Emtpbill

You call their supervisors and follow it up with. Written complaint. A few of those and they will be gone. This is a service industry. A lot of people forget that, that cause their is only one emergency number, 911, that who else are they gonna call.

I was always of the thinking that adenosine is kind of a diagnostic drug. Yes it can chemically cardiovert, but more importantly allow you to see the underlying rhythm of what is causing the extreme rate by slowing the rate long enough and take steps from there.

Years ago I got a call for someone who had been bouncing on a trampolene, while intoxicated, had smacked his face on the outer metal rim. Normal this would have been an uneventful call except that the man had braces, and some kind of retainer or palate expander. So when he hit, the metal and plastic broke off partially and was rammed half down his throat. The patient remained calm, I don't think he realized his peril at that moment, and allowed me to use magill forceps and manipulate the plastic and metal back up his throat and used tin snips to cut the mangled mess away. He said thanks, I will go to my orthodontist tomorrow. I advised him against this. , but it was his party and there was no way to get him to leave. Called command had them talk to him, signed him off and was offered beer and cake to take back to the station.

If the call was on the way to the hospital you could have stopped, started to render care, have your partner stay with the woman in the back and just nicely explain that it will only be a short delay. That way you can possibly get an airway and stabilization til the next crew shows up. Hand care off to them or transfer your patient to them.

Just for those who might be interested, a friend of mine who completed PFD academy for medics told me the city is planning another class for September of 2011.

BSR? BSL I am assuming is blood sugar level, but at 5.8 ? Do our glucometers in the states use different measurements?

Docharris, That looks like a gun holster,

I remember my first paid 911 job was a volunteer based squad. The one thing they told me when I started was that just like paid employees, volunteers can be fired. I know that is drastic and last option, but if those who are there refuse to give the quality service your customers deserve, get rid of EM.

German shears are the best..., But then again, how could anything German be bad.

Philly just put a medic class through the fire academy, started April 18th. I actually had gone through the process, got fitted for bunker gear, had physical at 19th and fairmount. Decided to stay in the counties. Fire academy for medics is 6 weeks long. There is a reason why they are hurting for medics, they have a high turnover rate. The management could care less about the staff and the union is at big odds with the mayor. If you are doing 911 somewhere else, I wouldn't go to the city. Once I found out everything I did you couldn't pay me enough. I am just glad I didn't quit my other gigs when I got my letter for the city.

In the same sense, how many services do random spot drug tests?

The narcs are in a locked cabinet that only the medic can access(emts don't carry keys) and they are zip tagged. But in the back of the truck when it is only the medic and the pt. who is to say the medic gives 5cc of saline instead of 100 mcgs of fentanyl. Patients don't know. Medics have a great deal of autonomy, atleast in the area of PA. I am in and could very easily get themselves in trouble.

<br /><br /><br /> I like the last part, separate quarters for ALS crews and BLS.

<br /><br /><br /> Well then this board would be a ghost town if topics weren't regurgitated.

<br /><br /><br /> From a rare, and I mean extremely rare, tour I may not get any rest in that 24. In Philly they can't do 24s as they don't usually see the station after the shift begins. But in the surrounding counties, where I practice, 24s are still allowed because there is almost guaranteed downtime. As far as being awake at hour 20 compared to hour 3 , absolutely not. Even if I slept half the shift, I still wouldn't be as sharp, but 24s still have their place, simply due to shortage of ALS providers.

<br /><br /><br /> While I am definitely not a rookie, and well, being an idiot is still out for debate.... But I kind of take offense at the last part of your statement. 24s have been the norm in this area since I started back in 92 and I am sure alot longer than that. Since I have a 50 minute commute with turnpike tolls it is cheaper( so to speak) to do 24 rather than double my gas and toll charges. As far as 2nd jobs.... It makes it alot easier actually. If I have to work 3 12s or 4 10s then that pretty much excludes a second job. A 24 and 12 leaves plenty of time to pick up more shifts at another squad. As far as liability. Studies have been done that 24 is the effective limit for our industry. Every time we would stay on status longer than that the county would send u a "nasty gram". Which basically was a photocopy of the study saying don't stay on longer than 24. So other than your personal opinion..... Do you have any other proof I'm an idiot?

Just outside Philly, I am doing a 24 starting at 06:00 tomorrow. I will get in around 5:50am, check my truck out, sign the Narcs in the other trucks, and hopefully by 7:00 am will be back to sleep. We have 2 "bunkrooms" each room has 1 single bed and a bunkbed setup, also each room has cable TV and is climate controlled. If a call comes in the tones set off the claxton and turns on the lights in the bunkrooms. In a 24 hour shift I hope to sleep 10 hours. Maybe not straight through, could happen, but probably 5 hour blocks, EMS Gods be willing.

We have MDTs in our trucks. Once we get a call and go enroute on the computer the address gets crossed over to the mapping program in the computer. Since this is the same county has, then we have what they have, as far as maps. It will give us turn by turn, updated as we go, and also give us ETA and any road closures that have been reported. Works well, so far.

Yep

In PA. It is medication assisted intubation, no paralytics. Versed 5-10mg and only if , and a big if, there are 2 paramedics treating the patient. I wish we had succ. or Vec.

Yea, had that happen to me as well. The passenger side rear compartment. Wasn't shut correctly when board was taken out. Made a left, door opens and bam, smacked a telephone pole. Bent the door on the hinge. Didn't live that one down for a while.

<br /><br /><br /> Unfortunately at this time Philadelphia does not play with other squads. Unless it is a MCI , which plans call for surrounding counties 911 and transport squads, Philadelphia has no setup for dispatching out of city squads. I know that in the surrounding counties if it gets so busy that they have exhausted the entire box card, they will call the neighboring counties to see if there is an available 911 squad that can be dispatched. Not in the city though.

One other advantage I just learned about, after taking a con-Ed class from a pain management specialist is that many people are now taking buprenorphine for pain. In the past it was used to help with opiate detox in the form of suboxone and subutex, but recently alot of Doctora now prescribe it for pain management. Now if you have a patientnon subutex or suboxone that requires pre-hospital pain management you must first give fentanyl. The reason being is that fentanyl is the only drug that cane knock buprenorphine off of the mu-receptors. Otherwise if you just give morphine, the patient will not receive any benefit. After the fentanyl you can follow with more fentanyl or morphine. From what I have been told 100-200mcg will knock the buprenorphine off the receptors.

Well, did u get your wish?

Also, preparation is 90% of the battle. Make sure you have all of your setup convienetly available. Your drip tubing primed and flushed. Whatever you want to use to secure the site ie. Tegaderm or tape. INT. Flush. Or any vacutainers and tubes you may need if you are drawing a blood set. When you get your own style you can even get nifty and get your glucometer sample right from the catheter before you plug any saline in.