ghurty

Hi, I am wondering if anybody can tell me what can be the possible cause for an 82 y/o male to have a BP of 142/36 and a hr of 56. The PT stated that he felt perfectly normal. I was O/S for a while, during that time, and on some of those BP readings, the diastolic was about 10 - 15 points higher, but then it went lower again. He also said that his normal BP was about 160/70. I had this earlier today and I transported w/o medics and I am just wondering what could have caused this? Was is it a true emergency? Thanks

I am sorry if I gave that impression. If it is a "load and go", and there aren't any of the vollys there, then dispatch is going to go ahead and allow them to go.

The time onscene for the first responder (the police officer) was crazy. In the NJ town that I am in we have a multi-tiered system that seems to work quite well. First of all, during the day (when there are less vollys around) we have a paid squad that runs out of the police dept. But in any 911 call, the call goes directly to our local PD dispatch, they will simultaneously dispatch EMS (based on the protocl, they also decide whether our not to request a mdeic unit). as well as a police unit. All our Police officers are Certified First Responders, and some of them are EMT's as well. In any serious call, the PD will be there quite fast, I have heard them being given orders to break off from a different call (like a traffic stop) in order to get to a cardiac call. So usually less then 3 minutes after the call goes out, emergency care is already started. Also, we have three squads in town that cover different areas, for a serious call, it goes out automatically to all three squads, so there is no wait time to see if the squads whose area it is in is able to cover. Our dispatchers also are pretty easy on letting medics transport (even though NJ state law says that they can only do it as a last resort), usually the dispatchers would give permission for medics to transport after it goes out 4 alerts (at 7 minute intervals) depending on the call. So while the whole volunteer system is going to eventually fall apart, I think overall there are some stopgap measures towns can do to stop incidents like this from happening.

Hi, While I may be “just” an EMT-B, I enjoy learning, and like to know what is going on with my PT better. So I decided that I will read a paramedic textbook (I know the dangers of this, but I believe I will not attempt to “diagnose” anything), I just like knowing whats flying when the medics show up. I see that there are many paramedic textbooks around, which book (Mosby, Brady, Etc…) would you recommend for clarity and ease of understanding. Thanks

I was looking through a PHTLS book, and comparing it to my EMT book and it got me a little confused regarding a severe hypothermic patient in cardiac arrest. In my EMT book (Brady 10th edition) “Assess the carotid pulse for 30 – 45 seconds. If there is no pulse, start CPR immediately and prepare to apply the AED” In the PHTLS book it says that you should not start CPR or defib until VF has been verified. So what does that mean for me as an EMT-B: If I come upon a PT that has an extremely low body temperature and no pulse, do start CPR and hook up an AED or wait to verify that the PT is in VF. Also in the PHTLS book it states not to stick any airway adjutants. But there is no mention of this in my EMT book. The PHTLS book is from ’94 if that makes any difference. Thanks

But based on those definitions, is this a bus or an ambulance: (I think this was posted somewhere here in the past http://www.emsvillage.com/articles/article.cfm?id=1934

Eventually yes, but as I stated earlier, no town is going to want all the additional expenses of having enough paid ambulances on the road to cover surges. So the vollys can be around to help out as backup. They dont need to be their own squads, they can be an extension of the regular paid crews. Also the more I think about it, the vollys should act more as First Responders (this will help greatly in rural areas) they shouldn't really have their own rigs, rather just go directly to the scene, and start care until the paid guys can get there.

I know I am relatively new at this, but in my “real” life I do corporate efficiency troubleshooting, so this is my free analysis of what needs to be done to fix NJ’s EMS (the BLS part that is, ALS is a whole different issue). I might not have all the facts, so I may be off on some issues. I Also Remember, I am a volunteer as well, so my point of view may be a little biased. I have to type this in secret or else a hit might be put out on me :glasses7: The way it is set up now is completely broken. With some squads, the duty night crew doesn’t stay in the building, they go home for the night, and if a call goes out then they go running. But this meens that there is a minimum of about 5 minutes from the time 911 call is placed until a rig will go into service. This is completely unacceptable. I know I enjoy helping out and answering calls, but there is no reason why patients should have to suffer because of that. First and foremost every link in the 911 chain has to be regulated. As everyone else is saying, do away with the FAC, as long as they are around, it would be too big of a political football to manage to get any normal legislations passed. I don’t think we should do away with volunteers completely. They are useful (to an extent that is). Towns should have paid squads, but there can be a volunteer supplement to help with surges. For example in one town I know, they currently have two paid ambulances on the road during the day. The town is also covered by three volunteer squads. When a call goes out, the volunteer squads can take or the paid guys can. Normally it is not busy enough for the paid squad to have more than two ambulances in service, but sometimes you have a surge in call volume, and in that case a third one would be necessary. But no way would bean counters be able to justify having three paid ambulances running. So you should have it that the volunteers are still around, and they will be able to help out. They can also (some of them that is) act as first responders, being that they are spread all about, an individual can go to the scene and begin treatment until the paid squad can get there. In some rural areas this would be a great help. BUT each of the vollys don’t need to have four ambulances. A maximum of two (one in reality) would be enough. Also if they are all serving the same town, they should be incorporated into one squad, as a matter of fact they should even be an extension of the paid squad. (I think the fireballs from heaven just missed me :blob6: ). This will save money and help with regulation and safety. This will allow volunteers to keep on helping out, (and letting some them play with their blue lights) but will still insure that there is adequate coverage. I think that would be the best of both worlds.

I know here in NJ, MONOC recently purchased a new bariatirc rig. [web:16d9ac1456]http://www.news.com.au/story/0,23599,21405098-36398,00.html[/web:16d9ac1456]

Look at the first picture below and you can see where this guy broke through the guard rail and left the road, traveling from right to left. He flipped across the end of the culvert and landed on the left side of it. Look at the second picture and you can see how lucky he was.

For the second time in the past year I have been on an airplane that had to make an emergency landing do to a medical emergency on board. Last time there was a medic on board as well, but this time I was the only one. Is there anything different that I have to know about, or that I should be doing on board an airplane (in regards to oxygen, AED, etc..) I guess perhaps due to pressure differences? Is there a course/document (on-line) outlining the differences (if any)? Thankx

Hi, I have been tasked with rewriting our Exposure plan and protocols (covering all types of exposures). Our current ones are hopelessly out of date. Does anyone know where I can get a basic one up to date one that I can work off of? Or any other adivce? Thankx

How many of you have had a call dispatched as a "CPR in progress" and end up taking an RMA on the call? It happened to me the other night. The call goes out as a CPR in progress, upon arrving on the scene there was a party going on. We noticed that it was strange that no one paid us any attention. The "patient" was wide awake (a little drunk though). When we got to the porch we find the "patient" laying outside (40 degree weather) with almost nothing on. After a asking a few questions we finally got the story. It turns out that everyone in the house was stoned. When they noticed one of the party goers was laying on the floor, so they decided that she was not breathing and had no pulse, so they called 911, and one of them decided that she knew CPR so she started it. After attempting CPR for a few minutes, (why they had to take off her clothes, I don't understand), they decided that they were unsuccessful, so they dragged her out side so that she wouldnt interfere with the rest of the party. Then of course they went back inside. The "patient" (or should I say victim) woke up by herself and just decided to stay laying there on the porch. I guess it is good to have such caring friends. She is lucky they didnt kill her by accident.

Was having a discussion with someone the other day about what different jurisdictions call different EMT Certs. I know LA calls Basic "I" (roman numeral one) and medics II, but I was looking at a ID card of an EMT-B from LA, and all it says on it is EMT-I. Does a medics card look any real different, or does is the only basic change that it says EMT-II. His card didnt say anywhere "basic" does the medics card mention Paramedic anywhere? Thankx

Hi, My volunteer squad is looking to purchase a first responder. Does anyone know where we might be able to get a discounted vehicle. We are in NJ. Thank You

Let me warn you. You can !!!!!NOT!!!!! start billing. Let me explain why. You are in NJ so your situation is unique. What the other posters don’t understand is that here in NJ there is something called the volunteer training fund. That is what enables you to get your free training/CEU's. You can only get this if your squad does not charge at all. Not even just insurance. There is also allot of legal benefits and protections written into NJ law that protects a volunteer FAS, but you lose them as soon as you bill anything. There was an article in Gold Cross about 2 issues ago listing what you stand to lose by switching. I will try to find it and post it. So if you want you can start billing, but you lose allot, and the amount of money you gain usually wont be worth it. What your town could do is what allot of other town do (mine included): Have a two tiered system. During the day there is a paid squad. It has to be a separate squad (in our case, it belongs to the local PD) they can charge, and they aren’t eligible for all the protections. At night the vollys run, and they dont charge.

Ok here is what happened. Upon arrival on scene, and sizing up the situation, he got on the radio and confirmed that we had one BLS injury, and one ALS. He then canceled the rescue truck. He told be that he was going to get the PT out was as follows: Stick the board in from the passenger side over the console. When I expressed doubt about doing that, due to the possibility of a C-spine injury, he turned and asked the PT if her back hurt her, when she responded "no", he then stuck the board in, over the console, he then asked for her to lift herself up by standing up a little (This is while the other EMT was holding C-spine stabilization), so that he could stick the bored under her. We then collard her, rotated her on the bored, adjusted her, put on headblocks. The medics arrived as we were loading her into the rig. They assessed her, and released her to us. End of story. My issue is that based on on the situation, there was no need for a rapid extrication. (she was completely alert and oriented). The Rescue truck was rolling already, and the door could have been popped very easily. We had a high index of suspicion that she could have had a c-spine injury (starburst on windshield, laceration on forehead) enough that the EMT started manual stabilization. I thought that we should have gone by the book; popped the door, put a collar on, put a KED on, then put her on the bored. We were anyways waiting on scene for ALS to arrive, and it would have only been a few more minutes until the rescue rig would have pulled up. Also, I don't think that asking a PT if her back hurts her is a good way of assessing for spinal injury. And if for some reason there was a need for a rapid extrication, a different EMT should have gone into the car, and lifted her in a sitting position rather then asking her to lift herself up a little. Please let me know if you agree with this, or if you have a different opinion, let me know why I was wrong in my thinking. I am always willing to learn. Thankx

I attempted to, but his attitude is "my way or the highway", and there was nothing I could do about it (as he is senior). I thought perhaps I was the one making the mistake, so I decided to post here to see other opinions. He was the one making the decisions, I went over to the other EMT (the bystander) he agreed with me. There are no opinions that I "wont like", like i said; I have allot of knowledge, but it is mostly classroom knowledge. I know that things are different in the field, so thats why I asked here, to hear other people opinions based on the voice of experience.

No, my question is focused on the patient that is still in the car. I'll wait a drop longer to see the other responses

I was on a call the other day, and I was not happy by what happened. The Senior EMT has more field experience then me, but i have more educational experience. So I would like to hear what you folks would do. Ill try to paint a clear picture as possible. I am a Vol. in a town where BLS is provided by volunteers, and ALS is based out of the hospital. There are different BLS squads covering the town, each one has its own area, but for MVA's or when one squad cant respond, it goes mutual aid to the other squads. Also, for MVA's and other "serious" incidents, ALS is automatically dispatched, but we can cancel them if necessary. A call went out for an MVA in my area, no details on the amount/types of injuries. The call automatically went out Mutual Aid. I responded with another EMT in one rig, while a few minutes later another squad put in service another rig, as well as a rescue truck (Extrication, etc..). Upon arrival on scene, it turns out there was two vehchles involved, there were no passengers, just the drivers of the vehichles. One of them was up and about, no problem, his vehichle didnt have any damage. The other vehichle had smashed into a light pole. The airbag had deployed, and there as a starburst crack on the windshield. The drivers side door was messed up, so it would not open. The Patient had a laceration on her forehead from striking the windshield. There was a passerby (a vol. emt from a diffrent town) was in the vehichle maintaing manual c-spine stabilization. The patient was alert and responsive, she remebered getting into the car and driving, but she did not remember the exact details of the accident. The only thing she was complaining about was head pain. So the drivers door could not be opened (without extrication equipment), but all the other doors could. Also between the drivers side, and the passengers, there was a non removable center console, about four inches higher then the drivers seat. Responding to the call you currently have one BLS unit on scene, one BLS and Rescue unit responding (about 5 - 8 minutes away), and one ALS unit responding (Unknown distance). Please tell me what you would do in such a case, and then I will respond by what happened, and why I did not like it. If you have any questions about the scenario, just ask. Thank You

I was having a discussion with a fellow squad member regarding laws governing First Aid squads in New Jersey, and we were trying to find a copy of the laws. Does anyone know where I can find it? Also besides having a red light rather then a blue one, is there any other legal differences between a captain and the rest of the squad.

Hopefully if this is around, bystanders wont just stand around doing nothing until we arrive http://www.medgadget.com/archives/2006/10/...pe_medic_1.html

Sorry, I was referring to Los Angeles, CA I tought since it was not directly medical. :?: The Vol. organization, is basically a first responder group. Someone calls 911, then calls them. They respond in POV to the scene, they are equipped with AED's, O2, Trauma bags, etc... They themselves dont transport. They also assist the city in Search and rescue operations, as well as disasters (they crosstrain alot with the city). They have a dispatcher, but those are volunteer as well, and the way it works is they have the "emergency" line fowarded to different lines depending on who is dispatching. (there is no dispatch center). They have approximately 100 units in the city, while the area they cover is not that big, half of it is in the San Fernando valley, so their are the Hollywood hills in the way. Almost all of thier funding is donation based, but they are currently looking to see if they are eligible for grants for equipment (AED's, Radios, ...) Thankx

In reference to the same vol. agency in my previous post. They are spread out across a few sections of LA, and they currently have terrible reception on their radios, even though they have a repeater. So he asked me if I know of any ideas. So I suggested perhaps using a land line to reach the other area, and rebroadcasting out from there. but they are worried what would happen in case the phone lines went down (earthquake, etc..) They currently are on a UHF system. Does anyone know if VHF would be better, or any other ideas? Also, they have a problem that alot of times people are stepping on other transmissions. Would a digital system solve this problem? would that also increase the reception? How expensive are these systems. i know this is not a technology board, but I just thought that being you are end users of alot of different systems, you might have some valuable input Thankx

My next door neigbor had to call ems yesterday because thier 16 year old son had collapsed. He was extemely diapharetic. BLS came and they transported him. Later that night he was released from the hospital. By neighbor told me that the doctor said that the reason why he collapsed was that he had a small cut on his wrist near a vein, and he had put cold water on it, and that caused his BP to drop. The mother wasnt exactly sure what the doctor was talking about. I am just wodering if anyone ever heard of this/and what it is called. And if they can give me more information on this. Thaknx