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MikeEMT

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Everything posted by MikeEMT

  1. This I do, I was raised with the mentality that you don't rely on the "easy way". I was raised in a carpentry family and my grandpa was a huge supporter of air powered nail guns and power tools. Before he even let me touch a nail gun or a power tool I had to hammer nails and cut wood the old fashioned way. He used to tell me that power tools will make your life easier but a hammer will never fail you. Haven't forgot that. How am I going to assess the patient? Hmmm, Are they responsive? No, then check pulse. No pulse, begin CPR. Not much more to it then that. Can I tell what rhythm the patient is in, no I can't. Even with our AED's I wouldn't be able to but that is moot because as a Basic it doesn't change my treatment. Don't get me wrong, I am pro AED. I just feel that there can be too much expectation placed on them. As a professional I want to be able to tell someone how everything works and why it works. As a Basic we don't carry fancy gadgets on board our rig but I know how everything I do have works and I under stand it. This is something I think we fail on as a profession. We give providers all this fancy equipment but we don't explain the equipment to them or why it works. How many EMT's know what the official name for a BP cuff is? How many of them know how it works and why we are squeezing to obtain a BP reading? How many know why we carry AED's or why they don't always work and the "no shock advised" does not mean to cease efforts? I am very pro technology and I subscribe to the mantra that you should work smarter, not harder. That said, technology is ineffective if you don't understand it. Recently I have heard a lot of talk about CPR devices such as the AutoPulse. These have the potential to be great save lives, but will providers understand why? 15 years from now when they are common place like AED's are today, will future EMT's understand how to do manual compressions? Will we be having arguments about "my rig didn't have an autopulse on board should I report them to the state"? I once went into an ER to take a patient out for an IFT. The RN came in to give me a report and saw me auscultating a BP on the patient with our own cuff. The RN asked me what I was doing and I told her I was getting a BP. She pointed to the monitor and said that is how you get a BP. When I asked her if she had ever taken a manual BP she replied no. I actually taught her how to do it. This is what I want to avoid. Regardless of how far I move up in this field, I don't ever want to become one of those providers that loses sight of the basics. Would I use a Pulse Ox or any other gadget we have on board? Sure. I'm not going to let lack of a gadget dictate how I treat a patient. Just my humble opinion.
  2. I will take issue with you on this. I know how to use a pulse ox properly and I understand its meaning. I pride myself on doing proper patient assessments and that includes looking at patient presentation. I don't need a machine to tell me that a patient isn't getting enough oxygen. As for your argument "if the machine didn't serve a purpose, it wouldn't be created" there are plenty of devices in EMS that have been created that are not useful. The most prominent right now being the backboard. Just because something is there doesn't mean it is the end all. I have seen pulse ox be wrong on numerous occassions and I have seen nurses and doctors stymied when they can't figure out why it is wrong or what to do now. I once went into an ER and got chewed out by an RN and a doc because the triage pulse ox said the patient was sating in the low 80's and had a very high pulse rate and I didn't have the patient on Oxygen. I told both of them that those vitals were wrong and the patient wasn't that bad. While the doctor was chewing my butt the RN got a different vital tree and it was discovered that the original vital tree was broken and I was spot on with my assessment. Pulse ox, AED's and other devices have their place but only if users understand how to properly use them and understand what to do if they fail. I would like to have a pulse ox on board just because it would be a little easier, but I don't miss it and I am not going to be affected without it. Just like an AED isn't going to change the fact that I do CPR. If I have an AED with me, great I will deploy it, if not then its compressions until ALS gets on scene. An AED, however, isn't appropriate in every case of Cardiac Arrest. The bottom line is this; an EMT or Paramedic needs to be patient focused, not machine focused. Machines are useful and do have their place in EMS but the provider needs to look at the whole picture not just what the machine says.
  3. This wasn't an Overdose where Narcan would have worked. It was an Ecstasy OD combined with Sherm.
  4. We don't carry pulse Ox onboard our rigs either. Treat signs and symptoms not a machine. I have never missed a pulse ox, though it does anger some of the nurses. I do wish we carried glucometers on board. Not sure why we don't. AED should be a state requirement. That said, while AED's are effective and have lots of clinical evidence to support their use, they are no replacement for effective CPR and rapid ALS response.
  5. It is thru the roof. I drive 60 miles to go to work because of cost of living. I have been an EMT for a little over a year and have seen and done more than most veteran EMTs in other areas. I remember I brought in a patient to HMC in severe overdose and was bagging the patient. A crew from another ambulance company was there and they were awestruck by what I had. They followed me to the bed and after dropping off the patient they approached me and said they had never seen anything like that in there years of EMS. My reply to them was welcome to Seattle. Contrary to what others think, we aren't the best in the world. That said, if you want to get experience and set yourself apart for acceptance into Medic One or any paramedic program, spend a couple years in Seattle. You will get a lot of experience.
  6. King County Medic One does NOT require you to be a firefighter. King County Medic One is a separate entity that partners with local fire departments. It is overseen by University of Washington which is why all training will come from UW / Harborview. Seattle Fire Medics are part of KCMO, however they hire from within. Seattle does require you to be a firefighter / EMT for three years. The requirements for admitance into the Medic One program are 3 years of field EMS service. There is no requirement that you have fire experience. King County Medic One (KCMO) will hire you directly from the street. Once you are accepted into their program you are an employee of KCMO. Upon graduation, you will be assigned to a fire station to staff a Medic Unit. I work BLS for AMR in Seattle. There is no ALS service other than Medic One. This is a requirement of Dr. Copis (spelling?). There are remarkably few medic units in Seattle / King County. Seattle has 7 Medic Units for the entire city. As a result, even though we are BLS, we take and treat a lot of patients that would go by ALS units elsewhere. Medic One does not care if you work for private or public EMS as long as your getting full time ambulance experience. I will tell you, having worked hand in hand with students, it is not an easy program. The current batch of students is currently in their field rotations. The amount of time spent in the field is staggering. I can't remember the hours, but they have told me that if you have a social life it will go away. It is a very competitive program. You would have better luck getting into the program at TCC or Central. I have met some top quality Medics and I have met some not so good Medics. My opinion is this, if you are going to have a heart attack then Medic One Paramedics are the best in the world. If you are hurt or have other injury there is a lot where we are lagging behind other areas.
  7. A selfie? Seriously? I have been on this forum for a while and have never had a selfie nor heard it mentioned to me or any of the other numerous members who choose not to have an avatar. What someone looks like is not a concern to me. I care more about the content of what you say. I used a duty belt when I was a LEO as well. Big difference between being a LEO and being in EMS. I would be curious as to what their actual job is. I always have my suspicions on boards like this about the "whackers".
  8. Having been a LEO I never had this issue despite having a belt full of crap. What in the world are you carrying that requires a duty belt? I have never seen a Duty Belt since I have been involved in EMS, in fact the closest I have seen is the leather strap for carrying a radio, I think its called a Boston Strap or something like that. My belt has my work cell phone on it and that is it. As for gloves or any other extra equipment, thats what pants pockets are for.
  9. The best part of this job is you can never see it or know it all.
  10. We also use the Pedimate. We will also use their own carseat if they have it with them and secure the car seat to the stretcher
  11. We aren't allowed to transport dead people, unless they die en route to the hospital and that is rare on a BLS rig. It does happen occasionally though because we have contracts with the numerous air ambulances that serve the region. Very possible one of their patients will die in our rig, but we also transport the flight crew with us. We do, however, get called to babysit dead bodies on occasion. There are only 7 medic units serving the city of almost 700,000. When someone dies either in public view or in the medic unit on scene we will respond and place the body into our rig until the ME gets on scene. Prior to this the ME must be notified and permission obtained before moving the body. I doubt FDNY is in the business of transporting dead bodies, though if it was one of their own I could see them transporting to the ME. When a cop or firefighter goes down Medic One will transport to the ME's office.
  12. The shoreline primarily is used to keep the batteries charged not to keep the ambulance warm. If an ambulance is equipped with a block heater that would be an option from the vehicle manufacturer. None of ours have block heaters. All of our ambulances are shoreline equipped but only the CCT units are plugged in. Out of our fleet about 90% of the units are ran daily. Our ambulances are all Diesel with the exception of our Bariatric units which are AEV boxes on a Chevy frame. Our fleet consists of approximately 80 BLS ambulances. About 50 are Ford type II vans and 25 or so Mercedes Sprinters. The remaining being our Bariatric units. The Mercedes Bluetec diesel engines leave a lot to be desired. They are quiet which is good for us since we do System Status Management and they are decent on economy. Other than that they are crap and I find them completely under powered. The Fords have tremendous power but they sound like a diesel, which I like but the neighbors don't. Both diesel and gas have their advantages. I personally feel diesel is more appropriate for ambulance service. They are more robust engines, designed for a longer service life and provide more consistent power. I'll take diesel any day. While I have never done it, several employees have put gas into our diesel ambulances. The Fords can be driven back to HQ, drained and refilled. About a $100 mistake. The Mercedes on the other hand must be towed. If the engine has been started with gas in it parts have to be ordered from Mercedes and replaced in the engine. According to our mechanics it is $10,000 to repair a Mercedes engine that has had gas run through it. We don't have dedicated fuel cards because we don't have our own pumps. We use a card that will activate any pump at any gas station in the country.
  13. We use Hospital linen for our stretchers (flat sheet, towel and bath blankets). Most of our ER's have the stuff sitting out for us to take and I keep a lot of it in my ambulance - especially towels and bath blankets. Our pillows come from the hospitals too. The only hospital that whines and won't let us take anything is Veterans Administration hospital. Our company provides wool blankets for when it is really cold out. If it is raining I will cover the patient with a blanket and then a blue paper sheet with the fluid side out to keep patient warm and dry.
  14. Anyone that has been in this field for awhile has certainly assessed their share of Peds patients. Anyone who has even a general knowledge should know that Peds patients compensate very well and then crash suddenly. I don't like relying on "news" reports to base my decisions on. What I will say is this, Pediatric patients can be very difficult to treat. There are a lot of unknowns. What were the patients vitals? Did the patient's condition deteriorate during assessment? Did the Paramedic on scene notify his Medical Control or provide a HEAR report to local ER? If so was the local ER equipped to handle these patients? Helicopters / aircraft are no different than a ground ambulance, minus the cost of course. I don't see a problem with flying these patients. In my Law Enforcement days, we had a toddler who died when a tv fell on him. There is no telling how heavy these shelves were or the weight of what was on them. Had I been in his shoes there is a very strong chance that I would have come to the same decision.
  15. Fortunately mine didn't result in injury but did result in a guy being removed from hospital and almost arrested.
  16. Family rides up front unless patient is a minor child and is not having life threatening issues. Only other exception is if patient doesn't speak English and family member can interpret for me. No release needed, it is my decision as the tech if a person rides with us or if they ride in back with me. The patient is my responsibility and I do not want anyone interfering with my care of said patient. I learned this the hard way.
  17. In my area SNF's are staffed by morons. I don't trust what they say so yes I would have ran hot to the call. I once responded priority to a Rehab center for an unconcious only to find the patient had no medical complaints other than vomiting (duh! its withdrawls) but the "nurse" just didn't want to deal with the patient. On the other hand I went routine to a fall only to find the the patient was ALOC, Hypotensive and had positive results when doing postural vitals. There is a big difference in responding to a scene priority and transporting to a hospital priority. I am sure anyone who has been in EMS can attest to responding to calls which they thought were going to be minor or BS only to arrive on scene and find out the call is nothing like dispatch said. It isn't just SNF's. The general public lies too. We respond to all calls priority. I rarely transport to the hospital priority. About the only time I go priority to the ER is if it is a suspected CVA or we are suctioning. Anything else should be going ALS if it requires priority transport to ER. Obviously this isn't a set rule, i will always do what is necessary for the patient care.
  18. Doing CPR for show is irresponsible and disrespectful. Do you give Oxygen just for show? Do you give medication just for show? No matter what your cert level, the public expects us to act like competent medical professionals. Doing CPR for show is not showing competancy or professionalism. Use your clinical knowledge, the patient is beyond help. Explain this to the family and prepare to assist the family / bystanders. They are your patients as well. While traumatic for family, in the long run it will be less traumatic than doing CPR for show.
  19. I'm not calling BS or anything but this story pops up time from time almost word for word. Always a new guy showing up at the Hospital to relieve your partner. Always taking off Hot. And always slammng brakes on at last minute. What agency would swap out providers at a hospital without a supervisor being present to begin with.
  20. The stryker can go up stairs easily, just don't use the tracks. We always use two people on our stryker's one at the feet and one at the head whether going up or down.
  21. While money may not be everything, in an area such as LA where EMT's are a dime a dozen I would be wary of any program offering "discounted" training. The first thing I would look at is are they certified to teach the course? I don't know about CA, but here in WA the State Department of Health has to certify a program and its instructors in teaching EMS courses. Failure to take a certified course and the State wont issue your certification, even if you pass the NREMT. Also, the NREMT may not let you take their test. Since CA likes to regulate everything, I would assume they regulate who teaches EMS courses. Second, why the cheap price? It costs money to teach these classes. The training materials are expensive and most instructors want to be paid. Additionally, there will be insurance and other expenses the facility would have. If this was say a reputable hospital such as Cedars Sinai I wouldn't be concerned. However, if this is a private school then it would concern me at the cost. Are they trying to recoup costs by selling stuff? Is the class going to be large? Are they even teaching EMT - Basic, or are they calling a first aid or first responder course an EMT course? I am sure there are reputable organization out there that teach discounted EMS courses and do it well. I can't see that being the case in a place like LA. Ultimately it is your money and your career. Do you want to gamble your career on a potentially bad course? As was said, you get what you paid for. My EMT course was $975 and while it didn't teach me everything it helped make me a good EMT and created a solid foundation that I can build on. I doubt a $100 course would do the same.
  22. We do C-collar only immobilization all the time. We don't have protocol for it though, usually its because fire will give us a patient and say "oh its a ground level fall with some foot pain" we get them in the ambulance and they complain of head or neck pain. I don't know how I feel about backboards. I think they have their purpose but i'm not sure they are used appropriately.
  23. iStater hit it on the head. The point I was trying to make is a NRB isn't the automatic best choice in every situation. I was hoping that the OP would come back and reply to my original post with the reason why he chose an NRB. I would like to see that the OP knew why he was providing the treatment rather than "the book says too". One of the most important things you need to do as a provider at ANY level is to justify your interventions. Being someone who wasn't at this call and knowing it was a peds with hx of asthma why did the NRB come out? Were there other signs and symptoms related to respiratory distress? I question the Pulse Ox reading, especially on a child. The pulse ox is very sensitive to dirt and grime on the patients fingers. Did you check the cleanliness of the fingertips? Was the child still? If they are in true respiratory distress they wont be sitting still, if they are that is REAL BAD. Did you consider other conditions responsible for the breathing problems? BTW thank you MariB, you seem to be the only one that actually read my post and got my point. Just so you know our cardiac monitors have SpO2. We just don't carry them BLS. Neither do the fire departments around here but this is a discussion for another thread.
  24. Honestly its hit or miss. Where I work they don't really like to see suits. In fact, my partner got hired after walking in wearing jeans and an untucked polo with bed head. Our process was written test then interview few days later. Pass those you got an offer for employment and went for your physical agility test and drug test. I think most employers, at least from what I hear, are going away from the suit and tie and just want professionally dressed. Personally I wore a nice button up shirt and slacks for every interview I have been on. Always had success.
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