Vorenus

I'll gladly defend any piece of equipment you define as "extraneous". I've received employee of the month twice in the last year, and I'm well respected in the local EMS community as a professional who takes my job seriously. I attend every training I can get to, buy the best equipment (and know how to use it), and pride myself in being a pioneer in the EMS industry. Anything you feel like challenging me on, go for. I'll gladly defend my practices as they've been proven to have effective results.

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'll gladly defend any piece of equipment you define as "extraneous". I've received employee of the month twice in the last year, and I'm well respected in the local EMS community as a professional who takes my job seriously. I attend every training I can get to, buy the best equipment (and know how to use it), and pride myself in being a pioneer in the EMS industry. Anything you feel like challenging me on, go for. I'll gladly defend my practices as they've been proven to have effective results.

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).

Are you gearing up for the zombie invasion too (if and when it comes)?

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.

I had a non medical driver in Kandahar Afg that told me one night, "You know Dwayne, I've decided to go and get some help when I get home..." I said, "Ok man....help for what?" He said, "Oh, you know...all the dead babies we've seen and all.." I said, "But, I'm the medic on the truck brother..and I don't remember seeing any dead babies.." He said, "Yeah, I mean all the dead babies I might have seen...." I said, "Well....hmmmm......Good on you then...it sounds like get professional help is certainly what you need." :-) (ak, I'll bet you can't guess who this was!)

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.

If you're interested: here in Germany the law is to have full protection gear issued by the organization/company, if paid or volunteer, large city or rural. A public accident prevention & insurance association's regulation specifies this gear (see "GUV-R 2106", linked PDF in german language but includes some pictures). However, this seems not to be known in all services...

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 brother, I don't know where you're from, but unless they are paying you a ton of money for each accounted hour I'd tell them to blow it out their ass. I am full grown, educated and have a family to feed. You never, ever get my time without paying for it...(Well, unless it comes with a happy ending.) And I can't imagine an employer with any respect at all for their employees ever asking such a thing. have you asked your supervisor, or whoever is in the office how many hours/month they choose to donate?

The exception would be super rural where you get paid to stage at home. Smaller amount of money for doing nothing but being ready and then and adjusted rate if you have to run calls. Otherwise, I can't really imagine it...

What makes an hour accountable as opposed to non?

Dwayne

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.

This is a good question, some people may wonder why you would consider upgrading an advanced airway that is already functional. Here are the main reasons; the king airway does not provide a "true" airway, it does not go into the trachea which does not allow you to monitor true end-tidal CO2 the reading is not correct, second you can not put a ventilator on a king airway for the same reason as above and third the king airway is a temporary airway not meant for more than two or three hours at the longest from what I have read.

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.

First of all, I just want to say thanks for sharing. At the service where I work it is frowned upon to have feelings about a call, so it is encouraging that not all people feel this way.

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.

I have said this many times the KED is a great piece of equipment. I have used it many times on STABLE pts. The other thing they are great for is small children and babies. I have never had to use 3 people to get this on but maybe I haven't had that call yet.

Dont even know what a vacume streatcher is so I cant comment on that one.

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...

I know what you mean LOL I think some of the equipment was designed by S&M folks.

I should have clarified that statment to say what kind of pain a pelvic fracture patient would experience in a KED.

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.

In my service we dont have vacum stretchers or splints so we use good old hard splints and now the KED for pelvic fractures. I agree about practicality, dont really know what kind of pain may be involved to the patient. I do know pelvics are extremely painful as it in. Might be the same as using traction on a femural fracture, could possibly relieve some of the pain until ALS arrives and administers meds.

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.

Yep, that stuffs quite nice.

We are getting Esketamine back on our vehicles (though if you ask me, that`s bullshit, `cause as far as I know, there are no profound studies, saying that it`s really less hallucinating).

Fully trained with it.

I have used in on afew occasions and both my services ambulances have them as standard equipment.

How do I like them? They are a pain in the rear end to use in the field. Its a 3 person piece of equipment and most times there are only 2 of us. It is a good piece of equipment dont get me wrong. It fully secures the patient prior to transfering to the long spine board.

We have also been training on using it now on pelvic fractures by turning it upside down. Haven't used it in the field in this manner but have been training with it.

Yeah, it`s quite a procedure to get them on.

Don`t know if it`s that practicable to use them on pelvic fractures as well (though I know that they can be used in that way).

In that cases, I prefer my good old vacuum stretcher.

So now to my questions.

How do you guys deal with deaths on the job?

Do you cry on scene if someone dies? Maybe a young kid.

Have you cried on scene?

Are you allowed to cry or tear up anyways... on scene or in the back of the ambulance when dealing with patients?

And if you'd like you can talk about how you deal with deaths in your personal life if it's different than on the job.

In the EMS you treat patients not that long (depending on whether you load and go/stay and play and how long your trip to the hospital lasts). The average time I spent with my patient is possibly an hour (+/-).

Therefore I don`t really have a deep relationship to the person who dies. Of course it`s tragic, but there`s a certain distance involved.

But there are, of course, cases that affect you more than others. That could be patients you know over a longer period, children, suicides, younger patients, etc.

Hey!

I`ve searched the board but found no thread with this topic, so I created a new one.

The KED.

Just wanted to know how common it is in your areas and how you like it.

I trained with it in school quite often, but never used it in the field, `cause neither of the two employers I worked for so far had one. In the area I work, I know of no organization having one - it`s not quite common with us (as well as the spineboard, unfortunately).

We use a scoop stretcher and a vacuum mattress.

Thanks for welcome!

Yeah, there are some pretty major differences, for one thing we have emergency doctors in the field, which makes thing often easier (but sometimes harder ).

Surely, I`m gonna write some stuff about our EMS system in future course.

Hey there!

My name is Marius. I`ve just accidentely come across this board and registered myself spontaneously.

I`m working in the German EMS as a Rettungsassistent.

I`m looking forward to reading some stuff about the anglo-american EMS and participating here myself.

Greetings,

Marius