armymedic571

just get a push bar...

Plus one for "Forward" thinking....

One of my big worries was along the lines of getting school done, getting into paramedic school, and not having anyone willing to hire a 49-50 year old. If you all feel that services or other places would give me a chance, then I will push forward.

Chief.....

Stop hib hobbin and get on with it. I currently work with a retired chief who is one of the best EMT's in our service......

I will echo the statement that it is more your attitude and physical ability than your age, that services look at......

You get my vote....

In short NO the military does not do that sort of thing any more. The only thing the military can put you to death for is for abandonment of a "duty" or post without permission in a time of war. But they dont do it since well shoting people does crap for moral even in a time of war.

That is incorrecct. Death is still a suitable punishment in the military for certain offenses. Murder, Rape etc. However, like most states that have the death penalty, it is extremely hard to get that point without further contoversy. Although it is an option, the more realistic scenario would be that the offender would get life on prison.

Also, just as an added bonus. In the "Manual of Courts-Martial" (UCMJ), death is not only a punishment, it is also listed under type of discharge.......

In short NO the military does not do that sort of thing any more. The only thing the military can put you to death for is for abandonment of a "duty" or post without permission in a time of war. But they dont do it since well shoting people does crap for moral even in a time of war.

That is incorrecct. Death is still a suitable punishment in the military for certain offenses. Murder, Rape etc. However, like most states that have the death penalty, it is extremely hard to get that point without further contoversy. Although it is an option, the more realistic scenario would be that the offender would get life on prison.

Also, just as an added bonus. In the "Manual of Courts-Martial" (UCMJ), death is not only a punishment, it is also listed under type of discharge.......

LOL i get -2 rep for talking about how the 232 medical battalion is, LOL.

But yeah too many females got raped so they took our overnight passes and whatnot. Did you know 68w(medic) and 11B(Infantry) are the only people living in bays for AIT? Every other MOS gets 2 to 4 man rooms for AIT. Lol.

Nope for being ignorant......

BTW, your last post isn't funny. That is serious business were taking about, and your using it like a punch line. FAIL.

CHBare, I went through school in '96. I am fairly sure it was 14 weeks long. It's funny because I made it and now I can think back about my time there. In reality, the curriculum is horrible and incomplete. Not to mention condensed.

I have sent several letters to the US Army Medical Center and School. But all I got back was a thankyou letter for being a concerned NCO. Figures.

Perhaps some may see this is a a bad thing. I however, do not. The tragic events that happened on 9/11 should not reflect on those terrorist's religion as a whole. Yes, they were Muslim but not all Muslims are terrorists. We as a country need to be more tolerant of others. Just because they are different in any way, some people have to dislike them. There is a Mosque being built near Ground Zero... I think this is good. It shows the world we ARE tolerant and welcome the faith of others. Even in the shadows of one of the worst events that has happened to our country, it shows everyone we are tolerant.

Remember folks, just because the spot is a dog, and spot has four legs.. doesn't mean all dogs have four legs.

Plus 1 FM65....

I have a cat with three legs.....but that is another story.

Seriously, I think you post is honest and well stated. Thank you...

AM 571

Dude........

What part of the stupid tree are you from?

"A different breed of EMS"......are you serious! Listen guy. Many of the current practices in civilian EMS come from the Military. HOWEVER, many of the military's current practices have been taken from Civilian EMS. I going to ask you nicely? Please think before you type...........please.

As far as not wearing gloves in Combat. Yes it is sometimes unavoidable, but to say that wearing nitrile gloves makes you a target.....ridiculous!!!!!

Wearing that excessively large trauma bag makes you a target.

Trying to be a hero and using a laryngoscope on a night OP makes you a target.

Pretending to be Audie Murphy instead of doing your job, makes you a target, and get you and other killed.

Are you tracking here????

AM 571 OUT!

As someone who has come late, I'd like to add a few thoughts. If they taught us everything we needed to know to be a doctor while in medical school, medical school would run 20+ years. Part of pursuing a (supposedly) professional education (training?) is the ability to learn on your own. It doesn't sound like this case is a protocol issue as much as a management issue. Let's face it, none of our patients ever follow the protocols. You have to be able to think outside the box. Patients never read the textbook or protocol manual before calling 911. I won't argue whether this pt needed 2, 3 or 100 people to manage but in the field you may not have enough people and will have to manage. To the OP, it sounds like your instructor was trying to give you what he/she could before the strike shut everything down, be thankful he/she cared that much and didn't leave you on your own. It also sounds like the instructor did not know about the "protocol" either so how can you hold him/her accountable. In the end, you are an adult undertaking a professional education and failed. Suck it up and deal with it.

Accountability.......what a concept....

Isn't ironic. Sad but ironic that some people find this a new and unheard of trait.......

Doc, your advice is the type that most people should heed, but probably will not. If you are a Medical Command physician, good for you....

You all make me laugh. When I went through Sam it was a 14 weeks program.......Key word here is DISCIPINE........but that is another topic.

I will agree that it is a different ball of wax. Not a whole lot of room to learn...just sink or swim....

Ft Sam. Love that place. Its more like a vacation than a duty station.

to answer your question. I am currently assigned to the 28th ID, Div Surg Cell. Pushing papers in not my bag.......I can do the work, but whew.....I hate it.

Before that, I was with HHT 2/104 CAV (RSTA), 56th Stryker Brigade in Taji, Iraq.

Later AM 571

Doc D. Welcome to the city.......

AM 571 here...... I have 14 in with 10 of those AD. 4 tours to the sand box. I know Taji and Sadr better than my own neighborhood.

To be honest, I just put in to go back to AD. Anywho....

Be cool, stay safe, and remember to duck!

SSG K.

I think when you look at "MOI", the only one that through really suggest serious injury through case study and research is "ejection from a vehicle". As stated in previous trauma guidelines, ejection from a vehicle increases mortality by .......( I think 25%)...... The point is Mechanism by it self is an assessment tool for what "could" be wrong with the patient, not what is wrong.

The exception to this is MOI plus significant physical finding.

I personally feel that transporting emergently based off of mechanism is just as ridiculous as transporting CPR in progress. But that is just my opinion.

Not to mention, why are we transporting emergently? If they are (the patient) that critical, why not call for aeromedical if in the appropriate setting. Obviously, I wouldn't call for them if I could get them there faster while being safe.

Dwayne. Plus 1 for a proper thought tree (your words) haha

I see. I am already home. I just passed through a few months ago from up north. Be safe....

Are you on your way for stay?

CH,

Most excellent art work. Great scenario.....

J

As far as CSFD I have noticed for the most part that they are nice helpful and some even decent looking However some are not helpful and etc. It is like that everywhere I am sure. It is HARD as hell here getting onto CSFD here. They rarely hire someone who has no fire exp. I have no fire exp.

As far as Pueblo I have not heard nor do I know any ems providers in that area. Plus I don't speak Spanish either. To be honest you kinda need to have some knowledge if not speak fluent Spanish in pueblo. However I never thought to even check about checking out the agencies in Pueblo. I may check them out down there. I do not know if AMR is down there however they seem to be EVERYWHERE!! I have seen lately some new trucks lately in town (either that or AMR changed their look).

If I recall, AMR had the contract in Pueblo....but that was several years ago.

CH-

With our left sided neck hematoma, is there any sub Q air? Eventhough there seems to be good compliance bagging, I would still consider the chest needle decompression. Just a thought....

In the event that it is a hemo... I don't think it would be necessarily beneficial, but would wouldn' t lose anything either....

J

Since we are on this topic. Does anyone else use Etomidate?

Not only does it have a rapid onset (1-2 minutes), but it has a shortn half life (3-5 minutes) for those fearing Trismus.

I understand correctly. Can't Etomidate inadvertently reduce ICP??? I am not 100% as to it's mechanism of action.

I recently took a Continuing Medical Education (CME) class, combined BLS/ALS, where CPR and Defibrillation were done. Not only were we told not to touch the patient, but to disengage the Bag Valve Mask from the Endo Tracheal tube, as the weight of the BVM could possibly dislodge the tube during the body's convulsive motion on application of the shock.

That's common....I guess the real question is what is based on medical fact and what is anecdotal fear......?

It is going to be interesting when the next set of recommendations come down.

The treatment of choice for me is some midaz to stop the seizure, wait a minute to see if he loosens up and look at tubing him.

This is a tricky one because we are giving midaz for the seizure but we would also give it (probably in a bit lower dose for RSI in neurogenic coma) however for RSI we can also give ketamine over midaz and should also be giving 1mcg/kg fentanyl.

So I am unsure as whether to give fentanyl and sux ontop of the midaz (which we gave for the seizure but also will have some amnestic properties) or just give him some midaz and sux.

Either way, intubate, add PEEP of 10 and go to the hospital lickedly split.

Kiwi..

Question that is slightly off topic. Do you prefer Midaz over Ativan and diazepam as its onset time is slower than the other two?........OR

is that all you have in your pharm kit?

What do you have to work with? Etomidate only? No other drugs? What could stop this seizure and possibly help you better secure the airway?

If the jaw is clenched then the patient is already suffering from trismus. Do you want to give them something that will only perpetuate the condition? Or move straight to the backup plan? Or try something that make make your primary plan a little easier?

Are you sure? Is etomidate really going to relax the jaw when the patient is actively seizing?

I understand what you're thinking. And you're on the right track. I just think there's a better way to go about this than what you've outlined so far.

I should add my apologies to Kiwi. I'm not trying to hijack his scenario.

Mike,

You are correct. Lets get back on track. I missed when Kiwi stated that are patient was having an active seizure.

In this case my priority would be to arrest the active seizure. My benzo of choice would be ativan IV, or diazepam.

Then, I would control the airway.

I still ned to disagree with you about the etomidate though......

Trismus is a possible side effect from the administration, and usually when it is given to quickely. As I stated before, under the right conditions, I would still consider it if possible. However, as you stated if the conditions were not present, I would go straight to plan B. Which for me would be nasal Intubation.

Hope that clarifies my thought process.

J

No. I want to stop the seizure and control the airway. Unfortunetly, that is waht I have to work with.

Also, If you give Etomidate to a person with a clenched jaw, and experience trimus ---> back up plan... re-oxygenate and nasal intubation, or NPA and BVM.

So, wait, I guess yes, I would give the etomidate.....

AT ,

I couldn't help but note that you stated Wikipedia as a sourece of factual information...........Sorry dude. FAIL.

I still disagree.....

Do you take the LMA, standard intubation, RSI or .... the mystery box? (the box, go for the box! It could be anything, even intubation or a new boat!)

Your patient is clenched up and having a seizure, how would you proceed if you are going to RSI (we use fent/ketamine/sux for RSI but can use midaz for neurogenic cause of poor airway/breathing)

You sir are hilarious.....

I would personally use our Medication Assisted Intubation (as we are not allowed to use Sux in our system). This is basically drowning our patient with etomidate. So, 0.3 mg/kg of etomidate please. Boujie tube if necessary.

If the patient is still clencked, re-oxygenate and nasal intubation.

When we get the tube in Fent and versed for continued sedation......

MB,

I haven't been in the Springs since 2002, but from what I remember both services were professional and all about good patient care. I did rotations with AMR in both the Springs and Pueblo, and to be honest I found the ambulance crews in Pueblo to be more laid back, professional and calm on calls.

However, call volume and call type was definetely better in the Springs.

If I had to give to 2 cents I would suggest looking into CSFD. There medics are competent and professional (as I remember). Also, they are better paid and less worked. Not to mention the benfits that come with the job.

Just my opinion as my info is out of date.......

PS CSFD station 11......ROCKS......

J

This is completely anecdotal......but how does this differ from some one who is touching a person who is tazed?

If I recall from less-leathal weapons training. Every person who was tazed, had two other people holding them to help them to the gound. Contact was never let go, and no one received any rougue shocks.....as I recall.

But like I said......That is just anecdote..... .