Lithium

Yes, know your anatomy and physiology inside and out, upside-down and backwards. Don't just memorize terms and structures. Know what they do and what they're there for. Try and think out of the box and come up with situations if that structure wasn't there, or what happens if it malfunctions (pathophysiology) then compare your thought process to your texts Concentrate more on the science side of things, don't get to caught up reading the chapers concerned with skills, because, that's all they are. Your class will devote enough time for you to practice those. Secondly, PHARMACOLOGY! Know your drugs better then you know your A & P. Not just protocols, when/how to give this drug, but also go as indepth as humanly possible to understand mechanisms of actions, phamacokinetics/dynamics. Yes, even most first responders know Nitro is a vasodilator, but by what exact mechanism does it accomplish that? And I'm talking at the cellular level here ... If you can understand how your drugs work at the cellular level, you'll be that much better off. peace

And America wonders why the rest of the world hates them ... :roll: You can 'feel' your way is better, but that doesn't actually mean it is. Do you think the person you're talking on the other end of the radio really cares that you only have ONE sick patient and are still 10 minutes away, when they proabably have a dozen or so right in front of them? I find it highly improbable. When giving radio reports, stick to what they need to know. (Basically, do we need to have a bed ready as SOON as you guys walk in the door and where should I have the most staff? Resus/trauma?) In all honesty, it's fairly common practice up here in my area to not even patch (radio report) to the receiving facility unless you have a critical patient being brought in. Otherwise, your dispatcher will assign you your receiving facility when you leave scene and you'll be triaged like everyone else upon arrival. peace

As far as GCS up here is concerned, I rarely report it in my radio report unless its of major concern. Even so, in my hand over I rarely report it unless there has been a change. As far as documenting, on our forms it is broken down into each category and then the total number assessed. peace

EMS49393 ... Rid's post seems to have struck a chord with you. I think what he was trying to imply is that when giving a radio report, only give what is absolutely necessary. When you give your report, it goes like this: :XYZ, this 9999, we're enroute to your facility code 4 with a 82 y/o complaining of atypical, retrosternal chest pain which began aproximately 30 minutes ago while she was watching TV., She self administered 3 NTG prior to 9-1-1 initiation which afforded her no relief. Vitals are are as follow (insert vitals within normal range), we've given her an addition 2 NTG, 160 mg ASA and began 2 mg morphine. Our current ETA is 5 minutes, XYZ this 9999 out." When they're listening all they really here is ... "XYZ, this is 9999, blah blah blah blah 82 y/o F blah blah blah CHEST PAIN, blah blah blah NO RELIEF blah blah blah ETA 5 minutes." peace

I'll be honest ... I can tolerate BOTH OPAs and NPAs no problem. Insert them myself that is (don't ask ... bar bet). All I'll ask you is this, does it really matter if he was faking or not? I understand that we as EMS providers feel cheated and sometimes enraged when patients make up ficticious complaints or pretend to be unresponsive, but usually when it gets down to it, it's a cry for help. Perhaps he really detests himself for putting himself in this lifestyle he's gotten into and wants out but doesn't know how ... or maybe just wants a comfy bed to sleep in for the night and warm food in the AM. Either way, if your assessment leads you to believe the patient requires such and such, then do it. As a sidenote, I'm not a fan of the hand drop test. Many years ago when I was on placement as a student, my preceptor did it to a patient who we believed to be 'faking it'. Turns out he wasn't, and the hand smacked him squarely in the nose. Now, not only did we have an unconscious patient who was unable to protect their own airway to begin with, we had an unconscious patient with a broken nose that was bleeding quite profusely. It was a constant struggle with suctioning to try and keep his airway clear ... Bad medicine. peace

I understand what you're saying, but again I reiterate ... don't be afraid to ask questions. That's just one of my pet peeves personally ... peace

Is that how you spell it? haha ... Interesting though the spell check didn't pick it up ... Anyways, if I can offer a slap on the wrist I will right now ... NEVER be afraid to ask questions, as that is what truly shows immaturity, both on your part and those you're asking if they can't give you an answer without a few stripes. I've ALWAYS encouraged questions, and although I joke around a lot at work, if someone can muster the guts to pull me aside and ask something (and in the process admit that they don't know something), I'll give them all the time in the world and find a way to relate the information so they can understand, comprehend and retain it. peace

Rid, that's a good point. I agree that we need to test the newcomers and make sure they know their stuff, after all, they're gonna be looking after us in a few years when we have our first MI However, I think one of the problems is people don't know where to draw the line and how to do this professionally. Dust, I really hope your comments are more USA geared. You seem to be familiar with the Canadian EMS standards and education, so I honestly don't see this being a problem up here. I will admit though, I am partial to the Alberta way of education. Monkey skills first and get those out of the way as an EMR, then you begin learning in EMT-A and EMT-P. Scaramedic, good point ... I suppose it builds comradery, but I do feel many people take it too far. peace

Why is it that EMS seems to be one of the few professions where we will eat our young? What are your thoughts, and have you experienced this in your professional life as an EMS employee? peace

Just because I'm not running on scene to the patient or the ambulance, doesn't mean I don't realise the seriousness of the event. If I need help, I'll ask for it. Please don't offer or just start picking things up. EMS needs more funding. We are highly educated in aspects of pre-hospital emergency care. The fire department is not. Please know when to call 9-1-1. No, defibrillating a heart that is asystole does not restart it.

I've found that the more you write them, the better you become at them. Once you write a form, ask your partner to critique it (and remember, take their advice along with everyone elses with a grain of salt). Remember to always include pertinent negatives, as it implies a comprehensive assessment. Also, the best piece of advice I can give you is to BE CONSISTENT when using short forms. I use short forms and abbreviations all the time on my ACRs, but I know exactly what they mean. I see people who interchange LOA and LOC daily for instance, and I truly believe that will come back to bite you in the butt. Develop a list you're comfortable with and stick to it, that way when when you're called into court and they ask you what you meant, you'll recall without hesitation. peace

We've never done lab draws in the field here ... at least not that I'm aware of. Quite honestly, I don't see the point, as the receiving physician will have specifics he'll want ordered, so why waste a rainbow of tubes if all they're gonna use is one? peace

What do you use as your stress relief from work? What sorts of coping skills do you find useful? Do you have someone you can talk to outside of EMS after a difficult call? I'm curious what others do around the world ... peace

Yes, but if I understand KevKei, he's implying that the concentration of morphine in the patient with 20 mg would cause the more rapid descent in concentration of narcan. I personally just don't see it that way ... to me, its more of a hit and miss. Narcan is a competitive antagonist, not noncompetitive. The scenario I see in my mind is that its not like two boxers dueling it out in the ring (narcan vs. morphine) and one comes out the champion. It's more like 2 horny male teenagers trying to race to the door of the girl they both want a date with (door = receptor). Basically, whoever gets their first gets lucky :wink: peace

No, this is more an Ontario issue ... Every land ambulance in Ontario has to be licensed by the Ministry of Health and is designated as a paramedic service. Now, since basically 1/3rd the population of Ontario, and therefore 1/10th the population of Canada lives in Southern Ontario, there is a HUGE market for patient transfers. The real ambulance services in place honestly can't support the demand for this and maintain effective 9-1-1 coverage, so private services are springing up like daisies. In essence, most of these private for profit businesses are nothing more then a stretcher taxi service. However, because they need to use stretcher transport for these patients, they buy decommissioned ambulances. The problem is, there are NO regulations for these services. Most of the staff working for these services are EMS system rejects, paramedic students and wannabes with their advanced first aid. The hospitals know that they can only use these services for 'stable' patient transfers, therefore again, they really are just a stretcher taxi service. Critical care transfers are done primarily by air, and some by ground in the Toronto region and stat transfers are done by the licensed ambulance service in that area. The education of our Critical Care paramedics is vastly different then the courses in the USA ... peace

C'mon now ... you know that won't happen til "paramedic" is a protected title ... WAIT! thats what the OPA wants to do, let's vote for the college of paramedics :wink: peace

Honestly, only some people use the term ambulance driver. We're a bit more fortunate up here in the North, EVERY 9-1-1 ambulance in the Province has "PARAMEDIC" decaled on it, so the most common slang term I hear is 'medic'. Personally, I prefer being called ambulance dude peace

Ahhh, I get what you're saying. I think I'll just have to agree to disagree. Even though there's many factors which affect a drugs affinity for receptors, I don't think the serum concentration of what it's competing against is really an influence. Mainly due to the fact that the narcan is not competing against the morphine in a one on one situation. All the narcan is doing is looking for a receptor to bind to. If anything, I would think the other factors you mentioned would be more of an influence (bioavalability, temperature, pH, paCO2 etc ... ) peace

Bingo! Male patient with suicidal ideations ... Either that or drowning. I wonder if they'll be using fresh or salt water ... hmmmmmmmm peace

Hmmm, interesting way of looking at it ... are you saying then that the harder the narcan has to compete to bind to receptors, the shorter the half life, primarily due to it 'working so hard'? That doesn't make much sense to me, because that would imply narcan is equatable to a living cell using energy exponitiously, when we all know that it's purely a chemical. Technically however (and I may be wrong here ... but this is how I understand it), serum concentration and half-life refers only to unbound drugs. If the drug is bound to a receptor, depending on the cells activity, it will either be utilized quickly or slowly, and then made available for biotransformation and elimination ... the rest, will simply attempt to find an open receptor and slowly (as I was actually taught narcans half-life is anywhere between 30 and 81 minutes) be eliminated. Therefore, the serum concentration of the narcan is not affected by the serum concentration of the opiate. peace

Forgive me if this has already been said, but I've just skimmed over most of the answers .... Perhaps most everyone calls us 'ambulance drivers', simply out of ease of use? The public, and probably most health care professionals don't have a clue about the difference between EMT-B, EMT-I, EMT-P, EMT-CCP etc etc ... and because they don't want to offend, they call us by what they see us do which is the most obvious? They don't see us in the back performing those critical interventions ... most news footage is either of people loading/unloading a stretcher with a patient on it with a whole bunch of fancy equipment, and driving off with the lights flashing or rushing quickly inside the hospital ER entrance. Who's fault is that? Ours ... public education is key if we want to improve this profession for the next generation of paramedics. peace

Well, there's your first problem. Backboards (although very convenient as a patient litter device) are used primarily for patients with suspected spinal injuries, which I'm sure you're aware of. Is this really something you want untrained personnel doing? If the police service is putting the money and resources into stocking for a tactical police trailer, this is an excellent opportunity to pitch to them the need for tactical trained medics. If that doesn't go over well, instead of acquiring a backboard, look into getting a model 65 ferno 'scoop stretcher'. It's much more versatile and takes up less space then contemporary boards. peace

JPINFV, drop the 'competitve'. Antagonist in its truest form means "that which counteracts the action of something else". There's subtypes of antagonism as follows: competitive antagonist has an affinity for the receptor almost as much as the agonist and is reversible noncompetitive antagnoist completely blocks the agonist, and is irreversible. clear as mud? peace

akroeze, thanks for pointing that out. I was taking it the wrong way. :? Honestly, I can't say. I've never been in that situation, and I can't see it being that plausible where I work. Even though Narcans half life is shorter then most opiates, it's still pretty long. 45 minutes or so, and 2 mg should be more then enough to last the time to hospital. However, if for whatever reason, I needed more because it was having an effect but began wearing off, I would definitely call for more. peace

Hammer, I think you just proved exactly why BLS personnel should not have access to ALS meds ... If 2 mg of Narcan hasn't shown a response, either every potential receptor is already occupied, or there's something much more serious going on. If that's the case, securing the airway and maintaining adequate ventilations is now my top priority. Not that it wasn't before, but as I previously stated, if I can eliminate the problem, I will. The line of thinking of "well if 2 mg isn't enough, I'll just call for more" is a little skewed. And yes, I do know of patients who've received much more, but that was in-hospital with a lot more resources available. Yes, narcan has a shorter half-life then opiates. However, it is an antagonist, meaning, it will compete for receptor sites. If there's still sites available, it will bind to them, lessening the effects of whatever the patient took essentially by having less receptors for it to bind to and letting the others already bound wear off. Sorry if I'm not making things clear ... peace