Lone Star

Here's a couple things to think about: 1. Cardiac 'problems' can strike at any age. It, like cancer, knows no age limits. 2. Your first 'run in' with CPR and other emergencies are always the 'worst' for feeling 'unprepared' and 'useless'. This doesn't make it so. While I could go through your post line by line, pick it apart and make disparaging comments, I'm not going to do it, because you're already stressed enough; you don't need another person jumping your case. 3. If you're serious about wanting to take classes to learn more, since you've expressed no desires to actually enter the EMS field, take a Medical First Responder (MFR) class. Maybe the extra knowledge will help you remain calm the next time this happens. Invest in an AED for your studio/gym/facility. Retake the CPR class and make sure that anyone that works there gets the class. 4. In the case of seizures, the grand-mal seizure looks like a 'flopping fish out of water', and the best thing to do is loosen restrictive clothing after ensuring that they're not going to smack their head on something solid, pointed or sharp. DO NOT try to hold them down, and DO NOT try to stick anything in their mouth! 5. Even after you take a MFR course, remember this: you're NOT going to 'save' everyone!

What is the condition of the pupils and their response to light? Is grip strength equal bilaterally? Range of motion? Slurred speech? Any pain on palpation of the abdomen? Guarding? Respiration rate? Equal chest expansion bilaterally?

There's nothing wrong with being 'gung-ho' about learning what you need in EMS. The focus at this point should be developing good study habits, and not just memorization. You should start with the human body, its parts, where they're located and what they do. Then you can focus on HOW they do what they do (ie: how does the air we breathe in get to the cells of our feet?) As far as aplogizing for asking questions; that's what we're here for. There is nothing 'wrong' with your quest for knowledge, but since you're 'pre EMT class', rather than trying to pick our brains for 'advanced knowledge', you should start with the basics of anatomy and physiology. You'll be surprized how little A&P will be taught in the EMT-B class! As far as terminology, very few people still use 'dorsal' and 'ventral' in their verbal/written reports. The more common terms would be 'anterior' and 'posterior'. Once you get an understanding of how the body works, you'll have a deeper understanding of how certain diseases and injuries affect the body. Then you'll be able to understand WHY you do the treatments you do, and how the expected outcomes will benefit your patients. It will also help you to understand what to do if the treatments don't yield the expected results.

Emergency Medical Technician - Paramedic: A person must be certified at least at the Oregon EMT-Basic level before being eligible to enroll in an EMT-Intermediate or EMT-Paramedic course and apply for and take any certification examination. Oregon EMT-Paramedic education is provided through the use of the EMT-Paramedic National Standard Curriculum, U.S. Department of Transportation, National Highway Traffic Safety Administration, 1999-Edition, as amended and supplemented by the Division. The following requirements must be met, according to OAR 333-265-0014: "The emphasis of a paramedic course must be the competence of the graduate and not just or only the number of hours of education received. In order to obtain and demonstrate the necessary competencies, it may require a student to receive approximately 1000 to 1200 hours of: Didactic instruction Skills laboratory Clinical education, hospital clinical areas as prescribed by the Division, during which skills as required by the Division are performed under a preceptor Field internship represents final evaluative phase of the paramedic program. The student must actively participate in providing care in at least 40 ambulance calls; no less than ten each in cardiac, respiratory, general medical, and trauma emergencies, during which clinical skills as required by the Division are performed under a preceptor The student must successfully demonstrate a skill in classroom lab or hospital clinical setting before that skill is performed and evaluated in a field internship." For an EMT-Paramedic applicant submit proof that the applicant has received an associate's degree or higher from an accredited institution of higher learning the student must successfully complete all mid-course and final examinations and final practical examinations. http://oregon.gov/DHS/ph/ems/certific/educate.shtml

It was outright murder for a 'crime' of being American. America has been blamed for some of the most stupid of things. For example, the tsunami that struck Indonesia...our fault. According to some Muslim Imam, it's Allah exacting revenge for our way of life, especially the fornication and our culture that allows women to dress in 'inappropriate ways'; in short for being the infidels that we are....

When I first started in EMS in Detroit, I started with a company that did the IFT's as it's 'bread and butter'. I also appreciated the occasional 9-1-1 bone they would throw us, but for the most part; I enjoyed the patient contact. I met some very wonderful people who were my patients. The 'downside' to the IFT trucks is we never got a 'scheduled break', we never knew if we were going to be stuck in the truck all day, or allowed to return to quarters between transfers. I got moved to a station that was in one of the 'less desirable' suburbs, and all we did was run. Because of the close proximity of the Extended Care Facilities (ECFs) and the hospitals, transport time was usually under 10-15 minutes, which meant that your 'turn around time' was usually very short. The last 24 hour shift at this station, we ran a total of 38 calls. That stands as a 'station record' for any station that company has. To show how unpredictable this business is....the first call I ran was a cardiac patient complaining of chest pain. Due to patient condition, I opted to 'override' a 'closed status' of the nearest appropriate facility. Even though the nursing staff was upset that we brought them another 'chest pain', they had no choice but to admit the patient (it helps when they apply a 12 lead and they realize that he's infarcting on the spot).

Late night 10 SEP 01 was a fairly busy night for fires. I had several calls throughout the night, so I was sleeping when the phone woke me up. The voice on the other end of the line was in sheer panic, and fairly screamed, "We're being attacked!". Like everybody else that morning, I turned on the television and sat in sheer disbelief as the second tower was struck. I had a sinking feeling that things were only going to get worse as time progressed. Sure enough, the towers came down. I just sat there wide eyed and slack jawed. I was having a really difficult time trying to process what I had just been witness to. I've seen some pretty amazing things in my life...from the death of Elvis, to the first successful shuttle launch (the resulting two disasters there). I've seen the election of an actor to the office of President of the United States and the launching of the greatest telescope ever created, and the images from a planet that no one would ever believe we could explore...but I don't think anything has made me feel so insignificant and helpless as watching our country being attacked by a group of religious fanatics.

Ahh yes, "It was the best of times, it was the worst of times...."

One of the potential problems with a 'verbal DNR' is that the family is tired of seeing X(insert family member here) suffer, so they decide among themselves to to the 'humane thing' and let the suffering end. While noble in it's intention, without that valid DNR, we cannot guarantee thats what the patient wants. I'm not prepared to follow in Jack Kevorkian's steps and commit 'EMS assisted suicide' (or would that be 'EMS murder'?).

It's always been my understanding that if you cannot be provided with a physical copy of a valid DNR, you must proceed as if there were none at all. It's been drilled into our heads time and time again that we MUST verify it's validity (signature of both patient and physician, current dates, specifies extent of treatments denied, etc.). If we cannot personally inspect that document, we can't take anyone's word for it that one exists.

Glad to hear you're alright mate! Any word from Scotty? How far from it were you? Speak up, man!

My condolences to the family and friends. LS

From what I read, it's not a matter of 'who gets transported first', but a matter of 'who gets ALS treatment, and who gets BLS treatment. Since pulse ox and cardiac monitors are not working (shouldn't that have been corrected at the begining of the shift, BEFORE you put 'in service'?), I would treat the stabbing victim as a potential hemothorax and cover the stab site with an occlusive dressing (if the weapon has already been removed) and tape it down on 3 sides. IV (NS/KVO)and pass him off to BLS. If the weapon is still in place, secure it with a 'donut dressing' and transport it as is. The GSW is concerning me more. Low calibre (I'm presuming .22, .25, .32) with no exit wound. Since I'm not formally in a medic class, my treatment options are still in that 'grey area' due to I haven't learned them yet. The bullet could have gone anywhere in the body after the initial penetration, so even in the best case scenario, we're talking about multiple system involvement. I would also be trying to figure out which pain med I could administer so that the patients are as comfortable as possible, without compromising respiratory function. Herbie, if you remember, a penetrating abdominal injury is an automatic contraindication for MAST. Isn't a GSW to the abdo considered a 'penetrating abdominal injury'?

Wouldn't cardioversion, whether electrical or chemical in nature; be considered 'heroic measures'? I'm trying to grasp the differences, since the intended outcome would be the same. Is this just a matter of semantics? It's been my understanding that DNR means DO NOT resuscitate. Isn't cardioversion considered 'resuscitation', or 'resuscitative measures'? Like I said, I'm not trying to be 'difficult', or play the Devil's Advocate here. This is a true quest for enlightenment.

Earthquake in New Zealand? You sure that wasn't Ben's ego getting shot down again? (LOL) Seriously, I hope there were no serious injuries and that our NZ members are safe!

If following protocol results in 'suspicious circumstances surrounding death', isn't that pretty much the same as saying, "Yeah, we killed the old bird."? Since you are the cause of the 'suspicious circumstances' surrounding the death of this woman, (and you've essentially admitted to being the cause), aren't you setting yourself up for criminal prosecution as well as setting the company up for civil liability? As far as not applying a monitor, I'm just as confused as everybody else. How can you even begin to think you're geting a 'clear picture' of what's going on with the patient if you don't use the diagnostic tools at hand? In reference to the post where the patient had a valid DNR and said "Help me!", I have to agree, that simple statement completely negates the DNR, even if the ink on it isn't dry.

Right now, it's not a matter of not feeling confident in the Doc. My biggest concern is how will bone fusion in the wrist affect my ability to perform the duties required by EMS? I know how 'limiting' it is not being able to bend your wrist, (I was in a cast during some EMT-I clinicals). If that's what is going to happen, then I may just have been spinning my wheels constructing an EMS based education. I'm not giving up yet... but that is the major 'concern' in the back of my mind.....

Well, after meeting with the new Doc today, it looks like the arthroscopy is out. Now they're talking about fusing at least two of the bones in the wrist. Also, I got to look at the xrays they took today, and it was pointed out that theres the formation of at least one cyst (indicating 'arthritic changes'). Then the doc decided to pump the wrist full of steroids again, (just had that done on the 27th of july). The anesthetic has worn off, and it's been aching for several hours now. Notified the lawyer about it, and he's not happy about this turn of events either.....

While the mint may not be printing them, they're still in circulation and still are 'legal tender', which means that they're still considered 'good money'. When money is removed from circulation, they're all gathered up and then destroyed so they cant get back into circulation. Why did the Treasury Department remove the $2 bill from circulation? The $2 bill has not been removed from circulation and is still a circulating denomination of United States paper currency. The Federal Reserve System does not, however, request the printing of that denomination as often as the others. The Series 2003 $2 bill was the last printed and bears the names of former Secretary of the Treasury John W. Snow and Treasurer Rosario Marin. As of April 30, 2007 there were $1,549,052,714 worth of $2 bills in circulation worldwide. The key for successfully circulating the $2 bill is for retailers to use them just like any other denomination in their daily operations. In addition, most commercial banks will readily supply their retail customers with these bills if their customers request them in sufficient volume to justify stocking them in their vaults. However, neither the Department of the Treasury nor the Federal Reserve System can force the distribution or use of any denomination of currency on banks, businesses or individuals.1 1. http://www.treas.gov/education/faq/currency/denominations.shtml#q5

I thought SC had the I/99 as well.... In GA, you're lucky if you can find a service that will hire you as an EMT-B, and IF you do, you'll more than likely only be a driver....

Not sure if SC is the same as GA, but I know that in GA, you can't get a job as an EMT-B. The EMT-I course is part of the EMT-B course. The first 6 months of the class is EMT-B, and the next 3 after that are EMT-I. I wasn't real enthused by that, as the more advanced course was only half as long as the basics. You'd think that the increased procedures and wider scope of practice would take longer to be taught.... As far as going straight to medic, it's a sound suggestion. The increased education will only be of benefit to your patients.

Great advice y'all! I have an appointment with the 'hand doc' tomorrow afternoon, (curiously enough, only two blocks or so from where I got whacked). I'll be asking all sorts of questions and I will address my concerns before I agree to anything! IF general sedation will be used, I will have a nice long talk with the anesthesiologist before anything is done there too! I don't mean to be a 'pain' for them, but I do NOT want a 'repeat' of the ulnar nerve relocation incident! Annie-droid, I too have that 'morbid curiosity'...I wonder if they'll do some 'still images' from the procedure for me? I'd like to see what's going on inside my own body. It's probably a good thing that the torso doesn't have an 'access cover', because I'd probably be 'peeking' at my 'innards' every once in a while!! Hopefully I can remember what he says so that I can update y'all afterward. LS