FireMedicChick164

First I need you to clear up a few things for me:

1. You said the BLS crew arrived and put the MAST on the patient. Did they inflate them right away?

2. Then you said the EMT arrived and started yelling for them to remove MAST from the patient. Was the "EMT" an ALS provider? What about the EMT that arrived with the BLS crew?

If the BLS crew inflated the pants then they should have NOT been removed in the field.

3. What state are you from?

Here in NY our protocols are for the MAST are for hypotension secondary to suspected pelvic fx and severe traumatic hypotension. They are NEVER removed in the field. (Compartment Syndrome comes into play here as well if they are left on long enough also)

In the 9 years I had been an EMT Basic and the 2 years I have been an AEMT I have never had to use the MAST. Our main hospital is pretty close to our district and even the trauma center is only 15-20 minutes away (5 minutes by chopper).

**The NY State Dept Of Health placed in their protocols recently the results of a study done on MAST. I have copied the recommendations below:

MAST (PASG) are "usually indicated, useful, and effective" (Class I evidence) for:

· None.

MAST (PASG) are "acceptable, of uncertain efficacy, [although the] weight of evidence

favors usefulness and efficacy" (Class IIa evidence) for:

· "Hypotension due to suspected pelvic fracture;

· Severe traumatic hypotension (palpable pulse, blood pressure not obtainable). *"

MAST (PASG) are "acceptable, of uncertain efficacy, may be helpful, probably not

harmful" (Class IIb evidence) for:

· "Penetrating abdominal injury;

· Lower extremity hemorrhage (otherwise uncontrolled); *

· Pelvic fracture without hypotension; *

· Spinal shock. *"

MAST (PASG) are "inappropriate, not indicated, may be harmful" (Class III evidence)

for:

· "Adjunct to CPR;

· Diaphragmatic rupture;

· Penetrating thoracic injury;

· Pulmonary edema;

· To splint fractures of the lower extremities;

· Extremity trauma;

· Abdominal evisceration;

· Acute myocardial infarction;

· Cardiac tamponade;

· Cardiogenic shock;

· Gravid uterus***

It basically states above that for a penetrating thoracic injury (such as a stab wound to the chest) that the MAST is inappropriate, not indicated, may be harmful.

The website that the information from the above study is on: http://www.health.state.ny.us/nysdoh/ems/pdf/2008-11-19_bls_protocols

In the PDF file the info is on page 123.

Hope I was helpful.

Meri

NY EMT-CC here! RSI is not in protocol here..although my agency does carry valium, versed, and morphine in an electronic safe on the ambulance. They are in protocol for severe pain and seizures. Although we have only been carrying narcs for about a year now and are one of the very few services in the county to do so.

This same question popped up on the JEMS website too. I have posted the link below so you can look at that too.

http://connect.jems.com/forum/topics/albuterolchf-1?xg_source=activity

In NY where I practice albuterol is indicated for asthma and COPD. I do remember our instructors telling us that we shouldn't use it for CHF patients. It can make their condition much worse. I always try to get a thorough history before I give any meds and the few CHF patients I have seen we have just given O2 and put on a cardic monitor. Our closest hospital is less than 10 minutes away.

I have a question for y'all about giving albuterol to a patient. I know that the indication for albuterol is wheezes. I also heard that CHF is a contraindication for albuterol because the broncodialators in the med will allow more fluids into the lungs, increasing the difficulty breathing (Someone correct me if this explication is wrong). So what do you do for the patient who has a hx of both asthma/ COPD and CHF and has diminished lung sounds? Would you give the albuterol/ duoneb until you can hear better lung sounds, and base your further treatment off of that? What if the cause of the SOB is CHF and you have now made it worse? CPAP?

Sorry if the question above is convoluted, I was wondering because I had a pt recently who had hx of CHF, but no other lung hx, and was diminished on the L side, and my partner gave her a duo neb treatment, even though she was stating at 98% RA, because her RR was about 30 (no other signs of SOB)

When I was initially certified to give neb albuterol, I never learned that CHF was a contraindication for it, and it scares me that I didn't learn all the information about a drug I was certified to give. If y'all have any good resources for this info, that would be great, but I would also like to discuss it here, I always learned best from class discussions

we don't carry them, don't use them, they aren't in protocol. The way I figure it, if a patient is faking being unconscious and is good enough at it to pass our "tests" (ie: the hand drop, scratching to bottom of their feet, etc.) then the hospital can deal with them because they are doing it for a reason (whether good or bad).

We actually had a female patient who was "unconscious" and had us fooled until we got to the hospital and the sat right up and talked to the nurses as soon as we were out of the room. Apparently there was an issue with her husband (unknown what it was) and she figured that was then only way for her to get out from under his watch and get some help. We even went as far as to cut off her dress in the rig looking for any reason she wasn't responsive! She didn't flinch at all.....even passed the hand drop test!!

don't go in to EMS to get rich....do it because you want to help people and you will be fine. Depends on where in the country you work and what type of entity you work for. I am a vollie so I work for free....love every second of it!!

doesn't bother me...I actually think it's kind of amusing. Don't take yourself so seriously!!

practice, practice, practice....i suck at math but when i took my EMT-CC i had to learn it. My friends all drilled me using different numbers it until i got it.

CONGRATS! I have been an EMT for 11 years you are going to love it! Are you currently with a service or will you be looking for a job? I do my EMT as a vollie and work full time as a teacher. Nothing wrong with being a professional volunteer!! congrats again!!

just curious....what state are you in that allows 16 year olds to become EMT's?

here in NY you have to be 18 to sit for the test.

welcome aboard to the forums!

You need to purchase a license to operate! What state are you in? Do you have any business background? If you can get the license you have to contact your state DOT and DOH and find out what the requirements are. You need to find a building, get supplies, get contracts with nursing homes and other facilities. This is a big undertaking you want to get in to. Some states aren't giving out licenses any more...you have to buy out a company that has one already and use theirs under the new name. This isn't a cheap business to get into either...you have to work with insurance companies to bill for services, you need insurance for your building, employees, vehicles, etc. Do some research and contact your state DOT and DOH before you go any further. See if it's even feasible for you to do this. It's not as simple as just buying an ambulance and stocking it....Good Luck!

Is there any action you can take against the member that posted the content and caused all the trouble?

Have y'all considered making posting of links only instead of copy and paste stories. May have to make that a rule and get some more mods on board to help monitor everyone.

Hi Samantha!! Welcome to the wonderful world of EMS! it is a very tough field to be in (especially for a woman) but very rewarding and SO worth it! I have been an EMT Basic for 10 years and as of last year upgraded my cert to EMT-Critical Care. Loving every minute of it! I wish you good luck and if you need any advice/have questions/just want to complain or talk feel free to reply back!

Meri

Toby,

I would be more than happy to chat with you! I have been a Firefighter/AEMT for 10 years. You can either email me at groovyfirechick@gmail.com or reply back here. I am watching the topic. I commend you for starting down another career path at this point in your life!

Meri (FireMedicChick164)

We have had our Rad 57 for 2 years now and let me tell you it is the best piece of equipment we have ever purchased! Have used it many many times not just for civilian cases but for rehab for our firefighters at fire scenes. Has proved a very valuable and useful diagnostic tool. This has resulted in us diverting to a hospital which has a hyperbaric chamber (which is farther than our closest receiving ER) based on the pt's CO levels....better for the patient! Definitely worth the money!

http://medgadget.com/archives/2005/03/rad57_pulse_coo.html

To answer your inquiry:

1. I didn't know it was held yesterday.

2. Didn't know you could watch it online.

3. Why would D.C be any more appropriate than Colorado Springs?

4. I didn't see it.

5. I have never participated.

FireMedicChick164

How many of you knew that the National EMS Memorial Service was held yesterday, in Colorado Springs and was available to view online?

What is your view of it being held in Colorado Springs and not in D.C.?

If you did see it, what do you think of the facilities?

Have you ever participated?

I'm so sorry to hear about the passing of your wife. I just yesterday lost a friend and colleague of mine from cancer. I know that her memory will live on through you and your children and that she will remain a part of your life even though her body is gone her spirit will remain with you. Loss is such a hard thing to describe but we have all gone through it and understand it. I couldn't ever imagine losing a spouse and I can imagine that it is the hardest thing you will ever have to endure. Just know that I will be praying for you and your family. Keep your head up brother, things will get better.

Peace and Hope

Meri (FireMedicChick164)

Hey everyone,

I know I have been MIA for quite awhile, As some of you may remember, my wife Janice was diagnosed with lung cancer in July 2009. Well after being given the all clear on April 30th, she began having neurologic problems and back & neck pain in early May, then on May 12th she had surgery to remove a ruptured disc in her neck that was pressing on her spinal cord. While that did help the neck pain some, it did not relieve the neurologic problems (Tremors in both arms and hands, Dizziness, and severe headaches and syncope when standing up, and weakness in her legs) so about a week after surgery they did a lumbar puncture and discovered that the cancer was back in the CSF and in her brain.

This past Saturday, June 12th, Janice lost her battle and passed away.

I am attaching a copy of the obituary with memorial info. for anyone who may be interested.

Thank you all for the well wishes and prayers back when we began this journey,

I will try not to be such a stranger in the city from now on.

Thank you

well welcome and congrats on getting your EMT! I'm an EMT-CC from NY....been a tech for 10 years now and been a vollie FF for 11 years. It's quite a ride but you will love it!

Hey ya'll,

I am a newly minted NREMT EMT-B. I found out this morning. I am currently looking for an EMT job. I want to go to paramedic school eventually. But until then I will get my feet wet as a rookie. Lol. I am currently waiting tables but am so ready to get on a truck. I am looking forward to getting to know ya'll. Can't wait to learn my way around this site.

lol how do people think up this stuff?! that was really funny

well...no....my b/f actually pees in the shower, not me...but thanks for the guess...

The person below me makes s%^t pay because they work in EMS.

Happy Holidays!!

I'm going to have to warn my little sister about Imitrex then...thanks for the info guys I will pass it on.

Meri

I can't tell you when I'm working how many times a day I hear from people "Oh honey, the ambulance drivers are here." or "The ambulance people are here." I just let it slide....the patch on my shoulder says New York State Emergency Medical Technician as does the card I carry in my wallet. I could care less what people think we do....also you'd be surprised how many of the rich yuppies in my town think we are a paid FD..even though it clearly says "Volunteer" right on the front of the firehouse.

Just my thoughts on the subject.

Meri

we don't carry narcs on my vollie rig...at work the medics carry narcs....never seen em used yet...

I totally agree with managing pain though. I have a recent example having to do with me.

Monday at work I crushed my finger between the stretcher frame and the release lever while we were loading a patient into our rig....broken finger...my partner and I watched it swell as I waited for the stars to fade from my vision and tried not to pass out. So after I got my bearings I splinted my finger, slapped an ice pack on it and got in the back of the rig with the patient (we were taking her to the ER for abnormal labs) and we proceeded hastily to the hospital where we delivered the patient to s bed and then I signed in to get my finger looked at. After I saw the triage nurse and reporting my pain was an 8 they gave me Tylenol and sat me in a chair by x-ray..no I have a very high tolerance for pain but this FREAKIN' HURT! The Tylenol didn't touch it....needless to say when I got home afterward I took some Benadryl and some Vicodan that I had and slept for 12 hours....that was 2 days ago...my finger is still blue in spots and swollen to the size of a hot dog and kinda gross looking and the Tylenol is finally controlling the pain. So much for effective pain management!!

Since I was thinking about old TV shows...anybody remember the name of that show that had the robot girl who lived with a family..I think she "slept" in a closet..I seem to think her name was Vickie and I have part of a theme song in my head...Boy I feel old!

Thanks guys this has been bugging me for days!

It's kind of sad but I still have my NKOTB (New Kids on the Block) cassette tapes and still know most of the songs...

My Little Pony, Care Bears, Popples.

Does anyone remember the Fisher Price toys? They had the houses and the people figures that are no bigger then my thumb..I still have them all stored in the attic (for my kids some day). I also have the ambulance, fire truck and fire station..I used to fight over them with my little sister!

Sneakers with Velcro and those socks with the stripes at the tops?

The white leather Keds with the rhinestones embedded in them? (the stones fell out after awhile)

Romper Room? Magic Garden?

I used to ride backwards in my mom's old Plymouth station wagon with the fake wood paneling on the outside..it didn't have seat belts! :?

This is more recent..I used to watch Animainiacs after school on channel 11 (I think) Yakko, Wakko and Dot!

Still can sing the Gummie Bears and Duck Tails theme songs.

My dad used to put on RECORDS on Sunday nights and we used to dance in the living room to the Twilight Zone theme song..now you tell kids about records and they look at you like you are nuts! :roll:

Boy I feel old!