Niftymedi911

I'm a former Manatee County Medic.  What would you like to know?  Sorry, but I'm just getting back to this site.  

Mine is a hybrid of Chart and Soap. Med-5 responded via 9-1-1 dispatch to a female with chest pain. Upon arrival found 62 y/o female seated upright in a kitchen chair. Patient is noted to be aware of surroundings and presents with levine's sign. Patient reports that earlier in the day, while she was weeding the lawn, she developed sudden onset chest pain / Indigestion that caused her to break out into diaphoresis. She reports that she came inside and layed down thinking it was just the tacos she had for lunch. When she woke up, she reports the pain is worse and she vomited. Patient reports that she took some Tums and ASA just in case because she's had a prior MI in the past. Patient reports the pain is a 10/10, radiates to her left arm and jaw. She reports its a constant heaviness that makes her nauseous. Patient reports that she took the meds at 1400 and time of onset was 1330. She reports her cardiologist is Dr. XYZ at Madeup hospital which is a PCI hospital. Patient reports no further. Patient is placed on 4 lpm NC, baseline vitals, and given 324mg of ASA. Patient is assisted to EMS stretcher and moved to awaiting ambulance. Patient received rapid 12 and 15 lead ECG with revealed ST segment changes inferior lateral. No RVI is noted. Transport is started to Madeup hospital. While enroute patient received: SPO2, Serial 12 leads and ECG monitoring, IV NS Lock x 2 18G in bi-lat A/Cs, MS04 total of 10mg in mg increments and x 3 0.4mg NTG sublingually. Patient is noted to respond well to treatment with an overall pain decrease to 3/10 with ST segment elevation receeding but still present. No further changes were noted. Code STEMI is called and 12/15 lead ECGs are relayed to PCI. Upon arrival to ED, EMS bypassed the ED and brought the patient to cath lab where report to RN and staff is completed. No further incident. FCJ Original Document Treatment times are approximate.

Is chat free again or does it require subscription?

I'm available most of the time. Just post a date and time and ill try my best to be there.

What is "Action Jackson"? What is "SOA"? Please don't say shortness of air. There is no shortness of air. As for your question, I agree with CHBARE. I'm wondering, too, what evidence you took with you to present when raising these questions. Action Jackson is my term of endearment everyone calls me by. It was derived after a shift I had where I was first due to a plane crash and MCI bus crash @ 55 mph all in the same shift. SOA is an accepted term here in lieu of SOB. I'm used to using the term dyspnea myself, however after working 3 years in Kentucky I was sick of getting called an arrogant A hole because I used big words. So, thus why SOA. As far as evidence, 2010 AHA ACLS guidelines is a start for some of the stuff. However, I didn't even get that far. I was cut off in mid sentence and told no. Which is why I took to the masses to see what kind of atmosphere there was about it. I mean well with my posts and I do have the capability of putting all the studies that pertain to it as evidence. However, I am tad bit under the weather today and don't feel like it.

Dammit tapatalk is merging all of them together. Sorry for the jumbled mess.

Am I the only one who immediately though that old guy from Liberty Medical is out of a job?!? LOL. Action Jackson

C-Collar/LSB removal, Induced Hypothermia, removal of Atropine, Removal of Morphine, adding Ketamine, adding chemical restraint. Yes, we still use atropine. :/ It really is sad when the state EMS Board is too lazy to make they're own protocols/Guidelines they just copy and paste the one state that has the most restrictive. This all started after I was QA'd for not putting a C/P on 15 lpm NRB with no evidence of SOA. When I heard them say the ole mantra of "Everyone gets high flow oxygen". I could do nothing but *facepalm* Action Jackson

With the paradigm shift of EMS moving from a protocol/standardized assessment approach to pure evidence based medicine, have you encountered a lot of resistance from administrators to accepting these changes vs. what currently works? I work for a small rural service that prides itself on its good reputation to provide excellent medical care. But, with this in mind, would they not want to follow the paradigm shift to provide the best? I started this conversation with my current employers and they couldn't answer me. I'm looking to see what the attitude of the general population of EMS thinks. Action Jackson

I love tapatalk. I'm actually posting using it right now. Action Jackson

Oh dear Lord, it's been what 9 years?!? This will be epic!

You know, we always used to butt heads about how much of a Lee County fan boy at one time I was. Hell, when we chatted we even got in arguments about who was getting home (heaven) first. Well, Rob, looks like you just had to beat me down just one more time! I'll never forget you, you were an amazing person and about the smartest person I knew when it came to anything about public safety. God Speed Rob! God called an AMAZING angel home.

Welcome to the city! I started here 6 yrs ago when I was brand new. Been some of the best help and knowledge to date. Just please don't take this the wrong way, use the search function before posting on a topic, can't tell you how many redunant posts there are.

First off,

Good Luck!!!!

Second its 10 push-ups, 10 sit-ups, 10 jumping jacks, carry a 250 lb backboard patient 250 ft, stop do two minutes of CPR then bring him back to a awaiting stretcher, then place him in the back of an awaiting rig. Carry a 50lb med bag a certain distance, and few other things that I can't remember. But its been like 6 years since I've had to take it.

LOL, my nickname at work is "Action Jackson" bc of the same thing....... if it's gonna go down on my shift, its my call. It's not actually all that bad though. It keeps me on my toes. I say bring it!

your running your 29th 9-1-1 call in 31 hours of your 36 hr shift with close to 550 miles on the odometer since shift change and you get notified en route by FD its a v-fib arrest to a 350 lb pt. on the third floor an apartment complex with no elevator.

Just happened to me Sat. Does anyone know who to please the EMS God to take my black cloud away?? Seriously 5 yrs of black clouds is enough.

Skydivediva,

As a fellow Lee County citizen and Lee County Paramedic here's hopefully some insight to your questioning:

Part-time employment is only for those who are employed full-time and are credentialed through our medical director and are willing to switch to part-time. The county does not hire part-time paramedics or EMT's straight off the street.

Our shift schedules are 24 hrs on 48 hrs off in a A, B, C, shift pattern. Meaning if you are assigned to A shift you work every A shift which is always every third day after the end of your previous shift. It's the same for B and C shift. So if today is an A shift then tomorrow is a B shift, and so on. Now we also do have 12 hr shifts called D and E shifts. they work 2 on 3 off one week and three on, two off the next. But as far as scheduling goes that's it.

Part-time employment means you sign up for your shifts ahead of time. You get to pick them. The only obligations are, you cannot work more the 48 hrs in a pay period (two weeks) and you must work at least two shifts (whether its 24 or 12) a month.

We also do not hire volunteers.

As far as the 16 new ambulance thing, that's news to me. If they're obtaining that many its not to add new trucks, its to replace the aging fleet of ambulances we have currently. The budget was slashed more then 40% over the past two years. We are currently operating on 2004 budget standards. Meaning we're operating on what we did in 2004.

Our call volume is up close to 25,000 more calls then 2004 (50,000 runs for 2004 vs 78,304 for 2010). For instance, if each call we're dispatched to cost the county $176.00 and were responding to an additional volume of 25,000 calls this year it would cost the county 4.4 million dollars more over the 2004 budget standards to run the system. So we're sitting in rough shape because of economy. But there have been no layoffs, no pay cuts, and no trucks shut down. They're hiring now, bc we just had a few people go to part-time. So they're trying to back-fill those positions to keep things status quo.

So should you go to school and follow through with it? Absolutely! It is one of the very few careers that are as rewarding as ours. I hope this helped you. If you need to you can PM me for more information.

I will send you a PM as soon as I get done writing this. I'm used to 100k+ per year call volume, I used to working 36-48 shifts (my schedule is 24 on 48 off) with no sleep and I'm used to getting mandated every few weeks. I really do enjoy the agency that I work for (because of the freedom to practice here). But, I want to be more involved within my agency then just clocking in and clocking out everyday. The feeling of being "stuck" is not because of lack of promotional tree, but lack there of having the ability to be involved in pretty much anything besides running my ass non-stop (last shift I ran 20 calls in 24 hrs with a whopping total of 22 min spent in station), its getting to be really a pain in the ass. Administration is a closed group of good ole boys which isn't going to be changing anytime soon. Oh and croaker, working the system I'm in, with as much OT as I pull, (sometimes by choice but not all the time) there was a study done, that the equivalent of 3-5 yrs work here was the equivalent of close to 8-10 at any other comparable agency. And no I don't want a cookie. LOL

One word HIPPA. Read up on it bc you will surely need to know it.

There is more to it then just feeling pinned. But its kinda hard to put into words. RSI isn't all that important to me although it does come in handy. Thank you for the website ill have to look through it. I don't have many friends neither does my wife

We were up there for a week with a few friends that we have known for a while. And absoultely loved it. So hence why the move.

Hey ya'll,

Long time no see eh? Did you miss me? I was just wondering if anyone could quite possibly help me get more information on Louisville/Metro. I've looked at their site, wiki page, etc. I have much of a pretty good idea, but one thing that I cannot find anywhere is their protocols. I heard that they were majority of online protocols and I really hope that's not the case. I'm looking to move to the Lawrenceberg / Lexington area this year. I'm a a non-fire degreed Paramedic with 5 yrs experienced with RSI etc. coming from a county that has the most advanced progressive protocols in the entire country. I just feel at this point I'm stuck in my current position without the ability to promote without going back to school without at least another 2-4 yrs. Which is something I really don't want to do. I'm planning on working two part-time gigs for Anderson County and hopefully Air Methods as a flight medic on top of working for Louisville. If anyone could shed some light on them, from a road crew perspective, I would really appreciate it!!

Brother and Sisters of EMS, it is with a heavy heart that I inform you all of the passing of one of the most kind hearted and honorable people who worked for our agency. Here are the details and news article concerning the death. It was a senseless act of murder and should NOT of happened. Please send prayers our way as we are a very large, but very tight knit agency where everyone knows everyone and some are taking it very hard. I worked with her about 3 weeks ago and was one of my prefered people to work with if I had a choice. Please go home tonight and hug your significant other and children and make sure they know they're loved. Because you'll never know if its your last day on this planet.

God Bless you All

Fred Jackson Aka NiftyMedi911

Credit to NBC-2 News and its afilliates.

http://www.nbc-2.com/global/story.asp?s=13096387

Ruff. hey i think you might be mistaken. I work for Lee County.

Also, please keep our Agency in your prayers tonight. We lost one of our own to a senseless act of murder. Please, please, please......

Thank You!

Since we are on this topic. Does anyone else use Etomidate?

Not only does it have a rapid onset (1-2 minutes), but it has a shortn half life (3-5 minutes) for those fearing Trismus.

I understand correctly. Can't Etomidate inadvertently reduce ICP??? I am not 100% as to it's mechanism of action.

We have a CAM/DAI (Crash Airway Managment/ Drug Assisted Intubation) Protocol here. It entails the use of Etomidate and Succs in cocktail fasion. We also have a Fentanyl, Ativan, Versed cocktail for sedation in post-DAI intubations. The etomidate has been shown to reverse the ICP caused by direct largynscopy. It is an awesome tool when used properly and followed through flawlessly. We used to have Diprivan for post-intubation sedation, but too many people were finger flicking the doseages instead of using an IV pump, causing Diprivan dumps..... a no, no.

Here's a copy of our Medical Guidelines:

http://internet.lee-ems.com/intranet/EMS/pub/doc/2010/1/20100111103119_publication.pdf

ScoobyKate, he can bash them if he wants to, tis a free country. I find it comical sometimes. This issue and a majority of issues found with cases concerning vollies is plain and simple.... lack of medical oversight. Paid services have people who do that 24/7 (QA/QI). The paid services obtain training for their employees to be able to handle these types of calls. Just by reading what the news reporter wrote. The use of restraints was indicated with this incident. He presented with a classic case of agitated delirium, caused harm to himself (stabbed himself), and ran from authority. He's now a threat to himself, a threat to me, a threat to my partner, and a threat to anyone else on the road, while my partner is navigating the route. The unpredicability of mental patient's like this requires you to counteract that unpredictability and plan ahead. This guy wouldn't of step foot inside my ambulance without being restrained. Had the guy been properly restrained and monitored this would of never happened.

Oh crap I forgot to clarify restraints..... soft wrist restraints with police escort following behind the rig. Ativan or IN Versed at the ready just in case.

Breaking it down Kiwi.....

If you were to follow that SOB/CP/Rales protocol, it would indicate the use of NTG, Lasix, and CPAP. NTG is contradinicated to begin with..... But with the indicated heart failure due to poss pericarditis, he's dependent on pre-load. You give him NTG, you kill him plain and simple. Also, if you were also going to be doing CPAP, you will be increasing the intrathoracic pressure in the chest. With someone who's already suffering from an increase pressure on the heart, more pressure would also send him to asystole.

Tx: (In this order)

High Fowler's Positon on stretcher

15 LPM NRB and prepare for DAI

Diesel

IV x2 (Still kinda of leaning to giving this guy a fluid challenge, I'll start a 200 cc bolus and see how things change.)

Continous NIBP,Cardiac, 12 lead, SPO2, ETco2 monitoring

Radio report

Offload to ED