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Donavan

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  • Birthday 03/24/1982

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  1. When I was doing my ED observation time during my EMT class I recall one patient an BLS crew brought in, no monitor, no IV, no real reason for them to call a medic either. The patient wasn't complaining of any chest pain or shortness of breath, but I don't remember what his complaint was. While the ED staff was hooking up the ECG the patient started complaining of chest pain, got real pale and sweaty. The medic hooking him up finished, started yelling "Paddles! Paddles!" The guy was in v-fib arrest, one shock at 200J later, and he was awake again, this time complaining of 10/10 chest pain, but in normal sinus rhythm, and getting appropriate treatment.
  2. Jackets and pants are not mandatory in CT at all, you just have a service that gives a damn about their EMTs. Some services make do with cheap "Staff Protection Kits" that fit in a plastic bag. Be happy about that.
  3. I think the best thing they ever added to stretchers was an D-tank holder. I've left my portable oxygen on-scene twice. As for students, I've left them at the hospital, never on-scene. Critical call, can't find the non-critical crew member when we're ready to leave, their loss. I've no desire to teach those that don't want to learn.
  4. In Connecticut ambulance are allowed to take four exemptions while running hot: 1. Exceed speed limits while using due regard for safety 2. Travel the wrong way on a one way street 3. Expect right of way from other vehicles 4. Park in otherwise restricted areas None of these include leaving the scene of an accident. Check your local laws. I do agree with Dustdevil, ignorance is bliss. Making patient contact and leaving without obtaining a refusal or turning patients over to equal or higher level providers is abandonment. The whole situation sucks. You are bound to do what's best for your patient, but the law is the law, and we are usually held to a higher standard, especially when driving. In Connecticut our ability to practice is limited to working in our ambulance service as part of a full crew (MRT and EMT, or EMT and paramedic). Therefore, transporting in the police cruiser would be absolutely out of the question for me. I would walk the two miles to the hospital first. The last choice is an interesting one. I've always wondered about the potential ethical conflict of transporting people from an accident you are involved in. If any civil or criminal action were taken, you would be privy to information about that party that normally you wouldn't have, but you are still bound by HIPAA and privacy laws. I don't think I would transport the patients on my own, but I have the advantage of working in an urban environment, where I can usually get backup pretty quickly.
  5. It has nothing to do with the training or the meds you can give, it has everything to do with the most important aspects of our job: speaking to people, scene control, and patience. Without these vital skills, which I might mention a lot of physicians I have met lack, all your vaunted paramedic skill are for naught. I have met a few paramedics who were never EMTs first, either because of a RN-medic bridge course, or because they got their medic at a medic mill that included EMT-B, and they are usually poor paramedics. They tend to lose their heads, get tunnel vision, and other ailments that get medics (and EMTs) killed.
  6. Not necessarily. Less than one percent of americans are skilled auto mechanics and can take a car apart and put it back together again. That doesn't make them the top one percent of society. For anyone who thinks this is different because it isn't an innate skill, neither is reading, and some people are better at reading than others, even with proper education, just as some auto mechanics are better at it than others with the same training. More likely it's the fifty-five percent who fall near the center of the bell-curve. People of higher and lower intelligence have minds that work in different ways. Think Forrest Gump and John Nash (the subject of A Beautiful Mind.) Gump would probably fixate on the improper spelling and would trip up more easily, and Nash would probably glance at it and decide it's not worth his time to decipher.
  7. Medic students spend some time in the ED, but most of what they do there is practicing IVs. They also go to ORs to practice intubation. I don't know the exact figure, but I think they spend < 200 hours riding with various paramedic services in the area, some of which don't do a whole lot of ALS calls. Having had medic students riding with me and my partner, I can say they don't get a whole lot of experience this way. I can't speak for other services, but the commercial ambulance I work for require new medics to ride as a third with a paramedic preceptor for one or two months, and experience varies. Keep in mind that I work for a commercial for-profit ambulance service, so precepting medics aren't immune to interfacility transfers, even when they and their preceptors throw a huge fit. Even if they have very productive ride time during school, and their precepting goes well, they have about three or four months of practice before being let loose on the unsuspecting public. While for some people this is enough oversight, and we do get some good medics right out of the gate, it still doesn't compare to the support a new nurse or physician can expect.
  8. Okay, as an EMT I feel I need to add a few thoughts. One - I do believe you should have to work a few years as an EMT before becoming a paramedic. Being an EMT is more than just driving. As an EMT I have learned to talk to people of all walks of life, and make them feel comfortable telling me things they won't tell their spouse. I can also keep people calm during what may be the most stressful time of their life. I think this is quite an accomplishment, and a basic skill you should acquire before trying to practice medicine of any sort. This skill will make you a much better paramedic. Some people come with these skills from outside of EMS, but most don't. As an anecdotal note, most of the better paramedics I know spent a 5-10 years as an EMT first. Two - To those who draw the LPN-RN or PA-MD analogy, that is a poor comparison. RNs and MDs have to work with an experienced medical provider before they are allowed to work on their own. Even after they go through this training they will have a safety net of more experienced personnel to draw upon. As a new medic with all this training and a few weeks to months (if you're lucky) of riding with an experienced medic you can easily find yourself on your own and overwhelmed with no backup available. If you work with another medic who can bail you out, good for you, but what about medics who work with EMT partners? I don't know how to be a paramedic, so if my paramedic partner can't hack it, the patient suffers. All that education comes for nil if you can't apply it.
  9. It says fifty-five out of every hundred people, but nowhere does it say they are the upper fifty-five percent. :-p
  10. Who says it's the upper 55%?
  11. The Fire Monkeys in one of my service's response towns does respond cold to all automatic alarms, unless someone calls 911 and lets them know it's an actual emergency. As for EMS, I started working in a volunteer system where we responded lights and siren to all calls. That changed when the PD dispatchers were trained and started using an Emergency Medical Dispatch system, I don't know which one. The number of L+S responses dropped by about 30%, only to calls that were definitely not emergencies, ie bad labs, misplaced g-tubes, distal extremity injuries with minor mechanisms. Any unknowns, and we still responded L+S. It decreased the number of hot responses without endangering anyone who had a real emergency on their hands. I don't think this would benefit any systems that already have an effective method of over-the-phone triage and priority assignment.
  12. Hi, I'm Donavan, a EMT-Basic of seven years experience at various services in Connecticut. I've been lurking around these boards for a few months now, and have finally decided to register. I hope I can add something to some of these threads, and I look forward to some interesting discussions.
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