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streethealer535

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Posts posted by streethealer535

    Your opinion please...

    in Education and Training

    Posted

    How about doing the smart thing and running the EKG and 12 Lead at 50mm instead of 25mm standard?

    Ah haaaaa..............

    I was thinking as I read through this thread what about trying to vagal... it might not work but if it slowed the rythem enough to reconize something it my help. I guess running at 50mm might help but then I have never seen and EKG done like this is it easy to read and understand in relationship to the vertical lines on the tracing?

    ~street

    $500K program a "crystal ball" for emergency dispatchers?

    in General EMS Discussion

    Posted

    Well, the program sees 20 min into the future based on 10 yrs of past data. So if we've had 5 or 6 plane crashes in the same year and same time near the airport (which we've only had 2 or 3 (priavte aircarft, no commercial) in the past 5 yrs), and we're getting sent to the same general area. I'll just make sure to have my extra jump kits ready......

    The thought process behind the milage and over usage of vehicles is based on our current stand-by policy. When two trucks which cover a response zone are out running calls, we have to send another truck to that area to cover the zone to maintain response requirements. Based on the new theory or program, if two trucks are out and a zone left uncovered, but according to the program no call will be dropping in the area and it does not reccomend a unit for stand-by, you don't go. Taking that same theory for one truck, apply it to our fleet of 37 trucks and it adds up in a yrs time of numerous cost savings for fuel, wear/tear on our vehicles, and wear/tear on employees.

    The county in which we live and work in believes in providing the best service possible to the residents and vistors. If that means we're supplied with the lastest in vehicles, equipment, and technology to accomplish the job and be finacially responsible and efficient, then that's what we're given. Our PCR program enables us to collect for this year, 18M out of 25M billed. In which essentially means our service pays for itself, and we're not private! We've been able to keep the priavtes out of our county.... :)

    Thanks for the great Information its nice to hear from someone who is actully in the system!

    I hope this lives up to the hype it could realy benifit everyone.

    ~Street

    Off Duty Safety

    in General EMS Discussion

    Posted

    I do not know if it is still true but at one time having a drivers license in Vermont imposed a duty to stop and render assistance to the best of your ability if you were the first uninvolved driver to find the wreck. That information is decades old and I can only hope that the state has changed it's rules to some more common sense approach.

    Your pretty close... there are still 2 states in the union that are "Duty to Act" states. Vermont is one the other is Alaska. It is unlawfully to pass someone in need if you are a licensed provider in the state. That being said If you have a duty to someone else IE pt in an ambulance or child in car you do not have to stop. I have never heard of anyone losing a license or even being warned for not stopping.

    Sadly this is not the first accident of the like in VT. I have personally been on four scenes were off duty police officers and FF have been injured due to vehicles hitting them or there vehicle on the side of the road. (luckily they all survived)

    This is a tough decision to make... I know you feel obligated to help but at the same time is your life or your family's worth the risk?

    ~Street

    Daycare Dyspnea

    in Education and Training

    Posted

    Why do you ask? Last time I checked, SP02 is part of a comprehensive vital signs assessment...

    Timmy,

    Please Let me Clarify for you... I was not talking about you wanting to know the child's O2 SATuration Level... I was talking about one of my pet peeves... Every time you say O2 STAT you sound like a moron! ITS SAT short for SATURATION... get it?

    ~street

    • Like 1

    Can you take the EMT certification program if your pregnant?

    in Education and Training

    Posted

    Ok, so I finally got in touch with the people who run the EMT-B course where I live and the lady tells me that I might not be able to get certified because I'm pregnant (really not that big of a deal). I would be certified before the baby is born. I just need some clarification. Any thoughts would be greatly appreciated!!

    Seems to me the hardest part will be lifting and crawling around on the floor. If you will be early enough into your pregnacy that this is not a problem I don't see why you could not test. The biggest problems might come in the hands on part of the actual class (lifting, CPR on floor, ect...)but if they are willing to work with you it might not be a problem. Anyway good luck I have seen it done...

    Non-transporting ALS or ALS chase

    in General EMS Discussion

    Posted

    fenwayfrankee

    From your name I am going to assume you are in the Boston area. If this is the case Two of the best Intercept "chase car" systems I know of are in your area. Lawrence and Lowell Mass both run BLS trucks for transport (privatly run) with dual paramedic intercept vehicals (Hospital based). These systems work very well and are very progressive with their protocols.

    Just out of curiosity what was your interest in this type of system?

    Work her, or let her float to the light ????????

    in Education and Training

    Posted

    I think p3medic said it best... who are we to decide what is quality of life for anyone but ourselves?? There is no way you can not work this patient. It is not right for us to try and push our own morals and belives on others. If this Pt did not want all efforts (real efforts not medicating her bed) She could easily have signed a DNR.

    You may be thinking mabey she just did not get to it, or someone else talked her into not signing a DNR but as EMS it is not our place to assume anything.

    WORK IT and work it RIGHT!

    JJ

    Albuterol in CHF?

    in Patient Care

    Posted

    Most likely left sided failure causing right sided failure causing pulmonary edema.

    Mabey Im a little comfused but since when does RIGHT sided failure cause PE???? Its left sided failure causing PE then the elevated PA presure caused Elevated RV presure and then right sided failure!! Also we can get into the discusion of systolic or diastolic CHF, but I belive the question is a little easier to answer. Seems to me that most of our patients do not have simple one track disease processes. I might be wrong but it seems to me if there is PE then the Airway will become irritated and can be inflamed. So sometimes it takes albuterol to even hear rales instead of wheezes. Yes we can harm patients in CHF by giving them Albuterol, but in combination with everything else (C-pap, dieretics, baging, O2, Nitro if HTN) I think it is a good option as long as you continue to think about what you are doing to the patients.

    Just my thoughts... :wink:

    Street~

    Input on SOP "gray area" call

    in Patient Care

    Posted

    I think it sounds like we are all coming to the same conclustion...

    My only question is what was the final outcome??? Did the patient continue to refuse treatment in the ED? Was there a Mental change due to dehydration or mental defisency? was the patient released back to the SNF? Just wondering how it all worked out...

    JJ

    Input on SOP "gray area" call

    in Patient Care

    Posted

    VS... Why are you putting so much faith in the "DOCTOR" who was not there but on the phone.. A medical doctor (PCP) I am assuming would have no more a right to as you put it "form" a patient then we do as EMS... with out proper legal criteria met they have no ability to even touch a patient without consent. If the criteria is met as EMS professionals we could transport the patient with out the doc saying so anyway. I think we need to give this crew some credit for taking a difficult call and making the best out of a tough situation.

    I will be the first person to walk away from someone who does not want to be treated. I refuse to push medical help on a competent pt who wants to be left alone. However sometimes making the distinction between who is competent and who is not can be very difficult. Although it may be nieve I tend to belive if you have a good heart, make the best decision you can with as much knowledge as possible, and document the crap out of the call you should be able to defend it to anyone.

    I think MSDeltaFit got it right just cause someone is AOx4 does not mean they are competent. they need to understand the consequences of their decision.

    mshow00 good job..

    JJ

    Info on AMR

    in General EMS Discussion

    Posted

    In all my many years in EMS... (ok, ok, just 10 yeah I know Im just a pup.. but it makes me sound almost regal... :wink:) I would have to say Dust's comments have been the only possitive thing I have ever heard about AMR... of course I am from New England and have see first hand what Doug is talking about with AMR in Mass... Just my 2 cents

    JJ

    Paramedic sits up front on transfer, patient dies

    in EMS News

    Posted

    And amazingly, since they don't know what they don't know, they rarely ever even realise it.

    Dust your infinite wisdom shows again!!! I spent 8 years as a EMT-B and EMT-I and until I started my Paramedic program (AS degree with A&P 1 & 2) I had no Idea what I did not know or did not truly understand. Now my most used statement to all my partners and students is this.

    "You don't know what you don't know until you learn it!!"

    I belive this goes for everything in life not just EMS.

    As for A&P being mandatory I like to link it to other professions... Mechanics don't learn to fix problems they learn how a car works and how to trouble shoot to find the problem... same thought process just a different patient. We need to know the human body inside and out if we ever hope to trouble shoot patient complaints and use CRITICAL THINKING!!!

    Paramedic sits up front on transfer, patient dies

    in EMS News

    Posted

    We kinda had an unwritten rule. If we had a patient on the cot, there was an EMT on the squad bench. Sure the EMT may have temporarily had to sit on the jump seat to say something to the driver, but it would of had to been a minute or two. You never make a patient feel as if they are alone.

    I understand what your saying but think about this... three years ago I read a study conducted on ambulances. Any Crash over 35mph and anyone sitting on the bench had a 98% chance of not living through it seat belted or not.

    just some food for thought

    JJ

    In need of a class on "How to commit suicide"

    in Funny Stuff

    Posted

    Its called Gallows humor its a coping mechanism... so lay off the guy huh.. its dam funny... if you don't take life soo serious. Death is enevitable, life ends, its about what we do to make a difference when we are here... So light'n up and smile!!! :)

    JJ

    PS evilmedic13 ... thats some funny stuff right there...

    using a bvm on a conscious pt.?

    in Patient Care

    Posted

    My though is this... sounds like the patient has some Pulmonary adema from CHF.. (no lung sounds stated)

    The treatment for CHF: Lasix, Nitro, C-Pap

    Lasix is not going to do much if your only 4 min down the road and the medics were unavailable right? not your fault last time I checked

    Nitro is going to help but only if you can assist. pt might not have had there own and agin not your fault medics not available.

    As for C-Pap... what is it really but a little pressure to assist in ventilation... get were I am going with this... Bagging can do the same thing... I have had CHF Patients actually bag themselves. (I prefer to do the bagging but sometimes patients need this) Hold the mask and tell them to squeeze as they breath in. sound crazy right... well trust me it works... exspecialy when you don't have C-Pap.

    Now if the patient is breathing fast cause they are scared (they tend to get that way when we can't breath) then helping them will slow their resps.

    As for the RN YELLING at you I have a pet peeve with higher level providers Yelling instead of educating... its kind of useless to yell at someone for doing something "wrong" and not telling them what is "right".

    JJ

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