Iowa Medic

Agreed. I have stated in my opinion Zimmerman was a little man with a hero complex and made a series of poor decisions but the state never had a case against him due to the limited physical evidense and eye witness testimony at the very least not contradicting his story. The media attempted to paint him as a racist and again the data collected by the FBI revealed the opposite of their assertions. I have multiple weapons and a carry permit to go along with extensive training. I am all for the right to protect life and property from those who intend on taking either but this altercation should have never happened although technically not against the law.

I apologize Doc but on my android I am unaware of how to open multiple screens which would allow me to cut and paste links. When I am near a computer I will point you to sites with the information. The daily caller has the tweets from Martin with regard to drug use, street fights etc. There are several websites with witness testimony that recounts Martin mounting Zimmerman and striking him. YouTube has all of the 911 calls to hear the screams for help immediately before the gun shot. Again when I am on a computer I will do a better job supplying the data. Also, with regard to the law not mattering... I have stated in most my posts that I font doubt Zimmerman in fact made several poor decisions leading to TMs death but having said that strictly speaking about the verdict there is no way anyone could find him guilty. morrally is a completely different story

I didn't state that TM was high that night but the fact he used and possibly dekt at his school was brought up by classmates as well as his twitter account which was released as Google cache. Again I agree that Zimmerman made some poor choices that resulted in TM being shot but none of his actions were against the law in Fla or any other state. TM had the right to defend himself or stand his ground (not relevant to this case) buy even if you go against eye witness testimony and state unequivocally that Zimmerman was the aggressor then TM was within his rights countering Zimmrrmans aggressions up and to the point that he had Zimmerman mounted and throwing punches. At this point TM or anyone else by law has the duty to stop the attack. I'm speaking only with regard to the law and there is simply no way given the facts presented they could find Zimmerman guilty. You can disagree with the self defense laws, you can assume or create what is in your opinion more likely scenerios as "what actually happened' but according to the prosecutions case you can't say he should have been found guilty

Agreed Captn. What blows my mind is a Hispanic guy shot a black kid and its the white mans fault... How the hell does that work? Forget the litany of talking points that at the very least suggest Zimmerman was not racist those who want to see Zimmerman further prosecuted are conjuring up racial conspiracy theories with the white man pulling the trigger. I believe Zimmerman was a little guy with a wicked hero complex that indeed made a series of poor decisions that lead to the death of TM. I also believe that TM was in no way the sweet little boy the media and race baiters would have you believe and given TMs past texts messages and twitter posts likely started the physical confrontation. With regard to the court case no one being intellectually honest can state Zimmerman should have been found guilty. Further no one being intellectually honest can state racism played any role in this verdict. This is not to minimize the role racism still plays in this and I imagine every culture but for those like Rev All who are hooking their race baiting wagons to the Zimmerman trial are doing the civil rights struggle a great disservice. Why are Jesse Jackson and Rev All not marching in Chicago or the like where 91% of black males were murdered by other black males?

I'm amazed people are surprised by this verdict. I will state unequivocally that it is Possible that Zimmerman is/was guilty of being a hateful racist vigilante intent on killing a black male in his neighborhood. That said, what data would you have used to convict Zimmerman? Zimmerman was a racist... Infact he tutored underprivileged African Americans and the local LE as well as the FBI over a 16 month investigation could find anything in his past to even suggest he had racist tendencies. Jel went to his highschool prom with an African American girl and took up for an African American man in a case where the black man accused the Sanford PD of abuse The medical examiner stated the only way the fatal shot could have occurred was if TM was on top of Zimmerman and within 20 inches of the weapon. The 9mm used had a full magazine minus one bullet and the chamber was empty. The only way this could occur was for something being on the slide not allowing for the natural recoil to automatically replace the discharged bullet. This fact again lends credibility to Zimmerman's version of TM reaching for his gun. Zimmerman had a broken nose and lacerations on the back of his head which lends validity to his versions of the event. The multiple 911 calls which recorded the multiple screams for help immediately before the discharge of the weapon also validate Zimmerman's version as well as the medical examiners version as it seems unlikely that someone who was in the mounted position throwing punches would be screaming for help. Two eyewitnesses that confirm someone fitting TMs description and clothing was mounted onto of another person throwing punches. Eye witness testimony also validates Zimmerman's version in stating they saw someone fitting TMs description punching Zimmerman in the face prior to mounting him Zimmerman was within his right to follow the person in question and further phoned 911 which in my opinion doesn't coincide well with a radical racist vigilante looking to shoot a black person. Stand your ground has nothing to do with this case. This was 100% a self defense case and while TM also had a right to defend himself but only up to a point... That is to say if Zimmerman did initiate the physical aspect of the case once TM gained the advantage to a point where Zimmerman felt there was a danger of great bodily harm or death he then had the right to use deadly force. In an EMS forum I think we all would agree bashing a persons head against pavement could lead to death TM was propped up to be an innocent child even using pictures of him as a 12-13 year old instead of the 6'2 185 lb man. Recently released Twitter posts show a young man who was far from the innocent child the media would have you believe and confirms that this young man had been suspended from school for things ranging from drugs to possessing stolen items and what the school LE officer stated was "burglary tools" Texts messages show TM had discussed street fighting and obtaining a gun...again radically opposed to the image most media and the likes of Rev. Al would have you believe Again, I don't know what took place but for everyone stating that they are surprised by the verdict or position themselves as if they know what took place despite the overwhelming data to the contrary are using nothing more than the visceral response to the death of a young man and not facts .

I save it to the fire departments secure drive that has an individual file for each department member. There is no patient confidentiality issues as there is no patient information in said report. Address, names, companies responding, vitals etc are removed so it just acts as a template. It's good scene description as well as potential information for self neglect cases if the situation calls for intervention at a later date... Just gives you a record documented that states the scene is not suitable for kids, dependent adults etc if there is cause for such info at a later date. It also gives you a trail if a patient say progresses into a stage where they are no longer capable of caring for themselves or dependent loved one.

How many physicians or nurses do you see with "Doctor tat's or Nursing tat's"? Perhaps if more EMS personnel would treat the profession in a serious manner other practitioners would treat EMS personnel in a professional manner. I can't stand seeing medics etc with sleeve tat's and piercings that appear as if said person fell in a tackle box. Does the previously described appearance give anyone not to mention a 70 year old lady a sense of professionalism, competence or scholarly knowledge leading the patient to rest assured the provider is properly trained to deliver care?

I worked at a facility with the only mental health facility in a large radius. This facility for the most part was outstanding but in one instance I felt they failed a patient. 19 year old girl who was a stellar athlete and student with a paid 4 year tuition. This young lady was having a legitimate and what had to be a terrifying mental break minus any hallucinogenics or other mind altering substances. I arrived at the facility to find said girl in the corner cyring and shaking uncontrollably with a nurse stating "this is your patient, take them to X hospital" I inquired about sedation, impressing upon said nurse that the sedation wasn't for ease of transport but for patient comfort as she was having visual and audible hallucinations and I was about to put her in the back of a strange vehicle and transport her 1.5 hours. Given I was a strange man which is often very disconcerting to females especially young females having an acute break it may be more human and appropriate to make the patient comfortable prior to transport to lower the potentially traumatic impact which could further devolve the patient. I was told that she did not require any type of sedation i.e. valium, halodol etc and I should just do my job. With the assistance of family I loaded the patient into the ambulance and went the 200 yards to the ER where I explained my concerns to the physician. I further explained in a very respectful manner that I would not transport a patient with a broken hip etc 1.5 hours without pain medication and respectfully requested something to make the trip less impactful on the patient. The physician did not need my input as I'm sure had it been his patient initially he would have appropriately medicated the patient prior to transport. the physician thanked me on behalf of the patient for treating a mental illness as a legitimate medical issue in need of treatment and not as some attention seeking endeavor that some jaded practitioners see these types of situations. The trip was not uneventful but it was made much more comfortable for the patient with some medication that allowed for complete awareness without the full impact of terrifying hallucinations. From that point on I will call med control if I feel a patient is suffering unnecessarily due to lack of protocols. There are patients who require restraints but they are few and far between if you utilize proper de-escalation skills, anxiety reducing medication and compassion.

EDIT: apparently I can't spell

I would love to add a personal spin on this post given the subject matter and unwillingness to clutter up the board with my own topic... How do those who have been at this for years feel about my above narrative? Is it on point? Would you add anything to said narrative? Would you phrase or list anything in a different manner? Did I add anything unnecessarily that adds little to patient care and increase my susceptibility in court?

I'm a bit lost as to why anyone would suggest a medical run report would be to "wordy" unless said words were useless and not deliberately going towards thoroughly explaining patient condition, care or transport. My narratives are often looked upon as long winded with "useless pertinent negatives" but I find it odd that one would call them pertinent negatives if they weren't pertinent. All I can say is that I've never had an officer in the department suggest I make my reports shorter for the sake of allowing more time for breaks etc. Ambulance 4 and Company 1 dispatched to 12345 generic street america for a report of a 236 year old complaining of chest pain. Company 1 arrived on scene establishing 12345 generic street america command. Ambulance 1 arrived on scene to find 236 year old male patient found sitting upright in bed with feet placed on the floor approximately shoulder width apart. Residence appears to be well kept, free of debris and obstruction. Patient is awake, alert and oriented in no apparent distress at this time. Patient either is or is not using accessory muscles to breathe/tripod positions etc. Patient currently denies shortness of breath, difficulty breathing or other medical complaint at this time other than chest pain which he describes as "sharp, stabbing pain" which is non radiating, rates as a 7/10 and is increased upon palpation and inspiration. Patient has no known drug allergies, has a history of type 2 diabetes, COPD, blah blah blah. Patient transferred from sitting position to ambulance cot via (assistance, sheet lift, extremity carry etc due to syncopal episode, non ambulatory, pain upon movement, orthostatic hypertension, patient safety etc) and transported to ambulance secured to cot without incident. Ambulance 4, Company 1 clear of 1234 generic street america en-route to Holy Crap Hospital, there by discontinuing 1234 generic street america command. Initial assessment reveals: Airway - patent Breathing - (describe) Circulation - no visible bleeding BP Pulse Respirations Lung Sounds Skin Pupils Neuro's SAo2 End tidal CO2 Cap refill Rapid head to toe assessment (DCAP-BTLS etc) H E E N T Chest - Paradoxical movement, crepitus, lung sounds Upper extremities - grip strength, pulses Abdomen - bowel sounds, soft, non tender, rigid, pain upon palpations Pelvis - stable, denies pain etc Lower extremities - equal pedal pulses, dorsi flexion/extension Signs Symptoms Allergies Medications Past pertinent medical history Last oral intake Events leading up to chief complaint Interventions: Cardiac monitor - NSR or changes that may suggest 12 lead 12 lead - IV - reason for IV, Size Fluid etc O2 administration - reason for 02 Cpap - due to inability to increase 02 levels with nasal or nrb if indicated Board/block collar - if indicated Drugs - indication for drugs along with expiration date, allergies, contra indications, relative contraindications Vitals/pain assessment post interventions Pulses etc post interventions Ongoing assessment BP Pulse Respirations Skin Lung sounds Pupils Neuros SAo2 Patient continues to deny shortness of breath, difficulty breathing or other medical complaint other than chest pain which is rated as a 4/10, described as crushing, pain increased upon palpation and inspiration etc Further Head to toe if warranted or if not warranted if time allows Patient continually monitored throughout transport with (insert changes or lack of changes to condition). Patient continues to deny blah blah blah but still expresses (insert chief complaint) Insert monitoring of interventions (IV, Drugs, post vitals for said drugs, how they tolerate splinting, pulses/movement post splinting) Patient transported into blank ER via cot, connected to (02, monitor, pulse ox, IV etc and results of said devices) patient transferred to hospital bed #3 via sheet lift without incident and care transferred to Nurse Babcock RN at Holy Crap Hospital ER. EDIT: I also list all vital signs in my narrative which I know is redundant given the nature of Firehouse. I also list any and all exams, questions, comments etc in their correct chronological order in the flow of the narrative. I am not saying this is verbatim my narrative given I'm on little to no sleep but this is a general idea with the focus on telling a factual story in chronological order of how the entire run from dispatch to transfer of care happened. When (not if) you are in court an exact run down of the call will be invaluable when you are attempting to testify 2 years post incident. Also I think these types of run reports make you a better practitioner, especially if you like me are a new medic. EDIT: Last thing,,, Trick is to save a great run report to a word document with no times, addresses, patient info etc and label it as "Chest pain, Abdominal pain, Car crash, Motorcycle crash, Shooting, Stabbing etc" so in future calls which are similar in nature you can recall your report. I'm not suggesting using a template but at 4 in the morning it's great motivation and a helpful guide to write a great report on little to no sleep.

Been crazy busy hence the lack of updates. Going well, constant training and jumping a few calls as third wheel for the first 6 weeks then on the ambulance exclusively for the first couple years. Extremely excited and the Med Director allows you to operate within our scope.

I'm honestly terrified... I have ran trauma codes, trauma, codes, open fractures, etc but to be honest am worried about proving myself all over again. I don't abide by the theory of once you graduate (A.A.S. in paramedicine and BS) you stop learning. I have studied any and every piece of paper possible but have yet to see every call. I have also "proven" myself twice over since I graduated and while I have no issue with that process it's just terrifying to attempt to do so for a third time in a year and in a scenerio where you have landed your dream job. I have no idea what the intent of this message is or what I hope to gain from said message but for one reason or another it's therapeutic to type. I still agree with Dwayne in dropping the IO and pray that no one would call me a cook book medic but with my history in the hospital it's hard not to be well aware of what you don't know. I would suggest that what I don't know (which is immense) scares the hell out of me. That said I'm joining fire which I understand is viewed in a negative light. While I appreciate the viewed discrepancy Iive in an area where Fire is the only ALS crew available minus one private company but let's just say this was my only route to a legit 911 service. I have (as always) been reviewing my text and attempting to discover the light that flips the switch

Sorry, been working the last couple days... Took readings of multiple other people to find 0 % on non smokers and 4-6% on smokers. I also tried a different machine to get similar readings with the reading only changing a % or 2 on other machines. I did speak with a physician that stated the exhaust fan that leaks will cause the person to be subjected to relatively high CO levels but only when the exhaust fan is kicked on which could lead to a normal CO level when readings were taken if said exhaust fan wasn't on at the time.

Wow, thanks for the information... I was unaware of that

Patient is African American but did not include Sickle Cell in past medical history and by the time we arrived at the hospital patient was a decent historian with regard to her medical history.

Call the state in which he will be certified and tell them exactly what occurred. I live in Iowa so I would search for Iowa Department of Public Health/EMS and there will be contact information. There was a person on the local Volunteer department that went all the way through class only to be told he was unable to test due to not being honest on one of the four questions asked prior to starting the EMT-B class. Questions are akin to Have you been convicted of a felony, Lost your license, etc etc

Called to a seizure today (patient has hx of seizure) and nothing out of the ordinary with regard to the seizure. Patient was postictal upon our arrival, vitals normal minus an elevated pulse but when I put the Pulse Ox on the patient which is equipped to read CO levels as well it registered at 16%. Patient came around and was alert/oriented x 4 I called the FD to come down and test the levels at the scene which were normal. Continued to monitor the patient with our LP 15 in the hospital and it did decrease but remained above 10 throughout my shift. (I was only there about 20 minutes after dropping patient off) I apologize as I have no ABG's to report. Sinus Tach on the monitor, 12 lead showed no abnormalities minus sinus tach, Blood glucose 147, Patient was african american but mucous membranes were not red, patient denies head aches, incontinence or other S/S of CO poisoning. I placed the pulse ox on myself and it read 0% CO, I then placed it on a smoker at the hospital and it read 4% which indicates to me the machine was working appropriately. Any ideas what may have caused the elevated CO levels? Patient had been at the location where she had the seizure and the CO levels were reported to be normal for approximately 6 hours. Any ideas?

I have not had an opportunity to speak with any of the physicians as I was off today... hence the post here The previous protocol simply stated "Treat for pain, NPO, orthostatic challenge and consider bolus if indicated" Now it reads "Treat for pain, NPO, consider bolus" I suppose it could be nothing more than they no longer felt the need to specifically state "orthostatic challenge" but in my experience when it comes to the state protocols they have no issue with breaking it down to the point where the lowest common denominator could keep up. Thus I was curious if I was missing a glaring issue that would cause the removal of orthostatics from the protocol... harm to patient, inappropriately interpreting the results, relying too heavily on the orthostatic reading with regard to treatment or God forbid unable to properly perform the orthostatics Sorry for the confusion and I appreciate any insight or speculation It was an example of a skill being removed from the protocol and the reason for the skill being removed. Considering my question was "What is the rationale behind the removal of orthostatics" I was looking for "Orthostatics were removed from the protocol because it was causing spontaneous combustion in elderly adults" I really apologize and even after reading my posts again I'm not sure where I failed to get my point across... perhaps it's my lack of sleep and attempting to go from grave yards yesterday to 0600 to 1800 tomorrow

Perhaps it was worded poorly... They are removing RSI from the scope in some places due to the piss poor % of intubations and/or the inability of some to recognize appropriate indications or dosages. My question was more to the rationale behind removal than the necessity of having the procedure in the protocol. I don't need a cook book to treat nor do I regularly refer to said protocol other than when new versions comes out and feel it's appropriate review for changes. I'm now unsure if the original post was unclear or there are some that are just so anxious to bash a newbie over the head with "cook book medic" or "I can't believe you look at Protocols". Considering I do indeed work under a physicians license I suppose the least I can do is look at the changes made and attempt to understand the logic or data that caused said changes. Thank you in advance

My bad. Yes the new Iowa protocols released for 2012.

A topic I haven't seen brought up to this point is what about the obligation you have to your future patients... Is this person in the OP's scenerio a person you would want to care for your family/patient/friend if he is involved in not only a domestic dispute but assault on a police officer? What responsibility do you have if this person in question assaults a patient with a behavioral or mental health issue on the next call you arrive on when you knew he wasn't the quality of person that should be caring for patients?

Orthostatics have been removed from the abdominal pain protocols and I'm curious as to the reason. I am in no way dependent on the results of said test but I'm curious as to the thought process behind the removal. I've done a couple google searches as well as a search on this site and don't see any research behind the removal or research that would suggest that orthostatics are some how harmful/irrelevant etc. I'm sitting here talking to my girlfriend who is an ICU nurse and short of a serious AAA (which I would assume you would identify) I'm a bit lost as to why they would remove the orthostatics. Thank you in advance

Well, actually it's more like 7-8 years considering we have all known the change was coming for a year or two. The most terrifying aspect is most of those who opted for the Iowa Paramedic when it was offered only did so after failing the national registry the 3-6-9-18 times allotted prior to having to take the class over. I currently work with someone who is content with just riding out the 6 years instead of moving forward with a little more education needed to get to meet the national standard. In addition how the hell do we complain about not getting respect when we as a community allow for people to practice when they have failed and continue to fail to meet the national standard. It becomes increasingly difficult to lobby for a profession when those practicing said profession don't have enough respect for it to meet the minimal standard set by our accrediting body. I hope that doesn't sound to harsh as I know many in the community are not happy simply meeting the national standard and do go to a Associates program, get a Bachelors in a semi related field etc but until that is the norm and not the exception we don't have a very tall soap box to stand on... end of rant

Paramedic Specialist is simply a Paramedic in Iowa who has met the NREMT-P requirements. If you are an NREMT-P you will have no issue transitioning to Iowa as there is no "State" test to get your Iowa Paramedic. Once your class is completed you take the NREMT-P test and once you get your NREMT-P cert you get your Iowa cert as well. On a side note I think it's crap that "Iowa Paramedics" or those who only meet the 1999 curriculum have until 2018 to transition to the NREMT-P standard thus allowing more than a couple to never transition and simply retire in 2018.