JPINFV

I've recently had a rash of calls for SNF patients suffering from fevers of around 105 degrees fahrenheit. The worst one that I've had was tonight with massive lethargy (still A/Ox4), tachycardia (~110) and hypertensive (SNF and NIBP at the hospital was in the 170's, I swear that I was getting ~210 without question). Due to the situation at the SNF (we were already at the SNF dropping off another patient and the closest ER was about a block away), I can't blame the SNF for not calling 911, but I am starting to wonder how high is too high and how lethargic is too lethargic. I've seen the danger levels for temperature being set anywhere from 106 (Silverthorn, Human Physiology) to 107.6 (http://health.allrefer.com/health/fever-info.html), with no mention of any specific level in my EMT-B book (Brady: Prehospital Emergency Care 7th Ed.). The EMT-B text doesn't directly cover infection and directs "hyperthermia" in elderly patients (both fever and enviromental causes) to the enviromental emergency section. So, I am wondering if anyone could provide any hard barriers (106?) for when elevated temperatures becomes a problem and when exactly to include ALS (even if ALS can do pretty much nothing for an elevated temp) and/or emergency transport for these patients.

I cast my vote to start reform from the top down. Want to change the system? Start working with medical directors and universities to offer/require education. Better yet, run that class or become that medical/EMS director. You can't require more education until the educational resources are available and you can't expect people to go for the higher/more expensive education as long as they'd be lucky to find a job for $10/hr. Personally, I think a good system would be an associate's degree for the BLS level and a bachelor'S degree for the ALS level. Granted, this might require the addition of 2 cert levels to set the groups apart in terms of scope and pay. The BLS level focuses more on broad theory and breath (courses: chem, physics, writing, intro to physical exam, intro bio, intro to psych, genetics, biochem, etc) with the ALS level being courses taught through university medical schools like the special masters programs (SMP programs are like "Med school light" where it is a 1 year masters program with most of the courses being 1st year medical school classes. The classes are handled anywhere from fully integrated classes, separate classes, same professor, or distance learning with taped lectures). I think that one of the biggest crimes right now is the lack of practical experience prior to letting basics loose on the public. A physical exam is more than memorizing and regurgitating a sheet and being able to ask OPQRST/SAMPLE. You have to understand what your asking for, why your asking it, and what, if any, follow up questions you need to ask. Basics are neither expected or required to be able to do that. Too many of us are content to play with plastic O2 masks and cardboard arm splints to expect more.

I agree that EMT-B recert/refresher is a joke. The refersher was a useless waste of time taught by a burt out RN that was never involved with prehospital care. She, based on my experience in the class, did not even have a firm understanding of physiology. My 48 hours of additional CEs came from 2 college classes (I believe I used physiology and cell biology), each was worth 24 hours. Of course I'm not supposed to use anything from my college class because that would be "diagnosing" and EMTs aren't supposed to do that (per my company's ex-training coordinator).

Education, or the lack thereof.

Is your partner not a basic also?

What are heart sounds? /long shot guess

I'm in the same boat as Anthony, none of my company's gurneys have 3 straps, only one across the legs and one across the chest. I remember seeing shoulder belts a few times in my two years with the company, but they were rare (grant it, so are jump bags [these only see light for event standbys] and short spine boards [1 ambulance that I know of, no KEDs at all]). Most EMTs at my company are either too dumb, stupid, or lazy to care, the crew chiefs will just shrug (I love the, "No, you can't replace ___ piece of equipment from another unit because I'll just have to deal with it again tomorrow" line), and management only cares about the bottom line. Outside of any special cases (using the large body surface flaps, for example). the side rails are always up. We have 3 sets of seat belts on the bench seat and a seat belt on the captains chair with our newer ambulances have a shoulder strap on the captains chain. I always use a seat belt in the back, but again, most don't for the same reasons outlined above.

^ One more drug? O2 is just about the only thing Basics CAN give in my county.

It doesn't look like it's really been published yet. The article cites the May edition of the Public Library of Science (PLoS) Medicine, but the website for the journal is still on the April edition. PubMed and Google Scholar searches are coming up empty.

Err, I've always called the people (they're not RNs or LVNs for the best that I could tell) at assisted living facilities that hand out the medication "med techs." As an example: http://www.occupationalinfo.org/35/355374014.html

You can get college credit for just about anything, including volunteering. Heck, I've taken a class entitled "Why People Believe Weird Things" [1 unit seminar class, but I got an A in it]. My school has a program where students submit ideas for a class and then the student government in conjunction with academic senate tries to find people to teach the more realistic course ideas. My school has just started a program where students [again, with oversight] will be allowed to teach a 1 unit pass/no pass class. It might be 1 unit, but it's still college credit/ Futhermore, education and training leads to different types of jobs. For example, what is the difference between a med tech and a RN? Both hand out medications, don't they? How about the difference between an x-ray tech and a radiologist? Why else is there such a large wage gap in other fields between someone with a formal education vs someone with training?

To add to that last line, the mind can be expanded by not only understanding the "when" to do something (i.e. if the patient meets A and B, but doesn't meet C, then do X) but the how (drug X causes the body to do Y which results in Z) and why (G causes H which is bad because H results in I that can be counteracted by Y). If the only thing that was important was the "skill" involved then why not have 1 level that can do everything. As I've said in another thread, I have opposable thumbs, therefore I can push [as in the physical action of pushing the plunger, not scope of practice] medications, hence shouldn't I be considered ALS?

I've been on a premie vent transport once. The team consisted of 2 EMT-Bs, RN, RT, and a MD. The only reason that we had 2 EMTs on board was because the 2 primary children's hospital transport units were already being used so the backup unit (which is treated as a regular unit by dispatch) was sent.

Education and training are two seperate things. You can train a monkey to intubate, but you can't educate him to know when not to intubate. Now if you get free education, sign me up. I'd gladly give up student loans for a few nights a week.

Any organization that forces it's members to equip themselves sucks. When I worked at the water park, I had to carry around a fanny pack at all times with a glove/gauze pack and a cpr mask (there was also a jump bag in case something happened, but we didn't have to carry it with us if, for example, we were in the park getting food). They supplied the pack and we were allowed to add anything else we want to it at no cost to us.

Tell me about it. I've found an entire website with pictures of them.

What are they going to sue over? The girl got not 1, but 3 toys. Not that it matters, here's a picture of the girl anyways.

I imagine that you could go for more government style jobs. As an example: http://www.emsa.ca.gov/jobs/SLOEMSSpecialist.pdf

Ahh, but I don't live in LA county, I live in Orange County. Strangely enough, a LOT of people at my company live somewhere in Riverside county, anywhere from 45-90 minutes away from base depending on traffic.

/me quotes Adam Savage from Myth Busters, "Well there's your problem." Common sense isn't common.

I don't think the problem is a "ZOMG electronic devices put off EM fields that screw with electronics" as much as it's "ZOMG THIS electronic device is often attached to clothing near the heart." I think it's something that we'll end up seeing physicians warning patients to be aware of where they are attaching their electronics more than anything else.

That would mean taking a job in a different county and I'm not sure if any of the surrounding counties have online med control at the BLS level. I want to say that LA county doesn't offer it to BLS and I refuse to drive an hour to work for $10/hr [give or take a few dollars].

It varies regionally. In my little part of the colonies fire departments provide the paramedics. In my county, if the fire department doesn't transport themselves, most of the paramedics respond via fire engine, but I think one or two cities use an SUV or truck. In the county north of me, a lot of the cities use a truck or SUV for their paramedics.

Another helpful tip, the bed pan works as a perfect wedge to to place between the two tanks. /rather have an actual tank holder

What do you mean? The spare O2 tanks aren't supposed to be rolling around under the bench seat?