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zmedic last won the day on February 13 2012

zmedic had the most liked content!

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    New York

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    Emergency Medicine Resident

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  1. Hi, figured I'd pop back in and say howdy. Hope y'all are doing well, it's been a few years. I'm now an emergency doc and EMS medical director, but between residency and fellowship haven't been on. Hope to check in more in the future.
  2. I agree that you have to sort out what you want your full time job to be. I'm not in tactical medicine but have a lot of EMS experience, and my sense is that the vast majority of of people who do tactical medicine don't do it as a full time job. They are either full time medics who respond to call out with their SWAT teams, or they are full time police officers who have additional medical training. The big police departments have full time SWAT teams but most people who do SWAT are not in NYC or LA. The best place to start would be to figure out a few cities you would think about living in
  3. The most important part of treating a snake bite is to bite the snake back. Otherwise, they never learn how it feels and will keep biting people. (To the idiots of the world, don't do this)
  4. It's worth noting that there are plenty of people who get killed by people they think they "know." Like psychiatrists who get killed by their patients, you'd think they would know how to read them and figure out that its a dangerous situation. Sure I've gone into situations that maybe others would wait for the cops, and there are times that I've waited. It's worth keeping in mind that you can run 5 calls on someone who is "just a drunk," and the sixth time they show up with a gun in their hands. What I was taught was that about 40% of suicidal patients are also homicidal. So if you wa
  5. Couple of thoughts: 1: Trauma cardiac arrests don't cost the system much. Most of these people aren't transported, the system isn't build for these people because even if they were shot in the head or hit by a bus physically in the operating room, most of them would still die. 2: Part of the issue with having a perfectly efficent system is fire departments. I have big problems with a huge fire truck showing up to all these calls, but I understand that you have to give fire departments something to do if you want to be able to call up 50 guys for those structure fires. 3: Sure I've r
  6. I haven't taken the class. But I would add that people should be aware of the burns that may not look bad, but have high morbidity and mortality, and generally should cause you to think about taking someone to a burn center. Off the top of me head: Facial/airway Children Elderly Circumferential Hands Genitals Those are classic indications. I would also be very worried about electrical burns (ie lightning) where there may be hidden internal injuries.
  7. There are two things the jump out at me from the report. 1: I've never heard of starting transport with a living patient,having them die enroute, and returning to the scene of the accident and leaving the patient there. Everywhere i've worked either the patient is pronounced on scene or you complete the transport to the hospital. 2: It strikes me as a little sketchy having someone not from the responding ambulance department drive the ambulance. Is that person covered by insurance? Do they have EVOC? It would be very messy if there was an accident on the way to the hospital and some ra
  8. Couple of things 1: You have any data that patients have better outcomes in countries with a 6 year residency versus 4 years? You can assume more time is better, but why not just have a 10 year residency? I'm glad I'm not spending 6 months doing anesthesia, you don't need that much time to learn how to intubate. And most of the other stuff you do during those months don't really apply to emergency medicine (I don't whip out much isolflurane in the ER) 2: I think it's a bit insulting to call an emergency residency "vocational training." Therefore a pedatrics residency is just vocational t
  9. Most NYC EMS ambulances spend the day posted out on the street. So bringing ground coffee doesn't help much as the guys are spending 98% of the time out on the road. Better to just bring cups of coffee, or buy some when you are out on the street.
  10. Too much coffee and you miss a rush on the bus for a confirmed pin job. Then they send you a boss. Never want a boss for the bus.
  11. I think it depends on what your expectations are for the interventions. I don't think it takes that much training to show up and say "i know you aren't having an emergency today, but I want to go over: 1: What medications you are taking? Do you have a list of them? 2: What hospital are you followed at? 3: What is the name of your doctor? 4: When is your next appointment? 5: Are you in the process of getting home health help? No? How can we work on that? 6: Do you have a recording of your fingersticks? Pretty simple. Now it's a very different skill set to have someone show up and say
  12. There are those of use who have worked both paid and as volunteer. This isn't a volly v paid discussion. This is a "what is the role of volunteers within an established 911 system.
  13. My issue isn't that people volunteer, it's that they are volunteering by trying to jump calls rather than being part of a 911 system. I understand that a lot of volunteer groups were there before FDNY came in, but if the community isn't saying "we need more coverage, lets have a volunteer service" then something has to change. And I think it is. Look up what is going on with FDNY and Aviation Fire Department. It seems like there are groups that are volunteer and have a decent system in NYC. Columbia EMS for the university, Central Park Medical, Hatzola. People call them directly, bypassing
  14. My advice is to say out loud what you are doing and seeing. This is helpful for a few reasons 1: It calms you down 2: It reminds you what you are doing (by saying what you are supposed to be doing at that point in the intubation it reminds you to do it. 3: You get more time to try the intubation if the person supervising hears that you know what you are doing, and if things are going well, they know what you are doing to correct the situation and are not just staring and the esophagus. Example: "I'm opening the mouth wide, inserting the blade to the right and sweeping the tongue.
  15. Like I said. Are there other places in the US where there is a volunteer service that is scanning the radio and trying to beat the official 911 system to calls? In most areas of the country if you were jumping calls based on scanning the radio you'd get arrested. (Not saying NYC vollys should get arrested, just that it's a weird way to run a railroad.) It seems like it would make more sense for FDNY to say "hey, you guys have this 10 block area, you have the same computer system in the your bus as we do, you guys are 15 Victor, and we'll dispatch you from FDNY coms." That would allow them t
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