uglyEMT

"How can you say that? I've been like a father to you! I raised you, just like your father did! I believed in you, just like your father did! I slept with your mother, just like your father did! " "And maybe your father shouldn't have given you this afterall, look at the words your ancestors incribed in that ring: honor, valor, sacrifice, duty, commitment, bravery, justice, integerity, brotherhood, self-esteem, low prices, affordable housing, loose fitting pants, cheep internet porn, the rest is in Latin. " Uncle Albert: Remember, with great power comes... Rick Riker: Great responsibility? Uncle Albert: Well, I was gonna say bitches, but if you want to be a virgin for the rest of your life...

OMG Dwayne that long post was great. I needed a great laugh today. Umm I have nothing else to add. I am still learning myself and use my POS dual lumen on scene and the rig provided Cardio II while on the road. Hate to admit it but it takes me a few tries on certain patients to get clear sounds. But hey Im still learning. I will get great at it one day.

I always have my microshield w/ a pair of gloves on me. Hooked right on my key ring. Not a wacker but at least I offer myself some form of protection in case of an off duty CPR case or BSI need.

We have them in our two rigs. I used them once when we were going to an unfamiliar hospital on a noncritical transport. They got us there. I hardly use them, by the time you punch in an adress you can find it on a map or street card faster. I like my roladex for streets in my rig. I just flip to the name and get the quick directions. Here is an example Magnolia Drive 3rd left off Main after PD station if we have a one way Bird Street ONE WAY (one way is in red) Take Station Rd second left off Ridge Ave Make right onto Layfeete St first street in from Ridge Bird is 4th right To me its alot faster to read the card then type the street and also waiting to hear "Turn right" while I am passing the street because the GPS is off a little. Another thing I found is to learn your area. Spend time with maps and also just driving in your POV. I know your not going to remember every street but get the big ones down, learn where the nursing home is, learn where the school is. Stuff like that. Once your familiar with the maps and major areas the side roads will come with time and call runs.

Ok first to Dwayne: Love ya brother! Not so much take the vollies away take the wackers away LOL No need for Johnny Speedracer in his Pickup to have more lights and sirens then the entire fleet of rigs including heavy rescue just to get to the station or scene 1 minute ahead of everyone else just to sit in the rig awaiting a "driver" because he is 17 and cant LOL Nexct, on to the OP. I like what you are implying but I dont think entierly removing them is the answer. What I think is needed is better education for the drivers (guys hold off the - Im not calling us ambulance drivers, Im using driver generically) of the ambulances. I think a big problem is folks get minimal training. Yes one course of EVOC is not enough training. I think more training is necessary in the PROPER use of L&S. My take is somewhat different then most folks, but hey Im from NJ and we just do things differently I go Lights TO every call, sirens only at the 2 blind intersections (basically just pulsed once or twice to announce), after 11pm I dont use sirens unless absolutly necessary. Hey some people are blind to my lights even in total darkness. Once at the call just my safety lights are on because I am blocking a street. Once we have determined the patient's need of transport (emergent, non emergent) my decision on L&S is made. We have protocols per my squad that 2 major intersections on our route to primary care will NOT be crossed at anytime unless we have the green light. The only stipulation is if paramedics are onboard and want us to due to patient need (CPR in progress sort of thing) During our trip down the highway to the hospital we cross about 7 intersections that have traffic lights. Very few times will we run a red, we usually shut the lights down and wait at the light for the green. Then put the lights back on to clear traffic but not at break neck speeds. If we feel the patient is really in need of nothing more then a ride then we are all off and just a regular vehicle. I have seen other companies run L&S wailing and blarring passing us all the way down to the hospital and getting there no faster then us. Plus who wants to hear the damn siren for 30 minutes. What Richard talked about is a big problem that I try to educate everyone I get a chance to about. DONT FOLLOW MY DAMN RIG!!!!!!!!! I hate having either a family member or just Johnny Comelately get on my rear step and follow me through traffic and such. Bad enough folks dont yeild for us most times but if they do they are not expecting a POV to be right behind me. Also I may have to hit my brakes for whatever reason be it a deer in the road, errant car pulling out a driveway or side street, bus coming head on with me (dont ask). If I need to apply the stop pedal liberally and your on my ass you now become additional patients. Please don't. I try and get family members to leave ahead of us if possible that way its one less thing to worry about. ALS do what you want in the chase truck, your trained too LOL

Ok this JUST happened 4 hours ago!! I had to post it because the basics (me included) two medics, medical control, ER staff EVERYONE could not believe this medical mystery. Called at 2:30 AM ( I know nothing good at that time of night) for an unresponsive female that is diabetic. By the time we get the rig rolling the patient is still unresponsive and it being the third "episode" today. By the time we hit the door patient is alert but altered mental state. Husband says its her sugar but they havent checked it much. BGL on scene was 17!!! But checking the test strips (they were the patients) they expired in 08 so we didnt think it was accurate. Load and go and meet medics in route. After one tube of instaglucose patient is AOx3 before we reach medics. Medics take another BGL and get 11!!!! THEY call medical control and were basically laughed at. Take another BGL this time venously and get 18!! We have this women telling us stories of her grandchildren, knowing current events, and even the time yet her sugar is 18!! Two amps of D50 later we get a 48 on her. Hang two bags and recheck. 68 then about 3 minutes later 48 and droping. In the ER nurses take another and shes back at 38 and hasnt changed status AOx3. We are all scratching our heads.

Bierber I hope I did not offend you. I appreciate your comments and your ability. I was talking in general and was not meaning anything twords anyone in particular. I agree that we all make descisions base don our own knowledge and thats exactly what we all should be doing. I guess my rant was more for the folks that think they are or can be the end all be all of emergency medicine. Agan sorry if my little rant before offended anyone. I did not mean to come off that way, I just wanted to shake the box a little and have folks think about things a little.

The more I read this thread the more worried I get I dont know about everyones training or schooling what-have-you but I know that when I was in school I was told we DO NOT diagnose patiens, we are providers, not doctors. Ok that stubbed toe doesnt need m transport. I get that. BUT I am not refusing a pediatric patient, EVER. I have seen peds go from fine to pucker factor faster then you can read this. Most cardiac peds are from respitory problems. Choking is a big thing, they love putting stuff in heir mouth. Ever seen an exray after a relieved choking episode? Not pretty. As far as adult patients. If they called its THEIR emergency. Unless its tottaly benign, IE stubbed toe paper cut ect, I will be transporting. I am not loosing my liscence because I felt their wasnt a problem. I do not diagnose, I treat. Once I am trained and educated for a number of years in med school plus internship then certified as a Doctor and add PhD after my name I will be an EMT, Emergency Medical Technian, be it basic intermidiate or paramedic. I am not a doctor thus I treat not diagnose. I think some are getting that big head and think they can diagnose. I hope ou dont, I dont want to hear of any of us in the City lossing their liscense. I see it in the field alot, folks making desicions based on "diagnosis" versus training and SOP. Sorry for the rant and I hope I didnt offend anyone but I had to voice my opinion. Regards, UGLyEMT

"Emergency Medicine Physicians invited residents to submit a video showing why their residency research program is the best in emergency medicine. View the videos below, then vote for your favorites! The three entries receiving the highest number of votes by 12:00 Noon EST on 12/15/10 will receive cash prizes for the resident and the residency program-including a top prize of $5,000 for the resident and $10,000 for the residency program!" LOL Dwayne read before voting LOL

ER I totally agree. basic skills (not level here) are always important. I was just mentioning that sometimes when ALS gets onboard they dont want the EMT-B anywhere near "their" patient. Thats when I feel we get put off. I feel we have alot to offer the patient even in the paramedic / emt setting but their are some that feel once they are on the rig its their show. I was just letting Beiber know not to be "that" guy thats all. BTW Thanls ERDoc for giving Basics the thumbs up as a vital part of the crew

smart call on getting all 3 in the air. This will be a prolong extrication especially for Patient 3 the female red car passenger. Looks like she will actually need to be brought out from the drivers side. Even with cribbing the risk of collapse would be too great in my estimation. (I have no FD expereince so extrication is not in my SOP, just thinking it in general) I will wait till a few more chime in. I think i have given enough information to begin to think about treatment. Vitals will come next and also what the trauma naked reveals. You all most already be thinking what might be under those cloths.

I like the system I am in. If we need ALS we get ALS but most of the calls can be run by just BLS so it gives me great experience. When we have intercepts ALS they bring everything in they need, I have yet to see us leave stuff in their truck. We even have room for CPAP equipment to be secured down. FYI our ALS trucks are just Chevy Suburbans with just enough room for two medics LOL Yes one of them drives their rig and follows close behind. If we need both back in my rig, rare but happens, the EMT will get out of the rig and drive their truck. I guess it comes down to your area, what works for my area may not work somewhere else.

Beiber. No all my experiences with ALS have been good ones. But as you just stated being your ALS oriented you want monitor and IV which means BLS is out of the loop in my system. So I would just be in the back staring at the patient not really doing anything. If I dont have ALS on board I am the provider. I will do the vitals, take lung sounds, check pupils, listen to bowel sounds, ect. I get alot of experience as most of our calls are 30 minute travel times to the ED. Plus I get to have interaction with the patient, talk BS that sort of thing. Now with ALS on board the vitals are done by the LP12, the medic takes the lung sounds and has all the interaction. Thats what they do, its their job. They are the higher medical authority on the rig at that point. I learn alot by watching and listening to what is said and reactions that are got. I dont mind being with ALS I just wish in my system we could do more then sit there. Remeber that if your on a BLS rig at anytime Beiber. You may make some EMTs put off if its all about you you you in the back. Look at it this way, picture being in the back of your rig day in and day out and every once in awhile some hot shot gets back there and takes over like its all his and pushes you to the side. How would you feel.

Here in NJ its all BLS rigs with ALS being hospital based trucks (non transporting) that do intercepts. When ALS stays onboard with us EMTs turn into assistants. We will hang the bag, open packaging, hold things that sort of thing. If it was a code we will be bagging as the ALS uses their LP12 and manually difibs. Trauma calls ALS does their thing we do ours. We will be splinting, tabing bleed controling ect while they get intubations, meds, IVs done. I like doing the trauma calls with them because its the one time we all work together vs a parent child relationship when we sit on our hands while ALS does everything. Hope this helps

Well last night was the vote. I went from nominated to accepted Starting in January I will be the new 1st LT. Get sworn in Jan 8th so all is good in the world now Already started my ICS stuff. Doing my 400 in Dec. Already got the 100 200 and 700 out of the way online now just have to do the class time ones. CEBRN and Hazmat are this weekend followed by Rail Saftey with NJTransit the following. Then its all good, I will have all the prerequisites done.

All very good points! I listed burn center only because it was in my head LOL sorry about that. I know in my area the regional burn center also has a trauma unit so its a secondary site to send patients. My line of thinking was 3 patients, 3 traumas, one hospital may divert so want all my options available. OK FD has no problem doing spinal precautions. FD Cheif agrees to take Patient 1 (truck driver) out first. The cut away the door, you have full access to the female now. Patient 1 Upon entery RTA you notice: There is blood in the left ear Right is clear Pupils are dialating but are not reacting equally There is blood in her mouth by it is clearing on its own due to head position Palpation of the upper chest makes her moan but you feel nothing remarkable Palpation of the abdomen revels rigid ULQ URQ Pelvis is intact and stable A compound leg fracture on the right leg of the tib and fib Lower left leg is impaled on the emergency brake Verbal is still unintelegable Patient 2 and 3 are still being extricated during this time. Patient 2 You are near the patient and speaking with him. He is complaining of severe pain everywhere Due to his position (foward and twords passengerside) he is also complaining of difficulty breathing Keeps asking about his wife Bleeding from the head is on the left side inside the hairline No other bleeding is evident Hard for you to really see the patient due to position Patient 3 You are near the patient and speaking to her She is complaining of arm pain you visually see deformity above the elbow below the shoulder noncompound Shoulder is not in correct position Also says she is numb everywhere else "feels like pins and needles" Keeps saying she is sorry No visable blood Breathing is labored, rapid, shallow Again they are still trying to get into the red car.

Ok all good questions Ok all the scene is secured, fire guys did their thing, everything is safe. Before any cutting they want to know what EMS wants done. No CO detected as per FD, red vehicle wasn't started yet. Truck shut off on airbag deployment. As per the original post Helicopter is available, we are mid day sunny skys light winds. If necessary a ball field is a few blocks away. You are on the BLS rig with an ALS unit on scene with you (non transport unit) there are 2 more BLS units available and one ALS (again non transport). Times per the OP Level 1 is 30 minutes out by road Burn Center is 45 by road Local Hospital is 20 minutes by road Now for our patients. (this is what you see upon getting into the garage to guide extrication crews) Patient 1 Driver of Truck 45 yr old female Communication is unintelegable mostly moans but responds when asked questions She was unrestrained Windshield is spidered above the steering wheel with visable blood and hair on it Steering wheel appears bent foward Her position is against the wheel slumped foward and to the drivers door Visable blood from her head and on her cloths Airbags did deploy Front of vehicle is heavily damaged mostly on driver side Does not appear to have intrusion into passenger compartment There is an odor of ETOH eminating from the vehicle (can not tell if its the patient or the vehicle itself yet) Patient 2 Driver of Red Car 55 yr old Male Communication is verbal, complaining of severe pain everywhere He is restrained in the vehicle His position is foward and twords the passenger side Bleeding from his head Roof is crushed down into the passenger compartment almost to the door Patient 3 is Passenger in Red car 21 year old Female Communication is verbal, complaining of severe pain to her arm and shoulder feels numb everywhere else She is restrained in the vehicle Her position is against the passenger door, head foward No visable blood Remeber folks this is the intial assesment to guide the extrication crews, no vitals have been taken yet. I know I am going slow with this but want to give a good step by step to a multi patient MVA with confined space also a factor so other may learn. I know this assesment was probably done by 3 responders (be they als or bls) in 30 seconds to a minute by it is a vital step in the process. Especially when it comes to deciding the priority of the patients. Thanks for the responses PS: Again this is a made up scenario, not a real case.

Wow that story was inspirational. Definatly passing it along! I just want to thank all of our veterans for their sacrifices, some the ultimate, for it's because of you I can type this, it's because of you we have this web site, its because of you I have the freedom to be an EMT. Thank You To others just a simple reminder THE PRICE OF FREEDOM IS NOT FREE

You guys get to have all the fun. And the cool drugs too

all good questions. Nice we get to move foward. Ok heavy rescue is begining to brace both vehicles. You have made voice contact with all related parties. Female in the truck is unitelegable but is responding.. The two people in the red car are verbal and can answer your questions. Power to the garage has been shut off by FD. Looking at the picture and having part of the garage door between the two I would say the truck went through the garage door and landed on the red car. Floor is poured slab, no basment. now what?