katbemeEMT-B

We have them on all four of our ALS ambulances. They're nice because of their portability when we have to monitor on scene or have to do an inter facility transfer.

I agree that you should just do it. I started out for a volunteer service in my community and like you had limited calls. Some friends kept telling me to apply with an ALS service 30 miles away. I didn't think I had what it took to work for them so I didn't do it. Well, I finally got up the courage and applied and have now been working with them for two months. Per their policy, I was required to do ride alongs which allowed me to learn so much more. At the end of my probation, they asked if I felt ready to go out on my own, I told them I would like to do a few more ride alongs. They were fine with that. I would suggest checking out the service(s) you want to apply with and see what their training requirements are. I would also check out what they offer for furthering your training and education. They may even be willing to help pay for your medic schooling. Education is the key to being the best EMT or Medic that you can be so never stop learning and not just on the job.

No problem. A friend of mine does animal rescue and she would kill me if I ever mistreated an animal. She's the one that helped me find a loving home for our cat.

I didn't actually throw him EVER. The night he attacked my feet I did kick him off the bed but I'm sure any one who got startled that way would have. He got treated very well until we had to find him another home (my son was extremely allergic to him and medication wasn't helping). We found him a home where he is still KING JD. So don't get all upset that I abused my cat. It's not like I put him in the microwave. :violent2: I just kicked him off the bed when he woke me up out of a sound sleep. Oh by the way, he was kind of retarded (brain malfunction) that's why I ended up with him in the first place. I spent lots of money on him to keep him alive.

Not sure what was going on with dispatch. Didn't ask. Usually they are pretty good about relaying information. I'm thinking part of it was confusion from the scene on the Interstate. Can't be sure though. Our EMS Manager is checking into as he wasn't very happy. I used the term "rig" just for the sake of the example. I was feeling a bit lazy after putting in 13 hours at work and serveral more at home as it was raining and we had no shingles on our roof so we were getting wet. We're dry now though and the roofers are almost done. =D> Sorry about that.

Here is a good example of why dispatch needs to concetrate on dispatching calls and not providing interventions to patients. One of our rigs was paged out to a collision between two semi truck on the Interstate. Our rig was not active at the time so we were able to listen to the radio traffic. This is how the call went: I blocked rig numbers and state trooper numbers for privacy reasons. Dispatch: Dispatch to RIG (our rig), you're needed on the Interstate at mile marker 60 for a collision between two semi trucks. RIG: Copy dispatch. Put us enroute. Dispatch: RIG, Air care has been dispatched. RIG: Copy that Dispatch: STATE (State Patrol car) do we know what is really going on STATE: No, not on scene yet Dispatch: 10-4 STATE. I will let RIG know that CPR has been started. RIG: RIG to dispatch, has rescue been paged. We don't hear them yet. Dispatch: 10-4 RIG. They are enroute There is about a 15 second pause Dispatch: Rescue, you're needed for an MVA on the Interstate at mile marker 60 Cross traffic that can't be understood Rescue: Rescue to dispatch, you can put us enroute Dispatch: 10-4 Rescue Not even ten seconds later Dispatch: Rescue you can cancel it's not an MVA it's a possible medical Rescue: 10-4 Dispatch: Did you copy that RIG RIG: Copy Dispatch: Dispatch to RIG, you can cancel. It's not a medical RIG: Copy Dispatch calls our station an hour later to apologize for the mix up. The call came in as an MVA but was actually one trucker helping the other secure his load. The medical (CPR being performed) was actually a different call. Sorry again. So you see, they have enough to do just keeping the calls straight. They were trying to give CPR instruction to some one and got the two calls mixed up. I say leave the patient killing to those that are better qualified.

Nope, not me, I'm innocent. That's my story and I'm sticking to it. :-#

Way too damn funny. I'm gonna have to sing that to my neighbor, she's a dispatcher for our county. Anyway Brent, no one hear ever said we didn't need dispatch, we just stated that they aren't trained to tell a patient to take ASA. Let's be serious, from the way it sounds most EMTs can't give ASA so why should some dispatcher on a phone who has no possible way to assess the patient other than him saying he has chest pain do it. Some things are given when it comes to medical situations others just aren't that easy. We depend on our dispatch to get us where we need to go and to communicate as much information to us as possible about the situation. I wouldn't expect them (or want them) to do my job just like they wouldn't expect me to do theirs (don't think I would want to either). Being a dispatcher is can be high stress job and when all hell is breaking lose it's up to them to keep the shit in order. I can guarantee that if a dispatcher in our county told a patient to take ASA or any other medication they would be out the door so fast there would be no chance for it to hit them in the ass. Think of it this way, we in the EMS field are the most under recognized profession. We may have EMS week but it isn't on any calendar or talked about on the news. Even secretaries get their day. So it's not that we are picking on dispatchers, we are picking on EMS in general.

That's why our radios have this handy little button we can push and it opens the mike so that the cops can hear everything that is going on. It's what they call the panic button. Oh yeah, you want to take your radio off your belt when you use the restroom as sometimes these buttons accidently get pressed and yep the entire PD hears what's happening. Not me (thank God) but one of our male medics found this out. He still hasn't lived it down. :oops:

We had a cat once. :cat: My kids named him Jack Daniels (JD for short). Yep, they're corrupt, I used to bartend. Anyway, he was the most irritating thing put on the face of this Earth. You want to talk about retarded? This cat was soooo dumb.....you could throw him across the room and he would come right back for more. Not that I did that but there was that one night when I was sleeping and the dumb a$$ attacked my feet. I now have two dogs. :grommit: They are smart. They sit when told and get out of my way when I don't want to deal with them. They know that if they walk around looking cute they will get their way. LOL Anyway, I still liked the little story.

I would take this to your EMS manager as this dispatcher could be a threat to the health of future patients. He or she has no training and even if he did that is not part of their job description. It's performing care outside your scope of practice. If it is not okay for Basics (in some areas) to admin. ASA what makes this dispatcher so special. He/she has no assessment skills and is only suppose to give instruction per the "Oh sh*t what do I do" dispatch instruction book ei: CPR, choking, & eminent birth. The best part is that this will be recorded so there is no way the dispatcher can claim innocence. If something had happened to the patient the family would have come after EMS first, not the dispatcher. Not a stigma you want.

Yep, I think I got it. Thanks!

The demon is back....ruuuuunnn! LOL I understand what you are saying and I can honestly say that our levels have been equivalent to those taken in the ED (with the exception of the diabetic we treated and the level increased enroute but that would have been a cap. stick). When we do a BGL from an IV needle it is used for nothing more than comparative value of the ED staff. They are able to disregard it if they want. Out of the five docs that staff the ED, four of them want us to take a BGL from the IV stick even though we wouldn't have deemed it a necessary procedure. Like I said, we assess and treat the patient accordingly. If it happens that we started an IV, the ED gets their BGL. I think the big picture here is assessing your patient and looking for s/s that would be affected by an altered glucose level. When we see those we wouldn't depend on an IV stick we would do a cap. stick. If we also started an IV in the rig we would maybe use the IV BGL for comparison.

I'm not sure we do. Can you please expand on this statement? LOL Just joshin' ya. I like to deny as much as possible. Oh wait, we weren't talking about life in general were we. We were talking about denying a patient. Oops, my bad.

The ALS service is hospital based and owned and this is their request. They determine our protocols. That doesn't mean we still don't assess our patients and treat them accordingly. By the way, if we have been called out for or suspect a diabetic reaction we immediately perform a cap. stick. That is done on scene before the patient is ever loaded into the rig. We normally don't start an IV until after the patient is secured in the rig and a full assessment has been done. As stated before, the BGL taken from an IV needle is soley for comparison in the ED. It is not used for us to treat the patient. Let's also remember that things are done differently in different parts of the country. My protocols are not necessarily yours. I find this just between the two services that I work for. That maybe isn't the best as this does cause confusion when moving from one area to another but that is one of the drawbacks of EMS. Until EMS has a governing body that sets national protocols we are at the mercy of our local MD and what they want. Don't beat me up for what our local ED docs want. As far as the cost, all of our supplies come from central supply at the hospital. To my knowledge we do not bill for BGL testing. When the patient is admitted to the ED and they run a battery of blood work on the patient they include BGL and that is the only time I know of that they are charged for it.

The ALS service that I work for does the same thing to check BGL. We check every patient who receives an IV. Of course we also check those that are exhibiting diabetic symptoms. It's almost becoming a standard up here. There are actually very few patients that don't get a BGL. The hospitals like the fact that we are checking them because it gives them some thing to compare to, a baseline you could say. Just like the rest of the vitals we check. Do we get chastised for not taking one? Not usually, but there have been those rare ocassions. Depends on the doc I guess. Oh yeah, I prefer black ball point pen myself.

We check BGL quite often on our patients. Of course we also ask them when they ate or drank last and what they had so we can gauge how it is affecting the results. I don't know that I would say check every patient though. There is a doctor at the Mayo Clinic and Hospital who is pushing to have this added as a regular vital for all pre-hospital and ED care. His reasoning is that, put more simply because I don't remember the exact physiological explanation, is that the body uses the proteins and sugars from the insulin to assist it's natural healing. What he failed to explain to us is how we as pre-hospital care givers can treat a patient is their BGL falls outside the normal parameters. So again, I would say it's probably a case by case although I do think many patients, especially the elderly, do get there BGL checked pre-hospital.

I still say it's a case by case situation and your assessment of the patient should give you the info needed to decide if a patient is in need of O2 or not. I believe I stated before, we do not give all patients O2.

You demon! I can't do it I wil..I will :puke: Oops! Sorry. Lost control. bend over :pottytrain2: :ky: :pukeright: :crybaby: :help:

I would have to guess that if your service is totally dependent on state, city, or township funding then you are hurting badly. While we do get monies from the city which we service it is minimal. The money that we receive from the city actually comes from payments received for billing. We are allotted a certain budget each year for wages (we are considered a paid volunteer service), equipment and uniforms, and vehicle maintainance and are not allowed to go over that budget. We do however receive money from the two townships that we service and that money is used for education, additional uniforms, equipment not in the budget, and other expenses approved by those townships. An example is we did not have in our budget to replace our stair chair. One of the townships saw we had a real need for it and donated the money to us to get it. They actually treat us very well and realize that we provide an imperative service to the area. As far as the tax thing. We double pay on just about everything in the US. Think about the roads you drive on. We not only pay for those federally but also through the state through general funds made possible by our tax dollars. Then there's that wonderful gas tax. If you live in an area with toll roads you pay tolls too. There's also money that comes out of the City, County, and Township general funds that pays for those roads. We paid those taxes too. When one of these roads happen to run right in front of your house, guess what? You get to pay again. They assess you a certain amount to fix or improve that road (special road assessment). It's called the wonderful world of goverment and taxation. Ain't it great. Anyway, back to the original post. What was that anyway? Does anyone remember? :-k :dontknow:

:laughing3: :laughing8: :laughing8: :laughing5: :laughing6: Well, that just took care of half of our calls. A quarter of what's left I'm thinking I don't want to do the above to. Pleease don't make me. :sad1: :pale:

Maybe the answer there is to make it a requirement that to be a member of the fire dept you also have to be an EMT or Medic. That's what many of the Metro fire dept do in Minnesota. Most require you to be a medic though. They respond to calls before the ambulance gets there. They are like a rescue unit all though some of them will bring out the big ol ladder trucks to calls. :-k I still feel that the better we are educated the better we can care for patients and the better our communities will look at us as professionals.

I'm from one of those rural systems. Do you know what it is like to respond to a call with a guy who hasn't increased his education since 1979. It's pretty damn scary. He thinks he is SUPER EMT on top it. This would take those type of people out of the equation because they are only in it for the glory. Not that there is any of that anyway. Our local fire dept trains every fireman to first responder level. Some of the EMTs on our crew are trained no better and don't care enough to better themselves. The schooling has improved and the new EMT's are being trained at a higher level to accommodate the standards and protocols set by most of the rural services in our area. That is another reason I believe the schooling should increase to an associates. In all honesty, with all the extra classes I had to take to be certified for the meds and procedures we are allowed to perform I wasn't that far away. The only problem is that it went through the hospital and no college credit is given. The plus side is that when I do go to medic school I will have the edge over some of the other students who didn't get that same extended learning. If we want to be seen as professionals we not only have to act as professionals we have to be educated as professionals. :study: :read2:

I wouldn't say for all patients. Let's be serious, when you get some patients in your rig and it takes you longer to find the hole than it does to get to the ED you aren't going to get into the habit of taking their temps. Also, we don't do temps on all patients. I think this would definitely be a positive for ped patients. When they are screaming you can't get an oral. This also increases the tympanic and axillary temp. Rectal is the best way to go with them. WARNING!!! Duck and cover when taking rectal temp on infant 'cause it's gonna blow. :pottytrain2: So in answer to the question: Nope not all patients should have a rectal temp.

I agree we need to know what is going on with our patient. I was referring to dealing with a fever above. It is imperative that we know what's going on with the patient. That is why it is just as imperative to get a patients history including previous illness, injury, & surgery; medication; events of the current episode; and all other pertinent medical and non-medical information. You combine this with your vitals, physical and what I like to call a simple neuro exam and you should be able to get an overall picture of your patient. While it seemed I left the bag by the door in my previous post I by no means meant that to feel the patient was the only way to check for fever. It has been my experience that yes, your right, this can be very misleading. More often than not it is because the temp. of the emt/medics hands will determine how warm the patient feels. We use this as an initial tool to assessment before the patient is in the rig and we can access a thermometer. In school we were taught to take axillary temps. but unfortunately on our rig we carry the beloved ear thermometer. We have an oral therm. but it is connected to our BP machine which lately spends more time getting repaired than it does on our rig. I don't mind doing manual BPs but others claim they can't hear anything. Gee, that's why you watch the gauge dummies and visualize the pressure. Anyway Dust, thank you for pointing this out to me.