steve_emt_68

In my case, the fact that the regional trauma center wanted to give steroids and the patient had a good outcome would lead a reasonable person to believe that the use of steroids was a beneficial treatment. I believe the initial question asked if anyone had any experience with Solu Medrol and what were they. I gave my opinion and then kicked in the nuts for expressing my opinion. I am to the point of giving up on this site as there seem to be a group who only want to blast anyone who doesn't share their burnt out attitude. Unfortunately those who want to use this site to grow as providers end up getting shot down. Why don't those of you with your bad attitudes go start a new site like crappy EMS providers.com and blast each other!!!

I have personally been involved in giving Solu Medrol for suspected spinal cord injury. I was called for a diving accident where the party was still in the pool and completely flacid. Pt. was removed from the pool and flew him to regional trauma center. When we made contact with the Trauma center, we were given orders to administer 2 grams of Solu Medrol. We only had access to 750mg to administer but flight crew administered what they had and the patient got the balance at the trauma center. Turns out patient had C3 and C4 fracture with pressure on spinal cord. 2 days later patient was walking and today has made a complete recovery. Our service now carries 2+ grams of Solu Medrol on all trucks. This incident made a firm believer out of me for use on spinal injuries in the field.

I personally encourage family members to ride with me. My department performs interfacility transports that last 70 to 100 miles. Having a family member riding in front (seatbelted in) has a calming effect on the patient, eliminates family members from riding our butts for the 100 mile trip, keeps false complaints from being filed against our crews and in the rare case allows family to be with their loved one if they should pass on. I have nothing to hide and therefore have no concerns about "the family" seeing what is going on in the back of the unit. I always size up the family member wanting to ride with us, I inform them of where they need to ride and that they must maintain control if things go wrong. I took a patient from a local hospital to the regional specialty facility. The patient had a 9cm AAA and this was last ditch effort to save the patient. WE allowed the spouse to ride with us so she was at the hospital when her spouse was. She was involved in lifesaving decisions as soon as the patient arrived. Had our patient expired en route, she could have said her goodbyes. We hid nothing and she appreciated the extra time with her loved one. The spouse knew the risks of the trip and was prepared for her husband to pass. Overall, I would not change a thing and I would hope that this would encourage others to review all benefits of having family with you.

If a patient is already using a daily 75mcg Fentanyl patch wouldn't you want to continue with Fentanyl IV for pain control of a long bone fracture versus giving Morphine IV or am I missing something? It just seems like going back to Morphine would be like putting out a forest fire with a syringe.

I am looking for some insight on what other services use as an orientation period for new medic's. We operate a EMT-B/Paramedic crew and we do a combination of Paramedic intercepts and ALS interfacity transports. In the past we have based our orientation on how the medic progresses and how comfortable we feel with the medic. As budgets get tighter, it seems like there is a need to rush medics to the street. What does your organization use as a guideline for orienting new medics?

Trama shears, bandage scissors, stethoscope, forceps, field guide, personal cellphone, work cellphone, alpha-numeric pager, voice pager, wallet, gloves, at least 2 pens, folding knife, carabiner (great for controlling multiple bags/bottles of fluid), and a Tide stick

One of the things you have that you need to keep handy is being scared. What we do as Paramedics is scarry stuff. The first time you take a conscious person and paralyze them to insert an ET tube and you know that their life is in your hands, thats scarry. I have found that having a healthy respect for the skills that you learned will keep you out of trouble. I am not saying that you won't become comfortable with the skills, but rather you need to be respectful of the consequences of using those skills. Someone said it earlier, don't be in a hurry to use everything you learned unless it is necessary. I knew a flight medic who had been in EMS nearly 20 years before she decompressed a chest. When she needed it she used it, but only when it was actually needed. Best of luck to you and congratulations. You seem to be off to a good start as you know you don't know everything.

How about when you mention a patient name, you know you will see them within days. I also have found that every time I have on a new piece of clothing I will get blood or vomit on it.

One of the things that I pushed for and helped make happen was EMS run reviews presented by a nursing clinical manager. We invited all area squads to attend. We also asked squads to volunteer cases for review. We always provided a dinner at no charge and asked at least one physician to attend to give physician insight into the case. We would follow the case thru from dispatch to hospital disposition. We tried to present 3 or 4 cases a night and we did this each quarter. We would have anywhere from 25 to 35 people attend and we gave continuing ed credits. This was a great program, the squads learned from their mistakes but the also got to enjoy what they did right. I don't know too many EMS providers that don't like to know how a patient did after they brought them in.

I personnally like to explain dead as: Dead: just dead DRT: Dead right there, for the moments when someone just drops dead DRFT: Dead right F****** there, for those times when someone is shot dead DRFT & T & T & T: Dead right f****** there and there and there and there, and for those times when they get hit by a train or a semi

In my experience rural EMS forces you to know your protocols better, know your medications better and know the disease process better. Transport times are long, response times feel longer. In the big cities you can practically spit and hit a hospital. Out here in the rural areas, you might be 30 minutes to 2 hours from a hospital. You really do get to see medications work. It is not unusual to work a code on the way to the hospital to have the physician call it when you hit the door, not because you weren't doing it right, but because after 4 or 5 rounds of meds there is nothing left to do. You balance the short term good effects with longer term consequences of the meds (Lasix is a prime example). You have a chance to develop friendships with the physicians and nurses. You earn their trust, they know you by your first name and you know theirs. I also believe that we see more true emergencies and less taxi work. Patients seem to really appreciate what you are doing for them and they regret having to get you out of bed or keep you up late. The best part of rural EMS is getting to know your patients. It is not unusual to pick them up on the 911 call and then transfer them out later the same day. Then in a week or two, you see them downtown. They remember you and you remember them. I can't tell you how many times a patient I transported 6 months ago will seek me out in a store to tell me their story and thank me for the care I provided them even if it was just sitting and visiting with them en route to the city.

I agree that your class only gives you the basics and that you need to research areas where you have questions. As a new EMT, you need to keep it simple. It is not your job to diagnose what is wrong with the patient, you are there to treat the signs and symptoms. I applaude you in that you realize you don't know it all as a new grad. I made it a point to become friends with physicians and nurses that would take the time to explain things to me that I didn't understand. I read alot and asked questions. I have been in EMS for 12 years and still ask questions. A good resource is the American Heart Association website, keep studying and asking questions.

I was very reluctant about the stryker power cot at first. I have come to love it now. Our service is primarily critical transfers so the extra 40lbs is not a big deal. We recommend that both partners lift the foot end to load in the ambulance with one person operating the controls when you have a larger than average patient. I have had a 600lber on the cot and it worked great. I would not want to use it for 911 calls as the additional weight of the cot will catch up with you at the end of the day.

The dispatch center dispatched EMS to a rollover accident with ejaculation. How bad is it when you actually get ejaculated from the vehicle and I guess we know what was on the dispatchers mind.

Why are you embarassed? is it because you can't carry on an intellegant conversation with your partners or because of the care they provide? I have worked with college educated paramedics who scare the hell out of me. They only get the minimum required hours of continuing education. They have the attitude about new things that "I don't know anything about that because I didn't learn it in school". Are these college educated paramedic's PROFESSIONALS? I don't believe they are. Is the guy who took 2 years to take night classes to get his paramedic license less of a professional? What if he goes and takes every extra class possible? How about once he gets his CCEMT-P? Does that make him a professional? I ask all of you, Where exactly in your ambulance do you hang your college diploma? I have never had a patient ask me if I went to college or which college I went to. My point is that the public judges us on our actions. The ER judges us on our actions and dress. Try walking into a busy ER in jeans and a t-shirt and have your EMT-B partner come in with dress white shirt and EMS pants, see who the nurses talk to for report. I will not disagree with you that the more knowlege we have about the human body the better off our patient's will be in the long run, does taking a class in art history really help you in the field. Education is the foundation of our professon, a college degree is not the answer. Professionalism amoungst our providers is the key. We both have differn't approaches to professionalism, mine being personal responsibility. As a profession, we must weed out those who are lazy, carefree and only in it for the money. I would consider this to be the first step in becoming a profession. As far as belittling the nurses whom I work with, I don't belive I belittled them. I stated facts, In the field if a patient needs Adenosine I give it, If they have pain, I can control it. If my patient needs RSI, I do it. I don't ask for permission, I evaluate, assess and act. In the ER if my patient needs Adenosine, I call the on-call Doc, inform him of what is going on and wait for his orders. If they need RSI, I call the Doc and when he tells me I call the CRNA. If you would take the majority of nurses and put them in a cold, dark and wet ditch in an upside down car they wouldn't know where to begin. Try having two nurses run a code and see how that goes. Most nurses will tell you that they wouldn't want our jobs which is fine, I don't want theirs.

Wrong, many of my best fiends are nurses, I date a nurse. I work in an ER and help on the nursing floor when not on calls. I know what I can do in the field and what I have to wait for an order to do when in house. EMS providers get it done in the field without having someone tell us to tart an IV or give adenosine or take a blood sugar. When I work the ER I have to call the doctor to get an order to start a line or get a 12 lead EKG. My point all along is that as EMS providers we need to be independent thinkers, having a college education will not make us better providers. The answer to many of EMS problems is funding as stated earlier in the thread. The other problem is the way we act as professionals. Having lived in a college town for the first 30 years of my life, I can tell you that being a college grad didn't make you any more mature or respected than the kid who went to technical school or who got a job right out of high school. Matter of fact, I was the kid who went to technical school and then worked a blue collar job. I did get pretty good service from the college grads at Mc Donalds at lunch time! IF WE WANT TO BE VIEWED AS PROFESSIONALS WE MUST ACT LIKE PROFESSIONALS! No matter the education we receive the way we behave, dress, speak and act will dictate how people view us.

No, I am not comparing EMT to school to the "American" education system. I look at what all schools want from their students matter of fact what most employers want from their employees... SHEEP! follow along don't ask questions go about blindly do what you are told without asking. In a truely effective EMS system you want... NO YOU NEED independent thinkers who can make a decision based on what they see or hear or smell or sense. They do not teach this in school, book smarts don't help. Like I previously said EMS is attrative to independent thinkers who know how to make decisions without someone standing over them telling them what to do. People who need to have someone tell them what to do are called NURSES!!!

Way back when I went to "night" school to be an EMT, I thought there is no way that I would want a "C" student working on me or my family. Then I worked with a partner who was book smart, A+ student Common sense stupid. I'll take the "C" student everytime as long as they have common sense. Our profession was founded on the principals of being thrown into a situation and think your way out. Common sense rules good EMS providers. The American Education system doesn't want independent thinkers, they want sheep. They want everyone to do as they are told, don't think just do. That is why so many people who are independent thinkers are attracted to our profession. We have the freedom to be our own persons and use our brains. College education will only weed out the independent thinkers and force them to go into other career paths. I don't work in a mother may I system, I work where I have a set of very liberal protocols and a very large drug bag and I am expected to use it as I see necessary. Perhaps in the mother may I systems the college educated sheep would be beneficial, in my part of the world, no thanks. I'll take the "C" student with the common sense.

Glucagon has the effect of an immediate increase in BGL that will fall off without a carbohydrate. Glucagon releases glucose stores from the liver and is meant to only be administered once in a 24 hour period. I was once called to a nursing home for a bruetal diabetic who was yo yoing all night. Upon our exam and interview, the nursing staff stated that they had administered Glucagon at least 3 times during the night but the patient couldn't maintain an adequate blood glucose reading. My partner and I took a BGL reading which was low, started an IV and administered D50. Patient alert and oriented. We transported to hospital for direct admit. Found out later that the nursing home staff called our Medical Director to complain that we took too long on-scene and checked his BGL and started an IV when they had told us his BGL was low. We should have just transported. Turns out, nursing staff never feed the patient after Glucagon so he would drop off and since his liver's supply of glucose had been depleated he wouldn't maintain his LOC. When I pointed out to the Doc that the patient was never feed all was ok and we did the right thing. As far as the Thiamen goes, we took it off the truck once we found out that you actually have up to 24 hours to administer it to a patient after D50. We just made it a point to inform nursing staff that we had not administered any Thiamen. We didn't have any arguements with any of the Medical Staff for not carrying it on the truck.

Ok, without trying to cause a rebellion. Education is very important but requiring a degree in a field that has historically attracted those who didn't want to go to college is not going to help our recruitment efforts. I for one would not be in EMS if I had to sit in a classroom and take college credits for things I felt were unrelated to my choosen profession. Much of our problem in EMS lies within attitudes of those working in the profession. We have too many people who go through the motions of responding to calls. We have people who have to be on the fire engien because it is their rotation. In my opinion, Fire based EMS has a hugh detremental effect due to the fact that too many are forced into EMS duty. Medicare and insurance companies have played a major roll in the demise of private EMS organizations due to low reimbursements, thus forcing companies to put off repairing and/or replaceing equipment. Organizations have been forced to work short staffed by financial constraints. The latest technology is too expensive as well as the newest drug therapies. I do not see how having college educated EMS professionals will help us become recognized as a profession. We need to act like a profession. This means our actions our dress our speech our attitudes. It means not having Paramedics in the news because they stole narcotics or abused a patient. It means not being arrested for drunk driving while operating the ambulance. It means not wearing shorts, a wife beater and flip flops to calls. It means no more running down to the diner to talk about your last great call or worse yet the really nasty call. It means not standing at the convenience store telling off color jokes where others can hear you. Each of our organizations must make it a point of educating the public about EMS. You personally must make it your mission to educate the public about EMS. We all must hold each other to the highest standards. Quit covering up for the crappy EMS providers in your organization, clean house. Do you represent EMS as a true professional on and off duty? As a manager, I have had to remind employees in the past that those that you party with on saturday night may be your patient on sunday morning. I ask you again, do you represent EMS as a professional on and off duty or are you only a professional when you are in uniform or worse yet when you are on the clock? The short term answer to the question is in our attitudes as EMS providers, are we promoting ourselves as well as the fire service has done over the years. How many organizations actively promote EMS week? Fire departments promote Fire awareness. How many of your squads are sparkling clean right now? Fire trucks are. How many of your stations are spotlessly clean? Fire departments are. My point is that the public views them as professionals, are we living up to that same standard. Unfortunately the standards for public safety workers was set long before EMS was even a reality. We must first act like professionals before we change the requirements to become a professional.

Perhaps the systems you are used to is much differen't than what we have in Nebraska. This system truely does work. In addition to simultaneous dispatch we have also trained the Volunteer squads to request us when needed. I am not sure how much use a Paramedic will be in a community of 300 who might run 10 calls a year. How sharp on his skills will he be? Honestly, in our system we see ALS dispatched simultaneously in 75% of all calls. My point was that for communities that cannot afford fulltime ALS, Our system works. It is the best of both worlds. How do you fund a system that requires 3 or 4 fulltime ALS crews to ensure transport coverage for 6 hospitals that frequently has two trucks on 3.5 to 6 hour interfacility transports and provide ALS coverage to 2,500+ square miles? The cost involved would be stagering not to mention response times that alone would kill patients. By having BLS squads in each community, care begins sooner with lifesaving interventions (including Advanced airway, IV access, neb tx, glucometer, etc). I believe that there is a place for BLS volunteer squads especially in rural Nebraska. We don't live in an area where you can spit and hit a hospital, transports here can be 30 minutes or more. Head to western Nebraska and transports can exceed 1 hour. In the perfect world we would have better training, more ALS crews and fewer stupid people (lower call volumes) until then, I like our system and no I don't get to cherry pick my calls, I still go on nausea and vomiting and GI bleeds, I go when the pager goes off at 5am or 3pm, it doesn't matter. They call, I haul.

JakeEMT, Unfortunately having ALS on every call isn't going to happen overnight so therefore it is better that we provide ALS when available which right now is approximately 95% of the time. If we were in an all or nothing situation no one would get ALS. I believe that we really do have a win win situation. By working with the volunteer squads we have improved their level of care and instilled confidence in their skills so that when we aren't there they can do their best. The communities still get immediate response while waiting on ALS. The hospitals get more to work with by having ALS respond and having ALS there to transfer out their patients and our crews gain valuable experience by working in the hospital environment. Apparently you have some great disrespect for the volunteers in your area, that is unfortunate. I too have worked with poor volunteer squads. I however became involved with the squads to improve patient care. I currently serve as the training director for my local squad, we actually work on EMS skills not just rehashing old war stories. This country was built on the volunteer spirit and I have seen many a paid squads who just go thru the motions because it is their job and when the end of shift comes they care less. You truely will not find people more engaged in patient care then the volunteers of the local squad. Sure they lack experience, knowlege and skills but they never lack dedication. That is why the system that we have is a win win. The volunteers do their thing provide BLS care and do it right now and ALS arrives and takes over. WIN WIN.

As a Paramedic serving a rural area of Nebraska and a member of the local BLS squad, I think we have figured out a system that works well for Nebraska. I am employed by the local Critical Access Hospital to provide interfacility transports. I also respond to 911 calls for Paramedic intercepts. We have found that our system works well. We provide ALS to our community when we are available. The system works so well that we now cover six critical access hospitals with two stations and are looking at additional expansion at the request of outlying hospitals. We also work the emergency room of our two primary hospitals when not responding to calls. This allows our medics to stay proficient in skills like IV starts, rhythm strips and intubations, We also are exposed to numerous prescription medications that help us when in the field assessing our patients. Working in the ER also helps us "prove ourselves to the physicians in the area and builds trust with them. As in many rural areas, it is impractical to have a Paramedic on every truck, this system allows the communities to maintain their local volunteer squad while still receiving the benefits of ALS care and it allows the Critical Access Hospitals to have access to qualified interfacility transports without burdoning the local squads and pulling nurses from the hospital. This is truely a win win situation.