primemedic01

Would this mean you don't have BLS crews doing interfacility transfers? Because you would be downgrading care if you had someone in an ER being transfered BLS to a more appropriate facility. So, you wouldn't beable to go from RN's and ER Physicians to a BLS crew, regardless of patient condition?

I think that the only time I would use a true tourniquet would be for a serious crush injury, in which they are probably going to lose the limb anyway. With a tourniquet I know I'm not gonna save the limb, but atleast I'll keep the pt. from bleeding out. I would certainly not use a tourniquet for a clean amputation. For christ sakes the guy (or girl) just cut off their hand, and you're gonna cut off circulation to the limb so more tissue dies and they have to amputate it even further up? And lets be honest, a lot of people think you cut you hand off and it just squirts out everywhere and doesn't stop. Clean amputations DO NOT bleed that much, and are definitely not a life threatening injury. A tourniquet would (almost always) not be indicated for a clean amputation.

I think I'll get in on this...

No man I'm not joking. I bought an old van style ambulance that AMR was getting rid of and modified to my liking. Then I spent three entire month's paychecks on getting all this cool stuff from a Gall's catalog. Now I just drive around the city, everynight, even on the weekends, and just wait for things to happen, so I can bust out my skills and hopefully impress a person or two. Who knows, maybe I'll even get a date out of it... Also, please refer to my post on the second page (second post from the top)

We don't use the term jump bags either. On our trucks you got the red bag, and the orange bag. Red for medical, orange for trauma.

For this application, I don't think the BP cuff should be referred to as a tourniquet. A tourniquet is used to shut off all blood flow to an extremity, which isn't what it's being used for in this example. I'd consider it more of a mechanical pressure. It's doing the exact same job as if you were to use a pressure point method, just with a constant and increased force, and it allows you to use your hands for other things. I think the problem a lot of times with being able to control major bleeds is that people usually do not apply enough manual pressure. Most people don't realize that 50-60 lbs of pressure is what is needed to effectively control a bleed. This, along with some who may be in fear of causing pain or further injury hinders their actual ability to control it. This technique would absolutely be acceptable, granted you are just using it to control severe bleeding, and are allowing some to escape, as someone had previously stated. This will help prevent and manage hypoperfusion, and the light flow will prevent it from completely clotting, which will reduce the risk of a blow out when it is removed. I'd think something to consider would be to apply direct pressure to the wound after setting the BP Cuff proximal to the site, which would cause the actual injury to close, instead of only reducing the amount of blood flowing to it. It's 1am and I'm half asleep. Can someone let me know if what I'm saying makes sense. For some reason something just doesn't feel right, like I'm missing or forgetting something. I'll check back in the morning to re read what I submitted and make edits accordingly.

Brilliant.

Yeah, in all honesty, all I have is a few pairs of gloves, a pocket mask, and anything else (like someone had previously stated) that I pull out of my pockets when I get off shift and throw in the back seat...

You know what's funny, I wrote this whole thing out once, and something happened and I had to start over, and I made a point in the first to include the badge, but forgot it in the second. So I just updated for you...

How could I forget my SCBA, HAZ MAT Suit, DIVE Rescue Suit and Radiation Detector, Traffic Cones, Flares, Loli Pops for the children, Spider man, power ranger, barbie, and power puff girl bandaids, Tow Hitch, Blow Up Raft, Parachute, Life Preservers, GPS tracking, oh yeah... And ONStar.

Oh man, where do I start In my POV I have: Dyna Med BLS Trauma Kit (Fully Stocked) Dyna Med ALS Trauma Kit (Fully Stocked) Dyna Med ALS Airway Kit including - O2 (with three back up tanks), intubation kit, 5 pedi NCs, 5 Adult NCs, 5 Pedi NRs, 5 Adult NRs, 2 Pedi BVMs, 2 Adult BVMs, 2 CombiTubes, various sized airway adjuncts, Suction (Battery Powered and Hand Powered), Cric Kit, etc... Various sized Collars Dyna Med Long Board Dyna Med Short Board KED Stokes Scoop Stretcher Stair Chair 5 - 1000 Bags of NS 10 each - 24 gauge, 22 gauge, 20 gauge, 18 gauge, 16 gauge, 14 gauge catheters Various ALS Medications OB Kit Gunshot Kit Various CB Radios, Lights, Sirens I got one of those cool Decal Kits from Galls, so people and identify and flag me down if needed in an emergency Life Pack 12 Back up AED Spotlight with 3,000,000 candle power Full sized maglights (1 blue, 1 red, 1 black) Pedi BP Kit Adult BP Kit 7 Differently Styled Stethoscopes 6 pairs of backup shears 53 clip boards, with three packs of 100 pens each, just in case I have to handle an MCI alone, and need to get Patient Information Tape Measure Window Punch Broselow Tape Haligan 6 Different Fire Extinguishers Airbags for extrication Jaws of Life w/ generator Accident reconstruction kit 17 body bags Battery powered cooler for Body Parts 10 lb Sledge Hammer with interchangle rubber and metal mallets. Circular Saw Chain Saw (just a mini, I don't wanna be too extreme and be labeled as one of those Wackleer people) Well that's is some of what I have... I don't wanna keep going, I know everyone is getting jealous And as for what I keep on my person: I'm usually always wearing my BDU styles pants, with my pockets filled with various life saving equipment and supplies. I keep two pairs of shears in my breacher pocket, along with a mini maglight. On my Duty belt, I have a different pager for the surrounding three towns, so I can hear everything that is going on. I have two personal cell phones, just in case I have to call 911 and a battery dies. I have two holsters that carry a total of 4 trauma shears, 2 bandage shears. 2 tweezers, and 2 mini mags. I also have a glove pouch that holds thirteen pairs of gloves. I also carry five more extra pairs in each of my back pockets. I also have my fanny pack with a basic first aid kit, pocket mask, glucometer, and my Glock. I also always make sure I'm wearing a t-shirt that easily Identifies me as a healthcare provider. I make sure I always have my badge with me, which I keep on a chain around my neck at all times, along with a back up in my wallet, on my belt, and in my glovebox. I also keep a pair of shears in each of my boots, and also a 14" hunting knife strapped to both my legs. I guess that is most of it, but there is probably more. My new Gall's Catalog just came in today also, so I'll beable to update this list significantly tomorrow. Gotta love next day shipping. Stay Safe

1 pr shears 1 Black Pen 1 Pad Post-It's 1 Glove Pouch w/ 1 pr gloves 1 pr gloves in back pocket Cell Phone (Stays on truck and OFF while on calls) 1 Mini LED Flashlight (Stays on Truck unless I think I'll need it) My wallet type thing, which isn't even really a wallet. It's just like 1/3 of a tri-fold wallet w/ License, Certs, Insurance Card, Cash (If i'm lucky), Bank card etc... I guess that's it.

Consider Ipratropium 0.5mg with albuterol 2.5mg with 3mL NS via Neb p.r.n x1 Consider repeat Albuterol 2.5mg with 3mL NS via Neb p.r.n. q 5 min Consider Levalbuterol 1.25mg via Neb Consider Methylprednisolone 125mg IV With no response to Neb treatments and "impending respiratory failure" consider 0.3mg (0.3mL) Epi 1:1000 SQ or IM Magnesium Sulfate 2g in 100mL NS IV over 10 minutes

99% of everything that has been said is definitely NOT too much to ask of a new EMT. Most of it is actually common sense, apart from spiking bags, placing LA, RA, LL, and RL electrodes, setting up locks, etc, which are all extremely easy skills that I had down pat by the end of my first day as a Basic. Anything that has been said that really sounds outragous probably wasn't said with all seriousness. Also, I'm not really sure what feeling you are talking about MAGICFITZPATRICK having as a new guy. Let me quote the post he just made for you. So, obviously he likes the advice that has been given, so why are you telling people to stop? You shouldn't ever come into the situation of not having your truck clean when you get on scene. The truck should be cleaned before you are back in service. This also shouldn't be done in "downtime". This should be done at the hospital, when you are cleaning the truck, BEFORE you are back in service. Have a great Saturday everyone. Stay safe.

Yep, that's what I was going for. Exaggerating on a previous thread about whether or not people should carry pocket knives etc... on the bus.

When I referred to the "Bastard child of EMS", it was in regards to the education and certification process and organization, not the actual Intermediates themselves. Also, if you want to be completely technical, the Intermediate is a Basic with more advanced skills. So is the Paramedic. Remember, the Basic is the BASE of all advanced levels of pre hospital care. I don't recall anyone insulting smaller communities. I do however recall a point being made more than once that Intermediates play a vital role in EMS in a lot of smaller communities. Also, I don't believe anybody said smaller towns don't have Paramedics. It was stated that smaller towns don't have as many, nor do they have as much money to budget them. This is a fact that you are just going to have to live with. Please take into consideration that in most of these posts (and I even clarified this in mine) people are stating their opinions on the use of the Intermediate in their areas. Don't take it as a personal attack against you or your service. It's childish. I'm also curious as to who all of these paragods you are referring to are. There is really only one medic on here who I could see you taking his post as insulting. He does however make legitimate points to back up his opinion. All others were either Intermediates, Basics/Students, or Medics who agreed that the Intermediate is an important level of EMS. No one insulted your intelligence, let alone all Intermediates as a whole. So I'm not really sure as to where you are coming from with this. There were some questions raised upon one of the posters, but that was between him and another respective poster. I'm sure he doesn't need you to defend him, he did pretty well on his own. Your level of training wouldn't make me question your intelligence. I know Basics that are smarter than some medics This post does however make me question your reading and comprehension skills. On the first day of my Intermediate class, my teacher stressed that when writing reports and communicating with people in general, you should always be as grammatically proper as possible. When your writing is sloppy, people will assume you are sloppy. You WILL be judged on how well you present information. If you want people here to respect you and your intelligence, this post probably wasn't the best thing to boost your credibility in that department. Was this a quote that you just decided we needed to see, because I don't see it's relevance with this topic. More than 90% of the posters on this thread, that you were probably offended by, were either intermediates, intermediates at one point, or in school to be an intermediate, like myself. I'm fairly certain that this gives them the right to their own opinion regarding something they are directly involved in, and it also means that they have walked a mile in the aforementioned shoes. No one on this thread was judgmental, just opinionated. If you have a hard time dealing with opinions, then a message forum certainly isn't the place for you. So my advice would be to get off here and pull up the google webpage (www.google.com). Then search statistics and more information regarding the EMT-INTERMEDIATE in the United States, and you might find that things in other places of the country might be a little different than they are in your small backwoods town. Nighty Night all.

I definitely agree that in some areas the Intermediates are absolutely vital to the operation of an EMS system. And I think I may have described the NH system in a way that made it come across as if I thought that Intermediates are mundane and not needed/used. My criticism was directed more towards the curriculum and the process to become certified, rather than that actual role of the intermediate. I don't think the actual education is bad, depending on what program you attend. The intermediate certainly plays a large role in areas of NH. Especially in the smaller volly departments where they A.) can't budget medics and B.) Most who get any type of EMS cert (FR, Basic) and work for a volly fire department aren't really interested in the medical aspect of the job (Please notice that I have said MOST, and not all. This is how it is in my area, and I'm not meaning to offend anyone who works for a volly department), and have only gone through those programs because they were required too. In my Basic class, I was the ONLY one in there who A.) Had an interest in medical care, and B.) Had the intention of furthering my knowledge as a pre hospital provider. EVERYONE else in the class was from one of the small volly departments from around my area that had no interest in the class, and didn't really pay attention or care about really understanding the information being given to them. I guess what I'm getting at is that Intermediates definitely serve a purpose in those small towns that don't have medics and need more people other than those who are Basics just to be Basics. Intermediates also help the larger communities provide 100% ALS coverage. Where I live the Fire Dept has 80 Full time firefighters, with much more than half being medics. The rest are mostly intermediates (with the exception of a few officers who are basics, and have been there since before they started only hiring medics). The dept is set up so that no matter which piece of apparatus roles out of the bay, there will be a medic on it. The normal man power on an engine is an operator, an officer, a medic, and an intermediate. The normal staffing of a medic unit is either a medic and an intermediate, or medic and a medic. This system has worked out very well for them, with my community having some of the most highly respected medics in the region, and being one of only seven fire dept based ambulance services (and one of two ambulance services in all of New England) to achieve national accreditation (caas). Thanks!

In addition to that I remembered another silly fact about the NH Intermediate. Regardless of how the curriculum has been built upon the I-85, the NR tests the actual I-85 curriculum. So you would think that because the education has more skills and is more in depth than the original I-85, that it would actually make the NR test easier. The problem is that you actually have to downplay your knowledge, because taking the test is like pretending it's 1985 again. For example, you are dispatched to an unconscious person and find a patient unresponsive, apneic and pulse-less. You could have the answers A.) Pronounce DOA. B.) Ventilate, Begin CPR, Start IV C.) Ventilate, Begin CPR, Defib D.) Detailed Physical Assessment and obtain Sample History. Now according to the actual course (and common sense) the answer would be C. But because in 1985 I's didn't defib, you actually have to choose B. Not to big of a deal, and I don't think it will really be problem for me, but I can see where a lot of people will choose the obvious answer, not thinking that they actually have to pretend its the year of the Ox. Finished ranting. Time for night night.

I have a little phone clip that I use when I'm on duty, but it comes off when I get on the rig and it stays there while i'm on a call. I don't like having it in my pocket because it's just uncomfortable. I try to be as light and as comfortable as I can be. All I carry is my wallet, a tiny pouch with an extra set of gloves, shears, a pen, a post it note pad in my back pocket, and a stethoscope while i'm on the call (granted it's not something like a kid who broke his ankle on a trampoline). At night I'll throw a little mini maglight in my pocket when I get out of the truck.

I wouldn't hold your breath on this. As long as there are teenagers there wil be ignorance. And unfortunately you were lucky that you learned from a classmate dying, because death of a friend doesn't always make kids learn, and nor does cheating death. Almost a year ago one of my little sisters best friends died 2 months into their senior year. He was the unrestrained passenger of a mid sized sedan, that struck a very large oak tree head on, no skid marks, no evidence of an attempt to miss it. Investigators estimated a speed of approx 90MPH. Both the driver and passenger were extremely intoxicated. As the driver was pulled from the vehicle (extrication for both occupants was upwards to an hour due to the extreme damage to the car) he was still clutching a bud light can in his hand. Both were transported by ground to the area level 2 trauma center, approx 10-13 minutes away in Manchester (Medflight was grounded due to weather conditions). The driver died approx 4 hrs after the crash in the OR from significant chest, abdominal and pelvic injuries. The passenger was later transported to Catholic Medical Center, also in Manchester, and then later airlifted to Dartmouth Hitchcock in Lebanon. He died there about 3-4 days later due to a torn aorta. He was basically a vegetable and his parents had to make that difficult decision to pull the plug. He had a twin brother and an older sister. Basically what I'm really getting at, is that one of their friends had the nerve to place an empty bud light can next to the tree with all the other items that students placed there. Like they thought it was honoring them or something. Because my sister had been such good friends with the passenger, I had gotten to know him pretty well too So when I went to the tree to lay some flowers, and saw the beer can I became absolutely furious. I crushed it up and threw it in the woods. Then, another story bridging from this. During the funeral for the passenger, one of their friends was non stop talking about how he was never going to drive drunk again, never going to get f ucked up again, etc etc etc. Well about 2 months after this accident, this kid got piss drunk and jumped in his car because he was pissed at his friends. He got about a half mile down the road, hit a telephone pole head on, and got partially ejected from the drivers side window. His friends had started to follow him (the argument was because the friends wouldn't let him get in his car, and they tried to take his keys), and found him hanging out the window seizuring (so they say, he wasn't seizuring when the first medic unit arrived). He was airlifted from the scene to Boston, and spent 2 months in the ICU for a head injury. To this day this kid still goes out and gets fcuked up. So like I said, you were lucky, because some kids don't even smarten up when they cheat death. RIP Steven Hodgeman 2/2/88-11/7/05

I'm at the point now where I'll think about it, reach back to put it on, and I've already strapped it across my chest. Putting it on has just become completely involuntary and mindless for me, I don't even realize that it happens. That's why it blows my mind when people die because they weren't wearing it. I mean honestly, it takes absolutely 0% effort to put your hand up, grasp, pull down, and push in. And come on now, don't sit there and tell me you don't want to wear it because it's not comfortable. Millions of people can wear them and not complain. I don't know, I guess I just don't understand some people sometimes. In NH they started a new thing the year after I got my license. When I got mine, you couldn't drive without a parent or someone over 25 the first 90 days after you got your license. Then after that first 90 days there were no rules, just couldn't drive between 1am and 5 am until you were 18. This was pretty stupid because most kids would get there license, not drive for 90 days because they didn't want to look like idiots driving with there parents, and then get behind the wheel with all their friends. You could imagine how well this DIDN'T work. Now, there's still a probationary period, but it's a little different. When you get your license you don't have to drive with a parent, but you can't drive with more than 1 person that isn't related to you. So you can only have 1 friend in the car with you. Now, if you are best friends with all your cousins then you've found a loop hole, because as long as they are related to you, you can have as many people as the car will permit. I'm not absolutely positive on what the timeframe for this is, but I think it is longer than the 90 days.

Sorry to open up an older thread, but I'm curious as to what actions were actually taken and what the outcome for the patients were. PRPG?

I"ve designed this diagram for us to study and hopefully educate ourselves in the ways of the whacker. Disclaimer: Please be aware that this photo, although extremely lifelike and accurate, is in no way portraying any real life entity. This has been created for educational purposes, and should be used for just that.

I apologize. I'll remember that next time.

Ok, I think we can all agree that the EMT-I is the most unorganized pre hosptial provider level in the United States. With the Basic, there is basically one curriculum throughout the country, that almost every state follows. Same with the medic. Then, with the EMT-I, there are over 300 separate curriculum's that are utilized by all 50 states. The I-85 course is generally the basis of the original pre hospital provider, the paramedic, which was then built upon to what we know as the medic today. Then the Basic, which was created to allow services to hire people that could handle the "basics" of trauma and medical emergencies, and save communities time and money. As we all know in 1985 the DOT created the middle level, the intermediate, hence I-85, which was the EMT-B with IV therapy and slightly more advanced assessment. No meds, no EKGs, no defib, no ET, etc. In theory this is a 64 hour course. In 1999, with a growing demand for more advanced pre hospital care, the DOT decided to revise this level with the I-99. This went ahead to include 10 Meds, interpreting rhythms, defib, ET tubing etc, with a standard course being approx 400 hours, which was the same course length as the original "paramedic". The problem today, is that there are so many variations of both these I-85 and I-99 curriculum's, that it has become a complete fuster cluck. I believe that the only two states to utilize the complete I-99 are Maine and Colorado. Some don't use any, some use the standard I-85, and like NH, some have courses that use the I-85 as a basis, and have built upon it to include 10 Meds, Rhythms, Defib, ET etc. The NH curriculum is approx 200 hrs plus clinical time. The problem though, with taking it in NH, is that unless you are going to work in NH, you are kind of screwed. In Mass, it is generally the same course, except, you need to have 10 ET tubes in the OR in order to get your license. In NH this is not needed. Which means you need to accomplish this on your on time, which can be extremely difficult to do in Mass with the number of people that are trying to get it done. If you go to Maine, you don't have sufficient training because they utilize the full I-99. There is also a reason that makes it difficult to use NH training in VT, but I can't recall exactly what it is off the top of my head, so I'm not even going to try. So basically the EMT-I has become the bastard child of EMS. It definitely depends on where you live and where you work as to whether or not it is even worth it for you to waste your time. It is definitely a waste of time in Mass because there is such a high concentration of medics, that finding a job is damn near impossible. In NH it makes a little more sense because the job opportunities are definitely there. I still agree with most though in saying that you should go big or go home. And I'm saying this even while I am right now in an EMT-I class. I am taking for the fact that, I don't have a very big background in A&P and Pathophysiology, so I'd like to do this, strengthen by basic skills more, and also start the process of learning all I can in advanced medicine. I absolutely plan on starting my education in paramedicine by next fall, and I think I will be able to learn a lot more and a lot easier (not saying that by taking the intermediate I will blow through the medic course, I know this is absolutely not the case), but I definitely have a better understanding for what is being thrown at me than someone who is fresh out of a basic class. And hey, I have the time and money to blow. If you're still with me after that long drawn out rant, thanks for listening.