AnthonyM83

In what context? Legally, I do think they treat it similarly (perhaps in some states the same?) as killing a police officer.

Yes, it is one of those systems. FD sends a fire engine and truck to every EMS call and we get dispatched a few seconds later. Our arrival times are pretty much the same, though...very often we're first on scene and FD is few seconds to a minute behind...or vice versa. So, no waiting for BLS to arrive. There is no actual ALS ambulance...it just becomes one when the medic hops in the back with his kit (and the fire captain's truck follows behind to drive medic back). And I think you nailed with our employer wanting us to keep FD happy. They have a big say in whether we get to renew our contract with the county for 911 calls.

I don't know if we should make it policy that we'll respond to animal medicals, but if we get there and it's bad enough, I don't see too much harm in trying if there's no alternative. I know 24hr pet hospitals exist in SOME palces, but say a dog has stopped breathing and it's already been a couple minutes. How long is it going to take the family to drive to the 24 hour clinic in their private vehicle? There's no chance for that dog most likely...and it can be pretty traumatic for the family (esp. if it's trauma related). I know police dogs shot in the field are usually treated (best as possible) by EMS and I think I've even heard of transferred to an ER. Only b/c there aren't altenratives.

It's done extremely routinely in this area and really here you need fire to stay available for other ALS calls, because it's call after call in some areas. So, I'm just going theoretical here...could an EMT EVER hand down to a First Responder for transport? I'd say no because it's not a BLS versus ALS, it's now title of provider issue (but then again that logic isn't based on any rules I know of), but I'm just bringing it up for kicks as a theoretical.

Agreed. Refer to my posts where I acknowledge classroom theory, but say it's not the issue in this specific discussion or the quality to bring up about yourself in such a discussion. Of course you need theory, but I see application/common sense in the field as the rate limiting factor so to speak.

Those things aren't "EMS common sense" (rather theory stuff thrown out) ...I see it as in-the-moment decision making, knowing when to apply the knowledge you have and when to look at the bigger picture and realize what's needed at the moment for the situation. I never said theory is not needed (re-read)...I was making a point that you shouldn't try to qualify yourself with it too often (especially in field public safety). -Example me not using EMS common sense: (During training I was prompted to get BP as soon as we got inside the rig. Finally thought to do it on my own without prompt, but failed to realize medic was getting IV ready, which I should have been prepping instead) -Example of it: (RR decreasing on pt, so getting BVM out at my side). Even if you're being bullied, it's in poor taste and adds to the stereotype to some people that those with degrees are know-it-alls...and part of the reason why I avoid mention of my academic background at work. PS I think your debate with Firefighter was fine...but don't assume he doesn't know about infections. Classroom theory isn't the issue in question...it's applying it situation and figuring out which is a bigger risk (laceration/infection). I'm just a new (in EMS that is), so take it for what it's worth.

Yeah, that part I don't got. I asked my FTO about it and he seemed kinda confused and said, "you're right...we're only supposed to pass to those of equal or higher training." I guess it's written into caselaw or something? Not sure how it works...but I don't mind it. We'd get little patient time otherwise.

JPINFV, Quick note: Rarely use your educational accomplishments to back up your argument. There will always be someone better...every now and then it'll be the person you're arguing with. Certifications and experience is one thing...but talking about the classes you're taking is lame. (Especially when not that impressive) It's experience and application of knowledge and EMS common sense that matters more in this field. Education experience does not equal field experience. I've only met one person with a better academic background than me at work (my FTO who is leaving for med school), but most any of the others could school me anyday because I'm new to the FIELDWORK. And Firefighter, I think his original post debating infection with you was just that. No punches thrown yet...I think that's fine and it's an opportunity for everyone to bring their views to the table. As you can see, it wasn't only the newbie who had concerns with infection. Regardless of who is "right" it was a valid concern to keep pushing. That's all from me. (edited for grammar)

Depends where we work. EMT class had me all prepped to expect mainly geriatric calls, but then I moved areas. I'm new, but it's been mainly TCs, SOB, pregnancy-related, seizures, syncope of some kind. They often seem to come in twos...kinda funny that way.

PPS In this specific call the FFs were ready to clear the call and told the family they could private transport or take the ambulance. We routinely get handed off calls (extremity minor wounds, bleeding under control, some falls, etc). Problem isn't handoffs, problem is knowing if they're appropriate handoffs and how to approach inappropriate ones. If there is a problem that is...my partner is the one who felt there was an issue. I'm still undecided at this point.

I have a small decent wilderness first aid kit for camping, which I just decided to throw in my trunk with the spare tire. It's got 3x3s, small sheers, CPR mask. Really more than I'd need, just in case something happens and a friend turns and points, "He's an EMT!" Oh, OK, OK, I also bought a window punch a few years ago when the Crown Victoria's were bursting into flames. It's in the glovebox.

I hadn't considered this much before, because I took my EMT class where every rig had a medic & EMT, so we didn't review it in class and I don't have a point of reference. But my partner expressed concern about FD handing off certain calls to us. I later walked in on a conversation with another EMT who was telling him the old ambulance company with 911 contract used to refuse handoffs from FD all the time when they didn't feel it was BLS. That we should be too b/c our certifications and careers were at stake. The call that upset my partner was: Female, 40s, Severe RUQ pain x30 min, Neg masses, regular menstrual, no vag. bleed Has 7 children, states not pregnant Found in crouched position Pain becomes excrutiating every 2 -3 min ("feel like contractions") Recovering from stomach flu (with antibiotics) FD did history before we arrived, so that's from the FD runsheet...so sorry it's limited We were told to transport her no lights/sirens in heavy traffic, BLS. During transport, pain started radiating to her back. Partner said in EMT school he was told abd. pain should be taken extremely seriously. He felt FD just kind of did a quick history and passed it on to us just out of laziness/casualness (we weren't there for the history taking though). So, what do you guys think of the issue of refusing to transport BLS when firemedic tells you? Obviously, they'd never tell you to transport a hypotensive ALOC sucking chest wound, but wabout the others. I'd be hesitant to question them more than just, "So, you think ____ is okay for BLS? I just want to be sure." My reasons: 1) Partner & I only have 3mo combined experience 2) We're EMTs, they're medics (would it come back on them if it were a borderline & something did happen? medicolegal-wise?) 3) To upkeep relations with fire dept. Obviously, if I feel we really need a medic on board for the good of the patient, I'm going to be more assertive about it...but what about borderlines, do others out there refuse to transport BLS? Someone gave the idea of just moving to the next jurisdiction and then calling for ALS assitance from that fire squad. P.S. For the example given that was my partner's issue. While I was surprised they didn't come with us, I wasn't upset, since I assumed they thought it wasn't AAA/ectopic or something of the sort and there wasn't more they could do enroute. But I might be wrong in not having gotten upset?

Last night: I thought I was going to have my first post-arrival patient death today, as the febrile actively seizing 13 month old in the ambulance slowly stopped twitching and then breathing... his eyes (seemingly) locked on me until they started rolling back. I squeezed him with my hands, gave a silent goodbye, and silently told us both (me and baby) that we (medic and I) did what we could. Then started bagging him. That quick silent convo with myself and the baby allowed me to stay calm for the rest of the call and post-call, since I felt "at peace". When I left ER, he was still seizing & being ventilated, but staff seemed calmer, so I hope he'll be okay. I know I won't be able to have that moment (out of a movie really) to say goodbye in future crashes, but I hope I can remember that at least I tried and not feel too much guilt. As I told my friend, even if you didn't do everything you could for one person, your experiences will save another at some point. I hope I can remember that if things ever go wrong, as I've seen how my friend has suffered from his guilt from a call years ago, still. Edit: As far as them being dead when we get there, the only hard part is watching the family and seeing reflections of your family in them. Like when someone's mother dies with grieving children...cause I know I'll be in their place one day. Sigh.

Likewise

Just saw the wanker thread and read comments about guys carrying multiple pagers and stethoscopes around their necks. I'm 4th day on as an EMT and deciding what I want to carry on my person. Right now, I carry the required company pager. During clinical rotations, I was told to always have my shears with me, but I've only seen one other guy who does, so I just leave them in the side door pocket. Gloves in back pants pockets. Penlight in pocket, b/c it disappears if left in rig. We were given stethoscopes in EMT class, but no one seems to use their personal ones...and I'm hesitant about bringing dirty equipment home with me each day...so not using my own. Handwipes and breath mints. I'm considering a mini-flashlight. Haven't needed it yet, but I imagine there will be times when the ambulance is first on scene and we end up in some dark house or alley that can't be illuminated by ambulance. I saw someone with a compact pouch for flashlight and shears...but I don't want to a Ricky Rescue as we call them. I have no need to fill my belt up with toys...but also don't want to bulge my pockets or not have things handy when needed.

You have to be familiar with DustDevil's postings to really understand them. Statements like EMTs don't belong in ambulances aren't because he hates EMTs (notice how he gave me genuine useful help in the "Call Review" thread), but rather he thinks the whole EMS system should be different...Trying to get the true underlying messages in posts can be useful. Just some thoughts from me.

Yes, we were given paperwork, but never got a chance to look at it, since trying to package pt quicklyish...was going to wait until ambulance, then things started happening. In future, I should ask the attendent while package patient so at least I have something if I don't get to the packet. Also, yeah, I could have taken more time to do more assessments and look through papers before beginning to bag. There was panic involved...I knew I was there, too...that's what reverted me to cookbook. I actually look forward to more IFTs now, though.

Good responses guys. Very helpful. Looking back, I realize I was doing cookbookish medicine. And I even felt it at the time...my overall sense of urgency and danger for the patient wasn't bad...but I felt compelled to step it up to code 3, because of the different vitals...the data...rather than looking beneath the data. BTW, how best do I judge distal perfusion on a dark skinned person? Nails were too tough/crusty for cap refill, skin dark...pulse thready anyway, so I'd assume pedal pulse would be same...warmth of extremities? Do I just have to go with facial signs? (eyes, lips)

First fully mine-protected battle ambulance When fielded, this will be the first fully mine-protected battle ambulance in use with US Forces. http://www.forceprotectioninc.com/models/cougar/ This gonna be your "rig" Dust?

CT...or whatever other tools are used to check for head tumors... Does she work at the hospital? Maybe she needed a ride

Tell all the other medics individually that you're thinking of carrying some morphine in the rig...hand it to them to take to the narc box. See if they come back with a confused expression....or if they come back and say, "all taken care of".

Thanks for the feedback guys, especially akflightmedic and JPINFV. I was specifically looking for technical criticism, as well as mindset/big picture perspective direction (since I have no one at work to get it from...least on the rig), so thank you AK. Appreciated. As for the call: If you guys had to say when you would start either bagging or tracking for rapid breathing, at what RR would it be and under what circumstances? I don't know original RR. The 1 IFT I did with my FTO, we didn't setup like a real call. We did everything in the ambulance...I kept thinking back to it as my only point of reference. Again, that was a main mistake and will now treat all IFTs differently. Order of Events -Take pulse -Take BP (since I already knew RR was fast) -Trouble getting BP -Attempt to palpate, instead...I notice the pulse is much different (perhaps like AK said, it was stress...or a combination...but I think it was different)... -Move on to RR...I see that as most immediate problem I can address, so start using the BVM -And we can't do BG (or O2 sat)L...but good suggestion on utilizing nursing home staff who can. -His arm was slightly bent and turned in...couldn't get it open without putting extreme force... -His neck was outstretched and stiff and scruffy, so hard time getting carotid pulse...I stuck to radial pulse. I started bagging, basically, because I was taught you do that if respirations are high. I was told from 25 to 30s is when you'd start...He was 44, so while I didn't think was absolutely dying, I should be bagging/tracking...I ended up dong a combination of the two. So my question now is, as a general rule, when would you guys start tracking or full on bagging (1 every 5) for tachypnea? BTW, thanks Dust...it's all those police forms that taught me to document thoroughly...protecting against all the defendent attorneys.

Ah perfect...not to see if management would buy some of those to 'test out'.

Yeah...like the pouch Shade mentioned...or maybe a basket type thing...small one...just for extra gloves...maybe a BP cuff and stethoscope or NC or c-collar. Things we might use even if FD is already on scene.

The healthy young of mammals usually need a lot of exercise...usually through play/competition/chase/playfighting...it's totally natural and even necessary, I believe. Kids aren't going to run around the yard if there's no games to play