whit72

sss g-man wrote: I have never scene horse mounted EMS. Can people stop saying horse mounted EMS. Frankly I am not sure I want to see a horse mount anything. However if you stated in EMS have I ever felt like I had been mounted by a horse. Then I would have to state yes.

Does Boston EMS ring a bell. I believe most of their BLS trucks are staffed by medics, waiting to be promoted.

I might need to clarify my self here. My partner reviewed this topic, and stated to me sometimes I don't always get the point across im trying to make, in the fashion I am intending. Which is a valid point. I will admit this. I apologize (she made me type that.) LOL The fact of the matter is I don't believe this conversation was ever about immobilisation, We all agree the pt warranted it on MOI alone. As far as the NEXUS criteria, the fact that it dosent factor in MOI, is the sole reason I believe medical directors wouldn't endorse it. I would hope that most ems personnel would be able to factor in force needed to cause significant intrusion and minor, moderate and heavy damage. Regardless of a negative NEXUS finding. Although it is a helpful tool in assessment. Sorry dust you were speaking of my nimrod partners. She didn't like that comment, nor does she resemble it. Although I can usually decipher the meaning of your posts from you usual chest beating banter. I apologize to malignent for the rash og bull Sh#@ I directed towards you for the medicine practise comment. I will state that the practise of medicine comments do bother me. I have a close friend who sacrificed her entire twenties to obtain her MD/phd. For me to assume that I practise medicine would be an insult to her over a decade of education. Although she has made the comment that if you were to drop dead, you would have a better chance of survival if you did it at an EMS convention opposed to a physicians convention. God I feel I just left confession. Later

Malignent Wrote: Its sad to see that the contemporary view of medicine is still determined by the word "Doctor" and denial that pre-hospital interventions is not a form of medicine is not only narrow minded, but is undermining the professional standing that paramedics and EMT's internationally strive for amongst other allied health professionals What is sad is that fact you believe that some education and training, and a few tricks that your allowed to perform, have you confused about the aspects of your proffesion. We play a vital role, no ones denying that. What is undermining the professional standing that paramedics and EMT's internationally strive for amongst other allied health professionals. Attitude of some EMS proffesionals. Assumption that there owed something they haven't earned. The fact that they ride an ambulance gives them a right to questions every other allied proffesionals decisions. Clamoring about practising medicine. If you crave respect or acceptance from your so called allied health proffesionals. Do your job competently and proffesionally, people will notice. Why we don't get respect is the hoards of EMS proffesional who cry and stomp there feet about how much respect they deserve. Respect is deserved when earned. becksdad wrote: Qoute from another mentor - "Please do not impose your limitations upon me". However recognizing your limitations also factors in to the development of a good provider. hfdff422 wrote: No we are not doctors, but we base our treatments on realistic evaluations of our patients. Your initial post(s) indicated that, but when certain portions of your post were rebutted, you eventually reverted to the robot answer of we are not doctors, so I don't diagnose. I am a big believer in BLS transports and gives O2, but I will say that it is important to effectively care for your patient by initiating the assesment and trying to find out what is wrong with them. Actually I believe assessment is the most important tool I have, along with recognition. Those I believe are the most important aspect of our duties. The rest is useless, if those two practises are not mastered.

Malignent wrote: ts sad to see that the contemporary view of medicine is still determined by the word "Doctor" and denial that pre-hospital interventions is not a form of medicine is not only narrow minded, but is undermining the professional standing that paramedics and EMT's internationally strive for amongst other allied health professionals Its not determined by the word doctor its determined by the 8 or so years of education the 3 or 4 years of internship. We are a trained extension of them. There for a sole purpose. Cilinical decision making is part of that. (judgements) in the scope they provide for us. What undermines the proffesional standing that paramedics and EMT's strive for, is the burred vision some have with there place in emergency medicine. Yes I agree we play a pivotal role in the chain of survival. However we are what we are, and are training reflects that. The interventions carried out by pre-hospital care providers still appears to be seen as nothing more than a bunch of tricks we pull out. If we are carrying out interventions with appropriate underpinning knowledge and clinical decision making in the field of "Emergency Medicine" what exactly are we doing? Medicine is more than giving drugs, writing pre-scriptions and diagnosis, there is an entirety here most people dismiss. Medicine is a continuum and Pre-Hospital Care is the first point of contact I dont diagree with you entirely, It also takes longer then a year to understand the interventions and under pinning knowledge you speak of. hfdff422 wrote: Hey Whit, Do you perform CPR on and defibrillate everyone you encounter? I know it is an extreme example, but it may be necessary since you do not utilize patient and scene assesment to formulate an idea of what is going on with your patients. Oh well if you have som spare time, could you teach me that. Please dont jump in 3 pages later and assume you know whats going on. Typical EMS'er

What the hell is a small glass bauble? In any event I would blame it on, in no strategic order. Blame it on my partner...... Blame it on her....... Blame it on my supervisor...... blame it on the staff.... We usually blame it on the FD or PD (Joking)

I will end with this: Malignent whatever you call yourself. I have a little secret for you. The word judgment is used in the definition of decision. EMT s and MEDICS dont practice medicine. Emergency, wholistic, holistic, evidence based........ Doctors do. Certified technicians do not practice medicine. Doctors do. Ignorance is assuming that with a year of training and a handful of college credits that you practice medicine. The conversation was about extrication, others made it about immobilisation. Nexus criteria is a in hospital scale used for radiography. Not a criteria for pre hospital immobilization. As far as dust: I actually was taken out a hatchback immobilised, the emphasis is on competent immobilisation, not the route in which extricated. As far as the NIMROD comment, I would expect nothing less from a pushy self proclaimed EMS expert. I do however enjoy the conversations and your attempts at intimidation. I find them quite humorous.

I am still wodering how I implied that I wouldnt board this person. Neropath stated that a judgement call was "famous last words" I stated 95% of this job is judgement calls or decisions. He disagreed (the words are one in the same) We cry about protocol robots, but yet we state we dont make judgement calls. Which way is it? I treat pts based on assesment, that is the greatest tool I (We) have. My job is first and foremost recognition. Without that nothing else really matters. As far as Extrication, please explain to me if a person is immobilized either by ked, short board etc. How one way would be more beneficial then another (Passenger door, drivers door or through the roof)? If your immobilation practices and techniques are thorough. You should be able to pull them through the keyhole, without chance of further injury. (Keyhole is sarcasm) Anyway We can either diagree or realize there is more then one correct way to get to the eventual goal.

Ok this is the last time I will state I never said don't immobilize her. He asked our opinion on how to broach the subject, I answered. Furthermore: There was no mention of any LOC in the statement. I am guessing no one asked. There was no mention of any spinal neck/back point tenderness. I am guessing it wasn't assessed There was no mention of any neuro deficits. I am guessing it wasn't assessed. No, I feel confident in the fact that if I choose to immobilize someone in a car, I am quite confident, that it wont matter how the pt is extricated. I am not an extrication specialist, my job is to prepare the person safely and securely for any means of extrication. I love the fact that people have a problem with the fact that its not of big importance to me how the pt is extricated. Everyone now quotes nexus, but has no problem that the actual NEXUS assessments were not followed. Typical EMT city stuff. And the reason why although I do enjoy this sight at times, it dosent really hold much credibility.

Ah there is shock, someone siding with Dust. First of all the definition of decision is: act or process of deciding; determination, as of a question or doubt, by making a judgment So in fact every decision made is a judgement call. I did not state anywhere to not immobize her. If she is immobilized I dont care, really how she gets out of the car. Roof flap, door punch, or out the passenger side. That is what I stated was a judgement call, how she was removed (decision). I simply stating a thorough assesment needed to be conducted as to determine the priority of this pt. It either wasnt done or wasnt stated. As far as for the NEXUS study. posterior midline cervical spine tenderness = none or wasnt stated focal neurological deficit = none or wasnt stated altered level of alertness = none or wasnt stated (the fact she cant recall impact dosent means she altered, most dont remember impact including my self who has been involved in a few MVA's) I actually believe it was stated she was alert and oriented. Under the influence = none or wasnt stated Distracting painful injury = Maybe but a lac to the head is a stretch. So in closing I again state to you as a rookie choose your battles carefully, As long as she is immobilized. Does it matter which way she is taken out of the car. drivers side, passenger side, roof flap. To me the main concern that she is immobilzed correctly in the car before extrication. Diagree all you want. That is my main focus.

Oh I see the EMT told her to lift herself up to get on the board. Got it now. An neuropathy 95% of this job is judgement calls. Or do you just board everyone. Put everyone on oxygen Start an IV on everyone Place them on a monitor Put traction on every femur fx. In that case you have all your bases covered and you have nothing to worry about. Most on the other hand treat people based on assessment. My feeling is people who over treat, are lacking good assessment skills. They over treat to compensate for their insecurities as a provider. Judgement calls are also known as a decisions. And yes I make them everyday.

Your a pt advocate, if you see something you feel will exacerbate the situation, then you need to speak up. This I feel is just a judgement call, over the center console. Popping the door, rolling the roof back seems a bit extreme. Whatever, its preference. Pick you fights wisely as a rookie. If you look like a know-it all over and extrication decision on a stable pt, you could alienate yourself later, when you really need to step in and question the way something is being performed. Good luck

BushyfromOz wrote: And where and how would you like to carry this larger, heavier more expensive piece of gear, and how is this easier that will not fit in the bag Timmy already has, and how exactly is this smarter If you didnt carry a hundred pound airway bag you wouldnt have to worry about a ten pound suction unit. BushyfromOz wrote: It is all in one bag... So its not an O2 bag, its a first in bag. BushyfromOz wrote: 2 sizes of bag - Adult and Paedi - Infants bags are not usually used as it is much more reliable and effective to teach first aiders to do effective mouth to mouth on an infant rather than an overzealous and well meaning person blowing the kids lungs apart with a BVM Provide evidence of the above statement please. Timmy wrote: Let me refer to my other posts. “Main reason we carry all that stuff, we cover a lot of standby events, you don’t always have the ambulance to take with you or areas can be quiet difficult to access, having everything in the 1 bag and ready to go is good for us. Sometimes it might be a 15min walk into the bush or something along those lines so it’s just easier to take one bag. Also if it’s a multiple cas situation, there’s enough gear to go round.” You didnt state that in your first post. 15 minute walk into the bush carrying all that equipment? Sounds like fun where do I sign up(sarcasm) Listen if you dont like the answers you get when you ask a question, maybe you shouldnt ask the question. If you are taking my answer personal, them I am sorry, I was stating my opinion. If your question would have started it out with, Hi Im Timmy, we are first responders that for the most part are standby personell at sporting events, just wondering what other equipment people might use in the same situation. Then we wouldnt have had this problem. Any way good luck. Ill be waiting for the evidence that mouth to mouth is a more effective way at oxygen delivery then and infant BVM

I believe I ended my statement with in my opinion What ever you think I look like, I believe in working smarter not harder. Well if you want to nit pick? Where is the child BVM, oh maybe there isnt enough room. Get a battery operated suction. Therefore you dont need a manual one. Sorry I dont carry any thingys on my ambulance. They all have a name. So I wouldnt know what you are talking about.

thunderchild wrote: Point being, paramedics have better assesment and treatment skills than EMT-Basics. Even -without- ALS supplies like IVs, cardiac monitors, etc. etc. etc. The paramedic using his knowledge of A&P is better prepared to assess the patient and give a handoff to the ER. And, as before mentioned, it's usually not acceptable for an ALS provider to turf a patient to BLS providers, at least here. Ummm a paramedic without any ALS equipment is what..........an EMT. Pt. assesment is not an ALS skill. As far as it not being acceptible for and ALS provider to hand off to a BLS provider, that dosent say much for the competency of your BLS providers.

Timmy wrote: Just wondering what you guys have in your 02 Resuscitation Kits? I’ll get the ball rolling with what we keep in our kits but would love any input and add ons to my list. Would also love to hear about any little knickknacks you couldn’t live without Cylinder Laser Regulator Disp. Adult BVM Disp. Peads BVM Adult Pocket Mask W/ 02 Inlet Hand Suction 02 Powered Suction Yankee Suction Adult 02 Masks Kids 02 Masks Airways Ventolin Spacers O Rings Various hoses and adaptors Gloves Vomit Bags Various Spare Equipment Pupil Torch 02 Key/Rench Thanks Very Happy who gets to carry that? I have an idea, why dont we just put a handle on the top of the ambulance and we can just drag it upstairs. 3 different suction devices? if you have 20 BVM's with you, why do you need pocket masks? Remember everything that goes up must come down, including that 200lb pt. And what the heck are various hoses and adapters? 10 years ago everything was in one bag, hence the word first in bag, It worked great. Now everything needs its separate bag. It dosent work any better you just need 20 people to carry all the equipment. Now for what I cant live without: The national guard to carry all the equipment upstairs Sorry just my opinion

thunder child wrote: Yea. if the FF was also an EMT-P he probably should have gotten in and ridden with you to the ER, even if you didn't have any ALS supplies in the truck. And the point of that would be........what?

Actually infection is a strong possibility in open femur fx's, and contrary to popular belief some infections do not just go away. That in itself could be life threatning, if he has pedal pulse, a warm foot, good color, splint in in the position found and be on your way. There are so many different opinions for traction in an open femur. Whatever. Also placing traction on and open femur fx can cause just as much damage as the when the injury occured. You cant see the vascular anatomy of what lies or could possibly be tangled in the splintered ends of a bone. In my opinion if your hospital is a trauma center then leave it alone. the leg has a pulse, warm, and good color, Let the surgeons do there job. If you have a stable pt and you yank the leg and he blows an artery = really really bad Stable pt with angulated open fx = bad, but not really really bad.

Yes my mistake it was dust. Sorry Rid corrected

Medic 6698 wrote: Don't be afraid to boss them around a bit on calls if your are the sr. att. There is some good advice, the new guy bossing them around, you ought to get a lot of positive feedback with that approach.

Dust wrote And, luckily for us, most of us on this board aren't in the Northeast I think we might be the ones who are lucky. I might have asked you this before Dust, but did you get beat up a lot when you were a kid? At least you would have and excuse for your piss poor attitude for everything that is not DustDevil approved.

Hmm CA truck, you wouldnt be in the northeast would you.

Its getting out of the car that has become the hazard. Explosion, high voltage electrocution, and dodging the 10 to 15 airbags. Any one of which could probably kill you....LOL Before all you had to worry about was the impact. Now if you survive that, you could be decapitated trying to exit the vehicle, electrocuted, or even better a hydrogen explosion. No thanks I will stick with my 78 impala........LOL

Great. Thanks.

I meant from EMS standpoint. Such as: Battery pack location High voltage wires Identifying them Experience you have had with them. But thanks for the wealth of information.