NREMT-Basic

I dont know how common it is, but I do rehab during training, drills, extrication exercises, etc. I always try to let the FFs know that I am there to help keep them healthy and in one piece, but that if they fall outside of the parameters. The Chief says if they wont comply, tell them to turn over their helmets and turn-out coats, so I dont run into trying to enforce that one on my own. I do a full vital check pre and post including pulse ox and am also on standby to assist with first aide, etc. Most of the guys seems to appreciate it, though they might not seem like it at the time.

Actually, the only time you become a foolish whacker (in this incident) is if you pull yourself off one call without auhtorization while you have a peds seizure in the box. How stupid do you have to be? The folks that have expressed that your responsibility is to the patient you already have taken on are absolutely correct. To do anything else (ie stop at an accident scene) is to subject yourself to loss of license and civil suit for neglect and abandonment, not to mention the family of that peds patient will own you and every penny you make for the rest of your life while you work at McDonalds.

I cant think of a single situation where 90mph would be justified, let alone necessary. I tend to not push it past 70. Kyle, you might try taking an EVOC (Emergency Vehicle Operators Course). It will help your confidence and dramatically increase your skill at driving the meat wagon. Once you get your DL in the first place that is. Dont worry, buddy. Once they get you behind that wheel even once, they will never get you out.

I am familiar with the new protocols, although I have yet to be certified in them since they were just implemented right after I got my certs. While the new standard is 30:2, the 4 or 5 agencies that I am riding with (while doing my MS degree in Disaster Medicine and Management) are inconsistant at best. Some are using 30:2, some 15:2 and some have responders using both (that is one responder using 15:2 and some using 30:2). I know that my MS program is teaching 30:2 and thats what I will get from the AHA when I renew my certs next year.

I think PCB was addressing your "I know it all and fire fighters are s***, wanna-be but aint yet paramedic attitude." Im only an EMT-B/D but if I were your supervising medic and I handed you a center punch and told you to brake glass and you told me to have the firefighters do it, your training with my agency would be over. Get over yourself. Oh by the way, since only "real" paramedics dont roll hose, how much time do you spend doing it.

For what its worth, when I started my EMT course, the National Registry said no nitro with systolic pressure less than 90. About mid-way through the course (March 2006) they changed their minds and set the bottom end for nitro administration at a systolic of 100. But, as more experienced providers than myself have said, there is no absolute.

+5 and a hearty Bravo Zulu to you Dust. And would someone please shoot this thread? It has lived much longer than I intended.

He was not a citizen of the United States. He held the status of resident alien. Big difference.

Actually, this happened to me relatively recently. We got toned out to an MI and when we got there could here the elderly gentleman screaming painfully for help from inside the apartment. I opened the door, but the safety chain was on. I put my shoulder to it and in doing so, did some damage to the door frame where the chain slide was attached. Unfortunately, the patient coded and did not survive, but we sent information to the landlord of the apt building stating what we had done and why and that we would replace the damage if necessary out of the agency's pocket. The landlord said no, that he understood why we did what we did and that he would just get it fixed. Ive also run on a call where we had to break a window to get to a seizing patient (with police permission to gain entry). Once inside, we were able to take him out through the front door and again we offered to pay for the window, but the homeowner/patient again refused and thanked us for getting in to help him and repaired the damage himself. To me this brings up an interesting notion: here, we are technically supposed to get police authorization to gain forcible entry, though usually we do it first, explain it later and have no problems. Now fire fighters certainly dont need any permission to start chopping down doors to get in to save a life, so i wonder who among us thinks that we should have to have authorization from LE to do the same thing and further, under what circumstances/protocol would you always gain entry? Is it when you can see/hear the patient but cant get to them? If the patient has called 911 but then cannot let you in, do you have comms do a call back and if they get no answer do you force your way in? I know we talked about this alot in school, but we never really came up with a satisfactory answer. I talked to my father who was a LEO for 36 years and its his belief that if you know you have a patient in dire straits who cannot get to the door, they you are within your rights to force entry. I look forward to what others have to say.

You make a very good point about looking at your own writing before you post. For example, I didn't know that "atleast" was one word. I guess you can always learn something new.

First off, in your scenario of the pencil being in the gum line, the mandibular or maxillary bone structure would have stopped it before it went in very far and it would probably puncture the cheek, hit bone and fall out thus rendering this whole scenario moot. Quite simply, the way that a pencil or other impaled object in the cheek would be there without hitting the gum line if the mouth is open when the pencil is inserted through the cheek. If it is in the soft tissue and completely through the cheek, the tissue will have closed around the pencil or other item and would likely not "fall out." I think another question that needs to be asked here is, though this question and scenario have been around since time in memorium, how likely is this injury actually to occur. Ive only ever seen mocked up photos and I have to wonder how often this really happens. Of all the places that a person could be stabbed or otherwise impaled with a pencil, the precision necessary to accidentally impale the cheek through and through would be quite remarkable. The question still remains: if it is not impeding the airway, and bleeding is not an airway concern with proper suction, why remove the object? To prove that you can? Other than airway impedement, there really is no valid necessity for field extraction in the scenario described. In any case, in the hospital setting, a maxillo-facial specialist would likely be consulted and the possibility of cutting the pencil in two pieces, one inside and one outside thus facilitating its removal might be considered. There's also the matter of suction and tissue/vascular damage. If the tissue has "self-sealed" around the pencil and you start yanking on it, you are more likely to cause further tissue damage. The real question here in the absence of airway obstruction should not be why not remove the pencil, but rather why. As I asked earlier, do you take the pencil out just to prove you can do it. Anybody can pull the thing out, but the likelihood of further injury or soft tissue damage is much less in the controlled environment of the ER. Also, leaving the object in until arrival at the ER lessens the blood loss to the patient and also negates the argument of how to control bleeding. As I said in my previous post, it makes no sense to remove it and then have to try to conrol bleeding, etc when extraction, bleeding control and repair can all be done almost simultaneously in the ER.

Here's an example of reading into the question, which after all is what this thread is all about. The question does not mention the need to ventilate the patient. That being said, in the absence of any airway occlusion, there is absolutely no reason to remove the pencil. If it isnt causing respiratory difficulty or impeding CPR, there is absolutely no reason to remove an "impaled" object in the pre-hospital (scene or rig) setting. Why would you want to remove something non life-threatening that is going to bleed like a stuck pig when the object itself is controlling the bleeding to a certain extent and the ER has capabilities to removed the object, control bleeding and repair the puncture, virtually at the same time.

What I'd really like to know is what in the name of (insert name of whatever god, tree or other object you pray to) any of this has to do with EMS. It has nothing to do with it. The only reason that there are so many posts is that someone cooked up a topic, putting religion and sexuality into the mix and found a recipe that is bound to boil over every time. If we spent as much time talking about why the Medtronics company has been closed down by the US government for the second time in three years and why their products are under involuntary recall and what you are supposed to do if your agency uses Lifepaks and one breaks down, we might have something worth talking about. Its amazing that a non-issue can take up 7 pages on a forum and how it almost instantly degenerated into personal attacks.

No matter what your personal opinion about suicide is, it has no place in EMS. Your personal belief system is moot when it comes to caring for a patient. Some believe that AIDS is a punishment from God for being gay...if you hold that belief do you refuse to treat an AIDS patient? Or the drunk driver who rams into a telephone pole which collapses on his car (I have been on this call)...do you slow down and not work as hard because he was drunk and he "did this to himself?" I hope not. The fact is that when you get up in the morning and put on your gear, you have to take off your particular system of ethics and morality and while they may inform how you think, they must NEVER inform how you act or treat a patient. RidRyder pointed out that someone in EMS who has thought about suicide has no business in EMS. I disagree, because that makes the assumption that any who once contemplated suicide is unstable and not to be trusted, and of course nothing could be further from the truth. EVERY patient gets our absolute committment to excellence no matter what. We do not get to judge. It is a luxury we do no possess. If you find that you start to judge people and it begins to affect your attitude toward your patients, which will inevitably lead to how you treat them, then perhaps you should consider getting out of EMS for awhile until you can get that horrific anger under control. It will only eat you up and diminish the quality of care you can render your patients.

Im going to fall back on statements I have made time and time again. There is NO direct link between the ability of EMS providers at any level to offer the best level of pre-hospital care and their status as either volunteer or career providers. Some of the best medics I have ever met are vollys. If anyone can show me an article from JEMS or the like demonstrating that across the board volly EMS providers of any level have been PROVEN to be poorly trained, less qualified, etc I would love to see such information. My belief is that these statistics dont exist. I had my life saved by volunteer responders after an MVA in New Mexico..volunteers from a Native American/Reservation based service and I have to say that it was some of the best medical care I have ever received under any circumstances. I have run calls with both volly and so-called "career" services and have found that the same problem exists in both: individuals who are poor providers, not entire services. I recently watched a medic from a career service try to start an IV line 4 times and blow out the vein each time until he gave up, so apparently the skill level is not a 1 to 1 correlation with whether or not the providers on a given service are paid or not. Whats next? The argument that the career services that pay more are better than those that pay less. Its simply not true and there are not facts that Im aware of to back it up. This is an age old argument and not one likely to be solved in an internet forum. But lets start basing our assertions on fact and not anecdotal evidence. That is all.

I also wear Bates, but with the zipper. This model also has a little flap that velcros over the top of the zipper when its all the way up so it doesnt catch on anything. They are quick on and quick off...and ultra-light. I recommend them highly.

The judge makes a determination about whether or not he will drop, amend or decrease the original charge. However, it is the secretary of state drivers division that determines what action will be taken on your driving record. And generally without action on behalf of one of those two parties, tickets dont "fall off" ones record. This is a common misconception and doesnt occur. If you want to find out whats going on, go to your local drivers license bureau, ask to see a hearing officer and request a court purposes driving abstract. Also, if the judge wont order the charges amended in some way so the secretary of state can make a determination of action, you need to learn to slow down...two speeding tickets in one year means you are headed toward a suspended license. Personally, I wouldnt hire ya even if you got those tickets dropped....simply because they dont appear on your record doesnt mean you didnt get them and the fact that you got them reflects on your driving habits. Thats a big, dangerous, expensive piece of vehicle that you are asking this agency to let you be responsible for and the fact that you have two tickets in a year probably doesnt give them the utmost confidence in turning it over to you for 12 or 24 hours at a time. When you start working in any type of public safety or service position, you have to start holding yourself to a higher standard. Its not just you anymore...its the agencys property, your patients, other people on the road....maybe you should go to driving school no matter what the outcome of all of this is...sounds like drivers ed didnt stick the first time.

When I lived in Boston, I got a job through a headhunter service called Kennington and Associates, one of the biggest on the East Coast. First of all, keep your resume to one page. The average potential employer looks at your resume for a maximum of 15 seconds. Second, regardless of what Dust says, ALWAYS put down volunteer work, even if you list it under a special section. Employers care far less about how much you made than they do experience of any kind in your chosen field. Any most, if not all, are impressed by the fact that you care enough about what you do, that you are still out there helping people for no pay. At least 50% of the job apps I have filled out ask for volunteer experience. If they don't or if you are putting on your resume just list it as another job, ie "ABC City Volunteer Fire and Rescue." Trust me, they care about that experience.

In any case, what good would it do to work toward prosecuting this patient. Im not excusing his behavior, but are you just looking to get even? Many people that are not prosecutable in criminal courts for battery can still be held liable in a civil court. Of course, unless you are emotionally scarred by this (ie having nightmares, flashbacks, etc), a judge would likely not find your patient civilly liable either. My advice, take a good self-defense course. DT4EMS comes to mind. You can find several videos of their technique on youtube and also on their website. The techniques they teach are designed not only to keep you from getting mauled by a patient, but also to use just enough force to allow you to escape and hence be more defensible when the patient turns around and sues you or presses charges. This has happened to me a couple of times. Its sad, but its part of being in the box. You might alway want to check into better ways of restraining violent psych patients or perhaps using chemical restraints like haldol if your state allows it. Thats life in the box.

Doc- You say that a "normal response" will cause the eyes to turn with the head. The article linked above says that in a case of brain stem lesion etc, the dolls eye causes the eyes to move in direct opposition to the direction of the head. It says if there is brain stem damage, then the eyes will move with the head. I tried this in a mirror and turned my head, my eyes maintained an opposite angle to the tilt of my head. To my knowledge I have no brainstem injury (boy did I leave myself open with that)

I recently heard of a neuro check technique that I hadnt heard of and wonder if any one else has heard of it and can define it and describe it for me. Its called the Doll's Eye Reflex. It was only mentioned in my EMT course and I am fairly certain that it has to do with brain stem involvement, but would love to know more about it. Thanks.

I agree ethically with just flushing it. The problem here is that if it ever came up in a legal setting in any way, you are cooked. If you flush it, you can be charged with tampering with evidence, a felony in many states. Bag it, tag it and give it to your supervisor. Also include it in the addendum to your run report/PCR. Good on ya for tossing the "buddy" out of your rig. Plus 5.

Here it doesnt matter what med control says even if that med con should happen to be the patients doctor by some fluke. If it aint signed and on the nice IL DOPH bright orange form, it aint a DNR. That simple. You can have every doctor in the hospital say "let him go and pronounce him" and without that signature, you run a code. Worthless I agree, but thats what we are doing over here. We are even so picky over here that if its printed out on a computer and signed but not on the orange paper, its not a DNR.

Now I understand...and yes he is quite the Yellow Emperor....where have/did you study TCM or CCM (Classical Chinese Medicine)?

What youve quoted their doesnt appear to the from the Nei Jing (Yellow Emperors Classic), so Im not sure what you mean.