Hi everyone! Most of you are already familiar with me but for those who are visiting for the first time, please allow me to introduce myself. I am a Firefighter/Medic with training and experience in the following areas; HCP-CPR, Advanced Cardiac Life Support, Prehospital Trauma Life Support, Pediatric Advanced Life Support, Firefighting Operations, Hazardous Materials, Technical Rescue, Water Rescue, Emergency Vehicle Operations, Prehospital Pharmacology, and Medical Terminology. I am here to provide technical support for those seeking to broaden their knowledge of Firefighting and Emergency Medical Services. This board has a wealth of resources to answer any and all questions that may come it's way, so if you need to know, ask and we will help in any way we can!
Info on standard procedures
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Someone recommended this list to me to help with a story I'm writing and I must say I think it's a godsend. I need to know what emergency treatment would be for 1. A gunshot wound to the arm, entry near armpit and possible lodge near collarbone. 2. Head laceration, possible concussion and dislocated shoulder. Would it be possible for the shoulder to be reduced in the field?
#1 GSW
Asssuming Conscious, alert and oriented.
If bleeding, direct pressure. O2 via Non-Rebreather Mask. Manual C-Spine, Collar, LBB (Back Board), CID (Cervical Immobilization Device) and Secure. EKG. 2 large bore IVs enroute (Can be Saline, Ringers, or 1 and 1. Depending on vitals, the IV may be wide or KVO.
#2 Basically the same thing. O2, C-Spine etc. We do not reduce anything in the field except elbows (gotta check this). Other places are different. (PS. Average ETA to hospital in our area is 10 minutes). Depending on position of shoulder would be immobilived, however, it could be sling and swathe or use the body and backboard straps. Depends on presentation. If concussion presenting (assuming presentation is altered mental status) then IV medium/large bore with Normal Saline KVO, EKG.
In both cases, treat EKG dyrhthmias as appropriate.
I have never seen a scratch test or other titer test for tetanus, other that the vaccine itself. I believe that there must be one, since the reaction would be nasty. I had a skin reaction to the TB test when I went for my firefighter physical and it wa so bad, that they sent me to the public health clinic for a thoracic radiograph and more tests. I guess it looked too much like a positive reaction. (and it hurt too!)
Someone with mild asthma (by history) could at sometime have an attack that is moderate to severe. Usually, the people I see with moderate to severe asthma attacks have a history of bad asthma. Do you have an inhaler (MDI) prescription (Rx)?
After having some attacks myself, I consulted a doctor (who himself is Asthmatic) and he explained that asthma is simply a reaction by the body to some outside stimulus such as cold air, allergies, viruses and/or exercise.
The severity of your attacks (or reactions) will normally depend on the amount of stimuli.
I, personally, have allergies and have had a couple of attacks in 5 years. My son, on the other hand, has attacks more frequently during the fall through spring because his are virally induced (a head cold goes right to his chest).
Given that this is an employment site, the difference may not be in skill sets but in experience or other qualifications necessary to meet the job requirements. By dividing the classification, they may be able to have a multiple tier pay system. The only way to tell is read the description.
As a sidebar... years ago (10+) our system had EMT-P 1 and 2. The idea was a 1 could run on his/her own and a 2 needed another medic to function as a medic.
What you are describing, is probably, I'm guessing, on the order of a petite-mal seizure...
Most seizure runs, dealing with epilepsy, are cakewalks...
Vitals, depend solely on how upset the patient is about it all.. In fact, the seizure, might even have passed relatively unnoticed at first.
Epileptics, that KNOW they are epileptics, generally take even the furnature flipping grand mal seizures in stride... They know the drill... seize... consult with their doctor for an exam and POSSIBLE adjustment of medications... (The patient calls their private doctor and makes and appointment, etc... in other words, routine visit to their doctor) and that's USUALLY that.
Put in the context of Emergency!...
Roy and Johnny show up... speak with the patient, ask questions, gain VERBAL permission from the patient to conduct a reading of vitals...
Then they meet the crossroads...
Do they advise the patient to contact their private doctor and call themselves available and go home?
Or do they contact Rampart, and do the follow up to the hospital with patient transport?
THAT question, is answered in the patient interview...
Has the patient been taking their meds properly?
How many times has this happened today?
How does the patient feel?
WHAT does the PATIENT want to do?
(Remember... the PATIENT, if conscious and coherent and sane, has the final say.)
The answers to those questions, will tell the tale.
My best guess, based on limited facts... you're talking about the cakewalk run... They'll talk with the patient, speak in calm, professional, RELAXED tones, (Very conversational, since this isn't a life and death emergency)
And they'll probably give the patient the option.
"It doesn't sound life threatening to us... BUT... if you would like to go to the hospital, just to be on the safe side, we'll be more than happy to accomodate you. It's your choice sir... would you like to go to the hospital, or simply to call your physician and take it up with him?"
If the patient votes for the hospital, then they'll contact Rampart, and MAYBE... MAYBE... depending on the mood of the doctor, be told to start an IV of either D5W or Normal Saline (Sugar water or salt water, in layman's terms), at a rate of TKO...(To Keep Open, which only flows enough fluid to keep the IV line from clogging up at the catheder.*g*) and transport. Likely it would be a transport without lights or sirens, and obeying all posted speed limits and traffic signals.
If the patient elects to call his own doctor, (Which most of the time, epileptic patients will), then Roy and Johnny will call LA County and declare themselves available, then turn to the patient and say,
"Sir, we think you'll be fine... but if you seize again, or start not to feel well... please feel free to call us back immediately. We'd rather come and not be needed, than to be needed and not be called in time."
That's the quick and dirty on epileptic patients that ARE under the care of a doctor.
Some thoughts on patient care related matters, in writing stories...
It struck me... you might consider trying to lay your hands on a textbook used to train EMT's and Paramedics, to help you along, as well as using the board here.*s*
The textbook I used in my EMT training, was...
"Emergency Care-Fifth Edition" by Brady publishing.*s*
If you would like to know where you can find one of those textbooks... I offer the following options...
1.) Contact your local fire or ems unit... (Use the NON EMERGENCY or ADMINISTRATIVE phone number please... do NOT dial 911.*s*) and ask about it. They might be able to help you get your hands on at LEAST an outdated training manual, and might even point you to where you can buy the latest and greatest training manual.)
2.) I offer this website, as a possible reference where you, or others interested, can obtain training manuals, that are up to date, and in use across the USA.
Look under EDUCATION and choose the BRADY manuals... BELOW the shopping cart form, there are descriptions of the books and what they contain... you CAN get, a Paramedic, AND a BASIC EMT manual, plus other references there... They aren't exactly cheap... the EMT textbook, went for something like $54.00 plus shipping and handling... but they are authentic and in use around the country. (It's a Fire and EMS store, for firefighters and other emergency responders)
I have met the people that own that store showroom, as well as the website... and they are reputable, and are involved in the fire service in my local community.
I'm hoping to go for my EMT-P if not nursing. I read a lot of med books, and I'm always looking for new ones! I just haven't got to the chapter on sezures yet. Thank you again!
Not sure if you mean what Rx meds the pt would be on or what pre-hospital meds the medics would give. The pt's (for your situation) vital signs would likely be slightly elevated. BP probably near normal, pulse:80-110/min, resps: 16-20/min. A non-full body seizure in a person w/ known epilepsy is a fairly minor event. Rx meds the pt might be on would include (one or more): Dilantin, phenobarbitol, Tegretol, Depakote. A continuous full-body seizure in a person w/ no dx of epilepsy can be a stat situation. For that type of event, the most common pre-hosp med is Valium (diazepam). Usually 5-10 mg via IV. Some places use Versed instead of Valium. Blood sugar is also checked (sometimes first), as hypoglycemia can cause seizures.
I volunteer in Montgomery County and the requirements are similar to Frederick County, being the same state. You have to pass an EMT-Basic, in order to be either EMS or fire in Maryland. The best way to find out the actual requrements is to go to the website for the Maryland Fire and Rescue Institute, www.MFRI.Org and see what it says for Frederick County. Hope that helps.
Hey Everyone!
I'm a big fan of Michaell Norell and if possible I'd love to have his E-mail address! I've been trying to get in touch with him for quite awhile. If anyone has it please contact me! I would also like to have Mike Stoker's or a nice picture of him.
Thanks,
Lori Parrish
Unfortunately Mr. Norell's e-mail address is no longer available to the public. However, if you wish to send the e-mail to me, I will forward it to him for you.
especially when he called Johnny a "twit" 2 examples,
The episode where John is taking a picture of him:
JOHNNY: What's the matter, Cap?"
CAPTAIN STANLEY: You blind blinded me you twit, that's what's the matter." and
the scene at the kitchen table when Charlie the grouchy mechanic leaves, and says,
Charlie: this coffee is awful.." (or something like that. Captain Stanley asks, "Okay, what did you do to it?"
Johnny heatedly defensive: "I didn't do anything to the coffe, Cap."
CAPTAIN STANLEY: "Not the coffee you twit, the squad."
If I'm not mistaken, it would be in the soundwaves file. you can click on it to hear Captain Stanley say "twit" I've picked up on this myself, and I often use the word, "twit." Blame it on Mike Norell. LOL!!!
especially when he called Johnny a "twit" 2 examples,
The episode where John is taking a picture of him:
JOHNNY: What's the matter, Cap?"
CAPTAIN STANLEY: You blind blinded me you twit, that's what's the matter." and
the scene at the kitchen table when Charlie the grouchy mechanic leaves, and says,
Charlie: this coffee is awful.." (or something like that. Captain Stanley asks, "Okay, what did you do to it?"
Johnny heatedly defensive: "I didn't do anything to the coffe, Cap."
CAPTAIN STANLEY: "Not the coffee you twit, the squad."
If I'm not mistaken, it would be in the soundwaves file. you can click on it to hear Captain Stanley say "twit" I've picked up on this myself, and I often use the word, "twit." Blame it on Mike Norell. LOL!!!
HI MY NAME IS RENAE APPERSON I AM 31 YEARS OLD I AM A BIGGEST FAN OF YOURS ON THE EMERGENCY! YOU ARE A GOODLOOKING CAPTION ON THE SHOW WILL YOU SEND ME A PICTURES OF YOU ARE MY MAN MICHAEL NORELL I HAVE TONS OF PICTURES OF YOU OF MY COMPUTER.
HI LORI I AM A BIGGEST FAN OF MICHAEL NORELL HE IS A GOODLOOKING GUY ON THE EMERGENCY TVSHOW I HAVE TONS OF PICTURES OF HIM OFF MY COMPUTER TELL HIM IS BIGGEST FAN OK THANKYOU.
Hello! I have a question concerning night calls. Does the engine routinely go with the squad late at night, especially in rough areas? I wonder because in "The Nuisance" the engine runs with the squad and I have no idea why unless it was routine. Of course, it may have been for dramatic purposes--all the guys crowding around the fallen Johnny! For my story's purposes, however, I think I want the squad to respond alone, and I want to make sure that was feasible in the Emergency! world.
There's a episode were the whole station gets called out to a trash fire. The squad isn't needed and cancels, and Roy says "Well, at least we'll get more sleep than the engine company." Then the squad gets a run. I could be wrong, but I don't think that the company joined them. I've been an "E!" fan for most of my life, but I still could be wrong. I don't think anyone would really mind. Sorry if I'm wrong, it's been a while since I've seen that episode.
I volunteer with a rescue squad, and we are required to have overnight stays. We have ALS, BLS and heavy rescue units as well as the fire department support of engines, trucks, etc...
Many time, we get calls in the night(sometimes , not to the best areas)and we go alone, unless there is a need for "manpower". This means that certain types of calls(high rise buildings, car accidents, mass casualties)require you to have more rescuers than you might have with you. (and they can walk all the way back to the unit to get the stuff too!)
Units call always request extra manpower when they get there, but the dispachers usually know what calls will need them beforehand. This would be the only reason I could see that they would all get called out.
I don't know how things were run in the '70s, squad responding alone on calls vs engine and squad.
In today's world LACoFD (as well as most, if not all fire departments) sends an engine and squad on every medical response, day or night. LACoFD also sends a private ambulance at the same time. If the call is in a bad neighborhood then the police or sheriff responds as well.
In the case of LACoFD a squad covers their own district as well as two or three engine companies in neighboring districts.
If the engine arrives before the squad the crew evaluates the patient and if the paramedics are not needed the engine cancels the squad and the patient is transported by the private EMT ambulance sent to the scene.
I appreciate the info, Mike. Since I'm trying to stay true to the show, I was trying to find out what the norm was for the 70s. It sounds like I'll be able to keep my premise of the squad only responding to a late night call to a bad neighborhood. Thanks again for the help!
In my county, the ambulance and engine do not go together on runs. Like, I was listening to our monitor and dispatch only sent out an ambulance. I don't think it's standard throughout the country-just certain areas have certain things.Most of the runs I've heard have been ambulance alone, not engine too.
I should have included that in my post...that in some areas an engine responds with paramedics (squad or ambulance) while in other it doesn't.
I work for AMR in the Los Angeles area. We run with LACoFD and some other Fire Departments.
Most of the departments we run with send an engine with the paramedics.
Several other Fire Departments that we don't run with send engines on medical calls also.
I guess it all department protocals whether to send medics alone, or with an engine...type of call, distance the medics have to travel to get to the scene, things like that.
In the area I work in (metro N. Calif), the standard is an engine company and medic ambulance (FD or private) on every code 3 medical call. The reasoning for this is: 1) There are more engine companies spread out, so they will usually arrive first and can perform immediate treatment and assessment. 2) Running a stat call with just one other person, even if they are a medic, can be hectic and inefficient. We almost always have a two or three-person engine company, so one person can get vital signs for us (and do other things like set up an IV bag or get oxygen going) and one or two can get the gurney or stair chair. That leaves the medics to assess and treat the patient and perform proper documentation (good field notes). In E!, the squad had two ambulance attendants (gurney jockeys) on the call to help with patient transfer.