PCP

As a dad I don' t think I could stand watching my son or daughter go through such a thing. Know parent wants to see their child get sick let alone have cancer. I am not sure that it was right for the jurry to convict this mother as she is the parent and should have the last say as to what is best for her child. My question is, was the cancer treatable and was the child getting better? Maybe it was best for the child to take the meds and go through the side affects maybe?

I guess what bugs me is that I don't think it should have been left up to a jurry to decide if she was being a bad parent, Did they put themself in her shoes and think of what they would have done if this was their child?

Brian, absolutely not in the least lttle bit. I'd like to understand why you guys do it one way and we might do it another. 98% of the reason I "sit on a forum" is to learn new things. It gives me a good starting point for research.

The reason this thread started? My ILS partner made a comment that she "always" cleans with alcohol and then iodine unless there is a known allergy. She couldn't tell me why, just that was they way she was taught.

For a simple IV start, I use alcohol unless the person is darker skinned and then I use the betadine to help me see the veins. (It's quite a neat trick if you've never tried that before.) For our blood draws, I use betadine but its not usually preceded by alcohol unless I need to make sure the skin was clean first.

So, I'll continue my research if you'll let me know why you do the betadine first.

Happy to see that you did not thing my comment was rude. You never know how people take it when they read a post, as it may come across as rude. As a Primary Care Paramedic, we do not draw blood, only start IVs. So my question is why only use betadine when drawing up blood?

Thank you for the tip. Next time I start a line on a patient with darker skin, I will attempt to only use iodine and see if that helps me see the veins better

I am going to ask a few of the other paramedics I work with as to why we use iodine first then alcohol. I am on the same page as your ILS, as I was taught in school to use idodine first then alcohol. I guess I should have asked the reason why?

I have one more question for you. What is the reason that you take vials of blood from your patient and how many vials do you take?

Thank you again for the great tip!

Brian

Congratulations and all the best to you and your family

I feel you did everything that you could for that patient. The patient mentioned she did not feel that she needed to push, nor did she have any cramping and when you looked you said you did not see the fetus, so to me the best option was to head straight to the hospital and that was what you did. Now by putting the damp sterile dressing over the vagina, I feel that would have helped keep what ever it was that was exposed moist and possibly keep from drying out and soak up any body fluids. I feel that is the best that you could do for that patient along with starting a line which may have helped keep her blood pressure stable.

I don't have much experience in genral, and especially when it comes to dealing with OB. Hopefully some of our more experienced members can coment on this post.

Good Job!

Brian

I just doubled checked in my IV refresher course book to make sure that I had it correct and yes, we cleanse the site with a povidone-iodine swab and then with an alcohol swab. Seems you folks down in the US use alcohol first then the iodine. Not sure if it makes any difference, but if it does I am curious to know why? Hope that did not come across as rude, as I am always up for learning and new ways of doing things.

Brian

Who is going to win the Stanly Cup?

My bet is on the Canucks!!

We use iodine and then alcohol for cleaning the IV site.

An old guy walked into the dr. office and sat down next to another old guy. The guy he sat beside asked him why he was at the dr. office? The guy turned to him and said he was there to get circumsized. The other guy said " Oh man I had that done when I was born and it was brutal. I could not walk for a year!"

Dwayne, I always enjoy reading your posts and what you have to share. I think that is bullshit that a worker needs to see their supervisor before going to seek medical attention. What training does a super. have on first aid scenarios? I hope that the workers think the same way, and decide that if they need to seek medical attention that they do so without their supervisor's permission!

I will always try to teach and help out any new medic we have on site, until I get tired of their bullshit and there lazyness. I feel to be a first aid attendant you need to have the drive and passion for the job and always want to learn and practice your skills, as you never know when you are going to be put to the test! It is true we do tons of sitting around waiting, but there are things to keep us busy.

All I ask is that hopefully my next partner has the same passion for the job as I do, as my cross shift now is leaving in two weeks time after only working at the mine site for 3 weeks.

Well PCP sounds like a situation your in, my advise is unplug your phone. You will just get burnt out and be useless to everyone around you.

I wish I could unplug my phone Happiness, but being the back up attendant this is not allowed. Only one more block of 4 days left and then she is gone and lucky me gets to train another newbie

I work for a first aid company at a mine site and have now for four years. We have gone through many first aid attendants with that time good and bad. I am not sure if it is just me and if am anal or what, but it seems that the last 4 or 5 attendants we have had just don't seem to get the job. I am tired of training these new people on what we do on a day to day bases and then have them not do the job or even attempt to do what is asked of them by the owner of the company.

I am tired of listening how tired they are and how boring the job is. IF you don't like it find another job! Don't waste my time or my bosses time and while you are working at least do your job and practice your skills and go through the ambulance and fire truck.

I am tired of being woken after working a night shift, to come back down to the first aid office to deal with your first aid patient cause you are not sure what you should do. I have tried to help you teach you how to take a BP, blood glucose, splint an arm or leg, and help by going through practice scenarios. Sure I get over time when I come down to the office and help and then sit at the office until the on duty attendant transports the patient to town and back, but seriously it should not take almost six hours to treat your patient and take them to town, when town is only an hour away!

It burns me when the new attendants say they know there stuff, but when you ask them questions they can't answer the questions or just guess. If you say you know your shit, then don't ask what OPQRST is used for then and when I try to help you, don't brush it off like I am being a dick and Mr. know it all.

Sure I have only been working as a medic for three year, and a first aid attendant for four years and ya I don't know it all, but I do have some experience and smarts that I am willing to share with anybody who is new and willing to listen.

I just don't get it, when you try to help these people and they say they don't need to practice or they know they shit, but when it comes down to doing a call, even a simple report for a sprianed ankle or sore back, I get a phone call and come down and find the patient still sitting in the treatment chair and no questions have been asked or no patient comfort has been done! That really pisses me off!

Okay I am done and I am sorry for venting, but I have PASSION for my job even if it is just being a first aid attendant, but I care about my job and the people I am responsible for treating when they are injured.

Everybody have a great day and stay safe!

Brian

Hey UGLYEMT, I never thought of when we respond to a fire that it could be helpful as to letting the fire guys know we are coming and to leave room for our car, as well as give us updates as to if there are any patients needing medical aid. I always like to be prepared when I respond to a scene as to what we are possibly dealing with. As lots of times we get dispatched out for one thing and it turns out to be something different. At least this way fire or our us, can give each other updates. We just have to remember to turn on our radios when responding.

I am sure this combined events channel thing will take time getting use to, but for the most part it sounds like a great idea!

I havnt heard anything up here, but our fire is volley so that may be the differnce in our stations. but when we are called out for a MVA or something that may require the FF we ask our dispatch to call them and they will show up. Also if we are both on a call we do have a channel that we can do our updates. We are lucky to have good relationships with the FF and so far what we do has worked well.

Happiness, they are talking about using the combined events channel with our volunteer fire departments that surround Port Alberni, we will see how well that works out. I feel it is nice to have this channel to use with the full time Fire as they do respond to certain calls and I think it will be great to get updates as to the pt condition or if there is a certain way that we have to enter into the house. We have an okay relationship with the full time fire crews. I know I have never had any problems with them, but some crew members do.

We will see how it works I guess. I feel it is alway nice to have extra hands on a call, even if it is only for a lift assisst or to carry our gear back to our car.

P.S. where did you say you are located again? I think I work with a lady who was at your station for about 10 years. Her name is Sonja. Ring any bells?

We are doing a trial run by using a combined events channel with our local fire department. We have selected a certain channel on our portable radio that we are to use when responding to a delta or echo call. We are to let fire know we are responding and say the road name and that is it. Fire is to the same and we are let each other know of our arrival on scene. As well as who ever arrives first is to give an update of the situation.

Do any of you do this within your service or know of any other agency that does this and how it works for them? As mentioned this is something new to us as of April 1, 2011 and so far it has not worked very well, as either fire or the duty crew that is on forgets to turn on the portable radio and alert fire that we are rolling.

I think it can work for giving each other updates on what is going on at the scene before arrival. Either a confirmed arrest or we can let them know if we require an auto extrication to get our patients out.

Anybody have any thoughts on this good or bad

Brian

We do not have nurses riding with us to keep their certification, but just last week there was a sign up sheet for any paramedic who is okay with allowing nursing students to come out and ride with us for a shift. I think it is a great idea, so that they can see what we do at a call before we bring the patient to the hospital. Sometimes I feel some of the nurses that have been working at the hospital for a while need to come out and ride with us, as there have been times when they question us as to why are the clothes cut off or question why a certain procedure was not done by the time we arrive at the hospital. I feel they don't understand that there are times we are very busy on a call and the transport time is short to the hospital, so we may not get all the things done we would like to before arriving or we need to cut the clothes to do our assessment properly.

Hopefully by the nursing students coming out for a ride along, they will understand and not forget that the patient may be presenting differentley on our arrival then when we arrive at the hospital and not question what I tell them in my report.

Sorry I got off topic, but just wanted to add a few things.

Brian

At my station we have female partners working together all the time and they never have problems lifting patients and for that to be a rule for a company is just WRONG! Nothing wrong with calling for a lift assist, as I have done this multiple times evern while working with another male partner, due to the patient being over weight or because we have multiple flights of stairs do go down, or because we have lots going on at the call that we feel having those extra set of hands on a call very helpful.

I am sorry that your first experience on car was not very good at all. Hopefully next time you have a better expereince and more calls!

My 16 month old twins are still in a rear facing car seat and they don't mind it at all. I Went by the fire hall a month ago, and the guy I spoke to, said he would change the car seats so they would face forward, but they are much safer while the car seat is facing the back of the vehicle. I plan on leaving my kids that way until they are about 18 months to 2 years old. Depending on much they grow over the next few months!

Hi,

I live in Niagara, Ontario, Canada. I was just accepted to Niagara College's paramedic program (PCP)

I am trying to decide if this is right for me, but I have had little to no luck connecting with someone that will answer my questions.

HELP....

My first question is; Can this job be done if you have a chronic foot pain? (Plantar fasciitus). Please keep in mind it only hurts after extended periods of standing (3+ hours).Yes I can walk, climb stairs, lift things, but standing still in 1 spot causes me discomfort and pain.

Can you do the PCP schooling and immediately go to the advanced care paramedic schooling ? Or must you work before you go to the advanced care ?

Are 1st jobs hard to come by ? Someone told me it takes an average of 5 years before you even become permanent part time. Is this true ?

Is the Niagara region typically bad for jobs ?

What is the pay like ? I heard paramedics were not paid well given the risk and amount of work.....

IS there anyone who should not do this job ? Or can not do this job ?

Is anyone willing to chat with me via telephone or email ?

Thanks

I do not see your foot pain being a problem, as we are never standing for three hours at a time. There might be some people who should not be doing the job due to lacking personality. I feel anybody can do the job if they put their heart into the job and really care about helping people. I find a few people I have worked with or met have lost the drive for the job and may not do a proper assessment of a pt. and just want to load and go. This might be due to them being a paramedic for a long time and they are burnt out or like mentioned above have lost the drive for the job. If you are going to be in EMS I feel one needs to love the job, have passion for what they do, and really care about the patient. Always remember that we may not feel it is a emergency, but to them it is and that is why they call. A big part of our job is being able to talk with the pt. and have compassion. So yes there are some people that should not do the job, but everybody can do the job, just depends on how well they do the job!

It is true the pay is not the best, but it could be worse. Like mentioned above, most people get into EMS because they are interested in EMS and enjoy helping people and not for the money! Some of us have two jobs to make ends meet, so be prepared to work two jobs when you start.

Good luck!

Welcome to the city!

Hapiness I agree with you 100% I love the Golden slipper for transfering patients from our cot to the hospital bed or from a chair to our cot. As well as the clam shell (scoop to some people) is by far one of the best pieces of equipment we use on car. I find that many paramedics I work with forget about the Golden slipper and just use the blankets when moving the patient. Golden slipper is sooo much easier on your back

My only question is about the COMPANY'S policy, not medical protocols. If this injury occurred off the clock, then things may be a bit more simple. If it's an injury that occurred at work, often times workers comp or company insurance rules dictate how a person must receive their medical care. In most cases, if they refuse an ambulance, then the all costs incurred would be the responsibility of the worker- they would NOT be covered by company insurance. I'd check your company's rules and regulations.

As for the wisdom of refusing recommended care, as with any other patient it is their right, but they need to be advised of not only the possible medical consequences but any financial impact they may see because of their choice.

(All this being said from someone in the US. Not sure if the liability rules change north of the border...)

HERBIE1 that is a great question. I am not sure what the company's policy is if a patient declines transport and treatment by the first aid attendant on duty, but gets taken in by a coworker. The person who was injured is a staff member and as mentioned is the acting Mine manager for this week. I am going to bring that question up with the head of the safety department this afternoon when I see him. The company I work for is not part of the mine or the union. We are contracted out by the mine site, and I know if we transport a patient to the hospital via ambulance and I need to wake up my cross shift to cover the first aid office while I am gone, my boss sends a invoice to the mine and if it is another contractor that is being taken out by ambulance he sends the invoice to the injured works company.

Thanks for bringing that issue to my attention, I will bring it up with the safety department.

Just a thought, here, but anytime anyone signs an RMA/AMA when you as the EMT or Paramedic feel they really should have gone in the ambulance to an ER, follow the old mantra of "document, Document, DOCUMENT"!

I have heard of litigation where EMSers were sued because they accepted the RMA/AMA, when what the EMSers warned the patients could happen if they didn't go with them, happened. Admittedly, the lawsuits were unsuccessful, but time was lost, reputations were damaged.

Any time I have to code X a call or while on duty as a first aid attendant and my patient refuses treatment I Document everything. I tend to do more writting on my PCR when the patient refuses to go with me then when I do a regular call where we end up transporting the patient.

Sounds like it is one of those calls that just can't be explained I am probably thinking the same thing as you mentioned in your post. It was probably fractured, but not a complete break and all it took was that final move or bump on the road, but just guessing here.

I don't think you failed at all, it is just one of those calls that you think to yourself By reading your post it sounds like you did a good assessment and if I remember correctly did you not say a week prior she had X-Rays done on her hip and at that time they did not detect anything wrong? Only thing you can learn from this call, as I am learning as well is go with your gut feeling.

Hey guys, thanks for all your comments and suggestions. I am going to do a little reading today on Oxygen, as I feel after reading some of your posts, I did not get a full understanding of the effects of Oxygen and its use. I did feel this patient could benefit from some oxygen, as he had just suffered a event that caused a few injuries, as well as having to climb up a side of a bank roughly 60 feet up in the snow. As mentioned I am going to do some reading today about Oxygen and its use.

I am still going to stick to my guns and say that my patient would have been better off by being transported by our ambulance with me in the back. I received a phone call from the person who transported my patient to the hospital and told me that when they explained to the nurse what happened, she asked " how come he does not have a hard collar on and why is he not on a back board?" As well as the Dr. questioned them as well and attempted to put a collar on him, but he refused again at the hospital.

Makes me feel good that, at least I was not the only one who could not put a collar on this guy and that I was correct, by wanting to board this guy and put a collar on him as well. He is back to work today, so I will be popping over to his office and checking in him to find out the final outcome.

Thanks again for all your suggestions, questions, and comments.

Brian

PCP, is this patient a technical boss over you in your medical office capacity?

I presume Canadian law to be on the same level as American law, that the medical person (you as the EMT or Paramedic on the scene) is medically in charge, until and/or unless there is a higher medical authority either on the scene, or in consult from the On Line Medical Control. This does not take into account a patient who signs the Refused Medical Assistance/Against Medical Advice paperwork, which is a different situation.

Is Entonox also known as "Nitronox", kind of a Nitrous Oxide/Oxygen anelgesic*, which is not (yet) in any New York State protocols, as far as I know?

Reviewing here: Took a nasty fall off a snowmobile, complains of head injuries, stiff neck, and tighness in the chest? I'm thinking possible C-Spine involvement, possible Traumatic Brain Injury, M I. Patient wants to RMA/AMA, instead of all spinal immobilization protocols being implimented (I trust you would have), O2 therapy, and patient monitoring enroute to the nearest ER. Seems like you did your best, at the time.

Just for information, you've mentioned an hour's travel time to the ER by private vehicle, and presume roughly the same with the on-site ambulance. While a critic of overuse of HEMS (Helicopter EMS), this qualifies, in my book, anyway, as a good time for the Medevac flight. How long to request the "bird", fly it in for pickup, and get to that ER?

If and when available, give us the followup prognosis.

Yes Entonox is Nitrous Oxide/Oxygen anelesic 50% oxygen and 50% Nitrous Oxide. Ya know, I did not feel this guy needed a chopper, plus it is snowing here like crazy so they would not have flowen in anyways. I spoke to the head of safety about that today. I am in charge while I am on duty as the first aid attendant, but when I do everything I can to try and talk the guy into going to the hospital and he refuses and I have no back up there is not much more I can. I phoned my boss today to let him know what happened today and he agreed that he should have been taken out by ambulance, but said I did evethying right by having him sign my refusal form.

It pisses me off when patients don't listen to me when I explain to them why I think they should be brought to the hospital fully packaged.

(*Possible misspelling, I can't get the spell check to work. subject for another string)

If the only thing I know is that the patient has a sore neck, but is actively refusing spinal immobilization AND is looking to get checked out in the ED, then, baring anything else, no probably doesn't. However, the information presented is limited AND certain non-verbal cues makes a big different when assessing patients. I do not think that everyone who suffers a traumatic incident either needs to go to the hospital, and those that do do not necessarily need an ambulance. There's a fine line between having an abundance of caution and crying wolf. Especially when it comes to lines like, "maybe you have something else that I can't detect." Ok, you can't detect it. What are you planning on doing about it? It's not like he's going home to sleep it off. He's going to the hospital. If the only realistic treatment option necessary is transport, does the form of transport really matter?

Okay, I see what your saying, I am trying not to put to much information on this website about my call as it is a site that is open for the genral public. My patient did have two 4 to 5 inch lacerations to the back of his head with moderate bleeding as well. I just feel when a patient complains of a sore neck that he should be put on a back board with a collar and transported by ambulance. I may not be able to detect a underlying injury, but at least I can monitor the ABC while enroute and I can fix those if needed, make sure the bleeding stays and make sure the bleeding is under control. I wish I had a X-Ray machine and was able to determine that he does not have a spinal fracture or any underlying injuries that would make my job sooo much easier.

I understand what you are saying about the non verbal clues as well and ya, this guy did not have any non verbal clues that I was concered about. I just would have felt better taking him in my self.