island emt

We don't get many opportunities to fight major fires like some departments. however the fire side has taken on many other duties such as smells & bells as alarm calls are called. also car crashes and flooded basements. Fortunately with increased building codes and better inspections, along with a large amount of the really old firetraps being long gone , there are a lot fewer structure fires. Most of ours are tied to wood stoves & chimney fires. But EMS has been a fire based commodity here for decades.

I see a lot of consolidation and regionalization in the coming years. Even the small town rural services are finding it hard to continue providing service as in the past. Expenses go up and receivables go down,with insurance carriers wanting a fixed discount for services.

In many parts of this country EMS is provided by the fire service. I currently am a two hatter dual role, although EMS is almost 90% of our call volume. Every now & then we have to play hosers.

RETIREMENT

Confidence is a common problem for newbies. You probably know the right stuff and can do it in the proper sequence if you stop & think about it. What the preceptor is looking for is the automatic flow of all that information in your brain just happening when it;s needed. Some folks take a while to be comfortable with their assessment skills and knowledge. Maybe you just need a different FTO to take you to the next level . We like to see newbies be comfortable and to take charge, secure in the knowledge that we are there to back them up or assist them when they get in a bind. good luck

When I started in 1971: [yes I'm old ] We were called Ambulance attendants. Our training was basic first aid and little else. We had pontiac station wagons with a raised roof. . only gave an additional 8 inches height. 500 cubic inch motors ,700-15 bias ply tires and sub par drum brakes. We had an oxylator which was nothing more than a demand valve resuscitator and a first aid kit with some surplus military bandages, OPA's, along with some board splints. we had a jaw screw for siezure pt's and ice bags if we remembered to fill them up at the ice cream stand the family also ran . Every trauma Pt was placed in the mast trousers whether they needed it or not and put on a wood spine board. Not much else for equipment. I remember well when the owners bought a radio system for the base, [the family run Funeral home] and for the two wagons. They painted big letters on the side of the fender , ""RADIO DISPATCHED"". We no longer had to call in after finishing a run from the nearest pay phone. I know:: most of you youngsters have never seen or used a pay phone. :-} We had the two man dead lift ferno stretchers, & a folding steel chair contraption that caused more broken fingers than anything else. Oh how we have changed over the decades. Now we run in 14000 lb. GVW trucks with boxes that are bigger than some of the apartments I've rented over the years. Fully outfitted with more equipment than the emergency rooms used to have at their disposal. We do 12 leads as a matter of fact and IV's , intubation along with a myriad of medications at our disposal. Where will prehospital care be in the coming decades?????? Added a couple sentences for clarification.

As said above the endotracheal tube is the gold standard for secure a definitive airway. After inserting an inflatable ballon cuff is filled which occludes the area around the tube making aspiration all but impossible. the combitube or king or any of the other blind insertion airways are just a set of tubes that are introduced into the oropharynx in the hope that one will hit the trachea and one the esophagus. The LMA is along the same lines, it looks like a part of the female anatomy that is placed in the anterior throat in an attempt to control airway. It won't stop aspiration or stay put when bouncing down the road. Plus the multi tube adjuncts are way more expensive to purchase and have the same short expiration dates as ET tubes, which cost about $3.35 ea instead of $50.00 like the combitubes , or $38.00 for the king.

As the saying goes: You just can't cure STUPID !!! Hopefully the feds will put him on the no fly list and ban him from applying for a visa again

Good press for her and the service. Dwayne : She a hottie

the last I knew there are 39 states that require national registry to practice. Many of them also require a state license or certification in addition. Reciprocity is not an automatic thing.

it's really nice of her to hold that tire still for you.

Then EJ it is as I mentioned back on page 2. In hindsight, What was the reason for zero success in peripheral IV access? With her BP it wouldn't appear to be vascular shunting from the periphery. Just going off track a little here: Do you have a Rad 57 by chance or a LP 15 with CO capability? As far as the nitro spray: I'm still very leery of giving it without a 15 lead to check for rt side involvement & definatly not until venous access is established. Too easy for things to go to hell in a handbasket here . I asked for one a long time ago Trevor. he didn't do one

OK, so we transmit to the city hospital & the Cardiologist Gives the consent for SQ lovenox, but says no to the IO. Plavix 300mg PO. He states he suspects large MI and orders to bypass to the cath lab. New vitals: 148/88 HR 87. Resp rate 18, Spo2 97 An hour passes, we are now about 1hr from the cath lab. The patient is quite diaphoretic and c/o new midsternal crushing chest pain 7/10. She begins to vomit again. BP 146/70 HR98 At this point you have a pt that is heading down the path of no return and it's not going to get better soon. She is starting to circle the drain and you have no IV access. It's time to think a little outside the box here. Did you look at her feet & lower legs?? There are several good veins there that can usually be found even when you've had no luck on the hands & arms. Me : Would have gone to the EJ as a direct route , but it's all how comfortable you are with finding the landmarks. You really need to be careful with the nitro, looks to be rt sided from what little we've gotten from the ECG strip. Like Patience said pads on and be ready. Diesel bolus might be her only option at this point on your journey

There are several folks here that are banned for life from that other cheesy web site. Don't let it bother you! Welcome to the City.

Kind of hard to give a thrombolytic until you get Venous access isn't it? If you can't get a peripheral line, then maybe an EJ, then it's time for IO, She's not going to be happy, but what can you do Yes: I would bypass the doc in the box unless she has a sprained wrist. this lady is way beyond the capabilities of the local clinic. If you have 12 lead capability , you also have 15 lead. just sayin!

So where is the news link???

have fun learning today Kids.

Did he win??? Or is he still running?

Death by powerpoint is the fastest way to lose an audience. Use it as an outline to the lecture.

It's been about 10 years since I taught a first responder class. As I understand the EMR [new terminology] course is basic airway, breathing , splinting , & bleeding control, CPR and very little else. How many hours is the new standard course requirement? It was 44 hours for the First responder level which is now history. Teaching adults is very much like teaching 6 year olds, only you can use bigger words.

In many areas the duties of being the medcom phone answering point is delegated to RN's and even some areas , Paramedics. That said , If your requesting to go outside your published protocols , then you need to speak to an MD/ DO who is granting an exception to the published protocols. Document in your report , time and who you spoke to to go outside the protocol. This doesn't mean you can preform invasive skills outside your scope of practice, such as an EMT basic doing a chest decompression or surgical cric, without putting your license on the line. charges will be filed and you will have to face the consequences of your actions , even if a doc told you to do so.

The harborview crowd has always thought of themselves as better than the rest of us mere mortal beings when it come to cardiac resuscitation numbers. They have always posted numbers that are double the rest of the country. I've always said that there are questions on how they come up with there numbers and what types of patients are being included in their data. If you only include cardiac arrest that are witnessed and have immediate CPR & defibrillation, the numbers will be better anywhere. To openly state they don't follow AHA guidelines is just plain foolish , I can imagine a lawyer seeing that and waiting for the next non survivor to file a lawsuit.

55 degrees here today warm and sunny

Next time you need a 12 lead done , stop by the local ambulance service and I'm sure they would be glad to provide a professional courtesy freebie.

First off Glad you discovered what was causing the problem Second. I'g tell the urgent care clinic you were forwarding their invoice to the state attorney generals office for fraud investigation & maybe even the feds for violation of medical practice. As a licensed Paramedic , you more than likely have more education and training than a first yr med student. We gave you a better exam over the internet than they did for a grand. My invoice in the amount of $300.00 will follow.