EMS49393

I love three things, Guinness, language, and irony. The name Gustav means "staff of the Gods." There is the language part. The idea of a category 5 hurricane being named for a "staff of the Gods" is as ironic as one meaning "the cleansing." I've researched the meaning, and I'll ponder the irony while drinking my Guinness. You all have fun camping in the puddles.

Looks like New Orleans is getting a little more cleansing headed its way. They'll end up shipping those refugees out to the same cities that got them the last time. I wonder when they'll increase my taxes to pay for all this free healthcare, money, and housing they'll be giving out for another two years. :roll: I need to go bow in silent prayer and thank God for giving me this weekend off. It's Guinness time.

If this is the same Pafford that is in Hope, AR, I doubt the pay is excellent. There is no such thing as excellent pay for paramedics in Arkansas. My husband, also a paramedic and a resident in Arkansas for many years of his life, believes Pafford is probably banking on some federal funds for gathering a disaster team. Never count money you don't have stuffed in a lead pipe hidden in a false panel in your home. As of 1500 hours this afternoon my pager for my very part-time EMS job began going off. I only get audible pages if it's a "blast" page, and frankly that's the only time I check it, and thats just to silence it. They are forming disaster relief preparedness here in central Arkansas as well. I won't be there, I have prior commitments in my climate controlled ER and my climate controlled college. I don't camp, period.

I would suggest enrolling in some real college courses. You might look at a obtaining a degree, which will make your job search so much more successful. If college isn't your thing, don't fret... There is always some bottom-feeder private ambulance company out there willing to hire anyone for roughly $0.12 more than you would earn slinging burgers at the Wendy's. Of course, a lot of them only pay for 12 - 16 hours of a 24 hour shift, which would put you at the minimal pay for "tipped" employees. Last time I checked, it's around $3.00/hr. Good luck! :thumbright:

Good luck with that whole scope thing. We have a Children's Hospital in my city with ground and air transport. They utilize paramedics, however they are VERY limited and function more as an assistant than a practitioner. The team is generally at the physician level. They never have less than a nurse and a registered respiratory therapist on board. As ventmedic said, peds and neonates are a tough patient group. The clinicians charged with their care are educated well beyond the standard paramedic, RN, RRT, and physician. These folks are die-hard about their kids. They are, without a doubt, the most dedicated providers and patient care advocates in my area. Hospice nurses rank second here, but they're a distant second.

My very first basic class was 110 hours and 5 calls. Maryland did not, and still does not recognize national registry at any level except paramedic. I did opt to take the registry exam in another state, and I passed with flying colors, the first time. I admit, I didn't study much, but honestly, the information was simple, and I was busy studying for my real college classes. It wasn't, and still isn't rocket science. It's glorified first aid. If it doesn't breath, breath for it. If it doesn't beat, beat for it. If it's bleeding, make it stop. And never, ever, ever talk on your cell phone while you're driving my patient and I to the ER. It can't get any easier.

They were all incredibly easy. I'm pretty sure my sixth grade algebra final was more difficult. I still have yet to understand why anyone could think any part of the national registry exam is difficult. Skill stations are memorization. They never change, and the registry gives you cheat sheets to memorize. The written is easier. No anatomy, no physiology, and very few actual ALS scope questions. Most of them are drug dosage answers. The best part, the CBT kicks you off after an average of 70-75 questions. Apparently, you only need to know the answers to 75 questions to be a paramedic. If you do fail, just get back in line for another bright, new, shiny silver platter.

That is impressive. I have to agree with Anthony, that patient wouldn't have had a snowballs chance in hell of surviving in my area, which is a pity since I work in an urban area. I'd love to have another true save, however I'm just too busy transporting people that have had a cold, tongue pain, toe pain, arse pain, which in each case, has troubled them for a fortnight. I don't have time to be bothered with that silly cardiac patient. :roll: Maybe someone across the pond can explain why the British are so fond of fourteens. Fortnight = 14 days, stone = 14 pounds... Hey, 14 is groovy, I'm just curious.

Damn you! I have a full course load this semester, and I'm in a mad dash to finish the four books I'm currently reading so I can concentrate all my efforts into my studies. I need to resist the urge to read this book, and I'm trying to tell myself that I have six weeks off over Christmas, and I can read all I want then... Then, I clicked the link. Damn you Barnes & Noble, and your little excerpt too! I'm hooked, and now I have to fight off the urge to read this until Christmas. Oh, the agony. The excerpt was nearly identical to what I suffered with for years, and still often suffer from today. I found out I had celiac sprue almost nine years ago. I still get sick often. I've had 15 blood transfusions with the last one being about 8 months ago, so I look forward to needing another one within weeks. I've had surgery, hospitalizations, tests, tests, and more tests. Apparently, this is a difficult disorder to treat in certain people. All those gory details aside, I have a lot of people tell me how they never see other paramedics take care of patients the way I do. I get made fun of on a regular basis because I like to talk to my patients, take in the whole picture, often resulting in social work on top of medical treatment, and I'm the candyman, err, woman. I always figured that I wasn't as good a provider as someone that could just shut everything out and perform the basic medical care needed without getting involved in some long story from their 90 year old patient. I've never really had a doctor take the time to listen to me. Most of them like to give out prescriptions for fancy medications I can't afford and more than likely don't even need. I'll be asking Santa for this book in my stocking. I can't have my grades suffering, I'm in a competition with my son for the highest grades, if he wins I have to give him $100. Heck, I'll probably give it to him anyway, just for all the effort.

Gwatney gunned down. I tend to be the person that looks at the irony in situations such as this. The state of Arkansas government voted against funding to create a level one trauma center. As a temporary resident of Arkansas, I have to wonder if this shooting will help those governmental officials understand how wrong they were when they made that decision. It seems to always take the death of a political or famous person to elict a change. After all, who cares about the thousands of nameless people that have died because the hospitals can't afford to keep trauma teams in house 24 hours a day. Maybe now, we'll get our trauma center.

You can call me "looking for a climate controlled career."

I have a myspace, and it has nothing to do with my job. I use it to keep in contact with friends from my home state, and other places I have lived. My occupation does not define me.

The state of Maryland had a designation called the CRT, cardiac rescue technician, which was the old EMT-I program. As of this year, all CRT's had to upgrade to the new EMT-I and they get some fancy new patch that says EMT-Intermediate on it. Fabulous... What ticks me off is when they call themselves "medics" or worse yet, "paramedics." They went to night class for 8 months, twice a week, a total of 300 hours. I went to college for two years and passed that incredibly easy NREMT exam. The only NREMT exam required in Maryland to become certified is the paramedic level exam. The EMT-I exam is state proctored, and as far as I'm concerned, state doctored. This level is often the highest level of care since it's a whole lot easier to become an I than a P, and they can pay them less. Want to chap my ass, equate that education to my education. When are "medics" paramedics? When they graduate from college, pass that cheesy NREMT exam, and are able to treat patients without consulting the Martha Stewart medic wanna be cookie book for help.

I think you'll find that for every way you can do something, at least one paramedic wants it done that way. For instance, when I'm monitoring a patient, the leads can be closer to the chest, although I prefer upper arm and lower leg placement. In the hospital, the leads are generally places on the chest to decrease artifact. Most telemetry patients move around quite a bit, reaching for the call button, going to the bathroom, adjusting sheets, etc. In that instance, the purpose of the monitor is just that, to monitor. Diagnostic ECG's are performed when ordered by the physician. As far as the blood pressure thing goes... I like to get the initial blood pressure manually, and I prefer to do it myself, at least the initial. It's not that I don't trust a basic, it's that I have a different partner every shift, and rather than wonder if they got me an accurate pressure, I just do it myself. Unfortunately, our little one month wonder academy has failed to teach them correct diagnostic ECG placement, so I'm often left doing my own 12-lead as well. When you're with a new partner, just ask them how they like to do things. I make it a point to lay out how I function at the start of a shift, that way my partner knows what direction I'm coming from. It also saves the steps of me having to explain things in the heat of battle. I encourage questions, and I'll teach any basic or medic anything they want to know, they just have to ask me. Any good paramedic should be the same way, and if they are vile and mean to you for asking them how they like these simple tasks performed, they suck.

Wow, burned out much? "Stabbing" a person with an IV when it's not necessary or done in a harsh way is UNETHICAL. Doing anything to a patient out of spite is unethical. One of the paramedics in the city I used to live in got tired of hauling the same drunk patient several times a month. The next time he ran on him, he purposely blunted an IV catheter, a 14 gauge catheter, before starting the IV on this man. His partner witnessed it, and the nurses at the hospital were in absolute awe at how battered the IV site appeared. Last I heard, his license had been suspended pending revocation. It's okay to piss and whine about patients to other providers, or to you spouse, etc. However, we must remember why we are paramedics... to help, not hurt people that call us.

They didn't hire you not because you refused to do BLS transfers, but because you demonstrated bad attitude by thinking you were above that job. I worked on a BLS transfer truck until the day I became a paramedic. Working for a public utility model, I still run BLS transfers, at least one a shift, more if there are no dedicated BLS trucks scheduled. All that aside, your post had nothing to do with the topic at hand. If you have some experiences working 911 and hauling the same patient 10 times a week to the other side of town just so they can hang out with their homies, by all means, please share them. There isn't much of a challenge here in the city with short transports and people that are rarely sick, but I'm a city girl at heart. You just can't make up the stuff we urbanites see. :headbang:

I don't see medicare abuse (unless the patient resides in a nursing home) near as frequently as I see medicaid abuse. Where I live you can get medicaid for anything. Depression? Alcoholism? Drug problems? Creative physician? You get medicaid. It's super easy to get medicaid if you have never held a real job. Once you're in the work-force, it gets tricky and it's a lot harder to get medicaid and disability. Our most recent frequent fliers are a set of crack-ho twins and their crack-ho mother. I had the mother while I was working in the ER, she was suicidal because she couldn't score any crack, after being stiffed by a john. She has medicaid. Two days later I encountered one of her daughters while working on the ambulance. I got out, asked her what was going on, and she replied "I'm sick, I got nobody to give me a ride, you need to take me to XXX hospital." I asked her to elaborate on the word "sick" and was told that the other ambulance people don't get rude and ask a bunch of questions they just give her a ride. She told me she had sickle cell, and I asked her if she was in crisis. She replied that she didn't know. Folks, I've been working in an urban environment for a long time, people in crisis know they are in crisis and are generally curled up on the floor screaming in agony. I digress... Most of are abusers are looking for a taxi ride. They'll tell you they want to go to XXX ER because it's close to their Mom, or a friend, or a pimp. I won't even finish paperwork and they have walked out the door, on their way to their original destination. Unfortunately, we can't refuse to transport these patients, regardless of complaint or presentation. They call, we haul, and they all know it. The other real advantage to medicaid is that the patient doesn't have to pay a dime for anything. Medicaid pays a certain amount, usually about $55 dollars a run, and we are unable to bill the patient for any portion not paid. Medicare is different, and the patient can be billed. One problem begets another problem begets another problem. US healthcare is fantastic, if you can afford it, or you have it handed to you. For those that work hard, it's a curse, and a source of much debt for those too proud to go on disability and medicaid.

Smart, perhaps. Brilliant would have been to skip it all together and go on to nursing school. :twisted:

Bob Page's 12-lead book is the best one I've seen. It's concise and accurate. I also have the Walraven book, which is a good book because you have to learn lead II. Again, I stress that anatomy and physiology of the cardiovascular system, especially the conduction system of the heart, is ESSENTIAL to being able to comfortably and quickly interpret a rhythm strip. All the tricks and memorization in the world is not going to help you if you can't recite the conduction system and corresponding complexes. Learn your cardiac A&P, amaze your co-workers with your mad rhythm reading skills! Chicks dig a paramedic that can navigate his way around a heart! See, I have a sense of humor.

You do what your heart tells you to do. I used to be 18 and I couldn't wait to become a paramedic. Now I'm 33 and I rue the day I decided to do this instead of nursing. Thankfully for me, I have a good husband that is supportive of my decision to return to college, this time to obtain a nursing degree. Until the national educational standards change across the board for EMS, it will never progress, and will never evolve to become a part of the healthcare chain. Of course, it's your life. Good luck.

Turkel Safety Thorcentesis Catheter Had them, used them, loved them.

My error, I've dropped not less than 40 IQ points since relocating to the armpit of the country. 12 Grams. I can only imagine how good it must feel to call a person out in public rather than by PM. How proud you must be of yourself. I'm sure you're a stellar example of an instructor, no doubt as qualified as the one I have teaching my refresher this month. :roll:

No, you misread.

Mobey, We carry 500 ml and 1000 ml bags, so diluting would really only work if we had an extended transport, and needed to maintain the glucose level. When I administer dextrose, I push 6 mg (12 ml) into a 60 ml syringe, than draw 48 ml out of a bag of normal saline. I do this twice, and I can give 12 mg of dextrose within a few minutes with little fear of rendering my IV useless. Off the topic of D50W, I dilute my promethazine in a 30 ml syringe. We get 25 mg/ml doses. I draw 29 ml of normal saline, plus the ml of promethazine. I can then either administer 12.5 mg or the full 25 mg, slowly. I'm sure you know that promethazine can cause a dystonic reaction if pushed too fast. It is also extremely caustic to the vein, and downright painful if you don't dilute it. Perhaps a spin-off thread: "To dilute, or not to dilute."

Blood-thinning agents, down and dirty style. Aspirin: inhibits platelet formation Coumadin: inhibits clotting factors II (prothrombin), VII, IX, X Plavix: blocks ADP receptors, ADP causes platelets to bind Heparin: binds to antithrombin III Basically, aspirin is a "platelet slicker" while Coumadin and heparin are anticoagulants. My former service had the availability of aspirin, heparin, nitro sub-ligual, nitro drips, and retavase. Our goal was obtaining a 12-lead within the first two minutes of patient contact. Rapid assessment and treatment of life-threats and obtaining a 12-lead were paramount over anything. A 15-lead was obtained shortly thereafter. Our basics were trained in proper ECG placement and required little direction freeing the paramedic up for rapid assessment, treatment of life-threats, and if all goes well, obtaining IV access. The 12-lead determined the course of action to follow. Of course, all of these treatments are contigent on any indications or contraindications. A patient with chest pain, no STEMI present, would get oxygen, aspirin, nitro sub-ligual, morphine, and a nitro drip (if nitro was effective in pain relief) and a call to medical control. If the provider honestly felt the chest pain was cardiac in nature, we could request heparin. The patient presenting with a STEMI, not involving the right ventricle, we could proceed the same as above, and request retavase in addition to heparin, if the patient met the criteria for thrombolytics. A patient presenting with a RVI STEMI would be treated the same as the other STEMI with the exception of sub-lingual nitro. That patient would get a nitro-drip starting at 10 mcg/min and titrated to effect, or blood pressure, whichever comes first. Often heparin would be withheld in instances where the patient was already on Coumadin or Plavix. Aspirin was never withheld, unless it was contraindicated for the patient. I give it regardless of whether the patient takes daily aspirin. As with any home medication, you don't know if it's still in date, has been stored properly, etc. It's important to get that initial 12-lead, and get it quick. You are the only one that will be able to document that ECG, and our doctors appreciate them. It's also a good habit to run series 12-leads on your patient. I like to perform one a few minutes after an intervention or medication. You give oxygen, aspirin, a nitro, get another 12-lead right before you give another nitro, and so on. Hopefully you'll see a trend, and that information is often invaluable to a cardiologist. It's also VERY imporant to get IV access before you administer nitro. Nitro drips start at a 10 mcg/min while a sub-lingual nitro is 400 mcg in one dose. Think of a funnel. Once the blood gets to the drain, it's nearly impossible to push it back up. If you put your patient in that situation, you suck. Do a minute of prevention, get that IV. If you have a patient that has a STEMI and you see cath lab written across their forehead, and you have time in transport, go ahead and get that second line. Doesn't need to have fluid, a saline lock will do. Try hard to get two nice 18 gauge IV's in these patients, the cath lab will thank you, and so will your patients myocardium. Try to get one in the A/C, they need a good proximal IV for any emergency cardiac drugs they may need to administer. If you save the cath lab three minutes by establishing two patent IV's, you will have saved your patients heart muscle three minutes of tissue death. I wanted this to be a nice, short post. That's difficult to achieve when I start talking hearts. If you have any other questions, I'll do my best to answer them. I may have to dig through years worth of paperwork to find the answer, but I will find the answer.