toutdoors

One of the docs that supervised me while doing my intubations in the OR clinicals was a huge fan of the bougie. She made everyone of her students do at least one intubation with it. I loved it. I wish we carried them on or rigs. It would make sense. It is simple, easy, efficient, and ALMOST ensures you will get the tube. She was my favorite to work with also, very relaxed, gave me confidence I had no idea I had in regards to intubating, and was very positive. Every time she was with me, I got the tube. Now the other doc, I don't know what it was about him, but I just did not have good success with him being there to precept me. Must have been a vibe thing or something, he wasn't a jerk per se, it was just that something was "off" if he was the one with me that day. Anyway, I am a huge fan of the bougie. Now if we could come up with one that would do the same for IV's. This has got to be my worst week ever with the exception of my first few months as an EMT-I for hitting a darn IV. Must be cause I haven't arrowed a buck yet this season, who knows. If you have not tried the bougie, try it. If you can get them on your rigs, do it. I am trying to wear down our decsion makers into getting them.

I remember reading one of the highlighted boxes in our medic book in regards to RSI. It simply stated that using paralytics with no sedation to intubate a pt was a form of pt abuse. It struck me pretty hard, and I would have to agree with it. While sedating the pt prior to paralytics administration and thus intubating is not only the compassionate thing to do; more importantly it is the right thing to do. Learn the why as well as the how.

As a new medic, I like the dual medic rig. Makes me feel a little more comfortable knowing that if I want to bounce something off of someone, I can turn to my more experienced partner and discuss it, instead of calling med control, and maybe sound unsure of myself, or dumb; thereby earning myself a bad rep with the ER staff. I feel pretty comfortable tending to my patients, yet still have a small tingle of nervousness in me as I ride in, just going over everything, what is going on, what am I doing, what is the result, are they still breathing, yada yada yada. The system I work for is a little different, we are mostly medic/medic. There are only three EMT-I's on the staff, and hopefully in 4 months one of them will be a medic after her testing. I worked the streets as an I, (I-85), and learned alot! The only reason for that was because most of the medics I worked with would take the time to answer questions after the run was over. Did this experience help in medic class? A little bit, but it would have been smarter for me to get my medic a year or two after my basic or I, and not wait as long as I did; oh well, hindsight. In regards to EMD; it is only as good as the info the caller gives, period. No offense to any dispatchers out there, I know I read a post from one of ya, but seriously, if the caller does not answer the questions with the right words, then all is for not. An excellent example is to ask someone if they are having chest pain. They will say "no" Then ask if they are having any discomfort or pressure, and they will say yes. To me, if you say yes to any of these three questions, I am gonna start to think along the lines of cardiac event, and start down that road, and dig deeper. To the patient, chest pressure is not a heart attack, because it isn't really "killing" them pain, it is just simple pressure. (Hope this makes some sense, I am getting tired) As far as the toothache scenario mentioned way back in the first part of this post, it strikes a scenario that my first responder instructor shared with us. She was an EMT who responded to a person C/O a toothache. The family had called, and a middle aged man in his 50's was having a tooth ache. He declined transport, they did all the right things as far as initial V/S and talked to him, got a signed refusal and left. About 2-3 hours later, they were called back for an unconscious party, and coded him. He died. He had a heart attack (autopsy results) and his only complaint was a toothache. Does this mean that I am gonna hook up every tooth ache to the monitor? I highly doubt it, but it has stuck with me for over 15 years on what a unique scenario that was. I believe that a paramedic should be availble on every rig in perfect world. In our service, we go so far as to start moving towards an incident if it sounds as though it may need a second rig when we hear dispatch information. We don't go emergent, we just kind of cruise over in the general direction, while still being available to cover a call in our primary district if it comes in. In this manner, we are able to get at least two medics on scene rather quickly if the initial rig has a newer medic on board. Our shift supervisor, and field training officer will also respond to some calls if they feel that it may be a rather complex call if the medic responding is still a little new and working with one of the EMT-I's. I know it sounds a little like a cop out, but I really do think that this system is working, and working pretty good. Of course there are days we could use one or two more rigs on the street, but then again there are more days where we are just "comfortably busy enough" to have enough to do, but not up to our necks in backed up paperwork. I think I am rambling now, so I will just say that at least one medic per rig would be a beautiful step in the right direction.

When I was still an engineer on an engine company, our 3rd firefighter's young son was diagnosed with this disease, as a result from antibiotic Tx he had been receiving. The poor young boy spent countless weeks in a children's hospital about 90 miles from us, and suffered miserably. Thank God he recovered, and is now a normal, healthy active young boy enjoying his childhood. I don't remember all the specifics of the disease, and how it can be contracted, but if I remember some of it correctly, it does have something to do with some of the antibiotic treatments out there. On a side note, one of the proudest moments I have had as a firefighter was when I was able to present the hundreds of dollars to the family that we had collected from the brothers, so we could help offset the costs that were incurred due to all the travelling the family had to do. The humbling look that my friend and brother firefighter had on his face as I handed over the envelope stuffed full of 5's, to 100's warmed my heart like few other experiences in life ever have. From all accounts, it is truly a terrible and painful disease, which can be fatal if not caught fast enough. When the little guy got home, his dad took him around to all the houses so we could all see him. Just my two cents on this one.

Remember the ABC's, scene safe, BSI first. Then move on to the rest of the question. However, you state that reading the book will take too long. Why bother with the test at all if you are not willing to put in the work that it will take to pass the test with knowledge rather than luck? I don't mean to sound like a jerk, but seriously, if you are at all interested in providing care to sick and injured people, you owe it to your potential future patients to have a general knowledge base from which to work from. In all honesty, if you paid attention in class, you really should not need to read the whole book, but skim over it, and look for the things that stand out. Especially the tables, and comments below the pictures. Unless the test has changed drastically in 15 years, the basic test is not that hard. Put in the work that it will take to pass, whatever the committment will be.

Madaxe, I would have to agree with previous posts in regards to the fact that you may have been a little nervous, then couple that with a facepiece that is too small, and you are well on your way to experiencing this problem. However, at times I find myself feeling as though I am not getting the same amount of air when I have my face piece on and not "on air" yet. It is something you will get used to, and come to expect. So next time, make sure you get fit tested for the proper size facepiece, and just relax, you will be surprised how much more comfortable you will be. If you continue to have the anxious feelings, inform the training officer, and ask for some more training with the SCBA. Prior to any type of training, you should be as familiar with that piece of equipment as you are with your own toothbrush, remember, it is your lifeline to quality air; demand the proper training. I have seen new recruits completely freak out when they get geared up on the apparatus floor for the first time, some make it through, and others don't. The big key is to simply relax, and remember you are just training (for now), have fun with it and it will come to you. Good luck. Also, I agree with Arizonza, in regards to the hazmat suit classifications.

I will stop if there is no EMS on scene, I do have a few pairs of gloves in a small bag with a few 4x4's and what not bandaging. The first aid kit is more for the times my kids get scuffed up hunting, fishing, camping and whatnot, but it is nice to have a few items handy if needed. If EMS is on scene, I don't bother stopping unless it is simply obvious that the crew is in need of help. Such as commercial airliner in a corn field, and one ambulance on scene. As for the Rn's and MD's on scene, we have have a piece of paper from our state protocols in our EMS clipboard that the doc must read, understand, agree to, and sign if he or she wants to assume care for the pt. Otherwise they are not to interfere with our treatment of the pt. I have been on calls where an MD was on scene and of valuable assistance, and then there are the calls such as a motorcycle vs car where the "doc" on scene said the guy was doing fine, and breathing; only to do our own assessment to find an unresponsive pt breathing about 8 times a minute, shallow, his color matches that of the concrete roadway, and he later coded on us. The "doc" was a podiatrist. He had very little idea of what he was looking at, then again he did not want to assume pt care and he let us do our job, so really no harm no foul there on his part, other than a slightly poor assessment. This is the very reason the two agencies I work for have this part of our protocol so readily available to us. If someone comes on our scene and offers assistance, it will usually be politely turned down, of course that depends on who the medic is that is working on how polite the refusal will be too.

Get your basic, then get into the paramedic program; FAST. Don't waste a bunch of time trying to work to "get experience". I did just that; wish I had been smarter 14 years ago and just got it all over with at once instead of waiting so long. Get into your medic school as soon as you can after basic. You won't have to unlearn bad habits. Then pray to find a decent job.

Our city uses two tier response. FD is BLS engine, even though we have a good number of medics, we only provide BLS. The private ambulance is ALS, and does the transport. So it is a no brainer. FD has scene control in regards to safety, extrication, technical rescue and what not, the ambulance medics have final say in pt care. With the exception of a couple of ambulance medics who are grouchy, or down right rude at times to the FD, one is truly burning out, and the other; well she has always been that way. A few of our fire medics, myself included, work part time for the ambulance, so we have a pretty good rappport with eachother. In general, there is good team work here for both parties, I truly believe that we work very hard at providing a team approach to ensuring quality patient care. If the EMT's can do anything to help the medics, they almost without fail jump in with both feet, and are more than happy to do what is asked. Of course we have had a few bumps along the way, every now and then you get the call where one service feels something was not right with the performance of the other service, and the issue is normally addressed and actions taken. There is another part time medic at the ambulance that works on a different full time FD about 70 miles from us, and he says his FD and the private ambulance in that town are like cats and dogs. He used to work full time as a medic until he got hired on the FD. He said he was amazed at how the disdain for the other agency is so apparent where he now works full time. I am glad I work where I do, after hearing some of the other horror stories from other medics or firefighters, the grass is not always greener on the other side.

Paramedic was the first time I took a computer based test, just a month ago. All my others were the old pencil and paper. I walked out of there convinced I would be back in two weeks. 24 hours later, I was jumping out of my seat, and bouncing off the walls, my email told me I passed. In talking to a classmate of mine who took the test a few days earlier, we had completely different tests. His didn't even have one rhythm strip on it. Mine had 3, one on identity, one on treatment, and one the dang thing was just there for show, had nothing to do with the scenario provided. I only had a few drug questions, but seemed like a good amount of airway/respiratory questions. I have been told that the more questions in certain areas means the answers you are giving are not working in your favor, and the test is trying to get you pass, rather rudimentary terms, but that is how it was explained. I thought I had really studied the airway/respiratory stuff down pat, and when I went back to look at some questions I had, I discovered I was correct, so who knows. The one thing I did not like about the test was the inability to go back and change an answer. Answering a question and hitting the "next" icon is like firing a weapon. Be sure of your target, cause once you fire, you have lost all control over that bullet, in this case, your answer. The one thing I did like, the very quick turn around on results. As for the practicals, I did not think they were bad at all. When we tested, they had 5 medic candidates, and as we returned to the little gathering room, you literally had one or two minutes down time before they sent you back to another station. Thinking back on that, it was pretty nice. Did not give you any time between stations to beat yourself up on anything you think you may have messed up on in the previous station, so you did not put yourself in a slump. All three of us from my class that tested together passed both the written and practical on our first go around, so we were pretty pumped up. Our next mission was to celebrate in style, by ending up at a bar that had a breathalyzer in it so we could conduct well planned experiments on how our bodies absorbed alcohol in a given amount of time, we chalked this up as extra credit for already graded labs done in class. Though our instructors were pretty good natured, they denied our application for tardy submission of breath tests for extra credit. The skills sheet is something to remember big time for the practicals however, and don't study the day before the tests.

I liked the class, our lead instructor was magnificent. He barely looked at his powerpoint, other than to see which slide he was on. He would then ramble on very intelligently about the subject being covered. On the other hand, one of the co instructors recieved huge bashings from all the students in the class, she was horrible. I found that it really made me think more quickly as to what was to be done in the street vs what was to be done en route, you know; sick vs not sick type thing. It definately beat the crap out of the videos in ACLS and PALS; please, central line me some red bull to keep awake during them videos.

I bought a nice big push broom for the garage, brought it home, and told the wife I had bought a new car for her, a caddie. After hearing it was in the garage, she went out to look. She did not find the humor in my new broom having a bow on it for her. Broom: $30 Divorce Attorney: $2,000 New found freedom: priceless My current wife has a much better sense of humor, but unfortunately does not commit the offenses of previous smart alec actions on my behalf.

I don't think that a single conviction of DUI should be the SOLE determining factor in whether or not a person is hired. A look at the conviction and it's surrounding circumstances would be in order. For example, did the person stop after work, grab two or three beers on an almost empty stomach after work and head home, then get pulled over cause his turn signal or brake light was out, and then asked if he had been drinking, consequently blowing at the legal limit for DUI? OR was this person pulled over at 3 am after being in the bar all night, and blew 0.34, was driving all over, and could not stand up? Huge differences in circumstances, as well as judgement I think. End result is the same, but some big differences. Before our child was born, actually before my wife became pregnant, we would go out one or two nights a week. We would spend a fair amount of time at a bar and grill, eat, drink, and be merry. Then get a cab. Rough figure after tip and fare, $20. I figured it out one day while I was bored at work, and found that if I got a DUI, the cost of court fees, attorney, loss of job for 12 months, and high risk insurance added up to 22 years of cab rides twice a week. We decided we would continue our fun nights, and keep taking the cab until we broke even, and then re-evaluate our deciscion. JUST KIDDING! Seriously though, if a person looks at it in that context, a cab ride is really cheap. As everyone else has stated, do some research, and good luck. Call a cab next time too.

The ambulance service I work part time for gets a fax from comm center, and we enter the times on our run sheets. The times we record are time of call, time of dispatch, time en route, time on scene, time en route to hospital, time at hospital, and time we go back in service. The times that our supervisors look for are the time it takes to get the rig en route after we receive the dispatch ( 60 secs from 0600-2200, and under 2 min after 2200). They also look at our on scene time. Those are the two biggest ones, but they also look at how long it took to get on scene as well. If it is an extended time to get to scene, it must be noted, such as distance (which is rare if it is in the city), or if we were delayed by a train yada yada yada. The city provides the comm center dispatchers for us, and there are times when they are overloaded, so some of our times can get skewed. For the most part, we maintain pretty good numbers, every now and again there will be a glitch, but the vast majority of time we are on scene under 8 minutes from time of dispatch.

The service I work for part time is predominantly double medic. Hopefully after next week there will be three new medics working, myself being one of them. (Practical on Sat, written is done.) After Feb of 09, there will be another medic, leaving only one I-85 in our system. Before P class, I had 9 years as a BLS EMT, 1 as a basic, and 8 as an I-85. I have worked part time for the ALS service for three years now, and full time fire for 10. So I see both sides of the fence here. I don't think that eliminating EMT is the answer. Although I know there are some here who will shoot me dead for saying it. EMT is part of prehospital care. Definately not at the same level as medic, but it is the initial stabilizing of the immediate life threats that the EMT is trained to do. We all know this. I do think that paramedic does need to become more of the norm rather than the exception, or privelege that it is in some places. Some EMT's say that a good EMT will save a medic. Not true, sorry guys not bailing on you just pointing out the obvious. The only way that an EMT is worth a darn to a medic is if the medic took the time to teach the EMT a few things. I read an article from an old JEMS magazine lying around the office one day in regards to the EMT/medic vs medic/medic partnership. There were some really good viewpoints on this subject. Some of you may have been in the article because some of what is said here mirrors what was printed. Some medics hate basic partners, some will say they prefer a really good EMT over a lazy medic partner. Hey it is your rig and your choice, but some intersting points were made that I took to heart, and started to learn from. One medic said that it is not the basic's fault for not knowing the difference between sinus brady and vfib; it is the medic's fault. If a medic is to work with a basic, than the medic should teach the basic a few things. This medic went on to talk about the drug box, and how the medic should show the basic the difference in what the drugs look like, and when they are used. He also talked about teaching the basic how to read the 3 lead ECG. Now the medic obviously was not trying to say that he allowed the basic to determine a STEMI, or that he would allow the basic to determine if atropine vs epi was indicated, but rather give the basic a little bit more working knowledge. More so in terms of preparing the basic to be more of an asset to the medic, rather than just being a driver. After reading this article, I started to ask a lot more questions, and seek more of an in depth answer rather than the "cause that is what ya do" response. Of course some medics were very eager to share information and teach me things while others just wanted to get back to their nap. I was given informal classes on reading rhythms, and when what drugs were indicated, how the drugs are supplied, and where they are located in the drug box. Obviously, it was not a replacement for the much more in depth study that occurred in medic class, but it really made me feel better that if the medic was performing one task and asked for the drug box to get opened up and get out a med, I at least knew where to look for it, and what to look for. I was also taught how to hook up the 12 lead. Not a huge skill by anymeans, but it freed up the medic to look for the IV if they choose to do the stick vs allowing me the stick. I humbly yet truly feel I was a pretty good asset to my medic partners, and hopefully will be even more so this time next week after I finally find out if I get to wear the P on my shoulder. Of course, I will be one of the junior medics, with more to learn with all the new skills available to me, but at least I have become a more educated provider, that can take some more of the workload. I think that one of the things that hurts the EMT stigma is the fact that people want to try to push more skills onto the basic level, without furthering the education. I mean really, why can't basics needle a chest? What is so hard about shoving a needle the size of a pencil lead into a person's chest? Nothing really, but the general lack of knowledge in regards to A&P is what seperates the two "skill" levels. This is where the basic and medic differ, is in knowledge. Leave the basic where it is at. Let the skills that they possess remain, but give them more education, increase the class time, increase the number of patients they must see in clinicals. This might help, it might not. What I don't think will happen, as much as some would love to see, is full time paid paramedics on every ambulance. I won't argue it would then be a perfect world, well closer to it anyway, but I just don't think it will happen. Then again I could be wrong.

While I find it acceptable to allow an explorer type program to be available to 16-18 year olds, I do not see any benefit in having these same young people actually providing pt care as the primary care provider. If they can become EMT's, fine, but they should be treated as students until at least 18, plain and simple. I also think that the calls should be screened as best as possible to avoid having these younger people see some of the horrific scenes that await responders. I am sorry to all of you younger people out there, but I do not believe that 16 and 17 EMT's should be driving the rig, and providing primary care. I see alot of glory hound attitudes in young people involved in EMS, and fire. I also see a huge lack of incompetent, lazy, can't tell me anything attitudes. Not to mention the complete lack of respect for elders, or authority, and don't get me started on the non-existant work ethic that has been so deeply engrained into our American youth today. My wife is constantly on me because I have made the 12 year old mow the lawn twice in one day. Why? Because he did not do it right the first time. This is not my way of being a bully, nor am I a sadistic, mean spirited person who gets his kicks by making my step son do something over. I make him re mow the lawn, so he will learn a valuable lesson without the risk of losing a paycheck; this lesson is simple, do your job right the first time! This has been lost on our young people. I know you can not blanket cover every age and say that ALL 16-20 year olds are immature, it is true that there are some 16 year olds that are very mature. The way I see it is simple, it is a cross you must bear for a short time. Plain and simple. There are a great many young people to come before you that have screwed up the chance for you to be taken seriously as the potentially mature person you very well may be. It is no different than being a divorced father; one of the first questions I always get is "Do you pay your child support?" To which I reply in the affirmative, I am not a dead beat dad; but I get stuck with that moment of assumption because of all the dead beat dads out there. It is a cross that one must bear, sometimes not by choice, or liking. Some one wrote that if you do not allow 16 year olds to volunteer, than you may lose them by the time they are 18 or 19. So what. If they lose interest that fast, they never really wanted the career in the first place. They wanted the patchy shirt, so they could look cool to the chics. If a person is truly interested in EMS, they will pursue their interest. Then there is the education aspect of EMS. Seriously, it is not that hard to pass the EMT-B testing. The skills are pretty darn easy. The written test is not that much more difficult. All you need to remember is A before B, and B before C. Throw in some BSI and scene safety. Remember your OPQRST, and SAMPLE, and you probably just scored 60, now get a few lucky guesses and you could easily get a 71; good enough to be an EMT. The concern that I have is simple. How seriously do younger people study the material, or are they just thinking of how cool it is gonna be next semester when they can run out of that Biology quiz? Then there is the clinical time that an EMT student has to put in. Very very minimal. Are we honestly supposed to en trust our life, or the life of a family member to an EMT that has had a whole 24 hours of clinicals, and is on their 3rd EMS call, and the provider is only 16? Sorry, but that sounds like a recipe for disaster some where down the road. I am not picking on young people being involved in EMS. It is a great place to put your heart and energy if you truly want to help improve someone's really rotten day. Young people need to be encouraged to pursue this career, they should be mentored, and paramedic education should be made available to them. It would be a great program if they were allowed to ride 3rd for a year or two with the medics, and then go to medic school after high school. Wow, by the time medic school is over, you have someone who is ready to go to work. That would be a good deal. For all you young EMT's out there, don't feel beaten up on, or discouraged. Keep learning, take more classes, and pursue your medic. Then come back and tell some other young person how much they really don't know about the things they don't even know yet. You will learn that in medic school.(I did)

Just got the results back from my written test. Best diet plan I have been on since my divorce. After learning I passed the written, 300 pounds of dread, fear, and gloom were immediately lifted from my shoulders. Practicals are next week, but actually looking forward to them.

Riding the fence on this topic. I can understand that if an agency has a specified chaplain that is a member of the orginization, even if only by title, than it may shine a little light onto the type of things that are encountered on the streets. The informal, very sporadic ride along for a few hours, if invited, could not hurt the relationship between the employees and the chaplain, minister, priest, or what ever titles are out there. I think this would be more for the benefit of building a relationship between employees and the spiritual guidance person involved. I have seen a few excellent spiritual officials, (chaplains, minister, preacher, pastor.....) that can offer some comfort, or support, or just a kind word, and squeeze on the shoulder. These people were not even telling me to turn to God for serenity or comfort, they were simply being kind, compassionate human beings. At times the kind word was a help, and at others, it did not change a thing, depending on the circumstance, and more importantly, the person involved. Some of their education and training in counseling helps them be able to provide this type of support, of course their calling is in the religious domain, so one could expect to hear some mention of God while talking to them. Whether a person wants to accept their offer is up to that individual. Then again some people would rather talk to co workers, a shrink, or a beer bottle to deal with their troubles, what ever works for you. As far as the spiritual person being there for the pt's? Ah, not real hip on that idea, for the simple reason that the pt may be taken aback by the presence of the chaplain. Then let's not forget the impression it may leave on the pt. They may feel real doomed if an EMT, paramedic and chaplain all show up together. Could make them feel that the chaplain is there as the "hail mary" shot in case the EMT and medic can't correct the problem. (no pun intended) Seriously though, as far as Assembly of God is concerned, I have met with a lot of people from this background. My ex wife was a member. The one thing I have personally learned is that there are 3 people that I actually liked after getting to know them. ( Obviously the ex isn't one of them) One was a pastor who took his time to talk to me in a true moment of need, and he was very compassionate, and understanding that I was born, raised, baptized, and confirmed in a totally different religion; he respected that, and just sat and talked to me in general terms. I still think of that man from time to time, and am thankful he was there when I needed someone, and didn't know where to turn. The rest of the folks I have met from this walk of life are different than I am, and that is ok with me. If their choice of worship suits them fine, but please respect my personal preference, and try not to get too overbearing with me. This is a trait I have seen time and again with this faith, as well as a couple of others. If a pt is near death, and family wants their religious leader with them during the transport, I would try to make concessions for granting their wish. Of course this scenario I would mean a hospice type pt that was being transported for some reason, and they requested spiritual counsel to come along. If it will put the pt and family at ease, and will not hinder the limited care that may be provided, or create an unsafe condition, I would try my best to fulfill the wishes of family and pt. I am always willing to make the phone call for a family member who has just experienced a loss. If that one phone call will bring someone to the scene that has an established relationship with the family, and can offer comfort and support than that is the least I can do for the family. I am a christian, and fairly spiritual, but you will not hear me on my soapbox trying to save any or all of you from your possibly damning lifestyles. My spiritual life is personal, I will not push it onto you, nor judge you; that is not my role. I know some will say "no way, never gonna happen in my rig." That is fine, it is your call. I just don't believe that this is a black and white environment that we work in. Yes there are rules, my company allows one family member to ride up front if they wish to ride along. On some of the peds pts, we let a parent ride in back to help comfort the pt, if it will not hinder pt care. Here is another example that I will take execption to. As I stated earlier, if a clergy member of some sort is requested to ride along to comfort the pt and family in the event that the pt dies during transport, or is expected to shortly after arrival at the destination; I will bend my companies policies to suit the needs of what I would consider pt and family care at that given moment. All cases being weighed and judged on their own circumstances and no hard fast rules however. Just my thoughts.

Little off the EMS side of it, but I love getting dispatched to a vehicle fire in a large parking lot such as Wal-Mart. Dispatch will come back after we go en route, and advise us of type of vehicle, color, and plate number.

Get blood sugar, keep cardiac in back of mind. For now

I have always held the opinion, that if you want to do well in the medic program, go to it straight from the get go. Get your basic, then maybe your intermediate, ( for us in Iowa, it is essentially the basic all over with a little acid base balance and IV access thrown in, but 120 hours of clinics and ride time.) Then go for your medic. This way, you get some clinic and field time to work on the V/S and become somewhat decent at getting your IV. The biggest upside to this approach that I see is you are constantly in school, and saying the same things over and over. ie, Scene safe, BSI, OPQRST, SAMPLE, AVPU yada yada yada. It becomes ingrained in your mind, and your medic tests might be somewhat easier because you have not worked the field long enough to develop bad habits. So you don't start thinking "this is the way we did it in the street" when you are testing on a topic. That is my philosophy. Now for how I did it. I started in the EMT-A program, never tested out, girlfriend dumped me, I enlisted in the Marines. Got out and got on a volunteer FD. Started at the first responder level there. Got hired on career dept, got my basic, and my Iowa Intermediate. Next week is my paramedic national written, and the practical is 17 days away. Total time lapse between first responder and today? 13 years. 10 of them as an EMT. I had a few old habits to work out while in the paramedic program, no doubt. For me, having the street time as an EMT on the FD, and working part time with the ALS ambulance service has really been a benefit. I am fortunate in that alot of the medics I work with would answer questions when I asked why they did this or that, and why did they make the deciscions they made in regard to treating a pt. Of course Q&A time is in the rig after the run. Most of them were great, going into detail as to why this was done, and why the pt responded in such a fashion. Then again some of them just gave the generic answer "Because that is what you do." Even when I would tend to pt's on BLS transports, either to the hospital or interfacility, the medic was always listening to what I was doing, and would critique the call with me later if they felt there was something to talk about. I gained a great deal of experience working with some awesome medics. I really believe it made going through class a little easier for me. I was scared to death of ACLS. As we dove into the class, I found out that I already had a really good grasp on it for the simple fact I had been on so many blasted codes with the medics that none of this stuff was really that strange to me. I was always asking questions about codes, and the medics went so far as to open the drug box up from time to time to point out the different meds and explain them to me. They taught me about rhythms, sinus, sinus tach, sinus brady, vfib, vtach, SVT, PEA, and of course no explination needed on asystole. After all, I grew up watching Johnny and Roy, so I KNEW that one. Seriously though, the experience I gained working the ambulance for two years part time went a long, long way into making me be able to apply what I was learning to what I had been seeing in the field all this time. Of course I learned alot of new stuff as well, but it made alot more sense to me. There are pros and cons to both sides of the arguement here. If you really want to be a medic, go for it, work part time if you have some energetic, helpful medics that will take the time to talk to you and answer questions. They can be a wealth of knowledge, and if you get the ones who want to take the time to show you how the monitor on your rig works, great, you will have a basic understanding of it, it may not be the same monitor you have in class, but you have a general working knowledge of a monitor. On the other hand, if you are working with boring, burned out medics that only apply a nasal cannula and say let's go, move on; don't get caught in their lax attitude, it will just hurt ya. I only hope that 5 years from now, I have the energy level that most of my partners have had these past three years with me, and I will be willing to teach a "new kid" some of the things he is dying to learn. After all, one of the responsiblities of being a medic, is to be a mentor and teacher to the lesser educated EMS personnel out there. (In my humble opinion) This is the only way that basics become really good basics, and an asset to the company they work for, not to mention their paramedic partner. Good luck on your career, and in class, don't wait as long as I did.

Whichever one works at the moment.

ALWAYS, and I do mean ALWAYS ensure your cell phone is completely secured while retrieving a downed duck in a creek. Missed a phone call from a prospective date that evening as I was buying a new one.

Our EMS chief sent an email to us in regards to this line of treatment a year or so ago. If I remember correct, the article he sent us mentioned a Japanese doctor researching this method of lay person interventions. From what I can recall, it was felt that more people felt comfortable doing the compressions versus the ventilations on a person they may or may not know. The article did mention there was some benefit to the sole application of compressions, due to the fact that there should be enough O2 in the blood to maintain the critical organs during CPR. This was sent to us to inform us that we may see this happen in the street by lay persons, but not to expect to see it as a treatment for prehospital EMS. Have not heard much more about it though.

Never heard the bevel down technique, but have heard of and used the very lightly applied tourniquet or just using the opposite hand to occlude the vein. On dark skinned folks, have had a medic show me the old, penlight on the arm method, and that was a new one for me. Just hold the penlight at a 90 degree to the arm, and the veins should show up, normally. As for the nail item, blunt the end of the nail with one tap of the hammer and it works like a charm, also slicking it up a little helps at times too.