temsp40

Charlie Brown .....be right back, that stupid tree ate my kite again..... P40

Rid -- you bring up an interesting theory. Has there been an impact type of study, specifically in a rural area, done on the removal of volunteer EMS systems and replacing them with a paid, regional EMS system? I ask this because I am curious, I have just finished reading the thread since I threw in my theory of the disappearing volunteer, and I am glad to see that ACE is still alive and kickin'! I am curious about this. I have to agree with the overall gist of what has been being said, volunteers do have their position with EMS, but the time that they have is potentially limited by the demands of the evolving EMS system. Is the future of volunteer EMS in jeopardy? Most likely. Is it going to be gone forever? Probably not, we will always see Explorer posts that start doing fire/police/ems things that will volunteer for the local service to gain experience and an insight to the realities of this job. There will always be some super-rural place in the back woods of Montana that the closest ambulance is 30 minutes away and the volunteer service is going to go out and help out until the paid guys arrive. Does that make the paid guys better than the volunteers? Absolutely not. Especially if you get volunteers with an interest and desire to do the best thing for the patient and paid guys (and gals) that are interested in working with these vollies to keep them on top of their game and to have a continued interest in being an EMS provider. Again, however, I still see the volunteer services dwindle into the sunset. With training requirements to keep your certification current, the additional skills required to be an EMT and the overall time away from your family is going to get old. Those that volunteer should be praised and rewarded for their efforts. Those that volunteer and pay for furthering their education should get a tax break on this education. I cannot express my appreciation enough for the volunteers. Quick aside on the post comparing the US Military with EMS -- simply no comparison. Military Service is something that you volunteer to do, the US is not like other countries that require young men and women to serve their country for a set time. The Army life was not the life for me, I did volunteer to join and was then PAID for joining. Keep it shiny side up! P40

Time for P40's $0.02...... I look at the volunteer services as a dying breed. In my area there is one currently all volunteer service left, but that is soon to be a thing of the past. The service has recently realized that they cannot count on donations to continue to operate. They are talking about finally paying their members (this service has a habitual problem of not being able to find enough EMT's to cover their ambulance.) Even the fire department that I have been on-call with for the last 13 years realized that they could not rely on the on-call volunteers to cover their ambulance 24/7 anymore. About 5 years ago they had to hire 2 full-time employees to cover the daytime calls. This has worked out very well for the town and they are now actually looking to advance the level of service they provide. Utilizing this reality, I don't think that volunteer EMS is going to last. I think that the communities that are served by volunteer services are very lucky to have the volunteers. I think the EMSers who do volunteer are under-recognized for their commitment to excellance. However, I happen to live in the United States, so as an American we are all driven by that almighty dollar, and our spirit of volunteerism does not show itself until such time as there is some sort of horrific natural (or unnatural) disaster. Even then, most people are less likely to volunteer themselves, they are more than willing to give money (loosely interpretted TAX WRITE-OFF) to whatever the disaster is. Now, no one needs to throw 9-11 at me, that was an exception to the rule. How many of us know of a volunteer that runs EMS calls and is pleased to be awoken for the 4th time tonight at 0430 for the "flu-like symptoms for 1 week"???? I am paid to do this for a living and I definitely do not have a smile on when I show up to this particular call. I don't think that volunteer services should be run out of town at high noon any time soon, but I do think that you will see them slowly but surely fade away. I know people who can't fathom the fact that some of us DO volunteer or work for on-call services, they are used to the private EMS or FD EMS service being no more than 2 or 3 minutes away, not having to wait 10 minutes for the ambulance to arrive (and that's on a good day) and these people are moving from the big city to the countryside to "get away from it all" and still expect all the exact same services as they find in the city..... Maybe they can volunteer?????

Obviously these brainiacs missed the portion of the class that instructed them to "put the wet stuff on the hot stuff." Public demonstration of stupid! Oy Vey!

If you are a separate service from the Fire Department, usually the ambulance is an excellent marker for where rehab is. Other ways that I have seen this done are working with a support agency and setting up the rehab area with them. Working with the incident commander is also key as to where rehab is and ensuring that the firefighters know where rehab is -- should be part of the overall incident command structure, the safety officer is directly responsible for ff's getting through the rehab station.

Absolutely! But it is not JUST the nursing homes.... My all time favorite call was one where I just taken a patient from the ED back (literally) across the street to the nursing with a trach patient who decided it was time to quit breathing altogether. As we return the patient to the ED, I am of course ventilating the patient BVM to trach tube, one of the ED nurses says to me "well, stop bagging her so that I can make sure that she really isn't breathing." So as I stop bagging this patient (who simply is not breathing) my little brain is racing and thinking -- ok, I know I am just a stupid little basic who works for AMR, but I can sure as sh** tell the difference between a breathing and not breathing patient, especially when I watched this one stop breathing in the ambulance I says to the nurse after about 30 seconds -- "See she is not breathing and I am going to begin ventillating her now." At which point all heck breaks loose and they start screaming for respiratory and a vent and all of a sudden the stupid AMR crew actually knew what the f--- they were talking about. I wish I had known about Bill Engval back then, because my reply would have been something to the effect of: "Let me demonstrate for you the difference between breathing and not breathing" Squeeze, squeeze, squeeze "Breathing" waiting waiting waiting "Not breathing" Here's your sign

I'm being repressed! Come see the repression inherant in the system!!

....and who said we didn't? This post is concerning the new uprising of "The other Guys" :twisted:

She turned me into a Newt!! Well, I got better.

This is just a warning to all of you! Beware of "The Other Guys" because the hang out in the woods with "The 2 guys" who will steal your wallet and allow "The other guys" to force you to consume large amounts of alcohol. "The other guys" usually hang around with "The 2 dudes", "Those Guys", "Them Guys" and occasionally "Some Guy". Please, use caution when wandering through the woods in below freezing weather because this appears to be a new time for these gangs to strike. Apparently they have moved from attacking unsuspecting teens at illegal parties and during spring breaks. If you happen to encounter a victim of attack by "The Other Guys" be sure to inquire if your patient has Monty Python awareness. This can be confirmed by inquiring: "What is the air speed of an unladen swallow?" Of course any of you are familiar with Monty Python will know the proper return question to this inquiry.

hmmm....seems like another topic altogether.... BUT -- here in MA, we have the Comfort Care DNR, the only valid thing we can use for not resuscitating a patient that requests it. I have, however, run into the living will problem and as has been mentioned here before, began a BLS code, contacted medical control and explained the situation (terminal patient in cardiac arrest with no DNR present, family wishes no heroics underaken) and been told it was ok and even a good plan to stop. CC-DNR's mean no resuscitative efforts -- BVM, intubation, Cardiac Arrest Management, not Do Not Treat -- so if the patient needs oxygen, iv therapy and cardiac medications or respiratory treatment -- have at it, take care of the patient. Also, the patient or the health care proxy (person who signed the DNR) changes their mind at any time during a DNR moment, the DNR is now void.

I have found that this is a big problem if you are using "cheap" electrodes. There are several manufacturers out there that make "diaphoretic" electrodes. I have never tried the Benzoin, but I hear it works great, I usually dry the area down with a towel or a 4X4, then stick the electrode in place -- use tape if I need to. Also, on those patients that are a little hairy and diaphoretic, giving them the 12-lead shave seems to work really well too!

First Responders on an ambulance???? There is not a clear answer that is going to keep any of us from sounding either overconfidant or bashers of all that are not at least EMT's. I think that in some instances a FR and an EMT-Basic would be a fine combination -- as long as there was NO possibility of the patient requiring intense medical care (i.e. they have no reason to be in an ambulance in the first place) or if there is an MCI or some other over taxing incident to the EMS service involved. As a routine staffing combination, I don't feel this is safe or reasonable. How many times have you gone into a scene with your partner and missed something OBVIOUS that your partner saw? How many times have you ever wanted to be sure that you partner was looking at the same patient you are (assuming that you are working with an equally experienced and certified partner), or how many times has it been just as easy to flip the coin with your partner to figure out who is taking the alcohol enhanced individual to the the hospital? FR's may inhibit our ability to do this, to have the option of not having to tech every single call that comes our way and to be able to get another trained opinion on the current patient. I for one think that if the FR wants to ride in, observe, help in anyway they can and learn from what is going on, then great. But to make them my primary partner, I think not. Now, in many communities, FR's are the PD, the FD or another organization dedicated to getting to the patient before the ambulance. These FR's perform a vital roll in patient care, many that I know have been FR's for eons and have learned some of what is going to go on when the ambulance arrives. There are other communities that actually have EMS providers as FR's because for whatever reason, they do not have their own ambulance and have to wait for the private company to send one out from the city located below them. The "Fire Rescue" unit rolls and they can do pretty much everything for the patient except for transport. Of course I think I just got a little carried away -- we aren't talking about EFR services, we are talking about certification levels as a First Responder. Again, no, I don't feel that a First Responder belong as part of a primary ambulance crew, an assistant to the crew - yes. P-40

Joshua was killed by his psychotic ex-wife Joshua was killed by the Cherokee Indians on the Little Pigeon Joshua was killed by Rafe, Caleb and Livvie Joshua was killed by a pack of wild, rabid dogs in the Ohio Valley ironically. (of course I want to know how rabid dogs would kill someone ironically.......)

Yep -- and it should be here soon -- I ordered one last year too......... Vibe I'm getting is that it is going to be something that those in charge want us to be doing community type of stuff, not recognizing those of us that make EMS happen around here.

Here is the site for information regarding EMS 2006 EMS Week 2006

Zoll M series are great to be replaced by any other defib/monitor on the market..... nsmedic393 -- I believe that once that is set up in the lifepak's then you are all set -- you shouldn't have to perform that same function every time you enter manual mode. Check with your service, perhaps they are using the option that requires anyone attempting to enter manual mode to have a passcode to access it. Zoll's do make really pretty shelf decorations, they are great when you "trade them in" and now have a training monitor, and they are blue an white......... My service had 2 M series monitors -- we kept getting a wandering baseline (the best test for this was in the middle of a grass field, at night, with no lights, people or vehicles around -- monitoring looked like you were traveling over a roller-coaster) and never got a conclusive answer from the factory reps. Of course we did get the "It can't be the machine, it's not the way your people are setting anything up with it, so we don't know." (basically tough sh** and deal with it) and decided that since Physio-Control was the common option that every service around us was using--why not become compatible with the other services? We now own 2 Lifepak 12's and have had very few problems with them.

that was great -- this must be a great hospital to take your patients to -- they look like they have a lot of fun!

hmmmmm.....making dreams come true -- I work in EMS!! the person below me has not started their christmas shopping yet.

You don't think trailer truck when dispatched to a tractor trailer accident. You often wonder if the hay baler would actually have packaged your patient. You've ever been gun shopping while on duty You know where the big oak on the corner of farmer Bob's field was. You've been dispatched to the "Old (insert family name) House" Most of the patients you transport can remember you when "you were this big"

Establish EMS command, triage all your patients #1 -- black tag -- to many resources required (at this time) #2 -- red tag -- although may deteriorate to black tag if no units in a readonable time #3 -- green -- can wait #4 -- red tag -- vitals n/g #5 -- green -- ankles are not a priority #6 -- red tag -- Cushings Triad beginning? You need a total of 5 additional units (air/ground) Patient 4 or 6 will go with the first air unit -- depending on revaluation of triage with the support units arrival. Patient 4 or 6 (who ever is left over and is NOT black tagged) will go next Patient #2 next Patients 3 & 5 will go together Patient 1 will be revaluated after either (a) all other patients transported or ( upon completion of extrication. One theme that is not being explored here is how appropriate the triage is. Unfortunately the trapped driver and the 3 y/o are probably going to die because you do not have the appropriate resources to treat them all immediately, and both seem to be requiring extensive treatments. I, personally, would have a HUGE problem deciding not to work a 3 y/o, but that is the role I have accepted as a medic. Remember -- The most good for the most people. P40

You know you s/o has accepted the fact that you're in EMS when they come and find you for the second tone for the second ambulance call that is nothing but crappola! (loosely interpreted "DILIGAF") And then is absolutely amazed when you tell them that you really need to finish this up. Or even better, when they perform the above action and then get MAD at you for going!! (WTF -- you just came and found me to tell me that there was a call -- I went and now you're mad???? ](*,)

1. All things being equal, which is your preferred method of operation on an ALS medical run? Why? I prefer to bring the first in bag, O2 with me and monitor depending on the call, assess the patient, determine if interventions need to happen "right now", initiate immediate interventions, extricate and continue treatment en route to the hospital. The why answer to this is that this is how I operated as BLS, having been trained with the mindset that I need to figure out what is wrong with the patient and why this may be wrong with the patient, something I have carried with me to the ALS side of this profession. 2. Does your agency have an SOP covering this? If so, what is it? Like many of the other posters here, 10 minutes for trauma and 20 minutes for medical 3. Did your instructor or school ever tell you which way was the "right" way or the way you should do it? Yes and no. I have been trained to assess my patient and decide if I should be initiating treatments where the patient is found, or if things can wait the 2 minutes until we get to the ambulance. 4. Does everybody in your agency operate the same way, or does the controversy still divide the profession? Not everyone works under the same mindset. Some prefer to get the patient the "F" out of the house/apt/vehicle and into the ambulance, others play around on scene too long, without adequate explaination. Dust, I hope this adequately covers your request for answers! P40

Ok -- perhaps I misunderstood you with this. I still do not like to rely on a machine to get important information such as a BP. Auto-BP's are great if you are in a "stable" environment I am sure, coupled with a whole lot of maintanance and support options and backups when it goes down. How many of us have run into the BLS provider who relies solely on a machine to take their vitals and doesn't know what to do when the machine breaks? Probably to many to mention. I have met another service in my area that does rely on one of those machines and takes great offense when someone asks them to take a "real" BP.

I have never used an auto-BP takerizer thingy -- mostly because I have never had the option. I personally feel that there is no reason not to take a manual BP on a patient, although yes, a machine might be easier, I think that would cause your care to deteriorate over time because you are relying on a machine to do a very basic function of EMS. I am against their use in the prehospital setting where the patient to provider ratio is usually 1:1, and in all care one must remember that good BLS skills provide for good ALS skills. Now, if you are in a service that routinely does transfers an automatic BP machine might be nice, but not necessary, I have worked for transfer services that you can do long transports (hours) and sometimes the patient is really boring and wants to sleep........ --Angelkiss, I am just curious to know, what types of BLS calls are you running where it is that difficult to obtain a manual BP? --Ace844, that is a very interesting article summary you have there, and I think it is very interesting that these machines are as accurate as the providers taking the manual BP's.