MikeEMT

This actually angered me. Living in WA State (south of Bellingham no less) we didn't feel the quake. However we are in close proximity to not only the quake but also any Tsunami's that form. Did we receive any warning or notification at all? Nope we did not.

All the news networks were focusing on the East Coast and Sandy. While I agree that Sandy is a potentially destructive storm, and people here have family and friends over there, something that has a direct impact to us is more important than a storm 3000 miles away.

As it turned out we were hit with a Tsunami and the networks never bothered to issue a warning. It wasn't until 9:55 PM when the first network mentioned the quake and the Tsunami. The initial quake struck BC at 8:04 PM according to the USGS.

Per the USGS the Tsunami that struck us was only 2.4 inches in height so it was really a non event. The system failed us though and the networks failed us. Its lucky that it wasn't a destructive one. I know the networks have been receiving nastygrams all day. I know several people that have sent complaints to them.

I am glad that noone was injured in the quake or its aftershocks.

I never felt the so called prep exams were beneficial. I always thought they were a scam personally. You either know the content or you don't. Best advice anyone taking NREMT can get is to study and to read the question carefully.

I do not understand how something so preventable can be allowed to continue. Its not hard to wash hands and its not hard to cook food properly or wash fruits and veggies properly.

Food Borne illnesses is one of the most preventable types of illness out there.

People need common sense

Hi my name is Mike, why did you call us today?

So this is a story about a event not too long ago and a question. I didn't believed this belong in the scenario section.

So not too long ago there was a decent MVA at the intersection of a two lane road that I suppose you could call major. Its where all the traffic comes down to go to our beach town. Anyway, one car was t-boned pulling out of the back road onto the major road. A couple victims went to the hospital with minor injuries, others were just slightly hurt and received on scene treatment and walked away.

On the corner of the back road and the major road sits a house and these people decided to bring out a couple coolers full of drinks and snacks, they just felt like doing something nice. I thought it was kind and didn't really think anything of it till all of the firefighters made their way over to the coolers and left both vehicles unattended (although patients have been removed) and had a deadline to get the cars off the road and to clean the scene, which was not met due to stalling and eating.

I will not lie and I will say I took a water bottle right before I left, which I don't really accept food or drinks in those situations.

Have you ever accepted food or a drink from a patients home, patients workplace, or from a bystander?

Yes I have. When I was a cop we would frequently have bystanders bring us food and drink. If it was sealed I would accept it, if not then I politely declined. It can be draining working a scene for hours. Once patient care is handled nothing says you can't take a few minutes to rehydrate or replenish your blood sugars. I mean seriously how long does it take to drink a bottle of water or eat a snickers bar?

We had an agreement with our McDonalds that if we had a SWAT callout or major fire they would provide free cheeseburgers and orange drink. Worked out good.

The FD and rescue squads should not have the responsibility of clearing the road - unless a hazard such as powerlines or hazmat is present. Additionally, how effective are you going to be if you haven't had anything to eat or drink in a few hours and you just had the adrenalin rush of treating patients in a MVA?

When working fatalities or crime scenes we couldn't touch the body. Sometimes it would take hours to get the Coroner out there. Thats a lot of standing around.

I give everyone a chance. I don't care what other people say, I will form my own opinion of you.

Whether I like you or not is a moot point though. It makes for a loooong shift if we don't get along but my ultimate goal is patient care, not being popular or finding drinking buddies. As long as you do no harm to the patient and have their best interest in mind then we will be fine.

I don't like reporting people for what I don't know. I don't know ALS protocol and I am not a medic. Do something neglectful, or to harm the patient and I will be all over you. My name is on that PCR too, and I won't have anyone dragging me down because of their own ineptitude. I earned my basic and I will be damned if I will lose it over someone elses stupidity.

If I were you - first day you have a heart to heart with him. You outline your expectations to him. Be proactive as well and find out what he expects of you. Maybe he is perceived as a jerk because he has had crappy EMT's. If I were on an ALS unit, I would want to learn ALS protocols and techniques. My job as a basic is to assist the medic and If I can educate myself in what their role is I can help speed things along.

Just because your BLS doesn't mean you can't educate yourself in what his role is. You may not be allowed to give IV's, but nothing says you cant prepare the set up. You may not understand the different arrythmias, but what is keeping you from applying the 12 lead for him?

Im not a medic and I don't use 12 leads, but if I was a couple of minutes away from a hospital I might not apply a 12 lead either. What is going to be more effective for patient care: applying a 12 lead with all the wires dangling and the heavy monitor, or load and go the 2 - 3 minutes to the ER? Hard to answer that one.

Bottom line...ignore the "gossip" and form your own opinion. If you go out of your way to be the best EMT and he is still a jerk then the problem is his. It will catch up to him at some point. However, if you listen to the gossip and go in thinking he is a jerk, then you are as guilty as him and you deserve the blame for a bad partnership as well.

Pick your battles carefully.

Ok first off I take no offense but I think people are reading to much into my answer. I am an ex cop and ex PI, I have worked with the law and know the law. I am very well aware of consent. However I feel that people are treating this as a "emergency" call which it is not. Look at the facts.

The patient is in a SNF. Now it has been my experience that most patients in SNF's have medical issues that require constant care and they cannot care for themselves. What documentation is in the patients file regarding their mental status? Do they have a Power of Attorney. This is NOT a 911 call.

Involuntary Consent can be applied when dealing with a mentally incompetent individual. Further, someone has ordered this evaluation. The order either came from a doctor or a court. At that point the liability is on them, not on me or my agency.

The "van" the patient was alleged to have jumped from was most likely an "official" transport van. Likely some sort of paperwork would have been generated on this incident. This is an indication of the patients' mental status. A reasonable and competent person would not jump from a moving vehicle. Likely, this is the incident that prompted the order for the evaluation.

Not every "psych evaluation" is used to determine if someone is incompetent. More often they are used to determine if a person is competent and mentally stable. It is in WA State Protocols that we can transport a "behavioral emergency" (which this would fall under) against their wishes IF we gain consent per local protocol. A doctor's order or court order would constitute consent and would suffice.

As I mentioned prior, this patient would be transported and it would be legal for us to do here in WA in this situation. Patient would be placed in 4 point restraints and transported for a mental health violation.

If this was a 911 call and NOT an order for eval, then I probably would not transport unless circumstances presented themselves to indicate patient was not mentally competent.

Bottom line is the mental health eval was ORDERED by a competent entity (doctor or court). We would be protected under RCW 71.32.170 if we transported this patient. In fact we would likely be guilty of negligence if we didn't transport him.

Understanding and interpreting your State law will keep you out of trouble. It is not Kidnapping.

Ok, first of all he has doctors orders. Because they are calling for an ambulance for the transport that tells me he is already confined.

Second, he jumped from a moving vehicle on purpose. That to me indicates suicidal tendencies.

Third, he is a Psych patient. You would be hard pressed to find anyone that would label someone going into a psych eval as "competent." Obviously, there is a behavior that has been demonstrated to indicate to healthcare professionals that he needs further evaluation.

Maybe its my legal background talking but I see this as a non issue.

Now, if this was an emergency call and you responded to the scene rather than the hospital you would have to use your judgement based on the totality of the circumstances. As I mentioned in my previous post, per my company we wouldn't transport unless ordered by a mental health professional or a court.

I would have no problems transporting this patient because of the doctors order and the history of self harm (jumping from a moving vehicle). Document everything.

He comes with me. But then per our policy anytime we transport a psyche patient we must have the courtorder. He wouldn't get the luxury of refusing as the courts would have already decided it for him.

Even as BLS, sedation isn't an issue for us. Most of our psych patients are sedated before we arrive.

4 point soft restraints and he is coming with us.

If this was an "emergency" you would look at why the psych eval and who ordered it. Most likely the key words here are Psych Eval which indicates to me he is not competent to make a treatment decision. He still goes.

The truth of the matter is your classroom is just that - a classroom. It is not your "real" education. Books are to get you through tests.

Don't get me wrong, the classroom is vital but it is nothing to stress about. Everything begins to make sense at the end of class, once you start going on calls it will make a lot more sense.

I remember my A&P portion and it was hell for students literally. We covered A&P and Patho in 1 day. Wasn't a fun class.

You will notice something though, the same terms you see in A&P will also appear in later chapters. It will click.

Pay attention, do your best and get through the class. Open your eyes and ears and learn as much as you can. Just because you leave class doesn't mean your education ends. Learn from everyone you encounter.

If I can get through it so can you.

Well thank you for the update!

No problem. I actually follow Detroit stuff pretty closely as it could happen elsewhere.

How do you know this? Do you know the EMT that resigned? I know the video is old by the upload date, not trying to slam you or anything.. just curious

This is how I know: http://www.ems1.com/ems-management/articles/1339321-Outspoken-medic-resigns-from-Detroit-EMS

This is an old video and there is more to it than just no units being available. This was a report on the poorly managed state of Detroit EMS. This was their attempt to get help and change and it failed. Neither medic was fired for this video, but the medic featured in it did resign last week.

There is no structure or order to History taking. I ask the SAMPLE / OPQRST questions in the order that I need the information for the situation. SAMPLE is not the order that must be followed, rather it is there for you to REMEMBER what questions to ask. Don't get hung up on the order.

As far as who asks, ideally the EMT who is treating the patient should be asking the questions as part of the assessment. However, sometimes the partner will need to ask if you are busy with something else (i.e. dressing a wound).

Regardless of who asks, you need to make sure you are getting the information. The patient is going to be bombarded by questions as it is from nurses and doctors, last thing you want is for them to repeat themselves when they just told your partner.

Good communication is key, both with the patient and with your partner.

You were taught to recognize, the basic two shockable rhythms that an AED will shock.

Did they also teach the causes of these two rhythms?

What I think you were actually taught was an AED will only work if a pt is in V-tach or V-fib, as that is what the EMY-B curriculum covers.

There are many excellent basic cardiology texts available with some online versions available.

Happy reading!

They did teach us the cause of those two rhythms. Though I am assuming that there is much more to it than what I was taught.

I think I will look into some classes when I figure out my schedule.

What Rhythms did you cover? Are you familiar with type 1-3 degree heart blocks?

No, we covered V-tach and V-fib and learned what a QRS complex is. Though it was such a brief chapter that I dont remember much about the rhythms. I am really interested in cardiology and would like to learn more.

Acute, rapid onset pain and she's clutching the right location. The lowered HR and BP makes me think that it might've burst. Appendicitis requires emergency surgery and I'm not sure what an EMT-B can do for it. I'll find out what medications she's on/allergic to, pertinent history, full assessment if one hasn't been performed already, and other info for the ED.

I'm not 100% positive that this involves the appendix, but if it does, I want to limit time on scene and get her to the nearest surgery center that can handle it.

Correct me if I am wrong but the patient is experiencing pain in their RUQ that is radiating to midline. Appendicitis usually presents in the RLQ doesn't it? I don't see anything other than pain the indicates Appendicitis. Tenderness? Vomiting? Hx of Appendicitis?

Does she have history of Liver problems? She is 6 weeks post partum, when was her last BM? Have her BM's been consistent and regualr?

What is her temp?

I took it. It is a timed, adaptave, computer based test. There are several thousand questions in the question pool, and the computer will pick questions based on your previous answers. It is multiple choice.

It is a difficult test, but it tests you on all aspects of EMT or Paramedic. Once you pass it is good for 3 years.

The second part of the test is a practical scenario test infront of one or more evaluators. You will have 10 minutes to determine the problem and perform any interventions.

Thanks everyone. I wasn't concerned with it because I CAN'T do it, rather it was a curiosity to me.

I have heard pacing mentioned and heard of it being done, but no one took the time to explain it to me. I have no interest in working with something outside my scope. When I master basic I will move on into Paramedic.

We actually went pretty indepth into cardiology in my class. We also covered some EKG rhythms. I seriously doubt a 80 - 100 page chapter on cardiology doesn't even begin to touch on it.

Thanks again for the answers.

I dunno if News Robot posted this or not..

http://statter911.co...-in-the-street/

So this is probably a homeless man, has a pitbull. The man is having a seizure, and the dog is protecting him. Cops shoot the dog, and the crowd goes nuts. I watched the long version, in nine minutes of footage, not one single person comments about the condition of the seizure patient, and not one single person tries to help. Including the police.

There's one for your duty to act. I know they get a certain degree of emergency first aid training in their academy. Pennsylvania, equally among all Law Enforcement, gets ARC Emergency Responder. Not shocked at all, just pathetic. Damn cop car drivers.

As a former cop myself they did right. Shooting the dog, while unfortunate, was necessary for scene safety. Time did not permit animal control responding most likely.

What do you expect the officers to do for the seizure patient? Our first aid is limited to what the American Red Cross is teaching. Their is not much a lay person can do for a seizure patient.

How do you the convulsions weren't caused by something else? Were you there? You are relying on third hand information and don't have all the facts.

I was being trained on our Zoll Monitor and the video was talking about the Pacing mode.

I have never seen Pacing yet in real life so I don't know what exactly goes on with it. I do know that only ALS providers can do it.

My EMT class did not cover pacing or even mention it.

So why is it an ALS skill? Is it because you have to interpret the EKG? Or does the d-fib send out electricity or something?

I know this is a stupid question but I am really curious, any help would be appreciated. Thanks.

Since 90% of what I do is IFT, we bring just the stretcher. The sending facility will let us use their "vitals tree" if we need to take a set of vitals. Oxygen is attached to the cot so if patient needs O2 we have it.

On 911 or inbound medicals we take in our BLS jump kit.

Special equipment comes in as needed.

We don't do ALS, but we can do ALS transports when the sending facility has an appropriate provider accompany us. In these calls, we have an ALS jump kit, advanced airway kit, drug box, and zoll monitor that we will load onto the ambulance for the provider.

Emergency Vehicles & Red Light Cameras . . .

Here's something I never considered before and the following piece makes the point. Basically it concerns the thinking that people would be afraid to move into an intersection, in order to yield to an emergency vehicle, where a red light camera is installed.

I don't think it would be too hard to correlate the time the emergency vehicle passed through the intersection to the time the ticket was issued, but a motorist's first thought would be to avoid the automatic $341 ticket (here in California.) So that doesn't solve the initial problem.

BTW, I'm just finishing up the clinical portion of a Phlebotomy class and I really enjoyed it. (Our class motto is, "We stick together . . .") :wink:

NickD

EMT-B

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Your driving L&S should not force anyone to move into an intersection against a red light. If you can't proceed safely through an intersection due to traffic then you need to shut down and wait for the stop light to change and traffic to move.

There are a few videos on YouTube that show ambulance drivers getting on someones butt and blaring the siren until the car essentially runs the red light. I consider this unnecessary and reckless.

L&S are to REQUEST the right of way. They are not a guarantee. It is YOUR job to drive with due regard when operating under L&S.

As a former cop myself, if I witnessed someone run a red light to allow an emergency vehicle to pass that driver would be getting a ticket for running a red light. If I saw an ambulance or other emergency vehicle driving L&S in an aggressive and unsafe manner, I would be waiting at the hospital for them and we would be having a discussion.

There are other alternatives out there such as Opticom which can preempt the traffic signals.

I would suggest reviewing your training and your state laws. I can guarantee that no State would allow an emergency vehicle to "force" a POV to run a red light. You would never find that being taught in EVOC or CEVO classes.

Worst case scenario, take the oncoming lanes which is what we do.

What would happen if someone pulled into an intersection and got t-boned? Now you would likely be taken out of service since you were a witness and a contributing factor. Another crew would have to be sent to your original call. Your ambulance would likely be held at the scene until the field investigation wraps. Lawsuits would likely come down. Your certification may be challenged by the state or your driving privelages revoked. All of this why? Because you were trying to save a few seconds and get to a call.

The saying is arrive alive, our response should not endanger the public either.

After obtaining all pertinent information I would call medical control and let the doc make the decision.

I need Medical Control permission to give ASA anyways.

I took my EMT class recently and graduated this past May. I took my class through AMR. I will tell you while every class teaches the same content, some are better than others. In my area the AMR class is the best class.

The reason I say this is because colleges must operate on the school schedule. You will barely get 3 months of class time whereas a non-college location could give you longer (mine was 5 months) class time. You will also have to contend with other students and other programs possibly competing for space. That said it should be a fun class.

EMT school is very fun and I enjoyed it a lot. It is a lot of studying and is very fast paced. Expect to cover 1 or 2 chapters every night. You will be constantly tested as well: quizzes every night, tests periodically, evaluations on your practicals, etc. You will enter the class being strangers, you will leave the class as a tightknit group.

Don't be afraid to screw up or make mistakes. This IS the time and place to screw up.

You will be stressed, you will be confused but you will have lots of fun. Enjoy it, pay attention and learn. Don't get so overwhelmed that you don't relax. EMT class can be very fun as long as you remember to laugh.