fire911medic

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.....

Okay, I'm gonna step out on a limb here a big one and when I do it, I'll probably catch a TON of flack from you all as well as step on some toes, but anyway, I'm gonna say it. GET OFF THE SEIZURE FIXATION !!!!!!! First off, I'll tell you from personal experiences, not all seizures are as they seem. Depending on the type of seizure and area of the brain where it is coming from the person may not have your "typical" seizure. In class the subject of seizures is truly just glazed over, and well, all they think you will ever see is tonic clonic activity, despite the fact that there is over 60 different types of seizures. Here's a little education. Absence - person has NO post ictal period, seems like they are day dreaming for brief seconds, may have hundreds a day characterized by rapid eyelid fluttering during the episode. May be induced by hyperventilation. Complex Partials - impaired consciousness, may seem like they are doing purposeful activity like chewing, fumbling with clothes, but actually are not (process is called automatisms), may even seem to be combative if restrained. May last from a few minutes to several hours and the person may have several in succession called clustering. Typical come from the temporal lobe, but may come from any area. May progress into generalized seizures. Typically have warning called aura before hand. Simple Partial - not impaired consciousness, isolated body part affected (may be finger, arm, hand, etc). May happen several times a day. No aura is usually present. Normally self limiting. Generalized Seizures - full body tonic clonic activity usually synchronous on both sides, may be initial or from complex partial which has spread. May originate from any area in the brain. Post ictal time may be from several minutes to several days depending on severity and length of seizure. Corneal reflexes diminished or not present, fixed gaze with or without deviation, eyes typically open, mouth open during tonic phase, clenched during clonic, and patients are typically tired post ictally. However, IF the seizure initiates in the frontal lobe there may be little or no post ictal period, bizarre features like bicycling, thrusting, sexual like movements may be present, very difficult to control, activity difficult to detect via EEG without specialized equipment (ie specially placed electrodes), and are most likely to go into status. Patients are frequently combative during/after seizure episode. There are several other variations of seizures, but this is just an overview. There is truly such a thing as pseudo seizures which are a stress response to the body as well as factitious disorder (munchausen syndrome) where the person fakes an illness to assume a sick role. Difference is people with pseudo seizures are not consciously faking the seizures, and normally have been treated with medications for epilepsy for several years prior to diagnosis. It is frustrating for them as they are trying to control something that is difficult to treat as there are few psychiatrist/psychologists willing to tackle it. How do I know this? I myself went through the difficulty of being MISDIAGNOSED for over three years with multiple ER docs saying I was faking because I worked in healthcare and had knowledge of seizures which is common with those with pseudo seizures to have. However, after extensive investigation and an incident in which a deprivation of medication induced an episode of status which allowed them to video tape and EEG the event at the same time was it determined I was having epileptic not pseudo seizures. Now several years later after being treated appropriately, I am seizure free and live my dream of working in fire and ems, something I nearly lost due to people's lack of knowledge. I was treated rudely by medics who thought I was faking, even told to stop faking my some that I thought were friends of mine. It nearly cost me more than one job and I had to fight to overcome that stigma and even though I have been seizure free for a significant time now, it is something that is not easily forgotten. Bottom line, yes I know it's frustrating, and I've had patients that I was fairly sure were faking, and we had big issues with that in our county, but if you have any doubt, treat them right and treat them well and with respect. You will not regret it, and even if they were faking for attention, for that minute, they were treated like a person. Now, let's let the issue rest shall we? A good site to visit is the epilepsy foundation of america's website and read their section on info for first responders. Browse the area and read the message boards. Site is www.efa.org Check it out Oh, and the hormone which the level elevates following seizures is called prolactin. It increases with tonic clonic but not simple partials and is variable reliability in complex partials and absence seizures as it may or may not be increased.

I think we all agree that patient abuse is uncalled for and should be avoided at all costs. I myself know how frustrating it can be to be needed somewhere for a true emergency and be unable to respond due to being tied up with a bs call. I have seen people die from it and it's a site I don't enjoy. However, I don't enjoy watching the abuse of patients either. A call which sticks in my mind and forced me to learn very quickly shortly after becoming an EMT makes me never forget. We had a nursing home lady which we picked up all to frequently simply because she was lonely always complaining of general not feeling well, no specific complaint but just needed a friend. It was getting old with other people in the department, but I was new to her, didn't know the story, so when we picked her up, I treated her like any other general illness patient. Her bp was a little high, pulse a little quick, but said she wasn't having chest pain, no nausea, anything like that, but she just didn't think it was anything. I was a BLS truck and didn't have the luxury of a monitor, and other things. My partner slipped me a note as I got in that said "she just wants attention". I put her on O2 anyway and monitored her vitals all the way in. They got her on a monitor when we came in for kicks and giggles and that was when they found out major ST elevation....my partner went "oh crap". I was grateful I had given her good treatment. She recovered, returned to the nursing home and is doing fine six years afterward. Always treat your patients well as the one day you don't will be the day you regret. Let's be safe and not sloppy out there !

Did anyone happen to see what is now called "broken heart syndrome"? Evidently there is quite similar reactions from the heart in that and during actual cardiac related events. THey stated there was EKG changes, showed the cardiomyopathy with the use of an ultrasound, and presents with the same symptoms as an MI. Only difference is this is actually emotional related, and tied to a significant factor in one's life and may be a recurring thing yearly on or around that date. Also, the heart recovers from the "damage" it receives, whereas after an MI it does not. It can return to nearly normal function within less than a week. Amazing - anyone else know anything on this, any good links?

In my area, the state EMS board runs twice yearly backgrounds on everyone through the state police. If you are a medic student, it is every ninety days. Just keeps everybody honest. I'm more comfortable knowing that the person I'm working with isn't a criminal (read previous posts and you'll find out why this is so comforting). It became a neccessity. Good thing. If you have nothing to hide, what's the problem?

Your thought on a patient seeing a medic wearing a medic alert bracelet? SImple solution - what I do to prevent this from happening, is I wear a necklace instead of a bracelet. As far as that, well, I've had a handful of patients that have asked. I don't shy away from it. I may not disclose things to them, but I stress how important it is for them to have a way of telling their medical information when they can't. All is fair in love and baseball.

Experience? How much and what type? experience - minimum 2 years high volume ALS service for the area (at least 10,000 runs a year as is difficult to achieve more than that in my area), 5 years if non ALS or low volume service. Must be EMS as well, not fire runs included in that. No people waiting for their basic card so they can start medic class (as I have seen so much around here) Job status? Are those currently in EMS given preference to those working non-emergency or in another field? Preferably full time EMS 911 service, second to full time non emergency transport, third full time ER/occ health/clinic, fourth part time 911, then part time non emergency and finally part time ER/occ health/clinic positions. If not actively employed in EMS, I have reservations about letting into class unless they are willing to sign an agreement for a position with a company for the length of class as it does not benefit us to train people who will not use their skills. Volunteers considered on an individual basis with recommendation of their director/chief. Prerequisites? How much and what type? Prerequisites - well, for starters must have graduated with a C average in high school, completed two years of college though degree not required with classes in anatomy, physiology, basic english, math, and medical terminology and preferably pharmacology. All with a minimum grade of a C achieved - not a C average. I don't want idiots working on me someday. Education? Their high school GPA? Their college transcript? Is more always better? Does the MA in Fine Arts get preference over the third year Biology major? Education - read above for pre-req Aptitude testing or intelligence? What kind? aptitude testing similar to what the asvab test for the armed forces does to identify your strong and weak points. Intelligence testing- N/A as I assume if you can achieve the above requirements at an accredited college then you can cut it in my class. A psych eval would not be totally out of the question. Medical knowledge testing? Who makes the test and what sort of test is it? Written test involving questions similar to NR having to pass each 'section' with a minimum score of 80, practical with no failed stations, and test would be made by pulling questions from various test banks for basics (ie mosby, brady, aaos) with practical having 5 drawn stations such as medical emergency (1 out of 3 standard scenarios), trauma, general truck duties (changing O2, stretcher operation, etc), CPR performance with AED, and splinting. All administered by EMS personnel with at least two years experience and approved preceptors. May be basic or medic. Personality or psychological testing? Specifics? personality to determine your strong suits, and psychological to hopefully weed out anyone who might be a loose cannon Physical condition or agility testing? What type, and who sets the standards? How? Yep, definitely. Similar to fire testing. Be able to climb three flights of stairs and down with an O2 bag, ALS bag, and monitor in hand. Lift a stretcher with trauma terry loaded on it with a second person assisting. Must demonstrate ability to work on both head and foot end. Lift a person in a stair chair (terry trauma) up and down ten steps successfully. Be in good physical ability to perform required tasks of a medic per independent doctor's statement picked by us. Though in case of possible disqualifying medical conditions, letter from personal specialist dealing with that condition would allow acceptance. Drug testing? Urine screening, that is. Don't leave the station without it. You get screened via urine and hair my friend. Criminal history check? What disqualifies and what does not disqualify? You bet. Minor traffic stuff doesn't disqualify including license suspension provided not for a DUI as there may be many reasons for suspension ranging from a forgotten speeding ticket to a medical condition. If you EVER had a DUI, you are out of my class, sorry, find someone else's, drug use is same way. Disciplinary action taken on EMS license would be considered individually, with favorable recommendation from state board and current EMS employer. Any assault charges would be considered individually as well considering it may be a case of self defense. Dead beat dads, need not apply. Driving record would also be considered for the previous 3 years barring any major offenses. Personal interviews? What do you want to ask them? What answers do you want to hear? What answers do you NOT want to hear? What do you want them to ask you? Yep, what are your goals, tell me why YOU want to do this, do you understand what will be required of you, have you ever started class before, did you not pass or not finish, why, ask me what the goals of class are, about instruction methods, where clincals will be done, instructor/student ratio, lab time, etc show me that you care about the class for more than a patch on your shirt. Don't tell me you want to do this 'cause you want more toys to play with or you think it's cool, or you're tired of being a basic. Letters of recommendation? From whom would it make a difference? Preferably one from a college professor from the above required courses, your current employer, and someone you have known for at least 3 years that is aware of what EMS is. A recommendation from your medical director would play highly in your favor. Time on the waiting list? Does an applicant who was qualified this time, but was not admitted for lack of space, get preference next semester? Waiting list would be until next class started as applicants would be ranked and informed of their ranking before final announcements were made. That list would be maintained until a student requested to be taken off or was accepted into class. Only top 50% would be offered a spot on the waiting list. Those below would have to retest to be considered for acceptance. List would go in that order. Original acceptance, then new people. If that didn't fill class, all well, small class makes for better instruction and lab time ! This is actually very similar to the requirements for the course I went through. I thought it served me well. Has a few minor changes, but I do believe it's adequate.

In city, very short always less than 8 min unless traffic from hell. We cover county as well though, so if out in county, it may get up to almost 45 min depending on where we are. So call us urban, call us rural, we can go either way.

Formerly Cincinatti, OH, but now laying claim to one of KY's big cities (and yep we do have 'em ! )

Had a guy from my medic class- good friend of mine that worked in Camden- now in a much slower place....hehe he calls it heaven I worked in cinci for a while and well, that was entertaining, first time I saw someone clear a triage desk screaming they're coming after me ! and well, a herd of ghettos following with guns, and yeah, cop is sitting outside in his car. Needless to say, triage there now has a full triage window and I no longer work there ! Now where I work, we have our routine entertainment, especially early sat mornings at the awful waffle (cops congregate there for good reason six to ten squad cars on average). It's quite amusing, and I've worked more than one incident there. You definitely know when you work for urban ems when you are proud of the title of GHETTOMEDIC !

In most services I have worked with there have been husband/wife, girlfriend/boyfriend both employed there. If they are partners, they are typically split though at one service they both were co-owners of the service, so yeah, they had their say. I have seen too many personal issues dragged into the department and all out wars breaking out in the station. Even if on same shift. Where I am now, we have a husband/wife which work there, but husband is part time and wife is full time. She is the captain with EMS and he is a FF on the engine at different stations when on duty together. Bf/Gf are split as well, even if just to different stations. I personally would never put husband/wife together even in same station if I could avoid it just to prevent issues down the road. Just my thoughts for what they are worth.

Gentleman, let's not get into a pissing contest here. Dust - I may disagree with you occasionally, but I think you are knowledgeable in many aspects of emergency medicine and do contribute nicely here. I am thankful for our volunteers as most of the time we do not need additional assistance, but on those times we do, it is wonderful to have them. Do we need to pay an extra crew or two for three or four calls a month? Stupidity. I did the volunteer thing with a rescue squad, and yes, I left them due to their lack of concern. We have another service in town, but they are strictly BLS transfer and the counties surrounding us are solely BLS, next ALS county is almost 45 min away. Volunteers can be our life savers as all are basic trained with about half being medics. When we call, they come. It does not matter what it is, lifting a heavy patient or dealing with a multi crash scene (as we had almost 30 pts due to a huge pile up one day). Us and the next counties couldn't handle all the patients with staff on duty, and several of our volly medics went on transport with their trucks. I wouldn't trade 'em for anything. Having the extra crews is nice, but having the response vehicles, paying the crews, funding the equipment (most vollys carry their own bags stocked by us) and things is simply beyond our county's budget. We are fortunate to have paid fire (we are only paid career fire in the area) and EMS. We have nice trucks which were purchased courtesy of a grant from Homeland Security. We also have new turnouts and scotts for that reason and beautifully stocked trucks with the latest and greatest. I'm content. Some people simply can't afford to leave their well paying jobs wherever to work EMS as we all know it doesn't pay that great. Just because you can't afford to do this as a career doesn't mean you should be excluded. Volunteers (well trained) are welcome at my department anytime !

My main paying job is at an occupational health primary care clinic in a warehouse, 'cause I can't turn down the pay, it's great, but mostly sprains/strains/colds/minor allergic reactions/ etc. Get the very rare true emergency. Very boring most days. I still run full time with fire dept though two 24 shifts a week to keep up the skills I rarely (if ever) use at the occ health place.

Okay, tonight officially did it for me. No more watching the cheap bringing out the dead spin off. Original series? Yeah right. Don't know what they were thinking, but I swear some things were pulled directly from it. I just want to see the ambulance beating, no more. That's it for me.

wonderfully funny ! I especially enjoy the narcan scene, and the ambulance beating scene (I wish that I could do that to a few of our older ambulance before we got our new glory trucks -ah how I love 'em). We had to watch it in class and point out all the inaccuracies, but then watched it all together and had a great laugh. Good movie. Haven't read the book though, but would be interesting to.

Okay, I gotta get my two feet in this one. I am both a career FF and Medic. In my department we switch shifts riding the engine six months, riding the buggy six months. I love the switch. I enjoy both sides of the fence, though yes, I am partial to medical. In the next county over, which is very rural, fire responds before EMS many times, carries full ALS equipment and is ALL volunteer (they paid to put most of their people through at least basic class, though several are career medics with a local transport service). They do an excellent job as they have first responded for us a few times with calls right at the county line or when one of us is tied up. We join up for fire and ems training doing one shift training of ems stuff a month and the rest fire. We have fun, get along great, and both sides are very competent. I wouldn't trade it any day. I'm not saying my dept is any better than anyone else's but I think we have a great system, and if anyone challenges something that works, well, just show me how it can be improved ! No griping heard here !

Dust, THe show was based in baltimore, md at shock trauma. The lady had a subdural. They made the comment that it (clotting factor) would be short term fix, but that they could not take her to surgery without being able to give her blood. The lady ended up dying. I am not familiar with the factor 8 - but thanks for the insight. I was under the impression that you wouldn't use a colloid (other than whole blood) in a head injury. THis is a major contraindication with the polyheme (I refer to that as my service is involved with the trial - so I am most educated about it than other options). Thanks for the input.

Hey there everyone, I just got off a bad shift today, had it really rough. Had the call that sticks with ya, a little girl was killed because her mother drank and drove. Had a DUI suspended license already. Beautiful 6 year old. I don't have kids, so normally I don't have as much of an issue as those who do, but this one really struck me as this poor child died because of a mothers stupidity. Also, to make matters worse, she hit a state trooper who was escorting our other ambulance to a possible code (turned out to be DOA due to an overdose - 19 y/o, what in his life could be THAT bad?). I love my job, I truly do, but today I just wanted to cry for those poor kids.....sorry I don't mean to go soft on you all tonight, but needed to settle my mind before I tried to sleep.