JonathanGennick

On the topic of thinking outside the box: http://gennick.com/thinking_outside_box.html I use the term "business babble" for phrases like that.

The term "Jumbulance" is sometimes used in the U.K.: http://www.across-uk.org/content.php?folder_id=21 Gotta love that name, Jumbulance.

As a strictly on-topic reply, I just to say that yes, I find volunteers helpful. I work in a rural county with low-population density. In key, outlying communities, we have volunteer first-responders. They are EMTs (mostly Basics, but at least one is an Intermediate) who agree to keep a pager handy when they are in their home area. They cannot transport, but they otherwise have rigs with all the same BLS gear as we have. I can think of three recent runs off the top of my head in which these first-responders have made a significant difference in patient care and outcome. Strictly speaking though, our first-responder teams are not entirely volunteer. We call them "paid-volunteers", which is an oxymoron if I've ever heard one, but it's the term on their pay-sheets. They do get paid for each call that they run on. So far as I'm aware, there are no strict volunteers working EMS in my county. We are all paid, some by the hour, and some by the call.

In the software world, professionals give things away all the time. The discussion software on which this site runs is given away for free. This site is hosted on Pair Networks. The operating system they use is given away free. The web server they use is given away free. Etc. Etc. Lawyers do pro bono work. I know of some doctors who do several weeks each of unpaid work each year. I am not so sure we should be so quick to lay the blame for all that is messed up in EMS at the feet of those who volunteer. And FWIW, as communities raise the bar in terms of what they want, I suspect the number of volunteers will fade as a matter of course. It's one thing to volunteer when you need only a couple hundred hours of training, and when run volume is low. But as the run volume increases, and as training/education requirements increase, it becomes less and less feasible economically for anyone but a professional to volunteer their time. I don't mean to stray off topic. I just don't like reflexive, volunteer-bashing.

There are two medic services in a neighboring county that I'm familiar with. One runs medic/medic, the other medic/basic. Both transport. I've never seen a fly-car type arrangement in my neck of the woods. Edit: Actually, I'm aware of at least one system downstate that places medics in fly-cars. But there's nothing like that up here in the area in which I work.

This brings up an interesting side question: how many of us carry any sort of credential when we travel? I've a wallet-card, but it's tucked away in a file folder in my office. I never actually have it with me.

The product description for the 700 states: "The Stat Kit 700 is your best choice if you already have oxygen, resuscitation and suction equipment in your office." I would call a bag mask "resuscitation equipment". So the assumption is that you already have one. Otherwise, buy the 900. Nice kits. I like the way everything is organized, and not just a jumble of bits in a bag. Great information in this thread, btw, on how at least one airline handles in-air emergencies.

Talk about hitting one of my pet peeves. What to carry in is a topic I feel strongly about. In our service, we have a jump bag with oxygen, airway equipment, and pretty much all the other routine gear that we need on a call. Unless someone senior to me orders me to leave the bag behind, it goes in with me on each and every call, even on a simple transport run. If I have any inkling at all of cardiac issues (shortness of breath, unresponsive, diabetic, whatever), I'll bring in the AED/monitor. I'd like to carry in suction more often than we do, but I've not begun to fight that battle yet. stcommodore raises an interesting point here about best-practice. I'm going to have to give this one more thought. My thinking today is that I don't mind if someone goes in first if things are coordinated. On a recent cardiac arrest call, my partner (a specialist) went in first to attack the airway. I followed more slowly, climbing a bunch of icy steps with some other gear. Police followed a minute or so later with the cot. That was ok. We had a plan. We were coordinated. OTOH, I've seen an uncoordinated rush to the patient lead to silly situations. stcommodore raises a very thought-provoking point.

More important than a speed limit is probably a change in the culture of speed. Set an arbitrary limit, and some drivers will still manage to drive too aggressively or fast for conditions. It's not just about top-end speed, but also about how fast one takes corners and curves, how sharply one changes lanes, how aggressively one passes other traffic, whether one slows appropriately on snowy roads, etc. In some drivers, I see either too much emphasis on speed, or too much of a cavalier attitude towards driving.

I especially emphasize that last point that I am not a doctor. Mostly, I tell people that "I don't know". What I generally say is something along the lines of: "I'm a Basic EMT. All I'm trained to do is to try and keep you alive and breathing until we get you to hospital. I can't diagnose anything. I can't really treat anything either, except as a temporary measure (e.g.: a splint). You say your arm hurts? Then I have to assume it's broken and splint it. I am not allowed (nor trained) to make a determination as to whether it's actually broken. You need a doctor and an x-ray for that." Most people "get it" pretty quick. I don't have too many repeat customers. BTW, I'm nice enough when I reply. I don't mind getting the questions. But what I tell people is the honest truth. I'm not a doctor. It would be arrogant and presumptuous of me to go around giving advice. EDIT: In my day job, I work a lot with computers, usually with large databases. Believe me, it's not just medical professionals that get the questions....

This sort of situation calls for some judgment. If EMS or police or fire is already on scene, then I'd be very, very reluctant to stop unless there were some overriding and obvious reason to do so. If responders are already on scene, then I'd just be getting in the way by stopping. Besides, I don't ever carry my EMT cert with me, so I have no way of proving to anyone who I am. If no response is on scene yet, I would consider stopping. But again, some good judgment is called for here. Busy freeway in big city with lots of traffic? I'm probably not stopping. Family or kids in the car with me? I'm probably not stopping. Lonely back-road in the remote area where I live? Then I would probably stop. In the end, you have to make a judgment call. Have other people likely already phoned in the accident? Is an official response going to be close and quick? Does it really and truly look like it will be all down to you to call for help and get an official response started. I've personally not stopped for a wreck in some 20 years, and not at all since becoming an EMT. Once I saw a car spin off the road in my rearview mirror. That was last year on a freeway downstate. Weather was bad. Son was in the car with me. No safe way to turn around. Plenty of other traffic to call 911. I let it go. I didn't stop. Wouldn't have been safe. And would have taken me 15-20 minutes to get off at one exit and circle safely back to the scene. Heh. I don't even like car wrecks. I've been working as an EMT for about a year and a half now, and I'm happy every day that a shift goes by without a wreck.

Guys (and gals), I guess I just don't get out much. No nitrous use, that I'm aware of, in my neck of the woods.

Does nitrous really work? As a child, I had a dentist who tried that gas on me a few times. Was great for a buzz . But it still hurt like heck once the drilling commenced. I had no idea nitrous was used in EMS. Based upon just my own personal experience, I can't say that I have much faith in it.

Honestly, I think you have nothing to worry about in how you felt. I don't carry any gear in my car. So if I ever stop, it would be only to make sure 911 got called, to comfort the patient until help arrived, perhaps to hold c-spine. The only time I recall ever stopping though, was 20-some years ago when a guy lost control on a not-well-traveled back-road and ran off into a pond. I stopped. My wife drove to a nearby home to call 911. I stayed with the driver until the police came. I answered the officer's questions, as I was an eye-witness to the wreck, and then I left.

For writing "on the go", I prefer free-form. A lot of things I keep in my head, but when I need to write something down, then I want to get it written and worry about organizing it later. It's too hard to talk to a patient, get answers, try to write those answers into the right slots on a form, or to check the right boxes on a form, all while still processing what the patient is telling me. With a free form notepad, I can better pay attention to the patient. Plus, there's no large clipboard between us, and that helps too. What I do then, is to carry a small and inexpensive, spiral, pocket notebook. I jot notes in that -- usually just vital signs and times, but sometimes allergies, street addresses, whatever else I might need to track that I fear not being able to commit to memory. What I do works well for me. I don't promote it as the "one, true way".