad: You know when you hear girls say ‘Ah man, I was so shit-faced last night, I shouldn’t have fucked that guy?’ We could be that mistake!”

How do you guys find this stuff?

What are some of your services policies on going level zero on an IFT? Just to give you a little history, I work for a hospital based ambulance service and we cover a 1200 square mile area. Being that we have only 1 ambulance staffed ALS, and one ambulance staffed BLS and the nearest mutual aid ambulance is 40 minutes away, we try not to go level zero for transfers if we can help it. We have a policy that states that we will not go level zero for another transfer unless the patient needing to be transfered is going to basically die if we don't take them. Don't get me wrong, I have no problem with going on a transfer that needs to go but I have a problem with a transfer that is all of a sudden an emergency after the patient has been in the hospital with his troponin climbing for the last 19 hours. Tonight, we get a phone call from the hospital saying that we will have an ALS transfer to hospital an hour and a half away. Not a big deal. But our BLS ambulance was on a transfer and they wouldn't be back for atleast 4 hours. The nearest mutual aid ambulance was on a transfer so it would be 45-50 minutes for the next nearest ambulance to get here. I tell the nurse the situation and that they should call an air ambulance or try to find another service to do the transfer or they can wait until the BLS ambulance gets back. The nurse says ok. She calls back about 15 minutes later and says that the guy can't wait. It is then brought to my attention that the patient has been in the hospital for 19 hours and his troponin has slowly been climbing throughout the day. The nurse states the patient can't wait for a helicopter (even though the chopper would be quicker). I then call my boss and he says don't take the transfer and it is not acceptable to leave our area without an ambulance for that long. Long story short. The CFO (Chief Financial Officer) calls the station and says that we have to take the transfer and that what my boss said doesn't mean squat. We took the transfer. So after all this rambling, let me get to the point. This has been an ongoing battle with the hospital and the policy was signed off by the hospital, but they don't honor it. We have tried time and time again to come to a resolution with the hospital regarding this but it has fallen on deaf ears. I'm sure some of you have policies about this and I would like to hear some of them so we could maybe show the hospital admin folks that we aren't the only ones with this problem.

I think what jmp was trying to get at was, Do any of you go on calls to the wind farms, and if so, what kind of calls do you get. Is it the typical 2 pack a day smoker who just got done climbing the tower and now has chest pain? Or is it heat exhaustion, dehydration, traumas? We have had about 400 wind turbines go up in our response area in the last year. The construction companies have tried to practice/prepare for these kinds of things with us but I feel it has been somewhat lacking considering we had a turbine collapse about 30 miles south of us last year with several maintenance people in it. i found a video on youtube of a wind turbine collapse if any of you are interested.

Two weeks after we get our new rig the turn signals stopped working. Spent two days in the shop. The electrical load was making the computer shut off the turn signals. Our new rig has 2,000 miles on it and the air ride is already leaking.

I hadn't gone on a burn patient until last year. 60 some year old lady had leaned over a candle wearing a robe. I guess it must have been an old robe or something because it went up in a flash. We get there, 60% second and third degree. Pt is screaming about the pain, get the pt out to the rig. 02, IV, MS. Get to the hospital, they intubate her, then we take her to the burn center 2 hours away. What bothered me about this was that she had terminal cancer and was out touring the country with her husband before she died. Like she needed another problem on top of the cancer. I've had several burn patients since then and the only thing that really bothers me anymore is the smell. I just can't get it out of my nose. The one call that really bothered me was a triple fatal accident. 26 y/o female, 17 y/o female, and an 8 y/o boy.(I found out the ages about a week later) The car had left the roadway and hit a tree on its top. The car horse-shoed around the tree, so the front and rear bumper were about 3 feet apart. The boys leg was hanging out and one of the females arms was hanging out. That was all you could see. My partner and I didn't even know there was a third person in the car. It took FD 4 hours to get the car cut apart enough to get the bodies out. For about a week that is all I could really think about. Talking to others about something that bothers you is probably the best way I've found to deal with it. Sooner or later everybody will have a call that bothers them.

I prefer the type I's over the type III's. First off, I'm 6'4" and the leg room up front is very nice. They are alot safer in a head on. Where I work we need 4WD and from everything I've been told the type III's can be outfitted to be 4WD but its not an option from the factory. Being 4WD it is very top heavy and likes to sway when you get in the truck grooves on the freeway. Our type I is walk thru type but i think only a child could walk through it. Type III's ride about the same in my experience. It is alot easier talk to your partner in the back than a type I and see whats going on in the back. The type III might turn a little sharper but not much. They are alot easier to manuever in and out of traffic, mainly due to the fact that the don't feel near as big as the type I (maybe its just because I'm from the country)

Skamania County EMS in Washington (no fire affiliation whatsoever) just got union contract through IAFF.

An airway tech in one of my neighboring counties put an ET tube in the wrong way. The lost the end piece inside the guy. Needless to say, that county doesn't have airway techs anymore.

* In 1982, a survey of imprisoned criminals found that 34% of them had been "scared off, shot at, wounded or captured by an armed victim." (16c) * Washington D.C. enacted a virtual ban on handguns in 1976. Between 1976 and 1991, Washington D.C.'s homicide rate rose 200%, while the U.S. rate rose 12%. (1) * In 1986, nine states had right-to-carry laws. (14) * As of 1998, 31 states have right-to-carry laws, and about half the U.S. population lives in these states. (3) * Florida adopted a right-to-carry law in 1987. At the time the law was passed, critics predicted increases in violence. The founder of the National Organization of Women, Betty Friedan stated: "lethal violence, even in self defense, only engenders more violence." (13) * When the law went into effect, the Dade County Police began a program to record all arrest and non arrest incidents involving concealed carry licensees. Between September of 1987 and August of 1992, Dade County recorded 4 crimes committed by licensees with firearms. None of these crimes resulted in an injury. The record keeping program was abandoned in 1992 because there were not enough incidents to justify tracking them. (13)(15) * In October of 1997, sixteen-year-old Luke Woodham stabbed his mother to death and then went to school with a rifle where he shot 9 students, killing 2 of them. Assistant Principal Joel Myrick raced to his car, retrieved a .45 caliber handgun, and used it to subdue Woodham until police arrived. (51)(53) http://www.kc3.com/editorial/40reasons.htm I know a few of you touched on it, but I'm going to touch on it again. If the government was to say they were going to take away all the guns, only the law abiding citizens would hand them in. Criminals pick and choose what laws they want to follow. Us law abiding citizens follow all of them. I have a CWP (Concealed Weapons Permit), a Federal firearms license, a National Firearms Act stamp. I have gone through numerous federal and state background checks, been fingerprinted multiple times all through law enforcement agencies. If someone goes through the hassle of getting fingerprinted, having a federal and state background check to carry a weapon or obtain one, what is the probability that they will go out and commit a crime? According to statistics, not very high.

I was thinking the same thing about not working there but my boss, who is the ambulance director came to the rescue. He hunted down an ER tech job description (not the Health Care Assistant the hospital wanted me to have) There is no state cert for it but it is a hospital cert. He is getting a job description from Southwest Washington Medical Center for ER techs and some of their training cirriculum. What I'm being told now is that I have to sit through a class and go through all the skills they want me to do. I have to work under a doctors ok. An MD gave his ok, so now I guess I just have to wait until the Chief Nursing Officer, the MD, and my boss decide what I can and can't do and put an actual job description togehter, I have to re-interview and then go through my orientation. I hope thats the way it goes, but with the way thing happen up here it could be a while.

Sorry if I din't make myself clear, she did recieve versed after the vecuronium. I don't like back seat driving other peoples pts but I think the gastric lavage issue was because the nurses didn't know how to set up the whole operation. The lady ended up getting sent with the OG tube in place with a 60 cc syringe taped onto the end to block the tube off. The rest of the packet got sent with the patient so the other hospital go finish the lavage. As for the ABG I don't really know what happened there. Our hospital isn't used to serious patients. We don't have a respiratory tech, we have two CRNA's but they are on call. The only staff in the ER is the Doc and 2 nurses when it gets busy. I had set up the autovent because the medic left and no one else knew how. This happened Thursday and the Pt is still on the vent

Our hospital is a level IV hospital which means that we ship a lot of people. We don't even have an ICU. They do have the capability of doing ABG's but for some reason they didn't do it even though the patient was in the ER intubated for 2 hours. There was talk of doing one but I guess that no one got around to it.

Pt had taken pills an unknown time before her son called 911. Medic arrived to find 35 y/o female, GCS 3 resp. 4/min shallow. Pts vitals were BP 105/ 70, Pulse 90 Sinus rythm on monitor without ectopy. Resp. 12 on vent O2 Sat 100% 22ga Left dorsum of foot, 18ga Right dorsum of hand, central line She did not get hypotensive after the versed. OG tube placed, activated charcoal given but no gastric lavage. Narcan did nothing The funny thing is that only our ambulances have the equipment to measure ETCO2 not the hospital. She hung around 32 mmHg on an autovent with Resp 12, Tidal volume of 600. There were no ABG's done, just basic tox screen. No PH was taken, even though pt tested positive for TCA's She was paralyzed first and then sedated post intubation. Quote: Takes one hell of a lot of benzos to actually kill you, and attempting to reverse a mixed OD with Fluazamils could be a fatal error (just in passing). Why does giving romazicon to a mixed OD pt dangerous? I know its difficult to answer all of these questions without actually being there, but I appreciate the answers I have gotten so far

The other night one of our ambulances brings in an OD pt. The patient is being bagged and is unconsious . The medic didn't tube her on scene because they were only 30 seconds away from the ER. The lady had taken tylenol, benzo's, oxycodone. Needless to say the lady ended up getting paralyzed and intubated by the medic after arriving. After being paralyzed with suxs, vecuronium was given along with versed. Labs were drawn, tylenol level of 109 (i'm not quite sure of the way they measure it but high is 30). Mucomist, .8mg narcan were given also. Our hospital does not stock romazicon. We go to transfer her to a facility 75 miles away.The medic first asks the doctor why we have to give more benzo's on top of what she has already taken. The doctor replies, "to make sure she is out." the medic then asks if he can switch from versed to Ativan because of the long transport time. The doctor says no because he wants to stick the same drug. He says to give 1 mg Vecuronium and 2 mg of versed as needed. The Vec only lasted on her about 20 mins at a time. The transfer to the other hospital was uneventful. Now here are my questions: 1. why keep giving benzo's to a pt that already OD on them? 2. Is there any reason, other than doctor wanting to stay with the same med, that the medic couldn't switch from versed to ativan? 3. Do you guys think 1 mg of vecuronium is a small dose for a 70 kg pt? ( I have always seen it given in 5 mg doses after the loading dose and it lasts for 30-40 mins)

Lovenox 1 mg/kg SQ in the abdomen. IT has a weird injection method. You pinch the skin on the abdomen, enter perpendicular to the skin and leave an air bubble to act as the seal. The only indication we can give it for is Acute MI's (confirmed by 12 lead with ST elevation) and medical control concurrence Inapsine .75-2.5 mg IV, IM We use it for psych patients when they require chemical restraint. Benadryl goes great with inapsine.

ASA activated charcoal albuterol Versed atropine amiodarone benadryl calcium chloride Etomidate Morphine Ativan Demerol Fentanyl D50 D25 Promethazine hydro-oxycobalamin lovenox metoprolol vasopressin diltiazem verapamil inapsine haldol lidocaine (drip & preloads) NTG (Spray, tabs, paste, drip) procainamide glucagon thiamine narcan oral glucose epi 1:1000 epi 1:10,000 Adenosine Mag Sulfate lasix atrovent Bicarb Dopamine Suxs Vecuronium solumedrol decadron racemic Epi labetalol I think there is a couple of more but I can't remember

Danner 8" Acadias, hands down the most comfortable boot I have ever worn. They are expensive but they feel like they are already broken in. I live within 100 miles of a Danner outlet and you can get seconds (minor errors in workmanship but brand new) for around $100.

I am talking about Washington state. As I am sure you know, state offices are hard to get ahold of, my boss and I have both been playing phone tag with them. The state has a cert called a Health Care Assistant. In that, the state decides what you can do according to your training, which should be what I can do as an EMT-ILS/AW. In response to the hospital policy, There is only one other person doing this job and it has come under scrutiny as well in regards to certification required to work there and the scope of practice. The hospital isn't even sure of the rules, since they have never had experience with this sort of thing. The hospital doesn't have policies and procedures for this and the nurses don't have any idea of what our scope is. My understanding is that I would be working under the liscence of a RN (even though a doctor has to say you are working under them). I am only one step below a medic (be it a long step). The reason I am asking about all this is so I can figure out if I will actually be able to work there or I should go get another job. Besides the money, It will be nice to have pt contacts, considering our service runs an average of 2 calls a day. The first car runs about 85% of the 911 calls. I am on the second rig so you see how that sucks. I am worried about being the gopher which I am sure I will get to do quite a bit. I guess I'm just not sure of what to expect and am a little uneasy about the whole thing, not knowing and fully understanding the whole process. I appreciate the response. Nick

The ambulance service I work for is trying to have me work in the ER. We are a critical access hospital (less than 15 pts a day on average). I have heard conflicting stories that I have to get what Washington calls a Health Care Provider. Other people have told me that I don't have to. It has also been brought up that as soon as an EMT-B up to an EMT-P sets foot in a hospital, they are stripped of there ability to do pt care. It's a little confusing to me and I would like to have some unbiased opinions and answers. 1. Do you have to have a special certification or training to work in an ER at your scope? 2. Is it true that you are stripped of your cert once you are inside of a hospital? Thank all of you in Advance Nick

I have never seen an AAA but I have heard from several medics that MAST pants work really well to tamponade the AAA. Have any of you ever tried it and how did it work if you have?

Technically there is no EMT-I there is Emt-IV, EMT- Airway (intubations and plueral decompressions) EMT-ILS, EMT-IV/Airway, EMT-ILS/Airway. WA requires National Registry for EMT-P