Medic26

You could get a job as a nurses aide, Patient care aide, ER tech or something like that in a hospital setting. Looks good when you have had some interaction and experience even though you would not really be performing any "skills" per say.

All things have to be considered when pondering the response and transport modes. I work for 2 different services that have two different schools of thought with use of lights and sirens for response and transport. My personal experience with the use of lights and sirens is that they are rarely needed for transport of a patient. The time you save rarely has any effect on the outcome because in general it is very small. This can however be altered depending on the amount of traffic, time of day and distance traveled to the receiving facility. I have this debate all the time at my part time gig, just because the "protocol" states "rapid transport" for trauma, suspected strokes and STEMI's do's not automatically mean you have to use L & S to get there. Mind you this is a service that our maximum transport time is 20 minutes tops from the furthest out area under normal driving conditions. Do you really think that driving like a MORON and getting there in 17 minutes instead of 20 minutes is really going to have that big of an impact on patient outcome..........RARELY! If you have a patient who is that bad which is probably < 5% of the time then by all means.....GIT-R-DUN. As far as response mode to the scene... I am a little more liberal. Why you ask....because dispatch information is unreliable. People making these calls usually have no clue and are so excited they have no true concept of what is really happening. Generally I will response with caution using L & S for most respiratory, cardiac, MVC and ALOC/Unresponsive calls. Simple fall victims, sick person, general illness and the like get routine traffic generally. Our dispatchers are trained in EMD at the 911 center, but they rarely give us a priority code anymore. They also have the option to "upgrade" a call to Delta upon their own discression too.......which is usually a BS complaint when we arrive. Better to air on the side of caution I suppose. :roll:

I agree hole-heartedly with this, as far as doctors looking things up all the time. They have far more knowledge and information to retain than a paramedic with our scope of practice. In short we should be able to recall most of our training and protocols without batting an eyelash.

We have a quick reference pocket version in the trucks but I have never used it. My opinion is that a responsible provider should know them already. I would spend a few minutes each shift reveiwing the protocols until I knew them cold when I first started or we had a change.

One of my p/t services has had this for about a year, they have used it about a dozen times with great success overall, me personally once. I have not heard anyone complain about them yet.

What do you do with your vehicle? Where do you park it to keep it safe? Park it somewhere off the roadway, lock it, take the keys with me. If you have parked it, has it ever been broken into? Only by another crew who spent a few minutes whipping up a prank for me to return too. Some of the older medics had spare keys made for the trucks when they kept locking themselves out with power locks. What are your procedures in addressing the above questions? We really don't have anything in writing, just how its been done. I suppose there was a memo years ago. I have not met many BLS units that didn't have a spare person who could get out and drive my unit. I have many times opened the back doors and siad "two people need to get out and it won't be me", obviously these are extreme cases but 4 or 5 providers in the back is a little much. I like to try and keep myself with 2 or 3 at most of the BLS crew in these cases.

I have used a Littman Master Classic (single sided) for the last 9 years. To tell you the truth I wouldn't waste my money on a Cardiology scope, when this one dies I'll have it refurbed or buy the same one again.

I agree with this statement, but not in the manner dust meant. I believe that to be a truly effective team member during a "rescue" situation you must have basic working knowledge of the things that must be done to effectively "extricate" or remove the patient from the enviroment they are in. You as a patient care provider should be able to anticipate the needs of your patient during a rescue, the only way to truly do this is to have BASIC training and knowledge in rescue techniques. My own opinion is that all EMS providers should have basic rescue training for this reason. While I do work for an agency that performs rescue, it is not mandatory for all of our people to cross-train although its recommended. The only thing you must remember is what your purpose is on any given situation, patient care. Just my $0.02 worth. :salute:

Agreed, but Nurses, Doctors, Medics......there is a few in every bunch. Treat every doctor you encounter like a moody & hormonal woman......but there will still be times when you walk away scratching your head wondering what you did to deserve the comments made.

Our medical director wants to stick with the same type of procedure, so a #10 blade is out. But one of these "Kit" airways is better than a TTJ any day......just looking for input on which one to go with.

Our medical director has finally approved us to aquire and place into service a "surgical airway device" to replace our current trans-tracheal jets. :(/ We have been starting to research the multiple devices that are out there such as the Rusch quicktrach, Nu-Trach and Cook Melker etc. So what better place to get opinions and feedback than here at EMT City. Anyone have much experience with any of these? :scratch:

Some more info on the King for Dust and others, maybe this will help some: USER TIPS 1. The key to insertion is to get the distal tip of KING LT-D around the corner in the posterior pharynx, under the base of the tongue. Experience has indicated that a lateral approach, in conjunction with a chin lift, facilitates placement of the KING LT-D. Alternatively, a laryngoscope or tongue depressor can be used to lift the tongue anteriorly to allow easy advancement of the KING LT-D into position. 2. Insertion can also be accomplished via a midline approach by applying a chin lift and sliding the distal tip along the palate and into position in the hypopharynx. In this instance, head extension may also be helpful. 3. As the KING LT-D is advanced around the corner in the posterior pharynx, it is important that the tip of the device is maintained at the midline. If the tip is placed or deflected laterally, it may enter into the piriform fossa and the tube will appear to bounce back upon full insertion and release. Keeping the tip at the midline assures that the distal tip is properly placed in the hypopharynx/upper esophagus. 4. Depth of insertion is key to providing a patent airway. Ventilatory openings of the KING LT-D must align with the laryngeal inlet for adequate oxygenation/ventilation to occur. Accordingly, the insertion depth should be adjusted to maximize ventilation. Experience has indicated that initially placing the KING LT-D deeper (base of connector is aligned with teeth or gums), inflating the cuffs and withdrawing until ventilation is optimized results in the best depth of insertion for the following reasons: It ensures that the distal tip has not been placed laterally in the piriform fossa. With a deeper initial insertion, only withdrawal of the tube is required to realize a patent airway. A shallow insertion will require deflation of the cuffs to advance the tube farther (several added steps). As the KING LT-D is withdrawn, the initial ventilation opening exposed to/aligned with the laryngeal inlet is the proximal opening. Since this proximal opening is closest to and is partially surrounded by the proximal cuff, airway obstruction is less likely, especially when spontaneous ventilation is employed. Withdrawal of the KING LT-D with the balloons inflated results in a retraction of tissue away from the laryngeal inlet, thereby encouraging a patent airway. 5. When the patient is allowed to breathe spontaneously, airway obstruction can occur even though no obstruction was detected during assisted or positive pressure ventilation. During spontaneous ventilation, the epiglottis or other tissue can be drawn into the distal ventilatory opening, resulting in obstruction. Advancing the KING LT-D 1-2 cm or initial deeper placement normally eliminate sthis obstruction. 6. Ensure that the cuffs are not over inflated. Especially if the KING LT-D is to be left in place for a period of time, cuffs should be inflated with the minimum volume necessary to seal the airway at the peak ventilatory pressures employed (60 cm H2O, if cuff pressure gauge is available. 7. Removal of the KING LT-D is well tolerated until the return of protective reflexes. For later removal, it may be helpful to remove some air from the cuffs to reduce the stimulus during wake-up. My experience with using these in practice is that they are far more user friendly and can achieve an airway faster and supposedly safer than a combi-tube. We have 3 different airway trainers, we were able to intubate with an ETT all 3 on every attempt that we tried using the King and a Boujie stylette. This is much like an intubating LMA.

We have a nurse at the receiving facility sign for waste, then the doc must sign a sheet in the drug bag with his or her orders before we turn it into pharmacy......if it was a standing order either the ER doc signs it or the pharmacy obtains a prescription from our medical director. After that we turn in the bag and the pharmacy issues a new one thats counted and sealed.

I have worked in every style of ambulance and I can tell you that its rare when you need anything but a type II (van). The only exception to this is a critical care/ventilator type transport when its more of a convenience than a need and a bariatric run when you need more room to fit the patient. Honestly I prefer a well specified van ambulance and they are more efficient to purchase and operate.

We carry the king and combitube both......we haven't used the King since getting them about 8 months ago. We also carry the gum boujie too, but to my knowledge we haven't used any of them in about a year of having them. There are alot of good devices out there to look at but if the King is as good as we have been told.....it will eliminate our combitubes being carried.

Thanks for the reply.

Just to add a little more background, we have never had an issue with missing drugs or mis-use of them. I was just curious as to how other companies carried and kept the records. We have 8 units stocked at all times, ALS providers are issued keys and the drugs are kept in a locked cabinet, then the narcs are locked inside the drug bag with a second lock and integrity seal. We generally don't have more than 3 units "staffed" on duty at any one time. If it gets busy they will call more staff in from home as we are a combination department. I was just looking for common practice in the industry. I agree totally with the liability issue, but I have looked extensively and am not able to find the actual DEA regulations that deal with this specific issue peratianing to our set-up. SInce the hospital pharmacy "dispenses" the meds and "maintains" the stock.......I am unsure what our LEGAL obligation really is. Anyone know??

We exchange the bags through the local hospital pharmacy any time we use any medications, they verify and count everything....submit paperwork and so on. To be honest I'm not sure why ity hasn't come up in the past.

I'm not so interested in how you carry them as much as I am how you record, track or verify that they are where they are supposed to be. I recently started catching alot of "BS" from the rest of the guys when I brought back the policy that our drug bag integrity seals had to be checked each day and verified on a log sheet, this had only been done on the "back row" trucks once a week previously for the last 5 years or so. Our bags (thomas bags) have double locks with a break-away seal, stored in the cabinet...each day they are checked and logged, 10 minutes process. So how is your narcs tracked and carried??

The following is part of the PA state protocol on CHF: Give nitroglycerin dose based upon blood pressure: a. 3 SL tablets or sprays – for SBP > 180 b. 2 SL tablets or sprays – for SBP 140-180 c. 1 SL tablet or spray – for SBP 100-140 d. For patients on CPAP who do not tolerate SL NTG, may use 1 – 2 inches of topical nitroglycerin paste, if available. 4. NTG may be repeated every 3-5 minutes as long as blood pressure is greater than 100 systolic. [Note: One NTG repeated every 5 minutes is equivalent to a NTG infusion of 80 mcg/min] For the complete protocol follow this link: http://www.dsf.health.state.pa.us/health/l...ve_07-01-07.pdf

We started using Fentanyl in addition to Morphine about 9 months ago. It seems to be more effective for pain control with our standing orders of 1 mcg/kg, instead of the old 2-4 mg of Morphine that we used to get orders for.......I would assume that this is largley due to the more effective dose and that the Fentanyl has a shorter half life so the docs are more apt to be liberal with additional orders. The only thing we use morphine for now routinely is chest pain.

As I have spent countless hours recently viewing laws and federal guidelines. I was wondering if any agencies have there policy and procedure documents published online with there websites and if they could place links for review here. Also I was looking for any data on the web that would be useful to a compliance officer in EMS such as myself. There is so much information out there its hard to wade through it and decide what applies to EMS and what doesn't. We are also looking at accreditation from an independent 3rd party like, The Commission on Accreditation of Ambulance Services (CAAS). Does anyone have any input?

Oh Yeah I forgot everyone has L & S on there POV's. :laughing3: :roll: Not that some of you care but many of these places have few providers.

That's actually a good idea if you have someone who can. As far as the rest of the post is concerned, Yes I remember this happening in the early 90's when I started in emergency services. I don't think it should happen any more due to the obviously stated reasons above.

If you had arrived 5 minutes later and found an alert and oriented patient who acted fine, you would have done the same thing, right? This one could have easily been transported either way. ALS or BLS. You can what if a call to death but given what you've stated here I wouldn't have monday morning quarterbacked your call.