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First off, in EMS we use ALL of our senses as we make our clinical observations, and offer differential diagnoses. We have to be able to 'paint a picture' for the recieving staff, so they can take the appropriate steps in continuing patient care. Since there are a myriad of 'abdominal complaints', palpation will help narrow down the chief complaint of 'my belly hurts'. You claim to be a paramedic, and yet you don't advocate a 'full focused exam' strongly leads me to question your ability to be teaching students! Repeating this poster's comments, I would love to see what you're basing the 'Don't ever touch the abdomen' philosophy on. As the poster asks, is this in your protocols, do you have case study to base this on; or is it just your own 'personal standard of care'?

Was the 'lump' pulsating? Moving? Tender? Was it an umbilical hernia? What color was it? Tenderness around it? Just curious. Do your protocols tell you not to touch the abdomen in any way, for any patient? Or is that just something you set as your own standard of care?

Why NOT teach them? I for one believe that it is an important part of doing a complete assessment. And I agree with the previous poster about lung sounds. It isn't hard to learn, and provides valuable information. EMTs have long had skills removed from their education, and in some cases, now it is being reintroduced (Combitube and other airway adjuncts). Remember the old EOA?

I have been taught from Basic level through to Paramedic - Palpate the abdomen for rigidity and tenderness. In this case, obviously it was tender. However, rigidity would have led you to suspect internal bleeding. I'm curious, what was your diagnostic impression of this patient? Are there additional S/S that you didn't post? Also, what were his vital signs?

Shrugs... because it's a part of a full exam? Distention, tenderness, pulsating masses, etc are all going to be found on palpation. Heck, why don't we go the full 9 yards? Examine, auscultate, percuss, palpate? Do you not let your EMT-Bs and ride alongs listen to lung sounds?

The EMT-B is barely a good start in medicine. Take a few college level A&P classes and work a BLS transport truck until you can get into Paramedic school. You will have your own private lab with live patients to learn assessments, communication skills and read the charts where you will see disease names and meds that you will not get to in a 911 service. You will be way ahead of most Paramedics who ignored these opportunities when they were working BLS transfer because they just wanted the "action". The dialysis patient is probably one of the sickest patients you can have daily on your truck and yet, so few even take the time to know why the patient is on dialysis except for "renal failure". The acute rehab patients your transfer for advance physical therapy may have been some Paramedic's save from a trauma, CVA or cardiac arrests. They deserve someone who is attentive and they are probably over being the center of some EMT's "excitement". You might also see what happens to spinal cord injuries and learn how these are stabilized once they reach the hospital. You might also see how hospitals document how a patient is presented to them from the EMT(P)s especially for spinal and head traumas. That can help you later when you start doing 911 calls and will be giving report to the ED staff. They do take notes on everything even if they appear not to be paying attention. It would also be interesting just to read the extent of their injuries and see how they have progressed. It can be a big motivator for you to continue your education to learn how to better serve these patients or the ones you will see in the future as fresh traumas or cardiac arrests. Take advantage of asking questions of other health care professionals when you do transport patients in a more controlled environment. Network and you might be surprised at the opportunities that come your way. If you don't make good use of the opportuniites given to you on a BLS truck, don't get your expectations up to high when you get on an ALS truck. And again, never forget that the BLS or "BS" transfer patient or the dialysis patient could have been another EMT(P)'s save. Treat them with respect. They've got a lot to offer for anyone who is interested in "medicine".

Our county's emergency dispatch center recently started texting both fire and EMS calls-as soon as a call is saved into the computer, a text message is sent to a provider's cell phone. Does your city/county's dispatch center offer this?

So, it's the stroke of midnight on New Year Eve. I'm sure we all have good drunk stories to relate, but I'm referring to work. Where's the oddest place you found yourself at 000hrs? Me- Spent one year huddled with about 6 others in the tiny bathroom of a high rise housing project. (Safest place) Thankfully it was the usual nonemergent call there so we could easily delay transport. The shooting was so bad it was around 030 before the gunshots finally subsided enough to safely exit the apartment. Your turn...

As soon as we go enroute to a call, a text message with call no., address, x streets and chief complaint is forwarded to the rig phone. After we call complete, our call no. and times are texted to us as well. It's useful.

well Richard - if a man has a nice set of tools he builds a shed over them....

Lisa, I'll presume this reversal is a typo. Also, the condition is known as "secretary spread". Sometimes, the condition is accompanied by "Dunlop Disease", as in "My belly donlop over my belt".

I hear you man. But here's the catch. If you truly want to get your hands dirty, if you really, really want to be a good EMT/Paramedic, then start today. Use spellcheck. Noobs rarely want to hear this, but let me try and make my point this way.... Those that responded, most noted Ventmedic and Dust are terribly competent and experienced. Do you see the difference between their posts and yours? Did you get a feeling for the value of their opinions and advice simply by reading their posts? I'll bet you did. That is what you need people to see of you. Not the 3rd grade posting you've done here. Use punctuation, capitalization, paragraphs, proper spelling. Show those that take the time to respond to you the respect of at least rereading your post before you post it. Intelligent presentation of your ideas counts here. Not always perfect presentation, but something that shows that you can be bothered to spend at least two minutes looking for the information you need. Not to mention that you'll be spending the rest of your career writing untold numbers of reports should you choose this path. So far you've presented as a young, "Show me the guts! Oh, and which way is it to the fire station??" kind of guy. I have a feeling that there is more to you than that...give folks a chance to see it, OK? I'm not sniping, simply trying to give you some information that is often too long coming. Good luck to you. Dwayne

Well, par for the course for me growing up was hiding in an upstairs hallway away from windows with my family and waiting for the ghetto rats to quit filling the sky with lead. Strange? Matter of perspective, really... I think the best place I've spent it is Skate the Lake at Evergreen Lake with my venturing crew, doing medical support. Love it! Gotta work for pay this year though... day job got to me first, so I won't be joining my buddies out there. Had some good trauma in the past few years... kept Evergreen FD running transports like mad one year... Wendy CO EMT-B

Strangest place I ever spent it was Ramadi, Iraq. But the strange thing is that there was a lot less gunfire there than the countless New Years Eves I spent in South Dallas.

Meh... that's just Acadian's in-house shake n' bake school. Certainly better than some, but nowhere near the standards I would aspire to. Their job is not to educate the future generation. It's just to keep a ready pool of unemployed rookie medics who are ready and willing to work for peanuts, because the last batch already got tired of it and left. You'll get great reviews from n00bs, but then again, all n00bs think their school was teh aw3some. Most who have been around for awhile though seem to feel the education was inadequate, with a heavy emphasis on monkey skills and meaningless nonsense.

I rang in the new millennium sitting atop a 1987 FMC, manning the absolute most powerful deluge gun I've yet to see. Two 5" lines and two 3" lines, all at full pressure. Any movement I made, at an attempt to quell the inferno caused by thousands of bails twenty-five year old hay in a barn, made the massive truck lean just slightly. Fireworks and Barns aren't a smart combination. I've spent two at wrecks, and in 2004, about twenty seconds after the ball dropped, we were dispatched for a cardiac arrest. Nothing too exciting.

Oh trust me, Ive thought about that. Hense another reason for the time. I have an appointment in late January to talk to my doctor about this. Work out what I need to do, what can be done, medications, or just a complete change in diet...

Being relatively new at this (less than two years) I don't have anything to compare. I work in a rural setting and love it. Our service has three ALS that we work with. One of them will take over and you basically are along for the ride if you let him. I'm a bit of a control freak so I wouldn't back down. Now he puts me to work. Hopefully you will be working with a hospital that will let you help in the ER also. Maybe that isn't the norm out there but our ER docs are more than willing to let us help and teach us while they work on a patient. They are all docs from the war in Iraq and trauma centers from across the country. They welcome the opportunity to teach. Read, listen, watch, ask questions. Good luck!

Waist deep in a lake with Police trying to coach a drunk back to shore then being thrown up on by another drunk on the foreshore, she proceeded to be very apologetics and gave me a hug which mooshed it into my uniform more! Tonight I will be at a major RAVE party in Melbourne... Oh the joys lol.

I remember the original story and now this? I'm not really surprised - he sounds like a piece of work. Good riddance.

Oh trust me, it's been addressed plenty by the Republicans. The Democrats, however, will have nothing to do with fixing it. I'll sum it up in two words: Bloodsucking Lawyers

Paid BLS is the way to go for you then. That way you'll be in the back with the medics and can watch them/pick their brains.

As we all know-not exactly news. We've been down this road many times and this horse has been beaten to a bloody pulp, but... The question I don't recall anyone really addressing is: Why has it gotten to the point where people can (ab)use the system in this way? We can talk all day about how we can assist with social service interventions, how expensive health care has become, how some people need a safety net, and now Health Care Reform is supposed to solve all our problems, but I think this is a chicken and the egg thing. When did people decide that an emergency service is appropriate for things like ankle pain, or a sore throat? WHat did people do before EMS was instituted or became so accessible for so many people? Depending on where I am, I still encounter people who simply cannot fathom using EMS for anything. They even apologize for calling for nonemergent things like CHF and MI's. I don't think that even the best reform bill can address the reasons why so many people have become completely incapable of taking care of themselves. I think that over the last couple generations, we have become far less self sufficient in so many areas of our lives. I'm thinking this is not necessarily a good thing. The government has become the great benefactor for so many people, for so long, that they have forgotten how to forge their own path in life. Just musing...

VentMedic is right on and pretty much just said eveything I was going to say so read his post...twice! Even if you are in an area where Basics have the opportunity to go straight to 911 or Rescue, the amount of experience, education, and knowledge you can eke out of stable and/or routine transports (such as dialysis and interfacility transfers) is unrivaled, even by slinging the many nauseous, overdosed, or seizing 911 patients around the back of your ambulance. Always, always use your resources and for BLS transport work that includes talking to your patients, reading their paperwork and charts, asking the nurses and doctors questions about medicine, prognosis, treatments, diagnosis etc. It will not only prepare you to be a better provider, but will also give you more time to concentrate on the different mindsets, approaches, and multi-tasking that 911 calls demand of you. Your career as a pre-hospital provider is largely what you make it, so make yourself proficient in all areas of pre-hospital care! And for the Love of All Things Sacred, keep them hands CLEAN!!!!!! (EMT-B rule #1: your safety-B.S.I., baby!)

i mean i want to put the skills and education i got in school to use instead of wasting my education and i want tons of experience from trained and excellent medics. as for where i live i dont even hear the scanner go off that much if at most 10-20 times a day for the entire metro area i hear more radio checks then i do dispatch calls lol so when i get my b im going to save up so money and move to a much more busy state and take the transfer test or what ever i need to change my license to a different state ( i heard of a nice school in texas i would like to apply to)for medic training

I don't support lasix pre-hospital; it might have been a good treatment a decade or two ago (but heck so were M*A*S*H pants (MAST) and prophylactic lidocaine right?). A patient with a CPE is going to be third spaced and may infact be hypovolemic, so if we dose up him on lasix he's going to piss like a racehorse at the Kentucky Derby and deplete more volume. We also run the risk of causing him to become [more] hypokalemic or hyponatremic. Differential diagnoses is also really important and something I anecdotially hear a lot of medics are pretty bad at; it doesn't take a rocket scientist to work out a chest infection from a CPE yet apparently it's out there! The Los Angeles study cited includes differential diagnoses of LOWER BACK PAIN and HYPERVENTILATION as those who may or may not recieved GTN, laxis and morphine as the Paramedic assessment was a CPE. Does anybody see the problem with potentially loading up somebody on these drugs, and, more overarching, working up LOWER BACK PAIN as a pulmonary edema? It's 5am here and I tell you what in my semiconscious state, I can differentiate a CPE from wait for it, LOWER BACK PAIN! Now, where did I see LACoEMSA pull frusemide from lately, ah yes, Los Angeles .... suprised? I'm mixed on morphine use in CPE. Now I did see one study (retrospective) on CPE outcome in hospital where ambo had dished out morphine but it was poorly designed and I bet was riddled with false positivies. http://www.ncbi.nlm.nih.gov/pubmed/18973635?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=18 http://www.ncbi.nlm.nih.gov/pubmed/19234030?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=14 These studies suggest it may infact be of harm and not benefit. I was educated that morphine is not an effective treatment for CPE and is used for relief from anxiety and (possibly?) some of its bronchodialatory effects but I bet you there's better bronchodialators out there than morphine, salbutamol anybody?

well of course spenac.. and richard b too.... you and I are still babies....

well thank you very much for your feedback and i will for sure give both a try

Old? You are of course referring to spenac and not to those of us who are still waiting for our 39th birthday? Welcome piranah.

o man a fellow rhode islander and welcome

because you gave him the choice to have a shitty life back and he can change it. Also you do this so that son knows his dad is gonna get the best care and so he can cry on your chest. If you need more I will be there for your family member you be there for mine.

lol why the negatives?

It's taken about 1500 calls in a year and a half for me to figure out that this 911 paramedic stuff AS CURRENTLY DONE is not rocket science. It's great to understand the physiology of what is going on, but most of the time, on a call, what I am required to do is pretty limited. I try and go above and beyond, figuring out what is really going on with the patient vis-a-vis physiologically, socially, economically, psychologically etc. Is any of that necessary? Not really. There are hundreds of eager young things in the pipeline that want to go tube somebody. I am interchangeable with any one of them. I want to use my brain and knowledge to really make a difference, in a position where what I have to offer is necessary and required. I really like the idea of community based prevention and the opportunity to provide some answers to the situation as it stands. Let fire do the EMS thing - let those of us that want to do more find ways to do it.

so its not a good pick up line to say your a trained medical professional and then ask to give her a breast exam!!! lol jk but on a serious note the guy should of been fired along time ago hes a disgrace to the job and to his company

On going budget issues so no new ambulance for us. 4 years and 75,000 miles is alot of wear and tear in urban ems.

I was called to a 57 y/o man complaining of a sudden onset of mid line abdominal pain while sitting in his office doing some paper work. Patient has a history of hypertension and high cholesterol and is non compliant with his meds. Patient had not eaten lunch yet and tells us the pain feels as if something is "pulling apart" in his belly and lifts up his shirt to reveal an vertical 5-8cm oval lump in his abdomen just off the mid line. While in route to the hospital my EMT "ride along" placed him on oxygen, moves down and begins to palpate the abdomen? I yanked his hands up telling him not touch the any of my patients abdomens, ever! Regardless of what anyone thinks is wrong with this patient, could someone please tell me why we still teach EMTs to palpate the abdomen!