PRPGfirerescuetech

Job #1: 3 bachelors, working on a masters...

Job #2: Masters....

Job #3: Bachelors....

Job# 4: Masters

Job #5: Nothing beyond EMS cert...he yelled the loudest when they fired the last guy...

As the resident Philly / Montco / Bucks / Chester / Northhampton basic...allow me to make a few suggestions.

1. Dont plan on a 911 gig off the bat. Give that a year or so, roughly.

2. Try city transport companies, ill send you a few links with good contact info.

3. If your interested in heading into the counties, try a few squads in Buckswho do both transport and 911. It will be the resume notch you need to get into the bigger systems and better paying jobs.

PM me with questions

yes, there were spelling errors in my last post im noticing. Im tired, and dont care enough to fix it.

See yall tomorrow...

PRPG

One thing that always strikes me when vs-eh? posts on the topic of God is that he is always careful to capitalize God and He when appropriate.

He may not have respect for my God, but by doing this he seems to show respect for my opinions. When did we decide that disagreement equaled disrespect?

I have faith in a higher power, that has no basis in logic, that I can't represent to him with even the shakiest scientific evidence....

I have evolved to the point of having faith. If he didn't follow a similar evolution then his believing in my God is certainly equivalent to my worshiping his car keys.

(I might be able to fake faith in his car keys because everyone else seemed to have it...but would also refuse to do so)

I believe you learn faith, you don't choose faith. I appreciate his opinions and his logic, though I wish spirituality for him...it just doesn't compute for everyone....

(sorry vs-eh?, I was going to capitalize "car keys" to make the point but couldn't bring myself to do it)

Dwayne

Dwayne

AMEN Dwayne!

Disagreement does NOT equal disrespect. This discussion is a simple debate of beliefs, and to suggest disagreeing with your beliefs is a disrespect is a sign of a lack of solidarity in the foundation of the bliefs your faith is built on.

Side note. Im on a 24 at a slow squad tomorrow, so i will have the time to present the non anectdotal fact in LONG...TEDIOUS....format for you all to enjoy, to back the basis of my opinion, wghich i stated in the page 1 of this thread. Look forward to that tomorrow...call permitting.

Ah' sallam malakim

PRPG

First of all, I have to ask if you are the person who has the power to confront these issues ? Your employer should be following a progessive disciplinary process that ends in termination when the employee fails to improve. Your supervisors are setting themselves up for a huge problem, in that if they fail to terminate her, they will have trouble terminating anyone in the future. The other employee can say look at Miss soandso, you didnt fire her. It sounds as though they will not terminate her, so any efforts on your part are probably futile. I would look for a better employer, as employers who will turn a blind eye to poor performance, just so they can keep the schedule filled, are usually failing in several other areas. And it is difficult to change personality, which is why your employer needs a better screening process before they hire someone. But it sounds as though they are happy just to get warm-bodies in the door.

She is the supervisor.

Critical thinking scenarios for people who are often challenged by just learning CPR? These are just first aiders.

doesnt matter. theres a big difference between a video and actually performing the skills. if they can think out the simple treatments, their abilities when called upon will be more concise and clean.

we require the critical thinking from basics, and thats about the same as the first aid program. amping up education across the board is the only appropriate solution to improve emergent care across the board, be it the layperson level or not

Your a mess fella. I mean really...optimus prime? Who thinks of these things?

Count me in for a mark in the "god doesnt exist" column.

Ruff.

email me with numbers. If the proposal works ill bankroll it.

prpg@prpg.org

-PRPG

:bs: :bs::bs::bs:

Motorcycles. All im sayin.

Alot of good posts everyone. This call did go BLS, my partners reasoning being a "normotensive" pressure (regardless of the change from baseline. He was wrong, and I knew it, but i've never made it a practice to kick calls back to the ALS provider. Simply stated, if you boot it to me, its your mistake. Thats why we do QA. He'll learn. I did the oxygen thing, treated for shock and got the bleeding stopped with a pressure dressing.

My point was simple. Theres alot of ways this could have gone, and sometimes we can disagree. Did this call go ok BLS? sure. Could she have crashed out? Certainly. Theres always a varied opinion, because ALs is an ART, not a science. If it was a defined science, would we really be here?

As long as we are doing the best we can with the clinical indicators we have, in the best interest of the patient, we've done our job, and we've done it well.

Simple, yet a great posting. Ace, well done.

This piece of material is the cornerstone to every facet of

Prehospital medicine. WELL DONE.

PRPG

I already mentioned most of my management, but I also have another question for you. Because this is a new graft does the pt still have a triple lumen central line in place, if so where, and is it patent?

ACE844

Great question. Central line removed the day before.

For all those who responded ALS, please, without cutting each others modalities up, outline what your treatment regiment is going to be for the ten minute transport to the hospital. Ive got a point for this, bear with me....

PR:

If this were you and me on a truck I'd take it. Blood loss, a rate in the 70s, some BP changes on position all post dialysis would have me just slightly concerned. Even if this were a larger patient I'd still be concerned with the blood loss and lack of a tachy rhythm.

Did I miss it? You mentioned a complete treatment. How long was she hooked up?

And do I really have to guess with whom you were working on this call? I can guess, you know. In fact, I have a pretty good idea of who it might've been.

And let me guess further, she had you take it.

-be safe.

4 hour treatment.

Suprisingly, different organization, although I did chuckle at the likelyhood that she would be the one. It was a new medic, we were on our 12th? call, he saw blood and a "normal" blood pressure, regardless of change from their baseline, and kicked it BLS.

To everyone, great responses. This is a baseline call that could go either way for several reasons.

limited MICU ALS unit, EMT / Paramedic. Either the medic drives and the basic techs the call, or the medics techs the call and the basic drives.

Anticipate a ten minute transport time.

Keep in mind, im not bartering an opinion, just curious of yours (collectively)

43 year old B/F, on the 2nd floor of her residence in a rather affluent neighborhood, alert and oriented, complaining of moderate hemmoraging.

Patient began her at home dialysis treatment in her brand spanking new R arm skin graft, finished her treatment, and hemmoraged significantly (1200-1500 cc's) of a rather thin looking blood (lotsa heparin).

c/o "lightheadedness" which seems to change orthostatically. Supine in chair 134/88, 84, 99% ; Seated 126/84, 78, 98%; Standing 118/78, 76, 99%

Hx: RF, HTN

Meds: unsure

Allergies: PCN

Skin: clammy

PN: all but chief complaint.

Reports normotensive pressure 140's/90's

This go ALS or BLS? Explain your position.

XOXO, PRPG

HEAPING PILE OF UNNECESSARY CRAP.

As Azcep stated, its a pretty bow on the same old ratty shirt. Same stuff all, just another line of burecratic BS sent forth from the idiots above.

No, just a simple question. Unfortunately many people assume that if you question something, that you are attacking them or their position. I have not attacked, unless i have been attacked. I think i have gone out of my way to allow people to say their piece, even when i disagree with them. But if you would prefer that I only ask simple questions that never cause any concern or thought, I will:

What kind of wax do you guys use on your ambulance -- there is that safe enough ?

attack. Welcome to the boards. If you dont like it, wear a cup and toughen up a bit.

This is simple. You work to live. Regardless of situation. Im sure Medic Mike was there because of the wonderful staff, good municipal benefits, and attractive civil service compensation for retirement?

Just a THOUGHT, NOT THAT I WOULD KNOW FOR SURE OR ANYTHING.

sounds like we touched a nerve -- if any of that is true, why do you still work there ? I would leave the industry before i would work for someone that is unethical.

What color is the sky in your world pumpkin? Guess what, survival ahead of all else, welcome to adulthood.

GA, Be careful you don't hurt yourself with all the soapbox jumping.

My suggestion for improvement will be an elimination of all calls within 24 hours of polishing my boots. How are we supposed to present a professional image if we are forced to run into all manner of terrain and soil our footwear. Well, no more.

There, done, what do I win?

canigeta amen?

But seriously, interesting attempt at motivating EMS....good luck with that. World peace and a competent president would likely be easier to accomplish...

I posted a thread that asked what have you improved at your service ? After 100 views, there were only a handful of respondents who could cite any improvement. We are always quick to point fingers at everyone else in the world, when it comes to the failures in our industry, but in this area, we have only ourselves to blame. Therefore, I proclaim this challenge to each of you:

[/font:99b01569cd] Between now and August 31st, I challenge you to accomplish ONE improvement at your service. Please inform of us of your success, through this thread. I do not care if you just retype the daily checklist so that it is more legible -- Do Something ! Test some equipment, revamp a protocol, clean that green crap out of the refrigerator, replace that "Bambi Does Dallas" porn video with a real Bambi video --- ANYTHING -- just make ONE Improvement.

[/font:99b01569cd] Those who fail to accept this challenge, may no longer gripe about your service on this site.

Ok, your not as dumb as i thought. However, you are insane. Anyone ever tell you that?

Anyhoo, today, I redesigned one departments website, rewrote another departments infection control policy, and watched a 1/2 hour of Barneys "empathy education video" (i love you, you love me, blah blah...)

Ok im done

Hi everyone,

What methods do you use to take resp. while transporting pt's. in an ambulance. I'm having difficultly assessing them while in-route to the hosp. It's too noisy for a steth. and a lot of times I can't see the pt's chest rise or fall. I have put my hand on their chest to feel for the rise and fall, but it still is pretty difficult. any technique that you can share would be great. Thank you for your time.

Cara.

1. Get a better scope

2. Toss a pen on their chest. You can see the changes in its movement at that pointe.

PRPG

I don't recall hearing the term "selective immobilization" before but for what we are trying to refer to that works fine. Following the NEXUS criteria the doctor doesn't have to do xray, ct, or any scan like that to get someone off the board. I have also seen situations where the hospital took the word of EMS and called a level, and cases where they waited, nothing I'm sure we haven't all seen before. It all varies depending on the hospital, and tons of other factors.

Selective immobilization is exactly what this criteria were discussing is about. One could extrapolate that by using the NEXUS spinal protocol, your selectively immobilizing patients.

Regarding some of your other posts from this thread.

1. EMS absolutely should NOT be determining patient transport destination by a trauma centers class designation. This is simple kids. Trauma centers get trauma patients. It is not within any of our scopes to determine if a patient is "OK for a level two" or is "FUBAR'd for a level one". I encourage everyone to do some reading on what is required of each level of facility, and note the differences. BUT, keep in mind, delaying care for a patient by bypassing a appropriately level 2 facility for a level one will only serve to...how did asys put it...

give a greasy haired lawyer another 1000 dollar bag of coke to snort off a hookers ass.

Yeah...thats it. That was soooo classic line of the year...but anyway...

2. Call it what you want, but calling a "trauma alert" to any hospital is a good idea. Til your patient is complete BS, and your service gets the 1k bill for activating the team jammed directly in a place where it hurts...just a thought. Think it doesnt happen? PM me, ill give you the cell of the chief of the department who just went through it.

3. Your statements thus far are bordering practicing medicine without a license. Heres the thing. Performing the NEXUS protocol is great. If you do it right, its an awesome tool. Bottom line is, WE CANT DO IT. Period. First doc who hears you did it and get a bug up his behind is going to hang you for it. Lets also remember, PA BLS protocols stipulate all patients involved in MVA's and are transported are to be immobilized. This, of course, was a avoidance of liability move by the DOH, but as soon as they find out your toying with NEXUS, this is the protocol they are going to DE-cert you with...and send you off to Micky D'z patented burger flipper school.

4. Mike speaks of selective immobilization. Great idea. Err on the side of caution, and hope for the best. Not everyone needs a LSB. Everyone just keep in mind it only takes one time for a mistake in judgement to put us in the burger flipper class with commodore here.

Ok...thats all i got. Thanks for listening.

PRPG

Ok. To my PA people.

There have been update Con ed research programs in Pennsylvania allowing for BLS spinal clearing protocols, developed to mimic the NEXUS protocol. Some were sucessful, others werent. I was a part of a study at one time, and know they still run a continuing education program that teaches the principals of NEXUS, but doesnt allow for it in the field.

I can only assume pumpkin is confused possibly? Or im tired and feeling generous, im not sure.

Just the same, it certainly isnt in the BLS protocols.