streetsweeper

If prehosp ETI is discontinued. What will happen in the ER's? Most of the physicians depend on patients to have a controlled airway before they arrive at hosp. Most ETI's done in the ER's are done by paramedics here. We do them so often the Doc's would prefer us. It is common practice while in the dept to get asked by a Doc to tube someone. Going back to using an O/P and a BVM would suck. Filling the stomach with air then getting vomit sprayed everywhere. Not looking forward to that again.

This is my last attempt to get peeps to understand. I am stating before you jump into this career make sure you know what is all about. There is no glam or heroics. It will burn you out, physically and mentally. So if you start your career in this, late in life, be prepared. It takes a toll on your relationships and your family life. I am 38 y's/o and I certainly don't think I am too old. I have seen too many people get into this business thinking its all great, until they figure out that its alot to deal with. After five years they end up leaving. So if you are 30 or 40 or whatever age. You may be looking for a new job, only now 5 years have gone by and your 45. I believe peeps have the right to know the good and the bad about this job. If you don't want to hear the negative side then don't ask the question.

Yep, ya never know what your dealing with. I always like to introduce myself. More so just to see what response I get. Maybe it is a crack head wanting your meds. Maybe its a mental issue. This I would deem part of scene safety. Never rush to a patient and get in their face,, unless you want a knife in your throat or a face full of vomit. I don't care if they are 20 or 70 y/o. You did what I would have done also.

I stand by my comments. From your Blog... how can I take you serious.....your a joke. Get over it!

ouch! I guess my post did apply to some peeps. First of all I was not implying that you are to old or too young. Age does not matter. Its your physical ability. If you read the post correctly I was stating that you cannot just jump into something like this thinking its all great. You must be in it for the right reasons. People who are sincere about a career usually don't jump from one to another. Yes I know sometimes its takes a while to find a job that suits you, but you really need to be committed to something like this. I started worked in this business at age 20, for 18 yrs ALS . I started out at $3.00 an hour, working 100 plus hrs. a week. We paved the road for most of you. Show US a little respect. I apologize to NO ONE!

Dustdevil is absolutely right. No B/S. Just the plain in your face truth. I am so sick of the Gun HO!Oakley Sunglass,, High 5'n ,,Whoaah Crap. There is no glamor in this job. Get over it! If your in it for the right reasons then fine...Most are not. If it took till your 36 years old to do this,,than how serious were you about this .

When a person is alive the body compensates by vasoconstriction along with the other obvious responses. So when in a hyplovolemic state the body is already shunting blood from the peripheries due to constriction. Have you ever seen a warm and pink cardiac arrest. When you elevate the lw extreme's it probably helps because there is vascular wall rigidity. This may help because of the bodies ability to maintain somewhat of an overall venous pressure. But when a person is dead there is no parasympathetic or sympathetic response and no systemic pressure at all. Its like taking a rubber water bottle adding a cup of water and lying it flat on a table and pushing down on it. It just sloshes back and forth and even if you apply a large amount of force the rubber wall will just stretch outward. Large fluid bolus is also not proving to be effective. So no matter what you do it will not help. When you have total vascular collapse its over. Think of D.I.C. This is my overall opinion.

Well its been my experience that most people are aware they have allergies and know what they are sensitive to. When someone tells you they are having a reaction and they had experienced it before. You can believe them. I would get a quick history as to what triggered this. Then they get Epi and the Beni. (if they are not sensitive to it) asap. Don't take the time to screw around. Give it and always prepare for airway control. Yes rash and WELPS,,he,,he,, are good indicators but don't rely on that alone. A visual of the airway is fine, But don't screw around putting scope blades or anything else in the airway. If they are indeed having a reaction you could create a bigger problem with spasm. Then your ass puckers, pretty damn tight. Pass me the toilet paper along with the surgical airway kit!

I believe the main problem is why they would be at home on call in the first place. Its usually because they want to be at home and are required to do oncall shifts. If they need lights to get to the hosp in time then they should stay at the hosp. Whether it means no time for the new sailboat or missing out on a few thousand $$. It all boils down to money.

I had a similar situation. Arrived for shift and crew that was in that night had a late run so we were waiting for them to get back. They arrived and before we had a chance to do a proper stock check dispatch hit us with a priority transfer. We started out and before we new it it was mid day. It was busy. Throughout the morning we would check equipment, a little at a time. We noticed the ECG cables were missing. We reported it to the manager right away. He replied ,,Oh I was waiting for someone to report this because I was given these extra cables earlier this morning, by hosp staff. I replied well I guess we are of the hook then. He stated indeed not, this should have been reported during your equipment check prior to shift start. He was correct but... when I elaborated on the fact that he was aware there was a ambi without cables and that dispatch should have been notified to send out a call to all units to check for possible missing cables. He contributed to the problem 3 fold. I laughed and then said well I guess we get a get out of jail free card on this one. He replied don't let it happen again and that was the end of it. Well, remember these routine checks are designed to place all responsibility on you. Don't depend on others to bail you out. Managers don't care who is at fault as long as someone takes the heat. Take your time and check everything! Regardless of how long it takes. Don't move your unit until you are sure everything is up to snuff. I have learned its ok to try to help save someone elses butt as long as it dosent burn your own.

Here is the problem.. There are good medics and bad medics. The protocols are designed to simplify the steps,, for the monkeys. I use them as a guideline. If you are comfortable adjusting your treatment and it works then great. BUT if you screw up then your Doc. will let you fry. If you go outside the box and they live,,your a hero,,,, if they die,,, your unemployed. Unless you are 100% sure of what you are faced with.. stay in the box THEY built for you. Get your paycheck buy a beer and blow it of. Keep eating bananas!!

Of course the pressure would be adjusted and suction if required. I was just stating the short and sweet of it. limited resources too.

Something I wonder is that . was the pts respirations wet or wheezy prior to the puffer/ inhalaton? Alot of peeps think,, well my breathing is bad I need a my puffer or inhalations. I have seen when treating COPD wheezes you can cause what I call a Flash. This is when they go from a tight set of lungs to a flood very fast. I titrate nitro to BP. If their BP will sustain nitro then they get it, but only with a secured iv. When pts get to the weak stage and they begin to lose their effort. Its better to assist them with a bvm and your ET tube at the ready. They usually shut down and then with a little spray and some valium you tube them . They become more comfortable when you take over for them. It causes less stress on the heart. Not to mention you can push the edema across. I am aggressive when it comes to airway/breathing. Its easier to take control then to wait for them to crash, with no BP, no IV and your thumb in your butt.

Well many years ago our service hired the first female. The single guys loved the idea. The married guys were nervous about it. I remember one guy was totally against the idea. I wondered why, because he seemed like a nice guy. It wasn't long that I soon realized what the problem was.,, when I meet his wife. She was outraged by it. He would try to get the rest of us to jump on the band wagon. So one day I simply said to him. Your problem is not with the new girl, its with your wife. I said its simple, if you love your job than grow a bigger set of balls and tell your wife if she enjoys going shopping and getting her $60.00 nail jobs,, than she better learn to accept it. Not to mention the female could lift,,, he wasn't worth a crap. Although you do spend some strange long hours with different partners. Does it matter? You can easily have an affair with the girl at the coffee shop, that you see every night during your few breaks. You either have trust and are secure in your relationship or you don't... Its that simple. Oh, now we have many female employees and no problems.

When I started I had to give 100% of myself while I worked. The job demands it. Each day I went home I would leave 1% of me at work so I had 99% left to bring home. Add that up over 18 years. What do you have left, An empty wallet and an empty soul.

I feel like I found a new home here. Thanks for the support. I too hope I can educate people from making a mistake in this career. This is not a life time job. It is a 10 year career at most. So what are you going to do when your done, at age 30 or 40 with a messed up back? Who wants you then? 18 years for me I am Lucky I got this far. so now what? You are just as we say, a warm body to carry a stretcher. There are many more new 20 y/o waiting in line when your used up.

C(continue) I(ignore) S(seat belt) and D(drive) We don't need CISD its the people around us that do. We deal with this OK but its everyone else that can't understand us. Why we are miserable to be around at times. Its not just one call that screws you up its all of them! CISD is not for us. It's for our employers. Its there way of deflecting responsibility for their contribution in us snapping. They can say that they have a support system in place to help you deal with unpleasant situations. What a bunch of crap!

I handled my first loss with the pager peeping and dispatch telling me to get my ass in gear there are 10 transfers backed up. Then filling out a call report explaining why we were 40 min on scene. Not to mention the cleanup afterward. No time for emotions your just a horse. All a horse is good for is pulling a wagon.

Don't be crazy this job will brake you up faster then a new set of dentures on a baked potato. Thats if you are perfectly healthy. Theres nothing glamorous kneeling in shit and washing vomit from your cloths all day. You might look cool parked with your sunglasses on at the coffee shop but how cool do you look lifting the local 300 lbs drunk full of crap off of the side walk at 9am.

Hey, I'm new here and just wanted to blow off some steam. Well I am a 38 y/o paramedic with 18 yrs experience as an als provider. I am physical and mentally burnt out. I am presently off with the following; T-5 disk protrusion, T6,T7,T8 bulged,,,Hypertrophic degen. with multiple thoracic bone spurs with a lumbar disk gone. I am on LTD an am told that if I am able to work 1 hour a day I am considered to be employable so I get my benefits cut. My employer has no light duties and I am considered a risk now so they would be happy to get rid of me. I started working for $3 an hour in 1989 and have slowly worked my way up to $20 per hour,,,, now I'm done. I feel like I worked my ass of and literally broke my back to get a slap in the face. I have a sour taste in my mouth for this job that I once loved. I would instead of waiting for another crew to come to help lift, muscle the patient down the stairs or through the snow banks with my partner. I went through a few partners. I was crazy,, where did it get me. All the people I helped ,especially my employer and for what. Nobody gives a rats ass about you when your done. And mentally I am burnt... My body does not produce adrenaline, I drive my truck and something jumps in front of me and I don't even flinch. I am de-sensitized nothing seems to be significant to me. When you are pumped all the time and everything is so life or death and its all up to you then everything thing else is shit. Even family issues don't seem to matter. I don't cry or laugh. I feel like a stone. Yea this job really messes you up and when you become aware of it your already done for. Well that felt good , sorry if I rained on someones parade but its the cold hard facts. When peeps say you give your heart and soul to your job they don't know how true it is. Well thanks for the interest........

Yea its a nice tool. I use it when traditional method doesn't work. It really does sound like running your finger across a comb when it rubs along the trachea rings. A good cold tube with a decent bend works just as good for blind intubations.