the 100% directionless thread

[usalsfyre]

I really hate outdated protocols.


That is all.

One of the better parts of my job is I get to write the protocols. Unfortunately outdated thinking often means they aren't put to full use,

 

[EpiEMS]

I really hate outdated protocols.


That is all.

Hey, as long as you don't have to board every penetrating trauma ('cause I do...)

 

[Achilles]

:unsure:


:rofl:

Ya I saw that today. I wish I had hours of free time to post worthless crap on facebook!
Also did you know that if you like a picture you love your grandma but if you keep scrolling you're want your grandma to die?
It's like MySpace in 2005...

 

[Epi-do]

Hey, as long as you don't have to board every penetrating trauma ('cause I do...)

I can do better than that. Not only do those patient's have to be boarded, if you trip over something, causing you to fall forward and bump your forehead and you only have isolated pain to that spot, you have to be boarded. If you are involved in a MVC and have pain along your shoulder and the side of your neck from the seatbelt, you are to be boarded. Basically, if you have any sort of pain due to an injury that is anywhere close to your spine, you are to be put on a board. (And since we are the only ALS for the county, most of the time, the BLS crews beat us to the scene and have them packaged before I get there, so I can't even tell them not to do it despite wanting to do so. Per my medical director, after an extensive discussion about the matter, "It is better to board a few people that don't need it to avoid missing those that do."

And then there's cardiac arrests. I am only allowed to call it in the field if there are obvious signs of death. If I am going to have the crews onscene initiate CPR, or if the have decided to do so before I arrive, it must be transported. There is no working it onscene and then calling it after a reasonable attempt.

And let's not forget about those CHF patients who are having an exacerbation. The treatment for them is 0.4 mg nitro q 5 minutes, 40 mg Lasix (unless already taking, and then 80 mg), and 2 mg morphine. Studies have shown that Lasix isn't really effective, and may cause additional short term issues. Morphine has been out of favor for a while. It has been proven to lead to an increased need for mechanical ventilation, longer ICU stays, and increased mortality. And let's face it, 0.4 mg of nitro is going to do a whole lot of nothing. Current evidence supports higher doses, typically 1.2 mg doses.

And how can I forget that we don't need 12 leads because "they don't change what you do for the patient" and "the ED is just going to do one anyway."

But hey, I can RSI patients! Big freakin' deal, when I see a lot more patients that don't need backboard, do need a better treatment plan for their CHF exacerbation, would benefit from early 12-leads performed in the field, or are simply corpses that I am being forced to race to the ED with so I put even more people at risk.

 

[EpiEMS]

I can do better than that.

Wow. That's even more backwards than my system! Damn. And your medical director sounds like a *real* bright spark <_< It seems like he's a good ten-plus years behind on EM practice!

 

[Epi-do]

Wow. That's even more backwards than my system! Damn. And your medical director sounds like a *real* bright spark <_< It seems like he's a good ten-plus years behind on EM practice!

Well, he is an Internal Medicine doc that pulls semi-regular shifts in the ED. There isn't a single doc that works in that ED that is an EM doc. They are all internal medicine, GPs, or family practice docs. Of course, the hospital is a critical access point hospital, and doesn't have an ICU or any other sort of specialty floors. All they have is med/surg.

I am definitely struggling with the whole thing. I've only been there for a couple months, after being laid off from a previous employer. The previous system I had worked in had it's faults as well, but at least we were in the ballpark regarding current practices. There were even a small number of things that were considered quite progressive for the area, and were ahead of a lot of the other systems in nearby counties.

 

[EpiEMS]

Oof. So the hospital runs an ALS service without an EM-trained doc? That strikes me as sorta off...

How long are your transports, usually?

 

[Epi-do]

If it is something we can't take to the county hospital, it gets flown out. Transport to the county hospital can be anywhere from a couple minutes to 30 minutes or so. If the bird can't fly due to weather, and we have to do ground transports, the closest hospital with low level ICU is, at best, 30-40 minutes away. Anything that resembles a "real" hospital (full services, even if only during daytime hours/during the week) then we are talking at least an hour, if not more.

 

[Handsome Robb]

One of our units took two rounds while on scene with the crew and a patient in the box last night. Sounds like a high powered air rifle from what PD is saying. No suspects at this time.

Everyone is ok, unit has a blown out back window.

Keep your heads down out there.

 

[adamjh3]

Just got an "oh by the way, you need your Orange County certs within two weeks" email from the company I recently got hired by.

There goes another $120

 

[JPINFV]

Just got an "oh by the way, you need your Orange County certs within two weeks" email from the company I recently got hired by.

There goes another $120

Does your company do the local accrediation course, or do you need to find one?

 

[adamjh3]

I need to find one.

Seems like they're all within the 80-85 dollar range. Only problem is they fall on days I'm working for my other job.

 

[Amberlamps916]

Check out PARAMEDIC ADVANTAGE in Orange. I did my OCEMS class there and I highly recommend them. Also, their medic prep program helped me out a lot!

 

[NYMedic828]

So I went with this knife for $55 shipped from amazon.

Hands down best knife I ever bought. I've never gotten a new straight bladed knife let alone serrated one that can cut through an index card like a laser with one light swipe.

Spyderco has definitely won me over.

http://www.amazon.com/Spyderco-Resc...1358985847&sr=8-1&keywords=spyderco+rescue+93

 

[Tigger]

To be fair, its probably the best option given the volume of applicants. But yeah, it is a little inane.

And Tigger, if you ever decide to look east coast, there are a quite a few decent places in the Philly burbs that run basics--I made $15/hour starting at my last 911 job. No skiing for a few hours in any direction though.

The skiing is a deal breaker haha. I'm actually from Massachusetts and have been going to school in Colorado. With that concluding in May I hope to stay out here for a change of pace and scenery.

Skiing is a minimum of two hours away for me right now. :glare:

 

[EpiEMS]

So I went with this knife for $55 shipped from amazon.

Hands down best knife I ever bought. I've never gotten a new straight bladed knife let alone serrated one that can cut through an index card like a laser with one light swipe.

Spyderco has definitely won me over.

Darn, and I thought I wasn't gonna be spending more money on fun whacker stuff...

The skiing is a deal breaker haha. I'm actually from Massachusetts and have been going to school in Colorado. With that concluding in May I hope to stay out here for a change of pace and scenery.

Skiing is a minimum of two hours away for me right now. :glare:

What's closest for you in Mass? Just went skiing in northwest Mass, wasn't bad -- a little too icy for me.

 

[adamjh3]

So I went with this knife for $55 shipped from amazon.

Hands down best knife I ever bought. I've never gotten a new straight bladed knife let alone serrated one that can cut through an index card like a laser with one light swipe.

Spyderco has definitely won me over.

I carried a Spyderco Native III for a few years, loved it, I gave it to a knifeless co-worker of mine and as far as I know he still carries it.

Check out PARAMEDIC ADVANTAGE in Orange. I did my OCEMS class there and I highly recommend them. Also, their medic prep program helped me out a lot!

Thanks, yeah, I've looked at them but their next class is on the 4th, and I'm working for my first job on that day. Trying to get the shift covered is a pain because only like 15% of the employees can work it.

 

[Tigger]

What's closest for you in Mass? Just went skiing in northwest Mass, wasn't bad -- a little too icy for me.

Blue Hills is like 20 minutes from my house. One lift, three runs, super icy. I used to race there a bit in high school until I switched to nordic. Nashoba is an hour and Waschusett is an hour fifteen.

I rarely ski in Massachusetts though. It's way worth it to drive to Cannon in Franconia NH, which is only two hours from me. Terrain and conditions are so much better. Besides Cannon I spent a lot of time at Jay Peak and Stowe and Vermont. In high school I got really into backcountry skiing so I've done a lot of trips around New England. I've tried to summit Mt. Washington four times in the winter and ski it, been turned back by weather all four times.

I like tree skiing and deep snow, and I am willing to drive for it.

 

[med51fl]

So I went with this knife for $55 shipped from amazon.

Hands down best knife I ever bought. I've never gotten a new straight bladed knife let alone serrated one that can cut through an index card like a laser with one light swipe.

Spyderco has definitely won me over.

http://www.amazon.com/Spyderco-Resc...1358985847&sr=8-1&keywords=spyderco+rescue+93

That is a great knife! You will love it.

 

[NYMedic828]

Never watched Rescue Me before.

Not bad. Certainly no Chicago Fire :rofl: