fire911medic

EMS professionals beware. There are few out there who don't have some form of website out there, but there is an increasing amount of public safety people losing their jobs for what they post on the internet (even if they don't reveal names of where they work, patient names, etc). Currently, there are 15 people that I know of facing action in their counties for either posting pictures or things in blogs about their work. It has made me remove everything from my websites and take down any pictures I had (even though they didn't compromise patient identity or privacy). I am erroring on the side of caution as I like my job and would prefer not to lose it. People be smart and safe out there. Let's be careful !

I tried to put MM's on layaway, and a little old lady behind me said, "honey if you can't afford a pack of MM's, I'll buy them for you". Lol, it was too funny.

I also have walked around with the wet floor cones on my head all through the store, only to get one of their security guys to get the manager come look at me (that was most fun ! ). The manager laughed hysterically. It was great.

Last thing I've done to get myself in trouble in walmart was set off every single thing toy that could possibly go off. I thought I had drove the employees crazy 'cause I overheard a lady saying they couldn't find any help in the toy area....hehe.

It's fun to be terrible in Walmart !

I think it was a well done video, however, I am sad to see that they don't even really acknowledge EMS in it. We lay our lives on the line every day without much protection (though I do know medics which wear bulletproof vests). Cops have guns and vests, firefighters have airpacks and turnouts, but there is little for us and often we get into an unsafe position before we realize it is unsafe, many times due to poor information. Is how a friend of mine was killed and many others injured in the line of duty. I am both fire and ems as I work with a combined department and I do not see one as better than the other. Instead we are equal. Without fire, I could not access a patient dying of smoke inhalation from a burning building or pinned deeply in the wreckage of a car. We all depend on each other, so please keep the negative comments out and lets try to stay positive here.

Hey congrats on passing NREMT, pain in the butt, but hey KY doesn't have anything better, though there are thoughts of changing that soon - and yes that is directly from some of the people at KBEMS ! There is some serious frustration with the test. I try to take it every two years to stay updated as I am an instructor candidate to keep up with what they are asking and how it's being asked.

As far as getting your KY cert, I would think your instructor would have filled that out. As soon as they receive your passing scores, they will send you the card. You may be in the first cert cycle to get a hard card or that may be starting next year (I know they are requiring everyone as of this year's recert to sign a DMV form to get their license pic and driving record). If not, you get a pain in the butt paper card that you have to cut out. They don't even perforate it or put lines around it. It's a real pain. Make sure you sign it too 'cause if you ever have to show your card (ie you stop at an accident scene off duty, especially in another county) if it's not signed they can really give you some grief. If you want to know if it's been processed yet, call the EMS board (can get number from www.kbems.ky.gov) and talk to Patti Jeffries - she handles all basic apps and very helpful. Also might want to check out hultgren.org (ky ems connection) as it keeps a current list of employment for everything from first responder to medic and dispatch. Good luck, be safe, and listen and learn out there !

I'm glad to see my partner and I aren't the only ones bold enough to take an ambulance through a drive through. Bad thing is though when you get a run right in the middle of waiting in line (yeah you should have seen the looks and the air horn works wonders ! :twisted: ) Only one better was I rode a horse through a McDonald's drive through once. Around here we don't call it Taco Bell ('cause so many on our department got sick after eating there one night, had to send half the shift home) we call it TOXIC HELL !

I know you can obtain badges via Galls online, but other than that I don't know as that is who our dept deals with for almost everything medical. We deal with another company for our fire needs. However, silver is only appropriate as gold is typically reserved for officers. Your dept may be different, but that is most places.

Personally, I've had bad experiences with badges and patches (look too cop like and had more than one person very unhappy and taking swings thinking I was a cop) and was more than happy to see our department trash them for every day wear. Most services around here have gone to the polo shirts which I love. They always look good, and are easy to maintain. They wear quite nicely. Very practical.

For special things such as parades, going to schools to speak, etc which don't require class A's, but still need to look dressier we use class B's with the badge and patches, but that is the only time. I think that should be general rule across the board, but that's just my personal opinion for all it's worth.

However, one thing that disturbs me is that anyone can obtain things saying EMT, Paramedic, etc. I know at Galls (again I only know there as it is who we deal with for uniforms and medical stuff) anyone can walk in and buy stuff saying that. Have had several issues with people either claiming they were a higher level than they were or flat out buying things saying they were in emergency services when they weren't at all ! Scary thought, but true (I even had my car broken into and shirt stolen once when we still wore the blues ! Didn't like explaining that one ! ) With S.O. or PD though you have to prove affiliation or be registered with them to purchase anything with those decals on it. Does this bother anybody else?

Just be smart and stay safe out there !

strangest position ? A lady who had her car turned sideways in a small tree literally ! (back end was still on the ground) Once stabilized, just intubated from the front. I agree with Rid that it's easier sometimes to go right handed, as it can help re-orient you. Way I remember it is the jaw goes down, no matter what. I keep that in mind and really helps keep me where I need to be.

Dust, glad to see you're still poking around here. I've been away for a while due to overload at work and multiple people out on medical leave. Hope you're doing okay. I love the earlier statement " paramedicine is as hard as you make it". We've all had calls and patients that kicked our butt, but usually is pretty true !

Stay safe out there !

As others have mentioned, I think the statement comes down to if you can't achieve something at the ALS level (ie intubation, starting an IV, etc) for whatever reason, don't forget the BLS skills you have as a back up. Some medics if they can't get the intubation, stand there like what do I do now? Bag 'em or use an alternative airway, granted it's not as good as an ET, but better than no O2 for sure. I think most medics (least I do) start on the BLS level, then progress up as needed except in certain circumstances such as codes. If a call is BLS, I'll treat it as BLS, if it turns ALS, then I adjust as needed. Truthfully most calls most of us run can be handled with GOOD BLS treatment. I think everyone has their place in the EMS system, and the basic is not just the medic's stretcher fetcher (and I despise medics that treat their basics as such). I know of good basics I would rather have treat me than some crappy medics in the area that are cocky, but no skills to back it up. Let's not get into a pissing match with ALS vs BLS as they all have their place. Stay safe out there !

Hey,

While putting myself through medic class I worked for a small animal clinic and also an equine (horse) hospital as a tech. Due to my experience I was placed on the equine ambulance. We were trained in how to address the needs of the horse as well as proper extrication, sedation considerations, and even the worst case scenarios, dead or animals which were not suspected to survive. I live in a very horse related area, so having accidents involving horses and riders struck by cars (yep, I've had a few of those) and several involving trailers in which the horse had to extricated. I've intubated foals (baby horses), placed ng tubes, monitored them on a vent, done CPR (speaking of which Narcan is a common med to give in equine codes, don't know exact theory behind it, but is given, which I was suprised at), started multiple lines, and controlled seizures with valium. It was a great learning experience as I got great exposure to alot of the meds we used on the truck making me more familiar with them and their actions. Really helped. I still live in the same area, and to this day, I have remained on the equine hospital's emergency team and respond to assist them in scenes frequently. We also carry a canine oxygen mask on our engine simply for reason of dogs are frequent fire victims. It helps to have the experience in these situations as frequently the people doing the extrication don't know how to approach a situation like an equine extrication. We've also pulled them out of the mud, and even done one helicopter lift with a horse out of a canyon which I assisted with. The skills have paid off great in my area, but in other areas, I'm not sure how needed they would be if there is not a large population of livestock.

When the public doesn't know what else to do, they call 911 and expect us to help. Even if it's just a referral to a vet, we can help (provided you are not overloaded with human patients - never compromise human for animal and something I remind myself of constantly at truck and trailer related accidents). Stay safe out there !

Final Disposition : Home with no femur fracture, was given scrip for pain meds to go home with (Lortab) so pain concern was addressed after discharge, just not during ER stay, which was my main concern.

As far as the comment as to proper assessment and things, we have three on a truck usually. A medic student, medic and a basic, in addition to the rescue squad which had been dispatched, and pretty well had the patient ready to go for us when we arrived. All we had to do was board her and get her up in the truck. The attempts and care was divided between myself and the student. The student also expressed concerns with the care, but accepted the doc's refusal to give pain meds.

Regarding the following up with the patient, that is not unusual for me. If we are fairly slow, as is the ER, I'll check back up on patients later to see how they are doing, and see what the findings were. I use that as a learning experience for myself, as this will be as well. I am not looking to crucify a doc, I simply want to discuss a patient care concern and see what his insight was further on it as I am not an MD and do not have his wealth of knowledge (nor do I even remotely claim to). This doc is typically very good about educating us, and did so excellently in cardiac when I was in class, so I have respect for him. I am not looking to start a pissing contest, I want to address this with grace and tact, more of a discussion rather than an actual complaint. I guess I should have clarified that better.

As far as why did I apply this Sager? Well, indications aside from instability were there. There was shortening, rotation, pain midshaft, worse with movement, which was relieved when traction was applied, and bruising and edema were present. Do I think I was out of line applying the splint? No I don't. Last time I checked, that was all the indications short of deformity for a femur fracture, and I have seen femur fractures without frank deformity in well muscled or extremely heavy individuals (the person was fairly well muscled), so they provided splinting in itself.

I know I have alot to learn, that's why I love this job, and like i said, I'm not here to start a pissing contest, I was asking for indications to why doc may not have given meds and how to address the situation with grace and tact with them to avoid any resentment.

I understand that I may have opened a can of worms. I don't like that possibility, however, I do want what is best for my patient, and appropriate pain control is such. We only work one medic on duty per shift which happened to be yours truly, so I was shift supervisor. Only one ahead of me in the food chain is our director, who really didn't give a care. He stated it was no longer my patient, therefore, no longer my worry. The complaint was not filed in anger in any way at the fact that I was dismissed, and truly was not filed in anger at all. I thought very carefully before filing a complaint (didn't do so until the next afternoon to give myself time to figure things out and how to go about it in an appropriate, non accusatory manner). I don't care what a doctor says or does to me, that's fine I can take it, but I refuse to see a patient treated inappropriately. I've been in this a while, and I just won't have it. The fact that I spoke with the doc to attempt to get a legitimate medical reason for not giving pain meds and his flip attitude regarding it, makes me wonder if this doc really addresses the patient's concerns or not. I can understand not wanting to give narcotics, but there are several acceptable alternatives which could have been given, and I don't understand why they were not utilized. Vitals were stable, the patient was just in pain. The ER had minor patients (your typical headache, belly pain, two nausea, and I forget what the other was, but nothing major, all were stable). I wouldn't have even started down this road except I don't like seeing a patient suffer, and if it was well within my protocols to give pain meds without med control orders, why wouldn't they? I know I could have gone the IM route with her, but due to proximity to hospital, and the assumption that she would be given some promptly (I can understand a reasonable wait if busy or simply just overloaded that night with things), I opted not to give any. My thoughts are, if this was your patient, would you stand up for them? If it was you, would you want to be the patient laying there suffering or would you want someone to speak for you? And finally do you think what this doctor did was right? I'm not trying to start a war here, but I am looking for suggestions on how to address the situation with patient advocacy as I have left them a message requesting to speak with them "regarding a patient care concern on such and such a date" which was all I stated. Nothing more, so I haven't actually addressed the situation with a person yet. Any ideas? Thanks and I appreciate your experience and input.

I recently had an encounter with this. I took a patient into the ER from a motor vehicle accident (car in ditch, minimal damage to car, no airbag deployment, fairly low speed impact approx 35 mph estimate). Well, spoke with patient who had minor bruising on shoulder/chest area from seatbelt (was a restrained driver), but main complaint was from thigh pain. Pain was midshaft, no obvious deformity, but on any attempt to move, pt screamed out in pain. Leg was shortened and externally rotated, so traction was given and Sager splint applied. Patient stated relief with that. I did not give pain meds on scene as we were just a few minutes from the hospital, and also the person was an extremely difficult IV stick (0 success out of 4 attempts). When we got to the ER I gave full report to doc (mind you at a regional trauma center) and stated suspected isolated femur fracture. Pt was complaining of pain of 8 out of 10. We left assuming the pt would get pain meds, x-rays, and taken good care of as most people we bring in are. Approximately 2 hours later, we returned with a different patient, and decided to check up on the previous patient. Still in the ER, crying in pain, no x-rays, nauseous from pain, and still on a backboard. ER only had four patients in it, so no excuse. Spoke with doc as to the reason no pain medication was given, and he stated he didn't think it was neccessary. That our patient was probably a drug seeker just looking for meds (pt was local and had not been transported for chronic pain by us and not on any pain meds daily). I got angry, but unfortunately no longer my patient, I expressed my concern to the doc who completely dismissed me. He stated he'd give her some motrin before she left if she felt she was still in pain. Today I filed a complaint with the hospital, as I feel no patient, especially one with a suspected femur fracture and in traction should be forced to stay in pain for several hours. I am still waiting to hear back regarding that, but I feel the doc's care and attitude should definitely be examined by the hospital admin. What would you guys do in this situation and do you feel I took appropriate steps? Anything you would do differently? Note, an IV was never started after I stated 4 failed attempts, and no pain meds were ever given to patient prior to discharge, which I confirmed with the patient's nurse before filing the complaint. I did not speak further with the patient, but I am curious to see how you would handle this and what you would have done differently (note less than 5 min transport time, and scene time was approx 8 min total).

This poor, poor person. Wow, he's car is decked out more than our chase cars are, and they are pretty nice. Very comparable to an ambulance in equipment that is carried (the suburban is even outfitted to have a stretcher as we have had several mass casualty incidents with excess of 40 + patients transported). We are in the process of going paperless currently, so the laptops are a new addition. I love 'em. Plus dispatch can link us a map to help with directions on some of the unmarked or poorly marked streets, which there are many of in my area. Our suburban (which is supervisor's vehicle) is outfitted with a GPS, but it is the only one.

Now as far as volunteers, we have many on our department with varying levels of whackerdom. Most are pretty okay, with just a small ems or fire sticker in the window and a light as they respond from home as often they are closer to the scenes where they live rather than us responding from the station. We outfit those people with an AED, scanner, O2 cylinder, and a BLS bag (ALS carries an ALS bag). We have four people on the far edges of the county who provide valuable first response to the citizens in that area, and we have had great success in care for those patients. However, all the people are employed either with our service or a neighboring county and we know their skills very, very well. Also, for those that work an on call schedule, we allow lights in the vehicle for response to the station as they have to be there within 5 min (we allow them to go home provided they are in town limits, if out of town limits they have to stay at station or within town for duration of their call time.) These are department approved and provided. Anyone who has lights must have them approved through our chief and carry a card stating they are permitted to run them on their vehicle. One other thing is we are NOT allowed to wear our uniforms off duty. Our chief considers that an ultimate disrespect to the department to abuse the fact we get discounts, whatever. I wish more departments would mandate this.

Now, I am a responder off duty for my county, so here is how my little car is done. I have a small star of life on the side window of my car and maltese cross on the other. They are about two inches in size and very tasteful. I do have a small dash LED light which I remove when I am off duty, unless I am on a scene or making an off duty response due to my location. I do carry a bag minimally stocked as appropriate. I also have Emergency Tags which are required by our department for those who make primary response off duty. I do not carry a radio at all times, and there is not a scanner in my car. I respond when needed and appropriate, but otherwise, my time is my time. If there is adequate response, there is no need for me to go and simply be in the way, but I will ALWAYS go if asked. I have NEVER worn my uniform off duty (unless I needed to stop somewhere immediately prior to or just after getting off work). I do keep my stethoscope on my rear view mirror for one reason. If I put it any where else I constantly forget it. There I see it, and when I get to work, I always take it down and put it in the ambulance as I go in so I have it. I don't like exposing it to sun damage, and have tried putting it in the seat, etc, and I keep forgetting it. That way when I stop it smacks me in the head to remind me. No computer in my car (I couldn't and wouldn't live with that) and do everything I can to avoid the whacker look. I am a professional, not some wanna be. My skills and patient care should speak for what I am, not the amount of crap on my car.

I like the idea my service has of the disposable laryngyscope blades. However, they do pose one concern with me and that is they are made more cheaply than the preferred metal. I am always terrified I would break one off when really having to place a difficult tube and use a good bit of pressure to see. I also have a few other gripes with them, but as far as ensuring it is clean, I think you can't beat the disposables, though I still have a preference to a well cleaned metal (and yes, I have placed one in my mouth to assist students in being able to see what it actually looks like - dimished gag reflex - NO COMMENTS THERE PLEASE ). That way when they went to clinicals, they knew the vocal chords didn't look like bright white ruffles on Fred the Head.

I used to frequent the watch desk, however, I quit going there after it turned into a pissing contest between local volunteer fire departments and the EMS service. It had nothing to contribute to me sadly. Seemed like a pretty good site though.

For the one department I work for, shift change is varying depending on whether you are on for 12 or 24. It's either 8 am or 8 pm. At the fire department, 10 am is shift change. We like it late 'cause most of us drive a ways to get there and don't have to wake up early, and we don't end up on shift late from other services. (the one department has a 12 hour delay before you can begin shift there)

Kentucky has this law as well. It was enacted in 2003, and was a big part of the EMS for children movement in the state. They are referred to as "Burcher babies" (forgive me I may have butchered the spelling). It allows any mother to surrender her newborn child up to 72 hours with absolutely no questions asked. They may be given to any designated safe place. Typically it is a police station, hospital, fire department, or EMS facility. We have forms which the mother can fill out (typically they don't but some do) and if baby is not reclaimed, within 30 days the state moves forward to terminate parental rights. I am unsure of what the issue is if the baby's father were to question the surrender. To my knowledge, that has not happened yet. We will accept children older than that as a surrender, but the process to terminate parental rights moves much quicker I have been told. I think it is a God send to young mothers who are desperate and really feel like they have no other alternative. Granted I think they should have thought long before this point, but it does provide options. Just my thoughts and how things go in the bluegrass.

Do I agree with the post? No, I think it was inappropriately placed and is simply an excuse to belittle nursing staff. Each has their own place in the medical chain and they fit well there. Each person brings their own strengths weakness and baggage to the situation. Some are more educated in certain areas than others. I chose not to say anything against the poster, because I know just as I speak, I will say something stupid and the tables could be turned to me. One thing to the poster's defense though, a helicopter may not have been an option. In our area, frequently we have issues with them being able to not fly either due to weather or fog. I wouldn't volunteer for that transport by any means, but sometimes, you just don't' have a choice. I would be sending the most experienced personnel I had though. At any rate, I believe lesson was learned pregnancy + seizures = problem

I've always talked to my patients that were unconscious during long transports simply because it helps pass the time. I do it also because I figure what could it hurt? I talk to them just as if they could respond, telling them about my day, other things. I was told by a physician friend of our family that hearing is the last sense to go, and I do believe it. I think if you speak positively to a patient, it may help a positive outcome. I couldn't imagine barely hanging on and hearing people going, "nope, that one's a goner, ain't gonna make it." I use caution when around what I think are unconscious patients and advise my students to follow the same.

I cannot agree with the EMS board more. There is NO excuse for what they did. I have dropped off students due to class requirements on the way to NON EMERGENCY transports, but never with an emergency. I tell them if they cannot be late, don't go on the call with me and I'll sign off an excuse on their time sheet. Never had a problem with that. Only thing I could think of would be if you were having trouble with the buggy, even then, call a second buggy to the location, not return to the station. I know we hate to be taxi drivers to old people, but unfortunately, medicaid/medicare IS what supports our meager salaries and keeps ambulance services going. We do not exist by emergency runs alone. Give good patient care and that's all needs to be.

Controlling pain early on actually may lead to shorter recovery times. This is due in fact to especially within cardiac situations, because if a patient's pain is well controlled, their breathing will slow, anxiety decreased, and oxygen demand decreased resulting in less cardiac damage. It's a great win situation. Also, if a patient is a burn patient or multiple injuries (ie multiple fx) or an isolated long bone (ie femur) I am going to provide pain relief to the extent that they are stable. Granted their injuries may be due to their own stupidity, but then again, who are we to judge? We have all done stupid things does that give us the right to say what you did was more stupid than me? I don't think so. Most patients requiring pain medication will have a long enough road facing them with rehab which will be filled with pain. Why make them suffer needlessly? Now as far as my drug seekers, well, we carry a wide variety of medications ranging from Toradol to Fentanyl. Also remember, just because a med is a narcotic does not mean it works better for pain control. Amazingly, toradol is an excellent pain reliever for kidney stones, better than alot of narcotics. It also works well for the drug seeking "back pain" people. There is legitimate back pain, don't get me wrong, but that is for the docs to sort out not me. My department has fairly lax protocols regarding our ability to use pain control, and I will never make a patient suffer needlessly, but I will also use the mildest pain control possible. There are other ideas besides meds to control pain, and some patients do better than others with this. Distraction is a great things, especially with kids. The only time I will be cautious with pain meds is 1. If I KNOW the patient is a drug seeker and even then I will still give it under certain circumstances listed above 2. the patient's condition is unstable and I cannot risk depressing them with a pain medication - I will encourage them to fight the pain to keep them alive, it may be uncomfortable, but it may be what keeps them alive and 3. there is a specific contraindication to giving it. That's just my opinion, but I think it's an appropriate assessment. The biggest thing to keep in mind is that pain is a subjective thing, and what is a 2 for me, may be a 6 to you, and you tend to use your own scale in judging how much pain medication to give based on your thoughts. For example, I might take a tylenol for a level 4 pain, where as you might require something stronger. Also, you must take into account the individual's pain tolerance may be different than yours and what is an acceptable level of pain for you, may not be for them. An interesting note that was made recently in a class I attended at U of L is that pediatric patients tend to receive less adequate pain control than other populations. Because they cannot express pain, it is more difficult to judge their pain level and the effectiveness of control. But I would assume the same would be so for the elderly population, except there is a tendency to "snow" elderly patients, actually overdosing them. Again, as I said, these are simply my observations and thoughts, take them for what they are worth. Best thing is to practice safely, advocate for the best interests of your patients within your protocols and it will not steer you wrong.

I have a bit of knowledge in this as a good friend of mine trains assistance dogs and we also frequently transport a patient who has a service dog, and the way we handle it, is provided the patient is stable, and the animal is okay with it, we will transport the service animal with person in the back. Usually they will just sit in the well of the truck. If not, we request PD to transport the animal to the ER following us, or if the person is unstable seriously, they have agreements with local boarding facilities as well as the humane society to take in the animal due to tight quarters within the ambulance. However, you must remember there is a difference between service animals (which actually perform a function for the person they are accompanying) and therapy animals (which provide a therapeutic effect, but perform no specific function - ie opening doors, alerting to low blood sugar or seizures, pulling a wheelchair, whatever). They usually will have a vest or backpack on marked as service animal, or at the least a tag on their collar stating they are a service animal. May be officially "certified" or not as some people train their own dogs as assistance animals and formal certification is not required. Therapy dogs, though they may be well trained, because they do not provide a specific function of assistance are not required to be given all the same rights and responsibilities of a person. Service animals are permitted anywhere a human is with the exception of two areas within a hospital (ICU - may vary depending on situation and hospital and surgery areas, though Pre-op is acceptable). Also, they may be excluded from public areas if they are a proven nuissance (continuous barking during a movie, at a zoo, etc). Remember a service animal may not just be a dog, it may also be a monkey or yes, even a miniature pony (function similar to a guide dog). I've seen it, strange, but it does happen. These are general rules within the united states, I'm not aware of rules outside of the US. A really good reference site is the DELTA SOCIETY. They have alot of useful info for medical professionals and are a certifying agency which certifies dogs which people have individually trained, as well as placing appropriate dogs with people.

Around my area, most places use PAI as the medical directors are a bit nervous about giving the go ahead for full RSI to services, simply due to the fact that many areas are quite rural and the skill would not be used enough to warrant granting use of it, as the patients requiring it are typically flown out and the flight crews are more than capable of performing the skill with a high success rate. That seems to be biggest obstacle here, though a few select high volume services have been granted permission by the state for RSI. I think it can be a wonderful tool when needed, but it must be a constantly used or practiced skill and one must be proficient at it. I personally don't want to think about the drugs being used to knock someone down without a good knowledge of what is happening. I think we all would agree on that.

Sorry for the harsh words Ace, bad day and frustrated, kinda got to me a bit and it shouldn't have. Understood and thanks for the links.

I'm sorry, I thought this was a discussion regarding false seizures. I guess not, it's a place to inflate your ego and defend treating patients poorly, not learn anything further. I have noticed this trend recently in the boards, and I no longer wish to be a part of it. I came here to listen and learn and share what I know in general , not to any one specific person. For your information, I did read the previous posts, but I had missed the response of ER doc on the prolactin, which was why I posted it. I did not see anyone else refer to it. I respect many of the people on here, but some have no place here and I would never want them on my truck for fear of how they would treat patients. Everyone should receive respect doesn't matter what their problem is.....