Discussion in 'ALS Discussion' started by MMiz, Jan 8, 2017.
Drill them allllll !!!!!!!
I felt like I quickly got really comfortable when I started working on my own as a medic. I worked on a very busy unit, or I felt it was busy, and started a lot more IVs on all types of calls. I was not good with IVs at all during my internship. Not good at all.
I'm kind of curious how I will get used to the different IVs in Colorado since all my partner's are IV techs and my guess are usually the ones starting an IV.
Funny that you say that. I've been playing fill in for the last couple of weeks and the guy that was a partner du jour last week said he hasn't started an IV in ages, because the paramedic does them all.
Wut? Get back there and start me a line son!
He did all my I level skills the other day and said it was the most he'd done in the back of the rig in a year. I said, "what does your partner let you tech?" He said "BLS".
Ugh. Why mandate that medics have to have an I partner and then not let them do anything? No wonder people get pissed and quit.
I'm looking forward to the extra help honestly. It will just be an interesting dynamic that I now have to think about. I'm so used to basic medic that IV or aemt will be a big change.
I've never worked with a basic, but having an intermediate partner is nice because you don't have to do everything.
What's funny to me is now working in a dual medic system I generally do everything myself on the vast majority of calls. Might ask my partner to draw up meds or something but unless it's a high acuity call the lead medic does everything while the partner charts.
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A close friend of mine who's now one of our supervisors worked with me on a dual medic unit when he was still fairly new.
I swore he was like a super sneaky "position-himself-right-by-the-head-to-get-the-tube" ninja. Every arrest it never failed.
The relevance to my tale regarding this thread...I was always the IV medic.
This was a common occurrence at SCEMS when the admin staff would crash your call to try and steal an intubation. We called them flash dancers.
Oh, we had one those supervisors as well. I cannot confirm nor deny that I have done that in the height of my supervisory days myself.
Honestly, I used to like showing up, activating said trauma, strip the line, help package, and see that it was as an expedient and efficient call as one could hope, but I digress...
Back to the original questions, I know of several people who completed the Lenor program, and 3 or 4 of them are now paramedics. And they all said they program was questionable at best, and the paramedic program there was horrible.
BTW, getting your Intermediate in NC is pretty much as waste of time IMO. Many counties don't recognize it, many won't pay you for more it., and unless your agency operates at the Intermediate level, you can't do anything with it, and have to handle all the continuing education on your own.
just to clarify what I said before: Lenoir's program was questionable at best, and none of them attended their online hybrid paramedic program; they all attended the paramedic program located in the county where they worked full time, which was not Lenoir.
I do know one person who did attend the Lenoir paramedic program, and he didn't speak very highly about it.
We don't have intermediates here; Only EMTs and paramedics. I try to turf my call to my EMT partner whenever appropriate. Unfortunately, I feel like it is too easy for a call to have to go ALS here. My EMT partners can go many days or even a week or two without running a call.
I feel like there's a huge misunderstanding of what it means to 'run a call'. When I did my EMT program, one of my preceptors was a Paramedic. He was a quiet guy to begin with, but he would stand back and let the EMTs do almost everything. He recognized the most benefitial role both in the group-dynamic and patient care was to contribute his experience. Rather than feel the need to perform every skill and intervention himself, he would stand-back and guide the call offering input or direction when he felt necessary.
Just so I don't derail this thread even more, I'll offer some feedback to the OP:
I missed my first few IVs as result of poor instruction. They will likely teach you to approach at a 45' and once you've pierced the skin, lower that angle to around 20'. In all honesty, that's crap. It's way too steep an angle and all it's doing is preparing you to stab someone (or yourself) unintentionally when your unit hits a bump in the road. What changed the game for me was when my instructor told me to lay the IV flat on the patient's skin (Needle/catheter elevated in the air and the flash chamber against the body) and anchor it there with your finger tips. First prep the skin (obviously), but laying the needle flat will allow you to eye-up your vein again and do so safely when bouncing down the road. When ready, tip the needle down to make contact with the skin and pivot up to a low angle and advance. It's WAY shallower than the textbooks say and it will change depending on adipose tissue and how superficial or deep the vein you intend to cannulate is, but it made all the difference for me. Also keep in mind, for pediatrics you're going to be entering at a similar low-angle.
@CWATT I agree with a shallow approach as well. Finesse seems to go much further with most vascular access procedures.
I also never got why they taught the 45 degree angle and watched a lot of my fellow classmates struggle with that particular technique.
One of my favorite preceptors was like this. With the exception of the reallllly sick/injured people I got with him, he just sat back in the chair and let me do my thing. I've somehow dodged like 3 cardiac arrests lately, but my goal once I actually have to run one where I work is to essentially stay hands off unless I absolutely need to. I work with good partners and we have worked with the FD's to get on the same page for how we run them, all I gotta do is make sure all the details are being accounted for and let them do their parts. Think that's better than trying to crowd everyone.
It can be pretty hit or miss, it's only a 24 hour class.
You will remember the first call where you got the IV bumping down the road C3.
Mine was a stroke activation.
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