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I believe getting an AED is safer for the patient, than trying to have non-experienced staff attempt ACLS measures. Also, more economical. Usually EMS is within a reasonable time, hopefully to perform ACLS measures. Be safe, Ridryder 911

If your talking about patient care reports or charting ...a lot of people use the SOAP method and have designed call sheets to match their state requirements for Q.I. As far as telemetry, I have not used that since mid-70's. Be safe, Ridryder 911

Haven't seen paddles used around here in the past 10-15 years... Be safe, Ridryder 911

The Old Emergency Workers Test Scale (Beyond Veteran Status) You know you're an old emergency worker when . . . You notice that your colleagues no longer introduce you to others as "a dynamite paramedic", but instead introduce you as "a dinosaur paramedic." You notice that new partners are not that much older than your own kids. You notice that enthusiasm and excitement for the profession correlates most greatly with the relative youth of the person. You realize that several "crops" , "graduating classes", or "generations " of trainees have passed through your tutelage in the field. You notice people looking at you strangely as you describe actually learning to use Colonel Holger-Nielson's Method of Back-Pressure Arm-Lift Artificial Respiration and feeling that you were prepared with the latest and best. You notice that you're the only one who knows, understands, and can explain equipment such as "three-bottle suction set-up for chest tubes", "Thomas Splint, Keller-Blake Half-Ring Traction Splint, Pearson Knee Attachment, etc. When astonishment is expressed, you find yourself saying "they even used to have a Murray-Jones splint for traction splinting of the arm!" You are the only one in the group who can explain "How To Help A Wounded Man From His Horse." You have used a Stevenson "Minuteman" Resuscitator; or can explain the differences between it, the "Emerson", "E&J", etc., and basically give an experience-based history of "Artificial Respiration" and mechanical resuscitators. You have done gastric lavage with a hanging glass jar and red rubber tubing. You have carried patients with a "Poles and Canvas" stretcher. You're not only the only one who knows how to use a triangular bandage as a sling, but know six different ways to do so. You can recall when only one crewmember on the ambulance had to have a first aid card and that person was usually the driver. You can further recall that a mechanism existed whereby counties could be exempted from the equipment, staffing, and training requirements if hardship existed, thus less than minimal standards could be legal. You remember having to ring a doorbell or call the hospital telephone operator to have the Emergency Room opened for your patient. You remember when ambulance or E.R. equipment included a blackjack or billy club. You are the only person who knows what is meant by the phrase "Converta-Hearse." You remember when a mortuary operating an ambulance was not thought of as a conflict of interest, but a public service from the only fellow in town who had a car in which one could lie down . You remember when a doctor's house call "was" the Pre-Hospital Care. You remember the phrase: "Is there a doctor in the house?" You remember (and can still feel) nurses telling patients "The Ambulance Drivers are here to give you a ride" or even "The Ambulance Boys . . ." You remember explaining countless times each day "What's an Emergency Medical Technician?" to which the invariable reply was "Oh, you mean an Ambulance Driver!" You are introduced as a "Pioneer" in emergency medicine and you suddenly realize that you are. You realize, or it is pointed out to you, that many of your conversational items begin "I remember when . . . " You notice people remarking as they hear your paramedic number "God, that's a low number!" You realize that more than half of the hospitals you go to have been renamed, reorganized , merged, or closed. You find that most of the people you now work with don't know any of the people who "used to be here" and they really don't know anything about your original preceptor, and there have been several chiefs or bosses since you started. You find it is necessary to explain how vehicle manifold suction worked and how, to get full vacuum effect, it was necessary to call out "Suctioning!" so that he could let up on the accelerator pedal. People also don't understand how "The Resuscitator" had an oxygen-powered venturi "aspirator." You qualify if at any time in your career you worked in ambulances made from "station wagons", "panel trucks" (including "step vans" and "metro vans"), "sedan-delivery" vehicles, low-top Cadillacs or other brand of "limousine chassis", any "Converta-Hearse", etc.; younger emergency workers may qualify if they worked in any ambulance that did not meet federal KKK-1824A specifications. You qualify also if a substantial portion of your career took place before rubber gloves were supplied. You earn additional points for qualification if your career began before seat belts were common. You admit to yourself that nowadays the chief reason you enjoy precepting paramedic trainees is that you don't have to carry the gurney anymore. ©1994 Tom Trimble For all of us that remember these.. Be safe, Ridryder 911

LOL.... A little games in the backyard... [] a little personal time with my friend Be safe, Ridryder 911

Charles, Did you try to teach any new things on running a code to spark interest..kinda like getting motivated for CPR retraining for the 15'th time...ho hmmm. How hard is running a code...shock, shock, shock, med tube, shock med, repeat.. I get tickled of probies thinking a code is tough. Running a code is one of the easiest things.. they can't get worse...there is no past tense of dead. Keeping from coding & keeping them alive after the code is the tough job. Just a thought....from an "old medic" Let us remember this why AHA went to NO INTIMIDATION training & stripped the CERTIFICATION away. I suggest those who think the basic ACLS course was demanding attend the ACLS for experienced providers...

Very true USAF, as all cuff or pressure devices. I would like may a comment on PASG (MAST) etc. Yes these devices are rarely used except for pelvic stabilization etc. I hope we can learn by what happened to this device & studies. They were very popular in the late 1970's- to late 80's, yes I did see them work at about 50% of the time. No they do NOT correct shock, & yes they did raise blood pressure (which is NOT always a good thing). The Houston PASG study was published & voom!, EMS knee jerked over this & immediately started removing the devices. If you read the FULL study, what it said was "there was NO change in outcome "(with or without). Again, if you look at the WHOLE study, & compare the trauma patients based on the TRISS (trauma index severity scale) that these patients had, has a low outcome anyway. I believe that these injuries were so severe in this study, that even if you had a trauma surgeon beside them, the outcome still would be low. The main emphasis for the study, was "we don't really know the mechanism of how they work, side effects, etc." I personally know 2- of the physicians that were authors of this landmark study. They make the point of emphasizing increasing pressure = increases injury. (Duh..) more pressure- bigger hole. The authors also recommend letting the body to maintain homeostasis in a shock state. I argue the point that we need to maintain cerebral perfusion pressure as well as coronary artery perfusion level. (If we do not perfuse the brain, what difference does resuscitation matter ?) Theses Physicians have also authored several other articles on no fluid resuscitation etc.. Some of my concerns in earlier debates was that the study application of the PASG. (Pop-off valves released..wow. try that on a mannequin) & the amount of time & duration the PASG was left on the patient. Yes, I believe that this device has several limitations & possibly may due harm, if not used properly. My main concern was before a comparison study was performed we acted hastily & changed protocols & removed PASG before all the facts were in. Any medical device(s) should be evaluated & studied BEFORE used for patient care. I read on another forum Paramedic using the wave form for blood pressure eval.. again a scientific study should be applied before doing such. Be safe, Ridryder 911

Operation Homeland Redneck.. keeping our lake shores safe.. LOL Be safe, Ridryder 911

oxygen is an oxidizer...It self won't light up ... but it will sure light up the fire!... C'mon firefighters remember the tetra hexagon ... Be safe, Ridryder 911

True 1EMT-P, We are there not to FAIL students, but to motivate them to learn. No one can teach, if they are not willing to learn. This is why AHA, has totally changed their programs ! Intimidation & scrutiny was deferring prospective students. Although we have totally relaxed the medical standards, I agree with the layed back, non-stressful way of teaching. Be safe, Ridryder 911

Vaium used to be of the med's the recommended to go down the tube. Remember NAVEL.. narcan,atropine, Valium, epi, lidocaine.. but research has shown it to be irritable. Was nice to be able to tube & stop seizures at the same time though. We carry Ped & adult Diastat (rectal gel ) strength, & the usual IV/IM Valium. I recently have been using nasal atomizer Versed & have had great success with it, both seizures & pre-sed for RSI. So far, I have not seen it work. In fact it appears to absorb & work faster than IV route. Be safe, RIdryder 911

New ash trays at work ! Be safe & Healthy ! Ridryder 911

May I suggest, Summer time coming: Treatment of Burns Drowning & near drowning Environmental injuries.. including heat stroke, exhaustion Pediatric emergencies Trauma Sports Injuries Outdoor or wilderness injuries Just some thoughts Be safe, Ridryder 911

I guess; going on 27 yrs. paid, career; huh ? Be safe, Ridryder 911

I work at a urban/rural area. We cover a multi counties, with a town of about 40K. However, there are areas that we have a transport time of greater than 40 minutes. The nearest larger. hospitals is about 35 minutes from our metro & we do several scene flights, & inner facilities transfers. Be safe, Ridryder 911

Drive a gas-guzzling 4 wheel drive, Expedition. No lights, NO stickers of any identifying me as a EMT, Paramedic or RN, & NO jump-kits. Yep I DON'T stop at scenes. Professional medics here refer to these as "billboard medics" ..wanna be's. Do you see physicians or RN's with stickers, lights etc.. with I'm a DR. ! Again, professionalism. Then yet again, it might look tacky on that Lexus. I am surprised, with all these p.o.v units with emergency lights. It is illegal to place them on your vehicle here. I know the insurance companies have definitely enforced that here, describing unless your vehicle is insured through the F.D., EMS etc.. it will not be insured to respond in emergency status. Volunteers here are expected to drive in a safe & operating manner & do not have emergency exemptions. There is a law here that states "all lighted unmarked vehicles have a uniformed person." This is to help prevent impersonations from occurring. Be safe, Ridryder 911

As others stated "this happens every day"..is right. However; we do have laws.. written & documented living wills & D.N.R's. Maybe, lets look at it in a field perceptive. You arrive at scene with a patient in cardiac arrest, history of illnesses, no written DNR or living will. The family tells you "he did not wished to be worked" ..Do you go on hear-say ? do you not start resuscitation measures? Or do you tell them without proper documentation, you have to resuscitate.. (according to rule of best interest of the patient) . This is the debate, the family could not agree. Yes, it was a horrible state for both parties. What I do not understand is the spouse went on with his life (new wife & family) , he still wanted to control Terrie's. With the family wanting to continue tx, would it had not more simple to allow this ? Yes, he wanted to fulfill her wishes, & yes he promised her.. just as he promised to be faithful ...hmmm. Selective promising, I guess. My prayers our with both parties & the medical staff that had to deal with this horrible chaos. Be safe, Ridryder 911

I believe we will begin to use the capnography, just as much as we use Sp02 monitor. Unfortunately, there will be just as many of those that will not understand the limits of both devices. I continue to see both EMS & Nurses & even Physicians who do not understand pulse oximetery. Not realizing hypovolemia, low Hgb, dehydration, & poor perfusion can alter readings drastically. How many times have you seen as others have posted " tx the device, not the patient" ?. I hope we will educate EMS personnel better than we did or do on Sp02, and highly suggest using Capnography with wave forms. The type that uses a cannula (bi-furcation type delivers 02 on one side-monitors on the other side) is very helpful for detecting C02 retention. Color metric are O.K. are very limited. Just as any tools they are ASSETS to helping make a diagnosis. I have enclosed a site you can copy a waveform guide. I laminated and placed on individual units for a quick reference. Be safe, Ridryder 911 http://www.medical.phillips.com/us/products/resucitation/assets/docs/Capnography_Quick_Guide.pdf

I'm the only one on my crew that don't smoke... whew !!! Funny thing is most say they don't smoke off duty.. but, boy they make up for it when they are on.. Be safe, & Healthy... Ridryder 911

I too like Toradol for renal cholic (kidney stones) 30mg IV, but be sure they don't have a bleed, & not an asthmatic. Phenergran is good anti emetic & does potentiate Demerol, except for geriatric patients, really gets them going bonkers ! I agree Demerol has its place in the field for muscular skeletal pain, in lieu of Toradol... I prefer a little M.S., for fxr's with Phenergran.. if allergic to phenergran then I use Zofran for the anti emetic, or Reglan. Be safe, Ridryder 911

Thought they hilarious, funny at first.. unfortunately, most of the people around here fit those profile...LOL. Already getting tired of them though..same-o- routines, just like Foxworthy... my 2 cents worth Be safe, Ridryder 911

Good that some form of formal education is stepping up. I really do not understand university settings not accepting Para medicine as much as they do. Especially ones affiliated with medical schools & it affiliations, such as you noted & other allied health agencies. Maybe if More EMT's would show interest, Universities would re-consider. I really hope EMS will obtain the professional status it desperately needs, to improve pay, benefits, etc.. This would help retention and increase more to enter the professional status. Be safe, Ridryder 911

That is a shame, was he aware that some universities have EMS degree as a undergraduate degree ? I again, feel we will not shed the "blue collar, trade school image" until we are able to have it placed in collegiate setting. People in EMS are not quite aware of the long-arm & extent this has on our profession. This ranges from salary, benefits, to medical peer recognition. Those wanting to change their title to a license level, I highly suggest contacting states that currently utilize this. See how they am-mended & work with EMS associations, lobby legislature to ensure this occurs. I wish you the best of luck. Be safe, Ridryder 911

First of all, remember AHA ACLS is NO longer a Certification class. If you deviate from that or insinuate other, you might be misleading. Unfortunately, AHA has watered down ACLS it is a joke.. some areas don't even test, since it is now a education class only. Heck, our x-ray tech's have passed the course without any cardiac training. I recommend the ACLS for experienced providers course, it is a lot like the old ACLS with mega codes, central line placement & acid base balance, etc... This is a dilemma in the EMS & ER/Critical Care settings. I wished AHA would regain the respectability they once had & restructure these courses. Now every organization has their specialties ( ENA- ENPC-Ped course in lieu of PALS, EMS - PEEP, etc..) more $ for them.. & more classes to attend. Be careful, Ridryder 911

It all depends on the clinical problem Morphine or Demeroanalgesics work as follows: The opioid analgesics are "mu-agonist" drugs. The term "agonist" refers to a drug that binds to pain receptors to produce analgesia. Opioid analgesics include Morphine and Demerol & other drugs that relieve pain by binding to mu receptors in the nervous system. The term "mu agonist" is used interchangeably with the terms full agonist, pure agonist and morphine-like drugs. Examples of opioid analgesics are: Codeine Oxycodone Meperidine (Demerol) Propoxyphene (Darvon) Fentanyl Hydrocodone Tramadol (Ultram) Morphine Hydromorphone (Dilaudid) Methadone Levorphanol (Levo-Dromoran) Oxymorphone (Numorphan) Of the three groups of analgesics – opioids, nonopioids, and coanalgesic drugs, only the morphine-like opioids have no analgesic ceiling. In other words, higher doses increase analgesia and only adverse effects limit how high the dose can be. Thus, there is no set maximum dose for morphine and morphine-like opioids Morphine remains the standard against which all other opioid drugs are compared. Extensive clinical experience and multiple routes of delivery, including controlled release, make it the opioid most commonly used for cancer pain, burn pain. Morphine Sulfate is also a vasodilator and can promote venous poling in CHF, and is the preferred analgesic in acute myocardial infarct ions. Where as Demerol (meperidine) is usually used for analgesia & sedation purposes. I believe it all depends on amount of pain, & presenting diagnoses. I prefer Demerol for muscular or skeletal pain ( i.e back, abdominal pain (small amt 25 mg) For true pain for Burns, chest pain , etc.. Morphine Sulfate is the preferred choice, and has pooling effects as discussed earlier. Be safe, Ridryder 911