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MissAmericanPie
01-06-2008, 22:12
Hi Guys,

I am applying for a job with an ambulance service as an EMT-B. I was working at the ski area today (base first aid) and one of our area services arrived before our head trauma patient was being taboggoned down off of the hill. I talked with the EMT for about five minutes and asked him about getting some ride time with them.

He said that they are hiring B's and I's and that I should apply. I explained that I have no real experience (I forgot to mention the rescue since it is so slow!!). He told me to just jot down my experiences at the ski area and that I may be able to do per diem and transfer work to start and that they do hire people with little experience if it is a good candidate.

So, after that lengthy intro. - if I get the job, or for that fact any job when I do get hired, what do I do to be helpful and not be in the way? I'm unclear about that line. We had a serious medical patient in first aid the other day and I called the ambulance since the patient walked in and asked for one right away. He has transposition of the great vessels with a pacemaker and his HR was 225 and not budging.

I was with a ski patroller and we had another patroller who is a doctor on shift who arrived shortly after. When the ambulance arrived, they worked him and they were there for about 15 minutes before transport. I didn't want to get in the way, but I also did want to be helpful so I took notes and got a BP. It was also a great learning experience. When I am on the ambulance, how do I make sure it is known that I am willing to work hard and use my skills without getting in the experienced EMT's way (usually a medic or an I)? Clearly, I do not want to be a liability when the SHTF, but I do want to be an asset.

Thanks for your anticipated brilliant and insightful responses.:supergrin:

D25
01-07-2008, 00:57
When I am on the ambulance, how do I make sure it is known that I am willing to work hard and use my skills without getting in the experienced EMT's way (usually a medic or an I)? :

Just say those exact words. And make sure that you know what your responsibilities are going to be on different types of calls. Will you be holding c-spine on MVAs, or being the person who gets the equipment off of the rig? Taking baseline vitals while the P asks questions, or gathering PMHX and meds, or both? What will your role be on a code? And understand how your specific role may change when you are on a call that requires assistance from another agency. You may start out holding c-spine on an MVA, but when fire arrives will you be expected to pass this responsibility off, and go do something else?

Also, this is a little pet peeve of mine, ask your partner how they feel about Sellick's maneuver.

Remember that even the most grizzled old-school paragod was once the zero-experience FNG, and good luck to you.

MedivacRN
01-07-2008, 02:27
Is there a hospital near you? I worked at SNHMC in Nashua for a few years. I figure you are probably more up towards the White Mountains? Try to find a job as an aid in the ED. You can learn a lot there as well as meet many of the medics that come in.

Where ever you wind up, ask alot of questions (when appropriate) and learn all you can. Find yourself a good mentor/close friend in the business that loves to teach. Then, become their partner.

Good luck! D25 couldn' be more right. Everyone starts somewhere. I started at 16 y/o on a volunteer squad in NJ. Got my EMT-B and haven't looked back since. It's a great field to be in.

hotpig
01-09-2008, 11:53
In the back of my ambulance my basic is responsible for such things as getting the pt on O2, cardiac monitor , blood sugar, or setting up IV supplies.

In my area with a two man crew working a large rural area with little to no FD first responder help I need more than just a Ambulance Driver.

Generally we do not hire EMT's from the College because they lack experience and need way too much orientation before they can work. We do hire select EMT's from classes we have here at the Hospital.

Since we teach them and they do clinical with us they are work ready when their licenses come in.

MissAmericanPie
01-09-2008, 21:06
In the back of my ambulance my basic is responsible for such things as getting the pt on O2, cardiac monitor , blood sugar, or setting up IV supplies.

In my area with a two man crew working a large rural area with little to no FD first responder help I need more than just a Ambulance Driver.

Generally we do not hire EMT's from the Collage because they lack experience and need way too much orientation before they can work. We do hire select EMT's from classes we have here at the Hospital.

Since we teach them and they do clinical with us they are work ready when their licenses come in.

That is helpful. I have reconsidered and I am asking the same ambulance service for some ride time first. I spoke to one of their EMTs today who is one of our local LEOs and he said that they really need help but thought they may have no one who could spend the time to train me since they are so horribly short handed. What a catch-22. I told him that I had spoken to his manager about ride time and he said that it would be a very good idea.

Think about it - when you are new you do not know where everything is yet, some of the equipment/devices vary slightly from those of other services and what you learned with in class, etc., and procedures must become familiar. I would rather be unpaid and observing/helping.

Sucka
01-09-2008, 21:22
If you're doing a ride-a-long just be up front and ask what the medic expects from you. I've taken dozens of EMT students and EMT's on ride-a-longs and all i require of them is to ask questions, DO NOT JUMP IN while i'm doing an assessment and start asking their own questions (this is my pet peeve), and wait until i ask for them to do something before doing it on scene as far as grabbing a BP, holding C-spine ect. Once i get to know them, and what their skill level is, we work from there. For instance i had an EMT who loved to ride out on his days off, with him it was like having a third partner. We would arrive on scene, he would start grabbing vitals while hooking the patient up to the monitor, stripping IV bags, ect. He pretty much could anticipate what i was going to do, and i just let him do it. For the brand new guy, i like for them to observe and learn before i want them jumping in. There's a fine line with what you do out there. Some medics don't like to have their toes stepped on at all, others don't care what you do. I know medics that will get a BP reading from the EMT and then proceed to get his own. Everyone is different, and if you're up front with your skill level, and what you want to get out of the ride-a-long everything should work out fine. Of course help restock the rig, grab equipment, help clean, ect. That's a given.

If you're working as an EMT for the first time, just do what your FTO tells you is the best advice i can give. If you get thrown into the deep end, it's sink or swim.

MissAmericanPie
01-09-2008, 22:03
Is there a hospital near you? I worked at SNHMC in Nashua for a few years. I figure you are probably more up towards the White Mountains? Try to find a job as an aid in the ED. You can learn a lot there as well as meet many of the medics that come in.

Where ever you wind up, ask alot of questions (when appropriate) and learn all you can. Find yourself a good mentor/close friend in the business that loves to teach. Then, become their partner.

Good luck! D25 couldn' be more right. Everyone starts somewhere. I started at 16 y/o on a volunteer squad in NJ. Got my EMT-B and haven't looked back since. It's a great field to be in.

I am in the White Mountains. Unfortunately, the ED doesn't have any positions open any more. They had a bunch when I was in class, though! Oh well. I figure I'll get some ride time in and I won't need as much training.

Thanks for the advice. :)

MissAmericanPie
01-09-2008, 22:15
If you're doing a ride-a-long just be up front and ask what the medic expects from you. I've taken dozens of EMT students and EMT's on ride-a-longs and all i require of them is to ask questions, DO NOT JUMP IN while i'm doing an assessment and start asking their own questions (this is my pet peeve), and wait until i ask for them to do something before doing it on scene as far as grabbing a BP, holding C-spine ect. Once i get to know them, and what their skill level is, we work from there. For instance i had an EMT who loved to ride out on his days off, with him it was like having a third partner. We would arrive on scene, he would start grabbing vitals while hooking the patient up to the monitor, stripping IV bags, ect. He pretty much could anticipate what i was going to do, and i just let him do it. For the brand new guy, i like for them to observe and learn before i want them jumping in. There's a fine line with what you do out there. Some medics don't like to have their toes stepped on at all, others don't care what you do. I know medics that will get a BP reading from the EMT and then proceed to get his own. Everyone is different, and if you're up front with your skill level, and what you want to get out of the ride-a-long everything should work out fine. Of course help restock the rig, grab equipment, help clean, ect. That's a given.

If you're working as an EMT for the first time, just do what your FTO tells you is the best advice i can give. If you get thrown into the deep end, it's sink or swim.

Thanks so much. That is exactly the advice I need. I am virtually untested, since I am on a very slow rescue service in a rural area. I can get a BP, etc. however, I don't know about on a moving ambulance since we do not transport. It is experience that I need. The classroom stuff is fine, but nothing teaches like practical application.

Believe it or not, working at the ski area in first aid has taught me a real lot about pt. assessment, interviewing, splinting, sling/swath, dealing with concussions, etc.

However, I have not used many of the skills I learned in class yet. I also never learned how to assist an EMT-I/P in class. Should I know this before riding on the ambulance or will it be taught?

If I am thrown in the deep end, I just learn to swim, I guess.:cool:

MissAmericanPie
01-09-2008, 22:32
Just say those exact words. And make sure that you know what your responsibilities are going to be on different types of calls. Will you be holding c-spine on MVAs, or being the person who gets the equipment off of the rig? Taking baseline vitals while the P asks questions, or gathering PMHX and meds, or both? What will your role be on a code? And understand how your specific role may change when you are on a call that requires assistance from another agency. You may start out holding c-spine on an MVA, but when fire arrives will you be expected to pass this responsibility off, and go do something else?

Also, this is a little pet peeve of mine, ask your partner how they feel about Sellick's maneuver.

Remember that even the most grizzled old-school paragod was once the zero-experience FNG, and good luck to you.

The ambulance services near us do not respond first as a rule. Usually it is police, followed by fire/rescue, then ambulance for continued care/transport. I am on my town's rescue so I am more comfortable with "rescue type" scenes such as MVAs. I am less comfortable with medical issues, though. I want to get some good experience with that.

When I respond to rescue calls, I am usually not the first or second one there since I live at one end of town that is primarily vacation homes. I am usually the second or third one on and with an MVA or some other trauma situation, more hands are usually better so I get to jump right in. They are usually very straight forward. But with medical calls, I feel like I am in the way since O2 is usually on, vitals are being taken and I take down info. It helps, but I miss what happens before my arrival and I am often confused by the interventions taken/not taken until I talk to the others on scene first later.

I would like to be there from the time the patient gets into the care of the ambulance, to the time of transfer to ER. That way, I can help with or observe all interventions from A to Z. It then becomes less intimidating.

Thanks for everything. :)

Hunca Munca
01-09-2008, 22:38
What is the makeup of the service?

EMT/EMT or EMT/medic?

If it is EMT/medic get ready to be driving on all calls as the medic should be in the back with the patient.......

Don't be afraid of the medics if you have a good attitude and are willing to learn you will be fine!!

The best EMT skill to learn is Bag mask ventilation!!!!

<----------------- tells medics what to do or what they shouldn't have done.:supergrin:

MissAmericanPie
01-09-2008, 22:56
What is the makeup of the service?

EMT/EMT or EMT/medic?

If it is EMT/medic get ready to be driving on all calls as the medic should be in the back with the patient.......

Don't be afraid of the medics if you have a good attitude and are willing to learn you will be fine!!

The best EMT skill to learn is Bag mask ventilation!!!!

<----------------- tells medics what to do or what they shouldn't have done.:supergrin:

Well, medics are not on every ambulance and I don't think they work every shift. There are shortages of medics around here. I know they have a few working for the service and one is doing primarily management work now. Two are new(ish) paramedics. It sounds like a wide open career field for me some day - the hospitals love to have them.

The last transport for us (ski patrol), they had a student ride along from where I took my class. He seemed really timid. I'm not, so I don't want to jump into where I am not wanted.:supergrin: But, I'm not proud and I am certainly thankful for constructive criticisms and my goal is to learn. My biggest pet peeve when I start a new job is to be ignored and for my questions to be considered pains in the ass.

I'm not really afraid of medics, only of my lack of experience. I'm afraid that I think I know more than I do and I'm going to be considered a liability. In reality, I'm slowly learning that it is the other way around.

Sucka
01-09-2008, 23:04
Thanks so much. That is exactly the advice I need. I am virtually untested, since I am on a very slow rescue service in a rural area. I can get a BP, etc. however, I don't know about on a moving ambulance since we do not transport. It is experience that I need. The classroom stuff is fine, but nothing teaches like practical application.

Believe it or not, working at the ski area in first aid has taught me a real lot about pt. assessment, interviewing, splinting, sling/swath, dealing with concussions, etc.

However, I have not used many of the skills I learned in class yet. I also never learned how to assist an EMT-I/P in class. Should I know this before riding on the ambulance or will it be taught?

If I am thrown in the deep end, I just learn to swim, I guess.:cool:

Just understand getting BP's in the back of a moving ambulance is hard at first, real hard. The one thing i always tell new guys from when i was an FTO as an EMT until now is, DO NOT LIE ABOUT A BP. If you can't get it, just tell me you can't get it, and try again. If you can't get it after 2 tries, ask the medic to get it. This is normal at first, and it comes with time. If you can't get one, palp it. It's better than nothing, but don't lie about a BP, ever.

Secondly, they'll teach you anything they'll have you do, and be happy to do so (assuming they are nice guys). They'll show you how to hook up a monitor, strip an IV, C-Spine someone in the real world, move patients which is a biggie, and so on. Best advice i can give, is don't be scared to ask questions. If the crew is cool, they'll be happy to teach you everything they can in the short time you're with them.

If you have any specific questions feel free to ask, more than happy to help. Don't be nervous if you ride out, it should be an enjoyable thing, and a learning experience.

Edit: And oh yeah, on the BP subject, don't give an odd number BP, it'll make you look stupid :supergrin:

MissAmericanPie
01-09-2008, 23:48
Just understand getting BP's in the back of a moving ambulance is hard at first, real hard. The one thing i always tell new guys from when i was an FTO as an EMT until now is, DO NOT LIE ABOUT A BP. If you can't get it, just tell me you can't get it, and try again. If you can't get it after 2 tries, ask the medic to get it. This is normal at first, and it comes with time. If you can't get one, palp it. It's better than nothing, but don't lie about a BP, ever.

Secondly, they'll teach you anything they'll have you do, and be happy to do so (assuming they are nice guys). They'll show you how to hook up a monitor, strip an IV, C-Spine someone in the real world, move patients which is a biggie, and so on. Best advice i can give, is don't be scared to ask questions. If the crew is cool, they'll be happy to teach you everything they can in the short time you're with them.

If you have any specific questions feel free to ask, more than happy to help. Don't be nervous if you ride out, it should be an enjoyable thing, and a learning experience.

Edit: And oh yeah, on the BP subject, don't give an odd number BP, it'll make you look stupid :supergrin:

About your last point - it should!! :)

I was asked to get a BP in the aid room when they were dealing with a cardiac patient (the medic, EMT, and a doc who is a patroller) and it SUCKED!! He was being bounced around as the doc was massaging the patient's carotid as he attempted to get his pulse down (?). (He explained it to me later) I had to try three times but I finally got one. But I was unsure about it and told the medic that I was. He had the other EMT try and he also had trouble. Our number ended up being real close, so I was very proud. I wouldn't lie - I'd just sit there feeling embarrassed and dumb!!:supergrin: But in time I'll get over that.

I like it when people in class would get a 30 second HR and make it an odd number.:rofl:

Hooking up a monitor, stripping IVs, etc. I am not familiar with. I am familiar with c-spine manual stabilization and immobilization, backboarding, shortboarding, etc. since we do that on rescue. I never get a chance to get vitals at scenes, though, but I do get pulses and check pupils quite often at the ski area. With fractures, dislocations and head/spine injuries we are always checking CSMs.

But, I have never taken a glucose reading. I have the kit, I just have never done it. It's little things like that. Also, (don't laugh) I have never given a live pt O2!! I know it is quite simple, but I'm afraid that it will not be a smooth thing the first try. (Note to self: turn on oxygen, fill bag, THEN put on patient):supergrin: Someone I took my class with rode on the ambulance for his clinical and adminstered oxygen via nasal cannula. Unfortunately, he inserted the little prongs in her nose first and then proceeded to turn on the O2. Woopsie!! It isn't something that would invoke confidence in a patient or their loved ones I would guess.

But really, thanks for the valuable advice. You guys are the best.

Sucka
01-10-2008, 00:01
Don't worry about the BP thing, sometimes they're hard to get, and on some patients they are impossible because the BP is so low. Once you take it 100's of times, you'll get into your comfort zone, and it'll be really easy for you. We all go through the learning curve, they'll understand it.

Just remember "white on the right, smoke over fire" for a monitor and you'll be fine. White lead on the right, black on the left, red lower (lot of new monitors have a green lead, that just goes below the white). I still repeat that in my head when i'm putting leads on, it's just habit..lol. They are called "limb leads" so i like them on the upper arms, even the top of the hand if they have a lot of clothing on, but some medics like them on the chest, it's a preference thing. You can put them on the tops of the hand and the others on the ankles and you'll get an accurate read, so don't worry about "perfect placement".

Stipping an IV is cake. I can't tell you how to do it over the net, but they'll show you, and it's easy to do.

No worries on O2 either. If it's a non re-breather just remember 10-15lpm and fill the bag. If they're C-spined, you can tape it onto the stabilization equipment, about the only thing there. And remember if you have questions to ask them, ask yes/no because it's hard to talk with them on. For nasal, 2-6lpm. Just put it on, don't try and be to careful with it. Obviously don't jab their nose, but don't sissy around it either. Old people have nappy hair and you just need to pull it out of the way to get them on sometimes, don't be timid.

Just practice your vitals at work, and you'll be good to go in that department. Just have confidence in what you're doing, and it will all go well for you. On a ride-a-long it's really the crew that makes or breaks it, so i hope you get a good crew. If you end up with an EMT/Medic crew, you can probably bug the EMT all day long and he'll love it. If it's a dual medic rig, just hope they aren't burnt out :supergrin:

MissAmericanPie
01-10-2008, 00:10
Don't worry about the BP thing, sometimes they're hard to get, and on some patients they are impossible because the BP is so low. Once you take it 100's of times, you'll get into your comfort zone, and it'll be really easy for you. We all go through the learning curve, they'll understand it.

Just remember "white on the right, smoke over fire" for a monitor and you'll be fine. White lead on the right, black on the left, red lower (lot of new monitors have a green lead, that just goes below the white). I still repeat that in my head when i'm putting leads on, it's just habit..lol. They are called "limb leads" so i like them on the upper arms, even the top of the hand if they have a lot of clothing on, but some medics like them on the chest, it's a preference thing. You can put them on the tops of the hand and the others on the ankles and you'll get an accurate read, so don't worry about "perfect placement".

Stipping an IV is cake. I can't tell you how to do it over the net, but they'll show you, and it's easy to do.

No worries on O2 either. If it's a non re-breather just remember 10-15lpm and fill the bag. If they're C-spined, you can tape it onto the stabilization equipment, about the only thing there. And remember if you have questions to ask them, ask yes/no because it's hard to talk with them on. For nasal, 2-6lpm. Just put it on, don't try and be to careful with it. Obviously don't jab their nose, but don't sissy around it either. Old people have nappy hair and you just need to pull it out of the way to get them on sometimes, don't be timid.

Just practice your vitals at work, and you'll be good to go in that department. Just have confidence in what you're doing, and it will all go well for you. On a ride-a-long it's really the crew that makes or breaks it, so i hope you get a good crew. If you end up with an EMT/Medic crew, you can probably bug the EMT all day long and he'll love it. If it's a dual medic rig, just hope they aren't burnt out :supergrin:

Thanks, buddy!! Great advice. I'm not that worried about the O2 thing. I think it is just doing the right thing at the right time.

I don't think we have dual medic rigs here. I know some have shown up for transposrt without a medic on board.

Again, thank you.

Sucka
01-10-2008, 00:17
No problem, we're all here to help. Good luck getting the job, and if you ride out, have fun and let us know how it goes.

Hunca Munca
01-10-2008, 08:12
Have you been taught how to do a systolic BP by palpation?

1bamashooter
01-10-2008, 19:03
I have no problem with a basic helping me in the back of the truck or on scene. Don't be afraid to ask the medic what you can do to help, learn how to set up a IV, how to put a Pt on a cardiac monitor, learn what drugs we use in a arrest and what they look like, make sure you know where stuff is on the truck and what its used for. The best way to do this is get in the back when the medic is doing the daily check off. The longer you work in the field the more you will know, eventually if you work with the same partner long enough your partner will not ask, you will just do it. We know what a basic knows because we where one also. Good luck and don't be afraid to ask, and remember there is no such thing as a stupid question.

MissAmericanPie
01-10-2008, 21:02
Have you been taught how to do a systolic BP by palpation?

Yes, and I think I am better at it actually than by auscultation.:dunno:

Hunca Munca
01-10-2008, 21:04
I only bring it up because it is a way to get a BP without having to listen in a noisy environment.

MissAmericanPie
01-10-2008, 21:08
I have no problem with a basic helping me in the back of the truck or on scene. Don't be afraid to ask the medic what you can do to help, learn how to set up a IV, how to put a Pt on a cardiac monitor, learn what drugs we use in a arrest and what they look like, make sure you know where stuff is on the truck and what its used for. The best way to do this is get in the back when the medic is doing the daily check off. The longer you work in the field the more you will know, eventually if you work with the same partner long enough your partner will not ask, you will just do it. We know what a basic knows because we where one also. Good luck and don't be afraid to ask, and remember there is no such thing as a stupid question.

Thanks!! I find that some people are fine with questions and others are irritated by them. I tend to ask a lot so I do not want to interfere with someone's routine by having to constantly stop to answer me.

But, I guess if I am riding along and it is already known that I am interested in employment (where they are very strapped for help), it will only benefit those who are showing me the ropes to teach me as much as possible.

MissAmericanPie
01-10-2008, 21:14
I only bring it up because it is a way to get a BP without having to listen in a noisy environment.

Is it generally acceptable? If I say "hey I'm having trouble hearing, is it alright if I palpate for it?" I won't seem like a moron?

If it's not an issue, that is great to know. I just noticed that the other EMT that was with the medic on our cardiac call didn't palpate when he was having difficulty obtaining it, and in the end I don't think he was able to get the diastolic pressure anyway.

Thanks for the advice. :)

Sucka
01-10-2008, 22:27
Is it generally acceptable? If I say "hey I'm having trouble hearing, is it alright if I palpate for it?" I won't seem like a moron?

If it's not an issue, that is great to know. I just noticed that the other EMT that was with the medic on our cardiac call didn't palpate when he was having difficulty obtaining it, and in the end I don't think he was able to get the diastolic pressure anyway.

Thanks for the advice. :)

It isn't generally acceptable by most, but if you can't get it, it's better than nothing. I know nurses never like to hear a palp'ed BP, as it just shows laziness. However, there are calls you'll run (drunks, psychs, ect) where palp'ing a BP is acceptable from everyones point of view. Personally, if i arrive on scene to a legit medical aid and someone gives me a palp'ed BP, i just check it again myself and write it off to being lazy. But if you're in a hurry, or need a quick systolic for a medication (which i still don't do myself) it will work. And there will be BS calls you'll run on, where the person is all bundled up in clothing, making it darn near impossible to get a good BP, palp'ing may be the only way to go. But if you bring in a chest pain, SOB, massive trauma, ect. with a palp'ed BP, be prepared to get some smug remarks from the RN or even possibly the M.D if he happens to be in the room when you're giving your turn over. It's acceptable, but not as a substitute to oscultate a BP. Hope that makes sense.

hotpig
01-10-2008, 22:39
About your last point - it should!! :)

I was asked to get a BP in the aid room when they were dealing with a cardiac patient (the medic, EMT, and a doc who is a patroller) and it SUCKED!! He was being bounced around as the doc was massaging the patient's carotid as he attempted to get his pulse down (?).

Patients with a very fast heart rate are hard to get. In this case it is often hard to get a accurate blood pressure fast even for a 20 year veteran like me.

MissAmericanPie
01-10-2008, 22:43
It isn't generally acceptable by most, but if you can't get it, it's better than nothing. I know nurses never like to hear a palp'ed BP, as it just shows laziness. However, there are calls you'll run (drunks, psychs, ect) where palp'ing a BP is acceptable from everyones point of view. Personally, if i arrive on scene to a legit medical aid and someone gives me a palp'ed BP, i just check it again myself and write it off to being lazy. But if you're in a hurry, or need a quick systolic for a medication (which i still don't do myself) it will work. And there will be BS calls you'll run on, where the person is all bundled up in clothing, making it darn near impossible to get a good BP, palp'ing may be the only way to go. But if you bring in a chest pain, SOB, massive trauma, ect. with a palp'ed BP, be prepared to get some smug remarks from the RN or even possibly the M.D if he happens to be in the room when you're giving your turn over. It's acceptable, but not as a substitute to oscultate a BP. Hope that makes sense.

Thanks, it does. You are suggesting that I get an oscultated BP whenever it is not impossible to get one. Otherwise a palpated BP is better than nothing.

I think I just need to get used to the background noise. I'm sure it will get easier.

MissAmericanPie
01-10-2008, 22:45
Patients with a very fast heart rate are hard to get. In this case it is often hard to get a accurate blood pressure fast even for a 20 year veteran like me.

Why is that?

Sucka
01-10-2008, 23:57
Why is that?

Good point, i didn't mention that. Reason being, there is no clear distinction between beat and non beat, a lot of times those will beat all the way down. Therefore, you can't properly get a systolic and diastolic. Again, if you can get one, get it. If you can't, palp it. If someone has a heart rate where you can't get it (from other than activity) there needs to be a medic on scene anyways, same goes for BP's so low you can't get them either, via palp or not. I've found anything lower than ~70 systolic, you can't get it anyways, need to get one via a thigh cuff if that's even possible. Sometimes you'll have a patient where you'll get a systolic and then it'll beat all the way down, that's "normal" too. You'll run into all kinds of stuff out there. I've seen BP's so high and so low they seemed unimaginable, but alas i saw it. For an EMT-B it's good to get this skill down, but when you move onto becoming a medic, BP's are important for treatments you'll administer.

MissAmericanPie
01-11-2008, 00:07
Good point, i didn't mention that. Reason being, there is no clear distinction between beat and non beat, a lot of times those will beat all the way down. Therefore, you can't properly get a systolic and diastolic. Again, if you can get one, get it. If you can't, palp it. If someone has a heart rate where you can't get it (from other than activity) there needs to be a medic on scene anyways, same goes for BP's so low you can't get them either, via palp or not. I've found anything lower than ~70 systolic, you can't get it anyways, need to get one via a thigh cuff if that's even possible. Sometimes you'll have a patient where you'll get a systolic and then it'll beat all the way down, that's "normal" too. You'll run into all kinds of stuff out there. I've seen BP's so high and so low they seemed unimaginable, but alas i saw it. For an EMT-B it's good to get this skill down, but when you move onto becoming a medic, BP's are important for treatments you'll administer.

Thanks again!! I am learning new things every day. Thanks for contributing to my future success!!! :supergrin:

Sucka
01-11-2008, 00:10
Thanks again!! I am learning new things every day. Thanks for contributing to my future success!!! :supergrin:

Whatever i can do to help out, i'm more than willing. I was an FTO for a few years and enjoyed the whole teaching aspect. If i didn't move, i probably would be teaching at the college right now, so don't hesitate to ask anything, no matter how stupid as it seems. I've been in the field for 7+ years now and i still ask questions for those senior than me :tongueout:

MissAmericanPie
01-20-2008, 23:00
Took my first ride tonight on the ambulance!!!! I responded with our rescue and because it was a "female" issue, they sent me on the ambulance with the private service to the hospital.

They showed me how to set up the IV and I took notes. I got a BP!!! I hope it was correct - I took it twice to verify it since I had trouble hearing it. I got the same thing the next time. I was just thinking that perhaps I just heard it late since it didn't seem to coincide precisely with the needle movement. My systolic was 16 lower than our baseline BP yet my diastolic was right on.

He was surprised I could hear it. He has trouble he said. I explained that I do too, usually and that I couldn't hear her HR with the stethescope until the pressure made it audible.

They were awesome guys - very helpful. I've worked with them on several calls with the rescue, but they really made me comfortable. I think they enjoyed some outside company since they work together constantly. One of them is on his 7th straight day. 168 hours straight!! And he is married with kids. No wonder he is leaving for a more sane job (fire chief).

Anyway, thanks again for all of the great advice!

Sucka
01-20-2008, 23:31
Thanks for the update, sounds like you had a good time. Hope some of the tips we gave you were helpful on your outing. 7 straight days, i'm surprised he was nice to you, i think i would want to be left alone at that point....lol

And don't worry about baseline vitals and how close you are to their readings, because they might have gotten it wrong themselves. Trust your training, and trust yourself out there.

MissAmericanPie
01-21-2008, 00:35
Thanks for the update, sounds like you had a good time. Hope some of the tips we gave you were helpful on your outing. 7 straight days, i'm surprised he was nice to you, i think i would want to be left alone at that point....lol

And don't worry about baseline vitals and how close you are to their readings, because they might have gotten it wrong themselves. Trust your training, and trust yourself out there.

Thanks!! Your tips were great - especially with getting a BP. I just took my time, and took two readings since I wasn't sure. I was just wondering if there was a narrowing of her BP or if I got it wrong. She was bleeding a lot but chatty and quite oriented.

If I am unsure about whether or not I missed the first beats should I trust my ears or trust my eyes? I never even thought about the possibility of a discrepency before. He told me that if I had trouble to palpate it. He has poor hearing so that is how he gets it often although he said it is best if I can hear it.

I love this business. They told me to ride with them anytime and that if I want some extra money, I could probably get some shifts. I don't think it is going to be hard to get an ambulance job around here. Judging by the shifts he is working, I would guess that they are desperate for help. He hasn't been home in a week!!!

I will also ride with the service with whom I am interested in working. I spoke with their manager the other night at training.

Woo-hooo!! I'm on my way. It is a perfect time in my life to get busy with something like this - my son is going to college in September and my mental energy will need a replacement.

Thanks again, buddy. :)

Sucka
01-21-2008, 00:51
Trust your ears, not your eyes. It's always nice when you can see it along with hearing it, but you should rely on the audible beat you hear. If you can't hear it at all, just using the visible beat you see isn't a wise thing to do, that's when you palpate. I've always found i can almost count on the seeing the beat on healthy young individuals, but you get some funky things on the elderly and the sick, which is who you'll see the most. If you don't hear it, palpate it to be safe.

Sounds like you're well on your way, congratulations and welcome to the brotherhood. You'll find the field extremely rewarding and exciting (most of the time). Keep us updated on the start of your career, we're all pulling you ya!

1bamashooter
01-23-2008, 00:05
One thing that might help you with the BPs is get a quality stethoscope, it helped me hear better. I have a Littman Cardiology III that my family MD gave to me when I got my medic licences. There are several different kinds out there like Tycos and ADC. The ones that most services supply are CHEAP and I cant hear anything with them, Hell I can't hear anyway. Here is a good site to look at all different kinds out there.

http://www.stethoscope.com/

Sucka
01-23-2008, 00:15
I use a Litman, and it does help. The ones that AMR provided were crap. They worked, but that's a good point 1bamashooter brings up, good ears do make a difference.

MissAmericanPie
01-23-2008, 01:03
Thanks, guys. I have heard that as well. I have also heard of various techniques such as the pt's arm placement and using towels in your lap to rest the arm on. I'll see what works. I was just excited to get one, but I was worried that I missed some of the kortikoff sounds.

How do you know when there is so much outside noise? That would cause you to get a lower systolic reading. Should you just do it a couple of times in this case to verify your initial reading?

Sucka
01-23-2008, 18:29
With a good set of ears, outside noise should really be limited. If you can't hear it, do it again. You'll get into your comfort zone.

As for patients arm on you, i don't like that. Not only is it pretty gross on the elderly because their skin flakes off onto your pants, but you run a risk of getting bodily fluids on your pants. Not to mention when you're in the back of an ambulance, it looks bad to the person behind you when their arm is draped over your leg....lol

Just stretch their arm out along the gurney rail or if they're on the ground, just along side them. My first few years i used to drape the arm over my knee and i later found out why this is a bad idea. If you do it, the towel is a good idea. I used to work with one medic who would grab a pillow case (ours were plastic pretty much) and drape that over her leg and start an IV over her leg. She was a seasoned medic so i never questioned it (plus she almost never leaked) but for me, that was a risk i wasn't willing to take.

MissAmericanPie
01-23-2008, 19:54
With a good set of ears, outside noise should really be limited. If you can't hear it, do it again. You'll get into your comfort zone.

As for patients arm on you, i don't like that. Not only is it pretty gross on the elderly because their skin flakes off onto your pants, but you run a risk of getting bodily fluids on your pants. Not to mention when you're in the back of an ambulance, it looks bad to the person behind you when their arm is draped over your leg....lol

Just stretch their arm out along the gurney rail or if they're on the ground, just along side them. My first few years i used to drape the arm over my knee and i later found out why this is a bad idea. If you do it, the towel is a good idea. I used to work with one medic who would grab a pillow case (ours were plastic pretty much) and drape that over her leg and start an IV over her leg. She was a seasoned medic so i never questioned it (plus she almost never leaked) but for me, that was a risk i wasn't willing to take.

Thanks for the advice - I never thought about the gross factor.

Today's call was hell. I did get a BP, though. But I had to drown out the idiotic bickering between two of the other EMTs on the scene to achieve it. The patient's caregiver is pissed - with very good reason.

It was a situation between our rescue and the ambulance service I mentioned that I rode to the hospital with the other night (the exact same EMTs actually). Our rescuer was, for some reason applying a nasal cannula at 10 lpm, and it pissed the other guy off. But he caused a scene in front of the patient. Bad, bad. Apparently they have had words before.

I have always thought that it is never accepatable to apply O2 via NC at a flow rate of greater than 6 lpm. Since she was hypoxic (93 spO2) the only option is to increase her flow rate from 2 to 6 lpm or to use a NRB which she would never have tolerated. This is how I was taught. Is my understanding of this correct? I wouldn't think this EMT (ours) would ever get this wrong, however.

Anyway, I got a BP through the soap opera and I'll be writing a statement for our fire chief. Ugghhh! I would love to stay out of it - I can't win with this.

As an afterthought: I was a shaking mess for some reason taking this BP. It must have been amusing to observe!! I got her cuff on well - which I often have to do more than once. However, the stupid gauge was on the inside of her arm and I wasn't taking off that cuff. So I unclipped it. I then found myself in a tangled mess with my stethescope, the cord to the bulb and the one to the gauge!!! :clown: So about ten minutes later (okay it felt like it) - voila! I got the BP.:cool:

Sucka
01-23-2008, 22:42
lol......i'm sure it was funny to watch, i always get a kick out of watching the FNG's getting BP's and what have you, they freak out for no good reason. I sit them down after the call and go over what could have been done better/more smoothly and it settles their nerves most of the time. That whole thing will pass. As for the tangled mess, that will never pass, it just happens! Just remember, it's not your emergency. Treat all calls with urgency, but don't get carried away.

2-6lpm for a NC, that is it. If he wanted to give 10lpm it needs to be via a NBR. I wasn't at the call, so i won't judge anyones actions, but if i came on scene and someone had 10lpm on a patient via NC, i would just take it off and apply a NRB or bump down the flow rate, not a single word needs to be spoken on scene. I've seen some amazing things prior to arrival on scene, mostly from nursing facilities and family members that think they have medial knowledge, i rarely feel the needs to say anything, unless it's just absurd or dangerous to the patient. If they have beef, they need to handle it. Butting of heads happens, i've seen quite a bit of it, but it is never professional. Whoever is the transporting EMT (assuming all on scene are of the same level of training) should have control over the patient and what happens to them, bottom line. It's a fine line when say your captain wants you to do one thing, but you (the medic) wants to do something else. Sometimes the older guys just don't understand paramedicine and it can be a tricky thing to deal with on scene.

MissAmericanPie
01-23-2008, 23:20
I thought that was the flow rate. I do not know why he used 10 lpm. Perhaps it was a mistake and felt like he had to defend it.

The more I think about it, the more I am annoyed by the antics I saw. That poor woman was already experiencing respiratory distress (COPD) and dispatch sent us a request for a silent approach so she wouldn't be rattled. And then this happens.

But they are both good EMTs. I know the one from the transporting service has a stellar reputation (today was his last day - he is now fire chief in a neighboring town) and our EMT that was on scene is very experienced.

So, about the BP: I figure I can help diminish the chocolate mess of tangled cords with a hunter orange stethescope!! I need to get a good one anyway. And maybe I'll color code my BP cords with neon stickers.

Thanks for sharing your experiences/knowledge with me. It is greatly appreciated.

Sucka
01-23-2008, 23:38
Well it being a COPD patient opens a whole other can of worms there. Honestly shouldn't be giving COPD patients hi-flow under most circumstances anyways, let alone 10lpm through a NC. Hi-flow isn't going to kill them, but there is a chance they can undergo worse symptoms then when you first encountered them. I wasn't there, so i really can't comment on treatment and how it should have been handled, all situations are different.

Trust me when i tell you it won't be the last time you see someone butt heads on scene. I'm sure the day will come when you yourself will find yourself in a situation where you need to assert yourself on scene, and it can be misunderstood for stepping on toes or whatever else. Just remember, your encountering people on some of the worst days of their lives, and they don't want to see their "rescuers" bickering on scene. I know you're still new and all that, but in the future when you feel more comfortable, it's completely reasonable to say something along the lines of "hey guys lets deal with this after the call". And if you see something being done wrong, either change it without making a big deal out of it, or just say something like "are you sure you want to give 10lpm via NC?".

MissAmericanPie
01-24-2008, 00:08
Your suggestion on how it might be best handled "Are you sure...." could also help verify the treatment for the one providing it. He may have simply made a mistake and that would easily have rectified it.

The other issue was that the transporting service didn't want to do anything with oxygen since they were just getting vitals and transporting her. He wanted to get her hooked up on the rig. I think they just don't like each other.

Also, there is a slight power struggle, I think. It is technically our scene until we officially (which nothing at a scene is ever formal or official) turn over custody of the patient to the transporting service. Fire/rescue manages the scene, but we usually work well in concert with the transporting service. I think some people from both entities tend to let egos get in the way of patient care. It really doesn't matter who provides it as long as it happens and happens correctly, IMO.

Also, asserting yourself if an intervention will cause harm may be necessary, but I think there are still more pleasant ways of doing it - not "I don't know what you were taught - where did you get 10 liters from?" and "You are being obnoxious." :upeyes:

I didn't know (or remember, perhaps) that about COPD patients. I swear I learn something new every day. I try to read my book every day at work (I'm bored these days since it is pretty slow) to keep the material fresh. I usually pick a topic. "Today, I feel like refreshing my memory on cardiac issues", etc.

Until I am doing it full time, I need to keep it fresh. Thanks for your help. Discussions really make a difference. Tomorrow night is training on 12-lead/defib. I didn't learn 12-lead in class so I'm really looking forward to it. :)

Sucka
01-24-2008, 00:31
Sounds like you're well on your way to a good career, self starters who are willing to learn and do things on their own always make the best EMT/Medics.

I have a pretty good background with the "power struggle" thing. I worked as a single role medic for 5 years along with some time as an EMT, mostly with full time paid fire departments. With the departments that only had EMT's, they were more than happy to turn over the patient upon our arrival (which was almost always after they were on scene due to us not being stationed with them). They would be as helpful as possible, and never step on toes. You get the occasional fire captain who wants to move a patient a certain way, and typically i would go with his suggestion even though i didn't find it to be the "best" way to do it. So long as it didn't compromise patient/crew safety, i was ok with it.

Then i worked for a time with departments that had medics on the engines, now this is where head butting was common. Since we were private ambulance, the fire departments typically weren't huge fans of us. For whatever reason, they wanted to always run the show, until it came time to transport, where they didn't want to have anything to do with the paperwork, time, turnovers, cleanup and so forth. They always wanted to do the treatments on scene, and dictate how the call went down though of course. I worked with many "crispy medics" (burnt out) who would always have something to say on scene. Since i was/am still young, and had wanted to eventually work for some of these departments, i would typically keep my mouth shut unless it was a patient/crew safety issue. Sometimes it's best to just bite your lip if you don't agree with someone on scene. It makes for such a better working relationship in the end. If it has something to do with you or your partners safety, or the patients health, by all means speak up. If there's something you don't like about what another member on scene is doing, but it won't hurt anything just let it go.

Da-Squad
01-24-2008, 08:04
To Sucka: VERY GOOD ADVICE you are giving out to this young lady and to others on this board. I am not a medic or a emt. I just was taught the A.B.Cs. I came on as a firefighter and back than we were fire suppresion (Back when the IV bottles were glass). Later on through the years when I was an engine officer we started getting medics to go along with our new guys who were now emts. At our ambo. assist calls I would let my medic take over and the rest of the crew would assist him. At extracations the medics knew pretty much what I going to do and would let me know what they needed,,, or could not have done, to further injure the victims. Anyway, I am starting to bore myself with the long post,,, GOOD ADVICE and keep it coming!!

Sucka
01-24-2008, 12:38
Thanks Da-Squad!

After 7+ years in the field, as an EMT/Medic and FFPM i've gotten a pretty good understanding of what's going on out there from all angles. Happy to help in any way i can :supergrin: