uglyEMT

Yes mobey as a B I am allowed Epi Pen auto injector. In it is Epinephrine at 0.3mg for adults and 0.15mg for children. It is used to counter the effects of a severe allergic reaction. In my protocols I can only administer if the patient is going into respiratory arrest or the tongue or throat is swelling and will occluded the airway. Before that its oxygen therapy and monitoring of vitals while transporting to nearest facility or to ALS (in my case with the closest hospital over 25 minutes away its always to ALS unless none are available. After administration I would expect to see an increase in BP and heart rate, opening of the airway, reduced wheezing during occultation, and diaphoretic skin. I would also expect dilation of the pupils upon examination. If there was a skin reaction (hives) I would expect to see a decrease in the symptoms. The time until the effects of the Epi Pen wear off is around 15 minutes depending on severity of reaction. Upon contact with medical control we are, if advised, allowed to do a second injection. The second dose is rare. I haven't had MC allow it yet. Usually we have ALS onboard by that time and they do there thing with IVs and such or we are close enough to the ED that MC feels the second dose is unnecessary. The only caveat to the last statement is when we arrive and the person has already self administered their personal Epi Pen and the symptoms have remained or have returned, then if 15 minutes has passed we are allowed to issue our pen as if it is the original dose (ie offline MC) but document for ALS or ED that it is the second dose. As far as the sympathetic and parasympathetic systems go all day today I have been reading up on them. Besides the usual fight or flight, feed and breed responses I am now learning more in depth about them. So far I have been looking at the sympathetic, I am getting my facts straight and trying to connect the dots between the system as a whole and what individual system responses are.

I want to add something. It always makes me laugh when we hear politicians spouting religious ferver all over the place. One thing comes to mind when I hear all this "stuff"..... Seperation of Church and State. Imagine if we got the religon out of politics too? More people have died over "God" then for any other reason, its really ashame. This asshat just bolsters my opinion that religon should not be part of government. Any who thats my opinion formed from 12 years of Catholic school and many family discussions.

No I am not. I guess again at 6am my thoughts were muddled and not clear. I will stand tall, own my error and be better for it. I will be back here without a doubt, but this time will be with the knowledge to hold my own. I think I know the post you are talking about. Hey I never backed down from a fight and always seemed to persevere through the thick of it. This will only move me; us forward and make me, us stronger because of it. LOL I always forget to do that. Actually just noticed it in the upper right corner. edited to use spell check LOL

I have stated my story on several threads here but will stich it all together for you as I feel it is a full circle now. Since that time I have not gone back, I have not been near, I have not been part of any of the ceramonies. It took me 9 years to deal with that day, to be strong enough. This past December (12/11/10) my squad was asked to be an escort for some WTC Steel to a 9/11 Memorial in Wayne,NJ. Here is what I posted in another thread. Well thats my 9/11 story. Its a day that will stay with me forever so will the 12/11/10 memorial day. Stay Safe Everyone. Support Our Troops. If You Don't Stand Behind What Our Troops Are Doing Please Stand In Front Of Them. I Will Never Forget.

Thanks for the kudos Dwayne. Guess at 6am my words got lost a little. I am not throwing myself on a sword here at all. I am just backing a way alittle and going to do some research. I found out I have alot to learn beyond your basic anatomy and physiology. Yes I know I am breaking into the ALS side of things and guess what I will make mistakes sometimes and I expect to be called out when I do. I have no pity for my mistake, it was a mistake and I own it. I tried my best and used what analitical skills I had to try and grasp the larger picture but without sufficent understanding of the problem I came off as a wacker. Hey it happens, I bet we all had that happen in the begining. I dont mind getting called out about it, it makes me a better provider because now I will go and research this more. I will go read some more indepth anatomy books. I will try to understand the sympathetic/ parasympathetic systems better. Yes we glossed over it in school and I think thats where I thought I had the knowledge. 18 pages of a text book doesnt knowledge make. Now I want to learn it better so next time when i offer an opinion it may be more on par with my better peers. As you said you know me and pity doesn't suit me. When i first came on this site I was a whinny little bitch that I thought unless you were ALS or a bunch of other intials your were not taken seriously. I got over myself and realized you all were pushing me to be a better provider thats all. Well this is one of those pushes, I stepped up and struck out. OK I get it, now I will go get more knowledge and maybe next time I step to the plate I will knock it out of the park or at least get a base hit LOL Again thanks for the kudos and again I am sorry if my last post came off as throwing myself on my sword. I just ment that until I gained more knowledge on the subject to the point of not talking out my ass after some weak internet searching I will refrain from the discussion. Keep it coming brother, make me a better provider!

LOL we recently had this same discussion with the new members of my squad. From experience here is what I would recomend. First, this will be one of the single biggest expenses you will incure during your carrier, outside school. The money spent now will pay off in the long run. Quality has many benifits. Instead of buying numerous pairs on good pair will last a long long time. Second try them on! Go to a reputable store and have your foot measured both length AND width. Try both feet on. Walk around, climb stairs (benches work too), kneel, get on your knees with your toes bend, ect. Work them out. If in the store they feel uncomfortable or pinch ect. Try another pair. No sense in saying oh they will break in and for a week or so have aching feet that will make the learning experience miserable. Third. Get the side zips! They make your life so much better. You lace them up as tight as you want then release the zipper and let the feet breath. Or you can remove them and get them back on in a hurry too. Just zip them up and bam nice tight, supportive boots again. Fourth. Get the side zips! LOL sorry just had too hehehe Get a pair that are blood born pathogen resistant. No sense standing if fluids and having your feet get all nasty. Waterproof(resistant) is not the same as BBP resistant. Several manufacturers specify that they are BBP resistant. Non slip is great to have. As Dwayne said no need for super deep treads that will just track crud everywhere. Get a pair that will give you the confidence to walk on wet surfaces backwards with a patient. Notice I didnt say would let you slip. Its the confidence that is necessary here. I had a pair that said anti slip and everytime I was on stairs in the rain I was a nervous wreck, had no confidence in the boot because it "felt" like they would slip. You need the confience in the footware that will allow you to concintrate on patient care on moving. Personel preference here. I like composite toes, not steel toes. The composite toe is less likely to amputate a phlange if soemthing of weight drops on them. The composite is more likely to dispurse the weight and shatter then deform and slice. The reason I mention the reenforced toe is because I have had a D-tank drop onto mine one time with and one time without protection. After walking around in a walking cast for awhile I realized the reenforced toe is worth iots weight in gold. But like I said, its a personal preference, others may not agree and thats fine too. Polish or not polished again is up to the employer or in this case school. Most boots that I have come across can be polished to a degree. Yes I know there are kinds that can not be so take that into concideration as well. Find out ahead of time what you will be required to have. No need to purchase boots and have to return or buy another pair because of a polishing issue. When it comes to height I feel its better to have a taller boot because of the ankle support. But it is a personal preference here again. Some like 6" boots others the 9". Its what feels comfortable on you that matters. I use the taller boot due to my rural setting and quite often working in the woods or uneven terrain so the added ankle support helps me. I have less of a chance of rolling my ankle I feel. As far as brands go, there are several that are at the forefront of what most EMS wears. I can't speak for everyone but some are better then others in my opinion. 5.11, Redwing, Magnum are the three top in my opinion. Not in any specific order though. These companies seem to listen to feedback from personel in the field and incorporate the design changes into their brands. Hopefully these few tips, and the tips from others will help steer you in the direction of a great boot that will work for you, be comfortable, and of course last.

I guess I have alot more to learn. I appologize for making an ass out of myself. I will leave this one alone as I do not have the correct grasp of knowledge on the subject. I will also go wack my instructor upside the head for giving us a false sense of knowledge (ie the more sweat, the more symptoms, the worse you are). Well again i appologise and was called out by my betters which i am thankful for. Time to go hit the books some more and get a better handle on this. For now I bid you all adu.

The following question was posed in another thread and didnt want to derail it so I made this one. Dwayne as promised I looked up a few things and here they are. First lets look at the pathology of sweating first of all. Postganglionic neurons innervating sweat glands - which release acetylcholine for the activation of muscarinic receptors - and the adrenal medulla. The adrenal medulla develops in tandem with the sympathetic nervous system, and acts as a modified sympathetic ganglion: synapses occur between pre- and post- ganglionic neurons within it, but the post ganglionic neurons do not leave the medulla; instead they directly release norepinephrine and epinephrine into the blood The vast majority of sweat glands in the body are innervated by sympathetic "cholinergic" neurons. Sympathetic postganglionic neurons usually secrete norepinephrine and are named sympathetic adrenergic neurons. However, when sympathetic postganglionic neurons innervate sweat glands they secrete acetylcholine and hence are termed sympathetic "cholinergic" neurons. The only sympathetic postganglionic neurons known to secrete acetylcholine instead of norepinephrine. Now onto possible causes NOT associated with hemodynamic compromise. The biggest thing I found in relation to not having something that would make a patient "critical" is Hyperhidrosis. Patients with this condition will have exessive sweating without an external or internal influences (ie MI, trauma, shock, exercise). OK I am going to copy and paste a Wiki link describing the causes and such because it will make it a little easier to follow and in laymens terms for others. Hyperhidrosis I know Wiki isnt the best but it is useful here. So now that we know there is something that would be non critical but cause excessive sweating. As far as the amount of comprimise necesssary to initiate sweating according to the pathology posted above it would depend on the sympathetic nervous system's response to said comprimise and on the patient. I am sure the degree of sweating would be different from one to another all based on the number of glands and the amount of chemicals released by the body. I hope this helps start a discussion and if not then at least I learned something

Well I have nothing to add to this thread twords the OP but I can answer this question for Dwayne. Dwayne to have the level of diaphoresis that was mentioned the patient needs a heart rate over 120. Once the body senses the high heart rate the chemicals begin fireing (dont know which ones, still learning my cardio) and one of the side effects is sweating. So as long as the body is sensing a high heart rate the higher it is the more profuse the sweating. Here is a perfect example. Personel example so i can give you the indepth to it all. When I was 24 I came back from a long trip (drove florida to NJ in one shot) without much movement. Well the next day I started feeling a little "off". Then I got "heartburn" a few hours went by and I just brushed it off. Hell I'm 24 and invincible right? The heartburn didnt go away and I began getting anxious. I couldn't sit still and when I did I was just sweating like I ran a marathon. I finally gave up and went to the ED myself. Turns out I threw a PE that developed in my leg. My heart rate upon arrivial at the ED was 157 BP was sky high. I went from waiting room (which was packed) to a bed in less then 3 minutes. I thought the nurse was going to crap herself when she looked at my vitals. Within a few minutes of that I had pads placed on me and several IVs running. Felt ominus sitting there with a LP12 (at the time I just called it the shock box) in between my legs waiting for the line to go flat. I thought the last thing I would hear is BEEEE. At the time I wasnt even dreaming of being an EMT and most of my medical knowledge was from ER (the tv show). I never realized just how bad off I was until now. Now that I am an EMT and work closely with Medics I realise how close I did come. The one thing I did remember from all this was the sweating, no matter what I did I couldn't stop. The Docs said that was the one sign that should have had me at the hospital immediatly. I asked why and thats when he said it means my heart rate is sustained over 120 and my body is trying everything to slow it down and as a result I sweat. Now that I talked about it I will go research more and find out exactly the pathology so i can give an even more accurate answer for you Dwayne. Just wanted to get this down before I lost track of it, I will get better information though as I know anticdotal evidence is not the best.

Thanks for the laugh I must have started my own thermonuclear war by now

Call PD, wait in the rig with the doors locked. Remember priority ONE is you and your partners safety!! Yea it sucks to see an injuried party and you being in a position to help but the patient is too violent for you to render assistance. As you go deeper into your course some of these scenarios will come up and the instructors will delve into them a little. It is important to remember that you want to go home after your shift, uninjured. Wait for the PD, let them do the restraining, documnet document document, then finally treat. You will have a long healthy time as an EMT if you remember scene safety. There is a thread on these boards with a training video showing a police officer not taking scene safety into account. I suggest you watch it and learn from it as a student.

In my local area in the media we are simply called EMS, emergency medical services, covers both the ALS and the BLS side without much hassle and pissing matches.

Thanks for the heads up guys. Yes both our rigs are Hortons and I love them, the 4 wheel drive one rids a little harsh but I think its because of the shocks being worn. As far as the wiring, OH HELL YEA, thats priority one! Our current rig is a disco on wheels. Hit a bump and things get wacky, I just tell patients its haunted LOL j/k Like I have said I have PL coming up for a demo and being they are local I plan to visit their shop soon, need an excuse to go to the shore anyways. The suspention will be number 2 on my list as well. I am an avid offroader and have designed my own suspention setups so the math and engineering of suspenbtion comes easy to me. I will have the rig weighed before they set the spring and shock rates. I feel patient and crew comfort should be paramount, especially with us traveling a minimum of 25 miles to the ED and as far as 50. Plus with us having unpaved roads in our dispatch area bumps are common. I couldn't have myself see a patient suffer getting to the ED because we rode like crap (be it too soft or too hard). The interior design is important, staying away from touchscreens and gadgets, following KISS here. Our current setup works really well, just some ergonomic issues here and there but simple solves (like the MC radio being slightly behind the shoulder in the captains chair, I want it more foward so I dont have to turn around to get at it or in the driver compartment the switches are on a flat panel and not facing twords the driver, having the angled more would help alot) like I said simple changes. As far as the pretty blinking lights, going LED this time. Halogen was nice for a while but cant beat the lumins of LED. Not going crazy either with them, I have been in a few rigs that were lit up like a night club and in foggy or snowy weather couldn't see crap because of the light glare. Again KISS will be the norm. We have been polling our members and have a suggestion box as well. We have had some great feedback on both positives and negatives. Very few negatives but a few non-the-less. Everything will be taken under advisement and incorporated where possible. Sorry the patient ejector button and seat will NOT be included We are looking at the seat restraints as well. I feel saftey in the back should be adressed so We are looking at either 3 or 5 point systems. I have been in a demo rig with both systems and they seem really good, just have to see how they would impede patient care. Going to keep our current seating setup though, just have to see how the restraints would be incorporated. Our current setup is a bench seat on the passenger side, captain chair rear facing behind the driver, and a seat on the driverside midway down. This setup affords us great space when ALS jumps on board. We just rotate around, I go from the bench to either the capt or the mid seat, my partner takes the other unoccupied seat, and ALS takes the bench so they have room for their med bag and LP12 plus themselves. For the poster who suggested the exaust out the driver and spine board on the passenger, that is our current setup and will stay that way. We are basically going to keep our compartments the same on the outside, inside will be changed a little though, some of our current layout works some doesn't. The no sharp edges will definatly be incorporated, right now we have foam padding and it doesn't do a hill of beans. I hit my head enough on cabnits to know from experience LOL We are going to look at at least 3 different companies PL being one, haven't decided on the other 2 yet. I do believe someone else on the commission has a second company but for the life of me can't remember the name. We need the multiple for the bidding process to make things ligit according to the by-laws and such.

She was so cute and calm. Wish half my patients acted that way!! Amazing what a 5yr old can do!

New Jersey EMT was found dead Sunday morning outside his squad's quarters.Matthew Pellettere, 37, was found when the River Edge ambulance crew returned, according to NorthJersey.com. Officials suspect he responded to the station for a call but missed the ambulance. The married father of two had been with the squad for a year. My link Please keep him and his wife and family in your prayers.

Thanks for the heads up guys and gals. Yes we are in contact with NJFAC, we have their requierments for what the state will certify. We have contacted PL and they will be demo-ing a rig for us shortly. Again we are in the preliminary stages and are brain storming. We have alot of good ideas and I have fielded several good requests from squad members. We do seem to have a central theme going on as far as where we want to head with the new rig, which is a good thing. Just have to find the right company to get the job done. Thanks for everyehing so far everyone. Keep it coming

Sorry about that. When I read LA County I didn't realize City was what was looked for. You folks in Cali have so many jurisdictions its painful LOL lilibean if I moved you in the wrong direction, I am sorry for that.

Here you go liliabean..... this can be found here

Apparently alot of folks do. Look at the Jackass Franchise and oh yea YouTube Its threads like this (and other things) that show we definatly need some chlorene in the gene pool (and a good backwash too)

Thanks for the info points Richard. I am in Rural Highlands NJ so we basically know the lovely weather we see. As I was researching some designs I did see the Type 1 2 3 sizing. I have to go dig out the old schematics and see what Type our old rig is and of course take measurements. The other squad in our area forgot this and the rig was 2 inches too wide and 1 inch too tall to fit in there bay LOL. I will keep exterior specs in mind and on a handy reference card when we go vendor shoping. Good point about the trade shows, time to look around. I know AC's is in october so thats one to keep in mind. Have to check Javit's website for a schedule. As far as the equipment compartments we are hoping (as was suggested during the meeting) to see if we can keep our current configurantion of cabnits and doors. They are the same on both our rigs and everyone knows where to find everything almost by memory. We carry alot of equipment but nothing of the heavy rescue kind (unless you call a halogen bar heavy rescue). One set of cabnits are inside/ outside accesable so we will be looking to keep them that way also want (more would like) to keep the seat on the driverside of the stretcher in place, comes in handy when ALS is onboard. I do ride with the other Squad from time to time doing mutaul aid and like their new rigs. Some things I do some things I dont so I have been taking notes. A problem we do have up our way is alot of Squads are using older equipment so not alot of new to check out. Yes the 4 wheel drive is uping the price but a necessity in our area. Big snowfalls, narrow winding roads, some dirt roads (yes folks my town still has unpaved roads) so it is really important. Also you never know when NYC will need us again (wink wink ) Thanks for the questions folks. It is helping me think of what I need to ask vendors and suppliers and keeping the details in mind. Its always the small stuff that sometimes gets lost in this kind of process that can lead to disasters down the road. Keep them coming. Thanks