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".

Forgetting? I don't recall you telling us that to begin with. 225lbs doesn't strike me as that terrible of a weight. We'd just need more hands, that's all. That's 37.5 pounds each for six people, and only about 28 pounds per for eight porters. I'd try for eight, I think, given the length of the carry. Would settle for six, but I'd prefer eight. (Or maybe multiple teams of six, so that one team could take over when another got tired, like in a relay). Hmmm... Pregnant. We really shouldn't lay her on her backside, should we? We'd want her on her left side going out, yes?

Interesting scenario. Do we know about the 20-minute hike as part of our dispatch information? I'd want to get additional resources moving with an eye towards not having to hand-carry the patient out. For example, our county maintains a six-wheeled, all-terrain vehicle with a jump kit and litter that's ready to roll at all times. We also have deputies and others with four-wheelers (ATVs) that we can call in for help. And there's a search-and-rescue group. If I could, I'd try and get some sort of ATV lined up to drive me in. Or, if I had to hike in, I'd want someone -- park ranger, deputy, whomever, to be lining up help to get me and the patient out. The tough part of this call seems to lie more in the logistics of getting the patient out of the woods than in treating her.

It's actually quite common in Michigan to see family groups, clubs, and such out on the highways picking up trash. One local church school has adopted a stretch of county highway. And the state has an official program whereby any interested group can adopt a mile or two or three of state highway to maintain. If you pick up the litter a few times a year, the state will put up a sign plugging your group. You see these signs all over the place now. I suppose you could argue that volunteers are putting professional trash-pickers out of work :-). And shortly, in my city you will see a group of volunteers hard at work digging up contaminated soil, replacing that soil, and then planting flowers by the roadside and in a traffic island. I guess the professional landscapers are out of luck. I am too new at EMS to have a solid opinion yet on the volunteer versus professional issue. The one issue that I do have an opinion on though, is that of coverage. If by "volunteer" we mean that a call might come in only to have no crew show up, because everyone happens to be busy or out of town, or too tired to care, then that is just not right. I pretty strongly believe that there needs to be an on-call crew at all times. That's the way it is where I live. Michigan might require it--I'm not sure--but our service has a scheduled, on-call crew at all times, 24 hours a day, seven days a week, 365 days a year. (And we get paid for that too).

I don't see anyone rushing to be the janitor :-). But I do believe we actually have plenty of people who work for minimal amounts of money. City Commissioners and the Mayor in my town get paid only a token amount. I believe they get paid a set amount per meeting. School Board people, I think, also serve for little or nothing. There is a Downtown Development Authority, a zoning commission, a property tax board of appeals, and I'm really not sure what all else. I honestly haven't delved into the nitty-gritty details of how much people on all these commissions and boards make, but I'm pretty sure that none of those positions are fully-paid jobs. There is some money to be made, but people really do the work for their own motivations. Our EMS here where I live operates as paid on/call. We get a small amount per hour that we are on call. And then we get paid a set amount for each run that we actually go out on. I hear the term "paid volunteer" used sometimes. That's probably a poor term to use. It's a bit of an oxymoron. FWIW, I used to think I wouldn't mind being an EMT on a totally voluntary basis. Having worked at EMS now, I'm far less certain about the idea of working totally for free. I'm not sure I could, or would do it. I like helping people. But at the same time, I pay a price on many fronts for working the ambulance. I deal with stress, with time away from the family, with the inflexibility of being on call and having to be ready to run out the door at a moment's notice, with damage to my clothing sometimes, with the need to travel and pay for continuing education, with the risk of being in the back of a moving ambulance. The pay that I get in return makes all those things palatable.

We have them in at least one of our rigs. I was playing with the switches just the other day. We don't use them though, not for real. We have van-style rigs with an open passageway to the front seat area. It's easier, and probably makes for better communications, for the EMT doing patient care to just tell the driver to speed up, slow down, stop, watch the bumps, etc. Good point Brentoli, about using the stairchair more often to get people out of their houses. I'm going to file that idea away for possible future use. It might come in handy once the weather warms up and the snow goes away. (We got blasted with close to three feet last week). I don't know that I'd want to transfer a patient from chair to cot out in the cold. What about soft-stretchers? We carry them in our rigs, and I helped use one for the first time last week. (I've only been running for some 3 1/2 months now) Does anyone use those much?

Do I know for certain that the child standing and talking is the patient?

I almost couldn't survive the day without my pad and pen. I can measure pulse, respirations, blood pressure, and by then I've forgotten the pulse! Ok. Maybe I'm not quite that bad, but on some days it feels like it. Out of what little I carry on my person, I use the notepad the most. Anthony, I'm curious about the shears in your boot. Do you have some sort of holster for them? Or do you just stuff them in next to your sock?

I have to admit, it did occur to me awhile back that my 11-year-old son might have fun with a badge. He's a huge Star Wars fan. I bet he'd be thrilled if I went to Galls and ordered up a badge engraved with the words "Jedi Master" (or some such verbiage). He'd love that. But I'm unlikely to actually cough up the money. It's a fun idea, but one that's probably not worth the cost.

The first thing to come to mind about badges, metal ones at least, is that they are heavy. I hate having unequal weights on different sides of a piece of clothing. If I put a badge on one side of my shirt, what would I do to balance the weight? If on my jacket, then I suppose I could put a heavy cell phone on the other side, but then I'd be front-heavy, and I don't like that either. Thus, I am more than happy not to have to wear, nor carry, any sort of badge. A cloth "badge" would be ok. In our service, we have logos that are screened directly onto our shirts. They aren't separate "badges" as such, but the logos serve to help identify us as EMTs. BTW, for similar reasons I don't carry much on my person. I just don't like a lot of weight hanging off of my clothing.

I've been eyeballing that one in the catalog. What's interesting to me about is that it has a tunable diaphragm on one side, and also a bell on the other. The tunable diaphragm would seem to obviate the need for a bell. I'm curious, which side do you usually use for low-frequency sounds? Do you find that the bell works better for low-frequency than the diaphragm in "bell mode?" On a separate note, I'm also curious about how important dual-lumen is versus single. The cheap scopes we keep in the rigs are double-lumen, the so-called Spraque type. I notice the very expensive Littmans are double-lumen. There's only one chestpiece though, so I'm not sure why two lumens would be an advantage. I wish I had a bunch of different scopes available to try out, but I don't. Maybe I'll get a chance to try some different models at the Michigan EMS Expo next month.