tcripp

A very interesting read which has given me another opportunity to give pause to what I might do in the same situation. I went and reviewed our local protocols and there is nothing there specific to service animals, which I happen to like. I get to make the decision on how I want to handle and, if I do have concern, I can call command for backup. For the record, I have had dogs in the back of my ambulance, during a fire rehab, while attending to a patient having breathing difficulties. He is being given a neb treatment and the dogs are being calmed by the patient while, at the same time, are calming the patient because he doesn't have to worry about them while his house is ablaze. (I seem to recall, once upon a time, where care AND comfort of my patient is my job.) Now, these were pets and not service animals. Additionally, I wasn't transporting. But I can already see that I will do what I feel is best for the situation at hand. Had I needed to transport this gentleman, I would not have taken his pets because the receiving facility would not have had anyway to continue care of the animals. However, I had both my command and Red Cross available to assist which would have continued in his comfort. So, I can see where I would consider taking the service animal if at all possible and if the situation warrants it. At the same time, I can also see myself leaving the animal in the care of command, law enforcement, red cross, or my local VFD to have the animal transported en tandem. But, let me throw this one at you. Let's say your patient is unconscious/unresponsive and you need to fly your patient. I am truly assuming that HEMS most likely will not take the service animal for various reasons. Now, how do we get the service animal from point A to B with an extended transport time and across multiple counties?

Speaking of naloxone...learned an interesting way to administer it instead of IV/IN...nebulized Narcan. By applying it in this manner, you will know when it's titrated to effect as the patient, most likely, will move the mask from his/her face once he's regained consciousness. I think I like this as an option if I'm going to give it.

Verify. IV. Fluids. Transport to facility with an ICU. Treat any other symptoms.

This is what I know from personal experience. One time does not make for sexual harassment. If it's not already covered in your policies, this is when you update them to include expected behavior and yet the young lads know this is not appropriate behavior while on duty. If it happens again, your employee will then have grounds for sexual harassment.

Had a friend once tell me that she had difficulties remembering how much of each drug to give; mg/kg. So, she came up with a way to help her better remember it. Instead of 0.01 - she now says it's a penny's worth; 0.10 is a dimes worth. By giving it some relevancy in her world, she remembers it better. Yeah, it's still memorizing the dosage, but it was a step in helping to remember it. tlc

Mainlining drugs as an option? Definitely NOT being taught in school.

In the back of the EMT text (specifically AAOS, Care and Transportation of the Sick and Injured), there is a chapter on ALS. Start there? And, I agree with Ruff's points on the driving. I truly would rather go code one regardless of the issues in the back because once the lights/sirens go on, the quality of the ride goes down and it wasn't that good to start with.

I've asked but have never been given an answer. Finally gave up.

Would you believe that not all services allow for IN administration?

Wasn't...but I guess I should have. Would you attempt the EJ (counting it as one of your two) before you went to IO? I like that as a guideline. Ours is a little more simplified and reads as follows: Intraosseous therapy should be initiated in those patients who present in serious or life-threatening circumstances when Intravenous access is unobtainable, and patients who present in cardiac arrest. Any patient who requires fluid resuscitation (i.e., dehydration, burns, trauma etc.). Any patient who requires intravenous medications. Any patient in cardiac arrest. Leaves it way open for interpretation of "unobtainable" and "serious condition". Toni Edited for layout only

Well, sir. I do believe I have just learned a bit more about you that increased my level of respect for you.

Oh, I like this topic. I've yet to do an EJ and I've done 2 IOs on live patients with one of them being called "over zealous". I used it on a CHF exacerbation patient. Not to hijack this thread too much, what is your criteria for using the more invasive access?

USA is correct in that the plastic with a slit in it does not provide a protective shield from the mouth but rather just the face where your lips would be. You'd still have air and saliva and other stuff passing directly from the patient to the rescuer. Go with AHA's new standards and simply don't give rescue breaths. Press hard and fast until advanced care arrives with the appropriate rescue airway equipment. Toni

Big city vs local hospital...ICU capabilities. Fly vs drive...total time in managing an intubated airway possibly without a vent (manual ventilations). I do like your thought process on the fly vs. drive thing. Not to segue my own thread, but one area I (as a new medic) am struggling with is when is it best to fly vs drive especially when you factor in quality of life in to the equation AND code 1 vs code 3. I've personally seen a time saving difference of minutes between the two and truly feel that if we are driving, we probably could manage the patient for an additional few minutes in the grand scheme.

We had a patient the other day with a highly suspected benzo overdose. Our truck does not carry flumazenil - so we essentially maintain, treat what we can and transport appropriately. With that being said, there came a point to where our pt was unconscious/unresponsive and we decided to fly the patient to the nearby big city (remember, I'm rural). When the air crew boarded the box, they pushed the Romazicon and, voila, we are alert and oriented once again. After some additional reading on the anti-dote, there are lots of nasty little issues with the drug. Wondering what protocol your service has and, if you've used this drug before, what you've seen both good and bad. I'm hoping that someone else's field experience will help me to better understand the drug. Toni

Sorry. I just couldn't resist.

giggle...don't you mean, "ever since"?

But the medic in question didn't sell the number to anyone, nor did he give it to any one. I don't think this analogy works. So, let me put this twist on the scenario. For those who are calling this a HIPAA violation because he obtained the number for personal gain...would you consider it the same had he gotten her number (as he should have) when he was collecting demographics for his report?

HIPAA violation - no. Weird - definitely. But, if they met up at a restaurant or grocery store and they struck up a conversation and it went from there...that would be between two consenting adults. Their patient/medic relationship is a short term thing and it's over. Now, if I were single, would I go out with a medic who called me on the phone (by the way, he SHOULD have already had her phone number for his report)? There would have to be some serious chemistry for that to happen.

Not MetroCare...but the new 911 service.

May I recommend that you pick up the phone and call to find out information on upcoming hiring processes? Even better, if you are in the area, dropping in is never a bad thing, especially for smaller services. If you can swing it, you should come to the Texas EMS Conference scheduled the week of Thanksgiving to do some face-to-face networking. Also, I here Abilene (Taylor County?) is now hiring. Toni

Ny2tx, welcome to the city AND to Texas. Any particular place you are looking? Dwayne, once again...bite me.

All I have to say is, "Yay! More estrogen to the city pool!"

EMT or not, this is probably the best single answer I have ever heard and will begin to use it for my response. While I was in Paramedic school, I could see how those went straight through the program struggle and my initial thought was, "some field experience is a good thing". Then, somewhere along the lines, I changed my mind because I watched those who had some field experience struggle because, at times, they just couldn't accept the information being presented as it was. I graduate and get a 911 position with paramedic/emt trucks and I watch those who are getting hands on experience go through a paramedic program who do very well and I go back to my original thought. They seem to have a better grasp because, to some degree, they've already seen "it". My current stance is...no one can tell you when you will be ready. Only you will know. And, if you aren't ready, you slow down and work at your level. We were expected to know it when we started.

Kyle, There are lots of resources available by searching "NREMT practice exams". Not sure I can tell you that one is better than the other. However, what I can tell you is this. It is my personal opinion that once you get through the course, you should immediately go and take the test. There really is no studying for a comprehensive exam. Either you know it or you don't. With that being said, I also highly recommend you fully review the content at NREMT for any notes/updates to ensure you have the latest, greatest information prior to your testing. Choose a test time that allows you to have optimal rest and food. As you take the test, read each question thoroughly. Sometimes they are looking for "not" or "first" or "after". You'll want to make sure you are answering the right question. Then, read each answer before choosing. Usually, you can strike out two immediately. The other two will have a better response to the question. Beyond that...good luck to you and be sure to come back and let us know how you did. Toni FYI - this is the one I used...http://www.emt-national-training.com. I have no affiliation with them.