fireflymedic

I would go with King tubes all the way, simplicity of an ET tube with the function of a combitube. A single balloon to inflate, MEANT to be blindly inserted, can't posssibly screw it up, it's fantastic. Where I'm at. we are just introducing them onto the trucks, and with all positive results. You still run into the same issue with the King as you do a combi tube - just small adult, not really a pedi size. It's a great replacement for basic services against the combitube and a great addition to an ALS service. I first got to use them when practicing in TN, and fell in love with them bugging my med director here until he pushed the state to let us have 'em. Of course, nothing is as secure as a properly placed and secured ET tube, however, when you have those no neck patients or really anterior airways that you can't get to save your life (or theirs for that matter), it's a great back up.

I know a few years ago they tested this theory in Cincinatti, OH. It worked great for a while, until a dumb arse ruined it for everyone. They were able to exclude transport for those just needing a prescription refill, minor cuts, scrapes, teeth related complaints, and other minor things. They were also given the option of transporting to an outpatient clinic for these complaints. Required transport was any reason for altered LOC (including drunks), chest pain, head injury, fractures, stabbings, shootings, etc. What screwed it up for them was a medic who denied transport to an altered LOC patient who he thought was drunk - later determined he had head injury, so that was the end of the trial. I'm unaware of any other services with this policy. Most I know are "you call, we haul" no matter how trivial the complaint.

I've been in EMS for a while and I've had good partners and bad partners both male and female some couldn't lift, some had horrible attitudes, and some were barely competent (and unfortunately they are still on the street). I myself am a female and have been through various PAT's for fire departments, some worse than others. I think many females ARE at a disadvantage for these tests simply because fire fighting is a profession which caters to the strengths of a male better than a female. HOWEVER that being said, I believe if you cannot meet the same standards which are set for the males, you should NOT BE IN THIS JOB ! The hose will not be any lighter, the person weigh any less, or the fire be any kinder just because you are a female. I can't stand females who think they are owed a less demanding test simply because they are women. The job is exactly the same for both, so shouldn't the test be?

Our station is in constant fear of being burned down. Several bring matches in an attempt to hide the smell, and well, all it does is make the place smell like a burning turd....not fun.

We get paid time and a half for anything over 40, double time anything over 80

Had a partner who was a rather tightly wound medic (we nicknamed her paragoddess as a joke, though she really wasn't one, just a little antsy) that I rode in with on a serious trauma (car upside down in ravine) as a basic. My usual partner drove as they loaded the patient in my truck (we were BLS, but closest so responded first). He normally drove really well, but this night, he seemed to have a lead foot and a bit of trouble. The poor medic was getting thrown all over the patient as was I. She yelled at him to slow down and take it easier on the little curvy road we were on about ten times. Finally I heard her tell me to duck. She threw a liter bag of saline through the little window between the cab and the box. It hit the windshield and bounced hitting my partner square in the forehead. We arrived at the hospital and he still had a red mark across his forehead. It was one of the funniest things I'd ever seen. Several years later (same partner) we were transporting a psych patient (paranoid schizo). The transport was going really smooth until I decided to take his blood pressure. He freaked out (I explained what I was going to do well beforehand) and grabbed my hair which was back in a braid at the time. My partner was keeping an eye on me and saw what was happening. He slammed on the brakes so fast the patient let go of my hair and I flew straight through the walkthrough (different truck) up into the cab. My partner was already out of the truck and was looking around going "what did you do with my partner?" I was laughing so hard I couldn't help it. The guy got restrained and a cop in the buggy, and rest of transport went without incident. We both work for other companies now, but see each other often and still laugh about both things among others.

Have worked car races, a bike race, rodeos, several horse related events, even at the horse racing track. I have applied to work as part of the 2010 World Equestrian Games medical staffing, we'll see how that goes. In my experience, it's not so much the athletes you have to worry about, it's the stupid gawkers. The athletes know how to take care of themselves for the most part, but the people attending don't or won't, so they are normally who you end up caring for.

I am quite proud of where I work. The people I work with I feel overall are competent, I have a fair boss, and it's a reasonable working environment. I don't feel I get abused. However, like anywhere it has it's faults one major one being our trucks (I don't care for them at all - though new ones are slated for the beginning of the year fortunately). Our protocols are pretty aggressive and the docs really push us to think for ourselves and treat the patient, not just follow the cookbook. So yes, I can say I am proud of where I work, and I wear my uniform with pride.

My service has RSI however, with it comes alot of responsibility and we have the following safeguards in place to ensure our skills are maintained. Two medics are required before even attempted - none of this I'm a medic, I can do this by myself. You better have a back up airway other than a cric. The patient should be a good candidate (ie a reasonable belief that you can get the tube). You are required to do OR rotations every year to maintain the skill. Every single RSI performed gets a full review by the medical director in addition to an inhouse to ensure it was used appropriately. Also, all of our medics which are permitted to do RSI (and just because you are a medic with our service, does not mean you automatically get to do RSI) are critical care certified. RSI is a very useful tool in competent hands in the appropriate situations. However, in inexperienced hands and not in the right situations it could be deadly. Right now, RSI is the "new toy" that everyone wants to play with. It doesn't mean it is right for everyone. It is like any skill, if it is not used enough or properly with safeguards in check, it's a recipe for disaster. Think about this long and hard before considering implementing this within your protocols.

My partner at a former ambulance service used to always play another one bites the dust when we were working a code (he was a little sick and twisted - prompted the service to quit buying ambulances with CD players in them)....great guy though and we had a good time with it. Lightened the mood a bit.

was helping teach a new class of emt's and one of the things we do is teach them to immobilize a patient on a backboard so well that they can be turned upside down which they USED to do during the state practicals (I now know why they stopped doing it). Well, being the assistant in the class, the head instructor was the one doing the immobilization along with another student. We were using a set of well worn spider straps, but I wasn't worried, well I should have been. They got me all strapped in and went to flip me when the spider straps gave way and I fell out halfway landing hard on my knee. Being the tough person I am, I was like, I'm okay. But I noticed really fast my knee was swelling up huge underneath my jeans and I couldn't get up and walk on it, so they called a squad for me. Well, evidently they were bored because I got a full fire and ems response. My coworkers were laughing hysterically when they found out how it happened. I wasn't laughing though, I had torn my MCL and required surgery to fix it, so I really didn't appreciate the six week forced vacation I got. I never volunteered for that again. Several years ago, I also had the poor fortune of falling off my horse and getting knocked out. My friend who was riding with me called EMS upon seeing me laying in the arena and they showed up. Well, I ended up waking up on a backboard (again) and the guys had cut all my clothes off (I could have killed them) and worse yet, I was in my assigned truck (we keep the same trucks and they are set up how we like them) because that crew's truck was down so they had taken mine for the day. I was supposed to be on duty that evening, so my chief was called and of course he came down there. I felt like a complete idiot. A ride to the local trauma center, a CT scan, dislocated shoulder, and six hours later, I was released but didn't have a way home, so they called my crew to come get me and bring me back home. I still haven't lived that down.

as far as individuals, most of us keep them on an individual key chain with carabiner attached to belt loop. I keep mine in the bottom pocket of my pants with NOTHING else. As far as how we keep our narcs, we are assigned out a box to correspond with our bags (we have individual bags to set up how we wish) and then they are to be in a locked compartment within the truck. However, some of our trucks have broken narc box areas, and the doors fall off, so small problem they are in the process of fixing, so we carry them in the bag with the bag section locked and the individual boxes locked. Tends to work pretty well, especially the convenience factor for taking a bag in the house, don't have to go back to the truck if something is needed or wanted. Only problem we have is our medics are pretty trusting, and are bad to leave their narcs in the truck not signing them back in....

someone actually still has romazicon on the truck? Dangerous drug and was pulled from most protocols....suprised to see it. As far as us, lots of drugs, but we use the little like tackle boxes with the compartments. Fit in the bag like a glove and seriously reduce the bulk. We love it.

point well taken AZ - it is proven that if 20 mg of a benzo (either versed or valium) fails to bring a seizure under control that additional measures are probably going to be needed to abate the seizure. One thing we need to be sure of though pushing benzos to patients is that what they are experiencing is truly seizures, there are those out there that are pseudos (not consciously faking, but experience seizure like episodes which aren't). I've seen people go as far as DAI (drug assisted intubation as we don't have full RSI protocols except with 2 als providers) with them to only find out they didn't really have seizures. Better to error on side of caution true and overtreat, but good basic treatment, especially if they remain uncontrolled, exceeds any further ALS treatment unless you KNOW for sure (ie have dealt with patient many times, patient is well known as most of your poorly controlled are). Just something to think about.....

I have EMS plates on my car, but for practical reasons, they allow me to respond off duty if needed (we do an all page from our area if we get overly busy and there is a bad call any of us that are in the area are to respond to the station) and in order for us to be covered by department insurance in response we have to carry the plates. I also have a small LED which is dash that I keep in my glove box and only put out when I respond to an all page. That being said, my pager is small and very discreet which I keep on vibrate so it's not obvious. Also, I have my fair share of tee shirts which are worn at the farm as they were free from various fire schools. I keep a bag out there simply as if anything happens I am a good fifteen minutes of hard running response to get out there and well, you are dealing with thousand plus pound animals as I train horses and also teach students. I have a c-collar and things but BLS strictly. I don't keep any ALS stuff as I'm not going to be charged with practicing meds without a license. Gotta remember that people who keep ALS stuff.

I love phenergan, especially with the transport times we have and the curvy roads it helps patients that are puking nicely, plus puts then slightly sedated and they don't care as much. I've found it to be a very effective med. I'm not fond of zofran - they used it when I worked in ER quite a bit and unless given prior to onset of nausea as previously stated it didn't seem to have any effect. Ativan actually is a decent anti emetic in truth, and yes there are indications for it as that. Puking though inconvenient can actually be a good thing though and you need to watch when giving a drug to retard it as it is the body trying to rid itself of something. If you are bothered by puking, forget the basins best thing to do is get a bio bag, and one of those embroidery hoops that is large. Put the bio bag in the hoop and go from there. Catches almost everything and is easy to get rid of the puke, also don't splash out like it does in the basins.

We have several options we can use for seizures, ativan being at the top of the list (though it's biggest disadvantage in many services is the need for refrig - and yes it DOES have to be !). Versed also comes into play, which we can give up to 10 IV standing or 20 IM and valium which we can give up to 20 IV and call for up to 10 more. Sounds like she was in pretty significant status though and probably ended up sedated and intubated as most are that keep going that long or go through that much meds. Remember all those are a respiratory depressant and you can knock 'em down enough to need to be bagged or even tubed so just keep a keen eye on that airway. Be safe out there.

My boyfriend was a dispatcher before he was in PD and frequently told me where to go and how to get there LOL. I only got frustrated when we were seriously over ran with calls and they didn't realize we were all out and kept dispatching us toning multiple times, or when they would automatically double tone just to get out attention. I hated that. Short of that though, I realize they had a lot to monitor and it was difficult even with our smaller call volume (which has increased since we recently absorbed extrication responsibility from a volunteer squad). God bless the dispatchers as I know they get equally frustrated when we keep yelling at them to answer us. We are dispatched by state police post which covers not only the troopers, but all fire and ems for our district (4 counties) and provides us as ALS back up to two nearby BLS counties. I try to cut 'em slack, but I get so frustrated still as do they.

This is a general question, not meant to be crass in anyway or offensive, but recently I have heard much discussion about my workplace about medics which are on antidepressants. They state due to the typical type A personality of our personnel and the nature of our job (we are extremely overworked and understaffed as is much of ems elsewhere) with a high run volume that many should be on some form of antidepressant to mellow them out and prevent burnout. I have mixed feelings on this, and while I feel it may be beneficial to some I think it is over rated. What are your thoughts or personal experiences on this? I am truly interested in the answers, if do not want to post, you may PM me and answers kept private.

As far as ICE, I've never used it, but had it used on myself once. I was unable to give appropriate response to answers due to medical issues and the first thing the medic did was grab my cell phone and call the first number on it which happened to be my best friend and person I used as my contact anyway. I'd be willing to use it, though I rarely search my patients for things for fear of what I may be stuck with (we don't deal with the best and the brightest here)....

What are some of the oddest statements you have ever heard someone say while under versed? I recently had a medic tell me of a patient he had who made statements that they NEVER would have said if not influenced by versed (pt was very conservative). Anyhow, how much experience have you had with this and what was the strangest thing you have heard said?

If you don't want to drive, definitely go to medic class, otherwise you will be stuck on a BLS truck tater toting all day long which sucks. I prefer not to drive, and do so only on non emergency transfers, for emergencies, my partner always drives. It's a good mix 'cause he loves to drive and I'm not that comfortable with it. I've been in the field 8 years almost, but I still don't care for it, though I will drive if neccessary. Just a preference I guess.

EXCELLENT POST ACE !

Very well put indeed

Very well put, in agreement with you there.