TechMedic05

Cambridge, MA has one of these. Not very impressive. Take an overly-small ambulance - It's no good for EMS. Take an engine with only 500 gallons of water, less hose, and extra junk that isn't practical - No good for fire. Put them together on the same truck and all of the sudden it's the greatest thing?? :tard: It's a lot like Quints in the fire service. They learned 50 years ago that 50 foot aerials aren't long enough. Also learned that insufficient amounts of water, like 300 gallons, isn't enough for firefighting operations. But, 50 years later they can be placed back onto the SAME vehicle, and they're like, the greatest thing since inhalators. ::shrug::

Ok...here we go: New Hampshire is a National registry state. They require you to hold your NREMT certificate, and a 'State Provider's License' - free of charge once you get your service's liaison to sign you as a member. If you have no affiliations with any services, no NH Provider's license. License: Free of charge Maine, has their own way of things. Not 100% sure, but I believe they use their own exams, for their own State certificate. Licensure is the certificate itself. If you have NREMT, you only need to complete a paperwork shuffle that lasts about 2-3 months. Certificate shuffle: Free of charge Vermont, similar. They have their own tiers- Emergency Care Attendant, Basic, I-98, I-03 [Yes, two separate Intermediate levels], and Paramedic. For Medic, It's equivalent of NR Exam. Otherwise, it's another paperwork shuffle to transfer in with NR. Except for intermediates. I's need to retest using VT's exams, at whichever intermediate certification [i-2003, or I-1998 I believe they are]...and then go from there. Certificate shuffle: Free of charge Massachusetts: Someone has to be different. They are not NR, and don't care if you have NR. [gogo bureau of EMS wanting more money]. Any level, you have to take their written test for $150.00. If you have NR, and have taken it with a year, I think it is, you do not need to retake their practical stations. Practical stations are another $50.00, I believe. State Certificate is Licensure. Certificate shuffle: $150.00, and a day at Promissor taking their computerized exam. I work in too many states.

Hasn't veterinary medicine been using something similar to polyheme for years now?

15? That's the record? That's it?? I always thought people had more to say than that ;-)

thanks, chbare! Good scenario!

In my area there are a few bariatric trucks that are available. Most commonly, the bariatric stretcher with the 1600lb capacity while in the down position are on board, and ramps are popular for loading. There are two ramps, similar to a neonatal isolette's [for an ambulance] but a bit larger, essentially making the area needed for on and offloading a patient about 60 feet [Front of ambulance to the stretcher just off the ramps] The truck has a rear mounted winch located just under the airway seat with a wired remote that will reach out the back of the ambulance. They're quite a sight to see.

No succs due to the possibility of hyperkalemia due to the NMS? Airway = good. Cooling = good. I'd err on the side of fluids, possibly even a diuretic, in an attempt at keeping good urine production to help prevent renal failure from the rhabdo. I've heard conflicting stories on whether or not that's actually useful or not, but it's worth a shot.

Sounds like...Neuroleptic Malignant Syndrome?

Who works on a bus as an EMT-P SPONGEBOB SQUAREPANTS! I don't know if I'm excited, or not yet. I'll just go back to my jellyfishing. Come along, Patrick.

Respiratory arrest - Anyone in EMS can fix that. Withdrawal symptoms from opiates - Not everyone can treat those.

Not every ambulance requires a Paramedic. Silly assumption. And Intercepting ALS is most definitely your best bet. Even if it does take 20 minutes, there's still much airway management involved which I'm certain everyone is familiar with. Isn't that what the patient needs the most? Good BLS followed by Good ALS, not a mix-match of limited ALS skills.

I believe they dumbing things down, across the board. I recently recertified ACLS as well, and was rather astonished at the way the instructor informed us. He flat out told us "This has all been either streamlined or dumbed down." in my class there were 3 Doctors, all internal medicine, 3 PA's of various backgrounds, 2 ICU nurses from our state's only level one hospital, and lil' ole me, Paramedic. I guess what was most amazing was how little everyone from the class knew about ACLS...Just the 'algorithms', never mind drug or CPR effects. One of the ICU nurses scenarios was a chest pain, RVI patient, who she told 'Well, all I'd do is wheel them to the ER"...? I guess they may not be exposed to the prehospital or initial parts of ACLS, but why are they so opposed to try to learn it? It's not that hard. Especially now.

Yeah, I guess?

Ok, I'll bite. Why wear shinguards? Other than the obvious "To Guard my shins!"

Yeah, I did. Just a little late.

Rid - Unfortunately, you're right! Billing > patient care, right? Nate: ....You're kidding, right?

I'm finding, in my neck o'the woods [New Hampshire/ Vermont] that Intermediates are getting more and more, and yet getting the same information. Increasing the imbalance of education. joy. Honestly I'm feeling Intermediates are getting out of control in this area. They now have this feeling of entitlement to drugs and advanced procedures...And yet there is a FD Local who is pressing the state for Intermediates to not re-test practical stations every two years as required by National Registry. Skills that they do not get to practice enough, they feel that 120 hours is MORE than enough across a career. They could be waitresses in a tacky bar based off the number of 'coma cocktails' they've served. At least they're afraid of advanced airways. Combitubes for everyone! Albuterol for SOB is obviously the way to go, regardless of a screaming history of present illness of CHF. They fail to see the need to call ALS for CHF or chest pain, as the hospital is only 15 minutes away. [Aside from the argument that intermediates should have their own Nitro. Oh, Benadryl, too! Benadryl, nothing bad happens, right???Just like narcan, obviously] And of course, every patient gets an IV, and it's always with a liter bag hanging. Also, other Intermediate; i was once told I had '...No reason to transport a patient because there's no airway issues.' If Intermediates only see Paramedics as Advanced Airway management, I think we have issues. ](*,) ](*,) ](*,) ](*,) Sorry, in advance, I didn't mean to hijack.

Can we say "Cardioversion"? After that whole 'Call for help' thing.

Spock, you're welcome any time! Just gimme a PM heh heh heh

Street- Welcome to the City! Enjoy your stay. Regarding the "I-Tech" - Yes, he is inadequately educated. Severely. I know, because I know exactly who you're talking about. On the brighter side: Maybe it was a good thing in the previous combitube incident that he did remove it. Yes, it is theoretically impossible to misplace, however due to his lacking assessment skills, or poor education, or flat out stupidity, he was unable to determine which of the two lumens were appropriately ventilating the patient, so, instead of potentially ventilating the wrong lumen, he pulled it. Honestly, I'd rather see a completely BLS airway than someone who doesn't know how to assess a combitube ventilating the incorrect lumen. [granted, it would've been smarter had he deflated either of the two cuffs before he pulled it out, but I digress.] How does a provider that is severely inadequately educated get into Medic School? Go to one that has no formal entrance testing. ::cough:: And also for the graduating class of 2005, a 67% Fail rate for getting to the NR exam in the scheduled amount of time. [9/27 isn't so hot.] Also, off the record, this Intermediate is never wrong, and yet severely inexperienced. Maybe more education is what he needs. Or at least some good clinicals with a good preceptor to show just how much of an imbecile he is.

chbare- By airway management I meant for the immediate issue, to control the airway primarily BLS...NPA, BVM if necessary. RSI at this point is a stretch, I feel. And, as mentioned, RSI does not stop seizures, only the appearance of seizures. Perhaps even in a seizure patient it would be a good assessment finding to know if and when the seizure activity is abolished, if it ever happens. We can never know that if the patient receives a paralytic. [Well, Succs. is only for 3-6 minutes, but then there's the sedation issue with someone who we can not control seizures with, and some services have Roc. or vec for long term paralyzation] Theoretically, if lucky enough to have good compliance, and air movement, an aggressive BLS airways treatment may be, I believe, more appropriate. just my $0.02 Doc - curiosity: pupils? Provided no quinine poisoning. And vitals for kicks and giggles. Medik8or, kinda agreeing wih you as the TB meningitis as a stong ddx.

Anything significant on a brief assessment? FS was alright, abdominal mass? skin lesions? febrile/ cold? pupils? Associated vomiting? Anyone in her family know of her past medical history? Airway managment in the immediate time would be beneficial, but I'd think we're still a bit hasty for RSI considerations as of yet.

Rid, as always, well put. I thought I was just being 'moody' with how quickly confidence levels changed at times...yeah, not getting into ego, as I'm never allowed to really grow one with the constant medic bashing at work. It almost serves a useful purpose. Almost. A new EMT-B came into work today, first day. she couldn't even put her phone down long enough for me to introduce myself, never mind her to tell me her name. I just can't wait until I get to work with this Para-basic-God.

Unfortunately, we were given very limited PMHx in this scenario, although still lots can be determined by just looking at your patient.

Wow! Foolproof EMS! We now need to follow through out parts. heh. #-o