EMS49393

You're more than welcome to PM me as well. It's nice to see a teenager taking an interested in schoolwork.

Okay, the first thing anyone taking this test should do is... relax. How in the world can your brain perform at its peak when you're stressed out and worried. Cramming for the test is a bad idea. Hopefully, your paramedic program was at the very least 1500 hours didactic not including your A & P. You can't cram that many hours of education into 30 days and expect it to become established in your long-term memory. It's fine to take practice tests out of some of the commercially available study guides. It's best not to study the night before any exam. If you don't know it, you don't know it. I would hope that someone would have pointed out the fact that there is often two answers that seem correct on this exam. In some instances, you have to pick the answer that is MOST correct. A great number of questions on the exam are worded in "ALS speak" but have very basic answers. Read the questions carefully. Read each word of the answer carefully. Be on alert for double negatives, something commonly missed when people read faster then they comprehend. Don't get let your self get fooled by this type of question: A 58-year-old male is complaining of chest pain at a local doctors clinic. His current vitals signs are BP 132/58, HR 48, sinus rhythm, RR 14 and labored. There is an IV in place, and the doctor has administered Aspirin 162 mg which the patient was able to chew without problem. The patient has no medical history and takes no medications. He has no known allergies. He describes his pain as "an elephant is sitting on my chest," and states his jaw and left arm also ache. What would be your first drug choice for this patient? A. Nitroglycerine, sub-lingual, 0.4 mg. B. Atropine, IVP, 1 mg C. Oxygen, 15 lpm by non-rebreather mask D. Atropine, IVP, 0.5 mg A gung-ho medic student, eager to save lives would probably choose A or C. They both seem correct. The patient is bradycardic. The dosage of Atropine is 0.5 mg for symptomatic bradycardia. However he does have chest pain, so you could give nitrospray for the chest pain, after all the doctor took care of the whole aspirin thing for you. What a dilemma!! When you read the question very carefully, and remember way back to EMT school, what would you have answered then? Hopefully, C. The first DRUG you want to administer would be oxygen. It's amazing to me how many people that take this test forget the basics first. It's also amazing how many times you'll see what you think is the right drug choice only to notice that the dose is not correct. Take your time, read each word of both question and answer, relax, and go with your instinct. You might feel your answer is correct because it is correct. Don't second guess yourself. Be confident in yourself and your education, and go in knowing you're going to pass the test. I've met several people over the years that have failed the test three or even six times. You can tell by talking to them that they set themselves up for failure. Believe in yourself! Finally, you can't get tossed into a prison camp because you fail the exam. You just have to pay the registry some more money.

Your EMS scene is that hard on belts? We're issued belts, leather, with a metal buckle. No ridiculous EMS/God belt buckle, but a standard, buy anywhere buckle. I have one that's six or seven years old, it's still in very wearable condition. Then again, I only carry my pager and my truck fob (small little road safety key) on it. If it's not required, I don't wear it on my belt. I don't need that crap snagging on everything when I'm trying to work. My drug keys? Well, that's why I have front pockets.

Presently, I'm employed by a company that has CAAS accreditation. Honestly, I never worked any place that had this CAAS thing before, so in that respect I know very little about it. I will say that it's a very big deal here, complete with wearing the CAAS lapel pin on the dress uniform. This company is very proud of this accreditation, and is the only service in the area that is accredited. Sorry I couldn't be more help. I will do some talking at work and try to find out exactly what this CAAS situation is all about.

Although I don't mind the idea of driving a little farther for a better working enviroment, I'm sad to say that most of the state has it worse then we do. Leaving the working enviroment would require a larger move then I'm able to do in the next few months. That move is planned next year. In this case, if you can't beat them, leave them. I am not about to waste thousands of hours and dollars of education by joining them. While I'm saddened for the public, I agree that in some cases, the public get what they deserve, and in many cases what they will pay for.

No, there is no input from providers here regarding protocols. It's difficult to push ahead when you have a medical director stuck in 1978. I think I saw mast pants on my ambulance the other day during check off. It's also partly the fault of many of our paramedics who are simply too tired and over-worked to imagine proposing any changes, let alone doing the research to back one. When you mix these two, you have a system unable to progress forward, and paramedics that are often confused when a new item appears on their truck. I've attempted to effect changes a few different times when I was new and not tired. I was ignored despite the research I provided. I don't like it, but it is what it is, a battle one person can't win. I still read, I still participate, and I still treat my patients based on my education, which as a much higher level then the protocols. I rarely deviate, and I rarely require medical control, but when I do I'm confident enough in my assessment and tone of voice to be afforded what I ask for. I do the best job I can with what I'm given.

I certainly did not see as much discussion as I thought I would after posting this. I do have a personal story of my own about an aged member of a service to which I was once affiliated. At the time I was still an EMT-B and spent my time off volunteering for the last volunteer ambulance corp in this particular county. We had a lady around 70 that was a first responder. Being a BLS only ambulance with paid medic chase cars, we often ran calls together. To this day I have never had anyone drive an ambulance with as much caution, control, and due regard as she had. She wasn't able to physically do much, which was rarely a problem, given there was always plenty of help in this town. No one was bothered by her lack of physical ability simply because you were absolutely guaranteed the safest ride around. No, I do not volunteer anymore. That was long ago, and I have seen the error of my ways. So, no lectures.

The instructor responsible for my education taught that a 12-lead ECG would show a ST elevation in a person having an MI only 50% of the time. With a 15-lead, that increases to 73%. I value this statement to be pretty accurate, given I was a student of Bob Page. Cardiac enzymes are reliable, however the 100% gold standard for detection, and hopeful correction of the acute MI is cardiac cath. Again, same instructor. Sounds like a case of that patient not getting the memo on making sure his signs and symptoms were textbook. Sometimes they just aren't diaphoretic, they aren't nauseous, they have no changes on the ECG. Sometimes they have a toothache and syncope with changes on the ECG. Patients are all so strangely different.

85-year-old EMT in Pennsylvania In the word of my favorite SNL skit... Discuss.

At one point or another we were all new. We all had to potty train, start first grade, begin high school. There is no shame in being new. The shame is in pretending you know what you do not know. Mentoring is about more then grading how a new EMT performs a SAMPLE history, applies oxygen, performs CPR. It's more about grading how a new paramedic starts an IV, intubates, or defibrillates. It's about setting an example. What is your student to gain by seeing you angry, abusive, or degrading? A new person needs encouragement along with constructive criticism. If they have passed the course, they should know the skills. It is now time to help them deal with people, with partners, with other departments on calls. These things can not be taught in a text. We are all mentors. Lead by example.

What does first aid have to do with nursing school? What will California come up with next...

The last service I was employed for utilized RSI. Our lidocaine dose was 1.5 mg/kg in patients with suspected head injuries, including CVA. Etomidate was 0.3 mg/kg, and Succs was 1.5 mg/kg adult, and 2 mg/kg pediatric. We also used atropine at 0.02 mg/kg in patients under 10 years old. We had standing orders for Vecuronium if Succs was contraindicated. We had standing orders for one dose of Versed for tube tolerance and ability to contact medical control should we need to use Vec to continue to paralyze or required more doses of Versed for sedation. We have standing orders for fentanyl up to 200 mcg. I have used fentanyl numerous times before arriving to a service that doesn't stock it. I've had great success with it, especially in little, elderly ladies with broken hips, or to control pain in elderly cancer patients during transport. We had standing orders for pain control, so it was my call to attempt to deliver pain control. I've personally had as little as 20 mcg control pain in a patient before. As far as numbing the trachea, we had these wonderful devices called LTA jets, Laryngotracheal anesthesia jets. I tried to use one once on a COPD patient I wanted to intubate but wasn't sure I wanted to paralyze. I never made that mistake again. RSI is, IMHO the most humane way to control an airway.

I should like to point out the requirement of a prescription for carrying O2. Of course, the problem of what to carry would be a non-issue if you would not POV to anything. The issue would be solved even better with a staffed career EMS system. Oh, what a pleasant dream...

I've been biting my tongue for a while on this post, but I really can't hold back any longer. Khanek, did you learn about "projecting" in your psychology course work? I'm not sure JPFINFV is the one with the problems here. Did your nearly three years of education towards your psychology degree include any reading comprehension course work? Seeing as how you either misinterpret what you read or are unable to put your actual thoughts on paper, it's apparent to me that you were able to skip right over English 101 and 102 at your local community college in pursuit of your degree. That 21 year old young man understands the complications with training basics to use Epi-pens, start IV's, give glucagon, etc. As a paramedic, I understand education behind those "random" skills your medical director foolishly lets you engage in. I'll tell you what, you tell me what the drugs you are using are classified as, how they work, how they are metabolized, the contratindications, the complications, and what you would do in the event of an untoward effect, and I'll be glad to call you a over educated basic. Epinephrine and glucagon are not benign as many basics like to think. It's a real shame you went through the tragedy of a bad car wreck with a child. I'd really like to know how the basics saved her life. Did they throw her in the back of the ambulance and drive like hell? That's about all they can do in a trauma, and honestly, outside of control and airway invasively, decompress a chest, start IV's and defibrillate, there isn't much more I can do as a paramedic in a trauma. You can let go of the pompous notion that a basic is the only reason your little girl survived. I'm wagering the reason your girl survived has more to do with God and a good surgeon. I'd even let the firemonkeys have some credit if there happened to be an extrication involved. Regarding the topic at hand. Luckily I work in a service that is an ALS charter, meaning a paramedic attends every emergency call. However, if I were on a chase car system, I would rather a BLS crew call me than not. I don't mind running calls and dealing with patients. Golly gee, that happens to be the reason I became a paramedic. Any paramedic that shows up and berates a basic for calling is an uncaring moron, and it's a safe bet they have a pint of Ben & Jerry's waiting for them at a cozy station somewhere. If you feel you or the patient happened to be treated inappropriately, it is your right to report that to one of their supervisors. You are an adult, you should be able to string enough words together to complain. I'll now return my soapbox to the closet.

Phenergan is an antiemetic, Vistaril is an antihistamine with anticholinergic properties, and Valium is a benzodiazepine. Although all possess sedative properties, they are not analgesics. As far as adequate pain control, I feel we don't have adequate pain controls protocols in most EMS systems. I've only worked in one system that had a pain protocol that enabled me to choose from Morphine, Fentanyl, or Demerol for pain control based on what I felt was appropriate for the patient. Patient suffering does not appear to be a high priority with medical directors, and even less of a priority with most paramedics I've worked with.

Amen. My father used to tell me "if you're going to do something, do it completely, do it well, and don't cheat." When are people going to stop doing it incompletely, poorly, and by cheating? The excuses are old and worn out. Everyone has a sob story about why they can't become an educated paramedic. I don't know any educated paramedic that didn't bust their behind trying to get through school, and become the best provider they can be. They work hard after they become paramedics to learn and keep up with changing trends as we now focus on evidence based medicine. So you become some bargain basement ALS provider and you get a few drugs and skills. Congratulations on getting your certification to kill.

I am not a taxi driver. I am a paramedic, and I have a job to do. Regardless of the situation, I will always do the best job I can. EMS abuse will always be there, just as use of the ER as a family physician will always be there. The problem is bigger than EMS, bigger than education, bigger than hospitals, perhaps bigger than insurance companies. It stinks that we have to transport people we know do not have a medical emergency, however it's our job. We can fight the good fight to try to change our protocols, but the fact of the matter is, any medical director in his right mind wouldn't implement any protocols reguarding refusing a patient transport without having 100% confidence in their paramedics. After reading all the whining about education, begging for more drugs with less education, having five thousand levels of EMT, how can you expect that doctor to want to put his license on the line in such a way as to deny a patient a thorough medical evaluation by an EDUCATED professional, such as a doctor. Turn paramedic into four year degree, EMT into a two year degree, eliminate all the in-betweens, employ the use of a exam that is actually a challenge. Perhaps we can get our medical directors attention if EVERY provider has the same education and license. It's a shame you feel that you are a taxi driver. Perhaps it's time to for you to a) find a new career, or get the appropriate level of education and help to push through regulations increasing educational standards and licensing requirements. In the words of my boss, "Don't be a sidewalk pisser."

Do any of you more "seasoned" paramedics know the name of the genius that came up with fire-based EMS? I've got a present for that twit, in the form of a size 8 to the fanny. EMS should be it's own entity. I like working with fire fighters, however I have no desire to be in a fire department, much the same way most firemen have no desire to ride my ambulance. Best way to keep from getting burned out... Don't do a job you don't like, and remember it's a job. Work to live, don't live to work.

I will preface this post with stating that it is the preference of the paramedic to do either the IV or the 12-lead first regardless of whether the patient appears critical or not. I do my 12-leads on just every patient with a pulse and a problem from the neck to the knees. I have a goal of obtaining my initial 12-lead within 2 minutes of patient contact. It's also the standard at my service to obtain the 12-lead in that amount of time and be transporting any critical patient within 10 minutes of patient contact. It's an obtainable goal, and one I have attained numerous times. The IV, although important, is something I can do en route, and often prefer to do en route. It's to the point now that it is almost more difficult for me to start an IV sitting still then moving around. My reasoning for my rapid 12-lead is to assist in my assessment, not to mention, I've been bitten when I thought the 12-lead could wait. It's easy for me to perform, it doesn't take me away from continued questioning of my patient, it's usually a clean tracing without movement, and it enables me the opportunity to transmit any STEMI strips with ease if the patient has a land-line telephone. In the case of the particular patient you are speaking of, they would have gotten a 12-lead within 2 minutes of contact, and a 15-lead en route if the 12 was negative. I had an elderly lady once complain of dizziness and a toothache. She stated she'd been to the dentist and he told her he didn't know why she had a toothache since she had no evidence of decay. Her dizziness subsided while she was supine and I figured she was just orthostatic after admitting to having flu-like symptoms for a few days. I ran my 12-lead after she was comfy on the stretcher, some 13 minutes into contact. She was having an inferior MI. Needless to say, after taking my time in scene with what I thought was a sick lady, she got her IV en route. I might miss an IV, but I can always get the 12-lead.

Well, you obviously never worked hospital based EMS in southwestern Missouri. I don't know how other hospital based services are but I can tell you in southwest Missouri I worked for two services, both hospital based, and the above list didn't apply to either service. The service I started out with does have extensive classroom offerings and some good CQI, however the pay, benefits and treatment of employees left a lot to be desired. Starting paramedic salary was around $11/hr there. I describe the other service I worked for there as "a great place for crappy paramedics to hide." I saw things there that made me cringe and no quality assurance to find or correct any of the deficiencies in care. The salary was worse, the health insurance shameful. IMHO, they were both no better then the private ambo companies I would occasionally moonlight with for extra cash. On paper, hospital based EMS looks like the best possible EMS in the country. Having worked in it, I'll gladly take the PUM. At least I have health insurance I can afford to use with them.

Oh, Lord. There are so many things here that disturb me aside from the fact that they added yet another level to EMS. First - EMT-EN is a shortcut. Period. You weren't in school long enough to become a paramedic, therefore, you took a shortcut. Everyone has heard all the excuses for not becoming a paramedic. Second - How do you know that sometimes the only thing a patient needs to raise their BP is an IV? What are all the processes that can cause a drop in blood pressure? We'll just pick one. How about cardiac failure? Did you learn 12 and 15 lead interpretation? Can you assess a patient well enough to bet the bank they're not experiencing pump failure before you dump a ton of fluid on them? The alternative to drowning a patient is an inotrope. Bonus points if you learned what an inotrope was in school. Double points if you can name two inotropes. Third - Is a "breathing treatment" really all some people need, or is it all you are able to provide at your advanced level? What exactly is your "breathing treatment?" Are you using Albuterol, or the Albuterol/Ipratropium combination? So you can fix a garden variety asthmatic, brilliant. Now fix the "some other problem" crashing CHF'er or the exacerbation COPD patient. Fourth - This notion that you're helping your community by letting them think you're a paramedic is mind-boggling to me. I often wonder what the public would think if they knew how completely jacked up the EMS system is. Do you think a patient would want to see a Physician-EN over a Physician - Physician? Being seduced by educational shortcuts is not helping our plight to be seen as professional clinicians. Finally - I like my monitor. I use it often. It's not invasive, minus the sticky residue. It's saved my behind a few times during my assessment process. I run a lot of 12 and 15 lead EKGs. I like them. It rarely changes my treatment modalities. I also like capnography. I like the idea of being able to listen, touch, and see things on my patients when I assess them. I realize I hijacked this thread, so I'll close with my advice on passing the test... Go to a good paramedic school, study hard, listen, learn, then take the paramedic test. In this job, you are not the only person you are cheating when you do not obtain the full education.

Somedic, I do not wear my heart on my sleeve, and I don't particularly need nor want advice from you. People are annoyed because I chose to go the extra mile for my patients rather then shortchange them because I'm lazy or burnt out. I won't engage in berating patients on public forums or in person. Obviously, we wouldn't be good partners. I prefer EMT's with compassion. Remember what you post on a public forum. You leave yourself open for an obese person to see you calling obese patients "tater hogs" and "fat assess." Very professional. I prefer to build up my occupation as a profession, not tear it down by publicly referring to overweight patients in a derogatory fashion. :roll: You either want to do this and take the best care of your patients you can, or you don't. I'd advise you to apply at your local taco bell if you feel you are too delicate to move an obese patient. There is very little lifting in making a burrito.

This is a fantastic topic. I have had no problem praying with a patient that asks me. I will not ask a patient if they would like to pray, as some people are terribly uncomfortable when you mention anything to do with God to them. The area I live in is predominantly Baptist and Pentecostal. I'm Catholic. Although all Christian, those religions are honestly night and day. If a patient asks me to pray with them, I'll generally ask them if they would lead the prayer, and I'll hold their hand (Baptists love to hold hands in prayer) and give an "Amen" at the end of their prayer. I've been lucky enough to never been asked to be involved in a prayer that wasn't Christian in nature. In all honesty, I'm unsure I would be able to pray with a person that believed in a different higher power then I did without compromising my own beliefs. I would sit with them as they prayed. I wonder how a non-Christian would react to a Christian that asked them for prayer. Of course, all of this is dependant on the length of prayer and if it's feasible to stop what I'm doing to engage in prayer without endangering my patient or delaying transfer to definitive care. I have been known to personally contact Pastoral Services for patients and families at the ER. A physician or nurse can't dedicate a large amount of time to a family while trying to take care of a patient. A Chaplain can remain with the family for as long as they are needed, and families in crisis often appreciate the comfort. I think a large part of being a good provider is being able to meet the total needs of the patient. Sometimes the often forgotten spiritual need is as great as the medical need.

Ruff, I appreciate your kind words. It's difficult to understand me without knowing me. I'm very passionate about people. The events in my life have all worked together to make me the paramedic I am today. I'm a firm believer that most of what we see are symptoms of underlying diseases. Just as chest pain may be the symptom of a heart attack, being over-weight can be a symptom of depression, or of a metabolic disorder, etc. Alcoholism, homelessness, all of these are symptoms of underlying problems with these patients. Do you take time to talk to these patients and hear them tell you, "I don't like my life, but I don't think I'm strong enough to change." Some people are just not as strong as others. In reference to the argument that people have access to information and they know these foods are bad, so why would they keep eating them, and so on... Imagine you're a large person, with large parents that essentially taught you how to eat. Now you're being told by the TV that carbs are bad. You might have average intelligence and actually know what carbs are. You stop eating carbs. New report, carbs are okay, now it's all about transfat being bad. There are so many different stories about what is good for you and what is bad for you out there it's nearly impossible for some people to understand. Do I judge patients? No, I do not. I can't recall ever judging a patient. I'm the paramedic most people hate because I like to point out the fact that these people need us. For whatever reason, these people need help. We may not be able to provide the help they need, but we can certainly be kind, offer words of encouragement, and attempt to turn them over to someone that can help them. Think I'm fibbing about judging patients, ask my coworkers. They'll verify how much I annoy them with my compassion.

I'm frankly appalled to hear people that are in the business of taking care of the sick speak in such a derogatory manner about these patients. Not all obese people are lazy and victims of eating too much fast food. Both of my parents are greater then 300 lbs, and they both work, earning more money then several of us combined. They rarely eat out. My father is crippled from an accident and is unable to do the exercise we can do, and my mother spends her time doing the errands my father is unable to accomplish because he can't walk for any distance anymore. They also take care of a school aged grandchild, making sure he attends all the after school sports programs they have enrolled him in. My father had an accident eight years ago while he was landscaping at his home. He broke his leg in several places and shattered his patella. He is a diabetic, and because of his advanced diabetes did not heal fast or well post surgery. He had an external fixator in place for three months. At the time of this accident I was working for a transport company, and I arranged and often picked him up for any orthopedic appointments he required. There were times when I was not working, and the crew getting my father did not know he was my dad. I heard the moans, groans, and belittling aimed at my dad and his size. I know he's not a small man at 6'2" and 360 lbs. However, with my brothers help, we set up his living room to be a bedroom, and he was able to transfer himself to the stretcher. The back porch had no rails and was the same height as the ambulance, enabling us to put the cot to the floor empty, let him move over, and wheel him the 10 feet to the porch, we then acted as though we were unloading him from an ambulance, the wheels fell off the porch putting him in a loading position. Virtually no lifting involved in this transport, yet EMT's still complained about how big he was and how they were going to go out on a back injury because of this call. All of this done in front of my father, my mother, and myself. I know that 360 lbs is not 800 lbs, however we are in the business of taking care of patients, not berating them over their conditions. Have you ever stopped to wonder why some of these people end up weighing 800 lbs? Do you think they're happy? Do you think they might be putting on a front so they don't feel so badly about their situation? Do you think that you might be one of the few people in the world that could be nice to them? A majority of the patients I transport are between 250 and 400 lbs. I've learned to get creative about moving them without getting injured. I am also able to lift over 150 lbs, which is required before I was hired for my current job and verified in a lift test. You have a choice on every call you run. You can chose to be a low-life provider better suited to flip burgers in the back of a greasy spoon where you have no human contact, or you can chose to treat your patients with respect and dignity. You may be the only person in a great while that has been nice to the patient you're treating. What does your conscious tell you?