Fire Medics

[Richard B the EMT]

I visited the Triage Room, at the Duty Determination Clinic at the FDNY a few days ago. The teams in the room now have an automatic BP unit, but claim the thing takes so long to use, they continue with the older manual ones, in order to save time

Go figure..

[Kiwiology]

This highlights an issue with prehospital intubation. The physical skill is easy to teach and to learn. WHEN to tube someone, how to look at the whole patient condition, then the whole scene, then the transport, then the ER visit, then the ICU admission, all in the blink of an eye, and translate this into a decision, instantaneously... THAT is the skill that takes so long to master.

'zilla

Whip out an LMA, shove it down thier gob and blow up the cuff .... viola! So simple even a Firefighter can master it!

If that doesn't work call for an RSI trained Intensive Care Paramedic or Doctor provided they can locate you significantly faster than the patient can be delivered to hospital.

Edited September 22, 2010 by kiwimedic

[Doczilla]

Except that the LMA does a rotten job of protecting the airway from aspiration. It's great if the patient has been npo for 8 hours and is being electively intubated with minimal bagging beforehand.

'zilla

[spenac]

Except that the LMA does a rotten job of protecting the airway from aspiration. It's great if the patient has been npo for 8 hours and is being electively intubated with minimal bagging beforehand.

'zilla

You mean our patients are not text book perfect cases? I am shocked.

[Don1977]

Havent been on in a while so i appologize for that...

Is it me, or have the level of training and professionalism in this business degraded over the past 15-20 years ????

So, I go on this call the other day. Female stabbed in the chest, with absent lung sounds on the injured side..

Fire based ground unit does a good job and decompresses the chest, even sedated the patient first... sooo cudos for that..

Now the weird part, they advise this is a critical airway and they want us to RSI the Pt.

Only problem, the patient is like a class 4 airway, and she is about 250 lbs. Also she is concsious, breathing, talking, and ohh yeah good BP good pulses, and her O2 Sat is 98%.

I just do not know how paramedics get such tunnel vision..

OK RANT OVER

Standards of EMS are down in some areas, try PA...wow.....glad Im moving away from the state soon...

[FormerEMSLT297]

One of the other problems in the DC, MD, VA area, is that in order to become a Firefighter, you HAVE to BE AN ALS PROVIDER. I will not use the term Paramedic, because they are O.K. with EMT-I/99...

So we get a lot of FF candidates who push thru the I or P class, only to land that paid firefighter job. Watching a lot of them work, they do not care about EMS or Pt. care, they just do it cause the have to....

Sounds like I'm not the only one who has these problems.

Thanks for letting me vent hearing my stories, and sharing some of your experiences, sometimes i just feel soooooo alone when it comes to these things.....

[firemedic37]

Whip out an LMA, shove it down thier gob and blow up the cuff .... viola! So simple even a Firefighter can master it!

I find it interesting that someone even mentions LMA's. Then again you are not from the US. I have never seen an LMA on an ambulance in Iowa. But then again we let First Responders insert Combitubes if you can even find those anymore. Also the LMA is a Paramedic only skill and no one wants to spend the extra money to stock them when they will never even be used.

Everyone around here has switched to the King Airways and they are very simple and easy to use. And yes even firefighters can get an airway.

[Kiwiology]

One of the other problems in the DC, MD, VA area, is that in order to become a Firefighter, you HAVE to BE AN ALS PROVIDER. I will not use the term Paramedic, because they are O.K. with EMT-I/99...

Yeah but Maryland has "Cardiac Rescue Technicians" how cool is that? I mean gush, what an awesome title, like super whacker

Everyone around here has switched to the King Airways and they are very simple and easy to use. And yes even firefighters can get an airway.

The King airway is essentially the same as an LMA, it isolates the trachea a bit better I will admit however. Supraglottic airways are bloody fab and so easy, you just shove it down thier gob! We have been using LMAs in New Zealand since about 2005 and they work very well.

[DwayneEMTP]

Only problem, the patient is like a class 4 airway, and she is about 250 lbs. Also she is concsious, breathing, talking, and ohh yeah good BP good pulses, and her O2 Sat is 98%.

I just do not know how paramedics get such tunnel vision..

OK RANT OVER

I'm curious as to your level of certification? No dissing you brother, but it is relevant to your story.

I get suspicious of these kind of stories as they seem to contain just enough information to make the point. If you want to do a case review on such a call I like to have more information before I can get on board calling these guys dumbshits...

Would I RSI a decompressed talking pt? Sure, if I felt that physiologic degradation was imminent, there were other injuries that that I felt might compromise the airway, If the pt was unruly to the point that I believed that they were going to further their injuries and chemical restraints were not practical, If despite the fact that they were awake and talking I felt that they were to exhausted or injured to continue breathing on their own for a long trip to the hospital, etc. My point being that while it sounds good to say that these idiots wanted to RSI a pt that is awake and talking, in real life if you use 'awake and talking and her vitals were fine!" as your main criteria for whether or not to employ such a valuable but dangerous intervention then you really shouldn't have access to it.

I'm not saying that you missed any of the above conditions, nor that you don't know when to employ this intervention, only that if you are at the basic level, you're talking out of your ass when you make the statements given with the information provided, and if at the medic level you really didn't include enough information for me to know if I agree with your opinion or not. See?

Dwayne

Yeah but Maryland has "Cardiac Rescue Technicians" how cool is that? I mean gush, what an awesome title, like super whacker

I'm on the oil spill in the Gulf of Mexic and we just got re-badged the other day...(ID badges)

My new badge says, "Pararescueman Technical Specialist." Ta Da!! I said, "You know, I don't think that is really a title." They didn't care, as they were badging people and not medical people.

So I said, "If we have to leave that title, is there some way that we can add Ninja to it? You know, Pararescueman Technical Specialist Ninja? That would be so hot!"

Turns out that badging people seem to take their jobs very serious and don't enjoy badge making humor....

Dwayne

[tniuqs]

You know, Pararescueman Technical Specialist Ninja? That would be so hot!"

Dwayne

Can I get your autograph now ... in invisible ink ?

But you know you now WILL be forced to change your avatar picture so I located one for yall.