Dustdevil

25 is not excessive. The amount of Nubain is irrelevant. If the patient is suffering from nausea, or is likely to experience nausea from the Nubain, then 25mg is quite appropriate. Although, it would be dependent upon the patient herself. Weight, physical condition, etc... The only reason one might cut back to 12.5 in a well developed adult is if it were being inappropriately used as a "potentiator." Of course, the routine use of Phenergan as a "potentiator" of analgesia is quickly falling by the wayside though. Recent literature casts serious doubts on the entire theory, but old habits die hard. And, as Rid said, the IV use of Phenergan is to be avoided unless very clear benefits outweigh the risk. But if it's appropriate to give, then 25 is appropriate for a non-impared adult.

LOL! I didn't think of that either. I like it though! Nah, I meant the evaluator was much more likely to be forthcoming with an honest appraisal if he didn't have to hand it back to the student to read. Kinda like the secret ballot theory.

Sounds like your friend is either unreasonably paranoid, or else his EMT school sucked and he didn't learn a thing.

Is your school actually longer, or are the same hours just dragged out over twice the calendar time? And if you are so concerned about inadequate education, why didn't you take the degree program course?

Ideally, a program would not put preceptors in the position of having to hand their evaluation back to the student personally. They should be kept and collected by the instructor or coordinator. To do otherwise is just asking for dishonest evaluations.

What do you mean by "main city?" Are you talking about different cities, or are you saying that the central part of the city gets ALS, while the suburban areas of the same city do not get ALS?

Spoken like a man who has never been fired for acting in his patient's best interest. Trust me, you can definitely "go wrong" acting in your patient's best interest. But yeah, it's still the right thing to do.

Notice how those who say they don't (or rarely) use a KED never offer any scientific rationale for their actions? Notice they always try to obscure their ignorance with such babble as "the real world" and "how we always do it."? Tell one of those same idiots that you always shock v-fib at 20 joules because you don't think they need 200 "in the real world" and watch them throw a fit telling you how the book says you're supposed to do it. I am inclined to fire any employee I ever hear mouthing off about "the real world," because it is a clear indication that he likes to make up his rules as he goes rather than following established procedures. And, "it's what everybody does!" is going to get you laughed out of court. Out of the unemployment office too. Unless your patient is suffering an immediate threat to his ABC's, scene safety, or is actively fighting you, there is no excuse for not immobilizing prior to transfer to a long board. You can make scientifically sound arguments for not immobilizing more than half of the people we currently immobilize. But there is no sound argument for not properly immobilizing those who we do choose to immobilize. And that means using the KED.

Actuallly, it IS at the top of this forum. Apparently you didn't read it either. Most often, it seems that questions like this are asked by EMT's who are not employed in EMS. And EMT schools aren't teaching their students that EMT (or Paramedic) certification itself does not license you do do ANYTHING! Nothing at all. Only delegated authority from a physician authorizes you to perform ANY intervention. If you aren't employed by a system that has a medical director who gives you written authorization to do something, you can't do it. Period.

That's old skool thinking. The most current research disproves the whole theory. And, although old habits die hard, analgesia for abd pain is becoming the standard, even in the field.

"EMS boots" is an oxymoron.

Sorry, I kinda zoned out after that part. I missed everything else you said. :?

I have only used spider straps in training one day a couple of months ago. Never in the field. So, while I believe they definitely provide a secure system for the average patient in ideal conditions, I would not say I am completely sold on them. And, having used the basic straight seatbelt style straps for most of my career, I can assure you that I am not particularly sold on them as a secure system either. In fact, I have always said they suck. Obviously, the best system would involve lateral support, not downward pressure from straps. None of these strapping methods provide adequate protection from lateral movement, which is our prime goal. They all induce pressure on the victim which is bad on so many levels. Such pressure negatively affects spinal alignment. It increases decubital pressure. It restricts ventilatory expansion. And it just plain stresses the patient out. Meanwhile, the patient is still sliding right to left on the board as the ambo bounces down the road. The only real benefits to any strapping system I have seen is that it keeps the patient from falling off the board. Heck, just plain buckle straps do that. But none of these methods does nothing to immobilize the spine. And if I am going to spend five minutes knitting a web around my patient, it had better at least give me something that the ten-second buckle straps don't give me.

Sounds very time consuming and awkward in execution. How are the strap ends secured? Knots?

I am going to try my damndest to stay out of this discussion. As valid as the discussion is in theory, in practice, it is pointless. Suffice it to say that I am very disappointed in what UM correctly perceives as a lack of vision from many here. He is attempting to discuss the future, yet some are totally unable to see past the present to imagine it. Although, as dismal as our "present" is, I can certainly understand that. Basically, I completely agree with UM. Well, I agreed with him up until the stuff about prevention. :?

Man, that sucks! I hope everybody fares well from the exposure. It's a crap shoot. Asbestos abatement is such a huge issue here, with a tonne of local, state, and federal oversight that I would like to think that sort of coverup doesn't happen here. But, of course, I'd be kidding myself if I believed that.

Man, they're kind of pushing the legal limits of propriety with their personal questions. No matter how innocent their line of questioning may have been, I am a little concerned about any company who doesn't know better than to ask personal questions like that of their applicants. It may be a sign that they remain dangerously ignorant about contemporary standards that more professional organizations keep themselves apprised of. But that's all technicalities though. Overall, I kinda like the sound of this. It sounds like they are friendly people who like to relate closely to their employees. Even if it borders on inappropriate, it is still a good sign. If their facilities are nice to begin with, and they are still in the process of upgrading, then I particularly like the sound of that. And any employer that gives their applicants the courtesy of a rejection letter earns points in my eyes. Leaving people hanging is just plain rude. They wouldn't want to be treated that way, so it is unacceptable to treat others that way. How big an organization is this? How many units, how many stations, how many people? Is it 911 or transfers? I would like to have had a little more in depth answer to the orientation question. Sounds like they misunderstood you. Regardless, this sounds like a good foot in the door for you. I really hope it works out!

I dunno. Remember, we're talking about Sci Fi geeks. Sounds like pretty typical behaviour to me.

This is at least the third time this "long strap" technique has been brought up here. Each time, somebody has asked for an explanation of exactly how the process works. And each time, nobody has answered. Seems to me that if nobody can describe how it works, it's not that great a deal. xselerate, as for your contention that simple buckle straps by themselves are "secure," that's so absurd that I won't even waste time arguing it.

Y'all never heard of cars up there? :?

There is already a "New Users - Read First!" section which obviously nobody reads. If they wouldn't read a topic that says "Read First," then I really have no faith that they would read a topic that says general information. After all, everybody thinks their question is special. They think they are the first person ever to ask how long it takes to get their NR results or any of the other frequently asked questions here.

Hehehe... I never get tired of watching that clip! Anytime you're feeling stupid over a mistake or two, just go watch this a couple of times and feel better about yourself!

1. Fire them. 2. Hire permanent replacements for them, making lots of senior field medics very happy. 3. Those medics leaving the field will make lots of unemployed medics happy. 4. School goes on. 5. The union is busted. 6. New blood moves into the field. Everybody wins. Except for the losers.

If the transport was that short to begin with, then ALS or BLS, I wouldn't choose to go code 3. What's it going to save you? A grand total of 30 seconds maybe? Sorry, I'm not putting my partner and patient at risk for that. But I agree with Pyro, I can certainly understand how a basic would be uncomfortable with the situation and anxious to get it over with, the sooner the better. Therefore, as a supervisor, I would not be terribly upset by the decision. Of course, I'm not really clear on exactly what their concern was with your handling of the run. Was it because you chose to run hot? Was it because you chose to take the patient and not turn it over to an ALS unit? Was it both? In a perfect world, you would have turned it over to ALS because of the ALS interventions already established. Just like a medic should not be turning ALS patients over to EMT's, neither should nurses or doctors. For that matter, you shouldn't be accepting them. However, I also understand that many of them simply don't know the difference, and all ambulance drivers look the same to them. Trust me, they don't read your patch or have any idea what it means. And I tend to agree with you that, in this particular situation, simply snatching and running the 3 minutes was probably a viable -- and possibly even the best -- option for the patient, which is what counts. Although I damn sure wouldn't make a habit of that. Sooner or later, the patient is going to burn you. If anybody needs their ass reamed over this, it's the dispatcher who FAILED to properly assess and dispatch this to an ALS unit. Somebody needs some serious remedial education. If they're not fired.

Wish I could answer that one for ya. I have worked some relatively rural places, but even there I ended up making at least a couple of runs per 24 hour shift, if not three times that. Beats the hell out of an urban agency where I would make eight to eighteen runs in a 12 or 24 hour shift. I like to sit and screw off as much as the next guy. But man, if I don't make at least a couple runs a shift, I'm going to start feeling pretty rusty. But anyhow, so long as you are getting enough runs to keep yourself sharp, rural is beauty. The runs are better. The people are more genuine and appreciative. And generally, the people are just plain sicker than urban dwellers when they finally call an ambo. Combined with the extended transport times, it adds up to a much more serious practice of medicine than all the 5 minute drunk runs in the big city.