MikeEMT

I hate GCS. They updated our ePCR and it is now a requirement to do it twice for EVERY patient. While I see its benefit in say a trauma or ALOC patient I really don't see the need for doing it twice when we have a 5 - 7minute transport time. We have to do a minimum of 2 full exams for every patient anyway.

While I agree with the other posts about the NRB I am going to play devils advocate here for the sake of discussion. I find it doubtful that the CC is incompetent and would do anything to harm the patient (maybe they are, I don't know). So this leads me to question your facts and whether you have the knowledge to treat the patient or if your using textbook medicine.

The patient was apparently having an Asthma attack and had an SpO2 of 89%. What were the kids vitals? Did you auscultate the lungs? Did the patient have a hx of asthma? Skin condition? Hot to touch? Audible sounds?

I could be wrong but it sounds to me like you focused strictly on the SpO2 reading and not the entire condition of the patient. In my system we don't use SpO2 for this reason, we give oxygen only when medically necessary and to be honest when I first started I hated not having Spo2 readings though I find we have better care and better outcome when not relying on SpO2 reading.

The other thing is maybe the CC was angry because he was testing you. Maybe he wanted to see if you could defend your actions. I have rolled into an ER numerous times only to be yelled at by doctors and nurses for either doing something or not doing something.

One of the lessons you will learn is regardless of what your protocol or book says, you need to be able to back up and defend your actions. Maybe, the attitude of the CC wasn't to come down on you but to see if you could defend yourself. I have not heard anything from you that supports your actions except for the SpO2 reading.

I have heard previous discussions on tattooed living wills in the past. Apparently there is Case Law, though I haven't found any, that is in support of this and will uphold the patient's wishes if you go against it. Keep in mind though that a Living Will is not a DNR, rather it is an order specifying what treatment they want.

I would honor the tattoo

Consider yourself lucky that its only a 500 question test. When I became a cop I had to take a battery of Psychological tests including the MMPI. 2,500 questions in total. Took me 8 1/2 hours. Then had a meeting with the psychologist to review the test results. That was an additional 2 hours (fortunately on a seperate day).

I would have no problem taking any psych test and yes they can make you take it. As long as your honest with yourself it will go ok.

Whether he loses his certification is up to the State and the regulations. You can probably look it up on the webpage of whatever agency governs EMS in your state.

Here in WA we are an affiliation state. You must be affiliated with an approved EMS agency in order for the state to issue your card. Lose your job and you lose your certification because you are no longer affiliated. If your state is the same you can count on losing certification.

As for the job, that is up to the employer. Most private companies will fire an employee for a DUI because of the insurance company requirements. Most public agencies will suspend pending outcome of the trial. Since driving is a requirement of the job and a DUI is an automatic suspension of a drivers license, losing your job is a very likely scenario.

Life is about choices and consequences. Make bad choices and you have to live with consequences.

Mackey, I was a former police officer and I encountered this many times as a cop. There are often variables that you are unaware of. Maybe the patient made comments that they want to harm themselves (which you SHOULD be told about but doesn't always happen). Maybe the patient was acting a lot different before your arrival or they are acting different now.

I remember one example where I was the officer investigating a one car MVA with the driver being the sole occupant. Ambulance shows up and starts interviewing the driver who was sober and was for all intents and purposes A&O x4. EMTs were going to AMA him when I interviened. Argument ensued and I basically said something similar to you can go on your own or I will invol you. Patient went to ER on their own and afterwards the EMT's had some choice words for me when I showed up at the ER to complete my report. What they didn't know was I knew the patient and even though he was A&O x4 I knew something was wrong with him. The EMT's failed by asking only standard A&O questions and not going further in their questioning. Had they done so they would have discovered patient was altered. Turns out he had a brain bleed.

So the bottom line is without knowing all the facts, you can't really judge the cop especially when its third party info such as on this forum. However, on the flip side of things, now that I am an EMT I work with our police all the time and more often than not they make me want to pull my hair out and scream. Recently I had a cop get mad at me because I refused to put a suicidal patient in 4 points. I replied to the officer, patient is calm and cooperative for me if that changes I can put them in restraints but you don't arrest people because I tell you to and I don't put people in restraints because you tell me to.

Truth be told police and EMS interaction can be highly difficult.

Problem I see is what about supplies? If you use your AED you will have to reorder supplies, how will they come to you and how long will they take? What kind of AED will you be using? Will it have a manual override? AED's are programmed to shock for only a couple of dysrhythmias and they are not used for traumatic arrest so will the AED be truly useful in where you are going? I am assuming your going somewhere like Haiti where you will be doing more humanitarian type medical stuff and not a lot of trauma.

Here in Seattle we have a company called Remote Medical International and in addition to selling supplies (they have a pretty extensive catalog) they also specialize in third world medicene. They have a whole team of Paramedics and Doctors that they send to other countries. Maybe giving them a call will shed some light on this. They travel with EKG monitors I am sure they can tell you how to travel with an AED. Just a thought.

I would have a conversation with your boss first. Rookie Paramedic and Rookie EMTB ????? That is not only stupid, it is dangerous.

I would say this is an overreaction. While it is true that Faking is a rookie Paramedic, I strongly doubt he is rookie EMT. Most systems require a certain amount of time spent as an EMT before you can enter Medic school. Having read his posts on here he seems to be quite knowledgable. Good BLS is vital and I would think that Faking has more than demonstrated his BLS skills and therefore should be able to teach a thing or two to his new partner.

Since my regular partner has been on special assignment for the past 2 1/2 months, I have been getting a lot of new partners. Mostly fresh out of FTO that need a little more work. I enjoy mentoring rookies. I try to teach them things I have learned the hard way. Keep your eyes and ears open and you may learn something from them too.

Is that so? Do you have the data to back this claim?

I am not saying bumper / grill mounted can't cause damage. I am saying it is not as bad as roof mounted and is less likely to cause damage. The certification requirement for a siren is 100db at 4 feet. That is definately loud enough to cause hearing damage if your standing in front of the speaker for long periods.

The point being that sirens use sound waves which are being propelled forward by the driver. Therefore it will always be quieter behind the speaker. Of course factors need to be taken into consideration such as buildings, tunnels, etc.

I personally find this to be a frivolous lawsuit IMHO. To appease you you can find the regulations and guidance here https://www.ncjrs.gov/pdffiles1/nij/181622.pdf

there is no such thing as a "final exam" in this field. You are always tested: class, NREMT, CE, in the field, etc. You are just taking one of many tests you will encounter in this field.

Glad you passed, good luck on the NREMT

I have transported wheelchairs many times - both manual and electric. Even took a Rascal once.

It kind of depends on you ambulance layout. We drive type II vans and have enough space to cram the wheel chair between the bench and the shelves. Most of the time its easy, however the rascal was a real pain in the a$$. Those stupid things are heavy. We used a whole engine crew to help use load it and about 6 nurses and er volunteers to help us unload it.

We try to use our cabulance when possible.

We use Type II ambulances if it makes a difference.

I can understand the lawsuit from those who used roof mounted sirens. However with the siren being in the grill or front bumper it is not really loud enough to be much of a problem.

Our ambulances use 200W sirens which are obscenely loud, especially in a downtown metro setting. I feel sorry for the little kids that I come across and I try to limit my siren usage so I am not blasting someone in the ear. Its called prudent use. Also, if my rig is blocked I will turn the siren off. No point making people deaf if they can't move for me anyway.

Plenty of research has gone into lighting technology, but not so much into siren technology. Only recently has that changed and we are seeing things like the Rumbler and the Howler. Loudness doesn't always translate to effectiveness.

Croaker, I like your Ideas. They seem like they would be very successful. I bet you guys turn out some quality employees using that training model.

So I had a heart to heart with the newbie yesterday at the start of shift. I kept it professional and I did fill in a lot of positives that the newbie does but also brought up my concerns. I discussed a couple of ways I was going to try to help them out in resolving my concerns and the newbie was willing to try.

What a difference. The improvements made were astonishing. The newbie made one wrong turn going to the hospital which they immediately recognized. Could have corrected it with a U-turn, but didn't since they didn't think were allowed to make U-turns in this area (can't fault them for erring on the side of caution, especially with a patient). Used an alternate route instead to the hospital.

The only other minor issue was going to stage for a call the GPS gave us wrong directions so we got a little confused (Google maps and our map book also gave us wrong directions). Fortunately fire trucks are big, red and easy to spot.

To say I was impressed would be an understatement. I can honestly say I was very proud of this newbie and I made sure I told them after the end of shift. Now I just need to work on reinforcing those improvements.

I am both an instructor and an FTO..a formally trained FTO even .

Anyway, there are several issues here. First is the FTEP (Field Training and Evaluation Program....though your terminology may differ) has issues. Is it a Training and Evaluation program, or simply a training /orientation program? From both a professional and a legal point of view, if there isnt some sort of evaluation (daily, end of phase, what ever) prior to being "released"... then the program is setting everyone..the trainee, the FTO, and the agency ...up for failure.

In this case, either the trainee was evaluated for his /her ability to perform the job...and legititamately passed..and now has a previously unknown issue...or there was no or poor evaluation and the trainee was simply "passed" for simplicity. .

I cant speak to how your FTEP is set up, but here, if that trainee is having consistantnt issues...were these issues documented during FTO? If so... then a "performance inprovement plan" (PIP)is held. This is a Formal "Come to Jesus" talk and process that is both legally defensible and practical.

Without cutting and pasting the entire process, here is it in a nutshell:

1- The FTO(s) and supervisors identify the problems in clear terms, and make sure that the problems are documented previously. They also make sure that the "problems" are true issues and not personality issues. We have some specific criteria for what warrents this.

2- A "PIP" meeting is held with the trainee. This is a scripted, agenda led meeting. The reason for this is it keeps all parties on task. It also avoids any "Ambiguity" about the seriousness of the situation. This has been a probelm with previous, less formal meetings with problem trainees.

The FTO/Training coordinator or designee evaluated progress. Typically up to 90 days may be given by policy, but most problems we are looking for improvement with in 30 days. if improvement is not seen and it is clearly documented, then we look at why, and termination is a real option at that point.

Now, from the trainee pont of view, this may seem harsh, but really this is best for everyone. it keeps a trainee from being caught in "limbo" for ever, it clearly spells out the issue without any sugar coating. Some people simply need to know what specifically they are doing wrong, and given step by step plan for improvement. And if the trainee succeeds, then EVERYONE gets to "move on"...including the trainee..into the rest of his/her career.

Your right and we use FTEP as well. Our FTO program is designed to instruct and evaluate. It is not intended to be an Orientation - we have a two week "academy" for that. The FTO's do a pretty good job and they are constantly giving feedback to the trainee. The problem lies in the short time an FTO will spend with a trainee and the set up of the program. The trainee will get a minimum of 10 shifts on FTO, however they will rotate through at least 3 FTO's. In addition the FTO is a "working" FTO so the trainee will be a 3rd EMT on board an ambulance responding to calls.

I kind of have a problem with this kind of set up because it doesn't allow problem solving. I feel they should not be assigned to a working ambulance for their first FTO rotation. That FTO should work on driving, navigating, hospitals, etc. I would rate our FTO program as very good usually. They do a good job of getting trainees brought up to speed. However, we only have about 12 FTO's and we have been in a hiring blitz for almost a year and are continuing to hire. The FTO's have to be getting burnt out. In addition to new hires, they have to do our quarterly CBT's.

This trainee was given to me on a temporary basis (3 weeks) as my regular partner is on special assignment. While I have no formal say so, it is my impression that I was given this trainee to help bring them up to speed and try to fix what the FTO's couldn't. My trainee IS aware of their shortcomings and is making an active effort to correct them, there is just no improvement.

I have come to the conclusion that I will have a heart to heart on friday when I return to work. My gut is telling me that this is a confidence issue and that they are using the senior EMT as a "crutch". I have a plan in my head that I have come up with that I think I will implement and should be fair to them. If it doesn't work then I will be forced to contact our training coordinator with my concerns and see what they have to say.

As I mentioned, I have no intention to embarrass this trainee which is why I am kind of being vague. I know deep down they will be a good EMT. I am going to do everything I can and am allowed to do to make that happen.

Doubtful that it would effect your job prospects. Here we have waivers for workers that can't get required shots (usually used for Hep . I would be cautious with the MMR and maybe speak to your doctor about it. Maybe they have an alternative they can give you or something.

We have several EMT's at my company that have serious allergic reactions and several have had to use the onboard epi pen on themselves due to anaphylaxis.

Hey everybody. I am a student, i am from latvia, and now I am writing my diploma on the topic about geriatrics patient care on pre hospital period. Could someone help me, and tell about how often in your country your geriatric patients call you, and what the most problems do they have. Maybe you have some materials what I could use in my work, maybe some statistics about your country.

I would say probably 75% of my calls involve Geriatric patients. Of those I probably respond to some type of care facility probably 80% of the time. You don't really understand how many "old people" are around until you start responding for them.

It can be fun or frustrating to deal with them. I have had geriatric patients that were fun and talkative and I have had ones that cursed, were rude and made the drunk, belligerent college kids look tame in comparison. I have also had patients who were truly sick and tested my skills as an EMT and others who confided to me they were just lonely.

Sounds like a rough situation, I'm really sorry you're in it. My only suggestion would be to talk to their FTO who cleared them for the field. They aren't ready to be out there on their own it sounds like and I would want to know if this is new anxiety/fears or if the FTO didn't make them do night driving/mapping. Was their FTO shifts dayside? I would maybe start there. Good luck, I really hope you get it figured out.

Thats the problem, all FTO's are dayshift. I am trying to get my car to be a night time training car but unknown if that will happen. Every newhire will rotate through at least 3 FTO's before being cleared, but I can't go to them for help because it is confidential. They won't even officially confirm if they had this new hire.

Do you routinely perform learning style assessments and have resources for learning disabilities? This is not an uncommon issue I run into as instructor, and if we can identify learning issues we may be able to intervene and help people through the learning process.

I don't know if I am qualified to make that type of assessment. No we don't have resources for people with learning disabilities other than trying to find a FTO that will fit their needs. This particular individual seems pretty smart IMHO. I just think they have a difficulty translating the book world to the real world. During our new hire academy we go over mapping and they spend a lot of time on it, like several days. In fact it is one of just three tests that a new hire will take during the academy and it is the highest point value. Apparently this particular individual did excellent on the test.

The real problem is your employer has two main criteria for hiring A PULSE & A PATCH

not everyone who manages to get the patch is cut out to be employed in EMS.

If your noob can't cut it after FTO and a weeks worth of shifts as a driver. then it's time to have a come to jesus meeting with them away from the job. Ask them to stop & have a coffee after you get off shift. Explain to them your concerns and ask if there is something else you could do to help them improve.

Tell it like it is, they are headed in the wrong direction for continued employment with the empire.

Actually I would argue that we have a pulse and a patch requirement. We have a pretty difficult process to get hired here that starts with the application. We then do a pretty tough (I found it tougher than the NREMT test) pre employment exam. An interview and then pee test and physical fitness. Pass all that and you still may not be offered a job. Then you have to pass the new hire academy and FTO. For every opening we get hundreds of apps. Only 10 - 15 will make it to the academy. Is it as tough as a fire department? No, probably not. However, as far as private companies go I would say its a pretty stringent process.

I like your idea of a coming to jesus talk. I think I am going to have to resort to that.

I don't understand, is this just one EMT or multiple? Your first sentence states you were assigned a new EMT, then you go on to say "they" or "their"

This is one EMT. I am using "they" and "their" to protect their identity. I don't want to humiliate or embarass them if they are a member here or a lurker. I truly want this EMT to succeed and am trying to do everything in my power to make that happen, including seeking advice from this forum. Sorry about the confussion.

Need some advice here from some instructors / senior people. I was recently given a new EMT fresh out of FTO. Apparently they didn't comprehend everything in FTO and was assigned to me to help them out.

My partner can't seem to comprehend driving and navigation. Even using a GPS they constantly miss turns, don't know the names of major vital roads and don't know how to get from point A to point B.

When driving, they constantly drive under the speedlimit - even during priority driving. They stop at green lights to read the street signs, even though it is displayed on GPS. I got concerned enough that I asked how their night vision was (wears glasses at all times) and their reply was it was bad, even though their glasses are new. I work graves so this is can be bad.

To top it off they have difficulty lifting a stretcher with a patient into the ambulance. In fact I have never seen them successfully do it. We are currently using a spare which has a manual stretcher. Our normal rig has a power cot which is considerably heavier. If they can't lift a manual stretcher how can I expect them to lift a power cot with a patient on it? During FTO they would have used a power cot and a two person lift (which I don't do normally) but that isn't an option on a manual cot as someone as to lift the wheels. We do a pre employment physical fitness that includes dead lifting 142lbs and carrying it up some steps. They told me they barely passed the test.

I have FTO experience and I get that they are a rookie. I get that learning a large area like the Seattle Metro / King County area can be difficult. I get that driving an ambulance, especially in a large metro area at night, can be a scary and intimidating endeavor. I have lots of patience with rookies and enjoy seeing the improvements they make and their confidence grow. I had good trainers and I want to pass that on to the new rookies that are coming on.

I have tried explaining mapping and routing to them for the last 5 shifts. I have tried using other units' calls as tests to see if they could get there. I have tried to educate them on safe driving and the importance of maintaining speed limits, scanning ahead, etc. I have told them the importance of strength and that they have to be able to lift patients safely - I can't be expected to do it all. I just don't think they are getting it. It has been 5 shifts and I have seen minimal, if any, improvement. In fact, I think they might be regressing in some areas.

For those of you who are FTO's or Instructors, what would you do? I am at my wits end. It has gotten to the point that I can't trust them to drive to the hospital with me in back. What happens if I have a critical patient and I can't be looking ahead to see if they are going the right way? I am considering going to my supervisor with my concerns but I am worried that if I do they will be fired. I can see it in them that they will make an excellent EMT once they overcome this. I know its mostly confidence related. On the other hand, these are pretty serious shortcomings that could effect patient care. Maybe EMS isn't for them.

I don't want to give up on them, I really want to see them succeed. Does anyone have any advice or tips on what I can do to help them? Going back through FTO isn't an option, I think I am a last resort.

In light of the recent incident in Boston, are personnel justified in searching a patient's belongings. Scenario: EMS crew responds to a "street job" and the patient has a large backpack. The EMS crew could unintentionally escort a potential IED into a hospital behind normal hospital security procedures. Granted, after 19 years I'm no longer a field medic, but as I remember things NYPD does not respond to street sick calls in a timely fashion. In addition, EMS Crews don't routinely search patients belongings. Is this a valid concern?

I don't worry about it. Whats the point of worrying? If you worry they win. If you have any reason to be suspicious then do so, but being wary of every patient isn't going to accomplish anything, will lead to you becoming complacent. This is similar to our use of field oxygen. We teach students that every patient gets oxygen, whether they need it or not. We should be teaching them to look for the clinical signs that warrant its us.

The same thinking can be applied it provider safety. Instead of being suspicious of everyone we need to start teaching to recognize the "symptoms" of someone likely to cause us harm. I transport patient belongings all the time and have never been nervous.

Actions, words, clothing, markings, and surroundings will help determine if I should be nervous. We were given 5 senses for a reason, we need to know how to use all 5.

Bottom line, if your "gut feeling" says something isn't right then listen.

I wouldn't say they got tough conditions. Yes it is a war zone, but those are some of the best trained and best equipped medics on the planet. The training to be a PJ is 2 years. They are a part of the airforce but can be attached to other special forces teams regardless of branch.

http://en.wikipedia.org/wiki/United_States_Air_Force_Pararescue

Hello,

I am a student in California. Currently I am taking a work experience class. Through a series of career aptitude and personality tests, EMT is one of my prospective career matches. I am hoping that someone will be able to help me with an informational interview regarding being an EMT. I may be interested in enrolling in an EMT course next semester. Please help.

1. What sort of education do you have?

Police Academy, Biology, Anatomy and Physiology, Business Management, EMT school

2. What was your career path from college to present? Why did you

decide to follow this career path?

Became a police officer, got hurt went into the private sector. Ran my own Private Investigator business. Wasn't happy so followed my dream and went to EMT school. Now a full time EMT and happier than I have ever been in my life.

3. What are your basic duties performed during a typical day? Week?

Month? Do you have a set routine? What are the major job responsibilities?

Basic duties are all the same. Keep ambulance properly equipped and ready to respond. I start out the day by doing an ambulance check. Once I leave base I don't return until the end of my shift 12 hours later. Nothing is predictable about my day

4. How much variety is there on a day-to-day basis?

Every day is different. Every patient is different. I can respond to 5 flu patients for example and every one will have different needs and be a different challenge. Only thing predictable is the unpredictable nature of the job. Even though I am a basic, I have treated some very serious patients that in other systems would require paramedic level care. I have had stabbing victims, shooting victims, traumatic unresponsive, non traumatic unresponsive, anaphylaxsis, cardiac problems, etc. all in the back of my ambulance.

5. How many hours do you work?

I work 12 hours a day on a 3/4 split schedule. One week I work 3 days, next week I will work 4.

6. Does the typical EMT have a set schedule or are the hours

flexible?

This depends on where you work. At my company we employ over 400 EMT's and have a variety of schedules. We have 3/4 split, Spokane, 5 8's, 4 10's, 14 and 24 hour shifts. We also have part time and full time as well as full time float for the EMT's taking college courses.

7. Which skills do you feel are most important to acquire?

Assessment skills. You can't treat if you can't figure out what is wrong. Knowing your basics is the most important.

8. What types of technology are used and how are they used? How

often are changes made when it comes to new technologies?

Computers have made their way onto our ambulance. The ALS side of the field is experimenting with things like Ultrasound on board the ambulances. Various inventions have come around to ease the burden on the provider. In the field technology is very hard to implement. Despite all the advances in medical technology we still do things the old fashioned way. Most of the advances comes in the form of newer versions of similar products. For example, updates to the C collar.

9. What educational program do you recommend as preparation? What

kinds of courses are most valuable in order to gain skills necessary for

success in this occupation?

Biology, Anatomy and Algebra. If you can find one a medical terminology course.

10. What degree or certificate do employers look for? What kind of work/internship

experience would employers look for in a job applicant?

High School Diploma, State EMT Certification. Work experience not necessary

11. How can a person obtain this work experience?

Need your EMT certification, then volunteer or get hired.

12. What entry level positions are there?

They are all entry level. Some companies / departments want experience, however once you have your EMT cert you have met the minimum requirements no matter where you work. Whether you can do the job is dependent on individual person.

13. What steps besides meeting educational and experiential requirements are necessary

to "break into" this occupation?

Volunteer for Search and Rescue or a Fire Department. Work for a hospital

14. What are opportunities for advancement? To what position? Is an advanced degree

needed? (If so, in what discipline?)

Field training, Supervisor, Paramedic, RN or PA. Paramedic and above require advanced training

15. Is there a typical chain of command in the field?

We have Crew Chiefs, Supervisor, Ops Manager, General Manager

16. What are the different salary ranges?

EMT is not a highly paid career path. Though at my company we get decent pay, the majority of EMT's make minimum wage or slightly above.

17. What other kinds of workers frequently interact with this position?

Fire fighters, police officers, paramedics, nurses, doctors, flight teams, pilots

18. What are the main or most important personal characteristics for success in the

field?

Mentally stable, able to handle stress, critical thinking, friendly

19. What are the satisfying aspects of your work?

Getting to help people

20. What are the dissatisfying aspects of the work? Is this typical of the field?

Getting blood, poop, pee, vomit, etc on you. Dealing with violent patients. Seeing death. Having patients that you know you can't help.

21. How would you describe the atmosphere/culture of the work place?

Happy, fun, light hearted

22. Is there evidence of differential treatment between men and women EMTs with

respect to job duties, pay, and opportunities for advancement?

At my job no, I would assume in some areas though that there probably is.

23. What do you feel are the toughest types of problems and decisions that you must make?

Knowing that making the wrong decision can have a negative impact on patient.

24. What are the demands and frustrations that typically accompany this type of work?

What are the greatest pressures, strains or anxieties in the work?

See number 20

25. What do you know now which would have been helpful to know when you were a student?

Would have paid better attention in Biology

26. Any other important questions that I have not asked that would be helpful in learning

about the job or occupation?

Nope

Thank you for your time.

I'll play, hope it helps.

A $50 Stethoscope is considered a "Cheapo"

$30, $50, $75 or $300, use whatever works for you. However, it is not easy to press "lightly" while obtaining A bp. You usually have their arm tucked under yours, they are talking etc. Pressure is inevitable.

I do have a need for a Cardiology Stethoscope as I have a hearing deficiency . I couldn't hear breath sounds or obtain a BP with my $75 Littmann , I now have the Master Cardiology. No it is not a waste of money, and it was $210. I could not have continued in class without one.

I can hear their thoughts with it. lol

Very lucky, It is not easy to get a blood pressure cuff even near a 2year old.

"they" I put that in quotes because it has been said over and over and you hear it in class yadda yadda , that you are supposed to pull over to Auscultate , So I, with all my clinical work etc, choose to Palpate.

Observing and running with ALS units, they always Palpated also.. And it isnt common to get 120, most people being transported, are running 120. But whatever works for you, works, why not stick with it?

and Why dont you guys have a PEDs bag with a small stethoscope? Do you have special rigs you usually use for pediatrics?

$50 stethoscope cheap? Wow I want to work in your system if you think that is cheap, lol. If you have need for a Cardiology or other high end stethoscope then that is one thing, however if you are buying one just because "it looks cool" then it is a waste of money. At the basic level where we auscultate BP's and Lung sounds its not really necessary to go that high end. If I had to assess heart sounds our bowel sounds then yeah it might be different. You sound like you have a legitimate need for one, we have a bunch of EMTs that run around with the cardiology because it is "cool." Personally, I can think of better things to spend my money on.

I got two little girls myself, a 3yo and a 5yo. I am very good with pediatric patients and have never had an issue with assessing pediatrics. Never had a problem getting a bp from a pediatric.

We don't have specific pediatric bag because we don't deal with pediatrics that often. We do carry pediatric equipment though and part of that is pediatric stethoscope. I don't know where it disappeared to on my ambulance as I was using a spare. On my normal rig it hangs on the medic catcher. One of the reasons I hate spares is because people pilfer equipment out of them. When you have a fleet of approximately 100 ambulances just for our area, not hard to imagine some equipment running off. I informed my supervisor of this and they will order more. If patient was super critical I could have probably used my littmann or the dual head that is in our jump bag.

We do have dedicated ambulances for children though. We have two stationed at Seattle Childrens' Hospital both are specially designed for BLS and ALS transport of sick kids from newborn to young adult. We have a third one assigned to Swedish that is designed for NICU patients and has a special stretcher with its own Isolette.

I never have trouble hearing in the back of my rig. If you ever been in a Mercedes Sprinter, they are diesel but they are no louder than a standard car. I have no trouble hearing in them.

Just curious, what is your reason for rarely palpating blood pressures?

Why palpate when I can auscultate. We respond with the fire dept and fire usually "palpates" the BP on their initial assessment. However, I have come to find out that either the majority of the population has a bp of 120/p or quite a few of the Firefighters aren't accurately doing an assessment. I always redo an assessment when taking over patient care and usually prefer to auscultate.

That said I am not above palpating. I had a patient who was 2yo the other day. We don't carry a stethoscope that small so I palped the BP. If I am in a hurry due to patient needs I will palpated it as well.

So basically it is personal preference. I do compare the vitals I obtain with what we get at the hospital and I find that I am usually pretty accurate.

I can hear just as well in the back of the truck wit a $30 sprague as with my wife's master cardio II Littman.

It's an acquired skill thats takes time to learn.

When you start releasing the air from the cuff, palpate at the wrist and listen at the same time.

It may be a right brain skill that only lefties can do though:::

I find the cheapo stethoscopes hard to hear with. However my Littmann which is the $50 model is a dream. It might just boil down to the Littmann fitting my ear better though. I have no need for a Cardiology stethoscope but a few of our EMT's have them. Personally I wouldn't waste my money on a $150 scope.

Dang Lefty Show off

I can hear fine in most situations, but you get a loud whaaaaaabulance, and a crying patient, squawking radio, taking emts , I just palpate.

I don't like to palpate and I rarely do it. Only time I palpate is if patient condition warrants it or if I cannot auscultate. In the ambulance I just isolate the arm. We have Mercedes Sprinters though and even though they are diesel they are not noisy. I can still auscultate even in our old Ford type II's that we use for spares.

I think that the more important thing that the stethoscope side of things is knowing the anatomy and putting the diaphragm/bell right over the artery rather than just sticking it somewhere in the antecubital fossa. I strongly suggest taking the time to palpate the brachial artery to get this exactly right (and I do do this myself), but if you're not going to do that then you should at least know where the brachial artery lies. It is more medial rather than in the centre where many people seem to stick their stethoscopes before complaining about how it was such a difficult BP to obtain.

I am well aware of the anatomy and I too palpate the Brachial. However the patients that I had difficulty with were Bariatric patients and I wrongly assumed that pressing harder to get through the fat would make it easier to hear the BP. I was discussing this with a doctor because I was concerned about the difficulty I was having and he told me that my stethoscope had a tunable diaphram to pick up high and low frequencies. He had to take off before he could explain further.

If Korotkoff sounds are low frequency that would explain why pressing harder actually made it more difficult to hear. On one of the patients I was able to use a different stethoscope to hear - a dual head. I don't know what I did differently but I did something that made it so I could hear. The other patient I had to palpate the BP because I couldn't hear at all, I couldn't even palpate the Brachial.

It concerns me when I can't hear a BP which is why I asked this, because for those of us with tunable diaphrams knowing the frequency of the sounds were listening to effects how we hold the diaphram on the patient.