AnthonyM83

You remind me of my current partner on the BLS ambulance. He's very confident person (Ex-Marine) and often comes off very forceful (as you said abrasive) or excited/intense. He's also used to saying what he thinks...and thus has given his opinion one too many times on-scene. Example: Hypoglycemic. Short transport. Medic couldn't start line en-route. As he opens back doors, asks "Can't you give it glucagon IM when you can't start a line?" Sure, honest question, but also reinforcing medic couldn't get his line, questioning his decision not to give IM yet, and directing medic on what to do. It wasn't a true question...he knew the answer. Instead, AFTERWARDS he should have asked "Hey, if the transport was longer could you have given glucagon there?" or "What else could we have done if we were farther from hospital?". He should be able to deduce medic didn't use it, b/c he thought he could get the line, but then they arrived at ER....yet he still asked his question, implying medic screwed up. Also, since he doesn't realize his voice tone/intensity, he needs to feel the vibe of everyone else first (esp. lead medic), pace of the call, tone of the call (hurrying? slow/calm? trying to lead pt to specific diagnosis or asking every question we can?) Then, match it. Also, since you're new, you should be WATCHING how everyone behaves, interacts, asks questions on-scene...then imitating, rather than setting YOUR own flow based on non-experience. Is it normal for the OTHER EMTs or even medics bring up questions like radian nerve? Sure, you learned a fact in school, but have you seen how it's importance and style of application in field? With several people on scene, why would it be YOU who questions it? (You're the newbie learning how it's done...and asking a question mid-procedure like that isn't learning...it's like you said: questioning.) As far as the Narcan thing...why would you start talking about Narcan and it's use of oxycodone OD? All probably assumed to show off . . . yet all probably had already thought Narcan before you, but knew everyone else had too, so why say anything. Do we start talking about O2's effects on heart as we approach a chest pain pt (unless we're teaching a ride-along)? No, because it's obvious. Hope that didn't come off too harsh. Just my blunt opinion on that. It's great that you're working to correct the problem, though. Some don't. I know you want to be yourself, but people also need to go to work and get positive interactions, unless blatantly messing up or someone with standing tells them to correct stuff.

Honestly?

I think that's kind of what it comes down too. The best way I can see to differentiate dumb versus hero is whether you put others at risk when putting your life on the line AND how reasonable the action you took was. Running into a burning building to see if anyone's in there. (Who knows if anyone's in there & you're making other rescuers go in after you) VS Climbing into seat of a car to pull out someone who WILL burn alive within seconds is another. (Your actions are directly preventing driver's death & not significantly putting others at risk.) Like I said, it's hard to explain it. And it's all a gradient. To be fair, many people are called heroes in the media when they should be called dumbasses (Guy who disarms someone robbing the gas station . . . versus guy who disarms someone actively shooting gas station attendant) And on some level, I think society wants those "heroes" out there... especially the person who gets saved...

I keep forgetting you Aussies can drink at 19 . . man! Anyway, I have a friend who served expert witness for a suit where EMTs at a horse race yanked up up a fallen jocky from the ground and walked him off. As luck would have it, he DID have a spinal injury and ended up paralyzed. All on video. The EMT's defense was that he wanted to walk off. Jocky won the suit, of course. They should have done a full AMA before that or at least not participated in yanking him to his feet.

Not sure what state it was in and their specific Good Samartian laws. I'm going to try to ask further at work, but a few people said they had heard about it when someone brought it up the other day. The only thing I can think of is that he didn't have an AED on him so there wasn't as much of a need to remove her top. Don't know what kind of top it was either....depending on the type bra, it might interfere with hand placement. Then again maybe she was wearing a bikini? Let me know if anyone is able to track the story down. I just know if I had actually been REVIVED . . . I'd give the off-duty medic a freebie, even if I thought he had done wrong. I mean she most surely would have died otherwise...

So not only did she put herself at risk, she put her job at risk (being potentially fired). That just makes her more of a hero to me. I know it's not what your looking for and I do understand what you're saying...but when it's a rare ACUTE event that needs immediate intervention like this to certainly not only save a life, but prevent awful suffering while dying...it just seems different. Logically it's hard to differentiate it from going into a shooting scene before police clears it...so maybe it's not based on logic. Just a human factor? Maybe because it's not a common event (GSW's are common and rushing in isn't necessarily going to save the life). The pros vs cons might be more clear in the burning car case. AND I don't know how the setup of the car was...or the fire in relation to her when she went in. I know my agency doesn't want us to be dumbasses on scene, Ricky Rescues, or wannabe-heros....but the managers are also all human and probably wouldn't discipline us if it came to such an intense decision.

A few people at work were talking about an off-duty paramedic who was sued last year for doing CPR. The girl actually lived, but apparently successfully sued him for exposing her top while doing CPR. I don't know if there was more to it. Wondering if anyone could find the article.

Nope, not strange at all. People don't get awards for doing what they were trained to do usually . . . their everyday job. Rather when a citizen makes a rapid decision and saves a life. There's the whole keeping yourself safe and thinking intelligently that we promote, but there's also the human being factor. Someone's about to burn alive in their car. Sit there, watching, waving goodbye to them as they die or get the freaking fire extinguisher and use it?

That's the kind of stuff I love. I think everything we do should be done for a specific reason, rather than "just because". Of course, this takes experience....hard to borrow it from others at work when the medium time-on-the-job at the company is probably 8 months, with anyone over 2-3 years being considered old-school.... Thanks Firedoc, Former, and others. Reaper, I think the parachute system might be what we originally learned in school. Anyway to get a picture of that?

I'm sure they have stats out there for how accurate/inaccurate the AED is . . . I suppose it depends on how narrow or wide of an algorithm the programmers gave it. It cannot have collective knowledge, because we are unable to transfer that to a computer...but we can input our best algorithm.

Great. Go state of California. Do any of you just strap from side to side, chest, hips, legs and tighten? Seems like they'd have to be on awfully tight to prevent vertical sliding during transport. Dust, what do you prefer to secure them to the board? Binding? (cloth wraps)

The state disaster unit we were assigned has immobilization equipment similar to what we use (head wedges with precut tape, adjustable adult and pediatric c-collars) except for the backboard straps. It's one long strap (maybe 8 feet) with the male and female parts of a classic seatbelt buckle at each end. There are three straps for each backboard. What's the best way to utilize these? Two diagonal across chest forming an X and one across the hips? Each one straight across at chest, hips, and legs? (This leave a LOT extra strap...and I worry about vertical movement when accelerating/braking). Some sort of box method (we learned this in EMT class, but had straps that fit through more easily and haven't seen it since)? The backboards provides have the pins at each handhold (presumably to separate strap hole from rest of hand hold area and to prevent sliding around of the strap...but male end doesn't even fit through and female end has to be worked through. This is the closest pic the the strap (remember one continuous unit). This is a pick of the backboard. Note the pins sectioning off the handholds for the straps. In the end I'm sure we'll figure it out, but chances are someone out there has already spent the time to figure out the more efficient system.... Thanks for the help.

Touche. I'm just a nerd and get way too technical

That's kind of what I was trying to say. For EMT class, Standing Orders and Offline Medical Control can pretty much be the same thing. But if for purposes of discussion, we're trying to be technical, then a standing order may be pre-written, but require online medical control to approve its use. In LA, online medical control has very strict rules on how to advise over the phone...the nurse on the phone is following a standing order telling her that if such and such circumstances are present, she can allow use such and such med.

Since the topic is revived, let me ask a different question that might lead to discussion. In systems were ALS always responds, do you always visualize an injury that BLS has already wrapped? If not, could this be a liability for you if they mistreated somehow (thought an open fx was closed or somehow missed neuro compromise)? If so, doesn't that cause pain to patient manipulating the splint or wrap again?

Video was removed from YouTube. Let me know if someone finds it somewhere else...

I liked that enough to repeat it . . .

Pupils?

I honestly didn't get any training on the V-Vac suction. Had I had a call on my first day out of training where I needed to suction, in panicked mode, I might have done the same not even realizing there was a cap. Since then, I've learned new work values (from places like EMTCity) like knowing your equipment and thus have spent time playing around with it (though still don't know manufacturer's directions, because we're not given them) and asking around (people who only give me their best guess...from what they've seen others do). So shame on medic for not knowing his equipment, but also shame on agency for not ensuring their personnel knew their equipment, and shame on the EMT school for not instilling the value and importance of knowing your equipment...

The way I understand it, offline and online medical control are classifications. From there, a standing order could be written for prehospital care providers to read, memorize, and follow (offline medical control). BUT, a standing order could also be written for the physicians manning the radio room to guide them in advising prehospital personnel over the phone. So, in effect it standing orders and offline medical direction ends up being the same thing for us...but in technicality there is a difference. OR it could just be two systems using two different terms for the same thing....or want you to view things from the angle of online versus offline for whatever reason.

In some systems I've seen any sharp (retractable or not) treated like a bomb or those little green spheres of toxic gas from "The Rock". As soon as one removes the needle from patient, it's put into the sharps container. If there's ANY delay, even if you have to walk a single step or even turn around to the container, one yells "sharp out" and holds it up. Nothing else happens until the sharp is disposed of. NOTHING. You don't take the tourniquet off, you don't control bleeding, you don't connect the IV tubing or lock. I guess what I'm suggesting is psychologically make it a colossal deal for yourself. The anxiety from it might force you to re-learn a habit that took you months to acquire...create an anxiety/fear response to prevent you from doing it. Also, like Dust said, adding it into your IV procedure is a good idea. I can space out from time to time and forget things like giving dispatch mileage over the radio upon arrival at hospital...so I had to make a list. Turn off lights, use radio, turn off engine, grab gloves, open door. If one of the four is missing, I know I've forgotten something and won't open the door to get out.

If the problem started unexpectedly once I was en-route, I'd have to judge whether the patient was coherent and oriented and of sound mind to make his own decisions. With an O2 sat that low, recent surgery, and possibly other meds interacting, etc etc, I'd probably say he wasn't. Simple four point restraints if trying to calm how down doesn't work and if leaving him loose would cause more harm to him or others (versus the harm from applying the restraints both exertionally to him and me).

I'm looking for different versions of forms that EMT students get for their hospital clinicals and field ride-alongs. This would include sample PCRs, Evalutation Sheet for student, Evaluation Sheet for the EMT/Paramedic/Nurse (Preceptor), and any other sheets for documentation or instructions to students or preceptors. My email link is on the email icon below (or AnthonyM83 atGMAILdotCOM) If you only have hard copies and are willing to fax it, send me a private message and I'll give you a fax number. OR if you have any ideas you'd like to suggest for what should be on such a sheet, let me know (or post here). We're redoing our school's sheets to create a higher quality ride-along experience (get preceptors to teach more and students to get more involved).

Gotta say, I'm jealous. It's great that you guys were able to get the funding for all of that.

Cool. And I'm finally forced to admit you're not a carebear (first time I read your username, that's the mental picture I got of you...it stuck...tell me I'm not the only one?) Anyway, post some more!