emsbrian

Places I rode, even if a basic was in the back with a guy who has a stubbed toe, any care he gives is under the "supervision" of the medic. Sorta a bum deal. While I have never seen it play out where anyone gets blamed for anything but what they did, that is the "theory". Didn't mean you had bad advice there ERDoc, just worried some might misunderstand :-) I think for the most part we have to look at just that Anthony. The ride is the important aspect, Safe and smooth come first, this is patient care and comfort. When expedition is needed the smooth can be reduced for a little shorter time, but safe has to stay. ERDoc makes a good point that most calls do not require L/S, and we transport A LOT normal traffic. So to go L/S is a huge decrease in the time to get to the hospital, as we normally have about a 15-25 minuted drive anyways. We do tend to respond L/S more as dispatchers have to communicate with people who obviously feel someone is about to die and called 911, so their perspective on the needs of the patients may be more severe then the facts once we arrive. Anyways I'm out on this thread, Great advice guys :-) Sorry for the misunderstanding their Asysin, people seem to browse my posts a lot and not get the whole information. Most the time what I say is no basic advice, as I fear people want just a black and white answer and am trying to give them thoughts about it.

ERDOC: True, but a little dangerous to say just that. The higher cert is of course in charge, and blamed for everything. So while the driver may be making decisions as to L/S based on traffic and safety, he must try his best to follow the needs and requests of the care medic. Never should a driver decide to go code 1 when the medic needs a code three. On that note I agree with you on most everything, just wanted to clear that up a little, general statements scare me.

Whoa chill there buddy. Never said that. Said they were a good resource for me as a supervisor to judge my medics. Their are as many dangers to bad habits as their are from inexperience. Never would I want a medic to be scared to question what they saw as a problem, new or old. And that is what I said their. I knew I would piss someone off, but didn't think it would be about that. I never said that experienced medics are less valued then newbies. We have a big problem with times changing and medics not. But my experienced medics are the life of my business. Without them I would have nothing. Never in my life would I trust a newbie to go teach no matter what. But never would I trust an experience medic until I know they don't have bad habits. The whole point of my comment as I have said many times on here, is to increase the professionalism of EMS. We must value both experience and knowledge. When one has both they are at a peak of our job. But both have value and dangers by them selfs. I urge the EMS world to be more professional, do not make anyone scared to speak up, and supervisors/managers should treat their employees equal in both listening to them and correcting them.

I rode a few choppers as 3rd on... SUCKED now I fly a cessna for fun, Nothing like a stall practice to get that thrill out :-) Good point there my friend

I will say up front, my advice has limited experience as a flight medic. But around here you need four-five years with your medic/RN working before you can even have a chance. I recommend if you can afford it to finish both schools. The knowledge you gain in each is highly important. While after 5 years working EMS as a paramedic you will have honed skills, if you challenge it as an RN you may very well pass, but will pose some risk to patients who will have an emergency medicine inexperienced paramedic (although I do not know how long you have been a basic). On that note you can also become a paramedic and apply that credit to nursing school (it is a 2 year paramedic to RN transition through distance learning). But I recommend getting your RN before and challenging it as the best course if you wish to save money.

I'm going to keep it short and sweet (didn't know I could do that did you?) You pretty much lay it out yourself, you know the rules follow them. I trust my drivers with my life. I can count the number of times I have driven (with a patient in the back) on little more then one hand. I don't know about this 8 minute thing, we get questioned for an unreasonable run time, but unless you have a small area to cover (never the case around here) 8 minutes is pretty much a perfect response time, and you can't expect that every time. Stay safe, there is a lot of FF/medics out there who only do it for the pay, they don't care about the patient. They are adrenaline junkies. I know I'm going to get bitched at by any who are on EMT City, BUT IF YOU'RE READING THIS YOUR ONE WHO CARES. It is true your world would possibly be valued less, but as a supervisor the fact that my newbies could be anal was an advantage. You can learn bad habits of your "experienced" medics that way. As far as the siren, rules vary a lot obviously. My particular experience says its a judgement call of the drivers (unless I say "we need to be there!!!"). No need in a residential unless you expect traffic or pedestrians. If your hauling ass through residential then I would probably have them on just for worry about kids and the such. (even though they may end up staring instead of moving) But for the most part it is to dangerous on residential roads to speed much anyways. In general we don't speed more then 10 over for safety reasons if speeding. Interstate/highways/major thoroughfares always get siren, but if you could flow better without it as an in-charge I would not mind one bit, as long as you judged it safe. If you truly need to speed (example: working a code) you need to have a PD escort. I know these are rear, but the places I have worked I have tried to work with the PD to be able to arrange them. They respond to all codes when we call them back to dispatcher as on scene with arrest. (along with everybody and their mothers around here) And when we leave they shut down intersections in front of us, so we can go full speed code 3 safe. Remember, if we hit someone, we just screwed up royally. The patient is screwed AND the person you hit, never a good scenario. Well I'll shut up now, since this wasn't short. Just remember to stand up for yourself if you feel its better for the patients. (or just rant on here, so we can join in.

I once sat at a conference for a 2 hour lecture by a nice MD who made many great arguments why we done even need a stethoscope. Changed my views greatly on EMS... Still like my stethoscope though. It was more of a jab at the over treatment and over thought that happens we paramedics forget that one major step: Transport decision.

A good point is made above by Ozmedic. My advice in the thread IS STRICTLY NREMT PRACTICAL EXAM ADVICE. Please do not apply it to real life by any means. Your knowledge should be so great as to pass no problem. A majority of my advice centers around test taking for the exam. While a practical exam should be infinitely more comprehensive there is only so much that can be test in 10 minutes. Sadly NREMT examiners are only meant to ask questions to clarify. We can not ask leading questions or questions not related. For example we can not actually ask what % oxygen is in air. But if you bag the patient we can ask you what tidal volume you will use, but not why. Get the idea? Why is a written test thing in there opinion. Expect to answer more questions on the verbal as their is a little more to do there, but its not horrible. When you learn to take the test anybody can pass is, which is why we always wait until the last month of classes to begin to teach test taking technique that way students learn. This is the reason that FTO's and company entrance exams can be very tough. The reason we teach the test at all is time constraints, stupid things like HAVING to put high flow O2, and HAVING to say BSI fail to many people. Personally I feel to forget BSI is important but why not fail for forgetting to check scene safety? I digress. Feel free to call me, or e-mail me. The company line will get me most the time, as I prefer to keep track of business. Oz, I hate to say it, the NREMT practical offers very little in the way of EMS screening. Especially at an EMT basic level, which has been made even easier. Most skills can be passed in less than five minutes if you know the checkoff and critical criteria. I could say I could teach someone with NO EMS knowledge to pass them in a week :-( Because we know what questions will be asked. (Excluding paramedic only skills) But this is a topic for another post. Skills teaching, and skills training are sadly two very different things.

I was replying to the main topic of the thread, not just to you O2 curiosity. As far O2 for the NREMT tests just about every patient is in "shock" of one kind or another so get high flow O2, cover to retain heat and position of comfort (or whatever depending) So yes for test purposes you have to say hi flow O2 which is clearer to the instructor if you say 15lpm by NRB, other wise we have to ask you to make sure you don't think Hi-flow is a NC at 20lpm or something like that LOL. In general 12LPM is acceptable but 15LPM is the best answer. Any less than 12 on a a NRB is dangerously low, so we wont take that. If you want you can pump up higher then 15, but no reason. I'm sure all that is pretty obvious. And of course NC is not hi-flow for us. Hope that answers your questions direct about Oxygen and the National Registry Practicals. :-)

If you don't put O's on the patient you fail NREMT practical. Get your skills sheets off the NREMT web page, while it is a skills test, it is still a test. It can be passed hitting every point in only about 4 minutes (sadly). I recommend you learn the failing criteria on every skill so you don't pass and make some little mistake and fail (Like oxygen) Treating things like difficulty breathing in trauma is normally simple, like suction. Don't go for the needle decompression, you may forget to suction and fail. I cant give way scenarios but I've performed many NREMT practical tests as an instructor and can tell you they are not all inclusive. There are key points, that are fairly simple, just make sure you learn the skills seat. Don't waist time, get your skill done hit all the key points. All the advice is good above, remember you have time, a lot of people write out their list of what they are going to do to begin with. Just be thorough a lot of people miss points in things like genitalia or abdomen vs. pelvis. Also remember medical is medical and trauma is trauma. Your trauma patient will not have a heart attack (if he does your examiner needs to have a talking to) Also remember that vital signs will either get better or worse depending on how your doing. But don't expect them to change too much, or necessarily more then once from the patients baseline. Lets see other things the National Registry doesn't require are things like a verbal report. I've seen many fail by going over their amount of time just to try to do a run report which gains and looses NO points. If you need more advice just e-mail me through www.medicaltrainingspecialists.com , we teach skills training but I also do alot for free. --Brian

Texas is always a great bet and for paramedics work here is easy to find, and supposedly pay is good ($15 an hour or so average in my experience, up to 25 if your teaching). Our state web-page is http://www.tdh.state.tx.us/hcqs/ems/default.htm The page about reciprocity is http://www.tdh.state.tx.us/hcqs/ems/stdrecip.htm mostly for out of state, but give you some idea. USUALLY this will gain you a year of Texas cert. Within that year you must sit for the NREMT exam, [s:21373d536f]if[/s:21373d536f] when you pass the test you will gain ONLY Texas certification. If you talk with the NREMT they may let you gain their cert, but that is not guaranteed by any means. Hope this helps you. As a note TDSHS looses 15% of there paper work, so call a lot and used registered mail when dealing with them.

justify my never vote. I have gone hardcore, I'm getting my MD so that I can make a careerer out of bettering EMS

Hmm we always call the patient near drowning until they are pronounced. (Probably just positive thinking lol) not a rescue diver instructor Just EMS and all related there lol Lifeguarding like CPR has changed a lot in the pas 4 years. It is indeed true that the abdominal thrusts were recommended to expel water a few years back, but that has gone the way of the pre-cardial thump. When in doubt follow your AHA guidelines water is a foreign body. They are unconscious therefor CPR. Its hard but we have to keep up to date in this job. On that note, lifeguards are still covered by good samaratian laws and anything is always better then nothing. Just remember that if you just left the person they would die, any half logical attempt improves there chances.

Ok just a little confused about the question but Ill give it a shot here: Scenario one: Our patient is near drowning but conscious (remember near drowning, to drown means that death occurred.) No abdominal thrusts are needed because he/she will cough up any water swallowed. Just watch out for the throw-up. Scenario two: Bob passed out while drowning. Unconscious patients get CPR thats what AHA says. Obstructed Unconscious is CPR so does it matter? Remember we now use chest thrust (compressions) to expel foreign objects in unconscious patients while performing just as we would doing CPR. While as a rescue diver (misnomer for my area) we don't see many living drowns we do teach CPR/obstructed by the AHA guidelines and Red Cross Life Saver and from my knowledge of those I hope this answers your question.

Sweet, I'm an idiot... Yep now I can't even get what I mean right lol. Oh well. Moving on the the other part, that previous statement was awesome, both polite and informative. I've learned a lot here which will help greatly in my classes, as at times perhaps the NREMT's definition, the practical definition and the legal definition are different. While even on the paramedic exam (and lets be careful here, the NREMT is not kind on test discussion) ethical/legal is barely touched because it varies greatly, their definition is perhaps made so that a paramedic could understand it. (While I in no way advocate "dumbing down" things, it is common amongst many schools here, mainly because a majority of our paramedics care nothing about it and just want to fight fire.) If faced with a question involving assault vs. Battery in EMS on a test the answer is A=verbal B=physical. I would prefer to think think that the test reflected the correct answer, but this is apparently a misconception common in EMS. Perhaps another thread should be created with your very clear and precise (got it in the first post you did) definition of it, maybe we can fix this misunderstanding as I have heard it from many lectures and conferences.

I agree with Dustdevil, we have a lot of unnecessary activity by EMS in the ways of extrication. While it is obvious that if the patient is in immediate danger they should be extricated, a glass punch is the safe option. Regular trauma sheers in my knee pocket is fine with me. Personally never had to cut through anything harder then a Penny and a 50cent replacement cost cant be beat. Un-needed broken glass creates more hazard. I find with a little muscle most doors will open, if locked pop the glass on the door away from the patient and unlock there door for a safe extrication route (after checking all the handles of course.) I'm not saying it needs to be done, but FD once cut the wall out of a mobile home to get in, when the back door was open... so yes people do things because they can. (Its a mobile home for god sakes, why not just push?? not like it was Palm Harbor) If you want a window punch, buy a spring loaded pen punch, safest way for us amateur window breakers to do it. As far as big shear, I'll chuckle when I see you with them, along with everything else on your belt. (My window punch stays in the unit, don't need it much no need to carry it.)

Hey Jen, Sorry this head down a argument tangent, think a lot of advice came out of it thought. Glad to help what we could.

NREMT-BASIC has some issues with personal attacks. And to be clear my statement about legalese was to recognize an area of special knowledge you have. It was respectful, not to say I dislike it in any manner. You need to respect the knowledge of those who post in this forum. Me and Rid may argue on this one threat, for example, but there is no doubt in my mind that he has provided more then a useful amount of information numerous times. To maintain a level or professionalism we do not need to be attacking the level of others knowledge. On that note I would like to sum up the one and only accepted infos applicable to this in EMS: (Legal or not THIS is what is taught and accepted on the NREMT test) Assault- Physical Battery- Verbal (although legally apparent to have a physical action involved, but in no way taught or required as evident to MY PERSON <may not be true in all cases> experience) Self defense- The use of minimal force to escape a situation in which emanate harm is or may befall a person Minimal reasonable force- that which is required to remove yourself from the situation As far as legal definition that should perhaps be the actual use of the law: -Please refer to first NREMT basic post (ignore the "actually Brian" part though)

Darnit again with an actually, how rude Texas penal code 22.01(2) A person commits assault if they: -intentionally or knowingly threatens another with imminent bodily injury, including the person's spouse; Why my god, that appears to be solely a verbal act... and yes yes thats right in Texas assault can be solely verbal that the statement made indicates that bodily harm will be done to one or ones wife (my god Texas is great, love the fact I can shoot trespassers at nite) I really don't wanna get into a fight here guys, I love the fact that you cleared up a LOT of the legalese but actually's are to be little people, and I worked my ass off to get where I am in life. I am a respected individual and I have to fight for it sometimes so if you wanna do stuff like that, be ready to be sure.

To start with to say I am not aware that the ED and EMS is dangerous would be a joke. Belittling my experience and knowledge is not appreciated and I will not tolerate comments such as that. I feel you are a reasonable and intelligent person, with a vast base of useful knowledge, but in this case I feel your advice is dangerous to impressionable and new medics in our field. If you read my post you will find that I distinguish between those who are altered and those who are not. I fear for those who take solely your advice from this thread. Either you want to make a strong point or your callase. I'm not sure. While I'm in no way advocating letting them off for something, yes it is our job to take drunken rants, sure it is. We do no choose who we care for, they choose to be cared for. Never do we have any right to judge those who come to us. ED's over flow with idiot and pointless cases, while those who are scared stay at home. Where was security when this nurse was beaten, perhaps problems lie else where. Policies are needed to protect us. The average drunk will not consider the consequences of his actions even if "you have a reputation." I would beg the lawyers to tell me how in the world you could legally throw a combative drunk out. As far as I can tell you are not counting them as AMS. Now if an assault does happen sure file charges, but both hospital security and medics around here all expect to take a punch from an idiot now and then. Should I sue the driver of the car that hit me when I was working a wreck? No, there was no intention in their action, as there is none in a drunks. As to a Alert person choosing to be violent, what provoked them. You have no right to keep them in the hospital so let them go and likely no violence will befall any employee. As far as pressing charges, in no event would I recommend if you feel the need not to. If you feel significantly violated as to press charges, please do. But be judicious in your decisions as the job you choose does indeed require you to face violence and drunks and other altered mental patients, and if this is the root of your patients problems then why are you keeping them? If they are in police custody then the police should be with you, it is your right to have them with the patient at all times. Do not think a "reputation" or retribution for action will prevent someone who has little or no thoughts in there head to begin with (altered or not) from taking the action which you fear. To say we do not have to take is both true and false. If you feel that your management is attempting to keep you from damaging their image when you talk to them about the incident, contact your insurance advocate, they will lead you down a safe path.

As far as assault and battery charged, definitions change state to state, but in Texas assault is verbal and battery is physical. Either way unless some serious damage was done to you it is extreme to file charges. We are as a matter of our job, placed in a number of dangerous situations. Physical harm comes from people and situations if EMS is sueing and having patients charged they will be scared off and not use the system. It is not the reputation of the service I fear as Rid said, except that the one he earned his ED may have been a negative one. The ol' you catch more flies with honey applies. Most patients respond to a "I'm here to help you" attitude over "fear me." Which is not to say I have never been stern to the point of truly ordering patients when needed. On that note your service should help you out with the decision to press charges if need be. And any expenses should be covered by your insurance (you do have some right????????????????) So why Rid is a wise man, I fear his advice is brash in this case.

This is a real touchy issue. Legally you have as much right to protect yourself as a civilian. In any case if there is any worry about bodily harm to you or a partner the PD should be with you. How likely this is I don't know. What I do know is that calling for ALS or a supervisor because of this worry should be ok in your service. I have responded many times just as a worry with manpower when dealing with a patient. Now on the note of the problems: You know more then a civilian and are more accountable then a civilian. What ever you hear, "oxygen" or "clipboard" therapy is not an option (hitting them with either the clipboard or o's bottle.) Remember safety is NUMBER ONE to us, we can't help people if were dead (on that note, I once hung over the edge of a balcony with a rope tied to my belt, is that bad?) Normally your service should have pretty clear chemical or physical restraint protocols. If they don't you need to tell them that they should develop some. Even if there is not a need for spinal precaution backboards make a good restraint, but remember this is just for dangerous patients. As a rule we always restrained one arm above the patients head and one arm down, makes it harder for them to struggle, but go by your protocol. I personally have never had to use chemical restraints, as they are contraindicated by trauma, which almost all my combative s were likely head injuries, ETOH, or drugs. (a very very few psych) Yes I know none of these answer your questions directly but I hope the advice helps. If you are assaulted by a patient DO NOT beat the crap out of him, no matter how tempting (I'm a huge guy, it would be easy for me.) Let them out of the ambulance, once they assault you don't take the physical aspect into your own hands. If they want out let them out, call for backup to get them restrained. Remember unless PD takes them into custody you can't transport against there will if they are alert, that would be adult-napping. (Altered circumstances withheld from previous sentence) Just remember anything you should do should not be drastic, it should be in self defense in an attempt to escape the situation. Also remember to tell the police that you either received bodily harm, or feared bodily harm, and to document this well in both the run report (and incident report if harmed.) What you say is very important to what happens in court if it goes there. On that note, as long as you are justified in self defense use of a weapon is not good, but mace (pepper spray) is fine. But I would not use it in the truck, as everybody will end up suffering, including you. We always were happy to help worried medics, so don't be scared to call for backup, although not for every call. Don't let anyone tell you its the wimpy thing to do. There is a lot of old boys club in this game, and we don't need to loose anyone because she/he was scared to be made fun of. I have not had many bad experiences with patients, two of my worst were one who was restrained backboarded and got out. (velcro restraints were protocol, we had to upgrade) He hit me in the face with his fist, I layed an elbow to his chest and restrained his arms while sitting on his chest until my partner pulled over to restrain him again. The other I was driving my (small female) partner pushed narcan and the patient reacted well (if you call it that) to it. She yelled I pulled over and ran around back to see a half naked druggie running down the interstate. Both of which we filed incident reports on. The first told the doctor I sat on him, which went around to the police which came back to my report which justified it. (No problems at all). The second the police were called to get the idiot back so no problem there. So SUMMED UP: -SAVE YOUR SELF AT ALL REASONABLE COSTS -AS long as your trying to escape the dangerous situation and document the shit out of it your safe.

We have been using combivent or self mixing for years, it works well. We follow the same thing as above, start with a combo, the just albuterol. This is pretty much standard around here, some still just run with Albuterol, bust only for cost reasons, most of those are just transfer services.

Well since I voted ill throw in my 2 cents... The only time we put a johnny on them (gowns in these here parts) is if we have to disrobe for trauma assessment or 12-lead. I don't know about your parts, but if we had a forearm laceration, brought the woman in and had changed her to a gown the hospital would call our service. Even in the ER they wouldn't change someone for a forearm suture if they had it exposed fine, so why change them in the box? On that note most traumas where we need full exposure to treat(cant see it cant treat it-- give credit above to the first guy who quoted this old one) get a blanket not a gown, because the first thing they get in the hospital is necked, they have do there assessment, and if we have them in a gown they would have to remove it. Right thats about 3 cents so I'm out.

On that note, the place I was going to volunteer dropped me from the list (they dropped everyone, apearently they shut there training program down and no longer needed volunteer instructors) And now that you mention it, any idea if anywhere in Germany would like a medic for a few weeks over the summer? Can't waste much of my own money but I would love to get out around the world again and have some fun. Why bring the schnaps to you when you can go to it?