Niftymedi911

90 to 1 its toxicity i agree, but just in case.......... Orthostatic + or -?? Rhythm strip??? Stroke scale?? 12 lead??? 6L of o's??? your cause her to have a nosebleed by time you get her to the ED. 2 or 3 lpm sounds much better.

We've had 2 power cots on 2 of the FTO trucks trialing now for 8 months. They are so much easier to manuver and handle. The added weigh is a con, but like evryone else here the tracked stairchair comes into play:). My back loves them. Our agency just bought and had delivered 27 agency specific Power-Pro's bringing it to a total of 29. They're being placed on units first based on call volume. High volume truck gets a new stretcher. There has only been one shift that I have worked where I had to replace the battery besides during morning check outs. They're awsome........

If it's something that's not in my scope (Heparin). I talk to the Doc, have him order a bolus for the remainder of the transfer so I don't have to worry about it. 99% of the time the RN's at the new facility take the drip off anyway. Diprivan is in our crash airway protocol, that's a normal medication down here.

At least when I go to the other coast, it takes less then 5 to 10 minutes to offload a patient, but becuase of the powers that be here, it takes sometimes over an hour and half to offload. They need to wake up. I've waited at CCH 3 hours and 45 minutues to offload a patient in the ER. It went as far as 6 units at one time were waiting to offload there all over an hour. Normal offload is 5 to 10 minutes, but that is onl right around 0800 and between 0300 and 0700. Anytime after those your a a wall flower for 15 minutes and beyond. Reguardless of priority. I've waited 23 minutes with a priority 1 GI bleed, extreme hypotension, in the hallway for a bed. The only thing I can say about T1's. Is at least we have one, so we don't have to ship them to the next closest which whould be 3 hours north to Tampa after they've been stablized at a local.

LOL, sorry I got kinda off topic. The FD's here are trying to take our jobs..... our professions, our bread and butter away from us here...... I just have strong feelings bout that. I get kind of heated when I hear a FF trying to claim EMS is their thing..... when really it's not. We've been providing EMS for the county since 1972 and for the FD's to think they could "take over" as one fire chief put it, they're dead wrong. I didn't mean to offend you or get you upset. Welcome to the City!!!!

there they go making a case to justify their exsistance............ firemonkeys UNITE!!!!!!! You guys put yourselves out of business with fire prevention and the like, don't you think you could of done it at a modest pace, so as still things could stay moderately busy? Pd/FD/EMS are all necessary services, but it doesn't mean, you should have a police officer/firefighter/paramedic on scene to work the crime scene, dose the little fire the perp started and give the mom some nitrous to make it all feel better? If your gonna try to take a position, why not take all of them...... of course your not out of convience. You don't want to be running all those you hit me and I want to sue BS.......... Do youself a favor, sit back in your lazy boy, ejnoy your nice salary, and SHUT UP!!!!!

I had just mentioned it, I didn't want to give someone something without consdiering Pro's and Con's.... that's why I picked that article. I for one don't undertstand why we need them...... If we practice and hone our assessment skills like the article said, there would be no need for the Istat. VentMedic- I was simply refering to the whole, hyperkalemia thing, I undertsand why and what but, I was just clearly trying to show, CB that it isn't just that, hyperactue T waves are definately a ominious sign, and warrant a 12 lead, I was just trying to show that it anit just the "save all attitude". What you probably do not know, is Southwest Regional now owned by LHMS, will be shut down permantly once the new Gulf Coast hospital re-opens. And it is by far streamlined. The healthcare system here sucks a$$. Hell, even with our trauma center here, they still ship aortic trauma down to HealthPark, because they have no cardiovascular surgery at the trauma center. The system will be implementing the whole specialty care hospital BS once GCH opens, it will go something like this LMH- general medical, CCH- General, limited cardio/neuro capabilities GCH- All Trauma (Level 2 trauma center)/ Cardiology, Regional Women and Children Health center, Neurology (Stroke Center) HPK- Pediatrics PICU, Neonatal ICU, Cardiology, OB. And it will be nothing but transfer city. Why can't they get their head out of their a$$ and have everything at every hospital?? It makes sense but of course down here common sense isn't just that. The project isn't going to get off the ground, and we have bigger fish to fry, like keeping the privates out of our county. Apparently AMR just went to county comission to bid on interfacility transfers in Lee County. Well, needless to say as of right now, it got shot down because we just ( As of 12/2007) implemented our very own transfer divison. We now have 2 ALS/ 2 BLS interfacility transfer trucks to supplement the ALS 9-1-1 response. Now, no more 9-1-1 trucks will be running transfers unless it's a type I (priority 1 L&S) transfer. Type II and III's will be handled by the divison. We now offically have a total of 39 trucks, 4 transfer trucks (Medic 34/35 BLS)(Medic 38/39 ALS) and 36 9-1-1 response units. 5; 12 hour and 29; 24 hr trucks. To be honest, majority of our funds are actually from operational fees. Yes, our budget does come from the county in taxes, but we collect to offset that and last year in 2006 our re-coup rate for services rendered were close to 62%. Total budget for EMS was 22 million, we re-couped 14 million of that 22. This year, we're already at 18 million in re-coup. So techincally, we're acting and functioning like a private, but we're 3rd service.

http://www.segway.com/downloads/pdfs/Case_...ChicagoFire.pdf Chicago FD/divison of EMS utilizes these for downtown response in congested areas as well as during crowded events and the like......... Our agency was trying to get a set of these for a team to respond at our Major airport RSW. SouthWest International Airport. The idea was to have an ALS segway crew respond as first responders on calls and can advise if a transport truck woudl be needed. There are numeorus BLS calls everyday that are cancelled because RSW calls for stupid crap. Lac to finger, pedi vs. vehicle at .5 mph, I just want my blood pressure checked, burn in lap from coffee during flight, eyc. the list goes on and on. There have been 13 calls that have required ALS intervention since they opened the new terminal 3 years ago. Not very much really is worth sending a transport unit. Our County Commissioner's were on board, but because the Chief of Crash Fire/Rescue didn't like the idea, because they would be able to not justify they're budget and response, they decided against it. So now for every call Medic 25 gets sent wether its a cut finger or public assitance. BS!!!!!!! The Dammned fire departments need to realize they have no business in EMS. You guys play with hoses and want to run into burning buidlings thats fine, but DO NOT tell me that EMS belongs with FD and I need to be fire certified, I will kick your ass.

Yes, CB we are doing tests, keep up with the times,..... Read this article on point of care testing for EMS: http://www.jems.com/news_and_articles/colu...re_Testing.html My agency is doing a six sigma project on wether we should invest in starting the point of care blood testing for our patients. With our hospital system (6 hospitals) within the next 3 years are cutting the duplication of servcies out and creating specialty hospitals, this would make sense. BTW, you don't need to do a 12 lead on someone on diaylsis, they often have tall actue T waves in any lead if you hook em up. I'm glad your learning, we do try to fix everything, tell me exactly what you can identify as an EMT in the field and treat besides pain ( even then it's up to the medic for Morphine or Phentanyl) and trauma.

Yes, CB we are doing tests, keep up with the times,..... Read this article on point of care testing for EMS: http://www.jems.com/news_and_articles/colu...re_Testing.html My agency is doing a six sigma project on wether we should invest in starting the point of care blood testing for our patients. With our hospital system (6 hospitals) within the next 3 years are cutting the duplication of servcies out and creating specialty hospitals, this would make sense. BTW, you don't need to do a 12 lead on someone on diaylsis, they often have tall actue T waves in any lead if you hook em up.

Ruff, You forgot to mention they could taze the Bro to with an AED. There anit nothing like walking to a food fight with a shotgun. And as far as the duel medic response, it is so true. The only way it could actually have a good outcome between an EMT and Medic working a code, is if the EMT is a little more advanced, but still cert at the EMT-B level. Reference: The agency I work for has a lot of training that would ordinarly be reserved for medics. Example: EMT's here can take a 10 hour course and work with an FTO for a shift to get 10 live sticks before our Medical dir. will allow the EMT to be IV certified. Another is the King tube is our friend. That is the definitive airway for cardiac arrests in Lee County, simple, fast, effective. Loop, swoop, and pull. The good thing about our county is that 17 of the 22 FD's in Lee county are ALS non-transport. So BTT we get there, they normally have CPR, Rhythm interpretation, and airway implementation (not in that order hopefully) in place. If it's just us, the EMT is in charge of CPR, IV's, monitor and pad placement, Fluid administration, prepare drugs for Medic (pull out syringes etc). No rugs in a code many one has certain jobs assinged but with my experience since our trucks are EMT/Medic, that is the general norm for a code. Not saying there are variations which of course there are.

A couple ring to mind: We were status Red (less then 25% of our fleet available) and our MDC's were down due to a CAD failure so everything was verbal. We had one dispatcher for 33 units on duty. It was crazy, everyone was talking over everyone else. Medic XX: "Control, Medic XX 10-51 (enroute) DXX (one of the hospitals in Lee County, all the hospitals are in Delta codes.) ready to copy" Control: "...... shut up". Medic XX: "10-4, Do you want me to rub your feet too?" I saw some paper on that. @!@!@!@!@!!@!@!@!@!@!@!@!@!@!@!@!@!@!@!@!@!@!@@!!@!@!@!@!@@!@!!@!@!@ Control: "Medic X, Rescue X respond possible signal 4 (MVC) XXX & XXX, response on tac-3, XXXX hrs." Control: "Medic X, Rescue X, off-duty ff advising one possible pin in, one ejaculation, MedStar on stand-by (laughing heard thorughout the channel).

Tell dispatch to clear the unit unable to locate, have FD advise EMS if the person has been located. Being the only unit within 1500 miles, you can't just go find a needle in a hay stack if you got someone else with chest pain, (a situation where treatment can have a good outcome). And if FD is able to locate some drunk and he is still alive, I would want to be his best friend.

Once in 3 yrs here. Had a Critcial Care transfer a AAA that was on the verge of exenguenating. Both helos were busy so we had SO block and leap frog the whole way for 20 min.

TO be honest, I don't really give a flying leap how long it takes because I will never go that far, I was just guesstimating on the subject. Using the issue as an example, is one year when using it as an example a big difference?? The matter is they must maintain, educate, train, for however many more years then basics do. That was the point I was tyring to make. So if you were just to dumb to see that fact and just try to pick apart my post to make yourself feel better, then be my guess, it's just too funny.

I thought you might like that.

It's a generalization, yes. But think outside the bubble. There are roughly 410,000 EMT'S and paramedic's that are certified in America. You take that average further. In FL, there are roughly 25,000 licensed EMT's and Paramedics. That state mandated EMT-B course is a basic 3 month course. Yes, they train you, yes they show you. But think if it takes 7 years for a Med student just to reach residency and hopefully complete to get his doctorate, don't you think EMT's and Medic's, who operate like a "doc in a box" should have more then a 3 month course on how to wrap or splint an injury and give oxygen? Now, there are exceptions to everything and there is no exception here, just as you I took all of my pre req's for medic school while I went to EMT school, so I'm finishing my degree as we speak with my core medic classes. I didn't want to go into EMS with just basic knowledge and try to save the world. And it's those people who just get the course to wear a patch and think they're cool and not take EMS seriously. They'll be burnt out in 5 years and then have a mid-life crisis and then drop out and find something else to do. Don't blame Dust, because you always have 3 fingers pointing back when you point at someone. The people we should be blaming is oursleves because we all get that way when we start. It is just matter of when they decide to grow out of it and become a great provider. And it's those who don't grow up and realize, that Dust is generalizing about. And 99.9% of the time the only classification you normally find that in is EMT-B. Medics are usually headstrong, mature, and understand it's not just lights and sirens with shiny badges. Because they put forth the effort to understand and educate themselves, so when a lady drops in a near syncopal episode and after ABC's do a 12 lead to show elevation in II,III, AvF, they know exactly what to do, what's causing the problem, how can we fix the problem and minimize damage to the myocardium for this patient. If you don't have the knowledge to understand that 90% of the time syncopal episodes are either pump or volume related problems. Then you would be bringing a patient to the ED, who will have ultimately not the same quality of life before hand.

Did you forget to mention if we don't transport they'll call back 20 min later saying the same thing.

:dontknow: here's what the NET's do when they actually get an emergent patient or they get the "light up" feeling. :headbang: Dust, I'm in awe you slimply put everything into one single post.

We're being introduced to King tubes during our monthly inservice this week. Hope si to have them on the road for use by Dec 15. By the looks of it, way much easier. As soon as I learn more tomorrow I'll let y'all know.

Whoa whoa whoa wait a minute. Who even mentioned stupid EMT vs. Paramedic in this post??? Obviously sir, you have some undealt with anger. No one even mentioned or even hinted at the whole paramedic vs. EMT arguement. This was based solely on whether or not we believe the NET's are a part of EMS. Even going back further to a different topic, Dust said that all transfers should be completely eliminated from the EMS role. Which I agree wholeheartedly with. That would be the only way to get EMS from the dark ages. Reguarding the lights, that is all they freaking are. Hell MPDS, even regulates the response so that we're not running to a knife fight with a nuclear bomb. Whether we run code or not, we're called, we assess, we transport. That is EMS.

Yes, CON stands for Certificate of Need in the state of Florida. And you guys took my post out of context. I've got quite much more than just lighting up. Perhaps, I mislead. I've been doing EMS for 3 years now. I guess it's just hard for me to see the other side of doing NET's etc. I've done nothing but 9-1-1. That's where my comment came from. (Which even then isn't 9-1-1 except maybe 1 call a month.)

Oral glucose is overrated. It takes forever and majority of the time, if it doesn't work fast enough you have to suction it out just to clear the airway. I have always been an advocate for BLS providers to do more. But the more I am around, the more uneducated BLS providers are based on a 3 month coarse I find. I'm thanking God, I took additional courses while in school. Skills and procedures vary from agency to agency. EMT-B's at LCEMS: Start IV's under medic supervision Admin NTG, ASA, MD prescribed meds Oxygen Watch and supervise patients during transfers with saline locks, NS or LR hanging no further meds.

I would agree with the MD in this case only because of the high suspicion of stenosis or regurg simply because of his age + Hx. He has a previous event in the past which could have affected the intropric ability of the heart. The ECG readings are borderline, but if you put his hx, age, and presentation. I would be 95% sure it's just regurg because of the past event. BTW, (I'm not putting you down in any way I'm just curious) why would you be treating the monitor and not the patient? I would definately not make him a BLS patient just because he can't talk, but his just his presentation isn't very indicative of an MI and he didn't complain of it in your presence. As you've said in description, he would verbalize chest pain or shortness of breath if it occured. Again, I'm just curious, it's kinda easy to be the monday morning quarterback.