fakingpatience

Our protocols don't allow for sedation of combative patients. If it is a head injury we can restrain them and once I called medical control for sedation options and was approved to give Valium. My question is why are you sedating a 200lb drunk? Where I work if the drunk is able to put up a good fight then they are stable enought to go to the ER in a patrol car. Ive also had OD's that have been extremely combative but in that case the Sheriff deputy accompanies us to the ER and the restraining is done with handcuffs. Maybe its just a difference of where we work but I dont plan on fighting a drunk to sedate him. Im not saying its wrong just asking why endanger yourself or your partner?

In my system, we transport pretty much all psychiatric, and a good number of drunk patients to the ER, and PD follows behind in their car, if at all. We are not allowed to out and out refuse a request from PD to transport the pt, even if we feel the pt is very violent. We can request that they ride along, but we cannot refuse. Oh, and all we have are soft restraints, no hard restraints or chemical restraints . Also, PD can cuff a patient, and then only follow in their car behind the ambulance, not ride along. To me, if the patient is handcuffed, I would want a police officer in the ambulance with me incase the patient a. uses their handcuffs as a weapon, or b. deteriorates, and I need better access then what I can get with the handcuffs on. Unfortunately, my company will not support us if we say we don't feel safe with the patient...

Not trying to detract from the topic , but from reading the article, it seems the EMT was driving the ambulance with no one in it, after she had already dropped off her partner. Why would someone be in the ambulance w/ out their partner? Sorry if this is off topic, that part just confused me, and I was hoping someone can help explain it.

My thoughts are going out to everyone involved in the accident... hopefully they have as good an outcome as possible.

Instead of a definitive answer, or going to protocols, lets see if we can walk through it and decide for ourselves what the best course of action would be, and why, OK?

What is the indication for a traction splint?

Midshaft femur fracture

What are contraindications for a traction splint?

ANY other leg injuries that could be made worse w/ the pulling force, ie. other fx, knee injury, ligament injury, pelvis injury. I don't remember if open fx was a contraindication, but I know completly severed bone is a contraindication (So pretty much if the skin/ muscle/ ligaments is the only thing keeping the leg from being amputated). If the outside bone is very dirty, I would attempt to clean it first by flushing it with normal saline

What is a compound fracture?

Open fx

Why would you NOT want to use a traction splint with exposed bone ends?

Dirt getting back in? Risk of bone being completely broken/ snapped in half

Why might you choose to ignore the issues with reducing a fracture with exposed bone ends?

loss of pedal pulses/ cms

I'm asking those of you that know the answers to let those that are learning do their thing here, and for you not to spoil it for them. Please feel free to help, but not solve. Thanks.

Dwayne

Good to think about the traction splint, since it is one we use so rarely (I have never used it) It is aways good to mental go over it again.

On the same note, would to try and realign any other fx? I was taught yes, 1 try, unless you feel resistance, but some people here say no, never try.

I ended up getting a pair of women's Magnum stealth force water proof with the side zipper. They are much more comfortable for me then the other brands I tried, good from the first day of wearing They don't zip on and off as easily as my older version of the magnums, they changed the zipper, but my zipper broke on my old boots, and I think this design is stronger

Major surgery on a 92 year old patient? Really? To what benefit for the patient- an extra 6 months- maybe? How does it affect their quality of life- if at all?

Just because we CAN do something, does that automatically mean we SHOULD? Think about extended care and ventilator patients. With our technology we can now keep someone "alive" for a long time- even though there may be no hope for any meaningful recovery, much less independent living.

Who gets to decide what is appropriate/cost effective/worthwhile? Tough questions, indeed.

Sometimes the surgery, though risky, will actually greatly increase the pt's quality of life. Take for example the elderly person who breaks their hip who has a cardiac hx. The surgery would be risky, and chances for survival are slim, but their options are living the rest of their life in a bed in a nursing home, unable to move, or attempting the surgery, and have a much better quality of life if the surgery is successful. I don' t think there is a blanket answer to the question of care for the elderly, it is entirely case by case.

Loved this video... got an extra laugh out of it because our local fire departments have been known to do some of the stuff fire did in this video

I'll take a stab at it... My answers are in red

I came across this the other day and decided I'd play. Sadly, I got most of them right....

How many can you properly credit?

Who said it?

I Family sitcoms:

"Dy-no-mite!"

"Aaay"

"Stifle!"

"Oh, my nose!"

II Other sitcoms:

"Baby, you're the greatest!"

"I know nothing!"

"How YOU doin'?"

"No soup for you!"

III News catchphrases:

"And that's the way it is."

"Good night, and good luck."

"One small step for man ... " -Is this something specific, or just the first time they talked about walking on the moon?

IV Cop show catchphrases:

"Book 'em, Danno." Hawaii 5-0 (only know it cuz they have a new series)

"Just one more thing ..."

"Let's be careful out there."

"Who loves you, baby?"

V Sci-fi catchphrases:

"Resistance is futile."

"The Truth is out there."

"Beam me up, Scotty."

"You've just crossed over into the Twilight Zone."

VI Catchphrases from cartoons:

"D'oh!" - Simpsons

"Heh-heh."

"Don't make me angry ..."

VII Game show catchphrases:

"Is that your final answer?" - Who wants to be a millionaire

"Come on down!" - The price is right

"Once you buy a prize, it's yours to keep."

VIII Sports catchphrases:

"Do you believe in miracles?"

"Let's get ready to rumble!"

"Know your role, and shut your mouth!"

IX Comedy catchphrases:

"What you see is what you get!"

"Mom always liked you best!"

"Sock it to me!"

"We are two wild and crazy guys!"

X Variety show catchphrases:

"Here it is, your moment of Zen."

"Now cut that out!"

"We've got a really big show!"

XI Ad catchphrases:

"It takes a licking ..."

"I can't believe I ate the whole thing!"

"I'm not a doctor, but I play one on TV."

XII Reality show catchphrases:

"The tribe has spoken." - Survivor

"You're fired!" - The apprentice

"Smile, you're on 'Candid Camera'!"

XIII Political catchphrases:

"Oh, the vision thing."

"They misunderestimated me."

"I didn't inhale …"

"I took the initiative in creating the Internet."

XIV More political catchphrases:

"Senator, you're no Jack Kennedy."

"I'm not a crook."

"There you go again."

"Ask not what your country can do for you ..."

Wow, no wonder I always get teased for being so clueless about popculture!

Whenever my partner and I aren't together and I have mystery meat, I always tell him or her first off - I can't read your mind. Please tell me what you are thinking. I won't be insulted to hear "Can you spike me a bag?" or "I think we can BLS him."

I will be insulted if you get mad at me for not reading your mind. Every person is different. One medic might throw someone on monitor, 12-lead, IV, fluid and NRB - all before leaving the scene, while another might get around to a NC sometime enroute. As long as protocols are followed, two medics can run the same call completely different ways and both be right. If I haven't worked with you before, I don't know how you run.

That's my biggest pet peeve. Just say what you want. Think out loud. If we aren't permanent partners I don't have a lot invested in learning how you think. Just say it.

Yeah, I usually ask partners how they like to run a call when we start a shift, but the answer I get usually is "it depends" and they don't elaborate. I work with partner of the week (aka someone different) a lot, and it is frustrating not to have the jive, and know how to work together well.

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

I have had the opportunity to work with many different partners in EMS, and I was thinking what traits/ things a partner did that I liked, here are some of them:

Offer to drive if I have been driving all day and we are ping ponging posts, or if I just got food

Let me tech the BLS calls... I didn't get in this to be just a chauffeur!

Will interact with me, at least some of the shift, not just sit there texting/ playing games on their phones

Lets me ask questions about what they are doing with an ALS patient w/ out getting defensive, and can explain things well

Is willing to teach

Is willing to learn/ admit they are wrong

Going along with the above, lets me point out a mistake they may have made (like putting limb leads on fake legs!) w/out getting insulted

Will point out my mistakes in a kind way

Likes being a paramedic/ EMT

What are some qualities you like in your partner/ things they do that make you enjoy the shift more?

I used this book to study http://www.amazon.com/EMT-Basic-Interactive-Flashcards-Preps-Premium/dp/0738601233 I love flash cards, and that is what helped me. Actually, for me, I don't think the studying was as much about learning the information, because you should know it by the end of class, but assuring myself that I knew the info, to be more confident for the test. That said, I was still a nervous reck after my NREMT test, sure I failed... i didn't

From my experience in this industry, although I personally have never had a DUI, I have come across many who have been in your situation or worse and , unfortunately, I can tell you this incident will have no adverse effect on your career as a EMT good luck to you sir.

Really? Everywhere I applied looked at my driving record, and wouldn't hire a basic w/ out a clean record for a number of years. I also just had a coworker who was essentially fired for getting a DUI. I agree with what was said above, your chances are much better getting hired somewhere as a non driving medic then a non driving basic.

For class, I just bought the cheap stuff. A pair of dickies, a plain white button down shirt, and a $20 pair of black boots from walmart. Even if you plan on getting into EMS, you don't know what their uniform will be exactly. IMO, just don't wear something with frills/ extra strings for decoration that could get caught on something or pulled if you get a violent patient.

Suicides and suicide attempts always increase by the holidays. It is a stressful time for many people, with all the family expectations and let downs. Large family gatherings are stressful for a multitude of reasons, and if you don't have a family to gather with, it can be depressing. Society and the multimedia perpetuate the idea that everyone needs to have the 'perfect holiday.' Tie that in with the fact that many more people are now financially unable to provide a 'perfect' holiday for their families this year, and they feel like a failure.

That said,

I HATE dealing with family on scene at crap calls. I can work a code, or see a DOA no problem, but hearing the family grieve afterwards gets to me. I think part of that is because there is nothing we can do for them. I worked a code on a youngish guy, and I don't remember anything about the code, but I remember the toddlers wide eyes, watching us try and save his daddy....

I watch all directions around my rig. Foward, back and sides. I also look in my mirror to see whats going on in the patient compartment. Do I need to adjust driving to allow my partners to do something?

I know some say just to concintrate on whats infront of me but I feel total awarness is key.

As for pulling over because someone is on my back step. Maybe, depends on circumstances. I could care less about Joe Somebody I didn't tell not to. I was more talking about the patient's family. They are the ones sometimes that try following me through things they shouldn't. I don't want them to be patients too.

Its all good though, good comments and posts

I hate it when pt's family try and follow the ambulance, even when we are driving cold. if I go through a yellow light, to avoid a hard stop for my partner in the back, sometimes the family will drive right through the red light. One trick that one of my partners here uses is getting the family to leave first to go to the hospital, while we are getting everything set up in the back, so they have no opportunity to follow us

I was just wondering if anyone else had crazy things go through their heads during stressful situations.

My brain is weird, I tell that to anyone who knows me. I have never been in an ambulance accident (knock on wood!), but anytime anything stressful is going on, I tend to notice weird details. I am trying to think of an example of this, but drawing a blank, but just wanted to let you know you are not weird for thinking random things at stressful times. Or maybe you are weird, but then I am too

I think you are misunderstanding the original question. To me, the OP was about WHY it would be necessary to fully immobilize a person who has already been walking around with their injury for an entire day. Does it look awkward seeing someone sitting in a bed with a c-collar on- sure.

Maybe I'm wrong, but I don't think the person had any intention of refusing such a request.

Thank you Herbie, you are absolutely correct; I was not questioning the doctors call, I am merely asking questions about it, to help me learn. I don't think anyone would go against what a doctor says to do unless you have an absolute argument why it would be detrimental to your patient.

Here is my thoughts on boarding a patient who has already been up and moving around for a significant amount of time (not relating to the example from the original call). How would sitting still on a cot in the ambulance cause the patient to move in any direction they had not already? Instead the backboard is going to cause increased pain, and if you don't pad properly (and I don't know many people who do) could cause more movement of the back when you bump up and down.

I am lucky with my company now, where we have liberal back boarding protocols. We don't need to board every fall (from standing) w/ possible head injury/ ETOH/ drugs on board, only if they have a specific complaint of neck/ back pain.

Dwayne, I have seen you mention putting a folded blanket on the backboard before boarding your patient before. I was going to try this on my call, but my partner disagreed, saying that the blanket would cause the patient to slide around to much on the backboard. What has been your experience with this?

4c6: I used to have vacuum splint at my old agency, and I loved them for splinting extremities. I have never seen a full body vacuum splint though! It makes since that it would work better (it does the padding for you), and I would assume it would be more comfortable for the patient... through it doesn't take much to be more comfortable then a LBB

This was not my call, but I was in the ER, and helped the crew who took it, so I don't know all the details.

The crew was called to our local hospital to take a patient to the large trauma center in the city. Pt had fallen from a tree yesterday, but decided not to get seen at the ER, as she had cut up her face pretty badly, and was unable to see well enough to drive herself. Came in today w/ complaints of facial trauma (had one lac on forehead down to bone, and other swelling), and back pain. Our local hospital doesn't have CT or MRI, but they did an x-ray of pt's spine, and found a couple fractured vertebrae (I don't remember which, sorry!) Pt was sitting up in hospital bed with a C-Collar on. The hospital stated that the patient had to be put onto a backboard prior to transport to the trauma center.

Here is where I am confused. If the pt injured herself yesterday, and was already up and walking around, even though we now know she does have fractured vertebrae, can't we assume at this point that the fractures are stable? I was under the impression that if a patient was walking around for that amount of time, they had essentially 'cleared' their own c-spine of an unstable fracture, and therefore, even if they had a fracture, it would make no difference being back boarded or not, but the back board would cause additional pain. The crew who took this call didn't question why she needed to be boarded, so I couldn't find out the official answer. I asked them if, they had received this call today to the patients house, of a patient who fell yesterday, and was complaining of back pain, would they back board, and they all agreed no.

What is the benefit of back boarding this patient solely for transport?

In my class doing scenarios, my instructor hid fake needles and other "dangerous" things on the patients. It was to teach us about scene safety, and to look before you touch. I have seen many providers blindly reaching into a patients coat for something, or to help them get their jacket off, and you never know what could be there.

I don't know if you have done this yet, but get ahold of your local PD. Find out what gangs are big in your area, and what signs to look for. In some places, it may just be people flashing gang signs, or it may be graffiti, or the shoes around the wires. Know what the signs are in your area is always helpful.

PCP, seems to me, the guy had an allergy to stainless steel bracelets, hense his hesitation to getting out of the car, and if the LEO (Law Enforcement Officer) knew of the order of protectiion's existance.

Huh, I do actually have an allergy to stainless steel... does that mean I could get out of being handcuffed

I've actually found the opposite problem in new development areas; the road won't be on the map book, but my newer GPS will know where it is.

Our newer ambulances have GPS built into them. I alway bring my personal GPS with me, because I usually work on the older trucks. I am new to the area I work in, and while I am starting to know my way around better, I still don't know where many of the roads are. The problem with our map book system is we don't always know which section of a road the call is on, and that could make a big difference when driving to the call. Most times our dispatch gives us cross streets, but it is often hard to understand them over the radio, and they get ticked if you ask them to repeat it.

All that said, I know my GPS is flawed, often takes slightly longer, or more obscure ways to a call location, but there are times when it uses a short cut even the people who have lived here forever don't know. I think you need to use your own judgement when to follow the directions of the GPS, and when to use the map book.

Hi, Just got off shift so I promised myself a few "adult beverages" but your post caught my eye.

In North Carolina, EMS is strictly County Based with a pension in the LGRS and will match you in a 401K and or a 453b. Mecklenburg County EMS is the "elephant in the room" in the Carolinas as far as overhead, opportunity, pay, and we are the busiest system in both Carolinas. With National Registry I don't forsee a problem as my wife and I both came down from NJ over 2 years ago. The cost of living is quite less than up North. If you are interested, check out our website at medic911.com. All training is in house with state of the art medical services and training. We offer a bike team, SWAT medic, DMAT and there are plenty of opportunities for overtime. Hope this helped!

Rich Uhlich NREMT-P, CCEMT-P Crew Chief.

haha, you have me wanting to move there now, even though I just got settled at my new agency... Sounds like a great place to work!

Well, I found my own answer to half of the question, I do need all 72 hours of training time. Any suggestions on how I can get more CMEs? My agency doesn't support/ help me with what I need for the NREMT, and hardly offers any training hours.

Hello all

I am trying to figure out how to fill out the NREMT recertification/ CME section. When I go online to the NREMT website, to the manage my education section, there are two different sections, refresher training, and continuing education training. Which section do the CMEs I've taken go under? Do I need both the 24 hours for refresher training w/ specific requirement for what you learned, and the 48 hours for continuing education to re certify (not saying that is to much, just trying to understand it better)

I feel like I am not being very clear with my question, but if anyone could help me out, it would be much appreciated!

First, kudos to you for realizing that your mindset in your current job is the problem, not your coworkers!

Many private agencies do both IFT and 911, and most private agencies, while they might not be the best place to work, are always looking for medics. My agency does 911, and is contracted by the local hospitals to do transfers, and by a few nursing homes, where we do returns.

When I saw you wrote "which side is better to work on," I thought you were talking about non transporting, first responders w/ ALS capacity, vs. the ones who actually transport. I would think that transporting the patient all the way to the hospital from a call would be much better experience for a new medic then first response (fire) ALS.

Where are you looking at relocating to? Someone might be able to give you an idea of the agencies in that area.