Ridryder 911

I guess Paramedics are no longer taught Mcl1 anymore............ Be safe, R/R 911

Actually, approximately >50% of what I see in COPD patients is more panic attacks than true exacerbation of the disease process. Again, a little more psychological TLCis needed more than traditional medical treatment. Just because someone dials 911 of course does not equal treatment. Common sense will dictate that if they are on pre-existing oxygen therapy, you will maintain it. If they are truly exacerbation state, you will need to relieve hypoxia, and treat accordingly. Sometimes it is as comical as those that are on 2 lpm, with 15 feet of oxygen tubing. Only receiving a small portion of oxygen delivered. Psychological dependent more than physiologically in need. Be safe, R/R 911

and to add stupid and ignorant. R/R 911

Actually, both are owned & operated from the same organizations. As an instructor of both, PEPP is more geared at material PALS might not have covered such as trauma, medical emergencies, again where PALS does not get involved in. Not that one is better than the other, they actually should compliment each other, and I believe should be taught concurrently, so a person can receive credit for both. Be safe, R/R 911

hmm not really. They have few choices with me... either they can receive treatment as deemed necessary (i.e. LSB) and if to prevent a fuss, they have to sign a waiver recognizing they are releasing us from responsibility and going against medical advice. Some insurance companies will refuse to pay for AMA etc.. and also decrease their chance litigation as well. Funny, how most will change their mind, when informed when informed. Be safe, R/R 911

Sounds like they either used to LSB as a carry device or simply screwed up. Be safe, R/R 911

Actually it would be the other way around... there should be no confusion, if you were taught properly the first time. Having a full understanding would not confuse one. One should know about hypoxia and respiratory drive etc.. yes, it does matter.. again, we should learn medicine and think outside the box. There really is medicine than pre-hospital environment and yes, we should also know that as well. Is it really asking to much to really know medicine ? Again, with the advances of adjunct equipment such as EtCo2 , one can immediately see if there is Co2 retention and if they are really having an ventilation obstruction problem or a oxygen perfusion problem (v/Q). Again, knowledge in pathophysiology, disease etiology and detailed assessments may change treatment immediately. With a proper assessment and use of EtC02, I no longer use NRBM on most of my patients... there is no really no use to give a "high flow" for chronic lungers that are not in need of it. Again, appropriate treatment... not just treating. Be safe, R/R 911

I think we should be prepared for MCI within reason. There is no way that every town is ever going to be "fully prepared" for everything. Way too much emphasis has been placed on potential doomsday events. Meanwhile grandma still has a heart attack, and there is no ALS that is able to respond. Which is more actually to occur ? From what I have actually seen is several Fire, Rescue and a few EMS agencies.. grab grants and monies to feed their budgets. Shifting funds around to maintain status quo. Since a lot of the grant money is not "ear marked"; suppression equipment is purchased and equipment that has to be maintained or that can expire. It will be interesting in about 5 -10 years to see how much more money will be need to renew equipment. Hopefully, maybe this will cause more mutual aid responses, communications between agencies and pre-planning in which emergency services was definitely lacking. Be safe, R/R 911

I definately agree with Paramedic Mike. For more information I highly suggest Bob Page's Multi- Lead Paramedic and XII Lead Book . Bob (a Paramedic) has been teaching the use of 3 lead system and interpertation for years. It is nicely writtten and detailed enough to understand. Be safe, R/R 911

To add to Dusts's statement, I highly suggest having students take a variety of type of tests, test scan-tron (little dot) and computer tests. Since the NREMT is going to computer base in the near future, it would be helpful for the student to be familiar on taking these type of test with these as well. I agree with Dust's, look at scenario based questions as using stem key type of questions and multiple grouping type of questions as well. Questions with pertinent negatives such as all above, except, most correct should be used as well. Multiple choice question should used as often as possible. The answers should have one obvious wrong, one suggestive and then two that could be possibly correct. The answer should be as much a textbook answer as possible. May I suggest to also check in to test center banks such as Mosby, Brady, which has similar tests on a computer bank that one can purchase. Be safe, R/R 911

The main reason they are taught (the same reason for nurses) to worry is, they are not being able to protect the airway..i.e.intubate. Yes, it is true we should try to if possible, avoid placing a chronic lunger in a vent... it is hell try to wean them off if ever.... but, you got to do what you got to do... R/R 911

Woody!!!... Were have you been ?... Man, we have missed ya ! ... how's the leg?... have you checked some of the Internet sites with tattoo designs ?.. Come back !! we need your PEARLS of wisdom and definitely humor.. R/R 911

As others has noted, you probably will not "knock out their hypoxic drive"or give them oxygen toxicity. But please treat accordingly. These are the reasons some of us old timers and studious medics want more education level. Knowing about hypoxic drive, normal saturation range for COPD patients as well as "psychological induced hypoxia" etc... is essential in EMS and emergency medicine. The treatment can be as diversified and should be based upon an individual treatment regime based upon each clients need and response... not a blanket or "cook book" treatment. Personally, I agree with high flow until crisis resolves it self, then change to ( I prefer Venturi mask ) nasal cannula to wean them down... again, little things like a fan, or air vent blowing on them will aid more than the oxygen in some panic attacks. Remember the clients feel that they are "being smothered"... and any psychological intervention will help ans well as reassurance and being calm yourself... The old saying, if the Captain is calm, the crew will be calm.. is true. I suggest reading on respiratory pathology, and some methods of treatment ... the Internet is full of respiratory phases (even with videos, etc.) there is no longer an excuse to be ignorant. Be safe, R/R 911

Ditto.. to Paramedic Mike reply. Copmbitube is an alternative airway, not the best airway. Be safe, R/R 911

Well you could tell who the "advisors" were... Be safe, R/R 911

Sorry, you can't blame "cheating' on anyone but your self... if the relationship is bad.. then change yourself or the situation. Go to counseling or if no other choice.. get a divorce. Sorry, there is never been any proof that infidelity ever had been successful to anyone. Like I said, you are only as good as your word and character. Dignity does have its value.... If you can cheat or lie, to the one you love, there is not much you would not do for those you don't. My 5 cents worth...

We have the Field Supervisor, then FTO/ Supv. on each crew.. then Senior Medic.. that is dependent on experience and knowledge. When with lower level of license ( basic, EMT /Inter.) the Paramedic is technically over the patient care and call... With on a on shift Field Supv. there is little dispersion... Be safe, R/R 911

I agree, it has nothing to due with laziness... chances are most have never used the the "old two man" stretcher.. does this mean the current medics are lazy ?.. If it prevent back injuries and injuries to patients .. I am all for it. One of the concerns is with the additional weight, does this impede lifting it up and down stairs etc.....?.. just curious .. Be safe, R/R 911

How could he ever blame you for his actions ?.. don't be co-dependent. You might love him, but you also deserve to be respected as well. Love goes both way... not, just to give. If this matter is really important to you, he will listen and see how serious this matter is and can be. Again, I highly suggest professional counseling, if not for both of you, at least for yourself. I usually base relationship importance on how much effort each is wiling to work on the problems. Trust is something that is earned. Short and simple. To do inappropriate actions as this is he took take away that trust. If he wants to be trusted, then he has to earn your trust... & by chatting, flirting, etc.. is definitely not the appropriate way to do it. You actually have the upper hand.. you did not do anything wrong. If he blames you for his actions, remember it is his actions (no one forced him to do anything) He is responsible for his own behavior. I am sure he will describe it was "no big deal & nothing wrong".. well, it was to you and that is all that matters. Same if it was reversed. Again, respect, and trust. If it is not that big of deal, then he will have no problem attending counseling. Sometimes you have to shop around until you find a good counselor.. ask peers, co-workers. I highly suggest a family therapist, psychologist over social worker type. I wish you the best of luck... R/R 911

Sweeeeeet............however the other down size is the costs $$$..... Be safe, R/R 911

WOW !.. We are really digging up old threads... please, when answering a post, you might to look at the date.. almost a year ago ... Be safe, R/R 911

Stapled.... Sometimes ER has small little ampules/swabs of Benzoin, that they use for taping products etc... Like Dust said, apply where the sticky part NOT the gel on the electrode. Another temporary methods is try wiping with 4 X 4 , then apply then place tape over electrode. I always try to carry some extra electrodes from the unit an stress test lab.. they have a very stick adherence.. might ask if they will give you some for those special patients. (place in plastic bag to prevent dying out) Be safe, R/ R 911

Good points AK.. there are many of us that have made wrong choices and been victims as well. This topic has been discussed before in different formats. I agree, communication is the key of any good relationship. This might be part of the problem as well. Just because it is "chat room" does not excuse it. Like I have posted, my rule of thumb, if I would not participate in behavior where I would be uncomfortable or my spouse would be uncomfortable then there is something wrong. This be .. "rubbing shoulders, chatting on Internet, or even talking b.s. to others".. respect, dignity is values of maturity, in which many in this profession is lacking. The old rule the grass is greener on the other side.. especially when it is over the septic tank..lol.. Most married couples, can usually tell when there is problems, but are too scared to confront the issues. Like a snowball, rolling down hill gains momentum and gets bigger. I again wish you the best of luck... R/R 911

There used to be a an Christian EMT Association, many years ago.. I do not know if it is still active or not. Maybe, we could start something similar or another forum, dedicated to those of faith.... just some thoughts. Peace, R/R 911

I wished we could have the same reflective material that school buses have on them. It appears brighter than scotch-lite. One of the most dangerous things in EMS is nighttime work. We loose a lot of medics. What I have seen lately, Troopers. F.D., etc.. has not learned much about staging and protection at the scene. I really don't care how bright and color scheme .. as long as it worked. We have bright red, yellow, blue now, since we have finally got to change from the traditional omaha orange. LED are great sometimes, but are very unidirectional. We have combination strobes/ LED and appears very bright without glare. Along with the reflective stripes as well. I have started using the reflective vests, (1'st time in my 28 yr career) even though we have reflective stripes on our jackets. Again, with increasing poor staging and dangerous scenes, I like to be seen as much as possible. Funny how most EMS chooses dark blue as their colors, for jackets and pants.. (yes, they hide dirt) and turn black at night time. Be safe, R/R 911