AnthonyM83

Well, technically you'd have to have your lights going to drive in the breakdown lane...but I'd most likely just use my rear lights to let people know why I'm going in that lane. I would not go regular freeway speeds if I had my lights on for fear or someone pulling over in front of me, though. If it were the emergency lane on the left , then I'd go decently fast depending on speed on regular freeway traffic. If traffic's at 10MPH, I wouldn't go 50...but if it were at 40MPH and a wide E-lane (some are wider than actual lanes, right?) I might go 50...whatever feels safe.

What about me me!? I'm still seizing...what's a guy have to do to get some benzos around here?

Yes, yes, EMTB, Every Medic's Trained B****...you want to be more than that, but you gotta know your basic stuff inside and out like they say in the article before you start rising above and beyond, so you don't have holes in your training...least I view it.

My eyes aren't bleeding, but I think I just went into a seizure as my brain tried to comprehend it. Yes, we're a taxi. Yes, we also transport emergently.

Yeah, but they might still help some...and around here it really matters to the medics, because it can determine whether they get a bed or chair in the ER...if it's a bed, you find yourself waiting hours sometimes. So we need to find out BEFORE calling it a myth.

Too bad the risk of these types of complaints exist whether or not the medic in this case did or not didn't do those actions with honest intentions. I remember I shyed away once from doing a complete secondary on a female patient, my age, super attractive, on her way to go clubbing, so scantily dressed already, and sort of pretentious demeanor. It wasn't a bad accident, but complaint of back pain (only complaint). I just 1) Didn't want to creep her out b/c I'm sure she has enough guys in her daily life being creepy 2) I could see her starting a fuss about it. So, I basically just did an extremeties check and pelvic bone push :-/

As far as Trendelenburg gurney...I don't know. I know ours are far from it, though, especially when we have the portable O2 tank strapped to the head end, it gets in the way of lowering the patient's head to even a neutral tilt. The leg tilt is okaaay, but still better if you add padding to increase the tilt. I wonder what angles the studies were done at...I wonder what studies would say if done on Striker gurney beds with and without adding extra padding to elevate the feet.

Dude this phenomena saved my ass more times than I can count! I've been trying to come up with a good term for it for awhile. And I think Asysin's response is solid as far as remembering most the crash anyway. You might not remember up to the point of the crash, but you'll remember being shaken around or the noises and the car coming to rest.

PS Glad you told me about this one. I was just watching an EMT Refresher DVD course just for fun and they had one of those old "Emergency Medical Updates" clips discussing that. There I was absorbing it like it was new information. :-/ I believe they were saying injuries increase ICP as more blood tries to get to the area to feed it, but with O2 and even ventilations you feed it the oxygen it needs, thus reducing ICP. But I guess that's wrong. But apparently also giving O2 itself could increase ICP? Was that part of the O2 thread discussion..

In science, you can't assume because it won't work in one case, then it won't work in another case. You can suspect it, then come up with a study to prove it. Because 1 out of ever 100 assumptions will be wrong b/c there'll be an extra mechanism at work we didn't know about yet. And yes, in one study 2/3 saw BP dec, but in another it had (apparently) all 100% had BP inc. So, something's going on, either different ways of measuring, different periods of time in Trendelenburg before remeasuring, etc. Point is, we don't seem to be sure which one is doing it right (or at least which one is more like the circumstances in the field on a real EMS call). Isn't that what it's seeming like if BP did in fact go up? Could it be possible that stroke volume does affect BP, but BP doesn't significantly affect stroke volume (except maybe in extreme cases were BP is extraordinarily high or low)? Again, my point being that these 3 studies aren't exactly conclusive. And it's definitely not enough to convince my EMT partners, like one who argued he's SEEN it work (of course, he didn't test it, it could have gone up anyway without lifting the legs). Additionally, there's Spock who just posted that they prep CABG pts in T-burg to get SBP inc by at least 20mmHg. If I'm going to be the odd-man out at work whose always coming in with new EMS ideas/research, it's gotta good. Now, there are some good points and that's what warrants more research into the topic.

Dude, you're honestly not going to make much money at all working at this company and living on your own. I graduated college in LA, then moved back home for one year to save up money (working a job that paid a lot more than this), and then moved back down to LA and it was still a huge hassle. Balancing your first move-out AND getting started in the job is ridiculous...you won't get a shift right away, just a few sporadic training shifts, then you wait for a permanent shift to open up, and your paying for all your extra county registrations/permits, and at first you won't have a stocked kitchen, so you eat out almost every shift, which kills you financially. If you still want to do it, at least find a place/apartment, BEFORE you quit your current job...and do have some savings, because your first few paychecks are going to be in the low double or triple digits, most likely. The BEST idea, though, honestly would be to go back to college and finish the degree, IF you're truly interested in being a FF. 90% of the people at the company you're applying for are FF hopefuls and many have been so for YEARS...even those with degrees! But if you do decide to come on board, it'll be fun...just expect to be doing it for a while and have hard living for awhile. It's hard to balance FF courses, paramedic or paramedic prep courses, or college degrees while working...expecially financially.

Hmmm...that doesn't sound like very convincing evidence. The biggest study had only 15 hypotensive patients (which is who we put in Trendelenberg, no normotensive) and the other study had six hypotensive and they don't say if the two whose BPs did go up were the hypotensive ones (which would matter most to us). PLUS there's the one study where 8 hypotensives' BPs DID go up. Seems more like someone trying to shake things up and come up with a possible myth (which is definitely a good thing and I respect Dr. Bledsoe, but that's not very conclusive). It's going to take a lot more than those two studies to have people change their beliefs from what's in the textbooks and what they say they've seen work on their own patients. I feel foolish for arguing with someone at work about it, now...

Was there another thread on this same topic? I did a search, but only found this one so far. I swear there was one with people discussing how shock position doesn't really increase blood pressure except maybe in syncopal episodes. I want to make sure I have it right, because I mentioned it to someone at work and they looked at me like I was crazy.

If you wait to start a line, then give nitro, would are the negative side effects for the patient? You give a spray and immediately start on a line, what are the pros? What are the specific cons? BP dropping too low or is the fear that CP was caused by something else? If the later, then you'll still have the same problem you'd have without giving the nitro, right? Of needing a line? I guess as a non-medic, I'm just unclear on why people don't want to spray and start line simultaneously. IV takes time and NTG at least gets on board immediately.

What's his logic for this? Low flow O2 works just as well? Got anything else? details?

Here are some current choices. I THINK these are considered the best 3 programs in the LA area (?): UCLA-DFI http://www.cpc.mednet.ucla.edu/SRRS/Progra...px?ProgramID=13 http://www.centinelafreeman.com/News/paramedicprogram PTI http://www.emsparamedicpride.org/EMS_PTI.asp Mt. San Antoio College http://www.emsparamedicpride.org/EMS_SchoolsMtSac.asp Mt. SAC and UCLA are seeming most promising, so far....umm especially that I just saw PTI requires you having completed a fire academy. I'm half considering trying to find one somewhere else, too, like: http://www.emsti.com/index2.htm or heck why not go to WA for a few months...

Eh, not that much thrill doing 911 calls as an EMT...take vitals, 20, load up, prep IV, stick electrodes. If you're first on-scene, you can start taking Hx and lung sounds etc, but medics will show up in 30 sec, take over, and redo everything. I actually enjoy when they hand-off BLS patients to us, b/c I can actually "play" EMT for a bit (actually it often leads to good new info).

Acute Smurfosis

I'll give Tactical EMS the benefit of doubt for now, as it'd make sense to have EMS on standby for situations that have high risk in GSWs. A question I'd ask is: Is there a difference in effectiveness among different levels of medical providers?

Here a minor can refuse transport if he understands what's going on AND it's a minor injury. If it's actually, serious and they need to be transported not for precaution sake, but because it's life/death or risk of life/death, then they can't refuse.

As for the EMS setup down here, like JPINFV said, 911 medicals are dispatched out to FD, but simultaneously forwarded to one of five private ambulance companies (each has a different geographical area). FD and ambulance (EMT x2) usually arrive on-scene within 1 - 2 minutes of each other. If it meets Paramedic/ALS follow-up criteria, they'll ride with us (squad/truck will follow to take back their medic). If not, they'll hand it off to us as a BLS code 2 transport. By "medics do little," I meant they carry very few medicines based on looking through their drug boxes (Albuterol, ASA, NTG, EPI, Atropine, Glucagon, maybe 2-3 others I'm forgetting), they don't do many advanced procedures (apparently, the big news was that we recently got subcutaneous pacing approved, wow), standing orders are pretty limited and they seem to have to check-in to base for everything (though I don't have means of comparison for this). Also, most FD medics seem to be medics, because they REALLY wanted to become FF...this increased their chances (and pay). I've been told my current EMTs that they hate the medical side of FF, but are still going to medic school. Also, heard some FF talking about how a certain school was good, because they really held your hand and wouldn't let you fail (FD sents a lot of medics to this school and I'm sure FD wouldn't like to see their medics failing out...though I heard they're now switching to an easier county-run school). I'm all for hand-holding and not letting you fail, as long as they don't dumb the class down at all.

Hey guys, I'm emailing some of the medic schools in my area to ask if I could be put in touch with an instructor to ask them questions, possibly sit through a class, and basically find out if the school's a good match for me. So far I've only gotten one email back asking me to call him and mentioning that there's no sitting in on classes. So, I was wondering what would be good questions to ask him when we talk. Questions that might help me compare the different schools I research. I was thinking: -What kind of homework assignments do you have? -How many instructors switch off teaching class? (I've heard of classes with so many instructors, they never know what the other instructor's taught already) -What kind of extra projects do you have the students do (not sure if this the best way to ask this...but I've heard mention of student research papers etc on this site) -What's your national registry 1st time pass rate? -What's your drop out and fail rate for the class? -How many students get jobs as medics within the first 6 months of graduating? -Where do students do their clinicals? Ideas on what kind of things to ask or talk about on the phone with them? I guess I basically want a school that will teach me this in-depth and also see the big picture of medicine. This is especially important b/c in LA medics do so little. I feel they might not cover a lot of things well b/c it's not even in our scope down here. Thanks, Anthony

I'm about to go on a 24 hour shift, too. I've worked a few on OT, though, and I didn't really have problems sleeping in them. Every now and then one might get out of place or unfocused and you'll have to slide it back inito place. Or you might close your eye and pull on both your eyelids a bit...it creates a suction and air rushes under the contact across your eye and helps unstick them from your eye. I do carry eye drops, though, and 2nd pair in case they fall out at work.

By management I pretty much mean CEO (in private companies)...at least here, supervisors aren't getting says in that kind of policy making.