Hudson61

Oh yeah, one more thing I know some carry an IV start kit in their pockets, I do not, again that is in my response bag. Where it should be.

With my BDU style pants, right lower pocket are my narcs. (my per-diem agency requires we carry them) Left lower pocket is my DOK kit. Front upper pockets, sometimes loose change, if I have any Back left pocket, my cert cards and ID. back right pocket small bill fold with a few bucks for snacks, coffee etc. On my belt, a small LED flashlight and a multitool. I found both come in handy in places. And maybe the portable radio, depends on my partner. uniform shirt pocket, left side my cell phone, right side a notepad and a pen. The rest of the stuff goes in my response bag. Thats all. I do not carry a folding tac knife, nor a huge mag light type flash light. Also do not carry scissors scope or BP cuff, again thats all in my response bag. Except the knife and mag light, I do not have them at all.

In my BDU pants, left side lower, my narcs (my per-diem agency requires we carry them) right side lower pocket is my DOK kit. Back left pocket my cert cards Back right pocket, a bill fold with a few bucks in it. My upper front pockets, sometimes loose change Uniform shirt, left side my cell, right side a pen and my notepad. On my belt, I have a small led flashlight and a multitool. Thats all, the rest is in my response bag.

Here is a question. Under the new colaberative protocals, being MACed here in Hudson Valley, now if I want to work say in Plattsburgh (cause I like cold weather) do I have to redo the MAC test??? after all in theory it is now all the same protocol. Right?

I can not answer for what happened at the LAX incident. My prayers go out to the TSA officer killed and his family and friends. A sad loss. There is training available to police officers to deal with these types of injuries. TECC (Tactical Emergency Casualty Care) which is the civilian version of TCCC (Tacticle Combat Casualty Care) taught to our military troops. This training allows the police officer to deal with projectile injuries to various parts of the body, they learn how to apply tourniquets, pack wounds where appropriate, and occlussive dressings. ALS related skills as IV and chest decompression are not part of the training. They also are trained and practice applying tourniquets to themselves in the event that they are injuried. Part of the training also includes what is known as "Care Across A Barrier" in which a police officer who can not get to an injuried person but can throw needed equipement to them and instruct the injuried person in how to use it. Also keep in mind that Law Enforcement do often handle emergency calls that start off as one thing, and end up with weapons being used against them. This training will help keep those officers injuried alive until EMS arrives or the Officer is taken to a hospital. Now this is my opinion, I believe that Law Enforccement and EMS need to communicate and work together better on these types of incidents. I know there are folks in EMS that will never go into these types of incidents and that's OK. But there are some with a military background who would go in with law enforcement. (I am one, if asked) Go in, control massive bleeding and get the patient(s) out to a CCP. (Casualty Collection Point). We both have our own specialities. I am also OK with a basic EMT going in as part of a tacticle team and keep the medics outside. Now I know some of my fellow medics will get mad at me for saying that. But here it is, sometimes we medics get too hung up on all the fancy magic we can do as medics. In a hot tactile incident there is no time to start IVs, intubate, cardiac monitoring, etc. We need to stop massive bleed first then get the injuried out of the hot zone, then the rest of the script can be followed. It is difficult at best and almost impossible to maintain situational awareness while starting an IV during a tacticle incident. Every community has their own special needs. So what works one place may or may not work someplace else. Let's not be too critical of other communities but rather use it as an opportunity to learn and improve the vital services that we all provide. Keep it safe out there.

I have never had a hard time getting a report for a transport. As the RN or Doc gives me the info, I have my notepad out taking notes, if there was info that I think I needed I would ask, again, never was given a hard time. Even doing a critical transport from a hospital to medical center. At no time was I told "Hey I am too busy all the inf you need is in his paperwork" If however I would encounter that situation, I would remain the professional and try to get the info I need before taking over patient care. Politely remind the staff that a proper patient care report is needed to take over the patient. But remain calm, professional at all times. Do not get upity with any staffer.

I never did any research on which type of vehicle is safer. However from my personal experience, safety in an ambulance begins with US. One of my per-diem jobs is with a commercial EMS company. A few times I had to tell my driver to "slow the #%%% down" Really guys driving 70 miles an hour through heavy traffic is NOT safe. A few of those times I was in the back with a patient on a routine ALS run stable patient and my driver is driving like he was at a NASCAR race. Another time working an area I was not familr with, I was in a fly car and the BLS ambulance crew said follow us. I said OK, As we hit the main road, I was 10 over the speed limit and they sped out of site in a heart beat. Later the driver admitted he was doing 70+ to get to the call in the required time limit. We need to drive safe, these rigs tip easily, and they do not stop on a dime. Also, we need to keep our gear in compartments, not laying loose on the floor or bench seat. I know the whole seatbelt issue is going to come up. Yes we are all suppose to wear our seatbelts even in the back with a patient. But lets be real, how many really do?? All the more reason we should drive safer. Folks we do a very important job. But first we need to get there to do our job. We have lost too many co-workers to unsafe actions. If it is not safe, don't do it. I know many folks in commercial EMS work for different companies to make ends meet, going from one tour to the next with little to no rest. Hey, when you show up to work, you need to be well rested, ready to work, with your thoughts on the job at hand. Keep it safe out there.

Really?? Has the NTSB or the FCC proved that a cell phone being use on an aircraft can cause a crash?? No they haven't. HOWEVER.... if the airline asked you to shut down, what is the big deal, shut down. Enjoy the in-flight food, movie, read a book, do a word search, or catch a nap. I travel a fair amount by air, I shut down when I board the aircraft, and I turn my cell on after I leave the aircraft. It is my excuse to dis-connect from the world. And I got pretty good at word search.

As a medic this is how I would deal with this patient. Based on the information given, my first step would be O2 by NRM at 12+ LPM. The pursed lip breathing, accessory muscle use and respiratory rate at 20 is telling me the patient is starving for oxygen. However with that, I would also throw on an end tidal filter to get that level. I need to find out what both side of the respiratory system is doing. I am also thinking there may be more to the history then reported. At this point, transport is in order. And no doubt a 12 lead will be taken. Will take a listen to the patients lungs to see if wheezing or something else going on. After the end tidal and listening to the lungs will determine if I give a neb treatment or CPAP. If wheezing, go with a xopenex treatment, if rhales, I would be going with CPAP. Xopenex has less cardiac affects then Albuterol. If the 12 lead does show a cardiac event, I will go down that road and treat it. An IV is in order here, after IV access, I would hang a 1,000 bag with a bolus of 250 cc NS, then slow to KVO and re-evaluate. I do not want to give too much fluid.. Also will do a blood sugar reading. If low, will give dextrose, plus looking at the patient and the enviornment the patient was in, I may also give thiamine to help get the dextrose cross the barrier to the brain. If the blood sugar is very high, will be looking at starting a second line. As far as transport position, the patient may not go for laying down, so if the patient states he feels better sitting up, then that is how I will transport.

There are folks from our past who have helped shaped our careers (paid or non-paid) in emergency services. Be it in the fire service, EMS, or law enforcement we all had someone that influenced us. Here in this tab, let's pay tribute to those we know as our mentors. You do not have to use their real names, a nickname or initials are fine. The important thing, you know who they are. For me, there are three I consider mentors from back in the day. Charlie Lent, for introducing me to the volunteer fire service To Vince Vail, for teaching me first aid and developing my interest in EMS to where I first became an EMT To Al Wohrman for inspiring me to learn and become more proficient in emergency services. Thank you.

First, my prayers are with the EMT in Hoboken. Not only is there a physical injury, but I am sure emotional injury occurred also. Next. Wow, a few very passionate posts. Now I do not claim to have all the answers. But I feel before we talk about arming first responders, we should have a logical discussion on scene safety and situational awareness. When I use to teach out EMT students, in the various testing stations, the first words from the student would be "B.S.I. scene safety" and then deal with the station. No more thought to scene safety. Plus what I have seen in the field is scene safety goes by the wayside after we begin treatment. Scene safety should be a continuous evaluation of the environment that we are working in. Not just about identifying threats and unsafe condition's against us and our crews but also keeping in mind rapid evacuation of the scene should things get sour. We need to keep our eyes open, be aware of everything around us, do not allow ourselves to get trapped with no way of escape. And if a situation does not feel right, call law enforcement if they are not yet on scene. Now when it comes to arming first responders, there is a lot of emotion with this question. We must remember that there are very strong opinions on both sides of the idea of arming first responders. We come from different agencies, different regions, and we all have different experiences. The answer will not be solved here, but in honest and factual debate through out the entire emergency service community. What will work for one agency may or may not work for another. I urge all responders to follow their agency's current policies on this subject. Stay safe every one.

The term, "expedite" really does not tell me what is going on at the scene. I would rather the IC say something like, I have two patients one is conscious with severe bleeding the other unresponsive with shallow respiration. That give me a better idea of what I am getting into. Plus knowing my resources, I can decide to ask for addition resources if needed, All the term expedite does is get incoming crews into trouble by causing them to drive a little faster then they normally would. Hardly a few weeks goes by when we all learn about another firefighter or EMS technician is killed responding to an alarm. We have already lost way too many young and promising responders to dangerous driving. I agree with all of you who stated we need to drop the term expedite. Drive safe, stay safe. For the best way to help the folks who rely on our skills, is for us to arrive on scene safely.