Ridryder 911

Too vague, need to know pay period ending/starting, as well overtime ratio: etc. Standard working hours, PDO's, etc.? R/r 911

My standard questions on O.B. patients are if time permits: How did you confirm your pregnancy ( physician, health clinic, EPT?, just a hunch?) Are you under prenatal care at this time? How many times have you been pregnant (Gravida) How many live births, did you have? (Para) How many miscarriages (spontaneous abortions) did you have? How many therapeutic/ planned abortions? How long ago? When was the last menstrual period? (LMP) Estimated date of confinement (due date) and how was that determined? Difficulties in past deliveries? Vag delivery vs. C-sections. why? Have you been exposed to viral or childhood diseases, fever, Any medications, OTC, home remedies (which is common), herbs? Any vaginal discharge (d/c) or foul odor or leakage of fluid? When? Any past medical conditions? (HTN, diabetes, seizures) Recent weight gain, fluid retention, ShOB, etc.? I would focus upon risk factors ? Drugs, smoker, diabetic, did they mention at prenatal possibility of protein in the urine (when they dipsticked your urine) as possibility of toxic or high risk. Have they performed an ultrasound? If so, when and did they discuss the pelvic girth? Multi births (twins) Any foreseen problems? Of course the usual: Contractions/duration/interval Location of contraction( back versus lower uterus) Water break? When? Baby movement? (quickening) Pressure on the bowels? If the patient describes < 20 weeks, ask if there was any tissue or clots noted. If she has felt any type of displacement? >24 weeks I do a quick external examination, after I asses the Fetal Heart Rate (yes we carry dopplers) and assess the fundal height, and check per Leopold's maneuvers to check fetal position. Many times, the baby has not engaged towards the uterus, and may have false labor pains Many other things, this is off the top of my head.. there is much information out there. R/r 911

Try ECG.com and Bob Page's web site multi lead as he has a a power point presentation as well . http://homepage.mac.com/edutainment/PhotoAlbum6.html Also try EMS House of DeFrance web site (instructor portion of ppt.s) that has canned lectures of 12 lead ECG's. R/r 911

Wow! Go away for a few days and see what happens! I guess it goes back on the intent of the caregiver. If you are interested in what is best for your patient, you will learn what is the "best" for your patient, not the best for you. Even though, I used LP 5's, I knew I needed to view the heart from more than a couple of angles. Three lead is called a monitor lead for a reason. Many of us in that generation, realized we needed to perform a more in-depth direction to provide better assessment and thus better treatment. Even before Bob Page become popular, we realized that that .."those that view in three, cannot see".... It was not so much we could not educate ourselves, it was the technology would not allow us to be able fully assess. So yes, we learned multi-leads using the 9 lead method and moving leads around from MCl[sub:5271c31329]1[/sub:5271c31329] etc.. When I returned back to the field, I was appalled to find that even though my EMS had LP12 with XII lead capability, they were not using it. Confused and bedazzled, I could not understand the dilemma. The only comment from the administrator had on this was:.."It won't change your treatment and only delay transport"... I concluded," I would argue this if you truly understood cardiac care, but it is apparently you do not, thus I will not even debate this topic." We implemented 12 leads as soon as the XII lead course was over the next week. :wink: R/r 911

I get called at least twice a week in regards to travel nursing (damn ex-girlfriend was one). I have to admit turning down a butt load of money is hard, but it is nice to have an ace in the hole in case I finally give up... R/r 911

I suggest everyone should read the article "Relying on your H & P; Are we losing the art of clinical medicine technology" in this months JEMS. Basically addresses that we place too much emphasis on what the numbers are versus to good interviewing and assessment techniques, thus having good diagnostic skills. I do believe that an ECG is a lot different than using a pulse ox. Is there going to be any change in treatment from the pulse oximetry finding? No. In that regards do you use & monitor EtCO2 on patients? It is much more accurate on the respiratory system. Now in regards to the ECG monitor.. yes. Not just treating what is on the monitor but it as an asset to making the diagnosis, where pulse oximetry is what? You should have known they were already hypoxic, but again one may not realized they had a bifasicular block with that AMI. It takes an additional 45 seconds to perform a right side, to be able to determine the extent and location. Will this change my treatment modality... you bet. If they are borderline hypotension no NTG, no morphine but an alternative medication. Will this change the receiving hospitals plan .. yes. This is a cath lab patient, and if possible avoidance of thrombolytics. Thus when I notify ER, they can prepare for such and delay can be reduced. Much more reduced time, than me sitting and getting a right & posterior ECG. Again I believe many place ER treatment way above the field setting, when in reality there maybe no to little difference. Again, there are times to utilize our equipment as "tools" to aide us. Knowing when and how much is the key. R/r 911

Ever so often I will pop in an "Emergency" DVD or get online and watch an episode. I have to admit I get a little melancholy watching them. I guess I have a different feeling than some. I remember watching them as a young person, and idealizing them to point that they knew what they were doing and they were determined. Alike the series, we too had to fight to be recognized to take care of patients. We used to have bicarb cap flip-offs to see how far someone flip those caps...and yes, we used to start a lot of D5W. Hardly ever started saline then. The series did not end until after I had completed my Paramedic training. Sure we used to laugh at how unrealistic it was at times, but thank-God it was on, otherwise EMS would had never been distributed across the nation. The reason I guess I enjoyed the series was it was comical, clean, and had some value and demonstrated professionalism in it. Something that no other EMS show has been able to produce since. What is scary is there are still communities that still do not provide even that level of care. And that was uhh... 30 years ago?

I believe you actually found the reason the successful intubation rate has dropped. It is the attitude and stubborness of most medics. Even as one that been intubating for over thirty years, I would welcome any type of education and possible improvement. I admit I have been lucky to probably hit about 95% on the first time, but there is still the 5% I would like to improve upon. I believe we have lost teaching among Paramedics the emphasis of skill retention and understanding that one has to continuoulsy improve. I have as of yet met any Paramedic (or any other license) is "the all there is and plus some". I have to admit, I met many with that attitude.. R/r 911

Dialysis patients are a train wreck. They have so many complex medical problems that majority of ER residents would bargain anything not to have to take care of. Sure, weather induced asthma maybe a possibility but again remember what dialysis is for? To cleanse the body, because of kidney failure. With this there is of course excess fluid (possible pulmonary edema and probably what the nurse was thinking of, albeit she was poor on her action), major electrolyte imbalances and excess waste in the blood such as urea and nitrogen. All of the waste can become toxic as well again fluid overload. Treat the patient accordingly and don't worry about the attitudes of the medical staff. They would probably be the first to criticize you if you did not take action. R/r 911

I have seen waiting times even in the rural area now up to 2 hours. Not unusual to see 3-4 hour waiting times for non-life threatening conditions. If you think it is a problem now, prediction is within five years we will see double the wait and within 10 years fourfold. Do you think we will have to change our thinking in EMS? As the classic line says.." hang on, it going to be a bumpy ride"... R/r

Actually what occurs is almost all services large or small places data in their PCR somewhere. There are national requirements to obtain EMS information or states cannot receive funding for EMS and many other medical projects, highway safety, etc. Again, most medics are not even aware of such as described many are now ePCR. The information is embedded into the run report such as falls > than 10 ft, MOI, delayed extrication, to even the time of arrival to the ED are all required data each state have to provide to a National Trauma Registry. The choice upon how they get it and pay for it is another subject. Although it may be a pain in the arse, it is the only real way to obtain data. For example, this was a good documentation of finding out that a Trauma Center did not really have a surgeon in house. Time of arrival of patient until surgical intervention, can be determined. As well as scene delay justifiable or not, even proof skills are justifiable, etc. Just because the State's name is not on the PCR does not mean their not getting information. For example Oklahoma City & Tulsa EMSA ePCR (Medusa) has always been integrated with the State's requirement and is downloaded monthly into the state's data base. R/r 911

Hey I helped designed that damn thing !... I agree it sucks. It was designed in the early 90's and I had to make it be able to go through a bubble type scanner. I agree usually most state EMS does not get money, but that is why statistics is needed as well. It is a federal mandate that State EMS have some form of PCR points to be able to retrieve information. Most have went to ePCR and the filters are built in to be sent into the OSDH as needed. I placed the criteria needed for Trauma Registry, or then the EMT would have to fill out another separate mandated sheet for information. Actually most states do have EMS reimbursements such as Texas and Oklahoma, albeit many receive little it is still monies they would not have and research grants (both EMS and even medial studies are based upon these reports). R/r 911

Write the check... Get the orange suit out for the so called Paramedic. R/r 911

Well, let the litigation's begin. How many epiphyseal growth plates problems do I foresee? R/r 911

Last chance to be a psycho, fame and getting everyone attention... Cop suicide. R/r 911

Okay, let's take EMS out of the equation. Let's pretend a family member or even yourself has became ill. Would you go or take someone to an ER knowing that your family member would be triaged by an nurse aide or CMA? All the nursing care, would be provided by no higher level? ... No RN ever to assess or administer treatment? Would you be satisfied with that? Again, knowing that the basis of when and initial treatment will be solely based upon that nurses/medication aide assessment and informing their higher level medical personal upon what they found is either life threatening or not. Now, would you feel safe? See the EMS dilemma? Even nursing homes have a staff member that is higher level licensed, that is supposed to be able to provide a better assessment and provide medical care, yet EMS does not require such? Yes, we have a long way to consider EMS competent in delivering medical care. R/r 911

I document the facts. Now, with that statement, did the patient have stable gait, increasing ShOB with exertion, had to grasp objects while attempting to walk, was the patient confused and would grab door handles, etc? Again, attempting to paint a picture why EMS was needed. I also ask what the physician PCR form stated why the patient required stretcher? Oxygen, monitoring for safety, etc. I know of medics that had to make a professional choice of a job or falsification, I know it is a hard decision, but I much rather do the right thing and also keep my license and integrity. I would definitely address my discomfort and consider some choices. R/r 911

I have to admit I had not participated because majority of EMT's do not understand or truly want EMS research. As I had assumed, that it was of course based upon "let's do more skills" instead of really performing scientific studies. Instead of attempting to do empirical studies, and "justifying" procedures such as ALS in the field I hypothesize that we turn the table around and view it at another angle. If we stop the BS of defining ALS and BLS crap, and actually determine that we should deliver medical care (medical care as it should be defined as being able deliver the minimum of ALS) to patients. It is well developed patients that need emergency care, need it immediately and by those that are educated in delivering it. Now, let's again turn the view that maybe we should have to justify why the so called "BLS EMS providers" even should be considered to justified to exist. That any care delivered by rescuers should be at the minimum of what is now considered ALS, anything less than that would be negligent in delivery. Maybe the author of the original post should start some qualitative and quantitative studies (since they proclaim to be highly educated). Maybe the studies should emphasize why anyone with lesser education should be able to even be able to deliver care in an emergency scenario? Even, if those of such credentials; should be allowed to really be identified as a health care provider, since in reality, what "health care" do they really provide other than care that can be provided by the common layman with first aid? It is well known that even the common layman can assist in patient's medication, transport a patient safely, and if one wants to take an advanced first aid course and learn how to apply AED, splint and even administer CPR/oxygen if need be. Again, maybe the emphasis should be reversed and the need to justify the so called "BLS" provider level. Again, we should have to be able to justify the care, provider level and even existence. Again, we know and realize people that truly need medical assistance may need medications, monitoring, possibility of aggressive treatments. Since this is supposed to be "EMS Research" post; let us start at the first phase. Let us hypothesize that there is NO division of levels. There is really only one, and that one level can deliver the care needed and has the needed education, equipment and protocol advisement that is currently available in comparison to what we provide the substitute levels that are used today. As well, maybe another study could evaluate in lieu of all the money spent foolishly on so called BLS levels as a substitute for ALS , that money and time could be placed in public education to improve and deliver safe and appropriate "first aid "or BLS care. That responding parties, would always be able to deliver "medical care" instead of again nothing much more than was is already being delivered by the common layman already. So again we want to discuss EMS studies, let's do so. Again, I am all in favor of evidence based studies and definitely those that follow scientific guidelines. Alike most of the posts and posters, I doubt that I will see any further discussion from BLS providers wanting to really "study" anything. Again, all lip service and no real content. R/r 911

My service just competed on a bid against them in a local community. The general consensus was that they were a joke at first, until they started getting more & more communities, then apparently was actually stable. They paid medics decent (without benefits) and was actually being concerned from other EMS leaders and administrators because of the rapid growth they were doing. The rumor is that it is the same company (obviously same name, CEO, etc). I do have my suspicions and "bad instinct" about this company. Nothing formal except that they talk and attempt to underbid, that in a business sense would be near impossible to operate. If they can do so, they are a better administrator of finances than any other EMS services I am aware of. Communities are becoming aware of many "save your community EMS" companies. (Not saying Mercy is) . We have seen more and more shady dealings, (even though our state requires a million dollar bond before operation) that are leaving communities & EMT's high and dry without payments. R/r 911

Actually an on-line EMS magazine was done last year with two issues electronically published on another EMS forum by several regular contributors here. It is hard to get all material together and meet dead lines, etc. Not that it can't be done and would welcome it and help. Just realize the time needed to do it right..... R/r 911

Ardmore (Southern OK Ambulance Service/SOAS) usually are looking for EMT's and medics. They pay, okay in comparison and have liberal protocols. They are not far from Gainesville as well. Here is a link to their web site: http://www.soas.net/

Maybe she was constipated? R/r 911

Yes, they are having better contributions. Not up to scientific standards, but much better than it has been. I believe that they really do have the interest at heart. Alike, what we see on here attempting to convey multiple educational levels is hard and difficult. Just read some other EMS forums. Remember, they have to sell their publications. As we see more and more educated Paramedics, the more we will see more informative articles. Shameful, yes. But really, what can we expect when the majority of Paramedics still read at a 10'th grade level? Again, when the bar has been raised other supplements will follow, again they want to sell what to what is demanded. R/r 911

Wow! Duh.. I didn't know administering and stealing a narcotic was wrong? Although, I doubt he was a smart man, but c'mon ... I would at least attempt to think of another excuse! R/r 911

Like AK described it is an insurance issue. Surely, everyone has seen hospital rooms with two beds in them. Yeah, that curtain is real privacy getter .. R/r 911