Ridryder 911

Intubation clinicals are becoming harder and harder to locate for Paramedic students. This is a nation wide scenario, which I have discussed with several other states and programs. Some of those even with clinical sites have been warned that after their contract expires, they may not be able to return, while others are loosing contracts rapidly. Many anesthesiologist whom coordinate clinicals do not feel they are being properly reimbursed financially or want to spend the time with EMS students. Yes, it is a shame this is occurring and there appears to be more sites having difficulties every day. If your program has O.R. clinicals, consider yourself lucky and have other fellow students to be sure to thank them, for allowing students. I would hope with the increase intubation controversy, anesthesiologist would promote more clinical time.. however; it appears some are either apathetic or wants to turn this into a more profitable venture. Hopefully, NAEMSE will address this problem more directly this fall. R/r 911

Apparently many of you have not tried or attempted this yet... I did. My father had aortic stenosis repair, while he was in a so called rehabilitation unit, his PTT/INR was not controlled properly from the Coumadin and suffered a stroke. I took him home and my family and I attempted to care for him.. his CVA left him increasing confused, and as a large structure man of 6'5 and 250 pounds was more than my sister of 5'5 could perform by herself and even me to turn every 2 hours and assist in ambulation etc.. Without proper equipment (lift chair) additional support and equipment such as shower chairs etc, it is very difficult and yes even dangerous to the patient. Yes, it would be an ideal world if one could provide care for their immediate families, and I honor those that have and are doing so. It is very impressive to see families that still attempt to take care of loved ones and especially those that do provide excellent care. It is unrealistic to think or even have an opinion that most families will or even would be able to care for their loved ones, hell, even the hospital and nursing homes cannot perform this very most of the time & they have the staff, equipment , etc. to perform such. Yes, many are placed into the nursing home without thought, but I much rather see this than repeated falls, stage IV decubitus, sepsis, dehydration and aspiration occurring on well intention families. All I ask is that nursing home facilities perform the care they are there to do, and perform nursing care as it was designed as well. To actually perform assessments on patients, regulate their diets, medication, and tend to their physical and emotional needs I have NO problem reading physician notes and med orders and questioning them, "Why they have not been acted upon?"...If need be< I will call the physician at home and inform him. My partners describes the staff does hide more often, when they see me responding.. There are definitely bad nursing homes and yes 90% morons out there, with same or higher number of EMS representing the same. R/r 911

New text: Presentation of an AMI: Chest pain or may be described as chest pressure. The potential pain may be described as radiating into left arm, back, jaw. Diaphoresis may or not be present with episodes of nausea and vomiting. Pain may or not be present nor the patient may have any of descriptions or symptoms as noted above; especially if female, or known diabetic. Treat accordingly

I agree that 2 hours is too long and preferred to be removed after initial exam or performance of x-rays. I was not referring to Oklahoma, but actually at a very large area with one of the largest Trauma Centers where I worked at. I believe, if you were to actually study and read LSB studies, that there really is not a "gold standard" and that is part of the debate. Furthermore, part of the problem is not the conscious patient that can shift, or move to displace pressure upon the tissues, rather the unconscious patients that are unable to do so causing neuropathy, pressure induce occlusions, and nerve damage. (http://www.merginet.com/index.cfm?searched=/clinical/trauma/ProlongedSpinalImmob.cfm ) Remember, if the patient is package appropriately, they can turned on their side, etc . to displace weight... no where, does one have to remain supine. That is why more and more educators are endorsing scoop in lieu of LSB ( http://www.merginet.com/index.cfm?pg=products&fn=scoop ) especially ones with isolated injuries. Most of the time I see the LSB abused by EMS personnel, using it to remove patients, rather than using blanket rolls or even previously discussed scoop that can be removed in ER immediately after ruling out spinal injuries. How many times has one seen true spinal injury patients left on LSB and C-collar without Crutchfield tongs? If you can have a neurosurgeon to attend those with single spinal injuries from trauma in less than a few hours, you beat the national standards by far. I suggest discussing this with the physician one on one first. I warn those with a few nights a week of training, and the most the see a hospital is to pick up and drop off patients, to pick their battles very wisely before confronting any physician or ER staff. Remember it is a two way street, and I can assure you all us make mistakes at times, and those with the letters M.D. after their names definitely have more weight.....than any ambulance personnel, that is if one values their career. R/r 911 R/r 911

I doubt that any vagal response is from the NPA. Usually, the "gag" reflex is only temporary and transient. This would be describing same or similar incidence with NG tubes that are continuously left in place.. the body will adapt. R/r 911

First, feel lucky you have an OR rotation, we have lost nearly all the O.R.'s in my state, and now are thinking only mannequin cert is okay. The anesthesiologist group at the University teaching, wanted an $150 per intubation, per EMS student due to liability. Welcome to EMS, you are at the lower end of the food chain, and always will be.. until we have a undergrad, grad then post grad level education... hmm they can not see why your 2 night a week class, is more important than their 8 years of University education would be. Especially, when the one that is the preceptor has the same level that they do... Good luck, and continue to pursue.. get as much experience as you can... R/r 911

It is appearant that yu do not work around ER's very much .. < 2 hours is pretty good, especially in busy ER's ... I have seen patients on LSB > 8 -10 hrs.. ER Doc's are getting better and recognizing the dangers as well and are removing them in a better timely manner; as well as some medics are beginning to finally truly assess if the patient has an isolated injury and really even needs a LSB. R/r 911

So true... I guess they could be promoted as administration!..LOL R/r 911

Well you know what they say about a leopard they can never change their spots and once a con always one. Sorry, our patients and families should be treated by those that had a better discipline in life, and those they can trust. That is part of the consquensce of poor decision making and personal history, one cannot own a weapon, vote, etc.. part of the rights, one looses. Our patients expect it, our profession should demand it. Just like the rest of the health care professions does. .we already have a piss poor reputation on whom we allow in already, let's not make it any more of a joke. R/r 911

Not only do you have an ethical and moral obligation, you have an legal one as well. The person describes endangerment to themselves, and possibly others is grounds for evaluation.....period. I first would be blunt with this person and ask them point out if they have a plan, and how much they thought about it. Ask them if they have seen a counselor or treatment? I would inform them, they realize this has to be treated immediately ( apparently they are in health care as well) and for them to seek treatment now!.. otherwise, you will have to report it. This does allow them to seek immediate treatment on their own cognizance, if they do not I would report as others described, even if this involved LEO, and filling out 3'rd party statements. This is not to be mean, but to save their life. Depression, anxiety etc.. is a true disease that affects a large portion of EMS providers, and as others has stated this might be a preventive measure. Remember, they are telling you because they are crying out for help!......so help them. R/r 911

I am a patient advocate for pain control, however; the scenario as described, I would question true pain associated with fracture. I agree with Asysin2leads the description is of a hip fracture (surgical neck ) and definitely not a mid shaft, which traction splinting is only indicated for (even by manufacturers recommendations). Yes, trochanter and neck fractures pain can be increased with traction splinting. I am wondering if the patients representation of pain, allergies might had clued the physician? Now, lies the potential problem.. you have accused (falsely) the physician of disregarding the pain (appearantly, it was muscular-no fxr/x) and as well misrepresented a wrong diagnosis. This has potential back drafts of later patients you will bring in... and I am sure, he/she might be monitoring your actions as well. In this case, I would be very careful.. and as you described, ...."they do have more wealth of knowledge" ..... Yes, being a patient advocate is great.. however; pick your battle wisely and more so, be sure you are in the right, otherwise your fight has been reversed. R/r 911

I believe we have to much liberal thinking, and not scientific or even qualitative based on why we perform or believe in anything. The same is true, on wanting to do new things as well. Without, reviewing previous experiences, research to justify such changes or would change effect be really beneficial?.. So many people believe and perform without any knowledge of why they feel, perform and think the way they do. We have become so thin skinned in society? Part of the problem, no one knows how to debate anymore... and without such we have a vanilla society. So many are followers... with the only justification being of edited sound bites, movie or rock star promoting such.. ( and we know how educated they are). When even attempting, to discuss anything more than the weather, so many feel threatened when any discussion is made.. I feel because they truly do not know why or be able to defend their action(s). I get tickled, when asking any political discussion on what their party affiliation main agenda, goals, and even their main PAC's are.. most look at you with deer in head light look... I encourage all to become involved.. but know why and what you beliefs are.. and not just because it is a trend .. being medicine, lifestyle, politics, etc...

Here is the link for listing for accredited EMT Paramedic programs, private, associate, bachelors, etc.. select EMT program then state or all states... http://www.caahep.org/programs.aspx

I agree 100 % ... now, a different spin off. As a nurse, I expect EMT's to be able to give the following: Patent's name (if was given) pertinent medication(s).. yes this means cardiac, HTN, diabetic, COPD.. and yes you should know which ones those are a detailed history of precipitating events meds and tx given per EMS when and if family or other reputable person to obtain history is on the way Challenging the treatment that was given in the ER by the physician, have a problem with his treatment, then discuss this with the Doc... naw, I didn't think so. If I said the C-spine was cleared, and immobilization device was removed: that means the radiologist or physician determined it was safe... pretty impressive to argue from someone whom can't read an x-ray or probably even name the parts of a vertebrae No.. when I say a med has to be on a pump.. I do not mean gravity drips or dial a rate IV tubing...NO, I do NOT trust them, yes, a few extra drops in some meds will KILL someone! Really, temperature is a vital sign No.. not all patients need large bore IV's Really, no one is impressed that you can intubate or start IV's.. that is your job... Please, your job is important .. but.. it is part of the health care team.. not, the whole team Professionalism, is not wearing a baseball cap, T-shirt, with EMT in large block letters and your shirt tails hanging out and your butt crack showing...with 30 pounds of gear hanging off your belt.... Yes, people do listen to what you say... therefore, if you do not know how to pronounce a medical term or procedure, it is best to use common language, then to be thought of as a fool.. and people determine your competency on how well you can discuss and the behavior in-between calls.. so cursing, flirting, horse playing does not represent you very well. R/r911

When I started working in CCU, I rapidly learned that many patients have V-tach for several hours, and not be very symptomatic as well. Although, I would not recommend it, I have seen different modalities on treatment of such.. mainly do nothing. Yes, it is a different awakening to see a person in sustained V-tach, and not immediately treat it... Sometimes the most appropriate treatment is the etiology, such as electrolytes therapy etc... if they are not hemodynamically compromised.. R/r 911

Amazing, what the human body can tolerate at times. I know of a Paramedic that glucose was >2000, and you could smell the ketones. I remember him coming off a call and we drew lab on him, and his glucose was >2000 diluted. Fortunately, I knew a endocrinologist, that was able to put a Insulin pump in him, and he still functions as a medic today > 10 yrs later and his average glucose is 100 g/dl. R/r 911

Lot of rambling for one that has not studied theology, or one that appears to misunderstand of what "faith" is. For every argument against, there is an argument for. For simplistic measures this thread should die. R/r 911

Since Basic EMT is the foundation all EMT levels are built upon, it is very important on the program one chooses. I agree it is the determination and desire of the individual, and the length is somewhat is immaterial, I do believe the length should be extended enough to allow one to absorb and comprehend the material as well as have ample of time to practice skills and perform several scenarios. It can not be over emphasized this is the place to allow students to make mistakes and learn to correct them, not on true patients. One could compare medical schools or any education system the same way.. all have basically the same requirements and length of time.. but mention Harvard Medical School in comparison to Ten Buck Two State University. why the difference in reputation, will they produce better physicians?.. The difference is not the books, the basic equipment, etc.. it is the personality of those that usually attend or accepted, the study habits and perseverance, as well as the high demand and expectations placed on these students. To excel and learn more than what is in the text, and to explore and challenge outside the "norm". So when choosing any course look at the outline, compare it to others, ask around, what is their reputation and percentage of students hired into EMS? What is their pass rate on cert levels? It does not matter how good you are if you cannot pass the boards! What percentage proceed into advance levels? What is the length of clinical hours, lab hours to practice, is there scenario base skills labs to hone and practice before entering the work force? (remember, practice makes perfect) .. I have found majority of the time .. If one takes the easy way, one will pay for it later, down the line... I know I have paid for the short cuts, and have seen others.. I highly suggest to investigate and pursue the best program that is possible. Good luck in your education. R/r 911

Yes, we there were treatments way before adenocard, cardizem, etc.. yes Verapamil. I used it for years in the field, and yes I had good experiences and bad as well. I agree, for tachyarrhythmias, Adenacard is much more effective and less riskier than Calan. U have had the dreaded brady-aystole with patients commonly on Lanoxin, and Calan therapy. The most adverse effect I had sen was profuse vomiting, and hypotension. Like others had described all medications has good effects and adverse, dependent on the indication, and as well as other medication is invented it will change the usage. R/r 911

I agree, when instructing lay people I give out realistic facts. The chances are they are NOT going to make it, and if there was another procedure available, we would abandon CPR due to its poor outcome. Personally, I have never seen anyone have negative outcome from performing CPR, especially family members. In my 30 years experience, I have always seen that they felt they at least "did something", now I have seen those that felt guilty, in not knowing CPR and did nothing later. I agree CISD is a mythical excuse for federal funding, and unfortunately no one is addressing the problem of what and how to handle these emergency and crisis ... there is still a problem, and CISD does not address it and we found that out.. but, no one wants to change things and fins an appropriate treatment. R/r 911

No it's worse... hell, just watch t.v. Saved. he doesn't even have to wear a uniform.. Problem with EMS is: do we have active lobbyist wanting and requiring education.. no.. do we even protest among ourselves for furthering education...no(please see add above for 2 week EMT course), do we demand that competent medics be hired... nope, are we members of associations that promote EMS education such as Advocated for EMS, etc.. probably not.. now really whom is to blame ? R/r 911

I whole heartily agree, some nursing professors and I, were discussing this situation Tuesday. It almost appears to be like EMT classes anymore. Yes, we too were inspected as well for clinical uniforms and actually had a student removed from the program because her patch was 1/2 "" too low on her sleeve and another one that was removed because she was drinking a cola between clinical areas.. "unprofessional conduct and unbecoming".. and these EMT students think clinicals are rough.? LOL Some don't believe it, but I can truly state that most nurses I have worked with and had as professors actually felt it was a "calling, ever more so than a job"... maybe, if we had such desire in EMS, we would have lobbyist and the pay structure as well as dedication the nursing profession has.. but, alas it too is changing into a ...."it's a job"... and some form of quick easy money. Yes, you can definitely tell it as well... 90% of Nursing is compassion, with a medical flair. Voted one of the top (#1) most trusted profession, the public has always turned to nursing. Hopefully, we can continue that image. If medics would observe other medical professions, and copy the good and success of others, we could not -re-invent the wheel and excel as a profession, but we too are missing a lot of the passion and "calling". R/r 911

Good thing we don't have such laws for geriatrics.. Each station house would have a new patient, each time they returned... R/r 911

Most EMS requirements.. Pulse, Patch, Show up.. not necessary in that order. R/r 911

Duh... I agree KED is not designed or provides any support for spinal immobilization for standing patients .. thus the KED stands for Kendricks Extrication Device (KED) .. if they are standing, obviously they are extricated. It is VERY acceptable to place a standing upright patient on a LSB, and in fact BTLS and PHTLS has a skill station on it. R/r 911