EMT007

They're all over the place here in Los Angeles. However, I've found that they don't always indicate that an elevator will fit your gurney (and ours is rather small, compared to the Stryker style - we use Ferno 28's). Some elevators can be really damn small and still display the star of life. :roll:

Yeah well we can second guess ourselves (or our patients :roll: ) to death on the majority of calls we get. "Maybe the gas tank is going to explode on this TA" -- "Maybe there will be an earthquake and the freeway overpass will collapse, better have the patient come to me" -- "Maybe this patient has a knife; better have the cops pat them down before I treat that open Fx" Are you saying that if the door is unlocked, you're not going to go in and look for your patient because there might be a CO leak? Of course we consider scene safety - I meant that we don't have any thoughts as to "maybe we should have FD or PD come do this for us", etc.

My ambulance service actually works out of a state police department, and a few months ago, our officers got called to a welfare check for basically the situation you've been describing - elderly woman who hasn't been seen for a little while. They get to the house, no one answers the door/phone/etc. They decide to kick the door down, and find this little old lady lying in bed, unable to move from a CVA. Apparently, she'd been there for >1 day! So they call EMS out and we take her in - fortunately she survived. As for us, we carry a window punch, a huge pry-bar, bolt cutters, etc for just that purpose (forcing entry if necessary). We don't have any specific policy on the matter - it is left up to the judgment of the EMT. If its something obvious (where we can see the patient, infant locked in a car, etc.) we'll force entry without a second thought. If its less clear, we'd probably (but not necessarily) raise the police Watch Commander on the radio and give him/her a rundown on what we have and say "hey, we're going to break down this door - can you send us a unit and advise on anything you want us to do". However, it almost never comes to this. A lot of buildings around us have Knox boxes on them and we have the FD access keys as well, so its rare that we can't get access to a building/apt complex.

CPAP was just approved for use (by ALS or BLS) in my county, and my medical director is pushing for us to get it in the coming months. (We are a BLS unit.) Obviously haven't started using it, but its good to hear that CPAP has been having so much success.

It really wasn't so much "early morning humor" as a serious argument (perfectly logical and applicable, btw) meant to show the ridiculousness of the idea that the amount of education is the only important factor in whether someone deserves to be on a 9-1-1 response ambulance and that the more education, the better. Granted, it was a bit of a long sentence, but its more interesting that the sentence critiquing my grammar made no sense whatsoever. "Listen to your own belief"? :?

Hence the part about "emergency medicine-trained". Null and void indeed :wink: Are you saying that a physician's medical education is not applicable to the EMS environment (i.e. patients of all complaints)? As for the second part, well its a bit confusing so I will just say that many of my friends who have just gone through medic school only had 3 months of classroom training prior to internship. Granted, it was more or less full time (4 days a week), but this is still miniscule compared to the education physicians and nurses receive.

Why is it that all of you who advocate a solely paramedic-based EMS system because of the vast amount of education/training (i.e. 3 months of classroom and 6 months of internship) :roll: that a paramedic receives aren't offering to give up your jobs if it meant thatwe could have emergency medicine-trained nurses or physicians on every rig??? After all, its all about the "education" isn't it?

The question is a bit awkwardly worded, but I think what you're asking can be answered like this: DNR's do not apply unless the pt is in arrest - period. If the patient still has a pulse and resps, you treat them like any other patient (assessment, treatment, bagging, O2, etc.). Once they are in arrest, however, you must cease all resuscitative measures (BVM, defib, CPR, etc.). Like beorp said, it is a do not resuscitate order, not a do not treat. Here is LA County's Policy on the matter http://ladhs.org/ems/manuals/policies/Ref800/815.pdf

Yeah not bad huh? Actually, if you look back at the thread, you'll see that I never said that my program was volunteer. We've been a paid EMS agency since the inception of our progam 30 years ago.

We carry soft (cloth) restraints and just four-point the patient to the frame of our gurney. Just a few days ago, I had to restrain an ALOC football player (5'9", 250) who was extremely combative. We had about 5 firefighters and EMTs and 2 cops there trying to hold this guy down long enough to restrain him - we had handcuffs going in addition to the soft restraints and this guy was still fighting all the way to the ER.

As a philosophy major, I have to turn this around a bit and explain the problem with your logic haha - I think you mean that, as a whole, younger people are statistically more prone to poor judgment, which i would say is certainly true. However, this is no causal relationship between age and immaturity or poor judgment. I think that due to the nature of our program as a 9-1-1 first response ambulance and the competitiveness of our hiring and training, we are able to only hire and keep people who are mature enough to handle the job. That is our best preventive measure. I would certainly hope (and I like to think) that this is the case at other collegiate agencies as well.

This is more or less what I was trying to explain of my organization, so I have to say... very cool - sounds like a great program to be a part of! Do you guys run a 1 and 1 rig? (1 medic, 1 EMT)

Thats a very scary argument to me - the idea of a slippery slope comes to mind. What other personal freedoms should the taxpayers be able to vote away? Now, having said that... I love to ride - riding in a group with some good friends (usually cops and other EMT's ) is one of the best things in the world. I always wear a helmet - obviously, its stupid not to wear a helmet, and I have seen the consequences of failing to wear a helmet (as I'm sure most of you have as well). But I can't really justify mandating a helmet. Because really, if you are going to mandate wearing a helmet, you should mandate wearing a full face helmet. Those "brain bucket" types you see the Harley guys wearing are (while they are DOT approved) worthless in a crash.

I would disagree with this - I think we are well prepared to decide what needs ALS and what does not. And we can usually figure this out within a minute or so of patient contact and request ALS (if the call didn't come out with an ALS complaint already). We also can cancel ALS response if we determine that there is no ALS complaint. And before you say something about this, I will only mention that this is also how the BLS engines and rescues of the city FD handle things as well. I dont' want the EKG thing to become a point of contention. As I said, not all of our EMTs are trained in EKG interpretation (so it is not part of our standard assessment), but all of us are trained at least in application of 3 and 12-lead EKGs, and it is part of our protocol to initiate EKGs on certain complaints. SFTP - Standing Field Treatment Protocol (I assumed this was a standard abbreviation) A lot... Fair point, and I think we provide great benefit to the community we serve (in part, because of the extra things we can do for our patients prior to or independant of ALS). Our response time is much shorter than the city FD who would otherwise respond, and our excellent training makes us well suited to handle the calls that we get. However, I will not argue it any more, since it seems like you think that we are only denying patient's ALS tx. Thats fine, but fortunately, not everyone agrees.

We get many calls from doctors offices for "abnormal EKG" where that is the only "complaint" that are ALS calls - same thing. Not to mention an otherwise asymptomatic STEMI 12-lead readout. Our defib is automatic until switched into manual mode (and no, we don't do manual defibrilation without medics) And as EMS providers, we all have things that are potentially harmful to patients. Our age doesn't make us more prone to misusing things so no, I don't think its "the truth of the matter". Hasn't happened yet in over 30 years - no reason to think it will now.

The county we are in is very restrictive in terms of SFTPs (for both BLS and ALS), but we are allowed to perform things like the selective spinal immobilization algorithm that is otherwise restricted to ALS providers. And as much as some people would like it to be true, not every call requires ALS. We operate on a tiered response system and, if anything, we free up city ALS units to repond to other calls in the city. If there is a reason to call ALS, we call them. When I say I want this to develop, I don't mean a discussion of ALS vs BLS issues, but rather what people who work in collegiate EMS think about it.

Have a bit more faith in us We are a very professional organization, and I have had many cases of SVT and there was no sudden urge to slap on the pads and cardiovert the pt. No, there is no lockout for the pacing, and as for the defib - well thats a BLS skill anyway, and we use it on V-fib and pulseless V-tach just like anyone else. As for the EKG thing, its good for us to be able to recognize abnormality and the need for ALS (if no other ALS complaint to begin with). Like I said, we have a great training program.

My my such unnecessary sarcasm. Anyway, we are "actually EMS" - we have ambulances and everything :wink:. If needed, ALS back-up is provided by the local city FD. However, we are the only responding unit to the majority of calls on campus. We cover all of campus and surrounding areas (approximately a mile around campus). As for the other thing, we are the only first-in 9-1-1 BLS provider in the county that isn't the local FD. AFAIK, we are still the only BLS provider in the county to carry a monitor/defibrillator (which also has EtCO2, SpO2, NIBP, pacing, etc. - obviously, we can't pace, but its there if the medics want to use it). Most of us are certified in EKG interpretation, and we do both 3- and 12-lead EKGs. There are several other things, but this is the general gist. (we are also currently looking into getting CPAP) It really is a great opportunity and I love what I do. Collegiate EMS is a great thing, and hopefully there are a few more people on this board. Many other collegiate agencies are also fairly progressive in how they do things. Texas A&M, for example, uses electronic PCRs (not exclusive, I know, but still a very new things that almost no one uses).

Aww, if only this happened more often. :twisted: So many tickets could be passed out to people don't know how to handle a big van thats lit up like a christmas tree with siren blaring.

I'm mostly a lurker here and don't frequent it much, so I don't know much about these new chat rules (didn't know the chat room was so exciting haha), but hopefully something good can come of this thread yet. I work for a collegiate EMS agency and have great things to say about it. We run 9-1-1 calls only in a densely populated urban area, have the largest scope of practice for BLS in our area, and have a good training program. And yes, the NCEMSF is a good organization to look into if you are interested in collegiate EMS. Some of them run full ALS transport units 24/7.

Yeah that is policy at my department as well. We are told that we cannot (legally) force vehicles to go through red lights. If they move of their own accord, then hey, all the better, but we cannot get on the PA and tell vehicles to move through a red light. However, we do not shut "everything" down when we come up to this type of situation. Rather, we shut down the siren and leave the lights on so that vehicles know that we are still responding to an emergency and that they need to move over as soon as the light turns.