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+1 for first poster to use Emcrit as a teaching tool! I am secure with the fact I have a man-crush on Scott W.

Hey everyone! My name is Ana and I would like to introduce myself! I just passed my written national for paramedic and will be taking practicals soon! Just found out about this site and want to use it as a resource...nice to meet everyone!

Triplets?

In clinical's we pushed it like water in the ER's, Only pushed Morphine once for pain control, and twice for cardiac, and didn't push Fentanyl until I made it out to the field. So my limited experience with this med is partially based on my personal experience as a patient. Dilaudid Seemed to work a bit better on orthopedic pain than Fenanyl. It seems to fall into the "Rule of tens of Opioids" as well IE. 10mg MS = 100mcg Fentanyl = 1mg Dilaudid, IVP. Maybe I am just one of the sensitive ones, but Nausea did come but was relatively fleeting and dependent on how fast the dose was pushed, So might not be a bad idea to pre-treat with some Zofran. I haven't used it in a RSI situation, so I cannot comment on its effect that way. If you have any voice in purchasing, I would ask for the 1mg/2mL Carpuject vs the 2mg/2mL for ease of dosing and a touch better control if you hit a bump in the road. Fireman1037

Sihi, I appreciate your involvement with this discussion. However, you provide little evidence to support your stance with the exception of a n=1 case study. The topic of paralytics is not as easy to debate as some would think. This is especially true when we consider what occurs outside of the hospital in some countries. Attached is what I believe to be a good link where two physicians debate this topic as it relates to in-hospital intubations. Additionally, new evidence is utilised. http://emcrit.org/podcasts/paralytics-for-icu-intubations/ Unfortunately, I am not aware of a significant body of literature regarding the pre-hospital provider. At this time I have to error on the side of the traditional approach and perhaps more conservative option of using a paralytic. Of course, I admit that I have a bias against pre-hospital intubation in general and the context of my point is based on pre-hospital care and literature within the United States.

I am a walking poster child for almost everything we debate here in regards to EMS. Spent all of my childhood in and out of hospitals, in fact the day of my birth I was an inter facility transfer to a higher level of care...of course there were no IFT services then, so basically I got a fast ride in a Cadillac to a larger hospital 1.5 hours away. My whole life has had something to do with medical, I knew the terminology as a child as I was fascinated by everythign going around me and I am never one to sit quietly and be content...I want to know, especially if it involves me. Thought I would be a doctor all those years, even started volunteering at the base hospital at age 14 (illegally-but they tolerated me). Got real jobs (bagging groceries) and met another bagger who was developmentally challenged. He told these great EMS stories about the calls he went on and wrecks he saw, etc. I basically let him go on and on while thinking bullshit, there is no way they let this man-child work on an ambulance. Turns out, I was wrong. He was indeed a volunteer and because he was able to function as a fetcher and could follow basic commands, they let him in and took care of him best they could. He was very proud of his uniform. I was too young to volunteer but I thought it was cool, it all sounded neat and all I cared about was lights, sirens, uniform and the general perception of those in my circle regarding me---what would they think of me if I were to do that work. Patient care pre-hospital was last thing on my mind as I truly had no concept how EMS worked....and I was young, dumb and full of... I moved to another state and almost joined the local volunteer FD because I saw all the ass hats who were on it and knew I was good enough if not better. Again, still young (age 17)...I ended up suffering anaphylactic shock and went into cardiac arrest. Lucky for me, I had this episode inside an actual hospital as it was post-allergy shots when it occurred. Again, I was another IFT to the civilian hospital as they could not handle me since I was on a vent for 2-3 days. I have kissed death many times in my life as a child and an adult. Those stories are an entire book if I ever get around to it. Anyways, after being discharged, to my folks dismay, I moved back to SC...the only home I really knew after being bounced around within the military year after year. My grades had declined during high school and I no longer felt I was a candidate for med school. Amongst many other personal familial issues, I just assumed it was never to happen. So back to Myrtle Beach I went...party town for a man my age. I smoked weed, tried the local college, but just wasn't going in any direction particular. I was working in a bar at the time as well along with another job down on the boulevard...had to keep in the mix of all the excitement, just who I am. EMS is very busy in Myrtle Beach...started thinking I should try for it. Went and applied to local volunteer squad and was voted in after some interviews and ride alongs. Quickly decided this was for me and enrolled in EMT school. I ran my ass off volunteering...we had assigned shifts and I did every single one and then some. I was averaging over 200+ hours a month volunteering. Being such a busy town, the paid county EMS and the City FD were always overwhelmed so they tolerated us and used/abused us as well. It did not matter, I got a ton of experience in short amount of time. EMT school was easy for me...it all seemed very natural and none of it was shockingly new or hard. I passed the exam on first try and got my day glow orange patch soon after in the shape of my great state. I was now becoming a whacker...I lived and breathed EMS. I had a scanner, I would run calls in my POV, I even had a lightbar and jump bag on my vehicle. I wore EMS tshirts and yes I even had one that said "You got to be tough to work a code in the buff". HOWEVER, I was also going to EMS conferences and I wanted to know more, I wanted to do more. I very quickly realized how little I was actually doing other than patting myself on the back. I realized the volunteerism was all about helping me get laid and feeling good, cause yes there were/are a lot of badge bunnies on vacation looking for a "hero". I got a paid EMT job with the county and I also worked part time doing IFT. (FYI, this was when I started shucking the gear, lightbar, and tshirts as paid folks do not typically do that stuff and I was quickly realizing how much of a fool and how reckless I had been). I immediately enrolled in paramedic school less than 3 months after getting my EMT B. Paramedic school was a joke only I did not realize it...you do not know what you do not know. I did fine in medic school, was actually bored on many occasions as it was not challenging. To tell me to push a grey box followed by a purple box just seemed lame to me. Anyways, I became a medic after the very long and strenuous 3 nigh a week 6 month long program....yep...6 months...3 nights a week and clinicals...wham bam you are a medic man. I continued to work as a medic but knew there was more, where or what more was, I did not know. I moved to Florida! Wow, night and day right there...I immediately learned there are huge differences in EMS simply by crossing state lines. The move shattered all preconceived notions I had about EMS.I was an idiot! I went to test for various services and was blown away by how advanced they were. I had left an area where we did not do 12 leads and entered an area where they have been doing 12 leads for years along with RSI, nitro drips, surgical crics and a million other skills and drugs which I simply never fathomed to be done prehospitally. Yeh I had read about them on my own but we never were taught these things much less carried or performed them. All my years as medic to me were worthless, I was way behind the game and had no clue until I moved. So I made a plan... I went and got a job at the ER as a medic and returned to school. I started learning paramedic all over on my own as well (I had been out of school for years at this point). I started teaching as well, because if you do not get challenged or learn something new almost every single time you teach, then you are doing something very wrong including doing your students no favors and possibly intellectual harm. I had no clue there were degreed programs for medics...higher education had never been encouraged where I came from for those in EMS...never. Taking those college level courses opened my eyes to a whole new world. After completing college anatomy and science courses....so many things started clicking in regards to patient care. I now knew why I was doing many treatments. It all made sense and I gained a huge understanding of why we do or do not do certain things. It absolutely made me a better provider....no doubts about it. I have the benefit of having been a medic mill graduate, working for years, then going back to school and basically redoing paramedic with a new frame of reference and the differences are staggering!! Yes, a college education does make a difference in regards to your ability as a paramedic. My stint in the ER/Trauma center got me thinking about two things (flightmedic and nursing)...I was going to do one or the other. I finally landed a job with a county paramedic service...NO EMT Bs; all medic service. In all my years prior, I was always the only medic with basic partner and/or FD basics on scene. At first I was very leery of taking a job with another medic at my side. I was actually defensive about it...I was letting pride cloud my judgement. After working for many years in that arrangement, I will NEVER go back to Medic/Basic again, ever. (The caveat to this statement is I did go back to this arrangement during some disaster responses in other states...) but I am meaning a full time position as a medic on an ambulance, I will never work medic/basic again. Those years working dual medic were fantastic. Burnout was minimized, errors were minimal...did not have to command every single little action or prioritize tasks because if it needed to be done, it was happening. The service was very aggressive and progressive, always trying new trends, they were very pro education. Unfortunately, all this went to shit when the FD decided to take over. Yes, I have been victim of TWO FD mergers in my time. In the years since I have left, quality has gone down, dual medics are gone...and a lot of the old crew I used to work with have all become nurses, flight crew, PAs or docs....that should give you some indication of their knowledge base and experience. When the merger talks started, again I was proactive. I went ahead and put myself through the fire academy in preparation for the inevitable because I was not gonna be left behind when the deal went down. It was also during this time that I was studying on my own to be a flight medic. I was reading all the right books, took the classes and started applying. I even took a job in another hospital do I could get current ER and ICU experience. Well the day came before I even finished the FF academy....I was offered a job as a flight medic. I took it upon the condition that I finish academy first and they agreed. I then moved to very, very remote Alaska and started my first flight gig. It was hard core to say the least but after that for a couple years I now had the experience to go just about anywhere I wanted provided I get an interview. And that is what I did. I tried out several other flight gigs but then I did one which was international. After that I was hooked on international work. So, I made a plan... I started studying remote medicine and applying to those in the industry. I made contacts and marketed myself. I then got my job offer in Afghanistan. Remote, austere, war zone primary care and emergent medicine...does it get any better? Again, I had lots to learn...sutures, antibiotics, a host of primary care and patient care management issues. I did this for a couple years, crossed over into learning about Safety (another field some find exciting and challenging) to broaden my knowledge and make myself marketable and increase earning power. I soon tired of the work politics and started seeking employment. lo and behold I was offered a Project Management (EMS Chief) position for an EMS service in Afghanistan. I guess I had come full circle.... I did that for two years but this experience coupled with my past leadership experience as an EMS Lieutenant and flight medic put me on the business minded track. I was working on my final nursing requirements and my plan was to return and finish RN so I could travel and get paid decent. However, I realized a business opportunity when I saw it and I started making plans.... I am now in my 18th month of owning a business along with a year of planning prior to that and things are looking good....and yes, I am making a plan. To all who have read this far, I truly did not mean to write this much describing my entry into EMS, but I simply could not drop a quickie of how I became a paramedic. I did not think it would do justice. as I started writing however I thought maybe my story would inspire others who have similar goals or dreams. The story also gives credibility to all the BS we continuously speak about. I have lived it, I know both sides and there is a difference. Thank you for reading and I hope you enjoyed it.