EMS Solutions

Thanks for the link to see the details. I also was not aware of this.

" It is also known as the finger flexor reflex.

The test involves tapping the nail or flicking the terminal phalanx of the third or fourth finger. A positive response is seen with flexion of the terminal phalanx of the thumb."

It is similar to what I initially thought it was

me rolling my eyes

me flexing a different finger

me driving my car and flexing a finger

All also well known Hoffman signs.

I do agree though that time is an issue, and testing for these signs and others may not always be prudent with patients in the field. You may even find that if you start doing this and telling doctors of your +- Hoffmann's sign, they may have no idea either and start flexing their own fingers.

As far as it being easy, many things are easy in the field and not done correctly. So I suppose if this was part of a head to toe exam then you would have to take this into the whole picture and not use it as a stand alone sign.

While it is important to note that those of us that are paramedics were not born as medics and had to be an EMT at one point.

It is equally important to state that as paramedics, our feelings of one title, one entry level education and one license comes mostly from years of experience and seeing the benefits that this type of EMS provider structure can have.

I agree with previous posters on having an entry level 2 year degree type license with additional training for other areas in EMS to include recent discussions in some areas on house call type para-medicine.

I also think that by having one title, it will also help the profession grow and expand into what it is capable of. When government agencies both local and above can

understand what we do, it will help us get funding, education and growth support from them, much like fire and law enforcement.

By having us under one title - I think it will help them understand and get on board much quicker.

When will this happen? When we get out of each others way with adding exceptions to the rule, making excuses for small towns to keep EMT based only, supporting the volunteer mentality etc.

We need unity to make this happen, but go to any EMS council and see how everyone protects their small area of responsibility.

Just as a for instance, NJ came up with a report to try and revamp the system that is in poor shape. But leaders of the volunteer sector refuse to give up their status and still say that it works when clearly it doesn’t.

Right now we are so fractured it seems like an impossibility that any significant change will ever come.

We need to get behind a national organization like NREMT that has the recognition with many states and get a huge PR campaign going to increase public awareness. This takes millions of dollars and clever marketing and advertising.

Can it happen in my lifetime? Why not? I still have a good 20 years left in me. If we unify and get the financial support and proper political backing, we can at least lay the foundation for a new future of EMS.

Personally I wish we could just tear it all down and re start from scratch, but I don’t think that will happen. The next best thing is to at least start with a unified organization with standard entry level requirements and standard licensing with an organized body behind us.

Yes with dues, requirements etc, just like any other.

This can be done without hurting anyone’s bread and butter. We need the right people to head it. Most of all we need motivation and desire and not just talk amongst ourselves.

When can we start? Now.

Jim

I do not know any other details of the case. Not how much water was in the tub, what the pills were, what type of IO used, what color her hair was, if she was extracted by a special team of experts that without would harm the patient, or whatever other mundane details that nitpickers need to know.

Yes but how fast was the ambulance driving to the hospital. :evil:

How did you see his bruised butt if you already had him on the board? Was it before he rolled over as you were walking up? Did you unstrap him and roll him, and at what point did you get him "trauma naked" ? Before you slipped the board under him or while you were looking at his bruised butt?

Maybe his massive internal injuries were visually hidden. Did you check his vitals, besides telling him to keep his hands on his chest? BP. Pulse, RR, pupils etc.

8 mins to trauma and they couldnt find and fix massive internal injuries that lasted a day until he died.

Between that and the big speed limit discrepancy - I may have to call "Shananigins" on this "Case one" :evil:

I figured with all these yes and no answer polls going around that wind up into a 3-4 page thread, why not start another?

Try

http://ems-safety.com/nremt-audio.htm

maybe a different study method may help.

Good luck

I heard A-Rod spits :twisted:

As of a year ago.

You need to have a NJ paramedic service sponsor you.

The paperwork goes to Trenton with your school info (Clinical, didactic hours.)

National Registry Info.

Your time as a medic and type of service you worked for (911, critical transport)

If your school hours meet NJ requirements - you should get a Temp reciprocity for 3 months.

Then if you play well with the company you are working for, they make it permanent and you get your #( which is the same as your temp # but without the T)

Now if you do not meet educational requirements, they will consider your time as a medic and the type of service you worked for and may give you credit for this time.

OR

The Paramedic service that is sponsoring you will arrange for you to meet any lacking hours

via clinical or didactic thru them. Whether or not you get paid during this time depends on the service.

If you have specific questions. Feel free to PM me.

With the amount of training EMT's receive, medication administration should not be within their scope of practice.

Some areas allow for Epi pen adminsitration, albuterol admin and NTG admin by BLS if the patient meets very specific criteria and/or are previously prescribed the medication or have a history of a certain illness etc.

These programs also add more training to the EMT's to cover these specific standing orders.

The problem is that the specific guidelines do not always fall into what the EMT may encounter. This is where higher education comes into play. It may not be all the time, but there will be times when the patient does not present like the book and cannot be treated with by the book protocols.

Yet some BLS crews will still treat with the medication because they can and may not see a bigger picture.

I don't have graphs or charts to back this up, but I have seen it and I have seen medics do it as well. It cannot be about being a "cookbook" EMS provider. We must think about the bigger picture when treating patients, especially with medications.

Training, education and experience is the key to proper patient care. Not just being allowed to do something.

If only we were all at one level - Paramedic. Then perhaps EMS could go forward instead of just spinning our wheels. But that is for another thread.

Take a listen to my Bledsoe interview.

http://ems-safety.com/audio.htm

I believe the re test option is only for 2008 to give people a chance to take it using the new system.

You should get a form mailed to you November of the previous year before you expire.

So if you expire in March 2008 you get the form Nov. 2007.

Keep track of your credits and any documentation.

Jim

$70 is a lot of money.

I know of a site that is much cheaper and offers much more.

I wonder where I saw that "Solution"

"Know Your Job, Do Your Job"

Anything make it better worse, positioning etc.

Pain 1-10?

Dental issues?, Stress? Depression?

Pain location - front, back of head, wrapping around head, non descript?

Any issues with gait, dizziness?

I think I would want to take you to the ER, tell the nurse/doc that it has been going on for 2 months, get blood work, CT, Urine etc.

Have the ED contact me with the results, consult with your PMD and follow up with you

in another week or so. I would do it sooner, but I am booked solid. If anything changes or worsens give me a call. You know the number ... 911.

On/off X 2 months, constant x 3 weeks?

Did he go to his primary MD yet? Or is he using 911 as his PMD?

What makes this episode different that required calling 911?

That is barbaric.

I hope they got to split the ambulance bill at least

Having separate level providers EMT, EMT-I etc is one of the problems in EMS.

How can we expect to get licensed when someone goes thru a 120 hour course to be an EMT?

This also confuses the public, they don't know what to expect when they call 911. Some guy with an oxygen tank or someone with a mini ED.

I also feel that by promoting one level and therefore one standard of training. It will be much easier to pursue the cause of making EMS it's own entity and get that license and standard of education and care implemented.

By having all these separate levels, you would have to approach it with

an EMT can do this but not that

an EMT-I can do that but not this

an EMT-CC is allowed to do almost this but still

cannot do that.

Imagine someone with no clue about EMS looking at us and trying to figure all that out and give support to the goals we have.

I've been in EMS for over 16 years and my own family still doesn't understand what I do.

It's a hard sell IMHO.

When you have a system that is so all over the place, what needs to be done is practically breaking it all down and starting from scratch.

Jim

I've heard of a place where you can get a free testing tips report, some decent practice exams, study guides and other stuff.

I forget the site but you can look at my signature and maybe that will help

Great topic. One that can go in circles forever, unless action is taken beyong us talking about it here and in other forums.

So far I agree with most of the comments. But..

No vollys

No EMT, EMT-I, EMT-CC etc. - One license, One Level - Paramedic

Unity is also key to getting where we want to be.

One governing body is a great idea. Who wants to start that body? Who will start it and stay with it?

PM me if you are serious about making a change.

No it's free. I never get unwanted emails. When I mentioned spam above I meant

from other people on the site that will ask me to join their network but have nothing to do with EMS and are usually work at home ops.

However, I will say that those types of emails are very low. I usually just ignore them.

I thought that 80 was implied DNR. :twisted:

I'm a member

I have built some contacts. But you have to be wary of spam.

OK, Uncle Uncle

I agree that the patient should have been removed from the vehicle prior to the second ambulance getting there.

I agree that exposure of key areas as needed for this patient should have been done. However, I would prefer to do that in the ambulance with the patient supine on a board.

Not on the ground or inside of a car with some whacker holding a sheet to keep prying eyes out.

The thing is, if the patient was being extricated as she should have been while the ambulance was enroute. Then according to the ETA she would have been removed about the time of arrival and put in the ambulance for all this exposing to be done anyway.

Now a different scenario may have warranted doing some exposing on scene. But in this one I don't feel it was.

To just throw that in as a post to pick away at the scenario and what went on is just being a backseat driver.

I don't think that a patient as described needs a strip and flip, scratch N' sniff , pull my finger or whatever out in a roadway.

Of course her condition could have been this or that, the airbag could have released, the car may have exploded etc etc etc etc.

As the arriving ambulance ultimately responsible for patient care , I am going to do it over again anyway. I don't care what you did before I got there as far as exam goes. Just get them packaged and ready, so it won't delay my mastery of IV therapy for trauma patients.

With that said, I blame James for all this. I was just having a relaxing Friday.

Expose as needed. Round and round we go.

Everyone considered this patient stable. Now that a new comment gets made going against textbook treatment, she may be compensating or have a hidden injury.

Listen, I'm not saying to not expose and look at potential injuries. But certainly not on a roadway, unless of course the situation calls for that. So far this one does not.

She's been in the car for at least 10 mins, with a life saving collar on. All of a sudden everyone wants to take her clothes off.

Maybe she is compensating, maybe she is a drama queen and computing her lawsuit.

I wasn't there. However, those of you saying you would strip her down and use sheets to protect her privacy. Good for you. Let me know when your court date is.

Welcome to the city jtmills272.

Just a couple of suggestions for your future posts...

1) Grammar and post structure goes a long way. There is no problem with asking a question, but think through your post and proofread. Spell check is awesome.

Great tip for the brand new member. You never know what "company'"or how many "companies" you will find looking at your posts.

Well James now you went and did it.

Now while I think the patient should have been ready to go upon arrival of the second ambulance.

Strip the patient?? Let's be real here. Yes expose as needed. But a stable patient I dont think needs to be stripped out in the open, I dont care how many sheets your holding up.

Of course you can do it, and you can justify it as "proper pt care" But

Would the same person with the same training in the same situation do it?

I guess it would depend on the age, weight and + Jessica Alba findings.

If she was too young we could wind up in the EKG thread

Well, have fun on your next MVA second guessing yourself.