AnthonyM83

I've seen a teddy bear or simple blow-up glove silly face go long way with kids, distracting them from the strange people and environment going on around them.

Funny you say that....he's applying at my company and my new partner's an FTO :D We'll train him well

We don't have scoop stretchers, though we do have break-aways...which can be quite helpful when delivering the patients to their ER beds. The metal frame makes carrying easier than a stair-chair or backboard...it actually might be the most under utilized...partially b/c it's so difficult to re-assemble afterwards.

muahaha

+1 for you!

We get absolutely nothing. No CE, no money for CE.

I just stuff them in my boot. Got the idea from AKFlightMedic. My old partner though bought some boots that had a little knife sheath kind of, so he stuffed the shears there. Since they're mini shears, I'll lose them every few months...but they're $3/each, so I just replace them. I really like a minimalist look, so that's why I don't have a shears holder on my belt.

Found this cool site EMTs might be interested in. Anatomy pages too w/ pictures: http://www.healthsystem.virginia.edu/Inter.../Intubation.cfm You can explore other pages there like: http://www.healthsystem.virginia.edu/inter...tiveContent.cfm

My partner mentioned he's going to a PHTLS class that says they teach how to intubate while ventilating a patient? Any idea what they man by this? Obviously you can't have the face mask on and put a tube down at the same time...so maybe they mean you can intubate in between the breaths? Also, I read someone here say a good medic can intubate while CPR is in progress? I know little about intubation, but does have to do with just skill level or learning special technique? B/c all the medics I've worked have asked me to stop so they could intubate. AND while I'm asking questions on the topic: You guys know of any good online resources with pictures on intubating? I don't know what anything in thosei intubation kits do...it'd be nice if I did, so I could hand stuff to the medics (in the proper way, holding from the proper end, in the proper order) or better assist in anyway during codes.

I would tell the staff we won't be able to leave until we find out exactly what was ordered and what he ate, and if we stay much longer things could get worse and it'd be worse for the company's reputation. Could the new chef have screwed up the preparation of a poisonous fish? Ask to speak to the manager immediately and get him to interrogate the employees. Any actual pain/pressure, orthostatic vitals?, full field neuro assessment, base would probably tell us 12-lead. If that's not getting you anywhere, get a sample of what he ate and start transport, in case it gets worse.

I'm the one who originally asked the question when I just started as an EMT in October. As an update, after taking people's ideas here and learning from my shifts: 1) 2 pairs gloves (various reasons) 2) Small shears (in boot, out of sight) 3) L4 Lumamax mini pocketlight (freaking bright, small out of sight) 4) Pocket Knife (helpful...also work in bad areas) 5) 2 Pens & a Pad (duh) 6) Req'd company pager (receive call info) 7) Station/Rig Keys attached to Kubaton (prevent losing keys and #4) 8 ) Camera Phone (Safety reasons & to contact family of altered pts for hx or poison control etc) 9) $5 & Checkcard 10) Manager's Business Cards & a Drug reference card Backpack that stays in Rig: -Digital Camera -EMT Book -Thomas Guide Mapbook -Reference Binder I created with special maps of mobile home parks with gate codes, list of farther out receiving hospitals and resources (EDAP, Trauma, etc) w/ crosstreets -Heavy Work Gloves / Clip Board / Mints / Change / Water / Emergency Snacks / Sharpie

Our EMt instructor told us that it used to be that people were taught before. It was drilled into their heads. So, I understand why that user's mom who was in EMS for 20 years would say that...she's probably out of it now and many people might not have that topic covered in refresher courses. But in their minds, they're truly trying to save the patient by witholding O2 b/c that's what THEY were taught. Just shows why continued and updated education is important. What you learned when you take your class won't hold you through a 20 year career, I guess.

We've had a few discussions at work about EMTLALA, but don't think any of us fully understand it. Is it accurate to say that once you've arrived at a hospital with a BLS patient and realized they're overcrowded (say a 3 -4 hour wait) you can't leave and take your patient to another ER EVEN IF YOU HAVEN'T GIVEN A VERBAL REPORT YET? I was taught transfer of care occurs when you give the verbal report...our managers also told us we can't go to another ER once we arrived b/c it would be transferring care from hospital back to EMT (to a lower level of care)...BUT if we haven't given a report, yet, I understand why it would be transferring to a lower level of care if the hospital never had care yet...if they never knew you had even arrived. Any difference if it's an ALS pt?

I have this little "Quick Reference to Critical Care" book my Diepenbrock (only ways I'd know there was even such thing as Cushing's Reflex...too advanced for our EMT class I guess...grrr) Anyway, it lists it like this: 1. Bradycardia 2. Hypertension (with widened pulse pressure) 3. Bradypnea (often irregular) I know 140 isn't too high a BP, but he had more than a bit of blood loss. But I'm not sure....I guess the best way would have been to track his VS...but I was driver...I just heard the report as we wheeled him into ER.

So, how would you differentiate them? Tension pneumothorax will have a sharp pain and quickly get progressively worse? Pericardial effusion....decreased lung sounds?

Well it was the new passer by medic who said that. I think he was confusing Cushing's triad and early signs of (compensated) shock. It's interesting seeing things in the field for the first time...mainly b/c it's not always textbook, like shock. I'd seen a few patients who were hypotensive, but wasn't until 3 months into it that I saw a classic presentation with the cool pale clammy skin, diminishing LOC...or the first time I saw coffee ground emesis.

Honestly, a lot of things we do in the field are because of protocols and liability, rather than actually believing that's what the patient needs at the time. One example is how often we c-spine everyone...girl on bike gets hit by car at low speed...bumper against lower leg, she falls in sitting position, no KO, witnessed fall, head and back don't touch the ground, oriented and alert, only complaint is lower leg pain...but FFmedics get on-scene and cpsine! I doubt they really think she needs it either...but it's the whole liability thing...

I thought it would be interesting to hear how working EMS has changed different people. Either how you act or the way your view things. I've only been working in the field for a bit under 6 months, so haven't had any big changes, but did realize how much I view people's bodies as simply machines, now. When I bang my elbow or get a cut, I seem to think of the injury less as me getting hurt, but rather my body receiving an injury. Flesh and blood vessels receiving a trauma. I think this comes from the number of injuries I've seen where parts of people's bodies were injured/disfigured or flesh separated from main body...you start seeing bodies as just this biological casing for people's brains. Not sure if it's a good view or not... Other small changes are being more action oriented, as well as worrying about my health and that of my parents, after seeing what poor shape so many of the elderly citizens end up in.

Is that a round gel capsule with a only a T on it?

LA County only uses x3...seems like "event" would be a pretty important one.

Are we sure we can rule out anticholinergics? Benadryl seems like a common drug founds in "cough medicines" and would account for the lethargy and low BP and possibly irregular HB...Could that stress lead to a heart block? (A topic I know little about) I would request PD assistance, having them respond to the grandmother's house to look through her medicine, perhaps even taking the family to point out what the baby took.

Don't think I've taken anything for myself. I've overstocked on blankets/sheets/towels before for the rig, but I don't count that. Usually our rigs have enough of the common supplies that you'd easily find at the hospital. I've taken a forhead thermometer before, but showed it to the nurse before putting it in my pocket to gain permission. I do, though, know a guy whose taken actual rounds of epi, atropine, and a few banana bags for a home kit. He's a certified medic (but was still working as an EMT at the time). He said he'd like to have it just in case a family member or close friend went down, otherwise wouldn't use them. ..

I would prefer to lower the gurney to an appropriate level, but FFs pretty much decide everything we do on-scene, so that's probably not going to happen. On my first arrest, I was having some trouble with compressions from the ER parking lot to the hospital gurney bed and a medic told me to ride the gurney. I smiled and kept walking alongside with it. Afterwards, I found out he was serious and they showed me the spot on the gurney bottom frame that has a picture of a foot. Apparently, you're supposed to do that. I'm pretty light and there's usually two people at the head (heavy side) anyway during a full arrest to control both sides. So, I'm undecided, as to riding the gurney, yet. I know it would definitely allow me MUCH better compressions.

Temp? Is this febrile?

I was wondering how quickly people out there have seen Cushing's Reflex manifested in physical symptoms. We had a GSW last night. Approx 21yro male, Entrance wound to occipital, some brain matter loss, Resp: 8, BP: 140/p (seemed high for young guy with moderate blood loss), concious, but altered, some hand posturing on right side, would follow only some simple commands, eyes rolled back...don't remember the pulse rate (I was driver) but I think it was high. Cushing's Reflex popped to mind, aka inc. ICP (Guess not a big surprise having been shot in the head). Just wondering on average how quickly this develops. A passing EMT (whose gone through medic school) said he was told we wouldn't usually see those signs in the the field, as they're late signs. That we usually just see the rapid breathing, pulse, and widening BP as patient compensates. I think though he might have been confusing symptoms of shock with symptoms of ICP? Or does the same happen with ICP if there hasn't been too much blood loss? How quickly have you seen shock progress from a trauma progress in moderate (no excessive) bleeds. Just trying to learn a little from this call. Thanks.