fiznat

I'm not saying that ALL of those scenarios have happened to me, they are just examples. Also it is infrequent that the restock is absolutely not available. More often this is a question of time. I punch in for my shift and immediately they want me to run out for a 911 call because everyone else is out on other calls.

Okay, maybe it is better to list some of these "borderline" items specifically. Would you respond to a 911 call with: 1. Expired (or missing) benzodiazepines? 2. No spare monitor batteries? 3. One D-tank of oxygen only? 4. No macrodrip (10 gtt) sets, only microdrip (60 gtt) sets? 5. 1-day expired antidysrhythmic drugs? 6. No rescue airway (meaning no combitube/LMA. Still have ETT/OPA+BVM/Crich stuff) 7. No portable radio (saftey issue) 8. Dim bulbs in the laryngoscope blades?

I assume we all check out our gear at the beginning of our shifts to make sure that everything is on-board, in order, and working. My question is about what you guys do when you find out something is missing or NOT in place. Do you have a list of minimum equipment before your unit is available to take calls? What items are important enough to refuse a call if you don't have it? Does your company back you up on this? Lately at my service I've noticed that the supervisors and dispatch are trying to push us out onto the road to take calls before we're able to do a complete check of the ambulance/gear. Sometimes if we are missing something, the supervisor might say that we should "just take this one call" and come back to get the restock later when it is available. This situation makes me very nervous. In principle I would like to remain "off line" until I have done a complete check and made sure everything works, but in reality it is often hard to stand firm on this when dispatch is calling for you to sign on for a supposed critical call and you are the only unit "available." Now, I know some types of gear are absolutely necessary while others maybe not so much, but it is a blurry line. I'm also pretty sure the responsibility would fall on me alone if I showed up to a call and found out that I was missing something really important, and I hadn't checked it or insisted on it's restock. I guess my question to you guys is: what equipment would you refuse to go to a call without, and does your service/supervisor/dispatch back you up if you make the decision to refuse a call for these reasons?

Anybody know how this guy actually died? Some kind of tamponade? Head injury? In either case the CPR was probably a lost cause anyways. Still though, you're right the CPR is pretty piss poor. It is possible though that the airway was being managed by a BVM out of sight. It almost looks as if they are pausing compressions for respirations, albeit at the wrong ratio. Scene management might actually be better than the video shows. Although there are people watching, nobody is crowding around the patient and the providers seem relatively calm and collected. Eliminating freakout = the first step in cardiac arrest scene management, especially in a public place like this. The providers are probably speaking in normal voices to eachother, which is how it should be done.

AZCEP hit it on the head (with a nice House of God reference to boot!). The first step for every call is to check your own pulse. Relax. You don't have all the answers and 99% of your patients will require IV/O2/Monitor and nothing more. Know your protocols, and understand that there is no shame in looking up the answer if you don't know. I still carry my protocol book with me in the event of an unusual patient or the (more frequent!) brain fart. You WILL become more comfortable with things as you gain experience. Try to keep this "newness" as long as you can. New medics are always scared about missing something and - in my experience - this can be a redeeming quality. Never let yourself believe that you've seen it all. Patients will surprise you on your first day, and they will surprise you on your three thousandth day as well. I've been a medic for two years now so I think I can still say that I was (or am) recently brand new. I've been writing a blog about my experiences since I was in medic school if you'd like to give it a quick read: http://babymedic.blogspot.com Good luck!

haha I have to say, I'm disappointed in all you guys for feeding into that previous discussion. CLEARLY the guy was trying to egg people on. "We are dialed in shape firefighting machines," haha come on. That guy is a genius and I'm sorry to see him go, he had me laughing out loud for a good ten minutes. <--- Dialed in 12 lead reading machine.

My personal feeling, and what I am taking away from those who have experience, is that you should only even remotely consider this job if it is extremely well organized and has sensible (and legal!) policies in place that will dictate your practice. That includes a medical director and a protocol that you can rely on. If this is anything other than that, or if this camp expects you to take on a more casual role with these responsibilities, I would run far far away. Unless the pay is outrageously good. Everyone has their price haha.

NREMT only looks at felony convictions I believe. I happened to get my recert info in the mail just the other day and there is a question that asks about felonies but no other type of legal trouble. You should be good as far as NREMT. As far as actually getting a job, I seriously doubt it'd be a big deal.

Aw don't let people guess right away! Proper assessment! Proper assessment!

:shock: Oh my... Yours is high up in the Illium though. I wonder which kind of fx is more common (Femoral Head or Illium), and if the position of comfort differs between them. Looks like you broke yours in about the same place on both sides - you say both times it helped to have your knees elevated?

Youve broken your hip twice? ...Or you've taken care of two patients with broken hips?

I generally just pad everywhere. I don't think I'd apply any pelvic pressure at all, mostly for what other posters have said: don't want to make a non displaced fx a displaced one. Assuming the fx is at the proximal head of the femur, this part actually sticks out farther lateral than the rest of the hip/pelvis. Applying pressure to this area seems like it would cause undesirable forces on the injured area: If the fracture is in the Illium, maybe, but even then just padding would probably be a better solution. I think you did the right thing stopping the FD from applying that splint.

This thread has now spun out of control into OT land. Can we lock it so that other threads may have their day in the sun?

Not really if it is just a rhythm strip (IE not a 12 lead). The 3 lead stuff (I, II, aVF) is just for rate, rhythm, and regularity. You need a 12 to look at the ischemia/infarct/injury stuff where early ECGs might play some role. That whole "we were expected to have the patient already on the monitor" prior to ALS arrival is BS. You should tell anyone insisting you do that to piss off. It is out of your scope and they are being lazy. I agree with everything DocHarris said as well...

Heh so they are both EMTs until someone decides that something went wrong. Then - surprise! - you're a medic again! In my opinion, a paramedic with any sense in him simply doesn't put himself in this situation at all.

Yeah I think I'm going to go with a-fib as well. I thought for a second that the rhythm looked regularly irregular, but it isn't once you march it out. A longer strip or a 12 lead would definitely seal the deal.

A few signs I've picked up and now look for: Cullen's Sign: Periumbilical discoloration indicative of retroperitoneal hemorrhage (could be AAA or hemorrhagic pancreas etc) Grey- Turner's Sign: Discoloration at the flank, a sign of retroperitoneal hemorrhage as well) Murphy's Sign: Provide direct pressure to the RUQ and ask patient to inhale deeply. A positive sign is an abrupt interruption of inspiration due to pain. This pain is usually indicative of an inflamed gallbladder descending and coming in contact with your hand. McBurney's Sign: Tenderness located 2/3rd the distance from the umbilicus to the anterior iliac spine on R side. Associated with appendicitis. Kehr's Sign: Severe left shoulder pain. Associated with spenic ruptures and ectopic pregnancies. Rebound Tenderness: Tenderness on the removal rather than the application of ABD pressure. Associated with peritonitis.

^^ I would say the judgment should be made based on licensure, and not by anything else. If that person is licensed as a medic in your state, medical control or not, he/she should have that level of responsibility regarding medical decisions. Any medic putting him/herself in this situation should be well aware of the risks involved with "riding as an EMT." It's a dangerous situation, and one that I don't think I'd want to be in any time soon.

haha me too! You do enough of these calls in a day and they stop feeling like "individual snowflakes" pretty damn quickly. Just my experience.

Uh oh...

Thats another thing. Do you guys have MI patients who complain of agonizing pain? My experience has been that the true MI patients go as far as to correct me when I ask about their pain. "It's not a pain, really" they say, "It's more of a pressure." Even the really bad ones who look like crap- tombstones/hypotensive/cool/pale/diaphoretic/obviously having a MI aren't really in that much PAIN per-se. They complain of weakness, chest pressure, feeling "washed out," SOB, but never really pain. Not like my-arm-is-broke pain anyways. Do you guys have different experiences?

No no, I'll definitely do what I can to control pain in most patients. I gave it for ABD pain twice this week, and I even had to call medcon to ask for it (we have to call if it's ABD), so I'm not lazy. ...I just don't think it's worth the time with ACS when I've got all kinds of other stuff to do and the drug has been falling out of favor for this condition anyways.

hahaha Dust is a

Hypotension? Right sided involvement? Also, I doubt the OP carried Demerol. I don't know of many ambulance services that do...

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