mobey

Onset (time, sudden/slow onset)? SPO2? Associated symptoms? (chest pain) Has this happened before? BGL? Has she taken her MDI for this event? Are the MDI's empty or expired? Air entry sounds? Smoker? Is home O2 on and working to cannula? K thats enough for now!

My school study buddy took the Salt Lake course last year, it was in Red Deer. She was going to work for Saskatoon which is the only accredited dispatch in sask. For that service you needed that particular EMD prior to applying, and EFD within one year of getting hired. It was a fairly intense 3 day course.

Acknowledge...... ](*,) I am also registered with my gov't as an EMT. However my education level is Primary Care Paramedic, could we at least call each other paramedics in hopes that some day our gov't will recognize we are no longer EMT's. I don't know Alta education standards very well but here is Sask there is a huge difference between EMT & PCP.

Conscious... I may have made that one up :-k

What did you do with the unopened beer?? Sounds like you did the right thing, I had a simmilar call. The guy was Cx on arrival but as soon as he hit my stretcher he quit breathing. We bagged him all the way to the hospital where he awoke and abruptly jumped off my cot and climbed onto the hospital bed under his own power. A few minutes later he passed out again and quit breathing a second time. The doc shot him with Narcan, but it made no difference, so we brought in the guys girlfriend to keep him awake so he would keep breathing...Worked like a charm. CNS depressant indeed. :shock:

First off there is no such thing as an EMT in Canada, The bar has been raised please agnowledge that. Secondly what these guys are trying to say is Paramedics for most part have no "standard schedule". I work rural 5 days a week 24 hours a day paid on call. In the urban service I am involved with you give your availability for the following month and they will schedule you where you fit. Look for the service that serves the area you want to live in and ask them how thier schedule is formatted, that is the best way. Mobey

Just the simple fact that you had to ask the question is an indicator that you need the experience. I also work for a very rural service with a fairly low call volume. Therefore I go to an urban service every couple of months for a few days and take call to make sure I am retaining my skills and knowledgebase. The thing us rural peple have to remember is our calls may not come in as often but they are just as real. You should take the job for the experience even if it you are not sure it will be a career path.

Hey all I had an interesting experience I thought I would get your opinions on. I was paged to a 56 y/o male Cx & Alert c/o L sided numbness & chest pain. Came across pager as "Possible CVA/MI". Upon arrival it was clear this was indeed a CVA but no chest pain present (just numbness). When I asked about Meds pt. stated he had chewed 1 adult Asprin as per 911 calltakers instruction. It took us about 35min to get to pt. side and his BP was quite elevated, (can't remember exactly but the systolic was over 220). All I could think is oh sure just because he had ASA this will be hemmoragic. Anyway it was ischemic, and no cardiac event occured, he is now being treated for high BP. So what do you think should dispatch be giving ASA to chest pain when CVA s&s are present? Should they be instructing the pt. to take the ASA at any time?

I think this is the future for volley services, It is good that a town can create such a position. Now if the emphasis could be put on the EMS side. Things like you must keep a current BTLS, Bi-Monthly ride alongs in a busy service, maybe ER rotations, just to keep it sharp. Then maybe some on-call pay could be worked into the equasion.

How far apart were the P-Waves?? What was the rate? Maybe a rapid Classic type 2, Maybe Flutter waves? It could be an Atrial focused ectopic with a 2:1 Block, Check out this article. Do you have anymore specifics? http://www.medscape.com/viewarticle/433023 Mobey

....Does that mean you don't immobilize patients found ambulatory? or are you just refering to the KED in preticular?

Sorry should have been more specific.. Make sence to our service. 1) we would never leave the ER without our KED because our ER is 2.5 hrs away... we will wait. 2) In our service we have such a long transport time I coulden't imagine sitting on scene for X amount of time putting 2 KED's on. 3) Yes ALL of our calls are single occupant single vehicle!! :roll:

We are required to carry either 2 KED or 1 KED & 1 SSB. Since 2 KEDs don't make sence we do have 1 SSB. I would only use it if someone coded on my stretcher to add rigidity for compressions. But I don't think it would come out under any other circumstances.

That is exactly what I am trying to say..Thanks Asys. The reason I say such statements as the one that started this whole thread is because of experiences I have been involved in. Example: At a T-Bone in Alberta - "Sir try not to move your head, now carefully step out of your car and lye down on this board for us." (Then procede to spinal immobilize) Example 2: 15yr veteran volley EMT sandwiches a kid face down, helmet on, between 2 spine boards after hitting the wall with his head at a hockey game. I spoke with her facilitator and she said "there is not much we can do, if I give her sh*t and she quits the health region will pull our ambulance. (BTW that EMT quit a few months later for perssonal reasons unrelated). Money is just salt on the open wound, it is all about pt. care to me. I stand by my original statement.

=D> From Canada...I agree! Not only just the money issue, but volleys are held to a lower standard of education *prepares to be attacked*. Ya Ya argue all you want, I am sure "your" dept. is different. I am surrounded by volleys, great people... poor professionals. We just started getting paid decent on-call wages in our EMS system so we can attract people to our remote area instead of forcing locals to be volunteers or our ambulances will be pulled. Fire should take notes.

So far EMS has taught me: Don't be so judgemental, some things aren't as they appear. Charish your family and close friends they can be gone in a blink of an eye. Death is not the worst thing that can happen. The people who say thier hero's aren't, real hero's don't realize they are. When you think your life has gone for $hit, take inventory on your surroundings. Before EMS I was the opposite of these!! (I actually thought the off duty EMT who wore a flashy EMS jacket was a real hero)

Please keep in mind I am not claiming to be testing all 12!! Please add as you see fit. PCP/EMT school taught to assess: PERRL Facial droop Equality of smile Grip strengths Arm drift I have added: Directions of gaze. left, right, up, down. Have the patient recite "you can't teach an old dog new tricks" Raise both eyebrows Ask the Pt. to swallow and assess if extra effort was needed Stick out tongue Shrug shoulders I also do strength tests on Ext. and draw a number on the ankle and ask the patient to tell me what it is. Keep in mind I have an exceptionally long transport time so I can assess all I want. I was also shown how to test some reflexes and have tried it a few times to pass the time. I am still building on my assesments and any imput is appreciated. Mobey

=D> I totally agree!! I had a hemmoragic stroke not long ago and was presenting with nystgmus. I was pissed that I didn't know what it was when I saw it. I called up one of my paramedic buddies and he showed me how to quickly test most of the 12 nerves and some other tips. This should be a standard neuro exam as far as I am concerned.

The biggest complaint I've been hearing is students being preoccupied. Keep your cell phone off (no text messaging) If your reading make sure it is something medical Don't talk to your preceptor about personal issues, he's/she's a teacher ur a student. No games on the palm. Just act like your a guest (which you are) eg, no swearing even if they do, manners matter, etc.

Dust & Bushy: You are right I worded that poorly, I meant that a BLS is all that is practicle. I do agree that every service should be staffed ALS, unfortunatly some communities such as mine can't afford it. I did not mean to turn this into BLS vs ALS, there is no question. Every ambulance should be ALS staffed, every hospital should have competent RN's, unfortunatly in a province with a Population of 1 mil (approx same Pop as Calgary) we do what we can with the little funds available. Hopefully I have been more clear in this post. BTW you will notice I am upgrading to ALS... :wink:

Lowest common denominator?? Did you read my post? You honestly believe that those people who spend 15min with thier patients with a medic "babysitting" them are of a higher quality than us in the rural? You have to understand some communities cannot afford to staff an ALS car. I may be hours from a hospital but we only have a low call volume, what paramedic is going to sit around in the sticks waiting for his calls when he could be in the cities banging out calls and bossing around some BLS kid? and who's going to foot the bill for him to sit around? The Gov't :roll: like it or not there are some areas of the world where a BLS services make sence.

Hey all thought this could be a interesting topic. In my Intermediate class the instructor asked "what is the main difference between BLS & ALS? One of the urban PCP's answered "as BLS we don't have direct resoncibility for our pt because we always have a ICP or medic with us. I was very quick to correct his in the box thinking by informing him of this thing we call "rural EMS". I invited him to come take a call in my service where you are paired up with an EMR who considers themselves a driver only, no ALS for 120 miles, no hospital for at least 1.5 hr dry road driving, yada, yada, yada. So this person who claims to be on top of his game because he works for one of the busiest services in this province, has never had full responcibility for a patient!! I think it should be manditory in the clinical portion of EMS training to do a rotation in a rural service. I would like this kid to pull out of town all alone with a flash pulmonary edema at 3:00am knowing he is at least 1hr away from Ventolin, Lasix, Nitro, or anything else his patient "really" needs :shock: . So there you go, thats my thought of the hour... What do you all think?

You are getting excellent advice here, and everyone has gone through it. These 2 steps made the world to me: When the tones go off take a second, stop moving, take a deep breath and overpower your adrenaline, it is hard but you can do it. Secondly NEVER EVER EVER RUN. I used to run at some point during almost every call, and I think it forces you to panic. My heart would race when I ran and never slow down during the entire call making it hard to concentrate. Just what worked for me. Mobey

Hey all Just finished an MI call with a paramedic and we sparked a good conversation on the way home, (yeah it's a long drive). He suggested that giving Nitro spray without an IV is too risky and we should not do it. Note: in my province PCP's cannot start IV's but can spray nitro. Now we are not talking protocols here... I would never withold treatment from any pt. based on personal opinion. Just wanted to know your thoughts. How risky is this? I would be interested to hear some war stories about patients having a negative outcome from this sort of situation.