AZCEP

Echoing the others, if the transport is short, BLS should begin the transport to the closest receiving facility. Cardiac monitor and vascular access would be nice, but they aren't going to make a huge difference in the end.

Dude, no friggin' mercy on these guys. I want them all duct taped to a tree naked by morning. Let's move!

Damn! I'm gonna need more tape.

Let's see if I can bring this back to the point. Cosgrojo, I used my child's autism to illustrate that it does not matter what they may or may not know, if they can't communicate their knowledge effectively. As a medical professional, we all need to spend more time learning how to perform this basic task. We don't communicate our desires well to a number of different authority figures. Without exception poor communication has led us to where we find ourselves, as a profession.

If you can't communicate with your patient, you will miss vital information. If you can't communicate with your medical control, you won't get the orders that you seek. If you are unable to communicate with the plaintiff's lawyer, chances are you will end up paying for the miscommunication. If EMS providers were better able to communicate with regulatory agencies, perhaps we wouldn't be in the mess that we are in.

Take it for what you will. I will stand by what I said in my first post.

If you can't communicate through written/spoken language effectively, there will be no one that will respect you as a professional.

I'll throw testicular cancer in.

This is kind of like diagnosing from the information that dispatch gives you.

It will probably be something like a GSW, or cardiac arrest when we get on scene. :shock:

Brady and Mosby both publish "case-based" patient management books. Both have some good scenarios in them, but I'll be dipped if I can't find the titles for them. Might I suggest a "Google" search? Just a thought.

There have been numerous articles regarding pain relief in general. The item that I have found the most interesting is that if pain is not controlled in the first hour, then it probably won't be at all. As providers, we tend to think that a narcotic is the only thing we have to control pain, but there are others as well.

The pathogenesis of pain involves a number of different items occurring in a bit of a sequence. Histamine is released, prostaglandins are produced, inflammation occurs. If we can manage any of these, we can do a better job of managing the pain in indicated circumstances.

I will agree that a little of the opioid happy juice is a powerful agent that needs to be considered early, but as an adjunctive therapy, not as the sole treatment option.

And the last thing I want is to be associated with some dumb ass who's too lazy to spell/grammar check the PCR being written for errors. Not because it makes them look bad. They can do that all on their own. It's because it makes *ME* look bad. If I'm going to be regarded in a negative light, let it be for something I did. Not something my lazy coworkers did.

A little background that is not intended to highjack the thread, only to illustrate a point.

My wife and I have a 12 year old daughter that is autistic. She is extremely intelligent, but is unable to communicate a lick. When she wants/needs something she is perfectly able to get it on her own, and is extremely challenging to supervise.

Now, this child may hold the secrets to world peace, but if she can't communicate them, how can we give her the proper credit for them. Even President Bush, a highly educated man, comes off as a buffoon every time he opens his mouth and butchers his given language. I won't say English, because sometimes I'm not sure that is what he is using.

Written language is easily as important as spoken. If your COMMUNICATION is poor, it will reflect poorly on your intelligence level, and in order, your ability to provide good patient care.

Meh... I tend to lean towards the theory that damn few communities in the country are even prepared to handle routine EMS, much less mass disaster. I would much rather them concentrate on getting paramedic staffed ambulances everywhere they need to be for daily operations than stockpiling a bunch of disaster crap to sit and expire somewhere. Maybe that's just me. I'm just crazy that way.

Ditto, Dust!

One of the local FD's got an MCI trailer with all of the bells and whistles about 6 years ago, and it has been used once in that time. Yes, it is capable of supporting an MCI of ~25 patients but when those events happen the EMS crews just load more of the BLS equipment in their units and drop it off at the triage/treatment area.

The local ED is capable of managing 25-30 patients at a time. Problem is at any given moment, only ~5 beds are actually available. This is a fairly good sized community hospital, but it is the only facility for 40 miles. Where they think they are going to stuff a sudden influx of ill/injured patients is beyond me. Most of the time, there isn't adequate staffing for the numbers of patients that they do have.

Even better, administration is unwilling to perform a drill because of the budget. :shock: We are an area with a history of bus rollovers, train wrecks, even huge industrial/hazmat incidents, and the current admin doesn't want to work on possibilities. On the plus side, everyone that is in the street is fairly comfortable dealing with 7-10 patients at a time. Anything more than that will raise a few eyebrows, but once they get to the hospital, the system will collapse under it's own short-sightedness.

"I learned in my EMT class..." This is usually followed by "The class I took in 1962 said..." What, do you honestly think nothing has changed in 40 some years?

"When are they going to allow (insert level) to do (insert procedure)?" Do I look like someone from the state regulatory agency that makes that decision. Get away from me. You're stealing my oxygen!

And the all time favorite, "How do you deal with all of the blood and guts you guys see?" Answer: The same way you deal with the pile of cockroach infested, foul smelling former food in your kitchen sink.

To quote Mel Brooks,"If someone falls in a well and dies, that is comedy. If I stub my toe, that is a tragedy."

We deal with this garbage everyday, and we are supposed to suddenly feel sorry for someone who has decided to opt out because they don't like the hand they were dealt. Not going to happen.

There just aren't too many places still using a 3 lead monitor exclusively.

I know, I know, there are many small departments out there that can't afford 12 lead monitors, and are still using 3 leads only. Don't reply telling me how little I know, okay. That aside, the push for 12 lead monitors really limited the use of the MCL leads. Few remember how to do them, much fewer actually do on occasion.

Not that one is better than the other, they actually should compliment each other, and I believe should be taught concurrently, so a person can receive credit for both.

We teach them just as you suggest Rid.

The material for PEPP is used as a lead in to the PALS. Since we started doing it this way, the only real complaint that I've heard is that the prehospital folks get two cards and the hospital only one. Of course, these complaints are coming from the same nurses and doctors that do not want to have anything to do with the immobilization station.

Sometimes, I am glad that I don't work in a hospital anymore than I do :shock:

Leads II & III are enough to make you suspect an Inferior wall MI. Unfortunately, as was already mentioned, a three lead monitor is set in "monitor" not "diagnostic" mode so the information will be distorted. The information that is gathered should only build on your assessment, performed without the technology. If a patient looks/sounds like they are having an MI, chances are they are.

Use a little clinical judgement and use your tools to help, not hinder you.

Only if your receiving facilities can handle a sudden influx of patients. Most hospitals barely squeak by with the normal day's activity. Add 10-20 patients all at once, and you can forget about it. Make it bigger and the problem expands exponentially. Even for something simple like a tour bus accident, there is no way most places can do things the way they are currently being done. Throw in a hazmat, or WMD response and you can forget having anything close to a timely response.

Even with the best paint scheme in the world, once you step out of the unit, you are putting your life in the hands of someone that probably doesn't see you.

As an example, even with the required reflective vest on, with all of the flashing lights on a scene, it is next to impossible to see a human. Now the stripes and paint colors may make a difference in the daylight, but the night scenes are a bigger worry for me.

Is anyone using hypertonic saline in the field? What do ou think about it so far? Does anyone know by what mechanism it can cause seizure?

Don't have it, yet. Not really sure that it would be worth having, yet either.

As for the seizure concern, anytime you dump a large amount of electrolyte into the blood, you can cause rapid fluid shifts out of the neural cells, making them hyperresponsive and thus cause a seizure.

Give it a while, and I'm sure the Doc's(Zilla & ER) will chime in.

Unless you plan on working in an area that has minimal resources to support paramedics, the intermediate, 85 or 99 are money makers for the facility that is putting the class on, and money savers for department administrators. After that there is really little advantage to the level.

I-85's are basically glorified basics that can say that they sat through another class/test. The I-99 is a better step, but if you are going to get that close, why don't you just take a paramedic program and get it over with. Very few areas have the same standards for their intermediates, even in the same state. It was designed as a step between basic and paramedic, and has never really advanced beyond that.

Just to poke a sharp stick at the subject, most religions that I know of, follow that if you are helping someone in need you are doing "God's" work. My understanding is it doesn't much matter which house of worship you sit in to profess your faith, just that you do.

For some reason, we tend to think that our view is right, then exclude the possibility that someone else's could be right also :?

I for one, have to remove myself from people that can't accept that another view is equally valid. There may very well be more than one "right" way to follow the ideas that religion presents, and I am not willing to be told that my way is wrong just because it is different.

--Whoa! Got a bit off topic there, didn't I?

Have to agree with Dust. "All sales are final/Absolutely no returns."

Besides, God will only give you problems that you can handle. This is the measuring stick that is used at the end.

The same questions that you ask someone with abd pain or chest can be asked of headaches. Do they radiate? Does anything make them better or worse? Is there a certain time of day when they occur?

I will use the OPQRST for any pain. Then add system specific questions as needed. With a headache, ask them to compare it to previous episodes, if possible. Changes in level of pain, location, associated problems can be very important. Ask bystanders/family members about any changes in mental status. The patient tends to be a poor historian about their own mental status.

Go figure, I can compare paramedics with illegal Hispanic labor.

Isn't this the same argument that nurses/PA's/NP's/Dr's use to justify using specifically trained ancillary personnel? Nurses don't like to draw blood, because there is someone trained to do it cheaper. Dr's don't want to start IV's because there is someone else to do it for them. The list goes on and on.

Anytime the medical community learns that a cheaper alternative is available, the more expensive practitioner will give up the ability so they can assume a more supervisory role. Then when they need to perform they are no longer able to. How many times have you heard a doctor or nurse say, " I haven't done that since I was in school."?

They learn how to do it, actually perform it a couple of times to get their license, then forget how. Before long paramedics will discover that we have the same problem, what with EMT-B's performing IVs/Intubations. All to save a buck!

If your only frame of reference is an EMT class, take that and multiply it by ~10. Then you will have an idea of what you are jumping into.

A Paramedic is infinitely more hirable than an EMT, but the jobs are fewer. You will be paid more, but not enough to be wealthy. Take a look at your local area, to figure the jobs that are available before you decide to make the jump to paramedic. If your wife is supportive now, she would not be the first to change her mind mid way through a class. Talk to some of the previous student's/spouses of a program that you are planning on attending to get a feel for what you can expect. Just take their advice with a grain of salt, because everyone responds to the stress differently.

Good luck to you, in the meantime.

AZ doesn't accept living wills, or hospital issued DNR's either. For EMS to accept a DNR at face value it has to be a "Prehospital DNR". This is f@#$ing ridiculous, but what are you gonna do.

Now, when the situation presents itself, most medical control physicians are willing to allow for the patient's wishes to be followed. We just have to contact them first. The pattern is to initiate a BLS resuscitation, contact medical control, follow their guidelines. That way the responsibility for what we do falls more directly on the MD/DO.

Whether you want to admit it or not, being an EMS provider, by itself, means you are doing your God's work.

Your personal belief system aside, when you put yourself in a position to assist someone else that is in need, you are doing the work that God/Allah/Buddah or any other deity would ask you to do.

Besides, haven't we all, at one time or another, arrived on scene and exclaimed,"HOLY expletive!!" Seems like a religious moment to me

To paraphrase, "There are two types of medics. Those that have made mistakes, and those that are going to."

Now, the type of mistake that was made will make a difference in the advice that should be given. Did his error result in someone getting injured/killed? Did his mistake cause extra paperwork to filled out? Did his preceptor not get to finish his doughnut and coffee?

Because he is in a class, and is still learning new and "exciting" things, some mistakes are expected. Perhaps some dialogue with the previously mentioned preceptor would be in order.

Sub Q epi will only work if it is given early in the process. When the patient starts to tell you that their tongue feels funny, give the epi. If you wait any, the sub Q dose will be a waste of time. Anyone over ~40 or with cardiac history, we need to contact medical control, but if things look bad, a little epi before they code, or a lot after they do.