reaper

I have had positive experiences with Dale Dubin's Rapid EKG Interpretation, and would recommend it to anyone who is just beginning to learn EKG interpretation.

below are some free sites you may wish to view:

http://library.med.utah.edu/kw/ecg/ecg_outline/index.html

http://www.ecglibrary.com/ecghome.html

http://www.monroecc.edu/depts/pstc/backup/prandekg.htm

http://library.med.utah.edu/kw/ecg/image_index/index.html

If you have a chance to attend one of Bob Pages seminars, jump on it. You will learn what you need to know.

You can check the website for dates. multileadmedic.com

I thought all these volleys did it to help their fellow man? Now they are resigning over not being paid? Can we say HYPOCRITES!

Just for some anecdotal perspective, I have been in probably ten or twelve ambulance wrecks, of varying degrees, during emergent runs, over the years. The only time we have stopped at the scene was when we were hurt or the ambulance was disabled. Not once has there ever been any problem with this from the police or our administration. In fact, it has always been policy to proceed.

Of course, your mileage may vary.

Well, if PD is on scene already, then they know what happened and it would not be leaving the scene, plus you have notified dispatch. Roll the window down and inform PD that you have a critical Pt and you will be back after you are done. As stated, if you get out an assess, you then have abandonment. Your first obligation is the pt in the back.

Now, if there were serious injuries, then that may change the scenario.

Well, I've never worked in michigan, nor held a michigan license. However, here the law is very clear about what is permissable and what is not. They say if you do not have an active license by midnight day of certification expiration, you can not work. There are no extensions granted, no exceptions. There have been issues with some people trusting their training officers to turn in their certifications and maintain them and well, there has been more than once where certifications were dashed in on the last day the office was open in a depserate attempt to get them processed. I do recall one service having 13 employees which were off duty at midnight and continued that way until the 10th of January when their license expired the 31st of Dec (offices were closed from the 18th of Dec to the 6th of Jan for the holiday). They trusted their training officer to turn it in, and he didn't and they were without work until they got a new license (licenses required to be postmarked by 31st to be valid, but can't operate past that date if no cert in hand). Here you can be charged with practicing medicine without a license criminally in addition to the actions of the disciplinary board.

If the situation truly is as the OP says I would agree with him - I wouldn't be working for that service. Anyone that is willing to risk patient safety and skirt the requirements of the state is questionable and that is exactly what is happening IF things are as he said they are. Though, there are two sides to every story. I would have walked away as well - there are plenty of other places to work that are decent - don't waste your career on a place that might you your cert taken. I'm not sure if michigan permits anonymous complaints (I know you can't here), but anyone can fill out a complaint form with the info from a citizen to a person on the service and send it to the disciplinary board. It then goes to an investigator who interviews all parties involved, gets the story and it's presented to a preliminary inquiry board who decide whether there is enough evidence that something detrimental was committed - if so, then a complaint is filed with the attorney general and the legal counsel and the person has two options. They may either accept a proposed agreement (with wrongdoing always admitted and publicly posted - may be anything from a private letter of reprimand to revocation of license) or go before the board and fight it (with the typical result if they lose of suspension or revocation of license). It may then be referred for criminal action if applicable and decided upon by the board. I would definitely send it in to be investigated and let the board handle it from there. It's their ball game and worst case scenario, he's investigated, found to be okay no harm done, but if there is wrongdoing, then tough stuff for him and you've protected future patients.

Did everyone fail reading comprehension in high school? Both Lonestar and Vent Posted the Mich State law on this. You are allowed to work, while in the 60 day grace period. So the person is doing no wrong, yet!

The OP may have been wanting to do the right thing, but they need to know and understand the laws in the state they are working in first!

Ok, just been thinking lately, and how there is the main placement of paddles for defibrillation of sternum and apex for your general defibrillation and cardioversion etc, what do you do if you have a patient with Dextrocardia (Heart facing the right hand side)?

Do we still go for the paddles in their usual spots.... and hope we get a shock through.... or do we modify the placement of the paddles. I have been talking to my cardiac nurse educator and she was saying it is something that medic alert makes a bracelet for so if we came across it, do we need to modify paddle placement, hand position for CPR or go with what we know and hope it works?

I know it is rare and probably has never been encountered, but am just curious what would you do if you were presented with a cardiac arrest on a patient who'se medic alert tag said they had Dextrocardia.

Thanks and here is an xray image of Dextrocardia to reinforce the topic...

Scotty

I would think that hand placement would remain the same. Reversing the pad placement would be better, to ensure the electrical pathway remained the same. This is something you would need to bring up o a cardiologist!

I couldnt agree more, EZ IO is the forefront but the BIG would be great as a backup that is rarely used. I have had my share of IO's that did not make it deep enough in the bone, however, never had the second shot not make it. If i have to go for a second shot ud better be damn sure im gona make it work.

Has anyone ever tried it into the humerous? I have been toying with the idea in my head lately but havnt met anyone that has also tried it. Im curious, but at the same time kinda hesitant....

The Humerous should have been part of the training on the EZ-IO. It works extremely well.

If the battery dies (highly unlikely), you can still insert the EZ needle manually like a regular IO.

Chill out homeboy, I to have a two year degree, I just don't think we need the registry to pursue higher standards in this field. As long as people volunteer EMS will never go anywhere. Fire departments are the least of our worries, Do I think that I need a glow in the dark patch to tell an employer I worth an extra 50 cents an hour, No my degree and experience whould give me an extra 50 cents an hour or what ever low paying wage I so choose to go for.

All that and still couldn't pass a simple test?

Let's see, this might be hard!

Gloves

Partner

O2

Ambulance(stocked)

Cheetos

Mt Dew

My system has been trying to implement a priority dispatching system for some time now. Is anyone currently working for or have you ever worked for a service that uses a similar system?

What are the pros and cons?

If you had a lot of experience with the system please message me.

A lot of systems are using it. I have never seen anything bad come from it. It does cut down of the number of L&S responses, so that is always a good thing. You still get the low level calls that slip through, due to "Just being careful" with the response.

But , I see no cons to it.

If someone ever decides to drop off a new car as a thank you, then my partner can suck eggs. It is all mine!!!

Mrmeaner-

Physio is all we've ever used so I'll admit to having a bit of a knowledge deficit about the MRX. Can you enlighten me as to what you think makes the MRX superior to the LP12.

I have used all kinds. I prefer the LP12 over the MRX, but that is my personal choice. Do not get me wrong. There is nothing wrong with the Phillips, I just like the LP better.

I hate the Zolls with a passion! I really hated our old HP Code Master. That thing would read a NSR on the bench seat!

There's one thing that everyone seems to be forgetting here.....

Emergency Response Vehicles that traditionally respond in 'hazmat areas' MUST be equipped with diesel engines. That is FEDERAL MANDATE.

Since diesel engines do not have distributors, spark plugs and spark plug wires (obviously they don't require a spark for combustion), there is less chance of a diesel motor igniting vapors that have reached the 'explosive range'.

Do you have PROOF of this statement?

If a gas engine is properly maintained, there is no issue. The spark is a closed system and no chance of igniting outside the combustion chamber.

On a separate string, there is a discussion on the (alleged) virtues of diesel versus gasoline power plants in ambulances, as Ford is reintroducing gas powered V-10(?) engines for the 2010 model year.

This might be better answered by personnel who have more than the basic Hazardous Materials Awareness level of training, which is where I currently am at. I admit to not really knowing much about any car/truck engine repair, but presume I am not the only one with that particular educational lacking.

Someone on the string mentioned that, in a potentially explosive atmosphere, it was under a federal mandate (in the United States), that Emergency Response vehicles should be diesel powered, as there is danger of the spark plugs and/or electrical system of a gasoline powered vehicle igniting explosive fumes.

1) Could someone give both quote and link to this mandate? I have never heard of any mandate like this. Most use diesels now, due to longevity issues.

2) Could a plume of a potentially explosive vapor be triggered into an explosion by some random spark inside a gas fueled engine? Not really. A spark from something else can set it off.

3) Could such vapor plume cause an explosion by being sucked into the air intake of a gasoline powered engine, and "flash back" through the air intake from the spark plug inside the engine? In easy terms "no it can not" Once the intake valve closes, the combustion chamber is sealed. All spark and combustion is trapped in the cylinder, until the exhaust valve opens. to let it out.

4) As diesel engines use a non sparking gizmo called, I think, a "glow plug", referring back to question 3, could the diesel engine cause an explosion via the air intake, as previously described? Same concept as above. Diesels use no open spark.

4-A) If it isn't called a "glow plug", could somebody tell me the real name, and how diesel engines generally work? Yes, it is called a glow plug. Diesel fuel ignites from heat and pressure, not spark. A glow plug is only used on initial start up, to warm up the combustion chamber. Once the combustion process heats the chamber, it will continue to ignite the following combustion sequences.

As always, in questions like this, asked by your humble servant (yeah, riiiight! the man, the myth, the legend in his own mind, HUMBLE?), I thank, in advance, any and all who respond with legitimate answers to these questions.

These are simple answers to your questions. You can google diesel combustion process, if you want a more in depth read on the subject.

Perhaps you are just spouting off on things you know nothing about. Certs aren't issued based on personality. To get that revokesd, you would have to actually do something wrong. You go on believing that! Piss off your MD and see how fast they can get the state to pull your cert!

Perhaps its the people in EMS that kiss the ass of every patient and allow them to abuse the 911 system that gets everyone else burnt out. If EMS still stood for what it was meant to be in the beginning and we didnt put up with the frequent flyer shit, EMS would have a better name for itself. As far as working at McDonalds, Sorry, that doesnt fit my schedule. I enjoy only working 10 days a month.

Ask yourself, how many people that get into EMS actually stay in it once they are burnt out for any other reason than the schedule it has???

I could care less. If they are burnt out, then they need to leave EMS. You sound like you are on you're way there?

As stated, If you don't like your services policies, then leave or fight to change it. I can see you as the type that takes out their frustrations on the pt?

Has anyone used it in trauma, spinal injury?

We used to use it in suspected spinal cord injuries. But, there is no evidence that it helped much, so they stopped using it for that.

Like RR stated COPD and Asthma, it does excellent in reducing swelling. We use 125mg too.

By not having a consistent policy it opens you to being accused of discrimination on which ever of those grounds they choose. If you say yes to me a calm white person but tell the hysterical Mexican no in court it becomes you denied because they were Mexican.

The one thing you will learn in this job is you never make any decision, unless you can justify your reasons!

To many in this field are afraid of the almighty law suit. You can not live your life or work this job, if you are afraid of being sued over everything.

Back up your decisions and you will be fine!

my company is well aware of how i feel about things. I am not one to sit back and let my thoughts be unknown. The difference between me and most, I can put on a pretty dam good game face when dealing with the public. It's easy to full idiots into thinking you truly care what's going on in their life. This job is like any other job, its not more special, or more fulfilling. Its a job.

Even though we know that you put on this display, to look like an idiot here. If you truly thought that way. I would not only fire you, but push to have your cert revoked.

For you to come on a public forum and spot off like an ass, does nothing for EMS. If you truly feel that way, McDonald's is always hiring!

You that say decide case by case are opening yourselves and your company to discrimination law suits. You either have to live be set standard one way or the other. Case by case leaves to much open to scrutiny. This is why you should be consitent in patent care, documentation, etc. If taken to court you can bet the lawyers will be looking for any inconsistency so they can hang you.

Mateo the harm and danger far out weighs the mental comfort. That 90 miles leads to a lot more being done and you do not want to have the driver or the medic with the patient having to fight with the family member. I do see your point but disagree.

Again Tats are not comparing apples to apples, more like apples to watermelons.

There is no such thing as a Discrimination law suit, unless you are making that decision based on race,gender, age or sexual orientation. If that is influencing your decision, then you need not be in this job.

Sounds a bit like the story of "Two One 'Deli'".

Back between 1985 and 1990, the crew of NYC EMS ambulance "21 David" was on a meal break, at it's assigned street corner in the Bronx. They had just gotten back into the ambulance, and had just unwrapped their sandwiches, when several people ran up to the team, requesting assistance for a victim who had collapsed in the street, with CPR being administered to the victim. The crew actually was able to see this from the ambulance.

The crew responded, "We're on meal, call 9-1-1".

The crew then declined to help the person, and in the delay for another ambulance to arrive, the patient died.

When the newspapers picked up on the story, they printed the "shop number" on the side of the ambulance.

The crew was placed on patient contact restriction, meaning they could not work in the streets, or get any overtime, even if they wanted any. They actually were assigned to a small EMS "collectibles" store in the back of EMS headquarters, and the other 2 crews as well as the team's partner who was scheduled off, placed into a different vehicle, and given a different street corner to wait at between calls.

The ambulance actually was kept at EMS headquarters in the Maspeth section of Queens, for a month, in fear that any crew seen in that vehicle would be believed to be the involved crew, and possibly have an attempt of some form of "Street Justice" done to them.

Don't hold me to this, as my memory might be faulty on this, but, after a Departmental trial, they were fired, and the New York State Department of Health canceled their certifications.

The reason for the title "21 Deli" is a different phonetic for the "D" letter designation.

I just think it is great that they get meal breaks! Think of all the money I could save, by not having to leave before my food is ready!

None of that is our problem!! They let their choices go out the window when they or their family activated 911. Now don't get me wrong, they can refuse any kind of treatment that EMS may want to do, but what you are talking about in your post is a hospital problem, not ems. If they are old and senile, then they aren't going to remember anything that goes on and if it is a cultural issue, then, sorry, but we have a job to do. And when it comes to children, parents tend to make the child more aggitated because they cant control themselves. Regardless how you want to look at it to justify somebody riding in that is not seeking medical attention, we still have a job to do and we need to cover our own butts. So what if their feelings get hurt or they get offended, at least you will still have a job. There's nothing that states that we have to allow anybody to ride in.

When you actually have any EMS experience, then come back and debate!

I have never had a parent freak out in my truck, whether up front or in the back. If a parent is emotional, then I explain to them that they will not be aloud to ride, unless they can control themselves.

When I transport children, I usually have a parent in the back. It helps keep the child calm and I can get any info I need from them. If I suspect a problem, then they ride up front or follow along. If it is a serious call, then they can ride up front, they would be in the way in the back.

Same goes for elderly or someone that does not speak English.

You need to use common sense and get off the high horse of authority!

Ha ha, where is the kitchen sink?

I read some of the comments in that thread, and I agree when someone stated that for that amount, they should of had an AED in there.

This is the scary part!

10 x Tramadol Hydrochloride (Ultram) 50 mg

12 x Oxycodone (Percoset) 7.5/325APAP

12 x Hydrocodone (Vicodin HP) 10/660APAP

12 x Hydromorphone (Dilaudid) 8 mg

12 x Morphine Sulfate (MS Contin) 15 mg

8 x Ibuprofen (Motrin) 800 mg

12 x Promethazine HCl (Phenergan) 25 mg

14 x Levofloxacin (Levaquin) 500 mg

14 x Ciprofloxacin (Cipro) 500 mg

iGo® 6 Compartment Plastic Travel Case, Hinged-Lid, Blue, 2.5" x 3.5" x 1.25"

He states that this was all obtained from Dr's, for personal use????????????????????????????

Added question...

If you have 2 quiznos in your town, can you make two copies of this certificate?

Firehouse subs, by far the best out there!!!

Hey everyone, just got back from the NREMT practical. I actually did fine on the orals. Knocked them out of the park. I did them like I did a call and all was well with the world.

That doesn't mean I passed completely. I have to retest on the pediatric IO, pediatric ventilation, and adult ventilatory management. Now, you may pause and ask yourself, "Is asysin2leads really such a doofus that after being a paramedic for five years that he still can't figure out how to intubate and how to do an IO?" The answer, I assure you, is NO. The other answer is yes, I did study the skill sheets. Approximately 8 hours a day for the past three weeks I have been reviewing. I am not sure why they failed me on the stations. I know it is nothing in any text-book, skill sheet, or CME I could get my hands on that I missed. I do know that the reason I failed the KED station the first time (told ya), is because I put the middle strap on first and not the top strap. Yeah, apparently in their neck of the woods, they put the top strap on first, not the middle strap, and that's reason enough to fail your sorry ass on the random basic skill if you put the middle strap on first. Yes, I know the manufacturers instructions actually say there's not really any order to put the straps on, but what can I say. Given that experience, I can only assume their was some BS local idiosyncracy that I wasn't doing on the other stations that failed me. I would also like to take this time to voice my opinion that if the goal of the NREMT is to provide a standardization of EMS throughout the country, they are not doing particularly well, as their skills testing still allows too much wiggle room for the testers to throw their own little interjections into the testing. For instance, if on your skill sheet, the criteria simply states "Secures the torso properly" and you never spell out what "securing the torso properly" really means, then it is up to the local testing agency to decide what that means. Now, if you are the paramedic student who has been training with said testers for the duration of their curriculum, knowing exactly what they want is not a particularly difficult goal to achieve. However, for the paramedic who comes in from a different area to do your testing, it presents a bit of a challenge to psychically mind read the testers to know exactly what they want. Yes, I am a little annoyed. Just a little. A smidgen.

I feel for you man!

I did mine last year, after letting it laps years ago. It could use a lot of improvement on how it is set up and ran.

I failed Adult airway the first time. For all things of forgetting the "BSI". I was not happy. Had to drive 6 hours to retake one station. They would not do retake that day, because the NREMT rep had to leave. Even though we finished 3 hours early!

Just retest those stations, get it out of the way and never let it expire!

Maybe we should just trade in our ambulances for horses, and I do mean horses, then we don't have to worry about mvc's or what lane to travel in/pass in, just try not to get run over by a semi!

We would get even more injuries!!

Can you imagine all the drunks falling off their horses. That is a long fall!

Get her to a sports medicine clinic where the physical therapists know something about this type of injury. That's the best advice you'll get.

'zilla

Yes, her Doc should have sent her to a PT. She needs correct rehab or she may injure it again and beyond repair!