fiznat

Elderly + some mechanism + possible LOC + hypoglycemic + potentially altered = He needs to be c-spined. That said, if "fire" is the ALS on scene and they are transporting with the patient, its their ass. I think it's bad medicine and you should definitely voice your opinion to them, but in the end if they are in charge it is their decision.

Thanks for the heads up. I'm curious though, what information did your instructor think was the most difficult to learn?

I agree with Scott that this kind of training seems not only appropriate, but necessary and should be done more often around here. The idea of this kind of training is to drive lights and sirens while taking the adrenaline out of the situation. New drivers need to relax and worry more about the road than the patient. Practicing without a patient at first helps work towards that goal. As far as whether L+S saves time/lives, I don't know. I imagine it depends where you are. When it is rush hour in the city I work, lights + sirens can save me a half hour or more. At night when there aren't any cars on the road it probably makes no difference at all.

Actually I would be interested to hear what eight drugs EMTs are giving in other parts of the country. I can only think of a few: oxygen, oral glucose, epi pen, activated charcoal.... maybe assist with nebs, ASA, and NTG? I donno what else. Memorizing 8 drugs (whatever they may be) shouldn't be that hard. Like others have said, it helps to make flash cards with their info on them and then just quiz yourself for a while. You'll get it.

The word "education" is tossed around a lot around here. I'd like to know where people feel the line is drawn between "education" and "training." Just because a paramedic knows about the heart's four chambers and how electricity flows from top to bottom doesn't mean that he/she is "educated."

Do you guys routinely fly medicals like that? How far away is the hospital? Anyways, on patients like this who's sugar "should" be low considering the presentation and the history, I usually do doublecheck the sugar. The first time I get a finger stick, and the second time I check after I get an IV using the blood in the flash chamber. I think it is a good practice because I actually had a similar scenario before and caught it on the second check. A question: if you were ruling out hypoglycemia on this patient, what was your working diagnosis? Was there another reasonable explanation for the altered mental status? That said, don't worry about it man. Things really do happen, just learn from them and you'll be fine.

The too noisy for interpretation means that the machine thinks there is too much artifact for the automated analysis to proceed. Usually this means that it is too noisy for you to analyze it also, but sometimes if you get the "artifact- press 12 lead to accept" message and you press the button, you can get a clean looking 12 lead that still says "ECG override/artifact" or whatever at the top. I figure you get this message because the machine WAS seeing a lot of noise before you pressed the button ("to accept"), but then the artifact cleared out and you get a clean strip. In general I have no problem using any 12 lead that looks clean and has a nice isoelectric line, even if the automatic interpretation had some trouble. Usually I will try and print out another one for confirmation after that (sometimes I get my cleanest print as we're just stopping at the hospital), but for the most part just because the machine thought it was too noisy doesn't mean it actually is.

I wouldn't worry about active rewarming. Just do the basic stuff and you'll be fine. Chill out! haha

When I was brand new I started at Armstrong Ambulance working at the Brighton ("Bravo") base. It didn't bother me so much then, but thinking back we probably did about 90% interfacility transport. It was a really good introduction into EMS, though. I got plenty of opportunity to get comfortable talking with patients, handling the stretcher, working with nurses, all the basic stuff that we take for granted. I think I'd probably kill myself if I worked there now (can't stand transfers! haha), but in retrospect that time period was extremely valuable. There are things you need to know before you start going out there trying to be a hero and save lives. Starting slow may be exactly the right answer. Something to think about, at least. By the way, anyone on here work at Armstrong now? I sometimes wonder how people from "Bravo" are doing these days....

I used to do this all the time as well. I still do, especially when going to peds calls or something that I haven't done in a while.

Its been a few years now since I took my NREMT-P exams, but I just started this year as an evaluator so maybe I can help. Candidates seem to worry most about the oral stations, but surprisingly enough it isn't the station most often failed. That honor belongs to - believe it or not - the BLS station: long spine board or KED. ...So don't forget to review that stuff as well, even if you are sure you've got it down. The orals seem like a big deal but most people once they get in there are able to fall into the routine that they normally do. It might help to know that you will not fail if you miss little things. You fail for missing big things. Check the blood sugar on the altered mental status. Do a thorough airway assessment right away on the trauma. Don't give drugs to the hypothermic patient. These are the things you want to remember. People fail these stations tend to rush through stuff (particularly the airway) and miss something obvious that they would have definitely remembered had they slowed down and thought about each step. Just go slow, take a breath, and relax. You'll be fine.

No problem. If anyone is interested in this, PLEASE contact me asap!

That is an exaggeration, but I suppose this user decided what kind of attitude he wanted to portray when he created his username. Glad to hear the interview went well. You may have seen me there, I stepped in while you guys were taking the written exam to say hello to a friend who was also testing. As far as the languages, contrary to what others have said I've found even my limited Spanish to be VERY helpful working in this area. True there are other languages spoken in this city, but Spanish is far and away the most common next to English. That probably will give you an advantage. A letter to HR would be a nice thought, but honestly it probably wouldn't make a difference. As far as I know, the hiring decisions are made mostly by Rick Ortyl (who you probably met) and a committee of employees who evaluate the candidates. I'm also pretty sure the decisions are already made about who they are going to keep and who they aren't, so really anything you do from here on out probably won't matter too much. Again, good luck. If everything goes well I hope to see you around.

I'm a little late to this one but I think I'm joining the "would give cardizem" camp. A 70 year old with a heart rate over 200 needs rate control, regardless of whether she is hemodynamically stable at that precise moment in time. A person's max heart rate is 220bpm minus their age. This woman is exceeding her max by about 33%, which is significant in someone like this who is predisposed for cardiac disease. The pulse rate, while interesting, is irrelevant (imho) to this decision because we are worried about cardiac work and O2 demand, which is a larger consideration than simply looking at pulse-producing contractions. We have standing orders for cardizem, and I think I probably - barring some other finding - would have given it a shot. Let's not forget that this provider indicated that Cardizem would have been an on line medical control order. While I respect his decision to remain conservative in light of the physical presentation, I think at LEAST a discussion with the doc on the radio was warranted. I think if anything, the extensive discussion on this board has proven that the decision is not clear cut. The OP probably should have consulted with the doc about it.

I have to disagree with the above. AMR can be a real pain in the ass sometimes but I think the actual experience varies widely from division to division. True it was at Hartford where the management was caught trying to record union discussions, but there are a LOT of good things about this place as well. This service has a very good reputation among our peers in Connecticut and I don't think it is undeserved. There are a lot of really good people here and even though we work for the big bad corporation the day to day isn't bad at all. Are there frustrations? Of course. That doesn't mean you shouldn't run away.

Its a question of terminology I guess. When we do research we don't say we've "proven" anything, because we haven't. What we've done is provided evidence for, or against a hypothesis. The difference may seem like semantics but it really does go right to the core of the scientific method ideal. **Note, I'm going to have to "quote" you from here on using italics and underline. I guess this new software doesn't allow multiple quoting** I am having a difficult time in your theory that common sence has been detrimental to patient care. "Common sense" is not a basis for a standard of care. Think about back in the day when they used to bleed sick patients out in hopes of ridding people of the "bad blood" in their bodies, or more recently, MAST trousers. That was a standard of care based upon the common sense of the time. Just because something seems to make sense logically does not mean that it actually works. That is why we do research and why, even today, we must confirm with science even the most basic of our assumptions. Age is a huge determination in trauma outcomes ... and best re read the study yourself as clearly the type of trauma groups is disimilar. I know that age is a huge determination in trauma outcomes. Nobody is disputing that. What I am saying is that the differences observed between the two phases of the study were NOT due to age differences within the populations. As I posted, the researchers controlled for that. If you are telling me that the groups are dissimilar in some other way, please tell me where because age is not it. Again, the average age for BLS was 44.8 and for ALS was 47.5. Exactly ... .8 % is insignifigant in making a conclusion ... but that is what OPAL study conclusions claimed and has very negatively impacted ALS providers in AB. I don't think you understand the meaning of this reported measurement. A 0.8% difference does not mean that no conclusion can be made. To the contrary, it means that there was no observed difference between the two phases of the trial. This is called "confirming the null hypothesis," which means that the treatment (adding ALS to a BLS service, in this case) made no difference in the measured outcomes. Best look to inclusion and exclusion criteria before you suggest that I do not have a clue. If you have an issue with the inclusion criteria please identify it specifically. I'm not sure what you are referring to. So placing tubes "in hospital" and starting lines "in hospital" is superiour to door discharge positive outcomes ? Nobody said that. What the study showed is that it didn't help (or hurt) patients to have these things done prehospitally on trauma patients. It made no difference. Be careful about applying your personal feelings when reading research like this. Nobody said paramedics were bad at starting tubes/lines, or that the hospital did it better. The research is only capable of giving evidence about the specific areas it is testing. This research looked at adding ALS to a previously BLS-only system, and it turns out - in this case - it didn't make any difference (for trauma patients). My point is first attemtpts were far superiour to other studies ie Wang et all and without Paralytics or all the toys available that of us have today, could it be that 100 % of airway capture Ah, okay, but that really is irrelevant to the subject at hand. Not really that humerous as the bean counter "pole cat titions" jumped all over this, twisting it in the media and causing a huge step ass backward for advancement of prehospital are in Ontario, for a .8% difference in outcomes .... hey you said it yourself. Why would the truth result in a huge step backwards? If paramedics really ARENT helping these patients, maybe the money would be better spent elsewhere, right? Remember the goal here isn't to increase funding for EMS, it is to analyze the best way to provide prehospital care for our patients. We should want to perform treatments that are effective, not keep on doing the "same ol' thing" even though rigorous study shows that it doesn't help. That said, one study alone shouldn't be a basis for policy. It is the caveat of ANY research article that repetition is necessary before we can really start using these results in our daily practice. I am looking at the damage it did to Advancment of Advanced Care ... it becomes rather obvious that you are using this study to justify the status quo of the PCP in urban areas in Ontario. Again, we can't be damaged by the truth. If what we're doing isn't effective then we should be eager to change it. I'm not "using this study" to justify anything, I'm just reading the results and thinking about how it applies to our current standard of practice. Oh but you do have EPI PENS ... and just how many acute anaphlaxis are you seeing in ONTARIO? Huh? I don't live or work in Ontario.... Survival to door can not be the measurement when EMS is such a small part in the overall treatment of the trauma patient what happens in the hands of ALL of the others in the chain of survival, this should be factored in ... and good grief man, putting a spin on "this is why we do it" is laughable as a justification Sortof. I think you're right in that there are a lot of confounding factors when you try to evaluate EMS care based on results that occur days (if not weeks or months) later after many other interventions are made. Still though, it can't be ignored that survival to discharge is the only thing that really matters. What difference does it make if our patients arrive with a pulse only to die 10 hours later in an ICU bed? Sure I will give you a break ... but a question as well ... just why were the 2 largest poulation bases ommited ? Oh thats right because they are totally ALS, and so just what are the combined population of Hamilton and TO ? You do not think this is not sinister ? ... the look to just who provided the funding for this study, honestly a waste of 24 million . Yeah those are two large cities that were excluded. ...But they were excluded for a good reason. They weren't able to adapt to the model being used in the study. You can't ignore the fact that this study is STILL by far the largest prehospital study conducted to date. To say that it is invalid because it wasn't even bigger is a bit ridiculous because if you say THIS was invalid based on size, then NOTHING else is valid, either. No other study touches this one on population size. If you have an issue with improper funding then please point it out specifically. I'm not aware of any funding issue that might have resulted in tainted results. If you are, please let us know. I thing you are wrong, the studies in Trauma outcomes in IRAQ and AFGANISTAN and the difference in treatment ARE very different they are not limited to a bottle of the cheap "kool-aid" blend. You're talking about some VASTLY different populations here, in different environments with different logistical constraints but even still: if you are going to refer to a study, please provide a link. I'm not sure exactly what you're referring to. Ok now you are blowing smoke ... just how many acute anaphlaxis patients treated just BLS with an Epi Pen survive vs the ability to make a surgical intervention or treat the indivudual with inotropes if there truely not self limiting ... show me the MONEY ... NO study has ever been done in this area of present contraversy. Do you know how to use pubmed? http://www.ncbi.nlm.nih.gov/pubmed/ The value of epinephrine in acute anaphylaxis has been well established. Searching for terms "epi pen," "anaphalyxis," and "self-administered epinephrine" provides a long list of studies.

Hey everyone, JEMS offers a group discount to their conference if you get five or more people to register together. I was part of a group of five, but one guy had to drop out today so we are looking for one more. I was hoping someone from here was planning on going to the conference but wasn't part of another group yet. The discount works out so each member of the group saves $100 off of the total price, which I think is significant. Please post here or email me (fiznat@gmail.com) if you are seriously interested. Also understand that the "early bird" discounts end on Feb 20th (this coming Friday) so if you want to be a part of this you will need money in hand before then. Just a heads up. Please let me know!!

Its at a later date if you get through the testing process. Good luck!

^^ lol Along those lines, another website to check out might be www.ghamrunion.com (our union).

There's no magic pill, but it might help to know that this is how we all feel. In fact, it is my opinion that the best paramedics remain nervous, and do their best to avoid the overconfidence and hubris that seems to plague experienced members of our profession. You will feel better about your skills as you work more and more in that role, but don't expect to ever be so good that you can handle everything perfectly every time. It simply doesn't work that way. I guess I'll take this opportunity to shamelessly plug my blog. I started writing almost three years ago when I was in medic school and have continued though my first years as a "cut loose" medic, so maybe you might find some similarities between our experiences. http://www.babymedic.blogspot.com

The test has been changed recently so I can't be completely sure, but expect both written and practical sections. There will be stations much like national reg, and as I've heard the written test is similar as well. Don't freak yourself out though. If you have some experience and carry yourself well I'm sure you'll be fine. What time do they have you testing at?

Scientific studies don't "prove" anything. This comment is really very poorly written and hard to understand, but I think you are trying to say that response time is too obvious of a factor to be considered by rigorous research. On that point you are completely wrong. I don't think I should have to explain to you how often so called "common sense" solutions have been proven ineffective, or worse, detrimental to our patients. This is the reason research exists. ...And no, of course they didn't spend all of the grant money on answering this one question. Duh. Ah, wrong. I did read the study. The mean age was 44.8 for the BLS phase and 47.5 for the ALS phase. Considering the size of this study (2,867 people), the age difference is by definition statistically insignificant. Or are you suggesting that people become "geriatric" when they reach 47.5 years of age? Where are you getting this stuff from? Close enough. The point is that the outcome between ALS and BLS was statistically insignificant, meaning that the differences observed could very well have been due to chance alone. What? You can? Did I miss something? The OPALS is the largest and longest-running rigorous prehospital study performed to date. I don't think you have any clue what you are talking about. Its actually 71.8% success for intubation and 90.3% for IV access, but again you are missing the point. The study shows us that EVEN THOUGH the medics usually got their tubes and lines, in the end it didn't make a bit of difference for these trauma patients. lol So you want us to ignore the trauma study because it is "dated and jaded," but the results from other portions of the same study are accurate? How is that, exactly?

haha okay, nice gross generalization. The OPALS study was conducted in Canada. ....That first O stands for Ontario.

Not that we haven't gone down this road a zillion times before, but we don't have more ALS trucks on the road because they are expensive, insurance barely or underpays for them, and the research has not been very positive towards advanced prehospital care. That said, I think epi pens for BLS providers is pretty reasonable. They give epi pens to patients to take home and use at will.

I didn't realize epi pens weren't standard for BLS units elsewhere. Here in CT the BLS trucks have both pedi and adult epi pens, and EMTs have standing orders for their use in anaphylaxis...