defib_wizard

I'm not sure if this is the right forum catagory to place this, so I apologize if its in the wrong section. To all of my fellow prehospital providers: Thank you for doing your job 24 hours a day everyday. The friends,loved ones and fellow ems workers who died on this day will not be forgotten.I do mourn their passing for by the grace of god go I. So please take a moment and try to remind yourself; yes I'm here for my patient but I will do everything to go home when my shift is over. Be safe and vaya con dios my friends! ( Thats go with god, If you don't habbla espanol )

no problem.

Im sorry my posts were confused with the volunteers. I work full-time as a paid paramedic and am paid rather well. I started in this field as a volly ff-emt but we did not transport. The local amb was paid. I have been full-time paid for over 15 years now. I haven't been to NJ and by the sounds of things I don't want to go. I work in the southwest USA where the air is clear the heat is dry and the grass is; well brown. I don't feel like quitting this job. So that is not a solution, and we are hiring but not too many people want to live in the middle of nowhere.

Once again I have been told that the system I work in sucks, because we have emts running calls. I didn't realize that when we see one set of footprints in the sand dustdevil must be carrying us! Unlike the area you must be in we don't have an infinite amount of paramedics to staff the rigs. So I shall humble myself and ask for advice. How do we fix this problem? Instead of criticizing and being demeaning maybe you can come up with a solution that my coworkers and I haven't thought of. I look forward to your reply.

Well Dustdevil I'm impressed with your response. So in your perfect world we wouldn't have any EMTs. It just impresses the hell out of me that you went from civilian teenager to paramedic without any stops in between. I can understand that the view from "Up on the pedestal" your on can cloud your vision. I do not feel that saying that the system I choose to work in sucks is very appropriate when you do not know anything about it. Unlike the "Pleasantville " you live in, rural america needs EMTs and will continue to use them. If you can't handle that, stay in the city !

Epi 1:10000 Epi 1:1000 Atropine Lidocaine Mag Calcium Chloride diltiazem versed Sodium Bicarb D-50 Dopamine pre mix Lidocaine pre mix Narcan Diphenhydramine Furosemide Morphine Valium zofran Nitro ASA Adenosine 6 and 12 atrovent Albuterol thiamine glucagon oxytocin phenylephrine solu-medrol also approved for amiodorone

Congrats on becoming a medic. And welcome to the Grand Canyon State. There are some good people that worked for river medical, that will be your coworkers. I have some advice for you; Stay hydrated the summers can be brutal especially by the river. ( it's not a dry heat there ) Watch you butt on I- 40 the drivers don't slow down! Always know where the lane boundaries are if you step over a line into one, the odds are good that we could be mourning you here. Again welcome to the sandbox! P.S. One more thing you won't have to worry about daylight savings time anymore!

Well said toutdoors! EMTs are probably here to stay, I say this is a good thing! Every profession should have an entry level. EMTs are a needed part of the prehospital care team. However; I believe that as a team we are only as strong as the weakest link. A new EMT should be taken aside and taught how to be an EMT. After all getting the certification is just showing you passed the minimum standards to be an EMT. Years ago they taught you A & P ( not as in depth as a medic class ) and how to distinguish different types of medical emergencies. More importantly patient assessment was taught along with the treatments and why we do them. Now the course is ( dare I say it ? ) dumbed down to a checklist type of assessment : You see this do that type of care. Plus most services treat their EMTs as drivers and equipment fetchers! Then have the nerve to complain that the new Emts that are trying to upgrade can't pass a medic course. Unless the medic course is "adjusted" to the level of comprehension of its students. Then we can't understand why they don't pass national registry. We need to improve the curriculum of the basic EMT class. We need to let them get some experience and guide them to be better prehospital providers. This will in turn make them better paramedics when they decide to upgrade. I believe we let this happen and only we can fix it, Whining here will not fix it but makes fore some interesting reading.

What do you mean he was suspended for 3 months? Is this his full time job? If it is: The punishment definitely doesn't fit the crime. The supervisors and parents should watch mtv or go sit and listen to the type of vocabulary being used at school by students. If you were to check the student handbook, the penalty for profanity is probably a 20 min detention.

Our dispatch is through the police dept. So we use their times. This is not always a good thing, as it depends what clock they are looking at as to what time you get. example: Dispatch time: 1301 Time en-route: 1303 Time on-scene: 1259 However there is a computer that tracks the response time if it is needed, it is hooked to the 911 system.

Ok i remember it too. I suddenly feel very old. But at least I'm not alone!

Subject: Don't be a Victim!!! Be Careful - A 'heads up' for those men who may be regular Home Depot customers. Over the last month I became a victim of a clever scam while out shopping. Simply going out to get supplies has turned out to be quite traumatic. Don't be naive enough to think it couldn't happen to you or your friends. Here's how the scam works: Two very hot girls come over to your car as you are packing your shopping into it. They both start wiping your windshield with a rag and Windex, with their breasts almost falling out of their skimpy T-shirts. It is impossible not to look. When you thank them and offer them a tip, they say 'No' and instead ask you for a ride to another Home Depot. You agree and they get in the backseat. On the way, they start undressing. Then one of them climbs over into the front seat and starts crawling all over you, while the other one steals your wallet. I had my wallet stolen May 4th, 9th, 10th, twice on the 15th, 17th, 20th & 24th. Also June 1st, 4th, twice on the 8th, 16th, 23rd, 24th, three times last Saturday and very likely again this upcoming weekend. So tell your friends to be careful. P.S. Wal-Mart has wallets on sale $2.99 each

I can only think of one word- SEDATION!!!! And lots of it! Oh and give some to the patient with the injury. :shock: :shock:

Ak wrote "I just utilize the lesser known (possibly forgotten?) archaic remedy of treating female hysteria that was popular for many, many years." That works until their husband walks in. Unless you have written treatment protocols for the procedure. If you do then I have a question. Are there any job openings where you work? LOL

Sorry to hear that Eric. If this is the end, at least you weren't 3 years in with a house and kids. I'm not trying to be insensitive just trying to show you a silver lining in a cloud of crap.

I believe this patient has a occluded foley cath which is causing a sympathetic crisis. he needs his foley unclogged. I don't remember the mechanism but his full bladder is causing a release of norepinephrine. The distended bladder also stimulates the vagus nerve causing bradycardia. I would contact medical control to see about flushing the cath or removing it. Then reassess him.

could the "hamburger" be his chew?

It works because you don't go through the back of the vein as you advance the catheter. The bevel should be parallel to the wall of the vein after you get a flash. To start the iv you do have to use a slightly steeper angle then lower the flash end of the catheter as you slightly advance the needle into the vein. Once your in 3-4 mm then advance your catheter. it takes practice but will increase your "batting average" on your iv attempts. Oh yeah I was once told by a carpenter to blunt the end of a nail to keep it from spitting the wood. It is because it splits the wood fibers instead of cutting them. I still don't know how it works because you use an axe or maul to split wood. :?

The bevel down technique can be helpful especially with 16 & 14 gauge catheters. Another technique I use a lot especially on people with frail veins is to not use a tourniquet.You can lightly tamponade the vein if you need to with your opposite hand to distend it slightly. this is also how I do external jugular IV's since it poor form to tie a tourniquet around a pt's neck . LOL

At least he got it right the first time.

firedoc: why don't you trust the aed? If you do your 2 min. of cpr and have it do the initial rhythm analysis you can doing an iv administering meds and setting up for intubation. Then if no shock is advised go to manual mode. This really helps when you are the only als and have to multitask.

FTF failure to fly RDRT real dead right there

I was making a point that nurses are human too. That no matter who is doing the triage mistakes can and will happen, regardless of education. This is not about med errors. Having 20 patients can keep you from making proper assessments and treatment decisions. It is only going to get worse with the nursing shortage. Your right! but I know plenty of nurses that have been unable to work the er or icu until they take acls for the first time. They cant work L & D without NRP. Paramedics are required by National Registry to have current CPR and ACLS. Yes they are cert classes but the nursing profession uses them for qualifications to work also. I will grant you that this is in rural settings and there is a nursing shortage. In a perfect world a very competant nurse would be the only one doing triage. However in a perfect world we wouldn't be needed because people wouldn't become ill. The first post stated this was for discussion, so I'm trying to discuss this and be objective. So a question for you; You are traveling in a rural area and become ill. You go to the hospital & it is a 4 bed er. you are taken into the triage room you realize the person that is triaging you is a paramedic; do you leave, or request a nurse, or let the medic continue? Maybe this will sway your thinking- The paramedic has been a medic for over 18 years and worked on a ground ambulance and still works as a flight medic part time. The nurse graduated from nursing school last year and took acls 6 months ago so she could work the er. these were the qualifications of the people working during one of my shift days last week. As i was told recently the rules state that a nurse be on duty in the er they don't say how long they've had to have been one. As stated before the hospital admin will fill a void however they can. Let me know how you choose. VentMedic wrote I read it please explain your point on recommending it. I believe that I've referred to just medics and nurses, not CCEMTP or any other self important initials.

This has been a very interesting post. I have learned a lot about how many of you feel about the educational differences between medics and rns. I have to say ( at the risk of offending an ego or 2 ) WAKE UP! As far as why they blamed the medic his name was on the triage form. We were not there and he may have been the best person or most experienced healthcare provider in the er that day. However because he is an"unlicensed provider" it must be his fault. The last time I read the definition of standard of care it was; What someone with the same type of experience and training would do in a simular situation. I surely hope that any one of us in this type of situation would have figured it out sooner. but would you have been able to. We don't know what was going on in the er that day and it is sooooooo easy to monday morning quarterback! I realize that having an rn do triage is the ideal, but there is a nursing shortage. Do we know that an RN would have picked up on this pt's situation in some of the opinions here nurses don't ever make mistakes. The medication error form is there just in case an error happens, even though it never has. LOL As far as higher education for nurses yes they go to school longer and learn more disease processes, but the last time I took PALS, ACLS, NRP the er and icu nurses were taking the same course and the same test. Now some of the nurses I know are taking PEPP courses that are primarily for prehospital providers. Hmm same class, same card, god forbid we could have some of the same education. The reason this child died is because she was ill. If an rn would have triaged this pt and placed her in the waiting room they would have still sued and they would have won . The only difference would be the nursing forums would be reviewing this like we are Medics can be a useful addition to helping an ed's staffing situation. We can assess a patient and make a triage decision based on that assessment. Only the future will tell what happens with this. If there are no nurses to work the hospital admin will find a way to fill the void. Well I am ready for the name calling and medic bashing to start on your replies to this.

I agree! Stop the burning. then get some vitals and some lactated ringers going to keep her perfused so you can get her some pain meds. I carry morphine with standing orders up to 14 mg. Air transport should be considered to a burn center.