brentoli

How would you control the bleeding from inside the mouth. I am just trying to think here on a conscious vs. unconscious patient. With a conscious one I know I could give the patient a roll of Kerlex and let him hold pressure himself with out worrying about airway compromise. How would you get sufficient pressure on the inside of the cheek on an unresponsive? A roll of Kerlex wouldn't be secure, a few 4x4's would be loose and potentially slide back in to the throat. Any other solutions?

This is "Agent King" with the pop rocks. King = Royalty Can anyone find me a telephone that isnt really a telephone?

:?: So.. uhh... What are we looking for now? :?:

Are you talking about AED's or full blown she bang bang defibs? I am just a BLS provider, but the biggest thing I see is non standard connections between the pads. You should be able to put your pads from your AED on the patient, and when ALS arrives they should be able to take the AED off, and hook up their box with no difficulty. I know adapters are made, but we all know how small things and us get along.

Geezer Squeezer = an autopluse?

Forgive me for I am young and not as experienced. I do see the point about trust and the dispatcher. The more I think about it the more sense it makes. Still, that leaves open the question, should we even be doing EMD? Can a dispatcher even have that big of a difference in the outcome? And still how much can it hurt to have them ride out with us for some real experience? Make them see we really don't just "load and go." I know our county doesn't see why we would want status checks every 10 min. on a call. Obviously they haven't been with a violent diabetic, or psych patient. The police get 4 min. status checks on calls much more "routine" (I hate that word) then ours. Is 10 min. too much to ask for? /rant What do other agencies offer. Besides the feel good cases, is there anyone out there who thinks their EMD is making a difference?

touché

Require dispatch to work in the field, and require the field personnel to work in dispatch. I know it is not practical. I know not every caller is telling you what you need to know, and you are blind on the telephone. I should have clarified my point a little more. We need to focus on the interrogation skills of dispatch more and the treatment less. I hate the "person ill" dispatch. You are never just ill, there is always a reason you called 911. Is it the vomit, the fever, or the dehydration? Even if dispatchers don't work in the field, they still need to be out there on ride alongs. And not just one shift a year. What if we required 40 hours of ride alongs in the year? Would that improve the quality of dispatching? I have explained some things to my co-workers that amazes them. They have no idea about many ambulance and fire operations. That is where the break down is in EMD. There is no connection between the two ends. We talk about the chain of survival for CPR or what the buzz word may be this week. We have to work on the link between the caller and the responder. I have seen it happen here, dispatched on a person ill, turns out to be a butt breather. Injured in a fall? Massive stroke. I know you can't trust the information dispatch tells you. If we can get dispatch the experience to know what to look for, maybe that will help us out though.

I don't know if there is a scoop stretcher in our county. I have never used one, school or work. I don't know if I would know when and how to use it either! This isn't what you are looking for, but I think our ears are the least used equipment. How many EMT's have you seen go right into that patient assessment and history and miss that ONE little sentence. Only to get into the ER, treating the completely wrong thing, and be the nurses biggest joke of the day? It's happened to me, and everyone else in here too. Now as far as ACTUAL equipment. I think we could use the chair more often. We tear up peoples houses getting the stretcher in there and such, when the stair chair with its nice big wheels (at least our stryker model) could roll right in there, and you could do the cot transfer out in the open where there is plenty of room. What about the patient status Lights. Does ANYONE use those? The button that flashes the driver a light? GREEN YELLOW RED BLUE

Is Dr. Jeff Clawson the Powerphone guru? It seems like they are all about the money. $100 flip charts, $300 8 hour classes. My 3 day EMD class cost about $100 less then my 6month EMT course. Indiana is going to actually having A&R and Medical Direction for EMD, but it keeps on getting pushed back. Most EMD is minimalist as it is. There isnt anything in the book that could potentially cause a problem. Bleeding? Put a towel and pressure. No elevation, no pressure points. Broken leg? Don't move. No splinting, no bleeding control with pressure. Overdose? I will ask you for the next 5 min if they are still breathing. There isn't much accomplished with these too expensive books. But, it creates the 911 hero's right? Don't get me wrong, there are plently of times that we can control whats going on through the phone, but this EMD system is not the best. Most agencies don't implement it with the responding companies. You could talk to half of the responders in the county and they wouldn't have an idea we do any instructions. What about a system where the responders and the dispatchers are in sync with each other? A more in depth medical course. I feel like EMD needs to be more focused on getting the true complaint of a person and less on treating anything but life threatening conditions.

For the 911 people. Does your dispatch do pre-arrival EMD? (Emergency Medical Dispatch) Aside from CPR, do you see it making much of a difference? I have noticed, since I work on both sides of the radio, when I pull up on a call sometimes it seems like there is nothing that has been done. And when I hang up the phone with a 911 caller, sometimes I feel like I didn't make any difference in the outcome. Opinions?

Yeah, it is true here. You can usually tell who actually has reason to have the crap on their belts and who doesn't. I always have a notebook, pen, gloves, and shears. Ill grab the radio if my driver doesn't. Where I am at, the last ricky rescue we had wasn't even CPR trained. A kid on the fire side... he didn't last long. Always had foreceps and a roll of tape on his pants. What the hell he was going to do with them? I couldn't tell you. The only time it came in handy was when we taped his locker shut.

You still are looking at the end, and not the means to the end. How do we get EMS to that level where that education is required! Thats the problem I am saying we need to find the answer for. The end is always easy to find, the MEANS to the end is the tricky one.

This is your problem Dust... HOW DO WE STOP FILLING THEM FOR FREE? Pulling from thin air, I am sure upwards of 50% of the volunteer force would be willing to go though the extra training and such to become a paid EMS or Fire force. Manpower isn't the issue. The issue is changing 200 years of history. Since the beginning of America, the fire service has been volunteer. Since the beginning of EMS in the 70's, there has been volunteers. How do we turn it around? We can sit here and debate the dynamics and the economics all we want to. But that doesn't come up with a solution. The means to the end is what we are striving for, but we are stuck on the end to the means. I don't disagree with this. I would much rather see EMS as a more professional orginazation, instead of "Larrys Meat Wagon" the next town over. But we need to work together to get to our goal. We all know current orginizations, and the like would not be able to survive in their current form. But can we allow a denial of service to citizens because we don't want anyone out their if they are not being paid? There is no magic wand solution. I am not going to wake up at 1:30 this afternoon (I'm on midnight shift) and see paid EMS from coast to coast. Where do we start? How do we get EMS into the profession it needs to be? I don't have the answer, Dust doesn't have the answer, I bet Rid doesn't even have the answer to this one. I think if we all come together as a collective whole the answer could be found though.

Word, I'm Brent, from central Indiana. 22. I grew up in Missouri and moved to Indiana to flunk out of college. I don't regret it. I work as a 911 dispatcher. And I am also a volly EMT-B/FF. Going to be career someday. Flying, weather, computers... they all interest me. I tried to go to Oklahoma to be a meterology student, but I didn't get in. I don't regret it. I don't regret a lot. There are alot of people here that I have learned many lessons from. I lurk more then I post. I try to make sure when I post I at least have something constructive to say. Otherwise, I am all up for discussion, find me in the chat room, send me a PM, or write a post I can contribute to! "911? Yeah its Quagmire... Yeah its stuck.... again.... the window this time."

I've never had true unleavened bread. When I went to church it was always saltines. I hope Jesus isn't mad. All kidding aside... I had not heard the story about the exodus and the start of unleavened bread. I was only under the impression of the passover festival. I really shoulda paid attention in the Old Testament class I went to in college that I failed.

:roll: I knew that much..... Have you ever lifted a stretcher down porch steps, over curbs, across a grassy front yard, snow drifts, ect.... that is what i am referring to. .... a strecher with out wheels...

ADDENDUM TO MY ABOVE POST: I am not against abolishing the unpaid EMS. I am just making sure both sides of the issue are represented. You bet your hairy rump if I could get paid $35,000 a year doing this opposed to the $2000 right now I would do it in a heartbeat.

My biggest concern, how do you get the pt from the house to the ambulance? There is alot more lifting and moving in that trip then there is the controlled entry to the back of the rig. Unless you can park this thing in the living room? Some drivers I guess..........

Dust, I can see your point, and might I suggest the Van Dyke avatar for yourself? :twisted: Only playing of course. Imagine if every profession had vollys in it. Could you imagine the unpaid retail sales associate? The unpaid cook at Applebees. Or the unpaid road paver dude... (not the ones from the state prison). You have a completely valid point. But the system is flawed, and with out central guidance, it is irreparable. Where will the central guidance come from? Should EMS everywhere be private? Should it all be public and do away with private companies? A national EMS oversight board? Or leave it up to individual states? I am not trying to the pessimist here, but.... If you came to me today and said my fire department would be staffed 4 people a day, 24/7 full time with supplemental on call personal. I would be all for it. I would be the first one in there with my application. Dust.. there is a bigger point here, where is the funding to come from to make all serviced paid? And if these organizations stay the same and start paying, the money has to come from somewhere else. Tell me how these po'dunk services that will be paying $20k a year will help anyone elses salary? And when the little training and equipment money they already have goes towards personnel instead, what will that show 5 years from now? Like I said, don't get me wrong, I am not "PROUD TO BE VOLUNTEER" I am proud of what I do, yes, I am proud of my department, yes. My point here is everything cost money, and that money doesn't magically appear. It is going to take a much bigger force then we have right now to change the state of things. Hopefully in our lifetimes at least the ball will get some more momentum behind it.

Can't see what it would hurt honestly. I don't have any psychological background, but I have never seen an emergency vehicle with out these cute cuddly lil buddies on them Shoot, I steal one when I am lonely at the station. (joke)

Guidelines From The American College of Surgeons Call For Rapid Transport When: Ground transport to an appropriate facility poses a threat to the patient's recovery or ground transport is delayed due to weather or geography. [*]Extrication time or road conditions will seriously delay the patient's access to advanced life support [*]Motor vehicle accidents have occurred at 20 mph or more and the occupants are not wearing seat belts [*]The passenger area of the motor vehicle is compressed to 18 inches [*]The occupant is thrown from the vehicle [*]A motor vehicle rolls over [*]Another occupant in the vehicle dies [*]A pedestrian is hit by a motor vehicle traveling 20 mph or more [*]A person falls from 20 feet or more [*]Burns to chest, neck, face or perineal area. [*]Any traumatic injury which requires significant fluid replacement or neurological impairment. Now I am sure we have all seen people who were just fine after any of the vehicle conditions listed above. I am also sure we have all seen people who needed Level 1 treatment and did not fit those criteria. There is a key word in this post though... [spoil:43b14c9fb3]Guidelines[/spoil:43b14c9fb3] We use guidelines in EMS all of the time, we adjust them for the situation and what the specific needs are. Are you sure your service REQUIRES a flight on any of those situations? I only have a lowly 2 years of experience, but I can count on one hand the times we have landed a helicopter. And that includes 5 miles of serious wreck prone interstate. It sounds to me like some people are in kahutz with the state and milking some money out of services that don't know any better. As far as the KED goes, that too I have only seen used a few times. Is that right? Probably not. Does it happen, everywhere. Yes From the forum surfing I do, I notice there are issues that never die... badges, lights on POV's, EMT-B's and IV's, and KED's. I'm sure there is more out there. Anyway, you have to make a judgement call as far as the KED goes, you know your c-spine protocols better then anyone else (I hope).

Every department is different. Every one knows there are volunteer departments that are better trained/staffed/equipped then some paid departments. Everyone also knows there are some municipalities that CAN afford to make their departments paid, and some that can barely afford to sustain them as volunteers. This goes for EMS and fire both. The pissing match is useless. No one is going to change 75% of America. I come from a volunteer Fire/EMS orginization that is very professional. We have newer equipment, younger members, and a good attitude with everyone. Most of our members are FF I/II and EMT's along with advanced certifications. The truth is, if our department went to full time staffing, we wouldn't be able to afford a lot of the things we have now. Which is more important; nice, dependable, safe equipment or 4 guys on a 1990 van converted into an ambulance by Mike's body shop. Truth of the matter is everyone has to decide that. And not everyone makes the right decision, but no one ever said politicians were the brightest either.

Giggity Giggity Giggity ALL RIGHT! Congrats. Take it easy with the hair though. You don't want to expose that to someone all at once. :wink:

I have only had a couple of meetings with suicidal patients, so I don't have THAT kind of experience to go on. However, if you can find a class on suicide intervention, I would STRONGLY recommend taking it. I am a 911 dispatcher as well as an EMT/FF and I have taken a hostage negotiation class and a suicide intervention for my job at 911. Both are excellent classes. While we aren't usually in the position of trying to talk someone out of it, still, it gives you a better understanding not only of the person, but also a better grasp of how to communicate with anyone that is desperate.