the 100% directionless thread

[luke_31]

There's this thing where people are hungry and wish to eat. Tuna is a food that can be eaten. Humans can exchange currency for items in a vending machine to obtain goods. The goods are often times edible. The human can then consume the purchased goods to satiate their hunger

DragonClaw that really cracked me up today. Possibly the best explanation I’ve ever heard.

 

[DragonClaw]

DragonClaw that really cracked me up today. Possibly the best explanation I’ve ever heard.

YWFMS

 

[Jim37F]

Next thing you'll want is different colored lights for the calls. Red for fire, blue for medical.

You laugh but that is an actual system that exists:

(edit to add, I just noticed in their video that the actual station alert tones are also slightly different in sounds as well as the different light colors. Gotta be a pricey system...)

Some moons ago, back when I was still working at Glendale (CA) FD as a single role Ambulance Operator, they had lights, a red light for every call, plus a color coded panel for each apparatus. Engines had an additional red light. Trucks had green, Ambulances were blue, the Battalion Chief I think was White and Yellow was Misc units (like the USAR or HazMat). So if the lights lit up and only red was on, it was an Engine only call (or at least from that station only the Engine was going), Red and Blue standard EMS run etc.

 

[Peak]

I just preferred getting pages to my phone. Plus when I forgot the address and the MDC died overnight I’m not lost.

 

[ffemt8978]

I just preferred getting pages to my phone. Plus when I forgot the address and the MDC died overnight I’m not lost.

Plus you can do what I did...use the ole Station 51 alert tones as your ringtone for those messages.

 

[CALEMT]

You laugh but that is an actual system that exists:

(edit to add, I just noticed in their video that the actual station alert tones are also slightly different in sounds as well as the different light colors. Gotta be a pricey system...)

Some moons ago, back when I was still working at Glendale (CA) FD as a single role Ambulance Operator, they had lights, a red light for every call, plus a color coded panel for each apparatus. Engines had an additional red light. Trucks had green, Ambulances were blue, the Battalion Chief I think was White and Yellow was Misc units (like the USAR or HazMat). So if the lights lit up and only red was on, it was an Engine only call (or at least from that station only the Engine was going), Red and Blue standard EMS run etc.

One of our newer stations has the ability to select what individual rooms will get toned out. Like for example you can set your room to only receive calls for the truck. So when the engine gets 5 calls after midnight the tones and light in your room never activate until the apparatus your on gets a call. It’s pretty cool, don’t have it at my station.

 

[Jim37F]

One of our newer stations has the ability to select what individual rooms will get toned out. Like for example you can set your room to only receive calls for the truck. So when the engine gets 5 calls after midnight the tones and light in your room never activate until the apparatus your on gets a call. It’s pretty cool, don’t have it at my station.

Around here it's the other way around, the Ladder getting 5 calls after midnight while the Engine sleeps lol. But yeah that's pretty nifty for a multi company station. I think one of our newest stations has the hardware set up for something like that but that capability was never programmed in or whatever so it's the usual "every room gets alerted" deal

 

[CALEMT]

Around here it's the other way around, the Ladder getting 5 calls after midnight while the Engine sleeps lol. But yeah that's pretty nifty for a multi company station. I think one of our newest stations has the hardware set up for something like that but that capability was never programmed in or whatever so it's the usual "every room gets alerted" deal

Well the funny thing is the station that has that feature... is a single engine station...

 

[NomadicMedic]

We had some very snazzy house alerting at a fire station I was working at In Washington. Red lights in the bunkrooms at night so you had some night vision and a gong that started softly and got louder. Also, there was a separate tone for medics that only activated the loudspeakers and lights in the EMS crew bunks so EMS calls didn’t wake up the engine company.

Daytime fire response got the ”Leeeeeeeroy Jennnnnnkins” sound played over the in house speakers. It was a simple little computer that played the alert audio as a wav file. You could change it anytime you wanted.

This is compared to my time in Georgia where there was no alerting at all no you had to leave your portable radio on the dispatch channel and get woken up by EVERY CALL to determine if it was yours. I tried to explain that we could do radio alerting or put EMS dispatch on a different talk group... I was told,”we don’t pay you to sleep. That’s a benefit. If the tones wake you up, that’s just too bad”. Yeah, it was a pretty miserable time.

 

[ffemt8978]

I can just imagine daytime tones dropping ”Leeeeeeeroy Jennnnnnkins” during a show and tell tour.

 

[Peak]

We had some very snazzy house alerting at a fire station I was working at In Washington. Red lights in the bunkrooms at night so you had some night vision and a gong that started softly and got louder. Also, there was a separate tone for medics that only activated the loudspeakers and lights in the EMS crew bunks so EMS calls didn’t wake up the engine company.

Daytime fire response got the ”Leeeeeeeroy Jennnnnnkins” sound played over the in house speakers. It was a simple little computer that played the alert audio as a wav file. You could change it anytime you wanted.

This is compared to my time in Georgia where there was no alerting at all no you had to leave your portable radio on the dispatch channel and get woken up by EVERY CALL to determine if it was yours. I tried to explain that we could do radio alerting or put EMS dispatch on a different talk group... I was told,”we don’t pay you to sleep. That’s a benefit. If the tones wake you up, that’s just too bad”. Yeah, it was a pretty miserable time.

Because fatigue doesn’t lead to mistakes that kill staff and patients.

 

[Jim37F]

We had some very snazzy house alerting at a fire station I was working at In Washington. Red lights in the bunkrooms at night so you had some night vision and a gong that started softly and got louder. Also, there was a separate tone for medics that only activated the loudspeakers and lights in the EMS crew bunks so EMS calls didn’t wake up the engine company.

Daytime fire response got the ”Leeeeeeeroy Jennnnnnkins” sound played over the in house speakers. It was a simple little computer that played the alert audio as a wav file. You could change it anytime you wanted.

This is compared to my time in Georgia where there was no alerting at all no you had to leave your portable radio on the dispatch channel and get woken up by EVERY CALL to determine if it was yours. I tried to explain that we could do radio alerting or put EMS dispatch on a different talk group... I was told,”we don’t pay you to sleep. That’s a benefit. If the tones wake you up, that’s just too bad”. Yeah, it was a pretty miserable time.

Oooof that's rough. I guess they don't care if you're not fully alert and cognizant because you never got a chance to sleep....

I'd just have one (maybe 2 just in case so the first doesn't fall asleep) be Radio Watch and then wake everyone else up when you do get a call, but there's probably some policy against that or something..

I can just imagine daytime tones dropping ”Leeeeeeeroy Jennnnnnkins” during a show and tell tour.

That would be priceless

I remember one of the documentaries on Air Force Pararescue guys in Afghanistan, they had the LEEEEEEROY JENNNNNKINS!!!! as their alert tone on base

 

[Jim37F]

We had some very snazzy house alerting at a fire station I was working at In Washington. Red lights in the bunkrooms at night so you had some night vision and a gong that started softly and got louder. Also, there was a separate tone for medics that only activated the loudspeakers and lights in the EMS crew bunks so EMS calls didn’t wake up the engine company.

Daytime fire response got the ”Leeeeeeeroy Jennnnnnkins” sound played over the in house speakers. It was a simple little computer that played the alert audio as a wav file. You could change it anytime you wanted.

This is compared to my time in Georgia where there was no alerting at all no you had to leave your portable radio on the dispatch channel and get woken up by EVERY CALL to determine if it was yours. I tried to explain that we could do radio alerting or put EMS dispatch on a different talk group... I was told,”we don’t pay you to sleep. That’s a benefit. If the tones wake you up, that’s just too bad”. Yeah, it was a pretty miserable time.

Even my last ambulance job, at McCormick Ambulance, we didn't have any station alert tones. But we were still allowed to sleep. Dispatch would just call the station land line telephone when they had a call or move up for us. The shrill ringing of the phone served as our Pre Alert, and instead of a PA just the guy answering the phone was told which unit had either a County call or a move up, then they just grabbed their partner (but with a phone in each dorm most people pretty much knew the rotation of units so that when the phone rang you should know if it was for you or not). Then inside the ambulance, they'd go on air over the radio and then Dispatch would read over the dispatch info. They also still had pagers that would get the address and initial pertinent info. Sometimes the page would come in before the phone rang, sometimes you'd be making scene already when the page finally came in lol, but usually was going off in time for you to start mapping the call by the time you were going on air.

So unless you were street corner posting, even a minimum wage private ambulance company didn't expect us to stay up all night listening in to every radio call just in case, I can't imagine any FD getting away with that as the primary means of alerting without the Union eventually getting involved, but I've also never worked Georgia before, so idk, maybe it's just a culture thing there? Like do they scoff at us with station tones that can (at least try to) sleep at night? lol

 

[NomadicMedic]

Even my last ambulance job, at McCormick Ambulance, we didn't have any station alert tones. But we were still allowed to sleep. Dispatch would just call the station land line telephone when they had a call or move up for us. The shrill ringing of the phone served as our Pre Alert, and instead of a PA just the guy answering the phone was told which unit had either a County call or a move up, then they just grabbed their partner (but with a phone in each dorm most people pretty much knew the rotation of units so that when the phone rang you should know if it was for you or not). Then inside the ambulance, they'd go on air over the radio and then Dispatch would read over the dispatch info. They also still had pagers that would get the address and initial pertinent info. Sometimes the page would come in before the phone rang, sometimes you'd be making scene already when the page finally came in lol, but usually was going off in time for you to start mapping the call by the time you were going on air.

So unless you were street corner posting, even a minimum wage private ambulance company didn't expect us to stay up all night listening in to every radio call just in case, I can't imagine any FD getting away with that as the primary means of alerting without the Union eventually getting involved, but I've also never worked Georgia before, so idk, maybe it's just a culture thing there? Like do they scoff at us with station tones that can (at least try to) sleep at night? lol

This was at a Hybrid county/hospital based service, just outside of Savannah. When they upgraded the radios to a trunked system, there was no way to alert the stations, because the old UHF paging system had died. So, we were SOL. The alert for EMS calls was the HI Lo tone, which sounds like the evacuation tone, and the dispatcher would just say “medic station 1, chest pain at 123 Main Street”. We’d have 2 or 3 units at that station and we rotated trucks. You just kept track as to who’s turn it was. It really was like being back in the 80s in terms of how things were run down there.

To illustrate how crazy it was... I was on my way to a cardiac arrest and I asked for an update. The dispatcher, who was known for getting flustered, said, “med2, there CPR goin’ on.., the police are there... they doin’ CPR. And... oh baby, those policemen just be doin CPR.”

I looked at my partner, “did she just call me baby?”

It was all kids of crazy.

 

[Aprz]

To work as a flight paramedic locally, they require NRP (neonatal resuscitation). I just signed up for the class and paid for it. I am requesting the day off to go to the class. I am excited to be taking baby steps towards flight. I am strongly considering trying FP-C just to see if I can pass it first try or not since I feel like I am running out of time to apply. One of the first places I saw had openings (not so locally, but doable for me), had openings forever, closed their applications so I feel like I need to rush a little bit before the local one closes. At least get the cert, apply, and hopefully get it. I know most people don't get any of these things on first try, but I hope I am coming in strong (eg you don't need FP-C to apply, you just need it a year after hire, but I felt like it would be helpful to my job and the interview to know clinical questions for flight paramedics since it is so different from ground paramedics here and would make me stand out from other candidates who didn't get the certs yet).

 

[DesertMedic66]

To work as a flight paramedic locally, they require NRP (neonatal resuscitation). I just signed up for the class and paid for it. I am requesting the day off to go to the class. I am excited to be taking baby steps towards flight. I am strongly considering trying FP-C just to see if I can pass it first try or not since I feel like I am running out of time to apply. One of the first places I saw had openings (not so locally, but doable for me), had openings forever, closed their applications so I feel like I need to rush a little bit before the local one closes. At least get the cert, apply, and hopefully get it. I know most people don't get any of these things on first try, but I hope I am coming in strong (eg you don't need FP-C to apply, you just need it a year after hire, but I felt like it would be helpful to my job and the interview to know clinical questions for flight paramedics since it is so different from ground paramedics here and would make me stand out from other candidates who didn't get the certs yet).

That’s exactly what I did and it’s also what helped me get a flight job with only my 3 years of ground experience. Anything you can do that shows you put in effort, such as walking in with all the required certs like NRP and FP-C.

Not to mention once you start working you will not have to worry about passing the FP-C. I imagine it would suck knowing you must have FP-C by this date or you will be laid off.

 

[Aprz]

I just hit 5 years of being a paramedic I think, which I think will be another good thing. It's just that the scope of practice for paramedics in California, especially ground paramedics, is so limited. It's a huge jump to go from being essentially an EMT that can start IVs, Zofran, and intubate every once every blue moon (I actually intubate any time I can, jump cardiac arrest calls when I can, pickup extra shifts, so I have 12 tubes this year) to all of the sudden having RSI and a variety of sedation drugs to choose from, more anti arrhythmics, oxytocin, mannitol, ventilators, having to throw in flight physiology, monitoring IABP and ART lines, interpreting ABG, etc... It's a huge difference, but it is also what is so appealing for me even though I'd take a huge pay cut (I get paid $40.59/hour right now and the place I am looking at is around $30/hour). I am hoping to go part time where I work and stay part time. I just became a preceptor and FTO and would like to stay behind to teach.

By the way, do you have any tricks or resource for trying to use stuff like CI, PAWP, PA, SVR, etc to figure out what shock it is? I feel like I did have a hard time with learning that and going to go over it again. I know the values, but I can't seem to figure out shocks without pure memorization. The IA Med video was talking about trying to follow the heart to figure out where the problem is, but it actually still didn't make sense to me. I am starting to think it is just pure memorization, but the guy in the video was making it seem like there was a pattern if you follow the flow of the heart/lungs.

 

[Fezman92]

I get to ride in and occasionally drive an SCTU today. I think they’re bigger than some apartments.

 

[GMCmedic]

I just hit 5 years of being a paramedic I think, which I think will be another good thing. It's just that the scope of practice for paramedics in California, especially ground paramedics, is so limited. It's a huge jump to go from being essentially an EMT that can start IVs, Zofran, and intubate every once every blue moon (I actually intubate any time I can, jump cardiac arrest calls when I can, pickup extra shifts, so I have 12 tubes this year) to all of the sudden having RSI and a variety of sedation drugs to choose from, more anti arrhythmics, oxytocin, mannitol, ventilators, having to throw in flight physiology, monitoring IABP and ART lines, interpreting ABG, etc... It's a huge difference, but it is also what is so appealing for me even though I'd take a huge pay cut (I get paid $40.59/hour right now and the place I am looking at is around $30/hour). I am hoping to go part time where I work and stay part time. I just became a preceptor and FTO and would like to stay behind to teach.

By the way, do you have any tricks or resource for trying to use stuff like CI, PAWP, PA, SVR, etc to figure out what shock it is? I feel like I did have a hard time with learning that and going to go over it again. I know the values, but I can't seem to figure out shocks without pure memorization. The IA Med video was talking about trying to follow the heart to figure out where the problem is, but it actually still didn't make sense to me. I am starting to think it is just pure memorization, but the guy in the video was making it seem like there was a pattern if you follow the flow of the heart/lungs.

This is how I grouped it to remember everything.

Right heart failure is the only time the CVP and PAWP move in the same direction.

Then from there I group by SVR.

Septic, Neurogenic, and anaphylactic the SVR is low (think vasodilated)

Hypovolemic and Cardiogenic the SVR will be high (think vasoconstricted).

This way I only needed to remember the SVR range and not necessarily what it does in each type of shock.

From there you really only need to look at the CVP, or clues provided in the case/question.

I never see PA catheters and I dont have my notes handy so be warned im working off memory here.

 

[VentMonkey]

By the way, do you have any tricks or resource for trying to use stuff like CI, PAWP, PA, SVR, etc to figure out what shock it is? I feel like I did have a hard time with learning that and going to go over it again. I know the values, but I can't seem to figure out shocks without pure memorization.

The numbers (values) themselves are mostly a commit to memory thing.

Putting two and two together is also reading the whole clinical picture of the patient and the hemodynamics that go alongside (e.g., neurogenic shock obviously being one of the easier ones) them.

The videos you’re referring to make so much more sense to me almost 5 years after first learning this stuff, so I know the boat you’re currently in. You’re lacking the ICU-level component of your paramedic thinking. That mostly comes with time.

When you actually test, just like any exam read the scenario and it will clue you in as to what type of shock you’re dealing with.

And finally, there’s the sad reality that these values are seldom used in the transport setting anymore, but that may also vary from program to program as well.

Haha, gotta love the IBSC. GL.