AnthonyM83

PS My post was in regards to his paramedic administrators to prove a point to them, not actual patients.

Amen.

Check to see if they have the kinds of nails that would show cap refill, if not, go up to them, press on a fingernail, and say "over two seconds" and hand them a black tag, walk alway.

I never understood the cap refill criteria seeing as it's hard to get a good cap refill on so many adult patients even with good circulation. I guess the idea is not wasting time on finding or not finding a pulse....but that really leaves out a lot of the older population. It should be CapRefillorPulse...it only takes a half second to decide which to use when you see the patient's nails.

Okay, now I can answer. Had to set it up right, so I wouldn't come off as trying to say EMTs could be on par with paramedic partners. When I first heard the quote, it was in the context of EMTs being there to maintain BLS for a patient when their medic was getting too wrapped up in the ALS. And this makes sense, if one person in zoned in on a specific skill, he partner who has moved back to allow the medic to work is likely to have a big picture view. Other times, the medic could be very good, but due to nature of the call be spread thin and could miss something vital. It's just a line used to say "hey, I might just be an EMT, but I'm still helpful to my EMT partner." And they're right....it's just that a paramedic partner would be even MORE useful....provided they both knew their roles and both didn't get wrapped up in something and forget big picture. Here are the examples finally: -Catching that our auto vs. ped was pregnant....catching that our motorcyclist who dropped his bike was actually hit and thrown...catching that a patient has Hep...caught that another EMT had setup the 3-lead wires wrong...was able to ID some pills in an ALOC pt's car...a ride-along noticed tracheal deviation on an SOB...my partner noticed an extra bullet wound en-route to trauma center...caught an altered pt's arm and preventing a bloody hand print across my medic's face....when medic told fire crew to hold CPR after awhile asking if he still wanted it help (reply was "oh!? yes, keep it going!") So, like I said, all of these are things a good medic partner would have caught, as well...and even more. I included some that were just being a bad/inexperienced medic, some scenes were just chaotic enough it'd be hard for anyone to catch it, some are things I just considered on my own based on medical presentation... Some of the consequences would have been bigger...looking stupid in front of a trauma team....some caught eventually like the lead wires....some potentially serious...bloody diseased hand on your face... But all of that only justifies having a partner. And using the phrase "EMTs save paramedics" is still pretentious and makes you look bad...unless you use it only in joking as I do. I'm not defending the line. I just wanted to reply to your specific challenge...because it was definitely answerable. The issue isn't who saves who....of course every long-term partner is going to end up saving his partner, whether medic or EMT...sometimes just from a write-up, sometimes from seriously compromising his patient's tx, sometimes actually a physical save from harm. The actual issue is the attitude surrounding it and self-importance EMTs have. It's good to feel valuable and be confident, just know that you're training level is holding you back from saving your medic partner even more...the number of medic 'saves' you have is not justification for EMTs because medics would have even more medic saves

Heh, I had just gotten home from a 24hr shift...was writing on autopilot But yes, sometimes I DO feel like doing it to others, but try not to...it's difficult when others do it to you, though. I think it's a self-perpetuating cycle in a way...if management would just start showing disapproval for that kind of stuff...

LOL, I took it as funny, but I answered seriously...because it's a serious thing that does happen in real life...maybe that's why people didn't take it COMPLETELY as a joke. My answer given earlier would always be the style of answer I'd always give for this kind of thing. If you think about it, it IS a serious issue b/c as people said it's started quite a number of fight...

Does this kind of stuff happen among the doctors as well? I don't know what it is....everyone trying to prove themselves? Lack of skill in selves, so they bring others down to show they're not doing so bad themselves? I know at work I feel like I have to justify everything I do even when not on a call, because someone will throw me under the boss....yet I hardly ever do the same.

What is the general appearance of his legs? Upon your palpation? Edema?

I would post, but I'm waiting to hear from back from medic001918 about my last reply to him http://www.emtcity.com/phpBB2/viewtopic.php?p=131016#131016

But at the same time, learn some ways to defend yourself that ARE likely to kill your patient, as well. If your 280lb muscular male patient who was unconscious comes to and decides to try to harm you or pulls a deadly weapon at freeway speeds, know what you're going to do...and then what you're going to do if plan A fails.

I very much agree with the four limbs, plus chest/head restraint tactics, but that's when transporting a patient handcuffed to the mainframe of the gurney, I don't see how a patient's going to get out of that with enough time to harm you, whether there's one or four officers. Anyway, in LA if there's a serious threat they'll handcuff then just have one officer with a taser ride in the cab.

See, I'd agree with this, but considering the way current systems and schools are setup, it's seeming that before paramedic school IS the time to do it in order to survive in these systems. Even if it's a great school in other ways, the school might still be stuck in the current system. So, in order to survive it, it seems like students almost require that previous experience to do well in internships.

So, what about my original scenario of the EMT who failed out of his medic internship? I know my year as an EMT has helped tremendously. Key lessons are: multi-tasking under stress, patient interaction, exposure to chaotic scenes, delegation, ambulance operations. Taking the medic prep class, then going on scenes also greatly changed the depth at which I viewed and interacted in each call. I don't see how this can't benefit me during medic internship. I can't strongly advocate it, because I'm not a medic yet and haven't seen the results, but I really feel I'd be worrying too much about scene stuff rather than the medical practice during my internship otherwise. I'm not saying you need years of BLS experience. I'd say anything more than a year without a reason is too much. 6 - 12 months seems useful...as soon as your learning/comfort curve starts to level off, that's when you're ready to move on.

Reply: Woah, baby, baby, if you want a threesome you can just ask...you don't have to be so roundabout with it. How about YOU pick. AKA I will always answer with a joke and she will never get an answer.

Thank you. And yes, you have to be careful, that's why you wait to observe resolution of he episode (along with your pt interview/hx/assessment). Dust, we get those too sometimes, but not as often and they usually do the hyperventilation and faint bit rather than the hyperventilate and cramp bit....not sure if that's an age thing... FD transports most for fear of liability (*cough*poorconfidenceinskillsandassessments*cough). We've had a teenage girl c-spined for muscular non-midline neck pain resulting from swimming. No trauma. ER always flips out, but they never do anything about it.

Don't really know either...I've heard Saddleback mentioned a few times, though....but don't know about the quality.

I seriously think there's an argument being created where there is none...everyone wants to put in their word on EMTs not knowing enough, but no one really arguing against it....

I really doubt the even the people who were seriously using that EMT save paramedics line honestly thought they were at the level of the paramedics...rather that there were instances where they were able to "save" (whatever that means at this point)...jump in to correct a critical point (for lack of better definition)....unless I missed a post where someone did say that....and if so, I bet it was only one or two, not a widespread.

The way I do it, in practice: The age, race, and gender of that patient are my first clues as I'm walking up to them. The most common profile (based on our area and the calls I've seen) seems to be female in her teens 20s, but through their 40s, almost always hispanic/latina. No obvious suspected medical problems upon first glance (obesity, on a nasal cannula, obviously disabled, cyanosis, obvious lung sounds heard on approach). Often, there are family members who are very "excited" too. Once we make contact with patient, one person tries to talk to patient, calm her down, refocus their attention, remove them from the excited family members, coaches them on slowing their breathing, provides a steady voice, and lets them know that their contracted hands and feet are 100% normal when hyperventilating, they're not getting worse, they're not going to die, it's going to wear off as soon as they slow their breathing, explain the concept of having too much O2 and that it's actually causing it, and that as medics all we can do is try to calm them down, but their outcome is 100% in their hands, so they have to force themselves to slow it down. As they become able to answer your questions, you ask about their history, find out of an emotional even just happened, other medical problems, medical hx, hx of the same, any other complaints. Your partner is concurrently interviewing the family/friends/significant other and explaining that they must all calm down so that she calms down and gets better. Explain the hyperventilation syndrome to them too. Then you basically just wait to see if patient's condition improves on the spot. Then LA County FD jumps in and asks what hospital they want to go and you've got yourself a one hour BLS call and patient gets an ambulance bill and gets kicked out to the lobby at the hospital, so they have usually go home. At least that's how we do most of ours. Differential diagnosis for hyperventilation are huge, but so that's where history comes in...immediate hx, what was going on during the onset, past medical hx, patients current mental state and physical ability, any other complaints, and waiting to see resolution of event after "calming and coaching measures". You want to make sure it's not a trauma, side effects of medicine or drugs, complication of other medical problems they have, not cardiac, not stroke related, etc. Most of this comes from general impression, though...different types of hyperventilation TEND to look different. But just in case, you do your history/assessment etc.

Dust, did you find that officers were always able to provide four officers (plus officers to drive patrol car(s) over to pick their officers up...remembering that prisoner cage is a dirty place for them to sit) to ride in the ambulance with you? That's taking a lot of officers out of commission...I worked for a city of 32,000 and four officers made up the entire shift from 3AM to 6AM. Also, did that many officers in the back inhibit patient care? Where they all able to secure themselves with seat belts? Did they mind leaving four patrol cars parked on the street unattended possibly in bad areas? If a patient has all four extremities handcuffed to the main frame of the gurney, you have an officer aboard, and another patrol car following how much less safe would you be than having four officer aboard. If patient ends up having super human strength (and for some reason you didn't notice was on drugs) and starts getting out of restraints, do you really not have time to pull the ambulance over and step out to let police officers deal with it? I agree on the other points, though. BTW, what patient does not have a violent or psych history, but enroute becomes altered to the point of trying to leave (but requires emergency medical treatment). How hard does one as a medical professional try to restrain patient? At what point do you back off? How do you decide?

Seems like most bindings could follow that model? Cause really it comes down to Bohr/Haldane being a reflection of the classic factors that affect chemical reactions (temp, concentration, catalysts/medium(pH), physical state).

Ohhkay, that makes it completely clear now. When I read that it alters albumin binding, I assumed it inhibited it (like so many other proteins in low pH) and so it didn't match up with the intra/extra cellular calcium levels listed in the articles. So, I'm guessing that's one of the ways blood calcium level is regulated... by binding/unbinding with albumin.

I'm still confused on the details of it, probably because different net sources are explaining it different ways. http://www.medterms.com/script/main/art.asp?articlekey=13312 says it's low ionic calcium in extra and intra cellular spaces (that's measured as low plasma calcium in lab tests....which also confused me b/c where does the Ca++ go if not in the plasma or intra or extra cellular spaces...or does it actually go to plasma, but since it's ionic form isn't detected in the lab tests? And how does that relate to the Wikipedia article saying it affects the albumin binding ). I'm just trying to track where acidity affects calcium levels, which types of calcium levels (bound or free), and where it goes and make that fit with the different articles.

Honesty, I haven't been following the topic, because it's long and I've been busy, but I do intend to read through it for the info. What do you think of this situation: One of our recent EMT trainees said he had previously gone through medic school, but failed in his internship. He attributes it to not having been an EMT beforehand. I asked him specifically howso. He said he just wasn't comfortable on-scenes or interacting with patients and it was to much figuring out how to do that AND practicing his ALS skills for the first time in the field. He gave the example of a lady hyperventilating and he wanted to start bagging her. He had never seen a patient breathing like that. He said if he had worked jut a few months as an EMT, recognizing her breathing as not an immediate threat requiring ventilations, he wouldn't have gotten so nervous. A common counter to that would be that you'll learn that stuff along with your training, but being comfortable on-scene takes some time. Speaking to several people at my ambulance company, it seems 3 months is often a breakthrough point. I think 6months and a year are also....(though for me the best breakthrough point was taking the paramedic prep class...you're a lot more confident on scene when you actually know what's going on to some degree). What do you guys think about preventing the above situations from occurring? I mean best answer would probably be a restructuring of the paramedic school programs and having concurrent ride-alongs during class, but what about within our current system.