RomeViking09

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.

RV---> Why carry all the size blades and no ET tubes or advanced airway... also are you licensed to use the laryngoscope? Just wondering....

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.

Rome nice first response kit. But this case we are talking about a kit for your personal survival if you are in a disaster. Though I do see you could treat friends and family with it if needed. I would suggest you add more food and water to the kit as in a disaster it may be sveral days before you can get food and water.

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.

Viking, is this a hefty 10 year old or a skinny arse Webelo type? Is he a new crossover, or a sibling?

Lets Say a "normal" 10 year old, new crossover in good physical shape

If we're stuck for at least an hour, I want to get some pain control onboard in this kid if possible, so I'm getting on the phone with my physician advisor (who has graciously provided me with authorization to use the drug list mentioned before) and asking him or her if acetaminophen would be appropriate given the situation.

I don't want to give anything that would interact with the stronger meds the ALS might be wanting to get on board, but I certainly don't want to let this kid suffer for an hour. I'm not just giving the meds because I'm *not* a doc, and at my camp I could only give the comfort meds to an adult or to a kid who had it authorized on his health form.

Given our off-line direction we can give the drug then and their, If I am sending the kid off to the ER in our van, I am giving him 1000mg of acetaminophen (the is the pain med listed in our protocols) I might consider asking for Ibuprofen depending on the amount of swelling.

Here is my Answer:

PT #1 - Given Rule of Nines he has maybe a max total of 9% surface burns, and has stable Vitals so he gets 2x 500mg Acetaminophen for Pain (pre Off-Line Direction), 2nd Skin Dressings on the Burns, or moist gauze. This leader get to make up his own mind about going to the ER and how he wants to go, given that he only has minor 2nd degree burns that can heal on their own.

PT #2 - I am going to take him to the health lodge, and he going to get O2, and a trip to the ER, look at his Vitals and his age you have Tachycardia, Labored breatheing, and high blood pressure so I am thinking treat for Shock then the burns. As soon as I get to the Health Lodge I am getting the AED out just in case and he is getting a full physical exam and watching his Vitals

PT #3 - Here is the tricky one, you need to treat for shock and get this kid inside ASAP, O2, and Burn dressings, I would have the kid on a backboard and we have a jeep that can transport 1 PT supine, 1 PT seated and 2 Medics. So I am taking this kid in to the health lodge to warm him up and then it is off to the ER with PT #2, I notify ALS in route but my plan is to get this kid into a ER asap so he can be sent off to a burn center, given Rule of Nines he has 36% surface burns and possible airway issues. The change of survival (Given COS= 100- (age + surface burn%) for this PT is 54%.

This was not a real Scenario but one we used in staff training week. In the training Scenario the camper trips into the fire and the adults are burned in the process of putting the kid out. the 2nd adult is a curve ball we throw so that Medics remember not top focus just on the kid, in Bad Camp and/or Wilderness scenarios you all most always have more than one patients that need your care at the same time, this a bit easier b/c you have two EMTs, but what if it is just you? what can you have others around you doing for so you you can focus on treatment's they can't do. In street EMS I don't see a lot of Use of ByStanders on Scene except maybe to hold an IV bag, or keep doing CPR, but here you may need them to do real patient care while you attend to another patient.

Scenario setting: Resident Overnight Scout Camp in the Blue Ridge Mountains in North GA

Time: 2216 Local Time

Call Info: A staff member calls into over the radio reporting a campfire accident in a campsite with 1 camper with "major" injuries, and 2 campers with "minor" injuries

at 2219 you, your partner, and the camp ranger (with ability to transport to the camp health lodge) are on scene with a BLS Jump bag and a Burn kit. You find the scene is safe and start to check out each of your 3 PTs. You find the following:

PT #1 - 43 y/o Male PT with Partial thickness burns to hands and forearms

A/Ox4

HR: 112/Reg/Strong

RR: 16/Reg/Unlabored

BP: 145/75

STCM: Pink/Warm/Dry (except areas burned)

P: PERRL

PT #2 - 46 y/o Male PT with Partial thickness burns to hands and forearms

A/Ox4

HR: 130/Reg/Bounding

RR: 26/Reg/Labored

BP: 160/92

STCM: Red/Hot/Moist

P: PERRL

PT #3 - 10 y/o Male PT with Partial Thickness burns to his chest, neck, left arm, & left leg below the knee

A/Ox4

RR:36/Reg/Labored

HR: 128/ Reg/Bounding

BP: 120/60

STCM: Red/Hot/Dry

P: PERRL

ALS can be on scene in 1 hour the camp heath lodge is stocked with almost everything that would be on a BLS ambulance with access the the following Drugs:

Acetaminophen

Ibuprofen

Naproxen

Diphenhydramine HCL

Pseudoephedrine HCL

Epinephrine 1:1000 (5x 0.3ml EpiPen, 5x 0.15ml EpiPen)

You team is yourself, a 2nd Medic of equal skill, and the Camp Ranger (who is a retired FF/Paramedic). You are operating under BLS ONLY Protocols (no IVs or Drugs unless listed above) Post how you would treat and when you would transport each patient (you have the ability to transport non-emergent in a camp van to a level 2 Trauma Center within 45 mins or Call for ALS Transport to the same Trauma Center, No Air Evac)

I keep the following on me on the Truck

Right Outside Cargo (EMT) Pocket - EMT Shears, Knife (serrated blade), Bandage Shears

Right Inside Cargo - Field Guide, ACLS & PALS Flowcharts, and Drug Field Guide

Left Cargo - Field Notes Pad

Belt - MinMag, Glove Pouch w/ 2 pair of Gloves, Radio, Cell Phone, EMT Pouch )w/2nd MinMag, Hemostats, Kelly Forcepts, PenLight, Buck Knife), Leathermen

Back Pocket - Wallet with Certs, DL, Creditcard

Shirt Pocket - Cigs & Lighter, Pen, Sharpie

and I keep my scope around my neck so I can remember to check lung sounds (trick I learned in school and it has worked so far, so why not keep with it)

Did you buy your bags from ebay?

I did . . .

My Wilderness bag is my old climbing bag but the other I got off eBay for a good price and it came stocked

it is tablets, I found that with some younger kids (I work at a Boy Scout Camp) that the tabs work better as far as getting them to take them, so I keep both on hand but only 1 tube and a bite stick in my Jump bag.

I like the backpack bag

Here are my bags:

Wilderness Bag on the Left, BLS Jump Bag on the Right

BLS Center Compartment

OPAs

2 - SAM Splints

2 - Ace Wraps

2 - Trangle Bandages

5 - 4x4

5 - 2x2

1 - Eye Patch

2 - Abdomen Pads

10 - Steri Strips

1 - Ice Pack

Drugs: Benedryl, Aspirin, glucose

Sting whipes, Antibotic wipes, alachol whips, band aids

Paperwork & clip board (BLS & ALS Note pads, refusal of treatment forms)

Shapie, Pen, Knife

Belt kit (Sheares, Mini-mag, pen light, bandage shears, twezers, hemostat)

EMT-Basic/ First Responder Pocket Guide

Drug Face Pocket Guide

Side Compartments

-CPR Mask, Gloves

-Scope, BP Cuff

Wilderness Gear

- 1.5L Water

- Climbing Gear for High Angle Rescue (except rope)

-4x4, 2x2, Abdomen pads

-glucose

-ice pack

-arm sling

-commercial 1 day/night survival pack (gray can)

-ace wrap

-syringes (for cleaning wounds)

I keep both bag behind my bench seat in my truck and take the BLS on backpacking trips over 3 days (repack everything into my backpacking pack or just strap it on top if I am not carrying the tent)

My wilderness bag is more for short camping and day rock climbing trips (I do take my BLS bag climbing but leave it in the car)

I am starting a Upgrade to EMT-B from Wilderness First Responder in October and then Starting EMT-I/85 in January, I wanted to know how many medics had to do I before they started Medic School. The Technical Colleges here want 6 months on the street before you can start medic school and to work on the street in my area you need EMT-I (no BLS services). and is there anything to watch out for in EMT-I that can screw me up in medic school.

My work so far has been at a Boy Scout Summer camp where we provided only BLS care in camp. We are given off-line direction to give more meds than a normal BLS service and we stock of our meds that normally the PT would have to have an Rx for and we also have some drugs in stock we can only use with On-Line Direction.

Our drug list is the Following:

Acetaminophen PO

Aspirin PO

Ibuprofen PO

Naproxen PO

Hydrocodone w/Acetominophen PO (On-Line Direction Required)

Diphenhydramin HCL PO

Pseudoephedrine HCL PO

Epinephrine 1:1000 IM, .3 ml Auto-injector, .15 ml Auto-injector (On-Line Direction Required for use of IM Injections)

Cephalexin PO

Calcium Carbonate PO

Bismuth Subsalicylate PO

Activated Charcoal

Loperamide HCL

Nitro SL (On-Line Direction Required)

O2

Glucose

Albuterol MDI

Now we are over 1 hour from any kind of ALS care (by air or road) normal time to scene for ALS is about 1 hr 45 min we also keep all camper Rx meds and have to assist and log them while the camper is in camp unless a parent is with them (this included SQ and IM Insulin) All health lodge staff are trained in Wilderness Medicine Protocols in addition to their over medical training (Past summer's Staff 1 Wilderness First Responder, 1 LPN with no EMS or Emergency Training, 1 EMT-I/85 who was on camp part-time) we also had 1 retired EMT and 1 Retired FF/Parmedic that worked at the camp and most weeks had 1 or 2 Adult Leaders with groups that where RNs, EMTs, or Medics

Yeah, that's way old school. Full orientation requires that the patient be aware of his current situation. If you know who you are, where you are, and what day it is, but don't know why you are laying naked in the street, surrounded by firemonkeys, then obviously there is a serious deficit in your orientation, no? The qualifications of any instructor who does not teach this to his/her students are to be doubted.

I hope that's not all he found, because that isn't what is causing his fever. And, neither of those BGLs would normally have a profound effect on the kid's mentation. Something else is going on here. Did anybody find it?

Fever was written off to environment (outside temp was 102º + that day) and lack of proper hydration combined with poor adult supervision, it was expected that the kid's undiagnosed diabetes lead to the AMS and after a few hours in the ER they kid returned home and went to see the family doc about the diabetes.

I doubt the skittles have anything to do with the fever...

Get rid of the lil bugger.. I'll go with spleenac

In the end the Skittles in the Water the ER doc found he had been making his own Glucose by adding Candy to Water (turns out he was diabetic and family doc had missed it)

A+O x4 =

Alert & Oriented to

Self (1)

Place (2)

Time (3)

Events (4)*

*Event Leading to MOI or HPI

In GA that DHR sets the Scope for the state, each region can go above based on need but needs approval of the DHR (example State Wide "law" EMT-B can work on a truck in all but one region you must be EMT-I to work on a truck and there is no such thing as a BLS Truck once you get north of macon) GA Had Scope for EMT-B, EMT-I/85, and EMT-P before the state used the NREMT Scope and Exams the had EMT (About the same as an I/85), EMT-CT (about the same as an EMT-I/99), and EMT-P (Went beyond NREMT-P). We still have EMT-CT running around but for the most part if your in GA you need to Be an EMT-I or a Medic. This does prevent the chance of a BLS truck showing up for an ALS call.