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So I realized that I was being a little bitch earlier but now its time to really get down to buisness.

From this point forward I will do a little research before I waste all of your guys time, like I have been. Don't worry. I'll be seen and not heard from now on out. Paramedic Mike you seem to be the most pissed about it. I would like to apologize to you first of all. If I do ask a question from here on out, it will be a complicated one.

Hello all... I'm DirteMedic. I've been a medic for Louisville Metro EMS for 6 years. We're a very busy urban/suburban service. I will be having an above knee amputation in the next month or so and hope to be Louisville's only active duty "Prosthetic Medic." Hope to see you guys and gals around. I'll be on here a little more than the past since I've got some time off in my future. See ya on the bus!!! Dirte Medic

That's my new acronym for BLS. Now before everyone gets up in arms, let me recite the paramedic's pledge. "I do solemnly swear that BLS comes before ALS because EMTs save paramedics, airway, breathing, circulation and that children are not little adults, so help me, my medical director." That being said, having suffered and currently recovering from a shattered distal humerus, I have gotten a new view on what is considered BLS care, and unfortunately, its not a really pretty picture. I cannot any more accept that manipulating orthopaedic injuries with BLS techniques alone is acceptable modern medical practice. I had a very bad break. The lower half of my upper arm was in several pieces and the radial nerve was being crushed between the bone ends. I was very lucky, though. I had an excellent prehospital care team that was able to supply some amount of pain relief and did some of the best prehospital orthopaedic care I've ever seen. It was still some of the worse pain I've ever been in, and I came very close to losing significant function in my hand. Luckily I'm making a full recovery. A lot of people who dial 911 are not anywhere near as fortunate as I am. We think of the sprains and strains as the "minor" calls that maybe some of us roll our eyes at while hoping we get a "real" call, but I think its high time we approach prehospital pain relief and orthopaedics with the same attention we give STEMI's or multi-trauma victims. While I was sitting in the cast clinic, I saw a sign saying something to the effect that good casting is an art that combines psychology, engineering, medicine, and artistic talent. I think that's very true. Why don't we start moving away from the first aid kit we have left over from World War II and towards modern orthopaedics? BLS transport should become a thing of the past, IMHO, and if the best an area can do is EMT-I, then let's find a pain medicine that even they can't screw up. We shouldn't be proud of our current standards for injuries. We need to focus less on the big ones we can't do anything for and more on the little ones that we can make a tremendous difference in.

I once ran a call on a woman with no nose, she wore a bandaid to cover the hole in her face and had never been to a doctor. I dont like doctors anymore than anyone else, but if something falls off, it is time to go. Some people just live in denial.

Look up epidural hematoma and lucid interval. That's just one of the reasons it's important to know if they had a loss of consciousness or not. Just because it's seems like everyone is saying they had one it doesn't diminish the fact that it is important to know if they did have one, like the boy who cried wolf. If you are suspicious, then by all means ask more pertinent questions like Dwayne suggested. He is still looking for the same pertinent piece of information.....did they have an LOC or not. Half the time my patient's wouldn't remember but I used the same method of asking what they could recall of the actual event which still doesn't tell you if they definitely had an LOC but can more likely rule out if they didn't. If there is even a brief LOC it is important to know, not only for the potential epidural (think Natasha Richardson) but also because it is relevant in classifying the degree of head injury. Studies have shown that multiple mild concussions can be just as bad as a single more severe head injury. If the force was severe enough for them to lose consciousness even for a short period then the brain has sustained a significant impact that warrants further investigation or at least monitoring for longer than a non LOC event.

One thing that I can say is this is EMS, we are really a great bunch of folks. One thing about EMS you do need to know it is like being with a bunch of egos. Because of a great call that we had last week, or just the fact that we just moved up the ladder in our cert, or just because we can be cocky the egos will fly. It is no different than any other profression the the healthcare industry. So you had a bad day, stick around and see the good days and you will know why there are some of us that stick around this business for a long time. It gets better.

Actually I am sure that I will be fine...I actually might (unintentionally) piss somebody off before to long. All kidding aside I accept any type of critism that comes my way. If someone pisses me off, then ask Dwayne what might happen to them .

Yeah, man, chat is chat, forums are forums, with few exceptions. I'm not sure what's got you panties in a bunch, but a word to the wise? Rarely does anyone cry in the forums when they really plan to leave.... suck it up big guy...if you can't handle online stuff, then you need to rethink your motivators. Hang out. You've had some harsh opinions, but you want to see really harsh? Look at the idiotic shit I posted when I first got here.... Hang in there Brother...you'll do fine. This is where we practice to get thicker skin... Dwayne...

Everybody relax. Kid got his feathers ruffled in chat. Advice to you and ALL n00bs here: Leave chat in the chatroom and forum in the forum. Lots of BS in the chatroom that has no bearing on what's going on in the rest of the site. Also: don't start threads whinging about how someone was mean to you so we all suck and you're gonna leave... and then be sitting in chat. Kid's been informed directly by me in chat as to the above... I think this thread will die a nice painless death (hint hint, mods?) Wendy CO EMT-B

Lemons from his tree .... he appreciates your concern, time and free advice. It probably is the most attention he has had in a long time. Weither you know it or not you made his day and might have saved his life. Lemons from his tree ... wow. There is no doubt you have made a new friend.

Phil's back.

As all the good answers have already been taken, I will go down a slightly diffrent route. How comfortable are you with your skills? Have you had the chance to start difficult lines in a moving ambulance yet? I had the bad experiance of having perfect classroom starts, followed by nicely lit, no rush ER IV starts, To having my first few "real" field patients be really sick and needed a line ASAP. If you get the chance and have access etc. have a coworker drive down a particularly bad patch of road, while you try to stick a fellow student in the back of your rig. I have found 24ga to finger viens mimic baby foot veins nicely. And that being said, are you comfortable with multiple different IV cath styles? How about Lab draws? Remember your Color order Draw de jour? Are you equally comfortable with a syringe draw and a vaccutainer draw? Practice improvisation skills, expecially when it comes to airway managment. Use a Bougie as an ETT Introducer. Use a lighted stylet for transtracheal illumination for confirmation. Actually hook up the wires to your monitor for the ETCO2 detector. Which Blade do you use. Why dont you try the other for a while? If your comfort blade is the goto, why are you using the blade your less comfortable as your "rescue" blade? Are you comfortable running a BVM and maintaining a great seal and head position? How about CPAP? We never put it on in school and had trial by fire. How do you feel about your Cardiology? 12 lead interperatation is one thing that got beat into us in school, but how many times did we go over pad placement on actual humans vs just the mannequin. Realizing sometimes the pads don't stick well, and to towel wipe or razor a hairy chest are things not covered in my classroom experiance. What point are you going to place the Combipads on a bradicardic patient? are you thinking far enough down the line to have them placed pre-crump? Protocols. Not knowing your school or internship locations, I don't know if this is an issue. But if you work in more than one agency/county, you may have varying protocols dependant on where you are that day. Yes subtle crap but important if you want to impress that preceptor. Lastly the drug box. I spend alot of time in the drug box while studying. I work with two separate agencys, with two diffrent styles of drug boxes, and totally diffrent layouts. Can you be so confident, if asked to draw a diagram of your box you can remember what is supposed to be in each compartment and quantities? Hopefully Amongst my ramblings there is something you might consider useful or thought provoking, if not chalk it up to someone who is just a few months ahead of you into this curve Fireman1037

I posted this on my FB and my friend called me asking "Why are you looking for drugs on Craigslist"

Haven't we been through this before with you? You say you're going to be an EMS student. Perhaps it's time you started acting like one. Why don't you go look it up and then tell us what you think needs to be done. I think you'll find that you learn and retain the information better when you do that. You're not going to learn the things you need to learn if you don't do the work to learn it yourself.

Mike, you got me. I do agree with you..but let me clarify one thing. That is the best way for me to learn. I read it (often more than once or six times) then I talk about it, then I do it. Or I get hands on instructions as I am doing it. Those are the best ways for ME to learn. Who knows what this guy's "best way" to learn is. I don't know this guy from Adam of Batavia maybe he is actually a Medic just trying to stir up S&*^* in here, or maybe this how he learns. I also look at it this way if he asks a question that is totally off the grid of what we do and it bothers you then don't read it and don't reply to it. Really it is that simple don't chastise the guy for asking a question. If you choose to answer it maybe it will remove that little bit of rust that we all get in this biz and maybe help us remember some of that information that we might of once knew but have now forgotten.

I would like to apologize for all of the valuable time that I wasted bothering you guys. I'm probably one of the stupidest people you ever met. I regret coming here. I've seen how some of you act. I don't want to be in EMS if thats how everybody acts. I thought that it would have been nice to learn a few things and meet a couple of new people. I think many of you judge people before you get to know them. I know your probably thinking why did I just read that little rant from the kid.