uglyEMT

Seen one the other day Front: I am an EMT (had the star of life on it too) Back: and YES! The gene pool needs chlorene One I want made up (I know its not mine but I think it would be funny) Front: NJ EMT (star of life or something else) Back: Forgetaboutit I Can't Cure Stupidity (photo of someone being stupid) edited for formatting issues

Sorry to hear PCP. Unfortunatly most cardiacs are not saves. As was stated, sometimes they are beyond our help even before they get to the floor. Personally, I don't think it gets easier, I think what happens is you compartmentalize it better. At the time you are doing what needs to be done, in the moment. After the call, after some more experiences, you learn how to put it aside, QA yourselves and move on. Not cold or unemotional but knowing you did your best but it just wasn't in the patients cards to come back. You did a great service to the wife. Staying with her a little after the call and offering to contact someone for her. Some times the best treatment we give is no treatment at all. I know a few times (as can be seen in other threads by me) when I was on the receiving end of a gental touch or an "it will be OK" it made all the difference in the world to me. BTW... stop kidding yourself this call did affect you. Just because your sleeping doesn't mean anything. You state your thinking about it 24/7, you posted here so obviously it has gotten to you in some manner. It a smart thing to talk about it though, especially in a place like here where others have gone through the experiences, some times lay persons don't connect on the same level that fellow EMTs (no level here just generically calling all of us) do. It a great thing to own it and bring it to us to help. Thats the first step. Keep your head up, walk proudly, and get back out there. But most of all don't worry, you and your partner sound like you all did everything you could, sometimes we get there first sometimes Grimm beats us to the scene.

Im sorry but if your holding a flashlight to anyone long enough to cause burns you should have your liscense pulled. Secondly, your flashlight is way too powerful get an LED. OP this is not directed twords you personally but to the anedoctal story.

That sounds like awsome crews. Definatly not the norm from what I hear. I forgot to add about the inside of the rigs. We wash everything down with a 50/50 bleach water mix when we get back to our building after the call. Also we saniwipe the cot and other objects after each call. In bad weather we mop the floors before going back in service. As far as other cleaning I always wipe my gear (personal use) after each call. I even swap out my ear pieces at the end of a shift and soak the other pair in disenfectant. I couldn't believe how contaminated they get!! We swabbed them one day and did a culture test and it was eye opening. I am the only one who uses them so i know its from environmental factors and not dirty ears LOL. Glad to hear others care just as much for their rigs as they do themselves.

Being I am the "Rig Guy" I can answer this very well LOL We wash the rigs once a week (low call volume so most of the time the rig is in the bay). I wax the rigs once a month and the full blown detailing is usually done every other month, unless of course my probies need a reality check then its more frequent Decon is after every call. I would rather spend a few extra minutes at the ED parking lot to decon then cross contaminate the next call because "we were tired". Full blown rig check (every piece is inventoried, yes even the band-aids) is every weekend. That usually takes a few hours each rig. We do one at a time so that if the tones go out we have a duty rig available. This means acurate counts of everything down to the smallest thing. Experation dates get recorded so I know when i need to replace things. BTW if the oral glucose industry is reading this.... MAKE THE DAMN NUMBER BIGGER PLEASE or at least a different color then the background. Yes yes yes I do run a sharpie over them to highlight the numbers but still any smaller I would need a microscope to see them. O2 tanks are checked after every call and recorded, even if they were not used, so we know to replace them if we are close to empty. Nothing more embarrasing then running out of O2 during a CPAP transport and looking at a Medic and getting that "Really Moron!?!" look. Same goes for the defib. Battery check after each call. Other then that I give a full detail 2 times a year and of course before any special duty detail. I will be good for a while since I had it professionally detailed for our WTC Steel Escort.

LOL kinda reminds me of the Staples commercial with the kid shaking the printer

Faking this statment jumped out at me. If the patient will be cuffed or restrained you must tell the PD how you want your patient. If hard restraints will be used make sure the arms are in correct positions to gain IV acess without having to unrestrain the person. Never transport one with their arms behind their backs and never face down on the cot. Im not saying you ever would! Just commenting on the above statement. I have read a number of articles where a drunk was rerstrained and asperated due to improper position, one where a patient went into cardiac arrest after being Tased and due to the arms being behind them and cuffed and time was wasted trying to get the arms moved to begin CPR. Its a nasty situation to have a patient restrained in the back of a rig without PD envolvment. If you do DOCUMENT DOCUMENT DOCUMENT. Poistion of restraints, type used, position of the patient, how long the restraints were on, any visable injury caused by the restraints, ect. CYA with these patients. I work rural EMS and on occasion we have restrained patients. I have a LEO ride with us, I want witnesses as to what transpires during transport. Especially when transit time can be over 1hr in certain cases. BTW Spider Straps work excellent even when used just on the cot.

Welcome to the City! Grab a chair and hang around awhile. Feel free to jump in on discussions and even if you don't have an answer ask questions and leave comments. BTW I had a friend in the BK EMS. Haven't spoken to him in awhile though. Again Welcome.

No problem Dwayne. I know what you mean about the insurance. I am only speaking from news stories from my local area that have happened since 9/11. Folks that have lost their jobs in the interm that have applied for new policies have been denied. I dont know if it was clear in my last post but the Health Care Bill also covers civilians that lived in the local neighborhoods so some that may have been unemployed before and found employment since have been denied or were put on capped coverage. I understand what you mean by the "hero" comments some make. Like you, I have FF friends and aquantences. Even they talk about the blow hards. I do agree with you that the "I do this to serve. I put my life on the line every day for you!" is over done and might be the bullshit they tell themselves when they look in the mirror everyday to justify themselves. I do feel the Health Care Bill will help many, yes it will be abused (got to love our day and age), but for those that really need it it will help tremendously. I would like to make one comment if I may about your one statment I know service members don't ask for special treatment so don't misunderstand my next statment. You still get special treatment though. You have the VA Hospitals, I know they are not the best but still. If you need them they are there for you. This Bill will be like that for 9/11 victims. If you were there, in any capacity including just living in the neighborhood, you are guarenteed medical coverage and treatments. That I do feel is fair. As far as disability claims. Agree with you. Far too many "back injuries" without loss of quality of personal life to go around. Now some of these 9/11 workers are gravely ill and legitametly need their disability claims and those are the ones I am fighting for. The ones that have died, soon will, or are so incapacitated that they have low if not zero quality of life. Those are the ones that need this Bill. PTSD guys, "I have nightmares" guys and others I can't think of right now... sorry I don't think so. I did it, I survived, I have issues yes but I don't whine about it and ask for a hand out. I went to therapy, I got the help I needed, I manned up and took care of my business and never once filed a claim. I could have had my hand out from day one but I wasn't raised that way. I did what i had to do. As I stated in another thread took 9 years to heal enough to relive it but "hey its a process." (nod to Analyse That). I am mad at this gentelman because of his tone and the way he tries to make ALL victims evil. I know it is his opinion and he is entitled to it just as I am mine so no issues with that. I just take issue with the statment we all should be reprimanded for what we did and with the fact he is "better" then us (I say us cause I was there) because he came back from Vietnam because he had all "the right stuff to get the job done" and we didn't use all our equipment everyday 24/7 for all the days we were on The Pile. Hopefully I made myself clear, I have reread this post several times and it sounds like I did but incase I didn't and offended anyone please except my appology at this time, I ment no offense to anyone. edited to reparagraph. no contexual changes made.

Here is what the Health Care Bill would provide Dwayne. Basically it is a 7.4 billion dollar program to aid in long term care for 9/11 responders, workers and families. Including people that lived in the area who became ill that are not part of the emergency services. Compensation claims vary from person to person but there is a cap as to how much they can get. It is a fund that would unburden families who have been denied medical coverage or whos coverage has run out and make it easier for these people to get the treatment they need. Yes, for those that didn't know, 9/11 workers are usually denied medical coverage and are classified as "preexisting exclusionary condition" if you still have coverage some companies have put limits on the amount of coverage they will pay, some as low as 100,000 lifetime. Thats right, they will only pay 100,000 in bills for the rest of your life. As anyone that has been in a hospital for more then a few days knows 100,000 dries up pretty quick.

Besides finding this guys and stringing him up by his ball sack over Ground Zero I do have something to say. He makes it sound like we all were walking around in our shorts that day. In the first hours everyone was in SCBA, respirators, white masks ect. We knew the dangers we were facing; asbestos, toxic fumes, unknown chemicals, decaying flesh; but we were then assured around 10:30pm the first night the threat was low. Basic precautions were only necessery ie white masks on the bucket line, gloves for moving cement, ect. By day two the EPA was spouting off that everything was OK. On day 3 they told the public the air was fine. We knew what we had to do, we did the best with what we had. I remember firefighters runnig through multiple SCBA bottles until the very last drops of O2 were used up. Then they ditched them. EMS was in HEPA filters until they became too clogged to breath through. Construction workers in regular dust masks until they were black and clogged. Remember one thing we thought it was a RESCUE operation not Recovery. We thought we would be pulling patients out not parts. 343 brothers and sitters were going to be found not buried. This primordial ooze (sorry for the disrespect to all single celled organisms) that mascarades as a human being should go to the homes of those affected, those on ventalators, those with COPD, mesothelioma, asbestosis, or better yet the GRAVES of the rescue workers that already passed and tell them to their face that they are leeches or conning the system. That they are corrupt and trying to just get a check. Then after they all kick his ass have him dial 911 and guess what... he will be treated by EMTs without hesitation, without regard for this article, because it IS our job it IS what we do. Check or no check we WILL do our jobs. FYI when I say we I dont mean EMS, FD,PD in general I mean those on the pile and around Ground Zero. I was there 72 hours so he is personally attacking me in this one. Now let me go punch a wall instead of his face. edited to remove so much vulgarity I would be banned for life

Being BLS I would like to add something, strictly from my perspective is all. I would of course request ALS but if none was available and the patient is post seizure and has a known history of them and has a patent airway with normal resperations I don't see a problem with transporting. I will explain my reason why. Most folks with a history of seizures usually know their bodies well. They will know when one is coming on and after know if they feel different then the last time. The reason some folks call 911 for a seizure is because they see the person writhing on the graound and panic. So if I get their and ALS is unavailable and I am able to communicate with my patient, they tell me of a history of seizures, possibly have prescriped meds, they have normal respirations, and are post seizure then I dont see a need for anything advanced to be done. Yes I know their can be complications, thus my statment that the patient usually knows afterwards if anything is off. Transport to nearest facility, monitor breathing and vitals, keep an ear out for the patient telling you another might be coming on, and transfer care to the ED. Now if there wasn't a history or the patient goes status epilictus then yea I wouldn't think about transport unless ALS was available unless a life threatening problem is arising where immediate medical intervention is necessary. In my response area both would be a BLS response with ALS availablity. If we get there and the "abdominal pain" is present but we find out the patient has eaten a large meal or a new kind of meal and has normal range vitals then we would advise ALS of our findings and if they feel it necessary we will meet enroute. Now we get there and the pain is on the right side, higher up and radiating twords the back, ect then ALS will be called and either meet at scene (depending on their location) or enroute due to high suspition of something major that would be better served by ALS then BLS. General weakness I would follow the same guidelines as above. If my findings are leading me twords beigin findings then I would ask for advice or just transport but if my findings are leading to something serious then its ALS all the way. Now this doesn't mean ALS can't release the patient back to my care and I continue transport without them. Just that I would consult them or call them forthwith if I felt it necessary. A few quick examples.. abdominal pain: 21yr F calls has 8/10 pain. Arrive on scene find her doubled over on her floor. After a brief history find out its cramps from PMS. Non ALS but a transport none-the-less (she insisted) General weakness: 24yr F calls for weakness. Arrive on scene and she is sitting on the couch. After a breif history find out she is running a 103 fever and fell down the stairs (15 wooden) before calling us. Full spinal precautions due to the fall (actually had decreased PMS in her lower extremities and fixed dialated pupils) ALS dispatched due to the temperature and also the possible closed head injury So the BLS side is able to make the determination after a breif history if ALS is warrented for the call and not just by dispatch alone. Now if dispatch has the time and asks the right questions sometimes they dispatch both units so that we arrive pretty close to one another to get the patient moving that much quicker. FYI the area I am in the ALS uses chase trucks and can not transport so a BLS rig is at every call but not necessarily an ALS rig. 4 ALS rigs cover my area (50 sq miles or more) so sometimes they just are not available.

I would be highly suspitious if it wasn't!! OK maybe drugs as well or including. Wrong way at 100mph doesn't sound like someone with all their faculties. My heart and prayers go out to all involved and I hope for a quick and full recovery for all.

Couldn't say it any better!! Can you be my teacher? Your better then some of the shitdicks I work with. This is huge, from a students perspective we are uncomfortable enough and nervous as it is. Pounce on the little tiniest mistake just makes us more on eggshells and distracts us from good patient care. We are more worried then about all the details then listening and treating the patient. Let us have some room and give constructive critisim AFTER the call and what we need to work on. Of course if your student is about to kill someone jump in and correct the situation. Excellent example. I learn more when it doesnt come easy and learn to adapt. Doing it right the first time usually leads to complacency because you think you know it all.

Unfortunatly paramedic school is not in the cards for me. It would be great to do but time, my job, and life wont allow me too. Plus in my area all ALS is hospital based so I wouldn't get to use the skills anyways. I understand about medical knowlege not being a la carte. Just seems interesting to me now and gives me a way to grasp some more knowlege. At least I will be able to understand the medic better LOL

Sorry about the image fiznat it was from an ECG website I was researching BBB on. I will see if they have a better example. Thanks for the heads up. I dont read ECGs so I didnt realize it was a poor example. One thing I have to admit though is while researching this I do want to get a book and learn to read the ECG! Even though I wont be able to use the knowlege "officially" at least I will be able to understand what the paramedic sees on his / her LP12. (side note: after some teaching from a medic friend I did learn to place all the pads for the leads and have assisted the medics in doing so ) Thanks also for the information regarding the movment of electrical discharge in the heart. Reading the literature it does get somewhat confusing, I still need lay terms sometimes, but Im getting there. edit to post new ECG readout. No new content added

Congrats BoCat!!!

Thanks for the tips guys. This place rocks. I have some more links now to go through and read up on. As far as the pt w/ the BBB yes he had an extensive cardiac history and thats what the call was for.. "crushing chest pain w/ worst headache of my life". Before ALS got onboard we did follow protocol and got one NTG onboard the patient. Other then that it was 15lpm via HC NRB. Being I never heard that term used by medics before it got me wondering. Time to read up more! But basically there really isn't anything that can be done prehospitally for a BBB we just have to treat the other symptoms and notify the reciving facility of our findings. Gotcha. edit was for formatting issues. no changes were made.

I understand EMT155. I too am on a volly squad and I know what you mean by "thank you". Unfortunatly we are always the last people folks think about. Anyways.. As far as benifits go my squad is part of the LOSAP program. We get benifits from the state for our service and ceu credits. The town also gives out a stipend to the squad which is then divided up among the members. My personel feelings are that if you joined EMS (be it paid or volley) expecting thank yous then you got into the wrong profession. They happen few and far between if at all. Most times from what I have seen the first thing to go from complimentry programs are the least visable folks. The reason the politicians got them is because of who they are. Like they really needed them anyways? But I digress. Don't go in half cocked and throw a "patented temper tantrum". It will get nowhere fast. Justify your needs with paperwork, statistics, petions, whatever. It will make you and your squad look more professional and possibly be recognized more often in the political arena of the town.

I always check my PMS anytime I am doing an intervention then reevaluate. On bumpy roads (we have a few here) after particularly heavy ones I will instantly recheck. On the highways or smooth roads I will check every 5 minutes. I learned the hard way a few days out of school from an ED Doc chewing me out because I made a bandage too tight on a splint and didn't recheck my PMS. Thankfully nothing happened because of it but it was the mere fact of being chewed out in front of my crew that made me never make that mistake again.

Ok I was on a call the other day and heard the term Bundle Branch Block. Well it made me think and I have been researching it for a few days now and am looking for help. I have read some literature about it. My understanding is that it is damage to the nodes that control the muscles of the heart and is noticed on ECG as a QRS response lasting longer then 120ms. The damage is brought on by MI, heart surgery, or coronery disease. Now for my question, is there anything that can be done in the prehospital environment to stabilize the patient? What can happen to the patient during transport ie MI or other potentially fatal outcomes? I have a sample ECG print out from a book but not the patients actual readout. Just looking to understand more thats all. At the time after the call I was discussing this with the medic and she got another call so it was cut short. Just wondering from a real world perspective vs a book. Thanks in advance.

Pictures coming soon. I had an issue with my network connection last night. Either later today or late tonight.

No problem Dwayne. Im glad that your challenging me to think! After seeing your comments I did some thinking. You are correct I jumped the gun and shot gunned my answers. For that I am sorry. I should have thought through it more and been more complete in my answers. I also reviewed my protocols and SOPs. Indication for use of splint: Closed femur fracture (suspected) in which PMS distal to the injury site is comprimised. Contraindication(s): Open femur fracture, hip fracture (suspected), knee injury, lower leg injury, ankle injury, possible amputation. Compound fractures are more commonly known as Open Fractures in todays literature. As per my protocols and SOPs (standard operating procedures) any open femur fracture is contraindicated for use of the traction splint. I am to splint the leg in place, if possible secure fractured leg to the other leg and transfer per log roll onto long spine board. OK thats what I follow, but here is my take on it after reviewing some literature from Doctor Bledsoe and others. Being a femur fracture is going to be surgically operated on the risk of infection is there but can be reduced with irrigation of the wound site and bone. Also antibiotics can be administered to help prevent infection. Thus the use of the traction splint would be benificial to any femur fracture because it would reduce spasm thus pain and also by attempting to get the leg to its normal length you reduce the void in which the bleed is allowed to flow thus reducing blood loss and possibly preventing hypovolumic shock. Again though even though this will probably by the protocol in the future in my area it is not now so I will follow my draconian one until I am told otherwise. Dwayne you are correct when I missed a big reason to manipulate the leg. It would be if my intial assement found absent distal PMS. I would want to manipulate the leg to regain distal PMS and either use the traction splint or hard splint to maintain the PMS. After application reevaluate my PMS and also reevaluate while in route to maintain distal PMS. Hopefully my new answers are a little more thorough and follow along with others thinking. Again as my one response said I stay within my protocols even though in my head I know different.

Femur fracture that has not punctured the skin Any femur fracture that has broken the skin A fracture in which the bone has broken completely and pierced the skin With the bone ends exposed (pierced the skin) the risk on infection is great. Due to the amount of blood loss from a femur fracture the risk on a blood infection is hightened. Pain to the patient from the bone ends hitting each other while tightening the traction goes against our ethos of do no harm. I can't think of any. Why risk the patient further injury by traction and possible infection. Then by splinting in place and possibly getting pain meds on board (Im BLS so its outside my SOP for pain meds) I dont know if I broke that rule LOL by answering but hopefully it can get a discussion going. Dwayne great way of going about this, instead of copy and pasting rule books or instruction sheets get the people thing as to WHY this should or should not be done. The more we learn the physiology behind what we do the better we understand why we do it. I think thats where the paramedic program excells beyond the basic, physiology, to me it should be taught in basic and expanded upon as you get higher certs. To many algorythem folks out there, need more critical thinkers.