FormerEMSLT297

I've been pushing D 50 for 21 years. I have never heard of aspirating back 3 times. I have heard and do know to ensure a patent line because of extravasation, inflitration, etc. If I get a good flash and can get a good pre dex blood draw, I know i'm in. I will push it slowly and maybe once draw back to check. Now if someone else started the IV and I'm pushing meds thru it, then I will go through more steps lowering the bag, drawing back maybe flush with saline and then drawing back before i use someone elses line to push a med like D50, or any med for that reason. But NO I've never heard of 3 times drawing back... I have heard of checking the med 3 times to ensure it was the right stuff before you gave it.

O.K. Here is the problem with the 2 medic vs. 1 medic system.... NYC uses it for several reasons: 1. they have extensive standing orders for many different patient scenarios and many involve reading an EKG is it V-tach, SVT, A-FI, etc. Obviously if there's only 1 medic then no partner to bounce the strip off of. 2. there are many places in NYC, like subways, some buildings, etc, where you can't contact medical control (telemetry) and your on scene time is extended. 3. While one medic is getting a history, physical, and starting O2 and EKG and a line, the other can get on the phone with telemetry and start getting orders for meds if necessary. The final reason is: 4. If there is ever a question about patient care and a review is done, they want to be able to say(or hear the medics say) both medics agreed on the treatment. This is one of the reasons that for years Lieutenants and Captains did not ride the ambulance with regular medics. They didn't want to be put into the position of LT. so and so ordered me to give that drug but i didn't agree with it. This being said, the problem is this. I worked full time in NYC*EMS (FDNY as well) and I also worked on Long Island. In NYC my partner was a MAC certified Medic, and on L.I. my partner was often an EMT or even just a driver. Except for very few cases like codes or critical ALS patients that require multiple treatments all at once, there is no difference in the care provided. I can teach almost anyone to run through an I.V. for me, put EKG electrodes on a patient, etc. And the bottom line for the union that is fighting this is this: NOWHERE is it documented that 2 medics on a bus improve the patients outcome. When this issue came up 15-20 years ago and Danny B. was still treasurer of Local 2507 (for those true dinosaurs out there) He even said we would have a hard time fighting it because of the lack of research studies. and of course managements answer is what everyone already said, more medics for patients that need them,, if the patient is critical sent 2 ambulances and you'll have 2 medics. I was just in NYC visiting several weeks ago and I heard that the push is again on to put LT's in PRU fly cars with EMT partners and letting them do ALS. Quite frankly as a former LT in that system, I can't see a problem with that except that when you need a boss for an RMA AMA or a standby they will probably be tied up on a job. The sad thing is that some EMS supervisors think (or used to think) that when they get their bars (LT. Captain) they are no longer medics and they don't have to provide pt. care. It will be interesting to see what happens. My thoughts are my own and dont represent my agency or dept. Former EMS Lieutenant, EMT, EMT-P, MAC Certified Medic, CRO, Dispatcher, blah blah blah

What the Canuks (no disrespect intended) have to understand is this. In the U.S.A. the anesthesiologist are VERY concerned with law suits, damaged teeth, sore throats, etc. When Intubation was first introduced into my EMS system in 1989 (yes I said 1989) they sent all of the ALS providers to an OR rotation to get live tubes. While I was fortunate to hook up with a relative who was an anesthesiologist and I got a fair number of tubes, a lot of folks reported that the docs just put the blade in and said "see thats the glottic opening" and didn't even allow the student to pass the tube let alone hold the blade. When I got into a full medic program we spent several weeks in the OR until we got a certain number of tubes. and even in the full paramedic class the docs were so scared of being sued ,,, some didn't let you hold the laryngoscope blade but you could pass the ET tube. It was only years later when i got to a flight program and went for RSI training that I was allowed and expected to do all the skills from pre-oxygenation to pushing the succs, to direct laryngoscopy , and placing the tube to placing an OG tube... So you have to understand that the FEAR OF GETTING SUED. is very real in this country and it sometimes stymies EMS training especially when the OR docs don't know you and you rotate through for a few days and then leave. I still know of several Paramedic basic students who because of liability issues did not go through ANY OR training and was told to get tubes on ambulance rotations, and the only practice they got was on mannequins. That is the reality of non-socialized medicine where fear of the lawyer outweighs providing paramedics with good realistic training. My thoughts are my own and don't represent my agency or department.

Heah Timmy: I remember the 2 things that scared me the most about medic school. Math and needles (practicing on each other). Well the math part of it I struggled with for a large portion of the class. I got some remedial training, and some more remedial training and then all of a sudden my instructor Owen T. Traynor, former NYC Medic and now an MD sat down with me and a few other students as well. He went over some stuff and all of a sudden it clicked: DD over DOH = VTA etc. So don't worry if you are a mathematically challenged. Eventually you will get it. And while I'm at it Thanks Owen I couldn't have done it with out you.... Anyone in the Pa. Area. Owen is the Medical Director for the Paramedic program at the University of Pittsburgh Dept. of Emergency Medicine. He is also co-author of the book Street medics handbook, a former NYC-medic and EMS Instructor in N.Y. and all around great guy. Former

Good question: There are many problems and here are some on them IMHO. 1. EMS is a job, not a career. Most Medics stay for a few years and go on to MD, PA, or RN, or they leave the profession totally and go into something else. One of my former partners is an Attorney, another a police Sgt, another was a fire Lieutenant, etc... Why does this happen? Because the EMS jobs in general unless they are attached to a Fire Service don't have the salary, benefits and retirement that "traditional Emergency Services" i.ae. Police and fire have. Until not to long ago, NYC*EMS EMT's and Paramedics did not even have 25 year retirement, and Garbage men, NYC Sanitation workers made more money, still do,, and had a better retirement. Slowly, these things are changing. Some of the other problems are the career path for senior Medics who don't want to or can't carry patients down multiple flights of stairs after years of service (the back starts to go, the knees etc.) I also think some of the problem can be societal changes. Hear everybody saying EMT's aren't what the used to be. Medics aren't what they used to be. Well I speak with friends that are cops and regardless of the department, they say unequivocally, cops aren't what they used to be. I think to some extent, it is generational. They are in it to learn the basics get by do the LEAST amount of work possible and get a pay check. And the least amount work also translates into the LEAST AMOUNT of knowledge. I remember when I left NYC and came to this area, I was speaking with a medic and I asked him why Thiamine was not in the protocols for Unconscious hypoglycemic patients and the replied "Thiamine What's that..??????" I was agast. I started to explain Wernicke's encephalopathy, in chronic alcoholism patients, etc. He shrugged his shoulders and said he NEVER HEARD OF IT.. And he was a NREMT-P, college program educated, with an associates degree.. So I dunno. When I became a medic and I came across a patient or situation I had never seen I followed up. I asked Dr's, Nurses, found text books, looked things up in medical dictionaries... and I followed up. checking on the patients in the hospital finding out if my treatments should hae been any different. And i dont see many medics doing that anymore. They drop the patient off and go on to the next assignment. I've even heard medics say they don't care what the patient outcome is. Hmm,, not a whole lot of compassion there.. And before all the responses start I'm young and new and I care. I am not saying EVERYBODY. What I's saying is as a generation I see less caring, compasionate and concerned EMT's and Medics than I have 10 and 20 years ago. This generation is all about ENTITLEMENT. Not what they can do for the job but what the job can do for you. I see a lot of people come on a job, be it Police, fire or EMS and it's "they need to give me this or that" or I need this shift or that. I need this special training. Whatever.. and Its O.K. if you've been on for a while but I'm seeing it with brand new employees. I remember being a new EMT and later a new Medic, you sat there and did as you were told. Tried to absorb, learn digest the system.. You didn't walk in to your supervisors office and demand this of that shift, or day off or a specific partner. That being said, I also see a lot of great EMT's and Medics leaving the system for higher paying jobs with better retirements and benefits. The other thing is that as long as EMS is attached to the Fire Service and people just get medic cards so that they can get hired, work a few years on an ambulance before getting into the fire side. NOT A WHOLE LOT WILL CHANGE. EMS should be a cadre of concerned caring 3rd service providers with good career paths and good benefits, in line with professional firefighters and Police officers. Just my humble opinion, my thoughts do not represent my agency or department. Former.

I have heard that BOSTON EMS is the greatest place to work. I heard that it is inovative and progressive and all the other words you can you to describe EMS Heaven if there is such a place. Question: Anyone here from BOSTON EMS.?????? Can you shed some light on this. I understand that medics work BLS for years just to get a medic spot in Boston. Someone please explain to me, and I'm not trying to be obnoxious, smart-a**ed or anything else,, but why is Boston EMS such a great place to work ?????????? Educate me please. Maybe we can start a new thread/post about Boston, EMS Heaven.

Correct give that man(men/people) a cigar. I will say that I am 99.99 % certain that the 23 years of age is to satisfy a Driving Insurance requirement... Rembember trying to rent a car at under 25 ? they don't want some kid with 6 months of driving experience wrapping one of their 35-50K dollar ambulances around a tree or other vehicle let alone with a patient on board. that being said, if you want to work in FL get your FL EMT, then go apply,, there are PLENTY of EMT jobs out there. goo luck Former

Heah dude, Several questions: 1. Where do you want to work? what state ?.... what type of system? Hospital based, 9-1-1 system. military, etc. 2. What type of patients do you want to see? Traumas, Medicals, both, transfers ?.... etc . In Maryland most of the scene flights are handled by Md State Police, in Virginia most scene flights are handled by a combination of hospital based helicopter units AirCare (Inova Fairfax Hospital, MedSTAR, etc.) and Police medevac services like Fairfax Police, Virginia State, Etc. I know for a fact that MedSTAR Flight nurses are RN's and required to be NREMT-P, as well as DC, MD, VA, DE, and I think WV medics... as well as ACLS and all the other alphabet stuff... If you want to stay in MD and work as a flight medic your options are limited.... If you are willing to travel or relocate your chances are better. For flight medics most systems REQUIRE a minimum 3-5 years of service in what they call a "High volume" EMS system. with a lot of good well rounded ALS experience. Some have very stringent testing and evaluation systems to weed out people who look good on paper but are what one would call a "paper tiger". What ever you choose to do GOOD LUCK,, also, follow your dream ,,,,, I wanted to be a flight medic since I was about 8 years old. I became a first aider then EMT at 18, went into the Navy worked as a Corpsman, got out worked some 10 years in NYC and finally at age 39 landed a spot as a flight medic full time. Best of luck Former

At my full time job I make the decision to fly all my patients out. The usual criteria is if the helicopter will get a patient to a trauma center within the "golden hour" or "golden period" which usually means within 1 hour of injury. . . www.miemss.org/MdMedProtocols2006.pdf It should be on page 37 or so... . . . . . . . . Opss,,, I forgot, thats right, I'm a flight medic LOL ..... check out the Maryland state protocols for medevacs at the link above.

WHAT???... 3rd Watch most accurate ???... the Firefighters in NYC don't want the EMS personnel in the Firehouses,, 99% of the stations are not co-located with FDNY Engine or Truck Companies ..... so I dont know what system you worked in but 3rd watch is not a very accurate depiction of FDNY EMS... as for him working and going to college.. good luck with the mandatory overtime ,,, if you are going to a college like John Jay that offers Day/Evening classes so if you miss the day class you can catch the same class later in the day ,, you might have a shot... as for most EMT's and Medics going to school ... I dunno if that is true.. I just visited NYC last week and was visiting many of my former colleagues at FDNY-EMS (formerly NYC-EMS) and there are a lot of young kids there going to college,, but there are a lot of people who aren't going to college also ... What ever happens try to find a shift that works for you and volunteer for KVO (Known Vacancy Overtime) to prevent from getting mandated when you have important classes ... Good Luck Former.

Your teacher was 100% right. the correct word is "ORTHOSTATIC" >>>>>>>... Page 1180 of Tabers Cycolpedic Medical Dictionary Copyright 1985 Defines Orthostatic as "straight, causing to stand or concerning an erect postion" It defines Orthostatic Hypotension as "Postural Hypotension" as for Orthostasis.............the word is not listed.... so just because Google doesnt have a word,,,, doesnt mean it is wrong

get a car,,, get a mannequin,,,, put the manny in the car and make him a resp arrest,,, then say he is trapped in the car and have them try tubing him either digitally or with face to face,, if no medics use BVM and have FD cut them out of the car while your people work on him. I used to do a lot of training and it's only limited by your imagination. Everyone loves a mock MVA with hurst tools going ...

How long have you been in NYC-EMS ??,, because I remember when we used to cram the Valium and Morphine into an empty insta glucose box and put it in our breast pocket.... then they got smart and went to the eye glass cases .... to many UOR's from breakage LOL

In both my EMT-CC (I)class,,, and EMT-P class as well as Navy Corps school , ,we practiced I.V.'s on each other. Heah DUST,, I just curious ,, how did you practice IM and SQ on each other ? Saline ?..... we used oranges and dummies for that ...

OPPS.... It looks like i misread your post.... Are you and EMT-I (intermediate) or EMT-1 (which I guess is as Basic EMT)????????? I need to get thicker glasses..... gettting old sucks LOL

I concur with what AK said as well ,,,,, where are you from ,, where do you want to land,,, are you getting out of the Navy? or are you trying to work 2 jobs 1 navy 1 civilian.... But regardless check out fire depts' in Maryland and Virginia,, and i think DC I know that MD and VA recognize NREMT-I 99 as an ALS provider... I think DC does as well.... I'm assuming that the class is the NREMT-I99 class.??????.... correct.... Also New york uses EMT-I and EMT-CC but which are both ALS levels below EMT-P but I don't think they will let you get NYS certified without taking a NYS EMS course.... you might want to check though.. I have heard of some NREMT cert people being allowed to take a NYS refresher course and sit for the NYS test... the other thing is if you can get state certified as an EMT-I NYS may (MAY) let you get reciprocity off of your State EMT-I card.... whatever you do be prepared to provide a course syllabus, and contact info from your instructor. whatever you decide good luck. Former HM2 (FMF 8404)... blah blah blah ......

try the following web sites www.aacounty.org (for anne arundel county Maryland and www.mcfrs.org (for Montgomery county MD) Basically ALMOST all fire depts. in the state of Maryland use NREMT-I 99's,,, they call them CRT's or cardiac rescue technicians.... I know for a fact that AA Co. just hired and will begin again in early 2007, also montgomery County is hiring... also do a web search for Charles County MD EMS,, they are hiring EMT-I's starting at 39K.... If you PM me with your info.. i can give you more.... but these are good places to start... for info on the CRT test and MD protocols ,,, go to www.miemss.org Some dept's use CRT's as stand alone ALS providers and others like AA County,, use them as 2nd ALS provider, 1 EMT-P and 1 CRT..... All of MD is short and are hiring... some places will hire CRT's and some want full P's ,,, AA County has a program that sends CRT's to a 2 year Medic college degree at AA County Comm College after hire, but i understand that the program is temporarily on hold because they are so short.

And the report from today is that the trooper is doing better and still intubated, but responded to family members and writing notes to them,,,,, this from WBAL news

The "Tactical Paramedic" in this case may have saved his life. http://www.baltimoresun.com/news/local/bal...baltimorecounty

Ohh heah Dust I got one more before I go..... and this works well OLD Cigar tubes .... they come in a varity of sizes and can be glass (no good),, aluminum, plastic,,, wood,,,, etc. and the added beneift you get to smoke the cigar first....

NYC Administrative Law makes it a crime I think A misdemeanor, to sell any patches crests or insignia of NYPD, FDNY or other stuff like it to anyone who is not employed by that agency... NYPD Internal Affairs does stings and will shut down a uniform supplier for that violation..(this applies only to retail outlets and not individual person to person sales) That being said it isnt illegal to trade or swap patches.... as for wearing them... THAT IS JUST WRONG..... put it on a wall at your station ,,, patch board what ever ,, but you look like a BUFF a--hole if you walk around in it... also wearing a police item could get you injured or killed if you walk into something like a robbery in progress.... etc. I wear NO POLICE tee shirts, hats ,,, badges or insignia when i'm not working .... and if im on the street wearing the uniform,, i ALWAYS wear a vest... Some food for thought for all you buffs out there ,,,, stay safe

Heah Dust,, how goes it in the sand box ?.... hope you are staying safe..... When I worked in NYC, we used to use the plastic cases from the insta glucose,,, in the front breast pocket,,, that didnt work so well and we then came up with the eye glass case..... it fit well it may have been a little longer than the "normal" eye glass case and we had a nylon pouch custom made that the glass case fit into. The pretty much ended the accidental break in the pocket.... As for combat ops..... try an old plastic tampax tube...its fairly durable, and should be long enough to fit. Another option is taking a 50 or 100 cc syringe ,,, what ever is long enough ,, and cutting down the plunger or just using a piece of cardboard over the top and throwing out the plunger....get some 4x4 to wedge it in the syringe and a pice of tape with cardboard over the distal end...... Some other stuff that might work is small pelican cases or a kids pencil box. When i was an FMF Corpsman we used to use small 35mm film containers for stuff like epi ampules.... now ,, if you cut the bottoms off 1 or 2 containers then tape them together end to end with 100 mph tape until they are long enough to fit the tubex,,, then use the cap supplied for the top.... you might have to get different brands of film containers so they will mesh with each other.... I personally like your PVC pipe routine,,, sounds almost bullet proof and VERY sturdy .... Good luck let me know how it works out.. Stay safe Former The other thing you can do is to tell the pharmacy that the pre-filled syringes arent working and they need to buy you the vials or ampules .... good luck with that one.

If you want to go through a "tactical course" I agree with what everyone else said..... most of these week long school will teach you how to get killed..... Real law enforcement tactical medics .. go through an ENTIRE SWAT school,,,, (my dept. then sends you to a second SWAT school .. to see the differences in team tactics..... then they send you to advanced school like sniper or breaching, then after you survived and put thousands of rounds down range you can go a week long EMT-T school..... but very few teams (NONE THAT I KNOW) will take you simply because you went to a week long CONTOMS or any other EMT-T school. Concentrate on your EMT-CC class,, then work for a while and if you still are interested join the NAVY. GO NAVY ,,,,,, 8404 Field Medical Service School ,FMF, Combat Corpsman ,,,,,,,next stop ,,, the SANDBOX... Corpsman UP. !!!!!!!!!!!!!!!! best of luck to you Former HM2 FMF blah blah blah,,,,

I don't know if it has changed since I worked in NYC, but......St Clares of old (St. Vincents of midtown) always was a dog and cat hospital... i wouldn't want to go there.... Cabrini,,, same thing.... Parkway also not the best care..... Cant speak to the upstate hospitals...... Still it sucks when hospitals close,, the Medics of 13William and BLS 13 Charlie.... and the Cabrini medics 12William (i think) were always top notch and great to work with... Cant say the same about the ER staff though .. IMHO... These thoughts are my own and do not represent my agency or department.

WELCOME to your second career..... best of luck to you in your endeavor.....I know of several people ,,, M and F who started EMS late as a second career..... its never to late.. being older you probably arent in it for the guts and glory, but for the more altruistic reason of wanting to help people.... You can do it.