Asysin2leads

OMG, calling your wife in to arrest someone? Jeez louise, call me old fashioned but this guy must have his balls in a pickle jar by the front door. I bet he got his mom to get him out of fights when he was a kid and getting his ass whipped. Can I have his e-mail address so I can make fun of him? Please?

Well, in about 2 years you can become a nurse, so its not such a bad idea. Although I'm not sure if anyone goes KABLAAM when you graduate nursing school. God forbid we should have one standardized level of care on ambulances around the country.

Paramedic school is for wussies! Be man and buy now or the terrorists win!

"So if you can scoop and run, treat w/ diesel" ??? Was there something I missed? The problem with this stuff is that sometimes we get so bogged down in the details of the complications that we miss the obvious. While there may not be a clear indications of when to intubate an asthmatic, being unable to decide who needs to be intubated is unacceptable. Intubation is the last resort, so I don't come to the decision lightly, but when I do, its because the person is going to die or suffer serious complications if they don't get air, and at that point, things like increased intrathoracic pressure really are not the most pressing concern. You know, most people don't realize that one of the more common rhythms in severe hypoxia, especially in pediatrics, is bradycardia. A bradycardic pediatric should automatically be considered to have an airway or breathing compromise until proven otherwise. While adults will sometimes will go into a fibrillation rather than bradying out due to hypoxia, it is not uncommon for even an adult to go into a bradycardic PEA from severe, prolonged hypoxia. Personally I have had at least three bradycardic PEA arrests that regained a pulse shortly after being intubated. So, I'm wondering, all of these arrests you've seen who are bottomed out in the BP and are bradycardic, do you think its possible its not because of a lack of a fluid bolus or because of vagal stimulation, but its because people waited too long to fix the emergent problem and save the patient's life? If someone is gasping for breath, they are getting intubated. I'm not starting two wide bores on them, I'm not doing anything but prepping and tubing.

You're beginning to catch on. Wasn't it your state official who said "paramedics are only good for rare heart conditions, anyway?" =D>

Treat with diesel. Nice. You know, I probably have one of the shortest distance to hospital times of any EMS provider in the world, and the only time I ever transport rather than attempt to intubate is if there is an extenuating factor. When someone needs to be intubated they need to be intubate. End of story, and if they need it done, then do it sooner rather than later. If I think I can clear up and asthmatic without intubating, then by all means I go for it, its the right thing to do. But recognizing a patient who needs aggressive airway management and acting accordingly is one thing paramedics need to know like their own feet, and failure to act on it, for whatever reason, is not appropriate treatment. My saying is it might be five minutes to the hospital but it'll probably be 20 minutes to airway securement if we don't act. I'd rather risk bottoming out a blood pressure than wait for a fluid bolus in a critical asthmatic. These theories of increased intrathoracic pressure are always good to keep in mind in case the patient codes (I'd say rather unlikely vs. the chances of coding because they are hypoxic) but the first and foremost thing should be sedate, intubate, move on. Oh, and the reason we give steroids right away is because they have a synergistic effect with the albuterol. Thats what my medical director told me and I'm sticking to it. Every single person of the scoop and run crowd, I always want to take a plastic bag, put it over their head, and twist it real tight, then tell them it'll only be 5 minutes like this and its really for the best.

The reason the doors are locked is because they are always auto-locked. One thing the FDNY does do is build tough ambulances. The openings are all custom made, including auto locking high security keys, one for each partner. To open the door you have to insert a key. It takes a few seconds more, and you'll leave the key in the door here and there and look like an idiot, but all and all it really is worth it for security. Do you ask why the doors to the ER and the trauma bay are locked too? Or are they locked around your neck of the woods? If not, I'd suggest they do it.

I'm guessing some kind of synergistic reaction of nitrates? Either that or he should have his prostate checked. So glove up and have at it, fella.

Asys angry. Asys in process of cleaning out apartment. Asys find old flash cards, stacks and stacks of, and notebooks, stacks and stacks of, meticulously filled out and filed, from paramedic class. Asys reminded of labor of paramedic class. Asys eat bad EMT's saying BLS before ALS now. Asys angry and hungry.

Gaelic, right now I'm in a position where I am really pissed off at the whole firefighter/medic thing. I'll be okay in a few days about it but right now I am pissed off beyond words. Here's my position. For the past 10 years I have basically eaten and slept EMS. I have an associates degree in it. I have worked in one of the busiest systems in the country. I have several commendations and not a single complaint. I've decided its time I relocate. So with all of that you'd think, hey, this is an attractive candidate for a 911 position, right? Wrong. Instead, if I want to do the job I have been doing, I have to go through and be lumped in with every single tobacco drooling moron who wants to be teh fireman. I have no problem with firefighting. I enjoy it. I don't mind getting back in shape. But I do resent the fuck out of having to go through entry level fireman bullshit just to do the job I've been doing for a couple years now. I Asys is angry. Very angry. Angry at somehow scoring very lowly on an entry fire exam. Angry because being able to differentiate between fine v-fib and asystole, in the weird, wacky world of fire/medic, means less than if you can respond appropriately when someone puts their socks in the laundry before you or how to stop the argument over macaroni and cheese. I am angry.

congrats, Dwayne, there was never a doubt in my mind.

Sometimes I think we get off on the wrong track here. I've read the literature on acupressure and acupuncture, and they may have some benefit in the rehab and chronic pain areas of treatment, but the last time I checked, pain in the emergency setting is something that needs slightly more aggressive treatment. In other words, if I had a femur fracture and you offered to do acupressure on me, I'd use whatever strength I had left to crack you one. I need morphine and/or fentanyl. Heck, mix them up for all I care.

I've never understood the whole fireman worship thing. When I say I don't understand it, I mean, I really don't, I don't understand the people who prostrate themselves to be liked by the firemen. Sure, I liked riding on the fire engine as a kid... got to do it in kindergarten, I even met Sparky the firedog. I used to watch the fire engines go by from my grandmother's window, even. But, in the end, the whole mysticism and magic that people have for it was just lost on me, I guess. I always saw it as a job, a very important one, a very dangerous one, but at the end of the day still a job. I can understand kissing up to say, a CEO, or maybe a powerful politician, but the ones in EMS who kiss up and act all... well, you know, to firemen, I just never quite got it. It this behavior that fuels the egos in the fire service that we all know and loathe, however. Tell someone they are a hero enough times, and sure enough they'll start to believe it. I'm waiting for the FDNY newsletter to tell us that the firemen have cured cancer or landed on the moon. I'm sure its either this or next months article.

The latest and greatest DCAS standards actually say "paramedic certification REQUIRED at time of promotion." I'll see if I can find a link for you. So right now, as this latest test stands, you can take it as an EMT but you'll need to be a medic by the time your number comes up.

I would really hesitate to call this a sinus rhythm. 158, in my mind, isn't quite fast enough to hide the p-waves as in a true SVT. The first tracing I would identify as a junctional tachycardia, but static EKG's were never my strong point.

Laura, it sounds like you did all you could on this job. The only change I would have made is that I wouldn't have spent time fighting with the NRB. In my opinion, given his state, the NRB and neb wasn't going to do much. The patient needed to be intubated. Until his airway was secure the only thing on my mind would have been sedation and intubation. Perhaps someone can jump in here, but it is also my belief that when someone is at this point in COPD or Asthma, while 0.3 of epinephrine IM or nebulizers might help, they are really like using a garden hose on a house fire. My plan of attack would have been, sedation, intubation, neb down the tube, and 2 grams of Mag.

As a matter of personal policy, I try not to comment on cases based on what is in the newspaper. Try to remember, our papers here in NYC sell themselves by sensationalizing stories. Its how they make money. If you ever have the time, do an archive search of the Daily News and the New York Post and how gradually over time, the tones of their 'reporting' towards the detectives changed as the facts came to light in the Sean Bell case. I'm not defending anything that may have happened on this case; I'm merely saying take what the Daily News claims as gospel with a grain of salt. Addressing what Dustdevil said, yes, you don't need to be a paramedic to be a Lieutenant or any higher officer with the current system. No, I don't agree with it. Its one of my biggest frustrations. However, the FDNY has only limited control over promotional standards, the rest is left to the overall civil service agency of NYC, known as DCAS. The latest standards for promotion do require a paramedic certification for promotion. Its only taken them about 25 years.

My biggest advice would be to offer incentives to volunteer. Some ideas I can offer: Free EMT training, with stipulations. See if you can finance forgivable loans so that you 'll put someone through EMT class if they agreee to answer the pager an acceptable number of times in a given time period. Offer free CPR courses at the volunteer building: You'll get some interested people with each class plus its cool teaching CPR. Canvas local colleges: Many nursing and/or pre-meds like to have EMT on their resume. I'm not sure why, but they do. See if you can finagle tax credits or paid-on-call services for responses from the town: Even if you are giving the responders $20-$30 per call, it'll help with retention, or see if perhaps the town could work out something with the responder's property tax bill each year... Start knocking off a few percent points and people will be beating down your door to volunteer... If that's even legal to do.

Even with 5 minutes to the hospital, anyone with hypoxia that cannot be corrected by other interventions or an airway obstruction should still be immediately intubated. If you don't believe me, next time you get a 911 call, the moment it goes out, tie a plastic bag over your head, and don't remove it until you are laying supine on a bed in the ER with the airway kit prepped. You'll find 5 minutes to the hospital is a lot longer than your think. (BTW, don't really tie a plastic bag over your head, its wrong, dangerous, and can kill you.)

Well, your employer puts you in a poor situation... for me a pulse check is a very poor and subjective measure of whether someone is DOA or not. Yeah, I know it goes against what the AHA says about procedure in evaluating the unresponsive, but I submit that while finding the presence of a pulse is easy, confirming the absence of a pulse is hard. An apneic and hypotensive person can easily mimic a DOA, and vice versa. But if you feel okay about it, then tell your employer. Invite your employer to attend CISD if he feels that shooken up about it.

I think it is the duty of all providers to serve in a mentor role, but I also think that this role is often times abused both academically and professionally. If you are in the role of someone who's success is based on the success of others, such as a teacher or a supervisor, it is in your interest to try to pass off some of your responsibilty onto subordinates, i.e, pairing a weak student with a strong student or a weak partner with a strong partner, and if it goes to far, it is patently unfair to the stronger students and partners. I don't mind helping others. I enjoy it. But my job as a student is to study and succeed, not to play tutor, and my job as a paramedic is to make sure that appropriate prehospital care is rendered, not to babysit. Its one of the many current frustrations I deal with in my current position, I am given substandard people as coworkers, and the impetus is placed on me to make it succeed, and it is wrong.

What are people's thoughts on using them in the field? Initially, I was against the idea, but after being in a few close calls, and reviewing a study of police officer's dashcams (surprise surprise they exonerate the officer far more than they show any wrong doing) and also, reading the following case from our sainted Civilian Complaint Review Board has changed my mind: CCRB Investigation: Officer Exhibited Remarkable Courtesy and Professionalism in the Face of a Civilian's Barrage of Insults At 2:40 p.m., on March 4, 2005, a police officer approached a car that was illegally standing in a bus stop, and issued the driver, a 52 year-old woman, a summons. The woman did not believe she deserved the summons and argued with the officer. The woman subsequently filed a complaint with the CCRB. During her interview with the assigned investigator, the woman said she did not deserve the summons because she was simply waiting to return to flow of traffic after being beaten to a parking space in front of the bus stop. She claimed the officer had spoken discourteously to her, called her stupid, and that when she requested his name and badge number, he shoved his badge in her face. Assigned to work alone policing traffic and parking offenses, the officer informed the CCRB investigator that he uses a digital recorder to document his interactions with members of public to whom he issues summonses. The recording he made of this incident, which the officer provided to the investigator upon being interviewed, allowed the CCRB to construct the exact details of the verbal interaction, in which the woman, not the officer, was discourteous and threatening. When the officer approached the car, the woman immediately stated, "I'm not in the bus stop." The officer replied, "You're in the Q5 bus stop, ma'am." The woman answered, "No, I'm not." The woman argued that because she wasn't "parked" she shouldn't get a ticket; the officer explained that the law makes it unlawful to "stand" in the bus stop. The woman became agitated and asked for the officer's name, which he provided. She asked him to spell it and he did. She spelled it back to him, and added, "Yeah, you will hear from me.… I see why things happen to you folks." The officer asked her, "Why is that?" and she resumed her argument, asserting, "I was not parked in the bus stop." "Does that say bus stop, ma'am?" the officer asked. "I was not parked! Do you understand that? Do you understand I was not parked? What part of it do you not understand?… You're being totally ridiculous!" "Ma'am, your vehicle is in a bus stop right now." "I was never parked here! No!" "It [the parking sign] says 'no standing.'" The argument continued for some time. The officer gave the summons to the woman, who finally said, "I'm not in the mood for you and your mess." "Thank you for … your statement," the officer concluded. "Have a nice day." The woman then started to curse, screaming, "You are a Goddamned phony, you bony-assed motherfucker…. You can tape it." The officer remained calm, and stopped traffic so the woman could leave, stating, "Can you move it out? Go ahead, ma'am. I'm stopping traffic to allow you to get out." The woman did not move the car, yelling instead: "You're a stupid motherfucker! You stupid son of a bitch! I hope you die right now. You stupid son of a bitch! You stupid motherfucker." "Okay," the officer said. "You look like a Goddamned hobo." The audio recording at that point recorded the sound of tires squealing. The recording proved that the officer never told the woman that she was stupid, and that he politely provided his name to her. To the contrary, the officer spoke to the woman calmly and treated her with respect despite her rude conduct. On September 14, 2005, the board closed the discourtesy allegation the woman had falsely lodged against the officer as "unfounded." One of the first things I was told when working in the field was always to assume you were being recorded, and its true. Cameraphones, iPods, the expectation of privacy is vitually nil in the modern world. IMHO, if you are a professional provider and are cognizant of your duties and responsibilities and act accordingly, it is far better to have a clear documentation of your actions than leave it the hands of someone else or have it be a "he said, she said" situation. So now I consider a digital recorder part of my standard equipment. Anybody have comments on their experiences with technology like this?

Check this out: http://bfads.net/Omnitech-1GB-MP3-Player-at-Staples Omnitech MP3 and digital voice recorder. About the size of a stick of gum and fits right in your uniform pocket. Records for an hour and a half an can transfer right to a USB port. If the nurse is stooping to this level, then you have to stoop to one level further. It won't help with your current situation, but if she is in the position she is in with the attitude she has, its time to go full bore and record everything, because sooner or later she is bound to do or say something stupid and then you'll have all the ammunition you need. There are now people at work that I will not speak to unless mine is running, and there are many calls now where I turn it on. Its a must have for any professional EMS provider, IMHO. Plus you can listen to your favorite songs on it, too! Or, you can just hold the line until the affair with this doctor ends. These things have a short shelf life, and its far more entertaining when the entire thing goes down in flames. Feel free to laugh and point when it does.

JW, I think actually you are in a very good position to take the paramedic class. Sitting and reviewing calls with a paramedic is a very good way to really start to understand the field and what you are in for. I think you'll do extremely well. My paramedic class didn't require any prior EMT experience. In fact, you could take the EMT course as part of the course curriculum for the AAS degree. Before we started doing clinicals, anyone who had no prior BLS experience was required to do four ride alongs with the BLS 911 units. Four. That's it. And you know what the ironic thing is? Of the 3 people who had no prior BLS experience, out of a class that started with forty and graduated 8, all of them graduated as paramedics. I think that says something. Who is better qualified to teach you how to put in an OPA? Larry the Tow Truck Driver/Volunteer EMT, or a respiratory therapist?

You know, while in humor, Dust does have a bit of a point. Including 'Zilla, there is general agreement on these points: 1. Situations where it is necessary to remove the limb or lose the patient in the field are real, and while not as common as other scenarios, can and do happen. 2. In this situation, it is medically and ethically necessary to undertake the procedure. 3. A prehospital care provider can reasonably be expected to have to perform this procedure. If that is all true, then I think it is enough criteria to if not have a formal protocol for limb removal, than to at least touch on some of the points like 'Zilla did in an advanced life support class. Personally, I've seen this situation arise far more times than situations where a needle or open cric is needed, but we're trained on that. In other words, if we may have to do it, its worth having formal training, planning, and documentation procedures for.