Eydawn

You keep asking me the same damn question, just phrased differently, so I figured that must have been the angle you were going for otherwise you would have understood my posts and said "yes, that's what I was getting at, education makes the difference." I don't know how many times I said that only to have you ask AGAIN what I was getting at. Usually people comment on the clarity of my writing... wtf happened here? Just because I didn't phrase it the way you wanted me to phrase it you kept on it. I stand by all the posts I have made. The assessment ITSELF is different by virtue of the brain performing the assessment being programmed differently. (Sorry if I sound cranky, I had a rather rough shift and am studying for a microbiology exam at present...) Wendy CO EMT-B

You're basically arguing as to whether you define an assessment by the tools used in that assessment or by the use of information gleaned from use of those tools. I argue that it is the use of information and the knowledge of which tools to use that makes the ALS assessment different. Wendy CO EMT-B

BLS providers, by and large, are NOT taught critical thinking skills. Nor are they taught much of anything else for that matter. I think the difference is that you may do the same actions within an assessment, or many of the same actions, but if you can't interpret what you're taking in, it doesn't make a damn bit of difference. The assessments are different by virtue of being able to interpret information differently. I don't view the physical skills of assessment as "the assessment" nor do I view history taking the same way as I did as a brand new uneducated Basic. My assessments are VASTLY different now than they were previously, so I stand by what I said in my previous post. They are different assessments. Wendy CO EMT-B

How would you guys handle this call? Just curious... something that actually happened at my facility about 4 nights ago. 100 year old female (sharp as a tack and sweeter than pie) pushes her call light, tells the care provider (yours truly) that she just doesn't feel right and she's "never felt like this before in my life." She's lying supine, pale, drenched in a cold sweat, but does not complain of dizziness, chest pain or shortness of breath. LPN is grabbed to assess her, can't obtain manual BP, gets an electronic BP at 58/40. Resident just started amoxicillin this evening for a minor infection from a root canal, has had exactly one dose at 6pm (it's now 12am). We call 911, get a response... and then the general feeling is that there's probably nothing going on, she's chatty, feels fine, just feels "uncomfortable"... FD gets a BP at 60/40, EMS gets a BP at 90/50. Pulse is "regularly irregular" with hx Afib. Talking about how this is all just a big load of fuss and there's been no car accident so do we really need all these firemen (ROFL on the inside, trying not to show how funny I find this as this big fire guy is standing next to me...) What do you guys think? Consistent with some sort of allergic reaction? That's where my LPN's brain went... my brain went cardiac before the LPN pulled up the resident's computer records. I can't give you much more info, because frankly (even as a shift manager) I don't have anything else to give... we've got very limited health info on our folks aside from major diagnoses, previous events (usually what lands them with us in the first place) and their medication record. Where does your brain go on this as a paramedic? What kind of assessment would you do before you moved her? Would you have her self-ambulate at all or would you do a direct transfer from bed to ambo cot? Wendy CO EMT-B

At the BLS level, you can only really observe and make crude inferences about what might actually be happening with your patient, especially with more subtle presentations and complex situations. "Oh oh, she's breathing 42 times a minute and her heart rate is 200. She needs to go to the hospital quickly and help controlling her breathing." At the ALS level, not only do you make observations, but you can take those and apply critical thinking to them because you have been given the educational toolbox to work with... and hence, you can initiate more treatments in the field and better communicate what you observe going on with the patient to the doctor once you arrive at the ER. You see the same things and should be asking many of the same questions at both levels; it's what you do with the information and the other questions that you KNOW to ask at the ALS level that really delineates between an ALS and BLS assessment. I hope this makes sense... Wendy CO EMT-B

I can't believe how you guys got steamrollered. This is absolutely ridiculous. Kat- who was there at the Whistler Centre then? I was trying to see but the footage wasn't any good... looked like some sort of BLS crew... To the person seeking a place to stay: I would echo what our Canadian bretheren have said about boycotting your involvement, but if you choose to go, then you need to tell whoever invited you to provide you housing. Wendy CO EMT-B

Terri (itku2er) did this a while back, I think. --Wendy

I got my start as a First Responder with the Boy Scouts of America... I can highly recommend the experiences I had as a 16 year old with my local Venturing Crew. I can give you more info if I know where you're at... Wendy CO EMT-B

Again, this is an issue of education. The principle behind the idea of "BLS before ALS" is solid- you must master the building blocks and basic understanding of what you're working with before you move on to more advanced ideas and practices. The problem is that our education is not structured correctly. You are given the wrong building blocks at the BLS level and with that a false understanding of medicine. It is MUCH more important to understand the biology of medicine than it is to understand how to use a BVM or apply a LSB. Your patient history is one of your most important assessment tools, and if you don't have the correct understanding to inform how you go about your line of questioning, you're simply muddling around and missing the point. Anyone can be trained to master the physical skills of medicine... whether it's IV's, intubation, cardiac monitor placement... not everyone has the capacity to figure out how it all fits together at the level which allows you to make sound treatment decisions. I will, however, say that once you master the intellectual part of it you must also master the physical skills... because knowing what's wrong does you no good if you're incapable of performing the right actions to treat it. BUT! Without the correct thinking, all the skills in the world are useless to you. Wendy CO EMT-B

Dwayne- general emedicine article on the pathophys of "holiday heart": http://emedicine.medscape.com/article/155050-overview Didn't have a chance to read it in detail, but it talks about the arrhythmogenic properties of alcohol and why... Wendy CO EMT-B

My thinking is this... every time I've seen or done spinal immob, I felt that it was nigh-impossible to apply the collar without moving the patient's head. Which to me defeats the purpose of applying spinal immob. I think that you can achieve just as good immobilization without inducing the feelings of claustrophobia and physical discomfort that using a c-collar and hard LSB brings about... I'm interested to see what more research brings about. I agree that the most of what I've seen has leaned towards getting rid of it... Wendy CO EMT-B

I carried gloves in my wallet for the longest time. They came in useful more than once... especially for those 3am phone calls when I lived in the dorm. I no longer carry them in my wallet because a lot of them wander home in my scrubs... so there's random pairs whenever I need them, and I realized just how dork-tastic it was to carry a pair on me intentionally. Baiting Mr. Murphy is not a good idea! Wendy CO EMT-B

No.... they've been going through and neg-tagging ENTIRE THREADS. Every post. I spent a lot of pos. points just fixing that. They're not just after CrapMagnet... they're hitting every post in a thread. It's retarded! Wendy CO EMT-B

Wow! I wonder if it had anything to do with the actual toxins released by the bee-stings, or if it was a totally unrelated event? How crazy is this? Makes me wonder if the doctor who issued the death certificate did an EKG in the first place... I'm sure he probably did (at least, here's hoping!) Bee venom is such an interesting thing in and of itself. I wonder if it triggered the heart attack, or if it was just the adrenaline response to the pain of being stung. So many variables to consider here... Wendy CO EMT-B

As usual, I'm trolling the Interwebs trying to stay awake while on my shift and giving myself a break from some microbiology homework. I found this really interesting article on MSNBC titled When The Elephant in the Room Isn't Really There and thought it would be something interesting to bring up, especially for those of us who work with the elderly population with any sort of frequency. I had never heard of of Bonnet syndrome before reading this article; brings up some good food for thought. So, what if your patient is oriented, totally there mentally, but insisting that the giant pink elephant is in the ambulance with you? Are they really hallucinating? Is there something pathological going on in their brain? Or is it merely their visual cortex substituting imagery in the absence of readable visual input? Will it change how you interact with this patient at all, now that you have read this article? Wendy CO EMT-B

Lots of love and prayers coming your way dear lady. I'm so sorry to hear about what a giant mess this has all been. Please, if there's *anything* I can do to help you out (and you know it's not idle talk from me) you just email me and let me know. Stay strong, dear woman! God doesn't give us anything we can't handle. Love, Wendy

I have to echo the repetition. Spend time with the material; that's the only way to get it to really stick with you. Don't just read the book- take active notes while you're reading, write out questions you want the answers to, go research those questions and write out the answers. Coloring things is good if you're a visual and kinesthetic learner. Good luck! Working with classmates is a really good way to go, but make sure you spend enough time with the material on your own too, because others' confusion can mess you up if you're not certain in your knowledge. Wendy CO EMT-B

Who the heck is going through giving negatives to perfectly relevant, good posts? KNOCK IT OFF! Have the gonads to post something instead of just going through and neg-tagging everyone else! Wendy CO EMT-B

I'm with Dwayne and JP. You've got yourself backed into this corner of fighting tooth and nail to elevate the single-language non-English provider, everyone else's viewpoints be damned. Again... nobody's got issues with the person who can pass an English exam, because they have English communication skills! How the hell are you MISSING that? Take a good look back over your posts in the last few weeks. Those of us that know you are starting to wonder what's happening with you. If something's affecting you in your work or personal life, please, look into getting assistance with it. We've never seen you be so illogical and hateful before and it is really confusing a lot of us that have grown to respect you. Wendy CO EMT-B

Holy cow! Vent went off the deep end! ROFLMAO... I agree with JPINFV. This thread is about providing the exam in a language other than English, and does not directly concern those individuals who primarily speak Spanish but have enough working knowledge of English to pass the English test and attain their cert. So let us *not* confuse those two, as they are entirely separate issues. I agree that someone who doesn't speak English can be a wicked competent care provider at whatever level they are trained at. However, I also have first-hand experience in working with someone who did not read English at all and barely managed to communicate in spoken English in a facility where all of the rest of us didn't speak Somalian. The residents *also* do not speak Somalian. Guess what that meant? Lots of frustration and undue burden on those of us who went out of our way to try to accommodate this woman's language barrier. It turned into a giant fuster-cluck one evening as she was demanding that I tell her who the diabetic residents were so she could serve the correct dessert and I not only didn't know without my cheat sheet, but had my hands full dealing with other issues. I pointed out where the seating chart was and where the diabetic resident list was, and she went ape-shit on me. I could *not* communicate to her what she needed to know at that moment, and she was unable to cope. I have no doubt that there are phenomenal medical professionals of every ethnicity and language- but you could be the best RN in the world and it wouldn't matter if you couldn't effectively communicate on a daily basis with your patients and co-workers. Maybe your facility is a wonderfully integrated facility with bi/tri-lingual EVERYTHING- scope of practice documents, safety materials, etc. but most facilities (hospitals, EMS providers, take your pick) operate in the primary language of the country with the understanding that the majority of your patients will also speak the dominant language. Those areas that have high concentrations of other-language patients generally offer employment bonuses to individuals who can speak the patient language as well as English... As far as offering the EMT or CNA test in an alternate language goes, I think it's a bad move unless you have region-specific employers that are specifically seeking other-language ONLY candidates... pretty rare, as far as I can tell. Most places would prefer that you be fully bi-lingual. With EMT specifically, driving is a huge part of the EMT responsibility and so you would want your tech to be able to read maps and street signs and be able to communicate with dispatch via radio... seems to me that all those need to be in English in most parts of the country, so it is counter-productive to offer the EMT test in a language that does not reflect their working responsibilities. Let's put it this way: should we offer an alternate test to someone who doesn't speak "medical terminology"? They could be masters of the material, with fabulous understanding and patient care ethic... but they can't pass national standard tests (NCLEX, NREMT) because they just aren't good at medical terminology and it confuses them. Should they get a "plain English" version of the test? Or should they be held to the standard of communication that is in our field? edit to add one more thought... Also, you mentioned that communication can happen (RE: Puerto Rican VA nurses) but that it is not always ideal... yet workable. Don't we owe our patients the best we can give them without intentionally handicapping ourselves away from the "ideal" of ready, open communication? Wendy CO EMT-B

Lying, falsifying information or coercing a patient are all great big ethical no-no's in my book. The hardest thing for many EMS providers to accept is the patient's right to make stupid decisions. They have the right of refusal as long as they are alert, awake, and oriented... There is a sincere difference between honest education about potential consequences and using "scare tactics" to make them do what you want. You can educate until you are blue in the face; if the answer is no, then it is no. The exception to this would be a situation where you know that something is profoundly off with the patient, and you consult online medical control to get a legal "medical hold" in which you can supersede the patient's wishes. But then it is on the doctor's responsibility, and you have to paint a pretty good picture of whatever the funky situation is for a doctor to be willing to back that decision. Selective omission, as far as I see it, is much preferable to falsification, but only in certain circumstances. I think Vent covered that idea pretty thoroughly. I think the statement that has been called into question was honest and sincere in its intent, but poorly worded... I think what the educator probably meant was to emphasize encouraging care with whatever means you had available in order to increase the odds of good patient outcome. I don't think he was endorsing just flat out lying and scaring the crap out of people to get them in the ambulance all the time. I also think he was emphasizing that you shouldn't downplay something because you don't want to transport. In other words, I think I understand the purpose of the statement but disagree with how the message was delivered. Wendy CO EMT-B

I think that this is an excellent idea; the problem is trying to revamp the role of pre-hospital medicine to include some of this social intervention and community health/continuing care mentality. It also takes initial funding to set up programs like this; you have to pay someone to do the legwork in identifying those who need the program, you have to pay the extra truck of medics... while the cost/benefit ratio is much greater with making this initial investment, try convincing departments who have had their funding cut that it really WILL pay off... What sayeth everyone else? I think we should jump on this and take it as far as possible... but how do you really institute it? How do you sell the bottom line to the powers-that-be? Wendy CO EMT-B

I just happened to stumble across this video, and thought it was absolutely fascinating. I know we all think about encephalitis as being something more viral or bacterial in nature, but this would really be something to consider especially in our younger patients that are presenting with neurological issues. This is an auto-immune type of disorder, sometimes associated with tumors and sometimes not, and it causes an acute psychosis along with seizures, memory loss, etc. Today Show Clip: Case Study Here's a medscape article I found regarding the treatment of Anti NMDA-Receptor encephalitis which also helped to explain more about what it is... http://www.medscape.com/viewarticle/582263 What do y'all think? Ever heard of it before? Seen it? Wendy CO EMT-B

The only nursing school you will find without a waitlist in CO, especially in the Denver area, is Denver School of Nursing which is a private school that is horrifically expensive and still ends up with small (3-6 month) waitlists. http://www.denverschoolofnursing.org/FAQs.php Be prepared for a 2 year wait-list unless you have a previous bachelor's degree and want to apply to a second degree accelerated program through Regis or CU. As far as your EMT certification, you will to my knowledge be issued an EMT-B certificate here in CO, and much of your course-work from out of state will probably not transfer, at least to CCD or CCA (two of the main community colleges in the Denver area that offer EMT-P.) You can, however, take EKG and IV courses here as a Basic and do basic 3-lead interpretation and IV starts. Good luck to you on the move! PM me if you want some more specific info about Colorado or Denver, as I grew up there and have spent most of my life in CO. Wendy CO EMT-B

Everyone's got it covered I think- that's exactly what I have done when interviewing and I have been very successful in landing positions. The only thing I can add is my favorite question to ask a prospective employer: "Why do you enjoy working here?" If they can't give you a well thought out answer that seems genuine, no matter how good everything else might seem, you may want to look into applying somewhere else. The person interviewing you should be someone who is motivated and happy within the company- if they can't tell you why they like working there, then there's probably issues that you don't want to end up in the middle of. It also gives you some insight into what it's like to work your way up through the ranks if they can give you a good answer!! Best of luck to you! Wendy CO EMT-B