CAPMEDIC-EMWFR

Hello all! After coming here once only every few months, my life has stabalized to the point that I can come back!

Annnndddd with that being said, on to the topic at hand!

I decided to forgo prehospital education in favor of med school, and seeing as I kind of lazed around in high school (it wasn't so much like that as I opted to work and a long story... But that is most likely what medical schools will think of my transcript), I have decided to co-author 2 articles that I am going to try to get published. The main one, on the mechanism of apnea occuring secondary to oxygen administration in patients with associated COPD, does not really concern prehospital providers as much as the second one (that and I have a lot more work done and insight on it )... The effacacy and safety of traction splints versus manual traction and narcotic administration in suspected midshaft femur fracture. I got the idea for that after attending the 2009 Wilderness Medical Society's annual conference. Basically a review of the literature shows almost nothing about traction splints. Are they effective in reduction? Are prehospital providers in general capable of employing them effectively? In an urban setting do the pros outweigh the cons? How many patients are seen for soft tissue injuries secondary to traction splint application? How does the pain control compare to narcotic analgesics (fentanyl is what I am thinking specifically)?

If you guys could let me know what you think the likely outcome of this study would be, or even if it would be something you would be interested in reading, let me know! Also, if any of you ER docs out there are going to be willing to partner with me to complete it, I would be eternally grateful! This goes for either study.

My gut instict on this scenario (being that we aren't on scene yet) is that you are going to try to throw us for a loop on the whole scene safety bit. Other than that I really don't have much to add. Possibly consider sending for another air unit deponding upon local ground response - IE if ground is not on scene yet, why were we called first in? Other than that, not much else to add...

And going off the scene safety topic, if ground is not on scene, do we have an appropriate (and secured) LZ?

My opinion on this is that provided the tapes are kept properly, no competent provider should have to worry about his actions being videotaped. Should we not all be performing our treatments as if our peers, instructors, supervisors or managers were watching? Is that not a part of integrity? I can understand worrying about things that are said, an occasional swear with a patient who is CTD, or in the middle of a nasty code, but it seems to me like this would be a lot more for the provider's protection. As far as lawyers demanding access to the tapes-can they do that without a lawsuit? And if nobody below the supervisor level has access to the tapes, and that access is monitored, I do not see an issue as far as those videos ending up on youtube or the like. If they did, then there would at least be a record of who last accessed the tapes, perhaps some sort of encryption on the tapes or DVDs themselves?

Seeing as I work for sprint tech support (they are paying for my premed), I am sure I could answer at least some of your questions....

Here is the link to Jeff's page.

http://home.pacbell.net/whitnack/

Whether you agree with all of the literature he sites or not, it does offer an indepth explanation to the various receptors. The powerpoint at the bottom of the page is decent also.

Thank you, exactly what I was looking for!

Wow, lol-ing at the O2 allergy. Now as far as the risk of respiratory depression with elevated O2 levels and hypoxic drive, what is the reason it can take 1 or more hours for that to take effect? Does it take that long for the ABGs to shift, is hypoxic drive slower to react to a change in ABGs (I personally think that is less likely, as it wouldn't be much of a respiratory drive without the ability to compensate for minute by minute changes like that), or is it something else? Or is it something very basic that I am going to slap myself in the face for not thinking about?

Probably where the frustration is stemming from. Thanks for the advice, its the same I have gotten for years on end and really, REALLY wish I would have followed.

I know, I do need to just slow down, and yes, there is a big difference between reading and studying and doing, and that experience does matter, most likely a lot more then I realize right now, I never said basics were useless, they do have a use and are an integral part of the team. The only reason that I think that basic is a joke is because the level of education required to attain the cert is incredibly minimal, it probably is different when your out there in the field, and yes, I probably do need to just grow up and be patient, I have ignored everyones advice to just be a kid and wait until I was old enough to get the cert before I started into it, and this is probably why.

As a member of the EMTCity Old Guard, and someone who started out at a very young age, Timmy is right. Don't have the cheap & fast attitude. You are young and have time. Patience is a virtue. :roll: Don't be is such a hurry. Take quality classes. Don't worry about studying ALS until you finish EMT-B and other basic courses. It will only confuse you. Focus on what you need to learn now. Study diligently and be responsible for your grades, and keep them up. DO NOT just "squeak by". I'm not sure how the grade scale is in your area, but if I remember right for EMT-A (way back when in IL) you could not get below a 87%, EMT-I 90 %, and EMT-P 93%. If you did you had two weeks of being on "probation" to bring it up and if you didn't you were out. Maturity is a factor. You must be more mature than your age. When others your age biggest concern is covering a zit or trying to get lucky by any means possible, you will be out there responsible for lives.

OK, I'm done. Good luck to you. And no, your question was not one that would get laughed at. Rather you ask a question than not to and try to wing it. Ask questions anytime you need to.

I know this wasn't meant to offend, but I have tried as hard as I can for the past 5 years to be a lot more then just another stereotypical teenager, and I don't have a "cheap and fast" attitude, I said that is what I am looking at for an EMT-B program because A) IMHO basic is a joke and As I have tried to explain, I have spent a great deal of what little time I have to myself studying things, not starting out at ACLS, but starting with basic first aid and cpr, I did a first responder class at 14, went on to anatomy then the EMT-B stuff at 15, got an intermediate textbook at 16 and ACLS book when the new guidelines came out. Recently got myself a paramedic book for christmas. I just want the basic cert because it is a stepping stone to medic, and it is something I have been wanting to get since I was 12. And as far as Timmy being "old gaurd EMT city", I was here and remember when it split off into traumacentral and emtcity, spent a great deal of time in the chatroom with the Ditch Doctor and PRPGfirerescuetech, back before I worked as much as I do, and I was the 8th member of CAPEM when that first started, so I have been around for a while, too. Not recently, because of family issues and how much I work. I have gotten the lecture, many, many times on what EMS is from a number of people that I have a lot of respect for, so please spare me the lecture. . That being said,

You also seem to have a grave misconception about the COF stipend; it isn't a "limited fund" type deal that you can "save up" and use all at once. You get a certain amount of stipend PER CREDIT HOUR and DEPENDENT ON INSTITUTION- you just have to authorize its use.

Oh yes, I know that, sorry if I made it sound like it earlier, when I was enrolled with ACC I used a little bit of it, but that got returned when I had to back out of the class to take a full time job, again due to family issues, I fully intend on using it for all my classes! That being said, I can get student loans and funding isn't really a problem, its where to get the education that I am asking for advice on.

Thank you all for your replies!

Yes, unfortunately, I have, and I figure I can just about break even if I work 40 hours a week at the call center, then part time, around 20 or so hours a week as a basic, to get the "1 years worth of experience as a basic" that most medic programs require, I will make enough, I am also moving to a cheaper place as far as rent goes and things like that to cut down on monthly expenses, so that hopefully I can quit the call center altogether. And for those of you that think I am being irrational with the full time and part time job, i'm not, i am used to working 2-3 jobs during the school year and a minimum of 3 during the summer, so it isn't completely impossible, and thats about consistent with how many hours I work right now, even just 1 12 or 24 hour shift a week with a private transfer service would keep me happy as far as actually doing something in the medical field, and allow me to keep the higher paying job.

It is great that you're enthusiastic but I am always concerned when I see young people (BTW I do not mean to talk down to you as I am by no means old) who are so keen about the profession because eventually they learn that really it is a job like any other job. For sure it is a good job, but it is a job. It is not a calling, not a way of life, and should not be how you define yourself. It is great that you're excited about the career you have ahead of you, but please do not rush into it and spend your time outside of EMS doing non-EMS things that you enjoy.

You have no idea how many times I have heard that in the past 6 years, and I really wish that I would have taken everybody's advice and just left it along until I was old enough, but now that I am old enough to get the cert, and am already forced to work 50-60 hour work weeks because of the financial situation I am in, I might as well enjoy where I am during that timeframe. I understand that you are not talking down to me, and I really do see exactly why you would say that, except for the not a calling part, emergency medicine is what I have basically strived to live for (if that makes sense to anyone) for the past few years, and again, its the frustration of finally being old enough, but held back, by my own decisions, but still held back, from what I have wanted for the longest time. Maybe I will just get into a community college's program, take it in conjunction with a&p and try to get into medic school by the end of next year, which when I type it out sounds perfectly logical and rational, but like I said, I have made it my life for the past few years, and I just want the cert, just having the job and working on an ambulance or in a hospital instead of taking calls for Sprint-Nextel, where I work now, just sounds so appealing, I was hoping that maybe somebody knew of a program that was accelerated that could get me the cert, more soon then cheap...

Haha, a scholarship is a bit out of the question, the only textbooks I read in high school were published by Mosby, but we do have a Colorado stipend that I can tap into, and fully plan on doing for my paramedic education, right now its the basic that I am trying to get out of the way, since in order to advance to anything besides medical school, where I firmly plan on going, albeit financed from a paramedic job, or nursing school, where I don't want to go, I feel a very strong calling to the prehospital side of things, requires at least the EMT-B cert, which I should have made my main priority over getting a higher-paying job, as soon as I get the B cert, I will be moving on, hopefully.

If you already portray the knowledge of BLS and take interest in ALS then why do the basic program?

Colorado requires that you have a current EMT-B certificate to enter a paramedic program, at least with everywhere I have checked with, it would be absolutely phenomenal if somebody could prove me wrong, though :wink:

I suppose that your right, quality does factor into it, and that is another reason I don't really want to go with the people that I am with. On their online tests, there were a number of typos and answers that don't really have all that much of a basis in ethical decisions, for example the correct answer, in their eyes, to the question of "You respond to a 71 year old female who was the victim of a fall, she is conscious and breathing, complaining of pelvic pain, during your assessment what should not be preformed?" was "palpation of the patient's pelvis", even though, and correct me if I am wrong, is palpation of the pelvis not essential to detect crepitus, distention or instability, admittedly you would need to exercise extreme caution when doing so, but isn't a complete and thorough patient examination necessary? And as far as the rush, you would have to have known me for a while, I have been doing everything I can to get experience in EMS since I was 12, and now that I am finally 18 and can get the certification, there have been a number of roadblocks, I was enrolled in a program at a local community college, but due to parental conflicts I was forced to move out, and had to choose to go with a higher paying job and an online education, things came up at work, and blame it on my age, I didn't get my homework done in time for the cutoff for the practical class I was supposed to be in, I decided on a career in emergency medicine a long time ago, and I am just impatient, as I have always been, to actually get into it, I suppose thats what the rush is, my impatience, but I am currently in a job I don't want to keep for much longer, it pays great but a call center just is not my cup of tea.

Enthusiasm is one word, I have just been in it for a number of years and spend a lot of my "free" time studying ALS techniques and practices, and EMT-B is a stepping stone to that cert, so thats why I am a wee bit impatient.

I just have a question that I am hoping won't get me laughed off the site....I am currently enrolled in an online EMT-B program, but due to a few pretty major life events I was unable to make the cutoff dates for their prereqs, and I am now facing a $150 rescheduling fee as well as new plane tickets to reschedule a practical seminar that is out of state. I currently reside in Colorado, and was wondering if anyone knows of a private company that offers an accelerated basic program, I have been involved in ems as in depth as I can be since I was 12 (just turned 18 and DYING to get my cert), member of the forum here since i think 05, so I am just pretty much looking for a practical and the "certification to test" for NREMT, anybody know of anything that would be decently cheap and fast as far as getting the basic cert? If nothing else I will end up staying with that program I was originally enrolled in, but there are quite a few things I don't like about that program, yet another reason I am looking for something different. If anybody knows of anything that could help me, it would be very, very appreciated! Thank you guys in advance, and I hope this isn't as stupid a question as the back of my mind thinks it is, if it is, let me know and I will just go with what I originally started.

Very well put.

Thank you, I was rather tired when I wrote it but I hope I got my point across .

I have to agree with the general opinion here, we are a part of team, the first people to see and treat the patient, what we do impacts the patient's outcome. I can't really add any more to this topic than what has already been said, but the way I see it is that we are more then just taxi drivers, we cannot let anything get in the way of delivering the best care we can to our patients, and that includes passing complete and accurate information to the receiving facility. You can't let things like location of pain or your personal biases, regardless of what they are, against something effect the well-being of your patient.

OK, that makes more sense. I apologize for what I said earlier, but without that extra information it did make the story sound like bullshit. My aplogies.

I have had one call about 5 years ago. We were at the local hospital when a young kid approx. 10yrs old walked into the ER with his father his neck was deformed just looking at him you could tell what happened. Father stated son fell in the tub the night before struck his head/neck in the tub went to bed that night and woke up this am with his head turned hard to the right with his chin touching his Rt shoulder. the RN at the hospital was there we offered to take control of c-spine but she refused our help. The RN had the pt walk to ER room and sit there in a chair and wait for the Dr. We bought our concerns to her about c-spine but she said you were not called for this don't worry about besides he fell last night and has been up walking around he is fine. So the Dr. comes in feels the pt neck says you will be fine here is some TES you'll feel better in a couple of hours.

So I said to the Dr. your not going to x-ray the kids neck nope he fine.

So we ran out to the kids parents and told them how we felt and that if this was my kid I would demand c-spine and x-ray. parents said the Dr. knows best and they said that the Dr. wouldn't be wrong. We gave our advise if any thing changed to call 911 and we would treat him and by pass this hospital and take him to a hospital with CT.

2 hrs later toned out for the kid his neck got worse we c-spine him in position found he couldn't turn his neck when he tried he became weak in the arms and his chest felt heavy. So we called life flight in the kid was taken to Childerns Hospital had # c-3,c-4

Uhm, I may just be a student, but the above story kind of smells like bullshit to me. The majority of the Docs I know would never even consider not x-raying the c-spine with an obvious deformity like the one mentioned, or at least holding for observation. Talk about major liability. I think it is amazing how you were the only ones to see some sort of abnormality with that patient. What hospital did he go to, if the staff is that incompetent, I don't want to be anywhere near it!

Did anyone read what was on the Trivia card?

Jeff was killed by a metro bus

Or colorectal cancer

Or a vietcong rocket during a firefight

Or small arms fire near Baghdad

or, my favourite:

A fatuiged wal-mart truck driver

Ok,

I am only an EMWFR, but what the hell, sure :wink:

Ok, I am 16, and...well....just take a look-

1. You've ever ended a sentence with the word "SIKE"

2. You watched the Pound Puppies.

3. You can sing the rap to the "Fresh Prince of Bel-Air"… and can do the "Carlton".

4. Girls wore biker shorts under their skirts and felt stylishly sexy.

5. You yearned to be a member of the Baby-sitters club and tried to start a club of your own.

6. You owned those lil' Strawberry Shortcake pals scented dolls.

7. You know that "WOAH" comes from Joey on Blossom

8. Two words: Hammer Pants!

9. If you ever watched "Fraggle Rock"

10. You had plastic streamers on your handle bars..."spokey-dokes" or playing cards on your spokes for that incredible sound effect.

11. You can sing the entire theme song to "Duck Tales" (Woo ooh!)

12. It was actually worth getting up early on a Saturday to watch cartoons.

13. You wore a ponytail on the side of your head.

14. You saw the original "Teenage Mutant Ninja Turtles" on the big screen...and still know the turtles names.

15. You got super-excited when it was Oregon Trail day in computer class at school.

16. You made your mom buy one of those clips that would hold your shirt in a knot on the side.

17. You played the game "MASH" (Mansion, Apartment, Shelter, House)

18. You wore stonewashed Jordache jean jackets and were proud of it.

19. L.A. Gear....need I say more?

20. You wanted to change your name to “JEM†(She's truly outrageous.)

21. You remember reading "Tales of a fourth grade nothing" and all the Ramona books.

22. You know the profound meaning of "WAX ON, WAX OFF"

23. You wanted to be a Goonie.

24. You ever wore fluorescent clothing. (Some of us...head-to-toe)

25. You can remember what Michael Jackson looked like before his nose fell off and his cheeks shifted.

26. You have ever pondered why Smurfette was the only female smurf.

27. You took plastic lunch boxes to school... and traded Garbage Pail kids in the schoolyard.

28. You remember the CRAZE, then the BANNING of slap bracelets.

29. You still get the urge to say “NOT†after every sentence.

30. You remember Hypercolor t-shirts.

31. Barbie and the Rockers was your favorite band.

32. You thought She-Ra (Princess of Power!) and He-Man should hook up.

33. You thought your childhood friends would never leave because you exchanged handmade friendship bracelets.

34. You ever owned a pair of Jelly-Shoes. (And like ..24, probably in neon colors, too)

35. After you saw Pee-Wee's Big Adventure you kept saying "I know you are, but what am I?"

36. You remember "I've fallen and I can't get up"

37. You remember going to the skating rink before there were inline skates.

38. You ever got seriously injured on a Slip and Slide.

39. You have ever played with a Skip-It.

40. You had or attended a birthday party at McDonalds with an outdoor playground.

41. You've gone through this nodding your head in agreement.

42. You remember Popples.

43. "Don't worry, be happy"

44. You wore like, EIGHT pairs of socks over tights with high top Reeboks.

45. You wore socks scrunched down (and sometimes still do...getting yelled at by "younger hip" members of the family)

46. You remember boom boxes and walking around with one on your shoulder like you were all that.

47. You remember watching both "Gremlins " movies.

48. You know what it meant to say "Care Bear Stare!!"

49. You remember watching "Rainbow Bright" and "My Little Pony Tales"

50. You thought Doogie Howser was hot. (did not think he was hot, but have watched the show)

51. You remember Alf, the lil furry brown alien from Melmac.

52. You remember New Kids on the Block… when they were cool...

53. You knew all the characters names and their life stories on "Saved by the Bell," The ORiGINAL class.

54. You know all the words to Bon Jovi - SHOT THROUGH THE HEART.

55. You just sang those words to yourself.

56. You remember watching Magic vs. Bird.

57. Homemade Levi shorts.. (the shorter the better)

58. You remember when mullets were cool!

59. You had a mullet!

60. You still sing "We are the World"

61. You tight rolled your jeans.

62. You owned a bannana clip.

63. You remember "Where's the Beef?"

64. You used to (and probably still do) say "What you talkin' about Willis?"

65. You had big hair and you knew how to use it.

66. You're still singing shot through the heart in your head, aren't you?!?

Now you don't have to feel so bad Steve (ok, not as many as I thought reading thru it).