katbemeEMT-B

I think it comes down to what the people we are serving want. I do find it frustrating sometimes when you get a non-emergency call and have to transport the patient, but in the same aspect isn't that what we are getting paid to do? An example would be the patient who has a list of medical problems including asthma, COPD, diabetes, and more recently a seizure disorder. We transport this patient at least five times month. The call always comes in as SOB and chest pain. When we get to the scene, the patient is lying on his bed "gasping" for air. The odor of cigarette smoke knocks you over when you open the door. The patient refuses any treatments or interventions you attempt. Within three hours the patient is home from the hospital. Was this a true emergency? In my eyes no. This is a patient who is more than likely is looking for attention. But the one time we did not respond it very well could have been a true emergency. We transport because that is our job whether it is an emergency or not. As far as fraud, I don't know of a service in our area that falsifies their run reports. If we get paid, great. If we don't get paid, well, thats the way it goes. If it's a none emergency we explain to the patient they will be responsible for the bill and insurance may not pay for it. Haven't had very many patients refuse transport yet.

Our local BLS service visits the area elementary schools (fifth grade and under). We allow the children to tour our rig and show them some of things we would use on them to decrease their fears. We also hand out some sort of treat and the older children (fourth and fifth) get a special book that gives them info on first aid, cpr, and how and when to call 911. We also visit the senior citizens and this year we are helping them to fill out a pocket medical hx form which will make our jobs easier as health care professionals. Other years we have done vital checks on them. As far as being recognized, I think we are one of the most unrecognized professions in the nation. I think a little 6 year old at the local elementary school put it best when she saw us pull up to a house. She looked at her teacher and said, "Uh Oh, there's the meat wagon, looks like some one is going to the hospital." This is a direct correlation of how the public views EMS. Kind of sad isn't it.

While recently at an EMS Conference I attended a break out session on pediatric seizures given by a neurologist from the Mayo Clinic in Rochester, MN. He talked about a similar case study. The first thing is to assess the ABC's, first impression will do. Along with basic vitals and application of O2 get a glucose and treat as indicated, GCS, and temp. If there is no improvement after initial interventions contact MC and consider ALS intercept (if you are a BLS service). Transport immediately continuing to monitor ABC's and treating as needed. The objective with an ped. pt that is potentially unstable, unstable, or critical is immediate transport. All other interventions can be done en-route. If there is no hx to suggest trauma or previous seizure activity consider other etiology such as fever, CNS infection, ETOH or drug ingestion, disease, or injury although there are no obvious signs of trauma. The parents are not present so it will be difficult to get an adequate hx. This is why transport is so important. If the seizure activity continues en-route, anti-seizure med should be admin with MC clearance. It sounds as though this child was in Status Epilepticus which could be the first of many seizures or an isolated incident. The only ones to make a proper diagnosis is the docs at the hospital once they are able to stabilize him, run more tests, and get a better hx from the parents. In the case presented at the conference the pt was diagnosed with a Partial Complex seizure disorder as she had several more of the same types of seizures in the days that followed. She was treated with anti-seizure meds to control future episodes and now lives a normal life as an eleven year old.

The FT service that I am on requires you to pass their fitness and lift test in order for them to hire you. The fitness test consists of compressions at the proper rate for three to four minutes, carrying equipment up and down stairs and through hallways, several (monkey) tricks, and of course the lift test. It starts with what is considered the pediatric lift. They place sand bags on a backboard equalling 80lbs with most of the weight at the head. You are required to lift with another person both the feet and head of the board, carry it 20 feet one way, back, load it on the cot (not a Stryker power cot), raise and lower cot, then load into the rig. After you perform this lift they increase the weight to 125lbs, 180lbs, 200lbs, and finally 225lbs while repeating the same process for each measurement. The test takes about two to three hours. you are penalized for having to stop to readjust your hand position. I did great on all except the 225lb lift. Because the higher weight is a new test, I am being given the chance to redo the lifts. If I do not pass I will be relieved from my duties. I thought this was unfair until last week when we had a pt weighing in at about 350lbs. I am only 5'2" and being on the shorter side definitely puts you at a disadvantage. While loading the cot into the rig I have to hoist the cot and use my stomach to help support it. My abdominal muscles are getting stronger every day. If I have any advice for others out there, know your limitations to avoid injury. Also, there are specific stretches and exercises you can do to stengthen the muscles you use when lifting. Squats with your feet shoulder width apart and using a barbell being sure not to exceed 45lbs help to strengthen the leg and stomach muscles. Placing your foot on a stair with your leg fully extended about 8 to 12 inches high and stretch your upper body foward will stretch the muscles of the leg especially the hamstring. Lunges increase the flexibility of the legs and helps to strengthen the muscles of the back (you can also use hand weights with these). Arm curls with hand weights will help to increase arm muscle. You can also do shoulder circles both forward and backward with hand weights. These are things you need to do everyday in order for them to be effective. I do them while watching the news. Hope this helps.

I don't think it's a matter of if one is more important than the other. I feel they are equally important. We run with a medic and emt on every rig. As an emt it is my job to assist the medic. In this case the medic would be starting an IV while I set up for the 12 lead. As soon as I am finished setting up the lead I assume the position of driver. The medic will then tell me to stop the rig for a few moments so he/she can get a reading. We then continue to the hospital with the pt IV ready and the 12 lead then. Although it seems this would delay pt care it only takes a moment for these things to be done. If the pt is critical we will pull an on-scene officer or rescue personal (depending on who is present) to drive while we both attend to the pt.

I have had a similar experience, not as an EMT but personally. All the same symptoms except for the locking of the knees. I sought medical attention because I too thought it was my heart. After endless tests and EKGs the doctor could find nothing. I finally went to a different doctor who diagnosed it as part of my acid reflux intensified by anxiety. He ran a test for H-Pylori which was positive and scheduled me for an endoscopy. This confirmed his initial diagnosis. My stomach was inflamed due to the acid reflux and was pushing up into my esophagus. This was causing the pain and tenderness in the sternum along with extreme pressure in the chest. The pressure in my chest would increase due to anxiety as I was scared I was having an MI. It was actually the anxiety that caused the numbness throughout my body. The doctor treated the H-Pylori and acid reflux and I have had no problems since.

I am an EMT-B with a volunteer BLS service. I am also on a full-time ALS service. As a Basic with the ALS service we are allowed to admin. Albuterol and Atrovent via neb. We are also allowed to admin Epi-pen under the direction of the medic we are with. As a Basic on the volunteer service we work under standing orders that allow us to admin. Albuterol via neb. If we are dealing with an asthmatic we try their prescribed inhaler first. If there is no relief or they are unable to inhale deep enough for the med to be effective we will then use the neb. While administering the neb we contact medical control for any further instructions. We do not carry Atrovent. As far as the Epi-pen, we are required to ask if the patient carries his/her own and help them to administer it. If they do not have one we are required to get pt. history and confirm that it is an allergic reaction and to what, then we contact medical control to confirm the use of the pen. We are trained both in our EMT-B classes and through CME as to all aspects of these medications along with Glucagon. I guess we are lucky in the fact that we live in rural area and the local college takes great care in ensuring that we are properly trained. We also have yearly drug variance training that gives us the most recent and up-to-date information on the meds we are allowed to carry and administer.