Precepting a medic student this shift, was explaining the different MOAs of aspirin and nitro in chest pain. After a bit of teaching he goes “so aspirin is lube and nitro is poppers” honestly left me speechless

I’m a paramedic turned med student, going through residency interviews now. Virginia Tech Carilion has really surprised me, offering pretty much everything I’m looking for in residency. My wife is also a medic, but does not have fire certs. Can anyone with knowledge/experience in area share what the job market in the area is like? Is FD the sole 911 EMS provider? If so, will they hire without fire certs?

so my partner and i have been in this little argument. im in paramedic school and we have finished the cardiology section and on a call recently we had a patient throw 3 PVCs in a row. my textbook and what i have been tested on says 3 PVCs is a run of VT. i just pointed it out to my partner so he can monitor for anymore, then he wanted to argue saying a run of VT is 5 or more then told me my textbook was wrong 🙃 what do yall consider a run of VT?

I specifically would love to know your experiences with sirens and whether your departments have done any testing of lower volumes or running hot less often. If so how did they go?

I love medicine. I’m thankful that I had the opportunity to become a Paramedic. But Private EMS is absolute garbage in Las Vegas, and many other parts of the United States. Each and every private ambulance company in Las Vegas valley is trash. Why are these companies privately owned? Why are we not considered an essential service?

Where I work this is the starting pay and pay steps: For context full time operations is considered 3 12 hours shifts a week. First 8 hours of the shift is base pay, and last 4 hours of every shift is 1.5x that.

EMT starting pay: $12.83/hour
OT Pay: $19.24/hour

AEMT starting pay: I can’t remember exactly but it’s around $16.50/hour
OT Pay: $24.75/hour

Paramedic starting pay: $20.69/hour
OT Pay: $31.03/hour

Pay steps are generally yearly. Other than when you first become a Paramedic you get a pay step increase at 6 months, then 6 months after that. After that though I believe it’s once a year. The pay step is literally only 2% of your hourly wage.

I just think it’s crazy how people don’t talk about this enough. So many people I work with seem to be content about this. Quite frankly, it makes no sense. I think it is so EVIL how taken advantage of we are. The owners of the company are always going on luxurious vacations, while their workers are struggling to survive. It’s absolutely insane to me.

I can name 2 or 3 that DON’T… and it’s for religious reasons

Hi everyone,

I wanted to see how much of a difference acoustic design actually makes, so I tested the frequency transmission of a few stethoscopes I had on hand.

Setup & Limitations: I ran frequency sweeps from low bass up to ~3 kHz. Keep in mind that this is a DIY acoustic test bench: above 3 kHz, acoustic coupling and reflections make the setup less stable, but the range below 3 kHz covers the clinically relevant spectrum for heart and lung sounds anyway (S1/S2, murmurs, breath sounds). Every measurement was taken twice and both lines are plotted, so in the overlapping part they are very reproducible.

Graph:

• In the first graph (big membrane), the blue line is the no-name Rappaport, the red line is the MDF 747, the green line is the LuxaMed Sonus SX, and the yellow line is the MDF MD One.
• In the second graph (bell), the light blue is the LuxaMed, the dark blue is the MDF 747, and the violet is the MDF MD One.

A few interesting takeaways from the data:

• There seems to be no very big difference in frequency response between membrane side and bell side.
• All of them performed pretty similarly; however, the no-name one performed best, which was kind of surprising.
• Subjectively, the biggest difference was in noise reduction from the surrounding background noise; there the MDF MD One was best, followed by the LuxaMed, then the other MDF, and the no-name didn't reduce it at all.

Conclusion: I was really surprised to see the MDF MD One in last place in both measurements. I was pretty sure it would outperform all the others, but as far as I tested, the best bang for the buck (also considering sound insulation) is the LuxaMed. I also added some memory foam ear tips, which improve sound isolation even more, and with that mod it outperforms the MD One easily.

Questions for you:

1. Did I misinterpret the results, or do you have any other idea why the MDF MD One underperformed that badly?
2. Which stethoscopes would you like to see measured next?
3. What is your daily driver in the field/hospital, and what sound profile do you actually need in your specialty (med student, resident, attending, nurse, or paramedic)?

Curious to hear your thoughts!

Dispatched to a 32 year old male chest pain fifteen minutes before end of shift. Got on scene and patient was diaphoretic and pale laying on steps clutching his chest. Stated it was a sudden onset and that his left jaw was killing him. Got this 12 lead before we loaded him up. Based on presentation, the presence of some elevation even though he didn’t have reciprocal depression and my butthole was starting to clench ended up called in a STEMI alert. Unfortunately air was unable to fly so had to ground pound it 1:30 hours to nearest PCI facility. Started a nitro drip at 20mcg/min and bolused 4500units of heparin. Immediate relief with nitro drip which was titrated up to 100mcg/min over the course of transport along with 50mcg of fentanyl every 20 minutes. Got him to the cath lab and ended up with a 90% LAD occlusion at only 32 years old.

So we had a very odd code today, and it's sort of two-fold...

70 y/o male, HX of diabetes and recent cancer remission (didn't catch what type of cancer). Had his last chemo treatment today. Takes insulin and Eliquis.

Dispatched as chest pain and sudden severe SOB. While enroute, advised CPR in progress. Obviously witnessed, bystander and cop started compressions immediately. Pt is purple from the nipple line up, all S/S points to probable PE. Apneic (agonal at least), and no pulse....

We take over compressions, apply AED (we're a BLS Fire Dept., I'm FF/AEMT, should've mentioned that) and I begin prep for airway and IV access. Here's where it gets interesting...

After about a minute and a half of compressions, the guy opens his eyes, starts trying to talk, and we have ROSC. Carotid pulse and even a weak radial pulse, and he's fairly well conscious at this point. BUT, the AED is still attached and analyzing, and advises SHOCK, while this man is starting to talk to us. Kinda weird right?

Ambulance arrives, monitor goes on and this man's vitals are near perfect. Monitor shows RBBB, and maybe a slow VT, but nothing that really jumps out. No cardiac HX either.

So my question(s)...was it a PE, or maybe a run of VT that put this guy down? Say it WAS a PE, could compressions dislodge an embolus to the point it is no longer obstructive?

And why would an AED advise SHOCK on a conscious and awake patient? Malfunction or actually detecting a shockable rhythm?

14 years doing this and I've never seen an AED do that. I'd love to hear the thoughts of people smarter than me, haha

Was first on scene to a collision between to e-bikes on my way home from work. Ironically I’m a bicycle mechanic in my day job. Ski patroller when not working on shitty e-bikes. One rider was up and yelling to call for help. Second rider was motionless. Pulled over, grabbed my first aid kit. Patient was laying prone with his head turned to the side. Multiple facial lacerations, skull visible through laceration on his head. Bleeding from nose and mouth. Was able to clear his nose and mouth enough to get labored breathing. Since blood was running out of his mouth I didn’t want to roll him as I was on my own without any method to provide suction or supplement breathing and was worried he’d aspirate. Another witness had 911 dispatch on the phone and we were only a couple minutes from multiple staging locations for our ALS provider. Found his wallet and got his name from his ID and started talking to him. Still GCS of 3. By the time I was thinking I should drop an NPA the FD arrived on scene and took control. Paramedics were just behind. He was still unresponsive but the time they were loading him in the bus. They’d intubated and were bagging.

I know I’m not in the chain of people who can get an update on his status. Already tried sweet talking the ED phone receptionist. But it sucks to not know if he is still holding on or not. We send a lot of patients to the same hospital during the winter so I’m going to see if my patrol director can reach out through the channels we typically use for updates.

I also ended up doing a witness statement for PD as I saw the collision. Hoping if I can’t get anything from our medical channels PD can at least till me basic condition of the dude.

His face after they flipped him is definitely ending up in the memories I wish I didn’t have file.

And please wear a helmet.

Does anyone have any experience with First Due or Unified Solutions for ePCR and CAD?

We are currently using RescueNet Dispatch/emsCharts but are exploring other options due to costs. We are a non-profit, high-volume, primarily BLS-911 agency. ZOLLs costs are very high so we are looking to explore options.

The other obvious answers are ESO and Traumasoft. But I fear ESO’s cost will compare to ZOLL’s. And Traumasoft is just terrible for the end users. (At least based on feedback I’ve read online and my minimal exposure to it when a company I worked for briefly switched to it for scheduling.)

I am a big fan of how tech-forward both First Due and Unified Solutions seem. They have great AI integration from the admin side with abilities for natural language analytics reporting and DVR creation.

First Due is also fairly new but seems a bit more cemented in the industry, but I really can’t find much feedback on Unified Solutions. In facts I only learned about them at EMS World a couple weeks ago.

Open for feedback or suggestions on other platforms. We do want one that has an integrated CAD, so Imagetrend is not one we will explore.

Appreciate the assistance!

IFT EMT, there were two situations I was curious about from a HIPAA/professional boundaries standpoint. I’m not planning on doing either just curious!!

1). An old lady at an SNF used to teach Vietnamese and offered to teach me in her free time after i said i always wanted to learn, she then gave me a note with her number. Would it be a HIPAA violation to text her?

2). old lady mentioned feeling lonely and missing her family. Would it be inappropriate or against any rules to send her flowers to the SNF?

Hi!

I've been a modder for Cyberpunk 2077 for a while now, and I think this might be my most daunting project yet.

I decided to make an emergency version of the Militech Behemoth (a truck in Cyberpunk 2077, it's in the image list) and I've reached the part where I make it a mobile intensive care unit. I've taken inspiration from mobile stroke units, mass casualty ambulances, ECMO vehicles..

I'm still trying to get the layout in order, so here's what I have right now:

- The Behemoth has a container on the back that cannot pass through to the front (because there's an engine compartment in between). There are no access doors except a ramp on the back.

- The forward half, up to the wall of the container, is (I envision) a surgical suite, including a robotic surgical system (of my design) and a compact CT scanner.

- The rear half (where the chairs are) will likely include paramedic seating, space for one stretcher for a patient that needs to be monitored, possibly a field lab machine, and a control station for the doctor.

I'm already thinking about where to place the IV, oxygen distribution system, possibly an X-ray machine...

How would you organize this truck, r/EMS?

(Please, I'm admittedly somewhat lost.)

I live in a town with 225,000 people and average probably 6-11 calls in 12 hours, but only go emergent to the hospital (at least recently) like every 4-5 shifts. Honestly think I’ve gone emergent twice in the last 30 days. I am very much a white cloud but wonder if bigger cities create more frequent higher acuity calls. My system is ALS only

I have been EMT certified almost a year now and working IFT and 911 with a private company, until last week. I have been going through a real health battle in learning about/ diagnosing chronic illness and it finally became too much in this job. I needed a break and my employer kind of made that decision for me. I know I'm only on step one and fear I won't be able to move forward like this. I have just started an A and P class to start my medic journey but I don't know if I should anymore.

I truly felt so connected and prepared for this job, and I am in every way other than my health, I can't see myself doing much else. My goal would be to be a medic in an ER but I know that will take time just to become a medic and gain experience to have that option. I just don't know if I'll be able to"fulfilled" doing something else. Even my doctors have told me I should change course, be a med tech or nursing assistant but it is not the same in my head.

I feel like I just started and haven't seen half of my potential or experienced anything to push me and I want that. I like the adrenaline, I like being someone's comfort at 2 AM, I feel I do better seeing these people outside of the hospital and making personal connections. I also think im good at it, which is important. I think I will only get better, gain leadership and confidence in time, in every situation. I just don't think I'll get that feeling of completion anywhere else.

Is there anyone suggestion or people on the path out of EMS that can give comfort? What jobs did you have when searching for everything you got from EMS? Do I pause and do something less fulfilling till I can get a better "quality of life", would something like dispatch be as good?