Asysin2leads

Here's a better and far more plausible scenario. You are on scene with a person at an industrial accident with an almost complete transection of the lower leg, pinned under a heavy piece of equipment that isn't moving anytime soon. The lower extremity is obviously unsalvagable, however, there are a few small tendon and muscle attachments that are still connected to the patient, preventing him from being removed. You are unable to contact medic control and the patient is hemorrhaging profusely. The nearest field MD is more than an hour out. How would you deal with the last bits of tendon preventing the extrication? What would you use? How would you document? What if it was an artery?

Sorry, Barry, $2,500 is too much for a basic class. I wouldn't take my EMT class at Harvard for $2,500 dollars.

Look, if someone wants my wallet, they can have it. If they still come at me then, its on. I'm not saying that if escape is unavoidable not to give it a shot, but if you can get out, do it. Rushing a gunman with a fire extinguisher is a good way to commit suicide, IMHO. And yes, Dust I agree with you. The problem wasn't the firearm, it was the person, but if he hadn't been able to get his hands on a semi-auto, the body count would have been much lower. I think that if he hadn't been able to get his hands on a gun it would have been a knife or a gas or a club, but if hadn't been a semi-auto, there wouldn't be so many dead. I don't blame gun owners for the tragedy, but I do blame the standards for the sale of firearms that do not prevent people with documented histories of mental illness from swiping their Visa and going on a rampage. This guy wasn't just a little kooky. He had been, in the past, declared a danger to himself and ordered for psychological counseling. But guess what? Because of gaps in the reporting laws, Virginia never bothered to report that to the federal government agencies that are supposed to stop these sorts of buys from happening. I don't blame the students or the school for this tragedy occurring anymore than I blame the victims of 9/11 for not stopping the airliner from hitting them. It wasn't their fault. It was the fault of a government who despite its size and bureaucracy, still can't prevent a person who was declared a danger by a court from buying not one, but two firearms. That's who I blame.

You've never actually been in a situation where someone started shooting, have you? I find your frat boys and fire extinguisher plan for defense amusing, but this isn't Die Hard. Doing that will get you shot and killed. If someone starts shooting, the best tactic is to run away, as fast as you can. Secondly, it takes less than 20 seconds to reload a modern handgun. Even if you are Bruce Jenner combined with John McClane, you still don't have much of a chance. And how do you none of the people killed weren't attempting to disarm him? Lack of fire extinguishers found on scene? Wait, the guy on TV said it was because we've become a more violent society that these things happen. Which is it? I'm not sure where we get the notion that 100 years ago all was peachy and men were men and women all looked like pin ups, etc. etc, but it just ain't true. 100 years ago the average life expectancy was around 40. Disease was rampant. People lived in tenements and people were commonly lynched. I'll take the modern world instead. You know, its one thing to believe in the right to keep and bear arms. Its quite another to pretty much state that the reason Virginia Tech happened was because the students were cowards. That's just plain not nice. I'll never quite understand the people who blame the ones who get shot and killed rather than the gunman, but that's just me. I tend to look for the simple answers. Like it or not the reason Virginia Tech happened was because an asshole got his hands on a firearm when he shouldn't have. Its kinda like why 9/11 happened. It happened because some assholes hijacked an airliner, that's the reason.

I attribute the so-called phenomenon of 'freezing up' more to the inadequacies of the EMT-B program rather than any real, psychological phenomenon. Its not so much to with stress, but rather simply a case of someone not knowing what to do because they do not have the proper training do react to the situation. Now, it has been a while since I was in EMT-B class, but I do remember some of it. We had a nice field trip to the junkyard. We spent about four hours talking with the local FD and playing with the jaws of life. Was four hours of doing this enough to prepare me to respond to an MVA? Nope, not by a long shot. A new EMT-B simply does not have the knowledge to evaluate or operate properly on any sort of technical or inter-agency scene. If I take a lay person and stick them in the middle of an accident scene, they might just stand there because they do not know what to do, and so it is with a new EMT-B, and some older ones too, IMHO. For instance, EMT-B class teaches: 1. Scene safety. But they don't really teach it. They tell you to look out for people with guns and downed powerlines. They do not instill the knowledge and confidence in you to look at any scene and know when to enter. 2. BSI. But do they really go into the nitty gritty as to when to throw the turn out gear and when to stay with gloves and goggles? Nope. You can't tell me that you come out of EMT-B class and can tell me exactly what is needed for any situation that is thrown at you. 3. Airway. They teach you to clear it. They tell you how to do it. But they don't teach you how to look at someone and know exactly what to do. So, if you really want to have EMT-B's in charge of the critically ill or injured, my only suggestion is to drill, drill, and drill for 8 hours a day, five days a week, in a strict paramilitary environment, as in reciting, everyday, chapter and verse standard operating procedures for different incidents, or they simply will not know what to do.

You know, I think its ironic, for the amount of calls and the environment I work in, that the worst ambulance incident of the year in New York State happens in Rockland county. I guess this is a prime example of the real dangers EMS providers face and why proper training of providers cannot be understated. I'd rather work in the ghetto with a partner I know and trust than in the most pristine example of suburbia with one I don't. Godspeed recovery to the injured medic.

Thanks for replies everyone, especially AK. I'm basically in the same situation you are in, I need to get this done soon and I just don't have the time to take a week off for a refresher. I didn't want to try to cast aspirations on the quality of their work, just with the proliferation of fraudulent online courses, I felt I needed to ask before I took the plunge. Besides, being a medic $125.00 is like two weeks pay, lol.

Okay, sports fans, your old buddy Asys has himself a bit of a situation. I am desperately trying to put in for my National Registry paramedic certification. Long story short, to meet their requirements, I have to do a paramedic refresher. Now, recently, we've gone to a 5 year, on the job, CME based recertification process that I am still not sure meets their requirements or not, which leads me to believe I need to do a formal, 48 hour refresher course. Which leaves me with my problem. I can't find a refresher course in my area in the time frame I am looking for. I found this site: Emergency Educational Institute Which states it is an acceptable online paramedic refresher which is certified with the State of Florida. My question is, has anyone used a service like this? Is it legit? Yes, I know this is not the way I like to handle my education, but I do need to get this done PDQ. Thanks. I think this place was mentioned in a thread a while back but I can't find it. Oh and BTW for anyone who doesn't know I'm currently certified in the State of New York as a paramedic.

"Jim Walker of the Department of Forestry said "what we do know is 85 percent of the crew make-up is of Hispanic decent." What say you to that?

Mmmmm.... That's okay I guess. Glad to have someone to debate language issues with. Here's my question. At one point does one culture have the duty to adapt to the other? Its funny you mention Canada, and the issue of the French speaking population. It always made me scratch my head how a province that makes up less than a quarter of the population of the country could so drastically influence a country's politics. I mean, imagine if the State of California, which is the closest thing we have to Quebec with a population making of 11% of our total, had enough sway to influence how every single sign, billboard, greeting and label were printed? That would be insane. The rest of the country would just say "Eff you, California, we're dumping you into the ocean" if they tried something like that. Yet Quebec was able to pull it off. 1/4 of the population was accommodated while 3/4 was inconvenienced, not to mention the economic, social, and environmental impact of printing everything in two languages to satisfy a group of people that was well in the minority. That's not good government and its not good democracy, either, IMHO. At what point does a people's cultural identity have to take second place to society's ability to function? My personal feeling is that if you want to have your own cultural identity so much, go for it. Just don't rely on others when your identity doesn't allow you to function in the modern world. As an aside, anyone ever notice, generally speaking, the more someone is so worried about their cultural heritage and pride the less likely they are to have to get up to go to work in the morning? And that goes for everyone, including Mary Lou and Boseevus whining about the Confederate flag on the front porch.

Kaisu, you still haven't manned up and told me about your heritage yet... Come on, clock is ticking... I'm wondering is your login related to the Chinese/Singaporean/Malaysian word "Kiasu"? Meaning, literally "a fear of losing", but better used to describe a general perceived social ineptness?

Call telemetry. Have him triaged off on scene. Utilize resources appropriately. If all else fails, record his comments, and then forward them 'anonymously' to the news media, along with the names of your supervisors as to why it took so long to respond to the bus accident. Trust me, the media LOVES stories about bureaucracy and rules slowing down response.

Give me your ancestry and five minutes and I will give you a laundry list of shit your ancestors pulled. Were all in the same boat together, kiddo. The current trend in immigration happens every time America needs a cheap source of labor. When fat Americans won't put down the remote to put out the forest fires, then the Mexicans come in and do it and don't gripe about things like sick leave, OSHA, "the glass ceiling", and who's cubicle faces the window. They come, they work, they leave, and so long as there is work for them to do, they'll be here. When I worked in Jersey, I can't tell you how many people from the lawnscaping business I saw come in with horrendous injuries, who got patched up and went back to work. So long as there is a niche for people like that, they'll continue to work and employers will continue to adapt to hire them. Its all economics, supply and demand. So, Oregonians, either figure out a way to put out the forest fires with English speaking people or learn to speak Spanish. Or, stop building your million dollar McMansions in the middle of forest fire zones, and let f---er burn here and there, like it should, and then you'd need less wild land firefighters, and all would be well. Personally, I say let the McMansions burn. Evacuate, contain as necessary, sit in fire tower with six pack and barcalounger, enjoy the evening.

See, the name alone there makes me start reaching for the Xanax... Oh no... I'm hyperventilating... where's a paper bag...

:shock: Whoa... I do believe you just made a FACT.

You know, one of these days I am going to get the courage up to go to an EMS conference. I just have this fear of being in a large convention hall type arena packed to the gills with people with Star of Life T-shirts, tattoos, and poor personal hygiene standards. Seriously, I get anxiety just thinking about it. Are they as bad as I think they are or should I just embrace my fears and go sometime?

You know whats funny, one of the reasons I wear the full uniform shirt rather than the so called "golf" or polo shirt is because it DOESN'T have my name stitched on it. Listen, if you work in a large enough area you're going to run into bitchy people who will want to complain about you no matter what you do. If you make them go to a little effort to lodge their complaint, it will filter out a lot of the bullshit. Trust me on this one. Plus I don't like people calling me by my name unless I know them personally.

4 hours away running hot? So your traumas can pretty much be classified as "major case of prolonged death", I reckon?

I had one presenting only with abdominal pain WITH a history of ulcers, AND the first 12 lead came back clean. It was only when I did a second that the ST elevations showed up. Score one for beating a dead horse.

I'll rephrase your question a bit. The chances of someone having a "typical" cardiac event presentation are extremely low, and those chances get even lower when you throw in diabetes. Many times the only signs of a cardiac event is difficulty breathing, or the sensation thereof, in the absence of another obvious cause, i.e. asthma or COPD. You are right that the lack of diaphoresis is a bit odd for someone having an acute cardiac event. However, I'm willing to bet a shot of Jameson that if you go back and look at your patient, they were on a beta blocker such as metoprolol, which many times masks the adrenergic presentations of acute patients. All in all it sounds like you did this call pretty well given what you know and have to work with at the BLS level. My advice would be, consider every diabetic who is complaining of difficulty breathing as having a heart attack until proven otherwise.

Yes, nitrates are still an option, yet with someone with hypertensive crisis such as you described, nitropaste would be the preferred method, not spray. Hoookey dokey. Gvandellen, I'm confused. First you come in stating facts that run contrary to fairly firmly held and proven medical theory, then you attack others credibility when debating you, then state assertions such as "sublingual doesn't necessarily mean under the tongue" which, now also challenges certain definitions from Latin, and then you state "look, I really don't want to turn this into an arguement." My question is, given all that, what did you think was gonna happen? Do you usually go into biker bars, insult Harley Davidsons, and then tell everyone you don't want a fight, too??? The bottom line is sublingual means "UNDER THE TONGUE", and when you document 400 mcg S/L, then it needed to go UNDER THE TONGUE. Otherwise, you need to put, in your documentation, something such as "spray failed to enter sublingual area when administered" and accept the chips where they lie. If you feel comfortable enough standing in front of a medical review board with the drug insert and your instructors advice behind you, go on with your bad self. On a slightly different subject, I'm glad I'm not the only one who has trouble getting that first spray of NTG out of the bottle. I find "priming it", either pointed towards the garbage, a red bag, or the paramedic student, is a good way to make sure that first spray really gets administered.

I commend you on recognizing a critical patient, and hope that the nurse got out of her haze and realized the same thing and the patient received the proper care after you left. A few things. As Rid said, a dialysis patient is synonymous with "A heck load of serious medical problems." You mentioned asthma, however, from your presentation you stated the lungs were clear, so asthma is ruled out. In addition, typically, cold air can cause an asthmatic to have reach for their inhaler for relief, but it won't usually cause a true exacerbation. We could try to look for some sort of exotic acid/base, fluid imbalance, but I prefer cheating and going for the more obvious answers. Okay, so as we said before, a hemodialysis patient has a lot of medical problems. ESRD is commonly associated with renal artery stenosis and hypertension, and if your renal artery is errr.... stenotic, then there is a good chance some of your other vessels are stenotic as well, which is usually because of arteriosclerosis, and if they are really unlucky, its because of atherosclerois caused by plaque in the arteries. You also said he was NIDDM, which means that there is a possibility that they have neuropathy, in other words, they may not feel pain that others do, though this is more common in someone with full blown IDDM. Now lets put it all together, you have a patient who probably has hypertension, hardening of the arteries, with a good possibility there is some plaque involvement, and also, possibly some neuropathy due to the NIDDM which means they may not feel some pain. So, elderly patient + hardened arteries + plaque + sudden onset of difficulty breathing = stat EKG, IV, ASA, NTG, and tell the cath lab to get off their butts and stop watching Jerry Springer. In short, any hemodialysis patient who presents with sudden onset of difficulty breathing should be considered to be having a cardiac event until proven otherwise. Particularly when a cardiac event is one of the few things in the field we can kinda sorta treat.

sportygirl, first off, welcome to the city. I applaud you on wanting to further your knowledge on one of the most important, yet most overlooked, parts of prehospital care. I think you have a few problems. One of the first is that you're nervous and a bit shy. Its okay. It happens. Walking into stranger's houses and asking them personal questions takes a bit of getting used to. You might want to practice doing something that puts yourself at ease, which is just as important at putting the patient at ease. You might want to try starting off with a standard greeting which reminds both you and your patient why you are there. "Hi, I'm ------, and I'm going to ask you a few questions" is a good one because it sets up the patient with your line of questioning and also reminds you of what you're supposed to be doing. Sometimes my mind still goes blank and when it happens, I usually talk to the patient about what I'm doing and why, not only to let them know but also to remind myself. Secondly, it works far better to remember what you're supposed to be asking if you have a concept of why you're asking it. OPQRST is really geared towards cardiac/chest pain presentations, but if you think about it logically, they are really just common sense questions that you would need to know when someone is ill. How long has it going on? Does anything make it better or worse? What does it feel like? etc. SAMPLE is the standard medical history that everyone gets when entering the ER. The Big Five are name, DOB, social security number, medications, allergies. Medications are particularly important because they many times are also the patient's medical history in a nice neat package. Lastly, I would suggest the next time you are in the ER to spend all 8 hours sitting in triage doing nothing but taking medical histories. Good luck!

BVESC, I agree and disagree with you. On one hand I am quick to agree that American society wants everything in pill, injection, and spray form, from medication to food to deodorant. On the other hand, I also think we make too much out of "talking out our problems." I call this the Dr. Phil effect. We like to think that people with problems "just need someone to reach out to" when many, if not most times, its not the case. Sure, some people, and hopefully they are professional counselors, can offer insight into someone's suffering and give them some tips on getting better, but really, this has no more actual effect on someone then a physical therapist's advice on how to exercise in the morning. Most people can't change their lives, and if they could, they would, without help. People are the way they are for a reason. People do the things they do to cope, and the reason they are coping is because usually, they can't get out of the situation they are in, either for financial, cultural, or emotional reasons. The way I liken mental problems is to that of diabetes. Some people have type II diabetes, and it can be controlled with diet and exercise, just like people some people could probably get rid of their mental problems if they made lifestyle changes. But guess what? A lot of people go on pills for type II diabetes because they either can't or they won't make the lifestyle changes necessary. The same goes for mental illness. Many people simply cannot, or will not make the changes necessary to get better. That's where medication comes in. To further this analogy, just like some people have Type I diabetes, and their body actually physically does not make enough of a vital chemical, the ONLY treatment is to use a medication to regulate it. This is true for major mental illness as well, such as clinical depression. If someone comes into the ER out of it because their body is not making enough insulin, then the appropriate medication needs to be given for them to survive and function. The same goes with major mental illness, you can't get rid of it by talking anymore than you can get someone's pancreas to start secreting insulin by trying to talk them into it. Mental illness is just that, an illness, and the sooner we start looking at it that way the better and happier we will all be.