BillKaneEMT

Just finished a 24 and we actually had a L&S transport. spO2-72%, sinus tach, hr-132, resp-41. That was after albuterol and on 10lpm non rebreather at the nursing home. My (medic) partner concluded it was "get him to the ER right the f*#$ now" time. I've never actually seen anyone with that low an spO2 on a non rebreather with high flow. Hell, I've never seen anyone that low on room air. They just started giving me ALS shifts recently though, bls wouldn't get that call. Fortunately the hospital was about 5 miles away so we got the pt there fast and they immediately hooked him to a BiPAP which seemed to help. Last night was strange all around. Most off yesterday we had a few calls, just transport stuff. Then last night we got slammed with like 6 calls in a row starting at 23:30 or so. Very strange. But again, 5 of those "emergency" calls were completed without a flash of light or a hint of siren. Like I said, if you use them you better be able to supply a good reason for doing so in your report. At least for my service.

I hear ya Kiwi. 1 to 2 minutes max sounds about right. Given the general disregard for lights and sirens by other drivers and pedestrians you'd have to be a maniac to speed through reds with em on, in NW Indiana at least. Hell, during the NATO protest I was trying to get a patient to Rush Hospital in Chicago with lights and sirens and I had a group of protesters link arms and block the street in front of me chanting some random shit. That was kinda scary cuz said patient was not in good shape and I wanted her in the ER under a physician right the hell away. Amusingly as I was calling for CPD assistance about 30 people in full clown outfits showed up and yelled at the lunatics and made em clear the way. That's right. My patient that day was saved by a clown squad. I felt like someone slipped some magic mushrooms into my omelet that morning. Craziest workday ever. Anyway, the moral is, don't overuse your lights/sirens. In my opinion, unless you believe your patient is unstable enough that they NEED a doctor immediately, L&S is probably unwise. Of course, if you get a call for a patient found in a pool or in full arrest or whatnot you'd obviously want to get there fast. But if you wreck then who are you helping? You're screwing your patient because now YOU need an ambulance, and so does the person you plowed into, and your original patients response time just doubled. I'm not saying to abstain from them entirely, just that they seem to be used rather more often than is necessary. Just my 2 cents. The secondary moral is: Stay out of Chicago during massive protests cuz protesters are crazy. Except protesters in full on clown outfits. Which is odd.

I'm pretty cautious going lights and sirens for several reasons. One is my location, Indiana doesn't have a law that people must yield to ambulances/fire trucks, it's considered the right thing to do but there's no actual law. Unfortunately, people in my area are aware of that so I am often cut off or worse going L&S. Worse would be when people ahead are pulling off so I can get by and some jackass cuts in front of me to bypass all the non scumbags. That's happened twice this week. Even if they did make it law here people would probably ignore it as they do most laws so I doubt I'd change my driving tactics. Just speaking for myself I drive as if everyone else is a reckless, drunken piece of excrement with no regard for human life. Drive defensively x 10. That technique has given me 17 years of accident free/ticketless driving. I am well aware that some accidents are simply unavoidable. I've had a number of close calls, typically due to people who seem drunk and/or extremely inexperienced on the road. That being the case I'm not going to weigh in on this particular accident unless they post the investigation findings somewhere. Let's be honest here, is an extra 10 mph going to make a life or death difference in your patients outcome? According to our classbooks (which we've already established are not always correct ;-D) the answer is no. If someone has a differing belief based on some study I haven't seen I'd be more than happy to hear about it. Again, this is based on my area where a patient is seldom more that 10 minutes from a hospital. We have so many hospitals around here. Figure a max of 10 miles to a hospital. Slowing down a bit for intersections takes maybe 5mph off my average speed? Short distance runs (which all the 911 calls I've done have been), don't seem like they would be too terribly lengthened by some basic intersection precautions. I know everyone works in different environments, what do you guys think? edit: I should point out that different services have hugely varying policies regarding L&S. I did a few ridealongs with a certain fire department medic crew which shall remain nameless and I witnessed lights and sirens to the grocery store and to the bank. My service, you better either be responding to a real emergency or taking a critical patient to the hospital if you pop lights and sirens. The only exception is on a BLS rig when you have a patient who is not critical but is in extreme pain. A bite stick is not effective pain management, nor is baby aspirin, so they're ok with you going all out in that situation. It's at the driver's discretion but the driver better be able to justify his decision unless he wants to look for work. That's us though, like I said not everyone around here does things that way.

My dad was on a business trip to Montana last year and took a pic of a McDonalds sign that said "Now Hiring All Shifts. $15/HR, No Drug Test". Really? Talk about hard up for help....

Heh. When I started reading your post I was thinking "Man, Kiwi is realllllly angry today!" I enjoyed your amendments sir. of course, here in Indiana you can make that 15 an hour for an NREMT-P! (No more state certs for medics, those old patches are collectors items now!) You're making me so happy about the 12 grand and 2 years I'm investing come this fall Mr. Kiwi!! ;-D I kid, I kid. Seriously though, I'm moving to Lexington KY. (Not really). Frankly, if the original poster wants to ace this paper he should turn in the amended version. His teacher would probably give him an A minus just for the originality.

I just copy pasted this and emailed it to my boss. She knows our med director so I'll leave it to her to pass it up the chain (from my comfy perch at the bottom):-D Way to go!

Try to anyway. Leave the big bangs to the pros. Time to start my shift so let me leave you all with this. Much <3 to The City, have fun and be safe.

"I'm no hero. Hiro, the hero from Heroes. Now that's a hero."

Shoot the hostage. Wait, what was the question? ;-D

You're not driving hard enough Kiwi!!

They're from Massachusetts. A place I dislike even more than Jersey, though my experiences were limited to Cambridge and Boston which was enough to turn me off there completely. The only thing I enjoy about that place are the Spencer novels ;-D. Regarding their site, I was told it was "totally hilarious" and that I should check it out. I left in 3 or 4 days. I do occasionally get reposts from their page of amusing pics or jokes but some of the stuff they post is just sad. Such is life on the great wide world of the interwebs.

I spent 4 years driving over the road tractor trailer rigs in the lower 48, Canada and Mexico. Seen some really bad ones and some that turned out fairly hilarious. I drove through Dallas/Ft. Worth during an ice storm once and it was like a demolition derby. LEOs and EMS stopped responding unless it was a serious injury case simply because there were too many to deal with. I also saw a young kid in a brand new sports car hit a rig while driving at least a hundred miles an hour in Kentucky. Big rig trailers have a DOT bumper to prevent cars from being driven under the trailers and getting caught in a rear end collision but this was a really low slung car. The car hit the bottom of the bumper an inch or so above the hood and sheared it in half like a sardine can. I expect people in cars to make bad decisions while driving but I have absolutely no tolerance for a professional who does so. If you're driving an 80,000 pound vehicle at highway speeds for a living it's your responsibility to compensate for silly kids (and adults) who don't have the experience or training to realize exactly how dangerous tons of metal moving at high speeds can be. Let me provide an example. Every time you go down a mountain you have to be careful about your brakes. Not just the possibility of burning them out though. State troopers will often take radar toward the end of long downgrades, it's a good place to get tickets. People will speed down mountains racing to pass the trucks in the right lane who are endeavouring to keep their brakes cool and inevitably the car's radar detectors will go off, usually after the trooper has their speed in any case. The car will automatically swerve into the right lane and slam on their brakes. It sucks but it's one of the things you must plan for so you can compensate if you're a professional. There are a lot of CDL-A drivers on the road right now who damn well ought to be off it. Drives me nuts. As for the morons who get jacked up on meth so they can drive for 72 hours at a stretch.... ugh. It gives the profession a bad name and even though I'm no longer a truck driver it makes me see red. edit: caps:/

Hello and welcome! Regarding number one; it's not just a South Carolina thing. Each program requires a deifferent amount of class time/ridealong time/clinical time. The class I took in Indiana last year was minimum 182 class hours, 10 hospital, 10 in an FD medic rig. Most of us ended up doing at least 30 in the ER and on the rig though. In total the class came to just under 6 months I will say that your class is pricier than mine was but that can vary a lot so I dunno if that's really irregular. From what I've heard, some companies around here run their own schools which are cheaper, significantly shorter and don't offer anywhere near the scenario and skills time of a longer class. Apparently the largest company in our area runs a school that teaches their basics to start IVs and push narcan into head injury patients. That was mean, sorry. Anyway, the classes run by responsible organizations tend to be in the 140-200 hour range. You can be taught to pass the basic test in probably half that if they use rote memorization but you won't really have time for class discussions or many scenarios. Given your classes length I would assume an hour or two of scenarios every night. Fun fun fun!! Good luck and take care:) Regarding 2 and 3 I cede the floor to folks who can answer them better than I as I won't be starting medic class til this fall.

http://www.13wmaz.com/rss/article/186609/153/Three-Macon-Bibb-Firefighters-Injured-in-I-16E-Accidents?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+wmaz%2Flocal+%2813WMAZ.com+Local+News%29 I'd advise people to always remain alert when responding to accident scenes but I'm sure these guys were paying attention. I doubt you'd get much warning at highway speeds. Stay safe folks.

3 months til release. Wow. I wonder what specific protocol the nurse was referencing when a patient with an AMS and multiple siezures within 24 hrs was denied care? They either need a new nurse, or, if the nurse was telling the truth about this nebulous "protocol" that shall not be named, they need a new medical director. I think our protocols could use some amendments but.... just wow.

Yah, again most of the comments following the article are either stupidly supportive or extremely ragefilled, only to be expected under the circumstances. I rarely see people take a moderate tone on anything internet related these days regardless of the topic. I can't figure it out either, the basic had to know he'd get busted and the medic is in hot water too from the company, though apparently not from the med director. No one is saying anything official so the speculation just keeps getting wilder. ERDoc, I thought some of what those two said sounded off, glad it wasn't just my imagination. I'd say the majority of posters are now to the point of just talking crap to each other regardless of the original argument. Djdudley, as to whether he authorized the procedure I'm not sure but he's in the soup regardless it seems.I also have some difficulty with the idea that the basic was just randomly starting IVs and pushing drugs without the medic realizing it. We'll have to wait and see if they ever release some facts.

Topnotch Diner on US41 is still open 24 hours a day, 7 days a week. We'll occasionally roll in there around 0100 and drink their lovely coffee til we get a call. Saturday night to Sunday morning we sat in there for 3 and a half hours. Plus they do great soup. Their beef barley will put hair on your hair. Also they have spumoni ice cream. In fact, I believe they're the only restaurant on the planet that still has spumoni ice cream. Damnit, now I'm hungry! Oh well, It's close enough to run to without burning a bunch of gas. You show up Kiwi and I'll buy you some ice cream

EC is east of Chicago but west of Gary. South Bend is 90 miles east:P Apparently they also took over Griffith, Munster, Merrillville and a couple other towns too. Honestly I can't imagine what he was thinking. He had a medic right there, what could have come over the guy to break protocol the way he did in front of the people he was with I have no idea. Bear in mind, this basic was an operations manager for Prompt. Also bear in mind that Prompt and ECFD have to work together and they're openly hostile to each other. I mean, they will cuss each other out during a friggin house fire. This guy was not just breaking protocols, he was breaking them in front of his enemies. I dunno, the whole area is a flustercluck if ya know what I mean. I never actually met this Merry guy though I've heard of him. Can't imagine what he was thinking. edit: We'll have to wait and see what happens but scuttlebut is that his cert is getting pulled permanently. Like I said, no idea what he was thinking. Then again, the rumor mill isn't exactly the Associated Press so I guess we'll have to wait and see.

http://www.ems1.com/ems-news/1304647-emt-suspended-for-protocol-deviation/ *It would be best to check out the article and responses first. Otherwise my post will make no sense. In fact, my post may not make much sense after either. Oh well, I feel better having vented a bit so if it seems like gibberish we'll pretend I got hacked by Kiwi and he typed it. First a disclaimer. I am in NO WAY stating, implying or suggesting anything in defense of this emt. I wasn't present and I work for a different company, a competing company in fact. He broke protocols (allegedly) and got busted. I only wished to state something in regards to the comments following this article. One of the first in a line of angry retorts states that the poster is an East Chicago FD medic (who lost his job to Prompt) with 20 years experience who was making 32k a year when they lost the contract to Prompt. Now, again I'm absolutely not defending the Prompt guy but that poster was full of shit. I did my ridealongs in East Chicago and the BASICS that I shadowed were quite open about FF pay. Try 50k a year with minimal OT. Pushing 65 if you wanna work 65-75 hours a week. Unless their medics were making half what they paid the basics the FF medic in the comments was lying. Period. That said, I understand the irritation. EC lost their rigs and had to let a number of FF's go. And I feel for em, I do. I don't really think this was a case of payback, if it was...well. That's a shame. If you violate protocols in front of witnessess, even if you've been working als for years, even if you can start an IV in your sleep, even if you're one day from finishing your final practical station (probably an oral) for your nremt-p; you run the risk of suspension or losing your license. Like another poster said, if the patient had an adverse reaction this emt would probably be arrested and charged. Anyway, I went to class with alot of Prompt guys and we interact just about every day and things are getting...tense around here between the privates and the fire services. Fire guys are worried their towns will do what Dyer and East Chicago did and give the ems contracts to a private service. Privates are tired of listening to constant insults and ocassional threats/physical harassment. Hell, my emt class was held at a fire station. A third of our class were firefighters. I dunno, the whole situation is depressing. I don't know anyone personally involved in this story (by which I mean physically present when it happened) but even though my service is too small to take over a town's 911 service in addition to our current contracts we're still getting, at best, glares and dirty looks when we run into fire folks. Except the ones we know personally of course. Fortunately my classmates and friends in the FD's haven't turned on me. So, wasn't from the JEMS like the rest of the stuff in this category but I figured it should go here. Then again I've done a fair amount of editorializing here. Hmm. Well, I'll add a disclaimer to read the story and responses first before I post this. Frankly, hardcore unions tend to creep me out and the vocal union guys around here are getting a little mean and a lot loud. Ah well, I'm sure it'll work itself out. In the meantime I'll just keep on truckin til medic school starts. Have a good one!

Do you guys keep penicillin and prednisone on the rigs? I know Penicillin isn't covered under our local protocols for prehospital use. I read that it's used by some medics in the UK prehospital for meningococcal septicaemia but they're not allowed to give it for meningococcal meningitis. Or weren't at the time the thing I read online was published. I'm almost 800 miles away from NYC and have no clue what they carry. I've seen the tattoos (which, since they can't get lost or stolen are probably a decent idea from my perspective) but I hadn't even heard of the shoe tags. Another thing to watch out for. Thanks for the heads up Mobey.

1: If I find an non-responsive patient I look for med tags on the neck and wrist immediately after checking the airway in my initial assessment. It's not quite how we were taught but it takes like 6 seconds. Everyone does their head to toes differently but I imagine checking for med alert tags/bracelets is done fairly early. I've never seen one like the pics you posted but now I'll know to keep my eyes peeled for them so thanks for the post:-D 2: I have no info for ya. 3: Not sure about the abbreviation. You'll definitely want it somewhere though, even if you have to spell it out. I asked my medic partner just now and he wasn't aware of one but we don't carry it on the rig. I found an article here http://www.jephc.com/full_article.cfm?content_id=498 about the use of Prednisolone in a pre hospital setting but although both are corticosteroids I'm not sure whether it will cause the same reaction in you as Prednisone. They might be the same drug but google is being irritating so I think you'll be better waiting for Kiwi or ERdoc or someone to take this one. Good luck!

I liked the tiger story:) and it is funny how you remembered the elephant one after 15 years. You New Yorkers get some wacky calls! The bear story was slightly annoying, not because it happened (I fully comprehend the lack of good decision making skills displayed by people of all ages) but because the Times author of the piece says some really stupid things. ''People see bears as funny eating, tender loving creatures,'' Really? People do? First of all, those kids apparently did it on a dare. It was a bad decision,, as kids (and adults) sometimes make but I doubt they considered the bears as funny eating tender loving creatures or they wouldn't have bothered with the dare. It's a damn shame and I don't want to make light of it but does the New York Times paper have any editors? FFS, no sane person above the age of 5 should EVER think of bears as "funny eating, tender loving creatures,''. Ever. Period. I guess they should publicize the photos of what's left of bear attack victims. Like 3 inches of ankle and a foot still inside the boot. And a lot of blood on the snow. Sorry but that's a ridiculous statement. Anyone who sees bears as anything other than large, omnivorous(carnivorous in the case of polar bears), wild, potentially deadly animals is insane. I get that kids can make that sort of mistake (curse you Disney!) but saying "People" think that is either shoddy journalism or pure insanity. Let's try an experiment. A 1500 pound adult male polar bear with a mouthful of razor edged teeth, sharp claw tipped paws the size of dinner plates and a pissed off expression is right in front of you. 2 of the 5 words in the phrase "funny eating, tender loving creatures,' should apply here, you pick em. I don't want to pull a Dwight from The Office here but bears are not cute furry little critters. I have some pics my buddy Steve sent me from his home in Alaska a couple years back following the discovery of a bear attack victim that would turn almost any stomach. two thirds of a torso, a foot(in a boot), and part of an arm. They were, unsurprisingly, not in good shape. Never trust a bear. I may get that tattooed somewhere. Damn bears. Anyway, I'll end the ranting. These calls were pretty cool:) I have yet to run into anything so interesting but I'm sure I'll come across something to add to this list in years to come. Excellent topic:) Also: That's right, a bear attacked Chuck Norris! The audacity! At least it redeemed itself I suppose.

A medic student did these, presumably just for fun. Amusing:)

Hey Cap, I don't have any firsthand experience with insulin overdose but from what I read here http://www.diabeticconnect.com/discussions/11449-insulin-overdose-suicide it seems to be a fairly unpleasant way to go and surprisingly unreliable to boot. As for me, I have no idea what I would choose in that sort of situation but it will certainly be something as painless and reliable as I can manage. Admittedly, the people referred to in that link may not have used the amount you mentioned but even so.