armymedic571

If I recall correctly, wasn't there a story in the paper a few weeks ago about a similar situation in which a pregnant female sat in a NY ED for a few hours, then went to a coffee shop where she dropped dead. And in that shop were two in uniform Dispatchers. Is this the same story or a seperate incident. Or....have the facts of this incident been skewed to the point of ridiculousness? Regardless....This is poor, and criminal. The fact that they couldn't even be bothered to call for an ambulance is bad. Whether they were dispatchers, EMT's or Dr's of the year. Once they were asked to elp, they had a duty to act. I know that every state has their own laws, but this goes to show. If you are not in this business to help people...Then why the hell are you here? Go work for Taco Bell.

I am going to have to agree with the don't treat theory....But, I am curious as to those who say that the pt was Asymptomatic? Are palpatations a symptom? That was the chief complaint that was used to summon EMS. So.....you really can't say that the pt was asymptomatic. Remember, what the patient, MS, Nurse considers an emergency may not fit your criteria, but that is not the point. Once again, I would not have treated this pt. I don't think this should be symptomatic vs asymptomatic, but stable vs unstable. Also---> why would you give adenosine to a 50 y/o with a HR of 130???? Sinus Tachycardia is not SVT. I think we need to start teaching some people how to sit on their drug boxes......

According to the President, we should get Hope and Change.......but I think that's pushing it...... for us here in central PA, we went to a mixed MICU/squad system from a squad system. This let us hire more Paramedics, but we had to lay off 9 EMT's. Because the new system went into effect on the first of Jan, guess when those EMT's got their pink slips.........YUP BOHICA. Other than that, the new EMS act in PA is well, different. I am more interested in the new educational standards. Hopefuly, we go forwardds, and not backwards. Whoops, there I go with hope and change again............

Croaker....nice clip. I like that movie. I see your point about fire superiority, but it also encompasses speed, and violence of action. Meaning (as Maverick put it) some well placed shoots at the right time. I think the point that you were trying to make before about weapons in EMS as a whole is this: we as pre-hospital providers stand at a pivotal cross-roads in the civil sevice-medical field. Albeit you may be a exceptional provider, clinician, and mentor. But, if doing the job at 0300 in the snow at 0 degrees on a Friday night, while you drunk patient swears profanities and this upsets you, unnerves you, or is just to much stress for anyone person. Than perhaps you are in the wrong career field. I think the same analogy can be made for the tactical side. It is part of the job. Don't like it: 1) Become a nurse, or 2) Join the peace corp. Anywho, just my 2 cents. Time to sleep. I have to get up at 0300 to bring some drunk guy to the trauma center.. Oh yeah, there's snow on the ground, and I am going to bring my Thesaurus.........haha.

Matt, There is data and research on this. I would recommend searching "point of wounding care". The US military (for obvious reasons) has done quite a bit of research on this topic. There are some published reports that are unclassified. A google search should yield them. I will state that these are military studies, and may/maynot correlate to the civilian tactical system you are looking into. Also....In most tactical medical references that I have read, and practically every class on the subject I have ever taken or taught-----> Fire Superiority is the BEST Medicine on the field. Let me know how your search goes, I will try to PM you with some of the studies that I have, although they maybe a year or two old.

Croaker.... Didn't realize that this was such an emotional issue for you..... . I re-read all the posts, and don't see where this was an emotional issue? I am not really sure what you are getting at?

If your a Medic look here... http://www.evanhospital.com/jobs/ Central PA. Nice area, good call volume. 911 hospital based system that is Squad truck/MICU based. Decent salary/benefits from the hospital.

In my area we have done both..... Providing tactical medical care in both the military and civilian settings, I can say that haeing medics on your team works either way. As chbare already stated. 97% of a tactical medics works is done in the planning process, preforming day-to-day routine care for the team, preparing the medical threat assessment, and ensuring that your team mates are fit to do their jobs. If you are on a team that employees medics that stack. I find that most common theme is that these providers are cross-trained. Specifically, in my area we (Medics) train with the LEO, and up to a certain point must have professional LEO training (to include lethal weapons training). When we started this, our medics did not carry, but becuase we had trained with our counterparts, we knew that if we needed to utilize a weapon, then we were properally trained and proficient on that piece of equipment. Now that some of us are fully trained, we carry when ever we are performing as SWAT Medics. Once again, your SOP's and procedures need to be set. Cross training is key. I always argue for having medical personnel associated with the team carrying a weapon, because the best medical care under fire is fire superiority....... At least that is my $0.02....

HAhahahahahahahahahahaha. I love this. More to the point, I think your proving our point for us. What some people on th is forum fail to realize is that, yes you can JUST get a cert. and play paramedic, but doesn't make it right. Increasing our professional standards is the only way to improve our profession. It is the only way to improve scope of practice, patient care, and yes pay/benefits. Maybe my rep will go to hell like Diazepam for saying this, but maybe we can learn a thing or two from our friends up North. PS-I served with some brothers in arms from the Canadian Military. Arrogent.... Never. You just have to understand the sense of humor.........

Vent. This is a good point, but I need to remind everyone that there are still areas in th is country where your education, no matter how impressive, means nothing.... Unfortunate, but true.

Hey Paramedic Mike...... Great Link...Thanks...

Dude, A simple google search will yield the Paramedic programs in your area. You can also google the national guidlines as to hours and determine for yourself whether or not it is a good program. Firemedic 65 and chbare both have good points, but allow me to allaborate...... A GOOD program should have more than the national suggested hours for didactics, clinical rotations and for field internships. Because of this, they will give more than enough time in the field before graduation to master some of the more basic yet unrefined skills in the field of EMS. Yes, I am referring the the Assessment. BUT, since most don't. It is best to get some experience working as a basic, so you can master the basics, before moving on to sore more advanced techniques and methodologies. In the end, it is your call......In my book, it comes down to this......YOU GET OUT OF IT, WHAT YOU PUT INTO IT. Got it....GOOD. Good Luck. Also, if it is worth anything.. Look for a program that offers A & P as part of the program, or makes you take it through the school ,preferrably through an accredited college or university. It relates directly to your assessment. That probably didn't help, but hey...I feel better.. Good luck.

Tskstorm, I think part of the problem here is that your applying an old trick to new technology. In the past this would be appropriate. But in the world of 12-leads doing a 6-lead would be considered bad form. I think the time difference in using the other six leads is negligible in the fact that in the end if you decide to do a 12/15/right sided lead then you are actually wasting time. As stated before, unless you've lost your cables, or you have equipment failure. Don't bother.

I will say this. EMS 49393 has a point. The system is what you make it... The key is that every part of the system has to be in link with one another. This tricky in systems where you have multiple agencies working next to one another, but not necassarily in cooperation with one another. In PA, as stated by EMS 49393 box cards are influenced greatly by fire chiefs. The underlying issue here is that to many fire chiefs that are undereducated in EMS, have ego problems or are just is p!ssing matches with other fire chiefs to do the right thing. As much as I like my system, we have had some similiar problems in the past. Thankfully, our service director got everyone to sit down and they started hashing out their differences. It is an ongoing process, and not always a peaceful one. But never the less, a step in the right direction.

Gee, I was going to tell you the same thing. Agree to disagree.

I am not sure what system you are working in, or what system you are referring to, but I think it is safe to say that you are mistaken. You as an ALS provider, are a pt advocate and should be an advocate for your fellow BLS providers. Why are you not going to management with their concerns, or helping quantify their concerns so they can present them themselves. As far as accountablity and QA. We have one of the most stringent QA systems in this part of the state. Please stop making generalizations about a system you don't know or understand. I think your underlying issue here is you have a bone to pick, but thanks for your opinion. If your system is that bad, sorry for you.... Besides, If your MICU is a second due for BLS then that is mis management of resources. Hhmmmm......very skewed indeed.

This system is great for the quasi urban/surburban/rural systems. However, for a strictly urban system bad idea. This works well for us in Central PA.

Brandon, One addition I think should be made about Cushings triad is this: The vital signs you are looking for (hypertension/bradycardia/irregular respirations) is not a singular event, but something that needs to be trended. A singular set of vital signs does not constitute as a positive Cushings. Hope this helps....

I am not generally a what if person. Mostly because you can what if till your blue in the face, and not find any solutions. But that being said, this is a great question.. I would have to say that after securing the airway, obtaining IV access, and checking sugar, that epi would be the first step. After that...If you have more than a five minute transport, get on the phone and present your case. If you have attempted to rule out your differentials, and you are at the junction.. Depending on your Command Physician, they might let you try. I find that getting that second opinion Usually (depending on your relationship with command doc's) gives you additional insight on what might be going on or reaffirms your thought process. That is one call though, I wouldn't want to make......

Rock shoes.... I have to agree with you that paramedics from poor producing programs will not be suitable for such a program as an Advanced paramedic practicioner. However, that level of pre-hospital provider is exactly what is needed. Part of the issue is that we need to get our educational standards down as a nation and not by state.. But that is a different thread altogether. I actually find that the PA's skill set to be more towards the paramedics than a NP. NO offense to our nurses. But once again we have to talk dollars. You can pay a NP or PA the going rate, or a Paramedic their salary with some extra benies and save money. This will actually help to keep taxes under control, and provide the revenue for more positions. i think this goes back to the discussion that WE as providers (EMT-B to Paramedic) need to raise our standards not lower them. To bad we don't have as strong a lobby like the nurses do..... By the way. One of the services out in Pitt tried to put a flight crew (Nurse and Paramedic ) in a chase truck to do such things. Help Paramedics in trouble, do house calls for minor things. All the skills and knowledge of a flight crew in a truck, maybe even have the flight Doc on certain days. But no.. The State medical director put the Kybosh on it.... I hate backwards thinking, risk adverse morons.......but that is just my opinion. Cheers

Attitude......I like that. Like I said. You get out of it, what you put into it..... .. cheers

I have read some neat opinions, and some.....well not so neat ones. I think this issue can be boiled down to this. YOU GET OUT OF IT, WHAT YOU PUT INTO IT! Meaning that if you want to present a good professional appearance....you will regardless of your agencies uniform standards or lack thereof. The same can be said for competencies. If you want to be the best, you'll study, ask questions, read more, and learn. If you just want a job, well that is what you have. Despite age, upbringing, past life experience it all goes back to work ethic..... Some of us had great parents who instilled that good work ethic into us at a young age. Some of us might of had it kicked into our heads at basic training or boot camp. And some of us might have gotten fired from a few jobs before we got with the program. In this profession you have to GET IT! If you don't. Then your in the wrong career field........ But here is the kicker.....work ethic is a personal choice. But you can inspire others to get on the train. Go to your next shift with a good positive attitude, wear clean what ever it is you wear, hair neat and combed, boots clean. Call your pt's Mr, and Mrs. Sir or Ma'am. While your at it do that for your co-workers. Peers support your peers. Supervisors and FTO's motivate your subordinates. Subordinates, hold a high standard and show the bosses that your worth the money.....Bosses get with the times......If your employees are holding a high standard, reward them, motivate them. Show them that you appreciate their hard work. If you show that you appreciate their self pride, it will instill agency loyalty (which is a whole new thread in and of itself...) I know....it is harder than it sounds. But if this was easy....Everyone would do it........Until next time....Cheers.

Oh lets see..... Without looking it up, I would say it has something to do with the amount of covalence bonds the molecule has or does not have. Meaning does it have enough electrons (no charge), not enough electrons (positive charge), or too many electrons (negative charge). Depending on a molecules charge, it can determine what and how many other molecules it can or cannot bond with, or what kind of bond it can form. But..... that is all I can remember at 0430 in the AM. Over to you chbare......

The next thing to describe is the concept of charge? Take care, chbare.