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Successful codes are a rare occurrence prehospitally. Don't be disappointed, discouraged or frustrated if you don't get one for a long time... or ever. You do what you can, the best you can, in oftentimes exceptionally trying circumstances. There is always new research taking place. There will always be new methods, new interventions, new ideas about treating cardiac arrest scenarios. No matter what they do, however, no matter what types of ideas or interventions are developed, there is no escaping death. It will happen to us all at some point. The trick is to not let it eat you. Because it will if you let it.

Hey y'all. I'm a brand new 68W fresh outta school and I just want to find some sort of mentor or something like that to help guide me to be both the best medic for my soldiers and the best EMT that I can be. Any takers?

Comparing a heavily populated state like Maryland to the rural vastness of Colorado is a joke. Yes if you go out in the boonies you may not get the same response times or level of care as you get in a major North American city of over a million inhabitants. Many states have this same issue. There are parts of my state where your response time might be in excess of an hour, and transport to a hospital could be over two hours. thats what you need to expect when you move away from society and go out to homestead.

I've worked a few codes myself, had some make it and more that didn't. One thing I learned when I started this career is there are two rules of EMS: 1. People die, no matter how hard you try to save them. 2. You can't change rule number one. Sometimes, you work a code, knowing that what you might be doing isn't helping the patient, but is telling the family that you are trying to save their loved one's life. There are times when your interventions do something and you have a living patient. Take the good with the bad and do the best you can. At the end of the day, for me, that is most important.

I can. It wasn't 3AM, though. It was 0130-0200-ish.

46 states use the National Registry tests as their standard. To say it is a waste of time is a bit foolish.I did not have another test of any kind besides my NREMT. I took that, got my results and hours after getting my resume?ts I was active on my states website and had a state ID EMT number. I was then able to run EMT. A few weeks later I got my state issued EMT card. You can test at any of those 46 States and expect to get similar questions. The parts that may differ are the skills tests. Iowa is one that requires it for initial certification. I don't know about the cert/licensing title. Not a huge deal to me, but when I got it I was told I was now licensed to practice. Yet my card said certified. It seems its used hand in hand. I say certified, but others say licensed. *shrugs*

Uhh...except the states that require NREMT for initial certification... EMT's also aren't licensed I believe, they are certified.

Theres nothing that says you cannot be a FF/Medic but you have to not bow down to the altar of FIRE and you need to really try to be the best medic that you can be. I have many FF/Medic friends who hate the ambulance as well as they also say that the ambulance is a penalty or punishment. They try their hardest to get out of working the ambulance and even they say that they wouldn't want them working on themselves. If you choose to go down the road as a FF/Medic then it is incumbent on you to really take the job of Medic seriously and not fall into the trap or way of life that permeates many fire departments where EMS is a necessary evil and not a priority. You are in charge of your future, don't let a fire chief and a bunch of firefighters color your EMS experiences.

For coral snakes native to the US it's "red on black, venom lack..." There are coral snake species from central and south America that do not follow this pattern. It's a misnomer that there is no available antivenom - the FDA extended the expiration date on the remaining stock until the fall of this year and there is available supply. Without antivenom, a severely envemomated patient might need prolonged ventilatory support. I caught this thread very late and am glad that the original poster did not have any problems, but I thought I'd comment about some of the practices some of the respondents seem to be supporting for bites by pit vipers (subfamily Crotalinae), which includes rattlesnakes, copperheads, and water moccasins. Tcripp, you asked about "what to expect" - it depends on the species, location of bite, patient comorbidities, and other factors. Many patients early on will have pain and local tissue swelling. Some develop signs and symptoms of systemic toxicity (e.g. nausea, parasthesias, etc) early on. Shock is usually from third spacing of platelets and plasma volume. Very rarely, someone who has been sensitized to proteins in the venom (e.g. someone who has handled snakes or venom or been previously bitten) may have a true anaphylactic reaction. We sometimes see anaphylactoid reactions with rapid onset shock and airway edema. Many patients develop coagulopathy, which can range from isolated thrombocytopenia or a syndrome of defibrination or a combination of the two that is DIC-like. Neurotropic findings, which can include neuromuscular blockade, can occur after bite by several species of rattlesnake, not just Mohave rattlesnakes. In terms of first aid, do not apply tourniquets or lympathic constricting bands, or ice packs. Maintain the bite in a neutral position (some medical toxicologists think elevation is reasonable - others thing neutral until antivenom is started and then elevate. Do not apply any kind of suction. If a tourniquet, pressure bandage, or constricting band has been applied, do not remove it in the field. In general, when this is done, we get big lines in the patient, give them volume, and start antivenom before releasing this. At least one IV should be started. Give fluids for hypoperfusion (obviously), but patients with intact perfusion and extremity swelling also need fluid boluses. Extremity swelling early after a bite is usually from the effect of polypeptides in the venom, and these cause tiny cracks in vessels that are large enough to allow platelets to leak out, but not large enough for red cells to leak out. This third spacing can be significant very early and cause significant hypovolemia and hemoconcentration. Very often, we see patients with rattlesnake bites who don't get enough IV fluid in the field. Give antiemetics for nausea, and treat pain (if you have fentanyl, I think it's preferred over morphine as the histamine release from the morphine can cloud close monitoring for development of allergic response to antivenom). The destination hospital may not necessarily be the closest hospital, or even the closest hospital with antivenom, but this would obviously be region-specific. I have seen horrible outcomes when patients are taken to hospitals where arrogant physicians refuse to consult a toxicologist - we've seen patients diagnosed with compartment syndrome who get unnecessary fasciotomy and even amputations that were likely totally unnecessary. Where I work most hospitals have antivenom but we have centers available to us that have onsite toxicologsist and very large supplies of antivenom and we fly our patients to these centers. The 2010 guidelines from AHA and ARC actually mention snakebite first aid, and they advocate using a pressure immobilization bandage for Crotalid envenomations. This recommendation is based on no evidence of any quality - in fact, one of the studies they cite as supporting the practice actually demonstrated worse limb outcomes when pressure bandages were applied (in a pig model). This practice turns what is very rarely a life threatening event into a limb-threatening one. This should be addressed locally, and hopefully administrators and medical directors will consult a medical toxicologist with snakebite expertise when establishing local or regional protocols. Pressure bandages seem reasonable for eastern and texas coral snake bites, and are standard for bites by neurotoxic snakes that cause rapid development of symptoms in Australia, but they will likely worsen injury when applied to victims of Crotalid snakebite. Finally, you can not diagnose a dry bite (fang puncture mark without envenomation) in the field. This requires observation for at least 8 hours (and labs). Especially after Mohave Rattlesnake bite, patient can have a life-threatening, potentially fatal envenomation event with minimal local tissue injury, sometimes without significant pain. Patients with probable Mohave bites are admitted and watched for 24 hours at the tertiary center we work with.