Paradude

Most emergency services, to my understanding, don't use the "strike method" for getting things done. First, you have to live with yourself after not responding to the calls, then deal with the sometimes scathing public reaction. Most of the time, it is done through litigation. As I said JB, I started out volunteer. We also were not completely volunteer, because we also got call pay, and even a very modest shift pay. Never really amounted to much. If you are comfortable with your volunteer service, then go for it. I don't think that is the case. If you are not, then get the information out there, and don't quit. Your community suffers not having a professional service, not only you guys that are doing it for free. I have seen the problems and the friction in areas transitioning to paid from volunteer. I don't envy you. Truth is, as far as skills go... As I said, I can gaurantee you will run more calls if you service has a paid professional service. You stated that people will transport their own instead of calling an ambulance. More calls and more patient contact will mean better practice of your skills. Dust is right in saying that many times very low call volumes allow poor providers to hide out. I work for a busy service too, but we have very slow stations, and find that old timers with very poor skills can grow roots there, and not get found out. -Paradude-

JB when I first started, I worked for volunteer services in order to start getting my feet wet until I got a real job. They would have good people do that all the time. (Not that I am good people or anything). They would be an asset to the service, until they had to start getting serious and paying their bills. Truth is, these guys are right. I work for a very poor community right now. Poorer than some of the volunteer services I worked for years ago. I get paid 45K a year, and work with some pretty good equipment to boot. Why? Because they need an ambulance service, and that is the only way they can get it. It's all a matter of getting the people and the politicians on the right train of thought. If the politicians can report to their very ignorant and completely uninformed contituants that they are providing an ambulance service, and they don't HAVE to dig deep and provide a real ambulance service, they are gonna take the path of least resistance. If the word got out that they were not providing the service that they should, they would have to start getting with the program, and find the funds somewhere. Believe it or not, volunteer services are bad for our entire profession. As the name implies, we are PROFESSIONALS. I love my community too, but I would not work as a Paramedic for them for free. Mainly because I love my community. I also love my family and myself, and I won't give myself away for free. I can gaurantee that if your service was a well paid and professional service, you would do alot more calls. The small service I work for now, is a sparsely populated county of only about 6000. With that, we do an average of 2000 calls a year. -Paradude-

Dude, your protocols are weak. They don't keep me from doing anything. Obviously, the "fools" you speak of would refer to the ones for whom the protocols are written? As far as surgical crics are concerned, I have done 3 of them. All quick, easy, and successful. In all but one of the patients, who was a victim of a hanging and was dead anyway, just didn't know it yet, the patients lived and went on about their lives with only a small scar. By what studies, articles or other text do you derive the information for which your glaringly bold statement is made that surgical crics are dangerous? You choose to attack the best of the best in this forum, with unsubstantiated opinions based on your obviously inadequate knowlege and experience. They are gonna call you out on it, and you will look like a fool. The sad part is, you may not be one (a fool), but your digging your own hole. You wanna go up against Dust? Be my guest. I suggest you use a small shovel. Has he always been this way guys? Or, is he just having a serious lapse in judgment? -Paradude-

Man, you guys are harsh. Truth is, firefighter has gotten a Paramedic license, and a little experience, and is now elevated himself to that of Paragod. Such an attitude is poison to the EMS profession. His protocols are somewhat weak from what is sounds like, and that seems to be all he knows. Everybody knows that needle crics are discouraged, and even when used is rare instances, are only used temporarily (just a few minutes to get a little gas exchange). When you are trying to clear an FBAO or something along that line. We do surgical crics, and find them to be quick and easy with the proper training. We have kits, and train for them every six months. The times it has been used, it takes about 30 seconds from decision, to airway. 45 seconds on the outside. When someone needs an airway, why fart around squeezing air through a 14 guage catheter, rather than a 6.5 ET tube? There is some bleeding yes, but the risk of a serious problem of aspiration is very minimal. Especially given the fact that you are giving the patient a 100% secure and patent airway. They are faster than needle crics as well. We do chest tubes as well. We train for them every six months too. Why do we do these procedures? Its like Dust said. "Go Big or Go Home!" Just because your service does not do these procedures, does not mean they are wrong, or irresponsible, or dangerous. Quite the contrary. Another thing firefighter. Don't head to head with Dust. You are WAAAAAY out of your league. He was a Paremedic for many years before going to nursing school. He had opinions greatly advanced to yours, when you were still shyting yellow. Take some advice, and drop yourself down a few notches, and learn from these folks. Leave your opinions alone until you have quite a few more years under your belt. If Dust or any other of your far more learned collegues need your opinions, they will give them to you. You just don't have the ammunition yet, and you will only embarrass yourself. I think it was Thomas Jefferson who once said, "Better to be thought a fool, than to open one's mouth and remove all doubt." -Paradude-

You know, the whole " Remembering where you came from.." thing is very misleading. I came from my mom and dad. I became a medical prefessional when I became a Paramedic. All time before then that I spent in EMS as an EMT, I was preparing for that. The problem is that EMT's tend to stay where they are at, in order to make money without bettering themselves. I have EMT partners. One is a Paramedic student, and the other is a full-time firefighter who works on the rescue truck, and is wanting to work a second job as an EMT to make him better at this. (and to build a new deck). I have said many times that I have a problem with someone who is satisfied being less than what they need to be. -Paradude-

I can tell time too. 8)

The idea that running with a dual Paramedic system, is ultimately better than a Paramedic and an EMT. Any idea that tries to advocate a benefit to a Paramedic/EMT system over a Paramedic/Paramedic system is simply justifying a less than optimum system to get by less expensively. -Paradude-

I'm sorry dust.... We need to put this in a different string guys. This is not what this string is about. -Paradude-

Nobody has to call you out on anything Connie. True, if you don't like posting, then no one makes you do it. But, if you are interested in new ideas, attidudes and ways of thinking, then post and be confident in your post. If you have something to learn then thats good for you isn't it. If not then whats the difference? If you post something glaring, then people are gonna comment truthfully. Its not to hurt your feelings or put you down. Its just the way our kind of people are. -Paradude-

I gotta agree Dust. You know I love ya bro, but that is something I can't believe you wouldn't jump all over. Even though it is your thread. That is the kind of timid nature that I figured would bring out your "Alpha-Nurse" mentality. :wink: -Paradude-

Connie, If you don't feel a patient needs an IV, then don't start one. An ER nurse doesn't make that decision for you. If you are asked why you didn't, and you have a valid answer, then tell them that answer, and have some confidence in your treatment decisions. If you don't have a valid answer, then maybe you should have started an IV. I start alot of IV's , put on alot of cardiac monitors, and check alot of blood glucose levels. I do that, when I cannot come up with a valid reason not to. Part of not being a cook book medic, is being able to give your reasoning behind your decisions. Cook Book medics (in my opinion) are ones who do treatment based on black and white findings. (ie. if you see sign or symptom 'a' then you administer treatment 'a' and so on) Being a good pre-hospital care provider means that you must THINK. You have to have a good working knowledge of A & P, and what your treatment modalities actually mean, and devise your strategy from there. I have been asked about my treatments from nurses and doctors, and I just give them the straight answer, period and point blank. I have enough confidence in myself to feel good about what I do. If I have made a mistake, then I say so, and learn from it. If they disagree, then that is there right, but they were not in the field with my patient. I was. -Paradude-

Is Firemedic05 in court here? He makes some points and tells his preferences and somehow it gets spun into being a cook book medic. Trust me, there are few things I dislike more in our profession, and I have read this string. I don't see where cook book medic blares out. I could make it into that, but I would have to be digging. Guess what? I like to start IV's on most patients, and I like to put people on a cardiac monitor. I call that being diligent. Every time I start an IV, I do a glucose check from the blood in the flash chamber. All that, and I preach to students all the time on not being a cook book medic. Guess I gotta practice more what I preach. :roll: Lighten up people! -Paradude-

Uh Oh..... PISSING MAAAAAATCH!!!! -Paradude-

:roll: oooohhhhhh. Diprovan!!! I wish we could carry that. Ours is on standing orders, but is heavily QA'd. -Paradude-

I have also heard alot about the Melker system. It seems to be slower, much more expensive, and does not give as secure an airway. -Paradude-

Sure, but a surgical cric will give the patient a secure, sealed and positive pressure airway. No aspiration, and minimal scarring if done correctly. If you have a kit, and the correct procedure, it can be done in under 20 seconds. We use actually the fastest, and the cheapest method. We use a #11 scalpel, and stand on the patients right side if you are right handed, or left side if you are left handed. After donning your sterile gloves (right!) and disinfecting the incision site (right!), we stretch the skin taught over the larynx with the left thumb and forefinger, and note the prominences of the criciod cartilage and the thyroid cartilage. We then make sure to keep the fingers of the left hand in the same place so as not to lose the relative position of those landmarks, and make about a 3cm incision starting from the bony prominince of the cricoid cartilage to the bony prominence of the thyroid cartilage. With the fingers of the left hand now holding the incision open, we then take the scalpel and make a horizontal incision across the cricthyroid membrane. We then turn the scalpel over, and insert the handle into the incision of the cricothyroid membrane, and then turn it 90 degrees. Keeping the scalpel handle in place, we insert a 6.5 ET tube that has been cut off right above the stem, and insert it along the scalpel handle toward the sternal notch. We then inflate the cuff, and confirm placement. We then have a stack of about 20 4x4's that have been cut down the to the middle and take half and put one way across the incision, and the other half the other way. Then we tape it down. From first incision to airway, is only about 15 seconds or so. Other methods were researched, but considering this way was the fastest and easiest, we went with that. It sounds complicated, but I was trying to explain it in as much detail as possible. If you go through the motions in your mind, I think you'll see it is pretty quick and easy. -Paradude

Try to intubate... try hard. Get your partner to try. If unsuccessful, then consider a surgical cric. We're talking about airway aren't we? Shouldn't we stop &^%*ing around and get it done? -Paradude-

Dust you know my opinion on this. I think that budgets may disallow dual medic trucks. That is fine, in that at least they have an ALS unit. Ok, first of all, I work for a service that is working toward 100% ALS. We don't have that yet simply because we don't have enough medics. Working for a busy service where we do alot of critical calls in many of our areas, having two medics has two main advantages. 1. On a critical patient, you have two heads thinking as trained Paramedics. The many things that must get done go faster because two people are doing them. I don't know about stats, but I can say that better patient care IS the result. I work both ways, and do just fine with a basic, but I do better with another medic. 2. The paperwork load is split up. If you are working P/B, you may get many ALS calls in a row, and find yourself way behind in paperwork. This is an arguement that is solely based on cost. This can get you in trouble, especially when it comes to prehospital medicine. Any arguement or statistics that say that P/B is better that P/P will simply be a matter of justifying a less than optimum system in order to get by more cheaply. If there is a problem with people fighting over skills, that is another matter entirely, and obviously some personal issues should be ironed out. We take turns running each call, and whose ever turn it is, calls the shots. The other assists without question. This works out well, and I can't recall anyone fighting over skills. Unless they are poking fun. On a critical patient such as a chest pain, respiratory emergency, or significant trauma, there are many things that have to be done very quickly, and 4 highly trained hands are better than 2. I can recall some medics saying they would rather work with a basic, but generally they are medics that tend to be somewhat unsure of themselves, and don't like the idea of making decisions when somebody is watching that knows what they know, wondering what the other person is thinking. Or they may take suggestions or constructive criticism as being second guessed, patronized or generally made fun of. Two medics with confidence in their knowledge and skills can work well as a team. Honestly, I can't see how this can be a serious arguement. In a surgery suite, there is usually more than one surgeon when it is a complicated case. Why would that not be the case in an ambulance? -Paradude-

We use 5mg Valium mixed with 5 mg Haldol administered IM. (makes a milkl looking substance when mixed together) Then we administer 25 mg Benadryl IM separately. This is to avoid the extra-pyramidal effects of the Haldol. Works well! By the time we get them to the ER, they are lambs. -Paradude-

Well, I'll admit that etomidate is a better choice, we just don't have it. I will admit further that BP must be monitored due to versed's effect, but it doesn't have the effect you think. It has yet to happen yet with its use with us in about 8 years. -Paradude-

Sorry, I'm getting used to this forum. There are problems with RSI, when initial induction is achieved with sedation rather than paralytics. Studies have shown that there is a higher risk of aspiration. Sedation should only be done with the intention of making the patient more relaxed and unable to remember the incident. We use: Lidocaine Versed Norcuron (test dose) for defasciculation Succunylcholine **intubate** Norcuron (full dose) Further Versed Fentanyl for analgesia Works well, and we have been doing it for some time now. -Paradude- 8)

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