MikeEMT

This is the bag I keep in my car. It has some gloves, random band-aids / bandages, and then OTC meds. All that is for personal use. If I am across an accident I will break out the gloves and my iphone but that is about it. Maybe a 4x4 if they are bleeding all over. Why people carry these huge jump bags is beyond me.

OP: you are actually going to start an IV and fluids off duty?

Only thing is OTC meds need to be checked to ensure they are not expired. I never carry OTC meds in my kits because I will forget to check and they will be expired when I need them. If I need OTC meds I will buy the smallest quantity of travel size I can and carry those. That way I'm not likely to lose them to expiration.

no offense but it sounds like they are too lazy to do their own vitals. But don't fix it if it aint broke I guess.

Its not laziness. It works in our system and makes for an efficient way to get patients seen. Might not work for you, but works for us. The other hospitals don't take vitals until long after we leave otherwise they would probably have us do the same thing. I don't mind it and quite frankly gives me something to do as the driver instead of just standing there. I also like seeing how my vitals match up when I am teching.

Okay, seriously, WTF is a HEAR?

A HEAR is what we call our radio report to the ER. It stands for Hospital Emergency Alert Radio.

Maybe they do that rather than get a final set in the ambulance like the rest of us? Maybe someone came up with some wild only way to prove you dropped patient off at the ER? Never heard of it either so really grasping at straws.

Nope, we still need 2 sets in the ambo. Though with our short transport times that rarely happens and we can use that as our second set if we need to since we are still the ones taking it.

When you roll into Harborview triage is right in front of you. You hand your paperwork to registration if you have any otherwise they come and get the patients info. The driver will hook up the vitals tree and obtain a set of vitals while the tech talks to triage nurse. By the time the nurse is ready for vitals in their computer we have them completed. Bed is assigned, triage report given to us and we take patient to their bed. Total time from in the doors to bed is about 5 minutes. Of course unstable patients bypass this whole process and go directly to a bed with a trauma team waiting.

If ALS brings in an unstable patient they have called in a HEAR and Harborview will be ready. BLS doesn't call in HEAR's to Harborview (their orders not ours). If we roll in with an unstable patient the nurse will either recognize it by the condition or we will shout it out. They send us straight to a bed and page the appropriate team to respond.

Its a very efficient process and if you ever get to Harborview should observe it. Not sure if it would work for other systems as it requires team work from the BLS level all the way up to the dr's. They've been doing this for years so its ingrained into our system.

We don't have any lengthy wait times at any of our ER's. I guess we are lucky.

@Mike-Why do you get a set of vitals at the ER and why are you waiting for a vital tree? I have never gotten a set of vitals in the ER for someone I'm bringing in...Just curious.

It is University of Washington policy. When we roll into Harborview (which is part of UW) or UW Medical Center, the triage nurse requires us to take vitals for them. UWMC is a little more lienent than Harborview. UWMC we do it more as a courtesy, Harborview wont even look at our patient until we have vitals.

That said, they use common sense. If patient is critical they get a room right away and don't have to wait for vitals. Patient care is never compromised for us to get vitals.

Its a pretty efficient process with a lot ongoing all at once that gets the patient into their room quickly.

5 minutes is my longest wait time. We roll in and usually are immediately seen. At most of our hospitals we have to give a HEAR so they know we are coming. At Harborview no HEAR is required but they Triage the patient as soon as we roll in. Usually the delay comes from waiting for someone to clear the vitals tree so I can get a set of vitals.

I had one 20 minute wait once but that was because the room they had for us wasn't clean.

This is what I have only I got the prefilled one: http://www.buyemp.com/product/l-a-rescue-first-call-in-bag1 I got it for graduation from EMT school as a gift.

It stays in my closet and is used only for family emergencies. It gets carried when I go ATV riding or hunting since it can be hours for EMS to arrive on scene.

I have a store bought standard first aid kit in all my vehicles. The only "extra" equipment I have added is extra 4x4's. 2 4x4's aren't going to do much. I did add more gloves too, mainly because I prefer Nitrle to Latex and what can I say I like gloves that fit too.

I don't believe in stopping and helping like a "ricky rescue". If I see a medical emergency happen in front of me my phone can call 911. If there is life threatening bleeding I can apply pressure. Cardiac Arrest I can do bystander CPR.

To the OP, holy whacktastic. I don't know of any areas where you can start an IV with out medical control oversight.

http://www.livescience.com/22860-diabetes-blood-test-biosensor-tears-saliva-nsf-ria.html

Looks like the US is on its way to provide a saliva / fluid BGL test. While the article only talks about strip development and not its practical development, it is a sign that research is ongoing in this country.

8 hospitals in City of Seattle all with inpatient psych facilities. Several dedicated psych facilities as well including Navos which is a secure in patient facility used by the courts.

Psych patient - assuming none of the ER's are on psych divert they go to the closest or most appropriate facility. I usually take the to Harborview though they like to go on psych divert. They have the largest psych unit though and staff MHP's 24/7.

Other hospitals usually get pissed off because I don't automatically use restraints. I only use them if I feel I can't control a patient. Because I used to be a cop, there aren't many patients I can't handle. If my partner is nervous about a patient I will put the patient in restraints.

If you need to carry something on your person or your car your service should provide it. You want me to respond off duty you provide me what I need. There is no reason for a person to have to buy their own equipment. Not talking about some awesome toy I mean tool that is not a real need for anyone but actual supplies and tools that are actually needed.

Not every department can afford to pay for all the equipment. I know of several volunteer fire departments that require their members to pay for their own bunker gear. Some departments may require you to purchase your own medical kit due to budget constraints. However, they should still provide you a list of what you need to have most of which can probably be replenished at local ER's.

I honestly agree with gaining experience prior to going into Paramedic. Paramedic might be easier on paper, but there are practical skills that would come easier to you if you have experience. Just my two cents.

I like the idea of us Basics learning EKG. EKG interests me a lot. Especially since in my system I am routinely given patients that in any other system would be ALS. I don't carry a 12 lead, but I am often given strips by paramedics or RN's to be given to other facilities, etc. Be nice to know what I am looking at and what I could expect. But, this and pharmacology are two things that really interest me.

I would like to take an ACLS course but I don't think they are offered to basics around here mainly because our protocols are different from the rest of the country.

First off remember what you are - a MFR. You are essentially a first aider allowed to use oxygen. I don't want to minimize MFR's they are important but you need to remember your place. As an EMT my place is below that of a medic.

Regarding "kits" you don't need one, simple as that. If you are working for an agency or a dept then they will either provide you a kit or will provide you with the requirements of what you need to carry. The problem with EMS is there is a lot of useless equipment out there that is overpriced just because it is EMS equipment. OB kits come to mind. How many kids are born - even today - with nothing more than bath towels rather than fancy absorbtion pads.

I will be honest, I have a "kit" that was given to me as a graduation present. It sits in my closet because I don't need to carry it. When I do carry it are the times when I go hunting or quading due to how far away from help I am. It is used to help my family and friends and has nothing fancy in it. I never ID myself as an EMT when off duty and I don't stop at accidents to help out. My "help" is in the form of grabbing my cell phone and calling 911.

Realistically, all you need is a basic over the counter first aid kit with maybe more bandages added to it.

I wasn't even aware MFR's were allowed to use OPA's and NPA's.

The semen was in her vaginal area I think. The nurse was having trouble placing a foley because of it. I'm not sure what is not to buy out of the story.

It sounds like a crappy situation where the EMS provider will lose regardless of what actions are taken. We have to report all possible rapes in my area to local deputies. That might be an option...or maybe CPS?

I think I need to go back to bed, I completely missed that it was a folely. For some reason I thought the nurse was doing an airway. Wow, how did I get those mixed up?

Anyway, I still have reservations about this story. Maybe its because the author chose to post annoymous, maybe its the utterances made by the nurse, or maybe its just my skeptical nature.

I don't know any doctor who would complain about the work, especially when the victim is a child.

Sorry, just my opinion.

Anyway, my advice is simple: you didn't put the patient in the situation. Any help is better than no help.

Hmmm....I got some opinions about this "call". I have seen my share sexual assault victims and have never heard of doctors having trouble with airway because of semen in the throat. I also don't know too many doctors who would take a look and be able to immediately recognize what they were looking at.

There are specific tests and procedures in place for a sexual assault victim. Making utterances about what a nurse or doctor is seeing is going to lead to legal trouble.

Sorry but I am not buying this story. Too many inconsistentcies to me.

I can't believe EMT's still take CPR classes. We have to recertify every quarter under county protocol. But then again we don't do AHA CPR we do our own variant (no real difference on the BLS side other than at the AED). Got to love being in an AHA research area.

I would have thought that EMT's would recertify for CPR under their CBT's.

Our certification requirements are minimum 5 minutes of active CPR with 2 AED shocks and 98% effective compressions and respirations.

It allows this site to be located in the search engines. Something to do with tagging or something like that.

Sounds like he is going into shock. Spontaneous GI bleed? Internal Bleeding? Any Recent surgery?

Is he Anemic? Is he African American (Sickle Cell)? Toxic Shock?

Though the symptoms don't match up a muscle strain can cause diarrhea if the diarrhea was bad enough could possibly cause the other signs and symptoms. Doesn't explain the dizziness though.

Heat stroke?

I'm guessing here now

I would say gastroenteritis. He was just jogging so that could explain his RR and HR findings...especially if he is new to jogging.

I want to ask what supplements is he taking. What does his diet consist of? How often does he rehydrate?

You said he had explosive diarrhea, how much was there? That could explain the low BP since he is losing fluid.

Did pain subside after BM?

Maybe, however the point is that military style assult weapons have NO place in the general community..I own guns, I live in a rural area and abide by the laws that allow me to own them. Assult weapons are not used for "hunting" and most responsible people would agree with that.

Yes we do need to control the 'person', but we also need to control the óbject'.

"People say what if they had a knife?'' Trouble with that statement is that a knife cannot kill 30 people in one go from 50 feet, thent o be reloaded and then kill andother 30..........

Take the most lethal available weapon away from the 'mentally disturbed' and then there will be no easy way for them to ''go postal' (another great American term, that derives from these type of events) if they do not have the access to these style of weapons (assult weapons)

at the time the Australian Governemnt implemented the new gun control laws here in 1990's I was apprehensive and alarmed, but see the good it has done in both my role as an emergency service worker and a avid shooter.

So yes control the person, get better mental health services, but also control the tool that can cause this high number of deaths.

we can do some thing to prevent this, and we can do things to minimise these results..........no one is advocating that you dont own a gun, what they are saying is why does ''joe public" need assult weapons? Why do you not have a better way of recording where these weapons are? do all people that own firearms have them secured in a way that is safe storage (a locked gun safe, with the ammo separate)......

Do this and you can move forward to preventing things like what happened in Conneticut.

Actually a knife is more dangerous than a gun. Many mass murders have occurred with edged weapons.

I don't agree with gun control. People focus on guns because of the media. However guns are not the problem. There are far less crimes and homicides committed with guns than other weapons. Why should I be punished because of some dumbass criminal?

People die every day in car crashes. Many of those result in a Vehicular Homicide charge. Should our cars be banned because some idiot kills innocent people with a vehicle? Should I ban knives because people get stabbed to death?

A gun has never killed a person. It is nothing but a hunk of steel. It has no brain, no life of its own. It cannot make decisions on its own. It takes a person to make a choice. A person must choose to use a gun in anger. A person must aim the gun and pull the trigger. It is the person we need to control.

Plea bargains', good time, consecutive sentences, etc. must be abolished. In the 1800's our prisons were hard. There was no tv, radio, books or leisure time. Prison was an 8x10 cell with a bed and a bucket for bathroom use. If you weren't in your cell reflecting on your crimes, you were out in the yard doing hard labor or on a chain gang.

The ACLU, NAACP and other so called "civil rights" organizations have turned our society into a bunch of sissy, politically correct crybabies. Commit a crime and you should be punished.

Mass murders have always happened and always will. They occur every day somewhere in this world. We must remember that Evil exists and sometimes there is nothing you can do to prevent it. Wars have been fought over this.

The only way to overcome evil is to embrace the good that is in life.

Verbalizing is always a tough one to remember, especially with students that get test anxiety. It happens to me.

I find myself in a very unusual position now as a prehospital EMS Educator, and also as an EMT student once again. It has been over 20 years since I was an EMT student for the first time, and all of those nerves and jitters are back again.

I remember the first time during the finals testing week, I was on the verge of an anxiety attack for the whole week. And not so fond memories of that weeks experiences are once again bringing back the same anxiety as I get closer to my own finals week in February.

One of the biggest problems I had the first time around was forgetting to verbalize everything. I was so busy concentrating on making sure I remembered to do everything correctly and not screw up, that the pathway from my brain to my mouth stopped working, lol. My biggest fear is that it will happen all over again.

Remaining calm during testing is key, and unfortunately for a lot of people, that is the hardest thing to do.

One word of advice, never let your certification lapse. Even if you don't plan on using it for a while, keep up with your CEH's. Otherwise you may just find yourself back in EMT school 20 years later trying to remember how to be a student once again.

Verbalizing can be difficult. We are used to it because even in the field we verbalize our CPR. Our AED's record so when the Medics arrive they will find us talking to the AED as if it were a doctor. Looks funny but the CPR team will listen to the recordings. Since we re-certify quarterly it becomes second nature and it carries over.

Our instructors told us we need to either see you do it or hear that you did it.

So, after a less than stellar performance by a crew the other day I was reflecting on what happened and wanted to share (as much as HIPAA allows) to help others not make the same mistakes. Feel free to make this go both ways as it can be educational for EMS/RNs/MDs/DOs. The purpose is NOT to bash but to learn from others mistakes. Think of it as an unofficial M&M conference.

Paramedic "I'm not sure if the tube is in right."

60s y/o male who coded in front of family. FD first responders did CPR for a minute and got a pulse back. Upon EMS arrival, pt was still unconscious and they were able to drop a tube. 15 minutes out from the hospital the pt goes into arrest again. Asystole upon arrival at the ER. We hear a whooshing sound when we are bagging. At this point the paramedic makes the above comment. Take a look and the balloon is sitting in the back of the throat. Pt pronounced shortly after arrival.

Take home point: If you are not sure the tube is good, make it good or get it out. NEVER have a questionable tube.

Probably a stupid question but could improper tube placement cause the asystole or was that caused by other underlying problems? Obviously it could impact respirations.

This applies to more than just tubes. If your going to do anything - do it properly and don't half-ass it.

www.emergencysafetyacademy.org

that did not show up on my google search even though i typed that in. I got a lot of hits for fire and police academies. I figured I would miss a web page or something though.

Don't take this as a bash - my intent is to help you improve your organization.

I have to admit I am not impressed. You are asking for public safety equipment so naturally I did some research into your organization (sorry the suspiciousness has carried over from my cop days). Anyway, what I found was unimpressive to say the least. There is very little information out there to support that you are a legitimate organization.

I was able to locate your facebook page and looked it over. I didn't see any information concerning ownership, company headquarters, licensing, etc. I will admit I didn't look all that hard as I didn't have the time so its possible I missed it.

I applaud educating youth in first aid and fire safety. However most school districts do teach this already. What makes you different? Showing off "advanced" equipment is nice but unnecessary. Additionally, it poses no benefit to someone learning basic first aid or fire safety. A first aider will never use a c-collar nor will the average person need to be familiar with an SCBA.

My suggestion to you is become accredited with the American Heart Association. File your non-profit paperwork with the state and obtain a license (required by law to display the status on all advertising). The NFPA and CDC have fire safety education in place for youth. Contact them and obtain their curriculum. Teach to accepted standards.

My one complaint is the photo on Facebook of the boyscout giving mouth to mouth to the little girl. For starters I understand the photo was staged, but just seems inappropriate to me. Where is the water safety? Why is the "rescuer" not practicing water safety. There is a reason we don't do CPR at pool's edge - one wrong move and were in the water. The photo is contradictory to what I want to teach concerning water safety. My opinion only.

In this post 9/11 society, giving away equipment is typically frowned upon. Additionally, most equipment has a fixed life expectancy and needs to be disposed of. Equipment such as c-collars, backboards, splints, etc. can lead to injury if used incorrectly.

If you are serious about teaching proper first aid and fire safety then you need the proper equipment. PPE, a collection of bandages and basic splints (i.e. SAM or cardboard) and CPR masks are all you need - basically what you would find in a over the counter first aid kit. For fire safety a working fire extinguisher and maybe demo smoke alarms are all that you need. Everything else is overkill.

Again, not intending to bash you or your organization so please don't take it that way.

Good luck.

Thank you for the replies so far. When I posted this topic I was expecting a very basic answer. The airway seems like a very simplistic structure. I am continually amazed at how complex our systems really are and what difficulties it presents in the prehospital environment.

The more I learn, the more unsatisfied I become and the more I want to keep learning. One of the best things I like about this profession is how easy it is for us learn from different people and disciplines.

I wish I would have gotten to know you better. I have read some of your posts and I feel that you may have a lot of wisdom to pass on to us "young bucks" yet. Sometimes the best teachers are those that have answered the same question a million times.

I have owned a business and it is extremely difficult. My business failed because I couldn't devote my full time and attention to it (what can I say my EMT was more important to me). That said, the best advice I can give you is don't let your business consume you. Be dedicated and work hard but remember to take time for yourself and your family and friends. A successful business is no good if you have no one to share it with. Likewise, a business can't become successful or grow if you are burned out. That will reflect negatively with your customers.

I wish you the utmost success.