FormerEMSLT297

Also I would stay away from Nissan's because when you add radios, flashing lights sirens, etc... the drain on a standard alternator will just be too much to handle. Go with a heavy duty vehicle that is made with the extra lights and radio harnesses to accomodate all the extra stuff you need. That way no electrical problems.... There are some companies that specialize in Response vehicles... try www.odysseyauto.com Many of the South N.J. medic units use this company..... also, I think,, Rockland Paramedic Services in NY did also .. Anyone from RPS can confirm this ??????

In NYC we called them PRU's (Paramedic Response Units) they didn't work but it sounds like it may work well in your situation. The type of PRU vehicle you want depends heavily on several factors, like weather, terrain responding to, or on, and typed of equipment you want to carry. Having that in mind, I have a couple of questions: 1. What type of geography are you running? Beaches, sand, desert, off road trails like fire roads in forests or parks, lots of rain, or snow in the winter... or r u in the south without snow and/or staying on the hard ball?. If you have lots of snow, or desert or sandy beaches, or off road stuff like parks and forests,,, you'll want a 4x4. 2. Are you going to eventually have 2 medics in the truck or only 1... cause if you have 2 per vehicle, do you want to have enough room to carry 2 full sets of ALS equipment.. Some medic units do this so that if they have an ALS patient, 1 medic can stay in service while the other rides up to the hospital. 3. Are you going to carry turnout or extrication type gear so you need more room ... 4. and most importantly what is your BUDGET?.... The other thing I would say is DON'T get any vehicle that doesn't have a HEAVY DUTY at least "taxi" if not "Police Package" you'll need it for the extra lights, siren, radios, etc. My suggestions would be look at Crown vic's,,, Impala's,,(but they are tight for 5'10+ people), also look at the dodge magnum, and chargers, (with police package) or the Station Wagon style (more room for gear) If you want a 4x4 i never used the Jeep Liberty but my dept used the Cherokee and it SUCKED, seats uncofortable, not lots of room head hit the roof on hard bumps, etc... So look at Tahoe's Yukons, Suburbans, etc, but keep in mind the do burn gas like crazy. If the county if funding the unit maybe they can order the vehicles for you at the fleet discount rate by just adding a vehicle to the Police or FD's next order.

Fascinating,,,,... and the union... IAFF(Firefighters union.. NOT PARAMEDICS union) is defending them....... I'd like to hear some thoughts from other members about fire dept EMS.... when I was in NYC before the hostile takeover of EMS by FDNY,,, J. Fitch and associates came and did a survey on how EMS could improve response time.... we paid hundreds of thousands of dollars for them to tell us stuff we already knew like: 1. carry more than 2 O2 tanks on the ambulance so crews would not have to restock O2 after every call (NYS requires 2 D tanks to stay in service) 2. put restock supplies at area hospitals so that crews would not have to drive across town to restock, basic and ALS supplies. 3. Stagger the shift changes so that all units don't turn out at the same time leaving no units on the streets. 4. etc.. My point is this,,,, during the discussion with Fitch and associates we asked him and his staff what he thought about the rumor of impending doom. (FDNY takeover).. He said "VERY FEW FIRE DEPT's RUN A QUALITY EMS system...." When I asked him to name some that do,,, he listed several,, the one that stood out was Seattle Washington,,, I'm sorry this was 15 years ago and I don't remember the other depts.. My point is do you agree with the statement? "most Fire Dept's don't run a quality EMS system " And what are some Fire dept's that you feel do run a quality EMS system??

I agree with Paramedicmike, if you are going to call a helo,, call asap,, that limits the patients pre-hospital time and makes the most of the "golden hour"

... right,,, i mis spoke,, or mis typed as it were,,, the first thing you need to do is determine if the patient is a candidate,, and that involves MANY MANY factors,,, v/s signs sx of hypoxia, hypo ventilation,,, etc,... then if you think based on v/s the patient is a candidate, assess anatomical factors that may make RSI difficult,, like no chin ,,, lack of thyromental distance less than 6cm, large teeth, etc.. It can be difficult even impossible to assess the Mallampati scale in trauma patients.... but other factors like ease of ventilation with a BVM,, V/S including pulse ox.... need to be checked before you go about paralyzing someone and actually stopping their ability to breath... just so that you can "get a tube" or do a skill like someone else suggested... RSI is serious business, and a decision to perform it should not be entered into lightly without a through assessment and a high probability of success.

Heah KEVKEI,, the naemsp web site link did not come up and I couldn't find it,, summarize for us,, are they for it or against it. RSI involves a lot more than just knocking someone out and putting in an E.T. tube. The first thing you need to do is look at a patients airway and determine the class of airway based on the Mallampati class 1-4.... the size of the tongue vs size of pharynx,, the ability of the patient to extend their atlanto-occipital joint,, simply put the ability of the patient to flex and extend thier neck, size of teeth or other dental issues... presence or absence of tonsils,,,,,etc.. If the patient has NO NECK and is like 5'5 300 Lbs. they are probably not a good candidate for RSI... That being said,,, RSI is a great tool in the pre-hospital care arsenal if used properly and performed by skilled clinicians. My agency sends all of its paramedics to a Minimum 40 hours in an O.R. with an Anesthesiologist to learn to utilize the medications, perform the skills and do a good pre hospital airway exam. All RSI's performed go through a mandatory QA/QI review by the Medical Director and follow up is done at the hospital to determine long term patient outcome.... My opinion about RSI is that in some cases where a patient needs an airway and they are not being oxygenated witha BVM and O2,, then RSI is one way of definitavely securing an airway.

As I flight medic myself, i get the times after the call and sometimes wonder,,, call dispatch time 1400... first unit on scene 1410.. lifeflight requested 1430...... hmmm what took 20 minutes to request a helo..... I dunno what your protocols say BUT.... When I was solely a ground provider,, i used to look at it this way,,,,, the fastest way to the trauma center is helo.... but waiting for them to warm up and fly 10 minutes to the scene,,, you could have driven 10 minutes closer to the hospital. When I called for a helo ,, i tried to do it AS SOON AS POSSIBLE.... now sometimes u cant tell right away, by eye balling the patient.. but if you know you first due area,,, and what trauma centers are open/available..... you know what the traffic is like cause you just drove through it going to the call.... the sooner you call the helo the better. It'd just good patient care..... don't feel bad about it don't feel you have to argue about it.... If your supervisor is worried about the all mighty dollar,, ask him this..... If I didn't call for the helo, and the patient DIED or suffered a debilitating injury, and the family SUED our company.... then what would have happened. You acted in the BEST INTEREST OF THE PATIENT... which is all we can try to do..

The Dept. I was in on Long Island NY has an explorer program,, the explorers were used as victims at EMS drills, they were taught basic and advanced first aid, basic fire safety, they went to local schools and gave talks about the fire service to other kids... the minimum age to ride was 17 (with signed parental consent, as observer or First responder and 18 to be an EMT, or EMT in charge, or to ride on fire calls..... Under 18, they had to be supervised by a senior crew member. 20 years ago this was the norm.. i think that with the litigious society we live in many agencies are tightening up the ride along policy and increasing the age to a minimum of 18 ... Also a lot of Depts. are increasing the age to drive apparatus from 18 to 21,, some even 25. Stay safe

Hmmm ,,,, let me see,, whose side do i take on this one?... 1. First let me say that if she is in southern MD, the nearest trauma center is Prince George's Hospital center.. which may be 45-60 minutes drive time from the scene... maybe even more depending on the time of day, traffic etc. 2. It's not necessarily wrong to eye ball a patient and then start a helo,, you can always cancel it or turn it around, but if the initial impression is that the patient should go to a Trauma center then cant hurt to start, depending on how far away you are..... 3. Having been in a Medic for 20 years, and also in Law enforcement, there is a BIG BIG difference between SNOT SLINGING DRUNK can't make a rational decision about informed consent and maybe just "a little ETOH". Now my question is did the cops do a roadside breath test,,,, i might have tried that... cause if you get a very high reading then you have a suspect you can place under arrest, or at least have ammo to back up forcing the patient to go under emergency orders. If you get a BrAC of .02 or .04.. then you can reasonably determine that the person is able to make an informed consent. (I didn't make this up this was a judges ruling about "emergency orders" the .02-.04 thing) Now having said all that I might have suggested in the strongest terms possible that the patient needs to go and if the cops know haw to talk to the patient they may have helped you to convince the pt. to go. But keep in mind that Law Enforcement "emergency orders." in Maryland and most elsewhere specify that the person must be a danger to themselves or others, i.e. suicidal ideations... to be taken into protective custody. Now I have been to hundreds if not thousands of calls involving law enforcement and protective custody emergency orders, etc,,, and I can tell you that the advice the police are getting from their legal teams is that "UNLESS THE PERSON PRESENTS AN IMMINENT DANGER TO THEMSELVES OR THE COMMUNITIES" be very careful and selective about who you FORCE TO GO. What can I say,, we live in a VERY LITIGIOUS Society.... Stay safe

Interesting u mentioned propofol.... i would be interested to know if any agencies carry this medication for pre-hospital use. From what I understand the medication is not routinely carried because it requires great temperature control and constant refrigeration.

First let me say,,,, it's always good to treat the patient, not the monitor. Having said that a person who experiences V-fib or V-tach, is usually a victim of some irritable foci. I had a patient in V-bigeminy with runs of V-tach the other day with No CHEST Pain, and a bolus of 100 mg of lidocane, cleared him right up. The meds were given in the E.R. because he began to show ventricular ectopy a a run of 7 complexes of V-tach immediately after we transferred him over the the Hosp. stretcher. The ER Doc gave the lido even though the patient did not have chest pain or significant hypotension 112/72. The Doc explained that he wanted to prevent V-fib or R on T phenomenon and that's why he gave lido.. the patient went into sinus between 90-110, with no ectopy. I've seen lido work dozens of times, and i am a believer in it's use.

OK I will try to answer dustdevils exact questions: 1. all things being equal I prefer to do an assessment and any BLS, ALS in the house, get your O2, V/S, Baseline EKG and I.V, as well as first round set of medications, then package to patient and transport and we will contact med control either from the residence via phone or via radio while en route hospital for additional orders. 2. Our agency SOP's only address what equipment you must bring in to a call, not where to work, however if you get seen by a supervisor bringing a patient out of a house without ALS when the patient clearly needs it, s/he may question why you didn't do ALS prior to transport. 3. Medic school was a LONG, LONG, time ago but my instructors explained that they felt that getting the initial BLS and ALS treatment on board will usually provide a more rapid benefit to the patient, especially in the Resp. distress and cardiac pts. 4. a large large majority of medics in my former agency operate the same way, but some controversy still surrounds the question and at my new job in MD some medics will just V/S and O2 and EKG and do the IV and meds en route to the hosp. I hope this answers the specific questions that you asked...

First let me say that I agree with most of what others posted.... be systematic, have a plan and try to go head to toe.... Another good way to learn is to PRACTICE... and remember practice doesn't make perfect. "PERFECT PRACTICE MAKES PERFECT." LOL .. practice on family, relatives,,, children,,,, practice with the book open so that you can remember what u need to ask and do.... also read.... a lot of EMS magazines with patient scenarios can help you to think about different patient presentations. There are also some good books that specifically deal with patient presentations and pt. assessments. Good luck

:!: This question or a similar question has been around for AT LEAST 22 years... it was on the New York EMT test in 1984... I too knew the answer before reading the multiple guess questions... it is part of the National Standard curriculum as well. the reasons for it are as stated... 1. you can get to both sides of the wound,,, 2 in could impede breathing or occlude the airway.... not a stupid question,,,,, but they should have taught you this in your Soft tissue Injury portion of the course....

DUMBEST THING A PATIENT EVER TOLD ME.... went on call late month June 2006..... reported 8 month old child burned ... MOM on scene I say how old is the child,,,, she says 8 months ... I ask,, whats his birthday,,,,, she says July xx, 2005,,,,, (I DO THE MATH)... I say so he is 11 months old... she says "NO 8 months old ,,, he was born 3 months premature....."........ HERE'S YOUR SIGN..... !!!!!!!!!!!!!!!!

Long Island has a lot of great volly FD and EMS services.. but the cost of living there is VERY VERY HIGH.....I would find a place u want to live (translation can afford) and then look around the area for volly services.... if you ask about number of calls,,, 300 is about 1 a day, 600-700 2 a day,, etc... thats the way you can gauge business.... Then just ask about the things you want like upgrading to ALS,, training etc. Good Luck

I concur with Asysin2leads,,,,, so much is via computer,, even if a units wants a hospital notification, they can type it into the MDT and ask the disp to recall it and call the hospital.... when i lived and worked in NY and listened to a scanner at home or in the car,,, (i also did free lance photo work) I never listened to EMS freq.... except EMS Citywide,, and there were only 5 freq at the time.... now there are at least 8-10 for disp.. i lost track,, but point is you cant really learn much,, if u go to new york city then dial up the freq. and you'll see (hear) much better to listen to FDNY fire side and NYPD Citywide freq. if you want to hear the action... good luck

Sounds like you are crispy, burnt, well done,,,, I think the previous advice is good. EAP, maybe a social/mental health worker or psych visit,, most health plans cover it.... Might i als osugesst a peer counseling group,,, sometimes getting together with a group of co-workers can healp,,, some other sugestions include: 1. Start an excercise program,,, get a hobby, do some crafts build models,,,, etc.. 2. Try accepting your station in life,,, if the dept, doesnt care about taxi rides to the hospital look on the bright side, at least i dont have to carry the patient down 5 flightsd of stairs. 3. try a career change,, or transfer within the dept to training, or dispatch,, or something... best of luck

PCP, EMT-A, EMT-B, EMT-CC, EMT-P, CCEMT-P, MICU, Ambulance attedant, driver, "heah you take me to the hosptial".... its all just the alphabet,,,,, i've seen some great EMT-CC's who start I.V.'s and give certain meds,,,, ive seen some really bad EMT-P's,,, so i guess what im trying to say is " CAN'T WE ALL JUST GET ALONG".... i dont think that the asthma patient who is wheezing up a storm needs a lengthy expanation of your an EMT-CC but your like 2/3 a paramedic... they just want you to help them. but it does get confusing....

I worked in NY for the first 13 years of my EMS career,, first private BLS, and Vollies, the NYC*EMS, BLS, Disp, ALS, and LT..... I will give you the following advice with regards to NYS employement: 1. Go volunteer somewhere,,, no company likes to train from the ground up, lifting stretchers, how the stretcher operates,, PCR's etc. 2. apply for local private ambulance company,,, if you are in the city,,, there are a bunch look in the phone book of web,, 3. get as much additional training as you can, BCLS,, EVOC courses etc.. 4. Some ambulance companies will not let u drive if you are under 21,, ive seen some under 25, or some let u drive at 18 depending on their insurance comp.. 5. apply for FDNY EMS or other municipal units FDNY especially has a high turnover rate in EMT's and at least you will be on a waiting list for a 9-1-1 job.... As summer approaches look for jobs in the NYS park system,, Jones Beach, Robert Moses Roberto Clemente State Park all hire EMT's for the summer,, the pay ain't great but its interesting work, and good experience... Also look at the National Park Service in NYC/NJ,,, Statue of Liberty, Ellis Island, Gateway National Rec. Area, and Sandy Hook NJ all hire seasonal EMT's... Best of luck,, if you have any further questions feel free to ask,,,

I meant to watch it and missed it,,,, i guess i'm one of the lucky few....

I have been a medic for 20 years,,,, i worked in a very heavy herion OD area... and used it dozens and dozens of times... Im not going to belabor the point but i agree with chbare and others, medics who give this med must be grounded in its effects, actions, etc.... and there have been times when we withheld Vitamin N or gave just a 0.4 or .8 to prevent some of the more serious problems. So, if EMT-I's want to give this med. they must not just shoot in the dark,, they/you have to understand the potential harm you can do and the potential harm the patient, whom you awake and or arouse from a drug induced high, can do to you and your crew if vitamin N is used improperly. Remember, Do no harm, dont be a cook book medic. Former

The best benefit i can think of is that with gas prices so high you dont have to do 10 round trips to work every week, it will really save you on gas.... but it is also true about not being able to do it if you are working at a busy station...

Great EMS books and basic stuff like shears pen lights at the Barnes and Noble Book store in Manhattan i think its on like 18th st or 17th street and Broadway. Used to be a place called the Finest and Bravest and Best in the Bronx,, it sold uniforms , buff tee shirts hats, patches, etc..... but it closed down several years ago,,,, SCHLESINGERS in Manhattan may still be in business,, last location was off of seventh or broadway in Manhattan on like 15 or 16th street... alot of uniform store went away with the FDNY hostile takeover of EMS.. they now get uniforms from FDNY quartermaster... also look up a store called E.S.U. (Emergnecy Supplies Unlimited) in Valley Stream, LI,,,, I dunno if its still there but if it is they carry uniform stuff I would check with some of the volunteer units like Central Park Medical Unit or private hospitals like St. Vincents, or St. Lukes Roosevelt as to where they get their uniforms. I've been out of NYC for several years,, and thats the best i can tell u.

the brady work book has alot of test questions in it that are right out of NR... read the questions and you will see them again on the registry test