Niftymedi911

I have to agree with above. Simply put, one of the 5 rings of survival for CPR is early bystander CPR. The less time the body is without the pulse the better. King County system captializes on this issue. You can't really compare different agencies, they are all different in areas others aren't. But we still try to anyway, its fun Of course, you have the old dinosaurs of yesterday still in effect, like in our county. 17 of our 22 fire districts in Lee County are "ALS" and 1 "EMS" ALS transport agency that covers all of Lee County and serves a mutual aid agreement between Lehigh Acres (ALS FD transport) and Fort Myers Beach (ALS FD transport), we dont have a tiered response system. Of course in fashion we still send an engine and ambulance to every call and run L&S to everything

We just don't give propofol as a single dose. A propofol drip is given in a dedicated line, at the correct flow rate (our protocol). This rate keeps a pt under sedation. The only thing that sucks is the half life for the drug is so short. By the time the nurse asks you to DC the Diprivan and remove it from the hub, the pt is already slowly coming around. We just recieved capnography down here, oh by the way if you want capnography, do not buy the Zoll M series!! It took 2 yrs and 6 months for them to design, test and install a ETCO2 module for our monitors. We just got capnography about 4 months ago bc of Zoll. But our RSI program has been in effect since 2004. I've also been caught laughing at the nurses' sometimes, bc as soon as they tell us to stop the drip, (the doc's in the ER's down here flip out when we bring a pt in on propofol, I don't know why Spock, seeing as I too have seen it widely used in the ICU's) they're screaming for the doc for orders, bc they can't keep the pt down.

The RSI protocol we have called CAM (Crash Airway Management), is I feel very aggressive, sometimes a little too aggressive, but it gets the job done. We ultilize the combo of Succ's, Etomidate to chemically render them useless and the Diprivan to maintain the sedation

Dear Zoll the maker of our beloved M series Monitors, Your monitors are peices of doo doo. For about 10,000 a piece, they're the most expensive. They are a waste of much needed rescources that my agency can redirect in another area. ( Raises, a 10,000 dollar raise would be nice ) Your ETCO2 piggy back machine is a joke, (which you claim it to be 100% reliable) You did mean 100% unreliable right? Oh you mean so we have to re-zero it everytime we turn it on? Oh ok I thought that it was zeroed and never needed to be re-zeroed. Your NIBP is probably about the only thing its good for. 12 lead is less then legitamate, and the SPo2 is telling me I'm 74 % on RA on a 85 degree weather day. That one was funny!!! I cannot believe you guys even allow your monitor to be used on the president (when he ever needs it). I would much prefer the LP 12's any day, given they're not as "flashy" as yours. They are flawed as well, but nowhere as bad as yours. In conclusion, I would much prefer in ultilizing LP12's then allowing your monitor to be used on my family. BTW be careful those "ghost pacer spikes" will get ya!! Sincerely, The Zoll Zealot My name is Zoll Zealot and I approved this message.

=D> Well put Dust, I give you +15 for that one

Ok, I just sent a private message to Ruff on yur rebuttles: I am in the FTO program to credential up as a medic in my agency. I'm currently working under my EMT-B license until I credential, then it will switch over to my EMT-P license I obtained in Nov. I know it seems a little far fetched but, yes Ruff I have someone else in the back with me to assist in setting things up. The FTO trucks have a 3 man crew. So, maybe I should recanter and state that before I mislead you, sorry bout that. And again I dont continually do the 8 minutes, its just if I have to bc of short transport time, I can get it done. Majority of the time I'll have everything done by the time I get to the ER but its normally a 15 minute transport time. I needed to say that. But it was getting to be late as I'm on the last part of my 48. I know with my other posts I kind of blew myself out of the water with credability etc, so if you guys dont believe me thats fine. But I do want you guys to know that before I even went to medic school, I took a 12 lead course ( for CEU's) on interpreting them. I also went on and finished all of my classes but my core paramedic classes for my AS degree when I was an EMT. So recently when I went back to get my medic's I finished and earned my AS degree. So as an EMT-B I was able to read 12 leads(not by protocol). Our agency allows EMT-B's to start IV's and draw blood (by protocol), and now with our new protocol that was just released last month, EMT-B's can monitor saline locks or clear fluid (NS or LR) running KVO during transport. Given the medic does a full ALS assessment and deems the pt stable enough for the EMT to handle. If you guys would like a copy of the protocol if you dont believe me, let me know I'll be happy to send one to you. Now, I might be off the wall, as I am new to EMS (2 yrs as an EMT, 1 month as a Paramedic trainee). So please take what I say at a grain of salt, just be aware I have been secluded to the world of EMS in Lee county, I have not worked anywhere else before so, the only system I know is what I have worked for. So if I sound pig headed let me know. Given that 6 our our 32 units are rural units, I'm switching there next month so I'll have to see if I get anything and have to haul ass to D1 with a priority 1 Trauma Alert, without helicopter support and about 45 minutes out. BTW, I also apologize for taking offense to being called a "wham Bam medic" but thats just wrong, we are your borther's and sister's in EMS and just bc we get rid of our pt quicker doesn't mean you have to hate our guts. Simply put, Rural and Urban EMS are two different worlds and until you have experienced both, there's nothing you can really prove.

My agency, Lee County Emergency Medical Services (EMS) is a Florida certified ground and rotor-wing Advanced Life Support Provider. Lee County EMS covers more than 1,100 square miles with 32 Advanced Life Support ambulances, two twin-engine helicopters, two ALS non-transport units, and on-call bicycle paramedics. Each ambulance consists minimally of a State-certified Paramedic and EMT. In 2006, Lee County EMS responded to nearly 75,000 emergency calls and transported more than 1000 patients by air. Lee County's western border is composed of seventy five (75) barrier islands that dot Southwest Florida's gulf coast. My average response time is 9 minutes and transport ranges from 5 to 45 minutes depending on location of the call and of the hospital and traffic. We have 6 hospitals and 1 Level 2 Trauma Center in Lee County. Those of you reffering to "Wham Bam Medics" its easy to say that if you can't handle the quick response and transport times. You have to learn to be quick and accurate with your assessments. Once you get in the groove its great. I can do a full ALS assessment, start an IV, draw labs, hook em up to the monitor and do a 12 lead, throw em on a cannula in 8 minutes. I try to do my assessment on scene, IV, labs, 12 lead, O2 enroute. My partner has the HammerHead (Our tablet computer which we use to do our trip sheets), with all the info so by the time I get to the ER, I'll I have to do is type my narrative enroute, and print my trip sheet. If its a bad call and don't have all the time to devote to an IV or monitor nothing but my airway then if have to I'll grab a FF to ride in with me to accomplish everything.

Hey y'all I was in the chat room the other day and someone asked a question the came out of left field but I needed help answering. I tried searching for the answer but no luck Q: What is the least % of BSA with full thickness burns that is proven to be fatal? I originally thought roughly 40% but after reviewing our local Trauma protocols anything greater then 15% full thickness is life-threatening. (aka Trauma Alert) But that still didn't answer my question.

Sorry Dust just another one of my erractic rants without reading it twice over.

Speeding like that can kill someone, that was not warranted. Going over curbs and in other lanes, hell even into on coming traffic down here is normal. The roads and people down here are that bad I kid you not. I'll probably catch heck for that. Anyway, running to Admin with your complaint was not the thing to do. See here is where I'm frustrated over. Our partner has my back and I have my partner's back right? Wrong. I cannot count how many people nowadays are just in it for themselelves. And this is one instance. You need to review your chain of command there, and rethink your complaint. Yes he operated unsafe, but you just don't go running to Admin and being a tattle-tell.

Check the truck out what's that?? Can I play with the siren?? IF any new person starts and doesn't know that the truck needs to be checked out without asking doesn't belong on the road.

Wow, I feel out of place, so to speak. We have a 1 min 30 sec "out of chute" reguardless of time of shift. We are all full-time paid ALS providers, we have no privlage of staying at home. We are there for 24 hrs then go home for 48, and then come back. We are "on-call" when we sign up for OT. Then we have an hour to respond to the page to come in. We're stuck here at the stations no matter what. But we also answered 84,000 calls last year. We have 4 rural units and the rest (32) are urban. We are a 3rd service Government operated ALS transport. We have 4 fast response Expeditions which help around the central area with call volume.

BecksDad, You gotta admit besides the rats and mold at medic 7, medic 3, the trailer that has survived the past on slougth of hurricanes at medic 11, and medic 1 being a garage redone into sleeping quarters at STFD sta 1. If it wasn't for our Local 1826 union, we wouldn't have jack shit, meaning System status. But now, we have 24 hr shifts, we have beds, lazy-boys, high-speed internet, computers, cable TV, refrigerators, A/C, Showers, toliets that acutally flush , Microwave, etc. All the comforts of home minus the beer. And not to mention some of the best salaries for EMS (not FD) in the state of FLA!!! Mind you our Admin needs to be removed and replaced with people who know what the hell their doing. I'm happy, well somewhat.

Our Class A's consist of the dark Navy blue EMS style pants, and the light blue button down shirt, with our badge and collar brass. Our shirt must be ironed when reporting for duty. They are I think, 65 / 35 polyester and cotton, hot as hell down here in FLA during the summer, we often get confused with PD down hee b/c of the uniform. We have jumpsuits that we change into after dusk. They are the standard style of jumpsuit with reflective strips and swen patches, badge on uniform. The suit also has many pockets like the flight suits for flight medics, for us on the road. Quite comfortable, I wish I could stay in them 24 /7 while on duty. Our union just fought for us to change our day uniform from the class A's to new pants and Cool-Max polo style shirt with swen patches and badge on the front and reflective striping on the arms and around the back. The county just decided to start ordering them so I'll have to try it and see if their better.

With LCEMS, EMT's reguardless of years of experience max out at $50,712 / yr base. Not including OT. When they do max out, their 3 year raise every time we renegoitate our union contract they only get a 3% + a 3 %COLA raise. Every year there during the contract is a 2% COLA. The trick is that they never make more then a brand new paramedic. The Minimums and Maximums are always adjusted every contract negotiation year so they can achieve this. LCEMS Medics start at $48,517 / yr and max out at $67, 432 / yr, reguardless of years Exp. Not including OT. When they do max out, their 3 year raise every time we renegoitate our union contract they get a 3% + a 3 %COLA raise. Every year there after during the contract is a 2% COLA. Now figures with OT built in: EMT starting : $44, 456 / yr with OT and maximum with OT: $62, 484 / yr Medics starting : $ 52, 642 / yr with OT and maximum with OT: $72, 342 / yr We work 24 hr shifts, anything over 80 hrs worked bi-weekly is paid in OT, so ontop of regular pay at 80 hrs, we are also paid for 20-30 hrs of OT built in to our work week. We have 2 big checks and 1 small check.

No joke Asysin, they aren't that bad, but it would be nice to have a type 1 ford instead. We have 3 of them for the islands and when I'm working on those, I much prefer them by far vs the Frieghtliners. It's rough trying to go code down 41 with a semi / ambulance. Admin I think gets a woody by buying the trucks and utilize them.

LOL

8) Copy that Ridryder 911

That's why I retracked what I said and edited my post I couldn't either but I was hot about something before the. Sorry.

Other then the national shortage of medics everywhere probably is due to growth,I really don't. I'm sorry bout that Dust I was just hot and venting. If ya read my post , you'll get the info.

I'm sorry for all the frustration and anger I have caused all of you on this board. Dust, mucho respect to you, Asys, AK, and all the mature medics out there that are willing to smack an EMT around every once and while when he's not making sense. In relation to my last post about the dead waking: If you guys don't believe me of the account do you want to ask the wife that was on scene if it was true or not or how bout better yet, the 12 yr girl that was right next to him when he collapsed, ask her if it was true. I had limited time to post what I was going to post, and some parts were probably left out (intentionally and non-intentionally). So I am sorry for not making the account click, just goes to show you have to be there to see it. And yes I know understand the importance of posting accurately now, on here so I apologize TO ALL for not doing that. AK, yes we could of transported to D2 (Southwest was 5 minutes away (L&S)), but I was not the big man in charge to make the transport decision I just follow orders from my medic. Dust, mucho respect to you, Asys, AK, and all the head hanchos here. In response to me fidling around with ALS crap while he was doing the BLS CPR, I was doing what I was told to do until rescue got there. I don't just automatically grab the intubation roll as soon as I get there, I jump to CPR but when my medic tells me to get stuff ready while he's bagging the pt, I do what I'm told. And to the person who says, that if I start an account or post that says your not going to believe me etc.: you want to ask the wife that was on scene if it was true or not or how bout better yet, the 12 yr girl that was right next to him when he collapsed, ask her if it was true??? I am truely sorry that you guys had to rip me apart on the internet, I have mucho respect for you guys, i do learn alot from certain posts that intrigue me. The stuff I left out was the biggest part which made the sense that you guys so diligently pointed out. I promise from this post forth I will make sense, learn my place on this board, post accurately and stop acting like a dumbass. Sincerely, Fred Jackson

tttt

EMS billing companies can bill ALS if the call came in as an ALS call, even if the call, by the time you transport is a BLS pri 3 call. Now if the call came in BLS its has to be upgraded to ALS by the medic on scene to be able to bill. Our agency utilizes this loophole every well, we still respond L&S to everything. And Asysin, the Frieghtliner Ambulances nowadays are running us $174,000/per truck from American LaFrance MedicMaster, which comes with all the bells and whistles. ( Air Shocks, LED lighting Package, Extended Cab, etc.)

But Wouldn't that lead to vein influtration Dust? Big no no LOL yea I kinda worded that alittle odd, my mistake.

No, Asysin2leads, I can assure you no one who isn't a medic is playing around with Lopressor, its a new medication (to our agency) that our Paramedic's can use. To answer your question about supervision, protocol states that the EMT can start IV's under the Medic's supervision. Like for instance the Cardiac arrest we had today. I started 2 18 G IV's one in each AC for med and fluid acsess while my Medic was intubating. Like someone else said about down here before, the state gives the power to the medical directors on what BLS and ALS can do procedure wise. More then likely the medic is doing the LMAing and such, they control the airway. I either set the med's up (drawing them up, unless its a narc then its a no no for me) set the tube up, etc or start the IV's so the p/t is intubated and we have med access all in a few seconds. Rescue helps out in between doing the rest. There is a gray area in our protocol's, which is what your picking up on Asysin2leads, our protocol book is nothing but a bunch of guidelines, it doesn't mean that they are gonna be used everytime, in order and so on and so forth. and besides most of the time if its a Priority 2, we have time in the back b/c of our short transport times, unless your in the rural area of our county. The medic is there to watch you while they might be setting up and administering an updraft or setting up a tridol drip. That's what I'm talking about. And instances where we have a priority one, my Medic takes airway, I take IV's, and rescue takes whatever else needs to be done. It help the medics here out a lot when it comes time to deal with a P1. To answer the question about the training. All EMT's and Medic's must attend monthly in-services where we bring in Trauma Docs, Pedi Docs, Cardiac Docs etc. to talk and instruct on certain topics. We also hear from our medical director about his instances in certain cases etc. Also, all EMT's and Medic's must go through what's called a "Mandatory Skills Credentialing", every 2 years. We are tested on knowledge and skill of our BLS and ALS capabilities. (Yes, an LMA is one of the EMT's skills here). I learned for the first time how to use an LMA in my FTO program when I first started here 2 years ago. If we fail we are put into an FTO rotation (3 months) and are remediated on the skills before we can go back out and practice BLS or ALS again. The biggest by far attraction for people to come here and work is the fact, that you have the freedom to practice your skills and medicine without having to call a doc every 3 sec for orders. Everything is offline in our protocol books. My EMT training was also 3 months long, but I went further and took A&P etc while I was in EMT school. I just have to go back for my core Medic classes (Clinicals, Cardiology, and Pharmocology) and earn my AS degree. I already have the rest of my credits.