Ridryder 911

Personally, I much rather treat the cause than the symptom. As mentioned intubation to me is much more risky than awakening the patient enough for an increased respiratory rate or even awake enough to maintain their airway. I personally have ha calls similar to this and titrated Narcan to the respiratory drive. As you described, you do not want to increase agitation, but low dose and titration of Narcan in lieu standard initial dosages. R/r 911

Not sure, check with them to see. As well, I would discuss this with some other municipalities to see who covers them, for a comparison. I would even check with the OK Insurance Corporation and see what information they might have... Good luck, R/r911

Wow! Out of 35 hits five answered... hmm this is a no brainer where we can see why we are not a profession. Apparently not many understand... R/r 911

Good luck in nursing school, while you are at it take an English and spelling class. If you can't handle this heat, you will never succeed in nursing, where they eat their young far more than here ! R/r 911

Okay, after reading several of the posts recently I wonder how much is being taught about workings, involvement and the general profession other than patient care. Other than the initial chapter of professional development, how much discussion is made about such organizations, the general requirements, and information of programs. such as PHTLS, ACLS, PALS, etc? I know in nursing school they drive and push joining and being involved in professional organizations as well as the need of supporting such. As well it is each persons responsibility to support by working and financially supporting them. Did you discuss the advantages and disadvantages of organizations such as NREMT, NAEMT, state and local EMT associations, labor unions, related organizations such as American Heart Association, etc.? R/r 911

I do, I rather not be attorney poor, if something was to happen. Here is one of the most reputable & largest malpractice insurance companies for health providers, as well as one of the lowest I could find. http://www.hpso.com/

Just amazing it is always the lesser trained poorly educated ones informing us what is needed for patients and desired levels. The same being of those that develop levels to dilute and make levels to excuse the needed education levels to perform adequate patient care. Another way to get cheap and poorly trained individuals... Let's just call it like it is and really place a new level with the patches and card's etc.. Pseudo Paramedic or P P for short ! R/r 911

Nice to see there is still ER Doc's that can place TVP's in. It has been years since I have seen one placed in the ER. I believe it has became a lost art and procedure that needs to be re-enforced. R/r 911

Remember the purpose(s) of charting. First it is a legal documentation (charting) of what you found, assessed, treated/intervention, and evaluation, and plan. Second, where most do not understand, it is for billing purposes as well. This is the reason for documenting if they were non-ambulatory, bed ridden, etc.. If it is not documented and paint a picture that stretcher or treatment/monitoring required, chances are your EMS is not going to be reimbursed for their services. Thus, what does not come in does not go out.. = no pay, no raises, etc. My suggestion is to look at your company protocol and manual. Each should have an approved medical abbreviation(s) and format. This is what the attorneys and legal system will examine. Each hospital has an approved medical terminology and abbreviation list, this prevents people making up their own. If you don't have one, I suggest to discuss with the administrator to develop one. Look at charting and documentation of others. Charting and documentation is an art, and skill like any other skill in EMS. I personally document my physical examination similar to a physician, including pertinent negatives to prove that I did assess and evaluate or rule out, as well as in-depth follow up. I also include time & whom, I made any type of verbal report per cell phone , etc. R/r 911

ACLS for Experience Providers is multi disciplined. Part of the problem for most medics is that it addresses lab values, and practices not routinely performed in the field setting. Not, that Paramedics should not have knowledge in that area, just that many are not exposed to those tests and environment. My problem is locating these type of courses. Since, all hospitals require ACLS for license providers for JCAHO and EMS providers require the initial ACLS course and nothing more, these are the most popular and most provided courses. ACLS for experienced providers is usually for physician or practitioner level, addressing a more in-depth type scenarios and it is usually located in teaching hospitals. I do agree, that AHA should develop programs for emergency providers and those providing these services should require such certification. AHA's ACLS is not really advanced anymore and does not meet the requirements and objectives to educate those responding and treating cardiac emergencies on daily basis. Most cardiologist I have met have the opinion ACLS and AHA's format is a laughable format and joke, describing the treatment is made to simplistic for a decrease in morbidity to occur. We even have X-ray tech's with no prior cardiac training obtain ACLS. For fun, I allowed our janitor to attend the course and he was able to pass such without problems. So much for validity! R/r 911

Just my two cents. I believe I would go into a 911 system. Transport companies offer experience, but not much more than that. Learning cot use, etc. should not take more than 30 minutes in total to learn, only to find out the next company has a different cot. As well, many employers do not feel experience in non-emergency transport companies is not really experience and just a place to have a job. In fact, possibility of not being hired into an emergency service. Learning on what to do in emergencies is going to occur no matter when you enter the field or if you have experience in non emergency transport. If you want to be in emergency services, I would get into it as soon as possible, especially if you want to go into a fire service area. R/r 911

Dependent upon the situation. I have seen bosses send some guys to repair door facings and molding where the stretcher had marred the finish. This is usually from caused by from medics carelessness. If we have to kick in the door etc. the homeowners are responsible for damages. R/r 911

We are reviewing the SLAM Airway Course, and one of our FTO's is wanting to attend. My EMS administrator is not familiar with the program and wants to validate if it is worth the costs. If you have attended, I would greatly appreciate a P.M. in regards of your opinion of the course, and if is worth the costs, etc.. Thanks, R/r 911

Good points, I do wonder how those employers obtain their site ? Hopefully, most would never place their full name or personal information. I will warn as well employers and administration may look at these sites. I know we had a few medics "giving the one finger salute" on some personal pics' however they were on duty. The boss has not taken action as of yet, but I am sure he keeps it in mind. Many employers would feel that if you are in uniform or display any logos or information you are "representing the company". R/r 911

I am not going to answer until I understand the question. I thought the point they were asking as well was; how many males are involved in domestic abuse (as an abuser?). I agree poorly written question. R/r 911

As an ACLS Instructor for the past 25 years, I can attest it is no longer a credentialed course like it once was. At one time when someone had a ACLS card or wore an ACLS lapel pin, you could feel assure that person had an understanding of emergency cardiac care & could manage a cardiac arrest, knew proper airways, etc. Yes, it has been diluted down. I agree the videos are cheesy, but in all honesty at least it does cover some of the basics better than the videos in the past. We have to remind ourselves this is just a continuing education program and has no validity of knowledge of cardiac care, like it once used to. I truly would like to see another organization take over or NREMT and other EMS license/certification agencies require the ACLS for Experienced Provider program (which is similar to the old ACLS format) for re-certification.

It is not very often we send out a note a of a job well done in our business. Although, I am sure there were many mistakes and errors during this MCI, as all MCI"s have, Yet, I have been very impressed by the representation of the Rescue/EMS as per interviews on national network television. Like nearly everyone else I am not aware on how well the MCI was handled, but I have to say that I have watched two EMT's (Both first names are Matt. ?last names?) on several networks. It appears these gentleman did a smart thing and prepared a well thought out statement. I am very impressed with the way they have handled the press, they way they have spoke and in their personal & professional demeanor. If their actions and treatment is any reflection of the way they described and handled a difficult situation such as national press, and interviews, I am sure they performed their jobs as well. Again, my personal thoughts as many are with all of those involved in this horrible event, but was glad to see in this dark moment that our profession was well represented by these gentlemen, which is not always the given in such situations. R/r 911

Check this site and other EMS forums on scenarios and water it down and keep it simple. There are numerous on this site alone. R/r 911

Be careful releasing information on those that might plan to impersonate an EMT or medic. Especially, since they are asking for a sample.. sounds fishy! R/r 911

Wow! All this debate over a little thing such as an impaled object in the cheek! Geez.. Do they not teach anything in EMT schools anymore, like using common sense? What is a Doc going to tell you except do your job, and apply pressure and suction PRN? Okay, if it is bothering their airway pull it out, simple. Why leave it in there? You are not going to strike any more dangerous organs, lacerate any more vessels, etc.. Again this is the reason WHY you don't remove impaled objects. Apparently, not many people have seen very many lacerations or especially puncture wounds to the mouth and cheek areas. They don't hardly bleed, especially after a few minutes of pressure. Like EMSLT described, place a glove finger and "squeeze" with a 4X4 between the outside and inside cheek wall. Probably, within 2-5 minutes (if they have normal clotting time), the bleeding will have stopped, and yes, you can do more than one thing at a time; like suctioning the patient or if the patient is conscious, alert' allow the patient to suction themselves. This procedures is not hard to teach, we teach EMT's this all the time. Heck, I might even lay the patient on the side to "drool" out, remembering you can package for cervical injuries on the side as well. Personally, I do not see how an impaled object could be in the oral cavity and not be in the gum line, or bony areas, otherwise it would probably fall out on its own. Silly debate, this has been in EMT textbooks (remember the stupid moulaged picture) for at least 35 years, with the same answer. R/r 911

So if the one of the personality was attempting to resolve the issue, would they be called an negotiator ?

Okay, let's see if we can make this as simple as it is. The reason we do not remove impaled objects is because we are not aware of injuries the object might be into or against. Thus, the cheek one can see where the object is.. therefore we know exactly where and what the object is. The second reason, is pretty obvious one can control the bleeding simply by applying pressure outside and inside the cheek wall, as well it is pretty damn hard to ventilate a patient with a pencil or impaled object in their cheek and mouth! R/r 911

Check out this month's JEM'S it has a whole article on it!... as well as new EMS truck designs! R/r 911

Albeit, there are probably many devices, procedures, and actions that are unsafe daily however; there are many we do daily that we should not do. First thing I would eliminate is personal cell phones! Sorry, I am so tired of phones ringing (or should say those damn hip hop or humorous cartoon sound bites... nothing like Pdiddy going off, while attempting to listen for heart sounds) during an assessment. Worse is those that attempt to drive and talk while driving! I do make allowances to talk to dispatch, business (med control, etc.) but there is rarely any thing that can't wait for 30 minutes! Improper staging of vehicles, from Police, FD, etc.. apparently this is no longer taught! Everyone wants to go immediately to the area and leave EMS unprotected with EMT's exposed to traffic and unsafe areas.... Yes, we loose several EMS personnel every year from this. There are others, I will have to think of. R/r 911