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etfink

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Posts posted by etfink

  1. Hi All

     

    Im a paramedic with years of experience in fire, flight and third service.  I’ve been out of the field for a few years and am relocating to Jacksonville Florida.  I’d love a little part time or volunteer work, to keep my skills sharp and maintain my license.  I don’t care much about pay, I have a great full time job.  What I really want is a place I can run calls either EMS or CCT (I’m FP-C Certified) and am open to driving.  A huge plus would be a service that takes part in disaster relief so I can help in tropical storm situations.

     

    Any recommendations would be really appreciated,  

  2. You can't call into service. You are lying. I'm not trying to bash you, I know it can be a hard call. The only ethical thing you can do is to call dispatch and let them know you are out of service due to manpower. Then make sure your supervisor knows. I speak from experience, I had a partner just like this.

  3. I would have to agree that bagging while doing compressions would not be effective and would at best cause alot of Gastric Distention. So that is kind of odd to me. A couple other things in this scene don't make sense to me, maybe someone can help me understand or you could clarify.

    He was in V-Fib, You shocked him at 360J? Right off the bat? And that converted him to PEA, but he had pulses? You should have gone through the 200J, 300J, 360J on a Monophasic Defibrillator or the 120J, 150J, 200J on a Biphasic Defibrillator. Maybe clarify for me because on the last post you said he converted to a First Degree Heart Block, which also isn't PEA. Thanks.

    All right here we go:

    Our electrical therapy was in accordance with the 2005 AHA ECC guidelines. Stacked shocks are out. Check the AHA website you can download the new algorithms if you don't have access to them.

    In my post I said that he converted into PEA with a first degree heart block. PEA- Pulseless Electrical Activity, you do not need to show a perfect sinus rhythm with out ectopy to be in PEA. Our pt showed a first degree heart block with no pulses. That is PEA. He had a good rate on the monitor so we tried a fluid challenge before epi. It worked, after a challenge we had radial pulses.

    I think we were wrong to bag while doing compressions. I've talked to my partner and called our prehospital coodorinator. We should have done 200 compressions with no ventilations. Once the pt is intubated, you don't stop for cycles. That was our confusion.

    This is a good discussion. We had a save which is great however if we made mistakes I would like to find them so that we can do better with our next pt.

  4. I'll just repeat what was said in EMT class, O2, give it early and give alot.

    But as a basic, this is the best medicine we carry. Also, it can't hurt to give it to the patient.

    Please don't take offense because I don't mean any. That is what we were all told in EMT school and I always thought it was crap. We are giving a drug. If we ever want to elevate our profession we can not stand for answers like this. Go out research learn a little A&P, or ge content to be a Gurney Tech/Driver.

  5. I'm with kev, a little analgesia and re-allign to the best of your ability, then splint it.....

    Remember we are in a BLS thread, although I agree with you. SAM splints rock. There is not much I cant splint with SAM splints blankets and tape. As for the cost, The pt's insurance or medicare pays for it.

  6. Do you know what caused the arrest? I don't want to rain on your parade but I suspect alot of the ROSC has to do with why he coded to begin with, obviously.

    Unsure exactly what caused the arrest. He converted eventually into a Sinus First Degree Block rhythm. Hx of stroke and high blood pressure.

    Don't worry about raining on my parade. While the end result was that the patient converted was at least admitted alive, we have to be willing to examine our actions ex post facto. I'm starting medic school in Jan and if I can't listen to critisim or critique given with good intentions than I'm in the wrong field. I post here and read here to learn and maybe at some point share something that other may learn from.

  7. We are involved in a prehospital study, so the protocols may seem a little weird. To be very honest it is frustrating because several departments are using the old AHA protocols, some using new protocols and some are involved with this study. Because of the system several agencies often work together and there can cause confusion. I will look into wether we were wrong to bag before intubation. I don't believe we were. Thanks for the feedback.

  8. Great call last night:

    Dispatched C3 for a MVA, minor damage. U/A pt found slumped over steering wheel, unresponsive, apneic, pulseless. Wife states pt became unresponsive drifted and struck parked car.

    Pt was rapidly extricated to long board. Here is where it gets cool:

    Per new protocols for unwitnessed arrest began continuous chest compressions 100 per min for 2 min while bagging every 5 sec. Pt placed on monitor which showed microfine v-fib. Pt shocked once at 360J. Converted to PEA with a rate of 75. Intubated, two IVs established 14s in right and left ACs NS wide open. 250cc fluid challenge. Palpable radial pulses present. BP 80/palp. Rapid transport. En route: Lidocaine bolus and drip hung. At hospital pt started bucking the tube, pupils were reactive and bp raised to 125/77.

    Discussion-

    While this was just a single point of reference I really liked the 200 compressions prior to any other inverventions. The theory is that the heart needs to be primed and that there is sufficient O2 left in the blood stream. Another collateral advantage was that it gave us 2 minutes to organize, get equipment and meds staged and compose ourselves. I really don't see how this call could have run better.

    I just wanted to run this by the forum because this is the first cod I've run under the new protocols. What have you seen out there?

    By the way I just got the call last Friday that I've been accepted to medic school in Jan. I can't wait, I'm already studying every free second I have.

  9. Yeah... now that they have their First Responder training, they're qualified to handle just about everything. :roll:

    exploding_head.jpg

    OMG. I just finished my FF 1 and 2 classes. At the end we had the NFPA first responder. No matter what cert you already had, we were required to attend. What a complete joke. I was terrified to believe that after a few classes these people might be called to respond to a medical emergence. What was worse was that this "class" and this first responder "cert" made them believe that they were qualified. Disgusting!

  10. Boston EMS, www.bostonems.com, links to other sites, including the boston public health commision, who is the city agency we fall under. The hiring process involves a written test, practical exam and oral interview, all candidates must be Mass certified EMT-B or higher. All new hires are as EMT's, regardless of your level of cert, all ALS positions are filled from within the ranks, no direct hire of medics. If one passes the entry requirements, including criminal background check, driving record, drug screen, you spend I believe 10 weeks in our academy, mostly didactic work, with some hospital and field clinical time as well, covering all aspects of the job, interagency familiarization, hazmat, subway ops, airport response, police dept stand by with eod/entry, fire ground operation, etc...after the academic portion new hires are entered into the field preceptor portion, responding to calls with a fto and another cadet, or perhaps an fto and experienced emt, things are currently being changed, so i'm not completely sure how the current class is going to do this...anyway, the field portion is 9 weeks, with a possible extension depending on circumstances. If you pass all that, you get your badge and are a probie for 1 year. In order to compete for a medic spot you must be employed for at least one year, be a Mass certified EMT-P, pass written, practical and oral interview. Selected individuals spend a month in class, another several weeks in clinical rotation in hospital, (OB/GYN, OR, NICU, PICU, EW, Ped's etc...) The field internship is 9 weeks, then an exit interview. If selected you are a probie medic for 6 months with 100% chart review, and must work with a medic with at least 1 year BEMS experience. The testing process is very competitive, we have a large number of our BLS providers that have ALS certs, so having a medic ticket is only good for the chance to compete, it is no guarantee you will ever wear a white shirt.

    The system is a third service provider, with limited first response on certain call type codes by BFD/BPD. We on average staff 15-20 BLS trucks and 5-6 ALS, BLS trucks are staffed by 2 EMT's, ALS by 2 medics. We also have a north and south side division supervisor (Lt.) that are experienced EMT's, and a shift commander (Dep Superintendent) an experience medic. We staff BPD boats with EMT's and medics during the summer months or during special events as well. There are two tactical response units, tango 1-2, with trailers for specific equipment, i.e scba cascade system, mci, bike trailers, comm's, hazmat, etc...I'm not exactly sure of the pay scale, but starting EMT's are about 22/hr, medics 29/hr, after 5 years medics are just under 33/hr, not including built ins like haz duty, shift diff, etc...or OT. We are negotiating a contract currently, so these will change, hopefully a lot! but i won't hold my breath.

    CPAP is in stock, yet hasn't been fielded yet, should be on the street before the new year, but i've heard this before, we'll see...RSI, IO utilizing the EZ-IO, great tool in my opinion. Pain management is aggressive at the ALS level, nothing at the BLS level, yet....

    We conduct internal training every month, ACLS/PALS/BTLS/ Refresher all paid OT. We are fortunate to be in a city with several teaching hospitals, so are invited to attend training that is difficult if not impossible to get at other services. Medical examiners office, Boston Medical Center, Mass General, Brigham and Womans, Shriners, Beth Israel, Childrens, NEMC have all extended lectures or programs to our membership. We have a strong Union, good health benefits, 15 paid holidays, 15 paid sick days, 3-6 weeks paid vacation depending on longevity, a support services section, special ops, communications (dispatch center with BPD) tqi/tqa program, a research oriented training department, Medical director and Associate medical directors with active participation in training and research, and EMS fellows, who conduct research as well...We also teach AED to the community and businesses, and some outreach programs to populations at risk....

    Wow impressive. What shifts do you run. 24s 12s. Can a EMT with a ALS cert use any of his/her skills? When you said limited first response I didn't quite understand are you first in or is fire?

    Thanka for the post

  11. I usually carry a small first aid kit. Thats because my car came with one. I think its between the spare tire and the cd changer. I've used it twice. Both times for my daughters that got a boo boo. When I started I did carry a pretty wankerish kit, but have grown up. I will call if see an emergency. Usually I skip 911 and just call my dispatch directly. They have more of a brain than the average cell phone 911 center and will notify the correct department. I won't stop. To dangerous. My car no partner, no flashing lights on my car, wait car not big truck, no radio, no medical direction....no way

  12. I very strongly believe in G-d. I also believe in science and evolution. These beliefs do not have to be mutually exclusive. Open up an A&P book. I just cant believe that we evolved from the primordial ooze by accident. To me, thinking that this is random chance does not make sense.

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