uglyEMT

Dust ED is 45 min ride away, ALS is responding from said ED, no waiting just intercept along the way. BTW ALS responds to most calls as per protocol, we are just far from the ED so usually BLS is onscene, packaged and in route before ALS gets half way. Dont knock the NJ vollies in their entirety, we do make good decisions, we just work with what we got.

Richard sounds like the initial pt contact was by FD. FD EMT asked for the refusal. Seems as though their FD EMTs dont complete PCRs or transport. Dont know where the OP is from but I know in my neck of the woods FD will always call BLS for any MVA regardless of pt wishes. Not that big of a deal to go out, check the pt, RMA if OK. Perfect example... Low speed MVA, no airbag deployment. Pt sitting on the car hood upon our arrival. Stating quiet angerly why were we called, its nothing, blah blah blah. My partner goes over to the patient for a quick once over and imediatly calls me to come over. Points at pts ear, fluid seeping out. Long story short pt had closed skull fracture from a bar fight. MVA had nothing to do with injuries, but the injures caused the MVA. Never hurts to check, no matter how minor the MVA. Another example of low speed... My father!! Backing out of the driveway another car comes around the corner and he backs into the other car. No damage to my father's vehicle except some paint transfer, other car had a dent in the door. I run over to see what happened and my father is slouched over in the driver seat saying he can feel anything. I call 911 and while waiting the other guy starts screaming about how my Dad is just trying to get a claim out of him. Make a long story short, Dad damaged the spinal cord at C3,C4,C5 and has been in a wheelchair for the past 5 years as a near quadraplegic. If I didn't witness the accident I would never have believed such an injury can happen at such a low speed.

Gotcha JT. I can understand that. I haven't seen alot of the problems first hand but have read about them. I guess I just took offense to some of the comments about getting what you pay for and vollies aren't good. To me it depends on the person, when I went through EMT school I seen several students not give a rats behind about patient care and did just what was enough to pass (that lovely 70 average ) now are they going to become good or great EMTs? I dont think so but hopefully they get weeded out by where ever the go before the neglegence of a patient or worse. I do think they need to up the qualifications without a doubt. I do think even for EMT-B school they should require more rotation time, be it ED or ride along. I think 10hrs just isn't enough for that hands on expierence everyone needs. Hopefully one day the powers that be will get organized at figure out exactly what needs to be done and what level of training is necessary. I will say this, I feel my instructor at school said it the best as far as the current level of EMT-B qualifications...... Just think you get 120hrs of class time and are expected to hold someones life in your hands. A hairdresser gets 400hrs of class time. I guess a persons hair is just that important.

Being a volunteer from NJ can I ask why all the hostility on the board twords us? I understand about the FAC and some squads not being the best caliber but why blanket wash all volies as a whole? I know some great EMTs that are volies, I also know folks on my squad that will call ALS in a heartbeat if they believe its above their expertise or the patient requires it. As an example.... MVA w/ minor injuries but pt stated she was a diabetic and hadn't taken her meds today. ALS dispatched and checked pt.. released to BLS. Only reason for the ALS was the blood sugar, better have her checked then not.

Being a volunteer in NJ I can shed some light. No federal tax write-offs sorry. Some towns do give tax breaks on property taxes. Not all towns just some, check your local townhall. We dont get medical insurance, but being an EMS volly some insurance companies offer breaks on rates. We do have LOSAP which is basically an annuity fund that gets paid into by the state if you keep up with your volunteer duties. Google NJ LOSAP for all the details. As far as having to be from said town that again is all local protocall. The town I live in has two squads. Normally calls are broken up by boundry lines but we do cover with mutal aid if necessary. Also volies from both squad can respond to general alarms if necessary. Even FD can be drivers if we need them too. FD and EMS are seperate in my town but we all get along well. Best advise I can give you is too go to your local squad and ask questions. They would know the specfics of your area. As far as the benifits, those are statewide so I dont think much will change from area to area. Tax breaks, again, are local not statewide so check your local tax office for clarification. My town does not offer the break but the next town over does so thats a good example of just how sporatic it is.

I have a question about this. No tobogans(sp)? I worked the late Feb snow storm with my squad, we had drifts to 7 feet with a blanket 4 feet eveywhere here in Northern NJ. We were dispatched on several calls that day (plow was with us) we basically swam to peoples homes to get in. We used old fashioned wooden tobogans to get the people to the rigs. One emt was the puller and if needed one was a pusher. Not saying this is practice everywhere but in places that see large snowfalls couldn't it be done as well? I agree the women making the riduclous on air comments was stupid for doing so. As for 10 calls and asking the patient to walk out, I cant belive it was even a thought. I guess I am nieve as a newbie or jaded as to my local squad practices but I always thought we do what is necessary to provide patient care. Yes scene safty first and foremost but I would think getting to the patient is also a priority. As for the powerlines down (I believe I read that) isnt a phone call to the power company warranted same as in an MVA with down wires? Sorry if I sound like a total probie or what-have-you but I guess in my heart I would have tried things to get to these folks. Even a backboard might have worked to slide him across the snow. Pic below is from that storm....

2 birds only All out of the water. Besides the above mentioned injuries.. Patient 1 Front seat: Abdominal tenderness ULQ Patient 2 Rear Driverside: Contusions consistant with seat belt placement Patient 3 Rear Passenger side: Pelvic instability right side

ALS is just a suburban, Medic rides in the back of the BLS rigs with ALS vehicle following. (thats the way we do it NJ ) ALS has 2 medics onboard. If need be LEO or FD can drive the ALS unit. Birds are in the air after your review. Ruff what about the third passenger? low bp and fast heart rate, sign of shock correct? Wouldn't she be the priority after the head injury for the bird? Thats after the rapid extrication of the other 2 of course

Sorry should have made it clearer ALS is in route 20 min out.

We were discussing this at the building the other day while working scenarios. This is a hypothetical call.... Dispatched to an MVA with injuries, time out is 0340. On scene you find a SUV on its roof off the side of the road partially submerged in a creek (rural area, late march, water around 40 degrees F). Water level is up to the headrests. No airbag deployment. Driver was unrestrained and ejected, skull crushed, obviously deceased. Front seat passanger is restrained and fighting to keep head above water. Rear seat passenger driver side, restrained, is unconsious head fully above water. Rear passenger, passenger side has self extracated and is sitting on the side of the road hysterical. Fire Rescue is on scene, vehicle stabalized, no fire danger. Front passenger, Female Numerous abrasions to face and arms BP: 148/96 Pulse: 120, bounding Resp: 28, deep irregular Rear Passenger Driverside, Male Laseration to the forearm, abrasion w/ swelling to the left scalp BP: 120/80 Pulse: 100, strong Resp: 12, regular Rear Passenger Passenger side, Female No obvious signs of injury, wet cloths Bp: 90/78 Pulse: 140, weak Resp: 36, rapid and shallow All patients are in their mid 20s. Second Rig On Scene Nearest ED: 30 min Nearest Level 1 Trauma: Over 1hr by diesil ALS is available 20 min out

I know here in NJ we do not carry Nitro on our rigs but are allowed as basics to "help administer patient's own nitro" Basically we can help the paitent but his or her own nitro in there mouth. Usually by the time we get there the patient has already had the max 3 doses and the bp is under 100 but still has pains. Thus we are not allowed for several reasons to admin until ALS gets involved. Once ALS is involved they do their magic with IVs and such. In this case I do beleive it is OK for basics to be allowed to help. I wouldn't want to see basics carrying the nitro and administering to anyone. I know I personally would not feel comfortable administering non physician prescribed meds to anyone. Heck NJ doesn't allow us to give asprin LOL The only drug we are allowed to dispense off-line is Epi. Yes we have a bunch of protocols in place for it before administering. Nine times out of ten the patient has already taken their own Epi-pen and we are watching for a relapse of symptoms and transporting meeting ALS in-route hopefully. If not its 45 min to the ED and we carry 3 pens just in case, but protocol states after the first one we need on-line permission to administer any more.

AK thanks for the edit I was just in the middle of a rant and didn't think about it much LOL Herbie. I know what you mean. I have friends on paid services and they talk about being away from the family alot. I don't know whats harder, being away from home 24 to 48 a shift or being a voly and being home but getting pulled away at a moments notice. Sometimes I feel like I would rather just not be home then be home and in the middle of a great moment (whatever it is) and have to run out the door. I have seen the look on faces when I do. (actually had a call during brother-in-law toast at family party) It bothers me sometimes but I made this decision and once on the call usually get filled with a sense of pride that I am helping someone. As I said before I know my 3 calls pale in comparision to most folks but when you dont get many calls to begin with it seems like alot. Guess it all just got to me yesterday. Lack of sleep for 2 days, minor things on the calls, basic life stress. I guess yesterday was my breaking point and the vent cap broke. If it was earlier in the day probably would have happened with collegues or family but being so early in the morning I came here. STC I cant imagine that many calls period. Must be crazy running that many pts to the ED.

This will probably be a long drawn out rant from hell. I just need to vent and decompress so I can relax on my down time. Just came off my weekly second 6hr 1800-0000. Started off bad ended bad and was FUBARed in between. Get to the building for rig check. During rig check find one jump (go) bag was missing BP cuff. Where it disapeared to who knows, checked the call sheets and the rig hadn't been used since the day before (my other shift) and I know I put it back. Must be with all the missing socks in the world, either that or the leprachun needed to check Nessie's vitals before going to Bigfoot's house in the UFO. Anyways.. go to the supply closet and get new cuff, no big deal. Further inspection shows no darn medium gloves!! Check supply closet NONE. At least I knew I have boxes of them at home, no big deal I will just grab them if we get dispatched. Everything else was SOP. Get home and thow a box of gloves in my truck so I wouldn't forget. Turn up the scanner and start listening, waiting for the tones but hoping for a *#&%! shift. Must have been a new dispatcher because within the first hour of the shift 3 dispatches went out but to the wrong crews (some were already on scenes or were on a general) Figured OK nothing major but will be expecting wierd things. First tones come out and its a stroke call 3rd one in 3 shifts, not liking this but at least its the third so should be good for awhile. No major issues on the call except for the rampant complaing from the drunken family memebers that we are not moving fast enough. Bariatric patient, 2nd stroke, left side paralysis. Moving as fast as we could but awaited FD for lift assist. ALS meets at scene and decided pt needed immediate intervention, so instead of where the family wanted to go (ED over 1hr away), ALS advised closest appropriate facility, which was only 15min away but across the state line. (FYI this ED is normally used by us for time sensitive pts that are not trauma. It is in our local protocols). Well that decision leads to the husband attempting to ride on the hood of the rig. like I said earlier drunken family members. PD gets involved (already onscene as SOP in my area) and we transport w/o further incident. I didnt stick around to see what PD did. On the ride back we all get a laugh about the husband trying to ride with us LOL I also laugh alittle harder because of remebering the JEM's article about the wife and husband rig accident. Get back home and have a bite to eat with the wife. Literally a bite before tones. Psych transfer of a bi-polar teen POing his parents. Nothing remarkable with this call just a basic taxi ride. Get back home again and finish my dinner which is now cold and needed to be reheated. Tasted better the first time. Oh well what can you do. Finish my dinner and go sit down on my chair. Dog decides it hasn't seen me in awhile and reverts to its puppy age and tries to become a lap dog. 80lbs later while now in my lap and causing my shears and kelly's to dig into my thigh I just sit there and laugh. Hey sometimes its those moments that lighten my heart. Wife sure laughed. Checked my thigh no penatrating injuries so good to go. Nothing for a little while so I get comfortable. Bad idea, few seconds later toned out for a fire stand-by. Get on scene and canceled. Don't mind those calls too much but after getting comfortable wish it was a real call. Get back home then nothing. Ah relief time goes by and its time to grab some ZzZs while I can. Wake up before end of shift, dont know why just did. Look at the clock and see 10min to go. Think to myself not a super bad shift could have been worse. EMT gods are funny like that, just when I thank them for a decent shift, they notify the dispatcher. We get toned for a LOC but breathing patient. Get the adress and see its in the other squads area. Double check with dispatch, yup its our call other squad is tied up on 2 MVAs and a LOC w/ diffulty breathing. OK no problem 10-23 my rig and await the rest of my ever so happy to see me crew. "10 min to go really" is the now standard line coming through the door. Then hearing the location the jibberish starts in the back. OK full crew now 10-8 to scene. Dispatch says hold on. HUH?!? Hold on? OK awaiting further instructions. Other squad is proceding to the scene instead, they were closer and on the way back from the ED from the MVA. OK sounds great, start backing the rig in. Everyone is elated then we hear dispatch again. Rig 54 (dont laugh please) proceed to *blank* 10-0 involving motorcycle w/ MINOR injuries. We roll but thinking about the call. Motorcycle MVA with MINOR injuries? Maybe the guy just laid the bike down and we are looking at road rash. Get on scene guy is under another car looking like a rag doll. MINOR injuries who made THAT call. Notify dispatch we need FD for extracation and find out if ALS is available. ALS is available but 45 min out. OK dispatch ALS. Hell I would rather have ALS inroute and cancel then wait for them. FD shows up airbags the car we get in there to see what up. Guy is only minor injuries. Complaing of wrist pain. We take full C-spine and board him out. Everything else seems fine, airway is patent, vitals normal, RTA shows nothing else. Splint the wrist and get him in the rig, cut the cloths nothing. Helmet still in place we arrive ED w/o incident. Get back home. Have to be at my regular job in 2hrs. Great, no sleep and a long drive ahead. Well Im here at my normal job. Still tired but at least Im done for the next 96hrs. Thanks for letting me vent. I know it probably pales in comparision to some of your shifts and to some they would swap with me any day. I get that and I know it sounded trivial but felt like hell to me. As a squad we are not used to this many calls in one shift or in consecutive days. Last shift had 3 calls. 7 calls in two days when last month I had 6 calls all month seemed to be alot. If I count the weekend rotation w/ the plane crash we hit 12 calls in 5 days. 2 months of calls in less then a week. Its alot too me. Especially now I am not just a driver but an EMT and being involved with the patients, adds to the stress and emotions. Thanks folks again for letting me rant like this. It really helped. Stay safe everyone! Please note the paragraph breaks I inserted, even if not textbook paragraphs, you always break it up otherwise no one will ever read it. If I were not a mod, I would not have read it...AK

Dont watch Trauma but answering your cheerleader question from personal experience. My squad staffs all the home games for the footbal teams (peewee to highschool) and I can say from personal expeiernce we have transported more cheerleaders then players. Hell in one game we did 3 transports of cheerleaders and had just one "check out" of a player. Most of what we see are fall injuries, dislocated joints (mostly knees), and funny enough allergic reactions from bee stings (not saying the reaction is funny). Usually the players get a check out for possible concussions or supplimental O2 for asthma related issues. The injuries tend to get more severe with age. The younger squads dont do much ariel(sp) display but we see more knee injuries or other dislocated joints. The older squads with the flips and stunts we see more C-spine related injuries or fractured bones instead of sprains or dislocations.

Thanks everyone for the advise! I do appreciate it. I have to add an update since last night's shift. Apparantly I didnt get the memo (hehehe) and she was covering for one of my regulars last night. Diffrent shift with diffrent members, excluding me. Well I must say this, she was totally diffrent. We had a stroke call and from the moment we hit the door she was like a totally diffrent person. She dove right into vitals while I grabbed a quick history from the family members and got the meds written down. When deciding how to move the patient she came up with the best suggestion out of the 3 of us (the reeves). I must say it was a breath of fresh air to see her work this way. I did ask what was diffrent and she said it was the crew. She feels intimidated working with the Captn and is afraid to "make a mistake" or speak up. Also she feels the dynamic of that crew doesn't fit her in. I do understand that, like I said the 3 of us on that shift work pretty much without verbalizing and just have our "assigned" things. Knowing each others moves before hand can seem intimidating, I can understand and respect that. I was glad we had a chance to speak last night on the ride back from the ED. I got a better feel of whats going on. I am still going to take all your advice and suggestions and still talk with her more but instead of just her I will try and get the whole crew involved in the discussion. I know it might be hard being the Captn is on the crew but if we really are a crew or team then I think it should be welcomed and also will only benifit us and especially the patient if we are coheasive and all on the same page. Time will only tell if she really is cut out for all this but at least last night I got to see a diffrent side of her and her actions were commendable.

Thanks Kiwi. I have been trying the scenarios with her. So hopefully they work. Yea the O2 thing is worrying because its repition to lack of details. I mean yes we all but a regulator or two on wrong when we first started but after that it was pretty basic. Line up the pins, make sure the seal is there, tighten. She messes up at the pin stage. Maybe the next time around I will sit down with the whole crew and try going over our actual calls and reviewing them. That way it reinforces the real life expeiences. As I type this it sounds as though I am a crew chief when I am a newbie EMT. Not new to the squad, was a driver for over a year, just new to the patient side. Guess that is why I am trying to help her so much. LOL

Gotcha Timmy. Good advise thanks. I will try some of those next time I am on that crew. Sometimes it is fun being on 3 crews Makes things interesting

Thanks Timmy. As far as the OIC she is on my crew actually LOL Its my Captn. She has tried to get the member more active thinking (as we all have) it may be lack of confidence. One thing is that when she does stuff she does it well, she just needs to be told what to do. Just dont let her near the O2, cant seem to figure out the 2 little pegs go into the 2 little holes LOL I guess it seems she is worse then she really is because the 3 of us gel so well and she just seems the "odd man out" Talking with her is easy, I usually do that during the rig check before shift. I sit there with the clip board and checklist and have her do it all while I ask questions. I figure if she gets comfortable with us and the gear it might help. Right now it doesnt seem to be but hopefully it will. One good saving grace with her is she has no issues with the nasty stuff so shes usually cleaning the rig after a messy call. Like I said before, I really do think she will be a great EMT, just needs to get involved more and think on her feet. Anyone have suggestions on how to do that? I know it comes with time an experience but anything I can do in the meantime to help it along?

Ok folks would like some advise if possible. The volly squad I am on is small (14 active mebers) so we are on multiple shifts with diffrent crews. What do you do if one of the crews you are on has a member thats just not gelling? The crew I am currently on during my 48 is awsome. The two women and me gel very well, work without having to say much and basically know each others roles and where to be and what to do. Well on this same crew is a 4th member who just seems off. Stands around at scenes until told what to do, stands in the background without much input, basically just in the way. I know this person can be a great EMT and will probably work out well in our crew but even after trying to help (training days, rig checks, that sort of thing) it seems everything goes in one ear and out the other OR total deer-in-headlights syndrom. I dont want to switch crews and my other crew member feels the same way but we are at a loss on what to do. What would you folks do? I do think she would be a great EMT if she puts her mind to it and hopefully she does.

As far as GPs no preference, just be good at it. I can understand older generations reluctance to some things, folks just get set in their ways. As an EMT I do see the gender issue come up alot unfortunatly. Thankfully I run with an all girl, except me, crew so it is helpful. Just as an example we recently had a rollover with submersion. Female driver tossed around unrestrained so as the FD was making extracation preperations I drew the short straw and went in to the vehicle to collar her and talk her through it. After a few minutes of her puking on me and talking with me in freezing cold water we seemed to have a report (as much of one as rescuer and patient can have). Finally after extrication and getting her strapped and boarded into the rig we went to cut the garments and as I reached for the shears she freaked and asked that I not be present. My crew chief explained to her we dont look at men and women in that way we just treat patients. Anyways, after a minute of talking with her I just got out of the back and got in the drivers seat just so she would be more comfortable. I know it shouldn't have mattered who was in the back but she didnt want a man (her words not mine) seeing her naked. I know it made me feel kinda off after talking with her during the extracation, her appologizing to me for puking, her crying and telling me her life story while under the fire blanket then like a light switch didnt want me to do the rest of my job. Thankfully for her there was 3 females in the back to take care of her. I do feel patients should have the right to request male or female to check them out if possible but if it is an all male or all female crew then sorry, just be glad we are there to help. When I had an all male crew and we were transporting an uncomfortable female we usually requested a female officer (LEO) to ride in the back with us. Usually calmed the patient down.

Yes kiwi our ALS support is all hospital based. Usually with large response areas.

Yes Dustdevil very rural out here. Mostly state forests and lakes. Town has one traffic light LOL and we celebrate its erection with a festival every autum. Kind of a town where the wildlife outnumbers the residents. Our response time to the "local" area hospital is 45min, Trauma center is 1hr 15mn, nearest burn center is alomst 2hrs. Needless to say alot of calls get ALS support. Unstable traumas get medivaced usually. Stable ones get a nice long ride. We have probably one of the longest patient care times around our area. Get alot of practice in vitals and ongoing assessment. The plane crash was my first so I was super facinated. Wish I was part of the rescue and not just stand-by but was nice being part of the expeiernce though. The garage door spring was a bad one, no doubt. People should leave that stuff to the professionals. At least we were able to save the patient's eye and sight the rest is up to the plastic surgeons.

Had a busy weekend this go around. From the eye and face trauma from a garage door spring to the plane crash to the 3am MVA. Oh yea did I mention the plane crash!?! From Fox News: UGL was on standby for this one! Yea couldn't beleive this call when the tones went out. We were doing rig check and washing the other rig and we all did a double take and wondered if it was true. We found out later the plane was just purchased and flown down from Ithica, NY to pick up a friend (guy who survived) for a quick joy ride. The plane did take off from the local airport as witnessed by local LEO. Wish I was part of the rescue and not just a stand-by rig but was nice being part of the experience. The rest of the shift was pretty crazy as well. Psych call, OD, Stroke, MVA w/ extracation, eye and face truma. For a squad that sees around 300 calls a year this was a very busy weekend for us. Glad I was able to swing dinner with the family in between calls on Easter.

Thanks folks! Wasn't the quickest reply, was on my weekend rotation and it wasn't quiet. At least I had some dinner with the family yesterday. Can't wait to know more so I can reply more to other posts but at least so far I can share experiences and stories.

Hello folks. Introducing myself to the board Recent addition to the EMT ranks but part of a squad for over a year. Was a driver until January when our membership dropped too low and we needed the EMTs LOL I am on the Upper Greenwood Lake Squad in West Milford Township. Hence the UGLy screen name. Actually its usually what the ED nurses call us so I thought it fitting. Hope to chat with you all and learn some tips, tricks, and share stories with you all.