donedeal

No transport? So I'm assuming the medic will jump on the private/vollie transport ambulance. So does that mean they have to carry all their ALS equipt with them off the truck and onto the ambulance for every call? How do you get back to your truck after the call? Do you ride solo or with an EMT/Medic on the non-transporting trucks? Thanks again, I read the thread regarding which service to visit during your trip here. The banter gave me a headache.

10 hours from Northern philadelphia to northern Delaware (Wilmington area) ??? I don't think so. I should have been more clear in my post... I'm looking for info on New Castle County in Delaware, coming from Horsham/Philadelphia, PA.

Anyone have any info on NCC EMS? I'm relocating to the area. Shift shedule? Actual stations or SSM? Career ladder? Quality of equipment? How terrible would the commute be from northern Phili? If they have 24 hr shifts, I can handle a long commute a couple days a week. Thanks. Feel free to PM me if you have worked here or have some great info!

From the NR practical exam sheets, Ventilatory Mgt: adult. "Marks maximum length of insertion length with thumb and forefinger" pertaining to suctioning an ET tube. How does one measure the maximum length of insertion of a catheter for suctioning the ET tube? The Brady book states", insert until resistance is felt. There is nothing mentioned about measuring beforehand. Thanks!

Does anyone know whether National Registry centers its practicals and exam questions around a monophasic or biphasic defibrillator?

I've decided to move out of south florida and will be heading to South Carolina, the Charleston area. I've looked into all the county systems and city Fire and EMS agencies. Does anyone have additional info or experience with: Charleston EMS Goose Creek FD Dorchester county EMS georgetown county Fire/rescue Colleton county fire/rescue A lot of places in this area appear to be hiring, I've got several applications out and am playing the waiting game. I'll be moving Sept 15th and am getting ancy for a job. Please PM or write if you know some good stuff about this area. Thanks!!

I am looking to move to the North Carolina area. If anyone has knowledge or experience in the EMS system in NC please PM me. I am looking for a fairly large dept preferably fire/rescue based at the ALS level (which I believe is rare in NC). If not fire based, then 3rd service with decent pay and good benefits with potential for promotion. The more east the better, but an overall nice city with suburbs would be ideal.

Has anyone heard of or have in their protocols: give 1mg of atropine to a symptomatic bradycardic patient after an administration of .5mg with no change?

They don't only offer BLS, they do ALS inter-facility. However, the 911 BLS contract is a transport service for Palm Beach county fire rescue. They are already on scene, call for a bls unit, and you get called. AMR had most of the county, but now Medics has taken over I believe everything but the south. Even though its BLS 911 transport, AMR used to require a medic on every truck in that zone. Not sure what Medics is doing. PM me if you're looking for some more info, used to work at AMR and know a couple people who work at medics.

Has anyone heard of pushing calcium chloride prior to intubation in a spinal shock patient? I witnessed this in the ER today and later asked the anesthesiologist and he stated that the patient's systemic vascular resistance is compromised and basically it helps from dropping BP even more. My thinking is that since calcium causes an increase in contractility it will override any vagal effect intubation could cause? Intubation was successful and the BP rose from 80/50 to around 110/70. Is this use of calcium out of a Paramedic's scope of practice? Intubation wasn't listed under any of the emergency uses in any of my drug books for calcium chloride.

For those of you who recently took acls within your paramedic cirriculum, what did you get on the pretest? Our course is coming to a close, pretty much just acls, pals, and finals and I only got a 77 on the acls pretest. I am wondering how other people did on theirs, given the same circumstances (1st time taking acls and only previous training being within your paramedic class).

yeah, ill be taking the FL state first, but have intentions on moving to Virginia/DC area several months later, so I need the NR because VA doesnt accept FL state.

Where can I find a NREMT-P practical exam in Florida? On the NREMT website the closest available test is in Georgia!

Even worse, agencies down here without a station, such as AMR, have their units running all day. A crew working a 12 hr shift will leave the ambulance running the entire time, even while not on a call.

why were there 2 ambulances on scene for a drunk and disorderly? Seems like a waste of resources.

How do you feel about families watching you run a code on their loved one? This seems to be a common occurence in south florida hospitals. Family members are brought into the ER to watch to give a sense that we are working as hard as we can to save the person, perhaps give some closure. If the code is run efficiently it can be a positive thing, but if something goes wrong (cant get the tube, cant get a line, cant find something!) it can look really bad and shows disorganization on our part. Not to mention the added pressure and cluster of having the family right there in your face. Thoughts?

My experience is based in the hospital setting. It's not practical to sit in the room with your patient for hours in order to monitor for potential arrest while you have 4 other patients in the trauma area. Yes, we are in the room until the pt is considered stable or deceased. But you never know what could happen, that is why we monitor.

Based on the signifant injuries required to meet trauma alert criteria, which could include resp compromise and decreased perfusion. To monitor the patient for impending resp/cardiac failure.

no meaning neither? when a high index or trauma alert comes into the hospital it is a requirement. Trauma alerts require continuous pulse ox monitoring. so in that case, which extremity?

Deeper burns with subq edema can disrupt circulation, so my answer would be, yes you can start and IV directly on a burn site, so as the site or areas proximal are not edematous, which would result from full thickness burns.

pulse oximetry measures the percentage of saturated hemoglobin through 2 different light sources which are capable of calculating bound and unbound molecules of hemoglobin and presenting that difference in a percentage form. So my educated guess would be to put the pulse ox on the fx site to determine peripheral perfusion. If you receive a percentage less than expected based on pt respiratory status then you can further determine that the effected extremity is not being perfused (combine pulse oximetry with CSM) because of a potential fx. By putting it only on the unaffected site you neglect the additional opportunity to determine perfusion to the fx extremity. So my answer would be to check the fx site first. If you get a normal percentage as based on pt's resp condition, then leave it. If you get an unexpected percentage then try the other hand. But always remember to treat the pt, not the technology.

Is it contraindicated to start an IV on a burn site? If you can still see and palpate the vein? Does it matter if its a 1st, 2nd or 3rd degree burn?

Do you put pulse ox on the extremity with a poss fx or on the unaffected extremity for long term monitoring?

not trying to play god here, just simply asking: 1.) is there a shortage of blood supply? 2.) if so, does it seem appropriate to ration the supply based on need alone or need and potential outcome? 3.) if based on need and potential outcome, if there is a scarcity, then is it fair for someone in their late 80's to receive 5 units of RBCs/frozen plasma (a large supply for 1 individual)?

How scarce are units of packed red blood cells and fresh frozen plasma? Is the shortage detrimental, meaning it should only be used in serious cases where the outcome would prove worthwhile? Or is there more to go around where it can be used a little frivorously? For example, at the hospital one patient was given 3 units of RBCs and 2 units of fresh frozen plasma. He was born in 1918 and had little cognitive function. Yes, the blood will prolong his life, but perhaps only long enough to spend a few extra days in the ICU. If blood was a product of mass production, such as normal saline, then by all means. But if there really is a great shortage, shouldn't this limited life saving product be reserved for the patient with the greatest need AND the greatest potential outcome? While even more scarce, would you give an organ donation to an 89 year old?