mediccjh

You gotta be f--king kidding me.

OxyClean.

Just remember, Clinton had bin Laden handed to him on a plate 3 times, and rejected them all.......

I was a Clinton supporter, until I found that out.

I don't want my hard-earned money going to poor people who would rather sit on their asses with a big-screen TV in their public housing, and their kids sleeping on blankets.

You have any dancing Bassett Hounds?

Last night, while working my part-time ALS gig, we got dispatched 4 times with the jolly-volly BLS crew for jobs.

4 times they did NOT get out.

How professional is that?

Back on track now.....

If we can all hold hands, sing kum-bay-yah, and share milk and cookies, that would be the first step to improving professionalism in EMS.

If Paramedics save lives because EMTs save Paramedics, how come the EMTs always have to call the Paramedics to save their asses when they can't handle a patient, and not vice versa?

In an overly technical post I pointed out the problems with CISM. EMS is about humanity and its problems. True, people die and often times we cannot control that. It is OK to grieve and OK to feel bad. We have this ill-conceived notion in this country that we have to feel good all the time. That is far from true. You have to look at the overall scheme of things. Infants and children in the United States and Canada have the best chances in the world to live to adulthood. There are some that will not. In some of these cases, EMS can make a difference. In most, it will not. Despite millions of dollars of research, we still don't know much about SIDS. In over 30 years in this business I can never recall resuscitating a SIDS baby.

1. It is OK to feel guilt--all of us do.

2. It is OK to be sad.

3. It is OK to cry.

4. It is OK to keep your emotions to your self.

5. Just don't let the guilt consume you. Use your personal support system (i.e., spouse, significant other, priest, minister, rabbi, parent, pet, best friend).

6. Learn from each experience and move on.

People are overly concerned about PTSD. People who develop PTSD have underlying psychiatric issues--it is not a normal response to stress. It is quite rare.

If you are a good EMT, as the poster apparently is, she is suffering a normal reaction to a bad call. The best treatment is tincture of time.

Dr. Bledsoe, you couldn't be anymore correct.

Time heals all wounds.

For all those who are saying "My town can't afford...", lets break it down at a community level. Someone quoted to me that the cost of running a 24 hour ALS response ambulance staffed by two paramedics is around $1,000,000 a year. I think that may be a little high, especially since the person was talking about in the greater NYC area where prices of everything increase substantially. But lets use $1,000,000 a year for round the clock ALS service and transport. Okay, so if we broke it down evenly over a populace, which of course given tax rates wouldn't be the case, but lets say we break it down evenly over a populace, in a city of 20,000 people, the cost per person per year is $50.00. Yes, $50.00, or 13 cents a day per person to have round the clock, professional advanced life support at your beck and call, and that doesn't even take into account the fact that unlike a police or fire department, EMS can actually generate some of the revenue back. Certainly not $1,000,000 a year, but enough to defray a good portion of the funding. For instance, if you averaged 3 calls in a 24 hour period, your call rate for the year would be 1,095 calls for the year. If you billed $500.00 for each transport and only half the people or their insurance company ponied up the dough, you would generate $273,750 dollars a year. This leaves your operating costs at $726,250, or $36.31 per person per year for the ALS service, or roughly ten cents a day. Now, I ask you, is it really all that expensive to go paid ALS? And to be perfectly frank, if a town of 20,000 people doesn't want to pony up ten $.10 to $.13 cents a day to have me risk my damn neck, wreck my knees and back and leave me with a headful of bad memories, then honestly, f--k them. If they want something for free, I will gladly say "I told ya so!" afterwards.

Oh, and as Lt. Columbo would say, just one more thing sir. I have never understood this. If you don't want to be a paramedic and do all you possibly can to treat the sick and injured, why exactly did you get into EMS? I mean, if you have true desire to help others by providing prehospital emergency care, wouldn't you want to be able to do all you possibly could for your patient? Doesn't it bug you just a little that your patient may be suffering or even dying because of your lack of skills? This really isn't a slam against EMT's. It's honestly something I never quite got.

=D> =D> =D> =D> =D> =D> =D> =D> =D> =D> =D> =D> =D> =D>

I do!

D5W for medication drips. LR for traumas and burns.

Depends on the B/P and what the EKG looks like.

Personally, I try to get the line first, especially if the patient is not hypertensive. However, if I'm looking at an inferior wall MI, IV first.

Here ya go:

http://www.state.nj.us/health/ems/documents/njac841r.pdf

It's a lot to read, but it will tell you the role of MICNs and what requirements are.

It's not about the skill and how good we do it, it's about patient outcomes. We can't even educate the providers how to do other things properly with simple things, how do we now expect the majority of students to be able to learn good judgement, good ongoing assessments and good critical/clinical thinking skills? People are always complaining here about how bad XYZ school is, or the overall poor quality of students today. How often do you hear glowing reviews of a bunch of schools or the practicum students? We never hear the positive, it's always the negative.

Trust me, I don't like it for how it applies to me, you and many others, but for the tens of thousands of Paramedics as a whole (plus some EMT-I's, EMTCC and whatever other letter combinations)? They are also saying they want to take ETI out of the hospital setting, so how should we think we are any better. I think we as a profession (as Paramedics) define who we are by the fact that we can intubate and we can do it well, some of the time.

Take for example the airway Kings in Anesthesiology. Even they are moving away from ETI. Current literature suggests that the risk of aspiration from blind insertion devices (LMA, Combitube, King Airway, etc) is remote at best and can probably be suggested the infection risk is even lower than ETI due to the simple fact that the tube is passed through the cords. Simply stated, our arguments of using a 'definitive' airway are lost and don't hold ground any more.

I have had this argument for the last year trying to say we need to keep intubation in our skill set, it is needed for the benefit of the patient, etc. and all the other arguments. If you do what I did and look at the evidenced based recommendations objectively, you would probably see their point.

Try answering this, what are the arguments (benefits) in favor of ETI being preferred or needed prehospitally?

I believe it is common sense, when you think about it.

The best way to get gas into a space is through a tube. Therefore, the best way to get oxygen into the lungs is by an ET tube, which goes into the trachea, and when properly inserted and sealed, will bring oxygen to the lungs.

Number 2 is wrong. There are 46 states, and 4 commonwealths.

Great job guys!!

And to think, they didn't need a CFR engine!

OK, so once again, instead of educating providers and letting them practice, let's take the skills away. Not very progressive, is it?

First-time failures....something to consider is the condition we get the patient in while in the field. Case in point tonight, I had a cardiac arrest. Went in the first time, couldn't see crap. Suctioned, pre-oxygenated. Second-time in, I'm in without a problem, ventilating well with good EtCO2 waveform.

These are conditions that all these wonderful studies seem to forget about. Trust me, it's not an excuse. I've only missed 2 ET intubation attempts in the 5 years I've been a medic.

What good is all the education you receive when you don't carry the drugs that can help treat patients?

Drugs I'm talking about are Cardizem, Mag Sulfate, Ativan, and RSI drugs?

Geez, and I jus got my first heroin/fentanyl OD on Friday...but he's dead now.

Radar didn't mail a firearm, he was mailing a Jeep, piece by piece!

I am aware of that; however, it's the thought that counts.

And the AK-47 has less parts.

Yikes! Newark?

What's the matter, couldn't get a job in Trenton?

You are a glutton for punishmemt!

AKs are $200 usd from quasi-legitimate sources here. But a double sawbuck will get 'er done if you find an Iraqi soldier with a gambling problem. Or a mistress. Trust me, if there is ANY way to get one home, I will find it!

RPGs, complete with rocket = $5 dollars

Fragmentation grenade = 75 cents

And while the US is issuing crappy old Beretta M9s to our troops (or a Sig P226 if you're a SEAL or other Spec Ops guy), the Iraqis are issuing brand new Glock 22s to theirs. Funny thing is, their officers don't even like the Glocks. They prefer the Russian Makarovs and Tokarevs. Now don't get me wrong, I love Russian women, but the Russians can keep their pistols. I'll take the Glock anyday!

This place is Heaven!

Trenton is the Minor League. I'm in the Majors, thank you! 8 homicides in 13 days so far....I wonder if that's worse than Baghdad.

You can do what Radar tried to do and mail it back piece by piece.....

Be safe, bro.

They shot my hair! Son of a bitch!

Great movie.

Dust, good to see you're doing OK bro. Stay safe over there.

P.S. Can you get me one of those AK-47s to keep in the BUS now that I'm in Newark f/t?

The question is what was said, or what was the body language, that caused the firefighter to go after the guy? There is someone else standing in the line of the sight between the camera and the skell, so there is no clear shot.

Either way, there is NO justification for kicking the guy when he's already down.

F**K NO!

Plain and simple. There is too much anatomy and physiology for some jolly volly EMT from the backwoods of PA, whose company does only 200 jobs a year, that must be learned, and too much for them to f**k up when they get their stiffy going on the cardiac arrest with the new toys. And as was pointed out, what good is another hole that you CAN'T push drugs in?

78% success on a MANNEQUIN? Gimme a break.

DISCLAIMER: I live and work (part time) in PA, and started out as a volly. Therefore, it is within my constitutional right to bash my own Commonwealth, since PA is not a State.

Let the hate mail begin.

The search feature is your friend. This topic has been beaten more than dead horses.

Absolutely correct.

Extrication assessment is the same as medical assessment. Every consequence requires an action, and subsequent reaction.

You dont act without just cause. That being said, there is almost always a route out without breaking windows, let alone utilizing a rescue company for that matter. Unfortunately, we seem to have shifted into this simpleton mindset of rote routine for all rescues.

-Break windows

-Pop doors

-Cut posts

-Remove roof

-push dash

-watch ems extricate patient

-smoke cigars and admire another inappropriate cut vehicle

-tell lies about all the 3 year olds youve saved from fires in the week youve been in the fire/rescue service

-go home

That's great!! And soo true.

I love my job.