strippel

No, but we are currently trialing the Ferno motorized litter, and are not impressed. We have two of them, and have grant money to replace all litters with them. They have resolved the charger hook-up issues (but we still have the old chargers). The connections are not EMT proof, and can easily break wires, making the litter useless. Also, the battery weighs way too much, and it is very awkward to replace.

Rid, I wish I could figure out how they do that. Most don't have cell phones, some don't even have a place to live. But they sure do communicate. I wish our 800 mhz system worked that well. If PD, Fire, and EMS only communicated so well. We frequently take patients to triage, sign them in at the desk, and get them their little pager. We just need to walk them past the charge nurse, so she can see them breathe. Thank God for triage and fastcare. Took in an elderly male, not to long ago. He got a cold during the night, and couldn't stand the headache, nasal congestion, drainage, and cough. His wife made him an appointment at 1030 at the FMD, but he couldn't wait. He called 911 right after breakfast (0630, our shift change). We arrived, and offered the obligatory ride. His wife said no, he said yes. He said that he would be seen faster arriving on the litter. We walked him to the ambulance, seat belted him to the bench, and drove 2 1/2 blocks to the ER. He promptly walked into triage as his wife parked the car.

Nope, no on call. When you are scheduled you work, when you are not, you are off. I think "chair car" means wheel chair van.

Our LP12's have the BlueTooth modem. We send 12 leads (only those on patients who NEED a 12 lead ECG, and show evidence of an MI. The ER doc then calls the cardiologist, and the cath lab team in. All before (usually) we arrive at the hospital.

We have Opticoms on most of our ambulances now. Most of the townships and boroughs we serve have Opticoms installed on most of the lights. We have some traffic lights that need maintenance, and are hit or miss. When they work, they kick ass. It is great when you get 3-4 lights all flashing "clear" in a row. But you must be careful. Some police cars and most fire apparatus have them, and when you come to an intersection, you have to make sure it is green for you. The firemen won't stop. Our city didn't implement them, and has no plans to do so. $$$$ I was ordering wire guided missiles, but the grant didn't come through. + One of our medics works for the Department of Health. I keep after him to allow us to use tazers. Baby steps, I guess.

No. Can we borrow one?

"CC Does that stand for Captain Condom? Magnums are comfortable enough, but they just don't hold up. I prefer Bates. Rocky is good, too. We need to wear boots, preferably steel toe, per our employee manual. There is too much crap to get into. We once had 4 members go to the police station to have their soles imprinted. Grissom and his friends had to sort out the friendly blood tread marks from the non-friendly. Our crime scene people aren't as high tech, or good looking as those on TV. They can't afford a H2, we gave them an old ambulance.

Unfortunately, most calls end up with "special circumstances". There is way too frequently a large monkey wrench that gets pitched in. Both regions where I work, strongly suggest 10 minutes for a trauma and 20 minutes for a medical. Not that we really care about that, but it's usually around 20 minutes for an ALS call, slightly less for a BLS call. I occasionally do some math, and MY calls (BLS calls where I am in charge) are averaging about 19 minutes from dispatch to arrival (and available) at the hospital. When I trust my partner to do ALS care, we are on scene for usually right around 20 minutes. And that includes usually a patient family problem, and stair chairing them out. I think that about 20 minutes is normal for a standard ALS or BLS call.

I grew up in North Jersey. Back in the day, I thought that system rocked. And for the most part, back then it did. There were lots of BLS volunteer ambulances, all with lots of active people, and pristine expensive ambulances. And they responded to calls. ALS units responded from the hospitals, and all had decent response times, and people lived. I volunteered, and had fun. And then I started thinking about it. Why were there a bunch cops on every EMS call? Why did 2 vehicles show up with as many as 7 people on them? Soon, the ALS chase unit would start arriving before the ambulance. And then.....Humm..... Then I moved to PA (yes, I know we have our own set of problems). We had still had volunteer services, but they were always staffed, and got out in the allowed time. There were even volunteer medic units. It didn't take long to realize that call volumes were increasing dramatically. BLS units became paid, ALS chase trucks became transporting MICUs. Services realized that they needed to keep up, go ALS, and do transports. Either that, or they died a very painful death. many have. Now, with (almost) no government money, Non-profit ALS transporting services are all over PA. They have merged, been dissolved, and gone through metamorphosis. My service is fully paid, non-profit with volunteers, doing over 22,000 calls last year, making money, getting raises, providing decent benefits, and buying new vehicles and equipment. I recently moved my parents from Northern NJ, to here in PA. They were paying more taxes in one month than I do in a year. What (as far as emergency services) did that get them? A police department that puts out 4-6 officers each shift for a 2 mile square town of 8000 people, 1 paid "firefighter" who helps with inspections, and maintains 5 apparatus, a volunteer ambulance that has 2 huge stations, and 5 brand new $150,000 ambulances that don't get out (but do not charge when they do), and hospital based ALS chase that takes 15-25 minutes to arrive, and charges well over $1200 to show up.

144 hours a month, Damn. The last place I volunteered we had a minimum of 24 hours a month. You must be pretty rural with low call volume to have that many on call hours. When I volunteered, daytime was it's own thing. There was supplemental paid staff, because nobody would run on Saturdays or Sundays. Sunday-Friday nights had a set crew, with the same people usually running the same night 18-06. As call volume increased, so did the paid people, and the volunteers dwindled. Now, it's paid 24/7 with ALS, but there is still room for volunteers. Call volume went from 1600 a year, to about 5000 in less than 12 months. Got to love progress. Steve, if you are from the place where the grass is green, make your operations manager work weekends.

Going with Dust on this. I started at a rural service, only because that is where I was. I was lucky enough to learn rapidly. I was able to mature in EMS, mostly because I wanted to learn. There were many co-volunteers who just drove, or sat in the back and smiled. We were 30 minutes to the nearest hospital on a good day, usually without ALS. If I wanted my patient to survive, I became aggressive. After a year or two, I started working for a small private. (Had to pay for school). Mostly routines, but they were back-up for the city. Back then, that city government was pretty messed up, and we ran more 911 calls than city fire. When you run the projects, shootings, stabbings ODs on a BLS truck, you learn fast. Back then, there were no classes on scene safety. You rapidly learned to watch your back, and your partners. We rarely had police. If the city sent us, there was no ALS. What I have learned there, made me the quality EMT I am today. In a matter of weeks, I got so much experience on so many levels, far too much to explain. I now work for a small city service (bastard hospital/non-profit). I see and help train many new people. You'd be surprised how many come in, fresh from EMT class, knowing everything. They don't, and many leave. Those who stay are kick-ass EMTs and medics. Recently oriented a volunteer EMT with 13 years experience on a small town ambulance. She also taught EMT class. She was lost the first 2 weeks. It was funny, everyone got high-flow O2, and it turned out she only wrote a handful of PCRs in her 13 years.

Used to work for a service that had a fleet of 5 Hortons. Guaranteed that at least one of them would have electrical problems during any given week. We currently have 1 (yes, only one) Horton in a fleet of 26 vehicles. It has a messed up electrical board, and Horton wants $2000 to replace which ever one needs replaced. Ain't gonna happen, the truck is now in reserve.

I'm not that far away from you. We do psych runs frequently, and many of them are out of town, Philly, State College, etc. We could be gone up to 3-4 hours as well. The difference is we (usually) have adequate resources. We put 9 trucks out daytime, and 5 overnight, and depending on staffing, a combination of ALS and BLS units. Although our medics do more than their share of transports, a BLS truck will do BLS transports before an ALS truck. Sounds like you need either a additional BLS truck, or an on call crew. And yes, in PA, psych IFT runs are BLS, and insurance pays.

??? Got more important things to do. I'll gladly help get clothes for my patient while on scene, so they won't be naked when they walk out of the house, or are ready to return from the hospital. But there is a very small time frame when I am feeling generous. If they are BS, they have about 10 seconds to gather belongings, maybe a few more if I am feeling kind. If they are sick, I am not waiting. That is what blankets are for. As far as carrying gowns in the ambulance, and changing them eroute, Hell no! That is time you could actually be assessing, treating, or talking with your patient. Sounds pretty fishy to me. At the hospital, even though not my job, I will gladly get them undressed, gowned, and hooked up to the monitor.

EVOC is required by PA to operate an emergency vehicle. We also have "safety" information presented to us at annual skills review, and have had additional mandatory driving classes over time. Our safety manager always sends out an email with details of EVERY emergency vehicle crash.

Last week we had a dramatic person of ethnicity. I was very suspicious (as was my partner), but family thinks she might be diabetic, they don't know. So we go with the NRB and as I move the patient (she was in bed sleeping, no trauma) to get the mask on, and her arm for the IV, I notice her head is not dead weight. She is supporting it, and trying poorly to move it with me. I tried the arm drop (yes, I am a bad boy), and she failed. But she took an 18 in her L ACF like a champ. So, after the BGL comes back better than mine, another family member arrives with more drama. Amazingly, she wants to talk to her mom, so SHAZAM!, she is awake. I bet she would have tolerated a NPA, and tried like crazy with an OPA, but we didn't get that far. Had people take them before. We all don't like getting duped. But as stated earlier, you assessed the patient, and provided the care deemed appropriate. And they made it to the hospital.

Always in the front. In the back, it depends. If I am working in the city, calls don't last long. If I am working in the country, or doing a long distance, Yes!.

Thanks Dust and Rid. Rid, those dog bad outcomes were what I was thinking about. I guess I need to wait for his new protocols, and see what it says about the amounts and kinds of fluids. At my part time, many medics are into the "get it in fast" mode because of that. Hopefully, it won't be that way here.

Thanks for the info dgmedic. I actually was there (and a few other sites) looking before I placed the post. I just was beginning to think I was missing out on some new beneficial information. I also understand the blood replacement needing larger IVs. That is why blood tubing is HUGE compared to regular IV tubing. The blood cells can get damaged going through small diameter. My wife does reprofusion (where blood is processed and given back to a patient during surgery). In a small community hospital OR, one nurse couldn't understand the request for an 18g, because "we only use 22s".

I understand the not communicating. The memo is in the mail. Talks on permissive hypotension were numerous at EMS conferences. Now, not so much. I was just wondering if I missed any new information.

Not me. Our supervisors had a chat with our Medical Director. He doesn't want protocols changed until the memo appears. As far as talking with the new trauma doc, I have not met him yet. I do have the question into one of the other trauma surgeons, with no answer yet.

We stopped many years ago. The hospital lab claimed CLIA regulations, and stopped accepting them. Having worked in the lab, I can see it, kinda. EMS not taught "proper" (hospital specific procedures) for blood draws. The biggest concern was labeling the specimens their way, and proper tube handling. We also transport to many hospitals (2 close, and maybe 6 not so far away). To keep up with their specific rules would be a nightmare. Our big hospital restarts all EMS IVs within 24 hours. They cite national trends in infection control.

And PA is even goofier that EMT has absolutely nothing to do with NR.

medic001918 writes "With more theories coming out that support permissive hypotension...", this brings up a question. A hospital where I work part time became a level II trauma center last year. They brought up a surgeon from one of the teaching hospitals in Philadelphia to run the program. He states ALL patients get 2 large bore IVs (18+, bilaterally if possible). Period. No excuses. Our hospital (at my full time) has been a level II trauma center for many years. It has been perfectly acceptable to only have 1 IV. Our medical director's policy (at the time he was head of the ER) was to use common sense. If they need 2 IVs, give them 2 IVs. It was a well know rule that if you used larger than an 18, and the patient didn't warrant it, the medical director would use one on you, vein of his choosing. For years, IVs have not been a problem (or QA issue), unless the patient came in BLS, or without one. (Yes Dust, we have BLS trucks in our city. Sometimes we get busy, or a call is dispatched BLS. if you are 4 blocks from the hospital, it's kinda hard to rendezvous with ALS). We now have a new head of trauma. He wants 2 large bore, bilateral IVs. Period. We have had crews yelled at for not having them. The problem is the new trauma doc has not sent out a memo yet (it is due later this month), nor has our current medical director (now head of the ER) changed protocols. What happened to the idea of permissive hypotension?

We very infrequently start locks. It is just as easy to have a bag hanging. And I know Dust will chime in, but the cost is almost the same. Our service has not drawn blood on a patient in many, many years. It has to do with CLIA regs, and not ER or EMS staff. We transport to many different hospitals, and their labeling rules differ greatly.