What you want?

The usual patient will get a 20g not because of a "cookbook" approach but because it is the best size for the majority of patients we encounter... because as previously stated it is adequate for fluids and meds.

Nobody implied to go with a 20g "just because". It was simply stated the standard is a 20g unless the patient presents with a condition or venous type that would indicate going with an alternate size.
 
There's nothing wrong with wanting a certain size on all pts. The only time it's bad is when you try it innappropiatly.

I may want a 14g on all pts, nothing wrong with that. It's only bad when I try to do a 14 on all pts, such as granny or Lil Johnny.
 
Okie dokie, back on topic. Unless my partner is extremely familiar with me and how and why I do things, if needed I will try to let them know that I have only a few simple rules. But bare in mind that I'm not the kind of guy that goes around barking rules. These are only my personal "rules" that I live by on the truck. They are only guidelines for my partner. I'm only writing them down here because the question was asked. So here we go.

1. I run to only 2 things: the dinner table and the bathroom, and not necessarily in that order. If you are "b*lls to the wall" then odds are you have missed something important.

2. My preference on patient care is: I have no preference on certain equipment. I'll let the situation/presentation decide what I use. "Why" is much more important that "what" or "how". If you understand "why", then "what" and "how" will make sense.

3. If we're way out in the county, 99 times out of 100 I'll do everything enroute. There's no need in wasting time on scene. However, you never say never. You never say always.

4. If I'm holding on to the "Oh sh*t bar" above me like a spider monkey, then I'm not taking care of the pt. Drive the truck like you're driving on ice; especially if the little 4 year old child is dying on us. Plan your moves and we'll be fine.

5. I don't like getting caught with my pants down. We will take everything the call might need at least to the front door on every call.

6. There's no need in prespiking IV bags, or pre-setting up anything else for that matter, for the next call. That makes absolutely no sense whatsoever. We'll just pull out and spike/set up what's needed when needed if needed.

7. You're my partner. You're not my Basic. You're not my driver. You are my partner. We are going to work together. There are no if's, and's, but's, or ultimatums. I cannot do this without you. We are going to work together. Period.
 
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PapaBear434 said:
I don't know, AK, you seem to do this a lot. You, Sasha, even Rid. Going after a legitimate screw up or disagreement, like going straight to IO without even attempting an IV or my previous statement from the dead thread about our system rarely using pain control protocols, I can see.

But in this, you are arguing a philosophy. You guys assume that since we use a 20g most of the time, we are just going to shut off our brains and just use it without due regard. Sasha took it the step further and evaluated our entire service ability as "cookbook" because we stated that the Basic providers, when setting up an IV for us, set aside a 20g without asking because that's most commonly used.

You're not shaking any tree, you are just looking down your nose and attempting to appear as so much more enlightened by spouting the concept everyone already knows: Every Patient is Different and Requires Different Treatment. We know that.

It's being practical, and it's so simple Goldilocks could understand. It's not too big, it's not too small, it's just right. I should be able to say that without putting a disclaiming on my post to satisfy the nitpickers out there. (some patients may vary, void where prohibited, the statements found here do not represent that of Virginia Beach EMS or that of anyone other than the poster, offer valid while supplies last, see rules to apply, do not read while under sun lamp or other artificial UV device, do not read post if you have a heart condition or are pregnant or may become pregnant, standard standards and practices apply...)

Oh, and Edit: The use of the word "everything" is hyperbole. Just the last couple days, this attitude is taking hold as everyone rushes to be holier-than-thou. Myself included.
Click to expand...

Trees are being shaken due to the fact that what is obvious to you is not to others. Since you and I are carrying on the conversation, we speak "louder" so those within ear shot will maybe hear something of use to them. Most will not comment or admit to it, but most times a spark does occur and I respect those who have returned and stated such.

You, as I are a stage for the message.

I do not look down my nose and if you knew me personally you would agree as context is one of the hardest things to express on web boards. I am however growing more and more intolerant of ignorance and an unwillingness to change for the better.

I have yet to achieve enlightenment but I do have awareness...I believe it was you who attributed the zen to me for starters.

Anyways, I do respect your eloquent responses (nice to see proper grammar and spelling coupled with well expressed intelligent thoughts) and your sense of humor.
 
akflightmedic said:
Trees are being shaken due to the fact that what is obvious to you is not to others. Since you and I are carrying on the conversation, we speak "louder" so those within ear shot will maybe hear something of use to them. Most will not comment or admit to it, but most times a spark does occur and I respect those who have returned and stated such.

You, as I are a stage for the message.

I do not look down my nose and if you knew me personally you would agree as context is one of the hardest things to express on web boards. I am however growing more and more intolerant of ignorance and an unwillingness to change for the better.

I have yet to achieve enlightenment but I do have awareness...I believe it was you who attributed the zen to me for starters.

Anyways, I do respect your eloquent responses (nice to see proper grammar and spelling coupled with well expressed intelligent thoughts) and your sense of humor.
Click to expand...

I have taken this a bit farther than I had intended, and certainly let myself get more worked up about it than I'd like to admit. It's true, what is obvious to me and you may not be obvious to another. Yes, this "debate," such as it is, will maybe wake up the sleeping, dormant cortex of some long disenfranchised medic.

I do take exception with having to pick the nits to make your point, but as said the point itself is true and cannot be argued with: Equipment used on the patient depends ON the patient, not on what is USUAL. My point was simply that the usual will get set out as a default setup, because more than likely it will be the one used. Looking back over the posts, I suppose I did not make that clear with my initial outing. I did not say it was the basic setting up, and that I did not mean that it was guaranteed which one I was going to use. It kind of spun out from there.

And yes, context is right behind biting sarcasm on the "hard to express verbal cues on the internet" scale.

What say we let bygones be bygones, let the animosity (should there any exist at this point) go and try to avoid the needless conflict?

As far as my diction, grammar, punctuation... Well, I have always been like this. I cannot, for some reason, stand to put up the usual posts on any message board. Hell, I even text message on my phone like this, and bought a QWERTY keyboard phone just so I could do it with minimal effort. I've always been a wordy person, and rather in love with obscure vocabulary at times.

You know what they say: If you can't be smart, you better know how to fake it well.

And humor? Well, if you were to meet ME, you'd know that I am about as random an individual that you are likely to shake hands with. I can range anywhere from odd and quirky, with a self deprecating humor to defuse a situation and get a laugh, to full-on hyperactive Robin Williams in his cocaine years.

In this instance, I was trying to defuse the "argument," such as you can have an altercation on the internet, by trying to calm both you and I (mostly myself) and get back on topic.

So... the partner I work with most of the time knows I prefer subs and salads for lunch vs. greasy, nasty food. So he plans on that instead of pulling into Hardy's.

There, that's my contribution. Forget the IV thing. Let's focus on food, as it's a nice universal constant in EMS to want to eat.
 
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Hardee's :P
 
MSDeltaFlt said:
Okie dokie, back on topic. Unless my partner is extremely familiar with me and how and why I do things, if needed I will try to let them know that I have only a few simple rules. But bare in mind that I'm not the kind of guy that goes around barking rules. These are only my personal "rules" that I live by on the truck. They are only guidelines for my partner. I'm only writing them down here because the question was asked. So here we go.

1. I run to only 2 things: the dinner table and the bathroom, and not necessarily in that order. If you are "b*lls to the wall" then odds are you have missed something important.

2. My preference on patient care is: I have no preference on certain equipment. I'll let the situation/presentation decide what I use. "Why" is much more important that "what" or "how". If you understand "why", then "what" and "how" will make sense.

3. If we're way out in the county, 99 times out of 100 I'll do everything enroute. There's no need in wasting time on scene. However, you never say never. You never say always.

4. If I'm holding on to the "Oh sh*t bar" above me like a spider monkey, then I'm not taking care of the pt. Drive the truck like you're driving on ice; especially if the little 4 year old child is dying on us. Plan your moves and we'll be fine.

5. I don't like getting caught with my pants down. We will take everything the call might need at least to the front door on every call.

6. There's no need in prespiking IV bags, or pre-setting up anything else for that matter, for the next call. That makes absolutely no sense whatsoever. We'll just pull out and spike/set up what's needed when needed if needed.

7. You're my partner. You're not my Basic. You're not my driver. You are my partner. We are going to work together. There are no if's, and's, but's, or ultimatums. I cannot do this without you. We are going to work together. Period.
Click to expand...

Hey you said never and always so you are wrong.:P

Actually I like that response. I may steal it as it covers many points quickly and simply.



Maybe I should say so simple a basic would get it. :ph34r:
 
MSDeltaFlt said:
1. I run to only 2 things: the dinner table and the bathroom, and not necessarily in that order. If you are "b*lls to the wall" then odds are you have missed something important.

7. You're my partner. You're not my Basic. You're not my driver. You are my partner. We are going to work together. There are no if's, and's, but's, or ultimatums. I cannot do this without you. We are going to work together. Period.
Click to expand...

#1: My biggest pet peeve. Don't expect me to get all "Hollywood" and go running to the door. Because I would be the idiot that trips over the pothole/kid's bike/transmission hiding in the grass, land face first in the dirt while taking a Monitor to the back of the skull

#7: I wish so more people thought like this. I loved my prior job because we had set partners for 6months at a time, I usually lucked out and ended up with a medic/emt that just clicked....Even the ones that we didnt see eye-to-eye worked out because we KNEW we'd be stuck together so sacrifice a little on each part and make it work. Now where I work it just seems everyone is out to prove whose the bigger turd or see how many people everyone can backstab.
 
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MSDeltaFlt said:
Okie dokie, back on topic. Unless my partner is extremely familiar with me and how and why I do things, if needed I will try to let them know that I have only a few simple rules. But bare in mind that I'm not the kind of guy that goes around barking rules. These are only my personal "rules" that I live by on the truck. They are only guidelines for my partner. I'm only writing them down here because the question was asked. So here we go.

1. I run to only 2 things: the dinner table and the bathroom, and not necessarily in that order. If you are "b*lls to the wall" then odds are you have missed something important.

2. My preference on patient care is: I have no preference on certain equipment. I'll let the situation/presentation decide what I use. "Why" is much more important that "what" or "how". If you understand "why", then "what" and "how" will make sense.

3. If we're way out in the county, 99 times out of 100 I'll do everything enroute. There's no need in wasting time on scene. However, you never say never. You never say always.

4. If I'm holding on to the "Oh sh*t bar" above me like a spider monkey, then I'm not taking care of the pt. Drive the truck like you're driving on ice; especially if the little 4 year old child is dying on us. Plan your moves and we'll be fine.

5. I don't like getting caught with my pants down. We will take everything the call might need at least to the front door on every call.

6. There's no need in prespiking IV bags, or pre-setting up anything else for that matter, for the next call. That makes absolutely no sense whatsoever. We'll just pull out and spike/set up what's needed when needed if needed.

7. You're my partner. You're not my Basic. You're not my driver. You are my partner. We are going to work together. There are no if's, and's, butbut's, or ultimatums. I cannot do this without you. We are going to work together. Period.
Click to expand...

I appreciate you trying to pull the thread back on topic. I think this will give everyone a good idea what is expected of a partner. I know there is much more to being a good assistant but I like the "your my partner" concept. I almost went to work as a PMA (Paramedic assistant) here in WA. I knew working alongside a medic until I decide which path to take would have been a great experience. Our ALS agency really encourages the crews to work as a team and to forget the your my driver and I'm the medic way of thinking. Of course having an even tempered medic that is willing to teach helps tremendously.
 
MSDeltaFlt, I have to agree with your post, especially the part about being partners. I am sure we have all had "that partner" at some point in our career, whether it was for a shift, a week, a month, or a year. I know I have, anyway. It makes for a really long shift when you are stuck with a pain in the posterior instead of a partner. If we could all just remember what it felt like to be on the receiving end of working with "that partner" I bet we could all be better partners to whom ever we work with.

That being said, the best advice ever given to me while I was still a basic was to be familiar with ALS protocols. Once you recognize which path your medic partner is going down, then you can predict what s/he most likely will need from you. It wasn't expected of me to know exact dosages of drugs, how they worked, or why they were given. (Due to the nature of my personality, I asked alot of questions and did what I could to find those answers, but it wasn't expected of me.) However, if I knew a patient suffering from an exacerbation of CHF gets drugs X,Y, and Z, I could get them out of the drawer for my partner. It is advice that I give to every basic that has ever asked.

Of course, now that my partner is in medic school, I will occasionally be quizzing him about things, if that is something that he wants me to do. When my partners did it to me, it helped to reinforce other learning methods, and it was a good way for my partners to review as well.
 
MSDeltaFlt, hope you don't mind my quoting you in my signature. I couldn't agree more!
 
something I tried to teach all of my EMT-B partners: on any and all ALS patients, I wanted 4 things done.
1: pt on O2; if you think they need hi flow, then do it.
2: IV set up and ready
3: patient on a monitor
4: good set of vital signs, (not off the monitor)

which ever item I was doing, pick one of the others and do it till it was done, then start the next one. and they will change in what order you need to do them, or which order I was doing them.
 
Pretty much, if I am lead tech, I touch the pt and do proceedures... and the driver documents. Thats it.
Regular partners know when I need help and will fill in the gaps as needed, without asking. Of course... that comes with lots of 'together' training. But its nice when we can read each others mind and the scene flows magically smooth without much conversing between us. Each move is predicted. Now that is what I call a good team of partners.
Switching out partners regularly seems to slow the groove down, and it gets confusing at times.
 
MasterIntubator said:
Pretty much, if I am lead tech, I touch the pt and do proceedures... and the driver documents.
Click to expand...

Maybe I am misunderstanding what you mean by this statement, but if you are the one providing patient care, shouldn't you be the one doing the documentation? I mean, if your driver is doing his/her job, they are in the front of the truck driving, and can't specifically speak about exactly what you are doing in the back of the truck.
 
I could have filled in the gray areas in-between the lines. If the driver is not driving ( while on scene ), I generally do not want the MDT, 100% of me goes to the pt. While enroute to the ED, then I will tinker with the MDT, and ultimately complete it. With a good driver, most everything will be done documentation wise just short of treatments/proceedures done enroute and the narrative. Which are just a few button clicks away. Keeps my turn around times 10-15 minutes.
 
MSDeltaFlt said:
1. I run to only 2 things: the dinner table and the bathroom, and not necessarily in that order. If you are "b*lls to the wall" then odds are you have missed something important.

2. My preference on patient care is: I have no preference on certain equipment. I'll let the situation/presentation decide what I use. "Why" is much more important that "what" or "how". If you understand "why", then "what" and "how" will make sense.


4. If I'm holding on to the "Oh sh*t bar" above me like a spider monkey, then I'm not taking care of the pt. Drive the truck like you're driving on ice; especially if the little 4 year old child is dying on us. Plan your moves and we'll be fine.

5. I don't like getting caught with my pants down. We will take everything the call might need at least to the front door on every call.


7. You're my partner. You're not my Basic. You're not my driver. You are my partner. We are going to work together. There are no if's, and's, but's, or ultimatums. I cannot do this without you. We are going to work together. Period.
Click to expand...

#1 I've seen way too many people make this mistake and the bad part is I have even seen everyone do it, physicians, nurses, police, everyone. staying calm is something we should all remember, and consciously do on every call

#2 I like this, I will be using it when I workj with new people from now on. I'll be sure and give you copyright credit :P

#4 This is a point I ALWAYS make in my EVOC classes, as well as "if we dont make it there, we cant help the pt"

#5 every call, every time. unless its a discharge. no excuse for laziness, pack it on the cot and at least take it to the door

#7 too many people dont realize its a team, I may be a paramedic but that doesnt mean I dont want and need my partner whether B, I, or P


I left one out of my last post, I ask them for no more than the speed limit nonemergency, and no more than 10 over for emergency if weather permitting, especially until I get to know there driving. my usual partner drives as safe as reasonably possible, if thats under the limit or over. we cant help if we dont get there, and we only strain the sytem if we need to call more resources for our accident
 
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