CC64

But they didn't completely change it for backcountry medicine...

That, and west of the Cascades is fairly urban. I've a funny feeling that the minute somebody saw a snake near the Bellevue Mall that there would be a mass exodus. (...Snakes on a Ferry? :angel4: ) Now, granted, that doesn't mean that there can't be any poisonous snakes west of the Cascades, since there is a big chunk of the Olympic peninsula that is a forest, but it is a rainforest. Not the most hospitable of places for Western Rattler to live.

They still make those. Slightly newer, in an ever-so-cheery "look! You're NOT going to die!" yellow and lacking the scalpel, but I've seen 'em advertised and we were taught how to use them (and then saw it get tossed across the classroom) in my wilderness medicine course that was about three years ago.

Dust - To the OP - I learned once that the estimated percentage of snakebites that actually have venom in them is something like 33% for adult snakes. Juvenile snakes, being stupid young things, tend to waste venom and stick it in everything that is big and scary, even though it may simply result in a dead bear a little bit down the line. Bit big for a pit viper to eat, unless you're watching the Sci-Fi channel. (But then you get to drool over Michael Shanks...I'm sorry, am I acting girly again?) I'm going to have to toss out there that you'll get some swelling/redness/pain at the site of any snakebite; even though there is no venom in there, it is still a puncture wound with dirt, bacteria, and everything else that is in a snake's mouth.

What I still have difficulty understanding is why the parents are so permissive of this? I understand the "rich town, rich kid" aspect; been there, done that, saw people get the BMW. Keep the kids in school. If they want to run on the ambulance, fine, but put restrictions on it; I like the idea of applying the Child Labor Laws to that sort of thing.

Dust - why do you disagree with the fluid?

Well, (being that i'm slightly tipsy at the moment, please excuse any gross misspellings) needle decompression to treat the pneumothorax on his right lung. Where to stick the needle, I do not know. assist ventilations with a BVM; if they don't improve, intubate with the advanced airway adjunct of your choice (combitube, LMA, ETT). Load him up, fly to the closest trauma center...if he becomes unstable en route, then divert to closest ED for immediate stabilization. However, that also depends on local protocols. Thank everybody for their assistance.

Vitals? Breath sounds? I'm worried about him having a collapsed lung. Any trachea deviation or JVD? Be prepared to have to do a needle decompression. I'd disagree with the MAST pants. (people still use them?) Multiple open long bone fractures...this guy is sick. Easiest thing to do would be 2 large-bore IVs, pump him full of fluids and whatever else the ALS protocols call for and you can get away with from med command. The LBB is a whole-body splint, so put him on that, get him to a trauma center ASAP. Consider airway support.

For an Explorer post of that size, they would have been able to pick out which kids they wanted shown. The wackers, or potential wackers, would have been left on the cutting room floor, allowing the "best" or "most responsible" kids to be shown. "Pre-med." I was pre-med in college. I was also pre-vet, a biochemistry major and then a biology major. I'm now studying to become a paramedic. Bit of a difference there, between MD/DO and NREMT-P, no? But, as long as parents keep signing the permission slips, these kids will continue to get out of biology quizzes and band practice. /shrug. Although thinking back, the lady that they were transporting was looking at the camera like "I never agreed to this..." rather funny.

All well and good, although from a personal standpoint I'm not too keen on having a 16-year-old skip school, nor drive the ambulance when they have just gotten their drivers licenses. (although CT has written in an exemption to their graduated license program for teen drivers for fire and ambulance.) There is also another part of me that hates the idea, but I'm sitting on that rather firmly. There should be some restrictions on EMS volunteering; there are on everything else!

It's surprising, how much stuff you have to have in order to improvise...

Exactly. Anything that includes moving a patient with ropes requires a Stokes or SKED. Sadly, those are both things that aren't on your average ambulance... Determine what equipment the helicopter has. Your sitrep: patient visualized, voice contact made only, no physical contact made. Ask them if they have a winch and basket to extract the patient. (Rescue helicopter...I'm going to make what is possible a VERY bad assumption and theorize that they've a medic on board with all of his/her supplies at the ready.) Send the guys over the edge with some basic equipment - LBB, collar, CIDs, all that fun stuff so that they can make an initial assessment and start packaging him. Send an emergency blanket down, too, he's most likely shocky and needs some protection from the elements. Just be prepared to tape it down so that it doesn't present a risk to the helicopter. Now, if the SAR team shows up before the helicopter, and the helicopter needs to land to take this guy on board - does the SAR team have the ability to get this guy up the cliff? (Not all teams do, either in the equipment or training)

Send the rope-rescue certified guy to the edge of the easily accessed part and look down with a flashlight. Does he see the guy? Have him take a radio, for better communications with you. (It'll still be fairly LOS and short-range.) If no, bring him up and try another spot in that area. If yes, have him start yelling down to the patient, and see if there is any response. If there is some sort of response from the guy, stop and reassess the situation. Do the people who have rope training feel comfortable going down to the guy and then having to wait potentially two hours or so? Yes, send them down with equipment and have them start to stabilize the patient; if you can get him loaded on a backboard and in the stokes, then you can haul him up with the assistance of the guy trained in rope rescue, weather dependent. In the meantime, look at the maps and see if there is a safer way to get to the bottom! If, at any time, it becomes dangerous due to the weather, the search will have to be put on hold. No sense in risking your own lives to help what may just be a body now.

Hrm. I'm spoiled with my SAR team. Is it a guarantee that the radios will not work at all, or is it unlikely? What sort of training do the firefighters have in things like patient packaging and emergent moves, and general ropework? Are there any of the civilian volunteers that know anything about ropes? Boy Scouts? Girl Scouts? How about medical training in addition to you and your partner? What sort of additional training have you and your partner had, since it sounds like you guys are a bit away from a hospital? If my memory serves me correctly, ground transport time of more than an hour to a hospital is considered "wilderness" in a lot of areas, and the rules change slightly, providing that you have the additional training. What other sorts of resources do you have available? Ropes? Good maps of the quarry? Just "knowing it well" doesn't work; in weather and darkness everything tends to look a bit different. Having a good map with you helps pinpoint locations and routes. Tents? Rain gear? Camping equipment? If radios are right out, then what other types of communication do you have to use? How about communication with any sort of medical command? If you find the guy and he's still alive, there is a good chance you'll have to hunker down with him until daylight and until the weather has passed. The weather. 55 deg, tornados and wind moving in. How long is it expected to last for, and how violent is the system?

What time of year is it? If it is getting into the 40s or below, wait until daylight and call out local search and rescue. And the ME; he's probably dead. However, if weather permits a higher probability of survival, immediate call out of local SAR. The store is approximately 4 miles from the victim; use topographical maps of the area to create a list of probable areas for the guy, send out canine teams with some basic medical equipment and radios to do a hasty search of those areas. If he's found, awesome, get him stabilized on scene to the best of the responders' ability, carry him to a place where he can be picked up by helicopter and flown to a hospital. (Military or civilian, doesn't matter.) By the time that all the teams report back in, there will not only be more people at the store - use it as the incident command post - but it'll probably be getting close to daylight. Assign teams search areas, send 'em out. If he isn't found that day, then there is a reduced chance of his survival and you'd be looking at a search and recovery, instead of search and rescue. Good to know that the drunk friend remembered hearing the guy talk. Since ambulances are not able to get down the road to the quarry, then find people with ATVs. If you're really in the back of nowhere, then by the time the helicopter is to your location and you've found the guy, done initial treatment, packaged him, and gotten him to the LZ, the helicopter will be there or a few minutes out. For the TL;DR portions, call out local Search and Rescue, put the helicopter on standby, and sit back and watch the show.

Fireguard: sorry. :oops: I'll shut up now, keep real life stress from annoying people online.

Ah, then maybe it was only my squads that the drivers were the ones writing up refusals, recalls, no patient calls...

Why just driving? The adrenaline rush? The ability to say to all your friends "I drive ambulances!" like it's a reward? EMT-Basic is 120 hours at a minimum, and that is purely clinical. EVOC/CEVO is a separate class altogether, generally a single weekend, but I'm all for making it a longer length of time and reinforcing the basics - L&S are NOT used to go to McDonalds for dinner, a complete stop is a total cessation of forward movement, and those flashing lights? A privilege, not a right.

I've got a Littman from the 1980's - their precurser to the Classic II, I think. No idea which one it is for sure, since it was a gift from my father. When I replace it, it will be with another Littman; probably one of their cardiology scopes.

Next question for mom is how much was left in the bottle last time she saw it. size of bottle? GI upset, probably viral. On top of that, accidental OD of salacylates.

Day...off...what the hey is that. 80-hour weeks between class and work, then doing the whole take-care-of-the-house stuff that seems to fall onto the females of the household. I'm thisclose to dropping out of medic class simply because I don't have any time to study! (Internet comes in my 15-minute R+R break that I take between dishes and going to bed.)

Rich kid...asked for help from my parents. There are also student loans. I dispatch full time for a private company - I just got lucky in the class times and my already scheduled shifts. When it comes time for clinical rotations, again, work it all out in relation to work.

The way that my school's squad was set up was that there was 1 EMT-B for each 12-hour shift, and there may or may not have been an assistant (with training ranging from nothing to first responder). At the beginning of each semester, there was a list sent out with everybody's names on it, and it was also your responsibility to tell each of your professors that you may occasionally need to respond during class - your pager would be kept on vibrate and you'd leave as quietly as you could. You could not be on duty the night before/day of tests or during labs. If your teacher said that the did not want you leaving class, then you weren't allowed to be on duty during class. Only once during three years did I have to leave class. We picked up our shifts by signing up on a calendar passed around at each monthly meeting, and then any empty slots were filled by begging/bribing/simply not showing up at the assigned time for shift change. (got quite a few extra weekend shifts because of that. Bad form.)

Except...pre-hospital medicine really doesn't have any solid forms of research out there. The vast majority of the things that are done come from hospital-based research or anecdotal evidence. We do it "'cause that's the way it's done 'roun' 'ere." Gotta disagree with you on the research thing.