NREMT-Basic

Its called Katrina and when I said we I was talking about IMERT, DMATs, FEMA, NG, ANG, USCG and its Auxiliary. Most of the private providers were headed for higher ground or had their assets wiped out.

We do have a national response team. Its called FEMA. Old Brownie and W froze in their tracks during Katrina. Drive down there and ask folks about IMERT, or the US Coast Guard. Ask those people if they thought they had too much assistance. Or duplication or service. Or if they do now. If we had another Katrina scale event now, the DOD shows the National Guard would be too crippled to respond. Their numbers have been dwindled by Iraq and Afghanistan deaths, broken or missing equipment and people who have simply walked away. To the nay sayers....Put a big orange X on your roof next disaster and also spray "no thanks, Ill wait for the NG and FEMA." Which would you rather have? A response wheels up in four hours, or a 72? 72 is what youll get with the NG and FEMA. As God said to Noah: How long can you tread water? Its put up or shut up time. Or perhaps I should say join up or shut up. And remember...when the water starts rising...stay where you are...we'll get to you. We'll be the ones in the khaki BDUs with the Illinois Department of Public Health patch on our sleeves.

Ill give ya thte equipment drugs and funding. Will you know how to use them. Can your volly department triage and evac 33,000 people? Youre wasting your breath. We are here and not going away. We are the reality. We are the next step up from street EMS...more accurately 10 steps up. Street EMS has its place and so do we. Soo we give you all these drugs and they sit in a cabinet in your firehouse. Will people know they are there? will they break in to get them in the event of an MCI? Or will you have the training to be able to do methodically, logically and realistically. The fact is your department and most like it dont have the CBRNE response training. We do. Its just fact and not one that I feel I have to defend to you anymore. We're here because the state of Illinois says we are. Take it up with them.

Doczilla's common sense again for the win! DING DING DING! Doc you've hit it on the nose. There's an interesing little real time map out there in the ethers of the net which combines the resources of google and various terror and disaster response organizations. It refreshes automatically every 10 minutes and shows everything from suspicious packages and persons and powders, to explosions and overheated nuclear reactors to nasty storms pushing their way into the Solomon Islands. An old lady passes gas in an airport in New Zealand and it makes the map. The fact is, these things have always happened. In the post 9/11 world however, our radar, literally and figuratively, is collectively more sensitive. We are paying more attention and realizing that these things arent going away but rather happening with more and more frequency. Ill try to find that map, but if I cant link it through, find it for yourself. Then zoom in to just the US. The things you never hear about will scare you. I cant figure out how to link the map in here but its running the corner of my monitor and its scary as hell. We arent playing off fear here. We're planning, preparing and prepared for reality. Those "warehoused" supplies you envision do exist. But not in the way you envision. They exist under the lock and key and watchful eye of people like IMERT who can begin a deployment four hours post-event. Nobody was ever supposed to attack the WTC. But they did. Once in 1993 and twice in 2001. They werent supposed to be able to get here, to break our bubble but they did. The Army Corps of Engineers knew that the levies in NOLA and the pumps on the sea wall would fail in a strong C-4 or C-5 hurricane. But they did nothing and the walls failed because that storm was perceived to be impossible. They are not only possible, but a regular occurence. Im sorry if there are those among you who think that we are draining money and resources away from your volly departments and civil resources, the fact of the matter is that we are not. And if you could see the ledgers, you would know that we fight for scraps just like everyone else. Someone asked about avian flu and what someone like IMERT could do. Ill go ya one better than telling you myself. Find the best infectious disease specialist you can. You know, that guy at the university who crunches numbers on the nightmare scenario. Ask him to show you a worldwide avian flu epidemic with all the of the known capabilities and assets in place to mitigate it, from patient zero outward. Now start at patient zero, and take IMERT and people like us out of the equation. Patient zero becomes patient 5000 in a matter of a couple of days. 100,000 in weeks. Millions before a month is out. Now put IMERT and those like us back in. See what happens. Have you heard of supportive care? We arent going to save everyone, but we might save your mother, or your children or you. Look at the Asiatic, Hong Kong and Swine flu pandemics. Those who do no learn from history are condemned to repeat it. Only this time, when one too many farmers handles one too many dead chickens, or when the sea rises up to take out an entire coastline, there are 10s of thousands of people standing ready, listening for the sound of their pagers in the middle of the night. Sleeping with one eye open as it were. 10s of thousands of us watching that map I talked about just like I am now. We may not be able to save everyone and yes, there are specialized teams who do nothing but deal with dead bodies. But we just might be the firewall that stands between our own survival and that tsunami thats headed our way. We arent basing anything on what could happen. We are basing everything on what has and will happen. Just because you dont want to see the monster in the closet doesnt mean he isnt there.

The problem here is that you cant even make a concrete argument against IMERT because you have made clear you know nothing about it. We are state and federally funded, and no, we dont get paid. There are two paid members in the entire organization and they are the Commander and Deputy Commander. What would you know about us having background checks or not? I can assure you we do. Do you honestly think that a state would allow people to respond situations like what I have described with out vetting them first? Come on. We are not EMS. We are disaster/terror medical response and work under the auspices of the IDPH, IEMA, the Office of Homeland Security and we serve at the pleasure of the governor of our state and those states who may request our assistance. This is the big leagues. As I said, we dont respond to auto accidents. You need to do some basic research before you start bashing someone who may someday come save your ass. How Copy? PS- we are very well taken care of if hurt in LOD and our families are also looked after quite nicely. Thanks for your concern.

First off, you need a lesson in community economics if you think we are taking money away from you. We are a division of the Illinois Department of Public Health. Tell me, even if your area had the money for another rig, what would you do in the instance of say an anthrax or VX gas exposure. The answer is most likely nothing, because most EMS responders and systems still arent trained in Disaster and Terror Response. IMERT provides the medical support teams for Illinois Task Force 1, and urban search and rescue team trained to perform technical rescue on the scale of 9/11 or larger. We provide medical teams for the Illinois Terrorism Task Force and for the sorts of events like Taste of Chicago and the CHicago Air and water show where if a MCE took place, the local agencies, even in chicago, would be overwhelmed. We spend long hours and days training with the Illinois National Guard, The Air National Guard, The USCG and its Auxiliary. We have teams trained to respond to the most horrific of CBRNE events. We are trained an taught to triage a MCI, not with a few people or even thousands, but with potentially 10s of thousands of casualties at stake. We are not a fire department or a private ambulance agencies. We stand in the gap between what agencies like yours with limited resources (again, that has nothing to do with us) can and cannot handle. If there is a MCI in your area, we may also be treating your responder for exposure to whatever terrible thing someone or nature has done. When the team responded not twice, but three times to NOLA in 2005 it filled vital role that no one else was filling. Fire departments, Law enforcement agencies and other first responders were overwhelmed or had simply deserted their posts altogether. I am told that as the team worked through the city. residents, now homeless refugees, held up cardboard signs that read "We love you IMERT" and "You helped when no one else would." The affection between the people of NOLA and IMERT is palpable to this day. I would have been honored to serve with them during that deployment. But given the state of the world today, as my commanding officer says, "we will all get the chance to get in the game." Disasters that will simply render local, state and county agencies will come again and likely in ever increasing numbers and yet fire departments and EMS agencies are not fully prepared to deal with anything in the order of magnitude of Katrina. IMERT is. It is what train for. It is the nightmare scenario that we pray will not occur again, but to which we stand ready to respond when called. If you think that we are draining you of your resources, you just dont have an understanding of how big this picture is. Right now, if I had to be deployed, I would have to quit my day job because there is no legislation in place to guarantee it would be there when I got back. THe legislation has been introduced and awaits the governors signature, but I fear it may be a long time off. I will quit my job if asked to serve, confident that when I return from a deployment, the employers I would want to work with would see the importance of what I do and hire me. Finally, we are talking apples and oranges here. Your fire department may need more rigs or gear, but if there was a release of VX gas or anthrax spores, would you be able to manage it without massive specialized assistance. I very much doubt it. Are you prepared and equipped to handle an avian flu pandemic? We are. Are you ready to deal with a train crash that injures and kills 100s if not 1000s of people? We are. Do you have the ability to set up a fully functioning field hospital once you touch down and offer casualtys a place to get warm and dry, or cool as the case may be? We do. Can you say with certainty that you are prepared to work an mass casualty event with 33,000 casualties? We have. We are not better. We are just orders of magnitude bigger and better equipped to handle such situations? I dont know where you live, but if a disaster came through your city and wiped out fire and police stations and your public health and safety organizations were rendered inoperable because they are too small or not prepared for the nightmare scenario, you would want all the specialized teams, like IMERT and the DMATs from around the country there. You would need us there. Trust me brother, we are in the same fight. But when you talk about having one rig to cover a huge area with one response rig, you are talking about bringing a knife to a gunfight. We arent taking your money I promise you that. I do not question your comittment or abilities as an emergency responder, but I think that you commitment should be to the people of the community you serve and not to who serves them. We do not come in and take over, my friend. We come in and ask "what do you need from us." We can supply you with medically necessary electricity, water, lighting and personnel that a small department, or even a large one cannot match. We dont think we are better than anyone else, we just know that we are the best at what we do and that is repsond with a capability set appropriate to an MCI whether it is chemical, biological, etc.

Here is why us "ERT" types are around. We respond when local teams have become overwhelmed and federal response is long in coming. The team on which I am proud to serve is four hours from deploy orders to "wheels up." We are a civilian MASH. During a recent ice storm in a southern county of Illinois, IMERT responded because the power to the counties only hospital had been knocked out and their emergency power couldnt be brought on line. So IMERT responded and set up a field hospital to take patients that were on life support, patients that had just been discharged but need at home care were brought in and IMERT coordinated the evac or other types of patients. We have equipment and gear that so far only the military is using. And yes we can and do work seamlessly with other agencies and yes, though i was not with them, the team performed miraculously in NOLA in '05 and were cited by the President for their work. 4 hour deploy time. National Guard is 72 and FEMA is when we get there. You tell me if we are necessary and worth what we cost. IMERT is the first team of its kind in the country. Eight other states are modelling their teams on ours. We are different than a DMAT and we arent a local CERT, though both are valuable assets. If ever there was a group dedicated to the ideal "That others may live" its IMERT. If youre a resident of Illinois and have training/cert in commo, logistics, medical, transport, safety, nursing, dentistry, allied health and even veterinary medicine, give IMERT a call. I think you will be happy with what you find. How Copy? PS- I am not bashing FEMA, or the NG or ANG. We work with them regularly in training and actuals. We just work differently than they do.

Just make sure you get a vest thats rated for punctures and bullets. A normal (ie run of the mill police vest) ballistic vest will not stop a knife blade or shard of glass as these things slip right between the fibers, or at least they can. I have already ordered one for my disaster response pack. And I agree with Dust that all EMS providers should be wearing them. Of course I also think we should be carrying .40 Springfield XDs too, but that is neither here nor there. I am also proud to live in a country where Dust can say "fucktard." I fear if I did it often I would get banned. Nevertheless, "fucktard" shall be the rallying cry for free speech! God bless the DustDevil and God Bless America.

Oh DustDevil...youre the only one who truly understands me....swooooon :twisted:

Since joining IMERT and moving into MCI/Terror/Disaster Medicine, I dont run with EMS much these days except to keep up my CEUs and keep the skills ready to go. But I would have to say the most common call we get sounds like "Charlie 34, please respond 123 Smith Street, unknown medical." And if you ask if she has anything further on that call she barks back "I SAID unknown medical!!!" Speaking of IMERT, someone pointed out to me that there was a thread recently that was discussing wither MERTs, DMATS, MRCs, etc were necessary or a waste of time and money? Im interested in reading it but cant find it for the life of me. Anyone point me in the right direction? Merci! How Copy?

I agree. We have a local service who does pretty much nothing but transfers, so that helps. But then we have another which is hospital based which has ambulances and what you are calling ambulettes (a term I had never heard til I came here...we call em wheel chair vans....tomato tomahto). The only problem with this services divided system is that often it is still medics that are driving the ambulettes to take Grandma back to the death trap...er...i mean nursing home. There have been times where the medic has had to race Granny to the home, transfer her as fast as possible and then run an ALS call when the service is backed up. There really does need to be a clear division of who is doing what, or at least something like every 10 shifts, you have to take an ambulette/wheelchair van shift, and thats all you do so you dont end up with the snafu I mentioned above. And so, like sand through the hourglass....these are the days of our lives.....

As a wise man once said "Looky here, looky here, looky here!" For the name of all thats holy lets stop having every argument end up in "well if it had been a Medic who could have actually done something." I call foul. Ever since I have been on this site that has been the way to end and argument: "Well if it had only been ALS." Ya know what, most of the medics I know couldnt find their arses with both hands and a flashlight. Simply bungling your way through medic school and learning how to stick a needle in a vein and some basic pharmacology (yes there are medics who are extraordinary...we are privileged to have several of them among) doesnt mean that a medic is gods gift to EMS. Besides the idiotic decision to go C-3 L/S, what would a medic have done differently? Seriously? Give her a dose of Vitamin H so she would shut up? As for the EMT, the next time you get within striking distance of your partner, clock him a good one on the forehead for me. Any idiot who can get one eye open knows that when you have a hyper-excitable patient whose excitability is driving up her vitals, thte last thing you do is start running hot. Unless she was stroke imminent high, there was no reason to go L/S at all, let alone turn about and take her back where you just came from. Those decisions are made as a crew, so I guess I need to talk to your partner about giving you a knuckle sandwich too. From what you have said, her B/P was elevated, you two eggshells made it worse by going hot. If I were your supervisor you would both be sitting at home picking belly button lint for the next week watching three stooges and hoping the lights stay on cause you wouldnt be getting paid for it. And do gimme that you werent there crapola on a stick...I have been there. On a recent tour I did 20 hospital to nursing home runs with the medic driving. Ya know how many of them we turned around. None. Nada. Zipinski. You should both have your little rattly toy ambulance keys taken away from you and have to surrender every one of the thousands of star of life t-shirts, key chains and chick magnet caps you have over to the city to be burned. Then you should have to spend the next year working as bed pan attendants. "Ive tried nasty and Ive tried nice. Nice makes em think you are their buddies. Nasty gets s*&^ done." So sayeth the gospel according to me. Blasphemers repents before the gods of Mt. NREMT pulleth thy cards for good. "Repent, Repent I say, for the end of the world is nigh....especially if you two keep transporting our elders."

As a Buddhist for nearly 20 years, we have no taboos against tattoos. In fact, many Southern School (Theravada) Buddhists have religiously significant tattoos and in places like Thailand, Burma, Laos and Cambodia, monks are renowned for their skills as tattoo artists. It is an extreme blessing (and intensely painful one) to be tattooed by a monk. It is not at all uncommon to see monastics with tattoos on their scalps, necks, arms/legs and even faces. Having spent time as a monk at an American monastery, I too take offense at VS's comment. I lived for an extended period of time with men from the aforementioned countries and shared meals, sleeping quarters, religious practice and physical labor with 14 individuals whose culture couldnt be different from my own. -25 to VS for assuming his superiority in the arena of cultural awareness and sensitivity.

OK...simple but this is why the patch on by BDUs says "Basic Life Support Specialist"---- 1. Nearest hospital is closed and diverting according to what we are given 2. Radios and cells dont work but I am sure the schools phone does. Assume implied consent and spin up the helo. 3. While waiting, treat aggressively and symptomatically using shock protocol. 4 Standby with suction and intubation. 5. O2 by NC @2LPM 6. repeat vitals with BGL q5m 7. .9% saline IV, fairly wide open 8. Medic tx for nausea/vomiting 9. Give flight nurse the bullet, sign over your patient, go to church and light a candle. I know Im going to get flamed, but I am actually proud of being a basic. I like that I have pretty tight protocol parameters...its makes it more simple for me to do what I need to do. Im sure that the medics are laughing their asses off, but she is compensating in some areas and decomp'ing in others. As a basic I am most worried about not having the chaplain have to say to this girls parents "we regret to inform you..." I learn so much from those of you with more experience and training, but I do so love my basics. Im gonna let the medics amongst us work on the dx and worry about not losing this child before my helo is skids down. Oh yeah....starting move anything on the playground that isnt bolted down for an LZ.

Thats it. I am going to get my first ink this weekend and its going to be a picture of Dust violating a camel. I prefer realistic images. Who loves ya, my brother? :twisted:

I have heard three used and I have heard four. In my system, if you say "pt is a/o times4" they would have no idea what you are talking about. Im not saying this is a good thing, and I have heard many explanations of what the fourth A/O is. For me, it is person, place, time and event, as in "can you tell me what happened to you?" Maybe this means my education sucked but that is what I ask. When I call it in, knowing that A/O x4 would confuse them, I say "Pt is or is not A/O to person, place, time and event at this time." I may also include things like memory looping, changes in emotional state, etc. And yes, I cram alot into my 30 second call-in because I am sure of what I am saying and can speak very quickly and clearly.

Dont be gender biased. No mention of gender of our patient in original post. If the pt is male, we can probably rule out ectopy right off. What color is the vomit-ish substance? Does he have his gall bladder and/or appendix? Is he experiencing pain? Where? Vitals? Is he A/O? Lets not here horses and think zebras? Of course he is pale is diaphoretic...he just blew chow.

Im still trying to figure out where you work that EMTs and Paramedics arent licensed. And lets start using the whole word because a Medic is a whole different animal than a Paramedic. While I am and EMT-B, when I am working a disaster drill or actual disaster, and someone hollers "Medic!" or " Corpsman!", aside from knowing what branch of the service they were probably in in a previous life, I know they are talking to me. But I digress. I just wonder where you operate that Basics and Paramedics arent licensed. Please tell me so I can remember never to drive through that state. I would ld also venture to elaborate on something my good friend Dust hinted at: We arent going to get respect from the public. Walking into your local eatery in uniform and having your radio squawking and all your patches and other bling, most of the public has no idea what we do. As an example....you where a patch that says "Paramedic"...I wear a patch that says "Basic Life Support Specialist" and a name tape that says EMT-B/D. Ask the average soccer mom the difference and she cant tell you. Hell, ask alot of doctors and they dont know the difference. You practice "pre-hospital medicine" and I practice "disaster medicine." Again, altogether different. My protocols are different than a standard EMT-B in my state and probably different than yours. My team uses equipment used by no one else but the military. But do you think anyone besides people in this field know that? Not bloody likely. As Dust said, recognition comes with the patch the NREMT sends you. Respect is earned. And no one should care about whether or not the public respects us because they are likely never going to. But we have to start respecting each other. Stop the petty Paramedic vs Basic argument (remember a Paramedic is also an EMT so to use EMT to differentiate a Basic from a Paramedic is technically not correct). Stop comparing the size of rigs and lets start figuring out how we can work together in a fluid manner. Its about standardization. THats why in disaster medicine, we can use our state's protocols no matter what state we go into. This is the way the whole field should be. How Copy?

Does a Life Support Specialist on a state/federal disaster medical response team count?

I dont think its a good idea for a City noob with two posts to his name to start criticizing others

Actually, first responders are the lowest on the EMS totem pole. Whats its really about is each member of a crew knowing their jobs. The medic needs a tegaderm patch, I get it for him. He needs and IV start setup, I get it and pop it open. My job is to anticipate that medics needs and meet them before he even asks. When we are out on the sidewalk boarding a patient, i should be in the process of collaring and packaging before he ever asks. We get in the rig and he goes to the jump seat and I sit on the crew bench where I can get at all supplies without him having to get up. If youve ever worked or done time in an OR, its the same deal. Our job is to anticipate based on our training and repetition and meet the needs of the medic which are linked directly to the need of the patient. Im also in the business of providing patient comfort: are they warm enough, do they need some air conditioning? We are patient care technicians and we assist the medic. If any EMT who feels s*** on by their medic needs to see how good they have it, come out to a DMAT or IMERT camp sometime. You'll learn your place very quickly and the idea of questioning the medic, let alone our field docs goes right out the window. Here you will find that there are docs, then nurse commanders, then nurses, then medics, then EMTs....and then a whole host of warrant officers and chiefs who have nothing to do with medicine but who still outrank ya. Its the name of the game. If I have a Logistics Chief tell me what to do, its because he has been at it longer, probably has prior military experience and is trying to keep me from getting dead while i try to do my job. CHeck all egos at the door...no room for them in EMS. I am also very protective of those above me...screw with them and you will find yourself face down in the dirt real quick. Your mileage may vary.

So far in about two years, I have had two patients grab me. My order of operations is the same as Dust's: 1. retreat 2. let the patient retreat 3. go hands on. The one thing you dont want is a street fight in your rig. There are ways to physically defend yourself that will leave no lasting harm to the patient and will give you that moment of pause to escape. The first thing is to holler to your partner to pull then hell over. Otherwise its like trying to defend yourself on an out of control roller coaster. If you end up on the floor, you are going to be in a world of hurt. Cover your face and trunk and use your legs. Kip Teitsort who is a LEO/Medic teaches DT4EMS and is really a pioneer in the field of EMS self-defense. Anyone who says they are going to use a defib or a slug to the head with an oxy tank is full of it. Learn some ways to defend yourself that are not likely to kill your patient.

1. Spell check is your friend. 2. Basics are not there to make Medics look good. 3. Spell check is your friend, especially when typing/spelling is so bad, it obscures the meaning of your post or prevents others being able to tell what the hell you are saying. How copy?

If I may, I think what he meant was that no medic is better than any EMT simply because he wears the country club patch on his sleeve. There are VERY good and VERY bad Basics and VERY GOOD and VERY BAD Medics. When a medic is VERY BAD, it is much more obvious because of the level of interventions they are performing. Its gonna be much more obvious that he or she sucks or doesnt know what they are doing when putting down an ET than a combi simply because statistically there is a much narrower margin of error. The combi has a built in HUGE margin to it. The time in recent memory that I locked horns with a medic over something he did was my fault. By the time I worked with him, he had been a medic for about 3 months and I had been an EMT for about 18 months. Keep in mind if you will that he works for a service who is known for botching IV starts...I mean blood on the floor, on the cot, on the cabinets in the rig...its bad. He tried six starts before he accidentally got a good one. On this successful "attempt," I said "I dont think you blew that one." Looking back I see why he wanted to choke me. I was helping him get the start and all I meant was, "I dont think that one infiltrated or rolled." He took it to mean "that one didnt suck." Both were true. But this was a conversation between me and the medic I was assisting, not me calling him on the carpet as it were. Right now I am getting ready to take phlebotomy which will allow me to start simple lines in the disaster response team I work with. This is not so I can do it to say I do it, its the rules of the service and its there because when we are working all hell is breaking loose and I might be called upon to start a line while the Medic does something else. Im also taking a civilian version of 68Whiskey training because the areas we work in are often like war zones, minus the bullets (or not, depending...). Its hard to for me to think in the EMS terms I was trained in any more. In the field of Disaster Medicine, the BLS team member reports to ALS, ALS reports to charge nurse, charge nurse reports to nurse commander and we are all relied on to know what we can and cannot do. As I reported in another posting, some Basics can do things that others cant, depending on what EMS region they are from. In field medicine, we have to look at the medic-basic relationship like doctor-nurse. Im there to do the things I can on my own, and to assist the medic (or sometimes even have medics assist me if they happen to be walking by and its a BLS procedure). Disaster Medicine by definition is all about the first 72-hours post disaster. Everyone has to have excellent skills, well practiced because a Chief Medical Officer (IE Physician) may not be on scene for 36 hours into the 72. It helps to put things in proper perspective when we are all sleeping in disposable tents, eating MREs and getting malaria together. Its a team effort. One person is not better than the other because he is ALS vs BLS. Any basic who doesnt get that equation is going to hate his job and not last very long. Any medic who doesnt is going to hate his partner and not use them the way they were trained to function. HOW COPY?

We all know that we operate under a physician's license, but the fact remains that if you had no license yourself, you wouldnt be able to get as far as operating under his. If you just received certification and tried to practice, you would be charge with PRACTICING MEDICINE WITHOUT A LICENSE. My wallet card says that it is a "permit/authorization/LICENSE"to function under the EMS Act of the State of Illinois.