Just Plain Ruff

Another thread resurrection and it's a spam of their business as well.

I have found that putting a dose of phenergan (12.5mg to 25mg) in a miniinfuser run it over 10-20 minutes works wonders for the nauseated patient. That of course is in the ER. You get the patient a good solid slow dose of the medication and it seems to build up and it works over time. I have found that with the dose going in over the 10 to 20 minutes it gives the body enough time to adjust to the medication. If you are wanting immediate nausea relief then Zofran works really well. But it tends to wear off if the patient is in an acute nausea episode. For Hyperemesis, like my wife suffered from during her pregnancy, nothing really truly works well. ERDoc, what have you heard in regards to Zofran Drips? I had a OB doc tell me and the Mrs that if my wife's nausea didn't settle down with the next dose of zofran that she was going to give her that she was going to move on to the Zofran Drip. I've never heard of that. Any clues? *** Oh and NO She AINT PREGNANT again***

As for interpreting, theres' been very few times that I've not had someone who could interpret for me to the patient. Now those times that I've needed an interpreter have also been very few. I have had probably 30-50 times in 20 years that I've needed an interpreter and of those times about 18 of those times I've had someone who could interpret for me. The other 2 we did pretty good without. I urge those of you who have not done so to program in the AT&T language interprety line. I'm not sure of the number right now and I don't have my phone but I'm almost positive that the service is free. (someone correct me if I'm wrong on the price).

So needles, you've been given some pretty stellar advice from several here. I would go over this thread and think about what you can do to make your services service better. Just be advised and take this as it's meant, be cognizant that my suspicion is that your service probably does not want to make a change. I'll bet that they are very comfortable operating the way that they operate. They are comfortable performing at the status quo and by your offering suggestions for improvement will ROCK THE BOAT and that my friend is the surest way to end your job at that agency. So you have to ask yourself one question. Are you willing to stand up to your company and fight for what you believe is the right thing (not transporting granny with a small bowel obstruction without pain meds) or are you willing to not? Do you have the fortitude to go to the mat and push for reform in your service. Obviously a service who does these types of transfers without analgesic means, is not a service that I want my grandmother or my family member transported by if they need pain control. And you recognize that. So what you need to do is to decide if you are willing to fight for better patient care on this issue or whether you are not willing to do so? If you are not, well then that's ok. It's only a job right? They are only patients, right? But think of the difference you could make!!! But a transport service without the ability to give narcotics to a patient in pain is a service that is obviously a service that has issues. the balls in your court. What you choose to do with the ball is your decision. Like the guy said in the third Indiana Jones when he was guarding the cup of Christ, "choose wisely".

So what the heck is a POC firefighter? So if you like walks in the rain, do you love kittens too?

Rugger, welcome to the City Thank your cousin for his ultimate sacrifice to our country. Sympathies from the ruff Family from Raymore. Get your EMT, Don't stop there. continue on and go as far as you can. EMT is a stepping stone. good luck, lots of seasoned vet's here. You have but to ask and you shall receive.

You should be able to do you classes without a problem even with your baby at home. Clinicals might be a little more tricky. Paramedic might be a bit more difficult. Breastfeeding might be a little more logistically difficult as well unless you pump but clinicals for medic should also be doable as well. IF you want something bad enough, anything is possible.

I think you need to find out first why your company's drug boxes do not carry narcotics? There are a couple of reasons why off the top of my head that your boxes don't have narcs 1. Your medical director didn't apply for a narc license because he didn't expect that your medics would be administering narcotic analgesia 2. Your service lost it's DEA license due to some reason (nefarious or not) 3. Your service DEA license expired 4. Your service DEA license was never relicensed 5. Your service never applied at all. 6. some other reason

It's like people want a quick fix. They want it handed to them on a silver platter. They have no issues on how to search for things on Google. They are experts on searching on google yet for things like these, all that needs to happen is type is www.google.com and then type in the search window National registry of EMT's The first thing to pop up is the national registy. All the way at the bottom of the page is the phone number of the registry. It's not a 800 number but the number is down there. Takes less than 10 minutes to make the call.

Please call the Registry. They are the approving agency regarding this class. Although we can offer opinions in this forum we can't tell you what the registry will or will not say about your class. You will need to get the answer directly from them. If the national registry approved it then I would suspect they will allow it but per my most recent post which I urge you to read, you need to Call the registry. No one but them can tell you the answer to your question.

I'm seeing a common theme among many threads here that have been started in the past couple of weeks. I know it's easy to ask about things here but a little legwork on posters part goes a long way in the beginning. There are a lot of very very smart people here on the forums and I know that this is the reason why the basic legwork isn't being done but let's think this through. Maybe many will disagree with me here but hear me out. For a specific state or National registry question it might just be easier to do a quick google search for the particular State department of EMS or National Registry of EMT and call them directly. Especially the National Registry of EMT's as they are really really particular as to what they allow and what they do not allow. Instead of waiting for someone on this forum who might have the answer or may have an idea of what the answer is, a short search via Google for the national registry phone number or a quick google search for your state specific department of EMS and a quick phone call to NREMT or where-ever will give you the Correct answer and not an answer from Joe Blow from EMT City which may or may not be right. And trust me, you do not want to take the word of someone on this site when your licensure or your job is on the line. When your job is on the line don't you want the the most correct answer and not an answer off a website that is not sanctioned by the agency that you need the answer from? You are held responsible for getting the correct answer for your question and why not make the extra effort to get the right answer rather than take the lazy way out by getting it from someone who may or may not know the answer. It's your call. Do you wonder why some of the veteran members here keep telling those who ask the questions that are best answered by the NREMT or state agencies, to call the specific agencies. There is a reason we keep saying that OVER and OVER again. I don't know how many times we have to keep saying that until it takes hold.

I got to the last question and am questioning the last question. Thats triple redundant. But if you are doing a research question on how we use our shears,there's nothing in your survey on how we use our shears. I mean purchasing habits But you don't ask how I use them, I would have thought that if you were really interested in how I used them rather than how much I spent on them you would have asked do you use them on trauma patients, do you use them in cutting clothes or seat belts or whatnot. I mean the product if it's high quality and durable I would think that maybe you would be asking about what the type of stuff we use our shears for??? And then you ask me if I want more info on new products in the medical field which to me you are just throwing out a red herring for the survey by getting me to say Yes I'm interested in finding more info on other products so you can send me stuff. But I said Yes, but it never asked me to submit any personal info so that's good. I wish you luck on your roll out of the new shears though.

i agree with Dwayne. I have a bunch of them also and if Dust was here, since he was here long before Dwayne was Dust would agree wholeheartedly with the assessment that some of my posts being assinine as well. AS soon as you begin to put getting written up before patient care then you have become one of those crappy paramedics. Here is what I mean Had a transport. Patient had numerous spinal stress fractures due to osteoporosis. She was being transfered from our hospital to another hosiptal 3 hours away. She was given no pain relief except 1 Ultram pill prior to our leaving the hospital. The bumps in the road began to take their toll on her back and she began to start to scream out in pain. I began to attempt to call to the hospital to obtain medical orders to give pain relief and for 10 minutes was faced with no cell phone signal, our ambulance at the time had no radio antenna due to the previous crew drove too close to a tree limb and tore off the antenna. So I assumed medical control failure and worked under protocol and started an IV and administered fentanyl under protocol/standing orders. I did this and documented this. On arrival to the hospital where she was being transferred for the pain clinic and her procedure the doctor proceeded to accuse me of practicing without a license and reported me to my hospital administration who then reported me to my EMS Medical director. The doctor reporting me and my hospital administrator(director of nursing wanted me reported to the state for practicing medicine without a license) I was a supported fully by my Medical director due to my DOCUMENTATION on my run report and my reputation as a medic at the service I worked for. It went no further but Had my medical director not have supported me I still would have stood by my decision to do what I did and take my lumps based on the patient needing the medication in order to provide her a comfortable ride. There was no excuse that this lady not having been given pain relief. The hospital failed this patient on their core measures and I made sure to tell them that as well. Had I have worried about getting written up I would have made this lady suffer but I didn't.

First off putting a patient with the need for pain relief in a BLS ambulance for a 5 hour trip was FUCKED UP BEYOND BELIEF and if it was my mom or dad I'd be livid and pissed off. I'd be in that doctors office and the hospitals administrators office wanting to know who's head I got to mount covered in pitch tar on a spike on the peak of my roof. There was no need for that patient to suffer for that long. If I was you I would have stopped the ambulance, called the nearest ALS ambulance and requested ALS intercept. Sorry but pain relief is a an ALS skill and that patient needed it. Why don't you give the doctor who said it was ok to put that patient in a bls ambulance without the ability to give pain relief, a bowel obstruction, put him in an the same situation and drive him 5 hours without pain relief and see how many more of his patients he sends without pain relief. I'll bet he never sends another of his patients out without enough pain meds to snow a horse. That's just STUPID FREAKIN MORONICITY. I am not harping on you on this on Runs - not in the least. This is what really pisses me off, the patient needed pain meds and didn't get them. Now back to your regularly scheduled thread. You first need to find out if Entonox is even a allowable skill in your state for EMT's to give. If it isn't then you are not going to be given that skill, unless the state re-writes their guidelines. OR If your medical director goes to your state bureau of EMS and begins the long arduous process of asking for an exemption of letting your crew (emt's only) give this for these types of transfers only based on additional training. I would not hold your breath on your medical director doing this extra effort. If you do hold your breath, prepare to be intubated as you will probably passout and die first. Best thing is to just grin and bear it that you will still have dumb ass doctors who think that demerol will last for 5 hours and their patients will have enough pain meds on board for that 5 hour trip. And rest assured that you probably won't have another transfer like this for a long time. But another patient will have to go through this again probably tomorrow or better yet, is probably going through it RIGHT now. Comforting aint it.

no offense taken. I got it all figured out. I need a beer. so who's this Mike everyone keeps referring to.

I agree Dwayne. Her personal info is her business and the state be damned. If she wants to get certified then I say, get right in there, screw the nay sayers and certify all the way to physician but from what I'm getting in my conversation with this beautiful young lady is that that might not be in the cards. So I tell her in all honesty, take it as far as you can Lotus, you can always count on me and many of us here to discuss, digest, dissect and tear apart anything you throw at us and we can certainly argue among the best if Dwayne and I have shown that in the past. Go as far as you can, I for one will help you go further, and I know Dwayne would help you as well if both of us could get to where you are and you are in need. I know many others on this forum would do the same. So why not go all the way to physician, If it's a dream you have, it's a dream you have, why not strive for it. Capn

You take the advice I've been giving you in my PM's.

There is compassion in this one Obi wan,

you mean that my history of driving terrible and a criminal record might preclude me from a job. The fact that i wear my jeans down near my ankles might preclude me from a job. what I post on facebook might keep me from a job. The fact I can't write a clean sentence might keep me from a job. The amount of gold in my teeth and ink on my ASS might keep me from getting a job. the fact I have 5 kids before I was 20 might keep me from getting hi gh paying job. Say it aint so. I thought that quitting high school and getting mah GED would garantee me a jahb.

is your name mike too? There were a lot of mike's being thrown around. About 8years ago, my son was 1 year old. I was in church, I was holding him and we were singing a song. The song hit me particularly the wrong way and I looked down at his sleeping face and all of a sudden the face of a 4 month old that I worked a number of years ago flashed into my mind. I thought I had locked that little boy in my vault and kept the key in another part of my mind. All of a sudden the emotions came flooding out. Not knowing why they came out I handed over my son to my wife and left the sanctuary and walked out. I went to the place I knew was a good place to sit and just sat for the rest of the service. I sat in silence and just recounted what I went through on one of the worst calls I ever ran. A call I thought I had forgotten but apparantly it had not forgotten me. I'm not going to get into it here but it was a day that an entire family was forever changed as well as my entire ambulance service as well as a fire department and law enforcement service were forever changed. That's it. These calls never leave you. But you put one foot in front of the other, to put it like Kris Kringle talking to the frozen mean guy in Santa Klaus is coming to town, soon you'll be walking out the door. You get up, wipe yourself off, debrief, and then go back to work the next day. Tackle the next day and then the next and then you do it all over again. That's all there is to it. Once you stop feeling something, is the day that your career should stop and you should start looking for a new career at mcDonalds or Target.

So just what was this survey all about again? I seem to have forgotten?

I don't doubt that you will treat my pulmonary edema better than many remote doctors would. I expect no less from the Great mobes. (no sarcasm at all there). But I hope to not need your treatment ever, nor anyone elses treatments. But if I do, let's hope it's provided by competent medics who know what they are doing. That's all I or anyone out there want. Just don't make me worse. If you do and I die, I'm coming back to haunt you and it won't be pretty.

Systemet, who are you referring to? Me or Runswithneedles? My name is Mike, You need to be really clear as Captain Kickass's real name is Mike(that's me), ParamedicMike is Mike and is Runswithneedles also named Mike?????

For long transport times, there is no way that ambulances carry enough pain meds to help these patients. For ground transports of an hour or longer, what would be the feasibility of stopping off at a facility to medicate these patients and provide these patients with IV pain control such as pain pumps and such. With good communication such as call ahead, you could get a good enough report to the ER docs that they could get you orders for enough pain meds to provide pain control until you arrive at the receiving facility. Had a meth lab flashover on a patient. She had burns on her hands, arms, face, chest, belly, legs, and feet. (quickly, figure the rule of 9's) We had good airway support. Hour long transport. Had 200mg of demerol in the ambulance, 20 of morphine. We had a relay system set up for the transfer from the scene to the next hospital to the next all the way to the receiving facility. I ended up deciding to tube her right before leaving the scene because of a single drop in pulse ox and the long transport time. I am sooooooooooo glad I did. 15 mins into the transfer her face swelled up like a balloon and I would have never got her tubed after that. I would have had to cric her.. We kept her well medicated with the narcs that were given to us at the first hospital we got to and then at the 2nd hospital there was a pharmacist who just happened to be in the hospital (this was at 330am) and he set us up with a Propofol drip and a dilaudid drip and he and a Nurse anesthetist from that hospital continued on with us to the burn unit. It was a good outcome as the lady did great. She looked like the aftermath of a tracker Jacker sting victim but she survived. Her boyfriend did the chivalrous thing, when the meth lab flashed over, he pussied out, pushed her into the path of the flames and ran the other way. A real piece of work.

He's got plenty of money. He's looking to spend some of it.