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In the real world, being 80+ years old automatically gets you a complimentary EKG in my book. However, since this guy is LOC with a possible head injury, he would get an EKG whether he had A-fib or not.

Rid pretty much summed it up, but I'll throw in my $.02 just so I can sound smart. The effect of a toxin on the body is dependent on concentration, of course. It was a just a small amount, the damage may be minimal to the surrounding tissue, particularly if it was injected quickly and became diluted in the blood stream. Otherwise, the free hydrogen ions in the battery acid (H2SO4), would cause the proteins in the surrounding area to denature, like what happens when you fry an egg. The veins would become hard as Rid mentioned, and you might even get localized coagulation, but necrosis would be almost a definite. Injections of battery acid and related chemicals are common in industrial accidents, where a high pressure stream of chemicals forces itself beneath the protective dermal layer. A talk with your local poison control center might give you some insight into the overall physiological effects. And as for the guy being in with the 'wrong crowd', please don't talk about my family that way, okay?

Ummmm, I suppose reporting a sudden and equally mysterious mechanical problem with the ambulance is out of the question, lol. Okay, here we go. Enroute: Request fire and PD, get a message to any air evac and have them go into standby mode just in case. Have partner give report over radio, conduct rapid triage. Bleeding man is either yellow or red depending on whether he can walk or not and his mental status, during triage, quickly control any life threatening bleeds, use a tourniquest if necessary. If he isn't breathing, reposition his airway. If he still fails to breathe, he's a black tag. Walking man is green tag unless there's something you're not telling me. For instance, if he was talking about the flipped over Jeep, and pointing to the moaning bush at the time, we would upgrade his status. Unconscious female is red, and at this time, highest priority. Moaning bush is also probably a red, but maybe he's just a wussy who wants someone to help him up. The flipped over Jeep patients (if there are any), are black tagged. Mammalian dive reflex or no, in START triage anyone without an airway is black tag, and I would say being upside down up to your neck in water would qualify. Use C4 plastic explosives and/or thermite charges to destroy the Jeep to prevent any well meaning whackers who may arrive from going near it and becoming casualties themselves. If the patients are entrapped, but without airway compromise, they will be a good project for the hose monkeys when they clear up at the hospital. Throw some blankets at them and tell them to hang tight, with definite pun intended. The most important thing to do at this point is to get everyone up out of the weather. Tell walking man to go into the back of the ambulance and stay there. Assuming all three patients need to be boarded and collared, do so, then get them into the back ASAP, with whatever immediate interventions (bleeding control, only really, anyone not breathing is also a black tag.) If the ventilations need to be assisted, do so, with a BVM while moving. Get her into the back and have your partner stay with her while and do advanced airway management if necessary. Enlist the help of the walking man, if possible, to retrieve the bleeding dude. If not, do what ever is possible with a single rescuer where the patient is, maintaining body heat will be a high priority. Repeat with the bleeding man if he is indeed unconscious. If you can get every one in, put one on the stretcher, one on the bench seat, one on the floor if necessary. Transmit message for ALS unit (if we're not an ALS unit), and one additional BLS unit for transport. If the patients in the Jeep are black tagged, make sure you give the irstatus, lest we complicate the situation with a big red truck full of heroes barreling into the scene for a rescue. Rule out medical causes for unconscious female, secure airway, lidocaine, RSI if necessary if you suspect head injury. See if bleeding man is still bleeding, assess hemodynamic status. See how Mr. Bush is doing and treat accordingly. Find out why he is moaning. Give Mr. Walker some hot cocoa and a cookie for his help. Unconscious female needs to be medevaced, bleeding man too if he seems to be exsanguinating, which the unconscious female seems to be. If she's already at the point of unconsciousness from blood loss, she probaly ain't gonna make it to the trauma center even by air. Plan accordingly. if Mr. Bleeder seems stable, send him to the trauma center. Mr. Walker can get some more hot cocoa and cookies at local hospital. I'm assuming I am still a paramedic and my partner is too and I have a great big non-type II ambulance at my disposal. Patient prognosis: The Jeep family: Dead, unless they are up out of the water Ms. Sleeper: If its a medical condition causing her unconsciousness (maybe she's that woman who seems to exist in scenarios that is a diabetic and crashed or is having an MI and crashed), she'll probably be ok, if its a head injury that did it, she might be okay if we get her to surgery quickly, and if its blood loss, she's probably dead. Mr. Bleeder: Needs a trip to the trauma center, but will probably be okay, use the medevac on him if Ms. Sleeper succumbs in the mean time. Mr. Walker: He'll have a great story for the grand kids. If we get out of this scene with Mr. Walker and Mr. Bleeder okay and the other two dead, and no one else gets hurt, I'd still call it a success. You've crashed your car in -10 weather in the middle of no where. You can't expect miracles.

Dustdevil wrote: >Too shocked to even choose an appropriate subject title, eh? >That's pretty bad! Dust, let me take a wild guess, you're career as a grief counselor was fairly shortlived, right?

Great diagram! As soon as I get my computer back up and running i'll post the article that I have written so far. Its quite extensive.

Easy killer. If your partner is a paramedic, then she should know the same medicolegal rules that apply to ALS apply to BLS... pretty much... I mean, I can't do ALS procedures without a doctor's say so, I can do BLS procedures when ever I really damn please. I'm sorry things aren't going well in your service, but internet forums are not the place to snap at people when under duress. Now relax, take a deep breath, and tell your supervisor I said that he's a mouthing breathing knuckle dragging retard who isn't fit to manage a Chuck E. Cheese's. That should make everything flow a lot smoother at work.

Hey gang, I was slacking off the other day and using Wikipedia, which is great for people like who are interested in a variety of topics and have a limited attention span. While they're are articles on many things related to EMS and Fire and such, I realized that there was one glaring omission. That was an article under the heading of 'whacker', which would be linked to an entry for 'Buff'. I say, this article needs to be written, and by golly, I and the rest of this website should be the ones to write it. I'd like input on what everyone thinks it should contain. Here's what I think this article shouid contain so far, please add your ideas under each heading. -Definition Hard to define. Enthusiast come close, but doesn't really capture the whole essence of a whacker. -Phenomenon and Culture. My experiences with the Whacker/Buff culture has been limited to the New England/Mid-Atlantic area. Do they exist elsewhere in the country or the world? Are there other names for them? -Psychology Why they are the way they are. Don't try and tell me a grown man who looks forward to turning his baseball cap aroun backwards and flying down the highway to a car wreck doesn't have a few bats in the belfry. At this point, I think its safe to say that one common theme of whackers is to what great lengths they go to be noticed and paid attention to. Usually this results from some sort of childhood neglect or feelings of worthlessness or low self esteem. -Ways to identify Pagers, bumperstickers, scanners, stethescopes on the mirror, you all know the drill -Relation to volunteering This will be a point of contention, I know, but unless someone can convince me otherwise, I will have to go by my own personal experience that not all volunteers are whackers, but every whacker I've met is a volunteer of some sort. -Effects on EMS in general Quite frankly, I think they make us look like idiots, and are part of the reason that EMS is so lowly paid and regarded. I'm sure they have their good point too. Lets hear 'em. -Delineation It needs to be made very clear that the people described represent a small portion (or at least I like to think) of EMS workers, and that most members of EMS are proud of the job they do don't mind telling people, but do not go to the lengths of the whacker. -Hope for the future Ways to combat the whacker phenomenon. Increased educational standards, professional requirements for EMS, on the whole, but also a section about what to do if you think you may be a whacker. I would say chill out a bit, maybe some psychological counseling, etc. If anyone has some public domain pics I could use, please let me know. This is gonna be good.

You know, in my vivid imagination, I can see in my mind's eye the type of person who would display a bumpersticker such as the one named above, and I'd like to tell you all a little story about him. If you don't want to read all of this, or you just don't quite get the point and need it spelled out for you, please refer to the Cliff Note marked with an asterix (*) at the end for a nice summation. This person is an overweight fellow in his mid 30's, comfortably employed in the food service industry, who uses volunteer EMS to fill the void in his life most people fill with friends, family, and significant others. He lives in his parent's basement, it cluttered with stacks of Galls, Starlog magazines, and Victoria's Secret catalogues despite the fact he hasn't had a girlfrined since the Macarena was in style. One day as he flips the pages of a tome filled with equipment that no person in EMS, living or dead, has ever found a situation that they would need it. Suddenly, his mouth hangs agape as half eaten Cheetoes fall across the page, there, staring up at him, is what he has been looking for all his life, a single phrase, so clever and original that sums up perfectly what he and all the rest of his volunteer squad know, that they are really the difference between life and death. His bank account is a litle short because of the Star of Life tatoo he just got, but he has just enough to pay for his prize, plus the shipping and handling, and soon, very soon, he is able to slap that baby over one of the many rust spots on his 1986 Yugo, fitted with a strobe pack who's cost could have put him through a year at Harvard. He can't wait to show it off to the members of his squad and with as much power as the Yugo's engine will muster, radio scanner cranked up, he tears off to his squad's building, strobe pack causing corneal damage across the land scape, people everywhere wondering what the hell a Yugo is doing with a lightbar. He shows off his prize possession to the other former members of the A/V club, and with nasal snorts and guffaws, they high five each other, knowing this time they've shown those lousy paramedics up but good. The others invite him in for a night filled with root beer and gummy bears, and he accepts, but stops just for a moment, to blow a kiss through the garage door at his 'baby', a 2007 6 wheel drive fully armored Freightliner ambulance, which he has pictures of plastered all over his room right next to the Britney Spears posters, the ones where she was younger and looked less obviously like white trash. And as he falls asleep that night with a little smile on his face, confident in knowing now, now the world will know what has been a secret all this time... With out EMT's, paramedics would all spontaeneously combust in mass fits of panic. And somewhere in the darkness, a paramedic who caught a glimpse of the Yugo blowing by him with N'Sync blaring, observing the lightbar, the driver, and to top it all off the bumpersticker on his way home from another overtime shift because he makes half of what comparably trained people make, wants to shoot himself in the face with a bazooka, and considers that job at the sewage treatment plant just a little bit more. The End. *Cliff note - Anybody who has a bumpersticker that says anything about EMT's saving paramedics is a f---ing loser.

Actually, I like those moronic t-shirts because it lets me know exactly who to throw off of the scene if they show up wearing one. Although I have to admit the EMS - "It's not a hobby" and the firefighter one made me smile a little. I have one, count it, one blue t-shirt with an embroidery of a paramedic patch on it. That's it. I wear it once in a while while I'm out.

Lucky for you, bein in a rural area you have some outdoors areas to play in. My suggestion would be to find someone's field or lawn with road access, borrow an ambulance, and persuade someone to play victim. At the EMT level most of the work involves moving, lifts and carries. Be sure to include a CPR in transit scenario, remember, compressions on a moving backboard are ineffective. 30 seconds of compressions and ventilations, move for 30 seconds, down, compressions and ventilations, repeat until at the ambulance. Its better than Tae Bo for a work out. if the weather won't cooperate borrow a gym or rec center for an afternoon.

In teaching strategy, a good test should have a range of scores that when plotted with the percentage scored on the X axis and the number of scores on the Y axis, it should form a bell curve with the peak at 75%. If the bell curve is shifted to the left, you made the test too hard or did not teach the material well enough (or you are teaching morons, which probably happens more often than not), and if the bell curve is shifted to the right, you have made the test too easy. My ex-physics teacher once dropped that serious knowledge on us, too which one girl replied "Shouldn't you try and teach so that everyone gets an A?" Too which the teacher just chuckled and said, "No." As I mentioned in another post, EMS is like a science or math test, either you know the answer or you don't Sure, we may quibble over certain studies and procedures, but the base facts are the base facts and you either studied them or you didn't. Illinois is either going to have to make their EMS more attractive to the right people, or just give their nozzleheads guns instead of medical kits. That way at last they can make their patient's deaths fairly painless and quick.

I'm an eeeevil paramedic. I know the required rates for an an NRB, and a nasal cannula, and a BVM. But, I confess, my deepest darkest secret... I go by how my patient is presenting, his vitals, mental status, skin condition, and a whole host of other factos to determine the rate o flow of oxygen. SHHHHHH!!!! Don't tell anyone! Don't tell them I believe 10lpm is actually a pretty high setting for anyone who is not severely hypoxic! Do not let them know I have had great results in using an NRB at 6lpm, even 8lpm! I'll be tarred and feathered, I tell you.

Wow, glad to hear everyone liked my post. My clinical instructor who told me that was true to his word, I should add. The day we passed our finals and were certified, rather than have any sort of fancy graduation, did something much more meaningful. He and all of the paramedic instructors who had kicked the crap out of us all year took us to the local bar and bought us all lunch and a few drinks, laughed and joked with us, and treated us as equals. It was one of the most memorable experiences of my life.

I was kind of wondering why this was in the ALS section too. Okay, so the person is splinted and then says nahhhh I don't want to go. Now remember, splinting is not exactly an invasive procedure, Boy Scouts do it all the time. Lets talk about something known as false imprisonment. False imprisonment is defined as imprisonment of someone without legal authority. To prove a false imprisonment charge, you need to prove intent to commit the crime (radio transmission), the act (if you carried it out), resulting confinement, lack of reasonable escape, and absence of legal authority (which you don't have unless you are also a police officer moonlighting as an EMT.) It's a civil tort and something you can get sued over. Feel free to share this with your supervisor. I know all of this from an episode with a friend of mine who is admitted to the bar in two of the most litigious states in the nation, when we were at a casino in one of the said states. For some reason one of the security guards got it into his noggin that I was underage and had a fake ID, and decided he would hold it until his supervisor came to look at it. Said friend then explained the concept of false imprisonment (as in I could not be reasonably be expected to leave the premises without my ID), and he gave it back, and we got some nice comps too. Lawyers suck unless you're gambling with them.

Well, to be honest, you can have a focal point seizure and still talk... but still anyone who is having grand mal seizure activity and complaining about anything is pretty much full of Ca Ca. I'm sure there are some neurological disorders that are treated with benzos that could present the way you described, but applying Occam's Razor, its more likely she was full of it. My $.02, maybe if you posted some info on this neurological disorder it would help.

Dude, even as a former student of Classical History, that was one of the nerdiest things I've ever read. Come on man, we're trying to make the profession look cool. Now rename your ambulance "Ozzy Rules" and try again.

I forgot to mention there's some good non-amphetamine ADD/ADHD medications on the market now, Concerta, Stratera, ask your friendly neighborhood psychiatrist for more info.

Sorry, but as a person who has suffered from the same affliction, I can't ever say I've ever had a problem taking a test I've studied for. If you are having problems studying for the test, that's one thing, there are many sites devoted to assisting people with ADD/ADHD/LD/HDLP. You'll find however, that EMS is like a math test or a science test. Either you know the answer or you don't.

Well, this isn't really a dumb thing, but it was still pretty funny, not for me at the time, but in retrospect it was... My third or fourth rotation as a medic student. I go to do my very first IV in the field. On scene are five firefighters, two cops, two EMT's and my two preceptors. My preceptor, having just a bit of a sadistic streak in him, takes a look around the room and announces; "Everyone, this is my medic student, and this is his very first IV in the field. Go ahead, student, take it away!" So now I have an entire room full of police, firefighters, and EMT's watching me. Thank god I got it with no problem.

Am I a credible? Well, of course, thats a matter of opinion. By your definiton, Rid, I'm still a wet behind the ears rookie, so perhaps my credibility isn't the highest. I can say this, honestly, though. While I am still new to the level of paramedic, I know in my heart I have a good wealth of knowledge and experiences to draw from, and if I don't know the answer, I'll admit as much and then work hard to find it out. I guess all I can say about myself is honestly, while I may use some humor here and there, when I give my opinion on something, not only is it what I really believe in my heart, but also its something that I think I can make an informed judgement about. I take the stakes of this job very seriously. I made a vow to myself that I would never take a blind guess if I came to a situation that I didn't know what to do. The same goes for posts, I'm never going to make a statement of fact unless I can back it up either from personal experience or a source I can cite from. I think I know what you're getting at though, Rid. For some reason,. this whole big field of medicine, everyone thinks they're an expert, even the lowest civilian can watch an episode of ER and think they're ready to work in an ER. Even worse, give someone a piece of paper saying they're certified in something and they become a neurosurgeon, nurse, and orthopaedist all rolled into one. Its kinda the fate of the modern world though, isn't it? Studying, integirty, honesty, we have no more need for that any more, not when we have the Internet, where you can download an essay an Albert Einstein can fight for space with Paris Hilton. Oprah Winfrey will have more affect on the public's health than the Surgeon General could ever dream, and its just the way it is. (BTW, the acting Surgeon General is Kenneth P. Moritsugu, who took over for Richard Carmona on Aug. 1, 2006. I just realized I didn't know so I looked it up.)

Just to weigh in here on an arguement. Someone mentioned that firefighters aren't law enforcement either but have badges. Actually, in most places with professional firefighting services, firefighters, and in particular fire officers, do have legitimate enforcement powers, such as in evacuating a building or closing one down if it is a hazard, or other things. Yes, it sucks, but a fire chief can really tell people what to do while EMS still has to ask nice. You know, in the medical/legal portion of class, the fact that EMS has no more authority than that of your average citizen is pretty clearly spelled out. Also, for all you auxillary/deputy/not-really-a-cop-but-boy-I-wannabe-one/EMT's/etc/etc/etc's, you had better be pretty clear as to what function you are acting as when you are on a call, because if you can't decide, a slimy defense attorney will. Just a caveat.

Which is why, ladies and gentlemen of the jury, EMS and Fire should stay far, far, far away from each other.

While I've never delivered a precordial thump, I've hear many reports that it can work quite well for a sudden onset of V-fib or pulseless V-tach. If you are SURE the person just arrested on you, then there is no contraindication for using it. If they are in a rhythm other than ventricular fibrillation, it won't make a difference if you smacked them around a little. Then again, if you're wrong and induce a myocardial contusion, well, that's some bad luck for you.

JP, while I fully agree that an educated EMT is a good EMT, I do also have to add my own personal experience in that there is nothing more dangerous or irritating than an EMT-B who has two semesters of General Chemisty and Biology under his or her belt. We are talking Battle of Stalingrad like death rates if these people if they were to be released onto the general public.

JP, while I fully agree that an educated EMT is a good EMT, I do also have to add my own personal experience in that there is nothing more dangerous or irritating than an EMT-B who has two semesters of General Chemisty and Biology under his or her belt. We are talking Battle of Stalingrad like death rates if these people if they were to be released onto the general public.