JPINFV

I got into this because it fit a lot of my wants. It's fun (variable based on your attitude, your company, your partner, and your attitude. Yes, I did put attitude twice), it pays decently in my area (started at 8.50, up to 9.50 right now), works around my school schedule (not optional, my company has no choice, period), and it gives me clinical experience (I also have hospital volunteer experience). At least one extra benefit is that my exposure to the nursing home situation has given me my topic for one essay for my applications (In your opinion, what contemporary medical issue needs to be addressed in the U.S. healthcare system and why?, I heart Stony Brook for this question). I don't see my eventual "departure" from EMS as leaving for good. It'll be more like a 4 year hiatus.

Most of the SNFs I encouter locally are really bad. By better nurses, I mean an actual report for my patients. I mean being able to correctly triage full code patients (i.e. that patient with rales at the door, ALOC, diff. breathing, and almost no BP (UTO, ~40/30 via machine at the hospital after first round of dopamine) is not a BLS patient, and properly monitor a patient during an event (i.e. the patient tugging on her PVAD enough to loosen it shouldn't be left alone so that she can completely remove it). As I said earlier, putting infected patients with non-infected patients is not a good idea. Finally, I expect that SNF nurses (at any level, the life guards at my water park get taught this) to be able to correctly use a NC or NRB (especially in terms of flow rate). I understand the problem with ALS procedures (again, if within your scope, shouldn't you have standing orders for emergencies?), but most of the problems I see are simple administrative problems (when to request transfer to the ER, correct use of BLS vs ALS ambulances, room placement) and not really about independently treating a patient. With these problems, it is very understandable to not have standing orders. That said, a local problem is the lack of private ALS services (RN-CCT: yes. EMT-P: No). There are plenty of patients that aren't really stable enough for BLS, but aren't critical enough to activate the 911 system, but I'm not talking about those patients.

For the love of all that is good and holy, please tell us that you have a reason besides the fact that you are a college student for going for the bottom.

Sounds like your nursing homes, and mine, needs to invest in O2 (a lot here have high flow, though) and standing orders, or invest in better nurses until the doctors are willing to write these orders for them.

That is because most people, EMS or not, takes politics too personally. They feel that if you disagree with their position, then you must hate them and that the only reason to debate is to indoctrinate. These people need to grow up or die.

poll 8)

http://www2.sdcounty.ca.gov/hhsa/ServiceDetails.asp List of EMT-B training centers are at the bottom. Google is your friend.

SNFs have the same problems that EMT-Bs and transport companies have. For every good one there is, there is at least 5 that have nurses that don't speak the native language, refuse to give report, and are willing to put patients with MRSA of the nares in a triple room with patients who don't have MRSA (I've been on that discharge, and looking back, I wish I fought more with that LPN. That isn't about nursing or medicine, just common sense). Furthermore, no one remembers the good experiences. Out of the 2 or 3 good SNFs that I remember being in, I can only remember the name of 1, but I can recall 5-6 really bad ones in my area. So, think back. When was the last time that you had a good experience with a transport company or an EMT-B. When was the last time you had a bad experience. Just because we call out the bad does not mean that we know that good ones exist.

I get better reports and more concern from assisted living places (i.e. no RN, or LPN, simply just a med tech) then most SNFs. It was comical, though, the one time I've seen an RN do the entire, "I can't talk to you, I have to take care of everyone else. You have paperwork" routine to a medic.

The difference is that you don't get very many people saying, "You can't live without salt, therefore every patient gets a bag of saline wide open" where you do get people saying, "You can't live without oxygen, therefore everyone gets 15 LPM via NRB (and then I need to call medics [/answer to every medical question in basic class]). EMS isn't long term care, and that is why patients are brought down to the lowest level of oxygen that they need when they reach the ER. It's quite common for RNs in my area to ask me to take patients off oxygen so that they can get a room air sat. The second case applies to a limited population. You might as well say that candy is deadly because it can cause great harm to diabetics. Sure, deep sea divers might need 4% while diving to avoid O2 toxicity, but under normal atmospheric conditions, 4% is deadly.

You have my congratulations, good sir, on not using that bastardly definitive article that Fox decided needed to be put infront of our initials and makes us look like idiots. Yep, I'm born and raised behind the orange curtain, but I grew up in the "ghetto" of OC (aka North County, but Fountain Valley isn't that ghetto). I think I'd go DO before going to UCI for med school. Our EMS isn't just backwords, it's fire based.

O2 via room air is not a drug. Supplemental O2 from the tank in your ambulance or the end of your cot is a drug. It isn't like our patients are sitting in a vacuum wait for us. If so, then how come you or I can live on 22% O2? I give it a conditional yes. By itself (i.e. just a NRB. A BVM pushes the same amount of air if an O2 tank is attached or not, the only difference is the percent of O2 in the air) is useful in a few, rare cases (CO, for example). Most of the time it is given just in case supplemental O2 is needed and in these cases it might buy time, but it isn't a definitive treatment by itself.

What's always fun with fire based ALS is when fire shows up with an engine AND an ambulance code 3, then a few minutes later the local contracted company (always BLS), shows up with their ambulance for the transport. I bet nothing can be better then getting a bill from both the fire department for an engine and ambulance, AND the contracted company. Ohh, wait, it can. Living in an almost complete suburban area and watching fire buy medium duty trucks. There is nothing like watching the FD for one of the poorer, land-locked communities show up in what almost looks like a fire engine front with an ambulance box on back, especially when one of the richer areas used primarily use typeIIs untill recently (now they've upgraded to type IIIs and some medium duty).

http://www.ochealthinfo.com/docs/medical/e...mp;P/900.00.pdf [PDF] Interesting side note: Hoag Hospital (birthplace of the START triage system) is in Orange County, CA.

Hmm, I hear this thread [sDN ER Hall of Fame] calling your name.

lost

I once had a singing bass, does that count?

I think that we have a problem here. Just as there are those rare cases of BLS IFT providers with their heads on straight, there are those situations where individuals stock their cars but aren't a wacker. It seems like our new friend here isn't trying to call himself an EMS professional. He is simply involved in a high risk hobby with inadequate medical coverage (simply seems impossible based on his account due to the risk level, size of coverage area, and number of participants). He has taken the steps needed to help secure his fellow hobbyists. If he is a wacker for supplying some of his own equipment, then is it really that much different then those of us that have our own stethoscope. After all, the ambulance company should provide us with decent equipment, shouldn't it?

That's one of the great things about AHA. If you think it's too much reading, there are always the webcasts (including a set made specifically for EMS). http://americanheart.org/presenter.jhtml?i...ier=3037720#ems This is another problem about EMT education, and one that I'm currently trying to fix in myself. Yes, the EMS team needs to work from the same play book, but there also needs to be a team leader. Generally the leader is very easy to identify, in hospital it is the doctor, prehospital, it is usually a paramedic. Because of the limited scope for basics, generally there is no need for a basic to work as a team (i.e. you can take v/s, start O2, etc on a medical patient without too much difficulty as a solo player). In the ALS world (hospital or prehospital), there are several actions that can't be done at the same time as others (IV starts, establishing base contact, drawing up medications, etc, hx, physical, etc). For example, during a code in a hospital, the doctor actually does very little. A tech will do compressions, a tech or RN bags, a RN will administer the medications, an RN will generally run the defib. I've seen 5-6 code brought in by ALS(not exactly a great number, but anyways). Except for the one time that the MD had to remove a combi and intubate, the MD stood there with his hand on the femoral artery and directed the show. During my ride along (911 company) and over the past year that I've worked (IFT), it seems that most basics tend to not stand up and take charge. We either stand there like deer in the head lights (cluster fucks), or do most of the stuff by ourselves. During a code, one basic should take charge prior to ALS arrival. This person should be the one making sure that a constant ratio is maintained, proper compression depth is achieved and proper forced is used for the bagging. Now it's not about being on the same page in terms of 2000 or 2005 guidelines, but everyone is on the same page as the leader.

Simply put, there has been a lot of discussion on this board about "the book" and patients who have never read "the book." Thus, there have been several discussions (almost always at the ALS level) about protocols being more guidelines then rules. The change isn't based on one study, but on several of them. This is why AHA is changing how they train people to do CPR. As for the source, just because it is on the internet doesn't mean it can't be trusted. This isn't Joe Blow's CPR and First Aid Wackerdom or a page that just anyone can change (Wikipedia), but the American Heart Association's website. If you can trust their instructors and their literature, then you should be able to trust their website. If you can't just because it is on the internet for free instead of a $10 book at a $50 course then every discussion here that uses a study off of pubmed is just as pointless as calling protocols guidelines or claiming to care about evidence based medicine. After all, apparently nothing on the internet can be trusted, right? While I see you're point at being explicitly told to wait till your retrained, but I find this equally annoying. Basically your med control doctor is saying that the EMT (B, and most likely P too) are too stupid to look for information on the own and have to have it force fed to them or else they'll manage some way to screw it up. From what I've seen of EMS at the BLS level, it probably isn't too far from the truth (not an indictment against anyone here)

I can't fully help because each unit in my area does their own run report. If I'm on an RN and RT CCT, then the RN fills out a report on the care/assessments s/he does, the RT fills out a report on the assessment and care that s/he preforms, and the EMT-B fills out a report on the care/assessments that s/he does (generally the narritive directs attention to the RN or RT paper work for further details). If I'm on a call and have paramedics on board, I fill out a PCR and the paramedics fill out a PCR. Same for the 911 ambulances (fire/medics fill out an ALS run sheet and the EMT-B from the contracted transport company fills out a run sheet).

Unless I need to move about (rare, but it happens. Take vitals, go sit in captins chair, do paperwork, shift back for v/s, patient care/comfort things, etc. V/S on right side in vans

You will always have the rule and the exception. Sometimes being the rule is good. Sometimes being the exception. Unfortunately, protocols and laws have to be geared towards the rule instead of the exception.

^ No, I haven't. So I did what every provider should do, I looked up the new guidelines http://americanheart.org/downloadable/hear...2Winter2005.pdf So, no more blind finger sweeps, no more "Tounge jaw lifts" (what ever those were), only ask one question, and just do CPR if the patient collapses. 1. These again aren't the most life shattering changes. 2 Again, if an EMS provider is too stupid to read up on highly publicized changes that are constantly being talked about, then maybe they should find another field to work in. One that doesn't change after new evidence and one that doesn't involve people's lives.