# The frustration of BLS



## MMiz (Jan 7, 2005)

Working on the BLS level, I find myself often wishing that I could interpret EKGs, wishing that I had the knowledge to correctly diagnose problems.  

Right now I work at the reactionary level, and after I treat some of these patients I feel lost sometimes.  I get there in time to put them on O2, get get some vitals, then ALS shows up.  Usually I show up at the same time as ALS, and then I'm cleared by them so I can get back in service.

For the second time in my life, on new years eve, I transported a patient RLS with ALS on board.  An FTO on board started prompting me as to what I thought, and while I had some guesses as to the problems, I felt out of place and unprepared.

Most recently with my pt at 30,000 feet, I had an amazing drug box but no knowledge or authority to administer them.  When the medics came on board they immediately ran an EKG, and while the nurse made a face and told me what was on it, I had no clue what it meant.

What do you people do when ALS isn't a minute behind you?  I dont see a paramedic class in my future, so I think I'll have to be content being an Basic... but I'm not.


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## rescuecpt (Jan 8, 2005)

I was scared a lot as an EMT-B.  Because I don't like it when people die and I felt much the same way you do Matt.  That's why I took my CC.

In theory, you could take an ACLS class, or some CME's to hone your skills - but short of taking an intermediate, critical care, or paramedic class, there's not much you can do besides knowing that you are doing everything you can (training, con-ed, reading, etc) to give your patients the best care you can.


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## MCSHughes (Jan 8, 2005)

So much of a good paramedic is basic care!  Don't overlook just how much you can contribute to the good outcome of a call.  Gather and write down meds, name, birthdate, history, VS.  Do a good physical exam and write down what you find.  Use some common acronyms that most EMS providers would use, "OPQRST" and "SAMPLE" for example.  If you give oxygen, check to see the effect after a few minutes.  Only transfer patients get one set of VS, so repeat your VS, and agaiin, write all this down.  I'd LOVE to have first responders who could do such simple skills consistently and professionally and would hire them THAT fast!

Never underestimate your value as a BLS provider.

Mike


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## Luno (Jan 8, 2005)

Mmiz, all I can say, is when you feel deficient in something, study it, my first time out, I was looking at a patient's drug list, and I had no idea what I was looking at, so the next day I went out and bought a drug book, I carried it on every call, and every drug I didn't recognize, I looked up.  When I felt an irregular hr on a pulse check, it got me looking into what makes up a heart beat, then EKG strips, there are books out there for anything you want to learn, you just need the patience and discipline to learn.  Let me just say that while you're working in this field, the opportunities are endless, right now I am doing things that are completely outside of any prehospital protocols in the US right now.  Get a good idea about the basics, and you can take that anywhere, but you have to be able to learn, assimilate quickly, and sometimes you push limits h34r:.  You also have to get close to people who will train you, and convince them that you're responsible enough to be trained.  

Luke


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## coloradoemt (Jan 9, 2005)

Well stated Luno. I had a Paramedic friend of mine tell me that I would only be as good an EMT as I wanted to be. I am always reading, looking up info on the web etc. I love to just simply ask questions of any EMT who will answer with an opinion or a fact. One of the most important things I have realized after coming out of B school was in the grand scheme of things, I didn't really learn much. Most of what I needed to know was in the back of an ambulance. So I would simply say, if you feel left out when it comes to situations you do not understand, the only person you can blame in the end is yourself. Just because you are not P certified does not mean you can't study some of what they know to understand it. I hope you find some ALS folks who are willing to help you learn and not talk down at you on account they have more schooling than you do.


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## Jon (Jan 9, 2005)

> _Originally posted by Luno_@Jan 8 2005, 09:29 PM
> * Mmiz, all I can say, is when you feel deficient in something, study it, my first time out, I was looking at a patient's drug list, and I had no idea what I was looking at, so the next day I went out and bought a drug book, I carried it on every call, and every drug I didn't recognize, I looked up.  When I felt an irregular hr on a pulse check, it got me looking into what makes up a heart beat, then EKG strips, there are books out there for anything you want to learn, you just need the patience and discipline to learn.  Let me just say that while you're working in this field, the opportunities are endless, right now I am doing things that are completely outside of any prehospital protocols in the US right now.  Get a good idea about the basics, and you can take that anywhere, but you have to be able to learn, assimilate quickly, and sometimes you push limits h34r:.  You also have to get close to people who will train you, and convince them that you're responsible enough to be trained.
> 
> Luke *


 Dolby's Rapid Interpritation of EKG's - the orange book.

it is the bible - you can probably self-teach yourself with a little help from the medics.
also - GREAT ACLS site
http://www.randylarson.com/acls/

Jon


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## ffemt8978 (Jan 10, 2005)

> _Originally posted by MCSHughes_@Jan 8 2005, 04:37 PM
> * So much of a good paramedic is basic care!  Don't overlook just how much you can contribute to the good outcome of a call.  Gather and write down meds, name, birthdate, history, VS.  Do a good physical exam and write down what you find.  Use some common acronyms that most EMS providers would use, "OPQRST" and "SAMPLE" for example.  If you give oxygen, check to see the effect after a few minutes.  Only transfer patients get one set of VS, so repeat your VS, and agaiin, write all this down.  I'd LOVE to have first responders who could do such simple skills consistently and professionally and would hire them THAT fast!
> 
> Never underestimate your value as a BLS provider.
> ...


 Well said.

I would like to add that the best paramedics I've seen are the ones who don't forget their EMT-B training, and use their basic skills (when called for) before their advanced skills.  After all, what good is an IV with drugs being pushed through it if you don't have an airway secured?

Remember, paramedics save lives, but EMT skills save paramedics!


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## MMiz (Jan 10, 2005)

This thread highlighted many great comments.  Of course I had SAMPLE, OPGRST, had vitals, asked of about Hx, family Hx, kept questioning the pt ensuring he was AOX3, and questioned often whether the pain changed or whether he was having difficulty in breathing.

I owned the orange EKG book (Dolby's Rapid Interpritation of EKG's) since 2001, never used it, so gave it to a fellow EMT so he didn't have to buy it.  I'm going to check out the library and see if they have a copy.

I know very little about meds, and since I work so little, it seems I lose a lot of what I learn (besides the major basics).  I'm going to have to work on the meds though.

Thanks for all the great advice!


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## PArescueEMT (Jan 10, 2005)

I would also reccommend the ALS pocket guide. I am a basic, and carry that. It has a quickie overview of EKG, RSI, and other ALS skills. I look at it like "this is what to expect when ALS arrives." It also has the top 1500 Prescriptiuon drugs and what they are for in it. Always a good way to gather History on a PT. that 75 other people are working on.


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## Luno (Jan 10, 2005)

I think they even have an EKG for dummies book, (don't laugh, I learned HTML, Java, and Windows NT 4.0  for dummies, and that's harder than reading a strip) so give that a look.  Also, if you have a Palm/Windows based handheld, there are many different programs that you can download.  Also, once you get your basics down, there are no limits, you can specialize in anything, provided you are in the right place.  Just stay hungry for knowledge, and you can get anywhere.
Luke


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## coloradoemt (Jan 11, 2005)

"Also, if you have a Palm/Windows based handheld, there are many different programs that you can download."


Can you tell me where to find these?


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## ffemt8978 (Jan 12, 2005)

Do a google search for "PalmEKG" (a really nice freeware program that shows various rythyms).

If you got some time, do another search for "Palm OS Medical Download Freeware" and you'll be amazed as some of the stuff that is out there.


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## coloradoemt (Jan 15, 2005)

I appreciate the info. Thank you.


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## ffemt8978 (Jan 17, 2005)

Okay, I posted a link in the Advertising Forum listing some of the sites that I have used to get EMS software for my PDA.

Medical Software for the Palm OS

If anybody has any other programs they use for their PDA that might be useful to medics, please post a link there.  Thanks.


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## shorthairedpunk (Feb 12, 2005)

If you want to be a BLS provider and get to do things at a fairly advance level, come here to central Illinois in St James EMS System. Our basics are the most advance in the state, and we are also a pilot system for newer protocols.

Our Basics can:

ETT Intubation with Combitube as a secondary option (and the majority of our intubations are performed by BLS providers)

NTG admin without orders

Glucagon and BLS 12 lead ekg are on the horizon

Cardiac monitoring with basic rythym interpretation

glucometer usage (which amazes me so many places dont alllow basics to do this)

these are just a few things the B's do here, our basics actually are much much more than ambulance drivers.


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## rescuecpt (Feb 13, 2005)

> _Originally posted by shorthairedpunk_@Feb 12 2005, 01:25 PM
> * If you want to be a BLS provider and get to do things at a fairly advance level, come here to central Illinois in St James EMS System. Our basics are the most advance in the state, and we are also a pilot system for newer protocols.
> 
> Our Basics can:
> ...


 What are the hours requirements for class?  I'll bet you it's much closer to the hours requirements for critical care/advanced levels in other states.


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## shorthairedpunk (Feb 13, 2005)

it only adds about 15 classroom hours to the national curriculum


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## rescuecpt (Feb 13, 2005)

Wow, our intubation was at least 10 hrs in class (when you factor in practicing and stuff)...  But 20 hours of our clinical rotations were devoted to intubations.  What are the clinicals like?  Our basics here need 10 hours of ride time (from call received to leaving the hospital) or 10 hours of ED rotations.  Our critical care/ALS (non-paramedic) have 63 hours of various clinicals plus 90 hours of ride time (from call to leaving the hospital).


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## Jon (Feb 14, 2005)

> _Originally posted by shorthairedpunk_@Feb 12 2005, 01:25 PM
> * If you want to be a BLS provider and get to do things at a fairly advance level, come here to central Illinois in St James EMS System. Our basics are the most advance in the state, and we are also a pilot system for newer protocols.
> 
> Our Basics can:
> ...


 Hey, I want to work in yur system.

But can I still have blue lights??????



Jon


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## shorthairedpunk (Feb 14, 2005)

if you work for a FD you can have blue lights but our count has an ordinance banning ems and blue lights


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## Luno (Feb 14, 2005)

King Co has standing orders for NTG, and but we have everything else except ETT/Combi


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## Jon (Feb 21, 2005)

> _Originally posted by Luno_@Feb 14 2005, 06:47 PM
> * King Co has standing orders for NTG, and but we have everything else except ETT/Combi *


 does this mean basics carry nitro on the rig and give it if systolic over 100 and pt. complaing of chest Pain?


How about Epi-Pens? do you carry on the truck, or give pt's???


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## shorthairedpunk (Feb 21, 2005)

Our BLS NTG Protocol is systolic over 110

Epi is on the bus, but requires a call to med control before giving it if time permits


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## rescuecpt (Feb 22, 2005)

For BLS NTG is Systolic > 120, epi no call necessary prior to admin, albuteral call if younger than 18 or older than 70.


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## KEVD18 (Apr 14, 2005)

you want to learn about something, learn about it! i'm a ma basic. not really much in the way of actual medical practicew we can do in this state. so what. i took acls, learned how to tube. took the acls for basics course. learned about meds and rythms and defib/pacing/cardioversion. cant practice any of these skills(and consequently, dont retain as much of the info) but i had the interest so i went after it. could foundation to build on when i go for my medic.


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