MariB

There is really and issue with "c" and "s" here

Shall we start correcting that?

You need to go by your state laws. You can let him die, then what happens when she changes her mind then?

My laws tell me unless I have papers in hand, I have to do what I have to do. He is not in a state of mind to be making decisions now

Uh the wife is the one who called even after he told her not to. There are no papers at all anywhere you can read.

There is nothing else you can do but go off implied consent once he goes unresponsive.

Lvads have a manual over ride pump you can use in case of mechanical failure . I was taught that in EMT b believe it or not

Usually your best bet if possible is asking the patient or family as they are best educated hoping they are available to answer.

How long of a transfer?

87% on a nrb?

This is a patient I wouldn't hesitate to use lights and sirens on.

Most people get it within 2 hours

Log on the nremt site, check pending application status.

If it still has "print att letter" then your results agent in yet

I'm well aware of the levels in NYC and have worked with many EMTs and Medics on LI who also worked in NYC. Again, you failed to answer the question. Do you work for FDNY, a hospital based service or one of the privates? You know exactly what I mean when I say cowboy. Should I use the term buff? I know you understand that. I also know full well that EMTs and medics are not doctors. I did EMS in NY, not NYC, for 10 years and know the systems from Staten Island to Montauk pretty well. When we say scared, you know we do not mean it literally. However, the fact that you cannot do anything more and cannot properly provide the care the pt needs because of the standards in NYS and the fact that you are an EMT should literally scare you. People are dying because of the dismal state of EMS in NY but that is for another thread. So what are you going to do when this guy goes unconscious because his SBP is 70 and you can't bag him and your ALS backup is tied up on another call and you have to take care of the pt. You are right, there is nothing you can do but watch him die. The fact that that doesn't bother you makes you a piss poor provider in any system.

yes he works for FDNY. A simple search on him came up with his real name and his occupation. He also states he is an ems instructor.

He also does pot runs

Police and soldiers do have emotion.

/> correction: FDNY is only one of the many EMS agencies here in NYC.

in NYC there are only two levels of prehospital care. the EMT-B and the PARAMEDIC. anything under paramedic is working at the basic level.

ERDOC has his opinions on how a person should appreciate or feel or care etc etc.. that's fine, I don't mind the right to free speech.

"not wanting to see people die" means you are emotional, not necessarily good, certainly do not mean you are competent. Competent is competent,

Cowboy? there are no cowboys in NYC thus I don't understand what you mean.

EMTs are not doctors, Paramedics are not doctors. Our goal here is to get the patient to the doctor in no worse condition than we found them.

Please do tell me, what special things you are going to do for this patient that I was not going to do ?

it is BLS, there isn't a lot to do ! we all have the same national standards, so please do tell me what it is that isn't already in the protocols that you want to see be done for this patient ? ( dont answer that, its for you to think about)

Not scared, because that's not my job, but the medic will come put in a tube. not scary, no nightmares. if the tube wont go in down the throat, then the medic can do the cricothyrotomy.

I guess when you know what you are doing and trust your fellow EMS to do their jobs well, there is no place for scary panicky nightmares.Im done with this topic, be safe out there people !

We obviously don't have the name standards.

I can do spo2

I can do a blind airway

A bgl

A 3 lead

12 lead these are for doctors and nurses benefit

Cpap

Bipap

Epi pen

Pt assisted nitro, inhalers

Aspirin

Activated charcoal

Mast trousers (however our medical director has asked us not to use these so we removed them)

Helmet removal

Glucose..

Um hmmm what else.

There isn't national standards. There is local protocols

Dang it, didn't edit in time after seeing how poorly written that was

so please tell me, what special things you are going to do? I know what to do, and all of it is the same standard stuff I would do for anyone else. It's BLS, its not a lot there is to do.

I told you what I was going to do. But you got emotional. You got mad and "cried like a girl" and left the thread

My treatments within my scope of practice. Lets just say I have a 15 minute transport time to hospital

Eyeing him from the door hearing his mothers story and seeing his head drop, learning his gcs is 14 I worry if he is losing responsiveness. I would alert my driver to call als to intercept.

I will do respirations, pulse and spo2. He needs o2. He gets a nasal cannula at 6 since he is pretty low. If that brings it up over 96, I'll turn it down a bit to see how he tolerates it. If it doesn't bring it up to 93 to 94 I'll go with a non rebreather. I will listen to his lungs for bs.

Since he may be altered "head dropped" I'm going to get a blood glucose. I realize it may be off a bit as infection can do that but if he has been sick, he may not have been eating or taking meds.

Seeing he is coughing yellow secretions I will grab an emmisis bag and try to get him to cough up his sputum into that to show the doctor even though the Dr may or may not want it.

I'm going to look him over, put the leads on him , grab a bp since there is a history of hypertension, his pulse is fast and our life pack is right there with us so its fast and quick. Grab his meds and go.

Time to load.

I will get the pupils medical assessment etc in ambulance enroute

As I get the heart monitor print out. I'm going to spike a bag and get an iv ready for my medic. By now she should be meeting up with us.

Time to reassess.

While she is getting vials of blood and the iv going I'm going to do everything I just did minus the bgl.

I'm going to ALERT the er we are enroute with a patient and give a radio report.

At that time the medic would be busy doing her als part of the assessment.

When we arrive I would take the sputum, blood vials and meds in with us and then wait around because he would be transferred to a bigger facility

Eve though they just might fly him.

I know what to do, but you don't seem to. That's what is scary

/> "57 yo, male, in sitting position c/o coughing and spitting up copious amounts of thick yellow secretions. Pt is looking gray. mother states he had surgery a month ago. coughed up blood and a piece of metal two days ago. Pt appears weak."

well Im not saying he's healthy.

but this isn't really so bad..... because.... He's sitting, that's good. he's coughing, that's good, looks grey, (but sitting) not so bad, the surgery was a month ago, not bad, the coughing up of a piece of metal was 2 days ago ( if it even really happened at all, senior citizen's story is not always reliable ), that's not bad...

what the pt really needs is a doctor. so if he survived the last 48 hours after the metal cough, he can do 10 more minutes on the way to the hospital.

The piece of metal coughed up was a stent.!

The area is severely infected. He is in danger of losing his airway.

He is septic, the infection is through out his body.

Did you read what the vitals were?

People die sitting up, doesn't mean squat.

I would keep him sitting for breathing, but torn because I want to start treating him for shock! His airway comes first though.

I would be preparing to assist ventilations and you are thinking you might call ahead. Eh. If it is his lucky day.

I don't know why you are all so scared.

I'm not scared.

I am prepared to do my job... which is..... get him to the hospital so he can get the life saving treatment ?I have been to plenty of these calls just like this, (minus the metal part).

its very standard. Air and chair, Air and chair...

but as I said, ALS would do more.

that is all EMTs in NY do?

Wowsa why even test? You could save money having kindergartners do that.

I think our young padawan is suffering from a case of "the not knowing what you don't know". This guy should scare the hell out of anyone that has a clue. He's septic with airway issues and has the potential to have a nightmare airway

what scares me is the answer above this

/> Sure I work ems. yes I might call ahead. ( meaning emergency room notification )

it may sound strange to you, but I'm in NYC. Calling ahead is really a courtesy and is not mandatory. the ER is always operational and not very far away. Teams are always at the ready for more easily identifiable and serious things to call ahead for like CVAs and etc.

This patient don't sound very dire to me.

"57 yo, male, in sitting position c/o coughing and spitting up copious amounts of thick yellow secretions. Pt is looking gray. mother states he had surgery a month ago. coughed up blood and a piece of metal two days ago. Pt appears weak."

So I will take him to the hospital. because he is gray (read pale) he may be in shock, the yellow indicates some kind of infection. there is nothing I can do ( we are BLS) for him.

So Its Air and Chair.

I would do the standard stuff I would do for everyone else of course, the assessments and the questions.... fill out the PCR...

I would definitely ask the mother for the piece of metal.

I can imagine if ALS was present, they would use the pulse ox to see the SPO2, start an IV and administer fluids, if his breathing is so bad, may use CPAP. do a bigger assessment, ask more questions and then it would be transport to the hospital, and they will decide if they need to call ahead, depending on how bad the pt is.

What about this patient doesn't sound bad to you?

And call ahead. This patient is sicker than you think. He needs more than you can give him. I would be calling my medic if I was going to have a longer transport time. One of them would meet in route. In town, it would be quicker just to go.

Someone this ill deteriorates rapidly. His history and what he has going on now would kill him without medical intervention. Who knows how he would be had he waited until tomorrow

So what about this patient do you not see being that sick?

/> because if you don't spend a half hour crying after a call, you can be out on the next call. definitely an asset in my books.nothing wrong with people who do not get emotional after a call. in the world, humans come in all different levels of emotional. you got the girls that cry and get upset over the every littlest thing, and you got the serial killer that wont blink an eye as they press the genocide button.

EMS and other emergency type jobs like police, military, are better suited for those who are LESS EMOTIONAL and they are assets here.

Jobs like consular, therapists, etc are better suited for those who have a higer level of emotional availability

Oh my, where to begin? Nobody is talking about "girls that cry " " for a half hour after a call " that my friend will someday lead to someone shoving an O2 tank up your unemotional ass. I'll bet you cry then

I'm amazed you compared your unemotional self to an asset serial killer who would press a genocide button. Strange way of putting it, but it does make sense, if you feel little to no emotion, how can you feel empathy, compassion or concern?

You are wrong about police, military and therapists not feeling any emotion. I've seen police cry. I've seen social workers break down. And therapists usually have that job because they do care. They have compassion and yes, emotion. I would advise you to consider seeing one.

Did you just get into ems to see dead people? To get off on peoples pain? Does it turn you on?

I know you are new at it.

How many hours of CPR are you doing on a patient before you call a medic? Come on. Get a grip.

People dying after hours of CPR is a good thing, they have very little chance of being anything but a vegetable anyway. This call was nothing like that. I have done CPR on people for an hour or so, I have pulled bodies out of cars, I have seen some really traumatic injuries and never responded this way before.

My reaction did not cause me to miss any calls, or interfere with work in anyway.

And why do you have to make it a sexist thing when you say "girls that cry and get upset"? I don't think that has anything to do with it.

And yes I had an emotional as well as a physical reaction to the event, at least I waited until we cleared the scene. My MALE partner froze at the scene causing an issue where I had to work harder than I should have.

Eh don't fret it. He has said people with no emotion are an asset. And then compared people with no emotion to serial killers. I would rather cry like a girl when I get home after something hits close to home than have little to no emotion. People like that can not feel love, joy or happiness

I didn't get anywhere at all where the OP stated he lived in a state that didn't require the NREMT.

YOU live in one of 4 that do not use it to certify a new EMT. He is just confused about it is all.

Hello!

I needed to passed the NREMT to get my EMT in my state, however I do not need to keep it to stay certified in my state.

/> Do you actually work in EMS????????? For real? You MIGHT call ahead? Dear lord. The point of scenarios is to talk through patient care actions and critically think about the presenting patient, not just say well transport and maybe give the receiving hospital they are about to get a very critical patient that will likely need an OR prepped and ready.... Seriously dude.

I was thinking... don't we always call ahead? I mean it is part of transport. Its called " radio report

I am wondering if this person does work in ems also.

Just did a search on this poster. He just finished his class last year in NYC. So he has been an EMT for a year. Unknown if he is working as one at this time.

Why is it considered a weakness to have an emotional reaction to such an event?

because emotional reactions takes up valuable time that you can spend on something worthwhile. Its best not to have emotional reactions, and there are people out there who just DO NOT get emotional. they are the assets, wasting time by any means is a liability or weakness.

No, they are robots

I have seen a phycisian cry, a medic tear. It happens.

After time you get used to seeing certain things. Sad but true. However there will be some things that will catch you off guard.

.

People without emotions aren't assets. I believe the word is psychopath

"46 states use the National Registry tests as their standard. To say it is a waste of time is a bit foolish."

Its not foolish at all. If you read my post carefully you will see it is true.

to be an EMT everybody have to take an original course and a test that the state will recognize. Right? that's everybody.

So the guy takes his course, and his state test, passes, gets his state license... and then is presented with the chance to take a NREMT test and be certified by NREMT.

now, a NREMT certificate does not allow you to work as an EMT. the STATE license allows you to work and an EMT.

So what good is a NREMT certificate ? well, none.

So say our good man decides to move to or work in a different state. His home state EMT license only allows him to work at the home state. So he must apply for RECIPROCITY to the new state he is going to be working in.

each state is unique. Some ways to get licensed by reciprocity:

They take his home state license and give reciprocity based on it,

They will not take his home state license and demand that he do a refresher from the new state and that the new state's test.

They will not take his home state license BUT will accept a NREMT certificate in lieu of taking the refresher and the new state's test.

So as you can see, If he never plans to move, then a NREMT certificate is worthless.

My state does not issue tests. You must take the NREMT. Good luck getting your EMT without it.

We are human and will have emotions.

Yes I have felt emotion from a call. Instead of being told you are having emotional reactions you should have been offered a counseling session.

Its OK to hurt, be sad, scared etc. But you need to be directed to help so you know how to deal with those feelings so hopefully it gets easier for you.

I hope it gets better for you. I think we all have had those one calls.

Its OK

Yikes,

Als please.

He needs o2. Start transport and intercept als.

Vitals every 5 or less, watch the bp closing in.

I was guessing a stent of some kind, maybe for stenosis.

Unsure of course without more info.

I will definitely go through the motion of checking a long pulse, breathing, body temp. I will even listen with my scope, check pupils and put on patches. But at that time my attention will go to the family. I can call in help for them. A pale, cold body with rigor is pretty obvious. And I can't provide false hope.

In the case of an infant, the parents might need treatment, sadly.