Amitriptyline OD

[MeckRS83]

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

 

[Ridryder911]

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

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

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

R/r 911

 

[MeckRS83]

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

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

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

R/r 911

Very good points made Ridryder.

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

 

[Ridryder911]

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

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

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

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

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

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

R/r 911

 

[trauma1534]

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

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

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

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

 

[Guardian]

Very good points made Ridryder.

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

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

 

[jeepmedic]

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

 

[ResTech]

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

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

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

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

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

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

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

 

[jeepmedic]

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

 

[ResTech]

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

 

[Airwaygoddess]

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

 

[trauma1534]

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

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

 

[prizonmedik]

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

 

[natrab]

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

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

 

[captoman]

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

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

 

[Jon]

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

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

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

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

 

[FF/EMT Sam]

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

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



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

 

[FF/EMT Sam]

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

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

Have a nice day.

 

[Ridryder911]

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

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

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

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

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

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

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

R/r 911

 

[FF/EMT Sam]

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

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

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

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

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

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

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

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

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

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

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

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

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