Vorenus

It has been shown: A lot of really bad things can happen while being on the way to the bathroom...

Yeah, I`ve read something quite similiar the other day - and I wasn`t impressed. Maybe leave away the butchers shop and the liquor shop and toy a bit with the names to make them fitting to another setting - you could just as well use that text to demand tolerance from muslims if you write church instead of mosque. And rightly so, if that text would be about demanding tolerance - `cause tolerance should be demanded from anyone! But in my mind, this text is not a bit about having tolerance, it`s just about provoking. I wonder who really believes, that by that way, tolerance can be achieved...

Personally, I don`t like changing within one shift. I like to change within a round of shifts when having with the same partner and both being qualified to do so, but I avoid doing it in one particular shift, don`t know why, I just don`t like the concept. Though, if my partner is tired of driving after a long route, and he asks me wether I could drive from now on, that`s obviously different. But that would be only happening with transports, `cause with our emergency calls, we are kind of lucky. Our main station is in a small city with about 12.000 people and an primary care ER. The second station is in an even smaller settlement, with no attached clinic. But either way, it`s seldom to have times to the ER that are higher than between 15-20 minutes (primary care ER). The next big trauma ER, which is also attached to the nearest hospital with cardiology/neurology and the means to intervene surgical in those fields, is maximum 30-45 minutes away, often even shorter.

I only used the terms "combat gear" and "combat kit" as a summary of the items you carry, in absence of a better term. Well, even if everybody carried OC , I doubt if the world would be a better place. Imagine, in an unarmed crowd, the one person with pepper spray is possibly the one with the best weapon (yeah, I know, combat training, hand-to-hand...). So if anybody in the crowd got pepperspray - do you really think the one person that does want to hurt others in that group of people, or wants to threaten them, etc. etc. would also have only pepperspray? Logically he would be better armed, and therefore the people with the OC would be in the shit again... you can follow that line with any other weapons.

Sorry for being Off Topic, but: I`ve already heard that you guys only have chlorinated water. Do you actually drink your water out of the pipe too, or does that lead to buying more bottled water?

Really? Never heard of that. Here, Morphine is still the main analgetic in AMI. 50% in itself would seem like a huge figure - if that would be the case, I`m sure that study would have surely been recognized by a wider audience?

I`m with Dwayne reffering to the Nitro. Apart from the initial two tabs I wouldn`t give anymore (at least with a transport time of 10 minutes and no new increasing pain after an initial nitro-related relief). Addittionally I wouldn`t increase the O2. Since my biggest guess would be a cardiac event. The Pt. has a SpO2 of 98%. That`s enough. The ERC 2010 Guidelines (as well as the AHA, I guess) recommend a SpO2 between 94-98% in ACS. According to the Guidelines, hypoxia is to avoid - as well as hyperoxaemia, since it causes intracellular stress. Instead of fentanyl, morphine would be my choice. Aside from that - en route the hospital. Greetings, Marius

I`m unsure wether I can follow you. Your list seems extraordinarily huge (I`ve posted what I carry, which I think is quite enough, but I don`t condemn people for carrying more). But I think you`ve got the answers you can read above for all your "combat gear". So, since you`ve said they have been proven - do you really think all that combat gear has been proven usefull just after the "dog" incident? I recall you stating, that this was the only time you actually used your kit in reality. I don`t wish you to be in a dangerous situation, but I doubt that your proven concept will let you master every possible scenario with excellence and remaining health - even though your possesion of handcuffs, pepper spray, knife and 100+ hours of combat training (which - but this is only my own opinion without any real knowledge - doesn`t seem to be that much, at least not enough to feel as secure as you do). I`m unsure wether I can follow you. Your list seems extraordinarily huge (I`ve posted what I carry, which I think is quite enough, but I don`t condemn people for carrying more). But I think you`ve got the answers you can read above for all your "combat gear". So, since you`ve said they have been proven - do you really think all that combat gear has been proven usefull just after the "dog" incident? I recall you stating, that this was the only time you actually used your kit in reality. I don`t wish you to be in a dangerous situation, but I doubt that your proven concept will let you master every possible scenario with excellence and remaining health - even though your possesion of handcuffs, pepper spray, knife and 100+ hours of combat training (which - but this is only my own opinion without any real knowledge - doesn`t seem to be that much, at least not enough to feel as secure as you do).

That would be only sensible. As for me, in that likely case, I`ll be off to the Winchester, since I would need a place that would be safe and where I could smoke!

On duty: mobile phone some money lighter cigarettes fishermans friends some gloves EMS field guide (if i don`t forget it, which is fairly often) Off: duty the same, except the EMS field guide Anything else i need is in the car or the rucksack, anything else just wears me down.

Well, I think I can at least understand your drivers view on the situation (of course, just my own speculations). There is a stressfull component in the knowledge, that any minute you can get called to dead babies or other ghastly scences even though it might never happen, or never actually happened. It`s just a possibility, that`s always there. Of course, that`s characteristic for EMS, so if he couldn`t cope with that, he should reconsider his position. But still, I can at least see his point of view.

Tell me about it... the volunteer force that is attached to our station (rapid disaster response group, as well as child programms, etc. ) has pants that approve the specific regulations - on the contrary, ours don`t (theirs have two reflective stripes on their pants, ours have only one - according to the regulations, two are needed).

Yeah, it´s a hell of a system, but that`s the most common concept in Germany (at least in the areas I know of), except for some lucky guys (mostly in the south-east of germany, located on the border to austria... ) However, there were even worse times in the past. I know of an EMS provider firm, having 24-hour-shifts and only getting paid the time they were actually on the run (that was a big city, so they had a fair amount of cases, but still). Seeing that the work market has changed in the last years (especially in the more rural areas), we possibly can hope for some changes in the near future (otherwise they won`t get their manpower anymore).

Yeah, I suspected that much, that this procedure isn`t that common in the US. It`s not really a matter of pay (in the imminent month), since we have a fixed salary. There is something like a "hour account", with plus and minus hours. The ultimate goal would be to have a zero there (though that`s kind of unrealitstic). In theory, if you have many +hours, you should get more freetime - on the other hand, if you have more -hours, you would have to work more. Since there isn`t that much personnell around here, getting more freetime to delete your +hours is seldom, while having many -hours is even more seldom. Once a year, you get your overtime hours paid out. Still, every month there`s a big discrepancy between the hours I`ve actually spent at work, and the hours that "count". For example, this month I`m going to work 250 hours, but there are only around 200 left after applying the time factor.

Considering the strict weapon laws, carrying a weapon is in Germany way out of bounds. There are however certain areas, where EMS personnell runs with bullet proof vests (yeah, that`s something different from armed self-protection, but still). The other day I saw a documentary about EMS in South Africa, reffering to some guys running in a township. Those guys carried routinely a knife and a gun.

Hey guys! I was just wondering wether you are working on a certain time factor in your company? For example: For my 10 hour day-shift, I get accounted only 7.4 hours. For the 14 hours night-shift, it`s 10.36 hours. Here, time factors are very common - and equally despised (as you can imagine) by the EMS personnel. Very few areas get accounted their whole shift in actual "counting" hours, though there are vast varieties between the actual factor. So, what are your experiences on this field?

Sometimes I get wrist pain, shoulder or back only, if you have to do CPR in an uncomfortable position. After hitting my thumb at an accident scene on monday,it started hurting again after doing the CPR on a six-month baby.

Yeah, the LT is not a "true airway", as it does not go endotracheal (and therefore, you don`t have the same safety against aspiration that you have with an ET) . But - that there are problems measuring the etCO2 would be new to me, as well as that you can`t use a ventilator on a LT (I´ve never used a LT in the field, but we have them on the car and I`ve seen it used with a ventilator during my clinical time, furthermore I`ve never seen a remark in the literature regarding to that).

I wear ankle high boots from Puma with laces. But I`m thinking of upgrading. I`d like to have zippers, they are just more comfortable, plus safer (hate the laces when they get open while carrying a patient). Also, My boots aren`t really what you could call cold-resistant.

Right! That seems to be wide-stretched problem in EMS. It`s weird though, seeing of what the work sometimes consists of. There are some calls that affect you more than others, that`s natural. I remember that, when I was in training in the ER, my first patient was a 90 year old lady, who had tried to kill herself using benzos (and nearly succeeded). When we treated her, she was just regaining consciousness and muttered the whole time, that we should let her die and that she doesn`t want to live anymore. Just the perfect first day.

Well, it is convenient to do it with three people. Two on each side of the patient to get the KED on and the third to stabilize the head/neck. http://en.wikipedia.org/wiki/Vacuum_mattress I like to work with the vacuum mattress `cause you have an overall immobilization. Great for people with multiple fractures.

I probably laughed most at Nr. 6...

Don`t really know about that. But I could imagine that it is more painful than to be immobilized on the vacuum mattress. To make sure that the KED really suits, there`s gotta be more pressure->pain involved.

I guess dealing with the family/friends of the patient is in most cases more stressful than dealing with the dead person itself, especially when it comes to children.

Having been in the KED in training quite often, I can only say, that it`s not really comfortable. Especially in the pelvis/groin region.