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Scaramedic

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    A different scenario for you.

    in Education and Training

    Posted

    Here's the scenario for you.

    A 76 yo Female has pushed her LifeLine Personal Alert, LifeLine called her son who rushed to her house (she refused to have Lifeline call 911). He found her sitting on the toilet, complaining of shortness of breath. He calls 911 and you arrive on scene.

    You find her pale, diaphoretic, able to speak in full sentences but very weak. A&OX3, no LOC, no C/O CP, dyspnea has subsided.

    BP is 72/34, RR 24, HR 38, Sinus Brady without ectopy on the monitor, SaO2 98 on room air. LS Clr Bil, No neuro deficits. Finger stick Glucose was 133. Rest of assessment is unremarkable. Hx NIDDM, A-Fib, CLL, and HTN. Pt is on Glucophage, Coumadin, Atenolol and Lusinopril. NKDA.

    You start the usual IV 20g R AC NS TKO, O2 NC, Monitor. You do not do any further interventions. :shock:

    The question is this.

    Do you...

    A. Pick up all the trash you created and dispose of it in the unit.

    B. Pick up all the trash and throw in the patients garbage.

    C. Throw the garbage on the floor of the patients bathroom, kitchen and living room and leave it for the family to pick up later.

    Hah, you thought this was going to be a vagal thing didn't you? :D

    Well obviously it was, her Atenolol was causing too low of HR, and the BM caused a vagal response that dropped it even lower. The patient was my mom, I was the son who got called. She is fine and at home resting. They changed her Atenolol dose and D/C'd her after all the standard tests came back negative.

    The issue I have is that my family was irritated at the house being trashed, and they asked me if it is normal for an EMS crew to leave garbage everywhere. My answer was that I always tried to pick up trash that we created on scene. I understand maybe on a critical call leaving the occasional bit of garbage when treating the patient. This was not a critical call by far, I won't even start on the lack of treatment, that is another issue. My family does not know there were several things the crew could have done for my mom, they just know the crew trashed my mom's house.

    So the question is this; do you pick up after yourself when on scene? I am not talking an arrest or a load & go scenario, I'm talking your typical non-critical medical call.

    I would love to hear your opinions on this.

    Peace,

    Marty

    :thumbleft:

    Saved! New Paramedic Drama on TNT

    in General EMS Discussion

    Posted

    I sort of skimmed the discussion here, but which Portland is the show supposed to be set in, Maine or Oregon?

    Oregon, another TV show filmed in Vancouver, BC that is supposed to an American city. :roll:

    99.9% of the population won't know the difference anyway.

    I bet Multnomah County EMS and AMR are just thrilled about this new series.

    Peace,

    Marty

    :thumbleft:

    The best service in the country

    in General EMS Discussion

    Posted

    What is the pay in comparison to other progressive EMS ? Not just fire services, even in within the state, and EMSA has a union, I believe you would find it surprising. As well, what is the average length of stay of medics in their system. over-all education level, and the ability to advance within that system. One needs to ask why a company continuously advertise nationally, and always have openings.

    True as well, Steve Williamson has made sure that equipment has been upgraded and that is where a lot of the money goes, but many are not aware both cities help subsidize EMSA and the medics are employed by Paramedics Plus. With the recent correction of the dispatch, and some political battles, service times are getting better. Hopefully, they will improve their pay, some of their mind-set, and increased ability to progress within the system. Improved public relations at both East and West, it is obvious that OKC has more difficulties and always have for some reason, but it is still EMSA. Over-all they do have some quality metro type medics.R/r 911

    EMSA West (Ok City) has a union EMSA East (Tulsa) does not.

    What is the average length of stay in any urban EMS system? When I recently visited after 5 years I found 1/3 of the Para's I worked with with are still there. Many of the Basics I worked with are now Para's. Several Medics who started after I did are now supervisor's, and several former supervisor's are now upper management. So is this out of line with national averages? I am asking because I really don't know.

    I see ads from a dozen companies around the nation on a regular basis, AMR (Insert any city they contract in here) and Acadian run ads all the time.

    Yes they are employed by Paramedics Plus and before that AMR and before that some company I can't remember the name of. So?

    Yes, the City has a majority of the problems. The response time and dispatch problems are in the City not in Tulsa. I have no idea either why the City seems to be such a problem. Maybe it's because Corporate is based out of Tulsa, so if Steve or Ann have an issue they can just walk across the hallway and chew ass on the Tulsa management personnel. :lol:

    I agree they have some good Medics, and that is constantly who I am defending. Like any system in the country they have good and bad Para's, I challenge you to find any system in the nation that has only perfect personnel.

    Which brings me to Dust...

    Being a medic in a system like EMSA is like painting by the numbers and calling yourself an artist.

    Being a medic in a system like EMSA is like a fryer at McDonald's calling himself a chef.

    High volume of non-emergency transfers.

    Please tell me you are not comparing all medics at EMSA to paint by numbers artists or McDonald's fry cooks? You know this from personnel experience or just what you have read on the internet? Maybe you worked with some dumb-ass who got fired or quit EMSA and worked with you somewhere, I am really curious to know your basis for these statements.

    As far as "High volume of non-emergency transfers," ummm no. The rule was no more than 1 non-emergent transfer per crew, and that was only if the system could handle it. Numerous times I have worked a whole set of shifts without ever doing a transfer. That was also before they re-instated the HPC unit, that does nothing but transfers. So I am not sure where that came from. Could be one of those Tulsa-vs-The City things again.

    EMSA was definitely not my first EMS job, but I liked the system and I loved the people I worked with as well as the people of Tulsa itself.

    Peace,

    Marty

    :thumbleft:

    s/p MVA

    in Education and Training

    Posted

    :shock: Wow Rid!

    I would have just said a change in BP and/or a dropped radial during inspiration, but damn!

    No provocation/palliation with that upper thoracic pain right?

    I always over think these scenario based things. :roll:

    OK so what do we do, well lets start with "we care" oxygen, 2L NC. IV, monitor/12 lead. Anything interesting on that 12 lead?

    Peace,

    Marty

    :thumbleft:

    Does your service do this? Ontario paramedics rejoice...

    in General EMS Discussion

    Posted

    C'est des nouvelles merveilleuses ! Merci pour la signaler Contre-hein ?

    Mon service a actuellement des politiques et des procédures décrivant en place comment des coupures de repas devraient être réparties et dans quelles circonstances etc...

    Pour paraphraser : un servir d' équipier sera assigné à leur pause de midi à un station/hospital/or l'autre service acceptable 3.5-5.5 heures dans leur décalage. Si un appel d'urgence entre pendant toujours ce temps les besoins de servir d' équipier de répondre. Le servir d' équipier sera assigné à leur deuxième coupure de repas 3.5-5.5 heures après que l'extrémité de la première coupure. Si un servir d' équipier est sept dans leur poste sans coupure de repas ils informeront l'expédition et le surveillant est, qui prendront alors des arrangements (si possible) pour avoir le servir d' équipier placé à une base et pour faire errer une autre ambulance la proximité à moins d'un kilomètre de la base pour une demi-heure. Si deux appels entrent pendant ce déjeuner de temps doit attendre. Nous avions rempli hors des formes manquées de coupure de repas pendant environ deux années maintenant chaque fois que nous avons manqué un repas (qui n'est pas peu fréquent), et juste récemment expédition et la gestion ont toute la soudain mettant en avant le grand effort de nous obtenir nos coupures. Si ceci n'était pas écrit en anglais je faites des excuses.

    Il est été une longue journée. Je volonté add/edit, peut-être plus tard, pas maintenant.

    Actually you wrote it in French Hammer, but admin translated it for you. :D

    Paix,

    Marty

    :thumbleft:

    Cardiology books\downloads to help advance knowledge

    in General EMS Discussion

    Posted

    They do! But Dubin gave that car away to a lucky reader a few years ago.

    • In 2001, Jeffrey Seiden, a third-year medical student at Yale University, was studying his electrocardiography textbook when he happened upon the following message tucked away in the book's copyright notice:

    Congratulations for your perseverance. You may win the car on page 46 by writing down your name and address and submitting it to the publisher.

    Dr. Dale Dubin had inserted the note into his 50th printing of his "Rapid Interpretation of EKGs," putting his classic Thunderbird up for grabs. Of the 60,000 who last year bought the book containing the offer, only five spotted the hidden message and contacted the publisher with news of their find. The five names were placed in a hat, and Jeffrey Seiden's was chosen at random. The 1965 Thunderbird convertible was delivered to him on 4 December 2001 by Dubin's daughter, who drove it to Seiden's school.

    That was so cool of him, kudos to Dr. Dubin. Yeah, I would of loved to have that car too. But then again with price of gas, I bet it hurts to pull that bomber up to the pumps.

    I just noticed something else while flipping through this book, my handwriting was much better before I became a Paramedic. :lol:

    Peace,

    Marty

    :thumbleft:

    Techno-scope

    in Equiqment and Apparatus

    Posted

    Our bike team tried something like this because they couldn't carry a monitor, it was basically a little box with an LCD screen that showed the rhythm. To put it mildly it sucked, any movement on the patients part, you know like breathing showed massive artifact.

    Besides you should not need a monitor, or any other piece of machinery to tell you what your patient needs. Do not look at a monitor to see if your patient needs to be bagged, look at your patient. There is nothing you are going to see on that monitor that is going to change the treatment you can provide. A thorough assessment is the most valuable tool you have, do not waste your money on a useless gadget.

    If you want to spend money, buy a decent stethoscope and some tapes to learn lung and heart sounds. That will help your patients a lot more than a fancy EKG/Stethoscope thing.

    Peace,

    Marty

    :thumbleft:

    Cardiology books\downloads to help advance knowledge

    in General EMS Discussion

    Posted

    I want to clarify that Dubin's book is not just "basic" interpretation. And it is not just a textbook. It is a full programmed course in EKG interpretation from the basics all the way through very advanced diagnostics. I really can't think of anything you need to know about EKG interpretation -- aside from experience -- that you would not get from completing the exercises in this book. I sat down and completed the whole book in just a few days. I was not even a paramedic at the time, and I was able to walk into the EKG room at the hospital, pick up a 12 lead, interpret it, and almost always found my interpretation to be identical to that of the cardiologist. And it does not just teach interpretation as a "skill" like IV's or intubation. You learn electromechanical physiology, so you understand the implications of the EKG's you are interpreting. If you complete the book, which most who pick it up never do, you will be leaps ahead of over ninety percent of all medics in the US. And if you complete the book before medic school, you can literally sleep through the pathetically confusing and inadequate EKG module included in most paramedic courses. Hell, you can almost teach it!

    I didn't mention the exercises because I wasn't sure the new editions kept that format. Hell they've dumbed down everything else so ya never know. I wonder if the new versions still have the photos of the 1960's Thunderbird to illustrate various views of the heart. :wink:

    Peace,

    Marty

    :thumbleft:

    Why did the police pull your ambulance over?

    in Funny Stuff

    Posted

    I heard a version of this http://urbanlegends.about.com/library/blballs.htm story and believed it for years. Maybe it happened once.

    Actually happened dude. What I didn't mention is that it was pure harassment on the part of PD. A Little history of Portland EMS. Portland (Multnomah County) used to have 3 ambulance services and the city was divided in roughly three zones, west, southeast and north/northeast. We had dropped of a pt at Providence Milwaukie and were "out of" our area. Some Portland Police Bureau officers were very protective of their districts and out of district ambulances were open game. So this Sgt. decided he found an excuse to pull us over, that's what made it really funny. He did not ask why we were out of district or anything he just left without harassing us.

    Peace,

    Marty

    :thumbleft:

    PCP's calling themselves paramedics....

    in General EMS Discussion

    Posted

    Medicine is full of inconsistency when it comes to titles. Everyone from a CNA to an NP is called nurse. The public does not care that one person went to school for 8 weeks and one went to school for 8 years. An M.D. is called Doctor the same as someone who has a PhD in History.

    It's not just medicine that has this issue either. How many of us out there know the differences between all the disciplines in Computer Science? There is a difference between a system analyst and a data entry person, but most people just call them computer programmers.

    Titles are important within a discipline to differentiate who is who, but outside of that discipline worrying about titles is pure ego. This goes back to the "ambulance driver" issue, the public can call me what they want. I know my role and do not feel the need to educate the public on what I do.

    What would you want a PCP to call himself? A "primary"? Paramedic is in their title, if you have a problem with that talk to your lawmakers who changed the titles. Otherwise don't worry about it, the public sure doesn't.

    Peace,

    Marty

    :thumbleft:

    New USAToday article

    in General EMS Discussion

    Posted

    Dust & Rid, sorry if that seemed a little harsh. I still have a lot of friends in Tulsa who work for EMSA, I guess I am a little protective of my homies. :?

    Rid, I started another paragraph last night that covered the fact that the protocols are way behind the times, but I almost fell asleep so I cut it short. That was why I mentioned Sacra was better than Mengis Khan (I can't remember how to spell his damn name, Meninges?). Anyway, that was one of the things I did not like at EMSA. It was quite a shock to go from Multnomah County EMS protocols to EMSA protocols. Sacra loosened them up a bit, now they are on standing protocol, no med control, but they are still limited in scope. The excuse I was always told was short transport time, so we did not need expanded scope/meds. So your right, no pumps, limited meds, no RSI, etc.

    Another thing I found interesting is how protective they are of their protocol books. I still have my Multnomah Co. EMS protocols and my Denver Metro protocols, but I had to turn in my EMSA protocol book to get my final paycheck. Weird.

    I have been critical of EMSA on these boards before, I am not a cheerleader for them. I just wanted the people who work or have worked there, to get credit for the high arrest save rate. I still agree the study is complete B.S.

    Peace,

    Marty

    :thumbleft:

    some noob questions

    in General EMS Discussion

    Posted

    OK, I understand what you want now.

    You do not want to work as an EMT, you just want the training so if you have an accident on the farm. That makes more sense. My opinion, do not worry about becoming an EMT unless you want to volunteer at your local VFD. An EMT-Basic cert has to be kept current, if your not with an agency that can be a problem.

    I suggest you take a first aid course at the Red Cross, you will learn basic first aid and it will save you a lot of money. Another option is the Farmmedic program, there are several in Iowa, here's a link, for real this time...

    http://www.marshfieldclinic.org/nfmc/pages...page=farmrescue

    Peace,

    Marty

    :thumbleft:

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