JakeEMTP

Hey DC Aguilera, quit your bitchin'! The numbers don't lie, 53% ROSC is great. AHA says "early CPR and Early Defib" which you could use your AED for, is the key to ROSC. Leave the other interventions to the folks that know what they're doing. Kudos to Dr.Tober! Congratulations on the award and for sticking to your guns. All that BS last year from the FD means nothing now. That is all.

That what it is! He's got those wacker Black Nitrile tactical gloves on! Funny as hell!

Here we go again. If there is a need proven for additional services, doesn't it make sense for Lee County EMS to add additional units instead of the FD requesting 1.3 million for start up costs? I had to laugh at the idea of recouping cost from the transport of patients. And what exactly is a duel response vehicle? If it is needed for a fire, than they're right back where they started right?

Even more reason to have ALS on every ambulance. This is exactly what we're talking about. You shouldn't have to "work with what you have". Time to come into the '80's and have paramedics on all ambulances. It may hurt some people's feelings, but whatever. It is supposed to be about the patient. If a provider doesn't want to step up a few levels then step aside.

I have a feeling your sarcastic side is slipping through and I actually chuckled, being a huge fan of sarcasm. But yeah, right next to the "twit-ter" insignia are (gasp!) the rules!

Great idea. Might be something to put in the site rules, if anybody reads them when they join!

Ha! I always look to your expertise for assistance with respiratory questions. I just knew you could help our friend here!

Hey Matt, welcome to the City! Usually, if your pt. is having difficulty breathing enough to call 911 and has a hx of Asthma, I'll bypass the Albuterol and go directly to a duoneb of Albuterol and Ipatropium along with 125mg Solumedrol IV, depending of course on my assessment of the pt. But, Asthmatics know they have Asthma and are very aware of an onset of an attack. In most cases they have already used their meter dose inhaler w/o relief, that's why they called us. It doesn't make sense to give them more of something that isn't working. With CHF pt.'s, I will avoid Albuterol like the plaque. You're correct in your assumption that they will get worse. The patient is basically drowning. What we need to do is get rid of the fluid somehow, not add to it. Pt.'s with CHF having a true respiratory distress crisis will need CPAP, and nitro for the hypertension, not a nebulized Albuterol treatment. Sorry for the short response Matt, I have a meeting to go to. Again, welcome to EMT City! Take it away Ventmedic!

Well done! Keep up the good work. Don't be surprised though when you do well on a test. If you know the material, you should expect to do well!

To be honest, me either.

+1 Lone star. I agree with you. I had the opportunity to assist with a ITLS class. The thing that sucks about these classes is the recert thing. Folks just want to show up, do the scenario, take the test and go home. We had more people on the Sunday than the Saturday. They didn't want the education, they NEEDED the card! Oh, and the best part. The question was asked, " Are we going to go over the test?" To which we answered, "No, if you were here yesterday, you would know the answers. Since you weren't, we just assume you know everything already". Some of them are now searching for another class and I don't think my review as an instructor will be to favorable. However, if this the type of student I will have in my class, I really don't want to teach it anyway.

I really don't know what to think. Don't we have a member here that works for this umm, service? Maybe he can shed some light. I think these clowns were in the news for something similar a little while back, and the STATter911 link confirms this. Please, please assess your patients. This would include placing them on the monitor. It is very difficult if not impossible to palpate a pulse with a systolic of less than 70. I don't know all the circumstances regarding this incident, but at first glance it appears as if "no carotid, he must be dead" was the extent of assessment.

LOL! For some reason, this always makes me chuckle! So I guess we are for the most part, all on the same page. Medical Direction is necessary to put in place the standing orders and for consult if WE deem it necessary. The fact that some systems still operate like Johnny and Roy is for lack of a better term right now, pathetic. As what seems to be the answer in almost every thread, education is the key to progressing US EMS and it's providers to more independent medicine. As long as there are 6 month wonders and 3 week basics allowed on Ambulances, we can never move forward.

Phil, WM and Kiwi, The way you guys function is exactly the way we do it. We have a set of SOP's and protocols in which to operate. They are flexible and I can follow the whole algorithm or none of it or enough of it to manage the patient. On the few times that I would need to call Medical Direction is if there was something not in the protocol I wanted to do or try. I like the idea of having a Physician I can call to consult. They're the one's with the 10 years of medical education. Because I function under a MD's license, if we want to operate outside our scope for whatever reason, they must be contacted. Other than that, I have the flexibility to treat the pt. as I see fit, according to standing orders and my assessment of the patient. I hope that makes some sort of sense to you. My intention was not to get into a pissing contest. I was asking out of curiosity as to how it worked down under and over there. I hope I didn't offend as that was not my objective, I've been a fan for years! I submit to the fact the US EMS system is in dire need of a complete overhaul. I can only hope that someday the education requirements will advance to that of the rest of the modern world. And yes Kiwi, you did mention LAFD and it's ilk!

Congratulations! All your hard work has paid off! Time for a little celebrating.

Princess, I would never try and speak for someone else, but I believe croaker is speaking of a technique called the "tomahawk" method around here. Basically, it can be used when you are either behind the pt. ie: they are up against the windshield, and the traditional method of intubation is impossible or you can't get to the airway do to the position of the pt.. I could also be totally off base here though . If you ever have the opportunity to attend "The Difficult Airway Course" I highly recommend it. You will learn some techniques which will improve your intubation success rate. No, I have never digitally intubated a pt. in my short career. I don't think I would unless it was a similar situation as Dwayne described. However, one never knows which sort of situation they will be placed in from day to day, so I can't say I never would.

I have to ask WM, Kiwi and Aussiephil, do you guys not have any standing orders or can you just practice willy nilly? There are very few interventions I need to call for. I, like you, am capable of assessing my patient's and treating them accordingly. I agree most of the time with what you all have to say. Sometimes though, this "holier than thou" attitude is a little condescending. Not all of the medic's in the US attend medic mills, and function in a "mother may I" system.

If you began from scratch you'd be correct. Since I already have a AAS, I can take 9 hours per semester and complete it in 3 years. One can receive credit of 60 - 70 hrs for having an associates degree.

http://www.wcu.edu/4637.asp This is the programme I an currently enrolled in!

I am still somewhat dumbfounded. One can only assume that State Rep. St. Germain is firmly in the pocket of the FD. There is no reasonable explanation for the bill. I think she needs an psychiatric evaluation. Of course, Felton is a puppet for the membership. He has no choice than to try and spin this so that it somehow sounds feasible. The fact that this drivel is even being considered introduced to the folks in B.R. leads me to believe that Rep. St. Germain must also work in the Ministry of Silly Walks!

Ridiculous. Unless they plan on putting an MD or at minimum a PA on every engine, this makes absolutely no sense. Of course if they provide the same "medicine" as the Collier County FD, which is basically transport everybody high flow O2 NRB and little else (based on previous discussions) the pt.'s should be fine. But is that what the people want? It just seems that the FD doesn't want any oversight because they don't want to accountable for their actions. There is no possible way this could pass with any rational thought process. "Felton said the bill has the utmost_______ of every major Firemen’s Association in the state." I can only assume the missing word is "support". Not surprised at all though. And yeah, I can't believe this article made it past a editor. Pitiful.

Let me tell you how much I was anticipating the return of "Trauma". I forgot it was on and am glad I missed it from your reports! Let this show die in peace. Another save(d) isn't required, no ROSC.

Still thinking about it Ruff!

Glad we could help. I did notice the FB post. Different crowd over there. Pretty serious bunch here. I imagine none of them have ever worked a 48/96 schedule. I like to post on those just to piss off the tossers/wackers!

Hey, welcome to the City! Spenac is our resident expert on long shifts. However, I can offer my experiences from the limited number of 48's I have worked. There is a great difference between 24's and 48's, I would think it to be especially difficult in the extreme rural environment. The time just seems to drag on, at least it did for me. What they do offer is plenty of time to study, do some online classes, read that book you always want to read. It's really hard to explain. Bring plenty of food, water, extra uniforms, your own towel ( I just despise when some get's a towel out of the ambulance to take a shower. Seriously?), books, magazines, games, extra boots ( you never know when you will need them and it's better to bring them and not need them, than to need them and not have them), I think you get the idea. If you are running numerous calls, nap when you can. If it's kinda slow the time will drag. Just remember to use your downtime wisely. Congrats on the new job!