firemedic37

My Fire Department had two Chaplains, one was very active and went on calls and the other one I have never met. The one that was active has left due to moving away to service a congregation elsewhere. We really never knew what to expect from one, until we had the young chaplain that wanted to be active and was given membership on our department as well as our lead chaplain. It was extremely helpful to have him on calls where there was a death, it made it much easier on the family and you could tell that peace was with them. Other times it was nice to have one to talk to someone that had just lost everything they had, again you could see the peace that the individuals got. We have tried to recruit another chaplain to be as active as our last one, however not many want to. We expect our chaplains now to be an active member and get to know everyone and understand our aspect of the job. It makes it much easier for any member to approach them and talk to them about life and spiritual issues. I am an individual that is very spiritual, I once was a minister myself however I was called away to my to my new "calling". I help out on calls and talk with other members and families when problems arise, however it was nice to be able to go to church and see a man that you knew give a good sermon. Be sure to invite all of the departments members to your congregation and any events that you are hosting, this makes them more likely to attend your services.

Clarify they are not medium duty rigs, they are the Chevy Express 4500 and they are $190,000 for two rigs. Last month was an expensive month for repairs we average around $1,000 a month. These rigs are your "basic" rigs when it comes to safety standards, there is really nothing that we can cut out that would decrease the cost yet keep the safety aspect there. These rigs were designed for safety and functionality for our tasks, they may not make the ideal 911 rig but will definitely be safer than 99% of the rigs on the road. The biggest thing we did was remove the famous "CPR" seat due to numerous studies showing that it was the most dangerous seat in the back and add five-point harnesses in place of the standard bench seat and captains chair for the airway seat. This did add several thousand but I believe that it is well worth it. Financing the new rigs will not be a problem, we have the money in a account that is not generating any interest so we are losing a lot more than just the inflation. These rigs will be paid in full before delivery.

When a pt is in cardiac and respiratory arrest it is nice to notice the bleeding but it does not prevent you from starting effective CPR. Sounds like you did a very good job by telling the husband to call 911 and get an AED, this is the step most EMS providers forget when they are not on the job because they are used to being the ones responding. They eventually remember it when they go to hook the AED/cardiac monitor up and they are asked where they got it from. When we interview prospective employees (in your case students) we have a written, skills and a face-to-face interview. This gives us the prospective employer a good understanding of their weaknesses and strengths. You don't have to score perfectly to get hired (or picked), we look for certain thins in a prospective employee to ensure they will be a good fit. Since we stopped hiring the "smart" ones we have had much less (< 10%) turnover, our one turnover in 5 years was due to a non-work injury. Before if you scored perfectly on both the written and skills you were hired, regardless of your personality. Now we hire people that will fit in with us and if they need a little help improving on their skills or knowledge then we help them out. Sorry I got off of subject there. Just saying that you shouldn't of had to get a perfect, little mistakes are understandable, after all you want to learn more and become a paramedic. If your heart is in it and they could see that it is then you will most likely get selected. I would like to see more Paramedic Programs require an interview before being selected for the program. In the Paramedic Program that I help with there are a lot of students taking it because "It's different" and they really have no desire to be in EMS. It seems like this should be a good program if they require an interview for it. Is there a lot of competition to get into this program? Good luck and keep us posted.

One of the services that I work for was in the process of purchasing new ambulances until the recent recession. Our ambulances have over 170,000 miles and we are told that we will have them for at least 2 more years. Until this month, now they are looking into replacing them now since we spent $6,000 last month in repairs and probably another $2,000 this month. Our current ambulances are two (2) 2007 Chevy 3500 Type II (Van Style) with 170,000+ on each and one (1) 2001 Ford E-450 Type III Ambulance with 110,000+ and is ran as third out or Critical Care Rig. Our proposed purchase was two (2) 2010 Chevy 4500 Type III Medtec Ambulances with a 146" box. The price is roughly $190,000 for both after additional equipment is purchased and our other ambulances are traded in. These by no means are your basic ambulances, they have rear view camera, five point restraints, dual control panels in the rear and several other options. We are currently exploring other options to convince our administration to purchase these since the 2011 models spec'd the same way will be another $7,500 each rig due to inflation, new emission standards and depreciation of our current rigs. Any help will be appreciated. Thanks, Firemedic37

I will have to agree with this statement. I work for a private hospital based ambulance service that fought for sleeping rooms since they worked 24 hour shifts, they got their sleep rooms. However new management came in and did away with scheduled 24 hour shifts. You can still get stuck working 72 hour shifts, if you work the night crew you usually are on call during the day and you can do this three days back to back since we work 12 hour shifts and 36 hours is full time. We run 1,200 calls a year so we get called in regularly for 8-12 hours prior to our 12 hour shifts. We primarily do inter-facility transfers with limited 911 so we have 3-10 hour turn around times for our transfers so we try to sleep on the way home if we are not driving of course. Our sleeping policy is if we get tired we lay down if we got our rigs checked (one crew checks three rigs) and our reports are wrote. And as Dustdevil wrote this has caused several of our staff to come in poorly rested and go straight to bed, hoping that they don't have an early run.

EMS is a difficult career and is even harder for our spouses. They think they understand our job and in reality they have no idea what the job involves. I have had many relationships fail due to the sole reason that I was in EMS, they didn't feel that they got enough emotional support. EMS in extremely draining on any relationship. If they have never been involved in EMS then they have no understanding of it. That is why some of the most successful friendships are the friendships we have among co-workers, they know what EMS is and how it effects us everyday. I have been blessed with an amazing woman who has blessed me with a beautiful baby girl (she's only 2 months old). Now this is the reason I mentioned my wife. She was a 911 Dispatcher for two years, for those two years she told me where to go and I told her who to call. We only had seen each other a couple times, then she decided that she wanted to take the EMT-B class that I was teaching ... Now before everyone jumps on me for dating a student, we never dated until after the entire course and I was dared by my Fire Chief to go out with her on just one date. And that was that, she was the last person I dated. I think our relationship works because she understands EMS and how it effects us both. It is something we both have in common and will continue to do side by side. And maybe just maybe our daughter will join along side of us too. I know you are having a difficult time, try to explain your job to her and even look into scheduling a ride-along with your service so she sees what you do at work. This may help her understand and respect what you do every day. Hope this helps. I wish you the best.

September 11th made my life what it is today. I was in the seventh grade. It started out as any school day, first class of the day was Current Events as we were reading the paper and writing our summary of the stories in the paper. Then all of sudden out principal came running into the class and turned on the TV telling us to watch it. We stared at the TV and we were all uncertain as to what was happening and what would happen. After going to my next class which was Math we had a test, the teacher stated that nothing had happened and that the rumors were just trying to prevent us from taking the test. She handed out the tests and left the room, she never did return to class that day. We finished our test in record time and turned on the TV. Our school eventually turned off all of the TV's in the school and instructed all the teachers to go on as planned and not to get off subject. Not very many teachers followed the directions, however we had to hover around the computers to see what was going on. This was the one day in my life that changed it forever, I saw the dedication of the men and women and knew that I wanted to be them. So my journey began. I obtained my NREMT-B during my summer break between by Junior/Senior year of High School. After graduating I have obtained my NREMT-P and FF-II certifications and am on a volunteer Fire Department and a career Paramedic.

As a Paramedic that works for a IFT service as a profession I think I might be able to help with this one. When we hire someone we take into consideration more than just your level and experience in EMS. We look for individuals that have a good understanding of EMS, patient care and strives to make EMS their profession. It's not all about being a paramedic it's all about the patient. We do tend to favor paramedics but we haven't hired a paramedic for years. All of our paramedics including me were hired as an EMT and then went to paramedic school to advance our career. We have only three paramedics that work for us that were hired as paramedics and that was about six years ago. Are paramedics needed for IFT? Absolutely! We run ALS 95% of the time so we need paramedics. During the day we run dual paramedics and during the night we run with paramedic / EMT for the most part. The reason for this is our paramedics have more seniority and have moved to the day so our new hires usually EMT's work nights. If you are asking simply to see if you should go back to school in order to work for an IFT service the answer is no. I do not think someone should get their paramedic just to have a better chance at get hired. If you truly want to advance your career then by all means go back and get your paramedic. But don't let the small raise be the deciding factor. If your heart is not in EMS then by no means continue in this profession. Hope this helps you.

I know that the King Airway was designed for surgery and then used as an emergency rescue airway for EMS. They may put the pt on a ventilator in the hospital setting. I am speaking from an EMS perspective, our protocols state that a patient must have an ET tube in place to put them on the ventilator. Our hospital requires that the patient also be intubated to be put on a ventilator. I guess I should of included this with my earlier post. I believe that this is a local requirement to provide more protect from aspiration and the King is not intended to be used for extended period of time. Please look at the above comment in regards to being used with a ventilator. I am not against the use of the King airway, I actually pushed for them on our rigs since they are simple and quick to use. They are an amazing airway and they should be used more often. We no longer even carry the Combi-tube since they are not really sized very well and cause a lot more trauma to the patient.

Perhaps you can look into your english language and learn correct grammar in your spare time. I am not to fond of abbreviations or slang such as "gr8t", is typing great out really that difficult? This is another way to write the above statements and make it look as it were written by an instructor. I want to encourage each and everyone of you here to look into becoming an instructor for the American Heart Association. It is a great way to spend your free time and it allows you to build lasting relationships with other healthcare providers. It can really make a difference on your resume. I know it has helped me to build my confidence, leadership and teaching skills. And above all it gives me a great feeling of accomplishment and pride in all I do.

This is a good question, some people may wonder why you would consider upgrading an advanced airway that is already functional. Here are the main reasons; the king airway does not provide a "true" airway, it does not go into the trachea which does not allow you to monitor true end-tidal CO2 the reading is not correct, second you can not put a ventilator on a king airway for the same reason as above and third the king airway is a temporary airway not meant for more than two or three hours at the longest from what I have read. This does not have to be done in the field but can be very useful. I work for a hospital based ambulance service as well as a private 911 ambulance so I do understand and see both sides. I usually wait until I am at the hospital to exchange for an ET tube so that they can put them on a ventilator. I also don't exchange if it is a code and the patient does not have a perfusing rhythm.

The King Airway is my favorite primary and back-up airway. Most of the time when I am working I am the only medic on so time is very important to me. You can prep and insert this airway in less that 30 seconds when you get it down and feel comfortable with it. I usually use it as a primary airway on all cardiac arrest or when I am in very tight spaces and don't have the room to intubate. If you use the one with the suction port you can intubate through it with the use of a elastic gum bougie if you have the training and protocol for it. So it is very easy and quick to upgrade from a King Airway to a ET Tube. I use the King Airway and easy IO on all cardiac arrest because EMT-B's in my state are allowed to use the King Airways and I can do an IO a lot faster than an IV. This allows me to focus more on good chest compressions and ACLS.

Pt's can start to seize again even after receiving even a large dose of medications. It is not usually seen in the field very often unless you have extended transport times or status epilepticus which can be very difficult to manage outside of the hospital. Seizures are more complex than just jerking movements and can be life threatening. When pt's don't respond to traditional treatment such was Valium and Versed there are other ways of managing them. The most common method is to RSI, Rapid Sequence Introduction meaning that we sedate and administer paralytics to stop the jerking movement and control the airway (intubate the pt). This does not stop the seizure it just controls the airway. They need anti-epileptic medications in the hospital setting and evaluation by a neurologist. Another effective way of administering medications to a seizing pt is to administer it inter-nasally (IN) it is very quick and you do not have the risk of being stuck with a dirty needle. It is almost or as effective as IV administration. And there are limited medications that can be given that way but Versed and Valium are approved.

I find it interesting that someone even mentions LMA's. Then again you are not from the US. I have never seen an LMA on an ambulance in Iowa. But then again we let First Responders insert Combitubes if you can even find those anymore. Also the LMA is a Paramedic only skill and no one wants to spend the extra money to stock them when they will never even be used. Everyone around here has switched to the King Airways and they are very simple and easy to use. And yes even firefighters can get an airway.

It is interesting that everyone is assuming that the I/85 transitions into AEMT without any additional traniing. And I/99 transitions to Paramedic with training. It is left up to your State's current scope of practice. In Iowa the I/85 has the ability to establish an IV, nothing more. They are having to transition up to AEMT with a course and then taking the NREMT exam at that level, both practical and written. Or downgrade to EMT. I/99 has a lot of Paramedic level skills and is actually called EMT-Paramedic in Iowa. They can downgrade to AEMT with no courses or tests. Or they can upgrade to Paramedic with a course and then take the NREMT-Paramedic written test. Either way they are going to loss skills or have to go back to school and

It seems to me that the ground crew thought that since the patient had a tension pneumothorax that it required the pt to be RSI. It doesn't surprise me. I had a EMT that just finished his Paramedic course and he wanted to bag a pediatric patient with a tension pneumothorax that had a respiratory rate of 34 - 38 per minute with decreased SpO2 levels even with a NRB at 15 lpm. He thought that giving more O2 and tidal volume would improve the patients SpO2 level. Instead I simply said "Let's fix the problem". He just looked at me. So I needle decompressed the patient and the patient became stable and was talking and alert. Continued transport to a Level III Trauma Center. Pt was admitted and discharged a week later. I think sometimes new and experienced providers just want to do everything because they can and they forget what is in the patients best interestsd. It is interesting to see that RSI is very limited across the US. Seems that it is usually reserved for HEMS. It is becoming very common for ground units to do RSI. I work for two ALS ground services one hospital based and the other private, both have the same medical director so we all have the same protocols for each service. And it includes RSI for all patients with a compromised airway. We always have the following airway devices and back-up airways; BVM, Suction, Airtrach, Flexable Introducer, Quick-Trach, King LT Airway, Combitube and Oral/Nasal Airways. I feel that when RSI is correctly used it is a HUGE benefit to EMS, but when used incorrectly it causes great harm to the patient. Every patient that is critical is evaluated for RSI and if it is deemed neccessary it is carried out in the most controlled situation that is possible in EMS. Every crew member must know their job when undertaking this task. No one should have to think about what to do next when something doesn't go the way that they had planned. As with anything else RSI is a skill that is intended to save patient's airway and not to take ia away.

I have a lot of experience transfering psych patients due to the fact that I work for a hospital based ambulance. Over the last year or so we have really changed our policy concerning psych patients. We use to transport any and all psych patients if the ER doctor said to do so. Now we have the final say if the pt is stable enough for transport. We have several different medications to use for sedation due to being at a hospital. Here is the hospitals standard treatments; Ativan 2 - 4 mg IV/IM, Haldol 20 - 40 mg IM or Geodon 10 - 20mg IM. We give them the medication and then let it work before moving the patient to our cot. Here is our prehospital protocol; Versed 2 - 4 mg IV/IN/IM or Valium 2 - 10 mg IV/IN/IM and in EXTREME conditions we can use Etomidate with Medical Control orders since we are devating from our Protocols. I have never had to sedate a psych patient with Etomidate but it is nice to have just in case. We don't only carry Etomidate for psych patients. We also do feild RSI so we have Versed, Etomidate and Vecuronium. If you are having problems with psych patients you need to be sure you have a protocol in place to sedate the patient, calling medical control takes too long! It could be a life or death situation. Last year we got our new protocols and they are all Standing Orders besides calling a code in the feild or to devate from our protocols. We no longer have to ask for every little thing. It is nice, I get to help the patient sooner and there is not that delay in patient care. If you don't have a Standing Order then ask your Medical Director for one and express your concerns for you and your crew. I know many flight programs that sedate with Ativan 2 - 4 mg IVP. I also like the idea of flying psych patients, we are a ground service and we usually have a 6 - 8 hour turn around time for psych trips due to there being very few psych units in my State.

The CDP is a great resource for all levels of providers. When I went I had mostly people in my class that have been in EMS less than 2 yrs and 90% of the class was either a First Responder or EMT-Basic. So everyone in my group looked to me for guidance since I had the most years in and was the highest level. Just expect to learn a lot during your time there from anyone you meet. There are a lot of different people there, not just from different places but different careers. The food and rooming was great! There is a lot to take in while you are there. I am plaining on returning very soon to take some more classes there. When I went there my Training Officer told me that I was going down there the next week. So I didn't have any time to research it as you have the chance to. Always remember you are free to do as you wish for the most part. They provide shuttle services around the area and the drivers always know where the good spots to eat are! Hope you have fun down there!

I agree with the first couple of responces. Here is my one cents worth. I started in 911 for three years then moved to work at a hospital based ambulance service that does mostly Inter-Facility Transfers. My biggest reason was the increase in pay. I knew when I started that I was going to hate doing long distance transfers (3 - 12 hrs round trip) and I still do. But what I knew I would enjoy is the pleasure of caring for pt's that are sometimes worried about what is going on since they are having to be transferred to a higher level of care for treatment. And I get the previleage to help them understand why they are being transferred. Also I have learned more than I have ever imagined I would know as a Paramedic. I get to work even closer to the nurses, doctors and other healthcare careers and learn more about their jobs and how it effects our job in the prehospital setting. I still do 911 and lately a lot of them. I now know what the hospital is going to want and expect from me when I take a pt to them. It prepares me better to give my report and tell them the things they want to hear. It has given me a much better understand of a multitude of different medications that I would never have touched before if I wasn't do Inter-Facility Transports. I also get to work in the Emergency Department when we are not on the road, this is the place I can perfect my skills under the guidance of doctors. I really have and continue to enjoy my career. I am planning on staying in the Inter-Facility Transport feild since I still do get a lot of 911 time with it. I think it would be different if I didn't get any 911.

emtbasic13, Everyone has different thoughts as to what someone should do, however I don't know enough about you to decide if you should take the EMT-I or Paramedic course. You know yourself the best and you are the one going to be living with your desicion, not us. Do what your heart tells you to do and go with it, you will never regret it! As far as the EMT-I thing I am in Iowa and we have both EMT-I/85 and EMT-I/99. EMT-I/85 has only a two main skills gained and they are you get to start IV's and draw labs. Of course you are also taught more indepth assessment of pt's then EMT-B. And in Iowa this leve is called EMT-I. Then we have the EMT-I/95 they have almost all the Paramedic skills, they can administer almost any medication that is not a paralytic, intubation, needle decompression, cardiac monitoring, mannual defib and several other skills. And they are called EMT-Paramedic in Iowa. Our NREMT-Paramedics are called Paramedic Specialists and can do RSI,12-lead interuptation and other advanced skills. The biggest difference is the amount of schooling required and pay. 600 - 800 hrs for EMT-Paramedic and 1,600+ for Paramedic Specialists. Wish you the best of luck! Firemedic37

It posted my comment twice. Sorry.

My service currently has a mixed variety of needs to use for Tension Pneumothoraxs. We have the standard 14 - 18 G IV Angiocaths and ARS for Neddle Decompression. The ARS is a commercially made needle designed for Tension Pneumothoraxs and are a 14 G X 3.25 in. Here is the link: http://www.narescue.com/ARS_for_Needle_Decompression_(3.25_in.)-CN1ACDE14CD3FD.html I recently had a call that I had to Needle Decompress a 11 y/o that was involved in a 10-50PI (Motor Vehicle Collision with Personal Injuries)with entrapment. I used a regular 18 G IV Angiocath since it is what I had readily available to me and the pt was crashing. And it worked very well. I had no problems with it and it resolved the Tension Pneumothorax very quickly. This was also the call where we had three patients that needed to be flown but we only had one helicopter, one ALS and one BLS ground unit with extended transport times to the nearest hospital which was a Level III Trauma Center.

This is a topic that can go on forever, there are numerous ways that you can place your patch on your uniform. Follow what your service does and if they don't have a set guideline then do as you please. My services have the National Registery patch on the left shoulder with the service patch on the right shoulder and any State patches on the chest if so desired or on the left shoulder if you do not hold National Registery certification. I have seen the other way too. Personally I prefer only on the shoulders and National Registery since my State is a Registery State.