HF-EMS

im not sure where you are from, and it sounds like you guys have a system that works for you, but regional protocols have us go with the nationally accepted broselow system. To each their own i guess. And provided I have to use the tape, i might as well have the bag split out for me already, right?

hahahaha valid point

its not a question of the algorythms, per se its a question of Body Mass based dosing of meds. I dont know about you but i never get any information from hysterical mothers. Broselow doesnt tell you what to use, it makes sure you use the right amt of the drugs

thanks for the heads up

I am the training officer for an ALS ambulance, we have two ALS fly cars and two ALS ambulances in service at all times. I am an ALS provider. My friend, the equipment coordinator, a BLS provider is re-doing the peds bags, which really just consist of ped NRBs and Cannulas. All the ALS peds supplies are separate in the ALS bag with a broselow tape. I reccomended to him that he should purchase broselow bags, or broselow wheels, that way the ALS peds supplies are integrated into the peds supplies, rather than separate. What do you guys think?

Hey guys, im spec'ing out a new ambulance for my agency to replace a real lemon of a bus. I am looking at the Demers Millenium. Has anyone had any experience with them. Pro's/Con's? Can anyone help me out?

I agree with Rezq.... Any pt, wether im just hanging a bag for fluid rescusitation, or for precautionary reasons, i always attach a loock to the end of my line. It facilitates pt transfer at the hospital, as well as putting the pt in a hospital gown. But mostly, if you have to hange bags, eg. more fluid, hospital hangs a drug, you can set up your new drip set while the line is still flowing and just connect it to to the lock. In fact when i took my Medic class, thats how we were taught to set up an IV, with a lock or threeway attached.

Thanks guys, I would never wear the shirt on an actual call with a tactical EMS patch on it, it was mainly given to me as a half joke/half anticipation of me taking a course. I would never dream of impersonating someone, i have too much respect for what you guys do, thanks for the input. Thanks for confirming what I thought guys, the patch will go with my collection like I planned, good luck and g-d speed all That said Dust, they do make some stupid laws in NY, lol --HF

Thanks, It does. The reason I posted this was, though not currently on a team, I am really interested in TEMS. While working on my ALS cert this year, I have been reading alot about Tactics and trauma medicine. And for myself i bought a BDU uniform shirt, and have adorned it with a subdued NYS EMT patch, matching American Flag, and Name stripe. SO my actual question is this, a friend got me a Tactical EMT patch for the shirt, is it inappropriate to wear it? Thanks again for the help. -HF

Hi guys, i am working on becoming a tactical Medic, and test out for my ALS cert this weekend. I know there are tactical medicine courses (BTM/ATM), such as those offered by Cypress Creek, etc. My question is, is there an actual Certification for Tactical Medic/Tactical EMT, or is it just a specialty you can be trained in? Also any help on where to get started with a PT regimen would be greatly appreciated. --HF-EMS

The protocol issue aside: If you have a medical patient, or any patient with confounding injuries or symptoms that just don't add up, the key aspect of treatment is a good, detailed assessment. While you may not be able to treat the patient's illness/injury, the better you utilize your txp time, and the better your assessment, the less time the hospitals have to spend figuring out what is wrong, and the faster the patient receives definitive care. After all, that is our goal, getting the patient to definitive care in the fastest and safest manner. Additionally, any patient can have unusual symptoms for common pathological processes. A symptom is only an unusual one until we discover an association between it and a disease pathology. Similarly, with diabetes specifically, (& pt's lack of Hx) there is no Hx of anything, until it happens. My opinion on taking sugar, a 45 sec procedure tops, is the same on what my original medic instructor said, all patients where you cant definitely rule out medical causes, gets a 12-lead, case in point the pt with bilateral thumb main with a massive anterior MI. In New York State, I believe that Blood Glucose has been made a BLS Skill on the EMT level. I believe that as long as you treat your patient, and not your glucometer, BS can be a valuable vital sign if not for prehospital care, then as stated above to expedite the delivery to definitive ALS. That said, im sure people will disagree with me, i look forward to constructive criticism

:wink: :oops: People who overdo it with the smileys :evil: :twisted: :roll: :wink: :shock:

Here's another one “The Call Goes Out” 911, and the call goes out. We run out the door and the ambulance shouts. The grind of the gears and the bright blinding lights While some poor soul fights for his life. We slam on the gas and the engine growls mean. And the sirens let loose with their devilish screams. As we fly like demons down the dank city streets. And we enter downtown- a terrible scene. But 911, and the call goes out. My pager goes off, and the radio shouts. Alpha, bravo, Charlie: run. Delta, echo: run faster. The voice in my head is the mellow dispatcher. Waking me up, he’s my slave driving master. So 911, and the call goes out. I'm tired and broken, But can’t let it out. 911, and the call goes out. There’s someone out there, “help me he shouts” 911, and the call goes out. 9-1-1 The call goes out The call-goes-out.

Here's another one “The Call Goes Out” 911, and the call goes out. We run out the door and the ambulance shouts. The grind of the gears and the bright blinding lights While some poor soul fights for his life. We slam on the gas and the engine growls mean. And the sirens let loose with their devilish screams. As we fly like demons down the dank city streets. And we enter downtown- a terrible scene. But 911, and the call goes out. My pager goes off, and the radio shouts. Alpha, bravo, Charlie: run. Delta, echo: run faster. The voice in my head is the mellow dispatcher. Waking me up, he’s my slave driving master. So 911, and the call goes out. I'm tired and broken, But can’t let it out. 911, and the call goes out. There’s someone out there, “help me he shouts” 911, and the call goes out. 9-1-1 The call goes out The call-goes-out.

normally its the smell of feces for me. :pottytrain5: THe only time i came close to actually vomiting on a call was an intox call at the police station. The call was for a male with a hand injury 2ndary to ETOH. When i got there the kid was in a chair with his hand cuffed to the wall. Everything was going fine until he started vomiting with incredible volume, force, and odor. In about 45 seconds he filled 1 and a half desk sized trashbins with vomit. It was so strong and sudden, i walked out of the room and dryheaved for about 30 sec. :-&

HOW come when i posted my poem, see string http://www.emtcity.com/phpBB2/viewtopic.ph...&highlight= no one posted any poems in reply. I voiced my interest in putting together a compilation book, of EMS poems written by EMS providers, i have received good feedback from other members, and if anyone is interested, please feel to email me or post a poem and express your interest, people can be anonymous or credited to their liking, please let me know.

thanks for the words of wisdom, i will pass them all along

yeah, the initial dose, atleast in my region is .5mg, SQ usually followed by IM Benadryl and IV solu-medrol(with a physicians orders for the steroid)

A friend of mine is in his first ALS class, and during his field time, he made a mistake, that thankfully did not result in any lasting injury/effect to the patient. He has told me that he is no longer confident in his abilities and wants to stop the class he just made it half way through. I told him that even the best medics make mistakes, and he will learn from his experience. Can you guys share some stories, or words of wisdom to help him out. Thanks a lot.

Hi guys, I was recently talking to my med control physician when he mentioned a study he had just read saying that in the prehospital care and tx of anaphylaxis, the initial dose of .5 epinephrine could be given IM as opposed to SQ. What have you guys seen/heard, or have any of you tried it?

one night, one of our crack dispatch staff was on the tones came over the radio and we heard "SUNY to HF, you may have a call. Standby we are looking for your patient." about 5 min later we heard "SUNY to HF, you DO INDEED have a patient. The other night the tones dropped and much to my surprise, "SUNY to HF, need a FULL CREW, A FULL CREW (As opposed to all those calls we do with just a driver) to respond to ******* hall, party will meet you outside, pt states he ingested syrup of ipecac, concerned that he's not vomiting."

I agree, that is the policy we use in my area. 1st set of vitals manually and then on the lifepack, w/pulseox and NIBP. If vitals are supposed to be taken every 5 min in a moderate to critical patient, and you are all alone, or have only 1 attendant, you cant be tied up taking vitals. We have to let technology work for us. I cant wait till one device does EVERYTHING, (like those things on Star Trek)

Thankfully in the years i have been doing this i have been fortunate to have few losses. But no one can avoid them entirely. For me, it doesnt seem to hit me as hard as it does others. But when it does i as others say remind myself i did everything i could. But i also remind myself of all the lives i have saved, and that is a comforting thought for any provider. To know that they DO make a difference.

Is this an all Canadian thread Seriously though, are you talking management team on the State (or Province) side, or agency wide. Agency wide, you might consider having a dedicated unit on duty at the times of high frequency (Fri/sat nights) assigned for those calls. That way your main units are available to respond to actual emergencies. Govt wise, maybe the development of specialized public organizations, development of detox center, etc. I'm not sure, I know your govt-health care system is different then here. Hope the first suggestion helps.

Everyone is missing a pretty important point. Regardless of what 3 rigs equals, be it three medics, and three basics; 6 medics, or 6 Emergency physicians and trauma surgeons, three of them have to drive the ambulances to the hospital. If you put one critical pt and one not so critical pt in the ambulance; then the medic may not be able to adequately care for both patients, especially with pts one and two which will require almost exclusive care. Now you just put in possible jeopardy, the lives of the patients in the ambulances with them; or at least potentially denied them the care they really need. Now with pt one, she might be responsive to pain right now, but she is suffering from a crush injury. The reason she is altered(other than possible head injury) and that her vitals are falling is because the seat and steering wheel that are pinning her in place are probably the only thing keeping her alive. This poses two separate problems: Pt one is an ALS patient, who is going to be a prolonged extrication, and according to the scenario Fire/Rescue hasn't even arrived on scene. You wanna use a bird? What if they are a significant flight time out? Besides, the pilot of the chopper can cancel for any number of reasons, if that happens, you are caught with your pants down around your ankles waiting for and counting on something you're not getting. SO while you wait for the chopper, and fire to come extricate the pt you loose one medic, poof, and (assuming the 3 medic scenario to make the point more dramatic) you are down a third of your ALS to 2 medics which can work up patients. This is a pointless loss when you consider point two. As soon as you remove the impingement from the pt there is a good chance that she will crash from hypovolemia and exsanguinate. Also much like the application of a tourniquet, there is build up of toxins, and lactic acid on both sides of the impingement, releasing the pressure can cause severe acidosis and toxic shock. Not to mention throwing numerous clots all around the body. Well the argument can be made that the medic had plenty of time to get bilateral 14g IV's. Well all that'll do is replace what was blood with saline and push away whatever clots had formed and were helping to keep her alive. I'm not saying that saving her is impossible, but not knowing what additional resources you'll be able to get, with 5 other pts, some critical, all with the potential for crashing due to the MOI, attempting to save her is by far not the most appropriate distribution of your resources. With pt 2, the death of a child is horrific, but you have to remember peds. don't crash till very late, and this kid is crashing, this means irreversible shock, if not knocking at that door, again taking away a medic on one patient when they could be better used. Please don't mistake my post for callousness or coldness, leaving a child who is not pulse-less with a black tag is something I dread. But you have to appropriate your sources so there is the smallest potential risk for loss of life. The ability to make those decisions can only come with a lot of experience and the confidence to believe in what you feel is the right thing to do. Don't criticize people like PRPGfirerescuetech for making that call seemingly so easy, it takes a lot to make that call. Its also easy for us to judge without being there. Lets all keep that in mind.