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medic511

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  1. Yes, I think Just Plain Ruff's advice is a good starting place. This is a question neither you nor any of us can answer until you (and we) understand what he means. In preparing for that conversation (or evaluating it later), you would be well-advised in my opinion to review the closely related but very different concepts of compassion and empathy. they are different but related. Like so many things in life and especially in EMS, too much of even a very good thing, can become a bad thing. Using compassion as an example, it is a good thing to calm a worried, excited, and ill patient. It helps you get the info you need for a quality and accurate assessment. If the core complain is, for example, a twisted, dislocation, or fracture, and you are so compassionate that you stop your lifting or splinting every time the patient cries out in pain, you will actually cause the patient more intense and longer lasting pain than if you are less compassionate and plan your move fully with your partner, realize in advance that this will hurt and decide to complete the process in one move. Then there is the matter of time. Too much compassion may lead to longer on scene times, which is fine for minor complaints when multiple other response units are available. But, if the patient's condition is more serious, what they need is a quick (but still safe) ride to definitive care at the ER. When your patient has a relatively minor complaint but your system is out of resources and has calls holding, or is likely to have calls holding unless your unit gets back in service, then you have to also add the needs of those (perhaps not yet individually identified) patients into your overall decision. Finally, your employer also has an interest (that to me is a legitimate one to some degree) in seeing that you are not "unnecessarily" taking up either your time or the time of your patients when your patients are in fact your employer's customers (patients you are being compassionate with are also not spending money and, to be frank, compassion usually feels good, so it CAN be tempting to some providers to spend a bit too much time with talkative patients that are enjoying your supportive attention, which is another one of those too-much-of-a-good-thing situations.) Professionalism requires a good balance in all things, which is much easier to state in the abstract than to pull off in reality. Good on you for showing compassion! That alone gets you well on your way.
  2. Medic511 here. I have been a member here for a long time but not very active as a poster. Your question lit a fire under me today because of a local issue here that I had, in almost 20 years as an EMT and Medic,yet actually to see stated in writing. The manager of ALS EMS in this county yesterday actually sent out a memo/email that says we should save for reuse N95 masks and gowns unless they are visibly contaminated by blood or poop. I understand that it seems that our country or its government has been remiss in stockpiling an adequate reserve of PPE. But this seems to me like an outrageous plan to address the situation. On the first evening of my first EMS course (it was then called First Responder), I was taught about the fundamentals of Universal Precautions, BSI, and PPE. For twenty years I have followed that practice and as I became more involved in Instructing, taught it to 1,000s of students at all levels. As a National Registry examiner, I failed those students who ventured into a scene that they had no verified as safe. Donning a mask previously used during assessment of a suspected or confirmed COVID-19 patient cannot in anyway be said to create a safe scene even it it does not have any visible blood or poop. Similarly, taking a disposable gown already used treating a potentially contagious patient from a paper bag and donning it just because there is no blood or poop on it visible to the naked eye is a safe practice only in the eyes of an untrained or callously indifferent bean counter. As you can probably tell from my language, I am appalled, frightened, and devastated by the panic that must be behind this directive. Universal Precautions have kept me healthy through hep-c, HIV/AIDS, Swine Flu, and ebola and I have never been reluctant to assess, treat, and transport those patients. But I do not see how I can justify the risks of seeing possible SARS-CoV-2 patients wearing used disposable masks and gowns. My fire chief? Oh, yeah, he says he is convinced that "this is just a bunch of bull poop being spread by the media, and not something to worry about." Somehow, that scares me far more than the directive.
  3. I am a National Registry Medic certified in Florida and will soon be moving to the general vicinity of Jacksonville, Florida, due to the relocation of my significant other. I understand that Jax city and Duval county are combined and EMS is fire-based. Other than that, I am sadly naive about what agencies provide what EMS in the area, what continuing education opportunities may be available, and such things, in neighboring counties like Nassau, Clay, St Johns, and Putnam. Any info would be appreciated. Thanks.
  4. The surprising answer is, when the "medic" works for the National Park Service. Being a federal agency, the NPS does not feel that it is necessary to have their EMS personnel be licensed or certified in any state and they just rely on National Registry status. But things get really confusing because the National Park Service's official title for NREMT-I's is "Park Medic." (NPS RM-51 at Section 6.3.5) So, when dealing with the National Park Service, it's necessary to remember that their "medics" aren't paramedics at all. The Park Service does, however, call NREMT-P's "Paramedics." So. I guess the Feds would like us to stop calling ourselves "medics" and start calling ourselves "paras." In the meatime for a quick, painless upgrade from Intermediate to "medic," just join the National Park Service.
  5. NIBP stands for Non-Invasive Blood Pressure. That is, as opposed to an intra-arterial transducer placed inside the artery by an MD such as used in the ICU, CCU, etc. Manual BPs are also NIBPs. So, ALL EMS BPs are NIBP but they can be machine or manual. (The button on the machine often says NIBP).
  6. From my perspective, we are really looking at a combination of ideal/textbook on the one hand and practical/in-the-field on the other hand. "Best" is meaningless until defined: most accurate under all conditions is one thing and which is in the patient's best interest in the existing circumstances may be quite different. So, you have to know, IMHO, if the call is a trauma with major MOI on the one hand or a probably minor medical with a not-likely-life-threatening NOI on the other. I don't think that a properly taken BP over a loose (neither really tight nor really bulky) shirt or blouse will vary significantly from one taken at the same time, same situation but with the single layer of cloth removed. IF the clothing bunches up around the upper arm, you are much more likely to get a bigger variation than you would had you left the single layer of loose but not-bulky clothing in place. I personally STRONGLY prefer a manual initial (or soon thereafter) BP but I really think that it's more because I get a better "feel" for the patient's overall condition. I have found that properly taken machine readings are actually more CONSISTENT in difficult conditions (usually noise related such as on-scene radio chatter or en route road and siren noise) as compared with readings taken by different personnel manually. ANY unexpectedly high or low machine readings should, IMHO, be immediately confirmed by manual readings and I like to use the other arm because its quicker and kind of has a built-in check for whether is this a unilateral rather systemic issue. Regarding the ECG lead placements, my initial observation about varying with circumstances is still true but maybe less important. The clinically "best" locations in a still room, with a patient without muscle tremors, and in an environment without problematic radio or electromagnetic interference, is clearly the just proximal from ankles and inside of wrists. However, in a moving vehicle, in an electrically noisy room, or with a patient that has continuous tremors, these placements will frequently increase the artifact (that's the meaningless random noise), which makes manual interpretation harder and thus less accurate. Machine or computer interpretation can filter out much of the artifact and thus better placement MAY result in a more accurate interpretation even though it also brings increased artifiact. Regardless of location chosen, you will improve results by (1) making sure that the locations are bilaterally symmetrical (that is not right clavicle and left wrist) and (2) making sure that the location chosen is backed by solid masses (like bone) rather than bouncing muscles that produce electrical impulses that are unhelpful (i.e., noise). Just remember, time is blood and muscle and brain, so DON'T waste time when it's critical trying to get the "best" or most "accurate" pressure or waveform. Your patient may be "best" served by a quick and sufficiently accurate assessment to get enroute quickly to the most appropriate facility. A few or even several millimeters of mercury or a few degrees of axis deviation really don't matter in the pre-hospital setting. Especially with BP, the trend is FAR more significant than the actual numbers as long as you are in the right ballpark; thus, consistency is often more important than absolute accuracy.
  7. I have been an AHA CPR Instructor for years but only recently am I teaching with new department and I now need to provide "disposable" supplies which includes a new one-way valve for each student along with a mask (ideally, the BVM type without the B&V!). What is the least expensive reliable source of supply? Thanks for suggestions.
  8. Leener77 makes an EXCELLENT point here. The quality of care that the patient gets in the bad depends at least as much upon the skill of the driver as upon the skill of the attendant(s) in the back. The best damn medic in the world can't do the best job possible when they are having to hold on and are fighting to avoid being thrown about in the back. Leener77 makes an excellent and most valuable part of the "care team."
  9. From a "liability potential" (as well as from a good-of-society) point of view, that is a REALLY bad policy. It shows an abuse of discretion. Failing to use any judgment is the worst case of bad judgment. Lights & siren ("running code") always increases the risk to ambulance personnel and the general public. Therefore, running code to ALL calls amounts to taking risks without reason. "Code" response should be used only when, based upon information actually available at the time, it seems reasonable that the added risks of running code are outweighed by the patient's circumstances. So, we should run code to cardiac calls and SOBs, but not to minor injuries and nausea calls. Sure, it's always possible that the nausea is really a stroke in progress, but until there is information that would lead a reasonable EMS staffer to believe that, it should be a "routine" response. That does not mean stopping for a soda at a convenience store, but it also does not mean running code. The sad part is that your protocol requiring a code response to ALL calls was probably written by someone who thought that it was guarding against the possibility of getting sued when your agency responded routine on what in fact turned out to be a critical call. But that myopic thinking is just creating fodder for the lawyers; protocols need to address all the competing risks and suggest, direct, and require sound judgment.
  10. That's certainly true, but neither is providing ambulance transport. If the Feds want to be be involved in clearly local issues like EMS transport, then they should certainly be willing to provide other, clearly less-local functions within healthcare, like universal healthcare. Of course, I guess "emergency transport" is a lot "sexier" than boring old primary healthcare. That's EXACTLY my point. Transport IS immediately available by local ambulance. Always has been. Seems the NPS and the citizens they serve would be better served by the Park using its limited resources to perform their primary functions, like traffic control and enforcement, accident investigation, backcountry policing, search and rescue, and -- how quaint an idea -- interpretation and education about the Parks and their natural and historic features.
  11. Thanks for all the input. This is NOT a case in which the Park necessarily provides better or quicker care. Response times are about the same, depending on where in the Park the calls are and where the Rangers are in the Park when paged. The town limit and the Park boundary are the same line, so it is NOT that our EMS comes from the hospital -- quite the opposite, it's more like a straight line with the hospital at one end, the Park at the other end, and us touching the Park but between the Park and the hospital. I guess it's a political issue but it is so contrary to what the Founding Fathers envisioned 230 years ago. (The federal government providing a uniquely local service and one that is already being adequately provided locally.) Golly, if only the Feds were so interested in universal healthcare.
  12. Not if the military base ambulance is transporting military personnel but if the base ambulance began transporting non-military patients from auto accidents that occur on a State Road that just happens to pass through the base, then, yes, I would. Are you aware of any other National Parks that transport sick/injured visitors for pay?
  13. I am hoping that someone may have some information (or at least research suggestions). I work for a small, rural EMS organization in a western state and our town is adjacent to a National Park. In years past, when a visitor was injured or became ill inside the National Park, we always did the transport to the nearest hospital (about 40 miles away). Transporting patients out of the National Park was about 50% of our annual call volume and revenue. Now, the National Park has purchased a new ambulance and is transporting injured and ill visitors in-house and, we are told, billing the patients for its services. The Park's "ranger medics" are all National Registry but they do not "bother" getting a state-issued "certification" because "as federal law enforcement personnel, they don't have to." I suspect that much is probably true. However, I am uncomfortable with the concept that the Federal government can spend taxpayer dollars to buy an ambulance and take over the transport of sick and injured Park visitors to a hospital 40 miles outside of the Park and then bill the patients, all in direct "competition" with local EMS. What do you folks think of this? Is this common with the National Park Service?
  14. I agree with the others that your IV and EKG skills (while GREAT to have) are less important in terms of being well prepared for medic school. I think that some form of A&P would be a really big help, and would in effect get you off to a running start rather than bogged down early on. Personally, I would get a "programmed learning" medical terminology book and really learn those latin and greek roots and suffixes. A couple weeks of hard work on that will make learning the A&P that you will need in medic school MUCH easier. (Note I said "medic" school not "medical" school!) A "programmed learning" book is one that has two or three paragraphs of new info, then a series of fill-in-the-blank sentences that repeat, refine, and build upon the initial few paragraphs. You take small bits and you use the new words yourself, learning the spelling (and hopefully pronouncing them to yourself as you go along). An on-line unabridged dictionary (or a CD-based medical dictionary) will really help because you can have the computer speak the words for you and that way you will SOUND like you know as much as you really do and most of us learn vocabulary more easily when we can "hear" the word as well as spell it and read it. The "speaking" dictionary that I used was the unabridged version of Merriam Websters on-line (it costs a few dollars a year) and it really helped me. Once you have the basic word roots down, you will have so much less trouble understanding rhinorrhea and diarrhea and all those -ostomy, -oscopy, -otomy, et cetera. Really! Good luck you are going to be a great medic; I know because you are planning ahead.
  15. EVOC (emergency vehicle operator course) is a US-DOT curriculum course and, as taught in Fla anyway, is more or less two days, one day (or evening) in the classroom, then another day on a driving course. I think the concept of a "course" was good but much of what is taught does not translate into safe or patient-helpful skills. You learn how to check fluid levels, tires, etc. Stuff that most adults know anyway. You also learn some of the physics behind vehicle dynamics, like coefficient of fraction between tires and wet versus dry concrete, etc. You learn how to back up, and follow a marshaller's directions, and stop within 12 inches of a cone without touching it. All good skills, but not the real meat in my opinion. The real "meat" is learning that when running code and there or two vehicles in front of you, it is likely that the farthest from you will pull over to the right and the one right in front of you will pull to the left to pass the first vehicle, just about the time you are trying to pass it. (A common cause of wrecks.) You will learn that the vehicle right in front of you that has not shown the slightest inclination to yield to you is probably operated by a nearly deaf, half blind dear old lady who is now frightened ^&*less by your lights and siren and so she slams on the brakes. In terms of patient care, you should learn that in almost every really life-threatening critical call, smoothness in back is preferable to speed. This is because if the patient is really critical, may interventions are likely needed and the caregivers can't do well when they are holding on with one hand and fighting gravity and centrifugal and other forces. Gentle acceleration, a smooth transition into braking, and gradually letting up on the brakes when braking is no longer needed are essential. Easing into and out of curves helps greatly too. As the driver, think of a raw egg (still in its shell) sitting on a book lying on the cot. Drive like you need to keep that egg sitting on the book. You know that many drivers are idiots, many are yapping on their cell phones, arguing with their spouses, and that some are substance impaired. You have to plan and expect them to do the least helpful, most stupid things. They guys and gals in the back are responsible only for one life, as the driver you are responsible for the lives of the patient, all the caregivers in the back, your own life, and the lives of each and every driver, passenger, bicyclist, and pedestrian you pass on the way to the ER. Like the other guy said, I learned all the real "meat" of driving an ambulance from my partners not in class.
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