fireflymedic

I worked in a county for a bit that seemed to have an overflow of seizure fakers. Word seemed to have gotten around that if you faked a seizure, you got valium, well in this poor county we had an abundance of both the real thing (people too poor to afford to take meds regularly), and fakers (people who just wanted valium as a cheap high that they didn't have to pay for). Well, one day my partner and I get called to a church out in the boondocks for a lady having while at work. We get there realizing we have ran on her one too many times and even her family has admitted she's faking them (which is a huge help to us), but she's there flopping away while guess what - talking on the cell phone ! OH MY GOD ! We ask her if she's seizing and she doesn't answer, we are like, okay well then...get her loaded in the back of the buggy and stick her with the largest IV we've got and will fit -14 ah how lovely....start it running KVO and she keeps floppin away VERY dramatically. We've had enough, but we're not giving her valium, we're less than two from the hospital, and we're not doing all the paperwork involved with it. Then my partner (and this is why he is my hero to this day) looks at her as we roll up to the ER and goes, well, no patent airway, guess they'll intubate. Tells doc the story (who was also our med director) who grabbed a handful of amonia capsules, stuck 'em in the O2 mask. Lady held her breath for quite a while, finally doc goes, "breathe B***h or I'll shove a tube down your throat and that'll be it !" Lady miraculously breathed, came to completely, threw off NRB, and shoved everyone outta her way and walked home. Needless to say that run didn't get QA review and I appreciated my med director all the more that day. Mind you, things got so bad in that county, we ended up pulling all narcotics off the truck for almost 8 months because of the frequency (company had high turnover, so newbies didn't know the fliers and pushed valium - most fresh outta class). Only thing that put them back on was having a neurologist come in and give a Con Ed on seizures, and having a lady in true status, aspirate, and us not able to do anything about it. Was clenched so bad couldn't intubate orally, and severly deviated septum ruled out nasal. Cric wasn't approved there, and wasn't an option. In the end, it was good education for everyone. Keep your heads up out there and be safe !

I believe dress depends on the type of service or situation you are applying for. If it is a laid back service then a button up shirt and dress slacks (docker style) or khaki style pants. Ties are optional for guys. If it is a more formal service then a pants suit of linen, polyblend or other easy to care for material is ideal, wool is great for winter. Somewhat casual but still looks professional. Guys should wear a tie, and a jacket is preferable but not required (this is typical business casual). For formal interviews with larger companies or upper level positions (such as director, etc) a suit I would think is most appropriate to portray a professional image for both ladies and men. Having interviewed at several services and worked everything from a backwoods EMS service to now performing occupational health EMS, I have found the business casual to be pretty across the board as acceptable. Seeing as a practical evaluation may be part of your interview, I would advise against ladies wearing a dress or suit with a skirt or even against heels. Low heeled dress shoes which are well polished and hair should be tidy with no large jewelry to draw attention (this includes earings, nose rings, etc the latter of which preferably would be removed). If you have visible tatoos, preferably they would be covered. I feel EMS is to lax in their standards of dress and I would definitely hire someone who looked more professional with good skills over a scruffy person. Remember, it is the company's professionalism you are portraying. I know I would feel more at ease being taken care of by someone who takes pride in their appearance. However, overdressing can and does occur, and yes, I have to disagree with you here RID (one of the few times you will see me do so) I believe a dress and heels is out of place in a firehouse. It is still considered partly a man's type job even though there are more women who choose it as a profession. I have seen women come into our station dressed like that only to be turned down for the job with the belief that they were too prissy for the position, and I have to agree I thought so as well. Coming in dressed in a business pants suit, professional and very appropriate. As for the thank you letter. It is amazing how far a few words can say so much. Be sure in it to reinforce why you are a good fit for their company and what you can do for them. Highlight important areas of the interview. Another great thing to do if possible, is to research their company before hand (really impresses directors that you have taken the time to learn about their company and their objectives as well as demonstrating a willingness to learn). Get the business card, then take the time to follow up on your application until they say the position has been filled. If they are looking to fill it immediately, I would send a faxed copy of the thank you letter with a hard copy in the mail. Makes them remember you as this is a small gesture often forgotten. Typically checking back with the person regarding the position once a week until filled is acceptable. Reminds them that you are still interested as some jobs take longer time to process than others. Above all, smile, have fun, and good luck !

Oh my God, that's great ! I love it

Ah, since I have had my head in the EMS sand lately (ie can we say overtime?) I did extricate it briefly to watch SAVED just to see what it would be like. Well, wasn't anything like what I expected. I laughed, and I laughed good at how STUPID it was. I agree with a previous post that it is way too much like Bringing out the Dead. I didn't know what was up with that. I half expected nicholas cage to pop out of the buggy ! Mr. Narcan dude - well, I would have liked to see him kick the medic's butt for that stunt (few if any would push enough narcan to wake 'em up THAT much - only if we were REALLY pissed at the ER that day :twisted: ) Anyway, overall, it was amusing, but due to stupidity rather than good acting. It amused me in the same way that BOTD did. Things I wish I could say at times. I just wonder when the ambulance beating is coming. I really really wished I could have killed Medic 3 that way rather than running over something....just my random thoughts. I think I'll watch round two before I get too evil and critical of it. As far as professionalism and reality - way, way off.....I doubt they'll ever get it right.

We do a class similar to this for all our basics, but it's primarily to orient them to what they will see on an ALS truck and be able to help the medic more efficiently. At least they will be able to play gopher well and know what they are being asked for, even if they don't know how it works per say (though we do include that to a limited degree). Does it increase their ability to do things? Nope, they are still a basic. Does it make them a more efficient partner? You bet. They are able to spike a bag, help set up intubation kits, prepare monitors to attach to the patient, print EKG strips for us, and replace batteries. It gives them some exposure to the ALS world without the additional responsibility. I think it's a great thing for them, so long as they understand this does not increase their ability to do procedures, just simply to help out as needed. Yes, there's alot to do as a basic, but in my area, we are stretched for hands sometimes, especially in the more rural areas, and you may get several basics or another basic truck to back you up and one medic. The extra hands IF they know what to do are useful, otherwise, they are useless !

42 sec BABY !!!!!!!!

Stripping patients should be done with modesty and discretion. I agree with the comments others have made in that isolated traumas (ie minor ankle or arm fractures, etc or basic medical patients) do NOT need to be stripped. As far as starting an IV with a patient who has a shirt on, come on, that's ridiculous. Now IF a patient is intoxicated with possible trauma, has altered mental status which is not corrected (ie diabetic), then some degree of undressing may be required. However, I am always sure to maintain as much of the patient's modesty as I can, even if it just involves covering them with a sheet. It is true you cannot treat what you cannot see, and in major traumas, or something in which you have a high index of suspicion, sorry, you are gonna get stripped. I promise not to take you in the hospital like that. We carry gowns on our trucks for that reason to preserve pt modesty as best we can. Having been on both sides of the fence (being an EMS worker and having been through a major trauma) I learned to appreciate that. Though I admit it was totally bizarre having my coworkers being the ones stripping me. I was like uh yeah...was awkward going back in a station full of guys after that. But I know they were just doing their job and under the circumstances, I would have done the same thing had it been one of them. Bottom line, expose the patient as necessary, but keep covered what you can and make use of those sheets and blankets on your trucks. Your patients will thank you !

Dust, Even though we ain't always agreed on things on the board, please go and return safely. My prayers will be with you. Good luck and kick butt my friend.

I was watching "the critical hour" the other day on tv (yes I was bored okay?) but anyhow, they had a lady on there who was Jehovah's witness and was refusing a blood transfusion. They stated on the show they gave her an agent to assist with the clotting of blood (was IV so affected systemic, unlike quick clot, etc for minor cuts). I am curious was this agent they were discussing plasmanate or dextran or another colloid solution? They are made from blood byproducts (plasmanate from plasma) similar to like the polyheme is, which is contraindicated for religious reasons in JW's just as whole blood is. If not, what may it have been? Definitely piqued my interest. Fielding to everyone here. Thanks.

Okay, as far as services go, here's my suggestions Chicago, IL - can be great or terrible depending on where you are placed. I went there and had a blast riding with them, a friend of mine rode there, couldn't stand it. Lexington, KY- Lexington Fire/EMS very active EMS service, only does 911 calls, very busy, and has both a rural and metro feel to it depending on the area. Plus, just an all around great place to visit. Have several friends work there and I have done some ride time with them, thoroughly enjoyed was treated wonderfully. If you get a good crew, you WILL have fun, be busy, and like every minute of it. You'll see and do it all. Philidelphia, PA - another fun one. Stopped by just to say hey and grab a patch from 'em, and they let me ride along with 'em later that week. Great crew, great fun. It would be on my list of places to return to for sure. I've seen several others reccommend, I'd check it out. If you don't mind rural progressive services, though they have a high call volume there are two that really stand out. I've worked with one of them. Laurel County EMS (is actually Ambulance Inc of Laurel Co) - was KY's best service in 2003- recognized several times by state board and very active in community and education, nice station, decent trucks and a great chief, plus protocols aren't that bad either. Has decent run volume- you will run your butt off all day with lots of trauma and good medical calls. Is tiered response if needed, though primarily BLS with one or two medics per shift. Stay away from Louisville, KY !!!!! It is bad ! There is an all out turf war going on in that area right now between the ambulance services, with two different services showing up to the same call trying to beat each other. The medics are overworked, burnt, and how shall I say this? THOROUGHLY CRISPY FRIED !!!! Go there and you WILL regret it. Not to say all medics there are bad, meerly the situation surrounding which I am sure you would rather avoid. Don't know anything about many other services in the area, most around me are county based and pretty slow consisting of mostly nursing home/doctor offices with the occasional trauma so other than Laurel Co EMS and Lexington, I would avoid KY all together. Good luck and have fun. If you want more info about KY services, you may PM me.

The person below me has no idea where I am from

In my area, we only do psych transports if there is a medical neccessity requiring them to be transported by ambulance (ie overdose, gunshot, etc). When they are transported that way, we have a state trooper with us (state usually responds with us, we don't have a city pd). In the event there is no medical reason, either state (usually) or the next county over S.O. transports. We used to transport, but after several violent psychs and the local nuthouse changing protocol to lock us in with the patient until a md sees them (which has been as long as four hours tying up a truck out of town), our protocols were changed allowing us only to transport for medical reasons and only with a police escort, (actually in the truck with us, not just following either). Tends to work well.

Thanks Dust, It is not that I neccessarily want to leave the EMS field, I simply want to move forward in a different capacity, and in order to do either ground or air critical care transport, you are more marketable and competitive having both a nursing and medic as opposed to just one or the other. I am quite content where I work now, and intend to stay here all through the program. I am fortunate to work for a service where I am quite happy. It's a shame more people don't have that luxury. Thanks for the little army quote "be all you can be" hehe. It's all good. I believe I will probably end up going the traditional route and retaking courses even though there is only three years between, by the time I apply and am accepted, chances are it will be around 4-5 years old, and that is longer than I would like as well. Thanks again for the advice.

I've worked nights since I was 17, previously on horse farms doing security/foal watching for three years while going through school. I've now solely worked on nights for almost five years in EMS. At first it was difficult for me to get used to. I really had a hard time adjusting as I tried to "live normal" on my days off. That is the worst thing you can do. I'm fortunate, we have a rotating truck schedule between four trucks as to who is first, second, third, fourth out. First crew is 6a to noon, then noon to 6, 6 to midnight, and midnight to 6. You go from 1st out to fourth, and gradually work your way up. Every truck is on the same rotation each shift, so you are pretty well guaranteed some sleep unless you have a major disaster happen. It works really well for our station. Some stations do things differently like 12 hour rotations in the smaller ones (I work in the busiest station) with just two trucks. My biggest thing is to really try to stay on a schedule and only come off it unless I absolutely have to. I typically get to sleep my six hours on shift from 6am to noon. We have a dark bunkroom and no windows, keep it nice and cool. Works well. At home, I keep that same schedule. I am primary truck always from midnight to 6 by choice, my partner likes that shift as do I, more to do, and we stay busy. We have two 9-5 trucks which we call our "five" trucks which does nothing but the doctors office and dialysis transfers. Those are staffed with overtime or part time workers. Is not a bad deal, perhaps discuss this idea with your co-workers of having a primary truck for part of the shift and a secondary truck. Most are pretty agreeable to that. Bottom line for adjusting to night shift, get room darkening blinds, keep your room comfortable for you to sleep in, try to keep a similar schedule to what you have at work (ie you wake up at 3 and go to bed at 9 on days you work, try to keep that routine, and avoid caffeine for at least an hour before you are due to get off shift to allow your body time to unwind before trying to sleep. This has helped me greatly. Good luck and enjoy nights.

Dust, I believe there was a misunderstanding there. I completed my course through a college program, therefore I went through the same anatomy, physiology, biology, chemistry, math, medical terminology as did the nurses. I hold a Bach degree in emergency medical care/fire science, and have completed that through a college rather than a fire department type course. I believe there was some misunderstanding as to that. I am not looking neccessarily for a "shortcut" as many of my previous credits would apply to the program, as there were multiple nursing students in those classes with me. What I meant was as far as clinical type experience, the good and bad how they compared and if you felt like the web based program or accelerated type programs provided an equal education or if you felt attending the classes in person at a local college gave an advantage. I am looking to further my education as I realize more and more that EMS does have its limitations as a career, especially if you are physically unable to do the job any longer. Nursing however, provides more options for a person from ER to patient education. I am not looking to short cut my education, but simply to decide which would be the most beneficial for me allowing me to still work full time (as I need the health insurance) in addition to going to school. I am exploring the web based programs as an option as well as the traditional setting. Thanks for the advice.

C, Everytime I have dealt with the king, it has been as a primary device. Usually placed by a BLS crew prior to arrival. I've never tried the method you mentioned. I'd be curious to see how it worked. We don't have that much exposure with them in my area (though I did get limited exposure during my clinical time), as they are not approved in my state. However, a service I worked for previously frequently ran ALS intercept, or was even the primary response for a local service directly across the state line as they were frequently understaffed or overtaxed. It was a great mutual aid agreement. I had to have certs though for both states as well as holding my cert for ohio and alabama, so I've gotten to see alot of different things used in different states. I wish we would get them more in my area as opposed to just in the hospital setting as is now. Thanks for the thought. Have to ask some of my southern friends if they've tried it.

I am curious if you pursued your RN through a transition program or if you did the full course for schools going back through the anatomy, physiology, etc. I am looking at the options available to me for continuing my education, and as I would eventually like to move into a more critical care setting, I feel obtaining my RN would be the next logical step in progression. What I am curious though, is if you felt you got as adequate an education in the accelerated medic to RN programs or if you felt that the full course is of more benefit. I have all the pre-requisites down that are needed, though it has been approx 3 years since I have taken anatomy/phys/english/math/etc. What are your thoughts on this as some input would be appreciated.

Hey, LMA's are okay, though they do not prevent aspiration well at all. That is their biggest problem. Combi-tubes are a good thing, and truthfully in a code type situation, they are better than nothing. It gives a basic a better airway until ALS can arrive. The one airway substitute that I have fallen in love with is the king tube. It is very similar to an ETT except that it is a blind insertion and acts much like a combi-tube, but only one balloon to inflate, there is sizing similar to an ETT, unlike combi which just comes small and regular. Tenn has approved them on trucks for both basics and medics, and so far all I have talked to, like them as well as I do. Nice device. Definitely gives a more secure airway and doesn't become dislodged as easy as combi-tube. Also, very easy to intubate following placement (though I believe if you have a good airway in place and no signs of aspiration or indication to intubate, just leave what's there!) I think they are superior to anything out on the market right now, but that is solely my opinion, take it for what it is worth (somewhere around 2 cents I believe). Also, they are more cost effective than combi tubes or LMA's. As far as intubating, great trick someone showed me (though I am sure it is commonly known) is if the first time you get the esophagus, just leave that tube in place, then try again. You only have one hole to hit. Makes it easier. It really does work. Anyhow, happy airways.

VS-eh, I appreciate your insight, but let me clarify a few things. First, I mentioned we took romazicon off our 'coma cocktail' two years ago. I wouldn't truly consider that a fairly recent change. It is still on our trucks, but ONLY if we are for sure that is what the person took, and on consult with med control. As I said before, due to the possible effects which can occur due to administration of it, I wouldn't give it unless I was 100% sure, and even still I would prefer it be given in the ER. Second, I stated that SQ was being discussed as a possibility, not that it was set in stone. Some of the docs at the local hospital were discussing the topic and were talking with us about it (we are fortunate to have docs that will talk with us, not disregard us as many do). They had the discussion in effect to a question I had asked following a code where we had a difficult time gaining IV access due to the patient's previous drug use causing poor veins. I had asked if epi would have a systemic type effect if given SQ in a cardiac arrest, or if it would have any effect. Was curious about this due to the systemic effects which occur when given SQ for allergic reactions. Lido though has a more localized reaction, so I would wonder about it. I know two different ballgames, but was on my mind. The doc was the one that made the statement, "why not". As I mentioned earlier, I am here to learn, I think you learn every day and if I can learn something that may benefit a patient one day, I'm open to the idea. I guess I should have been more clear in my statement, rather than making it sound as though it came from published literature. I'm sorry for the confusion there. However, I have seen strong support for the IO (just only if we could get them to run faster....ones I've dealt with were patent, but still ran slow-perhaps placement was an issue there?) I also mentioned that we are getting ready to revise our protocols, so there may be significant changes which are about to happen. I too have questioned the effectiveness of ETT meds, but I agree at least there was good efficacy behind attempting to deliver meds that way. I hope this clarified things a little better for you. Thanks again for the input.

Two simple words to you all. Thank You. I don't really have that many people outside of EMS that understand my job that care to hear about how my day went or what happened. When I am down after a really bad shift, such as the other day, people just tell me snap out of it. Had a much better day today. Went and spent the day with my horses, and saw a new life come into the world with one of them having it's baby last night. Kinda made me smile. I have already decided to name that foal (which was a girl) Ebnit (was the little girl's last name). It fits her too, she's cute as a button. Maybe corny I know, but in a way it won't let me forget and keep encouraging me to go forward on tough days. Thanks for letting me vent to you all. Stay safe out there.

You know what's really sad? I almost took a job at UAB when I lived there, I lived just outside Birmingham for a while. LOL, too funny. I can't imagine it getting that slow there ! Everytime I brought a patient in, it seemed like that place was outta control busy ! Dust, I don't know, but it would've been crazy workin there, for all I know I gave a patient report to you ! UH oh, what would you have thought then? LOL, hopefully it would be no hard feelings for us measly street people. Hehe. Have to admit though, video makes me wanna run down there and get a job. Lol, wish they had that kinda sense of humor around here. We could use it sometimes.

FFPM41 The handouts from Dr. Bledsoe were great. Really does a good job of explaining stuff basically. Flumazenil was taken off our "coma cocktail" two years ago and now is only indicated if we know for SURE that is what the person took. Even then, it is done upon consult with med control due to the possible negative side effects. Where in the problem with that lies is your seizure patients who take valium, ativan, etc as an abortive medication, decide to try to committ suicide and take them all. Flumazenil just opens a whole can of worms that's just nasty to deal with. I'd rather have it dealt with in an ER than I would the back of my truck. More people, more resources. Are there actually services which still have this in their protocols (oops GUIDELINES ?)

I had heard that they will be doing away with the "down the tube" method of drugs in a code due to the fact of unequal absorbtion, introducing fluid into the lungs, and general ineffectiveness. I heard that IO is more the way to go, and even heard mention of SQ as a possibility (I don't see why not, epi, lido are routinely done SQ in much smaller doses anyway, the person's gonna die anyway if you don't do anything, so why not give it a try?) Speaking of IO, anyone used the bone injection guns? I've not dealt with them, but curious as to those that have used them how they like them. Also, I know sternum and tibia are approved sites, but in my last PEPP class (taken Nov last year) the comment was made that the humerus, femur, and pelvis could be acceptable sites as well. I could understand the humerus and femur, but I would think the pelvis would have to be more carefully placed and slightly more difficult to stabilize....just a thought.

The pay around here runs approximately 7 dollars an hour for basics and in the 9-11 range for medics. Depending on the service, depends on what you make. The services which pay higher for basics (ie $9 or so) only let them work around 40 hours a week, some not even that much, only 36. You only have to work 32 to be considered full time in KY. However, most of the better paying places involve clinic work or as a tech somewhere. Few make that on the street. Industrial EMT's tend to do much better with their pay around the 9-10 range for basic, but then again, it is more of a clinical setting than true EMS. In my area, you are extremely fortunate to land a job with a 24/48 service which has benefits. Those jobs are in incredibly high demand for medics and very competitive for EMT's as there is little turnover with those places. There is frequent turnover in general with basics (we don't honor intermediates here) as the services which tend to hire basics are low paying and very poor or no benefits. The good services with hazardous duty retirement tend to be in the large run volume areas and are very difficult to get on with. Most of the time if they do hire basics it is with the requirement they are either currently in medic school, or willing to go within a year. However, almost all that I know of will pay for the class though provided you give them a year or two of service time (or pay out the remainder of your contract-which I have known some fire departments to do). Jobs with fire departments are a precious commodity. Very few and far between, especially for basics as we have excellent benefits for fire in my state. Also there is an abundance of basics in the state, but a serious lacking of medics, especially in the poorer counties. I work full time off the street in a clinic and part time on the street. I am content with what I make, but also remember, though our pay seems incredibly low, one must factor the cost of living here (short of big cities such as Louisville, Lexington, Florence, etc) is very cheap. I rent a small house which is relatively new, nice large yard, right outside of town for about $400 a month. All utilities paid. Not a bad deal at all. Anyone want to come here?

much of the literature I have read, and listened to other medics throughout the area have a clear preference for ativan (if available to them). However, I was under the impression that valium has effectiveness of approx 20 min (which is why they caution you to watch for seizure recurrance) and that ativan provided protection for up to 4-6 hours. There is one service near us which ONLY uses versed with seizures (used to use valium, but was changed over recently-don't know reasoning behind that). I agree versed is good for cardioversion or to put someone down to tube, though the medics I have spoken with that use it for seizures in the nearby county state more respiratory issues with versed than valium or ativan (of course if wishing to tube, that would not provide a problem). I was just curious how things went in other areas and the popularity of the drugs. Also another interesting thing, I've found is patients tend to remember more when under the influence of valium than ativan and versed (versed they forget all, how lovely)....just a strange but almost comical observation. I've had patients tell me things I've said when I thought they were out and everything. Comical indeed.