JakeEMTP

When I precept students, regardless of their certification, I always try and make them feel welcome. I feel it is MY responsibility to learn your name, find out how much you know, which stage you are at in your education, etc. It serves no purpose for me to try and explain something that you have yet to cover in your classes. Sure we might touch on some subjects, but without the theory of why we might do something for a patient might confuse the student. In a way I feel privileged that I was chosen for the student to ride with. We have to take a "preceptor class" to be able to well, precept. We do this on our own. Nobody pays me to take it but i feel obligated to try and help the student become the best provider they can. Sorry that you are having such a rough time. Some ppl are just assholes and shouldn't be allowed to have students. Mobey's advice is dead on as usual. It is your education. If you aren't getting what you paid for, feel free to complain! Good luck to you!

Along this line of thinking anf treating pt.'s, when I'm presented with a pt. like the one in Dennys scenario, I will administer just enough naloxone to allow the pt. to maintain his/her own airway. I have never adminstered enough to bring them totally around. It is easier to transport them when they are still somewhat unconscious and the decision to transport or not is a non-issue. Once during clinicals, the crew I was riding with was Medic/Intermediate. The EMT-I by what I want to believe was a mistake, slammed 2mg of narcan and the pt. became responsive enough to whoop his ass! I always thought it was an old wives tale when I heard the stories about the results of adminstering narcan to quickly. Right up until the time I witnessed it.

Congrats Toni! I've been thinking about doing the same thing. Currently, I'm working critical care but it's night shift. I'm getting to old for that though. Steady days would be the bomb as I would still be on the truck, but home @ night, and sleep in my own bed even!. I wish you only the best in your new position!

Kiwi, I can only speak for the services I have worked for, but I only have to call Medical Control if I want to do something NOT in the protocol. We have standing orders like everyone else, but if I want to try something "outside the box", that's when I ring the Doc.

There is very little "EMS research". Usually the ACLS inclusion/removal of medications and interventions are done at Hospitals ad nauseam before they are instituted. I would hazard a guess that none of the protocols we operate under were the result of actual EMS research. Some studies are done periodically and included in much broader studies. But for the most part, research is not a part of EMS and that is unfortunate.

No question they are good boots..Like anything else though, it would be better for your brother to try them on. Footwear in EMS is a very personal thing. If a provider boots are uncomfortable, it makes for a really crappy shift. Yeah, they mean that much! I like the 6" "Original SWAT" boot with the side zip, others may not. Good on you for wanting to do something for your brother. All good suggestions from the other members who joined this thread. I really like the gift certificate idea. However, if that's not exactly what you had in mind, you might just have to include your brother in the gift purchase. Suggest you go looking for boots, stethoscopes etc, and then just say "I got this bro. Proud of you and I want to do this". or something like that.

Taylor MI has seen the light. Should other Departments follow? 85% medical calls means no job for you. I mean, they were asked to take a "cut" to 60,000 + retaining all the benefits. Not a bad gig. Most medics I know would love to be making 60,000 a year, nevermind 90,000! http://www.jems.com/article/news/michigan-firefighters-face-layoff-privat

We alternate drivers. We ride double medic so whoever provided pt. care on the last call, drives the next call. Not to sure how many operators are on the bus, but last time I took the bus there was only one. We ride two crew members, but I have seen 3 on a ambulance also.

It is very rare that I will transport a pt. L/S to the hospital. I will however respond to the call L/S. No offence to the dispatchers out there, but you don't always have the information that is required. If it's a SOB call, it might require a more emergent response because we/you/us don't really know the extent of the pt.'s distress. STEMI's and CVA's (depending on onset of course) get a emergent trip to the hospital. Life threatening trauma will also get a expedited trip. I think though, being 25 - 30 minutes from the hospital, dictates whether a emergent or routine transport is warranted. We've also had severe asthma pt.'s like Dwaynes who we've managed with Neb's, solumedrol and Mag and on occasion CPAP. We have the tools to manage the majority of our pt.'s, Trauma Red pt.'s require a surgeon, not a paramedic. Sure we can control most bleeding, pain control and airway compromise, but the reality is, they need a higher level of care and we will expedite our on scene time and transport priority. I'd would also be in favour of removing L/S from ambulances. It would detract a great number of wackers from entering our profession. :edited fro spelling.

This is all we have for Head Trauma. I don't know if this is what you're looking for, but this is our protocol. http://www.ncems.org/pdf/Pro54-AdultHeadTrauma.pdf This is the Multiple Trauma protocol that is referenced. http://www.ncems.org/pdf/Pro57-MultipleTrauma.pdf

This was my first thought also. I was diagnosed with type II Diabetes in April '10. I had no idea until I went to my PCP for a annual physical which included labs. 2 Days later I received a call from my Physician informing me my A1C was 8.2 and that I was diabetic. I do remember her asking me during my exam if I was urinating more frequently.

Egads! I think some is having a wee bit o' fun at our expense! Like Vorenus mentioned, peruse the forums at your leisure. You will find all the answers you seek and then some.

Years ago? Here is a link to the 2009 protocol (our current one) regarding Hypertension. http://www.ncems.org...ypertension.pdf Locally, we have Labetolol as an option for the treatment of HTN. Clearly though, it is in the protocol. I'm not necessarily a fan of it's use for HTN, but it does work. Just be sure to monitor closely. If I had to use nitro for HTN, I would prefer a drip. That way you can stop it. SL Nitro? Not so much.

Tell them to grow the hell up, stop giggling and do a proper assessment. If they can't handle it in the classroom with a fully clothed pt, then how will they act in the field with a real patient? EMS is can be serious stuff. Trauma calls are where EMT-Bs can really help and assessments are where they can really show their education. There is no place for wannabe heros. I would like to think if one of my daughters required a trauma assessment, the responding EMS personnel could handle it without acting like a couple of grade 8 pubescents. It is imparative that they practice assessments on both male and female patients. Don't give up, heaven forbid it may be you that needs their assistance. You'd want them to conduct themselves professionally and do the job correctly. Practice, practice, practice. They will eventually get over it I hope. Maybe if you had the same partners for a little while and they became more comfortable with the "assessee" before moving on to different patients may help. If not, show them the door.

When I was working in EMS I used to pick up a patient frequently that had a hx of Hyperglycemia due to non-compliance with medications. The patient would present extremely agitated to say the least. Although talking to the patient was an option, it rarely worked. The patient had a prescription for Halaparodol however, the patient was rarely compliant with that either. The patient had poor venous access also, We would calm the patient down with 5mg of Haldol IM as well as 2mg of Versed IM. She would be much more compliant UOA at the hospital, her V/S were more in line with normal standards and the hospital was able to treat her accordingly w/o incident. For others, just talking to them does work. Part of patient care is the ability to listen and communicate with the patient as you are well aware I'm sure. Anxiety and patients with Panic attacks first need to control their breathing. Coaching them to breathe in through their nose and out through their mouth seems to work. Personally, I don't try to get to far into my patients problems. Some have real issues that are far beyond my scope and understanding. I will tell them that the hospital is far better equipped to help them with the resourses they require. I have the hardest time with sexual assault pateints, male of female. I mean, I can't tell them it'll be alright because I don't know. I can't say I know how they fell because I don't. I usually try and make some small talk, try and be as gentle as I can and always ask if it's ok to do certain interventions as simple as obtaining vital signs, but now I rambling. Versed is a good drug. But isn't there a (artificial) shortage of that too?

I agree with this statement, to a point. Is cross training really cost effective? Every fire scene I have ever been on there is at least 1 ambulance dedicated to providing rehab and emergency care if needed. This crucial service cannot be provided if the crew is fighting the fire. So, in essence, somebody has to staff the ambulance and is unavailable to put the wet stuff on the red stuff. The shift thingy is a sticky subject. If one is working in a busy urban system, 24 hours is ludicrous. There is absolutely zero chance of the provider providing the same quality of care at the end of the shift as they did at the beginning. Again, firefighting and EMS are two completely different professions and to try and melt them together is a recipe for disaster in a extremely busy system.

That's true. I don't have enough digits to count how many times the minimed alarms "Patient side occluded" or "Air in the system". The Syringe pump is a great tool and I actually like using it.

We use the Alaris 3 channel pump but it is becoming increasingly difficult to obtain parts for them as the military has them all! Granted, we use them in the Critical care arena and not EMS, but I have used a syringe pump as well as the Alaris when I've had 4 medication drips. Perhaps a syringe pump might be a better option for EMS. If I have anymore than 4 drips, I have to use the hospitals pump and bring it back after the transport. They're usually not to happy about it, but what can we do.

Agreed. We used to carry Dilaudid. There were people showing up at the ED with complaints of pain du jour. They insisted that they were allergic to Fentanyl, Morphine, Tylenol and the only thing that helped them was Dilaudid. Needless to say, we no longer carry it. It is a great drug though.

Bieber and Ignite44, FYI, Western Carolina University also offers a BS in Paramedicine. The programme is entirely online save for I believe 1 or 2 times (but don't quote me on that). I started the programme before switching tracks to Nursing, but I think Mateo is still enrolled in it. I know there are 2 different tracks to follow, mgmt and premed. Just thought I through that into the mix, food for thought so to speak. Good luck with whichever programme you decide on and kudos for furthering your education! http://www.wcu.edu/4637.asp

Just so I can wrap my head around this, would you support the use of humidified O2 instead of blowing the pt.'s face off with just high flow O2 in the pre-hospital setting? I have never come across a pt. that had pneumonia that I would have considered the use of CPAP. That being said, it is not out of the realm of possibilities. I have already learned a great deal in this discussion. Love it.

I wasn't sure how to respond to your topic, I just didn't know. I did admittedly very little research on this because to be honest, I'm tired. I did find this little blurb which was sort of interesting. Clearly, the jury is still out on the use of CPAP pre-hospital and pneumonia pt.'s. The studies I have found are mostly on ICU patients. As usual, pre-hospital studies are few and far between. I do find it interesting though that in this albeit small study group, ICU stays were shortened and ET tubes were not as necessary. Pneumonia The literature regarding the utility of NIV in pneumonia is mixed. One prospective, randomized study compared standard treatment plus NIV delivered through a facemask to standard treatment alone in 56 patients with severe community-acquired pneumonia.69 In those patients with pneumonia and COPD, NIV reduced the need for endotracheal intubation and shortened ICU stays. Other studies also suggest that NIV may improve outcomes in some patients with community-acquired pneumonia.8,28,70,71 NIV has also been well-described in the treatment of respiratory failure due to Pneumocystis carinii.72 However, some data indicate that patients with pneumonia are the ones most likely to fail NIV.73 In one small study that included 16 patients with pneumonia as a primary cause of respiratory distress, NIV failed to prevent the need for intubation.11 Clearly, further research regarding the utility of CPAP or BiPAP in pneumonia is necessary. Credit for this passage belongs to www.ebmedicine.net Very much looking forward to CHbare's input.

To be fair, the date in the corner was 2006. The new standards hadn't been applied yet. But yeah, the surfboard would have been a good idea before attempting CPR. Anyways, good job on the save. Early CPR, early defib. Who knew?

Here in the south, the expression "I don't mean to be ugly.......but" means someone is about to get ripped. Not a big fan of gossip or hearsay.

Mobey, I guessing we work with a different clientele. Most of the pt.'s I encounter "can't walk" and I won't carry a CP pt. out on the kitchen chair. We use the Ferno 35A stretchers. They're not that heavy to carry, not nearly as heavy as the new Strykers and Fernos and the electric stretchers are HEAVIER than them.. But yeah, I'm just not a fan. To each their own I guess. We (my partner and I) can load a manual stretcher quicker by just collapsing the wheels before the electric one can get the wheels up. How is hold that extra weight up good for your back? I like them for working critical care transports though. When we're going between facilities, they are perfect!