uglyEMT

I would like to add a few things to this topic as it is one I think about alot. I am a Basic, not in para school, just your run of the mill basic. We have ALS support w/ chase vehicle in my local system. in NJ all ALS is hospital based and BLS is town based. So know you know a little of where I am coming from.... On the topic of ALS vs BLS SOP in NJ anything above giving an Epi autoinjector is considered ALS. No blood glucose, no asprin, nothing. Even NTG has to be "assisted" and the Pt own Rx. Inhalers (albuteral and the likes) we can watch you do it (pt that is) and monitor vitals. So in my system I do feel Basics should be allowed to at least take blood glucose levels, administer asprin, give NTG when indicated, give albuteral and the like for respitory patients when indicated. Above that I feel we should keep our hands to ourselves. ALS is ALS for a reason, they know the modalities, the pathways, the meds inside and out. Not because of some course they took but because of actual schooling and clinical rotations. I would not dream of infringing upon their area because I, as a basic, have not the skills or the experience to do their things. Do they let us assist? Yes actually. But I must clarify, we ASSIST THEM, not do their things. They try and keep it all within our levels SOP but know a hand now and them is necessary. I will provide an example of what i am talking about. They will let BLS help with an IV, we (meaning BLS) will hang the bag they handed to us and get the line ready for the drip while they (meaning ALS) is inserting the IV and doing what they have to do. I then hand them the line from the bag, they clear it and attach. I didnt exceed my SOP and he didnt allow m,e to violate his. I just lent a hand where it was needed. As Dwayne said in a post about bagging a tubed Pt. We do that alot. ALS does all the intubation and then hand us the bag and tell us what they would like, every 4, every 6, what-have-you. Again not outside my SOP and not infringing on theirs. Usually the ALS crews have worked with us before so they kind of know our skill sets. My squad has BLS's with over 25 years experience so ALS almost doesnt have to ask them to do something its just done. Me? They teach me like a 4 year old and you know what, I am glad for that. Just because the bag goes on the hook, they dont assume I know it properly so they tell me what to do and I do it. This to me is great, i get the practice, knowlege, and skills to assist them and learn to do it correctly. As far as meds go.. we only get the empties to verify for the PCRs what it is (can the make the names easier, sheesh) and the dose. Do we get to do anything with them... hell no. Closest I ever came to that was holding the syringe for the Medic while he was on with medical control and reading the meds off to them for verification. I'll tell you what, just holding it made me nervous. Only because of lack of experience. Now if i do it more I will feel more comfortable and it will be easier to lend a hand. I feel certain things I should be allowed to do. Prick someones finger for a glucose level I dont feel needs to be done by ALS I feel a BLS should at least be allowed to do that. Now are their instances when it would be advisable for ALS to be there? OF COURSE, get someone with a 20 on the meter and I want my ALS buddies there to push the meds that they do. I cant give the glucose to an unresponsive so at that point it would be in the Pt best interest to have ALS there. Now if Im called to the house of a diabetic thats fully responsive but is feeling off then it would be benifical to both the Pt and me to take a quick test, see the level, administer glucose, wait a few minutes, retest and see where we stand. I have provided a good level of care, I have trends to monitor for both the Pts wellbeing, my knowlege, and the hospitals knowlege through the PCR. Another example, chest pain call. We get there, Pt describes 10/10 elephant on chest BP is over 100 no ED meds taken but is out of his Nitro pills. I feel a BLS should have them or asprin onboard and be able to administer a dose and do everything thats in our SOP. Which we can do if the pills are the Pts Rx. My only change is we as BLS should be able to carry them onboard. Would I still have ALS meeting me, YES, but in the mean time at least the Nitro or Asprin can do its work as a vasodialator and help the herat work less which would give the Pt more time to get to an ED without potential heart damage. Fine you dont want us having nito then at least bayer low dose, might not be much but something is better then nothing until the ALS meets us enroute, if they are available, and can push IV meds. I feel we should all work inside our own SOP but be able to lend a hand, within reason, to one another. I think the examples I gave are reasonable and not stretching the rules into a grey area.

I agree, basics shouldn't be doing Paramedic level anything. Yes we can assist the Paramedic with things, the local ALSes here encourage it, he gets the IV in while we hang the bag and get the drip flowing. Helping intubate we usually do but I haven't personally. Meds, we usually confirm dose and correct medication for our paperwork, I go a little further and ask the medic why. Its just information for my knowledge and nothing more but I like to know WHY something is being done and not just that it IS being done. I feel the amount of time and effort medics put into their education and training shouldn't be diminshed to anyone. Yes are there a few things I personally feel a basic should be taught (the administration of asprin or starting IVs, not the meds just the IV line for example) and that the crash course EMT-B program should be lengthened as well as rotations in both the ER and in the Rigs. But I dont think everything should be taught in this manner. I think a large problem thats out there now is the lack of civilian education as to what we actually do. These TV shows make it seem like everyone is a medic, we can do anything in the field, and we save people all the time. We were on a CPR call the other day using the AED while ALS was enroute and a family member wanted to know why were wernt starting IVs or reading ECGs (Im on a BLS only rig) like they do on House or <puke> Trauma. It made me ponder on our way back from the ED. People see these shows and think thats how it really is and it puts us all in a bad light when they think we are not doing something because thats what they did on ______ (insert show title)

maverick56 thanks for the info on those two definitions. As far as Christopher Reeves goes, he was my fathers roommate at Kessler when he was there. He was a very brave man and taught me alot about the human spirit and the human condition. In my fathers case it actually was never severed (the spinal cord) he had a blood clot between C3,C4,C5 due to a low speed MVA. When I say low speed I mean he backed into another car in a parking lot!!! One reason I am a PITA at MVAs with getting everyone checked even though there is no significant MOI. The clot put pressure on the cord and apparently the cord never recovered. As far as the limited upper extremity ROM its so true. He always said he would give up his legs over his arms. Ruff you are so right I also learned alot from the posts. It does help get through some of it. I know it seemed like basic stuff that I was asking for but for some reason I drew blanks. I picked up the event and got the wheels in motion but since then I have been like a space cadet. About the only things that are up there are my ABCs and BSI LOL FYI for anyone that was wondering, I was on the phone with him when he asked a very general question and it set the bells off for me.... What do you do for heartburn thats lasted all day? My question was have you been sweating? Yes. Difficulty breathing? NO Arm pain? NO Chest Presssure? NO Jaw pain? Yes now that you mention it. Dad get off the phone and put Mom on... Mom give him an asprin and get 911 there NOW. EMS came, he never had LOC, never needed the AED, basically just had the heartburn, sweating and jaw pain. I know we got lucky and there is issues ahead for us but at least we know what to look for as far as the heart goes. I am sure his regular cardiologist will give a complete rundown of what needs to be done and what can be done to prevent future episodes.

Their term not mine LOL Basically he has very limited movement of all extremities. He has control of everything internally as well. Some sensations of hot and cold, no pain though. Legally classified as a quadraplegic according to the Doctors. I say partial because he has some limited movement and sensation. He needs a wheelchair but is not bound to it. If helped to his feet he can use a walker with arm craddles and take a few steps. Cant do long walks but at least Mom doesnt have to lift him to get stuff done. Does that make any sense?

Thanks guys thats what I was looking for. I knew some of the terms just not everything. I guess it more scared me because I am not right around the corner to lend a hand. I will be tomorrow but until then I will make sure he keeps up with his cardiologist, thats the reason they are flying up here to NJ. His cardio is up here so instead of having the Florida doc work on him he's going to go to his doc. Thanks for the explinations.

Just wanted some basic info thats all. I tried talking with the Doc but he brushed me off on the phone. Like I said they are in Florida and I am here in NJ so face to face isnt possible right now. I basically just need to know whats going on, kinda like a scenario question just with an actual case thats close to home thats all. I kinda know what most of it means but some of it is just above my head right now. I also just reread my post, cant edit it for some reason, I mispoke when I said I diagnosed the NSTEMI, what i should have said was based on what my father described to me I felt it was an MI in progressed and had Mom call 911. My appologies. Thanks everyone for anything you can shed light on

Hey guys and gals. I need real world advice for my Father. My father is a 67 year old partial quadraplegic for the past 7 years. He was with my Mother when he had a (as DRs descibe it) mild heart attack. I need your advanced diagnosis and thoughts on this. I will give an exact description of the discharge paperwork that I understand but can wrap my head around right now. NSTEMI Non Q Wave Peak Cardiac Triponin .86 Marked Hyperlipodemia Marked Hypertension A-symptomatic Severe Cardiomiopothy Ejection Fraction 25% Akanisis of posterial wall Severe Hypokenisis of anterior lateral wall Mitroregurgitation 1+ and is now on Mononitrate 30mg Imador (sp) Please help me understand whats going on beyond my EMT-B knowledge. My folks are out of the hospital and flying home this Wednesday June 23. Is this advised? Dad did not go for the angioplasty due to his condition but still wants to come home. Please help me, in lay term s, whats going on and if travel is advised. Thanks everyone. UGLy PS I do not have ECG to upload. Only the hospital discharge sheet PSS they are in Florida and I am in New Jersey,&nbsp; I diagnosed the NSTEMI over a phone and had MOM call 911

Sick:shifty: Twisted:wtf2: I LOVE IT LOL:punk: Lets get them operational as quickly as possible.

Totally agree with you Lone Its amazing this number of folks decided to be lazy instead of taking the few extra hours to keep up their educations. Its also sad too that instructors allowed this to happen by providing the credits. Mass definatly did the right thing by suspending them all and possibly revoking their credentials. It is such a FAIL to the public we serve for this too happen.

Mass. Revokes 211 EMT Licenses By Erin Smith Lowell Sun (Massachusetts) BOSTON -- The state revoked the licenses of 211 EMTs after an investigation revealed they held falsified training records. http://www.emsresponder.com/article/article.jsp?id=13682&siteSection=1

Back from my training Ok I got to read through the comments. I see some others have had the same thing I did, having to go through the motions. Well i can now shed some light on things said and done. First off the instructor worked for a national cert company and did an excellent job of keeping the class interesting and giving real world scenarios. The first question he asked was does anyone have a CPR card, if we did he said we could go I stood because I could use the break He asked if anyone was a FF, responder, ect. I said I was an EMT and he made me his bit errrr assistant. He did a good job of conveying the whole if your doing CPR it means hes dead you cant hurt dead message. He did mention what Lone Star mentioned about being a higher medical authority I better hope, unless I want to help, that noone calls me because I would be the one responsible. Said it would be the same laws that we all follow in the field in regards to higher medical transfer. As far as the safety guy goes, again I still think he's in the shallow end of the gene pool, and the pool needs chlorene. He wanted folks extentions for their desks incase someone goes down he can call them. I see a huge problem here. What if the person he calls doesnt want to help? Not comfortable in helping? Ect, ect ect? By being notified of the situation wouldn't that be putting the person in a duty to act thus not doing it be a breach and thus liable? I dont feel the company should put that burdon onto folks trained for 2hrs in CPR. I can see the cluster F now... someone scrambling to call desk's of folks before calling 911 and wasting valuable time. Anyways, thanks for your comments and I think this may be a good thread for other folks too that might get into this work situation. Keep em all coming. BTW... Im a guy not a girl and second I dont mention any names hehehe

See this is why i come here LOL I guess I took it all the wrong way. I understand the OSHA thing. We get training constantly here for everything. I guess the CPR thing threw me though because I figured an AHA card was universally recognized thats all. I dont mind going through the training, it gives me 2 hours off from my job and practice at skills. I guess my thing was what was said and how it was said. Having one of those days and then this and well........ Thanks guys BTW my boss is still a moron in my book LOL

Well my day job's Safety Boss is officially a moron now. He calls me up today and says a I have saftey training tomorrow, so I inquire as to what and why. I have recently just got done with refreshers. He proceeds to tell me I have to go for CPR training and Defib training. I tell him no need and hand him both my CPR card from AHA and my state EMT ID which states defib cert. Now comes the moron part... He tells me and I quote, " Those mean nothing to me, you have to be trained by our instructors and on our equipment." I inquire as to why this training and equipment would be any diffrent then what I am already certified with. He tells me that just because I am an EMT doesnt mean I know what I am doing and that our equipment is diffrent then what anyone else uses. I ask what CPR training am I going to be taught.... we are going to show you how to do compressions and breathing by a "professional" cpr instructor. Um OK doesnt my CPR card already mean that? DUH!! I ask as to which Defib (I do know) equipment we will be training on... Fully automated AEDs again by "professional" instructors. Um OK doesnt my defib cert for manual AEDs already mean that? Double DUH!! I try and explain to the safety guy that all my EMT certs are at or above what they will be training me on and that it should be good enough that I am showing my credentials. I was then told that my credentials are not recognized by my company because their instructors didnt do the training. I officially work for morons. I will go to the training tomorrow and waste the day listening to them tell me what I already know. Oh well at least I can use the time to refresh my skills on the maniquins. I wonder if I can get CEUs from it LOL Just needed to vent folks.... repley away if you would like. BTW my day job has nothing to do with EMS or medical anything just an industrial company that wants workers trained to save folks yet wont allow a first aid kit because they dont want folks dispensing medicine. I dunno.. I dont make the policy I just follow it.

Richard if the siren is part of a buglar alarm and not used for another reason then no its not illegal. Just as anyone can have any number of strobes, wig wags, sirens, what-have-yous on their vehicle as long as they are used "off-road" ie car shows, events, parades. Using them on the streets to move traffic is illegal and actually, depending on the officer can be a crime. Here in NJ we need a permit for blue or red lights. Blue being for EMS and fire with red for Captains and Cheifs. We are allowed to have electric horns but not sirens unless we are chief or captain. 1. Section 1 of P.L.1977, c.223 (C.39:3-54.7) is read as follows: 1. An active member in good standing of a volunteer fire company or a volunteer first aid or rescue squad recognized by and rendering service in any municipality may display on any motor vehicle driven by him an emergency warning light or lights or an electronic horn, approved by the director, or both light or lights and electronic horn as provided in this act. The Director of Motor Vehicles shall not require the member to specify on which motor vehicles the emergency warning light or lights or the electronic horn may be mounted. "Electronic horn" means a non-pneumatic, non-wavering electronic, audible warning device. 20 (cf: P.L.1995, c.37, s.1) There is alot more to the law such as the part about red lights, mounting locations, use and the newly added (but never informed to the public) section about driver haveing to pull over to give you the same courtsy that an ambulance or fire truck gets. ... that the drivers of non-emergency vehicles upon any highway shall yield the right of way to the vehicle of any member of a volunteer fire company or a volunteer first aid or rescue squad displaying emergency warning lights or an electronic horn in the same manner as is provided for authorized emergency vehicles pursuant to R.S.39:4-92.(cf: P.L.1977, c.223, s.6) As far as selling equipment, if its not needed to be sterile or for life saving measures (aeds, cricks, ect) then I really dont see a problem with it. I bought some stuff off Ebay that I carry with me. Scissors, tape, gauze rolls, gloves, bags, tools. Nothing a trip to the supply store couldn't get me but the prices were good for bulk (the gloves, tape and gauze). As far as AEDs and the like, NO that should be regulated. I can see buying training ones (the ones that dont really work just simulate everything) as that would be good to keep your skills up but working stuff should need proper ID and orders to get. I am one of the supply guys on my squad and have a card with the Squad name and Rx number on it to go to the local supplier and purchase stuff like airways, meds, ect. but when I get there I still have to give my DL so if anything gets hinky they know who to blame even though the guy knows me by now.

We are issued... 2 T shirts 1 Pants 1 Sweat Shirt 1 Three Season Jacket 1 Rain Suit everything else is up to us. Of course the pager and radio were supplied as well. What I added.... Scissors Pens Pad Flip book Multi-tool LED Mini flashlight (both red and white leds) 3 Knives in various pockets Stethescope Mechanix Gloves in blue and white CPR Mask Pen Light Only thing on my belt is the LED flashlight and pager everything else fits nicely in the 5.11 EMS Pants. Scissors, Pen Light, and one pen show everything else stay out of sight. I know most dont carry a ton with them but I have more then once needed everything I carry with me now and it either wasn't in the rigs jump pack for whatever reason or I was in a position that made getting to the jump pack not possible. The stethescope is just because I like to use my own for no other reason then that.

Bout the only things we pull around the house and equipment is giving the new folks the fake tool gags. Noone gets hurt or anything damaged. Our favorite is asking someone to go and get the water based petroleum lubricant for the NPA. Some other good ones..... Go and get the catapillar straps. Get the medium sized back board Make sure you rotate the O2 batteries Go grab me a premade, cotton and rubber, semi-occlusive adhesive dressing During rig checks I always seem to ask someone if the muffler bearings were checked Was the kunuter valve replaced last week? Did they finally get us that (whatever season it is) air we ordered? Did they rotate the (whatever season it was) air out of the tires? These dont last very long but usually get a laugh when a probie joins us or when you can tell someone is preoccupied mentally and wont pick up on it quickly. Then there is always are favorite "tricks" with patients to help them calm down. No we dont do anything to jepordize them or us. Just some little ice breakers. Some scarred of going on the stretcher? Ask them to hold this (pick a tag end) strap, it will really help us. "please don't drop me, OK!" Nope we never do, only on days that end in Y does it happen. (that usually gets us a nice grin and a giggle) With some of our frequent flyers we have inside jokes that they are in on that we break probies in with.... One of our guys has a way of simply going limp, I dont know how he does it, that usually freaks the rookie into thinking the pt just coded. His que from the rest of the crew is usually this.. "Hey (name withheld) meet Soandso he new to the crew tonight and your his/her first patient, Please Be Nice. Usually with a touch on his hand or arm during the last part that the rookie can not see. He does his limp thing and we watch the reaction of the probie. Some freak and want to paddle ASAP, some freeze, some pinch, some go Um Uh I think he Um Uh Died.. He then usually opens his eyes and goes BOO. Ok its kinda sick but hey its all in good fun, plus we get the benifit of seeing the probie under fire but in controled conditions.

AMEN Brother. Finally something I 100% totally agree with. The public just wants someone in a professional manner caring for them in their time of need. Just like alot of the public calls all EMTs be they basic or not Paramedics. They are just accustomed through media and entertainment to assume we are. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- As far as House goes. There were a few discrepancies in the show, such as patient abandonment (which to me was a bigger problem then calling a medic an emt) . But we need to take it with a grain of salt. Did I yell at the TV? Sure. Did I point out the problems to my wife? Sure. Thats just human nature. Its a decent show if your in it for the entertainment value vs the real life value.

LOL Another Dead Shift. Thats 4 in a row and after I made my quiet post. Either the karma gods are building up am A-bomb for me or the superstion is bunk.

No need to bang head on desk LOL I'll still give you a 14

LOL GW was not the first president... John Hanson was the first President. The new country was actually formed on March 1, 1781 with the adoption of The Articles of Confederation. This document was actually proposed on June 11, 1776, but not agreed upon by Congress until November 15, 1777. Maryland refused to sign this document until Virginia and New York ceded their western lands (Maryland was afraid that these states would gain too much power in the new government from such large amounts of land). Once the signing took place in 1781, a President was needed to run the country. John Hanson was chosen unanimously by Congress (which included George Washington). In fact, all the other potential candidates refused to run against him, as he was a major player in the Revolution and an extremely influential member of Congress. Six other presidents were elected after him - Elias Boudinot (1783), Thomas Mifflin (1784), Richard Henry Lee (1785), Nathan Gorman (1786), Arthur St. Clair (1787), and Cyrus Griffin (1788) - all prior to Washington taking office. Why don't we ever hear about the first seven Presidents of the United States? It's quite simple - The Articles of Confederation didn't work well. The individual states had too much power and nothing could be agreed upon. A new doctrine needed to be written - something we know as the Constitution. George Washington was definitely not the first President of the United States. He was the first President of the United States under the Constitution we follow today. And the first seven Presidents are forgotten in history. BTW kiwi Henery Sewell 5/7/1856 to 5/20/1856

Well if it did work I would be busy but I have now gone 3 straight shifts without a single call. SLOW BORING QUIET And the one about the boots... took them on and off 5 times a shift so far. Nothing Oh and the one about the "haven't had one of those calls".... havent had an MVA, Respitory, Medivac, ALS, Code, FDGB, Dog Bite, or OD in a while. Again nothing. Oh well.

This I can agree with 100%. Thank you maverick You are correct about some folks fitting stereotypes to a "T" and I have seen that on the paid side as well. I agree with the prospect of running too thin or skeleton crews. Thats just bad patient care and dangerous. I would hope this town will at least after hiring would require CEVO. I know in my squad our insurance company wont allow anyone without a CEVO to be behind the wheel (I deal with the insurance so I would know LOL and also noone under 21) My squad is small right now but we all pull our weight and cover. We always roll 3 to a rig and some of us are "just drivers" but all are EMT-B certified. Just do to age or other things, they dont lift or carry patients just drive. It works for us though, and as you said, what might work for our little community might not (probably wont) work for some place else. I just dont like to see the broad brush stroke of fail when it comes to volunteers just because they are. Yes the ones that deserve it by all means go right ahead but please dont put down all volunteers. As far as firemedics go... I know a few and the services they work for actually care alot about the EMS side. These guys and gals never went to fire academy just emt school and do nothing but ems. Their town saved money by basing the rigs with the fire dept but each is a seperate entity inside of itself. The ems has its own chain of command and training, they just have the benifit of the fire depts resources. Again as with vollies I just dont like the broad brush strokes.

Um NO! I dont get this at all... Volunteer = fail WHY? We are all trained and state certified, paid or not A driver, not two medical professionals = fail I didnt see where it said just one and one? Maybe they need the driver to get 2 in the back 2 members and a driver = fail WHY? Whats so bad about that the last two are not even worth asking about. It is such a shame that this website HATES volunteers so much! We are all part of the same community yet volunteers and firemedics are looked down on like dog crap under a "professional's" boot. Im going to shut up now before I start ranting.....