medic_texas

Valium can be given rectally for situation that you cannot obtain IV access. We also have the IO but it depending on the situation, I could draw up Valium faster and give it rectally than doing the IO route. IO could be my second treatment after administering Valium.

Regardless of the system, short transport time, and his lack of knowledge/training, he failed to act aggressively and appropriately for this patient. Let me clear this up, I'm all about educating someone but when it's something that should have been taught in class, I would be frustrated when educating them.. again. GCS of 5, rales, weeping edema, CHF, RR of 36, and the guy gets a NRB ONLY? I don't know what your protocols are but I hope they are more aggressive than that. Why did you "feel" the patient didn't need to be bagged? Because he was drowning or because he was dying? :x

I think you dropped the ball on the patient and you deserved to be yelled at, I would have. Not only was his respiratory rate fast he had diffuse crackles, history of CHF with weeping pedal edema. What did his feet look like? A GCS of 5 and you only place a NRB on the guy? He was gurgling while laying supine and stopped when you sat him up? What does this tell you? What is your first s/s of poor oxygenation? How do you correct it? What is your respiratory distress protocol? What is your airway assistance protocol? Gag reflex? ALS backup? Did the NRB bring his GCS up? How can you be "alert" and have a GCS of 5? I would have bagged him (if I was a basic); it's hard to time it when they are taking a breath but it's possible.

I'd stay put until you get your medic cert in hand. I would then check out Rockwall or some of the other services that were posted. I looked at Rockwall a few years ago, they pay decent have aggressive protocols and seem very friendly. CareFlite isn't that great of a gig on the ground unless you just want to be a transfer monkey. 911 experience is going to look better on a resume than non-emergency transfer experience. Good luck with the job hunt.

These words come to mind.. Negligence Abandonment Discrimination Uneducated Lack of training The "seasoned" medic that told you to stop starting the IV should be reported. Withholding treatment due to someones HIV/HEP-C status isn't smart. If that came under question would the excuse of "they have HIV" going to bail you out? If you are not trained well enough to start a IV on someone who is infected with a bloodborne disease then you are not well trained at all. This just goes back to paramedics not being educated enough, trained enough, or have their eyes opened up enough.

Nessie, The call sounds horrible and I'm glad that you are reaching out for help. This is the type of thing that can come back and haunt you (PTSD). I have been in a similar situation and it is heart breaking. CISD is awesome and I feel that it really helps. Don't be afraid of appearing "weak" because that is not the case, ever. I'm sure there are a number of people here, including myself, that would be more than happy to talk to you and help you through this. Keep in touch and get well.

The lights and sirens asks for the right of way it does not guarantee it. If you are not slowing down and/or stopping at intersections, regardless of red lights, yield signs, or stop signs, you are not doing your job safely. Best advice is to clear all intersections before you approach and go through. It never fails that some idiot, who is deaf and/or retarded gets pissed and goes around the other vehicles that are yielding the right of way to you. I have first hand experience with this and it hurt a couple people in the back working a code. The intersection was clear, they went through it and almost made it across when someone went around the stopped vehicles (an old man with no patience) and t-boned the ambulance. He thought he did nothing wrong and had no clue that the ambulance was in the intersection (deaf?). Even when you're careful things can still go bad. Just stay focused and drive carefully.

Adding to my above post. She is a threat to herself, her patients, and her co-workers in the state she is in. That does not mean she can't come out of it and lead a normal and productive life. I used to work with someone who is in that exact same situation. She is working again after some time off to heal and recuperate. I have no problems with that.. But the state should be notified in case of a relapse and/or other issues that pose safety concerns.

The state needs to be notified of her condition and the suicide attempt. In my opinion, she poses a threat to patients, co-workers, and herself (obviously).

http://www.fpnotebook.com/Neuro/Exam/GlsgwCmScl.htm http://trauma.ucsd.edu/Portals/0/47%20GCS.pdf The second one is a better reference as it has infant, child, and the regular GCS scale to compare.

Use the PGCS (Pediatric Glasgow Coma Score) to figure the LOC of the child. This is used for children 2 years old and younger. Best eye response: (E) 4. Eyes opening spontaneously 3. Eye opening to speech 2. Eye opening to pain 1. No eye opening Best verbal response: (V) 5. Infant coos or babbles (normal activity) 4. Infant is irritable and continually cries 3. Infant cries to pain 2. Infant moans to pain 1. No verbal response Best motor responses: (M) 6. Infant moves spontaneously or purposefully 5. Infant withdraws from touch 4. Infant withdraws from pain 3. Abnormal flexion to pain for an infant (decorticate response) 2. Extension to pain (decerebrate response) 1. No motor response A child can be crying AND have a significant decrease in their normal level of consciousness. I would have treated the child aggressively with IO/IV, RSI, and rapid transport. To answer your question, YES this child is "unconscious" enough for the IO.

Another point to my argument that volunteer EMS needs to die. There is a need for volunteers but not as primary/first responding crews. I feel volunteers should be secondary to a primary crew in most areas. Some areas are too rural and small to have fulltime crews, and I'm ok with that. Studies should be done and towns with less than.. 500 people can have vollie only (that is just an example off of the top of my head, don't attack me). Laws should mandate that if they are responding code-3 to a call they should have the required insurance coverage. This is just like NOT having insurance at all because if you are responding code-3 without the proper insurance, you are not covered. What's the difference? I don't see any.... Stop working for free.. my job isn't a hobby.. Good post Spenac.

If that was the meaning, then I agree with it. However when I read it (and yes, I was a little tired) I was like... uhh.. why do NP have to change their mindset? I'm leaning towards PA or FNP honestly. I did love doing my intubations with an Anesthesiologist in the OR during medic class and in nursing school me and the Doc got along great (swapping ET stories, he was an old medic too). Plus, CRNA's BANK!

Some lucky medics there. My questions are.. Why was the scene not secured by LE? Did they know the 21 year old was in the residence? Did the 21 year old shoot the 20 year old? And finally.. you IDIOTS! Never go into a scene that isn't secured or cleared. He could have shot the medics and then himself. Nice guys.. nice..

Doc, I disagree with your statement about NP's "mindset needs to switch". Nursing has it's own approach towards medicine. True, the nursing approach is different than traditional medicine (MD, PA) it is still effective and has purpose. I think to fully understand nursing you must be a nurse. Example: a lot of nurses don't understand why medics do certain things and vice versa. It's not a knock against nursing, PAs, or medics, just explaining that it is different. I'm sure you have encountered some incompetent people while working, doc. I do agree that nurses with an EMS background are better nurses as nursing does lack in some areas. I think the "nursing theory" is a lot of common sense to medics but I think this "theory" is mainly to get away from officially diagnosing patients (medical diagnosis) but still addressing their problem. We left out CRNA. I think FNPs have an advantage over PAs simply because they have experience in the medical field. As with every area of medicine, we have our bad apples (the morons) and we have the good apples (the ones who do a great job), so I'm sure our personal opinions reflect some of our experiences with each area (MD, PA, RN, medics). I've been a paramedic for 6 years and I will graduate RN school in May. I'm like doc, I really felt like I achieved everything I could as a medic. I felt like I could do more and better myself; but to continue to support myself and my family for the next several years, I chose nursing. 2 1/2 years to get my RN and make about double what I make now seemed like an easy choice. I also have other reasons like: Working with an RN for a flight service, I do the exact same job as they do. The difference is they make twice as much as me. Why do the same exact job for half as much money? Also, nursing opens many doors to me (PA, FNP, CRNA, or management). PA or MD would be very limited for me and I tend to get bored easily, I feel like nursing will give me an opportunity to change if I needed a change. There is a PA program that I'm looking into that is designed for nurses. FNP programs in my area are mostly online. And CRNA school is tough and would be similar to medschool, only shorter in time (similar because I wouldn't be able to work and I would live off loans). I'll make up my mind as soon as I figure out where my life is going to go after I graduate. Congrats to anyone who has or is looking get an education and advance their career! Sorry if my grammar is poor, I worked last night and I'm about to hit the hay! Be safe!

Type I Wheeled Coaches and ford F250 "fox" trucks. http://www.lubbockems.org/images/ems%20poster%20small.jpg Old paint scheme New trucks with new LED light setup

Don't we have enough to do just DRIVING to the call than to call someone and do an assessment over the phone? That's stupid. I've worked both sides of the fence as a dispatcher and a field medic. Dispatching is a very important and complex job. Lots of multi-tasking (reading maps, talking on the radio, and giving pre-arrival instructions over a 911 line at the same time) and lots of training to do these many jobs. So, while driving to a call "spiking bags", reading maps, talking on the radio, looking at intersections so your partner doesn't get you killed, reading street signs, operating sirens, and talking to this patient over the phone sounds like a good idea huh? Ridiculous.. Sorry if I sound harsh, but this is really a stupid topic. Maybe your dispatchers need better training so you won't have to second guess them. I think your questions need to be geared elsewhere like "how do we get EMD certified?"

Thanks everyone! I just put down what I want to do with this new service. I hope we all continue to make EMS a better profession. I think we all have something to bring to the table, everyone has great ideas! Thanks again, as soon as I receive the package I'll let everyone know.

I’m currently working on getting an EMS service set up in the southern part of the county I live in. This area is called “Woodrow” and has a volunteer fire department, a school system, and many neighborhoods and housing areas. This is being started as a “Non-profit organization” and every cent that is made is going to be put back into the service. This is in Lubbock County and if you look at a map of Lubbock County, you will notice that along Woodrow road and US 87, there is a large area without adequate EMS service. Response times are very lengthy (between 10-15 minutes depending on which station is sent and where the call is located) and obviously transport times are lengthy. I live in the South part of Lubbock and I also have family in the Woodrow area. The calls vary from MVCs to major medicals. There is a major intersection in this territory and is considered by many "the deadliest intersection in Lubbock County". An average of 3-5 calls are made to this area daily. www.lubbockems.org has a map that can show you the southern part of the county (between Slaton and Wolfforth). First, we need a station. Two drive through ambulance bays with extra large bay doors. The floors of the ambulance bay will have drainage systems. The bay will be heat/cooling equipped and also insulated. The bay will have adequate storage for truck supplies, extra equipment, oxygen bottle storage, and a cleaning/decon station for backboards and other equipment. Also, a climate controlled supply closet for the extra medical supplies. Moving into the station, we need a conference/training room. Equipped with an overhead projector, tables, chairs, and training equipment (CPR dummies, fred the head, a training AED/12 lead machine, and other training equipment. Education is KEY!). This room will be used not only for EMS, also for public education and regional training. Adequate storage will also be needed to contain the training equipment. Near this area, offices will be needed for report writing, management, and billing and records. A living room complete with TV, recliners, and windows to let sunlight in during the day (I have stations without windows, what is this JAIL?). The kitchen will be complete with a nice eating area (enough for family members or visitors to eat with the crew). The kitchen will have a fridge, microwave, stove/oven, toaster, and adequate lighting (ever try to cook without good lighting?). The kitchen will also have a window or two. The crew quarters will have space to move around in, a closet, desk, and a pillow top mattress on the bed. Between the bedrooms, a nice bathroom with shower will be needed. A fitness room will also be needed. Weights, treadmills, stationary bikes, and various other equipment that are suggested by the employees. A fitness policy will be put into place and employees will be monitored to make sure they are fit and healthy (less insurance costs, less injuries, and a happier healthier employee). Wireless internet and a foyer complete with a couch and chairs for other members of public safety to relax in while on duty (SO, DPS, FD, EMS). This will not just be a EMS station, but a public safety station. We are all on the same team in my book. Since we have 2 ambulance bays, that are extra large, 2 ambulances will be needed. Two wheeled coach medium duty ambulances will sit there. Outside it will be equipped with dual air horns, Federal signal Q siren, and dual whelen sirens. LEDS all around (red and blue). Stryker cots (the ones that raise at the touch of a button!) in the back, Lifepak 12’s with all the bells and whistles (CO2 detector, auto BP, pulse ox, 12 lead and biphasic capable) and a airway bag (containing 02 bottle, BVMs, first line meds, glucometer, combitubes, airway/intubation kit, and some bandaging/splinting supplies). Outside the ambulance, I would like to have SCBA gear, jaws of life, bunker gear and helmets, and other rescue equipment. And obviously, the normal equipment that is on every ambulance (too much crap to list here! You get the idea!). The rest of the money will be as follows. Insurance plan, retirement fund, education fund, and a general fund for uniforms, pagers, radios, and station supplies. After that is set up, the remainder will be invested in Roth-IRAs. The money that the services brings in will be put back into the service and then returned back to the employees (better pay, retirement, benefits, equipment). Recruiting and retention are very important, also the staff moral. I also want to include yearly raises, Christmas and performance bonuses, and a emergency fund for the employee that hits a rough spot in life (paying for a funeral, birth, medical expenses, sick/extended leave, etc). I hope to have many education programs, have in house training, and offer competitive salaries. Tuition assistance, vacation, holiday pay, and a medical expense fund. I want to be an example to other EMS services of what EMS truly can be; a professional, educated, and valuable part of the community. This is only part of what I hope will happen, but it is the general outline of what I have planned without a million dollars. I guess blood, sweat, and tears will have to work.