2Rude4MyOwnGood

Arlington is the agency that i was referring to in my original post. I know that Fairfax City does RSI as well, the rest of Fairfax County does not though. From what ive heard, P's in Fairfax City can perform RSI without supervision.

Thanks for the replies! @Bieber, our I's operate almost the same as our P's here in Northern VA. When it comes to RSI, both levels of ALS provider can only push the drugs under the supervision of the EMS Supervisor, but intubation is a skill shared by I' and P's here. The only difference between I's and P's here is a better understanding of advanced pathophysiology, and surgical airways...i think. There might be something else that im missing but thats all i can think of off the top of my head. Im not saying its right, but its what we've got to work with here. I know that its a touchy subject around here and i completely understand. Our SOP is very broad compared to I's in many states/agencies.

Just trying to get an idea of what protocols are for RSI in some other agencies outside of my area. I was able to assist/observe in an RSI during my last shift and it was all very fascinating to me. Seeing the Succinylcholine go to work was an interesting experience. In my agency, I's and P's can perform RSI's, but only under the supervision of the EMS Supervisor. The drugs used (Etomidate, Succinylcholine, Vecuronium, etc) arent carried on the medic units, but only in the supervisor's drug box. I only know of one nearby agency that allows their P's to RSI without supervision. Just looking for some insight into other protocols. Thanks.

We have Chloropreps or whatever they're called for that. Kinda handy if you ask me. Im still just a fan of alcohol preps unless i really need to clean up a mess. I try to use as few materials as possible when starting an IV. (1 alcohol prep, 1 needle, 1 tegaderm, 1 piece of tape).

Alcohol alone here. Circular motion moving outward from the site.

Im in VA. No offense taken. Yes, Intermediates can push narcotics and intubate in the county in which i work. No NG tubes or manual defibrillation though. 12-lead interpretation is always done by a Paramedic as well. Intermediates are only up to speed on 4-leads by registry. I work in an all ALS county, so each medic unit will always have at least 1 P riding, often 2. Intermediates are called medics here, but they will never be the highest level of ALS provider on the ambulance. I know that I's are able to push narcotics, but ive never seen it done, the paramedic will usually handle that.

Having that patch is your best (read: only) way to get a job with any of the nearby counties. The competition is pretty out of control. When counties lift their hiring freezes and put a group through the fire academy (fire and EMS arent separate here), there are thousands of applicants for ~20 positions. The best thing you can do to get to the top of that list is have your Paramedic, they are given priority during the selection process. P's also earn a higher salary than I's, that extra schooling counts for something after all!

Yes ma'am. Our Intermediates follow the same protocols as Paramedics when it comes to drugs. There is very little distinction between I's and P's around here.

It is an ALS skill to push Zofran here, but Intermediates are considered to be ALS providers so there is no issue with giving the med. EMT-B's arent allowed to push any meds through an IV at all. They are limited to oxygen, oral nitro, IM epi, activated charcoal, oral glucose, and assisting the patient with their own inhaler.

I kinda agree with this. While there is some skill involved, a large portion of the process comes down to confidence. In the beginning it can be tough to just go for it and stick someone. After all, you are puncturing your patient with a sharp object, many people hesitate when they are new to IVs. Find the vein and advance the needle with confidence. If you advance it slowly you are often causing the patient more pain and sometimes resulting in an uncessful stick. Another tip is to make sure you are pulling traction when you advance. Veins can get pretty squirly and move around. Apply traction below the site to make sure it stays in place.

Its been a while since i made this thread so much of the call isnt fresh in my mind, but i believe that her clothes were cut off to get the leads on as quickly as possible.

I am currently using Bates Ultra Lites and i like them a lot for the price. They are only ~$75 and they are plenty comfortable and have side zips. They run a little larger than most running shoes (Nike, New Balance) so if you order online you may want to size down about a half size.

Seriously man, check out Northern Virginia Community College at www.nvcc.edu. The Medical campus in Springfield isnt far from DC at all, and has a great EMT-B, I, and P program.

Sorry for leaving some info out of my original post. Keep in mind that im a student so im still learning! Thanks for all of the replies, ill answer them as best i can. Her presentation didnt change from when her SPO2 was 96%. When we arrived on scene she was supine on her couch, skin was pale and diaphoretic. Once in the unit she was placed in the POC, or semi Fowlers. I was unable to tell if there was any exertional dyspnea since she literally didnt do any moving on her own while in our care. She was able to speak full sentences and didnt complain of SOB. But her back pain became much worse with each coughing spell. My reason for asking about putting the patient on a NRB vs. NC is that i just wanted to make sure i was doing exactly what the medic wanted me to do. He wasnt exactly excited to have me back there with him so i wanted to make sure i did everything the way he wanted it to be done. The patient said that it was likely a slipped disk, something that she claimed had happened before. Great point about the anxiety causing her sat to go down, i hadnt thought of that. Her respiratory rate was 18 and regular when she wasnt coughing. I was looking to start an IV because the medic directed me to do so when we got her into the back of the unit. I listened to her lungs despite the medic not doing so and found that they sounded clear bilaterally. The patient denied any history of COPD, CHF, or emphysema. Her only meds were Abilify and Xanax. I didnt know that O2 could make the coughing worse, thanks for that info. So far in school its been drilled into our heads that everyone gets O2 and an IV, ill be sure to bring this case up in class this week. And thank you Bieber for the lengthy reply! I didnt want to quote it and take up all that space but thats a very informative post. Im heading out the door for class in a few minutes but ill be back later to read it again.

We ran a call yesterday to a 60yr old female complaining of terrible back pain that his been going on for about a week. The last 3 days she claims only leaving her couch to walk no more than 5 steps in any direction. We enter the apartment which smells like cigarettes and old people, she has a nasty hacking cough and claims to only have smoked 3 cigs that day. Pain is a 10 at this point, but has gone as low as 7 over the past few days. She was unable to move so we laid out the Grier stretcher and used her sheet to lower her on to it. Pateint likely weighed ~300lbs. Put her on the monitor and it showed that her 02 sat was 96, BP was 146/90. She claims to have a very low resting BP so the medics told her it might be caused by the stress of the situation and we'll figure it out as soon as we can. Monitor also showed a C02 reading around 11. We got her to the unit and her cough certainly didnt decrease at all, but her back pain was her CC, and all she was worried about. The lead medics took over while i looked for a vein to stick. Neither myself or the medic could find a site that looked good enough to poke at so he began talking to her about her medications. We are already en route to a hospital thats less than 10 minutes away by this point. 02 sat now read 92. I ask the medic "would you prefer a mask or cannula for her?". He looked up and said " i wouldnt worry about it, we're almost there". I was blown away by that comment. This guy is a 30 year FF/Paramedic vet and he doesnt think that withholding oxygen is a big deal? Even if it wasnt her CC, she still could have benefitted from some air. So i guess im just wondering what the hell happened here? Did he just figure that since we were so close to the hospital, oxygen wasnt important anymore? Does any of this sound a bit off to you too, or am i overthinking it?

I posted in your other thread on this topic but here is how i feel about what you should do. Since you will be in DC, which is very close to VA, id go across the bridge and take my basic at Northern Virginia Community College (NVCC). The Arlington or Alexandria campuses are still very close to you. They have a great program with nice/new equipment for you to learn on. I havent personally seen a training facility in DC but i hear that they are pretty shabby. Another reason is that, well, DC EMS kinda sucks right now. They have old and outdated equipment on their units and regularly take skills away from their workers due to lack of proficiency. They are underfunded like a mofo and i just dont think that you will get the most out of a program taken there. Although the GWU class sounds like it could be a winner, thats a solid school so i doubt that they cut too many corners when designing the program. Give them a call and get some questions answered. I really think you should consider taking your course at NVCC, its 1 semester long and all of the instructors who i had contact with were fantastic.

I live just outside of DC in VA. I did my basic through Northern Virginia Community College which has a handful of locations located throughout the NoVA area. Not far from DC either. Looks like George Washington University is the place to be when it comes to basic training if you live in DC: http://education-por...hington_dc.html

Thanks for all of the replies! I ran this case by some of my instructors and most of them didnt have any strong feeling that in IO wasnt necessary. They seemed to think that it was a good idea due to the fact that IM Narcan takes a bit longer to take effect. IOs are used often in my area, since the EZ-IO guns arent nearly as "barbaric" as the manual method, and provide a quick route to administer meds.

I definately learned a good bit on this particular ride along. I was fortunate to be tagging along with 2 medics who were very eager to teach me. Both were young guys, very bright, and never made me feel like i was in their way.

The medic gave a Lidocaine bolus shortly after she "came back" because she complained of pain in the insertion site. After that her main concern was that they cut her only bra into pieces. The protocols state that any patient who has received a medication must be transported. She refused care but the PD was there to ensure that she came with us, since she had received the Narcan. Im not sure about protocols regarding transporting all patients with an IO, i was just a ride-along on the call so im not up to speed on the protocols. I didnt get a look at her pupils since i was trying to stay out of the way unless the medics wanted me to do something. As i said above, i was just a ride-along on the call. It would have been very helpfull for me to get a bit closer to the patient but by this time there were 4 other EMS providers besides myself in the back of the unit. I didnt want to get in anybody's way. Im in my 1st Intermediate semester and was there mostly to observe.

Sorry guys and gals i should have added a bit more info about her vitals and what not. Her BP was 130/88, pulse was 42 and weak, and respirations were at 10. O2 sat was 92. I saw the medic briefly look at her arms for an IV site but quickly decided to go with an IO instead. She wasnt too happy about it once she became alert and he gave her some lidocaine to dull the pain.

Recently responded to a 21yr old female who had overdosed on heroin. She was unresponsive but had a pulse when we arrived. In the back of the unit she became responsive to pain. Rather than start an IV for the Narcan/fluids, the medic dropped an IO in her tibia. Just curious what the benefit to doing this was. Save time? Does the Narcan absorb more efficiently through the bone? I didnt see any track marks on her arms to indicate that those veins were no good but i didnt get too close of a look.

Thanks man! Much appreciate the offer but i came home from class today to find my new scope sitting on my doorstep. I was suprised to say the least. The customer service from mystethoscope.com was TERRIBLE. They wouldnt respond to my emails requesting the shipping info. Thanks again for the offer.

Sorry i was MIA from this thread for a while. I ended up going with the Littman Classic II S.E. for $85 shipped from MyStethoscope.com. I dont suggest ordering from this website as my order has taken forever to ship out, still waiting. Started the medic program this week and clinicals will start on Monday. Really liking it so far.