katbemeEMT-B

So I'm not really sure how I feel about this. Part of me says no way, it would be stupid. The other, more rural, lack of definitive care, part of me says, hell yes. This is how I see it. If the service is not going to take the time to educate their members on how to properly place, read, and interpret the ECG, then they don't even need the LP onboard. Any simple bp machine would do. I mean, why spend the extra money for all those bells and whistles when you will never utilize them. And again, will it change how you treat and transport your patient if you print out a strip and have no idea what it says. That would be a big fat NO. On the other hand, being in a rural area, with a VERY rural hospital, I could see where being educated on EKGs and having the ability to perform a 12 lead would benefit our patients. If the ECG were positive for any kind of disturbance (let's say an MI), we would be able to alert the ED who in turn would activate Life Flight. This would save about ten to twenty minutes of time, getting the patient to the true definitive care that is needed. Our local hospital doesn't have the capabilities to deal with heart issues unless the cardiologist happens to be there which is only four times a month. The hospital's protocol is when a chest pain comes in, they do a work up, and then if it is determined the patient is indeed having a heart issue, they transfer them to a Metro hospital where they receive a more specialized care. Depending on the issue, transport is either by ground ALS or Life Flight (usually Life Flight). The nearest ground ALS is thirty miles away from the hospitial. But yet again, I can also see, being in wankerville like I am, a skill like this being over utilized and the wankers not following through with the training required to adequately perform an ECG. So you see, I am really on the fence with this one. I think deep down I know it just wouldn't work. On the surface, I want it to. My experience on the ALS service has given me the opportunity to perform EKGs and the medics encourage me to interpret them. They then take the time to explain what they see, how they determined it, and why it appears as it does. It truly is a wonderful learning experience.

Got another one that seems to happen often since they hired two new dispatchers. Dispatch: Ambulance XX, your needed at the intersection of ABC and XYZ for a 10-50 with injuries. Car versus semi. Hey dumba$$ dispatchers, that would make it a 10-52. 10-50s don't have injuries.

After responding to a call for a water rescue, the fire dept. from a neighboring town is heading back to the station. Over the radio, the following is heard: Chief: Nothing luck a bunch of dumb f*cking duck hunters to f*ck up a day. You would think they would be able to pull their head out of their a$$ long enough to realize that if all three of them lean over the same side of the boat, the f*cking boat is going to tip. How f*cking stupi.. Captain: Uh chief Chief: What Captain: Just thought I would let you know, the mike is keyed up. Chief: Oh f*.... The conversation cuts out. I happened to be at my moms when this happened listening to the radio. My dad was the chief. Mom and I laughed so hard I thought we would piss ourselves. We laughed for days. So did the rest of the county. I can't wait for his retirement ceremony this winter, I'm sure the guys will include this incident.

It depends on where you live. Every state is different in there certification requirements. In Minnesota, the EMT-B class is offered at least every six months. Many times the schools have it set up that they are offered several times a year at different locations. I agree that if you are really serious about getting back into EMS, go all out and go paramedic. Minnesota still requires the EMT-B course before entrance to the medic program but it not that hard. As for taking class online, DON'T DO IT. Especially biology classes. I'm getting my butt kicked right now by that one. Anyway, good luck.

I wasn’t going to reply to this post, but after some insightful thinking (and a good night’s sleep); I decided it might be of benefit to others and me. My first few posts, I can say without a doubt, that I got the hell beat out of me. I really took this personally and considered not coming back. I sat at home and licked my wounded ego for a few days. Well, my thirst for knowledge got the best and I made the decision that I would come back to read, but not post. I was sitting on the fence as to whether I would take that next step and return to medic school, and I was looking for information to help me make an informed decision. After a short period of time, just reading the information wasn’t enough. I had to ask questions too. Well, I got the information I was looking for from the exact people who had previously extricated me from my very self. I say extricated because it was not an easy job to remove the embedded way of thinking that my fellow co-workers were so kind to share with me. I now see EMS in a whole new aspect and understand where these mentors were coming from. With the knowledge that I have gained from this site and my experience on the job (inability to help some patients), I have made the decision to return to school. I am almost done with my first semester and look forward to the next five. I have also come to the realization that aside from the inadequate education in the EMS field (especially for basics), EVERY area would benefit from an all ALS paid service. This has prompted me to not only try to convince the “powers that be” into making our service paid (it’s going to be a tough sell), but also to go ALS. I look at the patients we care for who would benefit from ALS care and feel for them. Our only option for ALS is aircare. So, to all the n00bs and those that feel slighted by others, I say step back and really think about what is being said. Remove all the sarcasm and what some consider criticism and really read what is being posted. Don’t take it personally. Try to see it from the other person’s perspective. To those that have the experience, knowledge, and willingness to try and steer others in the right direction, THANK YOU!

This has happened to us twice now. Same lady, calls about four months apart. Ricky Retard Dispatch: Ambulance, you're needed at <address> for, ahh, a female, ahh, who is not feeling, ahh, um, good and won't wake up. (About five second pause). You'll find her on the couch. Okay, so after we finish laughing at Ricky, we put ourselves enroute. When we put ourselves on scene, Ricky says, "Did you copy she's on the couch?" Laughter again while responding, "Copy" We get inside and the home nurse says she can't rouse the patient. We do our assessment which is unremarkable, and yep, she's out. We begin the move to the cot when suddenly her hand falls off her chest and hits the cot. Well, this startles her and she wakes up swinging and bitching. Patient: What the hell are you doing? EMS: We're EMS, we received a call from your nurse that you wouldn't wake up. Patient: Well, she's fucking stupid. What the hell are you waking me up for? Can't a person get some sleep when they're tired? EMS: We understand that you're tired, but your nurse was concerned. Patient: Oh, she can go to hell. She's a stupid bitch anyway. Just let me go back to sleep. I was up until 4am. Old people need their sleep you know. EMS: I understand that, but your nurse was very concerned. Will you allow us to transport you just to be sure you're okay? Patient: Concerned about me my ass. She's concerned about her paycheck. You can take me as long as you let me sleep. That means shut the hell up and don't talk to me. We got her to the hospital and she was telling the truth. Nothing wrong with her except she was tired. When we got back to the garage, we laughed for quite a while over Ricky Retard's page. We never knew that it could take a minute and a half just to give an address and simple patient information. The ordeal with the patient made us laugh even harder. Gotta love the crotchety old ladies. Oh yea, she has a new nurse. The other one quit because she didn't like being called a stupid bitch.

Being a mom of four kids and having two jobs keeps me busy, so when I registered for classes I decided night classes worked best. I have to take biology but the only classes were held during the day, three days a week. The school did have an online course. Sounded good to me. Lesson: NEVER TAKE AN ONLINE BIOLOGY COURSE, especially when it's the inaugural year. After we spent much time meeting with the dean of students, they pulled the online classes being offered in the future. Unfortunately for us, we were given no alternative. She won't even let us join an existing class. I'm currently getting a "D". Gotta have a "C" to be accepted into the Medic program. Got "A"s in all my other classes. Oh well, I guess I'll just do even better when I have to retake the class next semester. Currently I am taking a psych: death and dying class. I am discovering that I have some unresolved issues when it comes to the deaths of some close family and a friend. I have been fighting depression for the last three weeks. The professor has been great about making herself available for us. Hopefully things only get better.

Contact your state licensing board. They should have a list of certified EVOC and CEVO II instructors in your area. I live in Minnesota about two hours north of the Iowa border, and we received our training through South East Region EMS. You can find information on the CEVO II class we went through at www.coachingsysytems.com. My other suggestion is along with the driving course, do ride alongs and practice driving. The main thing to remember is that what ever you feel in the front as the driver is intensified about 100 times in the back for your partner and patient. My boss explained it to me this way, the drivers butt should never move in the seat when maneuvering the truck and that's when you know you are driving with your partners comfort in mind.

We just went through training for the disposal of hazardous materials, medications used on our trucks was included. The hospital we are based out of has a special "hazardous waste" container that we dispose our meds. into. When the container is full, a company that specializes in the handling and disposal of hazardous material takes it away and replaces it with a new one. We can no longer through any equipment or supplies that have come in contact with meds into the trash. They must ALL be treated as hazardous waste. It's an extra step in the cleaning up process, but it only takes a few seconds. I don't know what other services do.

We don't run L & S very often. The patient has to be pretty critical. In 8 months on the ALS service I work for I have driven L&S once. Active MI about to arrest. The BLS service that I work for (only service in our area), we have ran L&S about 5 times in 17 months. Two strokes, ped. sez. after fifteen minutes of seizing, cardiac arrest, and semi vs auto mvc in which we had two helos waiting at the hospital, both critical one with assisted ventilations. I do have a funny story from the other day. Our ALS truck was called to do a L&S transfer from the local hospital to a metro hospital, (60 mile drive). We questioned why they wouldn't just transfer the patient via air care. Told us they couldn't get a helo. We got to the hospital, took one look at the patient, medic told staff, noway are we taking her. We called our dispatch and they had us air care within half an hour. Took us that long to prep her for transport. When I'm driving, I prefer not running L&S because it turns other drivers into idiots.

I work for two different services. One of the services utilizes the Hudson Map Book. When we get our page, it gives us coordinates that can be easily located in the book. I know the city itself pretty well, but the rural area is a mystery. I have responded to several rural calls that took no more time than if I had actually known where I was going. The other service I work for uses the old, call dispatch and get directions, and then pray like hell you get there. For the most part, we all know the streets within our PSA, but we provide mutual aid for a neighboring community. When we have to respond to a call in their area, it's pretty much a "wing and a prayer". Just the other night, our truck was dispatched into their PSA and the dispatcher gave them directions. I happened to know the area a little as I have a friend that lives out there. The dispatcher sent the truck in the wrong direction. I called them on the cell phone and was able to direct them to the general area of the call. A one-time lucky situation.

Per protocol, we are dispatched only to structure fires unless fire determines our services are needed. This is automatic for several reasons. One is to monitor the fire monkeys once their O2 tank runs out. They have to spend fifteen minutes with us checking vitals and so forth. Once we give them the all clear, they can suit back up and play in the flames some more. The other is just in case a fire monkey does something stupid and ends up hurt. I will say this..in most cases we are released within 30 - 40 minutes. The only time in the last two years we were on scene longer was for a garage fire in which we were stationed almost two blocks away and fire was on scene for fifteen hours. We left after four. The other was for a bar fire with apartments above fully engulfed. We on scene for five hours. The fire department was on scene for two days as it continued to rekindle. So, does EMS need to be called for every fire, no way! It's a waste of time, money, and resources.

Dust hit it right on the head. As a current medic student and practicing EMT-B, I agree whole-heartedly with Dust. The only advantage of my being on a service at this point, I am able to skip the BLS internship. This has allowed me to take on extra course work. I do like that advantage. Other than that, no reason to work before starting medic school. If you read any of my other posts on this subject, you will see my opinion has changed. I used to preach work, work, work. Not anymore.

I am also from a small rural area. We have had similar situations several times. on one ocassion, our third crew member stayed with the kids. The others, we took the kids with. The sad part is the one time we left a crew member behind, she ended up with a parasitic infection from sitting in the house. Groooossss!

Great scenario and an awesome learning experience for me. Thanks for sharing chbare.

What about airway obstruction? Have we assessed for that? Did he tube easily or was there some resistance?

What is the patient's temp.? Could he have Staphylococcus or an Infective Endocarditis? Has he had any other symptoms relating to general illness, nausea, vomitting, etc?

Spenac, I agree with you that in your scenario, the ability to check for dilation may be helpful. But if you are using it to determine if a woman is in labor is not a quantifiable reason. A woman can dilate and not be in labor. A better way to do this is to rest your hands on the womans abdomen and feel for consistent hardening of the entire abdomen. There should be no soft spots. When you feel this, you begin timing these "contractions". I have used this on two non-English speaking patients. This avoids the risk of introducing any type of bacteria into the vagina and cervix. If after monitoring the patient for contractions you note that they are two minutes or less apart, then yes, a more internal check should be performed. You are absolutely right when you say Hispanic women tend to internalize, especially if they are illegals. I see this with legals too. I also agree that as EMS providers there definitely needs to be more OB education. I believe that education should begin at the EMT-B level not just medics. If as a medic, you are on a truck with a basic, wouldn't you feel more comfortable knowing that your partner is just as educated in OBs so he/she can assist you? What is taught at the Basic level is ridiculous. I don't know what is taught at the medic level as I have not gotten that far in my education yet, (doing generals right now), but I am looking forward to learning it. I think the education should consist of general OB knowledge, OB complications (signs and symptoms, and what to do or not to do), assisting mom in proper breathing and relaxing (this helps oxygen intake for the baby), intensive OB rotations (at a general hospital and a hospital that specializes in neonatal emergency care), and maybe even a section on keeping the provider cool, calm, and collected. I'm sure there are things I missed that some one else can add. I would also like to respond to tniuqs. You asked how an OB can miss placenta previa. As has already been stated, they depend on ultrasound for an internal picture of the uterus. I do not know the exact details, as I did not ask the OB when it happened, but I do know that ultrasounds don't always show a clear picture of what is going on. Often times, the placenta is initially attached low in the uterus and as the baby and uterus grow, the placenta rises to it's normal position. It is the failure of the placenta to do so that causes placenta previa. I also know that this OB does not do constant ultrasounds on his patients unless he has reason to believe there is something amiss. This patient was progressing normally during her pregnancy and subsequent labor. She did not exhibit the normal excessive bleeding associated with placenta previa. If anything, she bled less than normal. Maybe that should have been the tipoff. When she came in for delivery, her contractions were three minutes apart and the OB happened to be on the floor as he had just delivered another baby. He went in to check for dilation and that's when all hell broke loose. She ended up having an emergency cesarian. It does not take much force to rupture a placenta enough to excessively bleed. You have to remember, OBs are human, they are not machines that never make mistakes and they aren't going to catch everything. As far as my comment about inexperience, that was directed towards something spenac stated (not you as I don't know enough about your experience or area of service), about not knowing what it's like to be in a rural setting and having long transports. In a city or urban setting when you are looking at a transport time of less then fifteen minutes, checking for dilation is not going to assist the provider or change their direction of care. Seriously, by the time you take baseline vitals and monitor the abdomen to ensure mom us truly in labor, you would be at the hospital. Experience tells us as providers that these are our main concerns, not how dilated she is. Now if a provider is placed in a rural setting with long transport times, yes, maybe checking for dilation can be of benefit. But I still feel other things take precedence and checking for dilation should be a last resort. Dilation is not the only determining factor when it comes to timing of a delivery. A provider must also take into account gestationally how far along mom is and how big is the baby. A pre-term mom or small baby due to inadequate prenatal care does not require mom to completely dilate. This is where provider experience comes in. I think you would have to agree with me that just because a person's EMT class touched on OB emergencies, or a medic did an OB rotation, it is not enough for either one to gain the type of knowledge or experience needed to be truly educated in Obstetrics, emergent or otherwise.

[quote="Dustdevil I agree with Spenac. A lot of people here seem to have no significant OB knowledge experience at all. And definitely no rural experience.

I definitely agree that it is a management problem which does seem to follow government agencies. I look at the difference between the two services I work for: City owned - paid volunteer with minimal CE. The only positive - we are actually scheduled to work shifts to avoid staff overflow on calls. City owned but hospital based - paid service with many CE. Great learning experiences on the truck also. The medics are great about explaining treatments and conditions. I have learned more in the last six months there that two years at my other job where I do primary care. The only downfall - they run medic/emt trucks but allow medics to fill emt slots. Then they end up with lots of medic slots that didn't get filled and emts wanting shifts but can't take them. Pushed me to work towards my medic degree.

Best descriptive medical term yet. I'll have to remember that for my classes. Hey, question, are most of your patients full-term or do you have many pre-term? Just curious. I can totally identify with the lack of prenatal care thing. We get moms that come through class with less then three month to go and haven't been to see a doctor yet. The first thing we do, set them up with our favorite OBs. They usually end up being illegals and don't want anyone to know.

We recently had an in-service on the ins and outs of the "Good Samaritan". It was given by a local lawyer and member of the state EMS board. They specifically stated that "when EMS personnel happen upon an MVC, respond to a medical, or any other event requiring EMS care, while off duty, they are responding ONLY as first responders and should administer care accordingly. With that being said, in todays world, all EMS personnel should still plan on being sued for some stupid ass reason". Not long ago, I responded to a medical in the neighboring community with their rescue unit. The fire chief knew I worked for the ambulance service and asked me to go. While I was unable to do anything other than assess the patient and monitor him until the truck arrived, the rescue was appreciative. Once the truck arrived, even though it was the same service I worked for, I stepped to the side and let them do their job. My thought is, they were getting paid, not me. Once they had all the info. I could give them, my part was done unless they needed me for something. Why give it up for free if you can get paid!

I understand that your ultimate concern is getting the baby out quickly and safely, but as a childbirth instructor and doula, I can also tell you that even OB docs are moving away from episiotomies. They are finding that woman heal faster from a tear than an episiotomy, and some woman have torn even after the episiotomy. I know of several that tore all the way into the anal tissue. Once the external folds of tissue are cut, they tear much easier because of the stretching. Perineal message and a slow, controlled delivery is the best bet. If you want to slow the delivery process, have the mom lay flat on her back, bringing her legs up to her chest as much as possible. It makes for an uphill climb for the baby. If you want to speed things up, have mom sitting up up much as possible with legs drawn up towards the side of chest while still allowing you access to the vaginal area. Some times changing positions ( lay on left or right side) helps also, as babys do get hung up on the pelvis or the woman may not be equally dilated. I am thankful I have never had a delivery in the ambulance. I would imagine the space restraints suck, along with the constant bouncing.

Funny but true.

What has to be remembered is that it's not only the staff that is licensed at a certain level, but your service is licensed to perform services at a specific level, (BLS or ALS). In the OP, the service is licensed at the BLS level. This means that regardless of the level of training of staff on the truck, they can only perform at a BLS level. When state issued the license, the service registered their protocols. If it is reported to the state that you have practiced outside of those established protocols, your service could be shut down. The other thing to consider, and I would assume it's standard across the U.S., the state does inspections of your service. They actually come in and look at all the equipment and supplies that you carry and stock. If it is found that you have ALS drugs on a BLS truck, they again can shut you down. It is possible to have a service that runs as part-time ALS. This means that when a paramedic is present, the truck is considered ALS, otherwise it is BLS. It has to be licensed with the state that way. Also, the ALS equipment and drugs can not be stored on the truck. They must be locked up where only the medics can get to them and place them on the truck themselves. We have a service about 30 miles away that is part-time ALS, that's why I know how this works. Our service was also looking at an ALS chase car, unfortunately, things didn't work out. The medic didn't want to carry everything with him. I realize it may not be the same across the board, but I also feel that if your service is licensed as BLS, regardless of what online doc is telling you, you should practice as BLS. I wouldn't take the risk. If the patient is in dire need of ALS, then call for intercept. I wish you luck in making the switch from BLS to ALS. I hope you have better luck than we have. If you succeed, let me know how you did it. Just my two cents.