fakingpatience

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.

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.

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.

I actually have looked through a patients wallet for information about them before. In this case a middle age guy was found wondering a building where he lived, with his wallet on him. The man was unable to answer any questions, but had nothing physically wrong that we could find with him. During transport to the ED, I looked through his wallet which the pd had given me to try and find any more information about him (some people keep a list of medications in their wallet). In this case, I had nothing else pertinent to do for patient care, so I didn't feel bad spending the time to try and find some more information about him.

Ok, so sounds like I am going to ask fire to take spinal precautions on all patients when extricating them. I'd let them decide who it is safest to extricate first, while telling them I would like the driver of the truck ASAP. Gonna need both other BLS units, and the ALS back up. So far I see no reason why we have a time out listed for the burn center, none should need to go there above the level 1 trauma center, which is probably where we are gonna be headed. For the woman in the truck: even if she smells of ETOH, I can't assume her inability to respond properly is due to the ETOH, since she likely has a head injury also. I'd also be concerned about a chest injury on her from the bent steering wheel.

A 400 pound guy with no medications? Something doesn't seem right there... When you ask him more specifically what "cruddy" feels like, what does he say his symptoms are? Vitals, especially a BGL. If he isn't already on diabetes medication, my suspicion would be that it is just not diagnosed yet. Hyperglycemia could lead to the dry skin and "cruddy" feeling, and symptoms are slower to present. Next question... can he walk? No need to carry someone who is just feeling a little ill, if all their vitals are good, and no reason to think cardiac/ respiratory/ anything that would get exacerbated w/ exertion.

I agree. Working a code, or going to a DOA really doesn't bother me. But seeing and hearing the family grieve when they hear their loved one is dead gets to me worse than anything else. Talking about the incident with my partners helps me, and having partners who can still make jokes and make light of things (not in front of the family of course, and still being respectful), liking singing "start your day with a DOA..." helps. Usually I depersonalize the incident completely, which is why it is harder for me to see the family, or if there is something in the newspaper about the person who died, I usually try to avoid seeing it.

Is the garage safe to enter? The roof looks a little iffy in the pictures to me. For now, I stand back and let the fire guys do their extrications, and try and talk with the people in the car. The people in the red car are able to speak well you say, do they complain of any injuries? How did the accident happen according to them? The woman in the blue car, what kind of responses is she giving? How far away is the ALS unit? Is there another BLS unit available? Based on injuries, we would probably be fine with 2 units, but if one of the people in the red car are hurt worse, then we might need a third unit. I don't think I'd call for a helicopter, unless we needed another ALS unit and non were available. Once the people are extricated, what is my first impression of all 3? Thanks for all these scenarios everyone, they are fun!

Don't mean to derail the train of thought on this tread, but I have a quick question. Posturing is a sign of head trauma, not necessarily related to spinal compromise, right? Honestly, I wouldn't worry about getting another 14G in, don't think I would have even tried with the first one. A 16 should be all the hospital needs to give bloods I believe, and everything we want to give would be fine with an 18. Does the pt still have a gag reflex? Oh, and what does IVC stand for? If we can't establish an airway in the field, I would pick the quickest option to get him to the closest place that can RSI or establish another airway (cric if necessary due to facial trauma). Probably would end up going to the ER, and having the helicopter there ready to transport this kid to a trauma center once he has an airway. (sorry this is so jumbled)

Not meaning to nit pick here, BUT where I took the EMT-B course, it was already 10 collage credits (not in NY). NY should first focus on catching up with the rest of the nation, and accepting national, rather then trying to restructure the entire program. The national standard for EMT-B is already about 1/3 longer then the NY standard.

After making sure he is breathing, or having someone assist him w/ respirations (including NPA/ OPA) if he is not, Vitals, including GCS. Is he posturing? Ask bystanders if he moved at all after crash, did he appear unconscious immediately, or was he initially conscious and lose consciousness slowly. What caused the crash? How did he fall, what did he hit first? What do his pupils look like? Are they responsive, are they equal, or is one blown? Full trauma assessment

Most are good for 2 years. Check and see if it is required for your class though. In my class, CPR for the professional rescuer was obtained in class, we did not need to come in with CPR (that I can remember).

I used to work in a place that had a computer system like that. Certain addresses could be flagged by dispatch for having violent offenses in the past, and whenever that address popped up, we always had PD go in first to clear a scene, regardless of what the call was for. As much as it sucks, there are people who will attack us simply because we are dressed in uniform. A call for a child w/ difficulty breathing could lead us into a very volatile scene, and IMO, if we know that location has a hx of violence, then it is our right and responsibility to wait for PD to get there first. As much as I want to help others, mine and my partners safety comes first. I miss having the computer system where you could see a record of recent calls to the address, and see if it was a flagged address. We don't get any computer info here, it is all what the dispatchers choose to give us over the radio, and sometimes they forget/ don't think info is important enough to say. A couple weeks ago, I called on location to a call, and was told "the scene is now safe to enter" I was NOT HAPPY with dispatch, since we had never been told the scene wasn't safe...

I also took a while to be confident with my skills as an EMT. In my town, the agency I volunteered with had me as the third person on the ambulance. So I was never alone with the patient, I had a paid staff in the back with me. At first, I observed and took vitals and anything else the person directed me to do. As time went on, I started taking more of a leadership role on calls, to where eventually the other person in the back wouldn't do anything unless I specifically asked them to (or I was missing something vital!). For me this was the perfect way to be eased into the EMS field. I now work full time as an EMT, and am confident in my patient care skills, but still trying to learn more to better myself as a provider. There are many people who are proponents of just "throwing you in there", sink or swim style of making you more confident in yourself. There is a time and a place for that, but I think that for myself, and others, if I had been thrown out there in the beginning, I would not be as confident in my skills. Unfortunately, in my experience, most private agencies (or actually, any paid agencies) won't do a lot to boost your confidence. You are either ready to work or not. I recommend finding a place to volunteer where you can get your feet wet and build up your confidence in your EMS skills.

Anyone know of any good WOMENS boots? I have a pair of magnum that I love, but they don't hold up well at all, and I need a new pair before it starts to get really wet outside. I have heard that a lot of the companies have actually stopped making women's boots. My local store is no help, they think the only difference is that the womens boots are smaller sizes. I have a really narrow heel, and there is way to much room in the heel in most mens boots for me.

Congrats! If it makes you feel any better, I volunteered for about 9 months, and moved across the country before I could find a paid EMT job... Don't get to bored during orientation

I technically had a patient with a flail chest, I think. Thats the thing that sucks about being the basic on an ALS ambulance. Our guy had major crush injuries and needed to be at the trauma center, so as soon as he was extricated, we loaded him into the ambulance, and I drove to the trauma center. I asked my partner about it after the call, but its still not the same as being back there with the patient. Can't wait till I'm the medic in the back (2 more years...) Anyway, the pt ended up having 6+broken ribs, and a small pneumo (my partner and the other medic in the back didn't realize he had a pneumo), but wouldn't even tolerate a pillow splint for his ribs.

Ok, I guess I will take a stab at the questions What is flail chest? If I am remembering my textbook answer correctly (no I am not looking!) when two or more (or is it 3 or more) ribs are broken in two or more places What caused it? As others have said, major trauma to the chest What are your primary short term concerns? A broken rib puncturing the lung, causing a pneumothorax (I am not really clear as to the differences between a regular pnumo and a tension pnumo, but I know both are bad). Or hemothorax, or hemopneumothorax... either way, not good. How possible is it for the fractured ribs to actually damage the heart? I would assume if it is in the right place, on a relatively skinny person it could, which would be bad bad bad. So pretty much my main short term concerns are breathing problems Longer term concerns? Um, complications from above? Load and go/stay and play? Why? Treatment? I am pretty sure regardless of BLS or ALS, I would load and go. BLS there isn't a whole hell of a lot I can do for them except use the BVM if their breathing gets really bad (if I am remembering correctly, the BVM uses positive pressure ventilations, which would negate the flail chest because it would not be negative pressure on inhalation, so the entire chest would expand w/ every breath). We don't have x-ray/ MRI vision in the field, so although we can guess, we can't know for sure what all damage is done beneath the skin on this guy. Whatever caused the force strong enough to break multiple ribs is going to put me on high alert for other injuries (not that I am triaging based on MOI, just higher index of suspicion). If he does have a punctured lung, he needs a chest tube, and while ALS providers could do a chest decompression in the field, I am pretty sure that is only a temporary fix. Either way, this guy probably needs surgical interventions (is a chest tube officially a surgery, since it is often done in the ER?)

Wow, I've never actually seen the paradoxical movement before! Is it usually that pronounced?