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We have had narcotic sealing/accountability problems recently at the company I work for and I was wondering what types of systems other services use to lock their narcs. Currently we have our narcs locked in our ALS med bags with a small combo lock. Inside the locked compartment the...

I think the biggest thing is a clash of egos. Sometimes they use the reasoning that we don't have proper PPE on (which can be the case at times) but instead of asking us to please put a full compliment of PPE on, they ask us to leave the scene and remain at our truck until they deliver the pt to...

I didn't intend for this to become an ICS debate, but it is all relevant information. Does the rescue person in charge have the authority to remove any EMS person from the hot zone or do EMS have the authority to dictate when and how rescue operations are done? That seems do be where most...

More often it's not that command isn't established (they all like to say that on the radio!) it's that command isn't enforced. Rescue personnel attempt to keep the EMS personnel out of the scene or visa-versa instead of working together. Usually the fire chief or captain has assumed command, but...

I agree with the fact that ICS should be followed whenever possible, but like it has been said before, it's difficult to follow ICS protocol when you have a small number of people on a one-car MVA. I guess the agencies in our area will have to find a way to work together better. Does anyone...

This has been an ongoing hot topic in the county where I work. Who is in charge at the scene of a motor vehicle accident in which there is entrapment? Do the rescue personnel from the fire company take precedence over the paramedics or do the paramedics have the authority to take control due to...

Yes, I did Google what you said and ask my coworkers about SvO2 and I will continue to educate myself about it. I appreciate the feedback. I did do a 12-lead and found nothing abnormal there. The nurses in the ER just kind of shrugged me off when I mentioned the color, but I was still curious.

She dialed 911 because her automatic cuff read 215/174 during her routine morning check. Her only symptom was heartburn, but she had a history of acid reflux disease and was being treated for it. She denied chest pain, difficulty breathing, headache, nausea, dizziness, blurred vision, and any...

Didn't notice anything I didn't notice any pulsations or increased flow when I attached my saline lock. I was just surprised by the color of the blood. I didn't give the pt any supplemental oxygen as she denied any complaints of dyspnea, her SpO2 was 98% on room air, and we were only...

I had an uneventful call with a chief complaint of hypertension this afternoon. Nothing out of the ordinary really: I boarded the BLS truck, went en route to the local hospital, did my assessment, put her on the monitor, started a line, drew labs, etc. etc. and then we were there. What I found...

Call command In PA, we cannot pronounce, but if there are obvious signs of death in a trauma we don't need medical command. I've had two medical DOA's in the last three days. I get on scene, confirm aystole in three leads, get the history, check for rigor, check pupils, call command and he...

Treatment Pt details: B/P hovering around 200/100 each time I took it, respirations 14, SpO2 96% on 4lpm, blood glucose 244mg/dl, lungs clear, GCS of 10. When I called in my report with my findings I asked if I should administer nitro and was told not to due to how close I was to the hospital...

Alarmed Yes, I was alarmed by this and that is why I chose not to bypass the closest hospital for stabilization rather than continuing on to a larger hospital that was 30min or more away. Had those runs of 15+ continued, his rate would have been somewhere in the 90's. They were regular and...

Thanks Thanks for the insights. I was thinking maybe dig toxicity since he was on dig or an electrolyte problem since he didn't appear very well "maintained" and had a history of diabetes. What would be the distinguishing factors for sustained v-tach? His rate was only in the low to mid...

I had a patient today that I brought into our local hospital ER and didn't take to a larger city hospital with a cath lab and caught some heat from my supervisors. I'm looking for some information. My pt had an altered mental status and wasn't much help in getting a past medical history and his...

80 questions I passed the NREMT-P exam in early August on the first try. It shut off at 80.

Differences In our system, we are billing the patients even though we are rarely transporting them. Our ALS used to be run by chase trucks out of the rural community hospital and they boarded the BLS trucks with their gear and rode in. Now, even though my company has left the hospital, we are...

I'm new to this forum and came across it on my quest for more knowledge about billing and billings agreements between ALS and BLS agencies. I currently work for the only ALS provider in a rural Pennsylvania county. We work in a tiered EMS system where the closest (usually volunteer) BLS crew is...