jafo

So my question is, while all of you are posting about what should have been, what could have been, or what would have been if you made the rules, how many of you are making an effort to attend this funeral, send flowers, or donate to support his family. Think Globally, act locally. This area is not used to this sort of thing and although I know they will get through it and do a great job, they should know that we are behind them. I've had communications with one of the TIERS members and he tells me they have no idea who will be covering their shifts during the funeral, so I offered my time. It's a 6 hour drive for me to get there (I was going anyway), but whether I am standing on the line or answering the calls it matters not to me. It's easy to sit on you ass and speak about what 'they' should do, it's another thing to get up and do what you can do to help. I am a little surprised to see that such a group, who is professed to help others, can only sit there and complain. To be immune to the pain of our patients is one thing, to be immune to the pain of our fellows and turn a blind eye in a time of need, is something completely different. Take a hard look in the mirror folks. And in case you are wondering, this is one of the reasons you don't see very many posts or visits from me on this site. Jafo

I have to make a comment. Just as a Proctologist is fairly useless on an Emergency Medical scene because he/she lacks training in the field, so would EMS person would be useless at a technical rescue for the same reason. It's simple: work to YOUR level of training. If you are trained in vehicle extrication, you KNOW you need to have the proper PPE on before you begin. If you don't know, don't guess. Our department does both, and both groups train together ALL the time so they know the strengths and skills of each other. Incidently NFPA reccomends that all Technical Rescue Specialists are Paramedics as an ENTRY requirement to the training. Standard rope rescue technique (in the course I took) teaches that the first person over the edge is an EMS person to do an evaluation. But of course, that person needs training in both disciplines. I keep teaching my people this all the time. do not do what you are not trained to do. Always do a risk assesment. "At all costs" is foolhardy and shows a lack of training, self control, and experience. Get the training and learn what you don't know, because it is what you don't know that will kill you. Be safe, Jafo

Thanks for all the feedback. It's helpful to know that these are being used in the field and working as an additional tool in patient care, as well as showing some usefulness. I think some may have misunderstood the purpose by jumping right to a decision about the type of treatment a particular patient may require. The reason we are looking into this purchase and addition to our tool kit is for prehospital evaluation. It's easier to get a relutant patinet to go to the hospital for evaluation if you can tell them "we have an indication that your carbon monoxide levels are a little too high and think you should be evaluated in a hospital". Than to just say "well, it's possible...". Also I'm more concerned about the firefighters we rehab at structure fires. I would like to know if he/she looks wiped out and winded because he/she overdid it, or because he took his mask off while doing overhaul and got a snoot full of CO. Thrid reason is, there is a ton of clinical documentation of patients going to a hospital with symptoms that get diagnosed as the flu and sent home. Hospitals only check for possibilitis that are indicated. A person with the flu can present the same as a person with a bad heater vent at home. The hospital has no way of knowing to 'look there'. We're not trying to provide diagnosis and treatment regimens, we are trying to provide the receiving facility with the best possible set of information possible on each patient. Thanks again, JAFO

Apologies if this has already been discussed, I searched and found no reference... We are a rural department, and during the fall and winter we get a lot of Carbon Monoxide calls, both for Fire and EMS. Most are bad batteries in the household detector system, but a few times a year it is a valid call with symptomtic patients. Knowing the extent of the CO saturation is, of course, impossible to determine in the field so treatment is always high flow O2 and fight with them to go to the hospital ("I feel much better now.."). I recently saw the new RAD 57 unit that masimo came out with a year or so ago which gives CO sats in the same way as a pulse ox, it also does the usual O2 level, pulse rate, and a couple of other levels depending on the model you get. This is a legitimate device and the only one on the market that has an FDA rating as 'proven effective'. They are marketing it to hospitals, EMS, and Fire departments (for rehab, there are some interesting studies there, but that's another thread). My question is does anyone out there have one of these units and can you share some experiences with us of how it works. I'm also interested in how you would be recieved at a hospital when you inform the staff that the patient has a SPCO of 18%? We have a hospital here that blows off most of what we tell them, I can only imagine what they would say if we provided SPCO when it was pertinent. The unit sells for $4,000, but I am considering working on a grant to get one in our department for patient care and firefighter rehab. We are rural and work closely with neighboring departments, so we'd probably provide it's use on structure fires to other departments if they wanted it. Looking for input, JAFO

>> So, being the smart ass I am, I said, "Well, I stayed at a Holiday Inn Express last night," and no one got it. I can't resist: We brought in a pt. who was HIV positive. The lead tech is anxious to share this information with the ER staff 'right away' (he's an excitable sort), so he walks up to this person in a white lab coat talking to some family members of another pt. and says "Excuse me doctor, can I have a quick word with you in private?" The guy looks at the EMT deadpan and says, "Well, I'm not really a Doctor, but I did stay at a Holiday Inn Express Last Night." Well, the tech was so thrown off because he wasn't expecting that answer that he just stood there saying "uh, well, I uh, need to talk to someone about a pt.. uh do you know...." Meanwhile his entire crew is standing behind him cracking up, the Doctor is trying not to explode in laughter, even the family members had tears in there eyes. To this day, I don't think he realized the humor. JAFO

>> So, being the smart ass I am, I said, "Well, I stayed at a Holiday Inn Express last night," and no one got it. I can't resist: We brought in a pt. who was HIV positive. The lead tech is anxious to share this information with the ER staff 'right away' (he's an excitable sort), so he walks up to this person in a white lab coat talking to some family members of another pt. and says "Excuse me doctor, can I have a quick word with you in private?" The guy looks at the EMT deadpan and says, "Well, I'm not really a Doctor, but I did stay at a Holiday Inn Express Last Night." Well, the tech was so thrown off because he wasn't expecting that answer that he just stood there saying "uh, well, I uh, need to talk to someone about a pt.. uh do you know...." Meanwhile his entire crew is standing behind him cracking up, the Doctor is trying not to explode in laughter, even the family members had tears in there eyes. To this day, I don't think he realized the humor. JAFO

This is a great question, and the opinions this far have been enlightening to say the least. The First Responder has been the ugly step child of the EMS community. Indeed, as many of you have hinted, he or she is not even part of that community. Every state treats the First Responder certification differently, and consequently the First Responder is treated differently. For instance, in PA there is no classroom time required for the certification. Pass the test and you’re in. As a result, there is little respect or use for those individuals in PA. In New York State, where I live, there is a required 50 hour course, followed by a practical and written exam. It is handled exactly as the EMT B, but to a different set of protocols. We call them Certified First Responders (CFR). The protocols in this state are very similar to the Basic, and it is easier to state what a First Responder cannot do, as apposed to stating what he can do. In this state Certified First Responders may not : administer oral glucose or activated charcoal, perform splinting, backboarding, or apply an extrication collar without a Basic assisting, and they cannot supervise a transport. They can do PCR’s, Vitals, Manual stabilization, OPA’s NPA’s, BVM, AED, etc.. The stated purpose of a First Responder is to get on scene fast, assess the pt, handle life threats quickly, update incoming EMS units, call for ALS if needed, and generally get things rolling quickly. We are a rural Fire/EMS department of volunteers. Although we don’t rely heavily on our CFR’s, they do have a purpose and a place. We encourage everyone to work to at least the Basic level. However, we do have young folks that are just trying this out, and the CFR allows them to work with patients and see if they are cut out for this sort of work. It also allows some of our more experienced but very busy volunteers to get in a course that teaches them the basics and allows them to initiate care until the duty crew arrives. I don’t know about where you live, but around here our CFR’s are treated with respect by the EMT’s, Medics, Nurses, Doctors, and Dispatchers. Of course we have LEO’s that were required to become Certified as part of their job and have no intention of touching a patient. They don’t practice, so they really can’t do the job. We understand that. (We had a LEO CFR call in a “Pediatric cardiac arrest, 15 y/o female†Our first EMT-B arrived on scene in under a minute to find the LEO standing with her hands in her pockets 25 feet away from the pt.. Turned out to be an elevated heart rate and nothing more. So yeah, we do have our bozo’s. The last “Dramatic Save†in our department was done by a CFR who was assisting an EMT-B. The EMT had grown frustrated in not being able to clear the airway on an overdose pt. who by this point was very hypoxic. The EMT asked the CFR if he had any ideas, and the CFR asked for a try at it. The EMT yielded and in one thrust the CFR popped out the obstruction. Both the EMT and the CFR had about 10 years experience. Did anyone care what patch they had on their jackets? Not on our squad. Its’ not what you have, it’s how you use it. When and EMT or a medic shows up on a scene, they EXPECT to hear something like the following from a CFR who arrived first: “This is Joe Bloe, he has had a really hard time breathing since he woke up this morning. Joe’s pulse is 95 and his resps were 22 when I arrived, and very labored. His BP is 140/90. We’re giving Joe O2 at 15 LPM for about 5 minutes now and his respirations have become a little easier and dropped to 18. Joe is on no medications and has no allergies but does smoke about 2 packs a day. He says he has never had a problem like this before and is a little frightened by it. His last oral intake was dinner last night. †SO having said all that, here is MY opinion: CFR’s have a definite place in the system. If we expect CFR’s to perform well, we must include them in all parts of the job. This includes being part of the crew on an ambulance. If nothing else, it’s an extra pair of trained hands. At best, that CFR will gain experience and confidence allowing him or her to move up the ladder when training time permits. I am a firm believer that if you hold people to a high standard, they will perform to that standard. As for all you folks who discard the CFR’s out of hand, I suggest you take a good look in the mirror, your narrow mindedness is showing. You who are so quick to complain about being called “Ambulance Driversâ€, are equally quick to toss out the efforts of some very dedicated and committed individuals. Not every system is like yours, and in places where the CFR fits, they should be treated as equals. I think I’m done here, JAFO

I think we all worried about those parts of the job that we thought might give us a problem. It shoulld be pointed out that you never really know what will affect you until it happens. For instance, I have no problem with any of the "losses", even my second one, which was a close firend. I seem to handle that fine, as part of the job. However, soon after joining the squad, we did a dog rescue, elderly male dog mired in the middle of a small pond in mud. The animal was stuck in water up to his neck for hours before he was discovered. To make it tougher, the pooch was blind and deaf. Something about that incident got to me, and I have no damned idea why I get weepy everytime I think about it, even today. BTW, the pooch had a borken rib and a broken ankle. He made a full recovery. The point is, when an incident affects you, you need to recognize it and deal with it in a postive way. This is what will keep you healthy and prevent burnout. Keep an open mind. Jafo

Nick, I'm coming into this a little late. I missed the earlier postings and I avoid these 'blue light' threads like the plague. I don't really care what colors you can use in what states, etc. After about 20 threads and 1,000 postings of that nature I don't even look at those threads. However, I'm gonna guess you are a little new to this game so maybe I have something of value to add (then again, maybe not). In our department, we put all new members on a 6 month probation. During that period they are not eligible for a light permit. The officers get to know the person and how they respond to calls, attend their training, and perform their job. If all goes well, then can get a light permit, uniform, and department ID's at the end of that period. HOWEVER, once you have the permit you have now become very identifiable with the department and every member keeps an eye on how you drive in response to calls with that light on. If you push the limit, you will be spoken to or lose the permit. A wise old officer put it to me this way: "If you pass someone on the way to a call doing 50 mph with no lights on, they will pass you off as someone in a hurry. BUT if you pass that same person doing the same speed with Blue Lights flashing, they will be on the phone to the chief that night screaming about the 'reckless fireman that flew past me at 80mph'. (As an example, one of our guys was doing a response to get a special piece of apparatus out for a mutual aid, and he had his lights going and sort of "forced" a slower driver to get out of his way. He didn't know it was our Congressman, who wasted no time in getting hold of the Chief.) The perception of you department in the public's eye is a precious thing and easily lost. Be very careful and responsible when you turn on the lights. We don't want to see you listed in the LODD forum. Jafo

Welcome Cadet! We have no Cadet program in our department, however I think it's a great idea and I applaud you for your commitment. Please share with us how your program works, what you are permitted to do, and what your are not permitted to do. How does your training work? What level of care does your group provide. This strikes me as a very cool thing, and I'd like to know more (do you have a web page?). Perhaps we could get something like that going in our town. Welcome to EMS. Take your time, breath deep, and plow ahead. Jafo

The birthday thread was interesting, but most folks (including me) didn't include a year. Here is a way to anonymously indicate how old you really are. I have been getting the feeling lately that I am old enough to be the father of most of the folks on this board (with a few glaring exceptions). I don't have a problem with that, but am a little curious to see just where the median age is. Jafo

Hey Village, if you get tired with "CPR Wednesdays" Come a little further south for "Pediatric Fx Thursdays". Every Thursday for the last 6 weeks between 1700 and 1900, we have gotten one. Just plain weird. Also there is something about weekend afternoons that seems to cause geriatric 'general illness" or "difficulty breathing" calls. Can't just be luck, can it? Its so regular that I almost plan for it by finding some excuse to be around the squad at the middle of the day on weekends, so that I don't have to do the nutso drive across town. Twice this had paid off and had me in the drivers seat in less than 2 minutes. jafo

We're close to half and half, but there may be one or two more guys. I count (in my pea brain) about 8 gals and maybe 9-10 guys. On the whole I think the gals are better at their skills, but I only say that because we have one guy that nobody wants to work with. Kind of unprofessional, y'know. We also have some members that are drivers only, and they are ALL guys. I find that curious, but I don't know why. Come to think of it, I don't believe I have ever seen a female driving. I wonder why that is. I know there is no policy in that regard, I guess it's because they are always busy in the back. Or perhaps it's because they prefer to work more with people than machines? (For the record, I am male. )

This is a great idea. The more fit you are, the better you handle the stress, and the better you sleep. I got off the habit back in September soon after completing a 12 day, 67 mile trek in the Sangre de Cristo Mountains. Three weeks ago, on a warm day I went for a run and after the first half mile I kept hearing a dispatcher's voice in my head saying "49 yo male, difficulty breathing, you will find your pt stumbling down the road". All of your posts serve as a good reminder and motivator for me. I'm gonna get back out there. Thanks, Tom

Ok this thread made me register..... You have a stokes basket with wheels that you can pull behind an ATV. -OR- You Fire Chief is talking the the husband on a medical call and says "We'll take good care of her, BUT the next time you call 911 please tell them that your at the "Old Simpson Place", don't be giving them no road addresses, we'll find it a lot quicker that way." (I swear this happened just yesterday.) -OR- Most of the guys wire their camper trailer harnesses the same way so that they match the departments ATV trailer. Tom