mediccjh

Welcome to America, speak f--king English! My ancestors learned the language and assimilated, no reason they can't!!!

F--king liberals.

Maybe he needs a copy of the IV Tricks publication from EMS Solutions, of which I believe there is a link somewhere on this website...

You're welcome Jim.

What was his initial blood pressure at the Jail? One thing that could explain his slow heart rate and lack of respirations would be a head bleed, due to cocaine.

You said he had a fresh track mark; my guess would lie in that he did a speedball (Cocaine and heroin). I say that because I had one c/o massive headache Tuesday night after doing a speedball or two, and ended up with a subarachnoid hemorrhage.

Considering the facility that you picked the person up from, I'm not surprised. I hate doing jobs there.

At my full-time job, we have EMS Rescue, so I rarely go in the car; if I do, I have a helmet and goggles, and am under a blanket.

In PA, I have a rescue jumpsuit, helmet, goggles, gloves, and a Nomex hood.

The article by Mr. Becker says

However, in the verbal history of the first organized ambulance service, from over 100 years ago, out of Manhattan's Bellevue Hospital, New York, that is exactly what the first ambulances did. If the non-medically trained crew, or the intern that sometimes rode along, felt a patient was of an emergent nature, they'd leave the route and proceed directly to the ED.

I was told, by a colleague (again, from before the EMS/FDNY merger), that his ambulance was called directly over an NYPD radio, to "get the 'bus' to" where someone had been shot. My friend, who is, if you can believe it, a bigger joke-maker than myself, responded back, "I'm going to be delayed en route, because I have to stop at the transit depot to pick up a bus: I'm drivin' a ambulance!"

Rich, you beat me to it!!

That is why I will always call it a bus. Since 1994 when I started in Bensonhurst, Brooklyn.

You know, one of these days I am going to get the courage up to go to an EMS conference. I just have this fear of being in a large convention hall type arena packed to the gills with people with Star of Life T-shirts, tattoos, and poor personal hygiene standards. Seriously, I get anxiety just thinking about it.

Are they as bad as I think they are or should I just embrace my fears and go sometime?

Show up in a T-shirt that says "You get what you pay for.....stop volunteer ambulances." I did, and the hooples left me alone. It was great.

ya I know what u mean ppl dont understand me or my humor either. But you have to love your job. I have a partner who does not understand my mind. But she is also in her 70's and yes she is still runnnin rig. We had a double homicide and would have liked to been on scene just to c the bodies.

YEAH, I know what YOU mean; PEOPLE DON'T understand me or my humor either. But you have to love your job. I have a partner who does not understand my mind. [Neither do I with your poor spelling and grammar.] But, she is also in her 70s (no need for an apostrophe) and yes she is still RUNNING rig (What's a RIG?). We had a double homicide and would have liked to HAVE been on scene, just to SEE the bodies.

Yes, I love running to scenes just to see bodies. Like 3 of them lined up execution-style, shot in the head, and throats and faces slashed. :roll:

This grammar correction brought to you by Herbie, the EMT City Spelling and Grammar Nazi.

Anybody who manages to actually make a profession of EMS in PA or NJ, instead of being a volly whacker, is worthy of my respect.

I'll take that as a compliment.

I am part of the Old Guard, right?

In response to many of the common statements below, here are my thoughts.

Paramedics are thinking about things from a much different perspective than EMT-B's. As an EMT-B, I was trained to look for obvious signs and symptoms and taught simple, quick, important skills that would presumably allow me to follow the adage of "do no harm" in most cases. However, what I was not taught was how to see past the obvious.

It is much easier for me as a Basic to care for a broken arm... to provide chest compressions to a pulseless patient... to place oxygen on an elderly woman with shortness of breath... for this is what I have been taught.

When the paramedic looks at the broken arm, he (used for simplicity... not excluding female paramedics) may be thinking of hemodynamic compromise from severed vessels. He may be thinking of long term nerve damage, of how much pain medication may be appropriate for the patient dependent on a whole host of factors, or of what he might be missing in terms of other, more serious life threats secondary to the trauma that caused the broken arm.

When the paramedic sees the pulseless, apneic patient, he knows that he must rule out a whole host of things and is thinking about physiology and pharmacology that we cannot even begin to understand at the Basic level. Is the patient in asystole? V-fib? A-fib? What drugs are appropriate? What continuing care can I provide enroute? Is it possible to ensure this patient's airway remains patent? Are there comorbid factors?

As a Basic, the most we can think to do is start the IV for the medic (in certain areas), and provide BLS airway support and chest compressions while the medic does the *thinking* work.

Same deal for the elderly woman with shortness of breath. We are taught the magic 15LPM NRB spell... but when that is not enough to fix the problem, we are left empty handed until the woman reaches the point where we must physically force air into and out of her lungs for her. The paramedic's brain engages and runs through the complexities of the human respiratory system, searching for the answer that may save the woman from being intubated- or from dying.

The key difference here is that yes, the physical supports that we provide as Basics are very important... but the mental toolbox we work from is much smaller. The paramedic may leave the physical skills to you because he knows you can handle them... but a good medic would never dare ask you to find the solution to the problem, because he knows you haven't been given the right tools.

It's like having a kid's carpentry set, and having a basic idea of how to hammer a nail into two boards to fasten them, and then being confronted with building a new wing onto Buckingham Square Palace with just your kiddo sized tools. It's not a personal affront to you, nor the medic being lax in what you've been trained is important... it's them using the most important thing they've got-- their education and assessment skills.

Paramedics are important for every type of call. There are always hidden subtleties. Ok, maybe not on the stubbed toe... but there's an exception to evey rule. Medics may seem arrogant because some have arrogant personalities... but others seem like "know it alls" or "paragods" simply because they're busy thinking at a different level and don't always have time to break it back down to the level where you, the Basic, can completely understand it. Them telling you just to do whatever they told you to do is because they're focused on the patient. Helping you learn and helping you to understand the complexities of the human body is best done off scene, where there is actually time to dissect what was going on.

A paramedic may choose to spend more time on scene because doing so may give them time to figure things out that speed up the in-hospital process. Starting IV's, when the patient is more stable, may save the trauma team valuable seconds in-hospital when the patient decompensates. Although we as Basics may not always understand what the paramedic is doing, or why, we have to trust that their higher level of education means they have some competence and our job is to do our best to support them. We do the same for the doctor or the RN in the ED, right? We know they've got more education and think about things differently than we do. The same goes for our medic partners.

I hope this helps clear some things up. Knowledge without explanation can seem like arrogance... and may be, but give people the benefit of the doubt and realize your own limitations before attacking Paramedics.

Wendy

CO EMT-B

=D>

I thoroughly enjoyed it.

Welcome from the Lehigh Valley/Slate Belt.

Scene safety should be replaced with situational awareness. If you notice any of my posts, that's the term I use. "Scene safety" seems to lead the provider that once you get there and the scene is safe, nothing will happen. How deadly wrong that could be.....

I loved the 747 boxes, until you had to carry them up numerous flights of stairs.

I like using the Flambeau PM 2072. Compact, but I could fit everything in there.

Bags aren't too bad, as long as they are designed right.

Yep. New Jersey EMS at its finest. What exactly have you vollie squads done lately to your medics that they are now telling you "Eh, no one's gonna get better in the back of the ambulance anyway..."

Actually I think you're right. I'm 86'ing the monitor and med bag. Screw it.

They would actually have to get out the door first if it's not a "hot" job.

This is very true, and an understated point. There are certain neighbourhoods -- or even entire cities -- where the time you spend on the scene is inversely correlated to your chances of still having an ambulance when you come out.

And my city is one of them. Granted, it's not as bad as it was back in the day (hearing the stories from the veterans is unbelievable); however, I've gone outside to find skells trying to break into my truck and I've chased them away with my RSI stick.

Speaking of drunken brawls, is the St. Patrick's Day Parade any safer to attend than the Puerto Rican Day Parade?

For that matter, is NYC safe to attend anywhere, anytime?

Yes, St. Patty's Day is safer. They don't go trolling through the Park afterwards ripping off women's clothes.

And NYC is the safest big city in the world. I'm biased, though, since I did grow up there during the crack epidemic and I did get mugged in front of my own church.

Well, they can go the ILGO route......

First off, we all know who the real Herbie on the site is (me, and I was here first).

I think we've beaten this in other forums before.

When I am at my full-time place of employment (which is the busiest per capita in the nation, 130.000 jobs w/ 13 ambulances so I WIN!), we tend to treat in the ambulance, unless it is a life threat. Does that mean we just leave? NO. We tend to go in, get the patient, treat any immediate life threats, extricate, and lock everyone else out of the truck until we're ready to go to the hospital. I still stabilize on scene before I go to the hospital; I don't run to the hospital unless it's something I can't handle.

When I work in suburbia, it's different. It's all about situational awareness.

If I were wearing anything under it, it would be a skirt.

So, who's gonna be at the parade?

LOL! Obviously not the ghetto, where most kids are raised by their Grandmother or Aunt.

Wanna talk about heartbroken, check out Father's Day in the ghetto.

Ah, Father's Day, also known as Baby Daddy Day....the most confusing day in the City of Newark.....

Like I said, all in fun and games.

I thought Northeastern was accredited too.

We have a tradition with them....they go back to Boston without hair if they survive working with us.

I follow the duck rule: If it walks like a duck and talks like a duck, it is a duck.

If the patient said that his pain was similar to his last MIs, then it's a cardiac workup.

What was the patient's final diagnosis/disposition?

I will be at the parade, and when FDNY Suppression marches by, I will gladly show them what is under my kilt.

Anyone care to join me?

I respectfully throw down the gauntlet and ask that you site a source.

It was in the episode when he was having flashbacks about his wife dying; it aired in 1979.