KSEMT122

Let me first preface this with the fact that I am an EMT so I can not totally stand in your shoes, but a few things jumped out at me. This whole situation sounds like one of those bad dreams where you can't scream "NO"! when something bad is about to happen. Except in this situation you were fully capable of screaming "NO"! Like many have said, it may or may not have made any difference in the outcome. I think the way I read your post you may be feeling bad because you didn't speak your mind. If you had spoke your mind and ran this call yourself at least you would have known you had done everything you could have thought of. A couple things... I've NEVER seen a Fire Medic take control of anything other than a hose and cigarette... As soon as they see the Ambulance they are usually out the door with no more than 1 set of vitals if you're lucky. I darn sure haven't seen one jump in the back of an Ambulance and tech the call. That is YOUR Ambulance, you choose who to let in. You make the decisions. You have to have a voice to tell people that. If you don't these types of things will happen. Go figure, the "ER" Doc (who is probably a dermatologist during the day) missed the tube... I can't tell you how many times I"ve seen this happen. And we seem to be the only ones that catch it time and time again. In fact when you say something you get ignored. The nurses can't believe you are going against "their" doctor so they ignore you or tell you to be "quiet". I've seen very confident medics literally push the doctor out of the way and pull the tube because it wasn't in. Guess what... The Doc might have a fit initially, but once things start to progress in the right direction the Doc realizes he was wrong and usually says nothing afterwards. Of course I ran in a system where we usually would run the codes in the ER because the Docs & Nurses weren't confident enough to run one. So with all that being said. I agree with the people who say "get out of there" and those who say "stay, those patients need you". You should only stay if you can find your voice. If you can't find your voice, it's time to move on to a service with more progressive protocols where hose jockeys can't take control in your ambulance. Hang in there...

https://www.labcorp.com/datasets/labcorp/ht...no/cf002900.htm This isn't the complete formula I was thinking of that I think you can find in the PDR book, but it articulates my point in using the D-Dimer in this patient better than I could.

I'm well aware of this. It's a place to start. There is a formula regarding D-Dimers that takes into consideration risk factors plus the level of the D-Dimer test. A PE can in fact be ruled out to a certain percentage that is quite high if the correct formula is followed. It can also be ruled in to a percentage as well using that formula. I would have to defer to Doc on the ins and outs of that formula. I've tried to find the link and I have been unsuccessful. The point being in using the D-Dimer, it's a place to start. There are many more false positives than false negatives.

With the symptoms you are describing (SOB, Chest Pain, Nausea, vomiting) and this quote above that he is driving a big rig from TX to CA I would suspect a PE. More than likely you are not going to notice a big change in lung sounds although you may. Just because the lungs sound clear doesn't mean he still couldn't have a PE. Once he got to the hospital hopefully somebody ran a D-Dimer just to rule it out. The signs and symptoms of PE's can be short lived and easily missed especially in the field. As far as the ECG goes. I was thinking short runs of V-Tach. Now what part that would play into a PE I have no clue. I've never associated V-Tach or ventricular rhythms with PE's. ST depression and/or tachycardia usually present right along with a PE. Only 13% of people with a PE have a normal ECG. I would call this one abnormal, I think we could all agree with that. I won't argue with the Doc on the interpretation of this rhythm since he's at one end of the spectrum and I'm at the total other end. That was just my first inclination when I saw it.

I have the Littman Classic II. I think it works alright. It is alot more comfortable than some of the el cheapos like Sprague. I wouldn't spend much more than what the Classic II is worth though.

I suppose we should post a link to the United States Border Patrol website so people can know their ACTUAL minimum qualifications. I will quote a snippet of the minimum qualifications. The full link is below. http://www.cbp.gov/xp/cgov/careers/customs...reers/bp_agent/

As a Former Law Enforcement Officer I will tell you this. I'd rather these Border Patrol Agents be on the actual border than 40 miles into my country. I guess the title "BORDER" patrol is lost on the agency. That is probably why the moral is so low at the Border Patrol now. When I was a Police Officer I went out of my way to PROTECT peoples rights, not take them away. I only took rights away when I was mandated by law or policy to do so. It is our right to question authority. The last I knew you had to have one of two things to "detain" someone. Reasonable Suspicion and/or Probable Cause. Neither seemed to be the case here. Even if you tried to apply the lesser of the two standards which is suspicion it wouldn't apply here. The very fact that the supervisor of these Border Patrol agents let this man proceed should tell you that more than likely the Border Patrol itself is questioning the legality of these check points and doesn't want to make a scene. I was once "detained" myself by a rogue Police Officer before becoming one myself. The feeling wasn't a great one. Without going into detail I made it a point when I became a Police Officer to only interject myself into situations that I was needed or called too. I was VERY pro-active, but I NEVER crossed that line of questionable detentions once. I would implore all departments throughout the United States to be the same way.

Ruff is nailing everything on the head in my limited scope of an opinion. The only reason I am even commenting is to commend Ruff for keeping an eye open for the potential of a blood clot. Although at this point it would start to look like that isn't the case. Thank you Ruff. One of the most misdiagnosed things in the ER are PE's.

Taken directly from the OSHA website regarding vaccinations. That at least covers one of the vaccinations you are talking about. I believe the flu shot is covered under OSHA as well, but I don't have the time to look that one up. http://www.osha.gov/pls/oshaweb/owadisp.sh...&p_id=10051

](*,) Advanced education directly related to EMS I would be for. Thank you for putting into words what I apparently could not.

Eydawn- Thank you for trying to take the time to look through my narrow minded eyes. I respect what you said and will ponder it. The only reason I will give it a second thought is because you have chosen a road above the others and not engaged me in a personal attack. So thank you for that. As far as everybody else goes...the heck with ya. If you so called "professionals" can't hold an intelligent conversation without lashing out irrationally at people with opposite views then I fail to see how you could be any good to anyone during an emergency. In the course of one topic I have lost all respect for people I have admired on this site for 3.5 years plus. It is disappointing, but that must be the difference everyone keeps talking about between college grads and non college grads. College taught you that ONLY YOU can be right and all others are wrong. What a waste of money. I could have taught you that for free. So let's address my personal reasons for not being big on REQUIRING a degree in EMS. Someone mentioned money, yes that is part of it. I pride myself on having a good credit rating and not going into debt, ANY type of debt including student loans. Time, my time is valuable, I'd rather stick to the facts of being a Paramedic than spend half of my time learning why Ghandi wiped his butt with his left hand, but wrote with his right. Motivation- In all reality if I wanted to enter a career that required a College degree I'd be a Lawyer instead and make 5 times what Paramedics make. Why would I want to spend the money, time, and effort in getting a college degree to make a whopping $40,000 a year? EMS will NEVER pay people what they deserve degree or not. So there ya go folks. Talk down to me please. Insult my intelligence. Make personal attacks. You are just making my case. DOWN WITH DEGREES!!! UP WITH MONKEYS!!!!!!

You will not learn MORE about being a Paramedic if you get your Associates or even Bachelors degree in it. The only thing you will learn more about is the core classes and whichever electives you decide to take. The Paramedic education doesn't change just because you get into an Associates or Bachelors degree program. I can get the same Paramedic education at a Technical School without all the BS extra classes that have nothing to do with the actual art of being a Paramedic. Now if you'd like to talk about expanding the technicalities of the job, that's fine. Make a degree program somewhere that doesn't involve wasted days and wasted nights (to quote Freddy Fender) dealing with Comp I and II, Math this or that, American History. Not that those aren't great classes, but they have NOTHING to do with being a competent Paramedic. Your High School education SHOULD have taught you what you need to function properly as a Paramedic as far as Math and English go. You're just not going to convince me otherwise. I'm all for education. The more education the better (If that's what tickles your pickle). I just don't buy into the whole "Paramedics with degrees are superior than those without" concept. It's been said time and time again on this forum people would rather have a Medic or EMT with street smarts and experience than one fresh out of College. I know we've said it in Law Enforcement countless times. I've heard it in EMS as well. As far as who I want working on my family or I? I want someone who can do the job and do it well. I don't care what their general educational foundation is. Someone who is confident in their abilities and took their Paramedic program seriously. I could give a crap less about a College degree or not. I don't need someone standing over me correcting my English as I circle the drain. I want a Monkey that knows how to push the damn buttons better than anyone! I said that for dramatic effect, but you get the point.

I meant to say ".....for any and every level of EMS is ridiculous were listened to and actually engaged in the conversation". I would like to state for the record more education can't hurt. It is great if somebody doesn't pursue a degree, but the world doesn't stop and start with a degree. Some may argue the world is progressing that way, but in reality, it doesn't.

This is one way to get the egos overflowing. Bringing up education on this forum does it time and time again. The summary I have upon reading the three pages is basically this. Anyone without a College degree is worthless and those that try to say otherwise are then being thrown under the bus and written off as incompetent. That's really a progression since the last time I've been involved in this argument on here. At least in times past those of us who think REQUIRING College degrees for any and every level of EMS were listened to and actually engaged in the conversation. I see a lot of people with that view now being steam rolled. I don't think that is right and am disappointed to see it. It's always easy to look back AFTER you've gone to College and then tell people "it should be required". That just implies to me a desire to make up for something that may be lacking in ones personal life. It would appear those of you with College degrees want to be the ONLY ones who are in this profession. You don't want anyone else to have a shot at it. Or you only want people who have suffered through College as long as you have to be able to be in EMS. Maybe it upsets those of you who have gone through College to know there are those of us who can accomplish the same things that you do without a College degree, maybe even better. I don't know why egos have to get involved in this discussion. It just makes me roll my eyes and wonder where we really are going as a profession. We may be headed up with education, but I see a terrible downward spiral of attitudes and sense of entitlement. Now I will step out of the way as to not get steam rolled.

Adam, Welcome to the world of EMS. Your teacher will more than likely tell you on the last day "Now toss everything I've said out the window, your real education begins today". It is a fact that the way the textbook says to do things is different in part from how you do them in the field. The textbook is a good guide though, for when you first start and are still learning the basics. You will develop your own style as things progress. It doesn't mean you're not doing things correctly. It just means you've found a more efficient way to assess someone. The goal in EMS is to treat and transport as quickly as possible. So multi-tasking is big in EMS. Such as one partner conducting an assessment on the patient while the other is checking vitals and hooking up the monitor. Just calm down and enjoy the ride. It's a fun one. And remember to always keep learning new things every day for the rest of your EMS career. Never think you've learned it all.