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Why dont we take all the lights and sirens off all the ambulances and just drive with the flow of traffic. I realize that there are some situations where you are in grid lock and lights and a siren might help but generally I have found gridlock is grid lock. More often than not the call we are dispatched to is not time critical such as a sprained ankle or a sick call or even in the case of an MI or CVA. It has been proven time and time again that driving with Lights and Sirens is not that big of a time savings over planning a smart route to the patient avoiding known traffic delays and in the late evening or early morning hours there is virtually no time saving. Does it really matter if we get there 30 seconds or a minute earlier? Just because we wont have lights and sirens does not mean on the odd occasion we need to clear traffic we cant have a police escort. Now lets think of the cost savings on and ambulance with no emergency lights inverters power packs and dual alternators or on board power management computers and in addition how the ambulance insurance costs would go down. Maybe with these cost savings we could add additional ambulances to cover the area that would cut down response time even further? Lastly, having not just suffered a harrowing ride screaming through the streets at the hand of another would we be calmer and think more clearly on the call and in turn more accurately diagnose and treat the patient? I think its worth a try.....

First step- palpate the brachial artery. I know this sounds silly, but many people simply guess as to where that pulse is actually located. Once you FEEL the pulse there, place the scope directly on it. Also good suggestions from others about having a good stethescope with a proper fit in your ears. Most scopes come with several sizes of ear pieces- choose the ones that fit you best. You also need to understand the difference between the bell and the diaphragm portions of the device. The bell side is used for low pitched sounds, the diaphragm portion for the high pitched ones. Make sure you are using the correct side- it's easy to have them flipped and never realize it. As soon as I put the ears on, without even looking at it, I tap the bell and diaphragm on to ensure I have the correct side in place- a habit I developed 30 years ago and still do to this day. Sometimes the head may be slightly turned- ie not locked into place, and you won't be able to hear a thing. Some places use electronic varieties, which can be useful in noisy settings like in an aeromed situation- or someone with bad ears. LOL As for lung sounds, it takes a lot of practice to become proficient. Listen to yourself and anyone else who will let you. Use both sides of the scope and see the differences in what you can hear and the quality of the sound. Remember to go back and forth on both sides of the chest and back- at the same levels- to compare and contrast what you hear. Different patient sizes/body types and medical conditions will also affect how well you can hear things. Good question. As the old saying goes- the only silly question is the one you did not ask. If you don't know, then how will you ever learn?

It's not a boring question at all. What causes the gastric distention and please if I am wrong anybody feel free to correct me, as I am fairly new medic. My understanding is gastric distention is caused by when someone is using the BVM and is pushing too fast and too hard and not letting the bag on the BVM to fill back up with oxygen before ventilating again . You want to be just giving enough air by pocket mask or BVM to make the chest rise, if you give too much air it will just go straight into the abd and start to cause the gastric distention. I am not sure how long it takes or how much air needs to be exposed to the abd. before this starts to happen.( Time to do some research tonight for myself) You are correct that gastric distention does increase the risk of aspiration and that is why the person at the head needs to be careful when ventilating a patien and watch for the signs of the distension. I know in my OFA level course that I just had recert, they taught us to ventilate the pt. every 5 seconds while doing continous chest compresions, but in my paramedic program we did the 30/2 standard and that is what I use. When a paramedic inserts a OPA that is keep the tongue from falling back into the throat and occluding the airway which then would deem as a patient not having a patent airway because the tongue is blocking the airway passage, but once the OPA is incerted and in place the patient is now deemed as having a patent airway. This is because the OPA is allowing as a device that as mentioned keeps the tongue from falling back and occluding the airway and allows for an air passage and for draining of any vomit which may occlude the airway deeming the airway not pantent do to the occluding vomit chunks or blood. Hope I was able to answer you question for you and if I missed anything or made any mistakes in my answer anybody feel free to correct me as I do not want to be leading someone down the wrong path!

Sounds like you have the right attitude, bogusdill. It's important to set the bar high and to have goals. Sometimes it's not easy doing the right thing- whether in your job or your personal life, but in the end, YOU need to look at yourself in the mirror and like what you see. As you note, there are all types of people in this business, and not all of them may be someone you want to take care of your family member. Always strive to be the type of person you would want to take care of your loved ones and you won't be steered wrong.

Saving money is always good. One example, collars. We would use the single size collars, pay $9.99 each, and they would occasionally reuse them. Whether or not that's bad, is neither here nor there, but they're disposable. Eventually, switched to select a size, again, $14.99 each. I suggested we switch brands, pointed it out in a catalog, bam. Selectable size collars, same fit, good quality, $4.99 each. That's a lot of money at the end of the year. Little changes go a long way.

Adding to what 4c6 said, look for something that you think can be improved. Ask around, see what problems folks have with the status quo- scheduling, check lists, streamlining procedures, training- or come up with something you feel needs to be addressed, and provide a possible solution. Unfortunately, just doing your job better than everyone else does not always translate into opportunities for advancement. You need to be proactive and and promote yourself- nobody else will do that for you. Add to your skill set- take every extra course, seminar you can. Here's the thing- you need to figure out exactly what your goal is- to move up in the company- which may mean no longer working the streets, become a supervisor, trainer, or start taking management/office/leadership classes to position yourself for that route. The more tools you have at your disposal and the more hats you can wear, the more attractive and valuable you will become to the company. Find a way to save the company money- that will almost ALWAYS score points with management. LIke you said, be careful to not step on any toes. Couch your proposals carefully as to not offend, simply provide a better way or even another option. Make sure you are seen as trying to help the company- and yourself, not just trying to stir the pot. Lastly, give it some time- you also need to get more experience, but there is no reason why you cannot start planning for the future now, so when your time comes, you will be ready to move up. Good luck.

What was the response you got back last time you asked for more responsibility?

I understand what you're saying. That may be more difficult to incorporate into your daily schedule, at a paid agency. However, you could start with a more thorough daily routine? Maybe check everything under the hood, clean the actual compartments and cabinets, be very thorough with cleaning the patient area, etc.. maybe wash and wax the rigs. Typically, while we have a check list, actual maintenance is done by a mechanic for liability reasons; QA is done automatically by the ePCR software. A log book of vehicle checks is a good plan. Perhaps you could look into an education based EMS management or leadership course; or an officer training program? Maybe even look into becoming an EMS instructor, and taking on a training role with in your service? That may help you climb the ladder, per se.