NREMT-Basic

Bushy- had you read my post instead of scimming it, you would have been privy to the fact that I was agreeing that Phenergan suppresses the CNS and in conjunction with other CNS depressants can make for a potentially lethal cocktail. And, if you are or have been schooled in research methodologies you would know that the opinions of experts are VALID forms of research Perhaps you havent gotten that far in Uni so far. As far as my comment about being a Basic and expecting to get slammed, well once again, experience on this forum and all others in the City has proven to be true. On many, MANY occassions, Basics who might have some knowledge even though he is not yet a Paragod, have been bashed, insulted, slandered and otherwise abused. The proof is in the forums for you to read. Read carefully and you will see that I was contributing to the conversation about Phenergan and other CNS depressants with the information readily at hand. You and I have always gotten on well, so this little attack coming from you is quite a surprise, especially since you have been known to whine from time to time yourself.

The following is from the website rxlist.com concerning phenergan/promethiazine hcl" DRUG INTERACTIONS Injection: Narcotics And Barbiturates: The CNS-depressant effects of narcotics are additive with promethazine hydrochloride. After reading this extra long post about Phenergan, which is really quite interesting, I spoke with a friend of mine who is a extremely knowledgeable and experienced pharmacist. His experience would indicate that EXTREME caution must be taken when administering Phenergan with morphine and other opiates/opioids as well as drugs in the benzodiazapine class since both phenergan and these classes of medication can have a HIGHLY suppressive effect on the CNS. In addition, Phenergan on its own, let alone combined with other narcotics/benzos, etc has the effect of producing extraordinarily soporific effects, disorientation, loss of memory, hallucinations (both auditory and visual) disorientation as to person, place and time, suppression of respiratory function, decreased cardiac efficiency as well as hypertensive crises. Having had personal experience with nausea meds since an auto accident in 2004, I can say that there is little else on the market that is as effective an anti-nauseant/emetic. However, I have also landed in the hospital due to a poor combination of drugs prescribed by my physician after taking phenergan for the nausea associated with vicodan. My respriatory function was supressed to the point that the ER staff had intubation tray standing by, and would not let me move and had the room darkened as my B/P was 210/100. The reason I ended up in the ER with this was that my roomates found my in a sleep from which I could not easily be awakened, extraordinarily labored respiratory effort, LOC as well as a host of other emergent medical concerns. All of that being said, I have found phenergan superior to both compazine and zofram, but there is a spate of literature cautioning its use with other CNS function drugs. Being only a Basic, I full well expect to get bashed for having done some research and daring to post it. Thats ok though. I know what my own research and personal experience have shown and am confident in the information provided to me by my pharmacist friend.

Just a quick note of correction about subsidized student loans having "little or no interest to them." This is not correct. They do accrue interest at a variable rate (since the government lifted the interest cap on student loans.) The only time that subsidized stafford loans do not accrue interest in when you are in school, or have applied for and have been given a financial hardship or other type of deferrent. As long as the loan is in the repayment stage, it draws interest just as any other loan does.

Not surprisingly, but my question about tazer and icd devices or pacemakers got twisted into the notion that the officer needs to determine whether or not a person needing to be brought into compliance should find out whether the offender has any condition which would be worsened by tazing. I simply asked what the ramifications might be in an icd or pacemaker patient. Having been tazed myself as part of private security training and having a father who was a LEO for 36 years and who had his life saved by use of a tazer several times in his career, I am all for them. I think the video of the student being tazed has nothing to do with my question and though I cannot find information to verify this, I believe that there were disciplinary actions taken against the officer(s) who tazed the student.. The only unfortunate part of the advent and use of the tazer as a less lethal option is that they may perhaps be used too frequently when other means might be affective.

And we wonder why the medical community at large doesnt take us seriously as healthcare providers? And who is that non-uniformed woman on the end. Though she didnt stop, at least she had the common sense to keep hollering "this is not a good idea...this is not safe." Negative 25 points for stupidity for one of the two largest private EMS agencies in the country and they lose another 25 points for doing sh** like this that doesnt help any of us in the professional respect department. Kinda makes me glad that AMR went of business in my community. Of course, maybe we could give them some points for a new fangled way to transport multiple pts from the scene of an MCI. Nah...just stupid. I hope those sledding EMTs had a good time and took the video to remember it by because if their Ops Manager sees it likely they will be out of a job. Take pics those AMR patches guys, cause I have a feeling you are about to lose them.

Recently, the supervisors in my city's PD have started carrying tazers. My understanding is that they give a shock of 50,000 volts over 5 seconds. Then are then capable of delivering a stepped down shock of 40,000 volts over 5 seconds. After that, the tazer apparently automatically "makes itself safe" and prevents any further use until wires and probes are replaced. My question is what would be the ramifications of a LEO tazing someone with a pacemaker or internal defibrilator? I assume that it would do serious damage, but I wonder if any has any experience with this and whether or not anyone has ever been called out to remove the probes (which are barbed on the end) and assess the patient prior to transport to the jail by the LEO. I look forward to reading about your experiences. Thanks.

I agree with Rid that there are probably details of this call to which we are not privy. However, just given the facts as presented in this new clipping, it would certainly seem that the responding EMS crew would me liable for neglect. I know that there are alot of suits filed agaionst EMS crews by people looking to make money any way they can and that many of these cases are completely unfounded (for example the medic with the service that I did my clinicals with that was sued for emotional damages and actually investigated criminally for accidentally brush against a female patients breast as he worked to secure her to the cot). Granted I am a Basic, but even at my current level of training, we were taught that we cannot "declare" death. That a person who is coding must be treated with due dilligence until such time as a physician can declare clinical death. That being said, we were also taught that there are several presumptive signs of death which allow a crew to call for the coroner and stand by until his/her arrival and take no measures to aide the patient. Of course there is "if you cant do compressions and ventilations in the same location" this is a presumptive sign. We were also taught the obvious grey matter in the hair test. It would seem that absent any of these presumptive signs of death, the ems crew described in this article is guilty of all of the signs of neglect: 1. A duty to act 2. A failure to act upon that duty 3. the patient is injured and or ill 4. the steps taken, or more accurately not taken, lead to a worsening of the patients injuries or illness and led to an overall decline in the patients condition and/or caused the patients death. All of the above being said, I wouldnt want to be a member of this crew.

I agree with Rid that there are probably details of this call to which we are not privy. However, just given the facts as presented in this new clipping, it would certainly seem that the responding EMS crew would me liable for neglect. I know that there are alot of suits filed agaionst EMS crews by people looking to make money any way they can and that many of these cases are completely unfounded (for example the medic with the service that I did my clinicals with that was sued for emotional damages and actually investigated criminally for accidentally brush against a female patients breast as he worked to secure her to the cot). Granted I am a Basic, but even at my current level of training, we were taught that we cannot "declare" death. That a person who is coding must be treated with due dilligence until such time as a physician can declare clinical death. That being said, we were also taught that there are several presumptive signs of death which allow a crew to call for the coroner and stand by until his/her arrival and take no measures to aide the patient. Of course there is "if you cant do compressions and ventilations in the same location" this is a presumptive sign. We were also taught the obvious grey matter in the hair test. It would seem that absent any of these presumptive signs of death, the ems crew described in this article is guilty of all of the signs of neglect: 1. A duty to act 2. A failure to act upon that duty 3. the patient is injured and or ill 4. the steps taken, or more accurately not taken, lead to a worsening of the patients injuries or illness and led to an overall decline in the patients condition and/or caused the patients death. All of the above being said, I wouldnt want to be a member of this crew.

In this area its: 1. Just not feeling right 2. Elderly falls 3. SOB/chest pain And as an aside, when I was doing my Basic clinicals in the ER, we had 18 rule out ectopics in a 12 hour. Three were actually ectopic. Makes me wonder if the physican (with whom I worked) tends to label any female abdomial pain as an ectopic. Of course he also happens to be fond of ordering the most expensive scans available. Many moons ago when I had a paticularly severe migraine, he order head ct and informed that I had a brain lesion. My mother was seen by this doc for chest discomfort. After MI rule out, he ordered a VQ scan of her chest and informed her that he had detected a large mass in her left lung. Both of his diagnoses proved incorrect. Maybe thats what happens when a D.O. is the attending rather than an MD. He also tends to prescribe darvocet even for the most intense pain. Sorry about the tangent, but I sort of felt it was related since it was this single doc that had 18 ectopic pregnancies ruled out by expensive scan.

The only sort of similar case I know of is from personal experience a few years back. I was in an autmobile several years back here in IL. There were three vehicles involved, one belonging to and being driven by a physician. The others involved were myself and an elderly couple (the elderly driver being cited for causing the accident). The physician hopped out of her mercedes and it was somehow made known that she was a doctor, I dont recall that detail. In any case she refused to render assistance until EMS could arrive. In the ensuing court action, the elderly driver stated that he asked the doctor to help his wife and the MD refused....this fact was later entered into a complaint and sanction against the physician with the IL Board of Health. What I know for certain is that we were told in the medical/legal portion of EMT training was that off duty we are not required to stop. I believe (but cannot verify) that we were also told that if we are on duty but have not been dispatched to an accident that we happen to drive by, that we are not required to stop, especially in jurisdictional situations outside our coverage area. I am not confident in this assertion made by my preceptor and have not been able to find this in IL law and, being a paralegal, I have really done alot of looking since we were told this and have not come across any such presidence. I look forward to reading what others have to say.

Here in Illinois, and EMT of any level only has a duty to act when he/she is off duty if they have initiated contact. If you so something as simple as walk up and say "are you alright?" you have now legally initiated medical contact and are required to render aide. I dont carry a kit and tend not to stop since about all I could do would be c-spine and get stuck there for a long time or cpr which could also keep me linked to that patient. On the other hand, I do question whether I should stop when I pass an accident. I suppose it sounds contradictory to what I said in the first place but if the accident was incredibly I would probably stop. I have had neighbors come to my front door and ask for assistance but I tend to advise them to go to the ER or an immediate care walk in facility. I just tend to follow the rule that once you make contact you are treating and use that to decide if this is something that I should get involved with or not. Usually the extent of my involvement in to call 911.

Yes, as a matter of fact I have been assaulted by a pt on two seperate occasions. And I never said anything about hard leather restraints. I said soft restraints. I truly am sorry that you had a bad experience with a patient attacking a medic. I have also had the job of pulling an unruly psych patient off of the medic. What I was disagreeing with was the idea that unruly psych pts never go in an ambulance. And as for dropping a patient in the ER and going back out to the rig...I dont know about where you live but here in Illinois that constitutes abandonment and will lose you your license. I also cant imagine that versed would not put a patient down far enough that they wouldnt be any trouble. I have been grabbed around the neck, punched and spit on. However, that doesnt mean that I am going to dump the transfer of an emotionally disturbed patient off on the police. And of the patient is put in handcuffs by the police, you better make sure that the police officer does in fact ride IN the ambulance and not behind it. In my region, we cannot have a patient in cuffs unless the person who put them on the patient (ie PO) is right there with us

"I can make myself aware of possible dangers all I want but awareness isn't going to be able to physically stop a patient that is trying to jump out of the ambulance while were going 100 km/h down the highway, or trying to grab the steering wheel or trying to harm me. If I have any doubt at all that the patient will be cool, calm, and collected the whole ride than they aren't getting in my ambulance." First off, a properly restrained patient, psych or otherwise, is not all that likely to leap out the back of the rig. That what soft restraints are for. Furthermore, an emotionally or mentally distressed person is not the pervue of the police. If they have are suffering from a biochemical imbalance, this is the realm of EMS just as cardiac arrest or an asthma attack.ie...the person is in medical crisis. If you expect every person you serve to be cool calm and collected, go work at walmart, cause it aint gonna happen. We were taught way back at the beginning of EMT school how to interact with patients etc. And what the hell is the patient doing in a position to grab the stearing wheel anyway...sounds like a refresher course in ambulance ops might be needed. You say if there is any doubt at all about the stability of the patient then they dont get in "your" ambulance. Idiocy. I dont know about where you are, but here once we have made contact with a patient, even down to asking them questions to get a history or introducing yourself (Hi I am an EMT...what caused you to need our help today?) you have initiated care...then pawning them off on someone else without a equal or greater scope than your own, you have just legally abandoned that patient and I would dust of my resume if I were you. You know what? Pts can be unstable, rude, violent...the can spit and curse and hollar to beat all hell, but you took the job knowing that that was part of the game. Does this mean that a verbally abusive and disoriented diabetic doesnt get your stamp of approval as worthy of care and doesnt get to ride in "your" ambulance? Just food for thought

I cant believe that this whole badge patch argument is still raging. How about this. Wear or carry or pin to your shirt whatever your department or agency issues and leave it at that. If you need a piece of tin to validate what you do, become a rent a cop. When he retired, my father wore the gold shied of a Sheriffs Detective in our county. Why? Because for 36 years he remained true to his oath to uphold the laws of our state. He went through the Academy, spent 9 years as a patrolman and the rest of his career as a Detective, retiring as Detective 1st Grade. If you feel the compulsion to carry a badge and have it entitle you to actually carry out specific functions, I suggest you do what he did. If you need a badge to feel important, wear the badge of honor that everyday that you go to work in the EMS field, you are saving or helping to save lives. Use this as your litmus test: when you are working on a criticial patient, do they stop to ask to see your badge? No? Then why bother? Let your badge be the fact that when you step out of that truck, you are doing something that very few people would want to do. Even one better: give yourself a badge for every one of your patients that lives.

Dust- Having investigated nursing school before going the emt route, I can state without question that the requirements for nursing in the State of Illinois require one to have a CNA certificate before proceeding to nursing school. While nursing may not be a tiered system like ems, CNA certification is a pre-req for being accepted to nursing school in this State.

I agree completely with Dust and Rid. Many EMTs are taught that we are using BLS to stablize until ALS can be had or until we arrive at the hospital. In my system, with a Basic and Paramedic on each rig, these things are algarhythms are happening simultaneously. I had the good fortune to be taught by a paramedic whose belief was that both Basic and Medic should know their skills well enough to know what is called for and to work as a team. This is where the true practice of pre-hospital emergency medicine takes place. Yes BLS and ALS skills are different, but they also overlap and intertwine. The notion of BLS before ALS is ridiculous. That being said, it is also the way that many new ems students are being taught...that the two are seperate entities and not that they depend and work off each other to off the patient an wholistic level of care. We arent taking BPs and pulses just to have numbers...they inform what other interventions may or may not occur. Yet another reason to keep studying and learning even after you pass your exams. Thanks to Dust and Rid for their experienced comments on this idea.

Dust- We have had our differences in the past but as far as I am concerned by gones are by gones. I wouldnt do what you are doing for all the tea in china. Seeing what you do and where you do it has definately given me a new found respect. Keep your head down and be in touch if there is anything you want from home. PS- What the hell did that piece of shrapnel come off? Apparently the insurgents didnt see the "Mission Accomplised" banner aboard that aircraft carrier.

Dust- I said Bachelors degree and should have said Associates with Bachelors preferred and to the best of my knowledge, it is all agencies in the State. I do know that all officers are required to complete the State Police academy before they are eligible to be hired by any agency. Sorry for the confusion.

Dust- IL requires at least a bachelors degree for police officers before they can enter the State Academy. This is largley do to the efforts of folks like my father who recently retired after 36 years as a Sheriffs Deputy. He spent the last almost 10 years of that career working with other departments around the nation to develop a national set of accreditation standards and worked for the first department to be so accredited. He helped to develop an organization called CALEA (the Council for Accreditation of Law Enforcement Agencies) and travelled all over the country helping to implement these standards. I think something like this would be a magnificent stride in EMS. Im still alarmed, though no longer angered, by your bashing (for lack of a better word) of Basics. When I first saw you start saying things in this regard, I thought you might just be a bit of a a curmudgeon, now its seems that its more of an elitist snobbery. Basics save and assist in the saving of lives everyday all over the country and you still seem to think that all we are good for is stocking the truck and driving. I recently spoke with a CCP and flight medic who told me that he would rather work with a good basic than a half-a** Paramedic anyday, and, he added, that the world if full of half-a** paramedics. It seems to me that you want respect for EMS as a profession but are not willing to give anyone but paramedics the deserved respect. And yes, respect has to be earned

Maybe I am just new enough to EMS or am out of the loop but I have never heard of reponders being stationed at hotels. This sounds a little..well..bizarre to me. I have however, run into lots of volly services so far where responders have ambulances at their homes. We have a volly service just north of me in fact where this is the case. While Dust has a point that many vollys may not live in their district (though in IL i believe they have to) it also seems that it would save time going out and getting in the ambulance parked at your residence than having to drive to the station, get the ambulance and then go to the call. I am sure there are plenty of things in my post here that will get me blasted my Dust but then it is the little things that make my life complete.

I agree with both the ideas of funding and increased public visibility/presence. I also think that EMS should follow the lead of Law Enforcement and require that individuals have at least an associates degree in some field (preferably related to EMS, but not required) before entering an EMS training program. I have read so many run reports in which the author cant find a coherent sentence with both hands and a flashlight. I also think more uniformity not only among the different states but within states would be highly beneficial. Finally...the education of the instructors themselves. If it had not been for my class being essentially taken over by a paramedic, I never would have gotten through it. The original instructor hadn't been on a call in 10+ years and couldn't spell let alone pronounce the simplest medical terminology and often had such a complete misunderstanding of simple procedures and information that the students were essentially teaching each other. So, in this order: education, funding and visibility.

Sounds like your camp nurse needs a kick in the pants. I cant think of a time off hand where i would consider a pt with the s and sx that you are describing being transported pov. What would your nurse have done if the patient had crumped and what would have been her liability issues?

OK kids. lets lay off the IL FF comments. I have worked with countless IL firefighters who are among the best I have ever known. As for treating snakebite...at the BLS level when I took my EMT course we were told to ice the site of envenomation, treat for shock and rapid transport with possible ALS intercept depending on the distance of transport. I would be interested to hear what others have to say about snakebite/animal envenomation protocol.

PS- Cost really isnt an issue with this device as the company that is currently marketing makes them available for $175. Not to bad when you consider the assistance it can offer.

I have only seen this device used in ERs. The one i saw used was about the size of an electric shaver, so I dont know where the writing implement size comes in. This device did seem valuable and was used quite extensively by nurses and techs in hospitals to prevent undue discomfort and or pain to a difficult stick pt. And I really dont think its a matter of the competence of the sticker...some people are just hard to stick and if there is a device which makes it easier to get a good stick the first time, I say use it.