P_Instructor

I'm not sure what they do in other nations, but wouldn't you think that since he is already in a coffin, the person has been embalmed? If so, how can the body function? Just curious.

Please clarify something for me. Charlie's temperature is 38 point 5 degrees? Either he is hypothermic, as the temperature is below 80 degrees, normal being 98 point 6, or someone forgot to indicate Fahrenheit versus Celsius.

Sorry, I'm used to working with the Fahrenheit scale.

Looks like the conversion is 101.3 F.

Oh, and to clarify we have a procedure for "civil disturbance" that includes what to do if you must abandon a station due to the area being unsafe.

All I can say here is "Lock and Load, baby!"

Awww were you so excited when you got yours P that you ordered NREMT boxers? HEHE

Tried to get the subdued ones to cover up the skid marks from those crappy calls, but alas, no joy!!!

I am wondering what your first call that you when on (not ride alongs)

September 10th, 1979: EMT-Basic transferring 93 y/o female nursing home patient from hospital back to nursing home, post illness. Also first call for partner in back, Ambulance Director driving. Transfer of 40 miles. Patient slept for 90% of trip. Both of us nervous as heck, Director listening to AM/FM. Routine transfer except I got to drive back to base. All went well except I drove down the only one way street in this small burg the wrong way. Never did live this down from the director.

You're sent two suburbs over to pick up Charlie fron a walk in medical centre and take him to the hospital.

- 84 year old male complaining of severe SOB

- Immeadiate hx of feeling sick for 5 days, no significant prior history

- Looks sick; pale, sweaty, nauseous, feels fluey, markedly increased work of breathing

- HR 63, RR 24 laboured, mid & basal crackles, speaks 4-5 words per sentance, temp 38.5°, ECG new onset 1° AVB with bigeminy PVCs

- No meds, NKA

The doctor is trying to find some chest films he took and it'll take a minute or two.

This is a two part scenario:

a) BP is 96/86, how do you treat?

a) If BP was 136/96, how would that alter your treatment?

Are the bigeminal PVC's perfusing? Are you assessing the monitor (fail) for HR of 63 or the patient?

Yeah, usually you follow the departmental policies on patch placement. I've seen everything placed everywhere. Watch out for those sew it on their underwear!

Does any department have an operational procedure/sop/etc for "kidnapped/missing" crew? I work in a major urban system that has directives, procedures, etc for basically every situation including civil unrest/abandoning a fire station. We also have the typical "police assist" for situations when your in danger but does anyone have any expierence with this type of situation?

-How long would it take within your local to find an ambulance, then the crew if it was seperated from the truck?

-How long would it take depending on your status (on a run, at a hosp, etc) would it take for your communications center to determine something was wrong?

-Does your truck, radio, etc have gps or some other type of tracking system to find you?

I guess this is sort of a rare and unlikely event but it would be worth talking about.

On the fun side, going 'submarine mode' really erks the Comm Center. As for the serious side, each medic carries an 800mhz portable that has an emergency button located on it, which I believe can be tracked. Also, they will provide status checks every 20 minutes dependant on the situation that the crew was called for.

Wie schreibt Sie Englisch?

Comment-ce que vous avez saisi anglais ?

Hur du stava engelska?

¿Cómo deletrear inglés?

Как правописания английский?

어떻게 영어 철자 할?

Come digitati inglese?

All above ask the same question. Give them the test in their native language, but IMHO, they should all be able to speak the English language.

Those born earlier than 1970 should remember the elementary school snickering when June Cleaver said to Ward, "You were a little rough on the Beaver last night".

I remember and that was 'classic'!

Dupe. This is the tenth post from the top in this subforum!

http://www.emtcity.c...lem-nationwide/

Sorry, it should be 'dope' instead of 'dupe' on my end. My apologies, I guess I must have missed the previous. To all, again, my apologies. Thanks Rav.

First and foremost go straight to your education. There is no reason to delay starting the Paramedic Degree.

Second go out and personally visit EMS stations even if they are not advertising job openings. Also if you see an ambulance crew out in town on break stop and visit quickly maybe buy them a drink, you would be surprised how some of the guys on the ambulance carry weight in deciding who gets hired. Never rely on mail or phones looking for jobs. No reason to spend time in the volly ranks. In fact some places will not hire if you were a volly.

Agree with Spenac......Start on the education, but if feasible, try to get whatever experience along with the schooling, whether volunteer or part-time. School and full-time may be difficult, but if you get hired at the right place, they may make schedule provisions to do both.

911 non-emergencies a growing problem nationwide

As more non-life-threatening calls are received from the poor and chronically ill, some areas make system changes.By Karen Auge

The Denver PostPosted: 12/29/2009 01:00:00 AM MSTUpdated: 12/29/2009 05:58:42 AM MST

var requestedWidth = 0; if(requestedWidth > 0){ document.getElementById('articleViewerGroup').style.width = requestedWidth + "px"; document.getElementById('articleViewerGroup').style.margin = "0px 0px 10px 10px"; } The 911 call came in as "ankle pain."

So Denver paramedics headed out onto frozen streets and brought Debra Neaves to the hospital.

With that trip, those emergency providers became makeshift patches in the frayed health care safety net, providing services they were never intended to provide — at enormous cost to health systems, taxpayers and everybody with health insurance.

Sitting in a wheelchair inside Denver Health Medical Center's emergency room, Neaves teared up as she recited a list of the health problems that tumble through her life: diabetes, sleep apnea, high cholesterol, a crushed ankle. A doctor visit was weeks away, and the pain was worse every day. On this morning, "I stepped out of bed, and it was just so bad, I couldn't walk."

Neaves is on Medicaid, the taxpayer-funded medical coverage that in Colorado assists poor children and disabled adults. The program provides transportation, but Neaves said, "You need three days' notice for a taxi to take you to a doctor."

So she called 911.

Paramedics and emergency medical technicians here and around the country say a substantial number of emergency calls aren't emergencies at all but medical situations best handled in a doctor's office.

"It's a problem, and it's getting worse," said Jerry Johnston, who just ended his term as president of the National Association of Emergency Medical Technicians and is an Iowa EMT.

It's costly — an average ambulance call is $300 to $400 — and it's potentially dangerous, Johnston said.

"It becomes frustrating because we could be tied up taking someone to the emergency department who, A, doesn't need to go to the hospital and, B, doesn't need an ambulance," and in the meantime, there is a pileup on a highway and no available paramedics.

He's not talking about the goofball 911 calls that occasionally make news: the woman who needs advice on how to cook her turkey; the guy who wants to know whether it will snow tomorrow. Those calls may be irritating, but they are easily dispensed with.

The non-emergency medical calls are another matter. Some of these calls are from people gaming the system, such as a woman well-known to Fort Worth, Texas, EMTs, who gets drunk every Friday and then calls 911 and asks to be taken to the hospital a few yards from her apartment.

Then there are those who are just plain impatient, said Dr. David Ross, medical director of Colorado Springs AMR, which is that city's ambulance provider. "There are a small percentage of patients who will use the ambulance systems to try and get bumped up on the be-seen list" in the emergency room, Ross said.

But many non-emergency calls are made out of frustration, said Dr. Christopher Colwell, interim director of emergency medicine at Denver Health and medical director of the paramedic division. "They have nowhere else to go," he said. "They deal and deal and deal until it reaches a stage where they can't deal anymore, and they can't go anywhere else."

Duty to respond

Even if they could see a doctor, the chronically ill and the poor often have no way to get there, Colwell said. "It often boils down to, do they need treatment or do they need a ride?"

Often, it's a ride they cannot pay for. Denver Health gets paid for about 28 percent of ambulance rides, which is one reason the paramedic division lost $1.6 million last year.

There are no solid numbers on non-emergency medical calls to 911, mainly because nobody tracks them.

Anecdotally, emergency providers agree that non-emergencies constitute a substantial amount of an EMT's or paramedic's workday.

One gauge is that of the 84,837 emergency calls to Denver paramedics last year, about 30 percent didn't result in anyone being taken to a hospital.

In Colorado Springs, it is roughly 28 percent, Ross said.

There are a couple of reasons why an ambulance will go out and not come back to a hospital with a patient, said Dee Martinez, Denver Health spokeswoman.

The first is that people refuse ambulance transportation.

"The other is that we get on a scene and determine there is no need to transport," she said.

Sometimes, that might seem obvious from the moment a dispatcher picks up the call. But emergency systems have a duty to respond, said Johnston. "If you're a system that responds to 911 calls, you must respond to every call."

That's why the woman in Fort Worth is so well-known to EMTs there.

And she is one reason emergency providers in that city devised a novel program that they say saves money and better serves those who need care.

"We identified our 21 most frequent fliers and then looked to see whether there is anything in common among them," said Matt Zavadsky, assistant director of operations for Fort Worth's paramedics.

Turned out, there was.

Many had chronic health problems, others had mental-health problems and some just wanted someone to talk to.

So, the city of about 720,000 created "community health paramedics" who are specially trained to respond to non-emergency medical calls and regularly visit patients to check blood sugar, blood pressure, etc.

"We wanted to make our frequent fliers healthier and decompress the system to make more ambulances available for other types of calls," Zavadsky said.

The results exceeded everybody's expectations, he said.

"We reduced 911 calls by 52 percent and saved our system $560,000 in the first six months," he said.

Paramedics in western Eagle County are working on a similar program to address unique health care problems facing people in rural areas.

Christopher Montera, chief of western Eagle County's ambulance district, and Anne Robinson of the county health department want to deliver health care to people in their homes, through something they are calling the community paramedic pilot program.

As Montera and Robinson envision it, paramedics would visit patients regularly after they've been released from the hospital. The result, they hope, would be fewer people needing to go back to the hospital.

Common thread

The program could save everyone — hospitals, taxpayers, insurance companies — in the long run, he said.

A common thread ties what Montera is trying to accomplish to the issue that drives overuse of 911 in cities: access to health care.

"In health care reform, we need to have this discussion, and we're not," Johnston said.

In the meantime, people with upset stomachs, low blood sugar and nausea will continue calling 911. And paramedics will respond.

"We tend to be the safety net within the safety net," said James Azuero, assistant communications chief for Denver's paramedic division. "If you call 911, someone will answer, and if you want, someone will show up," he said.

Read more: http://www.denverpost.com/ci_14084125#ixzz0cJy4T5Rd

What does everyone think? Just looking for opinions again............P_I

I was thinking as I read through this thread what about trying to vagal... it might not work but if it slowed the rythem enough to reconize something it my help. I guess running at 50mm might help but then I have never seen and EKG done like this is it easy to read and understand in relationship to the vertical lines on the tracing?

~street

Vagals were attempted without success of even slowing down the rhythm. Just double the time factor per box. Try it sometime.

Consider causes of such a rhythm.

1. Electrolyte imbalance.

2. Fever/ recent illness/ surgery.

Verify no signs/ symptoms

Weakness-Fatigue-dizziness-etc

If Medical control received the 12 Lead see what the Doc thinks. After all that's why some carry that fancy ECG transmission monitor for these days. (Amongst other reasons of course)

Not sure I would toy around with immediate cardioversion, although Amiodarone (150mg over 10 minutes) would be my choice if I had to choose an aggressive route.

Would definitely like to see the 12 lead.

Oxygen, rapid transport and being ready & aware of any changes in the 12 lead or patient status. I would discretely place the Multi-function pads.

My 2 Cents

No imbalance. No fever/illness/surgery. Absolutely no symtoms other that being hyped up from argument, but not starting to relax.

Medical Control got on line while 2nd 12 Lead being received. Concurred with what I thought. Forget the cardioversion, not needed as of now. Requested the Amio over 10 and MC confirmed that would be what he wanted and granted the order.

Patient only slowed down to 146 range, always asymptomatic, oxygen and transport. No other changes during transport and upon arrival ER. Workup produced only minimal findings, however, there were records of previous hx. AF.

Thanks for the comments, ideas, opinions. Just a little fun to see what others thought.

Question......If this patient is already on pain meds with booster, isn't anyone thinking about why all of a sudden the pain has increased in such a short time span? Is this an exacerbation of existing problem, or is there something else going on? The belly has got a bunch of things in it people!

Gee, sounds like the other post......do we palpate the abdomen?

Let us know what the outcome was.

Will try the scanning, but don't hold your breath. Further, since there was the LBBB, whether the QRS was slightly widened or not, and the faster heart rate, what would you do?

Option to look at the worst of the evils, the potential of significantly wide QRS and fast (VT) and the defibrillator going off. Would adenosine actually work in this case if there were reciprocal pathway causing the tachycardia? Could adenosine slow the rate down enough to realize the true underlying rhythm? Should antiarrythmic medications be given to stave of potential VT? Which med: Lido, Amio, or another???

How about doing the smart thing and running the EKG and 12 Lead at 50mm instead of 25mm standard?

Ah haaaaa..............

The whole 'have to wear what we tell ya' is a bunch of "Abundant Bovine Excretment". Let them wear what work for the individual as long as it matched the so called uniform requirement. They need to stick these boots up their ......... A loss of a good medic does not equal the cost of someones 'padded pocket' idea of what should be worn.

If his QRS was widening, I'd assume his device is ready to fire again. Check with medical control and see about a loading dose of the antiarrythmic of choice. Asymptomatic or not, if you can prevent his defibrillator from firing it seems prudent. Whether or not it may be effective-due to potential underlying problems- is another story. I'd increase fluids if you have reason to suspect hypovolemia. Wondering if the patient may be infarcting due to a thrombus affecting the conduction system- noted that Pt is on coumadin.

Perfusion good/adequate. Request from MC will be posted later. What else can be done to determine the specific rhythm is this case? Why the coumadin? Looking for more opinions.

I agree with chbare. Kinda need more info to determine the basis of his tachycardia as well. Any flu symptoms, dehydration, etc that might point you away from cardiac? His rate isn't fast enough to be causing symptoms, and there's no reason to think of conversion unless you can see a clear picture of SVT. If he's asymptomatic then treat him as so and simply transport to the appropriate facility.

Oops, just saw the update.

Yup, still asymptomatic, but could this change into anything else. What is the cause.....maybe just the heated argument with family member, but could this develop into something else?

You want to consider potential electrolyte imbalance. I would want to look at the XII lead, med list, and obtain additional history before charging down the blast em with the antiarrhythmic of the month pathway.

Take care,

chbare.

Nothing significant except the coumadin. Patient not specific on cardiac history other than defibrillator. Was just seen at physicians office 2 days ago and everything checks out normal.

Sugar good. Medical Control contacted with confirmation of 12 Lead. While on phone with RN who is getting MC, you notice that it appears the QRS looks slightly more widened. Second 12 Lead performed reveals wider QRS, still LBBB. This confirmed by MC as he get on phone when second 12 Lead successfully transmitted. BP now 96/66, RR 14, HR still 150.

Transport time will be 15 minutes. Any requests?

Called to residence for patient who's implanted defibrillator has gone off 5 times. You arrive and find elderly female sitting in lounge chair, conscious/alert/pink/warm/dry. Was arguing with family member and defibrillator goes off 5 times. Has no complaints of pain or discomfort. History of diabetes, cardiac. Only significant Rx is Coumadin. BP 130/90, HR tachy at 140-150, RR 14 non-labored. Patient completely asymptomatic. Oxygen per EMS PTA. Monitor placed show tachy undeterminable rhythm, not narrow, not significantly wide, rate 150. 12 Lead performed reveals undeterminable rhythm except for LBBB. Loaded to rig. IV established and oxygen continued, perfusing well, BP now 110/80 (normal BP low 90's).

Opinion: What would you do......Adenosine, Amiodarone, leave alone, or what else to help you determine rhythm?

Patient continues to have rates is 150 range, defibrillator has high and low settings.

Scene safety is scene safety, no matter while on duty or not. This gentleman looks like he took an oath to help whenever he could. The circumstances apparantly were stacked against him. Sometimes it is just a shame. My prayers are with the family.

On a personal note, I probably would have stopped also to render aid.

To quote the great early EMS visionary, Mother Tucker, "If you're gonna learn, then you may as well learn from the best." Therefore, I share with you this opportunity:

That's all I know. Questions? See the e-mail addresses above.

Dust, keep me informed on any statistics for the course. I've been teaching an online Basic course (hybrid) for the past 3 years, and the success rate has been very good. The main problem is the skills format and if the students are receiving enough training in this area. So far, so good, but like anything else, could get better.

I'm interested to hear how other people handle this aspect of our jobs, especially because I've been hearing some complaints lately that we are doing it wrong.

From arrival at the hospital (with patient), what is the average time elapsed before your unit is back and available for another call? Do you write the whole PCR before clearing from the hospital, or do you put it aside to write it later? Does your hospital have rules as to how soon the PCR must be supplied to the hospital? Please specify whether you are referring to an "ALS" or a "BLS" patient.

Just to start, it usually takes about 45 minutes on average for our units to clear the hospital after an ALS call. This includes bringing the patient through triage, then to hospital bed, report to nurse, write the PCR, and making the truck ready for a new patient. Some crews average over an hour. Dispatch will sometimes try and call us out of the hospital to handle an emergency call, but it is usually up to the individual crew as to whether they are able to clear for the call or not.

How does your system compare?

This will vary dependant on where and what type of service that you provide, and how the operational plans are set up. We on average clear in approximately 10-15 minutes for BLS, and 15-20 for ALS. For both, the crews are still subject to call and clean up. For ALS, medication restocking is not an issue as boxes contain enought meds for 2 ALS calls. PCR's in some areas are required to be completed prior to availability, but for us, whenever we can get them done withing the shift, then faxed to the receiving facility. Most of the time, this is done relatively soon (within an hour).

Again, opinions will be based upon the agencies operational plans.

Our local "protocols" do not specifically address things such as how to do a physical exam although it is in the state curriculum and the national registry. That being said I am not satisfied that the state or the national registry have all the answerers. There are many procedures we do that are contradictory to the curriculum.

However the additional information gained by invasively poking your fingers into the four quadrants of an acute abdomen in the pre-hospital setting can spark major problems can dramatically contribute to a poor prognosis and that can only be handled surgically. I feel the risk of the EMT pushing on a hot appendix and rupturing it, perforating an diseased bowel, bursting an abdominal aneuyrsm or causing the patient to vomit and compromise the airway to name a few, however minimal, are too great for the new information that could be potentially gained. Remember that because patients can be ticklish, rigidity, lumps or mases could easily be a reaction caused by the patients own embarrassment, or your cold hands, and as such palpation is low on the list of objectivity even in the hospital setting.

Students are taught to palpate the abdomen to have the skill and pass the test bla bla bla. We also educate using a objective body of evidence rather than just teach chapter 6 pages 132-158 from the manual?

1. Abdominal exam not addressed in protocols? This is a standard. How can you potentially treat a patient without a complete and thorough assessment?

2. Do the exam, and if taught properly (non 'poking', but gentle palpation) you could find out much good information that can be disseminated to the ER to prepare them for whatever event. You need to assess for lumps, bumps, masses, palpations, etc. Who knows, it might only be a 'diastasis recti', but without exam, you could hinder the idea of rapid transport of a dissection.

3. We don't teach what is in the chapter per say.....teach the curriculum which includes a good thorough abdominal exam along with history of the event. Teaching the newby Basics any other way could compromise good assessment tools in the future. Don't jump down their throats, teach them the proper way and what to look for, whether they or you can do anything for the complaint or not. Complacency can be a killer.

This is only the opinion of this poster.