triemal04

The above posts are pretty spot on, so just a couple points. Hypovolemia (often due to dehydration) is the most common problem, and will often not present as such. Unless there are contraindications, judicious fluid boluses are often a good idea. You CAN obtain a BP, though you won't hear normal sounds, but a "whoosh" (that really is the best description) and what you are getting is actually the MAP. If a patient is conscious and in vf, this is not "acceptable" just because they have an LVAD. Though these devices can, and sometimes do function as the only means of moving blood, they are not designed to; it's called a left ventricular ASSIST device for a reason. Something has gone wrong with your patient, and it needs to be treated. Beyond talking with a coordinator if you aren't certain about what to do, take the patient to the hospital where they are followed, even if it's for a problem you see as routine, and unrelated to their LVAD. If it's a longer drive...tough nuts. There are some devices that don't have ANY sort of way to manually activate them. Definetly look for a way, but realize there may not be one. Don't forget to check the battery life before you leave, and if the patient is capable of changing it, get a lesson on how to do so before you are on the road. (or failing that, take that person with you.)

Regardless of the OP, I have a question for everyone who said they would immedietly intervene when the patient loses consciousness: What are you going to do when the wife starts screaming "Get you hands off him! He said he didn't want any help!" The patient clearely refused care when he was consciouss. If you had allready explained the risks of not being evaluated further and the possible causes, and he was in a sound state of mind...do you think that changes things? Apparently he has some advance directives...should you inquire further about that before rendering advanced care? The patient was told he needs a heart transplant...should you consider that he may have decided that he doens't want that to be done, and/or is not a candidate and has decided that he'll pass peacefully in his home? The patient needs a heart transplant and refused care...should you be having a very direct and straightforward conversation with his wife about what you would be doing to the patient, and what care he would actually want?

I was going to suggest that this may not be the best career choice to you due to the simple nature of what we do. I was going to suggest that you consider that medicine is a complex thing to practice, and that physiology, both human, and pathophysiology are even more complex. I was going to suggest that you think about the fact that you will often be in situations that are not black or white, or even gray, and will be faced with multiple different possibilities, each of which has a different treatement pathway that you need to follow. I was going to suggest that you consider that if you are unable to make a decision based on your assessment (of medical, social, legal and ethical situations) because you are worrying about every aspect of them that it is a problem. I WAS going to suggest that...but since you made up your mind before ever posting, I won't waste my time. Really...why even ask if you allready are going to do something despite what people may say?

Actually there are a couple of states that issue licenses instead of certifications for EMT's and paramedics. I'm sorry, but that is blatantly wrong. Please don't spread information like that around as fact. Every state has a state scope of practise for the various levels of EMT's and paramedics. This is the maximum that they are allowed to do. (Texas is supposedly an exception to this as well). This is very much a legal thing, and like with other types of lower to mid-level providers, may vary from state to state. But make no mistake, it does define the upper limit of what someone may do within that state. Now individual medical directors may restrict that statewide scope of practise and tailor it to their individual service (or even inidividuals), but with the supposed exception of Texas, may not go BEYOND it. Doing that is what creates local protocols or whatever the term that you prefer is. This same type of thing can even happen on slightly larger scales- I believe that is how California works; counties or regions have defined what is allowed/not allowed in that area (but still not going beyond the statewide scope) and allow the actual medical directors to work off that. Same thing. Do not confuse "scope of practice" with "protocols."

Replies in red. People's own experiences will often color what they think/believe and cause them to make assumptions depending on the person, and what those experiences were. It's just how things work. But that's the reason why it is important to ASK questions about an individual service to see if those assumptions based on your personal experience/opinions are right.

Trollin' trollin' trollin'! Keep them troll's a postin'! Trolliiiiiiiiin'! Trollin'! (sung to the theme of rawhide) It's my new favorite song...

Lauri- Like I said, and meant sincerely, that's very impressive for a place with 3 EMT's and only a couple hundred calls a year. Short staffed or otherwise, it sounds like your department is doing things right. Kudos for that. I brought this up because your particular situation doesn't apply to all volunteer departments. (and obviously, before someone flips out, there are plenty of career departments that are...lacking...to put it mildly) There are plenty of volunteer departments (and I started with one) that have non-EMT's responding to calls, sometimes without any actual EMT's, that will say their "response time" is based on when some person (EMT or otherwise) pops up on the radio and says they are responding (from home without any equipment, and potentially not even to the station to get equipment), that do little if any real training and continuing education, have little if any real medical oversight, and so on. While there can be plenty of vaiability in how career departments act/staff/respond to calls, it's usually not as varied as volunteer departments are, especially in certain parts of the country. That's why I asked the questions I did. Without knowing the specifics of your particular situation, all I, or anyone can do, is guess and make assumptions. I would ask that you keep in mind that your department is not neccasarily a representative of the whole; while you might be well run, etc, that doesn't apply to all volunteer departments (and again, before someone flips out on a tantrum, the same goes for career departments), which is where problems pop up. If you've been doing this for awhile and have been working on continuing your education, I'm sure you have come across various people (career and volunteer) who were...poor representations of their particular group. When that type of person is seen again, and again and again and again and again and again...that is where the ill-feelings and stereotypes come from. Which is only natural. It really becomes a problem when someone can't figure out, or find out enough info to decide for themselves, if a specific group falls into that category.

Well perhaps you should get into a better mood and actually read all of what was written before you start throwing a tantrum, m'kay? Bushy was completely correct; would have figured between the 2 posts that was abundantly clear, but hey, if you want to freak out, go for it. Just keep in mind you are losing it over something I didn't say, or mean. Lauri- That's impressive. Nicely done.

I'm not trying to be insulting, but trying to point out that in some places just because a volunteer is responding to a call doesn't mean that they are actually an EMT who knows what to do, and that, responding in a POV is not the same as in an ambulance (if that's a service provided by that group.) The previous poster said her group has a 2 minute responce time...and 3 EMT's. I'd like to know a little but more about that. I think that she should (if I'm right and I could very well be wrong) think about that a little bit more; it's part of the reason why volunteer services are often looked down on.

But...what does that mean? Part of the problem with volunteer systems is the "standards" they hold to are often low, and not based on real things. Does that mean 2 minutes to reach the location of the call? 2 minutes for someone to be "enroute?" Is that enroute from home? From a station? Enroute to the station? Is that enroute in a department vehicle with all appropriate equipment? Enroute in a transport capable unit (if that is a service you provide)? Is that an actual EMT that is enroute, or just a volunteer? Part of the problem right there...

Well...yeah...it's the media...they tend to hype things in the most simplistic way. What I find most interesting is that, while he had landed at SFO before, the airports automated landing systems (for lack of a better term) where turned off during the crash. If this was a pilot that was used to landing under IFR instead of VFR, that may help explain why he came in so short of the appropriate point to land on the runway. It doesn't explain why he came in so slow, or why he (and the other pilots, if they were in the cockpit) didn't pick up on how slow they were coming in till far to late. My personal guess it it'll come down to that; lack of familiarity landing a 777 (or any other large jet) without all available instruments, and due to that lack of familiarity the fact that their speed had dropped wasn't picked up on.

It was the junior pilot actually, but yeah, it'll take awhile for the final say so, but that's how it's sounding more and more. And I really, really hope that SFFD didn't actually hit someone...

Don't know about New York but in Oregon and Washington any female, regardless of age, while pregnant is allowed to make decisions regarding all their medical care. Of course that stops when the baby is delivered. And it's not a true emancipation.

Took the MMPI or a similar psych test for my current job. Since I wasn't rejected I have to assume it went well...although the psychologist administering did mention that it was set to determine more the type of personality that you had/type of person that you were versus trying to find out if you were nuts...as he put it, "don't worry about this, if you were going to fail it would allready be very clear that you had a problem." There was no way to opt out, although I think for my department you can choose another psychologist or psychiatrist to administer the test, though at that point the fee came out of your pocket. I was NOT able to get the results; since the test was being administered as part of the hiring process there was no doctor/patient relationship, and, just guessing, but whatever my department paid probably didn't cover going over the results with the testee. I think he offered to send the results to elsewhere but I can't remember. We did the whole deal, including an interview during the test that was more of a Q&A with follow up questions based on my answers. I'm guessing, as far as what the specific department is looking for, it's probably similar to how various tests work; they want a specific type of person and use the results of the test to determine that. Exactly what they are looking for will vary, but spend some time riding with them and you can probably come up with a good guess. Personally I think it's a great idea, as long as it's administered by a competant psychologist/psychiatrist. Even if someone doesn't have any glaring problems, some personalities are just not cut out to be in the fire, law enforcement, military or medical fields.

(Quotes not used as they sometimes don't work properly for me here, and due, I think, to my net speed, I'm unable to preview posts before posting to see if they're correct or not.) "Dwayne...just gonna have to agree to disagree I suppose. While I can see some of your point about now wanting to scare off a new poster, there is a big difference in answering a question by a random person, and answering one by someone with a proven track record of being an [Edited by Dwayne]. Like I said, how someone acts will determine how they get treated, which if you are honest with yourself, probably holds true for you as well." It absolutely holds true for me as well. I've just never found that creating post after post of juvinile name calling is in any way productive. Not to the thread, the site, or the poster that you claim to be 'trying to answer.' From YOUR posting history I know full well that you're more than intelligent enough to see that this is in no way productive. That you can help no one with such behavior. How you've behaved is how you will now be treated. "I said these things for a reason:" [Edited by Dwayne] You can keep pretending that your comments are meant to be productive and presented for some mature reason, but, as you mention how things 'come across', they are coming across as childish ranting, bullying, and button pushing. In this case you win, you've managed to push the "site rules" button. You've read them, right? "1. You agree not to post or transmit any material that may reasonably be interpreted as abusive, slanderous, hateful, threatening, hostile, harassing, demeaning, intolerant, or intentionally offensive to any other member of this forum. This includes sarcastic, backhanded and double entendre comments, as well as any form of name-calling." "Nevermind. I'll just keep in mind that the new policy is to kiss the ass of everyone who posts and not ruffle any feathers... :bonk:" Not ruffling feathers has never even fallen on the City's radar. That's not what we're talking about here, and I'm confident that you know it. I've allowed you to have your say, yet you've provided little that's productive in this thread. The only drama is coming from you. I'm truly surprised that you are unable to see that you are behaving in the exact manner that you claim upsets you from the OP. [Last comment deleted by Dwayne] I've tried to gently explain that your comments have at times been unproductive, yet you've chosen to escalate instead of mitigate them. Having other things in my life to do besides try and explain to you why calling people names in post after post is childish and unproductive, I've no idea what to do besides begining to censure such posts. It's truly unfortunate that this has become necessary.

I don't know. I don't know the exact politics and public perceptions in your area, and while I can definetly see how you could be right, it would be very interesting to see what would happen if someone filed a lawsuit that actually went to court for something like that. It would be best to have a savvy lawyer, or be willing to do the legwork on your own (and know what to be looking for), but I think that once you were able to pull dispatch records (which would be public information) you could make a case for a suit. My guess it that the suit would fail, but what would happen in the court of public opinion would be interesting to see. IF you had the right info, IF you had the right lawyer, and IF you had the media willing to be unbiased to either side (big IF there) you could at least...maybe...get people aware of a huge problem...

Take a full A&P course; most schools that I've seen offer a 3 term/2 semester course that starts at the cellular level and works up to cover the entire body; that's what you want. If your school offers it, a medical terminology class is nice. If you can find a school that also teaches RN's, RT's, ultrasound tech's, x-ray tech's, etc, look into the curriculum for them. You probably won't be able to get into the core classes, but see what else is required. If there are some basic health courses...take them. Any classes that cover (in broad, general terms) sports medicine, rehab or nutrition...take them. Basically, see what other professions are doing, and follow along. Sociology and psychology classes are more than a nice to have; if you pay attention they will be worth their weight in gold in the long run. Given that both have a large part in what we do...good stuff. I'd start with a basic introductory class in each, but branch out into relevant topics if you can; some schools have a variation of the course "on death and dying," or "crisis intervention and management," that would be worth it. Most importantly, keep in mind that what you will learn in paramedic school is not all there is, not enough, may be outdated by them time you are done with class, and if not, WILL be outdated someday. So...keep learning. Dig deeper into pharmacology, ecg interpretation, pathophys, acute and critical care, primary care...and keep up not only with what is happening with EMS, but with the medical field.

Now why would anyone consider doing that? Since the point of this place is to talk, ask questions, BS, whatever, doesn't make any sense to shut it down because someone was using it for it's intended purpose. Of course...when you ask a question the answer you receive isn't always going to be the one that you wanted...as mine was in this case. But just because the answer doesn't fit in with what someone wants, or what someone else THINKS should have been said isn't a reason to get upset, and doesn't mean it was wrong to give that answer. Based on the OP's history and displayed persona I feel quite confident in my assessment, and believe, and will continue to believe that my response was the appropriate one. Like I said...end of story. Yes it is. And part of learning is hearing things that you don't want to. It doesn't make the message any less valid, and it doesn't mean that someone else might not be able to take something away from it. You know...since this site is about learning. Whether or not I like someone is immaterial in this case. As far as reporting posts...why? Aside from my personal opinion that it's chickenshit to do that...why? What would be the point of that, and what would it solve? My response wasn't "angry rah rah nonsense," sorry to dissapoint, but my response was based on Mike Ellis and how he comes across as a person. Believe me, this is much more polite and measured than I could be. When someone acts in a certain manner, be it good or bad, then it determines how they get treated. The OP has acted in a way that makes me think that he is all the things I said in the last 2 posts, so I respond as such. I have no problem with PM's...but since this was brought up in a public setting, it should be answered in a public setting. Especially when you consider that people from all different walks of life, levels of EMS, different medical providers, et al may be on this forum. However I may come across, don't you think it would be better for them to know that certain personalities and character traits ARE NOT what is looked for in a good provider, and ARE NOT what people in EMS should be like? I know that...but it IS my place to answer a question when it is asked...since this site is about learning after all. I think I addressed the reporting posts above, but beyond that, it has been made abundantly clear that this site will tolerate people who are...well...less than appropriate when it comes to EMS, so what's the point? This isn't the place to go into my personal feelings on that matter (unless you really want to, and then game on! ) so I'll leave it at that. But since the site tolerates that type of person...I don't see the problem in pointing out that certain types of people should not be involved in EMS, or the medical field, or perhaps more besides that, or pointing out that they are a detriment to EMS. Seems like the appropriate move, don'tcha think?

It has nothing to do with "moral chest thumping," at least on my part. On my part is simply being tired and disgusted with Mike Ellis and the type of person that he represents. Leaving aside who the "friend" actually is for a minute, let's think about this rationally, and using a little bit of common sense (two things that are very much required to be a competent provider and should have been done by the OP). Someone get's a DWI. This is an offence that generally stays on the driving record permanently (this may vary by locality and would be one of those things that the OP should be checking ON THEIR OWN), may potentially be a felony, likely will alter the drivers insurabability, and may temporarily or permanently cost someone their drivers license. What type of repercussions do you THINK there will be? In a job that requires driving? Hmmm...I wonder... Perhaps instead of asking a bunch of random people from various states and countries the individual should immediately be contacting their employer...you know...the one that will decide if they stay employed. Perhaps instead of asking a bunch of random people from various states and countries the individual should immediately be contacting their state EMS office/department...you know...the one that will decide if they keep their certification. Perhaps instead of asking a bunch random people from various states and countries and, I can only guess but I think it's a good guess, digging for sympathy and reassurance, they should step up, accept the consequences of their actions and and start figuring out for themself what will happen next. People screw up and make mistakes all the time. It happens. What's not ok, and what I have a problem with is when people try to duck responsibility and/or avoid having to do anything to rectify the situation, get informed about the situation, or any of the legwork involved. Happens far, far to often with younger people. (unfortunately even people who are my age) The type of person represented by the OP (and this is abundantly clear from his previous posts) is nothing more than an overly-dramatic, immature, ignorant, thrill-seeking wannabee. End of story.

Out of curiosity, are your fellow coworkers paramedics? EMT's? Volunteer? Paid? Very, very new to the job? Just wondering, since, depending on your answer, you either have a lot of work cut out for you, or you need to haul ass for a different place to work...

Tell your "friend" that he is an idiot, and an asshole. Tell your "friend" that he needs to grow up and stop acting like a whiny, immature little kid. Tell your "friend" that he needs to contact the state EMS office to find out what the repercussions are. Tell your "friend" that stepping up to deal with the consequences is what should be done instead of what...looking for sympathy? on an internet forum. Tell your "friend" that he probably should be involved in another line of work.

Along that same train of thought, it's really worth remembering that "SVT" is really just a catchall phrase; a supraventricular tachycardia is just that- a tachycardic rhythm with an origin above the ventricles. A sinus tach...rapid afib...rapid aflutter...multifocal atrial tachycardia...even junctional tachycardia's are all "SVT's." This isn't to say that adenosine will work on all different types of SVT's, just that people toss the term around without thinking about what it actually means way to often. This isn't a problem that only happens in New Zealand either. Probably, but not always. Though rare WPW is definetly something to think about when you find someone with new tachy arrhythmia and no history of the same. The higher the rate goes, the more you should be wondering about an accessory pathway. Granted, as you said WPW isn't in and of itself a contraindication, but it's still worth considering as a cause. Anecdotally they only time in 11 years that I can remember seeing WPW in the field the patient didn't have a clue that they had it...

Figures that's how it goes. There's always some...not angst, but extra concern maybe...when introducing a new drug/procedure/piece of equipment. It takes time to iron out all the kinks and get everyone up to speed and comfortable with it's use. You're right about the afib contraindication; I've seen some prolonged periods of asystole/atrial activity only when I've mistakenly given adenosine to afib/flutter (usually flutter), but I've also seen that when I've given it to an AVNRT. It's not that adenosine will kill them, it's just that it won't fix the problem and other drugs will.

At that point, with such a high rate you really don't have a choice but to call it an SVT instead of rapid afib/flutter or AVNRT (or anything else). So...give the adenosine. I don't know anything about your QA/QI process or interactions with the recieving docs, but I can't imagine them having an issue with you giving adenosine in that situation. Just have a copy of your 12-lead and rhythm strip from before the conversion for them and for your chart. If nobody ever mentioned it before, aflutter can often be right at 150 (give or take a few beats) without any real discernable p-waves OR flutter waves. Something to keep in mind if you see a rate that just sits at 150. If you were to determine after the initial dose that it's afib/flutter, then obviously you wouldn't give more. But up to that point, I wouldn't worry about it. Keep in mind there are some meds that adenosine doesn't interact well with (tegretol and persantine are two, though any in those classes will as well) and some rhythms that you absolutely shouldn't give adenosine to (though none are narrow complex so don't worry). Anyway, it's a great drug. Good deal that you guys are getting it. Not really. There are times when it shouldn't be given, but most of the issues that it creates will happen when it never should have been used in the first place. Give it appropriately and, while not 100% free of anything but transient side-effects (not much is) it's pretty benign.

Yes, and yes. In the US in many, many places unions are viewed as being on the same level that many people on forums like these see firefighters as being on. So...you don't have all (or even most probably) of the info...and you are basing what you know off of someone in the...city council? The people that control the purse strings? Huh...interesting... And here I thought you had said that the FD's budget was increased...not to be rude, but get your facts straight before you start complaining. I would have thought that someone in EMS, even tangentially, would know enough to know that a lack of problems, especially with firefighting, as with EMS, police, medicine, an the like, does not mean that everything is actually "good." Just because nobody is having problems and nobody from the public OR the FD is getting hurt does not mean that everything is being done safely. If all you think about when deciding if things are "good" in a department is the glitzy easy to see stuff then it's another example of willful ignorance. I'd have hoped somebody in EMS would have more sence than that. Uh-huh. So couple questions. What is the staffing on the Belton FD? How many engines? How many trucks? How many line command staff? How many people on each rig? How many calls do they run? Type of call? What are the cities buildings like? Whats the industrial/manufacturing base in Belton like? What's the residential building like? Population density? How many ancillary positions does Belton FD have, or not have? What are the total responsibilities of the FD? What are they FF's required to be doing on a daily basis? What is the salary like? Benefits? Retirement? Are the unfilled positions being staffed with overtime or left open? If staffed with OT, is it cheaper to do that, or to hire more people? How long would the 3 open spots stay that way? Would the retirees spots be filled? How is the rest of their budget? Is their equipment up to par? Stations? Vehicles? Do they have proper funding for training? Maintenance? Vehicle replacement fund? Equipment replacement? General fund? Did you know that there is a difference between the people who run a fire department and the people in a firefighters union? If you can't answer each one of those questions, plus a lot more that I'm sure I have left out, then you don't have enough information to make a real decision. I hate to tell you, but in city/county/govt agencies, or most large companies, there is a big difference between having a position left open (often to save money or because there is no money) and having a position eliminated. Left open means that, at some point in the future when funds are available, you can rehire someone for that spot. Eliminated means, even if the money is available, you can't, because the job no longer exists, and even if money did become available for all city agencies, it would not be going to the fire department as they didn't have a spot that needed money. It's very common for a spot to be left open for awhile (sometimes years) so that the money can be moved from the personell budget to something else (often times to a budget of another city/county agency). But that isn't the same as cutting one. Obviously you also have never dealt with budget issues or even listened to someone who has. Budgets are generally reviewed and renewed annually. The problem with cutting one is that, while it may be possible to scrape by for awhile, once a budget goes down it's hard to get it to go back up, and to often a reduction that doesn't cause immediate problems is seen as "well obviously you didn't need that money." This ignores the blatantly obvious fact that problems may take awhile to appear, but that doesn't mean everything is ok, and that just because people can do more with less doesn't mean they should need to. People need to quit having knee-jerk reactions just because they don't like a certain group. You're right. You can't argue with willful ignorance.