I really want to work for AMR

[thisismikedee]

Tell that to the AMI in bigeminy that needed Lido(which we wouldn't have seen without a 12L), or the CHF'er in acute pulmonary edema who because we CPAP'ed them, now isn't on a vent.

those treatments seem like they are from a county that lets you do something, let us not forget we were arguing LA County, the original poster of this thread was referring to LA county. CPAP is an amazing thing, but remember that oxygen powered, flow restricted ventilations devices are in a nationally registered emt b's scope, essentially a CPAP machine. Lido is not given in LACo

 

[thisismikedee]

hey why don't you go p rick off on some nursing board mikedee. this is a family you are pissing on, and it doesn't look like you are trying to contribute anything positive.

im only trying to have a good conversation, its only a debate. last i looked this is a place to where EMT and EMT-P can talk about things, haha, im not trying to make anyone mad, just trying to give the otherside of the opinion. I have already said i am biased to LACo medics, i have not worked in any other county so i dont know how it works. the original poster of this thread was referring to working AMR near LACo, thats the only reason im baggin on LACo Medics. All you norcal folks are fine in my books, progressive EMS systems do work, LA county is stuck in the era of johnny gage and squad 51

 

[thisismikedee]

Which is not characteristic of all of the hospitals in LA County. Additionally, early notification allows for preparation to began sooner.




[/B]Epi-pens won't help out when you need a second dose. Ventilation is going to be difficult as angioedema sets in.

-----touche, hopefully by that time we are half way to the MAR. respectable.


[/B]
Why rapid transport when you can begin treatment in the field? Preventing cardiac arrests is much more important than reversing cardiac arrest.

if i am not mistaken, i think it is better to rapidly transport, if the patient codes en route, then at lest we are already rolling...wasting time setting up a line (most of these patients veins are shot from excessive medical history) drawing up the drugs and or shock cardioverting just means more time wasted on scene, my AED can cardiovert all day. Chemical cardiovert is very nice, and i respect it a lot but i still think getting a roll on and getting half way to the hospital is better than running a long drawn out assesment, 12 leading, making base, getting order, setting up a line, analyze, pace, what have you...all this time can be potentially hazardous to patient health when the ER can do all of that, PLUS some.


Why assist ventilation when you can reverse the underlying problem? Sure, assist until the albuterol sets in, but assist + albuterol is better than assist alone.
[/B]
For pharmacological restraints, pharmacological restraints are better for the patient than a set of leathers and a surgical mask. Why not provider a superior level of care to patients with acute psychiatric issues?

The issue with D50 vs D10 isn't about which works better at reversing hypoglycemia, as both will do that. It's about which will cause a smaller overshoot in BGL and which one will cause less problems with maintaining a proper BGL in the immediate future.

im sure this is correct, but case in point then, why not a stick of Oral Glucose then? Blood glucose level overshoot wont really affect the experienced diabetic

...and yes, I agree that known diabetics who make a mistake shouldn't be forced into a transport.

happens all the time and i feel really bad when i make my patient sign away for a 900 dollar ambulance bill when a penut butter and jelly would have sufficed.

[/B]

So, basically there's no point in providing any sort of physical exam or most treatments prehospitally? Just put them on the gurney and run lights and sirens to the nearest hospital?

physical exams are key yes, but they should not increase the on scene time of any EMT B assessment, yes medic assessments are important but nothing can beat good old rapid transport



Why do I get the feeling, though, that you're the type of person who would deny most requests for treatment orders?

i am not that kind of person, i merely like setting up a good debate. this is never done at work, or when patients are involved because i do understand fluid work enviroment will do better for my patient than any ems interventions. thats fine, but i do like questioning the norm because there is another side to all of this.

 

[medichopeful]

I'm a nursing student, and I'm glad I'm gonna just skip medic, unnecessary in 95 percent of common cases.

I'm also a nursing student. And I'm a little bit shocked that someone who is in the same field as me is seriously saying that medicine more advanced then "OXYGEN AND DIESEL!!!!!" is useless :wacko:

 

[medichopeful]

who needs pharmacological restraints when i can just throw a spit mask over them and strap em down

You can't be serious h34r:

 

[thisismikedee]

I'm also a nursing student. And I'm a little bit shocked that someone who is in the same field as me is seriously saying that medicine more advanced then "OXYGEN AND DIESEL!!!!!" is useless :wacko:

medicine is in fact more important than oxygen and diesel, wasting time with statistically useless paramedical treatments is in fact, not.

PARA from the latin root meaning "NEAR" medicine is self explanitory

NEAR medicine, but not medicine. im not trying to beef up being an EMT-B either, im just saying lets get these patients to the hospital asap and waste less time lollygaggin on scene, i'd trust my grandma in the hands of an experienced cardiologist before i trust her with a bunch of needle happy god complex commando medics.

this does not refer to ALL PARAMEDICS, only to those that think they can be a medic without being an EMT first and foremost. remember, its EMT followed by the P
emt-p

 

[reaper]

All this comes from never seeing real medicine at work.

 

[thisismikedee]

All this comes from never seeing real medicine at work.

real medicine takes place in a hospital not on the field. And i'm an EMT, i have a lot of friends thats are medics, and i know nothing i have ever done, or anything a medic has ever done can replace hospital based medicine. EMS should have about providing BASIC live saving interventions and then getting the hell out of there to the hands of someone that went to school for a decade, as opposed to someone like me that took a 6 month emt course, or as apposed to a medic that took a 6 month medic course.

experience trumps cool names and fancy equipment.

Hospital Care > EMS care on ANY level

 

[HotelCo]

real medicine takes place in a hospital not on the field. And i'm an EMT, i have a lot of friends thats are medics, and i know nothing i have ever done, or anything a medic has ever done can replace hospital based medicine. EMS should have about providing BASIC live saving interventions and then getting the hell out of there to the hands of someone that went to school for a decade, as opposed to someone like me that took a 6 month emt course, or as apposed to a medic that took a 6 month medic course.

experience trumps cool names and fancy equipment.

Hospital Care > EMS care on ANY level

ACLS

 

[JPINFV]

real medicine takes place in a hospital not on the field. And i'm an EMT, i have a lot of friends thats are medics, and i know nothing i have ever done, or anything a medic has ever done can replace hospital based medicine.

I think you're selling yourself short. Proper pain management, including appropriate liberal use of pharmacological pain management, means the world to that patient. Chemical restraints of an acutely agitated psychiatric patient means the world to everyone. Albuterol means the world to the patient with reactive airway disease even if it doesn't change the ultimate outcome. NTG and CPAP means the world to the patient with acute pulmonary edema.

None of these will normally change the ultimate outcome. However, even when medicine, including prehospital medicine, can't cure the disease, we can at a minimum relieve suffering. Sure, the asthmatic patient will probably survive another 5-10 minutes while struggling to breath, but I'm willing it's a big relief to them to not feel like they are suffocating. While, at best, EMS treatment is equal to hospital treatment (and for initial care, a lot of it is), temporally EMS provides early intervention, which is a plus in ways that are not as easily measured as mortality rate.

EMS should have about providing BASIC live saving interventions and then getting the hell out of there to the hands of someone that went to school for a decade, as opposed to someone like me that took a 6 month emt course, or as apposed to a medic that took a 6 month medic course.

experience trumps cool names and fancy equipment.

Hospital Care > EMS care on ANY level

Again, don't sell yourself short. Care for a cardiac arrest, for example, is the same prehospitally and in hospital. Chest compressions don't care whether it's an ER tech, paramedic, or EMT providing it. Vasopressers don't care if it's pushed by a RN on the order of a physician or pushed by a paramedic understanding orders. However, chest compressions do care whether the gurney is moving relative to the ground (be it the gurney itself moving, or locked in a moving vehicle.

Yes, EMS providers shouldn't be spending an hour with the patient, but an appropriate assessment and initial treatment should often be completed on scene in most cases (especially medical patients in contrast to trauma patients), even if it delay transport by a few minutes.

 

[medichopeful]

real medicine takes place in a hospital not on the field. And i'm an EMT, i have a lot of friends thats are medics, and i know nothing i have ever done, or anything a medic has ever done can replace hospital based medicine. EMS should have about providing BASIC live saving interventions and then getting the hell out of there to the hands of someone that went to school for a decade, as opposed to someone like me that took a 6 month emt course, or as apposed to a medic that took a 6 month medic course.

experience trumps cool names and fancy equipment.

Hospital Care > EMS care on ANY level

Yes, there may not be a replacement for hospital-based medicine in many cases. However, that does not mean that EMS should provide nothing but a ride to the hospital. The purpose of an EMS system is to BEGIN CARE. What an EMT-B does, with very few exceptions, is transport. Any care they provide, again with few exceptions, is minimal medicine, if you can even count it as medicine.

You do bring up the valid point of a 6-month medic course, but for now let's say that that is the exception and not the rule. Let us say that the paramedic responding has at minimum a 2-year degree, for the sake of discussion.

A paramedic, with their knowledge and skills, will be able to start care IMMEDIATELY. Is that not what is being aimed for by EMS and, if I remember correctly, by yourself? You stated that you have had times where you drove Code 3 to a call to save time. Time until what, the hospital? Although a paramedic will not be able to do everything a hospital can, guess what? They're doing SOMETHING. They're not (hopefully) just throwing the patient on the stretcher and going to the hospital. No, they're assessing, gathering information, and then treating. And that treatment they are providing is the beginning of care.

Again, I'm not disagreeing that the hospital can do a lot more than an EMS system can in many cases. Rather, I'm saying that it makes sense to get medical started ASAP. That's not something an EMT-B and a ride to the hospital can necessarily do.

 

[JPINFV]

if i am not mistaken, i think it is better to rapidly transport, if the patient codes en route, then at lest we are already rolling...wasting time setting up a line (most of these patients veins are shot from excessive medical history) drawing up the drugs and or shock cardioverting just means more time wasted on scene, my AED can cardiovert all day.

I believe you're confusion cardioversion and defibrillation. I've yet to see an AED (under automatic mode for the ones with an override) that is able to synchronized cardioversion, much less detect when it is needed. Additionally, if the patient codes during transport, you're going to have substandard compressions due to issues with the ambulance moving. As you mentioned, the most important thing during a cardiac arrest is compressions and defibrillation.

im sure this is correct, but case in point then, why not a stick of Oral Glucose then? Blood glucose level overshoot wont really affect the experienced diabetic

If the patient can take oral glucose, then sure, go for it. However, there's evidence that points to D10 being superior to D50 for treating hypoglycemia when IV dextrose is indicated.

Example... I'm sure there's more. http://emj.bmj.com/content/22/7/512.short

i am not that kind of person, i merely like setting up a good debate. this is never done at work, or when patients are involved because i do understand fluid work enviroment will do better for my patient than any ems interventions. thats fine, but i do like questioning the norm because there is another side to all of this.

I think the problem is, intentionally or not, that you're currently in the position of supporting LA County's EMS system design. I can't speak for others even if I don't feel alone in this position, but I view the issue of the 9 month paramedic, 1-2 month EMT (I think the old EMT-II or new AEMT would be better suited as the base level (EMT level) should be at in scope, albeit more education than is currently required at that level), the paramedic's reliance on the machine interpretation, and LA's limited standing orders and strict requirements for base hospital contact as being quaint and backwards. Sure, there's short transport times, but a viable patient in cardiac arrest (which is, arguably, rare) who gets transported in cardiac arrest has essentially had their death warrant signed due to a lack of quality compressions. Similarly, (as mentioned in my last post), that 10 minutes of distress for the patient in respiratory distress or pain is going to be an eternity. Similarly, when in a part of LA that isn't surrounded by STEMI centers, the 12 lead prevents a huge delay with setting up a transfer.

It's not that a lot of people here are Ra-Raing paramedics, it's that there's a lot of people here who view Southern California as a whole as a good case study on how not to design an EMS system.

 

[ffemt8978]

This thread has gone WAAAAYYYY off topic. Get back on topic, or it will be closed.

 

[RanchoEMT]

Please no sarcastic comments about lousy pay and no recognition; that's useless information. Oh what the hell; go ahead. But if anyone can sincerely offer a few pointers I'd greatly appreciate it.

Why is this useless? The Pay is Horrible! Unless your gung-ho about getting hired, gaining experience and plan on leaving to go do something better, I think you ota' know, it's HORRIBLE. Just above minimum. Your spending money will be made in overtime, and you won't have time to spend it as you will be working all the time. When you work, You will be sitting in a 90 degree chair for 12 hours, driving back and forth to post all day, you will not be able to keep a consistent diet or sleep pattern. Whatever sleep you lose you will gain back in pounds. You will see things you could've lived without seeing. You will take calls home with you. You will work with egocentrics. You will stop talking to non EMS friends, and slowly shift to you work buddies. You will become callous and egocentric yourself. You will curse dispatch, fire, supervisors and trainees. You will wave to cops, and they will just look away. As if the paycheck wasn't enough, You will constantly be reminded of how uneducated and low on the totem-pole you really are when working with medics, nurses and doctor's alike.
--There's nothing sarcastic about it, Be Advised.

My Sincere Pointer: Unless your going to do Fire, DON'T.