akroeze

I would just like to point out that fortunately (for the pts) in many areas in Ontario they are moving to D50 for PCPs

Refresh me Acosell, where do you work again?

Actually, it's touché

So what would an ALS provider do? Malfunction: Nothing more than an basic really right? I mean other than a precautionary line and EKG Needed: Would you push drugs in this situation?

Aye.... I'm to the point where I just say "that's sad" and continue on....

Uhmm... go Tripod! :?

... why? :?

*wipes a tear*

Alrighty then, I can't be faulted for someone else's false advertising

If I'm not mistaken, hammer is a he... not a she

This pt sounds like they would have been perfect for canvas and poles... man I love using those

Anywhere outside of Toronto from what I've seen has PCP = 1 bar ACP = 2 bar CCP = 3 bar This is just from observation though.

Let me clarify. I have not seen it used in the field, no. I have however used it quite a lot as a nurse, therefore I PERSONALLY feel comfortable with percussion. Therefore yes I do have enough experience in doing the skill. My "specialty" in nursing is surgical floor... percussion is quite common. So I feel that my statements in no way contradicted themselves. Never said I was trained to the current level of RN. I may be reading this wrong but according to your logic, a PCP calling themself a Paramedic on these boards is misleading because they would not be called so in other systems...? That's what you're saying. Although even then it's not true as an LPN in other systems can still call themself a Nurse. So if anything I'm misrepresenting myself less than a PCP calling themself a Paramedic. Not going to side track this into a nursing thread... just made those comments as a point of interest. Not trying to say anything by them. I suppose I should have specified that I am personally comfortable with it from my nursing experience.... although to be honest, since the amount of training I received was the same in either course, why can't a PCP do it? You never get good at it until you actually do it a bunch of times. You're misrepresenting me. I am NOT taking issue with 30 minute on scene time, I have NEVER taken issue with this. I have said many times that I am taking issue with him saying that an ACP should take DOUBLE the amount of time on scene that a PCP does. Actually... I kinda wanted to hear if I was the only one who missed obvious things. While I am perfectly willing to continue this conversation, in hind sight it deserved its own thread.

Yes, I do. The person has absent A/E in an area, they have a chest trauma, they sound dull when I percuss. I'm thinking Hemo. The percussion has assisted me in diagnosing the problem. I'm going to stop myself from getting into an RN vs. RPN debate cuz this isn't a nursing board, it's an EMS one. What I will say is that I went through 2 and a half years of school just like many of the RNs that are out there did. Many of my instructors (RNs) said many times that we were learning things in way more detail than they had to in their two years. Anyway, not the spot for this. I disagree, but it's ok to disagree. Maybe I truly don't understand because I've had little exposure to ACPs, that's possible. What I haven't seen demonstrated here is what that time is spent doing. What do you do that takes double the time of a PCP? I really do want to understand.

I only mentioned RPN cuz it was the only thing I had to cmpare to. My percussion asseessment skills were just as in depth in my PCP training as it was in my RPN. How is this an objectionable statement? I didn't think that it was implying a superiority complex.... and when did I ever claim that an RPN is the same as an RN? I'm confused.... please explain. We practiced chest percussion. We went over what the different sounds could mean when involved with different pathologies. When we learned a disease, we learned what would be found on percussion of the chest. What more is there to learn about percussion that a higher level would have that a PCP doesn't? I agree with you totally, never seen it done... don't see it as practical at all in most cases. I'm not taking issue with being on scene a long time. It was with the idea that an ACP needs almost double (according to Lithium's numbers) the amount of time in the house that a PCP does. I was asking him what he assesses that takes twice the time a PCP would to assess. That's all.

I wasn't attacking anyone... I was genuinely curious what it is an ACP does taht takes so long that a PCP doesn't... and I still don't understand what it is... that's all.

Lovely non-answer there.... Why can't you explain why it is taking so long? What questions are you asking that I wouldn't think of? Cuz I haven't seen any skills listed that take that long...

I give you the spirometer, can't argue that Chest percussion, we covered it just as in depth in my PCP class as we did in my Nursing class if that helps... I don't know how in depth yours was so that's all I have to compar to. But your point on that is moot as you yourself point out that you are the only one to your knowledge that actually does it. And regardless... it doesn't take long. So why are you taking so much longer as an ACP than a PCP does? I truly don't see where the extra 14 minutes is coming in.

Nope, didn't ride with ALS. Nearest ALS is about an hour away... this is a BLS only service. I guess I don't see why what you are saying is specific to ACPs.... I can do those things as a PCP too.

Just out of curiosity, what more assessing does an ACP do that a PCP doesn't? SAMPLE OPQRST VS BS 12 Lead/3 Lead and the like What does an ACP do more that takes that much longer for assessment?

So I've been thinking about starting this thread for a while now and I'm just getting around to it. What have you missed that was so painfully obvious after the fact? I mean you look back and say "How could I have missed that??" Here is mine (I've talked about it on here before): We go for a SOB, first response car (medic) is on scene before we are. Pt has stable V/S, NRB@15lpm looks to be NSR in Lead II. C/O SOB (half sentences) and unable to ambulate without increased SOB. FR Medic states she thinks the lungs are clear but there may be some oh-so-faint fine crackles in the bases. My preceptor and I both listen and we both agree that we can't tell if they're there or not.... we both think we MIGHT hear something but don't know for sure. Pt has a Hx of MIs but states he has no C/P at all however the last time he had an MI he didn't have pain either, just this SOB. This throws up red flags so we decide to load and go (~35min leisure drive to the hospital, less with L/S). He doesn't seem to be in much distress. We stand/pivot/sit to the stretcher. Start to the hospital L/S as a precaution though he doesn't seem to be in much distress. Talking to him for a couple of minutes and then he says he's starting to feel a heaviness in his chest. OK, assess for Nitro/ASA, get V/S, go to give the Nitro.... he won't lift his tongue.... He won't lift his tongue because he is semi-conscious. He has a Rt deviated gaze. Recheck V/S.... normal (little to no change from previous). Ok, glucometer.... normal.... Ok.... this guy is having a stroke. That is what I thought. That is what I went with.... can't auscultate the lungs properly (at all) due to road noise. Look at the monitor... oh, he's throwing trigeminal PVCs.... odd for a stroke, I'll have to look that up later. Well in the end he was having a massive MI, heart failure and flash PE. He was FULL.... and I missed it. All the Hx leading up to it... the way he presented.... I should have known what it was... it was so OBVIOUS and I missed it! I felt really bad about that for a very long time.... I'm still somewhat shaken up by how I missed something so obvious. Does anyone else have something like that?

Ok, my background. I am a Nurse and I am going back for my second year of camp nursing. The camp has roughly 240 staff and 500 campers at any one time. We work in a team for health care, three nursing staff, a physician and a nursing student. I'll repeat what Dust said.... if you're an EMT-B with no other medical background you won't be able to do anything for most things you will see. Nothing against EMTs, it's just you aren't trained to be a camp nurse. When it all comes down to it, the best person to work at a camp is a nurse, not an EMT/Medic. Equipment? Well we are an anaphylaxis friendly camp therefore there are epi-pens posted everywhere and each nurse has one in their kit. What is our kit? You know those cheap hip packs that they give away for free sometimes? That's what we use. You don't need any more than that. If memory serves I had... bandaids, a couple of few 4x4s, a roll of tape, a roll of kling, a pen and paper, epipen, gloves x 2pr, maybe some 2x2s? That's it, that's all you need in your personal kit. It's small and to the point... maybe throw in an ABD pad if you want. Here is an idea for cleaning of wounds.... make-up pads. Those little round single use cotton things women use. Go to a bulk store and get 'em really really cheap. They're perfect for cleaning a wound (use tap water.... it works) and much cheaper than gauze.

Well considering this is the Tactical Emergency Medicine forum I would say it's safe to presume the second.

This question includes EMT-P right? Are EMT-Ps educated to the level to do what they are doing?