uglyEMT

BVMing so hard the patient looked 9 months pregnant. not us but... A wife giving Excedrin Migraine to a severe rapid onset headache her husband was having

Worse then a 3am toe call. I say iron maiden, draw and quarter is too good for such insult. just playing with ya

Oh i totally agree both ERDoc and Island that my protocols suck and we basically have our hands tied. We finally, last month actually, became allowed to "assist" a pt take BGL, "assist" a pt take ASA for chest pain, "assist" with pts nitro. I mean come on now but it is what it is like you said. Hopefully one day we can actually do something but until then we work the best we can. That RAD-57 sounds awsome, I don't even think our ALS units have it, well I shouldn't say that, I haven't seen one used even at a fire rehab. Most rehab is a quick set of vitals, check against their baseline, give O2 is "they" want it unless they are outside their parameters. Oh make sure we have water bottles and ice ready, they want that Usually an argument if we want to pull a FF off the rotation because of vitals. Usually are told make sure he IS fine and get him back in rotation ALS is usually notified of the rehab going on and are on standby if we need them but usually not on scene. Again, got to love protocols For the CO pts at least we have one good thing going for us, the main hospital we transport to also has a chamber so even if we don't know the blood levels we are transporting to the appropriate facility.

ERDoc sorry for the long delay between postings. Life gets in the way sometimes LOL How do I know if my patient is oxyginating? First off are they breathing normally? Adequite volume and rate? Color of the lips? Nail beds? Gums? Skin? What are the lung sounds like? You asked about a chest pain, per my guidlines its 15L NRB until ALS says otherwise unless the patient cant tolerate that high a volume then we back off to 10-12. As for my CO example, I never faulted the machine, I faulted the provider. He was so caught up in the tech that when it failed he blindly believed it and almost didnt seem to know what to do when he should have known. Its not the tech, its when the tech becomes the basis for diagnosis and it fails or gives false reading and the EMT doesn't know what to do or fails to realize its wrong. Again the tech works and has its place but it shouldn't substitute good knowlege of what to do without it.

I hear you ERDoc. I understand the benefits to using the technology and learning how to use it properly. Its just a personal preference in my book following the mantra. Its not that I don't know how to use it, I just prefer not to. I don't need a machine to tell me if my patient is oxygenating well if I am doing my job correctly (please don't think I am being snarky with that sentence, I mean it with respect) I have seen a few providers rely on tech to do the work for them and they get too comfortable and miss things they otherwise may have picked up. The CO patient was a big eye opener for me that the tech can sometimes take over.

Recently we had a drill with an active shooter in a school. First time around we did the stand-by wait for the all clear before entering. After action showed multiple patients bled out or would otherwise survived if medical attention had come sooner. We reran the drill, this time with a handful of willing EMTs to follow the sweeping PD/ SWAT team (2 officers with each "team" of EMTs). After action showed that the patients that needed the critical care survived due to more rapid triage and treatment. I do think in the large scale buildings or events this works I wouldn't suggest it for private dwellings. Even if the EMS agency can't afford the ballistic armor themselves I don't see why a few pieces can't come directly from the local PD. As far as tactical training, would be great if it was widespread I can think of many times just the situational awareness training alone would help folks. But in the big picture I don't see it outside of CEUs. For the above drill it was more of the officers giving us a quick briefing and going in. Basically it was stay behind us, stay close, stay quiet, do what you have to do as quickly as possible, get out. One thing I would like to add is maybe talk with folks that deal with these things more often. Israel comes to mind. Start a dialogue with agencies that have already dealt with and implemented steps and ways of doing this correctly.

I was just like you, tcripp, slept in my gear (minus belt and boots) so I wouldn't miss the call. Being volly I didn't have the sheet issue but instead of bed I slept on the couch as to not get too comfortable. 4 years later I sleep in bed in pajamas LOL all the cloths wait for me on the back of the chair. Still wear gloves all the time, just because it doesn't look icky or gooey doesn't mean its clean. Germs don't bother me much. Still wash my hands between calls guess its just ingrained by this point. I always laugh at hand sanitizer, think of it this way there are around 200 million germs on your hands at any given time, most sanitizers kill 99.99% of germs, 0.01% live. 2 million doesn't sound so clean. Being a shift worker I know what you mean about the rhythm being off. I can sleep almost anywhere and at the drop of a dime. 30 min or so and I feel revived enough for another few hours. When I do get to sleep in its wonderful but not often.

We don't have pulse ox either. rather treat the patient then a machine anyways. never missed it even after working on crews that did carry it. I even have a story about a CO poisoning patient that the EMT swore was OK because the machine said it was 98%. As far as the AED, are you freaking serious?? I don't know any place that doesn't have one on a working rig. Hell most PD, schools, shopping malls, even the grocery store have AEDs in my area. That sounds like a certification violation if I ever heard one. Oh BTW the company that went belly up overnight was First Med.

In NJ they are allowed to "assist" the patient in using thier's still but they did drop Basic from their title LOL Now they are just EMTs.

Richard seen it tons. Even had one patient who recieved facial burns from it and continued doing it on a daily basis (home oxygen use, cpap and NRB no cannula).

First I want to say that if the patient is stable as you stated your best course of action would be to asses the patient, stabalize the C-Spine if necessary and wait till a crew shows up. Unless you have all the proper equipment with you then you can not properly move the patient.(looks like ERDoc replied while I typed, yes we are learning that its not all necessary but please follow your local protocols just to CYA, no need for a law suit because you became Randy Rescue) As you say you are new to the field. Alot of that new knowlege has to be tamed. Yes its going to suck sitting in the backseat holding the person still waiting for the crew to show up because you want to do all that fancy stuff you learned in front of everyone. But I would rather roll up on you doing just that and tell you great job knowing what to properly do then seeing a person lying supine on the ground outside of the car (unless of course thats how you found said individual or circumstances required immediate removal) Back to the OP. After doing a quick check, No VA does not have a duty to act law on the books. Local protocol then would dictate what you should and shouldn't do. Ethics and morals then come into play as well. If that was you on the side of the road would you like to see a rig roll by and look but not stop? Think back to the story that made the rounds a few years back of the Dr whos son borrowed his car drove passed an accident (which he rightly should have done) but someone there spoted the MD plates and called the local news to complain. It wasnt until the details came out that the son was driving and not him that it died down. But for a while the Dr's name was dragged through the mud. That was just a personal vehicle with MD plates imagine what an entire rig would do?

Currently my Union is keeping the same insurance we currently have. We have been told no changes will occur for the foreseeable future. Hopefully this is true and I don't get a surprise. With a kid on the way it's a bad time to have the uncertainty

Didn't think of that at all. But hopefully labor laws will save the supervisor if and when she is "dismissed". I would say a lot. I know for myself after a few "doubles" the drive home was rather difficult. More than once I actually pulled over and grabbed some sleep on the side of the road. What some folks have to realize is that sleep depervation can actually effect you in the same ways as being drunk behind the wheel. I wish sometimes that scheduling officers actually realized these things. As far as the lawsuit goes, if he wins, its not just our industry that this will affect but any industry that has shift work. Hopefully OSHA will chime in at this trial also. I think within our industry 12hrs max should be the standard. With what we see and deal with on a daily basis our minds need to have the break, would alleviate a lot of the burnout. One thing i would change is the 12hr for night folks to 24hrs. It has been noted that the body really needs 24hrs to change over sleep patterns. Ask some 3rd shifters about what happens on the weekends if they have off. I know for myself I actually needed to set alarms to wake up at different times(earlier and earlier) so that I wasn't sleeping the entire day away.

It will be something to watch definitely. Especially with the Unions pushing for safe staffing level laws. One thing that struck me in the article was that her supervisor stated the staffing was dangerously low to the parent company. If she actually did say that and its documented, oh boy this law suit doesn't just have legs and traction but teeth as well. I would not want to be in the parent company's law room

That's a great idea Doc. I know my states EMS Field Guide (all 246 pages) are available online as a PDF https://njems.rutgers.edu/cdr/docs/NJEMS_FieldGuide_PDF.pdf

I like the idea Ruff. I think it would be better then a lot of the cut and paste answers that are sometimes given. Also might help a lurker become a member to inquire further after reading the basics. I can help if necessary. I think it would be good to have people from every state or region possible as to confirm or refute information provided from another area if it exists in their area. Or if not at least have a way to discern the factual basis from area to area. As an example what EMTs can and can not do from state to state.

Stubedtoe3am Needmorelights69 BatmanutilitybeltEMT That's all for now.....

Raaaawwwww Hiiiiiiidddddeeeee

Oh Crap

Caduceus I think the best way to find out would be to go up and ask them. If you see them at the game or elsewhere go up and ask. The individual my not know off hand the procedure but I am sure they would be able to give you contact info for a supervisor or Capt or even a Crew Cheif. The Crew Cheif would most likely be at the event as well. Yes go up and introduce yourself in person. Over the phone can work as well for basic information but nothing like meeting face to face. The game standby's, as we call them, would be a great experience for you. You may not be actually working on folks but being around the crews and seeing how they operate will do wonders. Heck they may even let you put a band-aid on (thats not a dig at you personally, its about liability thats all) Even though your local station is unmanned, most Vollies are, they still show up from time to time and do rig checks, drills, meetings, ect. Try finding out when a meeting is or when they check out their rigs. That would be a good time to say Hi. As an after thought, don't do it after a call. A) That would be bad form and B ) They may not be in the best frame of mind. Learning the equipment during rig check is great learning experience. For one you get to know the different things and what they do and why. Second you get to understand why certain things are done and start to gain the knowledge as to why we do certain things at certain times. As far as experience goes, take classes get your certifications once your eligiable. In the meantime take whatever local first aid, cpr classes are around that you can even online ones. The best experience is hands on experience. I hope you don't think some are coming of as crass when we talk about liability, it has nothing to do with you personally. One of the first things you learn is we all follow protocols (these vary from area to area) and we always CYB (cover your behind). Its amazing how fast we get sued over what can be percived as minor things so certain things are not able to be done. Keep asking those questions and I am sure someone will try and help in anyway possible. You can always PM if you have a question that you don't want everyone to see.

Ruff that sounded like a bad day for everyone. Definitely what I was thinking about when I said what I said. Well maybe not that drastic but still the headlines would be no less as bad. Looking at it strictly from a liability issue. I think the supervisory ride along would be great. Like you said get all the good calls leave the stubbed toe alone LOL If the super ride isn't available I still think helping around the building, participating with them at sporting events ect will garner some great knowledge and experience but in a more controlled environment. I was always looking for help for events. I was thinking of another thing between posts, see if you can come by for a rig check. OK I know it doesn't sound fun or exciting but you can learn a lot. I know with all the new recruits I made sure they did rig checks constantly. Who knows by going this route might make it easier to get a ride along once they see how you are around them.

Awesome post Clutzy Hello Caduceus welcome to the City. I see your welcome has been a warm one. Let me add a little to the discussion. As a former Captain of a squad I see a lot of liability issues but depending on your area (things change from area to area) might be able to get a waiver. One thing I would suggest is maybe not a ride along but more of an auxiliary. Help out around the bays, work those football games, pitch in at events. This way you get the experience of working with the EMTs but in a more controlled environment. As Clutzy said, if the scene goes wonky I may forget about you for a minute, in that minute a whole world of bad can happen. At a football game the chances of that happening are less. Plus helping around the bays helps you get a feeling for the crews and how they interact. Maybe crew 1 is crass and obnoxious maybe crew 2 is more laid back and receptive, ect ect. Not saying don't do the ride along just saying maybe wait a little. Get to know the crews a little. It may even make the ride along more enjoyable because those awkward silence moments would be fewer and farther between. As I think about it a little more let me ask you this, you said you have experienced bad in your young life already, are you ready to have that experience again but with the added weight of everyone wanting you, personally, to fix it? Even though you are just riding along and not being an active participant you came through the door with us so those around the scene assume you are "with" us and may expect action. Sometimes the hardest part of our job isn't so much what we do but what others seem to expect us to do. Call it the Hollywood Medic curse, people assume we show up and fix everything like they do in the movies and TV when in actuality it is far different. I'm glad to see someone so young willing to take the step and join our ranks, we need more motivated young participants. By all means stick around here and pick our brains.

Yes the AEV Brute kits are what got her looking into the pickup version. There is actually a dealership up our way that does the conversions and sells them right on the lot. Price is about what you suggested depending on what level JK you're buying first. I emailed her to ask, the Jeep Gladiator, she heard through the grapevine Jeep is coming out with them. I said 14-15 its actually 15-16 they should be coming out she said. Its her thing not mine so my brain is a little fuzzy on the details. Sorry about the mall crawler comment, its just what i think of when I hear stuff like that. I know Jeep does the right thing, I should have known better.

Now I REALLY want to see it if your saying its ranking with Kubrick and Scott

Yea wifey wanted the creature comforts in hers too. Talked the dealership into giver her the power package at no charge, just a little more on the down payment. Wife really is waiting until 14 or 15 I believe for the pickup one, she really wants that. Don't know the name of it, I am thinking Commander for some reason. Yea when I hear 9 speed 2.4L I thinking mall crawler more then trail rated. Its funny when I hear creature comforts my mind wanders to lockers and disconnects instead of Nav and keyless entry. But thats just me LOL Did the same with the Xterra, was asking for the lockers, disconnects, roof lights, and skids while the salesman was telling my wife about keyless entry and heated seats. Salesman looked at me like I was talking jibberish to him, finally found one that knew about the truck vs the gimmicks. Had to look hard to find one but got it set up right for the trails.