How do you feel doing BLS calls?

[Phridae]

To add...
I'm still learning. I like having a medic around. Most of them know their stuff and if I have a questions, they help me answer it.

 

[MMiz]

We have two people that run Medic / Basic, until the Basic gets his license in the mail a few weeks from now. They rule purely BLS and then do some Paramedic First Responder work (which usually only have a Medic on it).

That's only during the night shift, I loved that shift.

 

[Jon]

Originally posted by rescuecpt+Jun 7 2005, 12:30 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuecpt @ Jun 7 2005, 12:30 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-ECC@Jun 7 2005, 11:20 AM
What happened to the NO2 setup @ the FD...I know we had it there...I put it on the rig.

We got rid of it for the year or two when we didn't have ALS (after M. Frederick left)... and then we didn't get it back when we got ALS back. [/b][/quote]
Nitrous... did it get installed in the chief's car?????

Actually some real cool stuff...wish we could play with it prehospitally.

Jon

 

[Jon]

Originally posted by rescuecpt@Jun 7 2005, 11:31 PM
I hear ya. Last night they tried to burn the place down again with microwave popcorn.

Oh, that is the greatest.... I've heard a few - "Station 5, at Station 5, 170 XXXXXXX Road, a fire alarm, box 05-00."

Funny. Hilarious. Espicially when it goes off in social studies class, with another firefighter across the room, the vibrate alert wakes you up, so your textbook falls on the floor, and the the pager starts going at loud volume....

Jon

 

[aristigal]

I have to agree....there is alot of paperwork with narcs so I generally follow a rule that a medic told me a while ago. If you can prove to me you are in pain then you can have all the narcs you want till then...well. And as far as the RSI.....I WISH!!!! we are way behind up here and all we get is facilitated. I heard recently that they are going to do a study with sux in the city but they are close to a hospital so I don't think that's the best place to study it. As for n2o I saw that on and episode of paramedics and I think we should have it! We have toradol but that is like a fart in a sandstorm and sometimes some of the docs don't want to give orders for narcs. Especially abd pain you might as well forget it!!!

 

[wackermedic]

I am a Medic and have no problem doing a BLS call. I do not start and IV in every pt just to get the "big bucks". If the pt is BLS I will let my partner get in the back and I will drive. The thing the gets me worked up is the Medics out there that BLS calls that should be ALS because they are too lazy to treat the pt or do the chart. Exercise what you learned when you became a Medic and treat the pt that needs you. I do and so does a lot of the other Medics out there. Be safe and have a great day.

 

[rescuecpt]

There's an ALS provider in my dept who is very hesitant to do ALS and actually says that I 'overpractice' it. I don't feel that I do, and others I ride with agree... if there is something to be gained by an IV, I'll start it. I like putting the monitor on most patients - why not? It's a non-invasive diagnostic tool. This particular provider fought with me over a D-Stick once - I went with my gut and did it... the pt's blood sugar was 24. HMMMM.....

 

[wackermedic]

I agree with you Rescue. I would rather have somone tell me that I over treat than not treat. Be safe and keep up the good work. JC

 

[Jon]

I agree with you, Erika.

Ouir Medical Director pushes us to do what we can in the feild to help the patient, so that the pt. doesn't wait for tx in the ED. Start a line, push drugs for pain control. Give Compazine for neasua. Give IV steroids for severe asathma and allergic reactions.

takes a little more tme for us, but pt. doesn't have to wait for the doc to see him/her in the ED

over the weekend, we gave IM ketoralac (?) and then 4 + 2 + 2 IV of MSo4 for a probably fx'd ankle. that way, the patient was not in extreme pain waiting for the doc to see her and order films. Also meant she wouldn't go to triage but go straight back.



Jon

 

[medicNsand]

Originally posted by ECC@Jun 4 2005, 01:39 AM
I was indoctrinated over 14 years ago...There were quite a few things we were 'NEVER going to get'. Among them were narcs for analgesia, and paralytics for RSI.

Docs in the 60+ Hospitals in the NYC setting were adamantly against us doping up their patients for several reasons...

• it makes them loopy and poor historians.
  
• The very real possibility of calling EMS for some sort of pain, and us having to sort out those in pain for real from the junkies.

Also, keep in mind how many patients fail to tell the whole tale...and leave out important stuff in their history...or important stuff about the events leading up to what is hurting them. I have transported thousands of patients without analgesia. They did just fine...chalk it up to the culture of my youth and environment. I did not say I withold narcs...on the contrary, my MD wants his patients pain free...so that is the way I deliver them...but I did state my objection to it.

I would like to say " Right On!!". Ive been in situations where people call 9-1-1 for a ride to the hospital, then leave immediately without being seen. Which makes me an ALS Taxi for crackheads needing to reach their dealer. I work in an EMT-I based FD, they drive the ambulances, with NREMT-P members on board. We call'em shock-traumas, or a " stick-miss-an-drive" tech. LMFAO!!.
I appreciate a " Good Tech" though",......
MedicNsand

 

[medicNsand]

Originally posted by MedicStudentJon+Jun 9 2005, 06:37 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ Jun 9 2005, 06:37 PM)</td></tr><tr><td id='QUOTE'>

Originally posted by rescuecpt@Jun 7 2005, 12:30 PM
<!--QuoteBegin-ECC

@Jun 7 2005, 11:20 AM
What happened to the NO2 setup @ the FD...I know we had it there...I put it on the rig.

We got rid of it for the year or two when we didn't have ALS (after M. Frederick left)... and then we didn't get it back when we got ALS back.

Nitrous... did it get installed in the chief's car?????

Actually some real cool stuff...wish we could play with it prehospitally.

Jon [/b][/quote]
I would have loved to comment, but apparently the nitrous has taken over, ...Wheres My M-4,......hahahahhahaahaLOL

 

[TTLWHKR]

I had it for my leg, in the ER anyway, didn't do what they thought it would. I was in a lot of pain, so the gave me valium and versed... till they could get it put in the right direction anyway. I guess they thought I could damage them if I got really upset.

 

[asysin2leads]

>Docs in the 60+ Hospitals in the NYC setting were adamantly against us doping >up their patients for several reasons...

>it makes them loopy and poor historians.

>The very real possibility of calling EMS for some sort of pain, and us having to >sort out those in pain for real from the junkies.

I'm glad this attitude towards pain management in NYC is starting to (slowly) diminish. Being a trauma victim at one point myself, I have a real kind of soft spot for anyone with musculoskeletal injury. Last year REMAC approved morphine as a medical control option for isolated extremity injury. Granted, the chances of an ALS unit being assigned on an isolated extremity injury is very slim, but, its a start.
The poor historian part is crap. We give morphine to people in APE, and they're history giving ability is much more important than someone who broke their leg or crashed their car. In addition, any ALS crew doing their job properly would have gotten an adequate history PRIOR to medication administration.
As for the junkie part, I shake my head a little. Sure, the EMS system gets abused day in and day out, but just because something is in a protocol DOESN'T MEAN you have to give it. If I have some skell come wandering up to the bus complaining of "severe pain in the leg", do you think he'd be getting morphine? Nope.
I realize that with the Republicans in power, getting loopy in any way, shape or form, is pretty much the worse sin you can commit, but as a medical care provider, I'm gonna stick to my commie feel good ways and say that if I have someone with multiple fractures entrapped in an MVA, I'd like to give them a little something to take the edge off before I move them, because I personally know how much it HURTS.

 

[Flight-LP]

asysin2leads- Up to the republican comment I completely agree with you. If you have it and the patient needs it, give it. We need to base our decision off of a sound assessment and the nature of illness / mechanism of injury. Pain is what the patient says it is. Acute illness and injuries that are indicitive of pain managment require it. It is absolutely cruel to withhold pain medication because of any additional paperwork required or because a medic thinks someone is an addict. Both examples open you wide up for litigation. In my mind there are three things that will ensure a happy patient. Respond promptly, be nice and professional, and take away their pain. I'm not saying to dope up your chronic back pain for 10 years patient, but the ones who have acute issues deserve pain management, plain and simple. Some doc's do not like medicated patients, thats fine, they will get over it. Do what you know is right for your patient and what your medical director dictates, remember, you are here for them, not the ER doc....

 

[rescuecpt]

Originally posted by asysin2leads@Aug 9 2005, 04:05 PM
As for the junkie part, I shake my head a little. Sure, the EMS system gets abused day in and day out, but just because something is in a protocol DOESN'T MEAN you have to give it.

If I have some skell come wandering up to the bus complaining of "severe pain in the leg", do you think he'd be getting morphine? Nope.

I realize that with the Republicans in power, getting loopy in any way, shape or form, is pretty much the worse sin you can commit, but as a medical care provider, I'm gonna stick to my commie feel good ways and say that if I have someone with multiple fractures entrapped in an MVA, I'd like to give them a little something to take the edge off before I move them, because I personally know how much it HURTS.

LOL, it's not about Republicans. It's about providers needing to make major decisions that we are not trained to make - who really needs it vs who doesnt, what it will do to the rest of the pt's injuries, etc. That's why around here (as they should be everywhere and I think they are) narcs are controlled substances only administered with medical control approval. That's also why I don't give narcs very much - because I don't get orders very often. They are very selective because in the long run, that is what is best for the most patients.

I ride in two departments. One has pain control meds (narcs & nitrous) and one does not. Why don't we have it at the 2nd place? Because it is too hard for us to secure it and train our personnel on security procedures. It brings too much risk to the department and the squad.

Lots of skells don't look like skells. Sometimes it's REALLY hard to tell which soccer mom is really a junkie, no matter how long you've been on the streets.

 

[asysin2leads]

Originally posted by rescuecpt+Aug 10 2005, 08:46 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuecpt @ Aug 10 2005, 08:46 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-asysin2leads@Aug 9 2005, 04:05 PM
As for the junkie part, I shake my head a little. Sure, the EMS system gets abused day in and day out, but just because something is in a protocol DOESN'T MEAN you have to give it.

If I have some skell come wandering up to the bus complaining of "severe pain in the leg", do you think he'd be getting morphine? Nope.

I realize that with the Republicans in power, getting loopy in any way, shape or form,  is pretty much the worse sin you can commit, but as a medical care provider, I'm gonna stick to my commie feel good ways and say that if I have someone with multiple fractures entrapped in an MVA, I'd like to give them a little something to take the edge off before I move them, because I personally know how much it HURTS.

LOL, it's not about Republicans. It's about providers needing to make major decisions that we are not trained to make - who really needs it vs who doesnt, what it will do to the rest of the pt's injuries, etc. That's why around here (as they should be everywhere and I think they are) narcs are controlled substances only administered with medical control approval. That's also why I don't give narcs very much - because I don't get orders very often. They are very selective because in the long run, that is what is best for the most patients.

I ride in two departments. One has pain control meds (narcs & nitrous) and one does not. Why don't we have it at the 2nd place? Because it is too hard for us to secure it and train our personnel on security procedures. It brings too much risk to the department and the squad.

Lots of skells don't look like skells. Sometimes it's REALLY hard to tell which soccer mom is really a junkie, no matter how long you've been on the streets. [/b][/quote]
A couple things. If your 2nd department does not have people who can be trusted around narcotics and nitrous, they shouldn't be working EMS. Secutrity is no harder than a log book, a control number, and a count every tour. I'm not sure exactly what you mean by risk, but I know of ambulance services in East New York (bad area) that do just fine in keeping their narcotics where they should be.
As providers, we, in conjunction with the online medical control physician, are in fact qualified to decide who gets pain management and who does not. And countless of studies will show you, in hospital and out of hospital, that management of acute pain with opiates and other medications does NOT, by in large, create people addicted to pain medication. Recent theory holds that aggressive management of pain is the most beneficial to patient. As for the "soccer mom" thing, ummm, well, if Ms. McGuilicutty calls for the ambulance everyday (as a real junkie would need) for the same pain in the same area, well, we might catch on eventually. A junkie might get a free "high" once, might get it twice, but they're not gonna be feeding their habits on EMS narcotics. No way, no how. Pain is bad. We can treat it, and we should.

 

[rescuecpt]

A couple things. If your 2nd department does not have people who can be trusted around narcotics and nitrous, they shouldn't be working EMS. Secutrity is no harder than a log book, a control number, and a count every tour. I'm not sure exactly what you mean by risk, but I know of ambulance services in East New York (bad area) that do just fine in keeping their narcotics where they should be.

Yes, but the services in East New York are staffed 24/7. My second department is an oncall service housed in a public building that is accessible to not only the ALS providers, but everyone else including fire, police, community members, etc. Sometimes there are long stretches (days) between calls and inventories are performed on a per call basis, not on a daily or per shift basis.

As providers, we, in conjunction with the online medical control physician, are in fact qualified to decide who gets pain management and who does not.

Yeah, I reread my statement and realized you would say this, I just worded it poorly. But there are a lot of things we dont know about our patients that can play into our decisions - between us and the doc we don't necessarily know everything about our patient and what is best for them. All we can do is try. Sometimes it's better to be safe than sorry.

And countless of studies will show you, in hospital and out of hospital, that management of acute pain with opiates and other medications does NOT, by in large, create people addicted to pain medication. Recent theory holds that aggressive management of pain is the most beneficial to patient.

I'm not worried about creating addicts with 10mgs of morphine, I don't think anyone here mentioned that. Maybe your medical control is a lot more free-wheeling and aggressive than mine is, because we don't often get orders for narcs - I've gotten an order once in the past year - 5mgs morphine for an open ankle fracture.

As for the "soccer mom" thing, ummm, well, if Ms. McGuilicutty calls for the ambulance everyday (as a real junkie would need) for the same pain in the same area, well, we might catch on eventually. A junkie might get a free "high" once, might get it twice, but they're not gonna be feeding their habits on EMS narcotics.

Um, yeah. There's an Oprah on soccer moms with drug addictions you need to watch. But that wasn't the point of my statement anyway, but I think you know that.

Pain is bad. We can treat it, and we should.

Agreed, but it's not always that easy. If you would like to send my 2nd department the money for a safe system, training, and narcotics, PM me and I'll give you our address. Make out a nice fat check. In the meantime, if someone is in bad pain in my 2nd dept, that's what our buddies in the helicopter are for. They're free, and just a phone call and 10 minute flight away.

 

[asysin2leads]

Originally posted by rescuecpt@Aug 11 2005, 09:27 AM
Um, yeah. There's an Oprah on soccer moms with drug addictions you need to watch. But that wasn't the point of my statement anyway, but I think you know that.

I will long in the happy hunting ground before I base my treatment decisions on anything Oprah the 3 ring circusmaster says. One day its soccer mom heroin addicts, next day its "Let's do a MAKEOVER!!!", lol. I am quite sure there are a good number of upper middle class women with drug addictions, but I think Oprah is a for the birds too. Don't listen to TV. TV lies.

 

[rescuecpt]

Edited.

Nevermind.

 

[Ridryder911]

We have standing orders on pain management as well as anxiety management.. there should be no difference in treatment in field vs. ER... sorry, you are not going to cause chemical dependency in a < 1 hr ride with the little narcs we carry.

There is a hot trend to control pain.. They just now are recognizing it is not good for the patient...DUH !... I know in the ER, if pain is not addressed in the first 10 minutes, the staff goes under review...( dependent on the case)

Far as not able to assess or obtain hx.. what are you doing enroute ? A simple H & P can easily be performed ... also, don't buy the "physician are unable to obtain hx. B.S.... if they are really worried. they can give a sample dose of narcan.... c'mon 2'nd year residents know how to get histories...

Be safe,
Ridryder 911