Ridryder 911

I wondered when "millionaire" hunting season was legal.. so how many are you allowed to bag ?..... Next time, it will be a larger PAC donation or else... :twisted: Be safe, R/R 911

Around their throats or just use of hands Dust ? :twisted: Be safe, R/R 911

Shouldn't have to be explained.. it is in the basic EMT curriculum on up... Be safe, R/R 911

Although I agree with most post, let's be realistic as well too. For those that actually have field experience also realize the stressors of the scene, getting the unit available for the next available call etc... I will warn of potential dangers etc.. but to do an actual lung sounds, abdominal assessment on a lacerated hand ... no I don't and yes I will write deferred to patients c/c or briefly explain reason as such. There are too many times the person does not want you there.. or take their time, your presence or by any means mess with them. Touching or assessing them will either aggravate them or get me assaulted. Those who that do not understand what I am discussing, either has never worked in the field or dealt with people. The same in ER, once the patient makes it known that he/she does not want care .. vital signs and warning of risks, ask if they would like to talk to physician etc.. then I gladly open the door for them or point the way. It would be nice to live in a Utopia where everyone could be assessed, totally informed of all potential risks of every procedure, etc.. But realistically, there are 20 patients waiting for the single empty ER bed, and 2-3 calls waiting for that EMS unit. Again sure it would be nice to have a system that has so many trucks and so many beds it does not know what to do.... but, with the aging population this will never happen again. Before all the rant ... we all can talk what we try to do.. and then what we really do.. Each time before you start and I.V. , you inform the patient all the risks.. i.e phlebitis, infection, pulmonary embolus,before starting the line ? Or when you administer oxygen you totally inform the risks as well.. (it is a drug) you really are supposed to. So we are all human.. we try to improve on each call. So yes, proper documentation as usual to CYA and assess as much as possible .. I may discourage, but never refuse transport. Be safe, R/R 911

One of the most problems is EMT's do not place or measure the appropriate size cervical collar. No-Neck, is sometimes a good choice for those "bull-neck" type. PHTLS also has some recommendations on using blankets etc. for cervical immobilization. Be safe, R/R 911

I think or know MRSA is resistant to most even antibotics except Vancomycin. That you got pay the vet a whole bunch of money for some natural Lactobacillus acidophilus. It is primary used in humans for yeast infection & vaginitis, and has unclear to poor treatment in humans, except in G.I. tract to replace the flora. I am sure that the extent research of MRSA & VRSA has been explored to the extent. If prescribing something simple like acidophilus would correct things, they would. I am definitely not against homeopathic or herbal medicine they definitely have their place in medicine, and should be used as a supplement. Yes, I am glad all medicine is looking for and toward all different type of medical practices. Be safe, R/R 911

Grammar and proper usage of words as well as documenting such not only represents your ideas and actions, but your representation of patient care. Sorry, I know of people with a PhD making little more than $10-12 dollars an hour, so how much should one make going to a few hundred hour class. So the opinion I have gathered from some, unless the pay us more, we need to continue to be ignorant and stupid... hmm yet, again maybe that is why we still do not get high pay ? It should be a requirement that before applying to EMT school or advanced level EMS courses one should have reading & writing skills of least high school level for basic and college for advanced level. Like any other professional classes, (even with 3 college degrees) I was still required to take a writing test. If had not scored high enough, I would had to take a supplemental course & retake the test or not be accepted. The same should be true in EMS. If one cannot read or write or even talk then this person has poor communication skills. Communication skills is one of the essential requirements to be able to portray a picture or present an accurate assessment. Those that are not able to meet those requirements should be given the option to either increase their skills in such or be discharged. No variances should be allowed. Since documentation is a representation of the care administered and the legal record of the care, there can be no variations. One must remember, that they are not just representing themselves, but the company and the profession as well. Unfortunately, it does not matter if they are a "supermedic ", if they cannot back that up with proper documentation & effective communication. For those that seem not to care.or want to remain ignorant .... remember it will people like me & others that YOU will be judged against... Be safe, R/R 911

Really, a shame that states and services would want more control over patient care in (state protocols) instead of dealing with the problem directly. Be safe, R/R 911

Well before we run to hte table.. you ought to had done a few things first.... Be safe, R/R 911

Ditto.... meanwhile, Grandpa has chest pain and a basic unit responds...but, in case ther is an MCI we are prepared...? Be safe, R/R 911

What a bunch of B.S. !... That the court sided with the son... If the EMT's had taken her in the next thing you read would be "EMT's charged with kidnapping!".. It is a no -win situation. THe problem was the EMT's did not do the paperwork right... once you inform them of the potential risks, and hazards and IF they are alert and responsible enough to understand such risks, then they can and have the right to refuse such treatments and transports.. If the son was that damn worried, he should had power of attorney!... It is a shame the medics poorly documented.. and could not had counter sued the family. I wish more medics would start suing the families of those that charges and false claims. Maybe there be less ambulance chasers. You can only do so much.. you can inform them, you can be nice and suggest, but I be damn if I will wrestle them to take them to the ER. I don't know how many post seizures I took in, only to AMA as soon we entered the ER door. Even, had ones threatening to sue, when they awake, if I did not release them now!... Again, it is a never a wining situation. R/R 911

http://www.merginet.com/index.cfm?pg=medical&fn=morphine Morphine Often Underdosed in Emergency Medicine By Bryan E. Bledsoe, DO, FACEP January 2006, MERGINET—Pain is the number one reason people summon EMS or visit a hospital emergency department. Analgesic therapy is usually prescribed based upon the severity of the patient's perceived pain. Opiates, such as morphine, are often used for severe pain. Typically, the initial intravenous dose for adults is between two and five milligrams. But is this adequate? Researchers at the Albert Einstein College of Medicine in the Bronx, NY, evaluated the effectiveness of morphine dosing in the emergency department. The most frequently used dose of morphine—0.1 milligram per kilogram (mg/kg) body weight—was chosen as the test dose for the study. Patients in the emergency room who were prescribed morphine for severe pain were approached by a researcher and asked to rate their pain on an 11-point visual analog scale (0-10). There were 119 patients enrolled in the study and they all rated pre-treatment pain at 10/10 on the visual analog score. The patients then received intravenous morphine at a dosage of 0.1 mg/kg. Overall, only 67 percent of the study group reported that their pain was less than 50 percent better with the 0.1 mg/kg morphine dose. There were no differences in regard to age, sex, ethnicity, location of the pain, or associated nausea and vomiting. The researchers concluded that a morphine dose of 0.1 mg/kg was generally inadequate for most emergency patients. This study reinforces the growing awareness that we in EMS and emergency medicine do a very poor job of treating pain. EMS must assure that the pain needs of our patients are met. Unwarranted concerns about addiction, respiratory depression, and masking of abdominal findings have resulted in many patients receiving nearly homeopathic doses of analgesics for severe pain. EMS is an empathetic profession and we must assure that we are adequately meeting the pain needs of our patients. Perhaps it is time to revisit and revise protocols for prehospital pain management. Reference Bijur PE. Kenney MK. Gallagher EJ. “Intravenous Morphine at 0.1 mg/kg is Not Effective for Controlling Severe Acute Pain in the Majority of Patients.” Annals of Emergency Medicine

Here is an article I wrote a while back on CHF... it explains edema etc.. good review for all levels.. http://www.emtcity.com/phpBB2/viewtopic.ph...p;highlight=chf Be safe, R/R 911

Welcome to EMS... you learned something. Now review and remember not to do the same bad things... Good luck, R/R 911

I have became too lazy on spell check.. but what the heck. Now in other forums I have to google some dictionary...LOL Usually it always the simple words, like i before e.. I do agree that charting should be accurate and grammar as possible. I have a partner, that can not spell CPR.. so I bought him medical pocket dictionary to carry at all times. The i review his run report. It is also as essential to have a flow of the sheet, not just plugging things here and there. Be safe, R/R 911

Yes, we talked about before.. it is called "black humor"... although, outside laymen might think it is inappropriate, it is actually healthy and a way for us to keep what sanity we have. Those that are brittle about this, shows that they have little exposure of things and very little experience. The same way when a graphic video is played and there are a few chuckles in the audience.. it is s self coping mechanism... or sometimes just damn funny. Sorry, there are times you have to laugh at things to keep from crying.. and sometimes there are things that humans do are so strange and ironic, it is humorous in it's own way. Be safe, R/R 911

Okay.. after reading some EMS forums.. I continue to see sayings that for some reason or another.. just grates on me like chewing on foil. Here are some that makes me cringe...... 1) Basics saves medics 2) Oh, yeah, well my clinicals are ______ hours long ! 3)How much more training do we really need ? 4) Why won't they just let us Paramedics just test out on nursing school....... 5) Blah..blah.... diesel medicine or anything related to driving back fast....... 6) I took the National Registry test ______ hours ago, and I still don't know the results.... 7) The National Registry was (circle one) too hard/easy....... 8 ) Paramedics think they know it all...... 9) All basics are stupid......... 10) Any discussion that alludes that making < 100 calls a year, actually allows you to claim you have experience. 11) Making simplistic treatment regime .... hard 12) That basics have the knowledge and responsibility as a Paramedic 13) Assuming that there should be a difference in pre-hospital knowledge and emergency medicine knowledge... 14) Those with thin skin.... and those that don't know what black humor is and understand it is appropriate at times. Okay ..now it is your turn... what's yours ? R/R911

LOL...One of our medics has a sticker on the back of his truck.. Got Jenna ?..lol Be safe, R/R 911

Good topic.. actually we have started going into more debate on this ourselves since we will be held accountable like a physician and get sued like one as well. It does change your outlook the 1'st time you write a prescription out. America fortunately or unfortunately depending on how you look at it, is used to the best.. the best care, the best hospital available, the best and safest in everything and if you don't .....whoa .. look out court house!... The good point it has made us more aware of problems and be sure that the medical community monitors itself (to a certain degree) and definitely makes medical profession more self conscious. This has started TQI (quality improvement) and review of needless procedures and constraints of some costs of procedures. Review of each of physician and staff as well of performance and education is encouraged.The bad thing is over 50% of medicine is now prophylactic (protective) and not really not needed. This does not just means way excessive medical costs (Billions every hour) but also exposing patients to undo procedures, radiation, unnecessary medicine as well. I do believe victims of gross medical incompetence should be rewarded for their losses and damage both emotional and physical, HOWEVER there should be a cap of how much attorney and legal fees can receive on the judgment. I know that if we in U.S. was to change this there would be an immediate change in the number of litigation's that occurred and thus would change malpractice insurance affecting the medical community. Will we ever get this to occur ? Hell no ! .... Look at each states legislative composition... hmmm see any thing similar?... The majority are trial attorneys, now do we really expect them to remove or harm their profession ?.......... Since this will not occur the debate will continue until local communities can no longer get physicians to come to their town or there are no longer O.B. or E.R. Doc's that want to take the risk, or pay the extreme malpractice fees. Some do not realize, a lot of these cases are settled out without even the physicians knowledge or defending themselves. Thus, there goes their insurance rate... form $25,000 to $35,000. I know I have a friend that is a ER Doc, and was sued and he was definitely in the right, but since the case was only for $35K the insurance agreed to pay, since it was cheaper than litigation, hence there went his insurance rate up .. So in conclusion, yes there is a way to lower and keep quality control.. allow law suits that are warranted. Cap the recovery fee that is allowable to the attorneys. The other way whom ever lost the suit had to pay all fees and possibly counter sue. Hmmm be interesting to see ambulance chasers having to pay a couple million if they lost... definitely would change the outlook of the legal system. Be safe, R/R 911

And now we wonder why our system is so screwed up ?..... How horrible a program is that offers no clinical time as well as a state that does not mandate. I know most facilities now consider Basic EMT as observation only clinicals due to their limited abilities. But, even exposure is a good thing, and learning off exposure can be helpful. I personally, would wish that clinical time would equal or surpass classroom time... yes > 100 hrs for basics... I do chuckle when in comparison of clinical time... when I hear students describe hours, and I describe my clinical time in years. Be safe, R/R 911

Ditto what Dust said as well, you need to remember like basics, nurses are not taught on how to secure the airway as well. Hence.. the worry factor of knocking out the respiratory drive. As well, many are again looking at long term respiratory and ventilator care as well.. when working in a unit, trying to wean a chronic lunger off the vent for several weeks, you can imagine how you are not anxious about placing another one on one. I got into a debate with Clinical Nurse Specialist about this several year ago, she was discussing the pearls of high flow and how horrible it was that we would knock their drive. After several minutes of discussion (in which I understood her point, although did not agree) I pointed out that you allow a patient in respiratory compromise, to become more tired, increasing metabolism, becoming more acidotic, and increasing risk of hypoxia with all its complications (ectopi to AMI, to cerebral hypoxia). Which would you prefer.. being difficult to wean off the vent or multi organ failure and damage ?.. then still have to place on the ventilator, with very low probability of coming off... she did not reply...

I agree that XII lead is definitely the optimal standard.. but, there is many that still use 3 or ground leads. That is why I like Pages's multilead system. For all of us old farts, that still remember moving leads around to see chest leads; it does make a difference, of seeing anterior wall, inferior etc.. Yes, it takes an extra 15 seconds or so and a few extra electrodes, so I save that procedure on ones that I feel that I need more diagnostics on. There are a lot of tricks of the trade that has been used for years, that improves diagnostics and does not cost or really is difficult. Be safe, R/R911

I think we are totally loosing perspective of what cervical collars are and their function.. Basically, it is irrelevant if you use cervical collar, blanket roll, duct tape, or staple their ears to a LSB... :wink: The purpose is to prevent movement of the cervical region, thoracic region.. short and simple. How it is maintained is not as important as long as it is performed and performed correctly..Unfortunately, we cannot perform tongs in the field so we will have to rely upon standards in basic immobilization. Again, utilizing what works the best is the key.. to prevent potential spinal cord injuries and movement is the key. There is yet an absolute device.. but; taking precautions and making sure the client as much comfortable as possible is the key. However, if you have recognized and addressed the potential injuries by placing a cervical collar, you should immobilize. Can you really make the determination of differential of C3 and T-1 referred pain ? Unless you want to hold traction en route... you will need a LSB. If you immobilize you should use straps.. again, the standard of care is what you will be based upon. If the patient moves off the board, or slides off during moving of board etc.. you are responsible. Let's not complicate simplistic measures such as cervical immobilization. Be safe, R/R 911

I suggest talking to your instructor in private as soon as possible. Being an instructor, I can assure you knowing about your students as much as possible is helpful. I wish you the best of luck in your new career and studies. Be safe, R/R 911