AnthonyM83

I would imagine mapping in an rural setting shouldn't be too hard (with accurate maps) because you have time between each turn. In our urban setting, mapping skills are of high importance. Along with a written and skills test, we get a map test. On each call we get: FD district (gives us a direction to start), address, two cross streets, and a Thomas Guide map grid. I'd say you should have a general direction of travel out the driveway within 3 seconds, a general road to take within 5-10, and fully mapped out in 30 . . . exceptions do apply like when going across several mapbook pages or super tiny spaghetti streets. My general process is: *Know your map pages, so you don't have to find yourself on it each time. You can go directly to where you are and to the map grid. *Start your driver in the direction of the map grid. *Locate street and cross street. *See how street or a cross street connects to a main road. *Use the shortest L-shape to get to that main road. Be able to clear intersections for your partner (if you do guys do that).

But however much of a kickass medic you'd be without the other education, how much MORE kickass would you be WITH the extra education, so that when you took your medic course you could so easily integrate everything with what you already know about biology and the human body!

Once again if the caller gave you that info, why could you not say it over the radio, if it was given to call taker for the responding crew to know? Just like the chief complaint was given for you to know.

While others chime in, I'll just run through thoughts: Check the specific meds she's been given? OD? (check bottles) Her name on bottle. Interactions? Some environmental condition in the room she's in? Last oral intake? Can't really assess neoro b/c of her confusion, right? Nothing upon secondary physical... No on demand pacemaker? Complication of her gout (not in hx list, but she's taking a med for primarily for it)?

No, I'm not done, on second thought. Would you intubate in this case? She's still conscious...but seems to be passing good air (based on scenario responses), so unless she has an upper airway obstruction not sure how much it would help. You could assist ventilations? Possibly DKA as well as septic, but not much we can do other than fluids (already being administered), I think...Recheck sugar. Auscultate heart sounds? Does she have something physical around her legs blocking circulation? Anyone else?

Precordial thump? I'm dry. Anyone else?

The Joker

Does she still have cyanosis to the legs? What are the skin signs?

Ooh, I just read about this one last night, so I'll venture forward. VTach at about 150. I'd give 150mg amiodarone over 10 minutes and reevaluate rhythm and VS. I'd consider synchronized cardioversion, next. And of course confirm pt still has a pulse. I'm being cookbook at this point, now.

I rarely believe in chewing out, but they probably deserved one. It's one thing if they were waiting off on resuscitation until staff found the DNR (even though they technically shouldn't), but when they thought she needed CPR and they weren't doing it is pure negligence. It's the most basic core part of our EMT training.

PS If I were ALS, I suppose I'd give her IV NS. Interpret her 12-lead. Consider atropine. But need more.

Let's increase her FiO2 (thank you Dust & VentMedic) with O2 by NRB. Any other signs of hypoxia? How does the O2 affect her saturation and other signs. Has she been compliant with medications? When was the last time she looked normal (is it in the chart?)? Chest pain? SOB? Speaking full sentences? Equal grips? Nausea? Regular bathroom stuff? Skin signs? Pain anywhere? I'd start getting her loaded up, high Fowler's position if SOB. So far, I have what looks like noncompensated septic shock...maybe some pneumonia? (I'm bad at the possible/suspected diagnosis part.) Sugar high despite her two meds. Do detailed physical enroute. Reevaluate. Monitor Airway and mental status. Can we compare to her current condition to her normal vital signs and condition using her chart?

Hello, hello, I'm Anthony, I'm an EMT, CAN I HELP YOUUUUU? Ask someone to look up her medical history sheet, last vital signs, last meals, medicines, allergies. Go ahead an do an assessment. What's her Awareness/Orientation, Pupils, Skin, Pulse, Respiratory Rate, Blood Pressure, Blood Glucose, Oxygen Saturation? Physical findings? Airway, breathing (lung sounds), circulation quality (distal)? Pedal/Dependent Edema? Jugular Vein Distension? Tracheal Deviation? Stoma? Medical Jewelry? Surgery marks? Can you rule out any trauma? Does she have a roommate who might shed light on anything? Will looking around the room tell you anything? Can we find out what her normal mental status and mobility level is from anyone else? For now, run the 12-lead.

IN GENERAL, isn't hazing considered more of a fire fighter thing... I think the point of the teasing was to tease that stereotype for being "juvinile and imature" [sic].

A few of those are legit worries...

Medical students are broken in getting about two year's worth of internship equivalency while in medical school (might depend on school?). Afterwards, a few more years of residency where they're still learning. It's hard to compare them because so much of their learning is both on-the-job and concurrent book study. (Might be a good model for paramedic school in the future....)

It'd work better than playing a prank on them. If they have an attitude problem, imagine what tricks they'll be playing as soon as they feel comfortable enough. Instead he SHOULD have a sit down and be clear that the attitude's not going to fly. I'm down for playing tricks on each other...if all are down...not on the new guy, unless it's seriously little non-demeaning stuff. You don't want to break trust with the new guys or the trainees. Having said that, I've heard some funny stories about FTO's telling their trainees they need to do a NOAA report to dispatch on the tac channel. They switch to the weather radio channel and wait until they get to our area, then take notes on weather, and report it all when they go in-service. If that happened to me during training, though, my impression of the company would decrease by about half.

Two people with different experiences with different advice. Can't both be right....or can they?

Why couldn't they tell you? If the caller tells dispatch as part of the call, aren't they not only allowed, but also expected to tell the responding crew. What good if the info to dispatch? They might as well also not tell you that someone needs help.

Since the topic was brought up, I'll take this moment to throw in this clip I was going to post today anyway (and subtly helps change the topic): Ambulance Skit or Timmy's first day?

I'd say -20 for the cut and paste. +9 for the admitting it. Lot of credit for admitting, but the violation was severe. Another reason why education is important...the more classes you take (especially English) the more you are exposed to issues of plagiarism.

As far as I know, we can't deny transport. I don't think there's a county protocol for it, but the FD (medical authority on-scene) might have one, as I've never seen outright denial of transport. I have, though, put as my chief complaint "Per pt, it is cold outside".

There have been so many replies here that are so disconnected with the race issue, I don't even know how to reply to all of them. Too many false premises to address. Though probably none of you will do it, I suggest taking a class on race/gender/justice studies to be exposed the true problems. I had no interest in the topic, but took it simply because I was deficient in the topic, and it opened my eyes. PS -There are LOTS of Latinos and a good deal of African-Americans in EMS out here. -I know people with black friends, who openly admit they are racist. -Describing an black person that doesn't have interest in visiting African or learning a dialect shows how detached you are. It's just awkward, even within this conversation.

In theory, everyone takes full universal precautions all the time, but in reality it does help us to know when there's a communicable disease. We often have to get very close (like bear hug close) to the patients, leaning over them and the gurney to wrap them up on it, and we'd like to know. I've only responded to one nursing home that wasn't doing 2-3 of the things on the list...so even if there are good nursing homes out there, it's common enough to require a list

Huh?