P_Instructor

Interesting.....Was the compound fx angulated? Were the bone ends exposed? Usually (insert your opinion of this), traction/sager splints are utilized for non-severe angulated mid-shaft femur fractures only. If the bone ends have already been reduced, how are you to know. Your primary objective for these devices are elongating the fracture site as not to create more damage with the sharp bone ends. Also, they (supposedly) reduce pain from nerve ending irritation. Ha. Many can do this with proper splinting with other devices, and pain medication (if authorized). I can think of only one time that I had an isolated mid-shaft closed femur fracture where we used the traction splint. The majority of my cases were splint in place, and not compromise the distal circulation. If the bone ends are exposed, by reducing the fracture in line, you will also cause more tissue and possible nerve/vascular damage as the bone ends align. Open/exposed, probably not by me, open/non-exposed, depends on many other factors found with assessment.

Does anyone have insite to what this really means to the EMS provider?

EMS Approved as an Emergency Medicine Subspecialty

East Lansing, MI – September 28, 2010 -- The American Board of Emergency Medicine (ABEM) announces that the subspecialty of Emergency Medical Services (EMS) was approved by the American Board of Medical Specialties (ABMS) at the General Assembly of its members on September 23, 2010. EMS is a medical subspecialty that involves prehospital emergency patient care, including initial patient stabilization, treatment, and transport in specially equipped ambulances or helicopters to hospitals.

“The purpose of subspecialty certification in EMS is to standardize physician training and qualifications for EMS practice, to improve patient safety and enhance the quality of emergency medical care provided to patients in the prehospital environment, and to facilitate further integration of prehospital patient treatment into the continuum of patient care. We are pleased that EMS has been recognized by ABMS as a clinical discipline that extends emergency care to the acutely ill and injured patient in the prehospital venue.” stated Mark T. Steele, M.D., ABEM President.

EMS becomes the sixth subspecialty available to ABEM diplomates along with Medical Toxicology, Pediatric Emergency Medicine, Sports Medicine, Undersea and Hyperbaric Medicine, and Hospice and Palliative Medicine. The development of EMS as a subspecialty has been discussed for many years but it was through the concerted efforts of the National Association of EMS Physicians, the American College of Emergency Physicians, the Society for Academic Emergency Medicine, and ABEM that certification in the subspecialty was approved.

ABEM has assembled an EMS Examination Task Force composed of 12 EMS physicians that is working on the development of the EMS subspecialty examination and maintenance of certification program. It is anticipated that the first examination will be given in the fall of 2013.

Used the ammonia in the past, have done the hand drop, etc..... experience and exposure to the 'fakers' only makes you more aware in certain instances. Why do more harm. Look at the patient. Corneal pain, why. Just simply check without them noticing (of course their eyes are closed), lightly touch the eyelash. 99.99999% of your 'fakers' will have a eyelid flinch. Usually (percentage data unknown), the fakers will have a positive reflex, where the real patients will not. Just a tidbit. Does no harm also.

I hope he's fired, assuming he's not a volly, which seems likely. Sued, and then I hope dad tracks him down and beats him to death. Nope, I'm not exaggerating.

If this type of thing came to me of Babs or Dylan's last moments on earth the very next time you would see me I'd be on Court TV while they decided whether or not I'd earned the death penalty for my retribution.

Taking a video for education? Ok, with the families later permission. For the ER? Of course. To show your idiotic wanker buddies that you were actually in the vicinity of a nearly dead person? Holy shit.... I mean...Holy shit!! I'm finally coming to believe that EMS is not salvageable. But of course, we all know that if he's not a volly , the Chief or Captain or whoever is supposed to supervise these assholes will be disappointed in him for being a fucking moron and then give him a few paid weeks off while the press dies down, all the while speaking of how he's been "severely punished."

Makes me sick...

Probably can't tell that this pissed me off a little...

Dwayne

Dwayne......don't feel alone buddy......you would have many (including myself) accomplices with you in court!

All above responses are correct. The idea of getting into the field initially is the desire to wanting to help when it's needed. For the monetary aspect, again it's what you put into it, what you do with it, and how you perceive it. One must add that pre-hospital EMS is a great stepping stone towards other professions within the medical field, usually all that pay more, ie. RN, PA, MD, DO, Radiology, Administration, ..........

I've been in EMS over 32 years, and just eke'd by on salary, but it has led me to teaching EMS full time, and I still continue to provide my field services part-time. (Better salary and bennies.......no, not benzo's).

It's still again how you look at it.

Based on proper requests of further history and information obtained, this should lead to the aspect of visual/palpatory examination. However, full vaginal exam on female, no. Patients can be very vague in their complaints of discomfort in the pelvic region. A good paramedic should be able to acertain pertinent information with proper questioning to warrant a proper examination if needed as without the this, how the hell can they know what is really happening, and can they do anything for the problem. There are many things that you can inspect/palpate for so you have (no pun intended) a better handle on the situation (crowning, swelling, trauma, bleeding, drainage, etc.). There are proper times and improper times when examinations are needed. Either case, you should always have patient consent and hopefully a witness with you.

I have nebulized Morphine (bronchogenic carcinoma) but I have never heard of narcan neb.

cheers

Could you send me your protocol on nebulized MS, even for the reason displayed?

Could we call this the "Gene Simmons Technique"?

IS ANY ONE ELSE OUT THERE CALLED AN AMBULANCE DRIVER ..................

Yer dern tootin Roscoe. Also truck driver, cabbie, bed boss, and ambo ass...

................the dirty little secret in the medical/legal world is that even if you do everything by the numbers, it does NOT mean you are insulated from potential litigation...........

...............One little errant or ambiguous word in a report, or from a witness is all it takes to put someone through legal hell..........

I do agree. Reviewer's beware.

Is it me, or have the level of training and professionalism in this business degraded over the past 15-20 years ????

Well, you posted this just as I am about to begin the airway section of my Paramedic class. Personally, training institutions do teach the 'skills' of airway control, but I agree with you there is a lapse of instructors that don't teach the necessity of assessing for the appropriate response for this control. Personal opinion is many new (young and slightly experienced) instructors like to teach what you can do without why you do it. It is a shame that this happens.

I agree within the other posts that you should only do what is best for the patient by fixing the problem first, any you need to assess what the real problem is. To many providers are using their protocols as 'Bibles' instead of what their real purpose is......'Guidelines'. How or why in the h*** does a provider perform these skills without really understanding what they are doing? I personally don't instruct this way, and my students need to know the big 'W's' in everything they do. Unfortunately, I guess I'm in the minorty of this type of instruction, and then don't have control of the student once they enter the work force.

This does give the impression to your initial question in regards to training and the pros.....

Welcome and good luck.....remember on the test, keep is simple and by the book, SS, BSI, A, B, C........

I would be very careful about your policy...............................

Anyone who refuses transport needs to be advised fully of potential risks(however remote), as well as the costs. It HAS to be the decision of the patient and/or their family. As long as they are fully informed- and not coerced into making a decision- then you should be OK as long as you accurately document and converse with medical control.

I agree with the 'Herbmeister'. Make sure that all your policies are clear and that you understand them fully. The biggest thing is that you do not offer medical advise, but as stated to inform the patient of the potential risks of refusing medical care. Don't you make the decision that an ambulance is not needed, And finally, document everything with signatures. One little piece of jargon I always use with refusals after the patient is informed is that 'patient acknowledges understanding......"

Don't fret too much about it. Use the advice of the previous and practice. Spenac spells out the best formula for the drugs. Drip rates are easier. I'm currently instructing my P class in the math formulas, and many have difficulty, but with good, calm approach, it will come you you very easily.

My best advise is to get everything into the 1, 10, 100, 1000 catagories. Master this, and it is a snap.

Regarding an arrest situation; good bag mask technique ~ ETT ~ Combitube ~ LMA...............................................

Are are good as long as the airway has patency. Each develop their own opinions on which device is preferred. Overall, the ETT is IMO the best, but again, as long as the airway is controlled. I have used them all.

We use it exclusively for all the scenarios stated before. It is more versatile than Diazepam and if given IM, is more readily absorbed. Then only initial problems we had was underdosing in seizures. This was identified and protocol changed. Have had no problems with it since. Good stuff.

Thanks to those responding. The idea of having a elevator key is good for cities where it's use is often needed. For further, we not only send in background checks, but require the necessary immunizations, adult/pediatric manditory reporter, health evaluation, and other items prior to be eligible for clinicals. This is required for both basic and advanced classes.

I say if he's found guilty, and most assuredly he will be unless he pleas it out, his nuts should be cut off. raping a 11 year old girl, not only is he a rapist but a pedophile also.

Bravo!!!!!!!!!

In NJ the background check comes before employment. Nothing was done before or during class as far as checks went.

Its funny even me with a DHS clearence still got a indepth check

Thanks, it is usually common for the checks prior to employment. Our program does do background checks at the beginning of our EMS classes and if bad 'hits' come back, this may be a deterrant to obtaining licensure/certification from the state EMS Bureau. I was just wondering if any other programs provide the checks for EMS. I know that many Nursing programs also do the checks.

EMT with Firemans Key Accused...

It states he worked for the fire department.......Question for anyone, was there ever a background check (DCI, FBI, CIA, whatever....) performed on you at the beginning of your EMS class. I know that even cleared personnel can go bad, but I was just wondering if your programs made the initial check manditory to take/finish the class.

Come out and check the fresh air of the midwest......plenty of fishing and hunting areas......tryng to find the 150 acres could be possible.....Iowa/Nebraska/South Dakota baby!

Just a nice one, reported on WABC (HD) TV-7, NY, a station usually critical of the EMS Command of the FDNY.

http://abclocal.go.c...ocal&id=7536189

Cool....I wish more of this type of thing would happen around here.

Ok, so we attempted to do this in class and it was a disaster. Everyone tried to do it like dynamic cardiology but just verbalizing everything. So What ia a good way to prepare for the static portion??? It seems to be the one part that EVERYONE in class is really getting caught up in.

Relatively simple.....what do you have, and how would you treat it. Example: (caption) You have been dispatched to the residence of a 50 year old male. Your patient complains of severe chest pain rated as a 9 on 1-10 scale. He is very diaphoretic, cool, and ashen. Vitals are B/P 190/130, Resp 28 and shallow, Pulse 125. The patient states the pain started about 40 minutes ago and became worse. The patient has NKA and does not take any medications. The patient was working in his garden when pain first occurred. Provide oral treatment. (Strip) Sinus Tachycardia, no ectopics.

The rhythm appears to be a Sinus Tachycardia.

BSI, oxygen @ 15l/NRB, monitor, establish IV, 324mg ASA, NTG 0.4mg SL and reassess. No changes and B/P supportive, then 2nd NTG 0.4mg SL and reassess. If no changes and B/P supportive, 3rd NTG 0.4mg SL and reassess. If patient still having pain and vitals supportive, consider analgesic such as MS 2-4mg IV. Continue monitoring and transport.

Keep it simple but complete. This example would be a MONA type of situation. Of course, this is my interpretation and opinion, and there could always be variations on how others would respond to your inquiry. Good luck.

Damn....if they go to the LED lighting, then the title of this business saga "As the Beacon Rotates" will have to be changed. Oh, well, the spin-off "As the Siren Wails" will always have it's place.............

Several of the activities mentioned here will most likely involve theft (IV tubing and saline, lidocaine jelly, KY/surgilube)........

Use the items that are outdated and are being tossed out.......no loss.......

Harmless, but also hysterical........fond memories.

Don't do it in/on the streets....do it in the station. Fondly remember the time my partner and I strung about 30 feet of IV tubing through the rafters into the other crews sleeping quarters. This of course was connected in one of our rooms with self (by us) pressurized saline in 150cc syringe. We did 'Y' the connection so both of the others would benefit from a shower. But......prior to the dousing, we had to remove some of the slats from their beds, so when they came in and crawed into their respective beds, COLLAPSE, and the cursing began. Hilarious. We waited until they settled down (after fixing their beds), started the Z's, and then started the shower (of course we strategically placed the tips of the tubing just through the ceiling so they could not see it, and it was positioned right over the beds). Oh yeah.....a whole lot more verbage.......