croaker260

OK, I posted this request in the instructors section but no response. I know that many of you dont visit that area as often as the forums directly in pt care, so I thought I repost: I'm putting the touches on a 2 hour Scene Safety/Street Smarts Lecture and I need some help. I am looking for pictures or videos of patients, bystanders, residences, cars, or other scenes. Credit will be given where credit is due. I am interested in any pics or videos that I can put up on the screen and "pick apart" to identify specific threat cues/warning signs of trouble. I am specifically looking for scene photos in front of bars and similar venues, in front of crowds, and of residences/scenes in lower social economic areas (projects, trailer parks, compunds, etc) Also interested in scenes of horders, etc with poor egress. Scenes of guns under pillows and on nightstands, other weapons are nice as well. I am also interested in pics of scene safety done right. Good examples of approach, knock and announcing, position next to patient, and scene overwatch. I will of course black out any address , liscense plates, and patient faces. I am recreating some, but obviously I work in Idaho, and there are somethings we just dont have up here, so any help is appreciated. When done, if you want , I will pass the lecture back to you. And, of course, I will accept anything else you want to send that you may have thought of regarding this that I havent. Will share finished presentation with anyone who helps of course. Thank you so much... Please feel free to email me off list if you so desire: croaker260@live.com

A little more infor on what I am looking for: I am interested in any pics that I can put up on the screen and "pick apart" to identify specific threat cues/warning signs of trouble. I am specifically looking for scene photos in front of bars and similar venues, in front of crowds, and of residences/scenes in lower social economic areas (projects, trailer parks, compunds, etc) Also interested in scnenes of horders, etc with poor egress. Scenes of guns under pillows and on nightstands, other weapons are nice as well. I am also interested in pics of scnee safety done right. Good examples of approach, knock and announcing, position next to patient, and scene overwatch. I will of course black out any address , liscense plates, and patient faces. And, of course, I will accept anything else you want to send that you may have thought of regarding this that I havent. Will share finished presentation with anyone who helps of course. Thank you so much...

Hey all, I'm putting the touches on a 2 hour Scene Safety/Street Smarts Lecture and I am looking for pictures I can use to break down and analyze for "threat cues" of patients, residences, cars, or other scenes. Credit will be given where credit is due. I am recreating some, but obviously I work in Idaho, and there are somethings we just dont have up here, so any help is appreciated. When done, if you want , I will pass the lecture back to you. Videos also welcome. Please feel free to email me off list if you so desire: croaker260@gmail.com Steve

For the sake of Brevity, I am going to repost my comments on this topic from another EMS forum: I have added emphasis on the important part there, Pain Management is BOTH BLS aand ALS. BLS providers should not "wait until the medics get here" to begin to provide some relief...and and ALS providers should use both BLS and ALS interventions to control the pain once they get there. As one other poster mentioned, I probably use pain management interventions DAILY. It does deserve more discussion in initial and ongoing education.

This is the most powerful PSA for road safety I have seen in years. Please pass it on to EVERYONE you care about this holiday season. Be sure to watch THE WHOLE THING! Why cant we have adds like this in the US?

Well , Ada County is hiring in october. Applications accepted now. www.adaparamedics.org Of course, this is in Idaho....but beats moving to CO.

SO, I frequently write in house CE articles for my department ona variety of topics as part of our in house CE program. Additionally, other FO' sget tasked to do the same as well. One of oyur FTO's came to me an d asked "how do you do that". Well, I spilled the beans, I had a generic outline that saves me time in my writing.....He asked me to write it down for him, I did. He said "you should post this somewhere!" So, here is, I am sure the more seasoned instructors wont need it, but for the newer ones it may come in handy. Please feel free to add your own suggestions or tips/tricks too! Hope this helps....

We use 3.25 inch 10 G for needle crics (if we just dont do surgical) and needle chest decompression.

In all seriousness, I keep this posted above my desk as a reminder to keep fighting the good fight. I dont think there is any need to insert any words to make the meaning readily apparent... Somedays, my anger runs deep.

Not the same thing Richard. The OP question was regarding profound hypothermia in the 80's, where THERAPUTIC HYPOTHERMIA is typically in the 91-93 degree range depending on the protocol and/or study you read.

Ok, 1st, I am a huge fan of R Adams Cowley, the founder of the golden hour concept. That said, the golden hour is being replaced by the tri-model model of trauma mortality. That said, people die in one of three major time frames: They die in Minutes: These are the ones that EMS interventions - bleeding control, airway support,and rapid transport make the difference. Hours: Thse are the ones that transporting to the right facility (or the wrong wone) will make the differece between life and death. Days: The reasons people die in this phase are largely dependant on the facility they end up at, and the treatment they recieve there, but this is a multi-factoral issue.

Mick, it is good your looking at this in a mature light. We have this issue with several new hires, and we are upfront that all tattoos must be covered. I have had the argument that perhaps we should allow "tasteful" tatoos,or similar subjective comments. I know from personal discussions and review of other departments policies, applying subjective assessment to this issue is a mine field. This is my personal philosophy....keeep in mind I LOVE body art, and have some (non-visible) myself. But I realized that this is not at all about freedom of expression. It is only part about getting accepted as a professional. It is about medicine. Follow along with me here.... A key point of medicine is patient interaction. It is essential that we are able to subjectively assess our patients. If our patients fear or distrusts us...right or wrong....it interfears with our medical assessment and treatment. And anything that erects as a barrier to our medical care must be mitigated. Simple , huh?

NOT TRUE. If you are part of an agency , especially one that either recives public funds, or has a public charter/contract...and you are with in your response area (etc etc etc) you have just as compelling and legal "duty to respond/act" as a paid provider. Does not matter if you are not paid. If you are on shift or on call, you are on shift or on call. Period. This is why in many states the bystander good samariton immunity does nto apply when you are working for an agency/company/squad/what have you. NOTE this is not an obligation to be "unsafe". Now if your not on duty/call, you do not have to respond. If you are driving by as an offduty person, you are not obligated to respond unless you have some oragnizational specific policies.... The descision is an ethical and moral one at that point.

Our agency does charge. 500 dollar base plus OT costs of the mebers. Typically 25/hour x 6 man SERT = 150.00 / hour. This is in addition to the actual patient care charges if any. We are a paid agency with ALS capability on our team. This is our out of county rate. Think of it this way, the typical response can cost many thousands of dollars (I can think of one complicated multi day response costing over 5K in OT costs alone)in terms of equipment, training, etc. The local taxpayers bear the weight of that cost and supplement it by paying for the training and readiness already. We try to offset that through grants, but you know how it is for a non-fire based agency (we are 3rd service) to get grants. Anyway... I digress....many of these missions are out of county, so for people and/or areas who are not even part of our tax base to begin with, we are requested. Additionally, my county bears the liability for workmans comp and such. I think its perfectly reasonable for our agency to charge the fees so that the taxpayer who pays for the agency does not have to spend any extra dollars to support another county or non taxpayer in another county. In short, we are making these out of county responses "zero impact" on the in county taxpayers. Afterall they take responders and equipment out of the in county system, often disrupt the in county schedule, so I think the taxpayers are altruistic enough. Keep in mind we dont do search, only rescue and recovery. Other counties often have SAR teams, We actually trained some of them....and may are volunteers who depend on donations. GOOD FOR THEM! But we are th only ALS resource for rescue if they cant handle it. Most of them are BLS. I whole heartedly support the concept. But I work for an agency that has a responsibility for prudent use of taxpayer dollars. And since most of these rescues occur "out of county", we have an obligation to minimize the impact on the taxpayer whose dollars keep our operation running.

Two comments: 1) Glucagon is a perfectly acceptable option in this scenarion...however one should be aware that doses of glucagn may be in the range of 5-10 mg (units), typically more than most EMS units carry. 2) Epi is still used, however depending on your protocols, high dose EPi may be indicated. I know, I know, we no longer do high dose/escalating dose epi in cardiac arrest...true for NORMAL cardiac arrest, but for Beta Blocker OD...doses up to 5 mg each are indicated. As an alternative, Epi drips may be useful as well. Atropine may not be effective, but is not contraindicated weither.

Agreed. Unless it comes up in the interview somehow, respectful silence is best, otherwise you will likely come off as fake, brownosing, and invasive. If it does come up in the interview somehow...dont know how it would....then the less said the better...respectfully of course.

hey all, long time poster, first time listener Anyway... Consider this...while "limb placement" of the 12 lead is optimal, it is by no means mandatory. There have been times when that has been the only way for me to get a readible 12 lead for a number of reasons, for example: Amputees, patients with burn dressings on arms and legs, agitation and tremors. So, considering that there is indeed an alternative to the "limb lead 12 lead", giving a sedative, especially one of the limited number of sedatives typicaly carried on EMS rigs which cary a number of inherrant risks, simply to get a limb lead 12 lead in an otherwise stable, calm, and compliant patient is not something that meets the risk:benifit equation in my book. Just my thoughts..... Steve

While you qouted the first part of my post, I wish you had mentioned the rest of it. REFRESHERS DONT HAVE TO BE BORING AND USELESS. They can be fun, informative, and worth the time to sit in them. You just have to have the motivation of the instructors, the creative mindset, and be willing to involve a LOT of subject matter experts. The annual refresher course we do at my service is my biggest head ache to coordinate (I probably teach less than 25% personally, but I am there for 100% to monitor the guest instructors and be a "co instructor" to meet state requiremnts) but its worth it when its done. When a (approx) 30 year lifeflight paramedic comes up and says "I really enjoyed that (52 hour) long week, great job"...then something must be being done right. My point is not to blow my own horn, but to point out that we complane too much about our educational standards and do NOTHING to improve them at our own microspopic street level. Rant off.

Hmmm, How would she know if they had no bearing or not on her competence, as she DIDNT TAKE THE COURSE! Seriously, the first EMT refresher course I took took the by the book refresher aproach. No , absolutely no, new information, I promised myself that when I got into education I would never inflict that on anyone. Ive been in education now for about 8 years or more. I have coordinated refresher courses for about 6 years. We have MDS, PA,s specialist, LEO's, and all sorts of specialist help teahc topic matter. We cover the objectives, and stil provide new information in a fun way. if you are going to a canned sleep inducing refresher course, come up my way. I'll change your mind. BTW, our material isapproved by the state and NREMT.

I like the MERC Manual, but here are some others.... This is one of my favorites: http://www.amazon.com/Human-Physiology-Mechanisms-Disease-Guyton/dp/0721632998/ref=sr_1_1?ie=UTF8&s=books&qid=1276973279&sr=8-1 Notice $110 new, but used is very cheap. Also, if you are a EMT basic, a paramedic text such as this is a good start as well. http://www.amazon.com/Paramedic-Emergency-Care-Bryan-Bledsoe/dp/0835949877/ref=sr_1_1?ie=UTF8&s=books&qid=1276973399&sr=1-1 Again , 50 dollars new, but used very cheap. Not knocking the MERC manual, but it depends on your foundation. GUYTONS is one of my favorite.

Kudos for Mass state EMS for doing the right thing. My understanding is that many of these were from FD jobs. If that is the case, double Kudos for Mass EMS for standing their ground! I am sure the IAFF put tons of pressure on them to look the other way.

Interestingly, I recently had a conversation with one of my co-workers who has a background in exercise science, physical therapy, and a related fields, that involved feet placement and such during heavy lifting. His impression as that for most americans, who are not overly flexible, more heel support (as in raising level of the heels) would prevent more back injuries during lifting as it changes the geometry of the pelvis during lifting. As a point of example, he placed a 2x4 under my heels to demonstrate the difference in simple squats. If STRYKER was to invent a boot for EMS, it should look at the apparently considerable orthotic science behind the ergonomics of lifting , extrapolate or study that into the EMS enviroment, and improve that. I know that while I LOVE my boots, if I am standing for more than 40 minutes in them (not walking but mostly standing, liek a stand-b or something) my back hurts. So any boot that reduced back pain and injuries....THAT would be an improvement. I want a boot that helps reduce back pain and improve lifitng ergonomics, not one that looked cool with a scissor pouch or comes in the company colors. As a side note, I work in amixed urban/rural/frontier enviroment, and except for the times when I do hike in to a patient more than a mle, I vastly prefer a combat style danner boot over low or mid quarter style boot. When I do Hike in, I really wish I had a hiking/bouldering boot. If I worked soleley in an urban/suburban enviroment, I might have a diferent opinion, but our response area is 1050 sq miles, with desert and mountains as well as city all mixed in.

Actually, I may have the answer.... We recently recived a notice on a patient in our area with a new ventricular assist device. I will see if I can find the info on it. Im pretty sure it is still in the experimental phase, but with this device it is possible to have the patent in periods of Asystole witha pulse (that is generated by the machine) for periods at a time. It comes with a 1-800 number to call BEFORE beiginning CPR due to the fagility of the connections and the device. May not be what your instructor was refereing too, but there you go.

Wow, such a hard thing to quantify on a forum like this... This is exactly why medicine is an art masquerading as a science. SO may subtleties go into every descision.

For once I am agreeeing with a firefighter. (SHOCK) Especially considering the original post sounds like somehting a firefighter would do. As for cutting off the bands if needed for patient care...sure. But you could also ask them to remove them. or chose a different site (ek the A/C.