sowenstech

The service I work for here in Southern WV is Funeral Home based. It's actually quite busy. Most of the people in the area have used the Funeral services for their families, so they naturally call us for EMS services. In addition, we are a 911 provider for the county. And yes, we HAVE been used to go pick up DOA's! I told my boss we needed to put a new slogan on the rigs: Either way, your coming with us! Bad humor, but oh well.

I live in WV. Yes I do put normocephalic. Used to describe more indepth, but a local ER doc told me that normocephalic sums up "nothing abnormal above the thorax." I didn't assume the lower air entry is caused by COPD. Stated so in the medical records transported with the patient. Just used it to give the reason why. I don't assume. I do that I screw up. May seem like I try to hard, and you are probably right. I have maybe a 3x4 area to document EVERYTHING that happens. DCAPBTLS is just as effective as, say, stating "nothing remarkable during exam." I know I'm only BLS, but I try to do my job the best I can. Not enough people take this field seriously, (just read the news on the homepage) especially in my region. Most people do it so they can look cool to their drinking buddies, or stay out of a career at the Golden Arches Cafe. I had a child born with Persistent Fetal Circulation. His 3.5 week stint in NICU sparked my interest in the field. My youngest (I have four boys) was born 10 weeks premature, supposedly due to my wife being a gestational diabetic. I was in EMS by that time, but my mind wasn't. After that, I try to look at everyone like I do my own children. I had taken a Paramedic class about four years ago, but due to instructor/school screw-up, none of us were allowed to test. 18 months and then BOOM....brick wall. But in my humble opinion it made me a better EMT. So I took the knowledge I was given, and continued on with it. Nothing more frustrating than to know what the patient needs, know how to do it, have done it before during clinicals, yet you just have to sit there. So I do my damndest as a simple BLS unit to provide the best care I can. So yes, I probably do try to hard, but whether it be a simple dialysis run, OD, MVC, Code, etc., I make sure I'm ready. If I remember nothing else from "Basic School", it is this: NEVER stop learning, NEVER assume, NEVER get comfortable, and if you don't write it, you didn't do it! Whew.....Sorry. :oops: BTW, I meant to type AED electrodes not in place. Defib pads actually. Physio AED's. I saw no need to with a medic 3-4 minutes out, and the pt having a palpable pulse. Not necessary, but MCP likes to know if you had planned on doing so or not. I would explain, but the stories would be so long, they might crash the server!

Would love to, but per our protocols, UTO is only good if equipment fails/needs calibration. If pt requests it, we have to have them sign the refusal of service/release of liability form. Some insurance providers frown on that, leaving the patient stuck with portion of the bill. God.....it sucks to work EMS here. Can't wait for Paramedic class to finish so I can get out.

While I do agree with you on consistent patients that you see 3-4 times per week, this was a fairly new patient (to me anyway). I felt the need to give a good once over. Besides, I have, albeit very rare had patients i've transported on a weekly basis to suddenly tank on me. That's why I stated the fact that a transport is never just a transport. On short runs I usually use the last VS set from the facility as a base, then check once more upon arrival. The Dialysis units here are adamant about explaining to their patients the need for it. May seem silly, but I don't wanna have to explain to ANYONE why Uncle Joe assumed room temperature on the way home because I didn't check a pulse or BP. Just my $0.02 worth. Again, however, I do agree on not causing any undue comfort. I try to leave it with Resp, HR, BP. I get pulse and resp while I help adjust them on the stretcher, just gently hold the wrist. Pupil check when I kick on the compartment lights since the overhead canopy, combined with window tint, make the back fairly dark. Occasionally leave the BP alone based on patient mood, level of comfort, so on. But I never push it. Most of the ESRD patients we take are on the verge of quitting due to the pain, strict diet, etc. The main point of my post was that I had to defend obtaining a proper SAMPLE history, vitals, assessment, etc., to a person that should be in favor of it.

Ok, here is a detailed PCR of probably the most interesting call I've had in a couple years. The back story: Male tries to kill himself by eating 40 Oxycodone 7.5mg, washing it down with a bottle of Phenergan with Codeine, chased with a fifth of Wild Turkey. Pts girlfriend is related to an EMT in neighboring county. She contacts a co-worker, informs them they will be getting called for ALS backup, so they are enroute before tones drop. My partner and I are the unfortunate souls who fall victim to the following. All names, hospitals, and agencies are changed to protect the innocent, and the stupid. BLS unit 01 911 dispatch to Mtn Rd for 42 y/o male unconscious/unresponsive. Upon arrival, pt found lying supine in front yard, unresponsive. Pt presents with dyspnea, diaphoresis. Family states attempted suicide. Family provides empty med containers, filled same day, and empty liquor bottle. Pt NKDA, no meds, PMHx HTN, Bipolar disorder. PO intake at 1700. Vitals as follows: HR 140, Resp 3, BP 60 palp, GCS 1/1/1, Skin pale/diaphoretic, Pupils NRL/constricted. HEENT normocephalic, no blood/cs fluid present. Trach midline, no JVD, chest rise/fall=, lungs diminished all fields with dyspnea. ABD soft x4 quads. Pulse + x4 ext. no DCAPBTLS. Pt manual ventilation BVM/O2 15lpm, nasal airway size xat 1722, log roll to longboard shows no posterior DCAPBTLS. AED electrodes in place. Pt secured to longboard, stretcher x3 straps, trendelenburg. Contact control, ALS requested. Continue Ventilations enroute, vitals q 3-5 min. ALS intercept @ 1727, County ALS 02. Medic Doe boarded BLS unit 01. Continue assist ventilations, other interventions at Medic Doe request. 1735 pt fiancee, passenger seat, vomit x2, syncople x3. Passenger sudden onset CP,SOB,N/V. pale diaphoretic. C/C crushing substernal pain, non-repeatable on palp, radiating to L arm, 8-10 on pain scale. O2 12lpm NRB, ASA 81mg (x4)PO, NTG x1 SL per Medic Doe. Contact control, request second ALS unit. Intercept County ALS 01 @ 1740. Passenger transferred to County ALS 01. Male Pt vitals stable, 2 Narcan IV per MCP. Pt C/A/O x3 upon arrival to County ED. Report and care to County ED RN Jane Doe. Evidently, one of the volly FD first responders told her to go ahead and ride along with us. Could've been helpful for info purposes, provided she wasn't high at the time! So while the Medic and I deal with an OD, she passes out thrice, then has an MI in the front seat! Good times....Good times. EDIT** Forget to add that I referenced the medics PCR # on my PCR, so as to continue the flow of treatment and information from BLS to ALS.

The PCR here in WV has a relatively small space for the narrative. I also shortend it for spacing issues in the post. I do appreciate your comments however. I will post a complete narrative momentarily so as to give a better idea. I'm still fairly new, only six years in, so all criticism is welcome.

I'll start this by giving you a rundown of how I narrated my PCR for this particular patient. Service and Unit # Pvt dispatch to Address for __ y/o sex with C/C ESRD to be Tx to Facility for Rx of life-sustaining hemodialysis. Upon arrival, Pt presents with no distress. Pt denies any CP, SOB, N/V. Pt KDA to ____, Meds as follows:**list**, PMHx DM, HD, HTN, COPD, CVA, ESRD, PAD, PVD, Anemia. Pt last PO @ 0630. C/C 2º to DM, HTN. Pt lift x2 crew to stretcher, left lateral recumbent (cva) x3 straps. Vitals above, assessment enroute. HEENT normocephalic, Perrl @ 3mm, no JVD, chest rise/fall=, lungs c+e x2 upper fields, diminished x2 lower 2º COPD. ABD soft, N/T x4 quads. Pulse + x4 ext with = grip strength. M/S + R side, diminished L side 2º CVA. Pt presents with A/V cath R subclavian. No other DCAPBTLS. Pt admin O2 4lpm NC per PCP Rx COPD, monitored enroute, vitals q5 min, continuing assessment and care PRN. Tx to Facility uneventful with no other C/C or incident enroute. Report and Pt care transferred to LPN, RN, MD, DO, etc My so called "supervisor" said that my narrative was to Medical Sounding and that I shouldn't use such big words. I don't need to fill out the entire narrative box. I use too many shortcuts, etc. I was also informed that assessing JVD was not an issue on a routine dialysis Tx. First of all, I use medical terminology to the best of my abilities because....I WORK IN THE MEDICAL FIELD!! I feel that everything I put in my narrative is important. Since BP and Kidneys do go hand-in-hand, a presentation of JVD alongside a normal brachial BP reading may indicate some type of shunting. I've seen it. A/V cath or fistula placement is neccessary for another provider if the pt were turned over to an unfamiliar crew, ALS, etc. A transport is NEVER just a transport. I am just fuming right now over this! :evil: :evil: :evil: . I recently had an ER Physician tell me I wrote a very informative PCS. I document everything I see, do, find, what is pertinent to the C/C, pertinent negatives, etc. I document according to C/C and what I see. MVC? I look for all of the above plus CS fluid, bleeding from orfices, priapism in males, musculoskeletal injury or deviation, etc. the list could go on forever. So tell me what you guys think. Is there such a thing as overdocumenting. My personal opinion is that if you assess, document, Rx, and reassess, then you've given your patient the best care you can provide.

For Jumpers: Concrete Poisoning And for the people I work with who are on their fourth or fifth try at testing out: CPR=Can't Pass Registry

I do plan on going back for the additional classes to obtain my A.S. For now this is a positive for two reasons: 1) The instructor is FAR more competent than the college instructor, even the college knows this. I worked around him for awhile, and he is well respected and admired in the area. Plus he doesn't have ParaGod syndrome(sorry for any offense, but some of you know what I mean.) . 2) The adjacent county from the class, the one I work in, just lost its last EMT-P to retirement. We have no ALS in the entire county. These people need an advanced level provider. I do agree with you that the additional classes will improve my procedural skills and clinical knowledge. For now, however, Thes people need all they can get. I hope others will join me in the program, so as to fill the void of competent EMS providers in the region. If not, then my wanting to move is a moot point.

I have my level I FF. I run with a volunteer fire dept. here.

First off, hello to all. Just registered here after some lurking. Wonderful site with alot of obviously intelligent members. I currently work as an EMT-B in southern WV. Heavy 911 traffic with most calls being AT LEAST 40 minutes (live in the sticks) from a hospital. ALOT of ATV and MVC calls. Winter is even worse as the small, winding roads get covered with snow and ice. I lived in Naples, Fl. for about a year working as an electrician. Needed a break from EMS. Moved back when my wife's father became terminally ill. I am currently attending a Medic course at a nearby college. I should explain: I already completed one Paramedic program about 5 years ago. In WV, if it is an Assoc. Degree course, it need only be re-certified through the state OEMS every five or so years i believe. A certificate course, where you concentrate on the core curriculum only, needs to be certified before EVERY new class rotation. Our instructor had been teaching for so long, they assumed it would clear. Well......18 months later, after all our clinicals, competencies, ride time, ACLS, PHTLS, BTLS, NRP, PEPP, PALS, etc., we weren't allowed to test. College ate our loans for us. I feel it made me a much better EMT, so no regrets. The current class is an 8 month "rapid attack" course. Anyways, to finally get back on track, my family LOVED Naples, Miami, West Palm Beach, etc. What are the opportunities for a newer Paramedic in these areas? I would hope my heavy 911 background, high volume trauma and medical responses, and lextended transport times would give me an "edge" so to speak. Any and all replies, critiques, advice, etc. would be most welcomed.