CBEMT

The one time I've encountered a Combi-Tube during a call was a pediatric critical care transport of a post-cardiac arrest patient. Combi-Tube was placed by ALS after failed intubation due to the patient's size (140 pounds at an age where such a number is almost unheard of). I believe that one was a mainstem intubation, and the doc on the team asked the RT if she wanted to pull the tube and attempt ETI. "No way. It works, she's satting well, good waveform, it fits to my vent, why screw with it? Let's get the hell out of here." (Justification being that none of them had ever encountered a Combi before, since they aren't used in the state we came from, and as such they did not want to attempt a re-position of a device they didn't know how to use.)

Considering he goes on (in another post I think) to describe just what it is that nitro does, my sarcasm alarm is ringing too.

Your only ambulance is down for mechanical. Again.

I will admit that a large part of my aversion to medic/medic systems is an issue we have discussed here before- ALS over-saturation as being detrimental to patient care. I'm willing to accept the supposed increased paramedic workload if it means that the actual ALS patients are being treated by a provider whose skills are exceptional because he doesn't have to fight 6 other medics for the chance. The other part, probably, is because my service considers itself a "teaching service." Our student volunteers are here to learn. There's only so much they can learn from me doing all the assessments. Unless on approach the patient is blatantly someone I should be dealing with, the patient is theirs. If something gets left out, I make sure it's covered before a treatment plan is formulated or a transport decision made. If they decide they'd rather the patient go ALS, I'm there to step in. It's like a tiered system where the ALS is already there (for those of you who have to have that element).

It was on the national news tonight. They used chilled IV saline.

By recognizing that on average, 80% of your call volume (if you were practicing) could be handled by your EMT. They're only a "driver/helper" if that's what you force them to be. Not that I'd be surprised in the least.

Please, allow me Dust. -10 for talking in code. NIMS hasn't made it to your jurisdiction, I see.

Ours is similar. I don't know if I'd put the number at 100% but it's damn close. The (on the truck) supervisory staff are the career EMSers.

Perfectly within DEA regs. As for our keys, at my FT job, our key ring is so huge that I use a carabiner they provide and hook the 'biner onto my hip pocket and put all the keys into my BDU pocket with the inner button undone. Not a lot of jingling at all, and while it's a little annoying to get the keys out (a leather ID holder for our access card is attached too, always sticks) , the chances of losing the keys is extremely small. If the 'biner comes off my hip pocket (unlikely), the weight of the keys will pull the whole pile into my BDU pocket. If the keys come out of the BDU pocket, there's no way I won't feel it and hear it. At my part-time, we each have our own key. Mine is on my car keys so I don't leave it at home accidentally (it's a decent drive). Once I'm at the station, they go in a BDU pocket with both buttons sealed The station couches and chairs seem to have figured out how to get keys out of my hip pocket without me noticing. :oops:

Well, there you go. Someone who shouldn't have access to oxygen or pulse oximiters. Or other people's run reports.

Don't be stupid, that's not what I'm saying. I'm saying that your cardiologist has WATCHED Amiodarone work on multiple patients in various conditions. I don't care who pushes the plunger. I care that the provider teaching others knows what happens next in a variety of situations.

You done good, the ALS crew can go pound sand. The only other issue I have is with trying to get a helo with a 22 minute drive time. Unless the bird was hovering overhead when I pulled up, it wouldn't even be a consideration. That's even without the local consideration on my end that our trauma center's helipad location requires ground transportation from the pad to the ER.

Fiz, as yo may have noticed nursing home patients have both ALL THE FREAKING TIME, which makes your plight one I have run into time and time again. In the beginning of my ALS career, I mistook pneumonia for CHF and gave 40mg Lasix. The ER doctor, unfortunately for the patient, concurred with my diagnosis, and gave an additional 80. Days later I found out he'd been shipped to the ICU with a pneumonia diagnosis. I found out from the same ER doc, who looked as embarrassed as I felt. The best advice I ever got on the subject was "If you think it's CHF, and they're hot, it's pneumonia." Honestly, the BP probably would've thrown me as it did you, I won't lie to you. Most of the time when I get these patients they are already septic, so the hypotension + skin temp is a dead giveaway for pneumonia. There area always exceptions, but I've found the rule of thumb to be pretty accurate. Yeah, very often a patient is suffering from pneumonia AND an exacerbation of their CHF, as yours was. But I still don't consider that justification for throwing the CHF protocol at them- if they have both, I've found that CHF is almost never the main problem at that moment. It's not helping, certainly. But I feel treatment of secondary diagnosis in these cases is best left for the hospital. Worst comes to worse, I play it conservative- O2/IV/Monitor/Transport. I only start pulling out drugs if I'm EXTREMELY confident that CHF is the issue. If I'm certain that pneumonia is the problem, I'll run a fluid bolus. Other than that I keep it simple.

One point of slight confusion- if she's KEDed, how effective is our strip-and-peek going to be?

Since it was spread out over the course of the contract, all it amounted to was a COLA increase. But, considering the final offer previously was a pay cut, there is something to be said for small victories.

Unless you're talking about an MCI kit that's physically on your ambulance, I don't really think a trailer is the place for life-saving equipment. Backboards, replacement O2 bottles, fine. Not something to mitigate an immediate life threat.

If your paramedic instructor has 25 years of experience, but it was all with LifePak 5s and 10s, is he going to be a good 12-lead instructor? As others have mentioned, there are some things that aren't going to change. Anatomy, physiology, starting an IV, etc. Even most of the major pharm is pretty much boilerplate. But, say, Amiodarone is a recent development. What good is listening to this guy talk about how Amio is going to affect your patient and what to watch out for if the last anti-arrhythmic he used was Bretylium? Teaching skills is one thing. But EMS concepts and patient management ideas are always changing. Yes, most of that comes in the clinical phase, but I think it has an important part in the didactic- important enough that I feel it shouldn't be left to desk jockeys.

100% police responsibility. Their supervisor signs my run report, he gets a copy, I go back in service. If it meets ME requirements, they make the call and babysit. If not, family is free to call their funeral home. That said, at my full-time job a DOA is probably going to be a LOT more complicated than that, but this is how it would run at my 911 job (where it's 200x as likely). As of our last protocol update, under no circumstances is an EMS unit to transport a cadaver. (It happened after an MCI a few years ago; the after-action report pointed out what a @#$%ed-up idea that is. Apparently it caught someone's eye.)

For this and a thousand other things, I blame the Baby Boomers. Some of them are great parents. But the rest produce soulless hell-spawns like the girls discussed in this thread.

I am a paid supervisor with a collegiate EMS service. No, I don't want to chat. To cover Dust's questions to the other poster, we cover all of campus and any off-campus housing in the surrounding area if someone there calls the campus emergency number, which they are encouraged to do. Campus police also respond both on and off campus with us. We are also in the jurisdiction of the local fire department EMS. If 911 is called they will respond, or if we are unavailable our campus police will chop calls to them. We run an ALS transporting ambulance with an ALS-level supervisor and student volunteer EMTs (there is always a supervisor on duty). The overwhelming majority of our student volunteers are either science majors of various fields, or pre-med. Students who attain ALS-level licensure are allowed to practice at their level. We have the option of transporting either to a local ED or to our campus health services (the FD will only transport to an ER). We have 100% physician QA of our runs.

Well that would've been an unpleasant development. :evil: I have to call for Valium or anything else that needs to be locked up. :roll:

I neglected to mention that quite often EMS was actually forced onto a fire department by city management under pressure from taxpayers who perceived that the FD wasn't doing anything (usually being ignorant of the training, building inspections, and other duties that suppression units were increasingly being assigned). Basically if Joe Public didn't see them at a fire he figured they weren't doing anything. Mind you, these same people would be the same ones screaming that the FD didn't respond fast enough to their house burning down- when the closest engine was tied up at an EMS run that he wanted them doing because they had all kinds of time on their hands. Catch 22 any way you slice it. And yes, in many cases, EMS was dragged into the FD by unions afraid that the decreased fire load would mean layoffs. Just not always. As for reconciling the stories, I don't know if I can help you with that. All I can do is lay out information for you.

The first unit was transporting a patient and was flagged down by the PD, I think. I know they were flagged I just forget by whom. They stayed onscene (with one crew member remaining with their own patient) until the second unit got there.

At my FT job, during my 12-hour day a call is extremely rare. The 24s vary, once school's back in session I'll probably be good for 3-4 a night, the day is unpredictable. At the 911 job, I work 12-hour days primarily. The most I've done in a shift is 5, some people do 8, some none at all. I don't feel overworked, and I think my pay is adequate at the FT given our call volume.