uglyEMT

rotsen one thing to know and / or consider, will the ambulance just be used on site and the patient transfered to another rig at the mining property enterance or will it be continuing on to the ED (hospital). If it will just be on-site to get the patient from the accident to an awaiting transport rig then you can look into several different ways. I have seen a company that builds specialty vehicles for the mining industry that run on electric motors to eliminate the fire / explosion hazard. They do a great job on-site but doubt they would be of any use off site. If it will be doing the whole transport then look to a high ground clearence, good articulation chassis. The transmission is an option but the chassis is where you need to concintrate. There will need to be a comprimise here if it will be doing everything you want the ground clearence but dont want to be a high center of gravity so while on the pavement there is extreme body roll making both the patient and the EMTs very uncomfortable. The articulation will be important as well but again a comprimise. You will need the articulation to go over the uneven and rugged terrain but also need one stiff enough for onroad use. If you have any 4 wheel drive auto clubs in the area, go pick there brains (mine as well) for more information on dual purpose trail rigs. Yes I know they are not ambulances but the mechanics of the driveline and suspention remain the same. These guys and gals know what it takes to get the off road (mining) capability while being able to drive to work everyday without loosing their lunch on the windshield. Also your location is important, I didnt notice it under your screen name. If your in Europe manufacturers will be different as well as requierments and laws vs the United States. Same goes for OZ and NZ. Just a general area will help and we can steer you in the right direction.

Background is: We are a fully Volunteer Agency that owns our own equipment and building. We are in talks with our local municipality (sp) to differ some of the cost if possible. Our departments capitol purchase program is basically we gets bids submit them to the corps members and a vote is taken. The commision is set up to do the leg work so final submital to the membership will be smooth. Right now we do not have a favorite or prefered vendor. Our last rig purchase was in 1995 and we are shopping. As stated in the OP the only requirements that must stand are the chassis (F450) be a four wheel drive and have a standard box to fit inside our bays. We are a fully BLS squad that has ALS support in chase trucks. The rig doesn't need to be in service extremly quickly (we know it takes time) but we need a new rig so we are starting the process. Hopefully by end of year or early next year we would take delivery, sooner if possible but not necessary. We can keep our current unit in service for as long as possible, but would rather not spend capitol on big ticket items to repair it if possible. FYI we were inspected by the state commision in December 2010 and fully certified as to operation, saftey and compliance with our current rig. We are not going to jepordize patients or ourselves just to save a buck. She's just a tired old gal that has seen alot, time for retierment. Feel free to ask away. I was looking at Horton Bodies just a little while ago seem nice. Definatly want LEDs instead of incadecent. LOL why do we look at the pretty lights first LOL

Hey all. Hope everything is well with everyone. Well we had our first business meeting of the year, first one as well with me being 1st LT. Well it was decided and voted on that we need to purchase a new rig. Our tired old one is at that point where putting money into it is no longer viable due to age and number of issues. Well being 1st LT I am responsible for all the rigs and supplies so naturally I was appointed to the commision along with several others. I was wondering if anyone here has ever been part of the process of purchasing a new rig andf what it entails. Also I would like suggestions, what do you like on your rigs what dont you like. There are a few things that are predetermined for our new rig so thats the easy part. Everything else is up in the air. The predetermined is it will be a Ford F450 chassis, 4 wheel drive (replacing the old 4 wheel drive unit), and will use a standard box size in the back (to fit in our bays). Now everything else is up in the air LOL. Any info would be a great help. I have a few ideas but would like to hear others as well. Thanks folks

On my rig we are all BLS so are bags are pretty boring compared to all your bags In our jump bag we carry the usual suspects. BP Cuff (adult and pedi) Spare steth SAM splint Various bandages Various gauze pad sizes Glucose Gel OPAs Pen Light HEPA Masks Convienice Bags Bio Bags Sterile Water Saline Solution Tape Window Punch (still dont know why we have that in out bags) Note Pad In our O2 bags (just bring them on respitory or choking calls) O2 tank NRBs (adult and pedi) Nasal Cannulas (adult and pedi) BVM (adult and pedi) OPAs NPAs Extra Tubing Manual Suction Steth BP Cuff (adult and pedi) Burn Kit has all our sterile stuff and gels We have a pedi jump pack as well. That has only pedi size stuff as mentioned above for the regular jump pack. Our cots all have O2 tanks on them. We also have our fire standby bags which have blankets and tarps plus extra burn equipment just incase. We also have MCI bags and starting next month we are adding electronic tagging to the MCI kits to keep track of the patient from scene to definative care. (pilot program so we have to see how well it works) Each bag is in a seperate compartment, except the regular jump thats on the bench seat, so we keep it all organized. The fire standby bag stays in the station house until we get punched to a fire scene, then the bag, water, cooler and ice gets thrown in the back. Now if you ask whats in our rigs just kidding its a laundry list In my personal bag I carry in my POV BP Cuff Steth OPA kit Various Bandages Various Gauze Pad Sizes SAM Splint C-Collar Emergency Blanket Silver Blanket Tape Window Punch Seat Belt Cutter Knife Trauma Shears Kelli's Glucose Gel Trauma Pads Combi Dressings Pen Light Note Pad CPR Mask Gloves Sterile Water Saline Solution edited to add personal bag items

After seeing a few stories related to this topic and the OP from what I had gathered is the following... Yes he had ID, in every photo its hanging right around his neck and a local LEO was by his side. She was holding his hand for dear life literally. She squeezed it upon command from him and the medics. I think in this unique case the medics felt he was helping the patient. If she would not let go of his hand and they were using at as patient assesment then I see no foul here. As everyone has heard she is doing remarkably well concidering a through and through GSW to the head. ED Docs and everyone else is giving kudos to the prehospital care provided for this outcome. So if they let him ride along (I do believe they did) it apparently did no harm or distraction to the medics. We can all arm chair quarterback this MCI or any for that matter. I believe in the heat of the moment whatever was done was what was felt to be right. The outcome thus far has been positive. If this gentelman really did what he did (I believe he did) then he should be congratulated not ridiculed same goes for the medics that treated her.

When it comes to backwoods treatments and as you stated "make-shift" ANYTHING goes. I would look for strong branches or sticks that are relatively straight. Strips of fabric make excellent bandages to secure them, just think crevats. The umbrella would work as well due to the rigidity. When it comes to splints anything rigid and hard (not flexable) will work. Duct Tape works wonders too in a pinch. Now if I was part of a SAR team I would be carring a small assortment of hard splints or SAM splints and a few crevats. Can keep them in a small back pack or larger fanny pack. Even when I go hiking or camping I carry 2 SAM splints and a few crevats with me in my pack. You just never know!

Here its a judgement call. If you feel the scene needs more then by all means get it done. Just because they are DEA or SO or LEO does not mean they know what is medically necessary. If you are unsure call med control and your supervisor. You should by no means feel wierd or what-have-you by making this request. Scene safety is of utmost importance and is taught from day one. ANY, ANY, ANY time you feel unaware or unsure contact medical control. Advise them of patient status and any pertanant findings. Ask the questions, thats what they are there for. ER staff may have been unaware decon was not performed, remeber the old addage all assuming does is make an ass out of you and me. Now back to what was stated by the patient. He smelt ammonia and now has symptoms of ammonia (or other chemical) exposure. Right there the red flags should have gone up. Yes ammonia is a simple decon- remove close and lots of water. But say it was another chemical or substance, you could possibly put you, your crew and rig down for quite a while. If I show up to a scene, even if expsoure isn't stated, and ask questions and it begins to sound like some sort of exposure I go immediatly to worst case protocols and contact med control. If CO then fire is called and house inspected. Hazardous material my protocol says notify poision control, FD, and PD response team. They usually will send out FD in SCBA with a hand held tester and check air quality and possibly the clothing, if its safe then the amount of response is limited. When it doubt medical control it out! hers a real world example: Called to a residence for a patient with altered mental state. PD arrived before us. We go in and a friend found his buddy acting lithargic and not talking right. PD was there a few minutes before us and the buddy even longer. Just as we get in the residence my little CO meter starts chirping (one of those few dollar home depot kind, not FD or anything) I tell my crew to grab the patients, yes now I feel we have 4, and exit to the rig. Call FD and they come and do a sweep and low an behold the guys pilot light went out and the home was full of CO. Now here PD was figuring drunk or drugs (there words not mine) even the buddy thought so. If it wasnt for my little alarm who knows what would have happened. Moral of the story, just because PD is there doesn't mean they know whats going on. edited to add real world story no other changes made

Great question Ruff (as always). medic if this is as you say it was, was a hazmat team called in? decon done? you say you took them at their word. what was their word? just ammonia and not a meth lab or it was a meth lab? even if it was just exposure to ammonia it is again a hazmat scene and all hazmat protocols should be follwed. Ok I will assume this was done. All proper protocols and procedures followed. We now have a deconed patient in our rig. Ammonia interacts immediately upon contact with available moisture in the skin, eyes, oral cavity, respiratory tract, and particularly mucous surfaces to form the very caustic ammonium hydroxide. Ammonium hydroxide causes the necrosis of tissues through disruption of cell membrane lipids (saponification) leading to cellular destruction. As cell proteins break down, water is extracted, resulting in an inflammatory response that causes further damage. Immediate decontamination of skin and eyes with copious amounts of water is very important. Treatment consists of supportive measures and can include administration of humidified oxygen, bronchodilators and airway management. Ingested ammonia is diluted with milk or water. Do not indice emisis. If it really is meth again treat the symptoms. I would contact local area poision control plus med control to advise of the situation and ask for further guidance. (most of the care here is at the ALS level with IV meds and ECGs so above my SOP thus the reason for the short answer)

I want to take a crack at this one. emtbasic13 I too am a Basic but handle alot of ALS calls with Paramedics onboard so maybe I can help shed some lights. First off, please do not take offence at this question, but you do know what each level of EMT does correct? In other words what each levels scope of practice is. With that said... The question posed is very open ended. ALS do a whole range more things then a Basic would. During a BLS IFT you are basically (no pun intended) dealing with a stable patient that requiers little to no invasive treatment. You are basically checking vitals and patient comfort during the transport. Now on an ALS transport you can be dealing with unstable patients (cardiacs being brought to a coronary center from a clinic, trauma being brought to a Level One from some where else, burn victim to a burn center from a regular ED, ect ect ect) you will be dealing with invasive procedures or equipment (intubations, IVs, meds, pacing, ECGs, ect ect ect) which are above the Basic's scope of practice. The big difference between the two is the patient's requirements during transport and what those requirements would lead to if the condition changes. Like I said before they way the question is worded is very open ended and thus does not have a specific answer. I tried to break it down to the lowest common denominator. Now if your asking what would a Basic's role be during an ALS transport where you have a medic or nurse onboard then it is a little easier. You would be doing what they tell you to do. Its that simple. When I have ALS onboard my rig they dictate to me what they want done. Be it recheck vitals while they do IVs, I have spiked IV bags for them if more then one bag is being hung (they hand me the bag so the meds are correct), I have hung bags for them, unwrapped IV lines, handed them stuff out of their bag, ect. It is really up to the ALS what they will expect from you. The more you work with them and the more confident they are in you the more hands on you become. Now understand this though, they will never ask you to do something outside your scope of practice or will harm a patient. You are being a second set of hands for them if necessary. There are times you will be relegated to a seat warmer because what needs to be done you are unable to do, do not take offence when this happens it just means the patient requires a higher level of care then you can provide at that time. If you have specific questions about what ALS does then by all means ask away. I know for sure the paramedics here will be more then willing to answer them.

The protocol in my area states that if presented (and only when presented) with a DNR we must honor whatever it states on the order. In this patients case it said no interventions could be preformed. From what we did hear from the wife she called hospice to have the nurse come out and declare after he passed it was the daughter who called us. The family (except the daughter) had no intentions of calling us, this was what they wanted. Thankfully (for their wishes including the patients) they produced the DNR, if not we would have been doing what we had to. We have seen them say everything but CPR, yes to BVM but no to resperator, ect, ect, ect. These orders are on an official document that we get a copy of to attach to our paperwork and have a physicians signature on them, along with a witness. So we follow it no matter what we see upon arrivial as long as it is produced to us, we cant just take someones word, we need to have the document in our hands. Sorry I didnt make this clear in my last post, for that I appologize. I forget sometimes we are all over the place and what protocols I have differ from others.

After Dwayne's post I dont have much more to add except this. You really did no harm, this was a AOx3 patient wishing to go home. If he was told, as it did sound like because of the HHA, he would need help and better suited to a nursing home but still wanted to go home then thats his wish. It would be the same as a DNR call. It sucks but you have an obligation to honor the wishes of the patient and/or patient advocate. I'll give you a real world example so you see where I am coming from. Called to a home for difficulty breathing, get there and here is a man in a hospital bed in the living room. We can see the extreme distress he was in and were just about to do our thing when the wife presents us with the DNR. Didnt verbally tell us but presented it to us. We had to take a step back and it broke our hearts as we had her sign out paper work and walk out. Apparently the young daughter called us without the wife's knowledge so thats why we were there. Did we want to say "outta my way, we can save him." Of course but we couldn't and didn't. I went out and punched the side of my rig afterwords but honored the patient's wishes. Morals and ethics are a tough thing in our profession that sometimes we wrestle with. Its good to see you were speaking up and being a patient advocate, we need more of you in this profession. You will be a kick ass medic if you keep it up. Do I think your partner was an ass for making you feel like your job was on the line because of it, abso-freakin-lutely! But one thing you need to remember is after giving a patient all the information they can still refuse treatment, thus in this case transport home even with no mobility.

While I echo others statements of need more info I will add my two cents LOL Increasing to Code 3 is really not going to do much it sounds like. Would doing so decrease travel time significantly? I know your in BC and I hear the roads are winding up that way so speed shouldn't be a factor. What was the time of day? Would being Code 3 alleviate a traffic situation? If not then staying non-emergent was the right thing to do. Now of course if the situation changed or the patient's condition deteriorated then Code-3 would be fine. One thing that concerns me just a little, the low batteries on the unit. Both the main and the backup were low on juice? Did you have another AED available just in case? I would be watching my levels more closely or at least carry a spare battery just in case. Being you were doing a cardiac transport I would have double checked the batteries, dont want to have that pucker factor moment at the worst time.

OK I just got off the wierdest shift I have had to date. When i say just got off I mean 2 hrs ago (went home to shower and now at my day job). If I ramble I appologize I am on zero sleep since 4am yesterday and on about my umptenth pot of coffee. Started even before my actual EMS shift. At my day job had someone had an accident that needed immediate attention. My boss calls my desk and I pick it up and all he can say is we need EMS NOW (screams now) I grab my bag (personal bag, nothing major) and he's already at the door with a truck running. Get to the scene and someone cut there arm open really good. Nothing arterial but loads of blood none-the-less. I grab my gloves and the few packs of combine dressings I have and apply pressure and elevate. Bleeding slows to a trickle so I start to bandage a little to free up a hand. In the background I hear the sweet sound of sirens. The rig shows up and 3 guys get out and take over. Congradulate me on a job well done and one hands me a few combines from their rig to replenish my bag. One my way home I witness a MVA, nothing major but stopped anyways to check. Lady on a cell phone hit the rumble strips and turned into the divider instead of away. I get out and shes shaken but other then a bruised ego nothing. Shes in the left lane up against the barrier with a dead car, wouldn't start back up so i decided to use my truck as a shield and turned on all my lights (no not a wacker, now that I am 1st Lt they had me install rear emergency lights so I could be on scene with my POV if needed) few moments later PD shows up and takes over. I get another "good job" and am on my way. Well I was supposed to pick up my wife's present from the engraver but that didnt happen because now I have 30 minutes to make a 40 minute drive to get on duty. Ok Duty shift starts and all is well. Stays quiet the first few hours and I get a decent meal in with my wife. No sooner did I get up from the table to do the dishes then the Plex went off. I kiss my wife and get moving. First call of the night was a slip and fall with possible hip fracture (as dispatched haven't been on scene yet). Get to the home of two little old ladies and ones in a chair and the other greets us at the door. Ok I am wondering where my hip fracture is. We are brough to the one in the chair and she starts yelling at the other that she should never have called and disrupted our night. Apparently 3 days ago she fell getting in the shower and has been in pain since. Her friend noticed her limp and finally called us. We package and transport and all is said an done. OK the wierd part is 3 days with a hip fracture and she just sat there like nothing was wrong. Hoping it wasnt fractured and was just really bruised. On our way back, my crew and I are chit chatting when we get called over the radio to see where we are. Not usually a good sign. We call out our location and dispatch says "great". Oh brother, here we go. Divert to such and such address for possible OD. Man I hate geting these right before the Holiday (see my other thread) Get to the scene, we have another elderly lady that decided it was all too much and took all her meds, i mean ALL here meds. 4 prescriptions were filled only that morning. Pt is totally out of it. Ask her the time 1957 ask her the date Star Date 2112 ask her name Marylon Monroe. OK this is going to be fun. Ask her where she is Pee Wees Playhouse (these are her real answers I shit you not) We start transport to meet ALS in route. Well half way to the intercept ALS calls back and they were in an MVA!! OK no ALS. I ask for a diesil bolous and my driver agrees. We get her into the ED and the nurses are looking at us like what the hell (last time we were back to back there was last year). On our way back we hear over the radio that our other unit is doing the ALS MVA. We pass and wave. Ah we made it. We are back at base and I head home. Been a long 4 hours. Get in bed and try to get comfortable, guess the dog figures since I wasn't home the bed was her's for the taking. My wife is sound alseep oblivious to the tug of war me and the dog are having. I finally win and close my eyes. Tones go off. I look and its been just 1hr since I got home. Well its after midnight so nothing good happens after midnight. I listen to the Plex and its an MVA with injuries. I grab some extra gear figuring we will be out in the cold (it was 17 last night with a 20mph wind) while they extricate. We get on scene and there is no rescue rigs. Wierd I think to myself. I go to the first officer I see and ask where our patient is. He directs us to the back of the bar, thats right MVA happened in front of the bar and the patient goes inside. OK here is where we enter the Twighlight Zone and everything gets really wierd. PD is actually trying to conduct a field sobriety test INSIDE the bar. Well that didnt work. We go outside and ask PD if we can look at her before the test is performed. Looking at the car she might have some injuries. PD agrees and says what they have is enough, they will follow if we transport. Well our patient hears this and goes ape shit batty on us. PD helps hold her still and we calm her down with words. She asks if PD can exit the rig and she will be coopertive. They step outside and this girl gets all giddy. Next thing we know we realize 3 weeks ago we had her for a nasty fall down some stairs while intoxicated. She says, "Yes I remember, thats why I wait till now." Now for what? "well see I thought he (pointing at me) was cute, so I crashed my car to see hime again!" Holy Shit she crashes her car to see me. OK take the wacky juice away. So I kindly let her know my wife wouldn't like that very much. She starts sobing and during the sobs says if she knew I was married she wouldnt have drank 7 drinks, taken 4 Ambien and 2 Zanex. Nothing about crashing the car, just the drugs and ETOH. Anyways get her to the ED and she goes batty again, punched a nurse and security swarmed the room. Heading back, get another call. Oh great now what. We are giggling though from the last call (both my partners are female so they were getting a really big chuckle) so maybe this wont be so bad. Another possible OD. Get there and its a frequent flyer so we know the deal. Well it must be the Moon or something because it gets wierd again. Hes in the back with me and my partner and starts giggling but not once looking at me. I dont think much of it until my partner motions with her eyes twords the guys feet. I look down and notice some "movement" under the blanket. I ask what was going on and the guy started laughing. Next thing we know the movement was pronounced. Holy Shit he's masterbating. I have a guy wacking off in my rig. I get a little loud and tell him to knock it off. He was like aw come on man Im not hurting anyone. Both my partner and I begin to tell him why its not appropriate to do that in public. Well it goes back and forth a while and he stops. Think its over? Hardly. His hands are above the sheet but he starts gyrating. Tries using the sheet to continue. My partner starts getting mad and I have to calm her down while trying to get this guy to calm down and stop. Only thing I could think of was talking to him about Bee Arthur, dont ask me why but its all I could think of at 3 in the morning, he starts to dry heave because of it and it stops. We get to the ED and the nurses are pissed. Bad enough here is patient 4 but our last one we can still hear flipping out. Well we proceed to explain this one and the nurse said "Oh Hell No" After a little convincing we get him to a bed (apparently they want us to deal with him a little longer) we transfer him and then comes time to remake the cot. Well I am not doing it, my partner is nowhere to be found (aka the coffee shop) and my other partner is busy doing the PCR. Great just what Iwant to do at 3am. Well I get it done and miraculously everyone shows up just as I finsh. No problem I say, they get the next "messy" one LOL Well we get back and I look at the clock, I am off duty 2hrs ago, haven't slept in 24hrs and now have 30 minutes to shower and get ready for my day job. I walk in my door and get ready and here the tones again, oh well I'm off and heading to my job. I heard it was a puker (evil laugh) OK I know to some that might sound like a typical night but not for me. Was definatly one for the books and I just had to tell someone. I couldn't believe I had a stalker and a wacker back to back and ALS was in an MVA on the way to one of my calls. We did find out it was minor, clipped a bumper apperently, but the other car seeing the shiny stickers figures it was a payday. Anyways... hopefully I dont fall asleep at my desk now and hopefully I made some of you laugh a little. Happy Holidays! Stay Safe Everyone

Mike if that was the prereqs you would see alot better caliber Basic and also alot fewer wackers out there. Annie thanks for understanding. Yes it does stink they (students) are not taught why. I sickens me to arrive at an ED and overhear another rigs transfer to the nurse for a panic attack and notice them on a NRB w/ 15 flowing. Talk with them a little and ask why the mask for a panic attack, "well O2 can't hurt" Then ask if they know what a panic attack is, "yea she got nervous." Ask if they realize that the panic attack causes an over abundance of O2 or lack of CO2 in the bloodstream and get the deer in headlights look. Then asking them why didnt they just talk to the patient to calm her down instead, "I dunno, O2 seemed right, it kept her quiet being in the mask" (Nod to my paramedic friend for teaching me that one about the O2/CO2 cycle w/ respect to a panic attack) ok back on track..... Only meds we have onboard and are allowed to administer is Epi Autoinjector. We can "assist" patients with their Nitro and "advise" asprin for chest pain. I use the quotes because to me its BS, we should be allowed to administer per a standing order. So pharmacology is always taken care of by ALS but I would like to learn a little because it may help if we have an OD of prescription drugs (far too many in my response area) in that I would be able to understand what systems could be affected and what i would have to look out for because of it. No 12 lead, again ALS, but I have already been learning ECG and cardio related information. One because I would love to understand what the Medic is seeing on the screen and how it relates to what I am seeing on the patient. Again to have a clearer picture before ALS arrives or is met to know what to watch for. Two because of family history of cardiac events and helping my parents understand whats going on when the doctors talk to them. Thanks for taking the time to give me some ideas.

Another reason to be careful if you restrain a patient!! NJ probes death of man tied face-down by EMTs positional asphyxiation

Thank you fiznat. No I have no degree other then high school. I was attending college but due to family issues never finished and moved on with my life. Now after a time in the EMS field I realize I would like more education on the human side other then whats in the 120hr class but can't go all out for the Medic as stated above. I understand you hurt yourself by doing it al carte but being it will just help me understand more and doesn't effect my SOP I don't see a problem. It sucks that I am in an environment here that doesn't allow for doing it the right way and just getting my Medic and be done with it but I work with what I got. So besides anatomy and physiology what else should I look at to better help me understand the systems?

jmdjax in other locations fire and ems are seperate entities. So folks from these areas volly at squads or hospitals to get their "experience" before moving on. I believe what your asking and I think has gotten a little lost in the shuffle is that you dont want to get your medic in Florida THEN get your Fire Cert while still in Florida. I think the more important question should be where you want to live and work first. Then find out that State's reciprocity requierments to transfer your Basic cert. Then go for your Medic. Then if you find you live in an area where you are in a combined service (fire/ems) then get your Fire Cert. But if you dont want to be in the fire dept (it kind of sounds like you really don't) then find an area that has seperate entities and just go for your Medic and start working. Now that you have your basic and want "experience" why not try a hospital ED? I know some places let B's work in the ED, at least in my area, menial stuff at best but at least its something without just doing IFT.

OK let me preface this post by saying I am in a bassackwards State so going full Paramedic is not in the cards or my future. Now here is what I want to ask everyone. I am looking at taking college A&P courses to at least get a better understanding of the human body to better help me treat my patients. What other courses would be good to get a better, more indepth knowledge of the human body and systems? I know I know, why go through all that and not just get into a medic program. Well in my State I would need a "sponsoring" hospital to get enrolled into a program. I asked around and the few ALS hospitals want work commitments from perspective students after they become certified. Well I do have a full time career that has good benifits and job security so I will not be leaving that anytime soon to persue a paramedic liscense. Secondly with a P cert any rig I would ride on unless I am hospital based I would only be allowed B level care, go figure, so thus reverts back to reason one. I want to provide the best care I can and to me the only way is by knowing the human systems better then the miniscule pages or so in the basic text book (more pages are dedicated to attaching a regulator then to WHY we need oxygen ) Just like I took additional CEUs for trauma specifics and peds specifics I want to learn the human body and why things do what they do thus why we do what we do to correct the abnormality. I guess the question is vague but I dont know how to ask it any better, sorry about that.

Thats about our call volume as well Underdawg3ate1 so i definatly know about the dry spells. I do full rig checks such as yours once a week (ie bulbs, under carriage, fluids, supplies). I make sure my personel restock whatever was used on the call and keep everything up to the required numbers per the checklist. If we are getting low on a certain supply I get the text message and make the purchase order. I PM the rigs as per manufacturer recomendations. I use the milage on our call sheets to gauge. We just got all new tires just before winter so I will be good with them for awhile. I can put the tread depth gauge away now. I have to look into waxing the inside. Might help out on the "messy" calls. I do wash and wipe the insides down, just never thought about waxing. Might have to try it tonight during my shift (at least in an out of sight place to test) Im liking this thread! I now know I am not crazy