Ridryder 911

First welcome to the EMT City. We highly suggest use of Google .. it is even in the city header. Second, have you contacted Texas D.O.H. EMS division ? An official statment would be the best advise. Here is their link: http://www.tdh.state.tx.us/hcqs/ems/default.htm R/ R 911

These are the spefic definitions from the U.S. Census Bureau. It has defined what is rural by exclusion ."An urbanized Area (UA) has an urban nucleus of 50,000 or more people. Individual cities with a population of 50,000 may or may not be contained in these UAs. Urbanized Areas have a core (one or more contiguous census block groups or BGs) with a total land area less than 2 square miles and a population density of 1,000 persons per square mile. They may contain adjoining territory with at minimum 500 persons per square mile and encompass a population of at least 50,000 people. An urban cluster (UC) also has a core as identified above with a total land area of less than two square miles and a population density of 1,000 persons per square mile. They may contain adjoining territory with at minimum 500 persons per square mile and encompass a population of at least 2,500 but less than 50,000 persons. The Census Bureau's classification of "rural" consists of all territory, population, and housing units located outside of UAs and UCs" There are other set defiitions depndent on what buraucracy is defining it . remember there are rural, frontier etc... I find it difficult to see a city, that is that close a major hospital being called remote.... and as well having a population requiring volunteers. Again, it might be the old "traditonal system"...that we have discussed. R/R 911

This site has multiple links that has great links to sites to help those students that need more than "lecture material".. As instructors we know each person learns in different ways..some require more visual than others. http://www.unmc.edu/library/reference/medimage.html#anatomy It has everything from animated mitosis to ECG library with >1000 ECG's..very good anatomy sites! No more excuses of not being able to know !! R/R 911

Here is a site that offers free CEU credit after completion on their on-line study. After you have finished it, you print out the certificate. Of course one needs to be sure that is applicable within their local state and credentialing agency. http://www.strokecenter.org/prof/ems/index.html Want to know more about the brain and more in-depth here is a link from Harvard Medial school which is great ! http://www.med.harvard.edu/AANLIB/home.html Happy Learning ! R/R 911

A Medical Algorithm is any computation, formula, survey, or look-up table, useful in healthcare. More than 8000 algorithms is located on this site. Even for those with above knowledge and can't recall how to get that Equations of Jose and Collison for Predicting the Intrinsic Heart Rate (IHR) measurement to the Correction of the Observed Serum Anion Gap for Hypoalbuminemia formula. It has a lot of good resources for cardiology and pulmonary .. god site for book mark for referrences. http://www.medal.org/visitor/ Happy learning, R/R 911

Okay, I know that most are really smart out there... but there is some of us that could use any help possible. Is understanding that acid base got you down... donor of hydrogen ions.. compensated .. uncompensated .. ionic transfers, buffer systems; PCO2 x f x VT = K ? Here is site that is FREE and is online tutorial to help you understand that old acid base system.. http://www.acid-base.com/ Happy learning! R/R 911

I seen a sign once that read: Only God can understand Women... I just wished he would share it !.. :roll: R/R 911

Most EMT courses are 16 weeks (roughly 3 months) and you should be able to find summer course locally. If he was a medic prior and if it has been within a certain period time, he might be able to attend a refresher & re-test. This all is according to local and state policies. Be safe, R/R 911

The hurt is it may be " it is not appropiate" and here in the U.S the patient may be charged an additional $150 or more .... R/R 911

Please check out their web site : http://www.emsaonline.com/aboutemsa.html I know they work 12 hours shifts, and have a required academy prior to be putting in place. The pay is comparable, not on the high level or low level. Dependent on your level of license, is dependent on how your treated. All units is staffed with at least a Paramedic. As a public utility model your true employer is Paramedic Plus in Texas, units are placed various post and rotated around dependent on calls, which means you are in the truck usually for the 12 hours. There are a few members that are employed at EMSA on here and they can give you better insight. Their is a different attitude from the EMSA east (OKC) and Tulsa EMSA. I work with several that work both sides and hear the good and bad. The main point I want to emphasis is that EMSA has some outstanding medics and some very poor medics as well. Many, get "brain washed" thinking EMSA way is the acceptable way and they are on the cutting edge of protocol development etc.. I worked closely with their medical director John Sacra, M.D. and he has a very good insight of emergency medicine however; it is a large corporation and sometimes this causes problems. Good luck, R/R 911

Damn .. I didn't know that !!! R/R 911

I would not.. on patient 1. If the patient does not have a hx of such. Even if the readings are high, this does not mean much other than report it..a fasting glucose is necessary to determine any true DM. Number 2: I might it all depends on the situation. Personally, EKG , 0[sub:108a9d7c7a]2[/sub:108a9d7c7a] sat reading and a better history. I rather focus my assessment and history and perform a nuero assessment and maybe a tilt test. Be sure to focus on patient assessment and history and use tools to add to your diagnosis. Performing BGL routinely may be allowable but not appropriate on every medical call. R/R 911

You know it's kinda scary when I go into my directors office and he has a football and toy ambulances . :shock: .. (Flashback of F + B ) ... okay, at least he does not try to give us a pep talk and our secretary is not Mrs. Fishborne ... :wink: R/R 911

Yeah, looked the names from the movie Dr. Shivago.. knda makes you wonder where they came from... R/R 911

Hey!! That IS our summer uniform!... The person below me like goats .. a lot !.. R/R 911

First it would NOT be David Lee Roth ... True a national spokesperson that has some creditability would be nice. Too many local EMS allow ones that have good intentions to be the local PR person, unfortunately they usually are the ones that make you cringe even when they talk to kindergarten students. Each service should have a designated PR person or spokesperson. Hopefully, these individuals do not have a speech impediment and can pronounce words properly & use proper grammar. But yet again, it is usually "turfed" to whomever will do it... R/R 911

This is one thing I would like to addressed and scientifically studied as well. How many ER physicians rely upon EMS for intubated patients ?.. and what is the level of percentages in the emergency department ? Although, I doubt we see this since we do not have Dr. in front of our names... if you do, it will be allowable to only intubate once or twice every 10 to 15 years. Heck, when I teach ACLS at physician groups some even describe they had NEVER intubated anyone.. not even in internship or residency programs... but, yet again.. they are Dr.'s... R/R 911

From what I have seen in most posts, is ones that have usually just started EMS (<10 years) and married for a short period of time (<10 years). The reason for the time, is because most have not hit the "reality" yet... one mate thinking that "this is all there is ?" There are very few marriages that survive EMS .. short and simple. Especially, if the medic is over zealous in the profession. I know it may seem weird, but most mates really do not want to play second fiddle...for a period time the may allow you to grow in your profession and try to be a hero ; but after a period of time it gets old. Unless you can have effective communications, actually take time for each other and demonstrate to your mate that you do validate them and place them first, no one will stay in a relationship. Over the past 29 years of EMS, I have worked with several thousand partners them being married, single, etc.. usually there is a pattern of behavior. I have seen marriages that have been endangered and ruined by EMS. Enough of them , I know 2 marriage counselors telephone number by memory to give out.... Yes, it is that bad. I always said EMS to some is as strong as a drug is cocaine is to some. People become absorb into it.. and not realizing it is just a job or profession. Yes, it takes extra time, but hopefully not to the extent of ruining relationships and families. Believe me I have too have been there... Yes, our mates should have some tolerance while you obtain experience, education etc.. but, there is no job or profession worth loosing your mate and family over. R/R 911

If the child has a legal documented binding DNR, due to chronic illness, then usually most EMS will honor them. No resuscitation measures will be made as the same for adults. There should be no difference between the two. There was a discussion about terminating field resucitation after no response on another EMS forum. Ironically, no one had protocols to do such like they did for adults. Ending resuscitation measures in pediatric cases is still a hot topic and is still being discussed at the national level. Good luck in your studies. R/R 911

A couple of things... Let's look at the statements : Pro actions of EMS - 1) Airway from HELL!! 2) One, you can not place an oral airway in "clenched jaws" 3) Why did the urgent care Doc not administer Epi prior to arrival of EMS ? 4) I doubt allowing to have the "urgent care Doc" assist, would had helped. If he failed to tx initial anaphylaxis, he probably was a dumb-ass & I would not allowed to "assist either" 5) This article was flawed to point out that since there was no IV .. etomidate, could had not been administered. Cons of EMS actions: 1) Bad call document your butt off !!!! 2) Bad call document your butt off !!! 3) Bad call document your butt off!!!.. did I mention to document ? 4) Hmm ...30 minutes, okay time can get out of hand, but something should had been done faster 5) I assume the Versed was given nasal ?.. since there was no IV 6) You did not intubate the patient : You have 3 criteria: A) EtC0[sub:042106d0db]2[/sub:042106d0db] capnography waveform * Direct visualization of the ETI C) Clinical findings of bi-lateral lungs sounds and no abdominal air movements 7) When all else fails .. A) Resort to BLS with BVM & supplemental oxygen.. (if the patient does not have airway obstruction secondary to anaphylaxis) If possible intubation with blind intubation devices ( LMA, Combitube) C) Surgical airway 8 ) Bad call document your butt off!!! This call sounds like hell.. and yes, they did wrong ! No, I believe they were probably got an airway from hell... and I am sure it was a cluster as well. So, the main problem I see is not so much the treatment is the failure of the documentation. Their testimony and their paperwork demonstrated separate actions?.. Make your paperwork, at least sound like you had a call from hell.. and be sure to include the measures & actions you did to cover those problems. This is why I have endorsed EtC0[sub:042106d0db]2[/sub:042106d0db] capnography. Colormetric is enough to get by.... but they are worthless for documentation purposes and unreliable if secretions and emesis have occurred. If you don't have a capnpgraphy wave form displaying EtCo[sub:042106d0db]2[/sub:042106d0db].. then you did NOT properly inutbate ! I don't care how much you chest rise & fall... etc.. There is no "false" waveform....Folks, without this Paramedics are not going to be allowed to intubate! They cannot go against waveforms!! This is our only proof of proper placement ! I would had rather pulled the tube and tell the Doc. could not get her tube than to have a tube in the belly... QI/QA or even the shift supervisor, should had screened the paper work and asked for an "addendum" to cover their butts and the agencies. Should had caught the no documentation of Epi.. and explanation of delay at scene. Glad this call was theirs not mine.. I have been on several like these.. and I still have nightmares.. they are not easy, and there is so much external factors that one do not include. Sorry this happened, and the medics payed the price as well as the service, medical control physician, the profession and the ultimate .... the patient. Be safe.. and document your butt off ! R/R 911

Here is a link for a power point presentation with etilogy, and treatment etc.. for EMS http://www.aanet.org/ems/info/CRUSH_INJURY...SH_SYNDROME.pdf R/R 911

Okay.. pass the Thiamine around.. oh, heck hang a "bannana pack" for me... :wink: R/R 911

Hmmm.. wonder where all ambulances go when they die... DOn't know how much professionalism this presents.. but, I gues it is better than the plumber truck... R/R 911

Ditto... Nice to see medics that actually understand emergency medicine... good job Kev.. R/R 911

My suggestion is run away from any EMS that has a 700 pg. manual.... Obviously, they don't believe you can think on your own. R/R 911