defib_wizard

I agree the remark is crass and harsh but some of us are that way. This is a waste of a young life that ended by doing something stupid. Entry into a structure on fire alone is stupid and wrong. He payed for his mistake, the only good news is nobody else was injured during a rescue attempt. As a fire Lt I can't even imagine the thing you would say to a firefighter under your command if this occurred and the firefighter was ok or had minor injuries. I bet the people on the international space station would hear you! I am also willing to bet you would use the word stupid in your rump-chewing.

This is a tragedy but please Lt don't take everything to heart.

my condolences to his family both at home and on duty.

You do of coarse realize that Johnny Gage and Roy Desoto never rode the ambulance.....right?

Yes and back then Bicarb was given in all codes and they carried enough syrup of ipecac to make a fraternity kegger party jealous.

This was also in the 1970s I do hope you have continued your education beyond those ideals.

Here's the deal Lt (its time for a reality check ) You are a firefighter and proud to be one. That is fine and I commend you on that. I was a certified firefighter but decided I didn't like it. I believe in being able to think for myself and not worry what the chief might think. I also found that I love taking care of people more than polishing paint and spraying water.

We are not going to agree on this at all. You have said over and over that we don't live there so we don't know. Your right I don't live there and because of you I wont visit there either.

You seem to be intelligent so I'm going to try this approach to you. Why not staff more ambulances with more full-time paramedics. Staff the engines with an engineer and bls personnel. They don't leave the station unless they are needed. That equals less wear and tear and operating costs. You said yourself that ems was 75-80% of your calls why not invest in it with more ambulances and more paramedics. Hey you can even use them on the fire scenes if they want to become firefighters. If not they can be your rehab and treatment sector.

If you were to hire already certified paramedics you could save all the money from the class your sponsoring and buy a few more fully stocked ambulances. Then send the ones through your academy that want to go. ( Yes I know I'm repeating myself here but you don't seem to get it ! )

sirduke wrote

because unless you are just in it for the lights and sirens,

Hopefully you lose that in your 2nd or 3rd 45minute response to the middle freaking nowhere at Oh dark-thirty

Ive worked rodeos for many years and what you are describing is very typical. Unless the person doesn't wake up they almost always walk the person out of the arena. It's part of the rodeo culture to "cowboy up " and walk it off. Usually though they don't let you near the pt. More than one time I've seen a competitor get injured, bandaged up, and still compete. Then be called back after the rodeo to pick up the injured competitor. Now in severe pain. Or they went to the hospital in a pick-up truck and now need a ground transport to higher care. My personal favorite is when they walk them to your rig with neuro deficits and still don't want to be immobilized.

Good Job!

Many years ago my wife and I used to let our daughter sit in on cpr classes and practice it even though she was too young to get a card. One evening I was talking to my wife on the phone while they were eating dinner. ( I was on duty five miles away at quarters ). When she began coughing then dropped the phone. I yelled to my partner we need to go because it got quiet on my end of the phone. When my 10 year old daughter got back on the phone and said " mom was choking but I did the heimlich

( I think she said hiney lick ). She's breathing now and will call you back. THEN SHE HUNG UP! :shock:

This was before cell phones were available in our area so I stayed put and my wife called back and told me what had happened.

The life they save could be yours teach them well.

Two rednecks were looking at a Sears catalog and admiring the models. One says to the other, 'Have you seen the beautiful girls in this catalog?' The second one replies, 'Yes, they are very beautiful. And look at the price!' The first one says, with wide eyes,'Wow, they aren't very expensive. At this price, I'm buying one.' The second one smiles and pats him on the back. 'Good idea! Order one and if she's as beautiful as she is in the catalog, I will get one too.' Three weeks later, the youngest redneck asks his friend, 'Did you ever receive the girl you ordered from the Sears catalog?' The second redneck replies, 'No, but it shouldn't be long now. I got her underwear yesterday!'

Okay my turn at seeing who I can tick off! I agree that the staff at a snf has a difficult job to do. Taking care of the daily needs of one person is a burden. Taking care of a whole facility is an almost impossible task. From what I see the people that spend the most time with the " residents " are the cna's . While the nurse is trying to stay on top of administering daily medications and documenting that it was done. This amounts to maybe less than 10 minutes per pt per shift. So it comes down to the least common denominator the cna, who has the least amount of education. If there is a problem they have to find the nurse and have them come assess the pt. Who then has to call the doctor to decide if the pt should be transported or not. If he wants some things done like tylenol for fever or an enema for constipation, if these don't work then ems is called.

Once we arrive we should be given a verbal report, and a med list with hx and allergies listed. This is not a hippa violation this is a continuity of care! Also code status is a helpful document as well.

I have seen some competent and outstanding nurses in snf's and some that i wouldn't let care for a stray dog. However I can name plenty of ems providers that I can say the same thing about.

What I started to post was a description of some of the stupid things I have seen over the years from snf staff. I changed my mind and tried to be objective because I've seen some pretty stupid thing done by ems as well. Sometimes even by me ( hey I'm human ).

Ems is caught in the middle when a snf transfers a pt to the er and the er is not happy. Then transfers them back and hasn't done anything the snf nurse thought should have been done. So it can be difficult to maintain a professional attitude when all you hear is bitching. Including from your coworkers.

I once had a local surgeon show up on a critical trauma. We had all of our gear bags out and were working on the pt. He said he would like to help, we said ok. Then he very sincerely asked where is your crash cart? He was not as eager to help when my basic partner explained its here in the bags and the ambulance. This is the same doc that used to get mad when we medevacced trauma pts. He changed his tune that day when I asked him if he would like to assume responsibility for the pt' if so he would have to ride the 35 min to the hospital with me. No bitching about flying this or any more pts.

IV with fluid bolus of 500-1000cc + 25gm dextrose 50% ivp . What does the monitor show for a rhyhm. If after the D50 no change in loc and he still has an opa. Intubate him and continue to assist with a bag valve. start transport to hospital.

Yes go to the jobs section on this site.

so much for stopping and clearing the intersection on a red light.

call 911 and panic

just kidding! But do call for an ambulance.

Move him out to a less enclosed area & open his airway. Put him on his side if he is vomiting. Is he breathing? what about his pulse? does he have one. If not then cpr and get an aed.

Does he take opioids how about narcan maybe even check his bgl.

I need more info like v/s pupils and what equipment is available.

I'll make it simple for you. Crosstraining does not work; How about the plumbers union taking over the fire service. They are experts in moving water from one place to another and they have to know building codes! I know the argument doesn't make sense to you, well your argument doesn't make sense to me.

If the fire dept really cared about medical care for its citizens it wouldn't do this. The only reason the fire service wants ems is to increase its budget and justify its existence. The fire depts have done such a good job of demanding better building codes that fires do not occur that often as they used too.

I have a better idea; Lets use the taxpayer dollars the fire dept wants and staff ambulances with city paid paramedics. Instead of buying extra fire trucks you will save money to buy more ambulances. You will also save money in not responding a firetruck to every call.

If you want to save the citizens money how about crosstraining in helping the city maintain the roads. Filling in potholes will help keep you in shape plus your doing a public service.

Long story short if your area uses a private ambulance. Then unless you use it you never have to pay for it. Why should I pay more taxes for other peoples ambulance ride. I already pay enough for medicare and other taxes.

a while back I had heard; but can not remember where that some atropine dated sometime after world war 2 was found and tested still potent. I don't remember where I heard it so it is probably total bs. But it makes for interesting conversation. Like how long will something stay sterile in a glass vial. Plus what about when they find meds in ampules in shipwrecks and the like. On a personal note I have taken oral meds that were expired without any bad effects. I do inspect the meds first though, if its a pill and crumbling its tossed. Any liquid is checked for separation and particulates or discoloration. I know not the best idea but it has come in handy at 1 am or weekend with a sudden onset of being ill. Until the dr office opened.

I am very lucky where I work the police officers have my back. Anyone that tries to assault me is charged with a felony. ( Assault on a healthcare worker is a felony in Az. ) We've had more than a few rocky wannabes get 3mo to a year in jail.

This is a situation where you ask the cops- Please lets use my taser ( LP 10 or equivalent) . Wouldn't you like to give him 360j of bite me across the ears!

You just missed the testing at guardian in Flagstaff but there are a lot of smaller companies nearby.If you are interested in this area send me a pm and i'll give you some info.

Due to the fact that all we have to go on is a short question with limited info, we have done what we do best; assess the situation & evaluate the facts we have then decide a course of action. Of course Dust in his usual form takes the lead and pulls no punches. I admire that and do agree with the majority of what has been said. However I have some questions for the OP.

1. Why do you want to be an emt? Is this a mid life thing ( your profile says your 37) ?

2. Is this a career change that you are looking for? Or are you wanting to volunteer to "help" your community.

3. How did you come to this decision?

Please revisit your post and answer these questions.

To all of the other people that come here and lurk that have the same questions.

EMS is not a hobby to me. This is my career and chosen profession. If you want to be an emt, it is a free country and I can't stop you.

My advice to all is the same that has been stated here many times. Education is the key. There is such a glut of firemonkeys and whackers that it is coming to the point that the system is just beginning to realize that we are our own worst enemy.

The intelligent people are pushing for more education to make ems a respectable field in medicine. They are constantly being undermined by the people with a political agenda. You have a choice to be part of the solution or part of the problem.

You are right about the public having no clue what is involved in my profession. The ignorance that this is an easy, fun, exciting job is made worse when the public sees that people do it for free so it can't be like a real job.

This reminds me of what my paramedic instructor used to say. "Asystole is the only stable heart rhythm the pt has, their condition cannot worsen! All others have potential to change!"

spenac wrote

[quoteWhy do the vollys really do something that would benefit a whole lot more people. Go paid and then donate your entire checks to charity. You actually would do more good in a months time than an entire lifetime in volunteer EMS.

]

I agree:

Or go drive seniors to their doctor appointments, or read to children. Become a big brother or sister. Adopt a highway, clean up a neighborhood. There is a lot of things you could do to " give back".

If you truly want to save lives; organize and sponsor a local blood drive. Hand out clean needles or condoms. Better yet go forth and demand that your local ems become a paid agency where there is 24 hour 365 day a year coverage for your community. If all you have is a bls agency then demand als, and try to assist in the training and funding for it. That is how you volunteer and make a difference.

[fiznat wrote:

It isn't ETI-or-nothing. Come on.

BVM me. Give me a combi-tube, or an LMA, or a king. High flow O2 as well.

/quote]

OK break it down to the first rule of medicine "do no Harm"

Everything we do has a risk versus benefit.

BVM- benefit increased tidal volume and rate. Risk gastric insufflation= decreased tidal volume, aspiration = infection

Combi-tube - benefit some airway management. Risk cannot be used in burn pt. laryngospasm = occluded airway with adjunct in the way

cannot be used for long term. Aspiration is still an issue if distal cuff seal is compromised

LMA - benefit some airway management. Risk cannot be used in burn pt. laryngospasm = occluded airway with adjunct in the way

cannot be used for long term. Aspiration is still an issue as this just covers the opening to the larynx.

King airway see combi-tube except it may be fire medic proof. ( I doubt it though )

ETI Benefits cuffed seal prevents most aspiration ( post intubation only though ) . Tracheal suction can be performed. PEEP can be used. Laryngospasm is not a problem. Risks- ego of people attempting the procedure may prevent them from admitting they "missed " the trachea.

In summary Endotracheal intubation is the gold standard of airway control. All of the others are rescue devices that give you time until somebody can intubate the pt. So why not start with the best and use the others as back-ups.

It is not a terrible thing to admit you missed or cannot intubate a pt. I have used a combi-tube on more than one occasion. It is NEGLIGENCE to not pull a tube because your ego says you are in the trachea and you are not.

DPS medic killed by chopper blade

by Alyson Zepeda - Oct. 14, 2008 11:13 AM

The Arizona Republic

SEDONA — An officer and medic for the Department of Public Safety was killed during a mountain rescue in Sedona on Monday afternoon.

A DPS helicopter team was called to Bear Mountain to rescue two stranded hikers about 4 p.m.

One of the hikers had already gotten aboard the helicopter.

DPS Officer Bruce Harrolle, 36,of Mesa was escorting the second patient into the chopper when he was struck by one of the helicopter's rotor blades and fatally injured.

Both hikers were flown to safety.

Investigators from the department and the Yavapai County Sheriff's Office have begun conducting an investigation into Harrolle's death.

Harrolle is a nine-year veteran with DPS and he leaves behind a wife and two young children. He was based out of Flagstaff.

All officers assigned to DPS helicopter teams are medics also.

I knew this medic by aquaintance only. But he leaves behind a family and will be missed by all of us in az ems.

I would like to remind all of us to please be careful !

We have to remember that not only will a hypoperfusion state cause myocardial ischemia. the pancreas is very good at releasing an enzyme called myocardial depressant factor. So in retrospect a 12 lead would not be a bad thing. I just don't think I would delay transport for it. I would document why it wasn't done; eta to ed etc. I don't think a " ding " is necessary, but a hey think about this. Type talk would be more beneficial. I feel it is better to turn a situation like this into an positive educational experience. Rather than a negative butt chewing.

It would depend how he presented. Indigestion or epigastric pain = 12 lead