medic001918

I'm not going to answer your questions since a quick search of your local protocols should clarify all the differences in certifications for you and you'll remember more if you look it up yourself. But I am going to make a suggestion. Use spell check and work on your sentence grammar. Your posts are rather difficult to understand. When it comes to forums on the internet, your typed word is as good as your spoken word and right now I think people might have a hard time taking you as being intelligent since your posts don't come across as such. Shane NREMT-P

Ride time doesn't really count towards experience toward paramedic school. Take some time and learn the ropes of the job before jumping up to the next level. While the people from the last class may be doing well in school, that doesn't mean that they have their stuff together while enough to function in the street on their own. You want to learn the basics of assessment, scene management, resource alocation, interaction with patients and facility staff...there's far more to learn than what class has to offer. My advice to you is to take some time before you just jump into paramedic school or you may find yourself very overwhelmed rather quickly. Shane NREMT-P

And just as many times as people have been fired for something petty and not gotten their jobs back; I've seen the union defend and get jobs back for people who don't deserve it. It just depends on the individual union I guess more than anything else. One service I work for has a union that I don't have a great deal of respect for while the other service doesn't have a union and is great to it's employees. Shane NREMT-P

Here's my advice...learn to take a blood pressure with the stethoscope that you already have. It's more than adequate for your level. Practice in other noisy environments. Don't move too much when you do it. Press enough on the bell to seal out other noises. Do as many blood pressures as you can until you can do it w/little to no effort. Don't purchase a piece of equipment to make up for your own lack of skill. Once you have the skill down, reward that skill with the quality equipment that you want and desire. And paramedicmike was being nice. Use the search feature....you'll find many questions that have already been answered. Shane NREMT-P

I had a LP12 montior fail on me during a cardiac arrest. The monitor wouldn't sense the leads (even after changing the electrodes), so I was unable to pace the patient after getting pulses back. It was very frustrating since this was the same monitor I had been using all shift. In the middle of the call the "service" light came on as well. There really is all kinds of additional paperwork to fill out when you experience a "critical equipment failure." Had to fill out company forms, phsyio forms and state forms about the call. I was safe because I had my monitor test passed printout from the start of the shift showing that I did make sure I had a properly functioning monitor. Shane NREMT-P

Your supervisor is absolutely wrong in this case. The patient (or his parent in this case) understands the decisions they are making with regard to his health and well being and are choosing to accept responsibility for that decision. To keep this patient in your care after they have decided they don't want your services would be kidnapping. They didn't refuse treatment, they refused transport. There is a difference. This is a fundamental understanding of care and one that your supervisor most definatly should have an understanding of. Shane NREMT-P

Rid, there you go being logical again. Remember, most programs don't teach a logical thought pattern. Instead they teach a programmed thought system. If only we could get more providers to think outside the box and interpret their assessment findings...ah, only in a perfect world I guess. Shane NREMT-P

+1,000,000. A truely great post. Shane NREMT-P

I have refused to transport someone without having the proper resources to handle the job, this includes other personnel to assist me. It's one thing to work an emergency situation in the field with very limited resources. It's something different to take that patient out of a hospital with significantly more resources and into an ambulance without the resources you feel you may need. Call dispatch and wait for them to get you the help you need to do the job right. A large part of our job lies in patient advocacy and ensuring you have the ability to do the job effectively is part of advocating on behalf of your patient. Shane NREMT-P

+1. It is a critical care transfer, and one that should be able to be handled on the ground. It doesn't sound like your service is set up to properly handle a transfer with so much involvement. This kind of call would be best served by having a ventilator so you are not 100% committed to the patients airway and have the ability to further assess the patient. I do agree that the patient should have had more than just a continuous bolus of NS, but was the doc in communication with the other hospital where they may have had some kind of different treatment plan? Did your service tell them when they called that they couldn't transport certain medications that the doc may have wanted the patient on? There are a number of variables here. It sounds like you weren't comfortable with the transport and chose to do it anyway without evaluation of your resources. Don't hesitate to ask for extra help if you feel it's needed. With the equipment it sounds like you had, an extra set of hands would have been more than justified...ALS hands at that. Shane NREMT-P

I have no problem with something not being done because you don't have the order. But I also shouldn't have to explain to nursing home staff why a NRB at 6LPM isn't an acceptable delivery device that can actually make the patients problem worse. If they don't have access to high flow O2, then don't use a high flow device. Use the appropriate device. Shane NREMT-P

Great pick up. Glad you trusted that something wasn't right and thoroughly worked up your patient. This makes a great case for doing repeat 12-leads during transport. Few patients read the book of presentations... Shane NREMT-P

Even with a close proximity to the hospital, if you were so concerned with pain management and making sure that the patient received something for it you could have provided pain relief for your patient instead of trying four times for IV access as long as the patient had stable vitals. I believe you mentioned that you had pain control as a standing order. In doing this, you know that your concern has been addressed. I also have to agree that with the shortening and rotation, I would be thinking femoral neck or hip fracture as opposed to midshaft femur fracture. There are a few lessons to be learned here from this scenario. Taking those lessons and move on. Shane NREMT-P

Thanks for the correction spock, I had it backwards. Shane NREMT-P

Fiznat, remember that in our service versed isn't the only benzo we carry. So this opens up another option for sedation using ativan which doesn't have as much of a hypotensive property. It tends to work well, and I've used it for sedation on multiple occassions. Ativan tends to be faster acting and shorter lasting then the versed as well. Remember to consider all of your options and their potential effects and choose the one that fits the overall picture of your patient to provide the most benefit. Shane NREMT-P

Don't be so sure of being protected by the good samartian act. Like someone mentioned, depending on your state statutes you lose that once you identify yourself as being a trained rescuer. Also, I'm not willing to play games with my license with regard to practicing out of state or anything like that. It's their medical emergency and the airlines should have a plan in place for how to handle an emergency while in the air. Let them do their thing. There's nothing more that I'm going to do for the patient other than put myself at legal risk. It just doesn't sound like a good idea to me. If it were to go through, I probably wouldn't say anything about me being a medic. I would treat an emergency in the air the same as I do when I'm off duty on the ground...notify the proper people of the emergency and hang back. Shane NREMT-P

You're kidding, right? Shane NREMT-P

Like others have mentioned, AMR operates as a money making business. Once you understand the business model, it's easier to understand the directions. I've been employed by AMR for a little over three years and they haven't been bad. The division I work holds large 911 PSA contracts, so we see our share of 911 calls and we dont' have any other ALS service to take the call over. This allows for the employees to get real experience managing emergency scenes and emergent patients. Your individual experience will depend greatly on your attitude and more importantly your understanding of how the business runs. Management for the different divisions varies greatly and you'll notice that from talking to people from other divisions as you go along. All told, if I had to work for AMR again I would do so. I've been offered great experience through the areas in which we serve. 911 calls, intercept shifts, etc. I also got to spend 10 days working in Gulfport, MS after Hurricane Katrina came which is something I most likely wouldn't have gotten to do if I were employed by AMR. Give it a try. It can't hurt and at the very least, it's experience which is never going to hurt. Especially when someone is new to the field. Shane NREMT-P Good point as far as pay. Forgot to add that. We are one of the best paid services in the area. The "not for profit" service I work for I make about $1.50 an hour less then I do at AMR, but that's a dedicated emergency service still covering a city.

And I'm curious how your system works. An EMT-I having the same skill set as a paramedic and the only difference is in that they have to call medical control "a little more" is something that I find rather disturbing as it allows a much greater margin of error. If you want to be a paramedic, go to paramedic classes. Don't be an Intermediate and have to call a doc for everything that you might or might not understand. This is probably going to kick off another "EMT-I vs. Medic" debate, but it's one of those things that bothers me. An EMT-I is not a paramedic...even with having to call medical control. Shane NREMT-P

This kind of prompted a question for me, as while atrovent is not a front line CHF medication, it's also not absolutely contraindicated. In fact, from my reading it seems that it's something to be considered for CHF treatment. My usual choice of neb for CHF is albuterol, but the anticholinergic property of atrovent isn't totally harmful in pulmonary edema. A pneumonia case is where I would be more considered with drying out the hypersecretion than that of pulmonary edema and CHF. I even found protocols online here that call for atrovent (in the form of a duoneb/combivent) in CHF/Pulmonary Edema. Please explain how this EMT did the rookie medic a huge favor? Unless the medic meant to simply give albuterol and was going to give straight atrovent accidentally? This isn't meant as a chance to beat up on you or your system, but a chance for me to learn in case I missed something along the way... Shane NREMT-P

+1. That's something that many people tend to forget when looking at studies or getting into discussion about RSI or any other airway. One of the best things I ever did for my airway management was the DAMS (Difficult Airway Management in the Streets) course. I believe the course was put together by the University of Vermont (I could be wrong on that). But it was a two day course that was a good review of anatomy, and more importnatly a compliment of different techniques to use. The biggest benefit came from the instructors who were MD's and Anasthesiologists full of great insight. Given the chance, I'd go sit thru the class again for the benefit of review. Shane NREMT-P

If you have rookie medics making fundamental mistakes, then maybe your service needs to reevaluate it's precepting policies? Just a thought. It shouldn't ever fall on an EMT to prevent a medic from making a rookie mistake like that. Especially since the knowledge of those kinds of interventions is not provided on the basic level of education. Just a thought...otherwise, I'm agreeing that kids shouldn't be on ambulances. Shane NREMT-P

Hmm...sounds kind of similar to my vehicle. Only I have satellite radio as well. Seems to be a well thought out system that works for the majority of people. Anything else isn't really necessary. Shane NREMT-P

As others have mentioned, the search function is your friend. If you use it, you will find plenty of valuable information regarding benzo overdoses. Secondly, let's make sure we post in the proper forum. I thought this was going to be a funny thread, not a legitimate request for help. You'll get far more answers in a timely manner when your threads are properly placed. And onto the question about why they would be looking for IV, O2 and monitor for this patient...while Romazicon could be indicated, I wouldn't want to give it prehospitally due to the many complications associated with it. Sometimes the best thing to do for your patient is supportive care. That would be the most appropriate treatment. So it's not that you can't win with drug quizes, it's that you need to grasp the concepts in their entirety. Good luck, Shane NREMT-P

I have to agree with others that this would be a tough case to handle. I would shy away from pharmacological intervention though as many of the medications that we carry are going to make your situation worse, not better. A right sided 12-lead would definatly be in order. And just as an FYI, there are medics in your service who have done right sided and even posterior 12-lead EKG's...myself included, but I'm not the only one. There really isn't a good reason for setting up another 12 lead on the right side and having a look to confirm what you suspect. My first line of treatment would probably be a 250cc bolus of NS and see if the pressure responds at all to that treatment. As far as pacing/atropine, I wonder what her rate commonly is? Was she on any beta blockers that keep her rate down? Although, they don't usually keep the rate that low since it's usually around 60 BPM or so. My resting heart rate is in the 50's, even lower when I'm sleeping. I've seen quite a few elderly patients with bradycardia's as a baseline. I'd want to check into her history a little and see if maybe that's the case here. It's not likely, but don't rule anything out. I'm curious, was there any ectopy at all? PVC's? Ectopic beats? An increase in little things like that can indicate a myocardium that's becoming increasingly ischemic. Repeat 12 leads on this call would be a must. Let's see if the infarct is increasing in size or holding it's own in size. Given the hypotension and the overall presentation of this patient, I would start looking at the possibility of cardiogenic shock. You could try to call for an order of dopamine from the hospital. My guess though due to the short transport times we have is that they wouldn't let you go with it. Otherwise, keep an eye on the lung sounds and lay some fluid on her. Maybe the fluid will help get the heart to pump a little more effectively and bring her pressure up enough that you can do something with other treatments. It sounds like a good call to have been on. Shane NREMT-P