Do you have what it takes to work a code?

Ridryder911

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hahahah! Is it that service? I wouldnt know. I do know that we can only use the tools provided to us. Limited or not. But I would throw any amount of money down on our techs running circles around ANY ems provider in the country. Why not? How about the world. Privates, FF/medics, RN, CCP, Etc, etc,. Come one come all. Put in your app. Just make sure you bring a notepad and pen. Rest assured, your gonna get learned something.

Sorry, I have seen Detroit's. Some good and some.. well. Problem is most believe that they are far better than most others out there.

I may not be as smart as some of those city boys, but I work with new equipment (yeah vent's, IV pumps (yes, we carry more than IVP med.'s), and ride in no units over two years old, and work in an area that we don't have to wear body armour in. Run enough to be proficient and in comparrision of patient time, usually I have more. I also make a decent salary in comparison and have to only work ten days a month. Really now, determing how you figure "smarts" which one would you say might have the most?

How long does your medic spend with a patient.. 30 minutes, 45? How much in-depth assessment and care is really performed?

Oh, we know how talk in correct sentence structures. Who knows? I am sure we both could learn off each other. Personally, I want the best for my patient and for me and definitely would not brag about it if it was bad.

R/r911
 
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mxjagracer

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Did they not teach you obvious signs of death? Not medically trained enough to determine that then you need not to be in the business. Seriously, that is part of your job! Your chance of doing that is higher than performing CPR. Wait until the physicians grabs you in the hall and chews your arse out then reports you for not doing the right thing.

Remember, the job is NOT about you !



Hollywood CPR? Wow! What poor description of medical negligence! Sorry, don't enter the damn house without LEO! You better believe I'll leave the man in the middle of the road. What I am going to do transport a D.O. A. to where? Yeah, let's place an EMS unit out of service to transport a body!...Our police would have our arse for even moving it. Hey, here's an idea; cover the body and allow the M.E. tansport or a funerall home hearse or van.

I do undestand the dilemma. I have worked in the city. The reason I no longer will. Sorry you work in a crappy place. Yet, again why I always avoid cities.

R/r 911

AGAIN - Hollywood CPR is personal safety!!! You dont walk in and see someone who is rotting and go, ok!! LETS WORK EM! Hollywood cpr comes when you try to explain to a family member that their mother is dead. And he says NO SHE AINT!!! And gets loud. As far as public view? Yea, you remove him. The road doesnt get shut down cause there is a death. The police didnt come and stop oncoming traffic from running over that guys foot (thankfully by standers did.) and even worse for that matter, we dont have protection from traffic on pretty much every scene. ESPECIALLY during the summer. I had a guy shot four times last week on the sidewalk of Gratiot. Agonal resps when we arrived. (He got shot for pissing on the sidewalk at 730 at night). Dead before we even got him loaded. Preserved the crime scene by cutting the pt.'s shirt away at the scene and leaving it where he lay. Where two of the rounds were actually in the back of his shirt. (it was on the news if you wanna look... Troester & Gratiot, channel 4 wdiv). Traffic was never stopped. Gratiot is a seven lane road. The pt. was removed cause people dont need to see something like that. Crime scene? Need you ask?

You have just inspired my new sig LOL

Those who cant do, teach (and you seem pretty knowledgeable).
Those who cant teach, do
The select few how are do both excessively well?
Work for Detroit.
 

mxjagracer

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Sorry, I have seen Detroit's. Some good and some.. well. Problem is most believe that they are far better than most others out there.

I may not be as smart as some of those city boys, but I work with new equipment (yeah vent's, IV pumps (yes, we carry more than IVP med.'s), and ride in no units over two years old, and work in an area that we don't have to wear body armour in. Run enough to be proficient and in comparrision of patient time, usually I have more. I also make a decent salary in comparison and have to only work ten days a month. Really now, determing how you figure "smarts" which one would you say might have the most?

How long does your medic spend with a patient.. 30 minutes, 45? How much in-depth assessment and care is really performed?

Oh, we know how talk in correct sentence structures. Who knows? I am sure we both could learn off each other. Personally, I want the best for my patient and for me and definitely would not brag about it if it was bad.

R/r911

Its ok. I worked privates once too... Sucks dont it? I learned how to operate the vent and the pump. But, I'm not a ccp though<_< Yea, I dont know extensive stuff about PH levels, or ATP, or anything else like that. But I always thought real emergency care didnt go that deep. Especially since a drugbox on a truck isnt exactly a pharmacy. The company did want to send me to CCP school pretty bad though. I mean why not? They were gonna pay me to go to school, AND i would have been able to put all kinds of sweet little titles under my forum name. And if you dont know the difference between street smarts and book smart. And the difference it makes in pt. care (specifically, high-pressure situations). You must be the latter.

*Yea, I do work 14 days a month. Fourteen 12 hour shifts. And we do have trucks that are two years old on the road (x rigs). But our trucks actually get replaced once a year. But thats not a good thing. When you pull an average of 13 calls in a 12 hour shift, they take a beating. But who ever said that more calls and more pt. contact is actually more experience? I must be in the wrong place for experience then. My unit is up to 1000 runs as of yesterday morning for the new year. Another unit is beating us right now. They are at 1210. But thats nothing to be proud of right? LOL
 
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reaper

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Its ok. I worked privates once too... Sucks dont it? I learned how to operate the vent and the pump. But, I'm not a ccp though<_< Yea, I dont know extensive stuff about PH levels, or ATP, or anything else like that. But I always thought real emergency care didnt go that deep. Especially since a drugbox on a truck isnt exactly a pharmacy. The company did want to send me to CCP school pretty bad though. I mean why not? They were gonna pay me to go to school, AND i would have been able to put all kinds of sweet little titles under my forum name. And if you dont know the difference between street smarts and book smart. And the difference it makes in pt. care (specifically, high-pressure situations). You must be the latter.

Posts like these are exactly why we push for higher education in EMS!!!;)

I have always worked in the Cities, in "high pressure situations". I will take an educated medic over a street smart medic, any day! This must be why Detroit EMS is so highly regarded in the field!:rolleyes:
 

Ridryder911

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Its ok. I worked privates once too... Sucks dont it? I learned how to operate the vent and the pump. But, I'm not a ccp though<_< Yea, I dont know extensive stuff about PH levels, or ATP, or anything else like that. But I always thought real emergency care didnt go that deep. Especially since a drugbox on a truck isnt exactly a pharmacy. The company did want to send me to CCP school pretty bad though. I mean why not? They were gonna pay me to go to school, AND i would have been able to put all kinds of sweet little titles under my forum name. And if you dont know the difference between street smarts and book smart. And the difference it makes in pt. care (specifically, high-pressure situations). You must be the latter.

*Yea, I do work 14 days a month. Fourteen 12 hour shifts. And we do have trucks that are two years old on the road (x rigs). But our trucks actually get replaced once a year. But thats not a good thing. When you pull an average of 13 calls in a 12 hour shift, they take a beating. But who ever said that more calls and more pt. contact is actually more experience? I must be in the wrong place for experience then. My unit is up to 1000 runs as of yesterday morning for the new year. Another unit is beating us right now. They are at 1210. But thats nothing to be proud of right? LOL


Not really. More calls has never been proven to make anyone smarter, and again my unit responds to 12 to 15 calls per truck a shift but our responses maybe over thirty miles away and transports maybe 60 miles so being busy is relative. Personally, I think it sucks that EMS systems would place that high of demand on either one. I have also never worked for a private agency, mine is a third party, simply EMS not fire, police, hospital, private, or attached to anything. I personally feel your system sucks if they do not want place more trucks and continue to allow personnel to be endangered. That's not smarts, no matter how you look at it.. book smarts or street sense.

There is NO street medicine or "book type". There is medicine and if you don't think emergency medicine is that in-depth; obviously then you don't know emergency medicine nor emerrgency care by making such a remark. Yes, my drug box has more than 12 med.s in it and yes, I start infusion drips in the field for patients...why? Because they need it.

Before comparring systems, and the attached bragging rights to it. One better know medicine for that is and what we are supposed to be delivering. Steet smart's has nothing to do with that. Street smarts are how to survive to be able to provide that care and in the working environment.

As well, because I am educated does not mean I have never worked in the field. One does not stay in EMS over thirty years and worked in multiple systems including flight, Tactical, and even..."gulp" Fire Service. Like I described, I worked in large EMS in large cities as well as one of the largest trauma center in the nation. Seriously, do you think they pick flight nurses and Paramedics without extensive work history?

Each system has its own quirks and problems. Those in large areas one may get treated like crap and most want only those that have a pulse and a patch. The rural area, you are the only one with the patient for maybe hours... so you cannot just hand them off. I've been at both places and realize there are great medics and lousy medics at both.

Remember this, not all places are the "bronx" type. Not all have to have the hard street jargon or attitude associated with it. It really does not impress anyone. Let's leave that for t.v.
I am sure your intent is great, but; the way your presenting it is not the best representation for you or Detroit EMS.

R/r 911
 
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Sasha

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learned how to operate the vent and the pump. But, I'm not a ccp though Yea, I dont know extensive stuff about PH levels, or ATP, or anything else like that.

A local agency here taught some medics how to work a vent and a pump and called them Vent Medics. They didn't teach them anything about the vent or the respiratory system or the physiology behind it, just how to work the vent. They're all fired, because the medics would have the RRTs set the vent before they left and not touch it afterwards despite the beeps and patients suffered.

You have to know the physiology of the treatments you use! The "I know how to work a vent!" doesn't cut it.
 

VentMedic

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A local agency here taught some medics how to work a vent and a pump and called them Vent Medics. They didn't teach them anything about the vent or the respiratory system or the physiology behind it, just how to work the vent. They're all fired, because the medics would have the RRTs set the vent before they left and not touch it afterwards despite the beeps and patients suffered.

You have to know the physiology of the treatments you use! The "I know how to work a vent!" doesn't cut it.

Unfortunately I've heard of these. Someone even gives them a "cert" as a Vent Medic. In reality they don't even do the term "Knobologist" justice.

It is along the same lines at when they us the IV pumps which some must borrow from the hospitals. The RNs set them up and the Paramedic drive off. If the beeping gets too annoying, they just turn them off because "they ain't working anyway and we don't know how to reset or ain't allow to titrate nothin'". The same with troubleshooting the ventilator. If the tubing is disconnected, kinked or ETT plugged with an alarm indicating some problem, too bad because they didn't get to that paragragh in their 1 page inservice.
 
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Veneficus

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Our ABG machines can do electrolytes as quickly as an ABG. .


I need one of those machines :)

You haven't used the ultrasound to its fullest extent especially in determining causes of PEA

I think in the ED I was at, people were not lucky enough to make it there in PEA because medics worked and usually called codes on scene. The Europeans are quite adept at ultrasound.


ECMO: it depends on your hospital. No you will NOT see this in every little general. Large teaching hospitals with specific populations or those that deal with VADs may have the capability. There are about 5 transport teams that also take their services to the patient (pedi or neo) and transport back to their hospital.

Occasionally the ECMO team will be asked to place an adult patient on this as a life saving procedure until another alternative comes along. This is done before the patient codes.

Adult extracorporeal cardiopulmonary resuscitation was more common in the 1980s in the EDs. However, we've come to an understanding about the success of cardiac arrests over the past 3 decades.

I was trying to stick with the EMS/ED level stuff, ICU and surg is a different animal. early and mid 80's was before me :)
 
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Veneficus

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some pespective

Its ok. I worked privates once too... Sucks dont it? I learned how to operate the vent and the pump. But, I'm not a ccp though<_< Yea, I dont know extensive stuff about PH levels, or ATP, or anything else like that. But I always thought real emergency care didnt go that deep. Especially since a drugbox on a truck isnt exactly a pharmacy. The company did want to send me to CCP school pretty bad though. I mean why not? They were gonna pay me to go to school, AND i would have been able to put all kinds of sweet little titles under my forum name. And if you dont know the difference between street smarts and book smart. And the difference it makes in pt. care (specifically, high-pressure situations). You must be the latter.

*Yea, I do work 14 days a month. Fourteen 12 hour shifts. And we do have trucks that are two years old on the road (x rigs). But our trucks actually get replaced once a year. But thats not a good thing. When you pull an average of 13 calls in a 12 hour shift, they take a beating. But who ever said that more calls and more pt. contact is actually more experience? I must be in the wrong place for experience then. My unit is up to 1000 runs as of yesterday morning for the new year. Another unit is beating us right now. They are at 1210. But thats nothing to be proud of right? LOL

I spent some time with a "high performance" system. (who I will be kind to and not name) I thought that if I could run 12-18 calls in a 12 hour shift I was more than proficient. I thought the ability to determine caliber and relative distance of the shots in the hood was a useful skill that only the best medics had. If I could pump a whole drug bx in a pt in less than 10 minutes I was the hero of heros. I didn't need to know why I was doing what I was, I simply was good at doing it. The service even promoted "the best of the best" mystique.

Then I applied for a flight job. To say I embarrassed myself would be charitable. During my interview with the med director I was asking him what "those words meant." Suddenly my "experience" and "street smarts" didn't look so smart. Got a nice rejection letter on how that service only offers positions to the best.

It was painfully obvious that the one lacking in medical ability was not the doctor, it was me. I have spent many years since then rectifying my ignorance. I hope you might be able to see the difference before you find yourself in the position I was.
 

VentMedic

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I think in the ED I was at, people were not lucky enough to make it there in PEA because medics worked and usually called codes on scene. The Europeans are quite adept at ultrasound.

I just used that example since this thread is about codes. It definitely has more uses than just to pronounce death.
ultrasound simply to confirm no cardiac function.

A portable ultrasound machine is extremely valuable in the ED to do things like:

FAST (Focused Abdominal Sonography for Trauma)
Quick check of a fetus
Pericardial effusion
Intraperitoneal fluid
AAA
LV function
Gallbladder
Emboli
Renal disorders

A few U.S. Flight teams are also carrying portable ultrasound machines.

If you cannot get ABGs and electrolytes in less than 15 minutes (even the older ABG machines gave a result in one minute) it might be time to get your lab to look at the technology of this century.

http://www.novabiomedical.com/clinical/electrolyte.html

http://www.novabiomedical.com/clinical/onesize.html

http://www.radiometer.com/A8F9125D-0BD3-4472-A540-76F07221EB75.W5Doc
 
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Veneficus

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mxjagracer

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alright, this thread is boring me now. On a departing note. Ive worked the burbs, and Im working the big city. If your educated, then your educated. Doesnt matter what system you work. Diagnosing where in the GI tract the penny is that the 8 year old swallowed, doesnt make a difference. Being able to do something as simple as pressing the shock button on the life pack 12 without having tremors in your hand. Thats kinda important. Ive seen and worked with both kinds alike. Id take a street smart medic over a book smart any day. Any service in any city has both. The perfect blend is whats important. What good is knowing how adenosine affects your kidneys in five years, if you cant even start an IV to push it through? You may get your rocks off by having more drugs than me in your drugbox, but we are at the farthest, less than 8 minutes away from any level 1 trauma center in the city (there are 4 in case your interested.) So, no, we do not do RSI. If we had longer transport times, I'm sure we would have just as many drugs as you. Then maybe I could get a big woody when I get to hang a drip too. And there really probably isnt that much difference in our drug boxes.

We are a division of the Fire Department. More or less, the step-child of the fire dept.

Its been fun. Ya'all take it easy!!!
 

Ms.Medic

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alright, this thread is boring me now. On a departing note. Ive worked the burbs, and Im working the big city. If your educated, then your educated. Doesnt matter what system you work. Diagnosing where in the GI tract the penny is that the 8 year old swallowed, doesnt make a difference. Being able to do something as simple as pressing the shock button on the life pack 12 without having tremors in your hand. Thats kinda important. Ive seen and worked with both kinds alike. Id take a street smart medic over a book smart any day. Any service in any city has both. The perfect blend is whats important. What good is knowing how adenosine affects your kidneys in five years, if you cant even start an IV to push it through? You may get your rocks off by having more drugs than me in your drugbox, but we are at the farthest, less than 8 minutes away from any level 1 trauma center in the city (there are 4 in case your interested.) So, no, we do not do RSI. If we had longer transport times, I'm sure we would have just as many drugs as you. Then maybe I could get a big woody when I get to hang a drip too. And there really probably isnt that much difference in our drug boxes.

We are a division of the Fire Department. More or less, the step-child of the fire dept.

Its been fun. Ya'all take it easy!!!


So, is this service a 911 call telemetry for advice type of service ? Just wondering.
 

MedicPrincess

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Okay, you guys need to start acting like adults again! I can assure you I believe this thread has run its course. However, I will give it a shot at getting back on topic.

This WILL NOT turn into a service bashing thread/forum/community. Either follow the forum guidelines, or dont. Make your choices. We'll do what we need to from there.

Have a wonderful day. It is now my nap time.
 

Ms.Medic

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I had a brief discussion with a friend today on what it takes to be able to successfully resuscitate a coded patient.

Rather than launch into a tirade I figure I would open the discussion by asking everyone out there what you think is specifically required. (I know a few will say education, please be more specific for the newer members)

Please keep in mind for this a successful “save” is survival to discharge neurologically intact enough to not get sent to a “skilled nursing home.”

Of course my opinion to come later.


Patience, a clear mind, and the most beautiful drugs and aed money can buy. lol. kidding about the best money can buy to all you analyzers out there. But as far as the others, NO, there's no room for adrenaline, no room for being so pumped up that you slip up, and no room for "volunteers/bystanders" that are not well enough trained.
 

AJ Hidell

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