Dustdevil

Way to trash the guy's topic. :? Jim, I concur with MedicRN here. The total treatment you depict will depend upon how severe you make the injury and the patient's condition. Since you are talking MAST and hemostats, I am assuming you mean it to be a life-threatening wound with arterial bleeding. In this case, you'll want to go for the inner thigh. If you want to be very realistic with the treatment, you will have the medics rapidly apply direct pressure with a fistful of dressings, throw him on a backboard, and immediately haul ass towards the hospital. If possible, they will take a fireman or other first-responder to the hospital with them, and he/she will keep the direct pressure applied to the wound while the medic applies oxygen and starts IV's. If enroute to the hospital the direct pressure just isn't doing the trick (an extremely rare occurrence), then the medic would fashion a tourniquet out of a triangular bandage, just above the wound. Typically, there is really nothing else we do in the urban EMS field other than direct pressure. Most ambulances don't even have hemostats. And unless your medic is a former combat corpsman, he is unlikely to know how to use one anyhow. MAST would not be a totally unreasonable adjunct for this wound, since it applies pressure to the wound AND splints the limb, both of which are indicated. But you would inflate ONLY the section on that particular leg since you would not be using it as an actual anti-shock garment.

You'd think that any program that exceptional would be accredited by CAAHEP, and/or CoAEMSP and CAHEA. They are not. Give the director a call and ask them why not. I'd be interested in hearing the answer you get. Incidentally, NO Mass or RI schools are accredited. Seems like they have a real lone wolf attitude up there as if what the rest of the profession is doing doesn't concern them. Incidentally, in NYC, only Manhattan Community College and New York Methodist Hospital are accredited. Anyhow, I'm afraid I have seen the whole box colour thing at it's worst. I've know patients who were killed by it. But I haven't seen or heard of that sort of thing since the 80's. I would hope that the entire profession has come way beyond that by now. But I also know that as long as we have cities using EMS as "busy work" for "them lazy overpaid firemen," then we are going to have people in the field, regardless of their education, who live and work by the Peter Principle.

I can see that view. We just don't get it here in Texas where all professional firefighters are EMT's. Therefore, the default level of "first responder" really is EMT here. We have a lower "first responder" level of training, but we don't see it much, even in the rural volunteer areas. It is pretty well dying out since EMT became required for firemen.

Thanks, Ace! That's interesting stuff!

Granted there are crummy medics giving crummy reports all over the globe. And although I would expect to find a few in Ontario, just like anyplace else, I would not expect to find any of them talking box colours instead of drug names. I think that is pretty much a US phenomenon, since we are one of the only places with such disgustingly low entry standards. And the box colour thing started out in urban agencies where simplification was paramount. Consequently, you have a bunch of wannabe's who want to sound like the big boys in the big city using the box colour terminology just like wankers outside of NYC use the term "bus." Anyhow, I don't see where the thread has become an us vs. them thing. But I do see where some are still trying to take it off topic. STOP IT!

Funny thing is, most of the time you see a total wanker with EMS stickers all over his car, a cheap stethoscope hanging from the rearview mirror, and a red light on his dashboard, it's a basic EMT. You just don't see nearly as many medics doing that sort of thing. I think the basic-gods are simply jealous because they don't have somebody under them to shove out of the way.

LMAO! I love that analogy! Ace, it never even crossed my mind that he was referring to you. I think it was just a really good analogy.

You're crapping my thread. :roll: The topic is not about medics who are a-holes. It is about medics who become a-holes only after becoming a medic. If you have no specific occurrence of this phenomenon to cite, then you're off topic.

I'm not sure what's up with the right nostril thing. I've heard that you should start with the right nostril. I just looked and it says that in the 1994 Brady Paramedic textbook. But it doesn't explain why, and I've never been taught that in medic school or nursing school. I just did a pretty extensive Google search and couldn't find any other references to this.

I'll buy that.

Ideally, yes. The positions should go to the most qualified person. But there are other factors to consider. In a lot of volunteer departments, nobody knows anything! Therefore, who becomes a lieutenant or captain is really irrelevant, since all members are at about the same point of professional development. And if you are talking about administrative officers (president, secretary, etc...) then obviously fire and EMS knowledge would not necessarily be your top priorities in choosing. You would be more interested in the most organized and devoted person for the job.

I'd like to call them "unemployed."

Several types of heart disease -- not necessarily related to age -- are commonly responsible for hypotensive states. Mitral stenosis, prolapse, obstruction and regurgitation are not uncommon in young adults and can cause episodic hypotension. Same with IHSS. Closely related, there are aortic abnormalities which can also cause this. Auscultation can reveal a lot of clues, and an echocardiogram may be indicated. There are neurological abnormalities which can create a loss of normal sympathetic mechanisms, causing episodic hypotension. And of course, many endocrine and metabolic disorders could be the cause. Acute adrenocortical insufficiency can develop from almost any prolonged stressful state. I would certainly think that pregnancy qualifies as that. Pregnancy can also create sugar problems, resulting in hypotension.

Good point. Although when it's an EMT vs. any hospital employee, the EMT always loses. Doesn't matter who is right or wrong. We are the low men on the scrotum pole, so we are always wrong. Regardless, I would write up a formal report and insist that your agency file it with hospital administration. I don't recommend you do anything without informing your agency though.

I have a theory that the entire theory of so-called "paragods" is factually invalid. In my experience, those paramedics who are egotistical jerks were egotistical jerks well before they became a paramedic. They were jerks as EMTs. They were jerks in EMT school. And they were probably jerks in high school too. I do not believe that it is a common phenomenon for simply being a paramedic to actually contribute significantly to ones jerkism. And therefore, the term, as well as the theory of, "paragod" is not based upon a foundation of fact, but merely utilized in much the same manner as a racial slur. Comment?

True. The biggest lie in EMS is, "If you always put your patient first, you will always be right." That's BS. The unemployment lines are full of medics who put their patient first and got fired for it. It's not enough to be medically correct. In EMS you have to be politically correct too. Killing patients is perfectly acceptable, so long as you don't question a supervisor or upset the boss' boyfriend. :roll: Doesn't matter that your personal safety is universally accepted as the number one rule of EMS. If "everybody else" doesn't do it, then you're pegged as a troublemaker. Happens that way in both public and private systems.

Thanks Beagle! What area are you in?

I understand that. And that is what lulls idiots like your partner into a false sense of security. Just like idiots who think once PD is on a street scene that it is somehow "safe." If that were true, there wouldn't be hundreds of cops being killed every year. I am impressed to hear that you were thinking clearly and outside of the box. Next time, go with your instincts. Request a search before you accept the patient. Your partner is a clear example of what is being discussed in another thread. Just because somebody has experience does not mean they know wtf they are doing. Don't EVER conform to what "everybody else" is doing simply to avoid making waves. Do what is right, regardless of what everybody else is doing.

This is a great situation for the education of all those people out there who think they somehow "know" when a scene is safe and when it isn't. There are no "safe" scenes! And I won't work with anybody who believes there are. And nobody follows my ambulance anywhere either. Family either goes ahead of me and meets me there, or they get intercepted by police enroute. What is "SI?"

It's got nothing to do with EMT's. The law allows anybody who is not a convicted felon to carry a rifle wherever they want, except for schools and stuff. Nothing at all needs to be done about it, except for all you people who want the government to solve all your problems for you to take control and responsibility for your own kids. That's where all this violence is coming from.

If neither of the given choices work for you, then you either did not read the original question, or you're reading into the question, which I specifically asked you not to do. For that matter, I don't think anybody read the original post. Not one person so far has answered the four distinct questions I asked. :?

I never used amiodarone, but I can say that I do not recall ever having a single success with lidocaine in VF. Any VF I ever converted, I converted before I got to the lidocaine point. Same with bretylium and procainamide.

Only up there in the northeast where you bent over like bitches and let them disarm you. They are perfectly legal, and even common here. Congratulations, Asys. You just defaulted the argument. :wink:

I've been a cop. Half my friends are cops. My ex is a cop. I can tell you with authority that there really is very little difference between the two. Most are belligerent yahoos with bad attitudes. And if you don't believe there ARE a lot of government goons out there, you really need to get out more.

They do everytime they look in the mirror. :wink: