Dustdevil

Seriously? We have somebody post that very same story here at least once a week. You can go to almost any paramedic school in the country and find somebody ready to tell you that story. I hear it all the time. I don't know where you live that everybody with an EMT patch gets an EMS job, but it sounds like a fantasy world to me. For, if that were the case, there would be five ambulances on every block.

LMAO! I'm going to try that convo with a patient on April Fools and see if they believe it.

Florida society has indeed gone to crap since all the farking snow birds moved down. Queens Street. :roll:

Bushy is, as usual, on to something here. Sort of. If this guy's letter is not the tongue-in-cheek joke it appears to be, then I think there is an extremely good chance that the guy simply had a horrible experience with EMS that led him to his conclusions. Think about it. With the predominantly large percentage of stupid, undereducated, and incompetent medics out there, we know from reading this forum how often medics provide "care" that is so horrible that the public is easily led to believe that we are worthless. Intentional or not, the writer makes a very good point. Several, actually. It is true that there is a terribly disproportionate emphasis on technology spending in EMS while educational investment is minimalised. And it is true that, in the majority of the cases in which we are summoned, neither the technology nor the education are ultimately useful to the patient. Unfortunately, his correct points lead him to an incorrect solution.

I would say that the abilities and legalities of the FRs to transport would be the only prohibiting factors here. After all, it is not uncommon to suggest that people go to the ER by POV. Back to the original question, I don't think it is "inappropriate" to refuse an ALS to BLS hand-off if you are not comfortable with the patient, theoretically speaking. But there are many potential pitfalls to the situation. First and foremost is the probability of the medic being a nimrod and handing off ALS worthy patients either because he was too stupid to know what was wrong with them, or because he was a lazy tosser who wanted to get back to watch Turd Watch. Sooner or later, one of those two situations will come back to bite the average "trained" medic. As for your specific situation, I think your options will be dependant upon your relationship with the ALS provider. In other words, are you both employed by the same agency? Or is this one of those retarded FD-ALS-dumping-on-private-providers systems where you are separate agencies? In the former situation, you have some comfortable standing to contest inappropriate dumping. In the latter, your employer is going to fire you for refusing a paying customer and pissing off the fire department, regardless of medical propriety. In an urban or suburban system, where transport times are relatively short (and where most of these tiered systems exist), I just don't see much benefit or intelligence to the system at all. You'll spend as much time waiting for the non-emergency responding BLS unit to arrive and complete the hand-off than you would have spent just transporting the damn patient yourself. So that begs the question; what is the point or benefit of this system?

Invalid analogy. Neither MDs nor vets [usually] provide house calls. We do. If vets provided field care, you can bet that people would call them.

Yes, things that will win you big points, and show the crew that you aren't a clueless rookie would be comments like" "What are you stopping for? There's no traffic coming!" "The right lane is clear! Just pass him!" "Don't you use the phaser tone on the siren?" "Here, hand me the PA microphone!" "More diesel!!" But, on the serious side... As for the meal thing, if you're riding with hosemonkeys, then the issue is settled. You'll eat in the house, not on the road, so as soon as you see, hear, or smell somebody start making chow, find your preceptor and ask him who to give your meal money to. Don't make them ask.

Of course, the entire premise of the discussion is invalidated by the above quote. That's sort of like saying that the majority of the lawyers do not have licences to practise law. If they are not certified in BLS, then they are not EMS personnel. Period. :roll:

Yeah... now that they have their First Responder training, they're qualified to handle just about everything. :roll:

Anybody know the origins of the term "jump kit" anyways? I find it incredibly gay.

Ha, that's an easy one! ALL air transports are truly life threatening!

Minus 5 for posting in the wrong forum. Chuck Norris is going to be here at my camp next week. Unfortunately, I'll be at home.

I am using four different types of Pulse Oximeters out here, and every one of them does those weird, wild fluctuations constantly. If you're using one that does not, please let me know what it is so I can order those next time!

:shock:

Out here, where the population is about eighty-percent male, over eighty-percent of our ambo runs are on females, most with unexplained syncope. Go figure. :roll:

No you don't. The forum rules say do not revive old dead threads. What other factors could possibly make a difference?

It's the Venturi principle. With a mouth breather, the negative pressure is creating a flow of room air that is far greater than the flow of 100% O[sub:4d52aa068b]2[/sub:4d52aa068b] through the cannula. Consequently, even though they are receiving all of that O[sub:4d52aa068b]2[/sub:4d52aa068b] from the cannula, it is being diluted by the room air. That's why the old theory of "protocols" that say "Condition A gets flowrate B by device C" is so asinine. Every patient's response is going to be different, and the effectiveness of a given flowrate or device is very individual because of many factors, including the patient's breathing pattern. This is what the old Venti Masks were good at eliminating. Because they were high flow, pretty much everything the patient breathed in was a controlled fiO[sub:4d52aa068b]2[/sub:4d52aa068b], that was not diluted by flow-by. But the percentage delivered by an NC or SFM, or even the PRB, is affected by those factors. We use general rules to estimate the fiO[sub:4d52aa068b]2[/sub:4d52aa068b] delivered by delivery devices. Most accept 2% to 3% per lpm as the multiplication factor. Using that rule, a nasal cannula running at 6 lpm, that adds 18%. 18 + 21 (room air) = 39% fiO[sub:4d52aa068b]2[/sub:4d52aa068b] being delivered to the AVERAGE patient who is breathing with the AVERAGE V[sub:4d52aa068b]T[/sub:4d52aa068b] at the AVERAGE RR through his nose. Breathing through the mouth or breathing deeply or shallowly will definitely affect this figure. You are certainly not incorrect in that thinking. But the original point I was making is that a patient mouth-breathing does not (barring anatomical abnormalities) preclude him from receiving nasally administered oxygen altogether. It is only a factor that should be taken into consideration when deciding if the oxygen delivered by an NC is going to be sufficient for them. And, of course, that decision and process should be guided by O[sub:4d52aa068b]2[/sub:4d52aa068b] sats, or even better, by ABGs.

I'll go halfway with Lucky and Mike. The definitely should not look like combat boots or bunker boots, but something in-between that extreme and dress shoes would be nice. Of course, ideally, something that looked like dress shoes would meet all of the above requirements, and that would be fine. I MUCH prefer wearing a low-quarter shoe to boots. But I also hate walking in shoes full of mud or rain for 12 hours too because they were cut so low. In civilian EMS, I find myself compromising with the hiking boot height shoes which appear much like shoes, but go up to the ankle, instead of under the malleoli. BTW, Lucky~13, it's good to see you back!

SOMEDIC's assessment was not an exaggeration. That is indeed about the bottom line in a large percentage of the ER jobs for EMTs. But Rid is of course right. Your attitude sets the tone for their attitudes in many cases. I don't expect that you would have a problem with that. But beware that some nurses simply are going to give you $hit no matter how good your attitude, personality, work ethic, knowledge, and skills are. But there is usually that one nurse who is not that way and even understands and/or appreciates you and takes you under their wing, so to speak. That person can be a great help in assisting you to adjust, as well as taking some of the heat from other nurses off of you.

No argument there. Not like they take up much weight or room, so no problem there. I just wouldn't do it specifically for the purpose of allowing my partner to not carry his own equipment.

NC is inappropriate for anybody who needs over .4 fIO[sub:bcc94917f6]2[/sub:bcc94917f6] delivered. NC is inappropriate at 6 or more lpm, probably less according to many. NC is not inappropriate for a mouth breather, unless the patient's nostrils are completely occluded by debris or oedema. The nose and the mouth share the same pharynx, which is where the oxygen goes, regardless of which orofice the patient is using to breathe. Mouth breathers will get nasal oxygen just fine.

Why all the screaming?? :?

:shock: Hopefully, somebody got fired over that, right?

Although this is indeed true, it is really a double edged sword. Most in EMS don't see a lot of "really serious patients." The majority of what most EMS personnel see is not serious at all. And this causes even more complacency than seeing a lot of serious patients. Either way, those who do not bleed profusely or show funky rhythms on the monitor get mistreated. Too many wankers got in this business for the excitement, and when they find out that over ninety-percent of their work is a very boring routine, rather than move on, they just stay in the field with their piss poor attitudes. As Rid alluded to, this is a problem with the EMS educational system at its very core. If people weren't introduced to EMS with nothing but 120 hours of first aid training on how to deal with the most serious conditions, there wouldn't be this entrenched mindset that sexy, gross, life threatening emergency conditions are all that we are about. If the entry level of education for EMS included the normal lifespan, social and psychological issues of human development, and routine illness that people commonly present with, not only would we be much better prepared to deal with MOST of our patients, but we also might not have this annoying attitude being copped by so many providers that anything that doesn't bleed is not worthy of our attention. And maybe we wouldn't have so many instances every year of EMS providers undertreating, or worse yet, no-riding people who subsequently die because of it.

Just to re-focus the thread: So far, only Timmy has made any attempt to answer the question, and he's not even in an EMS system.