AnthonyM83

Maybe it's Medicaid that I'm thinking of, but we were told one pays for any ride, but ONLY $200 and by it paying out, by law, it forbids us to charge the patient anything further.

Use their Medicare and they'll pay out $200 (or whatever it is) and forbid ambulance company from charging more, no matter what the complaint is . . . so yup, free taxi ride. If you were to let them know that it'd be cheaper to take a taxi next time ($30-$40) rather than $800 or so, they're reply would be "nope, Medicare pays for it, ambulance is free".

So, no one else has heard of the idea that when deflating the cuff at high BP's, the sound might initially go away, then come back?

Ha, good call out Mobey. I was still recovering from last night when I wrote this...

What are the chances of spontaneous conversation from latent to active TB? Are the chances different if they were initially treated with antibiotics when they tested positive or were those just in case it was going to develop into active AT THAT TIME and no effect on future? Taking this further. . . should one be concerned about relationships with someone who has been exposed to active TB for long periods of time, but no symptoms?

People yell at me when I say it's quite...I mean they get freaking mad...but whatever. I will say though at a certain station everytime your head hits the pillow, a call comes out. We tested it. I'll tell my partner "hey, put your boots on because I'm going to take a nap", I'll go upstairs, lay down, and the station phone rings. We'll spend almost two hours without a call (rare), but as soon as someone lays down...riiing. I mean we've tested this stuff.... I figure there's some correlation with when people at work get tired and when the public feels like calling 911 based on time of day maybe?

I don't know how planned it was or not...but as far as needing to post it in ancient walls to be heard...no it doesn't need to be...but then again we don't need to go to church to pray, yet many people stop by to say a prayer . People create their own sacred rituals as part of their personal religion.

Someone was just telling me that their family is from a country where TB is much more common. She said most have it, but many are just immune to it, so it's not a big deal. She said it in the context of how hospital rushed to put a mask on her and get her tested when she came into ER with a family member who had active TB. Now, would such a person be a carrier? Would transmission be the same? Are they a health risk (they cough, everyone at their school gets TB)? While we're on the topic . . . what are some common TB meds that would alert first responders that patient has active TB versus inactive . . .

Seems like an interesting program to me...seems like it's trying to get away from traditional style of teaching and more interaction with students. This is important to teach students to interact with their coworkers / team members (rather than compete...one of the goals mobey listed)....as a side effect it will probably lead to more discussion on lecture material throughout the course which is a great learning tool.

Mateo, what was your EMT program like? The way you described your paramedic internship seems similar to the standard I'm familiar with . . . I'm trying to see if a similar program could be applied to EMT school...or at least parts of it, like specific precetors and patient contacts versus just a 10 hour shift...

Hey what part of Cali are you from? As far as strapping the mask to their head, from what I've seen with acute severe CHF patients, if that mask is going to help them breathe they will be caring ONLY about that mask and nothing else. It's like how someone described a tension pnuemothorax...they're in such distress they'll let you shove a large gauge needle into their chest if it's going to provide relief...

I was wondering what other schools did for their ride-alongs portion of the class? They they simply sign up for a ride-along with the local ambulance company and get randomly assigned to a crew? They take an evaluation or skills check-off sheet with them? What's on that sheet? Are they assigned to specific preceptors or FTO's or people who volunteered to take riders? Do you go by hours or patient contacts? How many? Do any of schools have the teachers also precept the students in the field? What would be an ideal system for you? Is it realistic? What resources or program modifications would it take? Be specific.

I know we all complain about how EMT schools teach such linear assessments or cookbook assessments. So, I want to know, how do other instructors teach their assessments? How do you think it should be done? Does it work? Do they leave the class knowing what they need to know? Do you require additional hours or do you fit it into the minimum hours (if you extend it, does that affect your teaching program financially?)?

That might actually be a good thing. If patient care isn't incentive enough, maybe money will be. They'll still get paid either way, so the concern about doctors not doing risky procedures shouldn't be an issue. This would be a bonus on top of that....

MM Style, not so appropriate for children due to inherent risk of injury . . . but yes, definitely is a sport.

That makes sense actually. It can cause venous congestion. How about the the theory of palpating on the way up to get an estimate of true systolic due to "silent gaps" on the way down. And while I'm on the topic.... What's the verdict on taking BP's on the same side as an IV? I've been it's preferred to use opposite arm, but if it's hard to get to using same arm as IV is still accurate and not harmful...but I've also read the opposite.

In my EMT class, I learned to palpate systolic first or palpate as your BP cuff inflates to get a rough estimate of when the pulse goes away, then when auscultating listen about 30 mmHg above that. Logic? There are some gaps where there is no sound and if you stop inflating during one of those gaps, you might think the first sound after you deflate is your systolic, but in reality if you had kept inflating the sound would have come back, then disappeared a second time....THEN you could start deflating and when you hear the beat THAT is your systolic. Usually there isn't a gap (of silence), but every now and then there is, so palpating first (or while you inflate cuff) gives you an estimate of ausculated systolic (because there are no gaps when palpated). So instead of systolic of 130, it might have really been 180, but you missed it because you started deflating at 160ish and just picked the first sound you heard. At least that's what I was taught . . . and just today we were talking about BPs with some coworkers and they had never heard of this. Have you guys? Was my BP skills instructor just nuts? (very likely...I'd just like to know)

I popped a little kid's soccer ball with my tires once going L&S But yeah, any at-fault vehicle contact, including scraping the sign = fired.

Words can certainly hurt. The person sending the words gives it meaning and the ones receiving it can decide if they're okay having that around them, at least in the workplace. As for the white rapper thing, they're not black, so doesn't matter much. Even Eminem doesn't use the N-word...he mentions in a song that he would be "F'ed up" for using the word "blank" and he blanks it out.

Thanks for the help. Even though this will be for disaster response, I think they want the skills presentation to be all-inclusive. Partially as a measure of how much work you're willing to put into it (for example, just getting the application was drawn-out process, purposely) and research your topic. The presentation is to our company's management (EMT's / Medics).

Technically I imagine it's still derogatory, but historically they weren't offended when other blacks used it, because they knew the meaning/reason with which it was being said to them, which was different than the meaning/reason of a white person saying it (just like now). I don't know about all that Jesse Jackson stuff...he's an extremist.

Yes, they do expect it, just like they originally expected it back in the day. It doesn't absolve from responsibility not to use the racial slur, just like it didn't absolve them way back in the day.

I hate to say it, because it usually means it'll happen within a week when I say I never have . . . . but no, I haven't. Hitting a sign (in anyway, even scratching against it) would result in termination. Any at-fault accident = termination...

I'm up for an interview for a disaster response team with my company. This includes instructing the interviewers on a piece of equipment: Teach proper use, storage, and care. I will be evaluated on my ability to communicate, thoroughness of the "drill", and knowledge of my assigned item. I was assigned "I.V. Setup". It's mainly from the perspective of an EMT doing an ALS-assist skill, I believe, but I want to learn as much as I can about them. My EMT text is limited, so I will be trying to look through paramedic books. Maybe a phlebotomy one if I can get ahold of one, short notice. Any links or discussions on this? I'm familiar with a Maxi drip and Mini drop, the only two our medics carry. I'm familiar with TKO (Or KVO) rate at 2-3 drops per second and wide open. I've connected many (always handed to me, so never had to pick sizes out for the situation), know the tips need to be kept sterile, announce good flow/drop, no flow. Know how to shut it down if infiltrated and dispose of sharps/catheters. Elevating when backed up. Just really basic stuff.... What else could I get into? Or how can I present the basic stuff in a technical sounding way? Any thoughts, pointers, or IV Setup info?

Well, I like I said, I don't do it. It just wouldn't bother me if someone else did. The reasoning? I guess everyone would appreciate a break or a heads up if they were going slightly over the limit, especially in a speed trap type situation.