Asysin2leads

[quote="1 AED Albuterol Activated Charcoal ASA Epi-pens KEDS (They have shortboards)

Okay, paragod, paragod, paragod, etc. etc. What name shall we come up with for those of the members of service who think that 15 years of doing volunteer EMT-B work makes them trauma surgeons cum fire chiefs cum sherriffs of this here town who know the real deal of medicine despite what those silly old texbooks say? How about E-M-TARD? Huh? Actually, I like that. I'm going to start using that. Yes Mr. E-M-Tard Captain of the Rescue Response Squad, I didn't realize my cavalier attitude towards proper placement of the NRB mask endangered the lives of the patient, myself, the crew and the earth in general. Yeah, I know BLS before ALS, yes EMT's do save paramedics, what was I thinking, you think I can treat the patient now?

This was a great article and I agree with the good doctor. It reminds me of a time that an ER nurse friend of mine was telling me a story that happened in the ER with all the technical details, and I realized after the pont the patient had been cardioverted and intubated, I really had no clue what she was talking about. Seriously, drip this, rate that, lab values and such.she could have been talking Chinese. When she then asked my opinion on the subject, I had to admit I had no clue and I had spent most of the conversation letting the words go in one ear and out the other while I looking down her shirt. I didn't want to make it seem like it was a complete waste.

> NO ONE is saying that volunteers ar evil or stupid or worthless.... Except, of course, for that one post where Dustdevil said "Volunteers are evil, stupid, and worthless."

I still shake my head at the high percentage of esophageal intubations that reach the ER. You miss, it it happens. You can't get the tube, it happens. But to be in the esophagus and leave it there and drive to the hospital merrily ventilating the stomach? Who is doing this? I really want to know. Lets find these people and ask them. Did you notice the person was turning blue? Did Did you notice there belly was getting very big? etc. etc.

I agree, perhaps this show doesn't show EMS in all that positive a light, but at least it presents a little a more depth to the characters than most of the 2D portrayals. First of all, the idea of a med school drop out/underachiever being a paramedic isn't all that far fetched. I know a great deal of people who have abilities, talent, and educational background to do a great number of things, but because of their own personalities or choices in life, they find working as a paramedic is where they want to be. The first paramedic I ever worked with way back in the day doing EMT-Basic observations was originally an architect from Boston. I really wish I knew him longer, there definitely was an interesting story of why he was where he was. I currently work with a former gourmet restaurant chef and someone with a masters degree in history. Myself even, I won't delve into my personal life, but at one time my career goals were far different from where I am now. EMS is a great place to be for the intellectually gifted underachiever. I haven't seen an episode yet, but doesn't look all that bad, honestly. I guess if I had to pick between watching Johnny and Roy get someone out of a train car after they were overcome by fumes with no protective gear on (seen it), or those friggin twerps on 'In a heartbeat' stop football practice to go save some lives, or Doc et. al on Third Watch respond out of the fire station to save a woman encased in ice (seen that too), or watching someone work a paramedic when he has other options in life and some emotional problems, I'd pick the latter.

I've seen this phenomenon twice before, both times on trauma codes. The first was when a helpless old lady met a drunk driver in a pick up truck. Same as you, intubate, CPR, abdominal distention, recheck the tube, its in, etc. I also saw it on a man who was on the wrong end of a tractor trailer's back wheel, same abdominal distention. My honest answer is I don't know. My best guess would be a combination of a pneumothorax and diaphragmatic rupture which allows air to escape into the peritoneal cavity. Perhaps you and I can do research and have it named the "Ruffems-Asysin2leads Sign", or the "This-person-is-fucked-now-stop-playing-around-and-call-it Sign."

Avvn, as a member of the FDNY EMS command I really feel for your position. Your wife I assume took the position for some sort of midlife adventure et cetera et cetera, I assume, I mean, she isn't just starting off her career at her age now is she? She's your wife, and you have a right to be offended if her male partners get out of hand. I am the rare one who doesn't hide behind the whole partner comraderie brother in arms crap to hide offensive behavior. If she can't tell her partners that they need to cool it and remain their friends, then plain and simple she needs to find new friends. Being an EMT can be a wonderful experience for a lot of people, but it cna alos cause a lot of problems. She needs to respect your feelings about this issue, and she needs to pass that on to her partners. I'm sure she wouldn't appreciate it very much if you bought a Harley and started hanging out with some teeny boppers, and quite frankly her behavior isn't much different. Yes, EMS providers do tend to joke around with each other about things that could be offensive to other people. After you've done a few 12 leads on 86 year olds with your partner, modesty kinda goes out the window. But that doesn't excuse common decency and respect for the people you love's feelings don't matter anymore. I know many partners who joke with each other and its really completely innocent, and I also know quite a few scumbags who work in EMS who will go to what ever level they are allowed. If you maybe want to elaborate on exactly what is offending you, it coudd help. Good luck.

Not to steer my own thread in the wrong direction, but I was on vacation this past week and couldn't post. Dust, RiderRob is a Nassau County volunteer. They are their own special breed. The Marines look at them and say "Whoa, you're a little fanatical, you know that?" Nassau County has one of the largest tax bases in the world, yet they have mostly volunteer Fire and EMS. There was a huge Newsday article about these squads, how they have things like million dollar stations and use tax dollars for their own racing teams. There are volunteers around the country and then there are the Long Island vollies. I deal with a great number of them in my line of work, and I do blame a lot of the problems FDNY EMS has on their attitude. Its really hard to ask the city for a decent wage for paramedics when you have the Long Island volunteer EMT's kicking down the door for the honor of wearing an FDNY patch and doing BLS runs. To quote the movie "The Terminator", you cannot reason with them, you cannot bargain with them, and they absolutely witll not stop untill you give them a patch.

I agree doing compressions on a stretcher is not that effective, and we need to seriously reconsider how we run codes in the field. My brother works in a rural area where the local squads are volunteer with long transport times, sometime plus 30 or 40 minutes, with only BLS capabiliities. When he was doing his medic rotations, he would tell how they'd bring in arrests they had been doing CPR on for 40 minutes or so and get quite upset when the doctor would immediately call it in the ER. I think this is a good reason for a push to have paramedic response standard in all areas. EMS never operates in a vacuum, everytime we transport, lights and sirens or no, we put ourselves and the public at risk, and we are at an even greater risk when we are doing something like performing compressions in a moving ambulance. In other words, I would much rather call 1,000 86 year old asystolic arrests in the field rather than ever have to explain to some 18 year old volunteer's family that he suffered brain damage when he went flying into the cabinents after a sudden stop enroute.

16% Dixie. Not my fault youse guys can't talk right.

I agree a properly funded level I trauma center is the gold standard for trauma care, but as you know, many places have to make due with what they have. I say a surgeon responding to the local level II trauma center is a heck of a lot safer than trying to pull off a medivac to a level I. Yes, believe it or not landing a helicopter is really dangerous.

The problem with the study about warning lights and sirens is that it is flawed logic. For one, it takes an average, where the use of lights and sirens should be looked at on a pinpoint, case by case basis. In other words, there can be 500 calls that someone only saved 20 seconds with l/S, and 3 calls where someone saved 10-20 minutes, and you'd get the same average. I didn't do the math and that probably doesn't work out to 43, I was trying to make a point, get off my back and go find some goofs in a Star Trek movie or something. Anyway, my esteemed colleague from Texas hit what I was getting at. I liked this program because in my opinion it looked at emegency medicine as a whole, instead of looking at ambulances and EMT's. EMS does not save lives, we may provide critical interventions, we may pull off some great work sometimes, but it is a continuum of care that saves the patient. There are those who want to have lights and sirens so they can play Dragnet, and there are those who view them as a means to expedite emergent care when necessary. I like to think in the latter.

Didn't read through all of the posts, but here's my $.02 If I was assessing your son in the scenario you described, particularly given the mechanism of injury, and I had no way to gather his medical history, especially in a mass casualty situation, I would probably go with the presumptive diagnosis of a head injury, and such measures as oxygen therapy, IV therapy, and spinal immobilization would be in order. IF necessary, soft restraints would be used to prevent him from harming himself or others. When properly placed by well trained providers, soft restraints are good safety devices that cause little to no harm to the patient, besides emotional distress, of course You asked about drugs, and to the best of my knowledge, so called "chemical restraints", or the use of sedatives to provide restraint such as benzodiazepines are not used by any advanced prehospital care providers. If someone knows otherwise, feel free to speak up, but I know even in the hospital chemical restraints are really a last resort. That being said, going back to your scenario, if someone mistook your son's agitated and combative behavior for a seizure (quite possible, especially if we are ruling out a head injury), then the appropriate pediatric dose of a sedative might be given. Now I'm giving of course the worse case scenario, your son is alone, no one knows his medical history, and you have a medic thinking on the mass casualty battlefield fly. I can't imagine how much worry you must go through with a special needs child, and I hope that if your son is ever faced with an emergency, the fact that he has a developmental disorder is picked up on by the providers, and they act with the appropriate amount of care and understanding.

Three simple tips to doing the perfect IV: 1. Don't miss. 2. Be careful. 3. Don't screw it up. Follow these three and you'll have success everytime. Good luck!

I'm not sure if the judge could be held liable if a patient suffered from his reckless and arrogant actions. I'd let each of the patient's families know the judge's decision, the basis, and his office hours. Maybe even his home phone number too, but that might be pushing it.

Bellicose, listen to me you little wannabe pencil neck dick. I'm glad you think you're a hero, but I've seen crap like yours before, and it cuts no ice with me. I was a firefighter myself for 3 years, my brother is a professional firefighter, and I am good friends with quite a few of them. You're nothing but a little punk who needs to stop dressing up in his fireman's costume before you get someone hurt. Real firefighters are not cocky. They are incredibly careful. Real firefighters do not go on and on and on about their bravery and the risks they take, they do their jobs and go on with their lives. So don't try and insult me or anybody else on this sight with the YOU DON'T KNOW crap, or lecture them about what firefighting is 'really' like, there is more knowledge about firefighting operations and tactics on this site then probably anywhere within your department As for the not risking their lives stuff, in the past year I watched as three members of EMS were laid to rest after dying from the shit they breathed in at the World Trade Center site, adding to the other members of EMS who died in the line of duty that day. Attend some of their funerals, then feel free to tell their grieving families how only firefighters risk their lives. Maybe after you become a medic, if you try someday, you can be a firefighter too. Until then, here's a friggin t-shirt, here's a helmet, you're a hero, now get the fuck out of my sight.

Okay, I remember hearing about this a long time ago and I can't remember where this was, but here's a subject of debate. A certain hospital which was designated a trauma center (obviously not a level I) put forward the idea that the on call trauma surgeons be allowed to equip their personal vehicles with warning devices and be allowed to respond, to the hospital only, with the same rules applying as an emergency vehicle, if a critical trauma came in. The plan was shot down, because they didn't want to give lights and sirens to the trauma surgeons. Given the mentality towards EMS in many places, I can't say this is particularly surprising. My feeling is that if Skippy the vital signs certified first responder is allowed to put some lights on his car, I think we should allow the docs to have some too if they're coming into the hospital to do some surgery. That emergency vascular graft is going to make a heck of a lot of more difference than Skippy and his first aid kit. Comments? Anyone know where this was? Anybody have similar programs in their area?

We may not deal with things that cops and firefighters do, but I'd still say classifying EMS as purely a medical profession would be grossly inaccurate and is detrimental to EMS as a whole. Let's say you have a municipal based EMS service, and they are up for consideration of benefits from the municipality. If they were classified as health care providers, they might be up for the same benefits as the doctors and nurses at the local county hospital. If you wanted something like Line of Duty Injury coverage, they'd laugh you off because doctors and nurses do not get kicked, punched, stabbed, shot, or thrown down a flight of stairs very often in their line of work. Stuff like that has been known to happen to EMS providers. I would rather EMS be geared more towards medical work, but we also need to recognize the public safety component of it. At least from where I'm sitting as a 911 thug, that's the way I see it.

Ahem. Let me amend my statement. If the brain is already mush and the person is acting cuckoo, then I guess yeah, they're not AMS from a lack of oxygen. Then again, something had to cause the encephalopathy in the first place... Oh never mind. Just in one of those moods, eh Ace? :roll:

These are all some good suggestions, but, as my usual caveat, garner as much information on scene as you can, in a timely manner, but don't lose sight of the fact that except for perhaps hypoglycemia who is able to follow directions, advanced medical or surgical intervention is the only thing that is going to help these people. In other words, get them to a hospital, ASAP, and remember, oxygen, oxygen, oxygen, ALS intercept if necessary. Don't play around with people's brains. Rule out psych history, diabetes, hypoxia (if the person is hypoxic to the point of being AMS, its probably going to be fairly obvious), CVA, ETOH (do the smell drunk?), Narcotics, head injury, hypovolemia (blood pressure), sepsis (have they been sick for a while? Do they have a fever?), there's probably a few others I'm not thinking of. All AMS is caused by the same thing, lack of oxygen to the brain, its what is causing the lack of oxygen that's important.

There are rednecks everywhere. Unfortunately in America we let them into public office. Anytime you see the word 'sodomy' in the newspaper, someone wasn't minding the store and the rednecks slipped into the government again.

That sounds like a good weekend job, so long as they let me have carry my knife with me. There is no way I'm letting some angry fundamentalist person turn me into a missle. Come at me with a boxcutter and I'll send you back to Allah in a f--ing box.

The maternity ward. You know those chicks put out.

Eliminating volunteer EMS would eliminate a lot of problems in EMS. But I still think volunteer services, in some areas, are still required.