RomeViking09

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

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

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.

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.

Scenario setting: Resident Overnight Scout Camp in the Blue Ridge Mountains in North GA Time: 1156 Local Time Call Info: Camper has been found near the lake he looks "loopy" and is being taken to the Health Lodge by an Adult Leader at 1159 the camper and leader walk up to the heath lodge you pull the camper's heath form and see no Hx, the camper says he has not had anything to eat since 0845. Baseline Vitals are: Camper Age 13 A+O x4 GCS 14/13 (problems with obey commands) HR 56/Strong/Reg RR 16/Reg/Unlabored BP 125/65 STCM Pale/Cool/Dry Pupils PERRL @ 5 mm Temp 99.2ºF Blood Sugar 75 mg/dL You give the kid a Gatorade and some water and let him rest for a while and then send him to lunch. @ 1732 The Kid is found again disoriented near his camp site he is taken to the health lodge and you take his vitals: A+O x3 GCS 13 HR 58/Strong/Reg RR 20/Reg/Unlabored BP 130/55 STCM Pale/Cool/Calmmy Pupils PERRL @ 6 mm Temp 102.6ºF Blood Sugar 141 mg/dL Kid says he has been drinking water all day but you get him to tell you that he dropped a pack of skittles into his water before drinking it and that he has been doing this all week (makes the water taste better). ALS can be on scene in 1 hour and 45 min. The camp heath lodge is stocked with almost everything that would be on a BLS ambulance, you can only provided BLS Care and can provide non-emergency transport to a ER that is 45 min from camp. Post how you would treat the PT and if you would send him home, to the ER, or allow him to stay in camp.

NREMT Scope EMT-Bs can't Transport IV you need EMT-Is or EMT-Ps to Transport with IVs

Helicopters are not going out to us for something unless the PT needs a Level 1 Trauma Center

local term for on camp medical emergency that requires ALS transport is Code

Per state law I would transport (all 911s get transport in GA) but I would call the Police and I have a gut feeling he would be brought up on charges for abuse of the 911 System

Scenario setting: Resident Overnight Scout Camp in the Blue Ridge Mountains in North GA Time: 1322 Local Time Call Info: A Scoutmaster with reaction to ant bites has stepped in a bed of red fire ants. at 1325 medic (you) are on scene with a BTLS Jump Bag and you have pulled 2 EpiPens from the Drug Lock Up. You know from the health form review that the PT carries EpiPens for ant bites, once on scene you find that the PT has given himself two .3ml EpiPens in the last 5 min "he did not feel the first one working" Baseline Vitals: A+O x4 (Destressed) RR 23/Regular/Labored HR 106/Regular/Bounding BP 145/P Pupils PERRL @6mm STCM Red/Hot/Damp Camp Ranger is Standing by to move the PT to the Camp Health Lodge. ALS has been called and will be on scene in 1 hour and 45 min 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, The Camp Director (retired EMT-I/85), the Camp ranger (retired Fire Fighter/ EMT-P), 2nd Medic (in route to scene who is EMT-I/85) and Camp Health Officer (LPN with no Emergency Training works as a School Nurse and is not on Scene) Post how you would treat the PT while waiting for the ALS truck (you do have access to On-Line Direction from the ER and radio comm to the truck in route to the camp)

Here is the info you asked for from my field notes from this summer: Review of PTs Class 1 and Class 2 showed no past Hx and review of camp med log showed no past injuries while at camp PTs Vitals upon getting to the health lodge where: A+O x4 (destressed) BP 120/80 HR 95/Strong/Regular RR 32/Regular/Unlabored (We do not have a pulse ox at camp) no O2 Stats Taken Pupils PERRL @7mm The Ranger, Medic (me/ you in the Scenario), and Camp Director Log Rolled the PT to a long board and moved him into the Health Lodge Trauma Bay (Note; C-Spine was applied while PT was still Prone before moving him) Upon getting the PT into the health lodge all clothing was removed to allow for a full Exam. The Ranger set up radio contact to ALS and the ER for On-line direction per local camp protocal. PT was give 02 by Nasal Cannula (camp did not have Non-Rebreather, only BVM, and NC) @ 4LPM per Online Direction Exam showed injury (visual bruising and swelling) to the spine between T-10 and T-11 (Scoutmaster says he thinks the PT fell on a rock) Good CSM x3, no feeling in Right Leg slow refill in Right big toe. PT was covered and Vitals taken every 5 min until ALS was on scene (Note: All Meds are covered under Off-line direction before camp starts based on the level of training of all medics on camp. Camp was staffed by myself (Wilderness First Responder at the Time now and EMT-I Student), an LPN with no Emergency Training, 1 EMT-I, and the Camp Director and Camp Ranger all Staff are trained in BLS/CPR/AED in staff week, all medical staff must take 5 hours in wilderness protocols related to the region the camp is in, the night of this event the EMT-I was working for the local Fire Dept and the LPN was on her night off) PT was transported to a Level 2 Trauma Center, ER doc was able to breakup a hemotoma in the T10 T11 Region and the PT returned to camp the next day On Scene ALS did gain IV Access and give Morphine per Online Direction Camp staff did not give any meds per online director due to a possible unstable condition. (I have two more Codes from this Summer I will Post)

Scenario setting: Resident Overnight Scout Camp in the Blue Ridge Mountains in North GA Time: 2000 Local Time Call Info: Scoutmaster reports one of his scout was running in camp and fell, the scout master is on his way to the health lodge with the scout. at 2015 the Scoutmaster pulls up in a 15 Passenger Van with a 12 y/o male in a prone position across the middle bench seat of the van with pain in the T10 Region and no feeling or movement in the Right Leg. ALS has been called and will be on scene in 1 hour and 45 min the camp heath lodge is stocked with 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, The Camp Director (retired EMT-I/85), the Camp ranger (retired Fire Fighter/ EMT-P), and the Scoutmaster (no real medical training beyond CPR). Post how you would treat the PT while waiting for the ALS truck?