crazydoctorbob

I've seen several instructors who teach KED vest application using something called "the shoulder roll" to take up the space between the victims head and the vest. Once the torso straps are secured, the shoulders are "rolled back" using an upward and backward movement. It seems to me, first of all, that movement of the shoulders in such a manner would cause motion of sternocleidomastoid muscles, inserted on the clavicles, and the trapezius muscles, inserted on the clavicles and scapulae, just to mention two. It seems that this would cause motion of the cervical spine, which is what we're trying to avoid to begin with. I've always taught my students that bringing the head into the neutral position, maintaining it as such throughout the vest placement and application, and that avoiding forward motion by the individual stabilizing the head and neck during placement and application, would minimize any space between the head and the vest. Most of the large spaces we end up with between the occipit and the head portion of the vest are the result of the tendency of the person stabilizing the head and neck to flex the neck and upper spine when moving the patient forward to place the vest and then failing to return the head to the neutral position when the victim is moved back against the vest. Any opinions. Has anyone else heard of the "shoulder roll" or does anyone else teach it.

I've found that EMT students in general are lacking in the reading comprehension and that Paramedic students are lacking in basic math skills. The failure rate for most classes I've been associated with of late have a fail out rate of 50% or greater. These are students who never make it to the State written or practical certifying exams because of poor grades. I think this speaks to our educational system in general. I teach in NY City with most students a product of the NYC public school system. All community colleges in this area have found it necessary to remedial courses in English, Math, and Reading just so that high school "graduates" can begin college level classes.

Just an update for those of you kind enough to offer your encouragement. Since initiating my post almost a yeaar ago, I have been working per diem for a large ambulance company but I haven't been doing the 911 type calls which I need to sharpen my skills as a paramedic. Unfortunately the vollie service I still work at doesn't have enough medics to partner up with and so I can still only work BLS. I've applied to several hospital based systems with no luck. I applied to the NY City Fire Dept Bureau of EMS and was called from the civil service list to take the department's physical agility test which I passed easily. After completing the department's physical I was interviewed and examined by the department doctor who proceeded to tell me that "the fire department doesn't like to hire 'old guys'" after which he proceeded to place me on hold pending the results of my taking a nuclear stress test (at my own expense) and getting a letter from my personal physician stating that I can perform the job (which I thought was the purpose of the physical agility test). I intend on getting the test and an ok from my doctor, but just hearing these words form a fire department physician just blew me away.

I've seen a number of instructors advising students that the proper way of checking response to pain when performing AVPU on an unconscious patient is to perform a Babinski or plantar reflex test. As far as I know,testing plantar reflex is a test for a pathology involving the motor neurons of corticospinal tract. It would seem to me that any response to this test, either a positive Babinski sign or normal plantar reflex, would indicate in tact sensation since such would be required to produce any response at all, but is this the proper test to be teaching to new EMT's to evaluate response to pain ? Also,does lack of any plantar reflex, normal or abnormal, mean that the patient will not respond to painful stimulus. Seems to me that this is an unecessarily complicated and perhaps unreliable test to teach new EMT's. It would seem to me that simply having them pinch the skin around the ankle or wrist, as I always teach,is more appropriate. Before critcizing another instructor's methods, I like to do my homework . I first learned about the Babinski reflex many years ago as an EMT student. It then seemed to disappear from EMT courses. I suspect that it may have been a method adopted by an EMT instructor who saw it done by a physician but didn't understand the purpose or pathology behind it.

Does anyone know where to buy Paramedci "rockers" for the old style "tombstone" NY State EMT patches. I've tried to order through Medica Emblem three times and my orders never seem to get processed. That's one messed up company.

I've been an EMT for 33 years and an instructor for 25. I recently began teaching for a new organization and I've noted several instructors advising students that "lifting handles" on the standard Ferno stair chair were not made for lifting, have a tendency to brake off, and should not be used for lifting, i.e. only the frame should be used for lifting. One instructor even went as far as to say that the rubber grips have a tendency to slide off. In all my years I've never seen a chair fail in this manner nor have I ever heard of this being an issue. Could it be I've been doing it wrong all of these years ? Why do they term them lifting handles ? I'm the new "kid" on the block ad don't want to get a reputation as a know it all unless I can back up what I say with some bona fide documentation. I've seen no documentation from anyone. Does anyone know if there is in fact a recommendation from Ferno, or any other manufacturer that these handles should not be used for lifting ? Seems to me they'd put a warning label on the chair. Also seems to me that using the lower frame rail for lifting is inviting disaster some where along the line in terms of a few lost fingers.

Dwayne and Mike, Thanks for the words of encouragement. To add some clarity, I volley in two seperate ambulance corps in NYC. Over the past 33 years I've averaged about 250 calls per year. Compared to the fire based and hospital based ems services, the standards of most of the vollies have been notably on par and better. In fact, most of the leadership of these services are either former or current vollies and many of my colleagues in the vollies also work for these services. What's frustrating is that many of our younger members with one tenth the experience and background seem to have little problem landing these jobs. The ems community here is smaller than you'd expect and I'm well respected by my peers as both an instructor and a provider. I seems I have all the right references. That's probably why I'm convinced age is the issue, but as you say, it may be the perception of maturity rather than age that's the problem. I doubt that my passion will allow me to give up. Thanks again for the encouragement, and I certainly will keep you folks posted.

I'm sixty tow years young and I've been a a volunteer EMT for 34 years, an instructor for 30 of those, and an IC for 15 of those. I recently retired from my full time career as an engineer to pursue my dream of becoming a paramedic. I'm less than a week from my state certification, and less than a month from my regional certification. I'm at the top of my paramedic class. I've been applying for jobs, mostly as an EMT with hopes for an upgrade and with all my years of experience, I've been running into brick walls. I'm beginning to face the fact that perhaps my age is being held against me. I'm in the best shape I've been in in 20 years and many tell me I look 10-15 years younger than my age.I'm in the gym every day lifting and running. I see some of the younger EMT's on the street and the shape they're in, some are MI's waiting to happen, and their skills as EMT's are meager at best. I wonder how someone like that has no problem getting hired and I can't seem to get anywhere. Am I fooling myself thinking that I can start a new career at this stage of the game ? I love being an EMT and I love even more what I've learned and experienced as a paramedic intern. Anyone have any encouraging experiences ?

I've seen a number of different opinions on how to transport a patient with penetrating thoracic trauma and a controversy has arisen in a refresher course I'm currently teaching (and learning from). Some of the EMT's and Paramedics I've spoken to advocate simply placing the conscious patient with penetrating chest trauma in a semi fowlers position or in the most comfortable position, and an unconscious victim of penetrating chest trauma, in the supine position. I've talked to others who advocate always placing the patient on the injured side to allow the "good lung" unimpeded expansion. The latter is also advocated in at least one popular EMT textbook (although I've found most texts to be mute on this point). It's impractical to place a conscious patient in a semifowler's position leaning on the injured side. Placing an unconscious patient on the injured side is logical except that if the penetrating trauma is on the right side, the patioent is now facing the wall in most ambulances. This can make for difficult airway control . Does it make sense to anyone to place the conscious patient lying down on the injured side ? I'd like to hear other opinions inclduing the logic behind them. Thanks

New York State issues a student manual which has a comprehensive breakdown of the assessment. I tell students from day 1 to read and reread these steps and practice using this as a guide. If you get this down , you'll have no problem with the skill sheets. Besides, the skill sheets are bare minimum. I also try to reference each topic I teach back to the assessment. This builds on the assessment with every new topic. It reinforces the assessment as well as the material being covered. I believe that students retain more if they learn the reasons behind why they do things rather than learning by rote. That may sound basic but I see many instructors who never grasp that concept. Finally, I have my students learn the main elements of assessment - sizeup, initial, etc.- and what is to be accopmlished in each. Then I have them kind of dissect each element. Repetition is so much more effective when it's accompanied by understanding.

Thanks guys for all your incites. Looks like alll agree there is no one correct method as long as it does the job.

A controvesy arose in a referesher class I'm taeching, when one of my lab instructors told students that the leg straps on a KED vest could be applied either over the top of the leg, down the medial aspect, then under the leg, and up the lateral aspect, OR, under the leg from the leateral side and up the medial side. I've been looking for manufacturer's recommendations but can't find any. Any thoughts?