ericenglund

I'm no pansie, but I'd bet my odds are better trying to get the hell out as fast I can, rather than stay in a house and have a gun battle.

I consider 99% of the people I know faaar too ignorant to "grade" a hospital. Myself included. Throw in the bias nonsense like someone mentioned earlier ("My peas were soggy and they didnt tell me what was wrong with my toenail"), and you have a mess.

It'd be like me grading an essay..written in german(I don't speak german.)

When you have 3 more Paramedics on that same engine, another 2 FF/Paramedics on Rescue and maybe yet another 1 or 2 on a Private ambulance that does the actual transport, how much hands on is any one Paramedic getting per call?

One Fire department in my area has over 600 FFs. Over 500 are Paramedics. Even though it is a busy smaller city, how many tubes, IVs or even ALS patient assessments do you think each Paramedic will get per month or year? How many of the FF/Paramedics that became a Paramedic because it is mandatory will be overly anxious to do lead?

Ok. When I am on the Engine I am the only firefighter/paramedic on that engine. The rest is firefighter/ (virginia) Emt-Enhanced.

When I am on medic, i am the only paramedic. my partner is an emt-enhanced and i do 100% of the ALS transports, obviously. My department has maybe 400-500 members and maybe 80 of which hold an EMT-I or EMT-P Cert.

What about my skill competency(since I can only speak for myself, unlike some people here)

Thanks!

Yes, it does. That "ALS provider" on the engine is stagnating as an "EMS provider". I would much rather have someone arrive who provides patient care on a daily basis, who can perform a complete assessment, who can quickly identify what needs to be done, who is proficient and efficient with his/her equipment due to repeated and daily use, who won't fumble with equipment or assessment or treatment interventions because of gained proficiency/efficiency than someone who may, or may not, have checked the equipment on the engine that morning because he'd rather fight fire than provide patient care.

All that "nice ALS stuff on board" isn't going to do anyone any good if the "firefighter/paramedic" can't work the equipment because he's rusty.

and then you called me ignorant? You're ridiculous. You do know there are fire departments out there that staff ambulances as well -- great many of them. At least half of my time is spent on what I consider a busy medic (~3000 911 calls per year, so don't count your dialysis transports). The other half is spent as the ALS provider on a busy Engine doing what we all know 75%(generous number, probably more) of the job is.

I like to think I have the required intelligence to do both aspects of my job beyond proficiently, sorry you can't even understand that concept. Ignorance is bliss.

And then what?

Why not dispatch an Ambulance instead of a piece of Fire apparatus so we can transport that patient? If there were more ambulances in service, which would happen if the FD really gave a shyte about pt. care instead of inflating call volume, that big red truck could sit in the station and remain shiny, waiting for "The Big One", just in case scenario.

I was referring to sending the engine with the medic. Obviously you need an ambulance at an EMS call. I'm saying an Engine, especially, with EMS trained personell would be a waste sitting a block away from a medical call when the medic is possibly responding from farther away. You never know how many hands you need. I don't know about you but I only have two.

Most fire department missions are something along the lines of life/property conservation. The call volume may have gone full circle(more fire, less EMS to more EMS, more fire), but the mission is the same.

I agree a smaller vehicle would be probably more logical. However, that would require buying/maintaining the vehicle and staffing it with a provider 24/7. Where as the Engine(or ladder, whatever) has obviously already been purchased and staffed.

EMS is not staffed to be able to provide the same response time as fire because I'm assuming Boston ambulances(along with the rest of the nation's) are held up at the hospital waiting for a bed for their stubbed toe patient or other nonsense BLS cab-ride to the patients PCP(The ER MD). I can see the argument for police trained as EMS providers, but I don't ever see that happening except for a few very small exceptions.

Dual response needs to be monitored by either dispatch trained accordingly, or the pieces themselves. I know when I'm doing my shift on the ambulance and the engine is dispatched with me and I don't see it neccessary, I'll cancel them before either of us go en route.

and if you read the article, it says they made it to the scene(ahead of the ambulance, by the way)

and as they were leaving the scene, the brakes failed.

I'd be willing to bet the fact that this was an EMS call vs. a Fire call had nothing to do with the brake failure. At least it wasn't on the way to the grocery store.

Say the difficulty breathing is 400lbs on the 2nd(or 3rd) floor. Or he's in cardiac arrest by the time you get there. Extra hands are nice. should you tie up an addictional ambulance thats probably even farther away than the first one, or send the fire engine from down the street?

Perhaps it's your grandfather having the CHF exaccerbation, or whatever breathing problem we're referring to. The ambulance has a 12-15 minute response time, and the fire piece(engine, ladder, whatever) has a 2-3 minute response time. Sounds good.

Now lets say the Engine has a firefighter/paramedic in the jump seat, and a monitor/drug box/cpap/ all that nice ALS stuff on board.

Sound like a bad idea sending the fire engine to the EMS call?

Not that I care how many firemonkeys are killed in crashes.

Ignorant

In addition, what were some of the indicators that the patient was getting ready to deliver?

Take care,

chbare.

28 years old

10/10 abdominal pain that comes and goes(can anyone say contractions)

Urge to urinate

G5P5 "I can't be pregnant, I had one less than a year ago." (a little ignorance?)

This should have been pretty obvious, letting her sit on the toilet may not have been the wisest of things. At least we played catch and saved face.

Any time I come into contact with a renal patient, I ask when they last went to dialysis.

I've had a call very similar to this, 50something female at home, couldn't get out of bed due to weakness. Asked about hx. she stated renal failure and that she had missed her last 3 dialysis visits due to the busy holiday season. :shock:

Horrible looking ECG, gargantuan T waves.

Did you see peaked T waves on the 3 lead?

Hypoglycemia secondary to sepsis from drinking the water in Mexico?

Aggressive airway management, dextrose, fluids, 02, IV, monitor, turn over to ED RN.

My .02.

He's faking it.

D10, why not. See what that does for his LOC. We should also be worrying about the 200+ heart rate.

And did the parents notice any seizure activity at all?

Glucometry, anyone? Easy rule out, as stated above.

Follow ACLS/PALS "Seek expert consultation." I'd be on the radio with a doc.

tell him to wait 10 minutes until his arm wakes up then have him sign a refusal.

there are always difficult nurses. my favorite is when someone takes a radio report and asks either A) something you just said(we have an iv established. "DID START AN IV?")

or something completely unrelated to the patients condition just so they can hear themselves talk on the radio(BGL on a chest pain or pupils on a leg laceration)

med list

allergies

Respiratory rate/quality

last time the facility checked his BS and what the results were(if you can get them to dig up the paperwork)

did they give him insulin or if the results were high?

BP

My old department used to fire anybody who failed out of paramedic school, because too many people were intentionally flunking out. But then somebody decided that was racist, and they stopped firing them, and reinstated hundreds who had been fired for failing paramedic school in previous years. Now that's quality EMS.

funny how that works these days

Allergies? Did she chill at home today or go somewhere new and possibly expose herself to something?

BGL / last time she took insulin/last time she ate?

12-lead?

Sp02?

any recent surgeries, does she smoke?

lung sounds?

have her describe how everything else, throat, head, chest, abdomen..yadayadayada, feels.

like doc said "COPD, MI, PE, CHF, pneumonia" are all possible DDx, maybe DKA?

Well say, for example, some person under the influence of (insert drug here) decides they want attention/revenge/ or any other reason and decide they want to go accuse their ex-significant other of raping or assualting them them or what not.

If you were the ex, would you not want to show to the court that the person was out of their mind and possibly not a credible historian?

Just me looking at it from the other side.

Always wanted to say this!

minus ten for posting in the wrong forum! (should be in funny stuff)

Due to the training, expertise, and equipment of fire service-based EMS responders, they are capable of simultaneously securing a scene, mitigating the hazard, and triaging, extricating, treating, decontaminating (if necessary), and transporting the patients who have been injured to an appropriate medical facility

eh..

Disagree..."EMS based" EMS responders are just as capable. They call for FD when needed. Just like the FF/medics on the ambulance will call for the engine if they need it.

Status Hispanicus x 2 million?

no thanks.

:laughing3: HAHAHA!!