# Personal Jump Bag



## RobertAlfanoNJEMT (Sep 3, 2015)

Does anyone else carry their own kind of jump bag in their car or is it just me? It's not a lot just like a pair of sheers, a bp cuff, stethoscope, gloves, etc. You know just the basics so that it's all together if I want to stop on the side of the road to help someone or if one of my family members get sick or I'm at a party and someone gets sick or hurt.. Does anyone else do this or am I the only weird one who cares too much? haha


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## BeansCO (Sep 3, 2015)

So I carry a bag with first aid items in my car. I keep it on hand for personal use only. 

I suppose if I witnessed the incident and scene safety wasn't a concern I would stop and most likely use it.

Just make sure you know your duty to act laws of your state.
If its a side of the road response use common sense and be sure that you are not putting your life at risk.


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## chaz90 (Sep 3, 2015)

What help are shears, a BP cuff, and a stethoscope going to be? These are all basically assessment tools assuming you have the ability to provide some sort of intervention after assessing. There's another thread discussing this right now, but what help would it be to stop at the rare "bad" MVA with serious injuries and have a BP cuff available? You already know the severity of their injury, and BLS airway maneuvers and bleeding control would be the only helpful things you could provide. Conveniently, neither requires equipment and both are layperson skills. 

I kinda understand the gloves tucked away somewhere, but everything else is nonsense IMO. Do what makes you happy, but the only other "equipment" I could ever see myself keeping nearby hand might be an Epi-Pen if I had a close family member with a severe allergy.


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## RobertAlfanoNJEMT (Sep 3, 2015)

chaz90 said:


> What help are shears, a BP cuff, and a stethoscope going to be? These are all basically assessment tools assuming you have the ability to provide some sort of intervention after assessing. There's another thread discussing this right now, but what help would it be to stop at the rare "bad" MVA with serious injuries and have a BP cuff available? You already know the severity of their injury, and BLS airway maneuvers and bleeding control would be the only helpful things you could provide. Conveniently, neither requires equipment and both are layperson skills.
> 
> I kinda understand the gloves tucked away somewhere, but everything else is nonsense IMO. Do what makes you happy, but the only other "equipment" I could ever see myself keeping nearby hand might be an Epi-Pen if I had a close family member with a severe allergy.


I mean the bp cuff I just happened to have so I threw it in with the rest of my medical stuff.. The sheeres can be useful for a lot of things like cutting clothes to get access to bleeding or cutting a seat belt.. As for the epi pen I can't get access to that because I don't have a prescription


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## teedubbyaw (Sep 3, 2015)

No.


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## TransportJockey (Sep 3, 2015)

Cell phone is all you'll need


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## teedubbyaw (Sep 3, 2015)

TransportJockey said:


> Cell phone is all you'll need



You're heartless.


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## SandpitMedic (Sep 3, 2015)

SMH....ugh... everytime...... FNG. I remember those days though...


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## SandpitMedic (Sep 3, 2015)

EpiPen? Is that even a BLS admin? Me thinks no.

I am with @TransportJockey on this.


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## chaz90 (Sep 3, 2015)

The EpiPen was only mentioned as something medical and weird I would keep on hand for a family member with a history of anaphylaxis. I certainly wouldn't carry one as any part of my non-existent personal jump bag.


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## teedubbyaw (Sep 3, 2015)

If I ever put together a bug out medical kit damn straight I'd have epi.


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## RobertAlfanoNJEMT (Sep 3, 2015)

teedubbyaw said:


> If I ever put together a bug out medical kit damn straight I'd have epi.


And where the hell are you getting that from? The black market? Lmao


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## RobertAlfanoNJEMT (Sep 3, 2015)

SandpitMedic said:


> EpiPen? Is that even a BLS admin? Me thinks no.
> 
> I am with @TransportJockey on this.


In New Jersey it is... We can even carry it on our ambulance but you have to take a little certifying course... It's like a 3 hour class I think


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## NomadicMedic (Sep 3, 2015)

Carry what ever makes you happy. As long as there no Narcan. (That stuff makes people crazy!)


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## Shock (Sep 3, 2015)

My service issues a gear bag that has to go with you when you leave your shift, and has to be on the truck with you. I just keep it in my car. It has turn-out gear for MVA's. I stuffed some c-collars, some gauze, a roll of tape, and some prep pads in it from various supply rooms. I figured that's all I'd ever need off duty. Without a truck, you can't do much. But if I'm ever in an accident myself, having that stuff close is comforting. Even if I have to instruct a passer by how to put a c-collar on me, at least it's there.


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## RobertAlfanoNJEMT (Sep 3, 2015)

DEmedic said:


> Carry what ever makes you happy. As long as there no Narcan. (That stuff makes people crazy!)


Smh you guys are stubborn! Haha what can you expect from ALS!!


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## Ewok Jerky (Sep 3, 2015)

RobertAlfanoNJEMT said:


> Does anyone else carry their own kind of jump bag in their car or is it just me?


It's not just you, buts its definitely not me.


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## Tigger (Sep 4, 2015)

One time several years I ago I caught myself on Amazon buying the contents for a "BLS bag." I vomited on myself, and since then things have been fine. 

There is a bag of gloves and some bleeding control things in my truck. That covers the two things that might actually make a difference if the situation presented itself. Certainly don't need a bag for that (though I do have an old first in bag that I use to organize all my backcountry ski gear, does that count?). 

Think to yourself; if you arrived on scene in your ambulance and some guy was like "she's 134/80 bro, says she sick and stuff," would you just be like "ok right on, lets go to the hospital then?" I am going to do my own assessment 100% of the time and there's a significant chance I'm not actively listening to the bystander anyway...


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## Honeybadger (Sep 4, 2015)

Tigger said:


> One time several years I ago I caught myself on Amazon buying the contents for a "BLS bag." I vomited on myself, and since then things have been fine.
> 
> There is a bag of gloves and some bleeding control things in my truck. That covers the two things that might actually make a difference if the situation presented itself. Certainly don't need a bag for that (though I do have an old first in bag that I use to organize all my backcountry ski gear, does that count?).
> 
> Think to yourself; if you arrived on scene in your ambulance and some guy was like "she's 134/80 bro, says she sick and stuff," would you just be like "ok right on, lets go to the hospital then?" I am going to do my own assessment 100% of the time and there's a significant chance I'm not actively listening to the bystander anyway...



Bystanders can be great sources of information. Why wouldnt you listen to an off duty ems personnel with pertinent info? We had a kid die recently and one of our off duty EMT's was there to witness the crash and timed the concurrent seizure along with getting him into a c collar that he had in his car. That was incredibly helpful. That said, I have a bf cuff because I use that bag for household medical nonsense too, but when I call 911, here in seattle, the information I have can help me request ALS off the bat. And a bp cuff can pull double duty as a makeshift tourniquet. What harm is there having a cheap scope for lung sounds and a cuff for pressures? What if that patient was in the 60/p range? Sure there would be other indicators going on, but you would have that much more to help guide responding units initially.

Laziness and dorkiness are hardly excuses to not be prepared to help people with the skills you have. I'm not all gung ho running up to every fender bender and slapping on c collars, but if I see a motorcyclist go down or a nasty collision, I help, because I'd want someone to do the same for me.


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## DesertMedic66 (Sep 4, 2015)

Just because they are an off-duty medic/EMT, nurse, PA, Doctor, etc doesn't mean they have accurate information or are even what they claim.

Regardless of what bystanders say I am going to do my own assessment and what they tell me isn't going to change my treatment plan.


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## Jim37F (Sep 4, 2015)

The only jump bag I have in my car is the one on my FLC vest when I leave it in the backseat between Battle Assemblys. As such it's great for penetrating trauma..and not much else. It's got 2x CAT tourniquets, a QuickClot combat guaze, 2x Israeli pressure dressings, an S-Rolled guaze, old school Muslin bandage, 2x 28FR NPA, 2 pair latex gloves, and an IT4C casualty card (mini PCR lol). So unless I happen across someone who is hemorrhaging externally (i.e. someone gets shot while on the range at drill) I'm not gonna pull it out automatically if I stop at a TC off duty (which would have to be one that looks pretty bad with no responders on scene)


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## Honeybadger (Sep 4, 2015)

DesertMedic66 said:


> Just because they are an off-duty medic/EMT, nurse, PA, Doctor, etc doesn't mean they have accurate information or are even what they claim.
> 
> Regardless of what bystanders say I am going to do my own assessment and what they tell me isn't going to change my treatment plan.



Oh absolutely true, I dont trust anything an ON DUTY seattle firefighter tells me (had a guy vomiting red four loco with pancreatitis. Firefighter tells me "I think this might be the real deal, he has a hx of aortic dissection") and you should never fail to perform your own examination, but that doesnt mean that you can't multitask. Bystander information can be invaluable for establishing timeframes and helping establish your own treatment plan. Accidents in particular can go very differently when you have a clear understanting of the mechanism of injury. And if someone tells me they're a doctor and demonstrates knowledge pertinent to that claim, I'm sure as **** listening to what they have to say.


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## redundantbassist (Sep 5, 2015)

I am a gun guy, and I have a small pocket sized trauma kit that I keep in my vehicle and that I put in my range bag. It is intended to help a fellow shooter at the range who was injured in the (unlikely) event of a negligent discharge. It consists only of an emergency bandage, 2 CAT tourniquets, chest seals, quikclot and gloves. 

In most cases the equipment in a BLS jump bag will be of very little use to you in a first aid scenario. Some of the most important things you can do off duty to save a patients life and to prevent further injury require very little if any equipment. Some examples are:


Calling 911

CPR/ Public access AED

Hemorrhage control

C-spine if necessary

Directing traffic around the patient, if he is in the road


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## Tigger (Sep 5, 2015)

Honeybadger said:


> Bystanders can be great sources of information. Why wouldnt you listen to an off duty ems personnel with pertinent info? We had a kid die recently and one of our off duty EMT's was there to witness the crash and timed the concurrent seizure along with getting him into a c collar that he had in his car. That was incredibly helpful. That said, I have a bf cuff because I use that bag for household medical nonsense too, but when I call 911, here in seattle, the information I have can help me request ALS off the bat. And a bp cuff can pull double duty as a makeshift tourniquet. What harm is there having a cheap scope for lung sounds and a cuff for pressures? What if that patient was in the 60/p range? Sure there would be other indicators going on, but you would have that much more to help guide responding units initially.
> 
> Laziness and dorkiness are hardly excuses to not be prepared to help people with the skills you have. I'm not all gung ho running up to every fender bender and slapping on c collars, but if I see a motorcyclist go down or a nasty collision, I help, because I'd want someone to do the same for me.



A collar is incredibly helpful when you need to extricate someone from something while maintaining an advanced airway. That is about it. I also have a BP cuff in my home, but it's to help out a roommate with some early onset HTN concerns. I do not need one to determine when I need ALS or a helicopter. If the patient is 60/P odds are that they will look like absolute crap, and there's nothing I can do about that substantively. I also have a real CAT in my "kit" because that's not something I want to improvise and as it turns out BP cuffs are not really made for tourniqueting wounds in patients that are relatively hemodynmaically stable. 

As someone that has been in need of EMS afer some substantial injures, I want EMS to take me to the hospital and that is about it. I and most people are more than capable of waiting on their own. And when I arrive at scenes with "knowledgeable" bystanders I am happy to listen, but I am not replacing a thing that they say with thorough assessment.


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## Honeybadger (Sep 5, 2015)

Tigger said:


> A collar is incredibly helpful when you need to extricate someone from something while maintaining an advanced airway. That is about it. I also have a BP cuff in my home, but it's to help out a roommate with some early onset HTN concerns. I do not need one to determine when I need ALS or a helicopter. If the patient is 60/P odds are that they will look like absolute crap, and there's nothing I can do about that substantively. I also have a real CAT in my "kit" because that's not something I want to improvise and as it turns out BP cuffs are not really made for tourniqueting wounds in patients that are relatively hemodynmaically stable.
> 
> As someone that has been in need of EMS afer some substantial injures, I want EMS to take me to the hospital and that is about it. I and most people are more than capable of waiting on their own. And when I arrive at scenes with "knowledgeable" bystanders I am happy to listen, but I am not replacing a thing that they say with thorough assessment.



Why does everyone keep assuming that when I say that bystanders are great assets, that I am implying that they're doing your job and you should not listen to them at all because you should be doing the job that you better damn well be doing anyways? What kind of idiot doesn't assess patients themselves? But asking someone when stroke symptoms started being noticed in someone else is a damn good use for a bystander, and I'd certainly use that information to help me determine a timeline for the patient's symptoms and help guide the beginnings of my assessment beyond the initial rapid exam. If a bystander was a physician, walked up to me and said that someone is exhibiting symptoms of an atypical MI, I'm probably going to use that information in getting ALS on scene a little more quickly. I'm not going to suddenly not examine the patient as normal, but I'm certainly going to keep that information at hand and use it as a resource.

How is a collar not helpful in maintaining position of the cervical spine? Why then, does a hospital usually collar anyone they suspect of having a possible MOI that could cause spinal injury, even when symptoms are not present? King county has relaxed our protocols quite a bit now so we don't C collar very often anymore unless the pt is complaining of neck/back pain or CMS related symptoms, and even still, once we get these otherwise stable patients to the hospital, a collar gets slapped right on them. I'd trust Harborview's stance on C collars anytime, considering they're one of the hospitals that writes the book on burns and trauma. Done more than enough airlifts to know the benefits there.

If you don't have a tourniquet and you need a tourniquet, a BP cuff will do the job for a few minutes at the very least. Never had to do it, but know people who have (here in seattle they don't issue us tourniquets for some ridiculous reason. Fire gets israeli bandages. We also don't have glucometers on our rigs which is pants-on-head retarded) and have heard that they actually do the job well enough to prevent quite a bit of blood loss when you crank them up to 300-400mmhg

If you've got a proper CAT in your kit, you've got a bona-fide jump bag, mate. you were making yourself out as having a couple large ABD pads and some kerlex, which will handle the vast majority of bleeding emergencies. There's nothing wrong with keeping a BP cuff in your "all in one" bag. And I'm sure you've seen people with BP's in the tank that were still compensating reasonably well. Kids in particular can look pretty good while being pretty trashed internally, and I've taken a few "drunks" who fire didn't examine properly only to find that they'd taken too much lisinopril and his BP was in the tank. Pressures can be important tools. Not necessarily on the scene of an MVA, but why does that discredit ladening your vehicle down with a whopping half pound and 4x4 square inches of BC cuff?

My point on keeping a BP cuff in a "jump kit" is that it's more a matter of just keeping a bag with most of your atypical medical **** in it. Mine's got cold and hot packs and there's absolutely no reason I'd be using those on an MVA that I rolled up on. But I know there's always one or two in there, so when I sprain my own ankle I can hobble out to my truck and grab it, and it's also there for when I'm out in the woods with buddies and one starts having chest pain.

Do you keep a pocket mask or BVM in your "kit"?


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## DesertMedic66 (Sep 5, 2015)

I think the question that is being asked is "as an off duty personal what good is taking a blood pressure?" 

What are you going to be able to do with the information? You can't start an IV. You can't transport. You can provide it to the EMS crews when they arrive and pretty much get the response of "cool, thanks bro. Hey partner go get some vitals like usual".

Atypical MI symptoms are well atypical and can be pretty much anything. It could be ABD pain or even just nausea. Without a 12-lead EKG it will pretty much be a shot in the dark if someone says that. 

I'm not quite sure if you were implying that blood pressures on kids will tell you how critical they are over skin signs, cap refil, mentation, etc but kids are the exact opposite. Their BP will be good.... until it's not.


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## RobertAlfanoNJEMT (Sep 5, 2015)

I mean I think you should listen to what they have to say and mention it in your report it will give you a good idea of what is going on with the patient.. I also defiantly believe you should take your own set of numbers before administering any interventions..


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## Tigger (Sep 7, 2015)

Honeybadger said:


> Why does everyone keep assuming that when I say that bystanders are great assets, that I am implying that they're doing your job and you should not listen to them at all because you should be doing the job that you better damn well be doing anyways? What kind of idiot doesn't assess patients themselves? But asking someone when stroke symptoms started being noticed in someone else is a damn good use for a bystander, and I'd certainly use that information to help me determine a timeline for the patient's symptoms and help guide the beginnings of my assessment beyond the initial rapid exam. If a bystander was a physician, walked up to me and said that someone is exhibiting symptoms of an atypical MI, I'm probably going to use that information in getting ALS on scene a little more quickly. I'm not going to suddenly not examine the patient as normal, but I'm certainly going to keep that information at hand and use it as a resource.


I have no idea how that relates to what I said. As stated, I will certainly bear in mind whatever is said, but if someone has a set of vital signs for me it's of pretty much zero consequence. I don't really know what you mean with the whole atypical MI symptoms bit, we should know as competent providers when to be suspicious.



> How is a collar not helpful in maintaining position of the cervical spine? Why then, does a hospital usually collar anyone they suspect of having a possible MOI that could cause spinal injury, even when symptoms are not present? King county has relaxed our protocols quite a bit now so we don't C collar very often anymore unless the pt is complaining of neck/back pain or CMS related symptoms, and even still, once we get these otherwise stable patients to the hospital, a collar gets slapped right on them. I'd trust Harborview's stance on C collars anytime, considering they're one of the hospitals that writes the book on burns and trauma. Done more than enough airlifts to know the benefits there.


There is minimal evidence (if any) showing that c-collars (as used by EMS, maybe philly collars are better, maybe) make any sort of difference in terms of patient outcomes. You having done a bunch of airlifts does not somehow prove benefit, and neither does a hospital's blanket policy. 



> If you don't have a tourniquet and you need a tourniquet, a BP cuff will do the job for a few minutes at the very least. Never had to do it, but know people who have (here in seattle they don't issue us tourniquets for some ridiculous reason. Fire gets israeli bandages. We also don't have glucometers on our rigs which is pants-on-head retarded) and have heard that they actually do the job well enough to prevent quite a bit of blood loss when you crank them up to 300-400mmhg


 It is difficult to maintain such pressures with a blood pressure cuff. They leak, and the velcro protests. Have not had good success using them for that, but better than nothing. 



> If you've got a proper CAT in your kit, you've got a bona-fide jump bag, mate. you were making yourself out as having a couple large ABD pads and some kerlex, which will handle the vast majority of bleeding emergencies. There's nothing wrong with keeping a BP cuff in your "all in one" bag. And I'm sure you've seen people with BP's in the tank that were still compensating reasonably well. Kids in particular can look pretty good while being pretty trashed internally, and I've taken a few "drunks" who fire didn't examine properly only to find that they'd taken too much lisinopril and his BP was in the tank. Pressures can be important tools. Not necessarily on the scene of an MVA, but why does that discredit ladening your vehicle down with a whopping half pound and 4x4 square inches of BC cuff?


Lulz, there's only one person that gets to call me mate. I do not have a jump bag. I have two rolls of kerlix, some 4x4s, gloves, and the majestical CAT under the back seat of my truck. That's all I wish to carry, I have no plans to assess people on the side of the road out of my truck. I can deal with immediate life threats that take a half second glance to find, and I am fine with that. Also, while you are anecdotes are certainly impressive, they don't really provide much in the way evidence.



> My point on keeping a BP cuff in a "jump kit" is that it's more a matter of just keeping a bag with most of your atypical medical **** in it. Mine's got cold and hot packs and there's absolutely no reason I'd be using those on an MVA that I rolled up on. But I know there's always one or two in there, so when I sprain my own ankle I can hobble out to my truck and grab it, and it's also there for when I'm out in the woods with buddies and one starts having chest pain.
> 
> Do you keep a pocket mask or BVM in your "kit"?


I'm not really sure what you insinuating here? No, I do not.


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## ChoctawMedic92 (Sep 11, 2015)

I've never been a fan of "personal jump bags" unless they're provided to you by a volunteer department. I've always felt like they can cause more liability than good. Definite lawsuit waiting to happen if you're not working under your medical director with approved gear at the time. HOWEVER...in my car I keep my phone, paper towels for cleaning...and latex gloves for cleaning and in case I get fast food. I don't like to touch my food


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## Martyn (Sep 13, 2015)

RobertAlfanoNJEMT said:


> In New Jersey it is... We can even carry it on our ambulance but you have to take a little certifying course... It's like a 3 hour class I think



In Florida it is, one of the 5 drugs that EMT's can administer


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## SeeNoMore (Sep 13, 2015)

What's interesting is that several times family members and friends have commented on how odd it is that I don't carrry ... well anything.  Comments are made like "but you're a medic shouldn't you always be prepared" or "what if you come across a bad accident.". People seem utterly baffeled by the idea that I would simply call 911 (and obviously CPR and other basic interventions) , as if I am neglecting some cosmic duty to save lives with my bare hands and pluck.


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## Household6 (Sep 14, 2015)

EpiPen and AviQ is BLS here, I keep a few pens in my volly bag.. It's not an uncommon call for the volunteer EMR team.. The funny thing, is I'd have to check a SBP every time I'd give an EpiPen dose.. That's probably one of the only real reasons why I carry a cuff in my bag.


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## SeeNoMore (Sep 14, 2015)

Household6 said:


> EpiPen and AviQ is BLS here, I keep a few pens in my volly bag.. It's not an uncommon call for the volunteer EMR team.. The funny thing, is I'd have to check a SBP every time I'd give an EpiPen dose.. That's probably one of the only real reasons why I carry a cuff in my bag.


 
I hate random rules like this. Is there some cut off point where you are not allowed to use the epi pen? If not why even bother (other than the fact that you will be taking blood pressures anyway as a normal part of care). Not that you can change it, just saying it's odd.


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## Tigger (Sep 14, 2015)

Household6 said:


> EpiPen and AviQ is BLS here, I keep a few pens in my volly bag.. It's not an uncommon call for the volunteer EMR team.. The funny thing, is I'd have to check a SBP every time I'd give an EpiPen dose.. That's probably one of the only real reasons why I carry a cuff in my bag.


Before or after?


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## Household6 (Sep 14, 2015)

I don't think it's too odd.. If the patient was exposed to a commonly recognized allergen and has resp distress OR a SBP <90, may administer .3 of 1:1000 IM... It's actually a BLS call here, unless for some reason you have to give an IV of dyphi, difin.... BENADRYL.. But I've always given Benadryl PO..


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## chaz90 (Sep 14, 2015)

...Anaphylaxis as a BLS call?! Oh boy. 

True anaphylactic reactions are one of the situations where promptly delivered ALS makes a huge difference. IM Epinephrine is obviously the biggie, but there has to be serious consideration for IV crystalloids, antihistamines, steroids, inhaled beta agonists, consideration for IV epi drips PRN, cardiac monitoring, further airway management...I mean, this should be one of the ALSiest of ALS calls.

Also, not a big fan of a BP restriction for determination of allergic reactions requiring treatment with epinephrine. Obviously hypotension can be a factor, but it probably shouldn't be the determinant in treatment modalities most of the time. Isolated hypotension even after exposure to a known allergen probably isn't the primary sign of a reaction anyway.


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## Tigger (Sep 14, 2015)

Household6 said:


> I don't think it's too odd.. If the patient was exposed to a commonly recognized allergen and has resp distress OR a SBP <90, may administer .3 of 1:1000 IM... It's actually a BLS call here, unless for some reason you have to give an IV of dyphi, difin.... BENADRYL.. But I've always given Benadryl PO..


By the time the patient is hyoptensive it is likely that they will be exhibiting a variety of more obvious signs of anaphylactic shock.

Perhaps the first line intervention is "BLS," but that's it. Had a recent anaphylaxis with angioedema walkin, pucker factor level: rulll high.


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## Household6 (Sep 14, 2015)

I think the BLS you are used to isn't quite the same as what my trauma center is doing on an EMT-A level.. Considering placement of an invasive airway is part of our protocols. Unless it's a ped requiring an ET, our BLS can do just fine with a King on an adult. Antihistamines are PO, up to 50 mg, BLS can do that too. Beta antagonists, you mean Ipratroprium.. Our BLS can do duo nebs, but I think I'd call med control, because it's not specifically in our protocols. I don't believe our ALS can administer steroids, I don't think we even have steroids on the truck, does yours?  Help me understand why you think cardiac monitoring would be useful. Do you mean 4 or 12?


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## Tigger (Sep 14, 2015)

Household6 said:


> I think the BLS you are used to isn't quite the same as what my trauma center is doing on an EMT-A level.. Considering placement of an invasive airway is part of our protocols. Unless it's a ped requiring an ET, our BLS can do just fine with a King on an adult. Antihistamines are PO, up to 50 mg, BLS can do that too. Beta antagonists, you mean Ipratroprium.. Our BLS can do duo nebs, but I think I'd call med control, because it's not specifically in our protocols. I don't believe our ALS can administer steroids, I don't think we even have steroids on the truck, does yours?  Help me understand why you think cardiac monitoring would be useful. Do you mean 4 or 12?


Well if the patient has any sort of upper airway edema PO Benadryl is not going to do much. These patients may need aggressive fluid resuscitation (though I suppose that's AEMT level). Ipatromium Bromide is not a Beta agnonist (Albuterol is), though both may be needed. Corticosteroids are a commonly carried paramedic medication that may make a difference, especially with longer transport times. Racemic epi (nebulized), a mag drip, and an epi drip might also be considerations.

But as always, it's not so much about the tools but rather the knowledge that comes with it.


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## Household6 (Sep 14, 2015)

Nah bro, there's no steroids on our rigs.. You'd use mag to treat a pt with hypotension?


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## Tigger (Sep 14, 2015)

Household6 said:


> Nah bro, there's no steroids on our rigs.. You'd use mag to treat a pt with hypotension?


I'm surprised. While there is not spectacular evidence for their use prehospitally, they have their place and given their relatively long onset time they seem to be a worthy, "we've got the big stuff done and aren't there yet" sort of intervention. Not a necessity, but a nice to have. 

As for the mag, it would depend (as always). If nothing else is working and we are bringing the patient's pressure back up with fluid, it might be a consideration. Again with the whole education thing. Presently, I lack the education to make that decision.


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## chaz90 (Sep 15, 2015)

Household6 said:


> I think the BLS you are used to isn't quite the same as what my trauma center is doing on an EMT-A level.. Considering placement of an invasive airway is part of our protocols. Unless it's a ped requiring an ET, our BLS can do just fine with a King on an adult. Antihistamines are PO, up to 50 mg, BLS can do that too. Beta antagonists, you mean Ipratroprium.. Our BLS can do duo nebs, but I think I'd call med control, because it's not specifically in our protocols. I don't believe our ALS can administer steroids, I don't think we even have steroids on the truck, does yours?  Help me understand why you think cardiac monitoring would be useful. Do you mean 4 or 12?


By beta agonists, I'm primarily referring to albuterol here. In cases of potential for increasing angioedema, I'd prefer an ETT to a supraglottic airway, though if they are already severely swollen at time of EMS contact either one may be out of the question. 

Yes, we do carry steroids. We carry PO prednisone and Solu-Medrol for IV administration. I'd rather give IV Benadryl for anaphylaxis than PO, but if PO is all you have then that's appropriate. Aggressive fluid administration is important in cases of distributive shock, but if your AEMT scope can do that, fair enough. 

IV epi drips are a huge consideration here. Not that I have vast experience in treating hundreds of severe allergic reactions or anything, but I've used an epinephrine drip on a teenager experiencing severe anaphylaxis that failed to respond to anything else. I mean, this guy was absolutely circling the drain with absolutely absent lung sounds, extreme hypoxia, and a systolic BP of ~70. No responses to 2x 0.5 mg IM Epi, but 10 minutes after the epinephrine drip he was talking, breathing, and pink. 

Cardiac monitoring is more precautionary for any adult patient that's receiving epinephrine, particularly IV. I'm mostly referring to 4 lead monitoring, but I may do a 12 lead on an older patient if they develop any chest pain or increasing problems after the primary treatment for the reaction. 

I'm with Tigger here. Just because the scope of a lower level provider may allow most of the interventions doesn't mean it's a substitute for higher levels of education and critical thinking. This is no different than Maryland's EMT-Cardiac or the way we've built paramedic education in the US. Simply adding more skills or medications to the drug box isn't a substitute for education or clinical competency. For critically ill patients, the provider with the highest level of training should be caring for the patient if they are available. I would never sit in an ED with a high priority patient and try to maintain patient care as an ER physician is trying to take over, and this would be a similar situation on a prehospital level.


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## triemal04 (Sep 16, 2015)

Household6 said:


> I think the BLS you are used to isn't quite the same as what my trauma center is doing on an EMT-A level.. Considering placement of an invasive airway is part of our protocols. Unless it's a ped requiring an ET, our BLS can do just fine with a King on an adult. Antihistamines are PO, up to 50 mg, BLS can do that too. Beta antagonists, you mean Ipratroprium.. Our BLS can do duo nebs, but I think I'd call med control, because it's not specifically in our protocols. I don't believe our ALS can administer steroids, I don't think we even have steroids on the truck, does yours?  Help me understand why you think cardiac monitoring would be useful. Do you mean 4 or 12?


You give a beta-antagonist to asthmatics?  Huh...are you using metoprolol or a different beta-blocker?  Or did you mean a beta AGONIST...which would not include ipratropium bromide?

Minor details, but when speaking in a professional setting to other professionals, especially when you are trying to show how you do so much more (and one would think are so much better) it helps if you are saying accurate things.

Just my personal opinion of course...


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## Bullets (Sep 24, 2015)

RobertAlfanoNJEMT said:


> And where the hell are you getting that from? The black market? Lmao



What do you do with the ones that "expire"? I take them home with me, i always keep 2 in my personal shtf(for me) bag. If you break them open the vial that holds the drug has usually another 2-3 doses in it. 

Otherwise i just have a small IFAK that i can handle the major trauma injuries, 2 SOFT-Ts, 2 olaes bandages, 1 set of AED pads, an NPA and some gloves and a pair of shears. Little pouch strapped to the back of my headrest


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