NYCEMS9115

ABC? History of Present Illness? Trauma vs Medical? CUPS? Is there any pain? If so, where? OPQRST? Is she A/Ox3? GCS? Baseline? Can she sit up? Can she perform normal activities of daily living? Vitals? Head to Toe? Findings? ALS Intercept or Intervention? Contact OLMC? Anyone with her? SAMPLE? If she's alert, she can tell you the best way. Especially, if she's a frequent EMS user. Any help? Any treatment devices (Oxygen, ECG, Fluids) which needs to be with the patient during the disentanglement phase? How strong is your partner? How strong are you? What devices do you have?

If it is just plain transport to ER for something that's chronic or a non emergency call, there is no pain, and you have all carry devices in the textbook. Then slide the Reeve's under her to carry her out (cover her to maintain heat) or use the stairchair with sheet open with the longest side going across so the ends do not drag and place her on the chair, wrapping her like a cocoon; covering her with a blanket or use a folding stretcher and go head to toe to place her on; maintain body heat with sheets and blankets or use a scoop, making sure the snaps are fasten when she's on; maintaining body heat or if she's not heavy (I think the PC word is thick. LOL); place her on the stretcher; covering her with sheets and blankets, its only five steps (I've done that for many patients who were very thick). However, its foremost that the stretcher is waiting for you at the bottom with the straps unfasten and you've communicate which way to exit to make placing the pt on the stretcher easier. Unless your using the stretcher to carry her out. If you have many hands; then you can carry all the way (even with the stairchair; but roll it when you can. Unless the stretcher is situated in the ambulance which doesn't allow the chair to fit) to the back of the Ambulance with someone in the ambulance taking the hand off; the stretcher needs to be in the back though. Don't forget your equipment on scene.

There are so many options. Experience, situation, condition, and resource dictates the proper way.

Humility is enlightenment. I've learned that the hard way; in my whipper-snapper days......

Its like saying the severity of chest pains is proportionally related to the size of the infarct.

http://www.aflcio.org/joinaunion/how/howto.cfm

Good Luck....

It all depends. They all are fine. Don't forget about the Folding, Reeve's, & Scoop Stretchers. Carrying with a sheet or under the patient's armpits and behind knees can be appropriate. There are pros and cons for every carrying device & method used.

The call, weather, egress, partner, self limitations, & patient condition will determine the device(s) & method(s) used.

You should survey the scene from the address front, path to doorway, path to patient, & patient area. This will determine the best device(s) and method(s) to safely move the patient.

There are no clear cut way like everything else in Prehospital Care and life.

What you learned, heard from others, seen from others, work experience, & lessons on other methods can guide you to make the right decision.

The three No-No's: DO NOT HURT THE PATIENT, YOURSELF, OR OTHERS... Good luck; all the best....

Thank you HERBIE1 for the kind words....

DwayneEMTP you're right. What I was explaining before I posted my event; was what you should do. I threw in my experience to throw it out there because it was relevant. I was young and I think differently now. All of us do. What I did over a decade ago was me but not me now... My post was a tad confusing but I do stand by it; I have to, I did it. My intentions were at the right place. I'm not a violent person. I felt my partner & I did what was right at the time. I look back at it and I could have done things different. I'm older, more educated, & more experienced. However, I think we stopped something that could have been something really bad. I have no regrets but its not something I talk about. In fact this is the second time I've mentioned this. My wife heard it that same night... Thanks....

Thank you. Its not something I'm proud of nor do I bragg about it. It was relevant so I wanted to share... All the best....

Abosultely right. Its well in the pass; I can't change that. We never hit him just held him but no excuse. However, maybe our intentions were good but not waiting for PD was a mistake, it only took then 10 minutes. I can't assume but maybe something bad was going to happen. I don't know; him banging on cars, screaming, lunging at people wasn't illegal (I don't think). I can't justify it. I can only relay the story. I never said I was right. It was a decision we made at the time. It was a long time ago; would I do this now; NO.... Unless it was to defend myself. But we see so many times; where people say, "Why didn't anyone do anything?" Maybe that wasn't the time; not yet. It hadn't developed...

I can go on and on but I am wrong. I got no thrill out of it. I wanted to help him and others from being hurt by him. I didn't have to share it; I'm not proud of it but I wanted to share it; so others can see all sides. Thanks. All the best...

I was just sharing. There's nothing I can say to defend it. Your right... I shared an experience. It was something that had to be done. I could have continued to follow until PD came. Hindsight is 20/20. Thank you DwayneEMTP.... All the best...

http://www.hvremsco.org

http://www.jstandard.com/index.php/content/item/16511/

Dr Lippe was my Medical Director at Rockland Paramedic Services. A man was not only great but always had the time. You will be missed dearly.

™Scene safety. Safety in numbers. Call for Police and additional resources. Safe distance. If you have determine that the patient is a danger to self and/or others. You've determine that there are no weapons (even though it is tough to determine); your gut tells you otherwise. There is no clear cut way to handle any situation; especially violate ones. You have to go with experience, gut instinct, peer experience, & readings/media. I can't tell you what you should really do other than what the textbook says and what your protocol dictates. Neither can others.

I can give you a event which happened to my partner and I. We were sitting 89 (NYC EMS lingo for at our assigned cross street location) at St Mark's Place & 2nd Ave: we were just sitting and viewing the passerbys. We witnessed a person; acting bizarre, walking against oncoming traffic, going up 2nd Ave. He was yelling and smacking himself; he was shirtless with shorts. He walked in front of cars. We called for PD backup and we followed him up 2nd Ave. I was driving and went alongside him; I notice no weapons on his waist; I saw no bulges in his pockets; he had sandals on: he was a mid-age white male. I asked him if he could stop so we could talk. He iterated that they're trying to get him. He kept smacking himself. He pounded on cars. He appeared to be under the influence. I following him for several blocks. He almost was hit by cars. In NYC, drivers don't care about lights & sirens. He barked and lunged at passerbys. In NYC, bystanders are always so nosey. We waited for PD and asked for an ETA (estimated time of arrival); no one came. I looked at my partner and we knew what we were about to do without saying anything. I drove up ahead of him; we exited the vehicle and asked him to stop; so we could talk. He passed me by: my partner was ahead and facing him. I went behind him & grabbed the waistline of his shorts and tripped him backwards over my body and braced his head; I held his body to the ground until PD came. My partner held one arm down; while I held the other. PD rushed to the scene and cuffed him. We took him to a Psych ER. He remained restrained. Hours later I checked up on him; he had taken a cocktail of illegal and legal drugs; too much, I can't remember. I'm not saying; this was the right move. My background in Martial Arts and Wrestling helped me subdue him and get him help. Yes, my partner and I could have been injuried or killed. It was our decision; luckily it was the right one at the time.

I hope this helped; not to confuse you. All the best...

Its cool that NYC has implemented Hypothermic Cardiac Resuscitation. There's allocated hospitals for it. I'm all for change to benefit the patient.

It would be great if the Department of Health and Human Services (DHHS) was on board; if they increased their scheduled reimbursement wages this will help healthcare institutions to survive. If they do; HMO/PPO/EPO will increase their remibursements too. DHHS needs to balance Gov't sponsored insurance. Premimums and Copays need to be enforced and inplemented. That's another argument for another time.

Things always come full circle. If it was a hit then; it'll be a hit today.

There are audits and restriction that has crippled the healthcare institutions. As science has advanced, wages and benifits increased, taxes gone up, insurance premiums on the rise, attorney retainers, stocking & re-stocking costs, vehicle maintenance, computer aide dispatching, GPS, refective strips, denial of insurance claims, payroll tax, etc: this has not made it easy on the employer.

Ex. Many people have Medicaid in NYS especially the Nursing Home residents. At the base reimbursement for ambulance service at $139.50 (Regardless of care; ALS & BLS; travel distance: emergency or non emergency; carry down or carry up; morbidly obese or non obese). How do companies survive? Medicaid reimbursements has gone down over the last decade, as expensives has gone up.

What I'm saying is; look at your net income and your expenses. Say if your net income continues to go down but your expenses goes up. How do you survive? You won't.

So sorry for hating but we all hate something relating to the government.

But awesome FYI stuff, thanks....

DwayneEMTP your words are always encouraging. You're the best...

emsgirl911 thanks for the kind words. All the best.....

You have every right to be confused; you're young. It's a tough decision to make; decades ago; it was a decision of your life. Nowadays you can have multiple careers. That's what college is all about; confused young adults, trying to find there own. The only thing you really need to decide is which degree path you're going down: Arts or Science. Its a PITA (Pain in the Ass) to switch from one to the other, after several semesters. Enroll at your local Community College or Senior College (Hopefully it will have Nursing, Paramedics, and Other Allied Heath Professions); take English and Anatomy & Physiology I with 2 other classes that is needed for all Medical, Allied Health, & Nursing. The first 1 year (2 Semesters); its all the same. That way you can qualify for Financial Aide (You have to be Fulltime). This will allow for decision making; go to each dept and speak with an advisor; hear all your options and hear what your family & friends have to say. You must get all feedback to make a good decision. Any decision you make in Heathcare will be fine; if you change your mind; which you may; go back to school. Its not as hard as you think or expensive.

Let me give you my like experience; I'm 35. I've been an EMT since 95 & a Paramedic since 98. I never graduated from HS; like you I was indecisive; school was so long. I was pressured to take the EMT class by my friends; I wasn't doing anything. I enrolled and got my GED; since it was a requirement. I loved the class; I did more rotations than required. I finished the course and passed. I worked at a Private Ambulance and Volunteered. This was exciting; I was young and energetic like yourself. I wanted to do more than oxygen, vital signs, & transport. I interacted with Paramedics and it was something I wanted to do. I took a Paramedic course at a Hospital; I passed with top honors & got a 911 job; very pristine in NYC: 4 months out of school. I worked in a Private while looking. I worked at several Hospitals in 911 and gained so much experience. I became a Manager at a Hospital Based EMS in 06 without a degree. My years there and experience got me the job. In 08 I received my Associates and now I'm completing the final phase for my Associates in Nursing, Class 2011. Since 08 (since the Hospital closed), I've been a Manager of a Private Ambulance. I found my calling and a job so flexible; I can finish school and continue with it. Retirement age is 67; I still have time; you have time. Its never too late. Whatever path you choose will be fine; its not set in stone, so you can always veer off the path. Ultimately, you need to do what's right for you and be content with your decision. Your future depends on it. All the best.

If you provide your state; I can fwd you the sites to surf. Thanks. Good luck.

To become a RN you must take a Nursing Program from an accredited college. If your talkng about alternative schooling; there are some.

Go to www.excelsior.edu (Excelsior College) Albany, NY.

You can wave all clinical rotations and take only the required class and all the Nursing Components with life experience. I'm pretty sure that an ERT doesn't qualify. An ERT is a CNA with a little more skills but a CNA is nationally and state recognize. Even EMTs do not qualify for the exemption.

Give them a call or an email to find out more: 8886472388 or excelsior.college@excelsior.edu.

Good luck...

Its about quick decisions but that's not what its all about. The decisions will quick and there is no way to simulate it. You just have to be there. You'll see it will all fall into place. Just read, ask questions, research, and ask to do more rotations for your EMT course. Once you finish and start working and/or volunteering and attending Continuing Medical Education (CME) Letures; you'll see if you want to venture into Paramedic Studies. Its not for all but a selected few. Be open minded; its not easy but the benefits far outweigh the risks.

I've been an EMT since 95 and a Paramedic since 98; I've been in EMS Mgmt since 08. I love the choice I made and I will be a spark in EMS change.... Good Luck.

Well your right to feel the way you do. People can be cruel and so negative. Am I an old timer? I don't know; I've been an EMT since 95 and a Paramedic since 98; I guess I'm getting there.

To give you some words of encouragement; I never graduated from HS; I wasn't doing much of anything at 19. It was through positive peer pressure; that I took the EMT course with my friends. I got my GED before the class. I loved it; it was new and exciting. I worked in the Privates and Volunteered as an EMT. I loved it so much; I knew I wanted to do more for the patients. So I took the Paramedic Course. It was the best thing I did. It built self esteem, it got me out of debt, and despite my family members having degrees; my career path had made me money and it was interesting to others. I was the first one in my class to get a position at 911; which was pristine in NYC. In addition, I became a Manager of an EMS Dept in a Hospital. Now I'm a Manager at a Private Ambulance. I just got my AAS in Paramedics in 2008 and I'm getting my ASN in late 2011. I guess I can say I was the most successful in my family.

So what I'm saying is; it can be done. A degree must be obtained if you want to progress up the ladder but experience will assist in this. So do your thing and don't let anyone discourage your dreams. Its our nature to hate. Good luck...

Plus, I'll get my RN but my current position pays more than what an RN makes but I'll get some Part-Time RN gig and have the Hospital pay for my BSN. Now that's the spirit to have. Goal oriented and directed...

It's unfortunate that there is no correct definition for EMS Providers within the layworld. It is what it is. If you get all bent out of shape about it; then choose a profession with a correct title which will be illustrated by all.

As long as you know; it really doesn't matter. I get called EMT all the time. I don't correct them because my salary says otherwise. Even if you didn't want to go down that route; then correct them and spend wasteful time, trying to get them to say it right and understand what they are saying. On a call, many do not care; most think the fireman (no offense) did so much by giving oxygen via non-rebreather mask and obtaining vital signs. I get there and throw the monitor (MI going on) and a line (mind you; the patient has been iterating that she's a tough stick); give nitro, aspirin, and labetolol (Hudson Valley NY). They become better and did better (PCI) at the hospital as a result. Do I get a high five? Where's my thank-you? I don't care; neither should my "EMS Workers." As long as my check clears; its all good. I've been at an institution where it didn't and I used my personal resources to keep my department afloat but thats another topic. So, check clearing is pretty much on my top of the list for my employer to fulfill.

Sticks and stones people; remember? We've all been called: Ambulance driver (even though you're on the passenger seat), the ambulance is here (even though its on the street and your on the 10th floor), EMS Worker, Emergency Guys (And your partner is a woman or you're the woman), Technicians, Rescue Workers, Medical Personel, etc. It's all good; they really mean us no harm. I mean they are right. Its a nice topic for all of us to ponder with but not one which I will have my dissertation on (No offense). Please don't take this to heart. If you do, you might displace your fustrations and I might have to start the UnemployedEMTCity.com website (Just kidding; I hope).

It was an unfortunate event. Mother Nature always wins. There was nothing anyone can do to stop the storm but a Snow Emergency should have been activated. Was it FDNY EMS's fault; I guess. I mean rear wheeled drive vehicles are the best for snow, right? The little shovels given to all emergency personnel was ridiculous; it was the little foldable shovel; similiar to what the military used in WWI & II. Come on; isn't EMS persons suppose to be able to trek over 2feet of snow through the sidewalks and courtyards?

I guess EMS was Emergency Mover of Snow that night. The only thing FDNY EMS can be criticized about, is that they waited until 3am before activating the Mutual Aide Plan. It was impossible for me get any units out; I could have helped, earlier. Oh well.

Chief Peruggia isn't the greatest of all men; he wasn't very popular. The pending investigations involving him, is another conversation for another time. He being the first head to roll was a tad inappropriate. Commissioner Doherty of the NYC Dept of Sanitation should have been the first to go. Especially, for giving his employees an A for their job on the snow removal. We had streets that was not plowed until 3 days later. Many streets were purposely left unplowed. Director Bruno of NYC Office of Emergency Management; didn't know how to activate the Snow Emergency for NYC; he didn't know he could do that. I guess that's fair that the 2 persons immediately involved in the clearing of snow & making that the citizens of the city were safe; did their job.

NYC is sooooo freaking retarded. I am the first to criticize the city but not the last.

Being an EMT is a start; it may not be a start for most who want to be in Medicine but never less, its a start. You must have your HS Diploma.

After completing the EMT course; get whatever job you can get; its tough out there. The 9.4% unemployment includes EMS Providers. Even volunteering; take advantage of being young and having no real responsibility (If that's the case). Gain all the experience you can.

Go back to school and non-matriculate; if you're unsure. Take the pre-requesites courses for all Allied Health, Nursing, & Medical which are: English I/II and Anatomy & Physiology I/II; this will give you 1-2 semester of Part Time School worth of time to decide if you want to go to Paramedic, Nursing, Medicine, or Other Allied Health Professional. All have its benefit and draw backs. It depends on your desires and goals. Good luck...

You have to remain calm. Composure is your ally. Sometimes taking 10 seconds to play it out in your head can have you make the right decision(s). Guides are just that, guides. It doesn't portray all events you may be involved in. You must be confident but show humility. Lets face it, Multiple Casuality Incidents (MCI) link up many people from many backgrounds; so there will be head butting but as long as you go through assessing for the priorities and triage all accordingly then you will have no real issues. After this incident; since it is fresh in everyone's mind. All involved in the rescue effort should sit in a room and open things out with a moderator who had no involvement at the event. CSID (Crtical Stress Incident Debreifing) will help all involved and make the next incident to go better. Good Luck....

That is fine because thats what ACLS and PALS preaches... Look it up; don't question yourself....