Medic26

Danner Strykers

We have had it in our service here for about 3-4 years. It's been done a few times with Versed but none that I know of for Narcan or Fentanyl yet. I have not heard any complaints from anyone that has done any of the IN administrations. Some of this reason could be that we have been going down the path of airway management for narcotic overdoses and not giving Narcan unless the patient is hypOtensive as well. I like this because now the medical residents in the ER and the nurses have to do all the wrestling instead of us. :wink:

I have worked for 5 services at the ALS level, all of them have a "minimum" amount of calls or hours. Sadly most of them are equal to about a 1 week internship.....which is way to short for a new provider. At my home service you must ride as a third person until you have been successfully "signed off" as competent provider. This system is currently being overhauled and I hope that when it is done the program will be a true work of excellence. But I won't be holding my breath too long waiting for it. I'm not sure what an exceptable standardized approach would be, somewhere between 1-3 months of riding as a third person with FTO's who shape and mold you from a minimally trained technician to someone who is actually starting to get a clue. The hardest sell on this of course is the money aspect from managements point of view. :roll:

And as far as narcan, it should only be allowed in 0.4 mg doses that are carried in seperate amps. Where you get into trouble is pushing too much too fast from those 2 mg pre-fills.

Here in my neck of the woods, most rescue units will kick a medic out of the car if they don't have a minimum coat, helmet and eye protection. Its only for your own good. I personally carry a blue jumpsuit, helmet, goggles and gloves whenever I work. This all fits into a very small duffel bag that neatly stays behind the seat unless I need it.

Just some fine american trying to make a quick buck. $$$$$ Its all about lawsuits nowadays. :roll:

Although in EMT class they really don't cover as much as they should, when you get hired your employers are supposed to get you "trained" for all of the above. Most employers also lack the adequate level of in house training regarding bloodborne pathogens and their own policies on how to handle/prevent exposures. TB is scary and fairly rare unless you have large prison polulations you serve. Its transmitted in the vapor droplets. Put a mask on the patient if they have a cough and/or put a mask on yourself. Even if its not TB your protected agianst SARS, avian flu or whatever else could be "infecting" them. Hell most of the time its a simple flu or virus anyway. Use that noisy exhaust fan in the back of your bus to keep some air moving. As far as preventing disease transmission, wear gloves and wash your hands after every run. According to the CDC its the greatest one thing you can do to prevent transmission of any disease, germs, etc.

I know she has had 10 stents placed over the last 5 years.....not sure what happened the other night but I plan on checking tonight. Will let you know. BTW..I like the idea of prophylactic treatment of N/V in a STEMI. Never thought of that before.

Well, yes that was my initial impression too but after the ER doc called a STEMI and she went to the cath lab I had him explain to me what he saw. When I saw the 12-lead I figured she had something going on but I wasn't calling the doc.....still treated appropriately. He siad: Elevation in AVL, V-3 and he says V-4 too but how can you tell. Depression in II, III, AVF He also said that V-1 and V-2 were elevated one mm but that would be a stretch. YUP.....I walked away scratching my head too. So far I've only had one medic that I've showed it too say that he would call it a STEMI. I suppose that is why the MD's make the big bucks. :wink:

This is actually one of our regular patients who kind of took me off guard.

As far as the airway go's, a nasal intubation could have been in order. So many people people forget this great technique and cop out with....we don't have RSI. :roll: If the patient was that unresponsive he certianly needed his airway protected. As far as treatments with ALOC, not much else we can do but supportive measures once we rule out low blood glucose and give narcan. A good history helps but you aren't always blessed with good information.

One of my part time services has had tough books for a few years now with the Zoll software...no major problems. In fact I prefer doing paperwork on them because it only takes about half the time with the touch screen. We have mounts in every unit with a direct wired power source. Access to internet at all the local hospitals and all of our stations to sync up the dispatch times and info. Most of the time we have the charts done in the 5-10 minute drive back to qaurters. If you are having alot of problems it must be your software package.

In our little crevice of the world we ran just over 5,000 calls. Roughly 300 of them were IFT's and contracted stand by's and the rest mostly 911. We have one ALS truck 24/7 and one 12 hour truck from 6a-7p with a second crew at night being on call from home.

It was actually a female operator and as luck would have it this is her second MVC that I had treated her from in less than a year, first one was a rollover. I'm willing to bet she has trouble getting an insurance carrier to insure her after this.

Late Night, ETOH and Speed. Driver was self extricated but damn lucky.