medicv83

I am currently a Paramedic in the City of Buffalo up here in Western NY. Yes its right on the border of Canada hahah. It is hosted by a Rural/Metro Ambulance which is a private ambulance company. We cover multiple areas within WNY, such as the city of Buffalo, Niagara Falls, Cheektowaga, Hamburg, Evans, Eden and some smaller outlying suburbs. There are also plenty of volunteer rescue and Fire companies that service most of the suburbs as well. The reputation of Rural/Metro in WNY is not a generous perception of the companies actual employees or services. There are outstanding employees who are generally underpaid and without adequate benefits, however we are all very good at what we do. It'd be worth to check out. I can get you some more point of contacts if you like.

I greatly appreciate all the responses, and I think two things I will take from this thread.... 1) o2 was obviously in order, in at least the short term aspect of the pre-hospital care that was performed. Which I kind of already had figured out, but was looking deeper as to why this Nurse was so adamant that it be taken off 2) I have to do some more research on this A-a gradient/equation that is being talked about. On this note....It can be said now that, if we are not already doing so, we must look deeper into the broad picture of a simple tachypneic patients hx or s/s to take this essentially BLS level call, and identify the true etiologies that may be effecting this pt and his resp rate. Certainly sounds like something we say we do, at least for me, and to be honest with you, I packed this one into my head right from the get go as an anxiety induced sort of hyperventilation. Thanks again for the educational responses~! I need to get on here more often, I almost forget how informative this site can be!

As far as the chest pain is concerned, I personally, in my own mind, felt as if this chest pain was secondary to the tachypneic state this pt had been in for nearly 15 min. Pt wife states that he has no med hx, w/nkda, and does not take any prescription medications. Sounds kinda lame I know, but he has no medical problems. Throughout the day though, the wife states she started accusing him of cheating on her with someone who works at the hospital. She states that he was getting angry throughout the day, and that he did have an earlier episode of this rapid breathing, however it lasted appx 2-3 minutes, and he was crying and very emotional when this happened prior to. She was able to calm his breathing verbally. She states that he walked outside after she suggested that if he wanted to get angry with her, that he should leave and go talk to his "girlfriend". Once he was walking outside he started breathing heavy and it turned into what was present when we got on scene. Vent, I was anxious to hear your response to this, for no other reason than I like the way your responses are worded. I had read those articles prior to posting on here as I was trying to find this out through my own research. However they dont state how the admin of o2 is bad in strictly a hyperventilating pt. As far as the other etiologies of tachypnea, one would think from an EMS point of view, that they all deserve o2 admin correct?

Thank you JP, as I was just going to say this. The pt wasnt sucking this bag down at all. I am not curious as to why he had chest pain during a period of hyperventilation, of course his chest will be tight. Yes the agitation is from the hypoxia, well at least it can be assumed that way. Once the pt regained his consciousness, his bp thereafter was in the mid 130's systolic, and a pulse rate of 97, nsr w/o ectopy at all. Im just more curious in the administration of o2 in a pt who is hyperventilating. Why would this nurse be so adamant that o2 not be administered, and we can call this whatever we want, either respiratory distress, sob, diff breathing, or hyperventilation. However either way, isnt any of these an indication for o2?

Greetings all. Haven't posted in a while, but I have a question that could be debated. Sounds very simple and basic, however I was "yelled" at by a triage nurse yesterday, and it baffled me slightly as to her statement..... Let me run the scenario through first. Pulled up on scene of a 24 y/o male pt found sitting upright on the porch steps, in care of the local FD. Pt is conscious and alert, however unable to identify to what level his alertness actually was at the time. This individual was noted to be breathing at appx 40x/min. Very shallow. Lungs were clear to auscultation in the apices of the lungs anteriorly and posteriorly, and diminished in the bilateral bases. We immediately placed the pt on the pulse ox and it showed o2 sats of 89% room air. I was crouched in front of the pt, attempting to calm his respirations by requesting that he look at me and breath with me and normally. The pt family member stated that he walked outside after an argument and began breathing in this manner. The pt is not able to answer questions, however when asked if he has any pain the pt does point to the center of his chest. The pt was then guided in an upright manner and placed on our stretcher. He was sat in an upright position of comfort, and I had my partner place a NRB on at 10 lpm. The pt was beginning to get aggitated at this point, and was attempting to climb off the stretcher. I was continuosly talking to the pt and attempting to calm him down verbally and reassure him that I was there with him and for him, and told him every single movement we were going to make. Once in the truck, the cardiac monitor was placed on showing a sinus tach rhythm w/o ectopy at 132 bpm. Bp of 165/113. Respirations continued at appx 40 - 45 bpm. Pulse ox of 91% w/ nrb in place. We then began transport. As we began to drive, the pt then began to bob his head up and down and side to side, and w/in maybe 10 seconds of this became unresponsive, as I figured he would at somepoint. I think moved the monitor off of the back of the stretcher, and layed the pt supine, opened his airway utilizing the head/tilt chil/lift method. Pt respirations were appx 10/min at this time, and he was completely flaccid and unresponsive to sternal rub. I placed a nasal airway, and provided bvm respirations at 12/min, w/ high flow o2 @ 15lpm. This lasted appx 4 min, and upon arrival at the hospital the pt opened his eyes and was looking up at me providing ventilations. I immediately welcomed the pt back to a responsive state and explained to him where he was and who I was and what I was doing. I removed the bvm, and the pt gently reached up and removed the nasal airway. The pt now had regained control of his respirations and was breathing appx 16/min, w/ adequate air movement into the bases, clear throughout auscultation. I then replaced the NRB and maintained it at 10lpm. o2 sat of 99% on room air. Pt w/ complaint of slight chest tightness upon arrival. Pt states he does remember me coming to the scene, however nothing from then on. Phew......Now, we enter the hospital, and are in the "line" waiting to see the triage nurse, and she comes out and says she needs to know what every unit is here for. She asks my, and I begin to give her a bit of the situation. She then stops me in my sentence and says "I need two words, thats it, two words so that I can make a disposition". I tell her --"hyperventilation". She then says, "well why is he on oxygen then? Get the oxygen off of him". I said, "Well can I explain what had happened?" and she proceeded to tell me that I need to get the oxygen off of him if he was hyperventilating as this will continue to cause him to hyperventilate. From this point on she would not allow me to describe to her the scenario as I saw it, and stated that If I continue to maltreat pt's then she will continue to not listen to what I have to say about the scene, and she will form her own conclusions!!!!! I was utterly shocked. Not a single indiviual providing care for this pt from this point on asked me a thing about the scene! After all that, my question is.............Is there something I do not know about o2 administration during possible hyperventilation syndrome?

Buffalo has all of what you are asking for, except for a MLB team. The outlying areas, like the southtowns are ideal for you as the schools are tremendous, and the Buffalo Bills are literally like 5 minutes from my house out here in Hamburg NY. Hamburg area is a small town vibe, but your like 10 minutes from the city of Buffaly. I work in the city, but live in hamburg so the schools are much nicer, and the little hometown ambiance is very nice. We do have the farm team of the Mets in the city, which is fun. We also have great hockey here w/ the Buffalo Sabres. Tons of sporting opportunites w/ soccer, baseball, football and especially hockey for the kiddos. Tons of experience out here in Buffalo as well. Send me an email if your more interested and I can get you points of contact. We definately need more medics and they would hire in a heartbeat. The reciprocity process isnt horrible through NY either. I moved here from NC and it didnt take long to change out cards. Lots of snow in the winter, and right now its in the low 80's daily. Gorgeous area here in the southtowns, and your also only 40 minutes away from Niagara falls.

I work in Buffalo NY, and the use of lights and sirens is determined by the dispatch center in relation to the dispatch code they input. We, as the responding crew ultimately make the decision to go hot to the hospital or not. I will say that there is a dramatic difference in response times here in buffalo when comparing the use of lights and sirens to a scene and when going "cold". Simply because of the traffic and amount of traffic lights. A huge factor in response times w/ and w/o lights and sirens depends on your area and the demographics. Once again, the use of lights and sirens to the scene and from the scene can make a huge difference in time for the pt. Now granted, I rarely use lights and sirens from the scene unless it is a time sensitive pt, however dispatch tells me how to respond to the scene.

I work with Rural/Metro out here in Buffalo NY, and we are busy busy busy. Decent size little city w/ all the works as far as EMS is concerned. Shitty upper echelon as far as management is considered though. Lousy pay, but where is there good pay I guess. I am also a father of two boys active in sports and I make every game/event. I work Sun, mon, tues, Friday all 0500 - 1700. You can work 8's, 12's, 16's, 24's - whatever you want around here.

I work with Rural/Metro up here in Western New York and the uniforms issued here are great. They are dark blue EMS pants, with a neon yellow and silver band across the pocket flap. The shirts are button down, stain resistant, dark blue with army type name type depicting your level of care on one side, and your last name on the other. Also on one shoulder your NYS level of care patch is present, and the other is the Rural/Metro patch. Very professional uniforms. Unfortunately the quality of the ambulances and equipment negates the good uniforms. We also get winter jackets that look the same as the tops, also a fleece type liner for the jacket tha tyou can wear seperately with the RM logos on it. You can order fleeces as well with your name and level of service with all the patches on it as well. Very good, professional uniforms

Anyone know what type of monitor Rural Metro in WNY is using? If this is in the wrong post, sorry!

Whats the deal with some of these nursing homes? I went to a call maybe two months ago to a 80 something yr old woman who had fallen in her room by the door. Staff couldnt open the door to get to her, so they went around the next room and into hers which the two rooms were connected by the bathroom, as we did as well when we arrived. The LPN who was caring for this woman was sitting on the floor next to the patient, patient still lying on the cold tile floor and all, with a small laceration to the elbow that she fell on. A smear of blood on the floor as well from her elbow. Anyways, the LPN was literally sitting on the floor next to the patient, complacently monitoring "vital signs" until we got there. The call was held by dispatch for like 2 hours!!!!! Literally like 2 hours the patient had been lying on the floor after she had fallen and the best the staff could do was place a "watch dog" on this patient in the form of an LPN who stated " there is nothing that I am allowed to do for the patient except to monitor". Not because she is an LPN or anything, but thats what I guess the protocol is for this place or something. I didnt ask to many questions as to why she wasnt helped up or at least a small 4x4 or something on her elbow lac. Needless to say the woman was also incontinent as well. Sitting on the tile floor in her own urine for a few hours was astonishing to me. Just goes to show ya the level of empathy that some nursing home staff put into their patient care, whether it be a doctor, nurse or what have you.

I think Dust, that I must be confused I guess on the application of synchronized vs unsynchronized shocks and when to use them. Either medically they performed or attempted to perform synchronized shocks on an arrested patient, in which I cant imagine they would have, which then makes the records errored, or it makes the author of the article lazy and incompetent on reporting an accurate scenario of the patient care given. I like to think the latter in this case, as Im sure there were attempts of unsynchronized shocks delivered to this patient. Im curious though, as to the way in which they present statistics on ROSC. Your condescension is disgusting Dust by the way.

http://www.foxnews.com/story/0,2933,433830,00.html Take a look at this story printed by Fox news on their website. Entails a woman being seen at the ER in a hospital in DE and being pronounced dead, and subsequently the morgue attendant noticed breathing. Im lost at this story, just figured Id share. Says per the "medical charts" she was seen for CP and ultimately had an MI, then arrested and they gave her "multiple meds" and "synchronized shocks".

You are the man!!! Thank ya!

Yeah I asked, they said they would send them to me, and here it has been like a month now. No protocols

yeah thats the only thing i found too. standard list for BLS, which is what I was looking for, but its mainly the ALS portion. Thanks for the help of course

Hey, if anyone can please help me find NY state ALS protocols I would really appreciate it. Im moving to Buffalo in a month, and have a good line up with Rural Metro so far. I really really really would like to get a head start on BLS/ALS protocols, I just cant seem to find them at all online.

I work in cumberland county. great service. Very busy though, 12 - 14 calls a day usually. Around 4300/month. Hospital based service with great medics around here. Crappy city but good burbs.

Man Vent, you sure do think nurses are the end all be all in medicine dont you? Im anxious to see your answer to the question. You seem to think that everyone else in here has to do their research, and that everyone else in here is wrong, and that you are just top of the heap. I can imagine what type of physician you must be. Type that has his little entourage of nurses saying "yes sir, yes sir, yes sir" to everything. All your little statistics and what not, they really dont mean a thing to anyone, especially when your posed with a solid question based on sole experience. Your right, the ancillary courses that healthcare providers take are just that....Ancillary, however we are all on the same page generally as far as what goes into those ancillary courses. We all (nurses, medics.....) have had to gain information in order to take those courses and have them be easy. I just think you have a thing for nurses as far as their skill and expertise, because you sincerely cannot stop talking about how great they are.

Although my opinion is obviously not as well versed as those above, it still holds true, at least in my hospital, that the nurses do very little than the staff medics do. Things as simple as starting an EJ. Once again, I said it in a previous thread that many of you had opinions on, these nurses are not even allowed to put oxygen on a patient without the Doctors consent. Now once again, hardly an experienced or educated view, but a view none the less. Does this make them less educated, we all know that is absolutely not the case, but it does show that these nurses, even though better educated, are limited in a scope of practice that pushes the paramedics scope above the nurses. Unfortunately this leaves cracks for weak, and lazy paramedics to slide through. Paramedics can, and should be able to triage a patient with any disease process. It ties in with the education recieved and the objective of a paramedics duties. Everyone has their own scope with the education to back it. RT's, LPN's..you pick. But to say one is better than the other simply isnt a basis of education, but education with scope. The nurse, at least here, is held back. Limited if you will, in his/her duties, even though they have the education to back it. The ER actually would be better employing more medics than nurses, saving themselves a buck or two, and have an even more "hands on" approach to the sick/injured ER patient. It just seems to me that the nurses (at least here, once again) are just robots, simply taking vital signs, and keeping a close eye on a patient. When the pt goes sour, the nurse simply informs the Doc, and the doc does the ordering. Again, not knocking the nursing profession, I understand that is not the case in most areas. Just saying though.

As AmboDriver said, we here as well have paramedics working triage, amongst many other portions of the ER. They triage, and if needed will fast track a patient, as well as obtain an EKG as needed, and line and lab the patient if need be. The functioning medics in the ER here are generally indistinguishable from the staff nurses usually. As a matter of fact, the paramedics are generally the only ones assigned to triage, However, Im fairly certain that a nurse accompanies them, and is responsible for their actions.

I mean honestly, whether it was an LPN, RN, Medic or Basic, anyone could have under - triaged this patient. As was stated earlier, this family is grieving, and are looking to blame someone, and they are in my eyes, correct for placing blame somewhere other than on themselves - somewhere in the healthcare system. The doctor obviously missed the big picture with this pt. two days prior. This medic has as much responsibility in her death as the clothes she was wearing - NONE. This may very well devestate this medic as well. What a horrible situation in which I hope to never be apart of.

Sounds good! Thanks for the info yall! Once again, sorry if the nurse comments offended anyone

blah blah blah...............thank you to the people who put in valuable information on this.