NREMT-Basic

Having started the optional pre-course classes and seminars for paramedic school, I can now officially, after two years of basically holding the "Paramedics save lives and Basics save Paramedics" view of the world, I now stand here with my hat in my hand. I can now officially state that I am in the place of knowing what I do not know and lord oh, lord is there a lot of it and honestly it started with the extreme number of ways that a good, patent vein could be screwed up by an incompetent with a needle when time is of the essence and there is a shortage of all around skill and training in the box rolling down the road. After graduating from oranges to a number of very expensive IV access simu-aides, I have gained extraordinary new respect for those paramedics amongst us who can hit that bugger first time every time and am happy (though not yet experienced enough to be proud) that my first "live stick" (conducted on my instructor which increased my pucker factor to +100) was a success with a beautiful flash and a lovely, babbling brook-like flow. Once I remembered to take off the tourniquet. LOL. I couldnt figure out why the proctor was just staring at me. I got my flash and thought I was all good. Ooops!

So to all those medics, nurses, and ER docs out there, some of whose experienced hands may be guiding me over the next 18 months, I say "I realize that, though I was a good Basic, what I was giving was stabilizing first aide and what I am now being taught to give is life saving medical care. I now know what I dont know and have also gone to the nebulous place of I dont know what I dont know. So be gentle with me. Each new procedure or algorhythm learned is a maiden voyage, as it were" The EMS stick of awakening has come down hard upon my shoulders and I am humbled when my instructor, who just retired after 30 years it the field as a medic, both military and civilian, can look at a 12-lead and say quite confidently and correctly "Well...there's your problem."

I now also see why so many of my Basic friends (and I include myself at times in this) get excited over the lights and sirens cause a lot of us still hear William Shatner narrating even our most basic of BLS calls. I have also learned the difference between what to me used to seem an emergency an what I now know are the types of emergencies that should strike fear in the hearts of all who behold them and awe for those ALS responders who can not only bring order to that kind of chaos, but actually bring order which is compatible with life.

It used to be enough to know "the breath goes in and out and the blood goes round and round." Now I see why so many of my paramedic friends have said "Yes, but can you see why its important to know WHY the breath is not going in and out when it fails to do so and WHERE the blood has ceased to go round and round when the body decides to go FUBAR."

I will always be proud of the work that I have done and will continue to do as a Basic and will never be a Basic -basher. But after the last few weeks, I can truly say the real work has begun and I look forward to the day when I can bring order compatible with life to the chaos. After my first couple of ride alongs in medic school, I am also smart enough to know when to look to my medic proctor and say "I got nothin'" and know that I need assistance and to go home and study harder.

I hope all the ALS providers out there will be willing to answer my plethora of questions over the next year and a half.

FormerEMSLT, Iowa has the EMT-B, EMT-I, which is basically going through the EMT-B all over again, but adding IV access, and acid base balance into the cirriculum. The clinical/field hours are 120 however, well now they are contact based. The "Iowa Paramedic" is what would be considered the EMT-I99. The "new paramedics" are paramedic specialists. Oh, and don't dare forget the first responder as well.

I am currently what is considered an Iowa EMT-I. Then again the next two days hold my written final and practical final for paramedic (specialst) class. The biggest advantage I have personally seen with the Iowa EMT-I, is that after I was done with the class; I felt much better at pt assessment. Simply because I had (at that time) 120 hours of clinic/field time to do in addition to the class time. Did the acid base balance stuff seem clear as mud? Dang right it did. We also covered, very quickly, and very sparsley, the P QRS T complexes, and what each wave meant. They weren't trying to teach us EKG interpretation, just broadening our horizons a little.

Does our system "work for us"? Yeah I guess you could say it does. I have seen a few times where it was nice to be able to gain IV access to a critically injured or ill patient as we awaited arrival of ALS, or at times, assist ALS with getting a line as they worried about advanced airways, such as in a code. I know, some will say that 120 hours of class and 120 of clinics does not completely or properly introduce a person to A&P, or pathophys, but, in some truly dire situations, a line was accessed early, and it facilitated the care that the paramedic specialist provided. Of course, you first have to worry about the basic stuff.

As for being called a medic? Paramedics are medics, EMT's B's and I's particularly, are just that; EMT's. I never let someone call me a medic, because I wasn't. I still am not a medic, just a tired student praying to get through the next 48 hours in one piece. Personally, I think that when you say medic, people think of you as a person who is trained to give meds and hook up the monitor. They may not know what all the stuff is, but they see it and hear about it, so they expect it. What is a name but a name? Nothing really, but what is important is how others, the public in this case, percieve what is in that name.

Just my few cents worth.

But...to add yet another wrench to the works, the National Standard curriculum of the DOT/NHTSA still uses EMT-Basic, EMT-Intermediate and EMT-Paramedic and EMT-Paramedic is what we use hear in IL an according to my friends and the IDPH, a lot of agencies are soon going to have to change their patches and emblems to reflect that they are all EMTs and then also reflect what "level" of EMT the responder is. Except of course for the MFR, who is, of course, at least in IL, not an EMT at all according to the law.

Actually, I'm solidly on board with the OP.

Don't want to pay for medics? Simply pay for Intermediates and call them medics, bullshitting the public of course. Not to mention you'll have a waiting list of Intermediates that are willing to work for peanuts so that they can be called medics without having to bother with all that additional schoolin'.

It's ridiculous, dishonest, dangerous, and another thing that's holding EMS back.

Great post.

Dwayne

Not to mention that I know a certain EMT from the Pacific Northwest who used to frequent this forum and perhaps still does under yet another alias, that never got past Basic and even that licensure was dubious at best who always called himself a "medic" and when he got called on it said "the public doesnt know the difference anyway and thats what they call us all."

This dry-drowning business is something that I had not heard of until recently. In EMT school, I was taught about drowning and near drowning...that is to say death from drowning and death from near drowning with death from drowning being immediate and death from near drowning being a death from complications secondary to the inhalation of water and occurring 24 to 48 hours after the actual event. When I spoke about this with a medical examiner friend, she stated that they will list manner and cause of death variously for water related deaths. It can be listed as "Manner: Accidental---Cause:Drowning" or "Manner: Accidental---Cause: Injuries or Illness Secondary to Near Drowning Incident" or as specific as "Manner: Accidental---Cause:Complications Secondary to Aspiration Pneumonia."

Oddly for some reason, my medic school syllabus has us studying environmental MOIs early on in the course so I will be interested to hear what the lifeguards from the Chicago area beaches that will be teaching us about drowning and water related MOIs will have to say in terms of how these are defined and differentiated.

I had also heard that aspiration of "clear" water and aspiration of salt water caused different MOIs if anyone can speak to this. What I have been told is that the clear water fills up the lungs, broncioles, etc and air simply cannot enter the lungs and salt water essentially corodes these structures causing them to fail and is generally the cause of what was defined above (read as I was taught....) as near drowning. As I live in IL, I'm not likely to deal with salt water aspiration any time soon, but I wonder if chlorine in pool water can have similar reactions with the structures of the lungs causing similar complications.

I also see that there has been some discussion in this thread about "swallowing" water and "inhaling" it. While I have heard the terms used interchangeabley ( as in when we used to vacation in the Land of 10,000 Lakes, we would hear that someone had "swallowed a lung-full of water). But to me the term "swallowing" anatomically speaking has to do with the act of taking something into the stomach and inhaling is taking something into the lungs. Obviously, if there is an epiglottal "malfunction" something can go where it isnt supposed to go. I also learned during a recent AHA CPR refresher that there seems to be a lot of confusion surrounding the term "choking" not in terms of how the AHA or other medical bodies define it (gonna run and look it up in Taber's) but in terms of people's (both lay and emergency responder) understanding of the exact mechanics of choking. Personally I was surprised at how many folks looked surprised in that recent class when the instructor said "if your patient is coughing or gasping, they are NOT choking." Everyone sort of looked like stunned dear on that one but it made perfect sense to me. I guess the best way to determine if it is actually happening is still to ask your patient "are you choking" cause Im thinking that pretty universally, if youre choking, you know it.

I look forward to the emergency docs among us pontificating on this since, as a new medic student, I have had to become much more involved with all matters cardio-pulmonary than I ever did as a Basic.

Generally, yes.

'zilla

Almost impossible since they generally want you to be a SWAT member first, which involves becoming a LEO on a department with a team. For most of us, tac-med courses are an expensive waste of time and there are lots of better ways to spend your EMS educations dollars, though few are as fun. I took a tac-med course knowing I would probably NEVEr use it in the field, but I learned stuff I can use and it was a good time. Plus now I am also proficient with a Mossberg 870, MP-5, MP-4, and Beretta 9mm as well as various chemical, contact and "distraction" less lethals.

Well not only are you a well educated armed Private Detective Agency employee, but obviously an English teacher as well. I will concede that reading what I did today does not make me an expert, but since your so intent on NOT taking the time to educate me a little, how about something more constructive like addressing the OP. How should we as EMS providers respond to your presence on A scene after you have re-arrested a bail skip?

When I did find the information, that you so graciously accused me of paraphrasing, and post it, I highlighted the area speaking about "some states". If you continue to read through the post you will find that IL is not listed as having any requirements at all, unlike the 3 (CA, LA, and TX) that are listed and KY that has no "bounty hunting". From this my question to you is: What formal training did you undergo or is required by the great state of IL? Can you explain to ME (a lessor of you) what a "Tan Card" is? I am curious, but only due to the fact that you have no time to educate ME, although you obviously have time in your busy day to take cheap shots at my spelling, and explain to me how to use the spell check. It would be nice to have a conversation with you a little about this issue, but of corse when you have the time.

As far as the racial comment is concerned, I have no idea where you think that you know me, or what I'm about, so I will ask of you, not to let that crap get started!

That's because if you actually did research other than a 3 minute wiki quote, you would know that the bail bond system as well as bail enforcement agents have long been stricken from the books in IL. We dont use them here which is why there are no requirements since neither can operate within the state. A bail agent, while he may cross state lines to apprehend a skip, may not enter a state for the purposes of a fugitive recovery which does not have an operating bail bond system or allow the use of bail recovery agents or "bounty hunters" to recover those who skip bail.

While I agree that if there are problems; then by all means, bring law enforcement into play. Having a shouting match with anyone over who is the actual boss is counterproductive at best.

The 'problem' I'm having with this post is the section hilighted in red....how can the bondsman even BEGIN to decide whats best for the patient, or even refuse medical treatment on the patients behalf? If theres ANY signature on a refusal to treat form, it had BETTER be that of the patient!

To allow the bondsman (or law enforcement officer) to speak for, and ultimately refuse medical treatment for the prisoner would constitute abandonment.

Even in the event that the patient is a minor, the ONLY people that can sign a refusal would be the minors LEGAL GUARDIANS, appointed by the family court. Last time I checked, not even law enforcement has that power; even with 'one in custody'!

Here in IL, if a person is refusing care but will not sign the refusal, the signatures of the medical responder and a LEO are considered sufficient along with an explanation of same in the run report.

No offense taken here, but in all reality they have the same arrest powers that you and I do. Last time I checked the citizen has the right to arrest, and thats what these men and women really are as stated by Asysin2leads above. When it comes to keeping everyone safe on our scene we use the PD not a bounty hunter, so in this situation the PD will be dispatched to protect us from the "skip" as well as the bondsman. It is a territorial issue at this point. It's my responsiblity to run that ambulance, and maintain order in that ambulance while I am on duty. Thats what the taxpayers pay ME for, and if I allow somebody (PD included) to take control of my truck, then I haven't done my job. Trailrunner, your right, we are responsible for the medical "stuff", and that includes the safety of the "skip" if they are requesting medical assistance. If the bondsmen don't want to follow the "rule of the truck", then sign here and take the "skip" to the ED yourself, or talk to MY officer about it.

Except for the fact that bail agents have (in most states where they are legally allowed to operate)the right to "break and enter" a residence in which they have a reasonable belief that their skip is residing. In laymen's terms, they can kick down a door and turn the place upside down to find their skip. You or I do that and we will find ourselves on the receiving end of multiple felony counts including home invasion. Also, bail agents are not bound by the same laws as law enforcement officers so comparing the two is apples and oranges. In many states, LEOs must take a defendant to ED if they have been sprayed with a chemical agent or tazed. Most bail agents are not required to do this.

So I was wondering, as I continue to see more and more bail enforcement companies and agents in my area. Just how does HIPAA apply with them?

If I get called by PD for a combative suspect I can choose to have them come on board the ambulance or follow me in their vehicle. But Bail Enforcement Agents are not sworn officers of the law and do not "arrest" a suspect, therfore if I am ever called to treat a suspect they are taking into custody... do I contact PD if needed or can they legally be in the ambulance?

Actually, they do affect a lawful arrest (assuming they follow the rules) since they are apprehending people on surety warrants which either automatically issue when the person fails to appear in court or are issued by a judge in the form of a bail revocation/bench warrant. And no. They are not bound by HIPAA since they are not health care professionals.

I am a huge Bates fan. I wear them all the time even when not working. I wear their 6", side zip with velcro to cover the zipper so it doesnt wear out the legs of my pants or get caught up on stuff. I've had the pair that I am wearing now for two years, they are amazingly water proof (working in the recently Mississippi flooding proved that) and have good BBP protection. Also, in two years of wearing them on almost every surface imaginable, the sole is just starting to show wear.

Congrats. I also start back in my 18 month L O N G medic program this fall. I took two classes last fall and quit b/c I started a new job. Now I have to pick up where I left off. I think the long programs are good. You should feel confident when you graduate!

Best wishes.

Peg

Peg-

thanks for the kind words and best wishes right back at ya. We will have to stay in touch for periodic sanity checks. Like you, I also like the long programs. I think the boot camp styles should not be accredited in anyway as I have worked with some of the medics they produce and most of them can barely start a hydration line. Unlike some other aspects of life, faster does not mean better.

IMHO initial BP should ALWAYS be manual while the NIBP is checking on the other arm. This establishes two things: Gets your bilateral BP which is always a handy assessment and if the numbers are consistent with both readings you have confirmed that the NIBP is accurate.

I was interested in this method of taking pressures and checked it with my ER doc friend. He is of the opinion that taking pressures on both arms simultaneously will throw off your readings and make them inaccurate. He also states that in his experience and due to anatomical variations (IE location of heart, etc) that left and right side BP readings will generally differ by about 10 points in the systolic.

Also, in school, I have taken BPs over shirts, on bare arms and on the wrist and gotten the same readings and if there is one thing that I absolutely know that I took away from EMT school its how to get accurate BP's.

One of our local private agencies actually carries one of those things that usually say "CAUTION WET FLOOR" on them except it has the SOL on it and says "EMS CREW INSIDE---DO NOT MOVE" and its weighted heavily enough to hold open most doors. I also know of a particular crew that experienced exactly the scenario you are describing (minus the EDP) and they ended up having a state trooper force entry back into the building by breaking out the windows next to the door with his baton. One of the many reasons I prefer external walkway to internal egress hallway buildings.

Well...now I've gone and done it! I have finally taken COMPLETE leave of my senses and will start the 18 month paramedic school process the 2nd week of September. No... I don't know what moved me to such insanity either. Maybe I just decided that since I like to make snarky comments anyway, I may as well go ahead and become a paragod so that occassionally someone will agree with me.

Wish me luck, send me your crib sheets and light a candle for my soul, if thats the way you roll.

PS-

I haven't been around for a very long time because my quality made Dell Inspiron 1100 overheated to the point where the hard drive/case actually split open and died and I have to go to the public library and wait in line for my two hours a day of computer time. It's now being used as a bookend.

Nice, comprehensive list. I'd read some things about Illinois also having the EMT-Coal Mine certification and even seen some sources that say we do have it, but the Illinois Dept of Public Health seems not to have heard of it. Of course, no matter what one asks the IDPH EMS Division, they refer you to the EMS Region you live in and here in IL my Region is run by one person whose qualification for the job of Regional EMS co-ordinator seems to be the ability to kiss the right butt. And we all know that state jobs are virtually impossible to lose...as an example, visit your local DMV

Cliff notes:

6 ambulances, 2 ALS, 4 BLS. Units are dedicated to 911 work only.

Ambulance company takes care of and gets to keep all patient billing.

Fire department maintains scene/patient control at all times.

BLS ambulances=2 EMT-Bs supplied by the ambulance company stationed where ever the company wants to station them at.

The fun starts with the ALS units.

• Company supplies an EMT-B to drive the unit

[*]Fire department supplies either a civilian EMT-P or a fire fighter EMT-P

[*]Regardless of utilization, the ambulance company will reimburse the fire department for $84k/yr per civilian medic and $94k/yr per fire medic used. This includes pay, overtime, and benifits.

[*]Ambulance company will pay the fire department $400/month for room and board at the fire station for the ambulance and the EMT-B (I'd hate to be the EMT-.

Personally, I don't see why any fire department that wants to run EMS doesn't take it all the way. If you want to supply the medics, then supply your own damn transportation too. If they can find a company that is willing to take that contract, then so be it. It's a "free" market anyways.

Some of us dont have any choice. Our Fire based EMS was taken away from the department several years ago. Whereas we used to have ALS and BLS in each of the four stations, now we have one ALS rig split among the four stations. It was a decision of the fire protection district board, and not even put in front of the responders. One day we had ambulances, the next day they were being sold off. No we run non-transport BLS/BTLS trucks. Most municipal departments dont have a say in how they are run. They do what their board tells them to do.

They way I look at it is that EMS is a continuing spectrum from field to hospital. If we get things done in the field, great. If we get the patient to the hospital really quickly and provide necessary care enroute, that's good too. I mean, if you are 3-5 minutes away from the hospital, and you have a critical asthma patient who needs intubation, and well, you just can't get the tube, I think it is the more responsible thing to control the airway using BLS techniques and get to the hospital where a respiratory therapist can give it a shot in a controlled, well lit environment. EMS works on a time/procedure factor. If it will be quicker to start a life saving procedure in the field, do it. If it will be quicker to get the patient to a hospital to have them do it there, it is in the patient's best interest to do that. This attitude of "if you didn't do the skill in the field, you are just lazy/incompetent/etc. etc." needs to stop. Too many providers are putting their egos above patient well being.

Very well said Asys. I know medics who are gonna that line started, it doesnt matter if we are two minutes out. I also know medics who "extend" their time with their patients by sitting curbside at the scene starting a line, taking two sets of vitals, filling out parts of their PCR, making a nice long report to the ER. We are pre-hospital emergent care. Not diddle around so you can do as many of the things you ever learned as possible---care.

Of course there is the reverse side of the coin. I also know medics who insist on getting that line started because they know if their patient doesnt have a line, they are coming in the ambulance entrance and going through the ER and right into the waiting room where they will get a wristband and sit for 9 hours. So in some cases the medics are doing it out of a belief that the things they do will get the patient in a room and perhaps actually seen by an MD sometime this millennium.

For the most part I agree with what you are saying. I asked for a reasoned and reasonable response and got one. Your absolutely right that one of the main reasons that we may get sub standard EMS responders when FFs are forced to become EMTs or Medics is because they dont want to do it and are forced to in order to keep/get a job. However, there are those of us who are committed to quality patient care and the fire service (like me) and who are trying to improve the level of first response care offered by their departments. If I am the first medical responder on scene and I happen to be getting of an engine, I really want more available to me than an oxygen bottle. I think an AED, bleeding control, airway, etc would be a very good idea and once I see exactly everything that my department carries in its jump kits, I hope to be able to make some helpful suggestions. Thanks for your thoughtful comments.

/ That's funny right there, I don't care who you are. Its not often that someone slaps me around and I enjoy it (without paying for it that is). Maybe its the cold medicine. So with this memo that now allows cursing, is there a list of the 7 words we cant use?

Here's the way I see it: Somebody or a group of somebodies smarter than most of the people on this site put together says that in Illinois, EMTs give glucose, glucagon, O2, nitro, ASA (assisted admin) and epi. I also think we should have a national standard for EMS protocol and use the NHTSA model and bring the education of EMTs and Medics up to meet it. I know its naughty to say that medics are also undereducated, but anybody thats gonna be sticking needles in necks should go to school for more than 18 months. Then of course there was the medic that tried to start an IV in the back of my mothers hand and stuck it in a tendon, but you know, really, the problem is only with Basics.

By the way Scara, how much did you have to pay for your mod status?

And, knowing you as I do, I don't doubt that for a minute. It's usually not that hard to size up a provider's competence and potential. And -- although there are exceptions and misjudgements -- you're generally going to be treated according to that size-up. Now, just think of your initial impression of others at this forum, and think of how comfortable you might or might not be with them on a scene.

There are basic providers out there who I look forward to seeing on my scenes, and give them all the respect and appreciation they deserve. But there are others out there who are not only worthless, but they carry a chip on their shoulder about it, making even their personality unbearable. They reap what they sow, but they'll whine like victims for their entire career.

It's pretty easy to tell who is who in this discussion.

Actually, for accuracy's sake, MFRs are at the bottom of the totem pole.

Here is a question I have had since starting with the fire department and it would be nifty if we could actually discuss it instead of turning it into another excuse to bash basics (though I doubt that can happen) or even entire states. My department has three stations. Since EMS was taken away from the FD itself and the FD's ambulances were removed from the stations, we now have one ALS ambulance in our district of about 40,000 people. Of course ,if the ALS crew is otherwise occupied, we can get mutual aide. But in the realistic world where we have 1 ALS crew with 2 paramedics and a fire department with 90 firefighters of who maybe 15-20 are EMTs and the rest of MFRs, what are we supposed to do if I respond to the station to a medical call and I get on the truck and I am the only EMT? When we get to the scene do we just stand there and pretend that we dont know what to do and wait for the ALS Cavalry to save us all. Yes, ALS care means advanced, but if we are waiting and a patient is crunking, if the EMT (me or whoever it is) knows what we are doing, should we just let the patient circle the drain and hope the mutual aid ALS rig gets there in time. In the best of all possible worlds, we would have insta-medics on all calls that come into the FD. But we dont always and thats just the reality of the situation. We act as first responders. If we get there and can do something but somebody thinks we should wait for the ALS crew and the patient goes up the spout we are going to get hammered legally. While all the medics here will have a fit, there are times when the EMT's are the medical incident commanders until ALS arrives. We dont all live in the bright and shiny world where there is a medic on every corner and a chicken in every pot. Sometimes a Technician-Basic has to take over when a Technician-Paramedic isnt available. And when I said I would ask my chief, that was a typo because I was talking about FDs. I meant to refer to my paramedic or medical control. I started with one thought and finished with another And no, just because I know how to interpret a glucometer reading and administer oral glucose and when not to, it doesnt mean I am going to give atropine.

(Here ends the hopeful, constructive part)

And by the way, when did the language filter come down. We want to be taken as professionals and yet we refer to the places that our colleagues work as "god forsaken shitholes." Come on guys. They're only going to see you as professional as you act. That was one of the more mean-spirited posts I've read lately. An interesting knew use of the quote-clip-paste technique though and you do get style points for all your pretty colors. Other than that, mostly useless. Yes Virginia, there is a Santa Clause and yes, Basics in Illinois are TRAINED and EDUCATED in the use and admin of glucagon. Also, a about giving glucagon to a "decreases LOC" patient: Can that patient swallow? Does he show signs of stroke when evaluated with something like the Cincinnati Stroke Scale? If the answers are yes and no respectively, he is altered, can swallow and has a low glucose, day below 45-50, then I will cut open the tube and start giving it instead of waiting for the medic who will walk in the door, ask for my assessment and do the same thing anyway. Decreased LOC (level of consciousness) does not ALWAYS mean total LOC (LOSS of consciousness). LOC can refer to the degree to which the patient is altered or it can refer to GCS. I woulda thunk a medic would know that

Come on ahead, and visit us in Illinois. We'll leave the light on for ya. Just put a sign in your car window that says "Drag me to another state before extricating and treating me" so we don't waste our time.

Another example of why the FD should not be involved with EMS. People with a medical emergency need an ambulance not a fire truck.

That has to be [s:8f38ca7b1d]one of the[/s:8f38ca7b1d] the most ludicrous statement ever made concerning Fire and EMS. I somehow doubt that the guy fainting has anything to do with him being a firefighter. :roll: And people with a medical emergency dont need an ambulance or a fire truck, they need someone with medical skills. The vehicle is irrelevant. Ive ridden with medics who couldnt start an IV on five tries and without getting blood all over the rig, the floor, the patient and the cot. Get over it, Doc.

Probably because he hoped he might get more than the off the cuff bash the EMT-B, run of the mill answer which prevails on this site, particularly from certain members.

I guess so... the idea here is that complacency breeds an environment that hurts all the good people to the point of forcing them away from what I consider to be an honorable and upstanding job & profession. First on shouldn't be first to wait... I gave oral glucose to a patient who had a BS of 27 by a family members Accucheck, pt meets the criteria... the Engine is waiting for the Squad... why? I did my job AVPU V/S ABC's O2 & Gluc... medics get a BS of 58... push D50 = b/s 157 package and were gone...

How many of my "peers" would wait... along with the 5 EMT/FF from the engine and watch the coma?

Here's a modified statement from the PHTLS book I provide to all my "new Hire trainees":

Our patients did not choose us. Rather, they present to us because of some traumatic occurrence that has resulted in injury or illness requiring our assistance. We, however, have chosen to treat them. We could have chosen another profession, but we did not. We have accepted the responsibility for patient care in some of the worst situations: when patients are at their most stressed and anxious, when we are tired or cold, when it is rainy and dark, and often when conditions are unpredictable. We must either accept this responsibility or surrender it. We must give our patients the very best care that we can – not with unchecked equipment, not with incomplete supplies, not with yesterday's knowledge, and not with indifference. We cannot know what medical information is current, and we cannot claim to be ready to care for our patients, without reading and learning each day. At the end of each run, we should feel that the patient received nothing short of our very best. (NAEMT PHTL 6th Ed.)

This is very good. As soon as my Mod A FF2 Training is done, I will be running EMS calls on a regular basis with the fire department I work with. Sometimes the ambulance is 10 minutes out. Im not going to hold of assessment or appropriate treatment because the ambulance crew is still waking up and it took me less than 1 minute to get to the station and we are out the door in 3. The example of glucose. You bet I would give it if I had a reliable BGL and the patient showed hypoglycemic signs. Then the paramedics can start D50 if they wish, but they will be informed fully of what I have assessed and what drugs I have given. And this will draw heat, but if I cant get an AVPU response from my patient , I am also going to call for order for glucagon. These are the orders from my supervisor. My Chief. If you are able and ready to give correct tx based on correct assessment, you dont need to wait so you dont bruise egos.

I'm taking tactical medical operator (TMO) through Tactical Element this summer. Im pretty impressed with their programs.