# Amitriptyline OD



## trauma1534 (Nov 27, 2006)

I had an OD situation some time back involving the drug Amitriptyline, I was wondering if anyone else has had dealings with this situation and how did you handle it?


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## jeepmedic (Nov 27, 2006)

I slept through mine.


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## trauma1534 (Nov 27, 2006)

jeepmedic said:


> I slept through mine.



no... tell the truth.... "Press hard 3 copies!"


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## Guardian (Nov 27, 2006)

trauma1534 said:


> I had an OD situation some time back involving the drug Amitriptyline, I was wondering if anyone else has had dealings with this situation and how did you handle it?



This is where you are going to feel bad about giving ridryder a hard time, and this is where you are going to see why a good formal education is so important.  After he blows you away with his answer, you might have a better understanding why I think all ems providers should be paramedics (at the very least).


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## trauma1534 (Nov 27, 2006)

Guardian said:


> This is where you are going to feel bad about giving ridryder a hard time, and this is where you are going to see why a good formal education is so important.  After he blows you away with his answer, you might have a better understanding why I think all ems providers should be paramedics (at the very least).




Now, that was uncalled for!  Be pretty!


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## Guardian (Nov 27, 2006)

I didn't mean it as an insult but I guess it came out wrong, sorry


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## trauma1534 (Nov 27, 2006)

Guardian said:


> I didn't mean it as an insult but I guess it came out wrong, sorry




Guardian, act pretty!  

I want to clarify something about Ridryder.  I don't hate the guy's guts.  I think he is very inteligent, just alot of times, he comes off sounding like he is trying to insult people.  Hard guy to figure out.  I just call things as I see them from some of his comments.  I don't disregard everything that comes out of his mouth, or in our case, fingers when he types! ;-P  

Lets not get a pissing match going in here, please!  I just want to discuss the situation with the drug.  

again, guardian, don't be ungly, act pretty!  ;-)


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## Guardian (Nov 27, 2006)

I'm pretty enough as it is, i don't need to act it!


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## trauma1534 (Nov 27, 2006)

Guardian said:


> I'm pretty enough as it is, i don't need to act it!



Pretty is, pretty does!  LOL


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## Fedmedic (Nov 27, 2006)

trauma1534 said:


> I had an OD situation some time back involving the drug Amitriptyline, I was wondering if anyone else has had dealings with this situation and how did you handle it?



Just hang a bicarb drip and then "press hard-3 copies."


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## trauma1534 (Nov 27, 2006)

Fedmedic said:


> Just hang a bicarb drip and then "press hard-3 copies."




Fedmedic, have you ever known anyone with this type OD?


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## Fedmedic (Nov 27, 2006)

trauma1534 said:


> Fedmedic, have you ever known anyone with this type OD?



Yep, picked several up. It is a tricyclic antidrepressant. Treated with bicarb, due to it causing metabolic acidosis. Now why do want to make me access all that useless information I have stored, now I have a headache....geez


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## trauma1534 (Nov 27, 2006)

Fedmedic said:


> Yep, picked several up. It is a tricyclic antidrepressant. Treated with bicarb, due to it causing metabolic acidosis. Now why do want to make me access all that useless information I have stored, now I have a headache....geez




Well... a little birdy told me that you knew someone personally who had this OD.  What was done for that patient?  I believe it had something to do with a bathtub?  LOL


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## Fedmedic (Nov 27, 2006)

Oh...now I know what you are getting at....hahahahahahahahahahah


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## jeepmedic (Nov 27, 2006)

you know he's our uncle


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## Fedmedic (Nov 27, 2006)

We should probably get Prizonmedik's take on this one.......


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## jeepmedic (Nov 27, 2006)

I called him today and he said he was grounded.


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## Fedmedic (Nov 27, 2006)

He told me the same thing...imagine that.


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## MeckRS83 (Nov 27, 2006)

Bicarb would be your friend here, and only a paramedic staffed truck.  I think paramedics should be the only level allowed on a truck anyway.


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## trauma1534 (Nov 27, 2006)

MeckRS83 said:


> Bicarb would be your friend here, and only a paramedic staffed truck.  I think paramedics should be the only level allowed on a truck anyway.



That is a matter of an oppinion.  I happen to love to work with good eager to learn EMT-B's.  What about the EMT-I's?


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## MeckRS83 (Nov 27, 2006)

I think EMT-I's are just taught enough about ALS to get them in trouble.  They are in my book, Kindergarden ALS....  Medic want to be's!


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## Ridryder911 (Nov 27, 2006)

Tricyclic overdoses should be lavage as well, and yes bicarb if possible. There is was an article that described a 50/50 rule. Fifty percent of the patients that present with tricylic poisoning are asymptomatic, and 50% of those die...(sorry, can not find the article) This type of overdose is one of the most serious types around, when many are concerned with Valium, Lortab etc.. which does not cause as much toxic effects.

So being over cautious is good advise on tricyclic O.D.'s. The patient may appear okay, and in a few minutes be dead. Idioventricular rhythms are prominent in many of the O.D.'s

In our state Intermediates are able to administer NaHc03 (and D50W as well) due to it is considered an electrolyte solution not a medication (according to the State Medical Director). Most of the EMT/I's in my state are in rural areas, EMT/I's in metro areas are usually EVO's. Basic's and Intermediates are generally considered the same here. As well most of the EMT/I courses are no longer taught.. either Basic or Paramedic. 

R/r 911


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## MeckRS83 (Nov 27, 2006)

Ridryder911 said:


> Tricyclic overdoses should be lavage as well, and yes bicarb if possible. There is was an article that described a 50/50 rule. Fifty percent of the patients that present with tricylic poisoning are asymptomatic, and 50% of those die...(sorry, can not find the article) This type of overdose is one of the most serious types around, when many are concerned with Valium, Lortab etc.. which does not cause as much toxic effects.
> 
> So being over cautious is good advise on tricyclic O.D.'s. The patient may appear okay, and in a few minutes be dead. Idioventricular rhythms are prominent in many of the O.D.'s
> 
> ...



Very good points made Ridryder.  

As far as Basic classes, I think they should just do away with the Basic program all together.  I think it is just a waiste of time.  I mean if someone is going to be an EMS provider, why not go ahead and be a real provider.  Paramedic is the only way to go.  Don't you agree?


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## Ridryder911 (Nov 27, 2006)

Personally, I believe there is a place especially in rural and volunteer systems. The mindset though is how to use them in the best way and appropriately. They are a valuable asset as a first response system and especially in assisting in care. 

Albeit, it would be nice to have all Paramedics, I personally understand that this would not be financially feasible for most companies, and as well research is now showing that skill deterioration may be occurring due to the over abundance of Paramedics in some companies, services. In fact one study described that some larger services Paramedics may only intubate 3-4 times a year. Yes, it would be nice to have a dual Paramedic to reduce mental, and physical fatigue, as well quicker ALS procedures to be performed and hopefully a more thorough assessment. Patients should at least have a Paramedic to over see and perform ALS treatment if and when needed on all emergency responses. Yes, there are many do think that Paramedic level should be the entry level for EMS transport units, and many of these are active EMS physicians. But this debatable, and I personally do not have a set opinion. I do believe though all Paramedic programs should be at the minimal an associate degree level, so professionalism, educational levels can be validated. Not that this makes them better, but at least can be validated so increase wages, promotion, and career and education ladder can be pursued.
Current text books are not in-depth enough to keep up with the current assessments, equipment used, and treatment needed. For example most health care psychological, O.B. texts are over 1000 pages alone, now compare that with EMS addressing these with a sole chapter, yet many have the opinion they are "trained in-depth" enough.   

Abolishing Basic and even Intermediates will not correct EMS problems. Rather attention to those programs should be highly examined, increasing educational standards and increasing clinical requirements, is my recommendation. As we have discussed the curriculum had increased in length, but diluted in content. It used to be most Basic etc.. was prepared to enter Paramedic courses without much prompt or changes, but now; I see increasing difficulty from students a higher drop out rate and instructors having to not just to teach ALS but BLS as well.

The whole EMS system have been abused and ill treated. When I watch old t.v. shows such as "Emergency" those patients portrayed receive more advanced care than 30% of the citizens do in the U.S. right now. More sad, is this t.v. show was filmed over 30 years ago... so yes, we advanced in individualized care and treatments, but our system has sucked as a whole. 

So my madness and being a ..."poop stirrer"..is to motivate EMT's all levels to be involved in legislation, EMT associations, and State Committees to adress these problems and solve many. Most EMT's really do not care, unless it affect their pay checks.. then when it does, it will be too late. I know, ask about 15 EMS personnel that just lost their jobs this last week. This occurred because they too thought.."it won't happen here"... and it did. 

I am not a pessimist person.. really. I just know, we can correct this, and I much rather for us in EMS change it then SOMEONE else outside EMS tells us how to and that will be the final answer.. and we will be stuck with it. 

R/r 911


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## trauma1534 (Nov 27, 2006)

Rid, I must say that I am really starting to see your point.  You are comming across more clear now, and not in an insulting manner.   You are saying that you don't dissagree with EMT-B's, you just want them to have a higher standard of training.  I can accept that.  I agree.  I think I read a post recently about EMT-A being a more indepth and better course, but they were not allowed to do the skills that EMT-B's can now.  If they could match the skills up with the old style of training, we would have dynamite Basics.  No, while they would not be able to provide advanced skills such as 12 lead monitoring, decompress, RSI, crych, they could be better trained to handle more situations.  I remember when I went through the old A program, the requirements were for you to learn all the med terms, all the bones, each system of the body was broken down, the different types of fracs... it was a 180 hour class with ER time, and Ride time.  Back then, you rode (or atleast our class did) untill the preceptors thought you had it.  I did alot of ER time.  The clinicals and the intense training made us better providers, with the combination of having access to other good providers who wanted to encourage and help us as we came through.  There was also the compitition between us that made us good.  

Now, EMT-B curriculam is 120 hours, I believe, someone correct me if I'm wrong...  you are no longer required to do ER time, and you only do 10 hours of ride time.  

Just a big huge difference, that I think we need to bring back. 

Meck, the answere is not to do away with EMT-B's or I's we need to make it better.


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## Guardian (Nov 28, 2006)

MeckRS83 said:


> Very good points made Ridryder.
> 
> As far as Basic classes, I think they should just do away with the Basic program all together.  I think it is just a waiste of time.  I mean if someone is going to be an EMS provider, why not go ahead and be a real provider.  Paramedic is the only way to go.  Don't you agree?




I too think there's a place for emt-b, example, first responders (firefighters), bls routine transport, etc.  I would even consider emt-b in ems in certain circumstances.  I just think we should get away from our reliance on poorly trained bls providers to provide a primary ems service.  As for emt-I/emt-c, that's just a poor, cheap, lazy mans paramedic (not a knock to every emt-I, there are some good ones).


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## jeepmedic (Nov 29, 2006)

Some parts of the country that is all they can get is an EMT-I. I too agree that everyone deserves to have a Paramedic on the Truck but that is the problem with our system today. People settle for what they get. How many hospitals run with just a PA or NP? They all have to have a DR. to operate. You still need the PA's and NP's but to operate you need a Dr. There are places in all medical fields for diffrent levels of providers but everyone needs to strive for the highest level possable for there area.


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## ResTech (Nov 30, 2006)

hmmm... topic took a steep shift from the original question. A lot of ignorance contained within this thread. Overall impression from this thread is EMT-B's are :censored::censored::censored::censored: and worthless and make no clinical difference which is total BS. I'll be the first to tell you that ALS is highly over rated. 

I work in a system that is two-tiered where ALS comes from the hospital (chase unit) and ambulance from the FD as BLS. BLS is more then capable of assessing a patient and knowing which patients will benefit from ALS care.  I don't hesitate to cancel ALS when they are not needed. In fact, it's a very frequent occurrence. Point being ALS isn't required as much as ppl think it is which supports my statement that ALS is over rated. 

So many studies done that show BLS care is more BENEFICIAL in certain pre-hospital scenerios then ALS care. To cite one study done in CA, pt's. with significant injuries that arrived POV at the hospital had a much higher survival rate then those that arrived by ALS ambulance. These findings were attributed to ALS ****ing off onscene whereas the POV group was "load-n-go". A patient needs to be in a hospital, not out in the field being asked a million and one questions by a guy (or girl) that thinks they are there to save the world. If ALS would worry about providing "basic ALS care" and not trying to be the latest and greatest and most impressive our patients would be a lot better off. 

I've been in EMS for 11 years as a BLS provider. I did attend paramedic school for a year and a half before withdrawing for personal, non-academic reasons.... in fact I was an "A" student. During that period of medic school, I've functioned as an ALS provider on an ambulance during clinicals and performed almost all the ALS modalities (IV's, drawling meds, injections, chest decompression (cadaver), IO's, intubations (OR, ED, field, and cadaver), and crics (cadavers). So I know what itz like on both sides and I READ ALOT and keep up with the current trends in EMS. Point being, ppl try to confuse the system. They dont always think practical they think biggest and best and anyone less then paramedic doesn't know anything. 

Someone made the point about needing to have a DR to operate a ED so why not mandate a paramedic on every ambulance? Why dont we go one step further and mandate a physician on every ambulance. Our patients need the highest level of care right? Then maybe we can all begin doing the treat and release thing onscene, get units back on the street faster, intro ultrasound into the field, start carrying two drug boxes instead of one. Hell, I say for trauma calls all ambulances need to have a surgeon onboard.

Staffing is not a superficial issue and not always an easy one. Way to many factors to consider and overcome. Would it be nice to have a paramedic on every ambulance? Maybe. But BLS providers are not stupid. They are ppl with the same intellect that go on to become paramedics. Yes they're are idiots for BLS providers and they're are complete idiots for ALS providers. Only difference is BLS carries a stigma and ALS is automatically thought of as divine beings. And to be clear, ALS is vital but lets not make it more then it is and forget about what our patients really need. Insulting BLS isn't going to help anyone.  

I got interrupted with a call while writing this and lost my train of thought but hopefully the point is delivered.


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## jeepmedic (Nov 30, 2006)

So now we have got back to the days of the Hurst transporting folks. Stop Flop and roll.


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## ResTech (Nov 30, 2006)

Well, whenever life saving interventions are performed in the field based on empirical data we sometimes find the old way is what works best and need to revert to it. Who cares if it isn't fancy or high-tech? Sometimes research proves our current approach is way off.


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## Airwaygoddess (Nov 30, 2006)

In EVERY JOB PROFESSION, There are people that are good and bad, I have worked with some of the best no matter WHAT TITLE is behind their name.  I have said before these folks were my first teachers and then became my mentors because they were proud of the profession that they have chosen.  It is a person's responsibility to keep learning and growing with whatever job that they choose.  I have worked with nurses, paramedics, and emts, some of these folks did decide to go back to school and further their education and move on to other fields.  I strongly agree with continuing one's education, we owe it to ourselves to keep up with new theories and skills, if we choose to go on and to achieve advanced degrees in our chosen professions or change all together that is great.  I also strongly believe that it is the person that is a  professional, not the job, no matter what the title is on the name tag.  I have worked with some of the best in the field and in the hospital.  These fine folks NEVER bashed someone because of their job title.  Did they call them on the carpet for not doing their job, hell yes!!  We are in the business of taking care of people, and it requires respect, education, and professionalism amongst ourselves and to others.  Respectful submitted to all
in the profession.


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## trauma1534 (Dec 4, 2006)

Guardian said:


> I too think there's a place for emt-b, example, first responders (firefighters), bls routine transport, etc.  I would even consider emt-b in ems in certain circumstances.  I just think we should get away from our reliance on poorly trained bls providers to provide a primary ems service.  As for emt-I/emt-c, that's just a poor, cheap, lazy mans paramedic (not a knock to every emt-I, there are some good ones).




How would you know?  You've never took the B class.  EMT-I's here are a couple skills shy of being a paramedic.  But, you will understand the business better as you get into it more.  It's not your fault that the first responder curriculam only touches on what ALS and BLS is.  You'll get a better idea of the things you can do as an EMT-B, when you become one!  Stick with it though.  You'll do fine!


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## prizonmedik (Dec 16, 2006)

FYI it was a shower, not a bathtub.  But I was able to drive home!!!!!!!!!


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## natrab (Dec 16, 2006)

Working in a 1 and 1 county (one medic/one EMT per ambulance) with 90% BLS fire, I have to say EMTs can be as useful as paramedics in most situations.  I've watched good CPR bring back a code before any meds were even pushed.  One great EMT-B actually held cric pressure to assure good ventilations while another ascultated lung sounds as I walked in the room.  Too many cooks can spoil the stew in many situations, and with the amount of people becoming medics after never being an EMT-B, there is a serious lack in BLS skills in many new medics.

One thing I wish is that the EMT-B scope could be expanded to include starting IVs and administering NS.  Most military people are trained in this, and it is a very basic skill.  That way EMTs can have some extra shock control and a medic can have some extra help when he is by himself and there's a whole lot of ALS to be done.


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## captoman (Feb 4, 2007)

Damn, what a can of worms this is! I work in a larger community/county, about 50k  ppl in winter and 250k ppl in summer. We have a level 4 community hosp in town, and are 62 mi from a lvl 2 trauma cntr, 132 miles from the cities which has a couple lvl 1's and specialty centers. our trucks staff 1 EMT-I, 1 CCNREMTP. I call our good emt-I's "mini-medics" becuase we hold them to a very high standard, and most of the meet & surpass the expectations. When there is a lot of stuff to be done, and we need to leave scene RFN due to a 30min code 3 time, I love the help in the back, we get set up, I do the rest enroute. Now even considering our run volume is 89% ALS, It would  be a finiancial nightmare to staff all medics. EMT's have their place and serve it well. Someone on here has a tagline that reads "The EMT you teach today is the Paramedic who may take care of you tommorow". That is a great mentality, one I try to take to work with me each day. 

Ridryder cited a study saying "some larger services Paramedics may only intubate 3-4 times a year".  I've done that many so far this year! I wonder what is behind this?


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## Jon (Feb 4, 2007)

captoman said:


> Damn, what a can of worms this is! I work in a larger community/county, about 50k  ppl in winter and 250k ppl in summer. We have a level 4 community hosp in town, and are 62 mi from a lvl 2 trauma cntr, 132 miles from the cities which has a couple lvl 1's and specialty centers. our trucks staff 1 EMT-I, 1 CCNREMTP. I call our good emt-I's "mini-medics" becuase we hold them to a very high standard, and most of the meet & surpass the expectations. When there is a lot of stuff to be done, and we need to leave scene RFN due to a 30min code 3 time, I love the help in the back, we get set up, I do the rest enroute. Now even considering our run volume is 89% ALS, It would  be a finiancial nightmare to staff all medics. EMT's have their place and serve it well. Someone on here has a tagline that reads "The EMT you teach today is the Paramedic who may take care of you tommorow". That is a great mentality, one I try to take to work with me each day.
> 
> Ridryder cited a study saying "some larger services Paramedics may only intubate 3-4 times a year".  I've done that many so far this year! I wonder what is behind this?


LA County has a Medic on virtually every ambulance and fire engine... and their medics supposedly get an average of 2-3 tubes a year... so, no wonder they SUCK at intubations. Boston EMS has *something like* 70 medics on the payroll - similar cities have that many medics on the street on a shift - and Boston gets WAY more Code Saves than a city like Philadelphia, with 80 medics on duirng peak hours.

The numbers here are probably a little old... these are what I remember from Bob Davis's heated debate at EMS Today 2005. LA County still has airway issues, though... they instutuded an "Airway Medic" program a year or 2 ago for that reason... the idea... the first medic onscene's SOLE role is Airway... not ACLS.


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## FF/EMT Sam (Feb 4, 2007)

MeckRS83 said:


> I think paramedics should be the only level allowed on a truck anyway.



I'm using every ounce of my self-control to not call you a few choice words.  Now, can you please back up that preposterous statement with at least a shred of evidence, facts, and/or data?  



Sheesh, I'm tired of the ParaGods...


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## FF/EMT Sam (Feb 4, 2007)

MeckRS83 said:


> I think EMT-I's are just taught enough about ALS to get them in trouble.  They are in my book, Kindergarden ALS....  Medic want to be's!



When someone is willing to give up a good portion of their own life to learn how to save lives, you have no right to say that they are useless just because you happen to have more training.  I am an volunteer EMT-B who ran literally 200+ calls last year and has saved patients' lives.  There are countless other EMTs like me in the United States, and we can save lives just like you paraGods.  I think that I speak for all the other EMT-B and I's on this site when I say that I consider your statements about our ability to be slander.  

Have a nice day.


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## Ridryder911 (Feb 5, 2007)

200 calls that's it ? That's about 4 calls a week. Some would not even consider that is not enough exposure to maintain proficiently. Now, when you quit bragging, let's really evaluate how many "saves" you really did actually perform. You (yourself) can actually present and demonstrated that  you  prevented and actually cured and brought someone back from the dead? All this within 200 calls? Better publish your results, because the national average is <6%.  It is hard to describe any medic or even an ER Doc that they will say that they save very many lives a year. 

You can actually say having BLS is better than providing ALS for your patients? What are you going to do when that patient has a right sided AMI, frank CHF, or even severe pain with that femur fracture or 60% burns with facial subglottic emphysema? We could list the potential problems that involves anything that requres medication(s) and monitoring of ECG and hemodynamic factors.

Now you described you gave a "great portion of your life" for a EMT certification. A few weeks of night school is a great portion of life ? Want to compare ? EMT courses are just a few weeks greater than the advanced first aid and the first responder courses.  In fact in California, one can take a complete EMT course in 2 weeks. Even a manicurist goes an additional 50 hrs longer than the standard EMT course to learn to cut and polish toenails, and the beautician (that cuts dead cells) goes almost 200 hrs longer than the standard Paramedic course in the U.S. This is a shame ! No matter if one is volunteer or paid. 

Slander?....  This is not from just the poster or what you labeled as _ Paragods_ rather by publications from national renowned physicians and EMS researchers.(Wang, Bledsoe, Pep'e. etc) Those that actually gave up "decades" of their lives to study and understand EMS systems and emergency and critical care patient care. 

I suggest that you might want to refer to medical journals such as _Prehospital Care, Studies of Prehospital Disaster Medicine, Emergency Cardiac Care Quarterly, Journal of Trauma, ENA Journal, ASTNA Journal, and JEMS _. Visit the web sites such as Advocates for EMS, National EMS Educators Society, National EMS Physicians, American College of Emergency Physicians, and American College of Surgeons, CAPEM,etc...

Health care professionals are concerned that the care being delivered is going downward, and the levels of training has become less and less efficient at all levels.

The concern should be for all levels and both paid and volunteer. If we do not improve it, someone (other than those in EMS) will. 

R/r 911


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## FF/EMT Sam (Feb 5, 2007)

Ridryder911 said:


> 200 calls that's it ? That's about 4 calls a week. Some would not even consider that is not enough exposure to maintain proficiently. Now, when you quit bragging, let's really evaluate how many "saves" you really did actually perform. You (yourself) can actually present and demonstrated that  you  prevented and actually cured and brought someone back from the dead? All this within 200 calls? Better publish your results, because the national average is <6%.  It is hard to describe any medic or even an ER Doc that they will say that they save very many lives a year.



Looking back over what I wrote, I can see how you felt that I was bragging.  That was not my intention, and I apolgize.  But I have saved numerous Priority 1's, and just last week I saw a former patient of mine who wasn't breathing last time I saw him.  I'm not a "super medic" and I can't do the whole "healing touch" thing, but I'm not too crappy either.  As to the number of calls, my agency runs only 900 per year.  I go to school and I have a job.  200/900 is a fairly high number for a rural community like mine.



> You can actually say having BLS is better than providing ALS for your patients? What are you going to do when that patient has a right sided AMI, frank CHF, or even severe pain with that femur fracture or 60% burns with facial subglottic emphysema? We could list the potential problems that involves anything that requres medication(s) and monitoring of ECG and hemodynamic factors.


I never said that BLS was better than ALS.  As for what I would do for those patients, I would load and go.  15L via NRB.  Monitor and treat where possible (traction split and nitro are two examples.)  Call for ALS.  Run to the hospital like something was chasing me.  

Here's a question for you: If you were one of those patients, would you want a BLS crew immediately, or would you rather go an extra 10 min. without any treatment at all, just so you could have an ALS crew when it finally arrived?  And what can you, as an ALS provider, do for a patient with gout or a minor MVA patient whose chief complaint is finger pain that I can't do?  Isn't it better to have a BLS crew treat the patients who don't need ALS so that ALS can stay available for the patients like the ones you were listing?  You are absolutely correct that ALS providers can do more for patients than BLS providers.  However, by letting the BLS providers take the minor calls, we can free up ALS providers and let them treat the patients who actually need them.



> Now you described you gave a "great portion of your life" for a EMT certification. A few weeks of night school is a great portion of life ? Want to compare ? EMT courses are just a few weeks greater than the advanced first aid and the first responder courses.  In fact in California, one can take a complete EMT course in 2 weeks. Even a manicurist goes an additional 50 hrs longer than the standard EMT course to learn to cut and polish toenails, and the beautician (that cuts dead cells) goes almost 200 hrs longer than the standard Paramedic course in the U.S. This is a shame ! No matter if one is volunteer or paid.


Four months while going to school and working.  I am also on call for approx. 36 hrs/week.  That's no small time committment.  However, I do agree that two weeks is FAR too short.  California needs to retool their EMT-B class if they can cram it all into two weeks.



> Slander?....  This is not from just the poster or what you labeled as _ Paragods_ rather by publications from national renowned physicians and EMS researchers.(Wang, Bledsoe, Pep'e. etc) Those that actually gave up "decades" of their lives to study and understand EMS systems and emergency and critical care patient care.
> 
> I suggest that you might want to refer to medical journals such as _Prehospital Care, Studies of Prehospital Disaster Medicine, Emergency Cardiac Care Quarterly, Journal of Trauma, ENA Journal, ASTNA Journal, and JEMS _. Visit the web sites such as Advocates for EMS, National EMS Educators Society, National EMS Physicians, American College of Emergency Physicians, and American College of Surgeons, CAPEM,etc...


If any of those journals ever advocated for removing BLS providers from ambulances, I would love to see the article.



> Health care professionals are concerned that the care being delivered is going downward, and the levels of training has become less and less efficient at all levels.
> 
> The concern should be for all levels and both paid and volunteer. If we do not improve it, someone (other than those in EMS) will.



All too true.  However, the answer is not to marginalize and push out the entry-level providers.


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## Ridryder911 (Feb 5, 2007)

Okay.. long rant..sorry, but I do believe we have some common beliefs. 

I totally agree initial BLS is essential such as in volunteers as a first response unit. ALS can never or ever work if proper BLS is not already put in place. 

What I am still trying to promote is conjunction of the two not separation. 

So many BLS and Vollies attempt to justify their actions or existence of "would you rather".. No; actually I would rather have both and one can. BLS trained first responders should be able to assess and treat and stabilize patients for at least 20 minutes. This is usually time enough for an ALS unit to arrive and stabilize for transport or even a rendezvous if it is to far. *Again, I am not against BLS or volunteer providers* rather I believe it is the way we are using them. 

What is going to occur is that we will see less and less volunteers as we will require more and more training, responsibilities and costs to those persons. I much rather see them utilized appropiately and to have them on a call, then not to have them at all. 

If a first response unit and ALS unit were dispatched simultaneously, the BLS unit would take approximately 10 to 15 minutes to arrive at the scene. ALS would arrive approximately 5 to 10 minutes later. The BLS unit would have initially performed the assessment, placed oxygen on the patient and possibly packaged the patient (LSB/CID). The patient is basically ready for another quick assessment and initial ALS treatment and transport. A hand in hand operation and thus a successful system. 

As well the BLS unit is ready for another call, and vollies can return to their normal life or if paid squad first response can be available again. This would be a benefit for all. Decreased response time, decreased scene time for vollies and the patient will have ALS if needed, also decreased costs for the communities. I would hope the professional ALS service would recognize the need and provide education and possibly supplies. 

We have such system and the first response guys are great! I know the patient is being taken care of and I have a possible viable patient to work upon. We provide in-services and trade out disposable equipment, since we are able to bill for the patient services. 

Each patient should at least have the availability to be examined by an ALS provider. BLS/ALS or two ALS should staff all EMS transport units. If the patient does not require ALS, the BLS provider can tech and gain the needed experience and exposure. It is too costly to have separation of the two transport vehicles, as well many times those BLS calls have turned into ALS calls while enroute.

For some reason, we (EMS) are mind set in the 60's and 70's and refuse to go forward. Compare ourselves to EMS systems in Canada, Africa and Australia. We might had invented progressive EMS, but we have stopped and dropped the ball. It is a shame a person in the outback in Australia can receive ALS care faster than someone in metro U.S.... or even compare that to a pizza delivered. It is embarrassing, we only keep telling ourselves our courses are long and difficult, that communities cannot afford ALS. When other countries have succeeded.

The only reason EMT's think of "running back to the hospital" is for two reasons. You do not what to do or cannot be done. I call it running scared. In  actuality "Running back" does not decrease time very much, maybe 3-4 minutes at the most, (that is if one is actually driving safe). But in reality, what it will do; will increase the sympathetic response, therefore increasing heart rate, increasing blood pressure..etc.. The heart has to work harder and faster... thus potentially increasing the heart attack. Personally, I believe it would had been much safer and more comfortable to transport them in their Ford from home.  

The point of the authors on some of the posts (albeit, it was not done nicely) is we have to justify what we do. Saying it is the way we always done it, will not cut it anymore. Every IV needs a reason to be started. Every time oxygen is placed on a patient, there needs to be some justification (albeit may be for prophylactic reasons)

Such as oxygen at 15 lpm.. who idea was this? There has never been no research to show or demonstrate it actually increases oxygenation to an AMI patient (once the Hgb is full, no other 02 can bind). All AHA ever stated was high flow > 10 per mask could be beneficial for ischemia. Now for some reason we felt EMT's could not figure that out and started preaching and requiring 15 lpm per NRBM. Therefore everyone is covered (in case someone screwed up). 

Side note**Actually, now some researchers have discovered it might actually cause harm, that it might actually cause constriction (similar to arterial receptors in the brain). Wow, if they are right, think of all the changes!...(and people gripe now, about simple CPR changes )

We have to stop training our providers to follow step-lists and check lists. Patient verily rarely falls into a check list category. Each one should be treated accordingly. But this is for another rant... 

We in EMS (volly, paid, BLS or ALS) have one important reason to be there... for the patients sake. Promote changes as they occur and evaluate the problems we have and correct those. EMS has never been a stagnant business... like patient care, it continuously changes. 

R/r 911


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## FF/EMT Sam (Feb 5, 2007)

^^^^^^^^^^^^^^^^^^^

Now _that_ is a position that I can agree with.  The BLS + ALS as needed system is, in my opinion, the most efficient and effective one.

R/Rid: I hope you can see why I felt that you were putting EMT-Bs down.  Apologies for flying off the handle.   :wacko: 

Peace,
Sam


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## FF/EMT Sam (Feb 5, 2007)

Ridryder911 said:


> The point of the authors on some of the posts (albeit, it was not done nicely) is we have to justify what we do. Saying it is the way we always done it, will not cut it anymore. Every IV needs a reason to be started. Every time oxygen is placed on a patient, there needs to be some justification (albeit may be for prophylactic reasons)
> 
> Such as oxygen at 15 lpm.. who idea was this? There has never been no research to show or demonstrate it actually increases oxygenation to an AMI patient (once the Hgb is full, no other 02 can bind). All AHA ever stated was high flow > 10 per mask could be beneficial for ischemia. Now for some reason we felt EMT's could not figure that out and started preaching and requiring 15 lpm per NRBM. Therefore everyone is covered (in case someone screwed up).
> 
> Side note**Actually, now some researchers have discovered it might actually cause harm, that it might actually cause constriction (similar to arterial receptors in the brain). Wow, if they are right, think of all the changes!...(and people gripe now, about simple CPR changes )



My head hurts.....   I'd love to see the research about 15L O2 causing more harm than good.  I regard O2 as a handy little tool in my toolkit that can (among other things) help a patient relax, reduce pain, and improve O2 sats.  I'd be shocked if O2 could harm a patient in the way you mention, but if it could, we need to change the protocols stat.



> We have to stop training our providers to follow step-lists and check lists. Patient verily rarely falls into a check list category. Each one should be treated accordingly. But this is for another rant...
> 
> We in EMS (volly, paid, BLS or ALS) have one important reason to be there... for the patients sake. Promote changes as they occur and evaluate the problems we have and correct those. EMS has never been a stagnant business... like patient care, it continuously changes.



Amen.


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## Guardian (Feb 5, 2007)

Ridryder911 said:


> Side note**Actually, now some researchers have discovered it might actually cause harm, that it might actually cause constriction (similar to arterial receptors in the brain). Wow, if they are right, think of all the changes!...(and people gripe now, about simple CPR changes )



Do you have a link?


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## Ridryder911 (Feb 5, 2007)

Remember although oxygen is a gas, it is a medication when applied into a higher dose than 21 % level. Like any other medication it too has side effects even harmful to fatal. 

Hopefully, you were taught not to hyperventilate (again not to refer of not applying oxygen, but hyperventilating) head injury patients due to physiology of what occurs with high levels of oxygenation concentration. Cerebral arteries are not like peripheral arteries and have oxygen receptor sites that are susceptible to high oxygen levels and low carbon dioxide levels. These sites recognize high levels of the oxygen and cause vasoconstriction, thus decreasing bleeding (which can be good) but this also causes decreased blood supply distal to the artery. Therefore impaired to no circulation may occur to the distal side of the artery. This could include causes of cerebral ischemia, necrosis. (copy of revised national standard protocols for brain injuries 
http://www2.braintrauma.org/guidelines/downloads/btf_guidelines_prehospital.pdf )


Now, they are discovering that coronary arteries might have the same characteristics. This is again the  possible  findings. 

Again, it is still under research.. but don't be surprised if it does not change with the next CPR and ACLS changes in a few years. 

R/r 911


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## jeepmedic (Feb 5, 2007)

I to would like to see the studys. Not that I don't think this is true but just to read it. As you very well know things in ems changes every day.


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## Guardian (Feb 5, 2007)

Interesting, I always heard no hyperventilation due to decrease in CO2 but never heard or knew that the amount of O2 had anything to do with it.  In fact, I don't remember reading anything about O2 sensitivity or receptors in PHTLS or ITLS either.

oh man, 80 pages, you're killing me.


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## Ridryder911 (Feb 5, 2007)

Sorry.. here is some links on potential oxygen causing coronary constriction.

http://intl-ajpheart.physiology.org/cgi/content/abstract/272/1/H67

http://circ.ahajournals.org/cgi/reprint/63/1/1

There are others, I cannot locate at this time...

R/r 911


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## Ridryder911 (Feb 5, 2007)

Guardian said:


> oh man, 80 pages, you're killing me.



LOL... aww. That is just a quarter of chapter.. lol Afer a while you learn to read real ... fast... 

R/r 911


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## mace85 (Feb 9, 2007)

*Was helpful.*

I am an EMT student, hoping to pursue my Medic, and I currently work in a hospital. 

I was actually finding this conversation educational and intresting. I particularly enjoy Rid's posts. I can understand much of it, and what I do not yet understand I look up or ask the doc's around here. Seeing the advanced information drives me to learn as much as I can (we have an awesome medical library.)

But let me say this. I want to further my education in every way possible. Hence why I am here. However everytime this forum turns into a pissing match between the EMT-B's, I's, P's, RN, CCRN, etc. it only drives me further away. I see this as a diservice to a providers who are trying to "be recognized as a profession." 

Please grow up, if you have an issue with a level of training, work to change it. It's easy to be a keyboard commando, it's harder to become an EMT-B instructor, or develop programs for your agency and improve upon the problem. If you feel EMT-B's are useless, then do something about it. But above all, do not insult the provider. For every one that is happy at their education level, there is another who wants to improve. All this *****ing is doing is removing peoples desire to work in the field, and destroying your "professional image."

You may notice this is my first post. I was forum lurker, but derailing this educational conversation to whip it out and play "whose is bigger" really bothered me.


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## Ridryder911 (Feb 10, 2007)

Welcome to the forum. I am glad these topics have peeked your interest. As you mature into the profession, you will see that this is a common problem among profesionals. 

If you are addressing me, I can assure you I have worked upon various ad-hoc committees at both state and national levels for the improvement of EMS.As well as a full time research and consultant to various states for betterment of EMS, and a EMS professor at various programs. Meanwhile still performed in the field and hospital setting. If you are not in the trenches, it is hard to identify the problems. 

I agree this appears to be some problems within our profession, however; you might find this is common in many professions especially health care. Increase debate leads to researching and discussing changes and improvement of oneself. Apathy is one of major problems, other are of course lack of education, dispensing inaccurate or poor information about EMS systems and medical care. Many assume if it is not performed or like it is in their area it is wrong. This is the greatness of forums, allow one to see outside local policies and protocols. As viewing the good and the bad, and the need of improved research. 

I do agree, it may appear to be harsh at times. I can reassure you it is the norm of health care professionals. I hear it and read it on med student forums, physician forums  of ... surgeons versus family practitioners.. etc. It actually sometimes entices one to research, read and hopefully learn something, if not at least recognize a different view. I know personally I have learned a lot from EMS forums, at least different approaches on the same problems. 

Again, good luck in your studies and career!

R/r 911


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## Guardian (Feb 10, 2007)

mace85 said:


> I am an EMT student, hoping to pursue my Medic, and I currently work in a hospital.
> 
> I was actually finding this conversation educational and interesting. I particularly enjoy Rid's posts. I can understand much of it, and what I do not yet understand I look up or ask the doc's around here. Seeing the advanced information drives me to learn as much as I can (we have an awesome medical library.)
> 
> ...



Ok everybody, you heard mace85, lets not discuss anymore hot topics that might be a little controversial.  Lets make this website one dimensional and stick with harmless educational topics.  Lets avoid the big issues that may threaten our careers in the years to come.

I agree that too much of one thing is bad and so I try to limit myself but stop altogether...hmm...no thanks.


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## mace85 (Feb 10, 2007)

Rid...I have read enough of your posts to know you are very active in those areas. Believe me I am not calling you out. I would like to eventually be able to look at things as you are able to. However, Guardian I am not implying that this forum should bland and 1 dimensional. You shared your opinion, and I shared mine. However when people imply that EMT-Bs have no buisness in the field that is out of line. Just because your a higher tier provider does not mean that the providers under you are useless. If  a paramedic believes that basics are without purpose, then maybe they should take an active role in educating them. Attempt to bring them up to the level YOU see fit. Formally or informally. Fix the problem. Do not make a blanket statement. 

My original point is this: a thread that was started to discuss a medical issue was converted into a pissing match. That helps no one.


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## Guardian (Feb 10, 2007)

mace85 said:


> Rid...I have read enough of your posts to know you are very active in those areas. Believe me I am not calling you out. I would like to eventually be able to look at things as you are able to. However, Guardian I am not implying that this forum should bland and 1 dimensional. You shared your opinion, and I shared mine. However when people imply that EMT-Bs have no buisness in the field that is out of line. Just because your a higher tier provider does not mean that the providers under you are useless. If  a paramedic believes that basics are without purpose, then maybe they should take an active role in educating them. Attempt to bring them up to the level YOU see fit. Formally or informally. Fix the problem. Do not make a blanket statement.
> 
> My original point is this: a thread that was started to discuss a medical issue was converted into a pissing match. That helps no one.



Congrats, you're now in your first pissing match with me. lol

"However when people imply that EMT-Bs have no buisness in the field that is out of line"  Says you, there are plenty of people who would rather have 2 critical care paramedics taking care of their family.  I don't want to get into this debate, just wanted to point out that you are now arguing the very same point you discouraged us from arguing in your first post.

"If  a paramedic believes that basics are without purpose, then maybe they should take an active role in educating them"...that's what I'm doing right now.

"My original point is this: a thread that was started to discuss a medical issue was converted into a pissing match. That helps no one"...well, you know the old saying, one man's pissing match is another man's...


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## premedtim (Feb 10, 2007)

You know, the interesting thing is I'm currently an EMT-B student yet I find myself agreeing that EMTs are poorly trained. Why? Well, every topic we cover in class such as respiratory problems, soft tissue injuries, etc. take up a whole whopping 30-page chapter. I'm sure some training is better than nothing but seriously, that's just nothing. My friend in medic school has about ten textbooks compared to my one. I don't think it'd be too outlandish for EMT-Bs to at least have a few textbooks worth of information to read if people want them to have more training. Hell, for that matter, it'd probably go a long way to start producing EMTs with associate degrees and paramedics with bachelor degrees in paramedicine.


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## MMiz (Feb 10, 2007)

*Lets keep this thread on topic please.  Keep personal issues/comments to PMs.*


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