RomeViking09

I had 2 cheap scopes over the years, started working for a service and had issues hearing BP in their trucks tried my partners Cardio III and no issues (same placement same patient) so I got a Cardio III and love it now. It is what works for me and I will not change. Now that said I don't care what band or model scope I own I want what works for me (happens to be a high dollar scope) but prior to EMS I was a stage lighting & sound tech and my ears suffered a bit so I more sensitive scope makes up for my bad ears (well 1 ear). Hope this helps.

For the record, He he was old and dying was a post call view 3+ days latter, my impression and treatment was based on elderly man in minor distress who happened to be in a minor MVC on the way to the ER. I did a full assessment and treated based on that assessment and got him to the ER, at the time I did not see any reason he would end up dead in less than a week as a result of his complaint or the MVC. As far as cause of dead I don't know and the medic I was riding with did not say. Glad to see good input at the same time think some folks missed what I was saying in my 2nd post. That was a view after the fact based on what I had seen in my time with this patient.

In our clinical we have to get 5 intubations, 25 IVs, 25 Drug pushes, so many patient assessment in a range of ages and complaints (example 30 adults ages 18-59, 20 adults 60+, each 2 newborn, infant, toddler, pre-school, school age, pre-teen, and teen, also need 15 chest pain, 20 trauma, 10 ABD pain, 20 Res distress, and so on) Basically in the ER, ICU, & CICU we act as techs and get most of some skills like drugs, in the OR we just tube, in EMS we put it all together. I would say ask questions and get hands on, don't sit back and watch when you can learn but know when to get out of the way. In our clinical we have to get 5 intubations, 25 IVs, 25 Drug pushes, so many patient assessment in a range of ages and complaints (example 30 adults ages 18-59, 20 adults 60+, each 2 newborn, infant, toddler, pre-school, school age, pre-teen, and teen, also need 15 chest pain, 20 trauma, 10 ABD pain, 20 Res distress, and so on) Basically in the ER, ICU, & CICU we act as techs and get most of some skills like drugs, in the OR we just tube, in EMS we put it all together. I would say ask questions and get hands on, don't sit back and watch when you can learn but know when to get out of the way.

Agreed, just subject to classmates saying I missed something in assessment or did not "treat" the patient as needed. My personal view is he was old and dying, now as far as 90 y/o patients go he was very healthy and I hope to be that healty at his age. But I want some input on what else if anything someone would do that I might have missed.

I was on my Paramedic clinical rotation a week or two ago, we got dispatched to a call for a 2 car MVC, on scene one car had rear ended another at low speed, 2 persons in each car both with seat belts, minor damage to both cars no airbag deployment, no complaint of neck or back pain from any of the 4 patients on scene. Both of the front car passengers signed refusals, the rear car a 80ish year old lady was driving her 90 y/o husband to the ER for general weakness when she hit the other car at the red light. She signed a refusal with no medical complaint but requested we transport her husband to the ER. After assessment and history the patient was a 90 y/o Male with minor chest pain about 4 hours ago that went away with 1 NTG. 12-Lead showed NSR @68 no ST depression or elevation, no other findings, no CP at that time just felt weak. VS all within normal limits for age and history, INT established, placed on 3 L/min O2 by NC, and transported non-emergency to the ER. find out the next week that he died 2 days latter. What if anything could have been missed by EMS in this patient. (also checked BGL, and temp in addition to classic vitals, ECG & SpO2)

I am a medic student about to finish school in march on my 2nd go around (failed PHTLS due to lack of sleep first time but passed with a 98 this time). Right now in my class (8 students including me) we have all but 1 who has at lest 4 of the 5 required tubes. The one who does not had two in the field and has yet to go to the OR. To set up I have 7 tubes on 8 attempts (1 field on 2nd attempt, some day missed a tube w/ glidescope in the ER b/c I did not have the proper styliet, and 6 OR tubes all on first attempt). How often are folks getting to go to the OR and tube after they are out of school, and how often are people getting to tube in the ER? (Note: the missed tube was a patient who was pulled in the ambulance bay POV by her friend in full arrest that we took in to the trauma bay and the glidescope was thrown in front of me by a RN who then tried to had me a 4.0 Uncuffed tube for a 50 y/o patient and the doc missed once before noticing it was not the proper styliet for the guildescope, and I had a good view of the chords in the camera just could not see the tube)

Give you 3 examples from my limited time in EMS (3 years) Example 1: a county with 2 services who rotated calls in the county and had set zones in the one major city, 1 service did not have 12-Lead, morphine, or CPAP on the truck (the city fire did have 12-Lead and morphine on their ALS non-transport units), the second service had both but did not carry as many drugs (did not carry Vasopresen, vapermil, or pre diluted D25 & D10 among others) Full ALS fire in the city, mixed ALS/BLS Fire in the county based on what town your responding with and what unit Example 2: 2 hospital based services that split the zones in a county, service 1 had more drugs and standing orders but only has less than 1/3 of the county (does provide primary 911 for a 2nd county their hospital is not located in) the 2nd service has more man power and trucks and a good set of protocols but lacking some things (Medicated assisted Intubation, not the same as RSI, more advanced equipment, and the ability to transmit 12-Leads to both hospitals in the county) no ALS fire in this county Example 3: 2 services that split the county based on the fire batt. Service 1 that covers 1 of the 4 batts has no CPAP but has medication assisted intubation, carries plavaix for chest pain and has more standing orders/protocols that do not require calling the ER. Full ALS fire in the county and all cities in the county My view is full state or county controled protocols and standards are better for patients and not leaving it to chance about what service responds

This week our instructor had the idea to break up a chapter on environmental emergencies and make us in groups of two teach the 4 sections of the chapter. First hats off to anyone who preps and teaches paramedic students on a regular basis. Second I was teaching the section on cold related medical emergencies and covered just hypothermia (my partner for the assignment covered all the "others" and had only about 1/3 of the stuff to cover given the powerpoint provided by the instructor and the amount of stuff in the textbook). We had a good debate over dealing with hypothermic cardiac arrest that I want to bring to the forum. When dealing with a patient in cardiac arrest the textbook says not to administer any drugs until you have warmed the patient to at least 86ºF, the point came up that if one of the reasons the body is not thermorgulating is due to lack of glucose should you not give that patient D50 in addition to CPR and warming the patient in an attempt to improve their outcome. What are everybody's thoughts?

Thanks for the input thus far, I know the cut dry ACLS answer is pace ASAP, but the debate was over atropine while setting up the pacer in the study group. Thanks for the help.

In paramedic school and reviewing from cardiology that ended a few weeks back, If you are dealing with a bradycardic 2º type II or 3º AV block that requires treatment (poor perfusion, ALOC, etc...) do you attempt to use atropine first are are you reaching for the pacer off the bat? Reason I ask is in a study group we found mixed things in articles online and even in our textbook. My view is that high degree 2º and 3º AV block are past the point that the atropine is going to work, yet some articles are saying to still attempt 1mg IVP (for adults) prior to attempting to pace the patient. What to get some other student views and those who are working on the streets.

Our needless system includes these orange "needles" that are plastic and rounded for drawing up drugs, we also have 2 port J-Loops for adenosine (drug proximal port, flush distal port). Before the J-loops never saw 6 of adenosine do anything always had to got to 12, I have seen 3 convert (2 did require the 12 dose but after about 15 min) with 6 since the switch. My two cents is if you can get a good needless system and all the things that go with them (like the silly draw needles) it is much safer. We also removed ampules for our 1:1,000 epi and went with 10mL multi-dose vials.

DOUGLASVILLE, Ga. -- A Douglas County paramedic died early Monday morning after he was involved in a crash, investigators said. Paul Holmes, 37, was responding to a vehicle fire call Saturday night when his unit was involved in the crash, according to Douglas County Communications Director Wes Tallon. Holmes died Monday at Atlanta’s Grady Memorial Hospital. Holmes is survived by his wife and daughter. He served with Douglas County Fire/EMS since 2008, according to Tallon. “Paramedics and firemen are a special breed of people who live to save the lives of others. Paul trained as a paramedic/firefighter to achieve that goal, and lost his life in the pursuit of that goal. He will be missed. The entire emergency services community mourns our loss,” Douglas County Fire Chief Scott Spencer said in a statement released Monday. “Serving as a fireman/paramedic/EMT is a calling, and those who respond to the call put their lives on the line every day,” said Douglas County Commission Chairman Tom Worthan. “Paul was responding to someone who needed aid, and in doing so, lost his own life. This is unselfish service at the highest level, and we will remember Paul’s spirit.”

State I am in (Georgia) Entry Level to work on an Ambulance in most regions is EMT-I and we do start IVs (I/85). Also after some quick research California's EMS laws allow for EMT-I (Basic) to start IVs with additional Training and EMT-II (EMT-Intermediate) can start IVs in their scope of practice. I don't know if SF FD Uses EMT-II or Authorizes EMT-I to do IVs. But just because where you live someone can or can't do something does not mean it is the same everywhere

With all the bashing of the new show Trauma, who remembers in 2006 when TNT came out with a short lived TV shock called Saved starring Tom Everett Scott and Elizabeth Reaser. The show focused on a medical school drop out, paramedic with tons of issues and baggage. In the first episode he is having sex in the back of the rig with his ex who is a resident in the Emergency Department. Now fast forward 3 years and NBC gives us about the same thing with a bigger budget. Some of the medicine in Saved was spot on, some was way out in left field. Trauma has it's problems but we need to remember that the people writing and creating these shows are not medics, have no medical background and are not looking to give a real world view of EMS (if they did they would not make any money). As someone who works in EMS but has also worked in theater and film on the production side, I think that both of these shows are a lot better than they would be if nobody in EMS was involved at all, advisors on have limited input on projects like a TV show (who would tube the medic or the EMT, what is the name of a drug to give someone with this problem, how many people work on a truck at a time, when do you call a chopper, etc.). Why waste time judging the slip ups in a work of fiction and getting all worked up about something that has no effect on you at all. Saved and Trauma are not intended to be a training tool, they are intended to be entrainment. Personally I enjoy watching some medical shows that are way out in left field at times (ER, Trauma, House, Saved, etc...) I don't see why people have to go looking to bash a work of fiction to the degree that has been going on this site with this show.

Talked with a EMT who had some of their 3rd riders and did not have good things to say, you might be better trying to get into one of the technical schools in the area (Georgia Northwestern Technical College or Chattahoochee Technical College), they tend to be over priced and don't give you the same quality as the technical colleges. I also know one person who had their class cut off midway thru b/c they could not keep instructors a few years back. I took my Registry Practicals at their campus and the facility looked nice. Right now I know most of the Tech colleges are getting to the point of having waiting list for EMT. If you have the money and want something quick you found the right place just be ready to teach yourself. If you have any questions drop me a note.

Going to watch to see how not to act on the job.

1- The attending Medic/EMT is in charge of the call, My paramedic partner and I (I'm an EMT-I) swap every other call who is in the back unless the patient needs ALS care beyond that of an EMT-I, when I am in the back on the call I decide how we transport, when he is in the back he decides. The only time it does not work that way is if the driver feels it is unsafe (due to weather, road condition, etc.) to drive emergency. 2-If they call you haul (unless they refuse to go), you do not have the "right" to refuse to transport anyone who wants to go (except maybe someone in police custody depending on your state and/or service policy) non-EMT drivers often have problems understanding that the medical needs are the reason for what we do. I have seen non-EMT drivers who want to run L&S to go get lunch b/c it is "cool" My personal view is if your on the truck you should at least be an EMT-Basic. I think the idea of an emergency driver does not make since and you should invest the time in becoming an EMT if you want to work or even volunteer in EMS.

I have had an IO (for Bone Marrow Sample, it hurts no worse than an IV and the discomfort is about 2 hours and that is it), I have seen two EJs in the field and both patients where in far more discomfort than the awake patients I have seen get IOs (2 in EMS and 4 more in Hospital settings)

All the Flight Service around here can only take 1, what treatment do you give the patients while waiting on als support?

I have always (since learning to do vascular access) been told to go for IO before EJ. Even in paramedic school we did not get much training on EJs other than about 30 minutes of lecture on how to do one and all the things that can go wrong and why we should try an IO first. THe books I looked up in where AMLS and Emergency Care in the Streets (6th Edition).

Ture, but even if they don't want to go you should first try to talk them into going. If you have a patient with a history and chest pain who does not want to go do you just hand them the clipboard? I think many EMS providers take hypoglycemia as a non-emergency and overlook what can go wrong. Treat for the worse (within reason) and hope for the best until you have reason to do other wise.

I know what I have seen here and if we do an EJ or they do a central Line in the hospital after taking them out they keep the patient for 12-24 hours to be monitored. and I checked the book, I am not confusing IJ and EJ.