Imagine89

I keep a jump kit and a stethescope in my car, but as a volunteer, I suppose I'm always "on duty", at least in the way our system works. To the first poster: wow I woudl never want to work in that environment!!

Never even heard of them.

Just for the record, in case you were talking to me, I did not, have not, and will not get into that debate. I don't have a problem with young partners. I do, however, have a problem with undereducated partners, regardless of age.

Okay that was a misinterpretation on my part. Apologies.

I would, however say that you were wrong to have spent that much time evaluating for something that you could do nothing about. Unless, of course, all of this pointless evaluating went on in the ambulance while enroute to the hospital.

And yes, your system was wrong for sending an EMT staffed unit to an emergency run.

Thanks for the responses.

Do you not have a directive in place for who goes to a stroke centre that maybe you could show this other EMT? If it's anything like ours then the other EMT should take a read of it before giving you a talking to.

The provincial directive in Ontario requires that to go to the stroke centre the pt have new onset of (at least one of) unilateral arm or leg weakness or drift, slurred or inappropriate words or mute, or facial droop AND can be transported to the stroke centre within two hours of "a clearly determined time of symptom onset or the time the pt was 'last seen in a usual state of health.'"

Based on our directive, even if the person was having a stroke (which it doesn't look like they were, but let's humour the other EMT) they would not be transported to the stroke centre since the onset may have been too long ago.

We can not determine whether or not the onset was too long ago in this situation, adn if he was presenting with stroke symptoms it would be negligent according to our protocols to transport to a facility without CT scans and other stroke equipment. I did explain myself to him, but hes very stubborn. WE'll see. Monthly meeting tomorrow night.

If all your assessments were done correctly I don't see the need for a stroke centre. What signs and symptoms of stroke did the senoir EMT think warranted a stroke centre? Also if the pt was last seen normal the previous night is there even any potential for thrombolytics to be used?

He was saying that since we can't diagnose, that confusion was reason enough...

He was last seen at baseline the previous night due to the fact that they were both asleep until the time of call. THe stroke could have had an onset (if it was a stroke) while he was asleep, which would indicate use of thrombolytics.

FYI, i completely disagreed with the EMT in question, I was just making sure.

We asked the patient if he'd ever had a stroke, and after a few minutes he said yes 5 years ago, however we asked the wife and she said no.

I think I would have to disagree with the " Senior EMT ". From the excellent information you provided, the pt. doesn't seem to be in any life threatening distress. In fact, other than being a little disoriented, he doesn't sound to bad at all. I don't think I would have called for ALS intercept either. IMHO, you made the right decision.

I can't really blame the Gentleman for forgetting who the president is. :wink:

Yeah I've not gotten a straight response on the president question yet.

I think as BLS we overuse ALS, and I dont think that theres any reason pts like this should take an ALS unit out of service...as emts we have the skills to continually assess and monitor patients, and if this guy went south, the resources are still there.

We are dispatched to a residence for an 80 year old male presenting with AMS. Arrive to find pt seated on bed, slightly disoriented. We get a brief history from his wife, stating that he had failed to turn off his alarm clock at the proper time, and he awoke in an awkward position, seeming confused. Last seen at baseline last night...seemed to sleep normally. History of CVD, nothing else, according to wife. We consider stroke, so we do some stroke tests, which find strong and equal hand grasp, equal smile, negative facial droop, negative slurred speech, and negative arm drift. Assessment of vitals finds bp of 130/84...pulse 68, skin warm dry and unremarkable, 12 resp/min, rales in lower left lung, SP02 93 on RA...NC on 4LPM based on o2 sats. Pupils PERL. These s/s were constant throughout transport. We didn't call ALS or transport to a stroke center due to the fact that he was requesting transport to his PCP's hospital., as he just seemed confused. He was unable to remember the year or who the president was, hwoever did answer personal questions well. Negative headache, neg chest pain, no SOB no discomfort/pain.

Would you have called ALS? Would you have transported to a stroke center?

I ask because I was told after the call by a senior EMT (i'm 17) that we made the wrong call, and I was wondering what you all thought?

We are dispatched to a residence for an 80 year old male presenting with AMS. Arrive to find pt seated on bed, slightly disoriented. We get a brief history from his wife, stating that he had failed to turn off his alarm clock at the proper time, and he awoke in an awkward position, seeming confused. Last seen at baseline the previous night, seemed to sleep normally. History of CVD, nothing else, according to wife. We consider stroke, so we do some stroke tests, which find strong and equal hand grasp, equal smile, negative facial droop, negative slurred speech, and negative arm drift. Assessment of vitals finds bp of 130/84...pulse 68, skin warm dry and unremarkable, 12 resp/min, rales in lower left lung, SP02 93 on RA...NC on 4LPM based on o2 sats. Pupils PERL. These s/s were constant throughout transport. We didn't call ALS or transport to a stroke center due to the fact that he was requesting transport to his PCP's hospital., as he just seemed confused. He was unable to remember the year or who the president was, hwoever did answer personal questions well. Negative headache, neg chest pain, no SOB no discomfort/pain.

Would you have called ALS? Would you have transported to a stroke center?

I ask because I was told after the call by a senior EMT (i'm 17) that we made the wrong call, and I was wondering what you all thought?

Well, personally, if I am in an mva/ medical emergency I want anyone that understands how to use the equipment to respond. I won't be asking if he knows how to type well. I will be glad that he understands the concept of 'logroll' and how to use a spine board. And kudos to you, too, for being involved in ems at such a young age.

Oh yeah me too, I'm just saying that there is usually at least some sort of correllation to the way someone types/speaks and the way they conduct themselves. Perhaps that's not the case with Timmy. Either way, I didnt' mean to be so harsh.

Timmy, don't worry about your grammar and spelling. Anyone that takes the time to try to understand it can. I am proud of you for being involved in something worthwhile at your young age. And the lol's are ok, too! Some peple just feel the need to criticize anyone they can when they know they are imperfect themselves. And it was a funny story, pig Ca Ca does stink! Glad I wasn't there on that call with you!

I dont know about you, but I wouldn't want someone unable to type so that I can understand it, to respond to an MVA/medical emergency that I was involved in.

You shouldn't have to take time to re read something just to be able to comprehend what it is saying, unless the vocabulary is dense.

This, by the way, is coming from a 17 year old, so it's not like I'm some bitter old man sitting at home. I couldn't understand his post either.

cart

I'm not going to answer your questions since a quick search of your local protocols should clarify all the differences in certifications for you and you'll remember more if you look it up yourself. But I am going to make a suggestion. Use spell check and work on your sentance grammer. Your posts are rather difficult to understand. When it comes to forums on the internet, your typed word is as good as your spoken word and right now I think people might have a hard time taking you as being intelligent since your posts don't come across as such.

Shane

NREMT-P

And as he criticizes someone else's spelling/grammar, he misspells "sentence" and "grammar" and is sure to include plenty of grammatical mistakes

I'm just kidding, I actually agree with what he said 100%.

I h8 wen ppl post things dat look lyke thay wear ritten bi a 2 yaer old.

It takes away from their credibility.

I try my best to be credible, but I haven't been on too many calls due to the fact that i'm still under 18 working as a volunteer in a low call volume area. I know for a fact that on a call i'm dependable. I know how to perform my skills, and I'm fairly competent. Right now, experience is my enemy, resulting in my "not as much as i'd like" reply.

jpinfv,

i really do think that you should go away and get some experience, by your profile you state that you are a student, study up on MIMMS, if you had any experience of terrerist incidents you may not be so cocky.

these incidents are an entirely different thing to an MCI, an MCI could be any incident with more then the number of Pts that the usual resources service, add to this unwarned use of explosives and its a nightmare for EMS, the usual scene safety goes out the window, other services come into play, EOD, specielist fire, hazchem the works are working around you......i say again working around you, its chaos and takes a while to organise but its still chaos.

picture the first triage from the first Veh on scene or the second, bringing priority Pts away form the area, you seem to think its funny to have one pic to redicule, how do you know when where that pic was taken.

unlike you i have had experience in this, and as a few ppl on this site have as well, i honestly dont think you can even see how silly your arguements and comments are, i did not want to say this as i thought you would have the maturity to leave this be, ppl read your signature and your profile and can see that you probably do not have the experience to actually comment on this, your just a bored student googling for pics...grow up this is not an arguement that i wish to have, even after i left the links you still come back like a petulent child.

I must say that as terrible as terrorist attacks are, this thread in no way disrespects the victims of such a tragedy. It is indeed a way to enhance our eye for problems, and discuss what could be done better, assuming the circumstances were normal. We're not being presumptious of the abilities of the EMS workers involved, due to the fact that we are unaware of any special circumstances. We are critiquing it for our benefit, not to piss people off. If it bothers you, dont read it.

WE HAVE PURCHASED BRAND NEW STERLING TRUCKS, AND MAY I SAY THEY ARE NICE. A FEW PROBLEMS, THE RUBBER DIAMOND PLATING IS A PAIN TO CLEAN. THE FRONT IS VERY SPARTAN, AND SO MUCH SPACE IS WASTED WHEN IT COULD BE USED AND POSITIONED MORE APPROPRIATELY. WE ALSO HAVE FREIGHT LINERS WHICH DO THE JOB. WAY BETTER THAN TINY VANS OR CADILLAC HEARSES OF THE PAST.

Give the caps lock key a rest.

"9A" or rig or ambulance.

The nursing homes I've seen are pathetic, and unclean...downright depressing many times.

A friend of mine was telling me a story where when asked why he was called she replied "he said he was having chestpain about an hour ago, but i didn't believe him. I figured you could check him out. He's in the bathroom right now." Friend enters the bathroom to find his patient unconcious on the floor in full cardiac arrest.

I'm not meaning to overgeneralize, but i don't have much nursing home experience, from what i've seen and heard, they're sad, sad places...

Everyone on our service has redlights...just because we respond to the station, and then hop in the ambulance and respond to the scene...is that legit?

You guess? Or do you know this happens?

I know that happens at at least trinity. I'm not sure about the other two, but since i have a total of 8 friends under 20 working for eascare and amr I assume that's how it's done around here.

When i dont have firsthand experience, I say "i guess" sorry for the confusion.

PS-thanks for your help guys.

So how do they deal with the insurance of under 21 year old drivers?

My experience has been the same as Rid's. If you're under the age of 21 you're typically not considered for hire due to insurance regs and the potential for needing to drive the ambulance. And this is consistent over several states in which I've worked or had dealings with EMS...not just one.

I also agree with Rid in that there's plenty of time to take an EMT class. Go to college. Get some solid educational experience behind you. That will help make this class a breeze for you. Plus, it'll give you the opportunity for some solid life experiences. Especially if you take advantage of a lot of the programs offered in a college setting (including study abroad). If you really want to do right for yourself, go to nursing school first. Then earn a paramedic certification. The education received from both will compliment each other and you'll be better off both job wise and financially in the long run.

EMS will always be here. There will always be a roll of EMS in todays society. And there is no shortage of stupid people waiting to give us something to do. Enjoy life some before getting involved in what can be an emotionally draining career.

-be safe.

I guess they pair you up with a partner that has been with the company for a while, and you run as the tech for a certain amount of time until they allow you to drive. That's probably not only for insurance reasons, but also based on the rationale that a new employee probably won't know the area well right away.

As far as the original post goes...go to college. Take an EMT class if you want, but with burnout rates as high as they are, don't cheat yourself out of a better education that may allow for a career change.

I actually have a question of my own. Is an RN higher up on the chain of the medical educationthan a PA? I feel like a PA would have to know more, as they diagnose, prescribe etc, btu I'm not sure...

Unfortunately, it is true most large private providers that use commercial EMS Insurance coverage, cannot employ ones under the age of 21- 23 (dependent on company) as a driver. As well many of these corporations require you to drive, even though you may never or not part of your job.

Cities, Municipalities, and Fire Departments are usually self insured, or have conjunction of self insured to have lower rates, etc.. they can and do sometimes employ EMT's < 21.

Good luck,

R/r 911

I dunno about that. Around here (MA) most people who go through the town class are 18, and upon completion of the course not only volly with us, but usually get part time or full time jobs with private services throughout the state. (SLEAZECare, Trinity, and AMR are the main companies that employ us). I'm not saying you're wrong, Rid, just saying that lots of people do get jobs under 21...

The question was not about putting the patient on a board. The question was about leaving the patient on a board.

Unless there is more to the patient's condition than I am aware of, no, I can't think of any good reason to leave him on it.

This same exact situation occured a few weeks ago with my service. We left him on the board because it brouyght his 8/10 lower back pain down to 4/10. Anything for patient comfort

I had 6 friends who worked for AMR. All six now work for different companies because they were treated like shit, and because AMR's policies are ridiculous.

Wow guys, I apologize, I have no idea why that happened. Last night as i tried to post, the request wouldn't go through on my browser, so I figured i'd try again thismorning.