Ask the Paramedic

Miscellaneous and Personal Stuff I Must Share
41

I want to emphasize that this WASN’T me, but somebody else that I worked with. They ran on a call for a car crash in front of a bus stop. One of the people there only spoke Spanish, none of the crew or firefighters spoke anything but Engilsh. They ended up backboarding him and taking him to the hospital. Once they got to the trauma center, the Spanish-speaking doctor figured out that he wasn’t hurt, or even in the car. He was just waiting for the bus!

At my old job, we had a bunch of paramedic students from a program that I don’t hold in very high esteem. They all asked me what the best call I ever went on was, and I told them all the same thing.

My partner and I are both kicking back watching The Simpsons when the radio goes off-
“Medic 101, Med Control.”
We responded “101, quarters.”
“101, respond emergent with Engine 1 X street and Y avenue on a gunshot wound.”
X street and Y ave is right on the border of our jurisdiction.
So I got right on the radio and put us en route with the fire department.
“Fire dispatch, Medic 101 responding with Engine 1.”
They responded, “Medic 101, you can go in service <other ambulance service> is on scene.”
So we copied them, and that was that. Everyone asked what was so great and I told them, “My butt never left the couch and I got to see the end of The Simpsons.” :slight_smile:

42

Compound fractures are fairly uncommon. The first time I saw one, I remember thinking, “Huh. That’s what bone marrow looks like.” Otherwise, it’s not a huge deal for me. Splint it, go to a trauma center, IV and pain meds en route.

43

What’s the difference between an EMT and a paramedic? From postings upthread I gather that the paramedics know more?

What’s an EMT-B?

:: googles ‘bariatric’ ::

Bariatrics is the branch of medicine that deals with obesity? I did not know that. It sounds like it would have to do with high pressure.

Do you have to have special advanced driver training? I’m guessing yes, but is it separate from the rest of your training (i. e. you need to go out and get a class ‘whatever’ licence before you start EMT/paramedic training)? Do you have a special driver’s licence?

44

Paramedics just think they know more. :wink:
It varies from state to state, but in Maryland, there is EMT-B (Basic), EMT-I (Intermediate) and EMT-P (Paramedic). Each level has more training than the one before it, and can do more procedures and administer different drugs. Again, what each one can do varies from state to state. I can administer nitro, glucose, albuterol, Epi-Pens, and charcoal. I can also use a Pulse-Oximeter. I know in some states, EMT-Bs can’t administer those drugs or even use a Pulse-Ox.

Yes, it’s obesity. The population is getting bigger. The county medic units (911) in Baltimore have a couple of the bariatric units like St. Urho linked to, with the treads and tracks that pull the stretcher up and into the ambo. At my company (private ambo), we don’t have the tracks; we do have an electric one, though. You still have to lift the end, and then push a button to lift the legs. Our dedicated bariatric unit runs all day, transfering patients who are 300-plus pounds.

I don’t need any special certs on my driver’s license, but I had to take a class called The Smith System at work. It’s a safe-driving class. At my firehouse, I had driver’s training, and some firehouses require you to take EVOC (Emergency Vehicle Operations Certification) before driving.

45

There’s 4 general levels of prehospital certifications: First Responder, EMT-Basic (EMT-B), EMT-Intermediate (EMT-I), and EMT-Paramedic (EMT-P).

First Responder is a 40-hour class, intended for firefighters, police, and anyone else who might be on scene to help but won’t be transporting patients. First responder training includes automated defibrillation, oxygen administration, basic airway managment (oral & nasal airways, oxygen administration, spinal immobilization and basic splinting. Many fire departments are moving to have everyone certified as EMT-Basics, so you don’t see as many first responders anymore.

EMT-Basic is a 120-hour class, and is the minimum requirement to work on an ambulance. It includes everything first responders can do, with some more training on disease processes. EMTs can also assist a patient with taking their own medications (usually nitroglycerin or inhalers). EMTs can generally give a few meds: oxygen, oral glucose, and activated charcoal. Some states (Colorado & Wisconsin off the top of my head) have programs where EMTs can do additional training and start IVs.

EMT-Intermediate is basically an add-on class to EMT-B. It covers about 300-400 hours of additional stuff. Intermediates can use manual defibrillators, orally intubate, perform needle decompression, start IVs, and give some medications. Generally intermediates can give cardiac arrest drugs, nebulized asthma medications, and medications for chest pain, allergic reactions, and seizures. There’s a lot more restrictions on meds given by intermediates. For example, Colorado requires that intermediates get verbal orders from a doctor (on-line medical control) to administer pretty much anything except cardiac arrest drugs. Intermediates are usually found in rural areas.

EMT-Paramedic is the highest level of prehospital care. It involves a minimum of 1200-1500 hours of training, including in-hospital clinicals and ambulance rides. Paramedics also need 2 semesters of anatomy & physiology, which isn’t counted in those hours. Paramedics can manually defibrillate and cardiovert (that means we interpret the rhythm and select the dose, rather than the computer), perform oral and nasal intubation, start intraosseous lines, surgical crichothyrotomys, and administer a wide range of medications.

I’ve had about 3 different driver training classes. As far as I know, there aren’t any states that require or even have a special class of license for driving an ambulance. Unfortunately, there’s no real standards on driver training and it’s generally left to ambulance services to determine how much training (if any) they want to do.

46

Hi. What do you wish your radio dispatchers would start doing, or quit doing, that would make things easier for you?

47

The biggest thing I’d ask from your generic dispatcher would be consistency- shift posts in the same way, send an ambulance from the same post to the same area, things like that.

We recently had some big turnover in our communications center, and I wish these dispatchers would pay more attention to the radio and make sure they heard what we said- not just assumed we said what they expected us to. I was on one scene where the pt had a violent and drunk boyfriend. I gave my unit number and said “police code 1” (code 1 is non-emergent) on the radio. Apparently the transmission was somewhat broken since we were in a house and the dispatcher thought I said code 4 (everything’s ok). The dispatcher gave the time, which means they understood us and had nothing further to say. The police were never called. You can see why this is a problem.

48

Moved from IMHO to MPSIMS.

49

Hi St. Urho! :waves:

I’ve seen your posts before and learned a lot from your replies in many of the emergency medicine threads. Thanks for being a valuable part of the board.

I’m a WEMT-B, but I’ve never worked primarily in emergency medicine - it’s just really useful to have someone medically trained on boats and expeditions.
I actually don’t get enough practice - could you recommend anything I might be able to do volunteer-wise to keep my skills from rusting away?
I almost get overwhelmed by how much I’ve forgotten every time I take a refresher/continuing education course.

50

Hi wevets, thanks for the kind words! What you’re going to be able to do is going to depend a lot on where you live. If there’s any volunteer ambulance services in your area many would be thrilled to have someone, even for a few hours a month. Another option would be looking into working as an ER tech, around here all the techs are EMTs, you might be able to help out in the ER, or pick up a casual (pick up shifts when you can, no guaranteed hours) job. Lastly, talk to the ambulance services in your area. You might be able to third ride with a 911-crew. Good luck!

51

Thanks, St. Urho - no volunteer ambulance services in my area (large urban,) but I’ll check with ERs and Fire Dept. EMS.
What made you decide to go into emergency medicine?

52

To be perfectly honest, I thought it looked cool. I worked as a lifeguard at a summer camp through high school. One year out there, we had a couple really good EMTs who trained with us a lot. I saw what they were doing and thought, “I wanna do that.” So, my senior year of high school, I took an EMT-B class at the local college. I enjoyed the class and I worked as one of the camp EMTs the next summer. I volunteered as an EMT all through college, then went to paramedic school.