medic001918

You sir, are wrong in this case. I have it on standing order to perform a surgical cric. Here's the link to my regional protocols. http://www.northcentralctems.org/documents...20Protocols.pdf. Feel free to read them if you wish. Shane NREMT-P

That's what makes a forum format great is that people can interpret things as they wish. So far, I haven't heard a story in any context of someone saving their paramedic partner. And that's with over a complete page of posts. I'd love to hear any interpretation, with stories of saving your paramedic partners as an EMT. I can honestly say that I've never had an EMT "save" me as a paramedic. I, as well as others I'm thinking are still waiting to hear stories of the paramedics that were saved... Shane NREMT-P

Great post Dwayne. Shane NREMT-P

Almost impossible??? You're kidding, right? To maintain my medical I'm required to obtain 36 hours a year, which averages to three hours a month. We also have to do a skills session at least once a year. By maintaining my medical control one year and doing my 36 hours, and taking a refresher the following year I manage to obtain my medical control requirement and significantly more continuing education credits than required for the national registry. If your medical control doesn't require a fair number of hours, they should address that in their system. Shane NREMT-P

As the OP (Original Poster), where did I say that I find joy in telling someone else they are wrong? I was simply breaking out a topic from another thread trying to gain that aspect of the thread more exposure. Actually, I'm more the type to help educate my partner (medic or basic) than to point out their shortcomings. But you can interpret that any way you see fit. But please, just so I can be clear...point to where I said I found joy in telling someone else they are wrong? So no, I don't think it's time for a career change. I'm quite content being a paramedic. I look forward to your response. Shane NREMT-P

There's a difference by "saving" your partner by having a good working knowledge of the body, treatment's, etc and someone catching an error caused by the very partner you've "saved." If I take out Sodium BiCard instead of D50 for a diabetic, that's a fundamental mistake that I shouldn't have made in the first place. If you pick up on a beta blocker overdose somehow and your partner wasn't going there, that's a different issue. Two entirely different levels of thinking. If people have to "save" their partners all the time from stupid mistakes, then those partners shouldn't be practicing at their given level in the first place. Shane NREMT-P

I know it's been brought up before, but I figured we might actually get examples if it were it's own thread. And it will hopefully allow the other thread to get back to it's original topic. This will increase exposure, and maybe the number of stories? Although, I'm guessing that the true number of stories will be few. But I could be wrong. Shane NREMT-P

So from the disappointment thread, the discussion turned to the idea of the statement "Paramedic's save lives, EMT's save paramedics." As a basic, let's here specific stories of how you "saved" your paramedic partners? There's a difference between being observant and catching something, and your partner simply messing up in the first place. Keep that in mind in your stories. My own opinion on the saying is that nothing could be farther from the truth. Provided that I'm on my game with my education and practice, an EMT-B is little more than someone who can assist me with certain skills by taking direction or initiative based on experience. There are countless times that I've done something or not done something only to be questioned by an EMT. Sometimes this questioning comes in an attempt to learn, and other times it comes in the form of an attack. But one thing is that I can explain to someone why I did or didn't do something. And until you share my knowledge, a basic should be delicate in how they word things to a paramedic. As a basic (assuming nothing more than EMT-B training), you're more than likely not sure of what a paramedic knows and doesn't know as far as their training. Many EMT's come out of basic training thinking they are ready to save the world. In my first few months of paramedic school we were simply coming to realize what I didn't know about the big picture when it comes to patient care. A few years later of practicing as a paramedic, and I still learn what I don't know about the big picture. With the experience that I've gained, I'm happy to admit that I don't know the entire big picture. It's part of what makes EMS fun and exciting for me. It's a never ending learning cycle. So let's here your stories of how you've saved your medics...Provide details, not that it's simply happened a lot. Shane NREMT-P

Because it's simply someone's opinion. I wouldn't waste my time getting so worried about what someone on the internet thinks of me, or my career decision. You have your opinion that you're doing the right thing by starting IV's to keep a nurse from asking questions; someone else has the opinion that maybe EMS wasn't the best career for you. In the end, who really cares what they think? But looking at the comment a little deeper, it's merely an observation. It's not saying that you're a bad paramedic. Or that you're a bad person. Why do people take the internet, and public forums so seriously anyway? I don't get it. I'll end this with if you want to stick around and contribute, great. If not, that's fine too. If you choose to stick around and simply read, but not post; I won't know the difference. I won't lose any sleep over it either way...and I already know I'll stick around and continue to post. But please, don't take the internet so seriously. While I may not agree with your rationale for patient care...you don't have to justify yourself to me, or anyone else here. Good luck in your endeavors. Shane NREMT-P

So we can't comment on your comments? So let's see if we can figure out a thread goes. A poster posts a thread. The end since nobody should comment on it. If it's in agreement with the poster, then there might be an exception. Those sound like some exciting threads. People call others out for a couple of reasons. The first of which is for more information. The second is to correct an obviously wrong statement. The third is to further discussion. The fourth is to ask why you feel a certain way, or do a certain thing. In that process, people also tend to give their thoughts, ideas and opinions. Nobody called you a poor provider or attacked you. If you feel that the idea presented in your post is the best choice, than be prepared to back it up. Nobody is going to agree with you 100% of the time. All in all, this thread has been rather civil compared to some. If you don't want comments on your posts, maybe it's best that you don't post here. Hopefully that's not the case and you will contribute to the city here. The choice is yours...I already know that I'll continue to post at the city and contribute. I've learned quite a bit along the way, and hopefully educated people a time or two as well. But I also know that anything I post in a public forum is open to questions, comments & even criticism. I'm ready for it since if I posted it, it's what I felt was the best answer at that time. If I'm wrong, I'll admit that too and write it off to learning. But one thing I won't do is take something that's said on a forum and get worked up over it. Good luck, hope to see you around the city. Shane NREMT-P

I don't think saying people jumped down your throat is the best choice of words. You were called out on your rationale for performing certain interventions. The only reason(s) you've given is so that you don't have to explain yourself to a nurse. That doesn't make an intervention appropriate and people called you out on it. Maybe if you can't back up your reasons without taking it as an attack, hiding is best. Hopefully that's not the case and you'll contribute to the forums. Difference in opinion is what makes a forum fun, and sometimes exciting. Voice your opinion, but be prepared to intelligently back it up when and if someone disagrees and calls you out on it. It could be a learning experience for all involved. You might teach me something or open me up to a new way of thinking, or the other way around. Or you could just read and take things in without ever presenting your point of view. Or as some other's have done, you could leave altogether. Whatever works for you. Good luck. Shane NREMT-P

I have had treatment's questioned by nurse's and physicians. And I've been able to provide my rationale for my decision to do something, or not do something in those cases. Personally if I know a patient doesn't need an IV, I'm not going to feel like a "retard" for not starting one. I have an obligation to advocate for my patient and to provide appropriate treatment. If an IV isn't needed prehospital, it's not needed. A nurse's attitude won't change that. If they want to complain, let them. Your company needs to talk to their personnel and explain the way things are. Are you doing any service to anyone but yourself by starting an IV on a patient that doesn't need it? Most hospital's aren't going to draw blood from your line or lock, so the patient gets stuck again. Sounds like a good deal for the patient. They get an extra needle stick simply so you don't have to deal with a nurse who doesn't know EMS protocol and clinical decision making? If this is a chronic problem with a particular ED, maybe someone needs to talk to the EMS director and see if they know about it? More importantly, can they do anything to correct it? I'm still not seeing your point to starting an IV on a patient when it's not clincally indicated, only to avoid a confrontation with a nurse. If the patient doesn't need one, and you can validate why they don't need one...then don't start one. By starting an IV that's not needed, you're only serving yourself. Shane NREMT-P

That's simple. There was no need to start an IV on the patient. End of discussion. No, I don't get your drift. When should we put our relationship with the receiving facility in front of patient care? If the patient doesn't need it, they don't need it. There's nothing else really to say about it. So again, why are you putting nurse's attitude's in front of patient care? I just can't agree with doing something to keep a nurse happy when a patient doesn't need an intervention pre-hospital. Maybe I just don't understand it. The one person I worry about when deciding on an intervention is the patient. Shane NREMT-P

That statement contradicts itself. But you did say that you do it on every patient. Here's your post: and If you're going to argue your point, stick to it. Don't back pedal and say that you don't do it on every patient. You've already clearly stated that you do so, and that it doesn't "hurt." You seem to be intelligent enough to rationalize your thoughts. Stick to them. While we might not agree with them, everyone's entitled to their own thoughts and ideas. You can keep yours. They just don't agree with me. It's the same way as my ideas clearly don't agree with you. Doesn't make either of us wrong or involved in a "pissing match." Shane NREMT-P

Whatever works for you to justify your intervention not only to yourself, but your medical control. If you want to say that a medic is lazy for not putting an IV in every patient, whether it's a saline lock, or a running line...that's okay as well. You say that the hospital is usually going to draw blood from the patient and that they can now just put a saline lock in. Let's ask if you're doing your patient a favor by gaining IV access (that you're not going to use) only to have them get stuck again at the hospital for blood? Now rather than saving your patient an IV stick, you've added another one. Most of us can somehow rationalize making most any patient an ALS patient. But is it always prudent? Or always best for the patient's needs? We have all had stable patients crash. It happens. And I think most paramedic protocols have a broad guideline for obtaining IV access. But just because it's in your protocol doesn't mean that it's the best thing to do. There is a place for "routine ALS," but not on every patient that we come into contact with. Just because a patient may fit a generally written, broad scope protocol; it doesn't mean that they should have the full protocol applied. They're more guideline's than absolutes. Shane NREMT-P

I haven't killed anyone either, but I don't do IV, monitor, finger stick on every patient. Well it may work for you, is it always appropriate for the patient? I prefer to make decisions about interventions based on a need, rather than a routine or practice. It does more for my patient to prevent them from having things done to them without a need, and also forces me to do a thorough assessment in order to determine that need. How would you feel if you were getting charged when you went to the doctor's office and they applied a "blanket" set of tests/interventions to you without a need? Not every patient that you come into contact with requires those interventions. I'm not posting to pick on you. But I would like to know more about why you perform those interventions for everyone? Just because you haven't "killed anyone," doesn't make it the right thing to do. Shane NREMT-P

That has to be one of the most painful posts I've read in quite some time. I found it to do nothing to further the image of EMS providers, but rather to take away from it. It's written on a mediocre reading level, poorly constructed and does little more than to serve the ego of the original author. While some of the points might have had potential to be valid, the general tone and construction take away from the post on a whole. The final note about partying was 100% out of line and never should have been considered to be public knowledge. There are plenty of other means that we deal with stress besides partyting. Chas, I'm assuming you didn't write that but rather found it and simply reposted it. That and I've already seen your progress in constructing posts. Keep up the good work. Shane

You're right, she has been in the car for 10 minutes with a life saving collar on. And she should have been removed prior (stable or not) to expedite transport and to perform a proper assessment (exposed or unexposed). I'd be willing to bet that in the case of exposing trauma cases, the court date comes sooner for those who don't expose than those who do. You can always err on the side of caution (and the patient) in exposing and justify it. Not exposing, however could easily be exposed as negligent in patient care. You pick which side you'd rather defend...the side of doing more in terms of assessing a patient, or the side of not doing enough of an assessment. I know where I would rather be. Now, I'm not saying that I would have completely exposed this patient making them completely naked in the street. But a quick cut up the pant legs and the shirt to expose and check for injuries in an accident that warranted air transport isn't too much of a stretch. Patient assessment can be justified more easily than patient privacy. Especially if you were cautious in how it was done. The bigger issue here is still that nothing was done for this patient while they were waiting for ALS to show up. Where is the justification in that? Shane NREMT-P

Yup, let's be real here. This a motor vehicle accident involving air transport, so assuming the potential for life threatening injury. And should this patient be stripped, sure. Why not? You can strip the patient and look while providing privacy. I cut up the pant legs, leaving the hip region in place to provide for privacy. It allows me to look at what I need to, while providing for privacy. And either way, you can still provide a much better assessment of a trauma patient while they are on a backboard than you can while they are sitting in vehicle. Shane NREMT-P

I have a great reason to remove the patient from the safety of the vehicle. The first is in the interest of patient care. How thorough of an assessment can you do on this patient while they're sitting in their car? I can assure you that it's not as thorough as if you had removed the patient from the vehicle and had a good look at them from head to toe. As far as shade goes, even a car with the doors open will increase heat significantly. Remove them, package them and transfer care to ALS. The few minutes that they might be sitting outside in the sun (assuming a 10 minute response minus a few minutes to pacakge them leaves just a few minutes), is not going to cause significant detriment to the patient if any at all. Let's put another question out there...did the airbags go off? If not, that's a good reason not to have a patient sitting in front of the steering wheel while nothing is getting done for them. There are plenty of cases where airbags go off well after an accident. I'm still siding with that by just sitting with this patient with them in the car, the only thing that has been advocated for successfully is a needlessly prolonged delivery time to the hospital. Remove the patient, package them and perform a correct and thorough assessment of this trauma patient. If another occupant of a vehicle was flown and is going to a trauma center, this patient could certainly benefit from a head to toe assessment. Especially since the patient is reported to be hysterical. Your best assessment tool in an uncooperative patient (for whatever reason) is your physical assessment. And a thorough physical assessment cannot be performed while the patient is sitting in the car. If you're not doing someting to get this patient packaged when I arrive if I arrive 8-10 minutes after you and you're just standing with the patient holding c-spine with a collar...you've done a disservice to your patient, and to your service as that kind of treatment should not be tolerated. We've put a percieved patient comfort (the hot sun outside instead of the "shady" car) over patient care (a proper and thorough assessment). That equates to a loss of credibility as a provider in my opinion. That loss has been properly earned back in this case by making an honest attempt to learn from the situation. While his supervisor's may agree with him in this case, that doesn't make them right. Let's not lose sight of our jobs as prehospital healthcare providers. That function is to transport the sick and injured to the hospital. Sitting with this patient in a car while the equipment and manpower is present to perform patient care shouldn't be tolerated. Shane NREMT-P

I'm going to go against the grain of many other's and say that if you had the resources (man power and equipment), then this patient should have been extricated and immobilized prior to ALS arrival, especially since there was an 8-10 minute response time for ALS. While slightly uncomfortable for the patient, they can sit on a backboard for a few minutes. This will give you the opportunity to have a much better look at your patient and provide a better assessment to report to the ALS providers. While other's may feel that you've done nothing wrong, nothing right has been done either. It's a neutral situation with minimal effort on your behalf to promote expedient transport of this patient. Putting the collar on saves 30 seconds. Everything else has still been left for someone else to do, and we've lost 8-10 minutes worth of time. Patient care should come before patient comfort. This patient should have been packaged and ready to go by the time ALS arrived without a doubt. After this call, I would have more than likely been wanting to talk to you and find out why the patient wasn't ready upon our arrival. Removing this patient would expedite transport, while allowing you to do your job better by performing a better assessment. And finally...this quote... Just out of curiosity, why is the medic a lazy sob for not being happy about doing something that should have been done before their arrival in the first place? Maybe the medic should call the provider a "lazy sob" for not having immobilized the patient? What's been accomplished in the way of patient care during the ALS response to this call? I'd love to hear your thoughts... Shane NREMT-P

I have to echo other's with your percieved difficulty in pushing meds through an IO. I've used the device multiple times in the field, and have always been able to obtain a rate of at least what a decent IV could achieve. I've found it beneficial to do a syringe flush through the IO prior to just hooking up a line to clear any marrow that might obstruct the IO itself. Once that's done, the thing run's with enough fluid to "fight a structure fire" as dust says. With regard to the efficiency of pushing meds through it, I really hope your comment was an error and made accidentally. The fact is that any medication that can be pushed IV can be sent through the IO. The entry into the vascular system is highly effective, and even a short half life medication such as adenosine may be administed effectively through the IO. While your experience with the device may be limited, or less than acceptable I think you'll find that the large number of providers using this device find it to be a decent tool and use it with adequate results. My suggestion would be that if you continue to experience problems with the device, maybe talk to someone and make sure it's being utilized 100% correctly. I find it hard to believe that such a large number of providers would admit to the successful and easy application of the IO, as well as effectiveness while you continue to struggle. Is it possible the problem is technique, as I doubt the majority of providers are wrong? Just a thought, meant with all due respect. Shane NREMT-P

When would vomiting be more appropriate than an NG/OG tube? Actually, we've gone away from the idea of having out patients vomit, thus we no longer carry ipecac on the trucks. Vomiting is actually bad for the body and poses quite a few risks. The acids in your stomach cause burns on the way back up. Aspiration is always a concern with a vomiting patient. This doesn't mean that if you vomit, you're going to die. But vomiting is rarely, if ever a favorable means of "treatment" for a condition. Shane NREMT-P

We have versed in our protocols, we can give 5 mg IM on standing, and can call for an additional 5 mg. Our front line drug for seizures though is Ativan. We can give 2mg IV every 5 minutes to a max of 8 mg. It sounds like she got a pretty hefty amount of medication to try to control her seizure. I'm guessing there was some other underlying cause if that much medication didn't control them. Shane NREMT-P

That's a painful post to read the way it's written. Please use some attempt at punctuation. It makes things a lot easier for the rest of us to read, and you come across as having put forth some effort in your posting. Also, in the US every helmet sold by a dealer (that's not a "novelty" helmet) has to be DOT approved. It's against the law to sell one that isn't. SNELL is another rating to look for, which is optional by the manufacturer. I do wear a helmet when I ride. I've never ridden without one. And while I don't think it's the smartest thing to do when you ride without one, it's your choice. I'm not going to get on a soapbox and tell everyone they have to wear a helmet. People are going to do their own thing. Just like people speed in cars and get into accidents. I've done plenty of significant car accidents related to unsafe speeds, but noone makes as big of a deal about them. Shane NREMT-P