bigj1130

Rid, Humeral Head I/O was a skill we introduced at the begining of the year as an alternative insertion site to tiberal tuberosity. I will say that in most cardiac arrests we have been running here in Austin that an I/O is primary insertion point on more than a few of those cardiac arrests. There was talk for about 2 months about our system removing EJ cannulation as a skill. This is where the humeral head insertion point came in. The paramedics in the system have convinced all of our powers that be to let us keep the skill by demonstrating proficiency knowledge of when's, why's, and how's etc. However we were still left with the Humeral head as an insertion point for our EZ-I/O. When i am asking about securing the I/O cath we all know that things can be bumped during movement etc. and I am curious how easy this site is to maintain and keep patent with everything else going on up by the chest head and neck area. One of the things I like about the tibial tuberosity is the insertion point. It is a skill easily erformed because it is out of the way of chest compressions, airway management, and defibrillation

I'm also going to add here. Is anyone using EZ I/o humeral head insertion? We started doing it the begining of this year. I haven't done one yet because if I personally am up by that part of the body I am going to go EJ. I was wondering if people have had issues with securing the catheter, moving patient etc.

Well it seems everyone has answered the question about whether to be a paramedic for the sake of getting on an fd or to be a medic to be a medic. I agree that which ever you choose just choose it for the right reasons. Now about burnout.... I am in my tenth year of providing prehospital medicine. I have gone through one stage of burnout and one stage where I wanted to "get away" for a little while. My burnout phase was rough I was working 120hrs. week on average between my 2 jobs all of it on an ambulance. after about two and a half years of it I found myself getting frustrated with my EMS coordinator my EMS system, my partner, and the firefighters in my station. I wasn't getting that little shot of adrenaline or excitement when I got to attend to an acute case, I was very bored and was going through the motions. The part that got me down the most was I didn't see an end in sight I had to work to pay my bills but I didn't want to get up in the morning and go to work. I couldn't escape to take a vacation or get time away from work for life because my life was work. The other part that attributed to this was a complete lack of support from my peers and superiors because we had to keep the ambulance on the street and I was next up on the overtime list so I had to do it. I tell you that story to inform you that, in my opinion at least, pay, hours, partners, runs or lack thereof, all will play into "burnout." What got me away from it was a complete change of Employer and a move across the country. Now I have a life outside of work and someplace to channel all my energy and time I spent at work before is spent doing something else for ME. So enough about me. Burnout is real and can happen to anyone at anytime. if you are afraid you will go through a rough patch and not like your job and wonder why you invested all of your time for a 2 year paramedic license, field preceptoring for system clearance, probation, 28 EMS Calls in 24 hours, people who hate you for doing your job, a public who resents you sometimes, and a partner you might not like, well maybe you should go into nursing. However, if you want to invest all that because the rewards are worth the risks, then EMS is a great place to be. There is no other job I want to do or think I could be as good at than what I do. I love to get up in the morning and go to work even with all the "milk runs" and "mindless medicine" I can actually make a difference in those people's lives for an hour out of my day. Where else could I do that and not have to go back to school for another 8 years? Whatever you decide to do good luck enjoy it and do not let it consume your outside life as well as your work life. Have fun with it and take the good with the bad

I just want to add a few things on this topic and they are just observations not designed to offend, upset, or anger, and are merely points of discussion. The forum has pretty much resigned itself to the fact that mistakes were made, be it by the EMT-P, The Hospital Administration, or the Primary care Physician. I think the argument about Start Triage, JCAHO, MSE's and who can do them, and what went wrong for this kid are interesting. That being said, I have very little experience with Bacterial Meningitis. I know the signs and symptoms that were taught out of my Bledsoe book. I also know the definitive diagnostic tool for Bacterial Meningitis is a spinal tap. Besides this basic info we are taught what should I know about Bacterial Meningitis? What kind of beneficial Field Tx. have you seen or done that works well for you, Aggressive fluid therapy etc? I am one of those medics who took a year long course and is now struggling to finish My AAS then Complete my BS. OK I got that out of the way, now this might seem like stirring the pot but... I know some facilities have what they call a "quick look" where basically you register and they get your chief complaint then triage you based off that. It has been several years since I transported a patient to Ingalls in Harvey. Is it possible that what this article is referring to as triage was only something like that and therefore JCAHO compliant? Perhaps some of our members in the south burbs of Chicago can help me understand what it is that Ingalls does. These points are not intended to try the clear the paramedic of any wrongdoing or create any infighting either. If I knew this medic's I would make pretty sure he didn't "triage" my daughter if he can't spot a sick kiddo that needs to be seen. A sick kiddo is a sick kiddo in or out of the hospital. Just my 2 cents

I will throw my hat into just from my observations. Should "old school" ways of doing things change with up-to-date treatments? Yes and No. When it comes to technology I have noticed some "old-timers" have a hard time incorporating the new technology into there assessment and tx. The "New School" however seems more reluctant to do assessment and tx. without it. In terms of tx. and being up to date I think most of the old timers will be the ones spearheading most new things. the new school will embrace more and use more but the old school likes it because it can make their job easier and they remember Calling rampart and getting orders for a liter of ringers or d5w and slamming 2 amps sodium bicarb. The new school need to appreciate the fact that some of those old school guys wouldn't take that as gospel and wanted to progress. Are the newer medics and EMTs coming in to the field with more knowledge base? I will say they come out with more book knowledge but the book will only get you so far some of my best education came with my training officer here in Austin AFTER I had already practiced medicine for five years. The skill of a good assessment and building rapport is not taught in a book but learned from an "Old-Timer" Scene management and confidence, not ego, are something that comes with experience or something that is learned from "Experience" What is your over all perception of the other generation? While some of them may be crusty, crispy, or just plain burnt, others have helped to make my profession what it is today by not getting complacent and wanting to make themselves and EMS better. How do we make change to better understand each other? Time, respect, and from a management standpoint... put your paragods with the crustiest medics you got. Management may not be able to eliminate a paragod complex, but a medic who is 5 years younger than dirt and has underwear older than the new medic will get rid of that complex right quick. Also, lead by example. I think new medics have to earn the right to do a lot of things, not hazing or anything like that, but your performance and attitude will earn you a place in the conversation or earn you a spot to write your report at the desk instead of standing and having to use a clipboard. Just the little things. Be first out the door to your unit, be early to work, help clean units on the hospital dock, help crews carry stuff when they have a code 3 return to the hospital, the little things that go a long way. These are all things old and new school should be doing, but when you are really new I think that goes a long way in an old timers eyes. These are the observations of an Old New Schooler.

I just had a random 5am thought after no sleep tonight. Does EMS Directly or indirectly contribute to the shambles that is the U.S. healthcare system? I'm not gonna post this as a poll because I want to hear what everyone thinks. Personally I think that EMS as a whole contributes indirectly by being an enabler, so to speak, to the ER abuser and 911 abusers etc. Kinda the whole you call 911 we will send someone thing. Also, Why on earth are we taking a stubbed toe to an ER to tie up a bed or a waiting room chair when we end up with stretchers with acute injuries and medical conditions stacked in triage trying to get a bed. I am not trying to rant but I guess being an optimist I would like to try to fix this. what are your thoughts? Is there a fix or is the system broken beyond repair? Who is to blame and what can we do? Just want to see what everyone else thinks. Thanks for looking

Just my preface before my remarks. I for one have never worked a volly department. That being said How long does it take to bunker out for an mvc? I can tell you that NFPA says it should not take more than a minute. Even as a paid memebr of my depratment on my days off there is a spare uniform tucked in the back of my car. Why is it so hard to not have appropriate PPE with you at all times if you are commited to your department? I understand there are circumstances where you will not be ready to respond, i.e. the car accident in front of you on your way to dinner etc. But if you don't have your gear with you take that call off? does your chief or you for that matter honestly expect to make every call? If that's the case go somewhere and get paid to do it. just my 2 cents

My Mistake My point was to say that Right sided failure is more often times caused by left sided failure I neglected the distal edema vs. pulmonary edema point. It read good at 0330 with these obvious points overlooked

Pulmonary Edema as stated is not a problem with constricted bronchioles. Pulmonary edema has everything to do with a pump problem. Most likely left sided failure causing right sided failure causing pulmonary edema. However some Failure patients have reactive airway disease also, IMHO this is where Qualitative ETCO2 comes in handy. The ETCO2 waveform will help determine air trapping due to reactive airway. these patients will also be hypercarbic as well. My experience says that's ok for a beta agonist tx then. Also look for the other subtle signs that is is Reactive airway rather than failure. Most not all Reactive Airway pts. will have that very expanded exhalation period because they are trying to blow off that co2 they are trapping. Failure patients I have seen are tachycardiac, tachypneic, and hypertensive almost always. In the case of pulmonary edema in a failure patients Positive Pressure Ventilations with a bag mask are going to do more than the beta agonist will to "open them up." Nitrates are also beneficial and in our system are going frontline with CPAP or BVM over lasix and morphine with lasix going way down the algorithm and morphine gone altogether. So in a nutshell My opinion is beta agonist are bad in pulmonary edema patients

PM sent

Here in Austin we have several couples that work here. The city is completely okay and the employees like because then a husband doe not have to insure his wife or vice versa because we get it for free. My wife works here, she started almost 2 years to the day after I did. She is not in the field, she is a dispatcher. This is the most common relationship here but there are a few couples that are field medics. They are not allowed to be on the same ambulance together, but could work same station, same shifts etc.

Not counting the sixth street population on friday or saturday. 1 transport paramedic per 25000 residents. That means one ambulance responsible for 50000 people. We have 30 ambulances up at any given time for a population of 1.5 million in 1150 square miles.

yeah I get that, My department wants to go away from whiskers below the lip i.e. no goats. Those of us that have goats are trying to show that other departments as well as OSHA and other labor departments are ok with whiskers as long as the seal is good. Just trying to make our case stronger you know?

Hello All, I am picking your brain for info you or your department has on facial hair. My Department wants us all to be shaved for ease of enforcement. Those of us with goatees really do not like it and I trying to find out if other departments have found a happy medium. We are talking a respirator policy for N95 SCBA and half mask respirators. Any Help any of y'all could offer would be great.

Ok I will throw my blonde moment in on this.To preface this I was on the back half ofa 48 and hadn't slept in 44 of those. Dispatched for weakness in a 70ish male onset of 2 hours. No other info. Upon arrival did my assessment and as I was performing my Cincinatti Stroke Screen I asked the patient to press down with his feet. I could not get a response from the left side. I asked the patient to press down again with the same result. I then Asked the patient directly to push down with his left foot. The Patient then advised me in not so nice langauge that if he wanted me to push his prosthetic down he would have to use his hands. Talk about a bad night

We have had it on our ambulances since May of '06. It was only given in ACS WITH OLMC. Problem with that was that we could not get approval 8 out of 10 times with our STEMI pts. Personally in the last 2 years I have gotten permission for it 3 times and been shot down 10-12 times. So, that being said instead of taking it offline we are doing away with it all together. Our medical director has sited a few studies that state Lopressor in early stages of AMI is not an absolute necessity, but Beta Blocker therapy is indicated to help reperfusion within 96 hours of AMI. I will have to find the study to support that. The times I was able to use Lopressor, I liked the results I would see in the hypertensive patients, but my experience is limited. Hope you have better luck with it than I did by losing it. Keep us posted about your successes, and uses for it.

Yes you can bag a conscious patient. However, I believe it is truly an art to effectively bag a conscious patient. In my opinion you have to have the complete trust of your patient, you have to be well versed in why you actually are bagging this patient( physiology etc.) Then I think finally you need to ask yourself if it will make the patient better. If you know that your patient is having a respiratory event and their breathing is ineffective, what can you do to make him/her better. Regardless of your skill level you have tools that can make your patient better, or at least not let him get worse. If NRBM made him better, then fine. In your case it didn't sound like NRBM made him better. You then have to move on to your next tool, the BVM. The positive pressure from a BVM can help the situation you described in your patient presentation just like the change in position from supine to semi-fowlers. This is just my opinion and personally I am a big proponent for Assisting ventilations in an ineffectively breathing patient so it may seemed a little biased

I think MICU is appropriate, no offense to any M.D. or Nurse or Fallout. I understand your points and they are valid but when working an acute case we are providing initial intensive care. while all of our cases are not acute ok 95% percent of our cases are not acute but for that 5% when we do intubate, defibrillate, cannulate, medicate, etc. that is at least to me intensive care. I do think it is a better choice than ambulance or meat wagon or maggot wagon or bus or any other derogatory word that describes our Profession and our vehicle for that profession. Maybe we go with MATV Medical Aid and Transport Vehicle. But that is a mouthful. Maybe just Medic X and Aid X for ALS and BLS units.

Dust you and everyone else make great points. I wasn't trying to stir a pot or get everyone off topic. I apologize for that. I think professionalism is a state of mind since we haven't established what a professional is supposed to look like. I have experience both as a fire/medic and a third service medic. In my experience (8 years) it seems that the public looks to the person that looks LEAST like everybody else to be the professional i.e. the fire lt. in the white shirt as opposed to the 2 medics and 2 firemen both in blue. Before anyone questions it I know it is a broad generalization that I just said, but like I said just my experience. If EMS wants to be taken seriously we should on a whole try not to look like FD or PD in any way shape or form. I think White is good, but there are white shirts in the fire service. I think whatever is decided in order to look "professional" A paramedic in Dallas needs to be the same as a paramedic in Chicago, and Austin, and Detroit etc. But then again A Fire/Medic will never look like a 3rd service paramedic or private medic. SO I guess my point is if someone can portray a professional look; a clean shirt, clean pants clean face etc, then maybe the public will think they are a professional. I wish I had the answer

haha... no I just work for a service that believes in looking the part. You know the whole if you look it you must be it thing. Doesn't matter to me if they wanted me to wear a pink tutu and bunny slippers with little wings I would as long as my pay check, my pension, and my benefits kept going in and I still got to be a paramedic. Seriously though, I think if your service wants you to look professional, then look professional. We all want to be in this business and we all want to be good if not great at it, then who really cares about a uniform. Let's talk about other things like services eliminating intubation and External Jugular Vein Cannulation. Or services that do not do 12 lead Interpretation or teach 12 lead interpretation. Sorry I will get off my soap box.

Alright I will throw my hat into the ring. We wear white blauer cool max poly cotton blend button down with epaulets name badge department badge state credentialing name badge and award bars(optional) as our class b normal work uniform. Our class c daily work uniform, you can wear b or c no big deal, is the blauer polos with sew on name plate, sew on, department badge service patch, and cert patch. we wear those with either blauer ems trousers or the 4 pocket uniform trouser. Our button down shirts must be creased and pressed. boots should be polished, and pants should be pressed. class a uni is the long sleeve button down with 4 pocket trousers and tie and all the award bars badges and brass you have been issued. for cold weather we have the green blauer coats and also can wear the wool sweater or a blauer fleece.

Austin Round Rock Area Huh? Let me see, you could apply at Austin Travis County EMS, My opinion the best service I have worked for and where I plan to ride out my career. You can check them out at atcems.org. There is also Williamson County EMS which is a fairly large county based third service that last I heard is about 25 paramedics short staffed. Check out jems.com for their web address. in this area there is also acadian which is transfer only and AMR which is basically transfer only. There is also Guardian EMS which does the 911 for Bastrop County which is the county east of Travis county. South of Austin there is San Marcos/Hays County EMS. Not Sure about their staffing needs at present. In Regards to your license Texas takes the NR reciprocity with your fee which I believe for a paramedic is $136. All of that information from Spenac is correct for your license. If you have any other questions regarding the area feel free to drop me a pm and if you are down here you can schedule an observation ride with Austin also. Let me know if you want to do that and I can help you schedule that. Also to answer what Jake Emt said, I am not going to stroke my own ego or my departments ego. The system has received several awards and in 2006 also received an award for the model 3rd service. As I said I am exceptionally happy here and plan to ride it out all the way to pension. Like other systems we have our problems and we also have our high points. Like I said feel free to ask anything you might want to know. If your interested you can also see our Medical director website at ATCOMD.org. the site has our protocols and other info posted. Good Luck with relocating and let me know if I can help you with anything

I know what i dislike about my job and my biggest pet peeve is the malicious 911 abusers. I don't care that I see the same person 200 times in a year for rectal pain. When I start to care is when they are rude and belligerent and start in on the "My taxes pay your salary" and "you tracked mud into my house who is your supervisor" or my favorite "I know the mayor and I could have your job on a plate." These are the folks that bother me. It was their choice to call me and now they are gonna treat me like dirt.... oh well I guess that is why I get paid well for doing what I do. I can complain about it all I want too and it still won't change the fact that it happens to medical professionals every day all over the country if not all over the world. because of that I really really try to not complain, but rather come in do my job kill them a-holes with kindness collect my paycheck and lord willing collect my pension and get on with my life.I take my job seriously and won't let something like this ruin my career. To me it is more trouble to dislike these things and get upset about than to just deal with it and laugh about it later. Just my 2cents

From muy experiences prior to moving to Texas, in Will County you can work for an FD as a basic and get ambulance time as a basic because they go one and one. You can also run One and One on a few of the privates like Kurtz and Med Care or I think they call it Trace East now Other than that there are a few privates in Cook County that have 911 contracts where basics run. The only downside to that is you also run transfers. Those Companies are Bud's, Trace, and Vandeneberg. In Dupage county the only places I know where basics get on ambulances is private services like Superior and First Care. Hope this help a little

I think we have the protocol books for a reason, Reference. If you need to confirm something use the book. I think for dosage stuff your pocket guides are invaluable, especially if you are doing weight based pedi stuff or drugs that you don't just use on a regular basis. I agree with Dust that if you are looking your standing orders to see what happens next on a regular basis, you should probably be a garbage man. just my 2 cents