Dustdevil

I'm the one who voted iodine only. Military aid bags include only iodine. It's been more than two decades since I took microbiology, so I'm going to make the mistake of speaking without the benefit of recent research here (which I always caution others not to do). So I certainly do not submit this as authoritative, just historically observational. The problem with double swabbing is that neither solution is left in place long enough to achieve antimicrobial competency. You may achieve the appearance of "clean" skin, but you won't achieve disinfected skin, which is your ultimate goal. Consequently, unless you are leaving both on long enough to dry, you are being less effective, not more. Iodine has a better spectral advantage than isopropyl alcohol against pathogenic bacteria. I proved that to myself in the lab, as have others for decades. But both come with potential problems. Iodine sensitivity is not unheard of. And isopropyl alcohol is too flammable for OR use. Electrocautery and a flashpoint of 53f is a very bad mix. Same reason we don't use flammable anaesthetics anymore, even if they are effective. Hell, we used alcohol hand sanitiser gel as a fuel for heating food and drink in Iraq. It burns like crazy. So, if those are your only two choices, then it is my opinion that iodine is the better way to go, and just hope for no local sensitivity reactions. As already mentioned, chlorhexadine solutions are quickly starting to spread in non-OR use. This is a good thing, and long overdue. It is a notably superior antimicrobial to both of the previous choices, is not flammable, and has a lower incidence of sensitivity. Unfortunately, this has been a long time coming into common use for several reasons. A little history: Before chlorhexadine came hexachlorophene. It was a popular OTC skin cleanser in the 60s, used primarily as an anti-acne face scrub, and for bathing children, who are typically germ ridden from normal child behaviour. Problem was that it turned out to be quite neurotoxic, and possibly carcinogenic. I blame it for my short stature [sarcasm]. It was yanked from the shelves, the concentration lowered, and made prescription-only, and few docs would even prescribe it. So then the expensive and bureaucratically hindered process of developing a safe alternative begins. Sometime in the late 70s, chlorhehadine began showing up in hospitals as Hibiclens. But it was very slow to catch on because of the high price as compared to iodine, the lack of evidence indicating efficacy, and the bad memories left over from the hexachlorophene fiasco. Consequently, chlorhexadine becoming popular and trusted enough to come into enough use to get both literature and price point behind it has taken thirty years. We didn't even have chlorhexadine swabs when I retired three years ago. I expect them to become the solution of choice in the near future. Until then, iodine remains the solution of choice. And using both iodine and alcohol together offers no benefit over the use of any single solution, as well as it doubling the cost of prepping every IV you start.

Name and digits off the smokin' hott babe at 2:35, or GTFO! Girls like that are the reason we don't give that state back to Mexico! But yeah, very well done. This should be required viewing for all EMS.

I'd know that face anywhere! Congrats and prayers!

I don't want to drive a cloud over your excitement, but you just hit upon a very important point that you need to seriously consider. Is any of this going to be practised by you with enough regularity and expert supervision that it is committed to long-term memory and becomes second nature? If not, you are playing a very dangerous game with human lives. This is why most civilised countries have 2 to 4 year entry level training, not 2-6 months.

Sorry. You didn't make it clear that you wanted encouragement, What you said was, and I quote: Usually when someone asks a very specific question like this, they are seeking realistic information, not sunshine blown up their panties. Unless you specify otherwise, we generally take people seriously. I didn't realise you just came to jerk us around. My mistake. I promise nobody here take you seriously again, so hopefully your dream world won't be disturbed by reality. Ciao.

Ah, you're right. I thought you meant SAmedic, a long time regular here.

And I am known for being less than delicate, so there is a good balance to be found here! Sorry for the tone. Nothing wrong with good SOP discussion. I just detest the penile measurement method of doing so. EMS isn't about "skills" that any monkey can learn. It's about medicine. And the South Africans are a good bit ahead of us in that respect. Does he still come around here any? I see him on the RemoteSupportMedics forum regularly.

There's only one person I took for better or worse (despite being Mormon). My co-workers ain't her. But yes, I agree with everything Dwayne said too. If what is best for my family happens to also be good for my co-workers, then I'm happy. If not, I won't be unhappy.

Wow... are you sure it wasn't BUDDY DAVIS LANE? If so, you must be very close to me! The same city has an EASY STREET. Nothing particularly funny about it, except it was the roughest "paved" (using the term very loosely) road I've ever driven on. It'd rattle your lugnuts off! There is a BONG STREET in Fort Worth. Pretty appropriate since it's home to the crack alley projects. There is a DILIDO ROAD in Dallas, which is always good for a laugh when a new dispatcher tries to pronounce it for the first time. And then there's this! http://www.msnbc.msn.com/id/41480994/ns/us_news-weird_news/

Words are inadequate to truly express my disappointment with this question. Heita, Emma! We're practically neighbours... sort of! I've spent most of my life in the USA, but mallie's side were Vallies from Pretoria. Some beautiful country in Zambia. How about near you? You mining copper? I hope so. Stay away from the Uranium! How often do you get to rotate home from the site? Thanks for dropping by. I do hope you'll stick around.

Are you saying this should be "additional", as in optional? Or do you mean that it should be added to all entry level paramedic education? Regardless, I reject either suggestion outright on multiple grounds. First, I reject the firemonkey philosophy that we must start doing other peoples jobs in order to justify our own. A jack of all trades is usually a master of none. If you stick around here long enough, you will realise that a distressingly large number of EMS providers can't even master the simple basics, even with two years of school. If we are going to add education (of which I am the strongest proponent), it should be aimed at solidifying our foundation, not more toys. Which brings me to the next point... IT'S NOT ABOUT SKILLS!! You yourself already made the point that very little of what we do can be fiscally justified by mortality rates. So I'm not sure where you get the notion that spending half an hour closing a non-suturable lac, then another 20 mins cleaning, restocking, and documenting a non-billable procedure, while the other crews -- who would rather be watching TV -- burn time and gas covering your territory, possibly delaying critical care to other patients, makes the slightest bit of sense on any level. If you find a system where they think that's good business, it is likely run by idiots. A lot of medics would love to do breast exams and Pap smears too. Both are extremely simple, I could teach both in a day. But, you know what? It ain't our job. And if you by some slim chance end up working someplace where it is your job, I expect that they will teach you how, just like Dermabond or suturing. And wound closure classes are quite standard for any medic interested in such a job. Go take one, then you can sew another nifty patch next to your tactical medic, dive medic, and space medic patches that you'll never use. Education is a good thing, bro. It's the key to our future, and our survival. Keep fighting the good fight for it. But, please slow down and get the priorities in order. Never confuse training with education. To answer the original poster's question, I have never encountered field closure by EMS. I have seen it only in the military, clinical, remote/expeditionary, and event medical/first aid scenarios, usually under supervision of a physician or mid-level provider (NP or PA).

What I'm trying to say is that getting a reciprocal licence is the uber easy part. Getting a job is the very hard part. A smart man would be focused upon determining the feasibility of actually making his investment back, not the routine paperwork of the transfer. A licence without a job is a waste of time and money. And that is very likely to be what you face.

LOL! I remember when I was young and naive like this. As I recall, it lasted only a few short months, so you should be better soon. If people were really that responsible, would they be hurting themselves this often? Think about it. You need to check with more hospitals and clinics before you make that assumption. But we're not talking about a hospital here. We're talking about a lone provider, with a daily personal relationship with the patient, functioning outside of her legal scope. You'd have to be pretty negligent to not regularly monitor that progress. After all, that's what friends do.

I agree with your conclusion, but not your reasoning. There are very few martial arts that are strictly offensive. Hell, even boxing includes some rudimentary defence. So let's not stereotype "martial arts" as just a lot of arse-kicking. All of the popular Asian styles include a great deal of defensive and escape moves. But no, you're not going to learn them competently in one night. Or one week. Or one month...

An adult meets the needs of his family before all others. I would have done what was best for my family. It's the right thing to do.

That would be EDUCATED healthcare personnel, not "trained" firemen. Two very different things. Except for very advanced practitioners, operating in extremely remote and/or austere conditions, with strong medical oversight, I would never approve this for the multitude of reasons already mentioned. And the number of medics that I personally know, and would trust with this, would not use up my fingers and toes.

Wow man... now I'm choking up too. I'm honoured to be held in such esteem by any provider. And the satisfaction I enjoy from knowing that another professional has found benefit in my babbling is greater than any other I have enjoyed in my career. I'm very happy to know that you are one of them, and that your career is on-track. Hell, I wish I had known better and taken that same track when I entered the field! It sounds just awesome. I dunno about NZ, but the mid-level provider (NP or PA) is just an awesome way to go here. My memory is still pretty good, but I honestly don't recall even knowing anything about your personal life before now. And I certainly never believed what the Aussies were saying about you and sheep. Not that there's anything wrong with that! Anyhow, if I indeed got out of line, I'm gonna blame it on the drugs. Or the lack of drugs. Whichever the case may have been. I truly appreciate you being the better man and not holding a grudge. Thank you. I don't need a home nurse yet, but I am just about to that point. I feel sorry for whoever it is, because I am a much better provider than I am a patient. Of course, I had my own "live-in" RN for a long time, but you all know what happened there (no names, please). Apparently, she wanted a husband, not another patient, lol. That's crazy that you're marrying a Texan! The world is so small these days. Hell, we may end up related! If you take your honeymoon here, drop by and let me meet the family! We can compare wrist scars.

Nothing wrong with that! If you're an outdoorsman, or just an active person, then there's a good chance that the training will come in handy someday. Just be aware that, like any knowledge, if you don't use it, you will lose it. Even those who get jobs on transfer ambulances end up losing much of what they learned and stagnating professionally. Luckily, you will at least have patient exposure as an RT, which gives you the opportunity to keep the mental gears greased. I don't know how far you are into the RT prerequisites, but most of us would seriously recommend that you have both semesters of A&P behind you before taking an EMT course. What they teach in EMT school is nothing more than just enough to make you dangerous. Having those classes ahead of time will put you light years ahead of the game. In fact, the better EMT schools require it. And hey, you gotta take it anyhow, so there's no better time than the present. Good to hear you don't plan on staying in LA forever. It's a Hell-hole, especially EMS wise. I'm sure glad I never got sick or injured there. Good luck!

The waiting list for Rad school is shorter than the waiting list to get hired by a fire department in the LA area, if that answers your question. A simple EMT-B card won't make you any more eligible than the half million other guys -- many who are paramedics with degrees -- that are applying for that same rare opening. Neither. It's not about how much you work or go to school. It's about how those two schedules work together. Typical ambulance shifts are 24 hours or 12 hours long, and that is only if you get off on time, which is never a given. One of the biggest reasons medics and EMTs never complete college (especially nursing school) is because they get kicked out for absences. As for an LA EMT-B only being transport for the FD, that's a best-case scenario. Most LA EMTs never even get close to an EMS scene. They spend all day driving invalids around to and from nursing homes. Sorry, but this is one of the worst possible choices for a part-time student job, bro.

If you mean a New Yorker moving back home from Floridia, no, I don't believe that has ever been done before. I do wish it would happen more often though! But seriously, I don't know where in FL or NY you live (both are big states, and the job situation varies greatly from county to county), but generally speaking, you probably will have a better job market in NY than FL. FL is notorious for having very few real EMS opportunities. The down side is that it is much easier to eat on a measly EMT salary in FL than in NY. Hopefully you'll be living with family for free. Good luck.

Ditto this excellent response. ^ Agree or disagree with his opinions, the fact remains that some of the most thought provoking and educational discussions in this forum originate with Crotch. That said, sure... it would be interesting to know if he is really someone else, just for the lulz. But I am totally opposed to ever exposing any forum member's personal information here without their consent.

Yep. Dept of Education. Dept of Energy. Dept of Housing and Urban Development. Dept of Homeland Security. ATF. DEA. Border Patrol. U.S. Fire Administration. Fannie Mae. Securities & Exchange Commission. Etc...

Agreed. Plus the video had racist overtones, which almost always results in the death penalty, whether you are right or wrong.

Beautiful. It's always easy to tell which parties in a discussion have formally studied psychology. The so-called "child advocates" do many more times the psychological damage to children than the criminals do in this country. And no, there is no crime to report. At best it is "delinquent behaviour" unless one of them are court certified as an adult.