Dustdevil

Doesn't sound like a very progressive medical control. Better medical controls will be more concerned with the patient getting the care they need at the earliest possible time than with how long it takes to get them to the hospital. The point of ALS EMS is to take the hospital to the patient. And if the patient immediately requires something we have within our capability, any overriding concern for scene time is grossly misplaced.

But are they armed?

That's pretty well a standard anyhow, Asys. I don't have any knowledge of armed medics on any tac team who aren't sworn officers, even if only reserve officers. And reserve officers "hiring" standards do not significantly differ from those of regular officers. I don't think your concern is even an issue.

Did you know that the great majority of medics killed in the line of duty are killed in their trucks? Food for thought. :wink:

When I left the field, there was still much debate among medics in the field over whether we should carry all our equipment into scenes and work the patient where we find them, like Johnny and Roy did it, or if everybody should be dragged back to the ambulance before beginning advanced therapy. Interestingly, there was never really any question over the matter in academic circles. They had long ago established the "proper" course of action. Yet, as frequently happens in EMS, a lot of undereducated technicians take it upon themselves to decide that they know better than their instructors and do whatever they want to when they get into the field. My specific questions are: 1. All things being equal, which is your preferred method of operation on an ALS medical run? Why? 2. Does your agency have an SOP covering this? If so, what is it? 3. Did your instructor or school ever tell you which way was the "right" way or the way you should do it? 4. Does everybody in your agency operate the same way, or does the controversy still divide the profession? Qualifiers: I don't want to hear a bunch of "what ifs." This is not a trick question. It is a simple, straightforward question that does not require any reading into. Your scenario is a safe, uncomplicated medical (not trauma) scene in a well lit suburban home with the ambulance parked close by and fair weather. You are not being rushed by low staffing levels, danger, or a lack of support. And I am asking specifically about ALS intervention, not ABC's.

I tend to agree. I am all for new medics spending significant time as a secondary medic before becoming a primary. But what Boston is doing smacks of pointless cronyism and snobbery. Considering none of the schools up there are even accredited, I can't figure out what they are so proud of. How long has BU been running it? Any chance the new administration will revamp the system to be more professional?

Only personal experience, without actually watching the second hand while in the process. You have to open up pads. You don't have to open up paddles. You have to un-peel pads. You don't have to un-peel paddles. You have to plug in pads. You don't have to plug in paddles. You have to worry about pads sticking. Not so with paddles. Simple math dictates it will take longer to shock with pads than with paddles. What that actual time difference is, I don't know. That would be the reason I wrote "about a minute" instead of "exactly a minute.

I can't disagree with anything you said, Scotty. For an industry who is constantly complaining about costs, they sure seem to be awful eager to spend a buttload of new money on pads now. Losing the "quick look" capability is the first thing that concerned me. I'm sure I'll get used to it, as it's not really a huge deal to me. But still, time is muscle, and it takes about a minute longer to shock with pads than it does with paddles. After that first look/shock, I'd rather have the pads because it will save both time and effort on subsequent shocks. Of course, I do like that losing the paddles has made the defibrillators lighter and more compact. That is a big plus for the medic in the field.

That brings up a good point that I'd like to hear some of you address. How has the field use of 12 leads affected your use of narcotics for chest pain? If the EKG is negative for signs of an MI, does that make analgesia contraindicated in your protocols or judgement, or the judgement of your online medical control? Or do you still treat the pain the same way as you would have otherwise without a 12 lead?

Well now, THERE is something worth dragging an old topic out for! It's a shame that an opportunity this good was presented on the board and left incomplete. People would rather argue about basics intubating than discuss realistic patient care scenarios. That's what's wrong with the profession! How can we possibly let this topic pass without telling EMTs exactly what "organophosphates" are and how to recognize them? The most commonly found organophosphates are insecticides. Commercial names like diazinon, malathion, parathion, Dursban, Spectracide and Real Kill are found in just about every garage and garden shed in America. While they are no longer sold in glass as they still were in the 1980's, you can still find old glass bottles of them in many homes. And yes, Protopam was used in 1985. I studied it in paramedic school in 1979. Now, does somebody want to discuss SLUDGE for us, or did everybody learn everything they will ever need to know in EMT school?

Now that's funny right there, I don't care who you are!

Ah, Philips HeartStart AEDs! Very good choice. In fact, the BEST choice, as far as I am concerned! They have two separate adapters. One fits all Lifepaks. The other fits all Zolls. Each is $30 bucks retail, which is cheaper than a set of pads.

Hey Man, welcome to the City. I just missed you in the chat room. I'll catch up with you soon. You can't swing a dead cat around here without hitting a paramedic. They're a dime a dozen. Even the fire departments that don't run ambulances still have most of their people trained to the medic level. Half of them are busy scheming behind the scenes to take over the ambulance service, and occasionally they succeed.

I don't have any experience with that particular model. But Icom does make quality, heavy duty handhelds. You're the only one here who knows what your operational requirements are and what specifications and features you might need. The F-11 is a pretty bare-bones model without many features, but as long as it meets your requirements and the price is right, you won't go wrong quality wise with Icom. Unless there is some reason that you are dead set on that particular radio, I would definitely not spend my money before I checked out similar Kenwood products and did a comparison.

You'd think somebody in that organization would have the common sense to just buy some adapters! A lot cheaper than using two sets of pads on every patient! :? What AED are they using?

Hmmm... seems to me that people would be a lot more likely to steal a little mylar packet of pads than a hardwired set of paddles. :? Anybody in the warmer climes having trouble with drying pads, like the EKG patches sometimes do? And are y'all keeping the pads sealed until you are ready to use them, or keeping them pre-connected to the machine?

Hmmm.... it does sound psychogenic. It is not uncommon for people to get so worked up over worry that it becomes a self-fulfilling prophesy. Plenty of people actually make themselves sick just worrying about getting carsick or airsick, before the journey even begins. Lots of medic students who have gotten sick at autopsy or gross anatomy classes probably would have been fine had they not been so worried about it. So indeed, your anxiety is most likely contributing to the problem. Assuming you check out physically, it sounds like you simply need some relaxation techniques. Do a little searching online, and ask your doctor about them when you discuss the medical workup. Relaxation is the key. I wish I had some magic pill for you, but really the best I can say is that this ain't rocket science. BLS is just darn hard to screw up in any serious manner, so relax, take your time, and concentrate all your focus on the patient, not on yourself. As long as your mind is occupied on your patient and the care you are providing, your mind doesn't have time to dwell on worry and doubt. That's why people who get sick at autopsies usually don't get sick while working on a patient in knee-deep blood. Same reason that some pilots get sick when they are passengers, but not when doing the flying themselves. Remember, thousands and thousands of people who weren't half as smart or strong as you have passed this way before you. There is no reason that you are not up to the task. Good luck!

Junkies seek narcs through complaints of chronic pain. Back spasms. Migraines. They know better than to try and fake acute injuries, as they have found out very fast that it doesn't work if we don't find any signs. And they are pretty easy to pick out too, since they are always "allergic to Stadol and Nubain." That's why they show up at the ER instead of calling an ambulance. Failing to find anything, the doc simply writes them a script to get them out of his ER.

Good points, guys. Two runs from the past stick out in my mind. I picked up a middle aged male from police custody outside of the burning meth lab that was his home. It blew up as it was being raided, and once he was in custody he began complaining of chest pain and SOB, so we were called. He had a history of prior MI, chest pain unresponsive to nitro, stable VS, and symptoms which strongly suggested another MI. We were 20 minutes from the nearest hospital. I gave MSIV. The doctor who had to wake up in the middle of the night to come to the ER made one of those smart-ass remarks about me wasting MS on somebody with nothing wrong with them. Ten minutes later, after seeing the 12 lead, he personally apologized to me. Then there was the elderly lady with the broken hip on the bathroom floor in the middle of the night. She was in severe pain and any movement only aggravated it. I called medical control (obviously a different system from the above case) to request MS prior to packaging and transporting the patient. The A-hole doc quickly said, "I don't believe in that. I'm busy. I gotta go." and walked away from the radio. "I don't believe in that?" WTF is that supposed to mean? He didn't even stay online long enough for me to ask if he might be more comfortable with Stadol or Nubain. When we got to the ER, I was sure to point that doctor out to the patient and her family and let them know that HE was the one who didn't "believe in" pain medicine for hip fractures. And I made sure he heard me tell them.

A lot of docs make asinine, off-the-wall statements like that during patient presentations, instead of shutting up and listening like they should be doing. And I can't count the number of times docs have smarted off to me about the use if narcotics in the field. Don't worry about it. When it is his mother lying on the bathroom floor in pain, he'll suddenly have a whole new perspective. Unfortunately, our idiotic "war on drugs" mentality in this country has created a popular culture within the medical community which places "just say no" over the care and comfort of their patients, and it's retarded. Fortunately, there is also a counter-movement within the medical community which is gaining in popularity which advocates compassionate pain management. The science is on their side. They just have to overcome all the hard-heads with the archaic attitudes.

I don't want my tax dollars wasted on either one!

I love that RNs aren't mentioned anywhere in the plan!

Quite obviously, you never bothered to read the forum rules, which clearly prohibit typing in ALL CAPS. What are you, special? :roll: I hope you are better at following directions in school and on the job.

I personally want my elected officials spending their time on more important matters. I'll just be careful with my own needles.