firemedic37

In my area there is the thought that any ventilator will be fine for interfacility transfers, however we all know that they all work differently. One service that used to have a T-Bird vent decided to replace it with four Autovents (not sure which model). So now their medical director doesn't let them do interfacility and they are for CPAP and codes only for transport to the hospital. I think this is what is going to happen around here, Autovents are for 911 only. I have seen way too many services using them on respiratory failure patients interfacility and usually the pt deteriorates rapidly. Personally my main service uses iVents, it works fine. However I don't like it; too big, heavy, bulky. It replaced our T-Bird vent, compared to that I guess it is very compact. My other service uses CareFusion LTV 1200 and CareFusion ReVel. I believe that they are both a better ventilator than the iVent. However the Revel is even better than the 1200. Yes more money but well worth it. The iVent is the one that I use the least, despite working there more. We have only had the ReVel since January but so far I really am liking it more than the 1200. Just my two cents worth. Side note: Autovents can be used by EMTs, AEMTs and Paramedics in Iowa. However the enhanced ventilators can only be used by Critical Care Paramedics.

These are just my personal views and anyone could argue the other way.

First and foremost Illinois is not a Registry state so they most likely won't have a AEMT course. They do however have EMT-B, EMT-I and EMT-P courses. Very few of their programs will allow you to take the NREMT Exam since they are not accredited. The EMT-B in Illinois varies a lot from one system to the next. Some allow EMT-B's to given SL Nitro, Albuterol, Glucagon and get this intubate pt's! But yet they can't acquire a 12-lead or start an IV. I would really think about going to another State if at all possible to get a better program that will allow you to take the NREMT exam.

First and foremost your Instructor, they can see or may already know your weak points. If they had let you test before they thought you were really ready then shame on them! However if you did great in class and passed everything just fine then perhaps it was more your anxiety than not knowing what to do. Remember to slow down and take your time, most of the time the student over thinks their response and therefore answers it wrong. Remember to keep it simple and walk through the call as you answer these questions. You may also benefit from taking the Fisdap comprehensive exam before attempting again. The best part about it is that it doesn't count as an attempt to pass your EMT, tells you what you need to work on and finally the best part is it's only $20! Here's the link. They also have more expensive packages such as the total Assessment Package that offers you even more.

If you plan on going back to Germany it seems that the best plan would to be study there. However if you are dead set on coming to the States to get your Paramedic there are many programs that teach strictly EMS and are not in combination to firefighter training. I think throughout the States you will find independent (strictly EMS nothing else) EMS services that are either hospital, private or municipal. If your goal is to be a Paramedic with clinical skills perhaps a hospital based ambulance would be the best option. One where you still run emergency (911) calls and then sticks around to help out once you get to the hospital. Lots of learning goes on in the ER, remember nurses are your friends. Honestly I have no knowledge of your EMS system or scope of practice. So maybe EMS in the States is better or maybe not. I would really think about your future and where you want to end up in the end.

From the NREMT: Typically, persons interested in EMS must be 18 years of age, take and pass an EMT education course, and not have a criminal background. EMT courses are taught in a variety of settings throughout the United States. All US Army and Air Force “medics,” are EMTs. The location of courses can be found by contacting State EMS Offices, found on our website. The EMT course requires about a semester of education to complete. However there are state requirements. In Iowa you only have to be 17 y/o, there is no requirement for GED or Diploma. You just can't and I repeat can't get your NREMT until you are 18 y/o. I would check with your State and see what the requirements are. I was fortunate and was 18 y/o at the time of my class so I got my National, some people in my were only 17 y/o and couldn't get their National because of this. My class was made up of only High School students (3 are in Med School, 1 in Law School and me). Once you are enrolled into a program or are hired they should provide a Emergency Vehicle Operation Class (EVOC) which will help teach you how to drive.

Don't have pictures but this is what we got: Service A - Private Rural Service 2012 Chevy 4500 Lifeline Type III 2009 Ford E-450 Medtec Type III Service B - Hospital Based Service 2012 Chevy 3500 Medtec Type III 2008 Chevy 3500 AEV Type II 2002 Ford E-350 Lifeline Type III Service C - Fixed Wing Service Cessna 402 Cessna Citation I Cessna Citation SII LearJet 35A

Pushing the wrong drug is probably one of the biggest mistakes I have seen medics make. I think it is a lack of field supervision and the medics thinking that they know it all since they graduated Paramedic school and passed their exams or have been a paramedic for "X" years. I have had at least three new medics and even a "seasoned" one push the wrong (or concentration/route) drug over just the last year and half. If in doubt look it up to see the right medication, dose, route and administration time. Forgetting to put the pt on O2 in the rig and your portable runs out and you wonder why your pt is desaturating. I always remind my partner to change over since I have seen this happen way to many times. Thinking that you have enough fuel to take that one run that was just a little too far from the hospital . . . Don't leave your keys in your ambulance, they do get stolen. (PS this has not happened to me personally, yet . . .) And most importantly not asking the RIGHT questions before an intervention or transfer. The more you know about the pt the better off you are (just don't get carried away with it though).

I remember back five years ago that we used only Valium and Etomidate for sedation to "knock" down the pt so we could intubate them. We soon realized that this was not working very well and decided to go full pledge RSI and the result speak for themselves. My "cocktail" varies depending where I am at. In the hospital it is Versed, Fentanyl and Succs and continued with Propofol and Fentanyl. In the field it is Versed, Fentanyl and Vec since we don't carry Succs on the trucks and continued with Versed and Fentanyl. A few years ago I would tell you to keep them paralyzed but if they are properly sedated the need for paralytics decreases. I think a lot of people over look the combination of Fentanyl and Versed, it is very potent and will do a very good job together. Now back to the original questions, the only time we used Ketamine is in the hospital for pediatric sedation and for pt's with severe asthma. Otherwise we use different medications as mentioned above. There are numerous "cocktails" that work and t is important to find one that will work for you and your situation. The first thing I would do is ask your training officer or Medical Director about it and see what their recommendations are.

It is always a good idea to get some EMT experience before entering the Paramedic program, I think it makes it a lot easier since you have seen and used a lot of the equipment prior to class. Volunteering is a great way to learn and gain experience in EMS. I obtained my EMT while I was still in High School and was volunteering for the local Fire Department and Ambulance Service as an EMT. I found employment at a young age as an EMT (18 y/o) and later as a Paramedic (20 y/o). The service that I volunteer on only states that you have to be 21 years of age to drive, doesn't apply to working in the back. The services that I am currently employed on only requires you to be 18 years of age to drive. I think the age requirements has something to do with the different States or company policies. If I had to wait to be 21-23 before working I would not be in this field. I will always value experience at any level over a brand new Paramedic without any experience or understanding of EMS. There is definitely a difference between the two, you won't understand until later on in your career but the experience is well worth it.

BLS - Oxygen, ASA, Oral Glucose, Epi-Pen (Adult and Jr) ALS - Lactated Ringers, Normal Saline, Adenosine, Amiodarone, Albuterol, Atropine, Benadryl, Calcium Gluconate, Dextrose, Dopamine, Epinephrine (1:1,000 & 1:10,000), Etomidate, Fentanyl, Geodon, Glucagon, Lasix, Lorazepam, Magnesium Sulfate, Metoprolol, Midazolam, Morphine, Narcan, Nitroglycerin (SL and IV), Oxytocn, Romazicon, Sodium Bicarb, Thiamin, Valium, Vecuronium, Verapamil, Zofran These are the medications that our Medical Director requires us to carry in our rigs. We are allowed to transport and administer many more medications than this but this is what is in all of our trucks. We provide 911, Interfacility and Critical Care Transports daily so we require a few more medications than some of the services that just run 911. All of our Nationally Registered Paramedics (Iowa Paramedic Specialist or the new PARAMEDIC) are allowed to RSI. We don't have any drugs that are strictly CCP.

Just got done going looking at a Demers Sprinter and WOW! is what pops into my head! Personally I have only seen them from the outside and usually a AEV model and everyone talks about how much they hate them. So of course that's what everyone at work hears and they didn't want anything to do with them so they always got pushed away, until this time around. We started looking for a new ambulance and the committee got cut from four people to two. I have served on the last two and was asked (more like told) once again to be on the committee. So we finally found one and just one Sprinter Demo out there and it was made by Demers. Called them and they set it all up and brought us the demo today. We were both surprised at how nice and finished the product seemed to be. This demo was nicely made and equipped, no doubt about that. Things that stood out to me is the room compared to a non-Sprinter type II, lots of room and places to store everything. Very nicely laid out work area. Everything was finished very nicely, all aluminum cabinets. All of the exterior doors are very large and I found it very easy to get in and out of. They even let us play around and put our equipment into the van to see how it all would work out. And of course we were all impressed with it. So now we have to wait on the final bids and get a few more bids from other manufactures even though we are set on the Demers. We found the cab to be more than spacious and enjoyable for all of us, we had the day crew join us. We had one very large male, average male and two smaller females all try out the rig and we all found it very comfortable to work in and drive. It was very responsive and fun to drive, we are used to the Chevy Duramax and Ford Powerstrokes. Our only concern was how it would handle in really wind conditions, however we have had to deal with that for years in our modular units. So here are my questions are: If you currently work in a sprinter what do you like or dislike about it? Quality issues with Demers? Issues with the Mercedes Sprinter Chassis? And your general likes or dislikes about it?

Welcome!

As the subject states I have been away from this site way too long. I have been so busy with family and work I kind of forgot about all of my peers on here. But I am going to try and make regular visits to you all once again. Since the last time I really was here and posted a lot has changed. I have gotten married and had a daughter which has been great. Also have furthered my career by getting my Critical Care Paramedic and working my way up to fixed-wing Critical Care Flight Paramedic. All of the hard work and dedication has paid off and now I have something to show everyone that has helped me along the way. Thought I would stop by and update everyone and try to get back into the swing of things on here once again. It is always nice to stop by and visit and learn from you all. So this is my I am back post.

There are a few different causes that come to mind, most probable one is an interaction with the antibodies that the patient has developed from the numerous platelet transfusions. The risk of an interaction increases every time a patient receives a transfusion of any blood product. We do have a protocol called "Adverse Reaction to Blood Products". We routinely transfer patients that we are starting or continuing blood products on so we have prepared ourselves in case we ever need to use it. This is what I would of done: Ensure that the transfusion was stopped and had been sent to the lab to recheck compatibility (ensure there was not a mistake made). Recheck vitals from the time they took them, compare for significant changes. Also obtain temperature, they should have a baseline prior to administration. Evaluate the patient, are they still symptomatic? If the patient complained of shortness of breath or difficulty breathing consider another albuterol or if significant consider CPAP with Albuterol. Remember patients can have flash pulmonary edema from a transfusion. O2 to maintain O2 saturations 94% Vitals appear to be stable, would consider TKO of fluids. Also investigate what happens when she takes Benadryl, sometimes an adverse reaction (tachycardia, nausea, headache, sedation, etc.) is not a true allergic reaction. And of course continue monitoring all vitals, SpO2 and EKG. I would of held off of the Epi unless there was significant concern for the pt's airway. Vitals were stable. I would say a majority of 911 services would have no idea how to treat an adverse reaction to blood products considering most Paramedic textbooks have about one paragraph in them about the evaluation and treatment of them. Treatment was acceptable.

This is becoming an all too common theme at work for us. As previously mentioned people don't get to pick and choose wether they have it or not. I have to remind myself daily that these individuals are the same as the rest of our patients; they are asking for our help in their time of need. Is that not what we got into EMS for, is to be able to help people when they need it the most? For most of these people their families are tired of dealing with it so they stop giving them any type of support. A lot of time these people just need someone to listen to them. I have taken my fair share of behavioral patients across the state. Yes we may not be able to practice our skills like a good trauma allows us to, but it allows us to get back to what all humans need. They need to feel as they are needed and worth living, focus on the positives in the patients life. Yes, it may be hard if we don't know much about the patient but we need to strive to get to know our patient so we are better able to help them. A simple conversation with these people can make a huge difference, I have seen it first hand. I have had behavioral health patient return and thank me for just listening to them and offering them words of encouragement. No I didn't preach the gospels to them, I simply talked to them as a human and treated them with respect. EMS has a bad reputation for treating behavioral patients as a burden and not as a patient. Remember back in class we could not wait to get on the rig? Well this is part of our job and we should be just as willing to care for a behavioral patient as a trauma or cardiac patient.

My favorite 12-lead book is "The 12-Lead ECG in Acute Myocardial Infarction" by Tim Phalen.

This is the site that I used for my Paramedic Written; http://www.fisdap.ne...we_make/testing I passed the NREMT Paramedic exam on the first attempt. Our final for my Paramedic course was the comprehensive exam, they offer you two of them I believe. However my instructor only allowed me to take one of the two since I passed it the first time. After you take the test it breaks it down as to what you knew and what you need to study more of. It is a great study aid.

This is the site that I used for my Paramedic; http://www.fisdap.net/what_we_make/testing I passed the NREMT Paramedic exam on the first attempt. Our final for my Paramedic course was the comprehensive exam, they offer you two of them I believe. However my instructor only allowed me to take one of the two since I passed it the first time. After you take the test it breaks it down as to what you knew and what you need to study more of. It is a great study aid.

I think the reason that this course is so different from the NREMT-I/99 is that they realized that every state and even every system within a state has a different definition of the EMT-I since they had the NREMT-I/85 then they bridge to the 99 in some areas and other areas kept the 85 and added the 99. The Intermediate level got carried away in some states, they either limited what they could do or expanded it to include too many Paramedic skills without the proper education. Example: In Iowa we have the EMT-I (NREMT-I/85) and the EMT-P (NREMT-I/99). Both are "intermediate" level but one gains IV skills and blood draws over the basic. And the other is a "Paramedic" with some skills removed. So a Iowa EMT-P is moving to Illinois and he gives them his Iowa card that says EMT-P and he is given a Paramedic certificate in that State, but he really isn't a Paramedic (this actually happened). This individual went on and moved to Missouri and was given a Paramedic certification there too. Remember this individual never even enrolled into a Paramedic course. So now Sates have to transition to the new levels which are much better defined and explained, hopefully causing less issues between States. I think that is why this new level is going to be hard to teach at first since we were all teaching the NREMT-I/85 or the 99 and in some instances both. I think this new level is going to be a good balance between the two.

I know this is an older post, but I am posting anyways. Personally I prepare a simple form letter for any individual or services requiring proof of completion. I include all the contact information for myself and my Training Center just in case they have any questions about it. I also find that if you include the AHA Logo on the form letter it makes everyone feel that it is "Official" and they don't tend to question it. You can just search the AHA website for the Media Packet and the Logos are included in the files. In my area only the Training Centers can print the CPR cards so there is no chance that I can have them prepared ahead of time and hand them out at the end of the class. Hope this helps.

We use and I will only ever use Iron Duck, their warranty is second to none and we have had to send our bags in more than once and they always end up just sending us a brand new one at no additional cost! Here is our main carry bag: http://www.ironduck.com/ems-products/ems-bags/trauma/ultra-sofbox-plus-32325

When we went through and changed our drug box from a tackle box to different soft cases we got some stock stuff for our Basic, Cardiac and Medical Bags but we could not fine anything that would hold all of our controlled substances. So we went and had Colorado Cases make one designed by us. Here is one that I found that is close to what we have, ours has different sized pockets. http://www.coloradocases.com/index.php?main_page=product_info&cPath=3&products_id=24 They were very easy to work with and even sent a "prototype" to us before we ordered the rest from them. There was no commitment to purchase a certain amount, they had a setup fee and then the cost of that size of a bag. Very reasonably priced for a custom "Narcs" kit.