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Indiana's EMT-A is the most pointless cert there is. You barely have anymore definitively life saving procedures than a B has available. The I cert has merit. While you should probably just finish it off, you at least have real cardiac and respiratory management drugs and equipment available. One of the area fire departments (all area departments are transporting EMS providers) is requiring all new personnel to become certified as at least EMT-I's within their first year on the department, and is looking at requiring all personnel to become certified to the intermmediate level. This is a wonderful move and will ikely result in more paramedics as they get no pay increase for the I level but get a nice boost at the P level. In Indiana, B's are limited like most places. The only thing we have working in our favor is the use of dual lumen airways. I am not a big fan of these, but it is better than not protecting the airway (depending on the EMT- but I won't go into that story).

"Unresponsive" always means cardiac arrest either when manpower is low or ALS is unavailable. Of course, it will definately mean cardiac if your BLS truck has no AED. Murphy's law is most dominant in EMS.

I didn't- hence the crack at the end- what, do you think I would want to live in the same place as ....... uh, well kumbaya folks.

Of course, the "can't we all just get along" theory rarely produces any stimulating conversation or exchange of ideas. I suppose if all the EMS personnel just lived together on a commune it would be a pretty safe place.

Depends on your location. In Indiana, ASA is standard and the epi-pen being provided by BLS trucks is being considered. No AED= No ambulance.

Boy this thread is old, and considering it's age and how many points of view were discussed in the first 10 pages, there is little reason for anyone to get worked up over it anymore. It really is as simple as if you are willing to stick with the status quo, you are part of the problem. There is no reason that every career and volunteer provider shouldn't work together to provide at least the primary ambulance response be a paid crew and a paid ALS chase truck, or even better (depending on your location and needs) two paid ALS ambulances. If you are satisfied with the "I hope someone responds" feeling that all worthwhile volunteers have felt, then that signifies a problem. As much as I love being able to make the first due, I love knowing that the people who dial 911 are getting an effective response. My volunteer department is trying desperately to work towards 24/7 ambulance and ALS coverage. There are a small group (approximately 6) that are opposing the merger we are trying to acheive so we can consolidate budgets and fund this (we have to because the trustee will not approve a territory that we were pushing for). Their response to the idea that this will improve services is "this is the way it has always been" or "we will lose our identity". :!: :x :x These are pride issues that seem to run rampant throughout the volunteer services. While many of the people on these boards are willing to be progressive and work hard on training and push for progressive solutions to problems, far too many in the volunteer community are not willing to do these things. Pride in volunteerism is as dangerous as it is important, since without it no one would volunteer but with it we are not willing to give ground to allow the best service possible. Volunteers will remain an important part of fire and EMS, but should be used as secondary or fill in responses. If you are interested in helping your community, then further your training and education and work to find a way to get paid coverage. cdemt5710- I agree with your statements that it will require a concerted effort from all involved to get paid and improved EMS systems in place. The only problem is the old crusts in the volunteer side will do everything they can to kill all of our best efforts- I have seen this first hand.

Trying to save a persons life will require straightforward and pertinent discussions. You are there because there is an emergency (usually :? ). We ask the SAMPLE questions as a matter of fact, not "as a matter of casual conversation". Do what is right for your patients and start your care for them immediately. OD call= what did you take, how much did you take, when did you take it, did you drink anything with it, when was the last time you ate, and after all the pertinent history is gained, then you ask them why. It really is that simple. This is all information we need and as soon as possible.

Dang, someone spoiled the joke right off- thanks. Yeah, you notice they get less and less funny. That was the intent. (funsucker)

The Most Complete List of Ways To Annoy People, Cops, Your Roommate, And More. 1. Pay tolls with $100 bills 2. Leave your supermarket cart on the street or in the middle of the parking lot 3. Eat produce at the market; don't buy it 4. When giving directions, leave out a turn or two 5. Leave the outdoor Christmas decorations up until March or April 6. Before exiting the elevator, push all the buttons 7. Knock and ask "How is it going?" to someone constipated in a public bathroom stall. 8. Develop at least three strategies for cutting into the front of lines 9. Announce when you're going to the bathroom 10. Chew other people's pencils 11. Invite lots of people to other people's parties. 12. Wear large hats during the movies 13. Touch strangers 14. Tell little children the truth about Santa Claus 15. Bite your dentist's finger 16. Select the same song on the jukebox fifty times. 18. Leave lipstick prints on people's cheeks and foreheads 19. Don't stand during hymns and anthems 20. Dance fast to slow music and vice-versa 21. Tell people they have bad breath 22. Invent nonsense computer jargon in conversations, and see if people play along to avoid the appearance of ignorance. 23. Flirt with a friend's spouse 24. Sit in the home bleachers and cheer for the other team 25. Shake with your left hand 26. Use the quote bunnies after every other word you say when talking to someone. 27. Adjust the tint on your tv so that all the people are green, and insist to others that you "like it that way". 28. Drum on every available surface. 29. Staple papers in the middle of the page. 30. Specify that your drive-through order is "to go". 31. Honk and wave to strangers. 32. Dress only in clothes colored Hunter's Orange. 33. Change channels five minutes before the end of every show. 34. Decline to be seated at a restaurant, and simply eat their complementary mints by the cash register. 35. Buy a large quantity of orange traffic cones and reroute whole streets. 36. Pay for your dinner with pennies. 37. Tie jingle bells to all your clothes. 38. Repeat everything someone says, as a question. 39. Leave your turn signal on for fifty miles. 40. Lie obviously about trivial things such as the time of day. 41. Reply to everything someone says with "that's what YOU think." Annoy Cops 42. Say out loud when he/she approaches you "You're not gonna check the trunk, are you?" 43. Ask to see his gun. 44. When he's telling you what you did wrong, start repeating him, quietly. 45. Say out loud "Hey, you must've been doin' about 125 mph to keep up with me! Good job!" 46. Slap his hand and say "Bad cop! No donut!" 47. When he frisks you, say "You missed a spot", and grin. 48. After every other sentence oink like a pig quietly to yourself but loud enough for him to hear you. 49. Refer to him by his first name. 50. When he comes up to the car, say "License and registration, please" right when he says it. Annoy Your roomate 51. Smoke weed. Do whatever comes naturally. 52. Switch the sheets on your beds while s/he is at class. 53. Twitch a lot when you guys eat dinner. 54. Pretend to talk while pretending to be asleep. 55. Steal a fishtank. Fill it with beer and dump sardines in it. Talk to them. 56. Ask him/her to do you a favor and get you a drink, then when they bring it, slowly pour it on the floor. 57. Clip your toenails while watching a movie or eating dinner. 58. Learn to levitate. While your roommate is looking away, float up out of your seat. When s/he turns to look, fall back down and grin. 59. Speak in tongues. 60. Move you roommate's personal effects around. Start subtly. Gradually work up to big things, and eventually glue everything s/he owns to the ceiling. 61. Walk and talk backwards. 62. Spend all your money on Jolt Cola. Drink it all. Stack the cans in the middle of your room. Number them. 63. Spend all your money on Transformers. Play with them at night. If your roommate says anything, tell him/her with a straight face, "They're more than meets the eye." 64. Recite entire movie scripts (e.g."The Road Warrior," "Repo Man," Casablanca,") almost inaudibly. 65. Kill roaches with a monkey wrench while playing Wagnerian arias on a kazoo. If your roommate complains, explain that it is for your performance at art class (or hit him/her with the wrench). 66. Collect all your urine in a small jug. 67. Chain yourself to your roommate's bed. Get him/her to bring you food. 68. Get a computer. Leave it on when you are not using it. Turn it off when you are. 69. Ask your roommate if your family can move in "just for a couple of weeks." 70. Buy as many back issues of Field and Stream as you can. Pretend to masturbate while reading them. 71. Fake a heart attack. When your roommate gets the paramedics to come, pretend nothing happened. 72. Eat glass. 73. Smoke ballpoint pens. 74. Smile. All the time. 75. Collect dog shit in baby food jars. Sort them according to what you think the dog ate. 76. Burn all your waste paper while eying your roommate suspiciously. 77. Hide a bunch of potato chips and Ho Hos in the bottom of a trash can. When you get hungry, root around in the trash. Find the food, and eat it. If your roommate empties the trash before you get hungry, demand that s/he reimburse you. 78. Leave a declaration of war on your roommate's desk. Include a list of grievances. 79. Paste snot on the windows in occult patterns. 80. Shoot rubber bands at your roommate while his/her back is turned, and then look away quickly. 81. Dye all your underwear lime green. 82. Spill a lot of beer on his/her bed. Swim. 83. Bye three loaves of stale bread. Grow mold in the closet. 84. Hide your underwear and socks in your roommate's closet. Accuse him/her of stealing it. 85. Remove your door. Ship it to your roommate's parents (postage due). 86. Pray to Azazoth or Zoroaster. Sacrifice something nasty. 87. Whenever your roommate walks in, wait one minute and then stand up. Announce that you are going to take a shower. Do so. Keep this up for three weeks. 88. Array thirteen toothbrushes of different colors on your dresser. Refuse to discuss them. 89. Paint your half of the room black. Or paisley. 90. Whenever he/she is about to fall asleep, ask questions that start with "Didja ever wonder why...." Be creative. 91. Shave one eyebrow. 92. Put your mattress underneath your bed. Sleep down under there and pile your dirty clothes on the empty bedframe. If your roommate comments, mutter "Gotta save space," twenty times while twitching violently. 93. Put horseradish in your shoes. 94. Shelve all your books with the spines facing the wall. Complain loudly that you can never find the book that you want. 95. Always flush the toilet three times. 96. Subsist entirely on pickles for a week. Vomit often. 97. Buy a copy of Frankie Yankovic's "Pennsylvania Polka," and play it at least 6 hours a day. If your roommate complains, explain that it's an assignment for your primitive cultures class. 98. Give him/her an allowance. 99. Listen to radio static. 100. Open your window shades before you go to sleep each night. Close them as soon as you wake up. 101. Wear sunglasses at night. Bump into things often. Swear loudly. Annoy your examiner during a Driver's Test 102. Turn the radio on. When the testor goes to turn it off slap his/her hand. 103. Beep your horn at everything. 104. When you stop at a light, start revving the engine while looking back and forth between the person next to you and the light 105. Get in the car, look down at the pedals, and say, "now which one is the gas again?" 106. After the examiner gets in the car, pop the hood, and get out and check the oil. 107. Fill your car with beer bottles. 108. The whole time driving, talk about how Aunt Gertrude smells like mothballs. 109. In the middle of driving, put your arm around the examiner. 110. Swear at everybody on the road. 111. Break off your rear-view mirror and then ask the examiner to hold it up.

The hospital writes our EMS protocols, so we have little input in our system in regards to patient care or training (minimums- but we have raised or standards to include additional certifications). Are you looking for general operating procedures outside of the patient care requirements? If so we would need to know alot about your company and the direction it is headed. Are you paid or volunteer, private, municipal, hospital or fire based, are you all ALS or combination ALS/BLS, chase trucks or ambulance only, 911 or transfer, who dispatches you? ETC. There are far too many questions to answer just on the business/employment side for us to be of much help, much less on the operational side. If there were specific areas to address, then please narrow it down for us.

#1 seems reasonable to me. If there is a recognized danger we will always wait for LE, of course that is when it is dispatched correctly (injured person= gunshot wound?). It is counterproductive to go into a scene with known dangers without at least LE, and an engine crew is nice too, as you cannot concentrate on the needs of your patient without scene safety assured.

Why the hell didn't she send a cop?- That is the SOP on any prank or hang-up call to any dispatch number in my area, period. I am guessing that the Detroit SOP is to send a cop as well.

I am not sure why cost is considered (I would not), but time spent on a dead body is counterproductive when it could be spent counseling the grieving parents.

Any soft restraints are allowed. We prefer the SD help, but it is not always feasible. We have a commercial restraint, but I am partial to Curlex (one roll per wrist).

Lets just cut the crap and run the dustdevil party. Crotchety old people make me happy :twisted:

I agree that in a place where ALS is scarce, they should go back into service as soon as possible. But any BLS provider that responds should be willing to stay as long as necessary. At least until family or a chaplain arrives.

Anything and everything. Take classes as often as possible. Find new books, read JEMS, affiliate with a hospital. There are so many ways to keep up on your skills that you could do it 40 hours a week if you looked hard enough. I would be careful about internet resources though, unless it is backed by a reputable agency.

It is odd that there are so many "yes" responses but so few persons willing to state their point of view in the forum.

We only use them in log roll situations where sufficient help is available or in situation where there is no suspected spinal injury such as geriatric patients with fractured or dislocated hips.

No one is arguing that you fail to act if there is even the slightest chance of resuscitation. I would even say that you would set a higher standard for children than most cases. It is when there are definitive signs that you then focus on treating the true patients which are the parents.

"Screwing" is kind of harsh don't you think? Depriving- mabye, but it is out of ignorance that departments/ services dont push for paid staffing in the more rural areas.

The best immoblization device I have ever used is a full body evacu-splint. Absolutely perfect formation- We train on ours with each other and on several occassions I have been so set I could not move even with trying and having all straps removed. These should not be used for most extrications though, as there is too much manipulation required to center the patient.

Truly, volunteers are still going to be needed. Hopefully someday the majority of the volunteers will be supplemental personnel (that are trained to full professional standards). The fact is that ever increasing criteria and training requirements are making volunteer fire and EMS less practical. We are currently pushing for full time EMS and part time engine coverage for one of our departments by pushing for a merger. This will give the funds for at least 1 full time ALS ambulance, a day coverage BLS ambulance and possibly a day coverage engine. Hopefully that will lead to a territory in the near future to hire full time career people to staff multiple apparatus. If, as a volunteer, I did not have intentions of supporting this I would be contradicting my stated objective for volunteering in the first place. And no, I am not job chasing as I will continue to volunteer at this department and work for another.

This is a big one for me- Extensive studies have shown that you will do more for the parents well being by using a direct, honest and tactful approach. Let them know that there is no chance of resuscitation. Let them know (unless you suspect otherwise) that it was likely not their fault and possibly an unavoidable medical issue (do not diagnose SIDS- use the term medical issue). In Indiana we have to take an annual refresher on SIDS, mostly a "care of parents" guide, to remain active with a fire department or other emergency service provider. I know that most peoples heart tells them to do the contrary, but do not start resuscitative measures on a child with definitive or multiple signs of morbidity- unless it is a crew safety situation. SIDS is certainly one of the worst calls we will have to deal with.

Page 10- yeah!