fakingpatience

Someone did that to me last week! I went back to the ambulance exhausted after dropping my pt off at the ER, and turn it on, only to hear the loudest, most annoying siren we have blaring. I almost jumped out of the ambulance...That woke me up for the next 10 mins or so!

What do you mean telling someone? Do you mean telling other health care professionals/ law enforcement? Or do you mean talking about something a pt told you to someone not in a professional setting? If it is the former, I think you are well with in your rights to tell the professional what they told you (ie, if someone admits to assaulting another person...). I do not think it is legal to tell the info to someone else. Simply by telling them the non-medical information, you are inadvertently divulging medical information, specifically that that person was transported by you, which I believe is protected information.

Remember, when you are starting an IV, even if you are nervous as hell, don't let it show to your pt. You need to show them you are confident and competent, and if you look nervous, then they will become nervous, and harder to stick (more likely to flinch, pull away, refuse to let you stick them). One of my first "real" sticks, I looked to the medic on scene to make sure she agreed with my vein choice. The pt noticed and started saying "don't let her touch me with that needle" I ended up getting the line, but afterwards my medic gave me a long talking to about not looking confident in front of the pt. You need to put your pt at ease, and they won't be unless they think you know what you are doing.

Wow, I am jealous, it sounds like your unit is better stocked than my paid ALS ambulance! I wish we had vacuum splints and a scoop!

Actually, I am not with AMR. I decided to go with the smaller agency in my area in hopes they would treat the employees better. From what I have heard from most people, private sucks, no matter where you go. My smaller agency doesn't seem to treat employees better than the big agency here, people just say "at (big agency) you can hide in the crowd, here they can see and punish everything you do wrong." Now I don't think there is anything wrong to being held to standards, in fact, I think my agency should hold us to even higher standards, it is how they run the business side of treating their employees that is wrong.

Let me take a stab at this from my BLS education (aka, I don't know much about the drugs) . Once you start ventilating the pt, have someone find someone who knows the pt, get a history, as someone else said, make sure no DNR, ask about other meds... Any other s/s of a problem, diaphoretic, wheezing prior to losing respiration, hives, trauma...? Any medical bracelet? Have someone check pt's carry on for meds they are carrying. Start an 18 G in one arm, and a 20 in the other if you can hook up two IVs/ have access to a saline lock. Reassess vitals. Pulse? Strong, weak, regular, or not... where can you palp it (to get a general idea of the BP). Get the AED hooked up to the pt, so you don't need to worry about it later. Find more people who can do CPR... once this guy goes down for the count, you could be doing it for a while. However, I don't think I would ask specifically over the intercom for someone who knows CPR. On a plane, you need to consider the potential for an MCI if you cause panic. I would probably try and bring the pt into the back flight attendant area (if feasible, and doesn't compromise care), just so that it is not in front of the entire plane. And I am confused, you said the plane had many other non-als code drugs... aren't all the code drugs ALS?

So here is my update about a month into my new EMT job. Things are very different in this new town I am living in than where I was before. EMS is ridiculously political down here, it is all based on the money, and making sure not to upset the volunteer fire fighters. We run calls in two towns. In one town we run with volunteer fire fighters. Now for that town, we have to go hot to EVERY call, regardless of the nature, unless it is an "ambulance only," and the fire departments never down grade us. For the most part, there is not a great working relationship with the vollies for example, if we get to the call at the same time as them, they will rush in to get pt contact first, instead of helping us grab all our stuff, and holding doors and such, since we will be the ones continuing pt care. The other town we run with is even weirder. They have paramedics w/ their fire department who are not fire fighters, and only go to EMS calls. We always go cold to those calls, regardless of the call coding. Once we are there (and we are an ALS ambulance, w/ a medic and basic), the fire medics can decide if they think the pt is ALS, in which case the fire medic jumps in the back of our truck w/ all their stuff, and techs the call, our basic sits in the back not saying a word or touching anything, and our medic becomes a driver. Talk about a redundant system/ waste of resources. If they decide the call is BLS, our basic techs it, and again, our medic drives. Pretty much, we are nothing but a taxi service in that town. Now, as far as my agency goes, we have a good mix of people who like the job, and people who hate it, but almost no one I've talked to wants EMS to be their career. They are all in EMS as a stepping stone job, until they finish nursing school, move somewhere else, get into PA school... Part of this I think is because the company doesn't treat the employees well. The pay is crap, and they can force you to come in and work on your days off, which really doesn't work for people w/ families/ lives outside of EMS. Also, the equipment is really old, which just makes it harder to do our jobs. I got really lucky with my partners, and I got people who like their jobs. I know most of this post makes it sound like I hate my job, but I really don't. I still can't believe I am working full time in EMS, and getting paid for it! Overall, I am pretty sure this company isn't going to be a long term career place for me, I just need to decide if I can stay here 2 more years, so I can get medic school done (they don't support you going through medic school, but lots of people are able to do it while working full time here), or if I want to move sooner than that.

OK, I am going to throw a female opinion in here. I would not under any (or at least any I can think of now) circumstances allow any provider who did not absolutely 100% necessarily need to to examine ANY of my privates. Even if the pt is in severe pain, there is nothing we can do by examining her that we can't do without the detailed exam. If she is bleeding, it will show through clothes and onto the sheets if it is heavy. Ask the pt if anything is stuck/ impaled, and if they say no, just trust what they say! Yes, some pt's will lie to you, but as someone else mentioned, pts lie and there is nothing we can do about it. Get a detailed history of the pt, when the pain started, type of pain, last menstrual cycle... Oh, and uglyEMT, " I do believe if the patient called us for pain in their genitalia then it would have to be pretty bad and I dont foresee them holding back information" You would be surprised some of the calls I have taken... let me just say that yes, I have taken a vaginal pain call where the pt was not in severe distress, just 3 am and mild discomfort... Again, as others have said, I think it is situational. If a woman is pregnant, and birth is imminent, than by all means, expose and do what you need to. Unless the call is very critical (and I mean, severe bleeding, pt unconscious... ) I would not expose. Sorry if this is disjoined, I went on a call in the middle of typing it...

Welcome to EMTcity! When you say you are getting ready to take the EMT class, do you mean you are taking prerecs now, or just personally preparing for the class? One thing that you could do now, if you deal at all w/ your clients' medications, is to start learning them. They will not be medication you are able to give as an EMT, but so often we have pts who can hand us a medication list, but don't know what any of the medicine they take are for. Also, study the diseases your clients have, they will be ones you will run into in the field, and more knowledge can never hurt! As far as stories, have you read any of the EMS blogs out there? There are many that are great in terms of stories and thought provoking posts. Let me know if you want any links to some of them.

Honestly, if that is your attitude, Don't become a volunteer. Yes, it will be hard to volunteer while you are working another paid job, but it is what lots of us needed to do to get our foot in the door. Most places will not hire you until you are 21 (some 20.5). In my experience, private agencies (the ones who are more likely to have jobs available) do not do a great job of training- my training was only 6 days long, and it terrifies me that someone brand new to EMS can come into my agency, have 6 days of training, and then be released as a provider. I volunteered for a year before I got a paid job (I also was not old enough), and I am so grateful for my experience volunteering. I had mentors who wanted to teach me and make me a better provider. Had I not had prior EMS experience, I WOULD NOT be comfortable now being an EMT, after such a short amount field training. But as I said, the private agencies are looking at the bottom line. They need more providers and do not want to pay for a longer field training time when you are only the 3rd person on the ambulance instead of clearing you to practice as a basic. IMO, you need to look at why you really want to do this. Are you in EMS simply for an 'easy' job and money? If so, get out now. Hate to be the one to break it to you, but you will never make 'good' money in EMS. However if you are in it for your love of EMS, then it won't be to much of a burden to volunteer first, while you build up your experience and wait till you get a little older to be hirable in most places. +medic mentioned IFT BLS trucks. That is another option job wise, if they would hire someone your age, but I know multiple people working IFT who also volunteer in a 911 system, just for more experience, and again, to make those connections that will be useful when you are looking for a different job. Long story short: yes, it will be hard work, but it is what you make of it. Your time spent volunteering should not suck, you should look at it as an opportunity to grow as an EMT, and be making a great impression on all you interact with so they can think "wow, I really want EMTDavid to work for us". Make those impressions and gain experience now, and in a few years, you shouldn't have any trouble finding a paid EMS job.

I am confused how they think this would keep the airway open in the first place. I tried pulling down my lip and sticking out my tongue (made sure my partner wasn't watching ) But I am pretty sure the airway would still not be open... Can someone educate me please? btw, doesn't pulling the tongue out of the persons mouth just put it in the perfect place for the person to, i don't know, BITE IT?

IMO, CPR classes vary hugely by who is teaching them. I have taken CPR countless times before I became an EMT, and then had to take it again for EMT class, and then recently I took a lower level CPR class for my other job (not required but paid training time). You know what? I almost failed my last CPR class. The instructors IMO were awful. They did not allow students to think outside the box for the class, they taught "this is what we tell you to do, and you need to do it exactly our way." I got into an argument with them because they were marking me wrong for not leaning across the pt to shaking both their shoulders. I told them that in a real situation, I would never reach across someone like that, because what if they weren't dead? I would have just put myself in a compromising situation. My first CPR instructor in high school taught me that. My point being that you need to find a good CPR class. If you just have an instructor who teaches straight from the book, you aren't going to learn a lot of real life practices, you will only learn the mechanics of CPR. Try and find a first aid/ CPR course taught by your local EMS agency. There you should learn not only the mechanics of doing CPR, but before hand, checking for a pulse and breathing on the pt (although I think that my last CPR class, they said if they are not breathing, don't even bother checking for a pulse), and actually assessing if they need CPR, and if not, what to do. Hopefully your class will have scenarios for you to work through. The only way you can get better is by practice. Hopefully you won't actually be practicing CPR on a real person..., but you can visualize what you would do if someone went down in your gym. If it isn't to traumatic for you, use your experience with the guy who had a seizure, visualize what happened, and what you should have done differently. It is a trick I kept from my days as an athlete, your coach tells you to picture scoring the goal, landing the flip; imagine yourself at a scene where you need to act, and see yourself going through all the correct steps. That has helped me 'practice' my EMT skills when I am not using them. You can also look into advanced first aid courses that the red cross offers. It is less training than becoming an EMT, but IMO, if you only want the training for working in your gym, that is all you should need. (sorry, hopefully the middle paragraph makes sense, if not let me know so I can clarify it)

So I tried other internet operating systems, and none of them were working for me. I guess I will just have to do all my crew scheduler stuff at work from a work computer I did email the company and here is their response: "I understand that you are using a MAC computer and working with Crew Scheduler. Unfortunately we do not support Crew Scheduler with MACs at this time. I apologize for the inconvenience this creates for you." Pretty disappointing, considering how many people use macs. At least they responded quickly...

This could be attributed to orthostatic hypotension. That is when your BP is fine when you are sitting/ laying down, but when you get up quickly, your BP suddenly decreases, causing you to be hypotensive, which causes the light headedness or dizziness. Unless it happens all the time, or you have had a recent trauma or illness, it usually isn't anything to be to concerned about. It happens to me from time to time, usually when I am feeling dehydrated. The mayo clinic has a good link about orthostatic hypotension, you can google that and find all their info.

I know this is a long shot, but I was hoping someone here might be tech savy enough to figure this out for me. My new job uses rescuenet crew scheduler, and I can't get it to work on my computer! I can log in, but when I try and click on any of the functions, such as shift bid, I cannot see any of the open shifts. It says I need Internet explorer 5.5 or higher to make it work. My problem is that I have a mac (using safari for my web browser), and they don't have higher than IE 5.2 available for macs (and IE 5.2 doesn't work either). I tried to boot leg IE, using a program called winebottler, but it is not working on my computer. Does anyone have any suggestions for getting the rescue net to work without using internet explorer? I am sure I can't be the only one using a mac operating system!

Unfortunately, this is not only seen in fire medics where you work. Many of the medics and EMTs at the company I work are the same. They hate taking calls (What are you in the job for!) and don't seem to strive to learn anything more. I asked a protocol question about oxygen to a medic I was working with; we had a pt. who was presenting fine (called the ambulance for back pain), maybe 70 years old, who was stating 93% on room air on the pulse ox. I opted not to put oxygen on him because I was always taught "treat the pt., not the machine" but when I asked, the medic told me that he used to put a non-rebreather, high flow o2 on every pt when he was a basic, because that is what our protocols say to do, but now as a medic, he still would have put oxygen on the pt. What frustrated me the most about what he said was that he didn't even consider that, although the protocols say high flow o2 for every pt, it is often not needed, and can be harmful. Another medic I was working with encouraged a diabetic pt to sign a refusal, even though he had just woken up after we had given him D50 and his sugar was only 150 ish, and he was vomiting every time he tried to eat, AND didn't have a blood sugar monitor, but was still giving himself insulin. I was not surprised when another ambulance was called back to the residence a couple hours later for an "unresponsive pt with diabetes". Many of the people I work with never even get a manual BP, they simply rely on the monitor, which while good, I still thought that you should get at least 1 manual BP first. Sorry for going off on the tangent; I just wanted to add that fire medics are not the only ones in our industry who are lazy, and resistant to learning anything more than they have to know.

Let me start by saying that I think what the nurse said was completely out of line A joke I have done with kids (not ones I just see on the ambulance, ones I know, and worked with for a while), if they are complaining about for example a paper cut on their finger, I might say "Oh no, that looks bad, I think we are going to have to cut off the finger!" This is something that I would never say to a kid unless I know them, because I don't know how the kid would react to it, and the kids I know, would know I was joking. The kids usually respond my laughing/ screeching "NO", and then go about their day. It gives them a little perspective. Maybe the nurse was thinking along those lines, had a good rapport with the kid and family, but just took it a little to far. While it is incredibly sad that the 11 year old has cancer, and may die with it, it is still important to joke around, but not quite that far. Maybe they could have said "uh oh, he can't sit up, I guess we will have to give him the shot on his bottom instead of his arm" but then again, that might have started the kid being combative again. I dunno, you need to have a good relationship with the kid to know what would work, but I do think that good, tactful humor has its place, especially when dealing with kids. To Mateo: Most 11 year olds, especially ones who have grown up around adults (such as one who lives primarily at the hospital) know far more than we give them credit for. I would not doubt that any 11 year old would understand exactly what the nurse was saying when she said "we lost your son"

When was your last seizure? Do you have a drivers license/ are cleared to drive? My guess is that that would be the biggest issue to being able to find a job.

thanks Dwane, I am so excitied to start, I think this company will be great to work for even if it means running less calls, they seem to really care about their employees. I will let y'all know how it goes!

Just updating you guys, I have decidid to go with the smaller agency. The call volume will be less than half but all units are ALS and I heard and get the impression that they treat their employees much better. I have decidid it is important to me to be treated like a valueed employee rather then just a warm body filling the emt spot

Let me start off by saying I have never really been a preceptor, only a brand new EMT So this is coming from my experience in that perspective One of the great things about where I volunteered was that I would change around the crews I road with when I wanted to (I was the 3rd person on the ambulance). For the most part, it was understood that the crews I road with were to help train me, to get me from a new EMT, to someone who was hirable by the agency. From this, I got to experience a lot of different styles of precepting. There were definite style which I liked better, and ones which I don't feel really helped me. One of my main problems was that I lacked confidence in my skills as an EMT. Most of the assessments I could do accurately, but I was never sure of myself. Because of this, it didn't help to have a partner constantly giving me "constructive criticism" I was doing this enough myself. What I really liked was after calls, all calls, no matter if I was the one running the call or another member of the crew, one of them would sit down with me and ask: "Ok, how do you think that call went?" This would help me to use my own critical thinking skills to assess the call, rather than just listening to what I did wrong. It also helped that we did every call, not only mine, so I learned that everyone thinks of this after calls, and it was not just me they were criticizing. Once I said what I though of the call, they would ask, "what could have been done differently?" Again this helped me to think for myself. Of course, if I missed something during the reflection of the call, they would casually mention it, and we could talk about it. During calls, if it was my turn to take the call, if we had a chance before they got there, we would talk about how the call should run, a quick run down of differential diagnosis based on the dispatch info, and whatnot. Once at the call, they made it clear that they were there to be my assistant, not run the call. I had to ask for everything I needed, right down to which vitals I wanted them to check (This also helped me learn to delegate, and not do it all myself). If i was missing something, but it wasn't something urgent, my partners would give me time to figure it out on my own (It takes a while to develop your own style for talking to/ questioning a patient, which questions to ask first...). On the contrary, I disliked riding with crews who would jump in the second I missed something, as I felt it then was harder to gain the trust of the pt, and continue my assessment. Of course, if I was missing something essential, or if i didn't get it towards the end of the call, my partners would give me a hint, or just ask the pt, themselves. Same goes for treatments. If I didn't get out a nasal cannula right away, they might ask me if I wanted oxygen, or subtly point to it, with a questioning look. Perhaps you could listen to a few of the conversations your new emt has with your paramedic partner, or ask your paramedic partner what style of teaching he uses, and then try and use that to see if it jives better with your new EMT. Sorry this is so long, hopefully some of it makes sense and gives you a few ideas!