MikeEMT

Confidence was my problem as well. Big difference between a pretend patient and a real patient.

What helped me was the critical patients I have been given that in all honesty should have probably been ALS.

First one unresponsive head injury with right eye drift.

Second, Unknown ALOC that I suspected was Hypoglycemia (and I was correct)

Third, Anaphalaxis that resulted in me giving Epi-pen.

Fourth, stab wound to thorastic cavity patient A&Ox4 and initally unaware had been stabbed.

When you get patients like these and you successfully manage them and get them to the ER then a case of abdominal pain just doesn't seem as difficult as it once was.

I don't want to minimize any call because the "minor" ones can turn out to be very serious. You will find though that when you successfully manage more serious calls, the other calls just flow better.

Confidence comes with scene time and dealing with patients. I would hope that you would be getting feedback from doctors and nurses as well.

I don't have a lot of time to get into detail here. But don't fool yourself thinking that it is simply functionality separating a skill between paramedics and EMTs.

I'll expand later when I have a little more time.

I am assuming there is more to it than what I know which is why I asked. The other day I transported a patient that had been tubed. This was an airlift patient and was on a ventilator. I didn't have time to ask the RN's (transport was less than 3/10 of a mile).

When I did my clinical at harborview, i was given the opportunity to watch an intubation but missed it due to another patient coming into the ER.

I enjoy learning and am never content with just the minimum skills. If I can develop a basic understanding of some of the stuff outside my scope of practice maybe it will help me in the field. Example here is the advanced airway. We don't drop the tubes as Basics but we do ventilate the patient once the tubes are in place.

Thanks for the replies so far. Very helpful.

Yeah Mike, a lot of times there is animosity between LEO's and Ems and vice versa. That animosity I would hope ends when either one needs the other in an emergency.

The info you gave above is pretty cool.

I was driving in Little Rock the other day and I saw the strangest thing on a police car. ON the front end hood and the back of the car were about 10 cameras mounted pointed towards the ground. Do you or anyone out there know what those cameras are for? I was told that was so they could run every license on the road without having to call it each in to dispatch. that it was a pilot project at certain departments.

Any ideas Mike?

You are correct, they are license plate cameras. They can scan about 1000 plates a minute and will alert if the car is stolen or the Registered Owner has a warrant.

I personally don't like them. I think it is a distraction and poses a risk to the officer. If they attracted your attention then they attracted others attention. With people demanding more privacy (sometimes using violence to get it) it can make some people target the officer. In addition some departments don't use common sense when mounting them on the vehicle.

I didn't like anything mounted on my car though. I wouldn't even let them mount a radar unit on my car. Just picky that way I guess.

I love that you're sharing this in the thread instead of privately....really cool Mike...

I got no problems sharing what I know with people who are interested. The first half of my career was spent in law enforcement. While this is an EMS website - if I can help people, especially those who work with cops, understand a little more maybe it could help in some form of our jobs.

State of WA uses the NR test but is not a NR state.

So can someone explain to me the differences between the blind insertion airways (i.e. combitube, King) and an actual endotracheal tube?

As a basic we can do the combitube but obviously can't intubate. I have heard that combitubes are not to be used for long term airway support.

Looking at them they look pretty much identical to me (other than the fact that combitubes are dual lumen).

I know there has to be some differences in functionality otherwise intubation would be a basic skill. So what exactly makes an ET tube different from a combitube?

Elementary question, but one that I have been curious about.

I think the problem with City is that the forum is old and tired looking. I find the main page to be really cluttered and quite frankly annoying. Personally, I like forums that use the software like Life uses. I like being able to hover my cursor over a thread and get a preview of what the thread is about to see if it is worth my time reading. I think if City would update its look and software it might find an increase in traffic.

Another draw back is that a lot of the topics are ALS oriented and there are a lot more BLS providers out there than ALS. While I enjoy reading and learning ALS stuff, the moderators should separate the two. Nothing worse than clicking on a topic that could apply to anyone (i.e. blood glucose levels) only to find the topic has to do with IV's or other ALS interventions.

I enjoy the scenarios but I personally think when a scenario is posted the ALS providers on the board should keep in mind that there are BLS providers here and to not necessarily jump into ALS interventions. Nothing worse that clicking on a scenario only to have the first replies being Medics saying "I would start an IV with..." and "I am going to drop a tube into the patient...".

Ultimately, life may get more traffic but as users realize what a cliquish group they are they will make their way over here.

I finished law enforcement training in '91. Due to an injury I sustained in an attempted escape from the detention facility I worked in, my career was over before it began.

In '91 there were no computers in the squads, officers carried hand-held radios, and no one carried cell phones. Would you be willing to explain how all that works these days?

Computers in the squads (called MCT's or MDT's) are used for multiple uses. Typically the "Home Screen" will be the CAD (Computer Aided Dispatch) page. This will show all of the units working, what calls they are on and what calls are pending. This allows officers to "self dispatch" and not wait for a dispatcher to send the call. I would also be able to look up details of a call that I am on or interested in. I can look up history of the call (i.e. how many times have we been to this residence in the past). I can run license plates while I am out on patrol to see if a driver has warrants or if the car is stolen. When on a traffic stop I can check the status of their license. I can also run people for warrants in general. Back in '91 officers had access to all of this information you just had to get it from a dispatcher.

Radios are now going digital which makes them more secure and reliable. Cell phones are used to call people what my old department called a phone detail. Not every "victim" requires in person contact. Sometimes a phone call is all it takes. With smartphones some departments are integrating their MCT's into the phone as well. This makes it really useful for bike or foot patrols and gives them the same capabilities as their vehicle counterparts.

What state agency oversees EMS? For me it is the Dept. of Health. If it were me my first stop would be the Dept of Health website to look at the requirements to be an EMR. As an instructor you will be teaching them to state or national standards so they can pass their tests. The state should give you a good idea of what you need to teach.

I think I am the only ex cop who regularly posts here.

While we can try to answer your questions it is difficult as things vary from location to location. Protocols dictate what we can and can't do.

In life, my friend, there are certain criticisms that you should take to heart, and that in turn will make you a better person.

Those criticism coming from the slight minded administrations of the (popular with the EMS personnel, namely from New Jersey) web forum, "EMT Life", are not the ones I speak of.

Let us take a journey. Ok, lets not. But sometimes people do better with analogies.

EMT Life is to EMS, what the Westboro Baptist Church is to... everyone that is not 100% in denial as to what is happening above the rock they reside under. We'll never know, because I'm sure they would ban them, as well as God, for religious views.

Let us pray for the souls of those on EMT Life. May the fires of hell and damnation rain down upon you, for all the days of your life, and you rot in the pits of hell, forever and ever.. Amen.

Yes, the banned the good doctor. EMS Nazi's

Now that just made my night

Blowing intersections or trying to be a race car driver does not benefit anyone and actually harms many.

Your right...I got the same message from the video, that and wear your seatbelt.

For testing purposes go by what the book says. The real world is much different and if you tried to copy what we do in the field you would fail.

I have never heard of the "box method" before. I am assuming they are referring to crossing the straps across the chest to better secure the patient.

We use whatever Seattle Fire Dept has attached to their boards at the time. They want us using their boards and their equipment so that is what we do. Sometimes they have 6 straps attached, other times they have a spider strap. We train and practice in both.

Best advice I will give you for testing purposes is always check CMS before and after.

The testing sounds stressful but in reality shouldn't cause you to worry. You should have a copy of the critical fails that you can review. Don't do those and you will be fine. Remember to verbalize.

Strange that the Seattle Fire Dept. would make a safety video based on a collision that occured in North Carolina. An interesting watch nonetheless.

Seattle Fire is in the process of switching to all tiller rigs for their ladders. My assumption is this video was made by them with the intent that it was to be used for inhouse training and someone leaked it to Youtube.

AMR created a similar video about one of their Paramedics in NY that was killed back in 2001 responding to a call and he blew an intersection. The Josh Hanson video is one we have to watch in EVOC and its eye opening.

This is a good video.

I post both here and on emtlife.

My guess would be the OP got banned because his website is seen as competition, or something along those lines, although that's a complete guess. The questions he was asking where a bit odd at first glance, but that's no big deal.

In all honesty I post far more there than I do here. This despite the very high number of moderators, unfairly and arbitrarily enforced rules, "family friendly" motiff, multiple instances of hero-worship among posters, and, just guessing here, a higher rate of posers.

So why do I post more there? Simple...it's far, far busier than here.

Sad but true.

(add in that the city seems to be coddling people more and more...unfortunate)

I agree with you about Life being busier. Like you I post there far more than I do here. That said there is something about quantity vs quality.

While I have had some worthwhile discussions over there it is mostly a "busy" site. I come here for more indepth and far more mature conversations.

My numbers here are less because I put more thought and care into what I post here. There is a topic here called "My second ride along" in which several members disagreed with my viewpoint. While they are entitled to that even the disagreements were thought out and mature. I have no doubt that if it would have been over at Life I can almost guarantee you that the topic would have deteriorated to name calling and would have been locked.

EMTLife is entertainment and gossip. EMTCity is maturity. There are good people on both sites but Life is definately the immature, juvenile of the sites.

I do wish City was a busier site though as I would rather be here.

I am on that site as well and I received a warning for calling someone a "troll" yet in another topic a female user calls me a Jerk and nothing happens.

I respect moderators and the site rules of all the forums I belong too. If your going to have moderators you need to enforce the rules fairly. I have come to the conclusion that "the other site" is a giant clique.

I have never seen a forum allow its members to vote on who should be a moderator (or as they call them "community leader").

There are a lot of intelligent people on that site but I think the cliquish behavior ruins it.

I have had my share of disagreements with people on this site and I can honestly tell you that I feel more comfortable and welcomed here than I do over at the other site. I think the membership here tends to realize that we are all individuals and right or wrong were not always going to agree.

I spent a lot of time lurking here before becoming a member and I can tell you that after reading a lot of the older posts there seem to be very few "banned" members by comparison to other sites.

As long as you don't create multiple accounts and are respectful of others opinions you should do fine here.

Welcome.

AHA is a national standard...and you dont follow it?? I guess the science is invalid in Washington....And I thought NY was backwards in some things.

I allow basic students to do whatever they can...splinting, bandaging, vital signs, administering aspirin or albuterol. If they have been taught how in class, then I let them do it in the field. If they arent comfortable then I do it and they can observe. The only way to learn is to do in this field and most people in the basic class have never had any kind of contact with this kind of work. Never had real contact with trauma or critically ill patients. So why not let them practice taking vital signs on Gramma who stubbed her toe? I've had nursing students and medic students flip the f**& out in the back of my ambulance because they are completely unprepared to deal with patients on the streets and I had to make the driver pull over and put them in the front seat. I just don't see why basic EMT students cant do what they have been trained in class to do. Its one thing to put a traction splint on a leg that isnt fractured in class...quite another to actually see the effects of a fractured femur and the relief that the traction splint gives in the field.

To the OP...if you really want to do what you have been taught in class, then you need to be more aggressive in asking the crew you are riding with for the opportunity. Be a go-getter and be unafraid when asking...even if your scared shitless. The best advice I ever got in medic school was this...be the duck, smooth on the surface and paddling like hell underneath. Dont let 'em see you sweat.

Good luck to you and I hope you are able to get some practice in.

We don't follow AHA because we are a research area. We are conducting different methods of CPR to figure out what works better. Not a whole lot of difference at the BLS level moreso at the ALS level. Where do you think AHA gets their facts? You think they just pull them out of their butt? They get their information by reviewing peer provided documents and making recommendations based on what works.

I said it once already and I'll say it again. WA does not recognize EMT Students. Our clinicals are meant to observe not go hands on. If a provider, RN, or Doctor chooses to let the student go hands on then that is at their risk and discretion.

There was a couple of EMT students doing their clinicals at Harborview a couple of years ago, back when they let them go hands on. The students moved a patient and ended up breaking the patients neck. Now students don't touch.

When you are hired and on FTO then that is your handson time.

Who's arguing for free reign in the back of an ambulance? That's where the preceptor's role of supervision comes into play. Fail to supervise a student and a preceptor should be fired.

Then you do not deserve to be a preceptor. If you currently are one, please, for the sake of your students, step down. You are only standing in the way of them taking care of people

We aren't talking about FTO type situations.

It's you protecting you. If you were properly supervising their activities and intervening when necessary you would be protecting them and your patient. By refusing them anything more than observation you are doing them, and any future patient they may encounter, a HUGE disservice.

Liable for what? You failing to be an attentive preceptor? You failing to intervene if necessary? You failing to teach? Any subsequent lawsuit won't come after a student. There's no money there. They'll come after you and your employer. So this goes back to you protecting you.

I'm not talking about ALS vs BLS. This is a BLS oriented discussion. So we're talking BLS.

I have no idea if you are a preceptor or not. I'm inclined to think not. So any "you" reference was a general reference and not you individually.

No I am not a preceptor. I fail to see how my opinion is a hinderance to a students education. Just because I won't let them touch my patient makes me a bad teacher? I'm not calling you a bad medic because of your differing opinion so at least show me the same courtesy. You don't have to agree with me, but my differing opinions don't make me a bad teacher.

I have been an FTO when I was a cop. I am new to the EMS game but I have already helped out several EMT students. I have even gone as far as to let the students observe me when they are on Clinical. I don't claim to have all the answers, but I will go above and beyond to help someone learn. Whether that person is a fellow EMT, Student or even patient / citizen that is just curious.

Maybe where you live things are different. Here, EMT students aren't allowed to touch patients. Harborview doesn't allow it, neither do we.

I think you have mis interpreted what I was saying. If you were a student on my ambulance, as a general rule I am not letting you touch my patient. That said if I trusted you, you showed a reasonable level of competence, and the patient was ok with it I might let you take a set of vitals. The rule though is you don't touch the patient. If its CPR I have no problem with letting a student do compressions if they wish - though we don't do CPR like is taught by AHA so that could pose a problem.

I don't know why it is such a difficult concept to grasp. I feel as if I am going in circles with this.

So, I will conclude my opinion with the following. To the OP, your role as student is to learn. Ask questions when appropriate. Take notes if you need to (never in front of a patient though). If you are allowed to do something then follow instructions. Don't go on your ride expecting to do something other than observe. If you do get hands on time, consider yourself lucky. Treasure any hands time you may receive and don't get upset by critisizm. Remember, school is nothing like the field - your real education begins when you enter the field.

Good luck.

This is where you and I disagree. I fully believe that students should be involved in patient care to the extent (and this is the caveat) to the extent of the person watching over them or in charge of them felt comfortable with them doing what they allowed them to do.

Let me ask you this, how do you think medic students get their skills checked off? They are students and by your reasoning they should not be involved in patient care so there is no way in your reasoning that they should be able to get their skills checked off. Right? So if they are not involved in patient care then how do you expect that medic student to get any of their skills or assessment skills checked off which is a critical part of their paramedic curriculum completed?

Again, I'm just asking the question, not jumpin on you. I'm just trying to see how you expect for medic students to get their skills checked off?????

I disagree with your premise but don't disagree with you having that premise.

Big difference between Medic students and EMT students. Most Medic students already have their EMT cert for entry into the program. Medic students tend to work more under the supervision of a doctor during their clinical time.

EMT students are usually entry level and are obtaining their first job in the healthcare field. Here in WA, an EMT student isn't allowed to practice.

As I stated, if I feel comfortable with the student, they have demonstrated a reasonable level of competency and the patient is stable with good vitals then maybe I will let them take a Blood Pressure. If I hear a strange lung sound maybe I will let the student listen so they can hear it too.

EMT students shouldn't have the expectation that they are going to be a "3rd provider" on the rig though. The expectation I have is that they are there to learn and observe.

I was a student myself a few months ago. I know how hard it is to get comfortable with your skills. But as a student you are an observer, not a provider. Many hospitals won't even allow students in the room to hear the Short.

Students haven't taken HIPPA, many of them aren't aware of local protocols or privacy issues.

Student Ride outs are designed to give the student a real world look into our field. See how equipment really works and how an ambulance is really set up. Once they get hired their FTO program will give them the hands on experience they need.

Medic programs are different and usually are under the immediate direction of a doctor which gives the student a little more legal protection. Basic programs are usually college programs under the direction of a college which offers no more legal protection than a standard good samaritan law. In fact many programs around me make the student sign a form that says they are to not practice what they learn until hired, may not refer themselves as an EMT and will hold harmless the institution should they violate any of that.

BLS and ALS is two different worlds.

If you aren't willing to let students learn then don't accept students.

Students are there for exposure, for practice, for experience. Failing to allow any of that means you are a poor preceptor/instructor. So what if your name goes on the chart? Did you not observe the student? Did you not supervise? Did you not step in immediately if they were making a mistake?

Some students need more guidance and teaching than others. They do not need preceptors who are too afraid of themselves to let anyone else get involved.

Guidance and teaching isn't necessarily giving a student free reign in the back of an ambulance.

Me personally, I would be more than happy to explain anything the student wanted. It is very doubtful that I would let and EMT Basic student touch my patient though.

Now if this was an FTO type of situation then that would be different.

Its not me being a jerk or not wanting them to learn, its me protecting them. WA doesn't recognize students and they could be held liable.

As I said in my above post, big difference between a BLS student and an ALS student. Different legal protections, different requirements.

So Mike did you get any hands on experience when you were doing you ride time?

Why do you think that students are in class and doing ride time? You are there to evaluate them, you are there to help them on a real world patient. If you don't trust them then you should not have them on your truck.

I'm having a little bit of a hard time understanding why you are precepting students. That's what preceptors do, they help students with their skills.

I'm not bashing you because it's your prerogitive to not let them touch your patient but they have to learn it sometime.

Does your service just put students with you and that's it. If so that's a shame.

But I will tell you this.When and if you go to medic school you will be expected to perform skills and get them checked off, what happens if you get a medic preceptor who thinks like you "i'm not going to let them touch my patient because my name is attached to that patient so they can't touch them so all this medic student gets to do on this shift is sit back and observe" How are you going to feel?

If you are truly observant of the student doing the skill on the patient and not just letting them do the skill then you can stop them when they begin to do it wrong. You also inform the patient that this is the student doing the skill and is it ok for the student to do it. The patient can say no or yes.

Frankly Mike, I'm disappointed in your response. Every preceptor I had when I was going through both EMT rides and Medic rides allowed me to perform whatever skills I had been trained on in class.

But you are entitled to your position and I'm not busting your balls about that position, just disappointed is all.

I'm not saying that they be able to do all the skills that you do as an emt on a regular basis but come on, EMT skills are not rocket science in the knowledge it takes to do so. How much knowledge does it take to put a couple of 4x4's on a wound and then wrap it with some kling?

But you should be showing them how to put on a splint and allowing them to help. Not just letting them observe. I'm sure they've done it dozens of times in the classroom setting.

Putting on a hare traction splint, that takes two or more people to do, why not get them involved in putting it on.

Not allowing them to get in and help and just making them observe is to me just tanatmount to a wasted 12 hour shift.

If you need to have them prove to you that they can do the skill before they get to do it in the field under your supervision, that's great, but to refuse to let them touch your patient except for lung sounds or a second set of vitals, is just silly.

I don't train students, I'm just off of FTO myself. We didn't do ride alongs we went to Harborview for our Clinical time. We weren't allowed to touch patients unless we were under direct supervision of a MD or RN. Even then it was limited to positioning patients. I helped log roll a patient and man were those doctors nervous - even though its a teaching hospital.

The point I am trying to make is I hear students all the time saying they are going for a ride along and you hear their expectations. The expectation of a student on a ride along is that they are there to observe what is going on. Hands on skills are developed on FTO.

One has to remember that an EMT works under local protocals where as a student is working under national standards, which can be conflicting. For example National standards teaches CPR to one set of standards, however here in King County we do a variation of High Performance CPR.

I think people get student ride alongs and new hire FTO mixed up.

Would I let a student touch my patient? I don't know, that would depend on my evaluation of the student, the patients condition and my gut feeling. Would I teach a student and explain things to them? You bet.

Bottom line, students should not expect to be involved in patient care.

Your protocols.

Field guides are a waste of money. Our field protocols come in a pocket version and have all the information we need including ALS indicators. Plus they are updated every year at no cost to us.

That said, something like an EKG reference or a drug guide to tell you what meds do might be benificial.

Never saw the point of spending $20 on something you could make for free.

I don't want to bash on students, but what do you expect to happen. You don't have a basic cert yet so anything you do will be under the cert of the EMT's you are riding with. It would depend on how comfortable they felt with you as to what they let you do if anything.

Me personally, I would have a hard time letting an EMT student touch my patient. That doesn't mean I wont explain things to the student and I might let them listen to lung sounds or get the second set of vitals. But, ultimately my name is attached to that patient and I am responsible.

Sit back, observe what the EMT's are doing, ask appropriate questions AFTER the call. If you are lucky enough to get hands on experience, great. That means they trust you and your abilities. BUT, if you don't get hands on experience don't sweat it. Just pay attention and learn what you can. Ride out time is meant to give you first hand experience as to how we operate in the field.

In a perfect world students could get hands on time. However, legally speaking it is not in the best interest and can get people in trouble.

Good luck to you and enjoy your ride along. Remember to thank the crew.

Solid post with sound reasoning and a reference to back your assertions up.

Thank you. Unfortunately this is something coming from first hand experience. I will never, ever wish that on anyone. That was the worst experience of my life.

Got me a ride in a ALS unit too.

I had food poisoning once and doctors in the ER gave me anti vomiting / anti nausea meds.

I would think that the risk of vomiting and diarrhea that often accompanies food poisoning would outweigh the risk of giving those meds.

Keep in mind most causes of food borne illness are Norovirus, E-coli, Salmonella. Once those get in your system the body will take care of it.

If the food poisoning is caused by something else such as maybe a reaction to the food itself, then maybe giving the meds would be bad.

I'm BLS so I can't give these but when I had food poisoning I was given the meds plus an IV drip to keep me hydrated. When the ER discharged me I was also given a prescription for some anti nausea meds.

Hope this helped.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002618/

AMR has the FEMA contract. They have been pulling resources from all over the country to fulfill the needs for FEMA.