Secouriste

Hello everyone! I have some questions for the australian EMTs (if there is any around here). I may move to australia to study (get into medschool), but I'll have to get a job to pay for the course. So beside the obvious "student jobs" I was wondering if my experience as an EMT in France could be of any use and if I could easily work as a BLS EMT. Leaving aside all the visa problems: What are the requirements to work in the most basic EMT level? Is it useful to have some past experience (even if it's another country)? Thanks in advance!

Thank you for your inputs! "We recently implemented a spinal protocol that essentially eliminates spineboards with the exception of extrication." => What else do you use for immobilzation then? "Being on the receiving end of a BLS driven 911 system has certainly been eye opening." => It's mostly the case in France. If we imagine that, for a whole day, there are only lesser injuries, no doctor will be involved in the process (in France, we don't have ALS, it's either BLS or doctors that respond) during that day. That being said, every dispatch center has a doctor you can talk to if there is a doubt on what to do. We use the backboard as soon as we suspect a spinal trauma. Some team leaders tend to overuse them too... Also, when we cover events we sometime have to carry the pt for several minutes before we can reach the rescue station (in the case of music fesitvals etc...), in that situation the backboard is really useful.

Where I work, an adult lucid patient who isn't under any rights restriction (mental illness etc...) cannot be forced to anything regarding his/her health. If a patient refuses to go the hospital we have to speak for a while with him/her to explain why he/she should undergo some medical examinations. Sometimes it works, sometimes not. In the case of an unconscious adult it's easy, we treat. In the case of a drunk adult who has no other mental condition, we decide and we can ask police support to make sure we can work properly. In the case of a lucid minor, the parents decide, however, if there is any suspicion of life-threatening injury/condition, EMS can start any needed procedure even against parents' consent. If parents prevent EMS from undertaking the required medical procedures, EMS call the Prosecutor to have the parental authority temporarily suspended (which will open an investigation) and a police force sent to ensure the medical crew can work properly. In the case of a mentally ill person, the designated tutor makes the decisions.

Hello fellow EMTs, paramedics, nurses, docs... I'm making a little poll about the use of backboards in the US! If you are outside the US, please post in this topic to indicate your country I would greatly appreciate to have you vote in each of the 3 questions and of course you can share any idea/opinion on the matter here. Thank you in advance!

Ok, thanks for the clarification. Then any idea what could cause such a dispute between the two crews?

1. Do you have any advice on how I can deal with it when the time comes IMO, what separates an EMT from a mere citizen is an EMT knows what's to be done. Stress and panick arise when you feel powerless to help or when ignorance freeze you. Know your protocols and there will be no place for anything else once you're on scene. In my own experience, my duty has always been a barrier against the stress of a situation. I am focused on what I have to do, no matter how much blood on my shoes, no matter the stench, no matter the screaming. If those bother me, I'll talk it out when it's all over, to release the pressure. But as others have said, it depends a lot on who you are, what's you life, what are your past experiences and what are your own traumas. I have weak spots too, but I've been lucky enough not to attend "that" scene yet. I know I don't care about wounds however gruesome they are, I know I'm not stressed when everyone else is freaking out but that's how I was before I became an EMT. I don't think I've acquired much in that regard. One thing though is to analyze quicker and be less impressed by some symptoms. 2. If I do have a less than favorable reaction and I decide to stick with EMS anyway, will dealing with such incidents get easier? To me, it seems the most important thing is to be bale to know when you can't take it anymore. I tell my fellow EMTs "If we attend a scene that you can't emotionally handle, you tell me and I'll let you wait outside." I don't think anyone could be blamed for not feeling he/she can handle a situation. What can be blamed though is to get in the mess, knowing you're not operational, and screw-up because you're terrified. I know some "veteran" EMTs who had had the same weak spot for years and always had the humility to step back when they felt they weren't up for the job. Hope this helps.

It seems the cots you're using induce high risks even during their normal use. Isn't there any manufacturer that designs cots with bigger wheels? The cots we use are either "up" or "down" no middle ground (we can block the "legs" in a certain angle to help the pt getting on the cot, but we won't push it around in that position). See some pics: Also, when we're not in a "safe zone" (ER etc...) there is always an EMT in front with a hand on the cot to secure it and watch for troubles.

I'm a bit confused about the responding system in this state. How comes 2 units are dispatched in the same time? From what I understood there was and ALS and a BLS int he same time, right? Then, isn't there a protocol for those 2 units to work together, given they both have a specific role to play? Or am I missing something?

Where I work, the BLS units handle all kinds of patients (hence we had to buy ped transport restrains and adapted monitoring devices). The ALS though are specialized, with emergency pediatricians on board. We have 2 big children hospitals to transport our little patients.

ED means?

I think that abuses like "shaking" can cause that sort of problem too (correct me if I'm wrong).

Without much knowledge on the subject, I'd say it's fairly possible that a GSW, even with no external bleeding, can cause an internal bleeding and cause death? Does it make sense?

We use both box bodies and regular vans. Renault, Peugeot-Citroën, Fiat and Volkswagen are the manufacturers we buy from.

Well, in my view the VM offers a better immobilization and better protection. It is also more comfortable for the pt. The only problem with it is maneuvering in very narrow staircases (you know, the ones where the pt ends up in a vertical position), because it is not as rigid as it should. In those cases we have to attach the VM to a backboard and grab the backboard for the maneuver. Also, using a scoop stretcher to put the pt on the VM makes things much easier. In my service, we tend to prefer using the VM, but it takes more time to immobilize the pt than a backboard. So if we're in the street of a not-so-secure neighborhood we'd rather use the backboard.

In some traumatic contexts babies and small children can suffer less damages than heavier, rigid-boned adults. But there is something I don't get. I've never had any trouble with any pt about immobilization. Some have found the backboard to be unpleasant to stay on, but I've never had any complain about the vacuum mattress. That is for the patients without any mental alteration. I've always worked looking for the reason to immobilize rather than the reasons not to. When the decision isn't so clear, I'd rather take precautions and put someone who's okay in a mattress, rather than deal with someone who suddenly feels a back pain while seated during transport, because he ambulance shook him/her a little. Or am I missing something?

Yes. The thing is we have to fit a vacuum mattress in our vehicle so we either put in on the stretcher, or store it where the red arrow points on above picture. If we choose the later solution, I want it to be well secured and I thought those nets would be a good solution. Yet we don't use them in France so I thought someone here knew where they can be ordered and how they're screwed in the cabin walls.

Fall + Head injury are enough for me to take precaution. The word says it all, it's "precaution", when I don't know for sure I'd rather do a bit more than a bit less. Plus, when arriving in the ER I'm sure to get the nurse's attention faster. In this case I would have used a collar + vacuum mattress. These precautions are also taken because we carry our pt, and drive around. In case of fall or crash, this additional protection wouldn't be too much.

I'm looking for these kind of stuff: We need to secure an immobilization mattress inside the back-cell, see the pic:

Hey, We're thinking about installing cargo nets in one of our ambulances, to secure some equipments. I know cargo nets are frequently used in the US so I'm asking you if you have pictures of the ones you have installed in your ambulance and the name of manufacturer. If one of you have ever installed such nets, please tell me Thanks

I see but I confess I lack the medical knowledge you have. I'll maybe be there in a few years (hopefully). So far, all I know is "no effort for someone with chest pain" I know for sure he died.

lol, the guy droped to the ground, cardiac arrest.

Seen on a documentary and on scene (by a doctor): tell the patient with chest-pain to put himself on the cot/chair rather than carry him.

The adam apple can be an indication, not matter what the face looks like?

Yes, cardiac arrest in younger people can often mean there is a serious malfunction that can't be treated. When I was 16 a friend of mine was dancing at a party, and dropped dead on the floor. I wasn't properly trained at the time but we called EMS and we did chest compressions. The doctor arrived with his crew fairly quickly but they couldn't do anything... Anyway, the questions are: - Have u ever used a CPR feedback device in your service? - Is it really useful? - Did it improve the CPR skills of your service? (through the post-event feedback software)

Errr I think it was a bit misunderstood. As the Doc said, this is not a compression device, but something that give the paramedic doing the compression a real-time feedback on what he/she's doing.