RomeViking09

GA Law FR = VS, O2, CPR, Basic First Aid EMT-B= SpO2, Traction Splint, EpiPen, NTG, Charcoal, Oral Glucose EMT-I= IV, D50, Narcan (is some areas of the state), CombiTube EMT-CT= ACLS Drugs, 3-Lead ECG, ET on apnic/ pulesless PT, Defib Medic = Full ALS

can never go wrong with a subway meatball footlong with banana peppers..yum!

I tell the ER Doc or nurse but not in view of the PT or Family, we have an issue with it around here and have a good number of both attempted suicide by OD and accidental OD, I have seen a PT who got refills b/c they could not find the bottle (could not remember where it was) and then found it two days latter then took meds from one latter that day could not remember if the took it and took them from the other.

ECG batt die while charging for a defib (did have an extra batt), SpO2 batts die on a long x-port, run out of on board O2 5th call into a shift (almost ran out of all 3 D Cylinders before we got to the ER) crap happens, check your truck after every call you never know what your going to get next!!!

I good education comes from both the classroom and the streets, while yes you can learn somethings in the street you do your patients a dis-service by allowing an untrained EMT-B (or even an EMT-I) perform a skill not covered in their classroom education. That sad I learned IVs in the field as an EMT-B before finishing EMT-I and I started to learn ECGs and Pharmacology from Medics I worked with while a Basic and EMT-I. But there is a limit, don't let your EMT-B do the medic's job so they can "learn" it is one thing to show someone how to read ECGs or what the drugs are and not have them making the call it is another to let them start lines and drop tubes before they have the book learning needed to understand what is going on with those skills. I run across FF who are not EMTs starting IVs and 70% of the time have to restart the line b/c they don't check it (oh I got flashback I am in the vine... forget that I went through the vine and the line is no good) your clinicals and field internships are when you need to start skills on the street not b/c you medic is trying to "teach" you or b/c your lazy. And don't forget the legal issues with exceeding your scope of practice. The best EMTs and Medics I know are always in the books and learning from the street, most of the bad medics I know have the attitude that once you finish school you can put the books down you just need to do the required co-edu and nothing else.

A is my off the hip answer... looking in the book (Nancy Caroline's Emergency Care in the Streets 6th Edition) we use for Medic "Hyperventilation occurs when people are in excess of metabolic need.." (Page 26.37) It goes on to say that head injury, OD, pH issues, stress, and chronic medical conditions that effect metabolic systems (like DM) are the major causes of Hyperventilation. I would say from reading in both the medic book and my EMT-I book that C is TRUE now on the EMT level you might not get into the metabolic as much and I could see how that might change your answer but I would say the BEST answer is A Hyperventilation from a head injury can cause cyanosis (true it is a second condition) by without the hyperventilation and just the head injury you would not have the cyanosis, lower SpO2, or abnormal capnography

IVs only get easier with time, ER is the best place to work on your IV skills (lots of PTs in need of the and lots of both good and bad vines to learn on) in my EMT-I clinicals I had to get 15 IV (5 had to be with fluids running) The first day I was on EMS and only got 1 (on the EMT I was working with at the end of the night) due to low call volume, but the first day in the ER I got 4 out of 9 tries the 2nd day in the ER I got 8 out of 10, and so on as clinicals go on you will get better and find the best way that works for you. I would recommend watching the person you are shadowing do the first one of the day then asking to do the next one, learn from how each person does it and find what works for you. Oh and don't go trying to stick a 14G in a drunk your first day.... Good luck! Wiping asses is how I got to help with a lot of cool stuff (Codes, seeing a chest tube out in up very close, watching a doc set broken bones with the fluoroscope, seeing the docs use the "cool" toys and so on Oh ya try to follow a nurse who is on the Rapid response team (or code team or whatever your hospital calls it) if your an ALS student, good way to get to do airways and see how codes work in the "real world"

Take in all you can, do what you know how to do and ask to learn, don't get in the way (well at least not too much) and help out when you can. The hospital is the best place to learn you patient assessment skills b/c they tend to be less rushed and the majority of you patients will be stable. When you get to your EMS clinicals focus on learning how things work in the field. I got to work a few codes in clinicals but learned more from the calls that most people hate to go on. (Had what started as a BS call for a ERSF PT at a Dialysis center with a blown shunt that turned into a bloody mess in the back of the truck 1/2 way to the ER) but pay attention and learn all you can. Good Luck!

Granted you invented the greatest video game system in the world but now have to run 90 times as many calls on 400+ pound patients due to the lack of exercise. I wish I could rule the world

For class I am doing a project looking into how working EMTs and Medics would triage these patients Here is the additional Call info: You are dispatched to a college campus for a football bleacher that has caved in. You have at least 30 PTs, 8 ALS and 4 BLS units in route to the scene your the first unit on scene and have started triage above are your first 3 PTs. (I would like to know why you place each PT and your working level {EMT-B, EMT-I, Paramedic, Etc...} and would like at least 10 EMTs and 10 Medics to respond) Thanks

I agree, I am in good shape but have worked with other EMTs and Medics who I don't think could pass a basic fitness test each year and are more prone to injury, I think we better serve the public if we don't hurt ourselves while helping them.

This question comes after having been applying for job in the past few weeks, I had 3 services out of 6 I applied at (1 where EMS is part of the Fire Dept., 1 Privet, and 1 County EMS service) that require fitness testing at some point in the hiring process, 2 of them (Fire and Privet) also required a skills test identical to the NREMT skill section. The fire service also requires fitness testing (pushups, pullups, situps, and 2 mile run) twice a year. What do you think?

I was RSIed in the burn center after a camping accident before they cleaned me off, I don't remember seeing anything, I heard the doc order the drug and do remember getting 1 drug in 1 arm and another in the other at the same time, the only other thing I remember from the first week is waking up in pain one not (with a sore throat from them removing the tube the day before) and them not being able to knock me out again for another hour and going tychy to the point they cradioverted me while I was awake. but I don't remember seeing anything when they tubed me.

I would want to hear what the warning is (is it a voice or just an alarm) might be smart to say something like "Stand Clear Administering Shock in 5.. 4.. 3.. 2.. 1.. Administering Shock, [sHOCK] All Clear" give the public (and us) and warning as to what is going on.

I can't Intubate as an EMT-I civilian side but can when working with State Defense Force (DOD Scope of Practice vs Office of EMS Scope of Practice). I am not authorized to carry ET Tubes, IVs, Rx Drugs, or Advanced Airways Unless At work or under state active duty orders, carrying a Laryngoscope does not violate OEMS or DOD policy. I have ET Tubes and a CombiTube set up at home with my IV gear that I can add to my bag for a deployment.

Mine is mostly for deployment for State DOD, so addition food and such is there when I get there if it is longer than 2 days, I also do keep additional water bottled (about 3 Gal) and had a box of MERs in my apartment but that is not with my pack at all times.

Personal 72 Hour Pack (I am a Member of our State DOD Search and Rescue Agency so I bit more that most folks) -2 Uniforms -Field Jacket -2 MREs -Load Bearing vest w/Camelback and the following: -Flashlight w/ Red Filter -Compass -Work Gloves -VHF/ UHF Combo Radio w/ Public Safety Frequencies - Personal First Aid Kit -Leatherman Wave Multitool -1 Man Tent -Sleeping bag Medical Kit (Statpacks Perfusion Style, w/ Drug Kit & Airway Roll) Main Compartment --------------------- Adult BVM 1 12” x 30” Trauma Dressing 1 60” x 90” Burn Sheet 1 8” x 10” Sterile Combine Pad 2 5” x 9” Sterile Combine Pad 3 SAM Splint 2 2” ACE Wrap 1 3” ACE Wrap 1 4” ACE Wrap 1 1” x 3” Bandages Box of 100 Quick Clot 1 Triangular Bandage 2 Space Blanket 1 Traffic Vest 1 Drug Kit (See Below) Airway Compartment ------------------------ Trauma Gown 1 Airway Roll (see below) Top Compartment --------------------- EMT Pouch (See Below) Thermometer w/ Shields 1 Glucometer Kit 1 Note pad w/ Pen 1 Broselow Tape 1 BP Kit 1 Field Guide 1 Irrigation Saline (250 mL Bottle) 1 Right Compartment ----------------------- OB Kit 1 Patient Assessment Guide 1 Gloves 50 Pair Trauma Glasses 1 Biohazard Bags 20 Left Compartment --------------------- 2” Sterile Gauze Rolls 2 3” Sterile Gauze Rolls 2 4” Sterile Gauze Rolls 2 6” Sterile Gauze Rolls 2 2” x 2” Sterile Gauze Pad 20 3” x 3” Sterile Gauze Pad 20 4” x 4” Sterile Gauze Pad 20 Sterile Gauze Eye Pad 4 Cold Pack 2 Hot Pack 2 Alcohol Prep Pad 20 Iodine Prep Pad 20 Adult C-Collar 1 (Multi Size) Child C-Collar 1 (Multi Size) Latex Free 2” Tape 1 Drug Kit -------- Glucose Eye Wash Ammonia Inhalants Alco-Screen Actidose Aspitin Acetaminophen Naproxen Ibuprofen Airway Roll ------------- MAC 1 1 MAC 2 1 MAC 3 1 MAC 4 1 MILLER 0 1 MILLER 1 1 MILLER 2 1 MILLER 3 1 Adult Magill Forceps 1 Child Magill Forceps 1 Medium Handle 1 OPA Set 1 NPA Set 1 CPR Mask (Adult/ Child) 1 EMT Pouch ------------ Trauma Shears Buck Knife Pen Light Stright Kelly Forceps 3 Curved Kelly Forceps 1 The main pack is a ALICE Pack holds everything but my tactical vest. My ALICE Pack, Tactical Vest, and Medical Bag live in the back of my Jeep, I do take the Medical Bag on the ambulance when working so I have my stethoscope and such. I also keep my climbing bag with my 72 hour pack in the event we get called on a mountain rescue. I also keep a clipboard with state PCRs, Refusals, and all my State Defense paperwork. I think this is a bit more than most people need for just a 72 hour pack, but I can handle a MVC until Fire or EMS get on scene. I have an IV kit that only goes in my bag for State Deployments and is kept in a locked box in my apartment otherwise. Here are Photos of my Medical Bag Set Up http://gallery.me.com/ghanthorn/100186

I have had a Statpacks Perfusion for about 6 months now working with a local scout council and I throw it on the truck. I like it b/c lots of room, and I like the backpack design for going up and down stairs. The only down side for me is you can't put a padlock on the zipper of the drug module they sell (where I keep IVs and sharps while out at the camp) you can use those zip ties but I have just gone to using a old fishing tackle box for our Rx drugs and sharps at the camp and keep it in the back of my jeep while I am out there. Overall I would buy the Statpacks bag agian if I was in the market.

THe last service I was at did not put AEDs on a BLS truck. We would carry a Manual Defib if we had an EMT-I (at our service EMT-I did not make a unit ALS). We also had a bad problem of BLS crews carrying ALS gear b/c they did not check the truck or the ALS crew did not pull the gear when they had to swap trucks. Worst I have seen was a BLS truck with full IV set ups, fluids, EZ-IO, ET Tubes, CombiTube (Not BLS in Alabama), and a vent. Our BLS units did not respond to 9-1-1 calls but there are times they would transport a PT from one hospital to another where it might have been a good idea to carry an AED just in case. When asking a supervisor what to do if something happened on one of those calls I was told just call for ALS and do what you can until they got there (not the best planning in my book) one of the reasons I left the service.

Post your state so some of can look up the info but hope this help: Under the US DOT 1994 EMT-Basic National Standard Curriculum an EMT-B is allowed to administer or help a patient self-administer the following medications: Oxygen Activated Charcoal (Medical Direction Required) Oral Glucose Epi-Pen (PT Assist & Medical Direction Required) Metered-Dose Inhalers (PT Assist & Medical Direction Required) Nitroglycerin (PT Assist & Medical Direction Required) (Taken from Emergency Care and Transport of the Sick and Injured 9th Edition Chapter 10 - General Pharmacology page 349) Personal Note: Some states also allow nasal administration of Narcan, and Nebulized Albuterol Hope this helps

My understanding from school is that the protocol says if you are asked by john doe to take him to ABC Medical Center that you must take him to ABC medical center unless it is too far away then you have to take him somewhere within your transport area. An EMT or Paramedic can not tell someone they are not going to take them. They can try to get them to refuse (and sometimes they will refuse after you tell them they are fine) but you can't tell them no. If you do it is patient abandonment. and in GA the DHR Rules and Statewide Protocols act as law so far as EMS goes.

"The patient shall be transported by the ambulance service to the hospital of his/her choice providing that the hospital chosen is within reasonable distance of the patient's location and is capable of meeting the patient's immediate needs. The ambulance service medical director will establish a reasonable distances for rendition of prehospital emergency care for each ambulance service. In the event of exigent circumstances on-line medical control may override the established reasonable distances. If the patient's choice of hospital is not within a reasonable distance, medical control will determine the closest hospital capable of meeting the patient's immediate needs. If the patient's choice of hospital is within a reasonable distance but medical control (or the medic, if the medic is unable to communicate with medical control) determines that 1) the patient's condition is too critical to risk excessive time necessary to reach the hospital chosen and a nearer hospital is capable of meeting the patient's immediate needs, or 2) the hospital chosen is unable to meet the patient's immediate needs, or 3) the hospital chosen by the patient has notified the medic that it is unable to receive the patient, THEN medical control and/or the medic should make a reasonable effort to convince the patient that a hospital other than the one chosen is more capable of meeting the patient's immediate needs. If the patient continues to insist on being transported to the hospital he/she has chosen then the patient shall be transported to that hospital. If the patient does not, cannot, or will not express a choice of hospitals, the ambulance service shall transport the patient to the nearest hospital bel ieved capable of meeting the patient's immediate medical needs without regard to other factors, (e.g., patient's ability to pay, hospital charges, county or city limits, etc.). Reference: DHR Public Health Rule 290 -5-30-.05(8)(k) Destination of Prehospita l Patients." GA Statewide Prehopspital Care Protocols 2007 In short, you must take them if they want to go and where they want to go if it is "within reasonable distance of the patient's location and is capable of meeting the patient's immediate needs."

On clinicals I have been riding with 2 services, 1 is "urban" with transport times of about 10 from the back of the county. The other is a rural service transporting to the same hospitals (they do have a small ER in the other county but they send everything to bigger hospitals) with a transport time of 25 to 40. The medics in the Rural service have to do more in the truck and on scene b/c of the transport times and tend to have the better medics and EMTs in the area. With the urban service often all we do is start an IV and take vitals and call in and we are done, more than once I have been finishing up the IV as we pull up to the ER and call in from the ambulance bay.

I work at a 1/2 volly 1/2 paid service, if I am on the BLS transport truck and a call for possible arrest or pt with cardiac Hx goes out I will hop on the ALS truck so they have an EMT to work with the medic in the back. Most of our other volly basics do the same. 1 time we had a call and I was driving the ALS truck and we did not have an extra EMT around the station but FD was on scene so one of the FF drove us in.

The dose is based on our current off-line protocol (approved and written by a doctor) for burn PTs, I do not know if their is other data the medical director has supporting his directions or if it is an oversight on his part.