# Boston EMS TV Show



## medichopeful (Jul 26, 2015)

Didn't see any threads on this yet.  Anybody watch it on ABC?  The first episode seemed pretty good!


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## EMT2015 (Jul 26, 2015)

I wasn't able to watch it last night and now I have to wait a week to be able to watch it online.


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## NYBLS (Jul 26, 2015)

EMT2015 said:


> I wasn't able to watch it last night and now I have to wait a week to be able to watch it online.



What website are you using?


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## EMT2015 (Jul 27, 2015)

The ABC Family app.  I don't have access to my family's comcast info, so I can't sign in.


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## shfd739 (Jul 27, 2015)

Watching now on UVerse on demand. Not impressed. Taking in a kid with severe allergic reaction apparently BLS with no interventions. Police officer with a dislocated knee and no pain mess. 

I don't  see that as appropriate at all.


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## RocketMedic (Jul 27, 2015)

Same here. Very minimalistic.


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## medichopeful (Jul 27, 2015)

shfd739 said:


> Watching now on UVerse on demand. Not impressed. Taking in a kid with severe allergic reaction apparently BLS with no interventions. Police officer with a dislocated knee and no pain mess.
> 
> I don't  see that as appropriate at all.



I think you're actually thinking of the other Boston show that came out recently: "Save my Life: Boston Trauma." That one focused more on the in-hospital stuff, but I agree it didn't paint EMS in a good light. Or the hospital, really. Overall, that show was awful in my opinion, from the cinematography to the patient care shown by EMS. 

Another show just came out though (on ABC again, and the show I'm talking about) called "Boston EMS." Most of the first episode showed BLS level calls, and I think showed a pretty professional response to them. Things from helping out a homeless gentleman without shoes, to making sure a gentleman with dementia got back to the correct house, without forcing him to go to the hospital. Sure, it wasn't perfect, but I thought it was pretty good!


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## medichopeful (Jul 27, 2015)

RocketMedic said:


> Same here. Very minimalistic.


See my above post. I don think we're talking about the same show!


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## Fleury14 (Jul 27, 2015)

FWIW the "save my life Boston trauma" one shows many more EMTS from the privates than the city. Look at the uniforms.


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## rwik123 (Jul 27, 2015)

It urks me that they stage Boston EMS giving CMED patches of incoming patients then blatantly show a private or fire department bringing in the actual patient (talking about Save My Life-Boston Trauma). Boston EMS was not originally going to be a show but they had so much extra material from Save My Life that they decided to make it.


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## RocketMedic (Jul 28, 2015)

Definitely was Boston EMS that BLSd anaphalaxis and a dislocation...


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## Clare (Jul 28, 2015)

Out of curiosity, I had a look at Boston EMS and it looks somewhat the same but quite different! 

Everybody sounds like a member of Kennedy family! 
Ambulances are much bigger but inside the patient compartment seems quite cramped 
Uniforms make them look like police not ambulance personnel and they are different colours?
No pain relief seen not even paracetamol or entonox?
No high visibility vests at night or road crashes!?
Driving with one hand and using the radio while driving - including urgent driving!?
The story of that guy who got shot walking home was pretty unbelievable
Only once saw anything done inside pt house, seemed to do everything in the ambulance?


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## Chewy20 (Jul 28, 2015)

Clare said:


> Out of curiosity, I had a look at Boston EMS and it looks somewhat the same but quite different!
> 
> Everybody sounds like a member of Kennedy family!
> Ambulances are much bigger but inside the patient compartment seems quite cramped
> ...



Uniforms are same brown color for all EMTs, medics where white. If you  are talking about the blue, thats a private (that I used to work for). How do you give report while driving? Boston EMS is still technically part of the police department and they carry and use handcuffs. After not living in MA for two years. The accents seem ridiculous haha.


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## Tigger (Jul 28, 2015)

Chewy20 said:


> Uniforms are same brown color for all EMTs, medics where white. If you  are talking about the blue, thats a private (that I used to work for). How do you give report while driving? Boston EMS is still technically part of the police department and they carry and use handcuffs. After not living in MA for two years. The accents seem ridiculous haha.


They are in the same union, but actually a part of the Boston Public Health Commission. 

And yes, it's a BLS heavy system. There EMTs are very well trained and they do make a commitment to additional education (three month classroom academy followed by three months with an FTO), but at the end of the day they are still EMTs. Etonox/Nitrous is very rare in US as it cannot be mixed in the same cylinder. For whatever reason tylenol (close to paracetomol) never caught on with EMS here. They are supposed to wear vests on traffic accidents just like every other EMS provider in this country.


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## Clare (Jul 28, 2015)

So what do you use for analgesia if you are not able to give parenteral pain relief, or pts who only have minor or moderate pain if you don't have entonox?


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## Flying (Jul 28, 2015)

Clare said:


> So what do you use for analgesia if you are not able to give parenteral pain relief, or pts who only have minor or moderate pain if you don't have entonox?


Kind, calm demeanor. In my region, pain relief is administered on a Fentanyl-or-nothing basis.


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## Chewy20 (Jul 28, 2015)

Clare said:


> So what do you use for analgesia if you are not able to give parenteral pain relief, or pts who only have minor or moderate pain if you don't have entonox?



People that are having anything over a 7 out of 10 are supposed to get Fentanyl in my system . With that being said, every pt says they are a 10 our of 10. So if they actually seem to be in pain they will get it. The person who is screaming for 5 minutes then falls asleep on the way in, or is talking or their cell phone is not getting crap. 98% of the time its the second scenario.


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## LACoGurneyjockey (Jul 28, 2015)

Clare said:


> So what do you use for analgesia if you are not able to give parenteral pain relief, or pts who only have minor or moderate pain if you don't have entonox?


High flow O2, backboards, and if I'm feeling really generous, maybe an ice pack.
I don't know of a BLS service that has any pain management protocols to speak of, and ALS will be giving morphine or fent.


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## Tigger (Jul 28, 2015)

Clare said:


> So what do you use for analgesia if you are not able to give parenteral pain relief, or pts who only have minor or moderate pain if you don't have entonox?


Less fentanyl. We carry fentanyl, morphine, and ketamine, with the ability to concurrently dose the first two with versed or valium. Yet we can't have tylenol because well I don't know. I looked at getting us a grant for a nitrous system but the price point was very high.


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## Chewy20 (Jul 28, 2015)

LACoGurneyjockey said:


> High flow O2, backboards, and if I'm feeling really generous, maybe an ice pack.
> I don't know of a BLS service that has any pain management protocols to speak of, and ALS will be giving morphine or fent.



I can be the guy in the back if the pt is given IN fentanyl or any IN med. But thats the extent.


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## RocketMedic (Jul 28, 2015)

Meanwhile, in a system that doesn't suck...

We have tylenol, toradol (awesome stuff), fentanyl and ketamine, plus Ativan and versed. Zofran and promethazine for vomiting.

Although I manage pain on a case-by-case basis, I try very hard to do right by our patients.5


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## Fleury14 (Jul 28, 2015)

RocketMedic said:


> Meanwhile, in a system that doesn't suck...
> 
> We have tylenol, toradol (awesome stuff), fentanyl and ketamine, plus Ativan and versed. Zofran and promethazine for vomiting.
> 
> Although I manage pain on a case-by-case basis, I try very hard to do right by our patients.5


Those are in your BLS protocols?


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## NTXFF (Jul 28, 2015)

We carry nitrous but in five years I've never seen it used.  We also carry Ketamine, versed, morphine, fentanyl, and dilaudid.  Pain management is on a case by case basis but all the above are used quite frequently.  Personally I'm a ketamine fan.


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## chaz90 (Jul 28, 2015)

Fleury14 said:


> Those are in your BLS protocols?


Nope, those were definitely ALS.


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## CALEMT (Jul 28, 2015)

Fleury14 said:


> Those are in your BLS protocols?



Hahaha Texas is a progressive state, but if those are drugs a EMT can administer then I'm a neurosurgeon.


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## NTXFF (Jul 28, 2015)

Deleted


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## medichopeful (Jul 28, 2015)

RocketMedic said:


> Meanwhile, in a system that doesn't suck...
> 
> We have tylenol, toradol (awesome stuff), fentanyl and ketamine, plus Ativan and versed. Zofran and promethazine for vomiting.
> 
> Although I manage pain on a case-by-case basis, I try very hard to do right by our patients.5



I really,  really wish that they would spread the use of Toradol more.


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## Fleury14 (Jul 29, 2015)

CALEMT said:


> Hahaha Texas is a progressive state, but if those are drugs a EMT can administer then I'm a neurosurgeon.


That's my point. They were showing BLS calls for the most part.


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## RocketMedic (Jul 29, 2015)

How is a knee dislocation BLS only?


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## shfd739 (Jul 29, 2015)

RocketMedic said:


> How is a knee dislocation BLS only?



Beat me to it.....or for god sakes a pediatric anaphylaxis..seriously how is a BLS crew supposed to manage that if they detoriate? They cant. God help them if that was my child.


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## climberslacker (Jul 29, 2015)

It's from the other show (Save My Life) but did anyone notice this dude with his tacticool quick-draw belt-mounted OPA kit? Never before have I seen someone do that! Bottom left in this screen-grab.


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## RocketMedic (Jul 29, 2015)

shfd739 said:


> Beat me to it.....or for god sakes a pediatric anaphylaxis..seriously how is a BLS crew supposed to manage that if they detoriate? They cant. God help them if that was my child.



Don't question the tiered system.


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## shfd739 (Jul 29, 2015)

RocketMedic said:


> Don't question the tiered system.


Ha! Their tiered system looks horrible...


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## RocketMedic (Jul 29, 2015)

But it's "high performance" lol


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## medicsb (Jul 29, 2015)

As usual, talking heads talk...  It's amazing that any EMSer would ever consent to being on a show since every EMS know-it-all will gladly step up on to their soap box to go on about how the subject EMS is awful and then go on about how great they are.  As a doctor and former medic... BLS the patella dislocation.  I've seen a number of them and they all were manageable for transport with immobilization.  It's the reduction that will hurt.  I typically don't give them anything because it will reduced in mere seconds and the pain will immediately begin to diminish, maybe a percocet afterwards.  

As far as the 14 month old... sure, ALS would have been appropriate, but it's tough to tell whether or not the kid was actually BLS'd (probably got epi at some point, though it is not mentioned at any time) or if she was even brought in by Boston EMS (notice the EMT carrying the child into the room is NOT in BEMS uniform).  Even if the pt. was BLS'd, epi-pens are required items on BLS ambulance and the state protocol allows EMTs to admin epi.  Epi is, hands down, the most important med, so even if ALS didn't take the patient, she would have gotten standard of care if BLS'd.  There is SO MUCH post-production in these shows, the scenes shown are often not in chronological order.  They will play a recording of someone "saying A8" in a report to the hospital and show video of A14 and then show video of a person giving a report using a different radio identifier.  That stuff is all over the show.


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## triemal04 (Jul 29, 2015)

medicsb said:


> As usual, talking heads talk...  It's amazing that any EMSer would ever consent to being on a show since every EMS know-it-all will gladly step up on to their soap box to go on about how the subject EMS is awful and then go on about how great they are.  As a doctor and former medic... BLS the patella dislocation.  I've seen a number of them and they all were manageable for transport with immobilization.  It's the reduction that will hurt.  I typically don't give them anything because it will reduced in mere seconds and the pain will immediately begin to diminish, maybe a percocet afterwards.
> 
> As far as the 14 month old... sure, ALS would have been appropriate, but it's tough to tell whether or not the kid was actually BLS'd (probably got epi at some point, though it is not mentioned at any time) or if she was even brought in by Boston EMS (notice the EMT carrying the child into the room is NOT in BEMS uniform).  Even if the pt. was BLS'd, epi-pens are required items on BLS ambulance and the state protocol allows EMTs to admin epi.  Epi is, hands down, the most important med, so even if ALS didn't take the patient, she would have gotten standard of care if BLS'd.  There is SO MUCH post-production in these shows, the scenes shown are often not in chronological order.  They will play a recording of someone "saying A8" in a report to the hospital and show video of A14 and then show video of a person giving a report using a different radio identifier.  That stuff is all over the show.


How dare you bring logic and actual medical knowledge to this discussion?  How dare you sir!?  Don't you understand how this goes?  The panic has begun, next comes the chants of "burn the witch!  burn the witch!" and the mob stocked with torches and pitchforks.  Why oh why would you want to head that off?  Wait...it's obvious; you must be a collaborator of the witch!  Ah...of course you know that this means that now the mob will come for you...  

Slightly facetious, but does anyone want to bet that I'm wrong?


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## RocketMedic (Jul 29, 2015)

I know I certainly don't want medicsb taking care of me or my family if that's their expressed standard. #itllbuffout


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## RocketMedic (Jul 29, 2015)

medicsb said:


> As usual, talking heads talk...  It's amazing that any EMSer would ever consent to being on a show since every EMS know-it-all will gladly step up on to their soap box to go on about how the subject EMS is awful and then go on about how great they are.  As a doctor and former medic... BLS the patella dislocation.  I've seen a number of them and they all were manageable for transport with immobilization.  It's the reduction that will hurt.  I typically don't give them anything because it will reduced in mere seconds and the pain will immediately begin to diminish, maybe a percocet afterwards.
> 
> As far as the 14 month old... sure, ALS would have been appropriate, but it's tough to tell whether or not the kid was actually BLS'd (probably got epi at some point, though it is not mentioned at any time) or if she was even brought in by Boston EMS (notice the EMT carrying the child into the room is NOT in BEMS uniform).  Even if the pt. was BLS'd, epi-pens are required items on BLS ambulance and the state protocol allows EMTs to admin epi.  Epi is, hands down, the most important med, so even if ALS didn't take the patient, she would have gotten standard of care if BLS'd.  There is SO MUCH post-production in these shows, the scenes shown are often not in chronological order.  They will play a recording of someone "saying A8" in a report to the hospital and show video of A14 and then show video of a person giving a report using a different radio identifier.  That stuff is all over the show.



I'm sorry, but that is a pretty mediocre standard of care for patients. Sure, you may be a doctor and all, but seriously, that reeks of arrogance and callousness. It's entirely possible to do most of what we do with no analgesia whatsoever, but unless you meet crews at the door, you're still leaving folks in considerable pain for prolonged periods of time until you get your magic doctor mittens on their dislocated patellas and reduce them. So much for reducing incidents of PTSD amongst our patients, or providing even minimal compassion...

Quite frankly, if you treated me (as a patient) like that as a medical provider, I would make it my business to make trouble for you. Certainly you could trot out your expertise and discretion and knowledge as a physician in denying effective pre-reduction analgesia, and you would not necessarily be incorrect- but you certainly would not be right. You certainly would not be receiving payment if I could help it.


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## Tigger (Jul 29, 2015)

RocketMedic said:


> How is a knee dislocation BLS only?


A patellar dislocation is not a significant dislocation and is not even likely to be a difficult/painful reduction. My system trains its EMTs to reduce patellar dislocations for what it's worth.


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## medicsb (Jul 30, 2015)

RocketMedic said:


> I'm sorry, but that is a pretty mediocre standard of care for patients. Sure, you may be a doctor and all, but seriously, that reeks of arrogance and callousness. It's entirely possible to do most of what we do with no analgesia whatsoever, but unless you meet crews at the door, you're still leaving folks in considerable pain for prolonged periods of time until you get your magic doctor mittens on their dislocated patellas and reduce them. So much for reducing incidents of PTSD amongst our patients, or providing even minimal compassion...
> 
> Quite frankly, if you treated me (as a patient) like that as a medical provider, I would make it my business to make trouble for you. Certainly you could trot out your expertise and discretion and knowledge as a physician in denying effective pre-reduction analgesia, and you would not necessarily be incorrect- but you certainly would not be right. You certainly would not be receiving payment if I could help it.



Immobilization and positioning goes a long way for controlling pain.  I see all sort of injuries that can have pain managed with basic measures at certain times, which are very much a part of the continuum of pain control.   Pain control does not equal meds all the time.  Most patients with patellar dislocation are happy with out waiting for an IV and meds to kick in when I can reduce it, have it immobilized, get them crutch training, and have them out the door with ortho follow-up in less than 15 minutes from time of arrival.  Now, if it seems they may not tolerate the reduction or are in serious pain at rest, then yes an IV, morphine or dilaudid, and x-rays before we touch it.


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## Chewy20 (Jul 30, 2015)

medicsb said:


> Immobilization and positioning goes a long way for controlling pain.  I see all sort of injuries that can have pain managed with basic measures at certain times, which are very much a part of the continuum of pain control.   Pain control does not equal meds all the time.  Most patients with patellar dislocation are happy with out waiting for an IV and meds to kick in when I can reduce it, have it immobilized, get them crutch training, and have them out the door with ortho follow-up in less than 15 minutes from time of arrival.  Now, if it seems they may not tolerate the reduction or are in serious pain at rest, then yes an IV, morphine or dilaudid, and x-rays before we touch it.



Don't bother reasoning with him. Not worth your time. I learned the hard way.


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## RocketMedic (Jul 30, 2015)

Jam it, Chewy20, your "reasoning" is mindless adherence to whatever you think trendy.

It's good to know you consider things on a case-by-case basis, medicsb. Your original post came off as disturbingly absolute. Personally, judging by the source material, there looked to be a decent amount of post-immobilization distress.

I'd love to be able to perform reductions in the field, but to get to that point, I think most systems need to work towards much higher standards of education.


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## triemal04 (Jul 30, 2015)

medicsb said:


> Immobilization and positioning goes a long way for controlling pain.  I see all sort of injuries that can have pain managed with basic measures at certain times, which are very much a part of the continuum of pain control.   Pain control does not equal meds all the time.  Most patients with patellar dislocation are happy with out waiting for an IV and meds to kick in when I can reduce it, have it immobilized, get them crutch training, and have them out the door with ortho follow-up in less than 15 minutes from time of arrival.  Now, if it seems they may not tolerate the reduction or are in serious pain at rest, then yes an IV, morphine or dilaudid, and x-rays before we touch it.


Burn the witch collaborator!  Burn the witch collaborator!  

See?   Knew that was going to happen; standard procedure really.  As was mentioned, don't waste your time with him.  Especially when it's someone who took joy in a paramedics suicide.


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## jwk (Jul 30, 2015)

RocketMedic said:


> I'm sorry, but that is a pretty mediocre standard of care for patients. Sure, you may be a doctor and all, but seriously, that reeks of arrogance and callousness. It's entirely possible to do most of what we do with no analgesia whatsoever, but unless you meet crews at the door, you're still leaving folks in considerable pain for prolonged periods of time until you get your magic doctor mittens on their dislocated patellas and reduce them. So much for reducing incidents of PTSD amongst our patients, or providing even minimal compassion...
> 
> Quite frankly, if you treated me (as a patient) like that as a medical provider, I would make it my business to make trouble for you. Certainly you could trot out your expertise and discretion and knowledge as a physician in denying effective pre-reduction analgesia, and you would not necessarily be incorrect- but you certainly would not be right. You certainly would not be receiving payment if I could help it.


Oh puhleeeeeeeze....seriously?

Not every patient needs drugs, particularly narcotics.  They are NOT the solution to everything.  And the measure of a good paramedic is NOT determined by how much "analgesia" they give.


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## Carlos Danger (Jul 30, 2015)

RocketMedic said:


> I'm sorry, but that is a pretty mediocre standard of care for patients. Sure, you may be a doctor and all, but seriously, that reeks of arrogance and callousness. It's entirely possible to do most of what we do with no analgesia whatsoever, but unless you meet crews at the door, you're still leaving folks in considerable pain for prolonged periods of time until you get your magic doctor mittens on their dislocated patellas and reduce them. So much for reducing incidents of PTSD amongst our patients, or providing even minimal compassion...
> 
> Quite frankly, if you treated me (as a patient) like that as a medical provider, I would make it my business to make trouble for you. Certainly you could trot out your expertise and discretion and knowledge as a physician in denying effective pre-reduction analgesia, and you would not necessarily be incorrect- but you certainly would not be right. You certainly would not be receiving payment if I could help it.



PTSD and refusal of payment because you didn't get narc'd up for a patellar reduction? Seriously?

Look, just stop. Really. You are embarrassing yourself and you don't even know enough to realize it. 

#doingwhattheEDdoesbutat70mph



medicsb said:


> *Immobilization and positioning goes a long way for controlling pain. * I see all sort of injuries that can have pain managed with basic measures at certain times, which are very much a part of the continuum of pain control.  *Pain control does not equal meds all the time*.  Most patients with patellar dislocation are happy with out waiting for an IV and meds to kick in when I can reduce it, have it immobilized, get them crutch training, and have them out the door with ortho follow-up in less than 15 minutes from time of arrival.  Now, if it seems they may not tolerate the reduction or are in serious pain at rest, then yes an IV, morphine or dilaudid, and x-rays before we touch it.



Pfft. Srsly doc? What do you know? You'd give 100mg of ketamine before doing a patellar reduction if you had any clue what you were doing! 

And positioning? That silliness is for EMT's  - just like mask ventilation. I'm a freakin' PARAMEDIC, dammit! I gots fentanyl and ET tubes! 



jwk said:


> Oh puhleeeeeeeze....seriously?
> 
> Not every patient needs drugs, particularly narcotics.  *They are NOT the solution to everything*.  And the measure of a good paramedic is NOT determined by how much "analgesia" they give.



Oh _yes_they_are._

Don't you know that the amount of drugs that you give absolutely defines how good of a medic you are? You ain't crap if you don't dope everyone up on as much ketamine and fentanyl and possible.

Cuz the ED docs don't know what they are doing. Or something like that.


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## Fleury14 (Jul 30, 2015)

It also must be taken into account that given Boston's relatively small size, that transport was at MOST ten minutes and it was more likely around 5.


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## NTXFF (Jul 30, 2015)

Coming from a system that's able to do reductions I'd feel like too big of an anus to not give them at least a bump of some love juice before I get going.... But that's just my two cents.


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## NYBLS (Jul 30, 2015)

jwk said:


> Oh puhleeeeeeeze....seriously?
> 
> Not every patient needs drugs, particularly narcotics.  They are NOT the solution to everything.  And the measure of a good paramedic is NOT determined by how much "analgesia" they give.



Correct, but managing a pts pain is important and should no be ignored. I think properly managing a pts pain is a good indicator for a good provider (among many other things).




Remi said:


> PTSD and refusal of payment because you didn't get narc'd up for a patellar reduction? Seriously?
> 
> Look, just stop. Really. You are embarrassing yourself and you don't even know enough to realize it.
> 
> ...




My god why don't you get up from your knees and relax.


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## RocketMedic (Jul 30, 2015)

Thank you, NYBLS. Sadly, Remi and a few other members of this board seem to believe that they are both infallible and that those who disagree with them are heretics.


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## Carlos Danger (Jul 30, 2015)

RocketMedic said:


> Thank you, NYBLS. Sadly, Remi and a few other members of this board seem to believe that they are both infallible and that those who disagree with them are heretics.



That's pretty funny coming from the guy with the 1-year paramedic certification who tells ED physicians that they don't know what they are talking about.


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## RocketMedic (Jul 30, 2015)

jwk said:


> Oh puhleeeeeeeze....seriously?
> 
> Not every patient needs drugs, particularly narcotics.  They are NOT the solution to everything.  And the measure of a good paramedic is NOT determined by how much "analgesia" they give.



Yeah, this patient CERTAINLY doesn't need HORRIBLE BIG PHATMA DRUGS THAT ARE ABUSED AND ADDICTIVE for pain. It's an experience, savor it!


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## RocketMedic (Jul 30, 2015)

Remi said:


> That's pretty funny coming from the guy with the 1-year paramedic certification who tells ED physicians that they don't know what they are talking about.



NYC doesn't seem to be a sycophant, though. Why don't you tell us some more how good positioning and an ice pack is better pain control than good positioning, an ice pack, inflammation control and opiates at appropriate doses?


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## RocketMedic (Jul 30, 2015)

Remi said:


> That's pretty funny coming from the guy with the 1-year paramedic certification who tells ED physicians that they don't know what they are talking about.


And you have what again?


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## RocketMedic (Jul 30, 2015)

Remi said:


> PTSD and refusal of payment because you didn't get narc'd up for a patellar reduction? Seriously?
> 
> Look, just stop. Really. You are embarrassing yourself and you don't even know enough to realize it.
> 
> ...



And you aren't doing much good if your literal only service provided is a ride, Ambulance Driver.


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## Carlos Danger (Jul 31, 2015)

RocketMedic said:


> And you have what again?


My education is irrelevant here, because I'm not the one telling people who are obviously much more highly educated than me that I know their jobs better than they do.

You don't even realize how badly you embarrass yourself by constantly bragging about all the drugs you can give and telling jwk and medicsb that they don't know what they are talking about. Your understanding of and experience with analgesia is a mere drop in the bucket compared to theirs. 

None of this would matter to me at all if it weren't so obvious that these attitudes continue to be part of the reason why EMS still has a hard time finding a seat at the table.


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## triemal04 (Jul 31, 2015)

I'm just going to leave this here again.  The really sad part is not that it needs to be said again, but that there clearly are far, FAR *FAR *to many people in EMS who truly believe, and act, like this.

Whoa whoa whoa there tiger.

MY ego is the only thing that matters in this job. Because I'm a life saving heart-breaking hero! I mean a super badass clinician! I mean the future of EMS! I'm so good I run rings around doctors and my top notch department gives me everything I need to save lives. In fact I'm so good I can make a difference just by thinking about it. How do I know this? Why let me just tell you.

I'm so good I can do whatever I want whenever I want; if I see some procedure done on youtube and I think it's appropriate...well I just go out and start doing it! Pfffft...data you say? Proof of effectiveness you say? Correlation to clinical outcomes? Ain't nobody got time for that!

My drug box is so big it takes 3 people to carry it. It's got more drugs than most ER's. My ambulance has a ultrasound, a portable x-ray and hauls a trailer with a CT scanner. When a new gadget hits the market we have it on the trucks before anyone else. We've got every automated device ever made for EMS and believe me, I use them all. Training you say? Appropriateness of medical interventions you ask? Pffft...I'm just so good I don't need to worry about that, just like my whole department. And you know we're that good because we do all these high-speed low-drag things that nobody else does.

Get with the program people; we need to show the world our worth! We've got to prove how good paramedics are! And how do you prove that? Why, you push as many drugs as possible and perform every procedure under the sun! Duh! It ain't rocket science kids! 

In fact, I think I'm the Chuck Norris of EMS.  

Cheers psycho boy.


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## RocketMedic (Jul 31, 2015)

Remi said:


> My education is irrelevant here, because I'm not the one telling people who are obviously much more highly educated than me that I know their jobs better than they do.
> 
> You don't even realize how badly you embarrass yourself by constantly bragging about all the drugs you can give and telling jwk and medicsb that they don't know what they are talking about. Your understanding of and experience with analgesia is a mere drop in the bucket compared to theirs.
> 
> None of this would matter to me at all if it weren't so obvious that these attitudes continue to be part of the reason why EMS still has a hard time finding a seat at the table.



Sounds like a cop-out, Remi. I am pointing out that people, including physicians, are not correct solely because of their education- for example, as a somewhat-competent provider of medical services (albeit not as skilled, educated or legally enabled as a physician), I think it is poor care to leave a person in pain until they are fixed when one could both remove the pain and rapidly fix the underlying problem. It is better service to alleviate pain quickly and effectively than it is to leave someone to sit until their turn in the treatment queue comes up. Decades of repetitive experience via anecdote doesn't change that.

The real problem with this industry is not compassionate, competent, educated people like me willing to recognize that good medical care is also good customer service. It's with fools like yourself who believe that lack of legal ability or support to teach us to manage conditions like this justifies converting entire swathes of our service into glorified taxi rides on the basis of cost efficiency...and it's with the culture that associates acute pain relief with crime, addiction and dependency, a culture you and many others seem to have bought into wholeheartedly.


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## RocketMedic (Jul 31, 2015)

triemal04 said:


> I'm just going to leave this here again.  The really sad part is not that it needs to be said again, but that there clearly are far, FAR *FAR *to many people in EMS who truly believe, and act, like this.
> 
> Whoa whoa whoa there tiger.
> 
> ...



You're simply a trolling idiot. 

For what it's worth, we will one day have access to reasonable developments of these tools and we will change and expand what we can do for our patients. It is not out of the question that we could one day replace direct in-facility physician consultation for many issues, and bypass facilities and physicians that may be appropriate per marketing and protocol, but are not optimal (this is already done in many places). Trolls like you put up strawmen and belittle folks like me, but science willing, we will be shown to be right.


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## RocketMedic (Jul 31, 2015)

My objection to the show is simple- it showcases the exact opposite system design from what I prefer. It does a good job of humanizing employees and patients, but it also spotlights what they do (or don't do) and solidifies an impression of us as technicians. Imagine if that police officer's patella had been here in Texas, in a system that allows its medics to reduce dislocations (and mine does not, sadly- it would be a valuable skill to learn, but that's another argument). Instead of a BLS ride, it could have literally been pain management, acute problem resolution, immobilization, training and crutches and referral to an orthopedist for follow-up or a surgeon if needed- we could literally have replaced the ED. Now imagine televising that care and demonstrating that we can do more than CPR and drive- imagine showing definitively that we can solve a problem, spare an ED visit and turn an unpleasant multi-hour experience into a simple bad day?

Instead of that, Save My Life and Boston EMS turn injuries into entertainment and our profession into goodhearted, powerless people-movers.


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## epipusher (Jul 31, 2015)

I'm in full agreement with Rocket on this one.


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## Chewy20 (Jul 31, 2015)

RocketMedic said:


> My objection to the show is simple- it showcases the exact opposite system design from what I prefer. It does a good job of humanizing employees and patients, but it also spotlights what they do (or don't do) and solidifies an impression of us as technicians. Imagine if that police officer's patella had been here in Texas, in a system that allows its medics to reduce dislocations (and mine does not, sadly- it would be a valuable skill to learn, but that's another argument). Instead of a BLS ride, it could have literally been pain management, acute problem resolution, immobilization, training and crutches and referral to an orthopedist for follow-up or a surgeon if needed- we could literally have replaced the ED. Now imagine televising that care and demonstrating that we can do more than CPR and drive- imagine showing definitively that we can solve a problem, spare an ED visit and turn an unpleasant multi-hour experience into a simple bad day?
> 
> Instead of that, Save My Life and Boston EMS turn injuries into entertainment and our profession into goodhearted, powerless people-movers.



You do realize BEMS does not have a lot of ALS running around right? So if a BLS truck can handle it, which they could, they will. My guess is thats why it was BLSd.

You also literally said it yourself earlier today in another thread...

"A BLS truck is cheaper to staff, equip and field and leaves paramedic units available for more acute calls."


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## Carlos Danger (Jul 31, 2015)

RocketMedic said:


> Sounds like a cop-out, Remi. I am pointing out that people, including physicians, are not correct solely because of their education- for example, as a somewhat-competent provider of medical services (albeit not as skilled, educated or legally enabled as a physician),



A cop out? Maybe you should look that term up, because you don't seem to know what it means. While you are at it, learn what "irrelevant" means.



RocketMedic said:


> The real problem with this industry is not compassionate, competent, educated people like me willing to recognize that good medical care is also good customer service. It's with fools like yourself who believe that lack of legal ability or support to teach us to manage conditions like this justifies converting entire swathes of our service into glorified taxi rides on the basis of cost efficiency...and it's with the culture that associates acute pain relief with crime, addiction and dependency, a culture you and many others seem to have bought into wholeheartedly.



The problem that I am referring to is one of lack education combined with overconfidence / arrogance / cockiness - or whichever other pejorative you think fits best - that plagues so many members of the EMS community. It has always been a problem, and it remains a problem. We used to use the term "paragod".

This discussion really has nothing to do with analgesia, it has to do with you and the other paragods and how your actions affect EMS and more importantly, our patients. Always thinking you are the smartest in the room, in spite of your low level of education and experience relative to those who disagree with you. Always confusing your own opinion with fact. Always outspokenly telling others that they are doing it wrong, yet refusing to consider the feedback that others provide you. Always thinking that "go big or go home" is a good philosophy of patient care. Always thinking that just because you carry fentanyl and sux, that you need to use them as often as possible, and screw anyone who tells you that that might not be the best thing for the patients. Always being sure that you "know" all about something, without even having any idea what the current research on that topic says. Or even knowing how to read research.

Ever stop to think that if the citizens of Boston or King County or Austin were as unhappy with their EMS systems as you think they should be, that they would change them? Ever stop to think that if the patients of the EMS system were being harmed or having a bad experience because of the poor system design or protocols, that the physicians and other officials who run the EMS systems might make some changes? Why do you think you know so much more about what the people of Boston should be satisfied with than the collective entirety of the citizens of that city?

Ever stop to think that perhaps medicsb _might_ know something that you don't about managing the pain of a patellar dislocation? That _maybe_ at some point during his four years of medical school and several years of residency, they thought to briefly cover the topic of managing a patient's orthopedic pain while they wait to be seen? Of course the fact that someone is a physician does not make them infallible. But it's a safe bet that a paramedic-turned-EM doc knows what he is talking about and isn't going about abusing his patients. Did you consider that? No. Instead of asking him to explain and maybe learning something, you insult him. Good grief. Same with jwk. The guy used to be a paramedic, and now he literally manages pain for a living. But you know more about what is appropriate and necessary analgesia than he does. Right.

Get over yourself, man. You don't know what you don't know.


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## EMT2015 (Aug 1, 2015)

Does the EMS partner actually ride in the back of the rig or was this just for the show?


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## Fleury14 (Aug 1, 2015)

EMT2015 said:


> Does the EMS partner actually ride in the back of the rig or was this just for the show?


Just a guess but there was probably a cameraman in shotgun.


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## EMT2015 (Aug 1, 2015)

Fleury14 said:


> Just a guess but there was probably a cameraman in shotgun.


Thanks!!


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## teedubbyaw (Aug 1, 2015)

The show definitely shows a completely different EMS system than I'm use to.


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## MonkeyArrow (Aug 1, 2015)

RocketMedic said:


> Instead of a BLS ride, it could have literally been pain management, acute problem resolution, immobilization, training and crutches and referral to an orthopedist for follow-up or a surgeon if needed- we could literally have replaced the ED.


Have you heard of any service, even if they are allowed to reduce dislocations in the field, carry crutches and knee immobilizers? What about write prescriptions for narcotics? Even have a printer on board to provide discharge instructions and a follow up referral. The mid level in the field doing community paramedicine is evolving, but is no where near developed enough to provide the level of care that you are claiming.


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## evantheEMT (Oct 25, 2015)

Als for a dislocation? What a waste of resources. This is the problem with ems and actually er's quick give pain meds to everything instead of splinting, icing and elevation if you can.  It's a call by call basis.


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## LACoGurneyjockey (Oct 25, 2015)

evantheEMT said:


> Als for a dislocation? What a waste of resources. This is the problem with ems and actually er's quick give pain meds to everything instead of splinting, icing and elevation if you can.  It's a call by call basis.


Have you ever had a dislocation? They're painful. Do you, as an EMT, give pain meds? No? Then call for someone who does so the patient can actually be treated. Relying on the ER to provide the same treatment an ALS unit could easiy provide in less time is not only lazy, but it's a disservice to your patient. You've never held the wall with a patient in pain? You've never seen a busy ER where your patient is not immediately medicated? 
Hint: provide appropriate treatment for your patient, even if it's not cool and life saving.


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## evantheEMT (Oct 25, 2015)

LACoGurneyjockey said:


> Have you ever had a dislocation? They're painful. Do you, as an EMT, give pain meds? No? Then call for someone who does so the patient can actually be treated. Relying on the ER to provide the same treatment an ALS unit could easiy provide in less time is not only lazy, but it's a disservice to your patient. You've never held the wall with a patient in pain? You've never seen a busy ER where your patient is not immediately medicated?
> Hint: provide appropriate treatment for your patient, even if it's not cool and life saving.


OK give pain meds just because is ridiculous but go for it. I've had a dislocation splinted and iced and was fine.


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## LACoGurneyjockey (Oct 25, 2015)

evantheEMT said:


> OK give pain meds just because is ridiculous but go for it. I've had a dislocation splinted and iced and was fine.


Ok, since you want to make it anecdotal, what exactly did you dislocate and how?


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## evantheEMT (Oct 25, 2015)

LACoGurneyjockey said:


> Ok, since you want to make it anecdotal, what exactly did you dislocate and how?


OK go to medic school to give pain meds out like it's a pharmaceutical company.


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## LACoGurneyjockey (Oct 25, 2015)

I'm trying to keep this informative. If you dislocated your finger that's a little different than a hip/shoulder/knee. That's all, no need to get upset.
And I did go to medic school, because I got tired of the limited treatments I could provide my patients with as an EMT.


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## evantheEMT (Oct 25, 2015)

LACoGurneyjockey said:


> I'm trying to keep this informative. If you dislocated your finger that's a little different than a hip/shoulder/knee. That's all, no need to get upset.
> And I did go to medic school, because I got tired of the limited treatments I could provide my patients with as an EMT.


It was my knee and als is limited too obviously not like bls but als is too. I'm just saying not everyone needs pain meds.


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## NomadicMedic (Oct 25, 2015)

evantheEMT said:


> It was my knee and als is limited too obviously not like bls but als is too. I'm just saying not everyone needs pain meds.



No you're not. You said:


evantheEMT said:


> Als for a dislocation? What a waste of resources. This is the problem with ems and actually er's quick give pain meds to everything instead of splinting, icing and elevation if you can.  It's a call by call basis.



Here's the takeaway. People in pain should have their pain managed. It's good medicine. It's good customer service. It's the right thing to do. It's what you'd want if your mom fell and dislocated something. You'd want ALS to show up and provide pain management. And you know it.


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## Flying (Oct 25, 2015)

Why even bother, all I'm seeing is the BLS before ALS mantra being repeated. Paramedics obviously are just upgraded EMTs to this gentleman.


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## Tigger (Oct 25, 2015)

evantheEMT said:


> It was my knee and als is limited too obviously not like bls but als is too. I'm just saying not everyone needs pain meds.


Generally speaking, people in pain could stand to benefit from pain control medication. Maybe not from opioids, but that's a different discussion.

Just RICE it and suck it up bro is not a treatment plan.


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## teedubbyaw (Oct 25, 2015)

Is this guy serious?


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## LACoGurneyjockey (Oct 25, 2015)

teedubbyaw said:


> Is this guy serious?


Yes. Have you seen his other posts lately.


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## teedubbyaw (Oct 25, 2015)

I stopped reading after he bumped up every thread. lol


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## CALEMT (Oct 25, 2015)

evantheEMT said:


> I'm just saying not everyone needs pain meds.



Just who qualifies for pain medications then? Certainly a knee dislocation is a pretty good qualifier. How about burns? Broken bones? All ice and splinting would do is help reduce swelling and prevent further damage. Not so much pain control.


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## ERDoc (Oct 25, 2015)

No pain meds for dislocations?  I'm going to try that today and see how it goes.  Maybe I'll try a few reductions without sedation too.


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## teedubbyaw (Oct 25, 2015)

Evan, do you think someone having a STEMI with chest pain needs pain management?


ERDoc said:


> No pain meds for dislocations?  I'm going to try that today and see how it goes.  Maybe I'll try a few reductions without sedation too.



If you pull hard enough something is bound to happen, right? huehuehuehue


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## Flying (Oct 25, 2015)

ERDoc said:


> No pain meds for dislocations?  I'm going to try that today and see how it goes.  Maybe I'll try a few reductions without sedation too.


At least you won't be a robot working for big pharma.


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## ERDoc (Oct 25, 2015)

Flying said:


> At least you won't be a robot working for big pharma.



Who says I'm not?  I push vaccines pretty hard and love my shillbucks.


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## evantheEMT (Oct 25, 2015)

CALEMT said:


> Just who qualifies for pain medications then? Certainly a knee dislocation is a pretty good qualifier. How about burns? Broken bones? All ice and splinting would do is help reduce swelling and prevent further damage. Not so much pain control.


Reduce swelling is very important and again just because someone has a broken bones doesn't mean you should shoot them up with pain meds.


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## evantheEMT (Oct 25, 2015)

Tigger said:


> Generally speaking, people in pain could stand to benefit from pain control medication. Maybe not from opioids, but that's a different discussion.
> 
> Just RICE it and suck it up bro is not a treatment plan.


Just giving pain meds isn't a treatment plan either.


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## ERDoc (Oct 25, 2015)

evantheEMT said:


> just because someone has a broken bones doesn't mean you should shoot them up with pain meds.



Interesting point of view, that pretty much anyone who practices medicine will disagree with.  Why would you want to allow someone who is in serious pain to continue to suffer?


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## teedubbyaw (Oct 25, 2015)

evantheEMT said:


> Reduce swelling is very important and again just because someone has a broken bones doesn't mean you should shoot them up with pain meds.



Because an ambulance is a taxi service who provides boyscout remedies only.


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## LACoGurneyjockey (Oct 25, 2015)

evantheEMT said:


> Reduce swelling is very important and again just because someone has a broken bones doesn't mean you should shoot them up with pain meds.





evantheEMT said:


> Just giving pain meds isn't a treatment plan either.



These two posts so perfectly exemplify the lack of education involved in an EMT course, and the difference between ALS and BLS mentality. Yes, of course it's a treatment plan. You're treating their pain and suffering. No, you're not placing a cast and resetting bones, but I don't think anyone here expects that prehospitally. If broken bones and severe pain are not indications for analgesia, then (as has been asked of you already) what is an indication.


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## evantheEMT (Oct 25, 2015)

LACoGurneyjockey said:


> These two posts so perfectly exemplify the lack of education involved in an EMT course, and the difference between ALS and BLS mentality. Yes, of course it's a treatment plan. You're treating their pain and suffering. No, you're not placing a cast and resetting bones, but I don't think anyone here expects that prehospitally. If broken bones and severe pain are not indications for analgesia, then (as has been asked of you already) what is an indication.


I forgot you're a medic that means you know everything.  Lol you guys are pathetic trying to boost your ego on the Internet.


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## evantheEMT (Oct 25, 2015)

evantheEMT said:


> I forgot you're a medic that means you know everything.  Lol you guys are pathetic trying to boost your ego on the Internet.


Also splinting, icing and elevation is also a treatment plan so try again Mr medic.


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## Carlos Danger (Oct 25, 2015)

evantheEMT said:


> Reduce swelling is very important and again just because someone has a broken bones doesn't mean you should shoot them up with pain meds.



Is there any scenario where you think a paramedic SHOULD shoot someone up with pain meds?


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## LACoGurneyjockey (Oct 25, 2015)

Remi said:


> Is there any scenario where you think a paramedic SHOULD provide ANY ALS treatments?


Fixed that for you, and to gain some insight into the brilliance that is Evan.



evantheEMT said:


> Also splinting, icing and elevation is also a treatment plan so try again Mr medic.


Evan, you realize ALS does everything BLS does too right? So splinting, ice, and elevation for an extremity injury would happen anyway. Unfortunately, your treatment plan results in a patient's prolonged suffering. I'm not sure why you're advocating that.


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## Jim37F (Oct 25, 2015)

When I broke my tib/fib at scout camp years ago, it was painful as all heck, I didn't get an EMS response due to remote location, just some splinting and POV to the local hospital  (off the top of my head it was something like a 45min to an hours drive away)...not too dissimilar from a typical BLS for a lower extremity fx. Let me tell you, if I had got 4 of morphine from the camp nurse before transport, it would have made the whole ordeal SOOO much more easier and tolerable, and when the ER doc set my leg by hand (I got my first dose of pain meds 5min before that) it probably would've been a less torturous experience having already dulled the pain before...

But none of that matters right? We're only here to save lives at 70mph doing cool things like CPR and major multisystem traumas and other Hollywood stuff right?


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## CALEMT (Oct 25, 2015)

evantheEMT said:


> I forgot you're a medic that means you know everything.  Lol you guys are pathetic trying to boost your ego on the Internet.





evantheEMT said:


> Also splinting, icing and elevation is also a treatment plan so try again Mr medic.



Sounds like you're the one who needs the ego boost trying to argue something WAY out of your scope of practice with someone that has a higher level certification than you. Why are you so against ALS? Did you mouth off to a medic about treatment/transport decisions and get your *** chewed? Is this a personal vendetta? 

Please explain why someone IN PAIN should not receive pain medication? We're all dying for your justification for this outlandish reasoning.


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## TransportJockey (Oct 25, 2015)

evantheEMT said:


> I forgot you're a medic that means you know everything.  Lol you guys are pathetic trying to boost your ego on the Internet.


You do know that one of the members who is disagreeing with you is actually a doc? We actually don't try to boost our egos as much as help try and educate ignorant providers such as yourself.


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