IslandEMS

With the 12/15 leads now in many rigs it is easier to find those right sided MI's and steer away from the Nitro with out a line. My question for the pathophysiology junkies out there is; Is it likely to have a right sided MI with a Systolic BP >100? If the BP would be <100 with a Right sided MI isn't it safe to give Nitro for the chest pain the pt is having with a higher BP and no need to use a 12 lead to rule out the right MI? Giving it to the pt without a IV and Monitor would then be an OK basic skill.

My personal favorite and a very common dispatch is for the "butt breathers" they are "altered LOC butt breathing" and "unconscious butt breathing". I listen for lung sounds down there but can not hear anything. I must be in need of a fancy cardiology stethoscope.

In Michigan we have a similar law. Allowing for a 2 year with a 2 year extension to make a transition. Has anyone been part of a program to add advanced protocols to a system. With the staffing problems for rural ems it is hard to provide staff 24/7 above the bls level. It is also tragic to toss aside advanced skills since they can not be provided 24/7. I think the protocol changes might be the way to go. Does anyone have any such protocols?

We currently have a small BLS service with 230+/- calls per year. We have 3 Paramedic providers that are often on call or available for intercept. I am looking for a way to provide ALS services when they are needed and when we are able to provide the coverage. We are not able to staff 24/7 365 with a paramedic so ALS licesure is not possible. Any ideas you might have or sources of information would be greatly appreciated.

Clinicals are what you make them to drive your education. I am currently finishing up my clinicals and would highly suggest your clinicals shifts match an ER Shift 8 or 12 hours. This gives you time to have more Pt but also get to know the staff. I was fortunate enough to do a batch of my clinicals together working 12 hour days 5 days within the week, for 3 weeks. I had others to do but the time I put together was the best. There were many benefits to this. The nurses know you and are comfortable with your skills, once you show them what you can do, are willing to do and want to learn. They work with you to further your skills and give you some more room to practice. All but 3 of the nurses, PA, and DR in this ER used to be medics so that helps a lot as well. Willing to learn and do ANYTHING is key. Take labs down after you draw them and see if any thing else needs to go. Help transport pt to x-ray when the ER gets backed up with trauma waiting on x-rax. Stock rooms on downtime and ask ?. Let me say that again ASK QUESTIONS. one of the best ones is: What can I do to help improve my _________ skills? So many staff have different methods and I learned some very useful methods this way. I learned more hanging out with the DR while looking at x-rays and asking him about the Pt and symptoms they presented with. Relationships are everything. I am able to start IV and EKG w/o supervision. I have started a External Jugular IV with the PA watching. Added a few stitches to a hand with the DR and Intubated a guy who coded in the ER. When you are able to build the relationship and willing to learn you become part of the team. When you are willing to do anything the staff will grab you when there is some really good experience for you. Oh ya ask the DR or PA is you can follow them a few days. There assessments blended with the nursing triage is your guide to Paramedic. It is also fun to see the change in stories between what the nurse receives and the Doc.

I would love the sponsorship to go with the photo. The problem we have is long patient removal time from buildings. Most buildings are 100 years old with stairwells to match. The ability to treat a pt. before trying to move them for 20 min. (before getting to the rig) would help. Trying to deliver a code is just moving a corps. The other side of the coin is our ER has 2 critical beds. With two critical Pt. we are pretty maxed out. We don't usually have more RN and no MD that we can call in. When we have to transport to a regional center that can take 15 minutes or 2 hours to get set up and get the patient moving off the island. I hope this helps. We just had a consulting firm tell the city that we should go BLS due to staffing and just "load and go" to the ER. I don't know the possibility of being BLS with some ALS protocols as in the post above but it is worth a look i guess. Any other ideas or anyone else that has a solution they are working with I would appreciate the time to talk to.

I am from an Island in Michigan. We have an ER on the island but no admitting hospital without transport. We are currently LALS and looking at becoming BLS, ALS, or Staying LALS. We have a limited number of runs (250) with 15-20 critical needing immediate transport. Arranging transport can be difficult do to weather, and early detection and treatments can save considerable time. The year round population is only 500 with over 800,000 visitors in the summer. We currently have 1 EMT, 4 EMT-I, and 3 EMT-P available to cover shifts. As a staff we want to become ALS and know what benefit it can bring to some patients. Early detection of an MI would increase our ability to get them transported to a cath table by almost an hour. I am looking for statistics to support becoming ALS or any other ideas to help bring better patient care with a limited staff pool. I am currently searching the net but looking out to the world of EMT City for anyone who has already collected some good statistics to support what we do. Thanks. Spell Checked to ward off dyslexia (I hope it helps)

I have always liked Redwings. I have pairs that are still going strong for 4 years. For EMS I use Red Wing 4473 - 8-inch. They have a zipper kit that is difficult to lace in. Yes, you have to read the instructions twice. Once they are in correctly they work great and are very comfortable. My current pair is being worn 300 days a year and still going strong on year 2. They even shine up nice when needed.