BLS WITH OUT PULSE OX AND OR AED. SHOULDNT THEY HAVE ONE ?

[island emt]

We all need to remember that Mike works for a cheap , crappy transport company that only spends what is mandated by statute.

They require a pulse & a patch for hiring .

They don't provide transport crews with any equipment that might actually prove useful unless ordered to by the state.

Having to wait for an ALS truck to show up with a defibrillator is almost criminal behavior.

You do know that CPR doesn't cure fatal arrhythmia's don't you???

Cpr attempts to circulate blood in the condition of non perfusing rhythms, while defibrillation will possibly correct those fatal non perfusing arrhythmia's.

Do they always work ??? NO

Just a hit young emtb. you are challenging many folks with far more experience and knowledge than you will ever gain working for the empire. Many of us have been in this profession since your parents were playing hide the sausage in high school.

[MikeEMT]

Edited December 12, 2013 by MikeEMT

[Just Plain Ruff]

Not sure what Mike posted but I'm sure it had to be good.

Me thinks Island rendered Mike speechless.

[island emt]

[uglyEMT]

ERDoc sorry for the long delay between postings. Life gets in the way sometimes LOL

How do I know if my patient is oxyginating? First off are they breathing normally? Adequite volume and rate? Color of the lips? Nail beds? Gums? Skin? What are the lung sounds like?

You asked about a chest pain, per my guidlines its 15L NRB until ALS says otherwise unless the patient cant tolerate that high a volume then we back off to 10-12.

As for my CO example, I never faulted the machine, I faulted the provider. He was so caught up in the tech that when it failed he blindly believed it and almost didnt seem to know what to do when he should have known. Its not the tech, its when the tech becomes the basis for diagnosis and it fails or gives false reading and the EMT doesn't know what to do or fails to realize its wrong. Again the tech works and has its place but it shouldn't substitute good knowlege of what to do without it.

[triemal04]

We all need to remember that Mike works for a cheap , crappy transport company that only spends what is mandated by statute.

They require a pulse & a patch for hiring .

They don't provide transport crews with any equipment that might actually prove useful unless ordered to by the state.

Having to wait for an ALS truck to show up with a defibrillator is almost criminal behavior.

You do know that CPR doesn't cure fatal arrhythmia's don't you???

Cpr attempts to circulate blood in the condition of non perfusing rhythms, while defibrillation will possibly correct those fatal non perfusing arrhythmia's.

Do they always work ??? NO

Just a hit young emtb. you are challenging many folks with far more experience and knowledge than you will ever gain working for the empire. Many of us have been in this profession since your parents were playing hide the sausage in high school.

We all also need to remember that Mike is less than accurate in much of his reporting.

BLS units do carry AED's, even in Seattle, and, as it falls under the SFD CPR training, are quite proficient in their use. Now, it is entirely possible that AMR does not (but I doubt it), but then AMR does little, if anything independently in Seattle.

[ERDoc]

Ugly, I realize that you don't write your protocols and have to follow what you are told but your protocols suck. We don't need to go down the whole free radical pathway again as we have discussed it ad nauseum. No worries about the delay, we all have real lives so I totally understand. Again, it sounds like these are all problems with providers and not the equipment. Your equipment is only as good as the operator. There is only so much you can tell based on your (not specifically you Ugly, but a general, all-of-us type of 'you'). That is why we develop technologies and machines. They help us narrow down our diagnosis so we are not doing unnecessary harm by making the wrong diagnosis. Not all pts read the textbooks and common presentations are not always that common.

[island emt]

Ugly et al:

Thats The reason to carry a RAD -57 and check every ones carboxyhemoglobin in addition to Oxygen saturation level.

Especially this time of year when homes are closed up tight and various heating sources are in use.

We all get those calls where the CC is weakness , general illness, Just not feeling right, possible having a headache for a couple days,

Yes most providers would suspect Carbon monoxide poisoning.

But how high a level???

With a quantitative level provided by the RAD -57 transport decisions are made with intelligence and knowledge of whether they need to go to a facility with hyperbaric medicine availability or not.

How many services are spending the money for this technology??

We bought ours 7 years ago when they came onto the market.

Also every Firefighter gets checked on the rehab scene as well as any occupants .

Again It is just a tool and shouldn't be how you decide they have elevated CO levels, as we should ALL recognize the S&S of it, but a laboratory quality means of providing information to the ER docs and possibly change our destination to the appropriate facility.

[uglyEMT]

Oh i totally agree both ERDoc and Island that my protocols suck and we basically have our hands tied. We finally, last month actually, became allowed to "assist" a pt take BGL, "assist" a pt take ASA for chest pain, "assist" with pts nitro. I mean come on now but it is what it is like you said. Hopefully one day we can actually do something but until then we work the best we can.

That RAD-57 sounds awsome, I don't even think our ALS units have it, well I shouldn't say that, I haven't seen one used even at a fire rehab. Most rehab is a quick set of vitals, check against their baseline, give O2 is "they" want it unless they are outside their parameters. Oh make sure we have water bottles and ice ready, they want that Usually an argument if we want to pull a FF off the rotation because of vitals. Usually are told make sure he IS fine and get him back in rotation ALS is usually notified of the rehab going on and are on standby if we need them but usually not on scene. Again, got to love protocols

For the CO pts at least we have one good thing going for us, the main hospital we transport to also has a chamber so even if we don't know the blood levels we are transporting to the appropriate facility.

[island emt]

Ugly:

We had a call this fall where an alarm was sounding at a home. We went to check on occupants while fire was in the house with multi gas meter. Reading in home were very low background levels.

But of the three family members that we evaluated , teen age son was fine, Dad was fine , Mom had elevated CO levels that were five times normal .

We asked about her car, [brand new] where she worked, where she had been for past 8 hrs. Come to find out she and a couple other co-workers had been getting headaches for past several days while at work.

I placed a call to department in that town & asked the deputy chief to send a crew to check the building. He called back to say they found CO levels high enough to be fatal over a few hours time. They had a furnace with a cracked heat exchanger that was spewing exhaust gasses into heating ducts.

Just a lucky catch on our part, but it turned out well for everyone.