medic001918

If you're able to collect on these accounts in 60-120 days, what's preventing a service from being able to collect themselves and saving the 15%? Once a service is established, their collections are always 60-120 days behind which should lead itself to be a steady cycle. I personally don't really see the benefit of this service other than not having to handle the collections process on their own. I think the service would have a better financial result using a true billing service instead of selling their accounts for a 15% discount so someone else can make 15% a 15% profit on the billing. I'm just not seeing where the benefit lies in this operation other then to the people buying the accounts to make the extra profit. Either way someone has to collect on the bill itself, and in this case it should be the serivce that collects the full bill. Not someone else who bought the account at a significant discount (which 15% or so is significant). Just my two cents. Shane NREMT-P

Not a bad idea. I like it...a lot actually. Go obtain a degree in public safety management, or any healthcare sciences field and you'll be light years beyond most of your competition when it comes to getting hired on the job. As far as if a judge will reopen a case, it depends on the laws of your specific state. They may take them away, but there's just as good of a chance that they won't since it's an old issue that's already been resolved. I guess it would depend greatly on the mood of the judge and what they are willing to do for you. Good luck, and please give some thought to the idea of staying in school and obtaining more education. It would benefit the career field as a whole if more people started doing that. Good luck. Shane NREMT-P

+1. Now that's some good advice. Shane NREMT-P

Don't disillusion yourself into thinking that CPR is a difficult task to perform. I don't know why any employer involved in EMS for any length of time would be impressed by "CPR experience." It's a pretty mindless process. If this is what your "employer" (if you don't have the job, then it's not your employer) finds impressive, I'd reconsider my thoughts on the service. Again, you're being asked what you consider a "save?" Is it ROSC? Does the patient have to survive to walk out of the hospital? What is your definition? Like others, I've been doing this for a while and can't claim more than a couple of saves. Does this make me less of a provider? Or just one applying appropriate definitions? Just some things to think about. Good luck with getting hired for the job. Shane NREMT-P

At 17 years of age, how much time can he have into the service? My guess is not very long. With my years in EMS, I find 12 "REAL CPR saves" that made it to discharge difficult to believe at best. It's not a secret that the majority of in the field cardiac arrests are never going to have ROSC. So for someone w/limited time in the field (I'm basing limited time on age) to claim 12 of them...I find it hard to believe. It's not impossible, but not likely either. Working as a paramedic in a city of 125,000 people, I see an average of 15-20 codes a year. And in the other city that I work for, we cover a city of 71,000 (covered with three ambulances) each medic averages 1-2 codes per month. Just some number to consider when you're throwing a number like "12 REAL CPR saves" out there to those that do it for a living. It sounds like a stretch, regardless of if it is or not. Shane NREMT-P

And I'm in favor of having providers that are capable of managing the scenario they're placed into for the extra time it takes for a transporting ambulance to show up when needed. No system is perfect. Is it better to have a BLS take an ALS call w/no medic available since that medic is riding a stubbed toe to the hospital? Or is it better to have an ALS provider on the scene with an ALS patient while waiting for a BLS transport unit? I would prefer to see the ALS provider with the ALS patient, that way at least some of the needed care might be able to be provided. No system is perfect. But some are better than others. When executed well, the intercept system is the least of the evils. And that's being said having experience in an intercept system, and one where the ALS provider is in the ambulance doing every assigned call that comes their way. It's about best use of resources...and the best use in this case is having the ALS provider with the ALS patient. Not the ALS provider with the BLS patient. Shane NREMT-P

While one of the signs of an MI involving the right ventricle is hypotension, they don't always start with the hypotension. The safest bet is to attempt to determine the location of the MI before giving a medication that may increase the size of the infarct. We have to be cautious every time with regard to a patient that may be presenting atypically. The general rule of a BP of 100 being the "safe" number for NTG administration is a judgement call. There are patients that generally don't appear well with a BP like that due to a relative hypotension. You have to take into consideration the patients entire history and story with regard to the event before giving any medication. On top of that, with 12-lead EKG's becoming a standard of care there is no reason for a patient to not receive one to ensure they are getting the best care possible. With regard to basics giving NTG based on BP, I would be hesitant. The biggest reason is that some people are more sensitive to NTG than others. I've seen people not have any BP change with NTG; and at the same time I've seen patients that have had substantial drops in BP. As a basic, should their pressure drop you have no way to correct the problem. More importantly though, you can't visualize if the damage may have been caused by your medication. The 12-lead is your safest means to ensure appropriate care. Anything less, and corners are being cut. Just my two cents. Shane NREMT-P

I've noticed a couple or replies with refrence to a long resume. From my time in any position (I was an engineer before I got into EMS), most employers aren't looking for a really long resume. In fact, I think most recommendations with regard to a resume is a cover letter, and then a resume that is a single page with two pages recommended as a maximum. Long resumes can lose the readers interest since in general they may have a large number to go through. Keep it short and to the point with regard to what your employer is looking for. In your interview process will be your chance to elaborate on points in your resume, as well as providing a chance for you to ask questions to your potential employer; as well as the employer being able to ask questions of their potential employee. I wouldn't recommend a long resume. Seems that it could be more hinderance then help. Just my two cents. Shane NREMT-P

Some of the first things that an employer might look for in a resume is proper spelling and grammar. That in itself goes a long way towards presenting yourself with a professional appearance. Otherwise, honest is one of the biggest things. Many services will take someone who they feel is a good fit into their organization with less experience rather than someone experienced who they feel is a bad fit. You can always work on someone's skills with them to improve them. As far as your not wanting to do transport, good luck. Many services are transport services since it pays most of the bills. A lot of the totally emergency services do prefer at least some experience in the field. Different services have different views with regard to how they treat volunteer experience. In your resume, you may want to outline how many calls a year your service does so a prospective employer will have a gauge of your experience level. Your probably better off accepting a position that does transports and emergencies to "pay your dues" before getting to move onto the highly sought after full 911 position. Good luck, Shane NREMT-P

I've never used study stack, but I like the way the system sounds. I'd hit the A&P review and then follow it up with what's left of the drugs. Good luck, Shane NREMT-P

The best way to understand meds is to understand anatomy and physiology, with the nervous system being the biggest key to the puzzle. When you know the way the human body works, the meds will make more sense. For example, epi is a sympathomimetic medication. So if you know the sympathetic nervous system, you should be able to understand what epi would do and the side effects. That leaves you far fewer pieces of information to simply commit to memory (dose, contraindications, indications). Besides, if you don't understand how the drug is going to work then you shouldn't be giving it to begin with. Shane NREMT-P

Like others, I didn't find much of the EMT-B course difficult. In fact, thinking about it now I don't think any of it was that hard. The class is presented in such a remedial fashion with little to no real content that would provide most people a challenge. The ease of the course and how little is actually taught is part of why we don't get a lot of respect from the medical field. The time spent on your education is roughly that of a CNA and you're making "life and death" decisions. I'm still in favor of seeing the educational level increase across the board for basic's and medic's. But that's another topic that's already being discussed. Shane NREMT-P

My first service was a volunteer service as well. Just like many other people on this forum. I find it difficult to believe that any service with some degree of risk management is going to let a brand new EMT fulfill that role without any formal field training to validate their knowledge and/or skills. Just because someone holds a valid certification card does not mean that they are capable of functioning on the job without supervision. That's a risky proposition for an organization to take even under the best of circumstances. Unfortunately this will sound pretty harsh...but if you can't provide the proper patient care than maybe you shouldn't be responding in a POV just yet? Get some experience under some supervision to build some confidence yourself before functioning on your own. Otherwise, you might find yourself in way over your head on a call if you haven't already done that. It sounds like that may have been the case already though. I guess some people might subscribe to the "something is better than nothing" belief with regard to who responds to a call, but if you're going to show up to help and you're not under the supervision of another provider until you're cleared, I'd rather you didn't show up personally. It seems like more harm than good can come from that scenario. The liability in you being on scene with a patient with a significant mechanism of injury (such as...a ROLLOVER MVC) and not taking the proper interventions is to great. Once you've demonstrated the appropriate decision making ability and have the experience to function on your own, you would be welcome to do so. Until you've accomplished that though, you shouldn't be trying to function on your own. Shane NREMT-P

Every sceanrio is different. Noone is arguing that. If the patient were refusing c-spine precautions, it seems to me that would have been mentioned. But as a brand new EMT, he shouldn't have taken it upon himself to do nothing and not hold c-spine at all. I know that the street and classroom are two entirely different environments. However, being a brand new EMT I also wonder why someone would think that it's okay to not hold c-spine after this call? C-spine is something that should be engrained into every new EMT's head. And as a new EMT, I didn't have to respond alone. In fact, the service had a strict policy against doing that until you were "cleared" and off of field training. Shane NREMT-P

It all depends on the scenario. I have directly infused dopamine, but only after I've already established another point of access elsewhere on the patient running normal saline. This way the med's aren't piggybacked, and there's two points of IV access. In most cases, you'll need to hang some clear fluids if you're going to be giving dopamine or lido (or just about any other medication infusion that I can think of off the top of my head), so it's easier to piggy back the additional med into that one point of access, or to establish a secondary point. Piggy backing is great when you have a patient that has very poor access but you were able to get a line on. Rather than waste time making a pin cushion out of the patient, just piggy back the infusion. It's an assessment of time and what you need to get done that might help you make the decision. Shane NREMT-P

So a less severe roll over has the potential for less injury? True to some extent, however in any rollover there is a potential for injury due to the unpredictability of the pattern. My suggestion is to read up on some kinematics of trauma. It might change your views slightly. Hindsight is 20/20. And in this case, you absolutely should have been holding some form of c-spine. Anything less is unacceptable. And as was mentioned before, brushing up on the construction of your posts will go a long way towards your credibility as a poster, and in some ways a provider when on the forums. Food for thought. Shane NREMT-P

In order to be able to answer your question, we would need more information about the patient and his status. Vital signs? Age? Previous medical history? Complaints? Seeing a 12 lead would be beneficial in trying to determine the cause of the PVC's (hypoxia or infarct?). Once a complete scenario is posted, I'm sure other's (as well as myself) would be more than happy to explain their treatment modality. Not all PVC's require intervention. And not all PVC's should have an intervention performed. It's a rather grey area of prehospital care. You state the PVC's are malignant, but are they cause of the problem? Or being caused by the problem? The picture you paint is far from complete. Therefore, it's impossible for myself (or anyone else for that matter) to paint a full treatment picture. This isn't an attack on you in any way. But if you want to ask a "what would you do," then you have to post complete information. Based on what you've posted, the only thing I'm going to do is to complete my assessment. Once that's complete, I'll make a treatment plan and execute. Shane NREMT-P

Are you 100% positive of that? Some doc's that I've talked to are starting to use Cardizem to treat SVT's instead of adenosine. In fact, I have cardizem in my protocol for an SVT that is refractory to adenosine. And that's on standing orders. Here's a link to the protocols if you'd like to read up on it yourself for verficiation: http://www.northcentralctems.org/June%2020...otcolsfinal.pdf And here's some more reading for you before any more incorrect information gets spread around. http://www.ionchannels.org/showabstract.php?pmid=11841884 This article states "CONCLUSION: Calcium channel blockers infusions were safe and efficacious in terminating spontaneous SVT." http://www.emedicine.com/med/topic1762.htm This article states "Other alternatives for the acute treatment of SVT include calcium channel blockers like verapamil, diltiazem or beta-blockers like metoprolol or esmolol. Verapamil is a calcium channel blocker that also has AV blocking properties. Verapamil has a longer half-life than adenosine and may help maintain sinus rhythm following the termination of SVT. It is also advantageous for controlling the ventricular rate in patients with atrial tachyarrhythmia (Ganz, 1995; Campbell, 1997; Connors, 1997; Levy, 1997; Xie, 1998; Gold, 1999; Siberry, 2000; Josephson, 2001)." So, as much as I tried, I can't find any information that agrees with your statement about "disasterous effects" when using a CCB in the presence of an SVT. Shane NREMT-P

That post was a little better, but there's till much room for improvement. It's written in a lot of short hand and still without punctuation. If you want to be taken seriously, a well constructed post goes a long way towards that goal. On a forum such as EMTCity or any other forum your written word is as good as your spoken word and people are forming opinions based on how your post is formed. Keep that in mind when you put together your posts, and you'll find that people respond much better to your posts, even when they disagree with you. Now on to the call itself. Regardless of someone is only claming a "cut" head, as an EMT-B you should not have been the one to decide if c-spine precautions were not warranted or not unless that's specifically in your protocol? From reading your post, it doesn't sound as though it's protocol for you to not immobilize a patient with that kind of mechanism of injury. Remember your kinematics of trauma lecture from class? Rollover MVC's can have one of the highest rates of unpredictable injuries due to the fact that you can't determine where all of the forces came from in the impacts that occur. There are a number of things that come into play when a provider decides to immobilize, or decides not to immobilize a patient. From your description of the events it doesn't sound as though many of those things were weighed into your decision. I can also tell you that as a paramedic, if I showed up and you didn't have c-spine being held on this patient or at least form of doing something being done; that we would be having words or I would be speaking with your chief and/or training officer. Regardless of the damage to the vehicle, this is a patient that was in a motor vehicle that was flipped over at least once (to get it on it's roof). Seat belts today do not offer the best protection against a roll over style crash, and there are a number of things the patient may have struck their head on to in order to get that laceration. Unfortunately, this is part of the learning process. We've all learned by making mistakes. It's just the nature of the job. Hopefully someone will be there to help stop you from making big mistakes when it matters. And hopefully this call will be reviewed by you with someone from your service to ensure that proper protocols and treatments are carried out the next time. Good luck. Shane NREMT-P

I think someone needs to learn to type in an organized paragraph and to use correct punctuation. That would make a post much easier to read. Shane NREMT-P

Having an ambulance on standby so they are there for immediate service and having them involved in the actual operation are two different things. Medicine shouldn't be practiced in a hot fire zone. The most appropriate action is to extricate the person (officer or civillion) to a safe zone for treatment. The only thing starting to do any form of treatment in the hotzone is run the risk of increasing the number of victims. Seastrat, a well written first post. Kudo's to you. While being familiar with your medics is a benefit, and having them familiar with you as well. But you should be competent in the medics in your area in general. If you're not, or if there are issues with certain crews; then these are issues that need to be addressed between agencies. In my opinion (while lacking a great deal of knowledge in law enforcement), I can say that from a medical point of view, having a provider in the hot zone is not an effective use of resources. Extraction is the key to minimizing losses and damages. Any delay while in a hot zone is potentially adding to casualties. Shane NREMT-P

I don't think anyone was doubting you. Some of us who don't use the chat room just found it odd that you had two posts, and one was announcing your departure from EMS. It has nothing to do with making ourselves feel better about anything. In fact, I did wish you good luck in my first post. Shane NREMT-P

Nope, thought the same thing myself. Just didn't really care enough to reply and be negative about things. But since you mentioned, I did find it rather strange. I would feel differently if it were a change being made by a regular contributor to the forum. This time though, that is not the case. Good luck to her though. Hope it all works out. Shane NREMT-P

We use 20-30mg of Lido after establishing the IO. There are more nerve endings in the IO that causes the pain when flushing the site. The lido is supposed to help to deaden the nerve endings and make it more comfortable for the patient. I find it kind of scary that a paramedic placed the IO and wasn't sure if it was working right because of the pain when flushing the site. Makes you wonder if she really should have been using it in the first place since she doesn't seem to know the device and it's actions all that well? Shane NREMT-P

Her story doesn't completely add up to me either. The whole idea of stripping a trauma patient is a standard protocol, but most people do maintain the decency of allowing for some privacy. I have seen other providers bring in a patient that is completely nude however. This whole thing seems to have gone pretty far for someone with a knee abrasion, and no other documented injury. My biggest thing that I'd like to know (that I think would prove or disprove a lot) is that if she was given a third dose and it wasn't reported, what kind of narcotic paperwork was done to account for the missing drug? I know when I turn in my narcotics after using I have to document how much of the med I gave, what is left in the vial along with the patients information and a copy of the run form from the call. It would be pretty difficult to get past all of that paperwork without putting some thought and deliberate effort into it. I'm not saying that it didn't happen, or some variation of the events. But I don't know as though it's worth what she's after. If that's the case, than you'll find a lot less personnel stripping trauma patients for fear of litigation. Shane NREMT-P