Bieber

I like to have enough in my box to run a full code without having to run back out to the truck (though the EZ IO stays in the truck, so we would have to run out for that), and enough to get my patient from point A to point B alive. Personally, I prefer doing most of my treatments in the back of the truck than on scene unless they're "must be done now" stuff; i.e. codes, unstable arrhythmias, active seizures, etc.

We keep those in the truck, probably not a bad idea to keep them on you, though.

Bumping this thread back up so it's visible to NannieKane.

This thread's already been done before. I bumped it up, it's in this same subforum titled "What does your department carry in your ALS or BLS bag."

Enjoy.

I have a question. You said this guy was being transferred for a diabetic foot issue? I assume this was a code green (or I, depending on where you are)? If this was a low priority patient, why did you put the monitor on him at all out of curiosity? I don't know how it is for you, but unfortunately for us an IV or a monitor automatically makes a patient a yellow (code II) where I work, though I assume you may have more freedom to place the monitor on a patient without having to upgrade their status.

I'm not sure how my treatment would have differed if at all, because like I said where I work if we put the monitor on someone we automatically have to make them a yellow and stick them with an IV, but I will say that if I'm putting the monitor on an older person (>35 years of age) I feel that a 12 lead is almost obligatory. But you've already recognized that, and I'm no one to criticize you.

I don't know if anything you could have done would have changed this patient's outcome. People die, and for all the treatments we can provide we're all really pretty powerless (all of us, not just paramedics) to do much to stop the Reaper. Tough call, man.

Single role, as Fire Fighters fight fire (and effect rescues), and Paramedics (and EMTs) handle and treat patients. Neither does both Fire Fighting, and patient care.

Related: LEO based EMS, we don't arrest them, we just reverse Cardiac Arrests (Well, I thought that was funny, anyway).

Oh, well duh. Sorry, I think I had just woken up from a nap when I posted that.

fired based, single role paramedics are the way to go imo.

What do you mean by single role paramedics? And why do you believe that fire based EMS is the way to go?

You should be saying "Thank You" for this, instead of mocking it. Municipalities have been cutting their budgets for years now, and most have spared "Public Safety" or let them make smaller cuts than other departments. Now public safety is being scrutinized. If we have the double-dip recession that many experts are predicting (meaning the worst is yet to come), it may very well be your job that is lost next.

With all due respect, I will never say thank you for the IAFF working to bring down educational standards, for twisting the facts in their addresses to the general public, or for trying to replace me or any other paramedic with a firefighter so they can keep their jobs. The way I look at it, the IAFF is a drowning man who's latching onto EMS to try and keep afloat, regardless of the fact they're bringing us down with them. I feel bad for them, I really do, they've worked themselves out of a job and now they're trying to keep from going under, but that's their problem to figure out--not ours. EMS is emergency medical services, not fire and emergency medical services. I get that they're drowning, but they don't have to bring anyone down to Davy Jones' locker (+1 for using that phrase in an EMS discussion) with them.

This organization has done a very good job in providing their constituents some "tools" to use to save their jobs.

Yes they have, but at what cost? This industry is about what's in the best interest for the patient, not "what's in the best interest of keeping firefighter jobs"; and because of that, an organization that exists solely to keep firefighter jobs is NOT working in the interests of the patient but in their own interests.

If you work for a government based EMS that is not Fire-based, could you argue the benefits of not merging the two departments, with your politicians ?

Yes, I can. And I gladly will. I learned from day one that EMS has to constantly fight for its very existence, and I for one will not give up on a progressive, constantly advancing, constantly improving EMS. I will fight for an independent, high quality, progressive and advancing EMS as unapologetically as the IAFF fights for a fire based EMS. Don't get me wrong, I'm not inherently opposed to fire based EMS--if it's done right. But the fire based EMS that the IAFF endorses and that many fire departments seem to endorse is not the kind of EMS I will ever support.

If you think you will never be asked to justify your department's existency, you are living on another planet.

You're a hundred percent right about that.

So it occurred to me the other day that I've never put down an NG tube, not even on my cardiac arrests that I'd intubated. I always checked to make sure we had them fully stocked on the truck, but I never did use one or even really think about it. What about you? When's the last time you put an NG tube down? Do you drop one on all intubated patients? Does anyone know if it significantly decreases mortality from aspiration in the prehospital setting or has any studies touching on it? Also, do you deliver any medications by NG tube such as activated charcoal for unresponsive non-narcotic OD patients?

It's been a while since I've even read up on NG tubes so that's something I'll need to go back and do today or tomorrow, but I was just wanting to get some feedback from you guys.

Very interesting! I haven't heard about it around here, but I really like the looks of it. It seems like it could become one of those very few tools that could actually give EMS a chance to make a significant difference in trauma injuries and subsequent outcomes.

So does that mean we can only elect atheist ? You point out the hypocrites who are not really religous to make your point. For every "one" of those, there are thousands of good religous people who live a truly christian life. Who do you think would do a better job of running your state, Howard Stern or Billy Graham (if he were healthy and younger) ?

I don't think anyone is saying that we should only have atheists for our political leaders. I think what everyone is saying is that a person's religion really has no bearing on how good of a political leader that they'll be, and that it would be best if we stuck to the politics and left religion out of it.

I submit that an education simply teaches someone how to learn, how to apply logic and reason to solve a problem, and how to find answers to something you may not know. As you advance in your studies-undergrad, grad school, post grad, professional school, etc, obviously you learn more about your subject, but you also sharpen your logic and reasoning skills, mature as a person, and essentially develop into an adult. The passage of time and the pursuit of higher education forces us to start basing our actions and personal choices on some developing moral or ethical code, vs seat of the pants, impetuous decision making.

We all know that doctors spend a lot of time getting their education, so obviously their medical skills and knowledge are unsurpassed, but what I think they also have is a more refined sense of ethics and morality- at least in terms of patient care. For years, under the supervision of an attending, they treat patients, but are also exposed to a myriad of "grey area" situations that illustrate how complicated their profession can be. Yes, many of us have well defined and developed moral centers, but many younger folks are still figuring things out, and many times they have yet to experience enough life situations to force them to confront moral and ethical dilemmas. It can be hard to make a judgment call when you have little life experience confronting such difficult choices.

I'm not at all saying that anyone without gray hair is immoral or unethical, but in terms of doing this job, at least getting an education slows things down and hopefully forces us to merge the didactic and book knowledge with our real life experiences.

I really enjoyed this part of your post and I completely agree with it. Being new to this field, I've felt almost "assaulted" by the immense number of grey areas, and while I may have a card that says I'm a paramedic, I certainly have not been doing this long enough to have a good answer for all of those situations. Extending our education and especially lengthening internship I think should be primary goals of EMS educational reform. You can't possibly see and do everything during internship, just like physicians can't possibly see and do everything during residency, but they certainly have a lot more time to become better entry level physicians than paramedic students do to become good entry level paramedics.

Welcome to the forums! I spent several years up in the Naperville/Aurora area myself, so it's good to see someone else from that area around here. Tell us more about yourself, do you work for the Chicago Fire Department?

Perhaps we've been going about this the wrong way. Many of us begrudge the IAFF (myself, for one) and bitch and moan all day long on EMS forums about how we don't want to become firefighters or engage in debates like this highlighting what we think are the shortcomings with fire based EMS. Perhaps we should be trying to learn from them--they're obviously doing something right, at least in the realm of politics.

In order for EMS to become a strong, unified, individual body that stands on its own merits, we need to look at other organizations such as the American Nursing Association and the International Association of Fire Fighters and ask ourselves: how did they get to where they are? And why haven't our organizations such as the NAEMT been able to achieve a similar kind of success?

I think that one of the major factors holding us back is a lack of motivation within the industry, which I think stems in large part from a severe lack of pride in our profession. Nurses and firefighters have been hailed for decades as national heroes, and idolized as champions of our society. In turn, people in both of these professions take tremendous pride in their work. I can't begin to explain the frequency with which I see nurses in scrubs and firefighters wearing their fire shirts while off duty, and they do so because they are very proud of what they do and also because we as a society hail them for being what they are. On the other hand, the general public has no idea who we are or what we are, and in turn I believe it leads to us becoming embittered and apathetic about our work. At least where I work, I can tell you the majority of EMTs and paramedics around here are more than content to "do their job and go home". We're not proud of what we are because nobody knows, nobody cares, and in turn the whole system becomes apathetic.

Furthermore, because there are great deal of fire based EMS systems out there, there hasn't (to my knowledge) been any national or state EMS association willing to risk the wrath of the IAFF by taking a decided stance AGAINST fire based EMS. We're so afraid of inciting the ire of firefighters that we quietly remain the neutral party while organizations like the IAFF make blatant attacks against non-fire based EMS services. We're apathetic cowards, to put it delicately. We don't care and those of us who do support advancement in EMS are too scared to speak up against a form of EMS that we perceive to be, on the whole, detrimental to the advancement of our profession.

We need to take a stance, if we want to survive in a non-fire based form. And I'm not out to pick a fight or to start making blanket statements about every fire based EMS service out there, but the IAFF has picked the fight to begin with and if it comes down to either fire based or non-fire based, I'm going to support a strong, unified and independent EMS. Neutrality from this point on is only a form of concession.

We need a national organization that is going to take a stance on this, and we need EMTs and paramedics and services that are going to stand up and forcefully say nothing worse than what the IAFF is already saying: that our way is the best. The IAFF is desperate to save firefighter jobs, which is noble, but their desperation is apparent in their weak arguments in favor of fire based EMS and I believe that none of their points are indisputable or unbeatable.

In order to become strong and independent, we have to use the same tactics that the ANA and the IAFF have used to become strong; that is take pride in our work and make our pride in our work known, become political (as opposed to remaining neutral) and take a stance on issues, be willing to fight for our way, and be willing to educate the public about who we are and why the way we do things is best (just like the IAFF is doing). If we continue to go along like we have been, independent, non-fire based EMS won't end with a bang, but disappear quietly into the night with barely a whimper.

You have to remember that in this economy with job cuts going on weekly , Schitberger and his union minions are trying to come up with any excuse or propaganda campaign to save the dues paying union jobs. If they loose dues paying members then the slush fund goes down.

Oh, I know. I know they're just trying to save their own asses, but at the same time, I strongly contest that fire based EMS can, in and of itself, do it better than non-fire EMS, and would even argue that, without taking into account individual departments and their particular handling of EMS, that fire based EMS in general is bad for the system, bad for the profession, and bad for the advancement of EMS in this country.

There are fire departments that do top quality Emergency prehospital care that is patient centric and is their primary mission. They do EMS because they want to provide the best care to their community, & hose work is a much smaller % of what they do.

I believe it. And you're one hundred percent right. But, from what I know and from what I've seen of fire based EMS departments (and I'll be the first to admit that I don't have anywhere near the experience of the majority of you), I haven't been impressed.

Without any real data, I opine that Fire Departments that decide they WANT to increase their usefullness, and possibly keep members on the payroll, by taking on EMS duties, are better than Departments that have the decision forced on them by outsiders from the department, such as Mayors, city councils, village elders, ect.

I would argue that on the point that whether or not administration wants to do EMS, the average firefighter probably does NOT. And whether or not you have a jubilant, bouncing for joy admin that is all about delivering top notch EMS, it becomes a moot point if the actual street workers don't give a crap about it and begrudge being put on the meat box.

As respectfully as I can put it: I'm not a firefighter. I don't want to be a firefighter. And I will never be a firefighter. And I won't fault a firefighter for saying the same with the omission of "firefighter" and the replacement of it with "paramedic".

Some fire services do it great, a lot seem to not do it so well. I don't really see any relationship between fighting fires and medicine, which is perhaps why I've so rarely heard of a doctor or nurse who fights fires in their free time and why I suspect they're not the first ones to jump into action when a fire breaks out in the hospital.

Response time is the absolute priority for medical emergencies.

I contest that, as I think many others would as well. True, some medical conditions are time sensitive, but I think on the whole the vast majority of what we see is not time sensitive.

Firefighters are in the best position to respond quickly and provide vital services.

Depends. Greatly.

Personnel are the most expensive part of any emergency response system. Fire departments are essentially "standing armies" in their communities poised to respond to an emergency. Utilizing firefighters to provide EMS gets more bang for the buck.

You know, until you take into account that even fire departments that provide EMS still have to staff separately for fire and EMS functions--which essentially means you're still paying for the same number of personnel if you exclude administration.

The ride for the sick or injured person in the ambulance is only part of the system. A comprehensive EMS system includes rapid response, intervention, stabilization, and then transportation to a definitive care facility, if needed.

And damn, here I had been doing nothing more than loading patients up and driving as fast as humanly possible to the hospital. If only I was a firefighter, then maybe I would have known to do interventions and stabilization first. (No offense to firefighters here, the implication was the IAFF's.)

Fire service-based EMS brings the treatment to the patient – wherever they are. Treatment by firefighters begins immediately, even if the patient is trapped in a building that's on fire, pinned in a car crash, or in a collapsed structure.

I'm not sure of the wisdom of trying to do anything more than extricate a patient that's inside a burning building. But I'm just a paramedic.

Let me clarify something: I have no problem with firefighters. I love firefighters. The vast majority of firefighters that I have worked with have been professional, courteous, and respectable human beings. However, like I said, I don't want to be a firefighter, and I don't much care for propaganda that seeks to disparage my ability to provide the highest level of emergency medical care or that pushes to replace me or force me into a position to become something I don't want to be. If it works for your service, great. And if you're a firefighter, that's great too. I applaud you and thank you for everything you do. But organizations like the IAFF are only out to secure firefighter jobs in the wake of increasingly harder financial times for fire departments and they're going to say whatever they have to to do that, which I can understand, they're fighting for their survival, but all the same if their interests run counter to mine (which they do), you can bet I'm going to fight for my livelihood just as hard as they're fighting for theirs. And furthermore, I think (as you all can obviously see) that the majority of their pro-fire based EMS arguments are flimsy at best. Another point I should bring up is the question of how good of care can or will a firefighter who was forced to become a paramedic provide? And will the IAFF and fire departments advocate increased educational requirements including a minimum of an Associate's degree and more Bachelor's options? Something tells me no.

I'll also add that I wouldn't be wholly against working in a fire based EMS system if they did it right; if they really focused on making their medicine top notch, and if I wasn't forced to function as or become a firefighter as a requirement for employment. I like my ambulance and the idea of running into burning buildings doesn't appeal all that much to me. Given those, I don't care if you call it "Generic County Fire Department" or "Generic County Emergency Medical Services" or even "Generic County Ambulance Thingamajig".

On my person:

Left breast pocket

-critical care pocket guide (not a critical care paramedic, but it has a lot of good information in it)

-patient info pad (we usually put it in the tablet on scene, but I have it as a backup)

-pen

Right breast pocket

-personal reference I made and laminated with protocols and drug references and standing orders

-pharmacopoeia

-pocket calculator

Pants

-wallet and cards

-cell phone

-car keys

-scope mouthspray

Belt

-gerber tool

-holster with mini maglite and trauma shears (don't like carrying them in my pants) and a mini sharpie

-radio clip and radio

-D ring for ambulance keys

-extra set of gloves tucked underneath my belt

Also, a cheap Wally World watch and my stethoscope (on scene, I leave it in the truck between calls), and my very vital sunglasses.

In my work bag (which is just a nice laptop bag, got tired of my company issued duffel bag)

-protocol book

-two more field guides

-x4 extra pens and a sharpie plus my penlight in case my maglite fails

-notepad

-ibuprofen

-extra trauma shears and x2 hemostats (though I haven't yet ever found a use for them)

-extra earbuds for my stethoscope

-black beanie for those cold days

-a paramedic book (that's actually an abbreviated version of the one I used for class)

Hi everyone. I'm posting a picture on here accompanied by some reflections by the famed astronomer Carl Sagan that I read from time to time when I think that perhaps I might be taking my problems a little too seriously. I always find it very humbling and something that helps me to step back from all the petty things I consider so big and important and really see them for what they are, and I hope it makes you feel the same way.

(The photo is from NASA, taken by the Voyager I and was taken in 1990 when it was 3.7 billion miles away from Earth and if you look closely, you'll notice a small blue dot which is our planet inside the gold ray of light, while the quote is from Carl Sagan's book, Pale Blue Dot: A Vision of the Human Future in Space (1994) http://en.wikipedia....i/Pale_blue_dot)

From this distant vantage point, the Earth might not seem of particular interest. But for us, it's different. Look again at that dot. That's here, that's home, that's us. On it everyone you love, everyone you know, everyone you ever heard of, every human being who ever was, lived out their lives. The aggregate of our joy and suffering, thousands of confident religions, ideologies, and economic doctrines, every hunter and forager, every hero and coward, every creator and destroyer of civilization, every king and peasant, every young couple in love, every mother and father, hopeful child, inventor and explorer, every teacher of morals, every corrupt politician, every "superstar," every "supreme leader," every saint and sinner in the history of our species lived there – on a mote of dust suspended in a sunbeam.The Earth is a very small stage in a vast cosmic arena. Think of the rivers of blood spilled by all those generals and emperors so that, in glory and triumph, they could become the momentary masters of a fraction of a dot. Think of the endless cruelties visited by the inhabitants of one corner of this pixel on the scarcely distinguishable inhabitants of some other corner, how frequent their misunderstandings, how eager they are to kill one another, how fervent their hatreds.

Our posturings, our imagined self-importance, the delusion that we have some privileged position in the Universe, are challenged by this point of pale light. Our planet is a lonely speck in the great enveloping cosmic dark. In our obscurity, in all this vastness, there is no hint that help will come from elsewhere to save us from ourselves.

The Earth is the only world known so far to harbor life. There is nowhere else, at least in the near future, to which our species could migrate. Visit, yes. Settle, not yet. Like it or not, for the moment the Earth is where we make our stand.

It has been said that astronomy is a humbling and character-building experience. There is perhaps no better demonstration of the folly of human conceits than this distant image of our tiny world. To me, it underscores our responsibility to deal more kindly with one another, and to preserve and cherish the pale blue dot, the only home we've ever known.

I really don't understand this country's obsession with mingling politics and religion. In the majority of European countries, politicians are not asked about or pressured into divulging their religious alliances because, in all honesty, it doesn't matter. Who cares what the religious views of a politician are? We're not electing them to be our religious leaders, we're electing them to represent and interpret the will of the people in accordance to the law in the legislative, executive, and judicial systems. Yet here in America we hold the religion of our political leaders to be of supreme importance, to the point that non-Christians in many states have a hard time winning the majority vote based solely on their religious beliefs. I don't want to get into a debate regarding president Obama, but I will say that I am disappointed whenever I see people insisting he is a Muslim and either implying or directly stating that that would be a bad thing even if it were true. I really don't care if our president's a Christian, Buddhist, Muslim, Bahai, Hindu, Shinto, atheist, agnostic, whatever--I just want from my president and all of my political leaders to do their job well and to lead this country in the right direction.

Thanks for sharing, NYCEMS. It's easy to share our successes but a lot harder to share our mistakes. So thanks for sharing your experience so we can all learn from it.

I got myself a pair of Herman Survivors boots at Wal-Mart at the start of my EMT-B class back in 2007 and have been wearing them ever since. They're starting to get a little bit of wear and tear, but for fifty bucks it was a great investment.

What about all of these together in one ECG? I understand that individually they can't be used to exclude VT, but if they are all present I would imagine VT is increasingly less likely....?

Less likely, from what I've read personally, but like the ACLS guidelines state when in doubt--even if there's just a little bit of doubt--treat as V-tach.

Thanks for sharing, Fiznat. That was obviously a tough call for you and I know how hard it can be to share it with the rest of us, but like you said we all make mistakes and we grow from them, and hopefully we all do what you have and share them with our peers so we can ALL learn from it. Glad to hear the patient turned out all right.

To those choosing drugs over electricity, I'm truly curious as to the answer to Mobey's question, and it's justification.

Dwayne

I chose amiodarone because, honestly, like chbare said, a definitive diagnosis of the rhythm is unlikely in the field and ACLS's recommendation is always, when in doubt, treat as V-tach. I also chose amiodarone because, and perhaps I need to review cardiology, I personally don't see enough there in that strip to make me think so much that it's something other than V-tach that I would be comfortable NOT treating it as V-tach in the field; and maybe part of that is inexperience. Also, the wide QRS complex makes me think that if this were atrial flutter, that there might be an accessory pathway present and to my knowledge amiodarone is the recommended treatment for such arrhythmias.

None of this means that electricity is contraindicated, and I certainly don't see any problem with cardioversion regardless of what the actual rhythm is and I agree it is probably the safest choice. However I don't think amiodarone would be deleterious to the patient in this scenario and to be honest I AM hesitant to light somebody up if I can avoid it. Perhaps the correct treatment would be to cardiovert, and I'll defer to your guys' experience, but that's my rationale behind the amiodarone.

Actually, I think the longest cardiac arrest is significantly longer than a couple hours...