nypamedic43

All I can ssay is WOW...can we get any further of subject?

NY and PA EMT and medic patches and 3 organization patches will be on their way to you hopefully on Monday. Sorry I cant help more.

It's kinda like a train wreck...you know you shouldn't watch...but you just can't help yourself

Hey Andy...Ill type up our protocols on transcutaneous pacing, adenosine for SVT and CPAP for you. Have a busy day today so I'll try to get it done tonight and get it to you by tomorrow. We dont do the nasal diamorphine so I cant help much there.

Actually titers will show if your are immune to things such as chickenpox and mumps. A good titer now means you have a lifetime immunity. However, there are instances that you may need a booster. Have an up to date tetanus (within 5 yrs) and Hep B series. There is now a Hep A immunization now as well. Get a flu shot and if possible get a pneumonia shot which is good for 5 yrs. Practice good hand washing techniques ie: wash your hands after every patient and wear gloves. This protects your patient but you as well. The college nurse should have a breakdown of what you need. You may also need a TB test. Congrats on getting into the program!!

Our service uses the Zoll program. We leave paper PCR's at the ED at the time we bring the patient in. Everyday the ladies in the office download and print the EPCR's and then send those to the ED. Not the most efficient way to do things I know but it seems to work. There are days we are so busy that we can't slap our butts with either hand, the paper PCR gives the ED some info on the patient including vital signs and interventions.

I've seen the preview and had already decided not to watch it. I don't know about anyone else but sex????in the back of an ambulance?? are you kidding me? Even with OSHA cleaned patient compartments...there is no way in HELL I would do that. And we wonder why we are still and probably always will be the red-headed step-children of Emergency Services. Why dont they show firefighters having sex in the hosebed....oh wait wait...that would be even more acceptable and just add to the hot macho firefighter image. And please tell me why a pilot has access to Versed?? He is to fly the chopper...which he's already proven he can't do very well if he's crashed 5 minutes into the show. I have a pretty good feeling that if I watch this show, I will be spending it's entirety yelling and throwing food at the screen. I'm not even gonna bother.

I have read all 6 pages of this thread...some of the replies I have really just shook my head at.. especially Diazapam's "he's dead". I don't post alot on these forums because my experience has been negative 90% of the time. There have been a couple of people (Ruff and one other) that have kept me coming back to these forums because there is ALOT of very good information here and even more learning opportunites. The question of whether any one of us would work this code is really a matter of our individual systems protocols but it also has to with the individuals conscience. I would work it because there are signs of life...albeit agonal breathing is not necessarily the best sign to follow. I was taught that a PEA is workable...if there is electrical activity you may get pulses back. The fact that there is a crowd of people around would prompt me to do SOMETHING for this guy instead of just standing back and watch him take his last breath while I'm on the phone with medical control. However I have to agree with some of the people that have posted replies...there simply isnt enough info to make any kind of call. Since this guy t-boned an suv at 70 mph on a motorcycle with no helmet on I am guessing that it would be fair to assume that he has other major injuries as well. A torn aorta at impact, abdominal injuries, a broken neck....besides the obvious head injury. I wouldnt fault the medic who made the decision to work this patient and I wouldnt be asking questions about his judgement behind his/her back. I would have gone to him/her after the call and talked about it. Most medics are more than willing to discuss thier reasoning behind the decisions made on a call if asked in a way that is nonjudgemental and truly in the interest of learning. There was also alot of confusion in the first couple pages of this thread because one of the posters interjected thier own personal experience of a completely different type of patient on a completely different type of call. And subsequent replies were tainted by that. It is easy for any of us at any time to armchair quarterback. But the bottom line is...if this was my patient, I would have worked him. While trauma arrests have low survivablity, there are people around today because someone wouldnt give up on them. The number is low but they are out there. We dont ever know what the outcome will be and it isnt for us to play God and decide that this patient isnt viable. Do what you can for him/her even if you know that the outcome will not be good. just my 2 cents....oh and tniuqs?? keep up the "poor attitude" you make us think before we speak

I used to live in Lemon Springs which is about 8-10 miles from Carthage and I remember when that nursing home was built and opened. Carthage is a sleepy little town best known for it's antique shops. Thoughts and prayers with those that died and their families.

I too am unsure about the system where you are. In the city that I work in, we have 2 hospitals. One doesnt do psych at all and the other has 2 psych beds in the ED and a BSU on the second floor. The psych patients that we come into contact with go to the second hospital, they are equipped to handle them. MOST of the time (but not all) the police are involved and the patient is a voluntary. This buys them 72 hours of observation either in the ED or they get admitted to the BSU. However, if the floor is at capacity and the ED cannot provide the correct care, they ship them out to another facility. Most of the time this in NOT voluntary, which requires a 2PC. 2 physicians signatures to say that they are not capable of making safe decisions. The thing that bothers me about your post is this....the state of NY frowns heavily on charge nurses putting a hospital on diversion for a specific type of patient. That decision has to come from the hospital administrators NOT the nurses that are working the specific areas of the hospital. They need to be very careful doing this. We had a nurse fired because she decided that the ED had taken enough patients for the night and put the WHOLE hospital on diversion. The hospital paid heavy fines and she got fired....immediately. From the EMS side...we have no control over the calls that are brought in the ED. It isnt EMS's fault if there is a whole slew of chest pain calls, or respiratory calls or psych calls. Unless it is in the best interests of the patient to go to a specific hospital ie: stroke center, chest pain center, BSU, they are taken to the hospital of choice otherwise, if they are lucid enough, they can sue for false imprisonment, kidnapping and the list goes on. My service transports psych patients over the PA state line...if the patient realizes it and they are a voluntary intake for psych, they can MAKE us stop and let them out of the ambulance and we have no recourse but to comply with their wishes. I can see that you are kind of stuck in the middle and being able to see both sides can put you in that sticky situation. I hope you find the answers that you are searching for.

I had absolutely the worst confidence problem when it came to IV's. As I did more and more of them it got much easier to put aside the fact that this a real live person your sticking a very sharp object into. Luckily for me I had 2 of the most awesome ER nurses that precepted me. One of them looked at me and flat out told me that nobody is perfect, everybody misses IV's and it's going to hurt the patient no matter what, even if it's just a for a minute. I didn't want to hurt someone who was already in pain or distress anymore than they already hurt. Trust me on this you WILL get over this. Now that I've been working as a medic for a few months if they need an IV they get one...no hesitation. Take a deep breath and let it out slow. Take another breath, hold it and poke 'em.... see your flash and your all done. Pretty soon you wont even need to take that first deep breath. You are going to be just fine and as one of my preceptors told me....be like a duck, cool and calm on the surface and paddling like hell under the surface.

It looks like a wandering pacemaker to me with maybe an occasional PJC. It's irregular with multifocal p-waves and some beats with no p-waves ( which is why I am thinking a junctional beat) but I could be wrong, even with the high res view it's difficult to see some of the p-waves. Thanks for sharing

Thankfully the mayor of New Orleans has been very proactive this time. They started evacuating the city yesterday and the buses will be running out of N.O. until midnight tonight and then start again in the morning. Most of N.O. is shut down. The company I work for is contracted with AMR and Acadian ( I think) and they are the ones who called us, not AAA ( American Ambulance Association). We didnt go "trolling" as you put it, we were asked to come and we went. Last time there was more than 500 ambulances that deployed from around the country. They all worked long hours with very little sleep and every one of them was one the road, evacuating people out of the bayous or evacuating hospitals. Nobody sat around and did nothing. Hopefully (im keeping my fingers crossed) people learned from 3 years ago and are getting out early.

The company I work for deployed yesterday morning with 6 medics and 2 trucks with a fly car to follow with extra clothes and equipment in the morning. Bang's Ambulance also sent 2 trucks and 6 medics. And management at Erway is working on a second deployment list which will deplete us by 2 more trucks and 6 more medics. Im sure that Greater Valley has been activated as well through Bradford-Susquehanna Strike Team as well as Western and Memorial. Those of us who are staying behind are picking up more hours than we should probably sanely handle, but its about making sure that the community is covered with the EMS system that they have come to expect not about whining about tax dollars. People get desperate when they have lost everything, now that doesnt excuse the behavior but you have to understand thier point of view. As of about an hour ago, Gustav is a cat 4 almost a cat 5. New Orleans wont be able to withstand another storm of that magnitude, it hasnt recovered from Katrina and Rita, and with Hannah right behind it, I have a feeling that its going to be a long haul for those that have deployed down there. Now we could all sit in our safe, warm homes with everything and everyone we love around us and say "Thank GOD that isnt me!!!" or you (EMS49393)could stop whining about how your VERY parttime ems pager is driving you crazy and shut it off, go sit in your climate controlled ED and dont give the people who DO care about helping others a second thought. But there are those of us who will, without complaint, step up to the plate and take care of business. Because, once again, the Gulf Coast and Florida are going to need help and thats what EMS is all about....helping people in crisis.

I have been doing this for 15 years and I have never been involved in an accident in an ambulance. I work for a service that does 20000+ calls a year and the last accident that occured was 2 yrs ago on an icy road...no patient in the back and it was very low impact. Barely dented the bumper. It sounds to me like running code 3 is a bad idea for you guys. Accidents are very uncommon in this area. There have been accidents in the more eastern part of the state, more towards NYC. With 4 accidents in less than a year... management should be very concerned about losing thier insurance and the underwriters. Doesnt matter if your running Code 3 or not, the cause of the accident is always blamed on the ambulance crew. And tell me...what were you running Code 3 on an arrest for anyway? Thats nuts!! We run code 3 to the call....and if it is an arrest...we travel expeditiously to the ED...no lights or sirens. Sounds like every member of your service needs to take an emergency vehicle driving course and they need to do away with the whacker mentality.....just because you CAN run lights and sirens, doesnt always mean you SHOULD. Our safety should always come first.

They were coming down the hill and Ryan missed a gear and lost control. They had just filled the tank, which hold 1000 gallons of water. You can see in the picture the skid marks of the dual tires, turning to the left, when he locked the brakes up. The truck rolled at least once, and Ryan was ejected through the drivers window. The tank came loose and landed on top of him. They had to lift it off of him. Its unclear when the tank came loose, either when it rolled or when it hit the tree, which was snapped off. The tree was about the diameter of a 50 gallon drum. Ryan was 25 years old and he leaves behind a wife of less than a month and a 1 year old daughter.

Its been a long time since we have had a LODD in this area. The name still hasnt been released, but the EMS and fire community here knew him well and he was a friend to all of us. I cant get the link to be clickable, copy and paste if you would like to read the article. http://www.stargazette.com/apps/pbcs.dll/a...ONTPAGECAROUSEL

One Slip-- Pink Floyd

This is just a guess, but are we absolutely sure that there werent any chemicals in the area at the time, or had been used in the recent past. Heres my thinking. Sudden onset SOB, with a hot flash. She isnt tachycardic nor is she hypotensive. O2 sat is low. Im thinking a possible toxic inhalation, because of the wheezes caused by bronchospasm and the stridor caused by layngospasm. No history of recent illness, asthma or allergy to anything. Several cleaning supplies can cause this and if the house wasnt well ventilated, the residual effect could cause all these symptoms. Or the chemicals used to make the cardboard for the boxes, especially if they were brand new. Just a thought

a little of both I think...I didnt drink that much on New Years. When my instructor handed me my patch, he told me to call Erway. Guess they want to offer me a job...HOLY CRAP, admission into the boys club...I must have done something right!! Graduation today....I keep looking at the results and thinking they had to have made a mistake :error: Have a great weekend everyone!

Thanks everyone and Scott?? I would expect nothing less lol. Im going to take a nap....my head is still fuzzy :drunken:

It seems to me that the whole volly thing is being used as a crutch to fend off improving education...Im sorry that BS. Im a single mom, work part-time and Im just finishing up medic school. I put everything in my life on the back burner (except my son) for the last 11 months. Why?? because I wanted to be able to give my patients the best prehospital treatment that they can get. Like Mike said, it all boils down to dedication. If you are truly dedicated to providing the best prehospital care you can...then 200 additional hours is a drop in the bucket. And being a volunteer and working a full time job is a lame excuse for not getting the additional education. Lots of people have done it before you and they survived just fine. And maybe a paid ALS service should be very seriously considered.

The question should be....why did she fail the first 3 times? Was it because she was having troubles with the strip interpretation and treatments or was it because she was having trouble doing it in the 6 minute time frame? If it was the latter...he may have given her the fourth chance because she was very close. Just a thought.

The KED works wonders if you roll the sides back. A papoose board is expensive and not many organizations have the $$ for them. I have to agree with firedoc and Dust...a 1 month old baby does not move around much, except maybe extremities. I would have a very high index of suspicion to mom maybe dropping the kid. I dont see a 1 month old as being combative at all, most of the time swaddling one so little will calm them right down. Its a comfort and warmth thing. And I must ask why on earth RSI'ing a 1 month old who is mad and voicing his opinion (as only he can) would even come to mind. The fact that he is squirming and screaming tells me that he really doesnt have a trauma injury but that the precaution should be taken. Better to be safe than sorry. Mom isnt gonna really tell the truth in this instance, accidents happen, but to say that a 1 month old squirmed enough to fall off a bed, I would really have to question that, without being accusatory.

I received this article in an email from another site I belong to. I thought I would pass it along. The EMS Contrarian by Bryan E. Bledsoe MAST Again: Medical, Not Military Anti-Shock Trousers Read Bledsoe's March Column: The MAST Will Not Die This will be my last tirade on MAST. In my last monthly column, I had a fairly detailed overview on the MAST. Like many things in EMS, discussions of MAST bring out an emotional response from many of us who used the device in the 1970s and 1980s. And for this reason, the issue is worth revisiting. MAST discussions tend to bring the usual comments about the “Houston study” being flawed and a constant reminder of how many lives MAST saved in Vietnam. Everybody knows that MAST saved many a life in Vietnam, right? Guess what? MAST were not used in Vietnam (except for a small field study). Here, too, is another EMS urban legend that must give up the ghost. MAST were designed by the National Aeronautics and Space Administration (NASA) in the 1970s. They were part of a congressional mandate to assure that civilians derive something of value from the billions of dollars spent annually on the space program. MAST were a derivative of the G-suit worn by fighter pilots. At NASA, they were primarily used for physiological tests on astronauts as they prepared for their trips to space. A press release from NASA stated, “The anti-shock trousers are an adaptation of the anti-gravity flight suits originally developed for pilots and astronauts. They were modified to combat internal bleeding in trauma victims in emergency situations.”1 As I answered several queries to last month’s article, I went back to all of the original research on MAST. I could find no evidence that MAST were used in Vietnam with the exception of a small field study. That study, conducted in 1969, did not involve MAST per se, but involved actual “G-suits” used by pilots of high-performance aircraft. The study had a cohort of eight patients (four Americans and four Vietnamese) ranging in age from 18-24 years. Of the eight patients, seven survived evacuation, but only four eventually survived.2 I looked and looked and even requested several books via interlibrary loan. I could not find one picture or one mention of MAST in Vietnam. Finally, I decided to call an expert. In fact, I called THE expert: Colonel Warner D. “Rocky” Farr. Rocky is a friend and the Command Surgeon for the United States Special Operations Command (USSOCOM). I co-chair the Certification and Evaluation Board (CEB) for all Special Forces medics through USSOCOM (thus, how I got through to the colonel). In addition, Rocky is a military historian and was a medic in Vietnam before he attended medical school. He stated, “I never saw MAST pants in the People’s Republic of Vietnam. They came in during the late 1970s as a part of ATLS (Advanced Trauma Life Support). There was one study in JAMA and they were used occasionally in the post-Grenada invasion.”3 For those of you too young to remember, the Vietnam War ended April 30, 1975 (before MAST were made). There. That’s it. Breathe in, breathe out, move on. MAST were NEVER Military Anti-Shock Trousers -- they were Medical Anti-Shock Trousers. They were developed by NASA and first manufactured by the now-defunct EMS manufacturer Dyna-Med. They had some sporadic use in the military — but not during wartime. It is amazing to me how these stories develop and spread. We know why R. Adams Cowley made up the “Golden Hour.” He had to sell his multi-million dollar shock trauma center (and assorted helicopters) to the Maryland legislature and the people of that great state. Because Cowley was so well-respected, the concept was bought “lock, stock and barrel.” Even now that we know the “Golden Hour” is a myth, people are still reluctant to give it up. In the most recent edition of our five-volume paramedic textbook series, borrowing from PHTLS, we now use the term “Golden Period.”4 That is about as nebulous as you can get. Why people had to embellish the life and times of MAST in Vietnam is and will forever be a mystery. I guess it made for good night time station stories. I promise I will leave MAST in the old cabinet in the back of the station where they have been for the last 15 years. But this has been an interesting study of how we EMS people embrace and refuse to give up something as boneheaded as the Medical Anti-Shock Trouser. When I get time, I will detail how I saw a chicken come back to life with only the music from an accordion as intervention. Maybe I need a debriefing… -------------------------------------------------------------------------------- 1Available at: http://www.sti.nasa.gov/tto/spinoff1996/28.html (Accessed April 14, 2008). 2Cutler BS, Daggett WM. Application of the “G-Suit” to the control of hemorrhage in massive trauma. Annals of Surgery. 1971;173:511-514. 3Personal communication. Colonel Warner B. “Rocky” Farr (April 14, 2008). 4Bledsoe BE, Porter RS, Cherry RA. Paramedic Care: Principles and Practices, Third Edition. Upper Saddle River, NJ: Brady/Pearson Education, 2009.