island emt

notice where the OP lists as his location: not many trade shows for EMS there

You should have mail doug.

It is interesting that the drugs we are running short of like dilaudid, Versed, fentanyl, morphine,diazepam,and last but not least Epinephrine. It makes for interest times when you need sedation. We are getting different strengths and doseages in different types of packaging than we normally have supplied. Way too easy to have a medication issue. We now double check and have someone else verify right drug @ right doesage brfore giving.

YAKC: Pm sent your way.

Okay We spent more than 30 minutes on scene in the wee hours this AM. Call came as diff breathing /poss chest pain.On arrival 5 min later pt found in chair with VSA. very Elderly ,prior recent MI hx and terminal disease. We did not work him and stayed to help his wife until family arrived to provide support. Called funeral home and Dr.'s office to get a death notice . Time on scene 1 hr 20 min.

Okay we get it: You do the Goth thing to piss your mother off and to be uniquely different in your mind from the thousands of other goth's out there. In an Emergency situation we will spend just about 20 seconds looking for a source of information as to why a pt is unresponsive or unable to communicate. By then if I don't find a bracelet or necklace , I move on and do what needs to be done . If you are covered in black leather and piercings the last place I would expect to find a medic-alert[ notice how they call it medic alert} tag. Same for having ICE in your phone. The last thing We have time for is to scroll through your phone directory to get vital info. You came here for advice from seasoned professionals and were given same. Hope you figure out what you want.

Thats exactly what we did Craig. We started out with a standard design and in our case a truck that has been built for many departments in our region. The salesman is also a long time Paramedic who has come up with a package produced by PL Custom that is easily modified within reason. Another big point for us was the length and coverage of the different Warrantee's things like a lifetime structural on the body and completed unit. 10 year on Electrical system, 10 years on paint are important item to us.The ability to remount the box on a new chassis and get it done by them is another thing.

Hope ya'll are safe out there in the Springs dwayne

It all depends on what you want in a finished product. I've been on truck committees that wrote: The xxx fire dept. ia seeking bids for a type 3 ambulance to be used for ALS service. On up to my last set which got us exactly what we wanted in a custom type III BLS/ALS transport truck. It has exactly the components we wanted in the layout we wanted and for the most part it was an off the shelf design with only a few things like the Know Narc safe added in. I've found that in the competition today among ambulance builders that if you want a Whelen LED lighting package , you need to spec that or they will put some cheap chinese clone of Whelen LED's on the truck. They are all assembling components and based on your location an extreme climate insulation package would be a requirement. Also an increased AC cooling capacity rating You don't want simple fibreglass batt insulation stuffed in the walls , you want a foam thermal barrier type of insulation applied. this also makes the body much tighter and less likely to develop squeaks as it ages. There are lots of ways to approach crafting a good set of generic specs that will allow several bidders . The new NFPA spec is like everything else the fire service does. Over done. Not For Practical Application. I say this as a two hatter who's been in the service since 1971 and seen a lot of changes over the decades.

My spec for our 2009 type III was about 32 pages long. It can be as simple as asking for a salesman to send you what they typically use for a bid spec ,,, or you can spend a lot of time building your own detailed line item spec. Google ambulance specs and read through a few to see how they are crafted.

Thats exactly what I was trying to figure out. Maybe they go in the kitchen and make a sandwich while waiting for their partner to decide whether to play or stay. Maybe they sit down & do the computer run report prior to transport. I had a cardiac call recently that had a 7 minute scene time with vitals , 12 lead showed STEMI , 02, & ASA done by the time we hit the truck. Didn't really need all the gear to know this lady was having the big one. Pale diaphoretic, clutching her chest, 3 word dyspnea. Big history of MI x 3. Yes i could have spent a few more minutes on scene to get an IV started, but I'd actually rather do that moving down the road towards the Cath lab which is an hr plus travel time. PSSSS: I don't even spend 30 minutes having my morning dump. :-}

Nice one Dave! Nothing like physician induced trauma to add to his other problems. No wonder they wanted him out of their ER quickly. Hoping he would die in your truck instead of there in the ER.

Okay after going back and reading the original post::: Did he suffer from an electrical injury to the soft organs by chance? Lets get him back into X-ray and do an abdominal series . Did they check him for electrical exit wound? front& back? As far as the leaking tube, Put in a gum bougie and install new tube over that with plenty of lube. reverify with CXR. ETCO2 & waveform? Do they have the capability to type & crossmatch? If so lets get that done and hang some whole blood for transport. My spidey sense tells me there is some other injury going on we just haven't deduced yet. Burn pt's are like that, never as simple as it seems.

I'd rather deal with extreme heat index than extreme cold environment. Yes they both have serious possible medical problem potential, but in the severe cold it become life threatening more quickly. If common sense is used high temps can be dealt with proactively by getting into the shade and making sure that everyone is drinking enough water and lessening physical activity. I was stationed in Western Australia where the daytime temps were regularly in the 110 - 120f range . We worked trop hours from 4 am to noon and got out of the sun in the afternoons until dusk. The other extreme of sub zero f temps can cause much more severe life threat in a very quick amount of time and getting warm means making heat to survive. frostbite, hypothermia and freezing extremities are much worse than dealing with dehydration or sunstroke.

We routinely have <10 min scene times. Unless you are working a code or resp distress/arrest needing immediate right now on scene care, why would you need more time. Walk in say hi ask what caused you to call 911. Get a set of vitals and maybe give ASA & do 12 lead or neb tx prn. while partner gets the stairchair or stretcher ready to travel, total time 3-5 mins elapsed. Do you haul in all the equipment on the bus so you can do IV's and med tx on scene when you should be on the road heading to the hospital. I prefer to be in my office where privacy and security are good and all the equipment is nearby . PS: We have a minimum of 30 minute travel time to nearest hosp ER & an Hour plus to a trauma/ Cath lab center, so plenty of time inroute to do all the care we want and the Pt needs. If you work in the hood where the transport time is < 10 minutes then the culture that develops is to spend 30 minutes on scene so the medics can accomplish their tasks . added PS

Last I knew AMR had the contract with the feds to provide disaster EMS services. I know during Katrina and other large scale southern hurricane disasters we got e-mails from them looking for crews to go on temp duty down south . Most states have DMAT teams through the state Emergency Management Office. They consist of military & civilian members to proved a wide range of medical service during declared disasters.

I know that this might seem strange: But does he have a hole in his airway thats leaking into his gut??? increased distention and continued gurgling?? JVD or tracheal deviation? what do his lungs sound like? Equal flow to all fields? did the chest x ray show lung damage? Hemo or spontaneous pneumothorax caused by the seizure activity. Back to lifelong seizure hx. What meds does he regularly take to control this? Don't like the elevate pulse rate or low BP at this point. He should have higher urinary output with the fluids he's gotten. renal failure early on with this case. Have to think on this a little more.

Forgot to add: make sure your supply of pain meds and whatever you use for sedation are stoked up before leaving the ER for the road trip/

Thats a sign of him not getting enough fluids. How much has he had in the 2 hrs in ER? as noted above parkland formula for fluids. Do they have capability for labs at this little doc in the box? Did they get some base values done and see whats what? Other than that get the travel vent and spare battery checked out and get ready to head down the road to the real hospital.

Will that be cash or credit :-}

I have Dubins book in my library. Good basic rhythm recognition. I highly recommend Bob Page's course for EMS on 12 leads. http://multileadmedi...om/Welcome.html He also has handouts available on his website and a book for sale.

just goes to show you can't cure stupid!

What percentage of body surface? What level of severity? Airway inhalation of flames? singed nose hair or swelling of tongue oral cavity? Any past cardiac hx? Is gurgling from him fighting tube? May need deeper sedation. What type of material was he welding? Possible toxic inhalation caused seizure?

Medic alert tags and bracelets are made of stainless to eliminate reactions. They come in many different styles and don't cost all that much when compared to saving your life in an emergency.

if a perv was molesting any 5 yo , he would be lucky to die: Trust me! Another case of justice served the way it should be.