Bieber

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.

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 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.

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. 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. 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. 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. Depends. Greatly. 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. 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.) 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)

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.

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.

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...

We're da ambulance drivahs. Weee-ooooh, weee-ooooh!

I agree with 4c6. Remember, the first rule of medicine is primum non nocere--first do no harm. There may not be any way to prevent that man from exacerbating his injury (even after the police have wrangled him in he's still gonna be squirming until the sedative takes effect), but you don't have to be the ones to get him riled up, and you definitely don't have to be the ones to get a bloody nose or worse when that patient starts fighting. Our job is to treat, not to get into scuffles with patients, and as a general rule I'd leave as much of the rough housing to the police as possible.

Hi and welcome to the forum. It's great that you're not only interested in paramedicine, but also that you're cautious about it as well. Becoming a paramedic takes a lot of time, patience, money and endurance and you obviously recognize that and want to make sure it's the right thing for you before you jump in both feet first. The first step to becoming a paramedic is to become an EMT-Basic first. This requires a one semester class that is probably offered at one of the local community colleges or universities in your area at the completion of which you'll have to take your state and national board examinations to get certified Probably the best way for you to figure out if you can handle the job and whether or not you'll enjoy it is to be exposed to it. I would suggest calling up your local EMS service and asking if you could do a ride along to see what the job is like. Don't know if you'll be able to, but if you can you should go for it and if you can't then I would suggest taking an EMT-Basic class because you'll have to do ride alongs as part of the program where you'll work several shifts on an ambulance as a third person. I'm afraid that I don't know of any quick and easy tests to tell if you can handle the job, but I will say that the human mind is remarkably capable of adapting and overcoming. You would be amazed at how much you can handle given enough exposure to something but only you can decide if the job is for you. The majority of our day to day calls are not gruesome scenes from a horror movie but every now and then you will definitely see some gruesome things. I will say that at least in my meager and humble experience even the worst injuries I've seen are never quite as bloody and over the top as they present in horror movies like Saw. As far as your foot injury is concerned, the amount of time on your feet depends on how busy your service is. I will say that I work for a busy service and even on a busy day my feet don't ever get near as sore as they were when I was in clinicals working in the hospital and on them all day like the nurses are, HOWEVER my back was never as sore at the end of the day during clinicals as it is after a day of working EMS. In some services you're running calls all day and in some you're lucky to get a call once a day, so it all depends. How bad is your foot injury? What's your level of mobility right now? Most services require you to be able to get from point A to point B without difficulty and also require you to be able to lift somewhere in the area of 150 pounds unaided and to carry all of your equipment to the scene and back, which can easily be up to 60 pounds or more, but you should always have a partner to help you and shouldn't ever lift more than you're capable of lifting. Good luck in making your decision.

I think I would hold off on anymore adenosine or diltiazem. If I'm seeing some flutter or P waves, then I'm thinking more and more that this is an accessory pathway issue and I want to avoid any AV nodal blockers. I'd rather go with amiodarone, diltiazem and adenosine might shut down the normal conduction pathways and pre-excite the accessory pathway.

Hmm, can I change my answer to symptomatic and stable? I guess that's pretty much what I implied in my treatment, in any case. O2, IV, patches, try to calm the patient and go ahead with the lidocaine bolus followed by a drip if no rhythm changes with O2 and relaxing him.

Wide and fast I'm going to call it V-tach until proven otherwise, though I'd like to print out a strip to make sure it's not a pacemaker deal. Patient said no history, but I want to check anyway. I'm going to call him unstable due to the poor skin condition and shortness of breath, however since his blood pressure is okay I'm going to slap the patches on and try to get an IV and bolus in 1 mg/kg lidocaine and be ready to cardiovert if he doesn't make it that long.

Thanks for all the kind words and advice, everybody. I've finished my guide and gotten it laminated and ready to go in time for my first shift as a paramedic this Sunday. Hopefully I won't need it, but like Dwayne said, it definitely makes me feel more comfortable and more confident knowing I have it right there. Of course, working my first shift as a paramedic with my former preceptor might counteract that confidence, haha! The format of my guide ended up like this: Medical Triage/Transport Criteria Glasgow Coma Score Trauma/Transport Triage Criteria Burn Triage/Transport Criteria OB Triage/Transport Criteria Drug Formulary with the drugs, dosages (adults and peds) and number of repeats by standing order and under which protocol we can give them by standing order highlighted (if applicable) along with a lidocaine and dopamine clock for me to review from time to time (I currently feel comfortable with those, but it helps to look it over every now and then since we give both of those drugs so infrequently. APGAR score.

Thanks. I actually use my pharmacopoeia on calls quite a bit, if I don't know what a medication my patient's taking is for or whatever, and my idea of making a little pocket reference came about after I started writing down the local hospital info on some pocket cards. I usually keep my protocol book in the back of the ambulance, but having something a little bit smaller is more convenient and I'm not too proud to admit that, hey, I'm new, and even if I wasn't I'm not perfect. I know my ACLS stuff fine, but if I'm just running a medical code yellow or something like that and I want to double check something and I have time, why not?

Thanks for the link. I have the old one that I carry with me, I didn't realize they already had the 2011 edition out. I'm not sure if there's ANY sort of protocol testing at my service (as far as I know there isn't) and unfortunately our protocols aren't the clearest or the most progressive at the moment. However we just got a new medical director and I heard there should be some revisions in the upcoming future, so hopefully that'll fix some of the existing issues.