croaker260

I'm surprised that this is a serious controversy, I'm curious as to the back story behind it. 1- No, O2 before or simultaneous with 12 lead. 2- Thats what you have a partner for..to help you do multiple things at the same time, right?

Well, short term clinical expertise, it wont. Long term career growth, it will. Business degrees will help you in many areas, not just upper management. It helps you with statistical analysis of resarch, simple interaction with buisness owners in the poublic arean, etc....So will education degrees, etc. But in the short term, for that first gig, see my posts above.

I have heard/seen this in the NICU. I do not know, nor have I heard of it being used in older populations, but my own daughter (who was in NICU for 6-7 weeks) received this for several procedures. Apparently it is a common practice in this age group. I asked about it but didn't get a good answer, but then by then I was butting heads with the NICU staff on a daily basis anyway (apparently I'm hardheaded becauseI like to be involved in my daughters medical progress...)

Depends...I believe that most are actually GS (governmental) positions (GS 5 and 6 for EMT's, don't know what Medics ring in at), though these are not the same as contracted private services like Eagle Air Med.

Interesting point. However, the VA and the military medical systems are not/nowhere near the same. Granted its been a while, but when I was active and associated with a military hospital, someone would get more than an ass whooping for doing the crap I (we all? ) see going on in VAMCs across the nation every day. Its the difference between a military run medical system (still far from perfect) and a civilian run government system. Though admittedly I've never seen them handle end of life issues (out side the ER/ICU) that much.

What is this? I got a little bar beside my name when I post, blank, that says "warn status"?

I love how chastising other nurses for not doing their job is "proof" that he was overdoseing patients. If that was the case, Im a serial killer! I don't know this, but I read between the lines a Nurse (who used to be a paramedic) who didn't fit in with "traditional nurses" clique (probably because of his "paramedic" upbringing and attitude) , rubbed them the wrong way, and now became a target...but thats just me. Seen that before with some medics who transitioned over to the other side.

Not sure your real question is about interactions of meds. Many diabetics (most eventually) will have HTN and CAD problems. Your real question is how to convince a stubborn family member to get help...reality is often times you cant. But perhaps their spouse could. When you explain to them that frequent need for NTG is a sign of worsening CAD (AKA a crescendo pattern of unstable angina), and that NTG is not a cure for the issue (for many, when you take a pill, they no longer have the underlying problem...) maybe that will help. Honestly though, having dealt with a stubborn relative (my grandmother who raised me) often tough love wont work. In fact it may make things worse. Especially if they are older than you and saw you in your diapers, there is NO WAY may people will be forced to do something by a "whipper snapper". Try the soft sell before you try the hard sell. End the end....People have the right to make poor choices.

For the long term.....BSN is good. Business management with an MBA tract is even better, or a management degree with a focus on health administration. A masters or a doctorate in public health is good too, but not for staying in EMS/Fire. But honestly, for the short term....try just getting you core courses for a BS out of the way, with A/P and a language for the short term. Seriously, TAKE a language..and not just a semester...LEARN one. A lot of people like Spanish, but in our area French is almost as valuable (lots of French speaking Africans), and German is good too (Bosians, Serbs, etc usually speak some German) Here's a secret: Your education credentials may get you the interview..but YOU get the job, not your resume. Get some life experience that is valuable to your employer, such as language, travel abroad, internships with social services type of work..the military, anything to make you stand out from the hundreds of young 20-something wanna be firemen/wanna be heroes out there who have only done EMS or hung around wacking off to Rescue Me/Back Draft and nothing else.

I actually have had opposite results. Both the pharmacology, and my personal experience, have had poorer "coverage" or duration of versed verses Valium in SZ control. In terms of actual initial SZ termination, I would say that they are comparable. Also I agree that given IM or IN, versed is indeed more versatile. Also, Versed has a bit more homodynamic trend toward hypotension as well, in my experience. We carried Ativan a short period (18 months) about 5 years ago, and IMHO, it performed abysmally compared to valium, even though the pharmacology says it should work better. Yes, we swapped it out every 2 weeks, so that added cost as well. Finally, after reviewing multiple charts and complaints about the drug, We went back to Valium. Here is our SZ control protocol: http://www.adaweb.net/Portals/0/Paramedics/documents/m06.pdf Here i our pain control and sedation protocol: http://www.adaweb.net/LinkClick.aspx?fileticket=40oCwEva7XE%3d&tabid=798

One of our stations has this, and it is indeed much nicer.

This is where you get the EKG on, press the 12 lead button twice(wich is an over-ride function)and then you move him. It prints out I, II, II, AVL, AVR, and AVF, but leaves your pre-cordial leads blank. it is in diagnostic mode. You dont get an analysis. Seen it done. Done it myself even. Basicaly on a criticaly unstable patient in a place you dont want them (like the bathroom on the toilet), where they are profusely diaphoretic and you would spend 5 minutes getting the precordial leads to stick......but you need to move him now. It is almost always followed by a full 12-lead as scene dynamics permit. It is not a "poor mans 12 lead" to see if you need to put a full 12 lead on, which I have heard mentioned before. If you have that much of a suspician, then do a full 12 lead. Is it ideal, no. Should a 12 lead always be done if you are doing this? I would say yes. Is this a good 5 second bridge action in a cramped place with an unstable patient, it is better than nothing.

In EMS....Associates degree - Definitely. Bachelors..yes, but not just for EMS, but any career field.Especially since most BS/BA programs tend to have a lot of business courses that are useful in a lot of different areas. Firefly medics, did you get your BS through EKU?

OK, I have been doing this for 19 years (soon to be 20). There are only two sub-categories of litigation I have ever heard of actually being pushed at services where I have worked. .... Driving related accidents, and gurney drops. As for medical care issues, its rare unless its something like " someone replaced my Valium with salt water" type of things. And thats pretty rare too. it just doesnt happen very often. In 19 years I gave been to court a LOT as a witness of one type or another, in civil and criminal proceedings, and deposed as well. but as the defendant..no. I had one case many years ago, where I had a early 20's female who was hypotensive, 30-some weeks gravid, and bleeding after her (drunken and violent on scene- had to be arrested) boyfriend hit her in the belly. It took multiple IV attempts to get a line (like ...3). a month later my service got a letter threatening to sue from a a lawyer representing the both of them together (it was just a misunderstanding, after all) for "undue pain and suffering" from the multiple IV attempts. I sat down with the counties legal team. They explained that this letter was simply a fishign scheme to get a nibble at asettlement, and unless the couple had oooodles of money up front for the lawyer to waste..and they didnt...that this would go no where. It went no where. This event was interesting for many reasons. It explained what a volume buisness civil litigation can be. It also illustrates that unless its a "clear cut" case of neglignce that is ALSO against a party with deep (really deep) pockets, or the plaintiff has really deep pockets...most of these CIVIL cases die in utero. Heaven help you if you ever piss of an irrational plaintiff who is a millionaire though, or end up on the wrong end of a CRIMINAL proceeding .

We are "Self insured" , so we set our own standards. We look at a minimum of 7 years. Often take a close look at events in the past 10. We have turned down peopel with minor infractions, but showing a "pattern". If you have a felony DUI (repeat offender, or involving injury to someone) , I don't think we can hire you at all.

You either get a KCM1 ambulance or you get a BLS aid car...either FD or AMR or another private. And those "less critical ALS " calls...go BLS or get the Medic One car. Depends on actually what type of call you are talking about. A year. Depending on the agency, you are either an employee or a contracted employee for the year, then you ar ean employee after that. So you are PAID to go to their program. Nope, it is my understanding that regardless of where you came from, you go through the same program. EMT or Medic. It doesn't matter. I could be wrong, but I dont believe there are any "exceptions" to that rule. Now , to be clear, thats a YEAR of FULL TIME school. 3000 hours. thats DOUBLE what most programs do in TWO years.

All of these agencies answer to the single authority of the medic one system. Up until recently that has been the Iron Hand of Dr. Mike Copass. His influence is still quite substantial. For decades King County has subscribed to the idea of a "high Acuity" EMS system. They run a very low amount of paramedic units (medic units) , but those units only go on critical calls. Add to that the INTENSE training (initial and ongoing) that is phsyician led from the UW school of medicine out of Harborview Hospital...and you have a small core of Highly Trained, highly experience medics unlike most anywhere n the nation. To put it in comparison, today a medic is lucky in most systems to get 12-24 field tubes a year. In many "high availability" systems (like many of the fire based systems in California and Florida)are lucky to do a couple a year. Some places get even less than that. A few years ago a friend of mine got over 50 tubes in the field. So when I say they are a tiered response, high acuity system, they take it to the extreme. The whole system is built around this concept. There are no ALS engines in the county. If you are working as a medic, you are WORKING AS A MEDIC. And unlike most fire based systems, working as a medic is a PROMOTION and an HONOR in that system. Whether you are working for SFD or KCM1, turnover is low, pay/benies/retirement is very good. The other main difference is the emphasis put on the BLScomponent (i.e. the BLS engine first response). My understanding is that these guys are fully bought into the "high Acuity" concept, but also understand that they are the safety net. They also are trained and empowered and over seen by the medic one system. f they get on scene of a "ALS" call that isnt, then they are empowered and even expected to cancel the medic unit and request BLS transport (either an "aid car" -FD BLS transport ambulance or private BLS). On the flip side if they get to a BLS call, and its ALS, they are expected to request the Medic One response. This ensures the ALS rigs are teir for those who need tem, and arnt wasted on toe pain. As far as being a paramedic in the system. it doesn’t matter if you are a 15 year paramedic or a 1 year EMT, you all take the UW paramedic program. This program too is different. It approaches 3000 hours, double what 99% of most program in the US are. It is 99% taught by Doctors. If you dont go through that program, you don’t practice as paramedic in King County. Period. You can work on a BLS ambulance if you want. Or go into one of the neighboring counties. Hope this helps.

With the back raft that is not an issue. http://www.thomasems.com/Back_Raft.html Really, this is one of the best things my department ever invested in. We have been using them for several years and I love them!

TONS of alcohol related silliness and alcohol ODs down town. One year I had a guy showing off jump over a railing, not realizing the ground was 12 feet below! Occasional minor injuries from running through the graveyard and tripping. A lot of taser deployments, batteries, and "assist PD" calls. Alcohol related wrecks. etc etc etc. The thing about here in Idaho is, Halloween is just about the time the first real cold snap hits. So Ive had it snow on Halloween before. The colder it is , the less stupidity you go on. This last Halloween it was unseasonably warm until about 4 AM, then it got real cold for some reason (20's). So it was pretty busy. That and it was a weekend. Me? For once I just went out with the lil kids trick or treating, then fell asleeep at midnight cuddled up watching "casper". Doe sthat mean I'm getting old? LOL!

Do you actually use padding? Under knees? In between knees? Blanket over the board itself? On EVERYONE? We are strongly recommnded to use the "back Raft" inflatable /disposable pads whenever possible, and we probably do on all bu tthe most critical patients. I cant reccomend them enough. In addition, we commonly add padding under the knees, or where ever needed. How do you immobilize head? Do you use head wedges? Cheese blocks. The styrofoam triangles and head pad? Rolled up blankets. Does it depend on patient? Medics choice, tpically wither towell rolls or "sta Blocks" disposable CID. Do you use backboards always? Or do you have the hard foam boards? We only have back boards, though we have a vac matress for back country work. Spider straps? "Box Method"? Straps that click in like an X over chest? Binders? (Pre-ripped sheets that wrap around) Spider straps or long straps in X patterns. Medics Choice. Do you ALWAYS immobilize cervical if immobilizing lower back? Vice-versa? If Im doing full immobilization, though we do practice Selective spinal immobilization here. Do you use tape over the neck? Does it go straight across or angled up (perpendicular to the forehead tape). Medics choice, typically a combination of tape and vwelcro (see reference to "sta-blocs"). Angled. Do you use the arm straps? What do you do for unconscious patient's extremeties. Leave one arm out for IV? All in and you unwrap later for IV access? Depends...

Just to give credit where credt was due, I think you should look at the freedom House Project as most likely the first modern paramedics, not the fire service. And, BTW, the freedom house project was disbanded only after the fire department took over. Just had to show the flag.....

Now I agree that the medic was in the wrong, so I am not defending him. That said... I feel I should offer you a bit of friendly advice. I dont know if It has been specifically discussed, but discussing such detailed specifics of an ongoing diciplinary process in a public forum, especially when you are involved in the disciplinary process (and presumably some kind of leadership position- appointed or implied) , would be grounds for termination in my service I am sure. I know that your a volunteer with a volunteer service, but at the end of the day, your best bet is to approach each leadership conundrum as if you were a paid employee whose reputation and career depended on you getting it right the first time. EMS is a very small world. Just food for thought, respectfully submitted. Thank You. Steve

I believe thats the same carrier our TACMED team used up to recently. It was III-a without the plates. They have switched to the same that the SWAT team uses (not the breach team ,, but the guys right behind them) wich was more compatable with the MOLE/ALICE/WHATEVER systems for pakc and gear. It was also lighter and more manuevrable...but was at least IIIa, but also had plates.

The nebulized epi is for laryngeoedema. We have it in our protocols here at Ada Paramedics in Boise Idaho, and it is very effective. It is given IN ADDITION TO other therapies including SQ/IM Epi, Benadyl, Solumedrol, Zantac, and albuterol. Think of it as topical administration of epi via neb to the very vascular tissues of the airway...the alpha effects of the epi vaso-constrict, reducing swelling, in addition to other therapies. It have very relatively mild symptomatic effects, and I have never seen a problem with it and SQ/IM epi given together. BTW: IM epi is prefered over SQ. I have had patients with a reported and well described anaphylactic reaction to Benadryl. I have heard it described as an allergy to the suspension Benadryl is in, but cant confirm that. What I can tell you is that IF you have a reported allergy to benadryl, then Phenegrgan also is an anti-histamine and a good alternative, although with more sedation issues. We also have this in our protocol.