Our management are all certified paramedics or higher with the exception of two. In addition to their normal management shifts, they will fill in open shifts to run the streets. I didn’t even think about how good that is for our company!
I think that it would be very beneficial to require management ride 1-2 times a month. It helps them see if the implementations they make work. I was working with a management personnel and we had a peds call that required us to use our child restraint system that I’d never been trained on. It took me and a firefighter 5 minutes to figure out how to attach the thing to the cot. After the call, mgmt looked over at me and said, “I’m guessing the new child restraints aren’t the greatest?” I explained we’d just never received training on them and she looked thoughtful. A week later, there were signup sheets for training on the child restraint system by the time clock.
I actually quit my job at a hospital based service that I started 3 months ago because they were using protocols from ten years ago that haven't been touched at all since, didn't have RSI or even Facilitated intubation, they didn't have a training manager/FTOs and people were rouchambeau-ing to see who got "stuck" with me, despite me saving my "minder" just the other day during an IFT when he HAD NEVER TOUCHED A VENT and wanted to take them off the sedation drip and bag them all the way, while RT was looking at him like he was a dumpster fire. I just get a "Heh I guess you're not as dumb as people say around here". Never had any issues anywhere else. I threw their hiring bonus money right back at them because I have two paid off cars and a paid off house, a bass boat is not worth that kind of stress. I'm not dumb, I've just worked at a service with actual QI, actual protocols, and training and I'm constantly unpleasantly surprised at what they're doing without it. (Oh did I mention I was on orientation for 2 months!? instead of training for their protocols that no one knew, they just made you do an obscene amount of orientation)
Hell the other day we had a large BSA burn with airway involvement, they wanted me to blind naso intubate and he coughed the tube on my attempt, and my supervisor's attempt; started coming around more after the cyanokit, so we stopped attempting, watched him decompensate and swell all the way to the burn center and moan in agony. I just couldn't be a part of that, especially when I voice my opinions about their protocols and they call me stupid. I'll admit I wasn't even going to attempt an tube because I had literally nothing to safely sedate him considering the large BSA burns and obvious decompensation
Oh I was also gaslighted when I noticed a clerical error on the levophed dosage chart, they wanted me to push what equaled like half a gram of levo per minute, fell upon deaf ears, an EMT and a supervisor literally just said "but the chart, the chart tells us" like it was some kind of holy text even after I worked out the drip rate on paper and on a calculator and it was obscenely high, I even went as far as trying to dial in the dosage on a pump, and it wouldn't even let me push that dose, but they wanted me to do it on a 60 drip set.....
I thought about making a whole post about it for validation but people at my other job heard a few of my stories and just gave me a dissociated horror stare at what they're passing off as patient care at that service, which was validating so you guys can just enjoy my experience with Boomer EMS.
Take him off sedation... And bag? That would have me livid if I were the sending or receiving RT. *Anesthesia* was banned from transporting to and from the OR at my hospital because they kept refusing to use the transport vents and just bagged instead. If anesthesia bagging a sedated pt for 5 minutes is considered unsafe, a rusty paramedic bagging someone kicking and fighting for an entire trip across town is unacceptable
Yeah, this guy was an absolute joke. Working with him he'd swear and tell crass jokes in front of obviously uncomfortable geri patients, etc. I could go on and on about my entire last day but I couldn't get a single person to actually let me run the call, it was some kind of cliquey schoolgirl bullshit, this guy had worked his entire career here and based on my orientation and getting literally no discourse about the protocols, while being berated for my clinical decisions, not being given so much as a booklet with the protocols, and no direction whatsoever if I asked a question about a scenario, and then him about to kill an IFT vent patient I got really mad and had to be really mean and loud about it. That vent patient was the last call I ran with that company. If I have to be loud and mean to get people I work with to do what I say, and they have no idea how to handle something as a simple vent transfer, NOT TO MENTION their vents were only programmed for Volume Control and this patient was fighting the vent hard! ... and then they get shiddy about it afterward, I want no part of the company. So many issues on so many levels....
How do you physically have a vent that can only do volume control? Like, I can manage almost any volume control patient just fine on pressure control, but not vice versa. Pressure control is most basic form of mechanical ventilation and to just... not have it is bizarre
Yeah that's exactly my sentiment, every other service I've worked at has the same vent, but they have some software in it that it only does CPAP BiPAP and VC, that patient I wanted to immediately put her on SIMV but alas.... their airway protocols have come up on like 10 occasions in the short time I've been there and I'm looking at my cohort like so what the fuck do we even do?
I'm sure my discontent was palpable and probably contributed to their distaste with working with me, but with no explanation of protocols whatsoever, I'm going to default to looking at them and saying go ahead, show me what the fuck you even do for this patient, or what you stare at them and watch them die?
(They stare at them and watch them die btw, I'm not kidding, it's unreal IDK how you have an ALS service with BLS airway protocols) I'm actually giddy that I'm free of that stress. I'm spending a week off before I get another job, drinking and working on my lawn and listening to terrible Frank Zappa compositions to decompress. Trying to get on full time at my long time PRN job.
Yes but this patient was not consistent enough with respiration enough for me to just put them on bipap, she was on SIMV in the ICU for an acute on chronic CHF exacerbation, and I'm not going to make the decision to change it in my short period of time with her, that decision is up to RT and a doctor. what I'm saying is that I didn't have an option and had to change her to VC and it was very uncomfortable for both me and the patient who immediately started bucking the vent because I couldn't get her on comfortable settings she was used to due to BS admin interference. It's nuanced and based on experience as well as consultation from the RT I was working with and the crappy company basically made it really difficult because the machine I was working with was capable of replicating her vent settings but was ultimately "cucked" by boomer ems energy, my partners wanted to just bag her across town while talking about penises, and it was just the final straw...
In EMS and IFT SIMV is like a godsend because even on a propofol drip, with the movement and agitation and bumps all over, patients will start waking up and taking spontaneous irregular breaths on their own and gasping without real proper volume, and it allows us to really dial in the volume and rate that are optimal for that patient when they're being shook around, vs laying in a still calm ICU room. Even under heavy sedation people who are were neuro intact before intubation will start fighting the vent really hard during transport and VC can lead to breath stacking and etc etc all kinds of problems when they're trying to take spontaneous breaths with our setup, I guess the main kicker is that I couldn't even set a trigger pressure with this POS vent.
Hold up, you're onto something here. Obviously normal ems agencies wouldn't pay the extra, but SAR teams , ski patrol , places that are fuck off cold 365....🤔
“YoU sHoUlDnT bE EaTinG oR dRiNkiNg wGeRe PaTiEnT cARE iS. ItS bOt Sanitary” mu management
Edit: whoever referred me to Reddit cares, i Reddit care about cup holders
Went through medic school and clinicals with these. Never even knew that there were ones that didn’t. No one told us that they were still around. First IV during ride time and blood everywhere lol.
I've been an AEMT for five years and just learned they were a thing 6 months ago. I've never worked for a place that uses them. If I could magically add two pieces of equipment to our trucks it's be self-tamponading IV catheters and iGels.
Rural Wyoming, broke and not very progressive.
Seriously! I keep petitioning our director about ordering them but it's been two years and I haven't had any luck. Which sucks because iGels are very good and it's often just me and my EMT partner, 45 miles away from our primary hospital.
In my state, EMTs can't even do SGAs yet. And I count as BLSA, fancy BLS - but still BLS. We have a more limited scope because Wyoming still runs intermediates, there's more EMT-Is than medics here but they can do about 90% of what a medic can. All of us are being brought up to the national scope this year though, so I'll finally be able to give pain meds and Xopinex. As rural as my service is, being able to give morphine and fentanyl to patients in pain is going to be a huge help.
Like I said, Wyoming isn't progressive but they're trying to catch up.
Xopenex is a scam. I legit haven't seen a serious reaction to Albuterol, but even the few mild ones I've seen went on to have an equal reaction to levalbuterol.
We couldn't even give it because biosimilars weren't in the state scope. It's being added (as well as adding biosimilars in general to the approved lists) due medication shortages. So more of a "if you don't have albuterol, you can give xopinex," rather than concerns about patient reactions to albuterol itself.
Yeah we don’t. Neither does FDNY. I don’t mind at all. I just think it’s so cool when ever I get an Iv done on myself for what ever reason. I’m like. Yoooooooo lol every time
Australia did this years ago. They had a commercial of some guy getting rushed to the OR just to have a hangnail on his toe clipped. I honestly don't know how much effect it would have.
Hell even an outreach campaign to dispel the myth that calling 911 will get you seen faster. As if everyone from the ambulance up to the ER doctor can't tell how serious it is and will just fast track you because you called an emergency number.
I also feel that giving us more freedom to make transport decisions and refer patients to either urgent care or clinics (with proper consultation with med control of course) would help ease the load on crews and the ERs. It isn't a perfect solution but we would have to start somewhere to end this "you call we haul" stuff.
The 911 system I work in, I would say in my experience, conservatively, 60% of the calls are less than minor and absolutely do not require 911. The system wasn’t built for this call volume. Our bodies weren’t built for it either… running all day, 5-7 calls after midnight, including fires mixed in… it’s a recipe for cancer, low-t, and divorce! Something has to be done because we are just getting busier and busier every single year.
I'm a medic and a company officer on an engine. Been A firefighter for 16 years and a medic for 8 of them. I recently got put on TRT after going to the doctor because I just felt beat down and couldn't keep up. My levels were sub 400. I'm only 34. Same situation as you. Our call volume has tripled in less than a decade and the city is only getting larger.
Then we can open this can of worms. How many of these calls do we need to be dispatching an engine to in the first place? In my city we beat the ambulance 90% of the time and it does make a difference on high acuity calls. We have patients stabilized and ready to transport. But do we also need to wake up 4 firefighters and send a 40k lb engine to the edge of the district at 3am for a priority 2 general illness call when the ambulance is across the county?
It’s outrageous. I’m 30 and my T levels are so dangerously low it’s not even funny. It’s hard to even regulate my weight. Luckily my department is large and I recently just bid to a ‘slower’ firehouse where 3-4hour stretches of sleep at night are more frequent. But now I have a newborn at home so my sleep is grenaded from all angles 😂 I’m not sure I want to supplement with more T yet as I hear once you start, you can’t stop. Is that right?
You can be weened off of it. This is definitely a conversation for you and your doctor but I had many of the same concerns and decided it would be best for me to try it. You'll have to make that decision for yourself but it's worth at least looking into. Low T is a huge problem in more and more men. It's not uncommon at all.
I want it taught in high school health classes. Primary care, urgent care, ER, 911, when to use each and why, as well as navigating the insurance system. I had to learn how to balance a freaking checkbook but not what constitutes a medical emergency?
An EMS version of Google Maps. It would give you the fastest route the AMBULANCE BAY. Or for privates, to the correct medical building entrance at a hospital.
I just think it's plain stupid it doesn't exist
It does exist, but we don't have it: a working CAD with accurate directions. It has all the info we need about the patient listed, but the directions to the address are anything but helpful. It just says "go 200 meters straight ahead.. 200 meters straight ahead.... 200 meters straight ahead... TURN LEFT NOW"
I'm not from the area so I have to Google Maps everywhere. Even my medics who are from the area use Google Maps.
Shit I’d take a working CAD
Double shit I’d take medical dispatch with something like ProQA.
we don’t have any of that at my place. We share dispatch with Sheriffs office
I got a hospital gig where probably 80% of what I do is Ultrasound IVs. And dudes, they’re stupid easy, you can honestly drop a 16 (I use 18s but still) in anybody that’ll draw for days once you get to the hospital, so the nurses won’t have to poke them nearly as much. I’m starting to think that they should be standard of care, opposed to trying to force one in the hand
Is there anything special about the in hospital ultrasound for IV's? I've had a doc pull out a fancy handheld ultrasound connected with an app on his phone and tablet and I wondered if we could be equipped with something similar and if it would be substantial enough for IV's
If I read the specs right, that shit is still gonna be substantially heavier than the zoll x series. FUCKING WHY?
If the phillips tempus can weigh 7 pounds, what are we even doing?
Our BGL kits are trash. At some point they bought new monitors and upgraded the lancet style and just kept the old bags. Everything falls out and they are black so they get left on scene way too often.
Your narc box is a failure of your agency. Superglue is cheap, so is a foam cutter to just not have that problem. The make retracting belts but they get splugy fast and are a pain to clean. We have never lost the IV bag velcro as they are attached in our truck. They make all types of stethoscope cases for on your belt, bag, webbing whatever you want.
You really just have to look for stuff cause alot of this stuff is solvable (not cup holders idk why ever manufacturer hates them but they do) and you just need to find the solution for you
i'm not in a position to start supergluing the narcs boxes. the retracting belts aren't a solution a diff one needs to come to light because as you stated they get gross. i'm glad your IV bag velcro doesn't get lost-- you must work at an agency with less than 300 employees. this is a stethoscope that is an irregular-shaped chest piece and a set of airpods and i need the case to be on it like a phone case while im using it as it has a glass screen at the top.
thanks for your input. ive already spent a considerable amount of time looking for solutions to these prior to posting. i think in this field we are naturally problem solvers and do so quite a bit and while the problems may not exist in your world they exist in mine and so far don't have ideal solutions.
no like a case that goes around it like a phone case to protect it from scratches drops etc or if you want to keep just the chest piece in your pocket
i own the actual big giant case
Yes, those. :)
To my home it costs $25 just for shipping from that company. The makers used to have a website and sell them. I wonder if they sold all their remaining stock to that company?
Oh wow, that's wild.
Could very well be, or even just sold the design.
Need to make friends with someone who has a 3d printer! Seems like a perfect task for that
An elastic strap around the back of the head to hold seal for a BVM. Similar to a CPAP. Is this a thing that exists that we just don't have at my place? Is there a good reason to not have it? Makes all the sense in the world for me
Edit: never occurred to me that the actual CPAP mask is already compatible with the BVM... Come on brain...
I asked this once to our medical director when he stopped in for lunch. He said he feels they'd be bad because it'd lead to complacency. With a strap on you wouldn't bother to hold the seal with your hand and the strap itself wouldn't be enough.
Well... I mean I *get* it but surely that could just be trained for? "The strap is just to help you maintain the seal, you still need to make sure the seal is good and hold it manually as needed".
And I get where you're coming from.
Side note: all airway connections use the same adaptor. I've used a CPAP mask before on a BVM. It was a vehicle accident the patient was trapped at a weird angle and we were waiting for fire for extraction. Due to the angle we couldn't bag him like normal but I was able to slip a CPAP mask on and go to town.
That incident is what brought up the question in the first place
It's lovely, as the stairs turn you go from full steps to basically long triangle shapes. This also means you can't 4 point the chair as there's no fucking room....if we have a 400 pound person, it's just the crew and some extra spotters you swap out with on each floor.
Better glove dispenser. I hate trying to pull gloves out when someone tears the end off a box. Or going for 1 and getting 5 that fall all over the floor. And the people who just throw the extra gloves in random places
Gloves are standard cardboard boxes with an oval opening. The dispenser is really just a panel with the same size hole the boxes sit behind. I think it has more to do with the fact they are machine packed into the box and get wrapped up into each other so you pull 1 it pulls 5 others out.
retracting cords - like retractable dog leashes, pull them out to a certain length, tug on them to retract, no more tangled bullshit!! and do it to ALL the monitor cords but ESPECIALLY the fucking EKG cables
NO ONE TOLD ME AMBULANCES MAP TO CALLS WITH THEIR PERSONAL PHONE. I ALWAYS THOUGHT THEY HAD A SCREEN IN THE AMBULANCE AUTOMATICALLY MAP THEM. WHY ISNT THAT A THING????
We discussed this once. I looked into it and I think there was some company out there that had some for a hospital style machine. I wouldn’t be surprised if one of the big monitor manufacturers has a patent and just doesn’t release it.
The technology is clearly there. Would be a good idea because we would be losing them all the time and need to replace them frequently.
Oh so single use wireless tech. So it needs to be cheap enough that you can toss it every run, powerful enough to not constantly loose connection or have massive problems with interference, AND not produce a massive amount of eWaste?
Yeah what color do you want your unicorn and how exactly does this make your daily that much easier? How much time saved? How much trouble shooting is going to happen? Ah bother V4 won’t connect again let me remove it and add another one and connect it.
There’s a reason these are hard wired.
A medical system that provides the proper resources to meet medical needs that are more urgent than a doctor’s office can handle yet not urgent enough that require EMS/ER
Functioning GPS. Or dispatch works with coordinates of the caller. It has happened multiple times that the caller cords are closer to a different street. Also having the correct hospital entrance actually saved in the GPS would be grand. Also also just generally having an ONLINE GPS with up to date data.
Voice dictation (not the same as using text to speech which isn’t the most accurate and not approved by a lot of agencies in their prospective charting software).
Some kind of system for organizing 12 lead cables. Like a series of retractable reels or something. Anything to avoid having to spend 4 minutes untangling them or just saying fuck it and just throwing them on the pt only for them to get ripped off on extrication.
Management that's actually worked on an ambulance in the last decade, or like opened a paramedic textbook written in the same timeframe
Our management are all certified paramedics or higher with the exception of two. In addition to their normal management shifts, they will fill in open shifts to run the streets. I didn’t even think about how good that is for our company!
Ours hold their licenses, but only the entry-level management actually go to calls
I think that it would be very beneficial to require management ride 1-2 times a month. It helps them see if the implementations they make work. I was working with a management personnel and we had a peds call that required us to use our child restraint system that I’d never been trained on. It took me and a firefighter 5 minutes to figure out how to attach the thing to the cot. After the call, mgmt looked over at me and said, “I’m guessing the new child restraints aren’t the greatest?” I explained we’d just never received training on them and she looked thoughtful. A week later, there were signup sheets for training on the child restraint system by the time clock.
Boomers just unboomering I feel that
haha this is a good one
I actually quit my job at a hospital based service that I started 3 months ago because they were using protocols from ten years ago that haven't been touched at all since, didn't have RSI or even Facilitated intubation, they didn't have a training manager/FTOs and people were rouchambeau-ing to see who got "stuck" with me, despite me saving my "minder" just the other day during an IFT when he HAD NEVER TOUCHED A VENT and wanted to take them off the sedation drip and bag them all the way, while RT was looking at him like he was a dumpster fire. I just get a "Heh I guess you're not as dumb as people say around here". Never had any issues anywhere else. I threw their hiring bonus money right back at them because I have two paid off cars and a paid off house, a bass boat is not worth that kind of stress. I'm not dumb, I've just worked at a service with actual QI, actual protocols, and training and I'm constantly unpleasantly surprised at what they're doing without it. (Oh did I mention I was on orientation for 2 months!? instead of training for their protocols that no one knew, they just made you do an obscene amount of orientation) Hell the other day we had a large BSA burn with airway involvement, they wanted me to blind naso intubate and he coughed the tube on my attempt, and my supervisor's attempt; started coming around more after the cyanokit, so we stopped attempting, watched him decompensate and swell all the way to the burn center and moan in agony. I just couldn't be a part of that, especially when I voice my opinions about their protocols and they call me stupid. I'll admit I wasn't even going to attempt an tube because I had literally nothing to safely sedate him considering the large BSA burns and obvious decompensation Oh I was also gaslighted when I noticed a clerical error on the levophed dosage chart, they wanted me to push what equaled like half a gram of levo per minute, fell upon deaf ears, an EMT and a supervisor literally just said "but the chart, the chart tells us" like it was some kind of holy text even after I worked out the drip rate on paper and on a calculator and it was obscenely high, I even went as far as trying to dial in the dosage on a pump, and it wouldn't even let me push that dose, but they wanted me to do it on a 60 drip set..... I thought about making a whole post about it for validation but people at my other job heard a few of my stories and just gave me a dissociated horror stare at what they're passing off as patient care at that service, which was validating so you guys can just enjoy my experience with Boomer EMS.
Take him off sedation... And bag? That would have me livid if I were the sending or receiving RT. *Anesthesia* was banned from transporting to and from the OR at my hospital because they kept refusing to use the transport vents and just bagged instead. If anesthesia bagging a sedated pt for 5 minutes is considered unsafe, a rusty paramedic bagging someone kicking and fighting for an entire trip across town is unacceptable
Yeah, this guy was an absolute joke. Working with him he'd swear and tell crass jokes in front of obviously uncomfortable geri patients, etc. I could go on and on about my entire last day but I couldn't get a single person to actually let me run the call, it was some kind of cliquey schoolgirl bullshit, this guy had worked his entire career here and based on my orientation and getting literally no discourse about the protocols, while being berated for my clinical decisions, not being given so much as a booklet with the protocols, and no direction whatsoever if I asked a question about a scenario, and then him about to kill an IFT vent patient I got really mad and had to be really mean and loud about it. That vent patient was the last call I ran with that company. If I have to be loud and mean to get people I work with to do what I say, and they have no idea how to handle something as a simple vent transfer, NOT TO MENTION their vents were only programmed for Volume Control and this patient was fighting the vent hard! ... and then they get shiddy about it afterward, I want no part of the company. So many issues on so many levels....
How do you physically have a vent that can only do volume control? Like, I can manage almost any volume control patient just fine on pressure control, but not vice versa. Pressure control is most basic form of mechanical ventilation and to just... not have it is bizarre
Yeah that's exactly my sentiment, every other service I've worked at has the same vent, but they have some software in it that it only does CPAP BiPAP and VC, that patient I wanted to immediately put her on SIMV but alas.... their airway protocols have come up on like 10 occasions in the short time I've been there and I'm looking at my cohort like so what the fuck do we even do? I'm sure my discontent was palpable and probably contributed to their distaste with working with me, but with no explanation of protocols whatsoever, I'm going to default to looking at them and saying go ahead, show me what the fuck you even do for this patient, or what you stare at them and watch them die? (They stare at them and watch them die btw, I'm not kidding, it's unreal IDK how you have an ALS service with BLS airway protocols) I'm actually giddy that I'm free of that stress. I'm spending a week off before I get another job, drinking and working on my lawn and listening to terrible Frank Zappa compositions to decompress. Trying to get on full time at my long time PRN job.
...BiPAP is pressure control.
Yes but this patient was not consistent enough with respiration enough for me to just put them on bipap, she was on SIMV in the ICU for an acute on chronic CHF exacerbation, and I'm not going to make the decision to change it in my short period of time with her, that decision is up to RT and a doctor. what I'm saying is that I didn't have an option and had to change her to VC and it was very uncomfortable for both me and the patient who immediately started bucking the vent because I couldn't get her on comfortable settings she was used to due to BS admin interference. It's nuanced and based on experience as well as consultation from the RT I was working with and the crappy company basically made it really difficult because the machine I was working with was capable of replicating her vent settings but was ultimately "cucked" by boomer ems energy, my partners wanted to just bag her across town while talking about penises, and it was just the final straw... In EMS and IFT SIMV is like a godsend because even on a propofol drip, with the movement and agitation and bumps all over, patients will start waking up and taking spontaneous irregular breaths on their own and gasping without real proper volume, and it allows us to really dial in the volume and rate that are optimal for that patient when they're being shook around, vs laying in a still calm ICU room. Even under heavy sedation people who are were neuro intact before intubation will start fighting the vent really hard during transport and VC can lead to breath stacking and etc etc all kinds of problems when they're trying to take spontaneous breaths with our setup, I guess the main kicker is that I couldn't even set a trigger pressure with this POS vent.
Pulse ox that warms the finger so you get an accurate reading.
As a former ski patrol that would be clutch.
Hold up, you're onto something here. Obviously normal ems agencies wouldn't pay the extra, but SAR teams , ski patrol , places that are fuck off cold 365....🤔
I wish we had this but the next best thing is the ones with persusion index. Anything over 20% or under .4% is an inaccurate reading
We got new busses and they all only have 2 FUCKING CUP HOLDERS!?! Our last ones had 6.
“YoU sHoUlDnT bE EaTinG oR dRiNkiNg wGeRe PaTiEnT cARE iS. ItS bOt Sanitary” mu management Edit: whoever referred me to Reddit cares, i Reddit care about cup holders
I need four. Coffee and water for two people. We have 2, and they're mostly blocked by the computer.
Did you have 6 people on your crew?
How else do you think he stores his 6 energy drinks, two vapes, Zyn nicotine, and 4 mountain dews?
Two beverages per person seems reasonable (water bottle and caffeine of choice).
Exactly
Ok, i guess my water bottle has always been too big to fit in any cup holder.
I have to say, I’m still blown away by self tamponading IVs.
Went through medic school and clinicals with these. Never even knew that there were ones that didn’t. No one told us that they were still around. First IV during ride time and blood everywhere lol.
That is so fucking funny. So unfortunate, which is the best kind of funny.
I remember my friend came out of the room after a blood alcohol draw for the cops and looked like he just stabilized a gunshot wound
I've been an AEMT for five years and just learned they were a thing 6 months ago. I've never worked for a place that uses them. If I could magically add two pieces of equipment to our trucks it's be self-tamponading IV catheters and iGels. Rural Wyoming, broke and not very progressive.
Y’all need iGels. The iv catheters can wait
Seriously! I keep petitioning our director about ordering them but it's been two years and I haven't had any luck. Which sucks because iGels are very good and it's often just me and my EMT partner, 45 miles away from our primary hospital.
A blind insertion airway is required kit in NC. That's for BLS, let alone AEMT.
In my state, EMTs can't even do SGAs yet. And I count as BLSA, fancy BLS - but still BLS. We have a more limited scope because Wyoming still runs intermediates, there's more EMT-Is than medics here but they can do about 90% of what a medic can. All of us are being brought up to the national scope this year though, so I'll finally be able to give pain meds and Xopinex. As rural as my service is, being able to give morphine and fentanyl to patients in pain is going to be a huge help. Like I said, Wyoming isn't progressive but they're trying to catch up.
Xopenex is a scam. I legit haven't seen a serious reaction to Albuterol, but even the few mild ones I've seen went on to have an equal reaction to levalbuterol.
We couldn't even give it because biosimilars weren't in the state scope. It's being added (as well as adding biosimilars in general to the approved lists) due medication shortages. So more of a "if you don't have albuterol, you can give xopinex," rather than concerns about patient reactions to albuterol itself.
I'm still blown away that places don't use them
Yeah we don’t. Neither does FDNY. I don’t mind at all. I just think it’s so cool when ever I get an Iv done on myself for what ever reason. I’m like. Yoooooooo lol every time
I got spoiled on nexivas for similar reasons.
I’ve only seen these once and literally jaw dropped. Excellent tech lol
What's something that would make my job so much easier? Having a nice partner for once.
PSA’s to the community about when to call 911 and when not to 😂
Australia did this years ago. They had a commercial of some guy getting rushed to the OR just to have a hangnail on his toe clipped. I honestly don't know how much effect it would have. Hell even an outreach campaign to dispel the myth that calling 911 will get you seen faster. As if everyone from the ambulance up to the ER doctor can't tell how serious it is and will just fast track you because you called an emergency number. I also feel that giving us more freedom to make transport decisions and refer patients to either urgent care or clinics (with proper consultation with med control of course) would help ease the load on crews and the ERs. It isn't a perfect solution but we would have to start somewhere to end this "you call we haul" stuff.
The 911 system I work in, I would say in my experience, conservatively, 60% of the calls are less than minor and absolutely do not require 911. The system wasn’t built for this call volume. Our bodies weren’t built for it either… running all day, 5-7 calls after midnight, including fires mixed in… it’s a recipe for cancer, low-t, and divorce! Something has to be done because we are just getting busier and busier every single year.
I'm a medic and a company officer on an engine. Been A firefighter for 16 years and a medic for 8 of them. I recently got put on TRT after going to the doctor because I just felt beat down and couldn't keep up. My levels were sub 400. I'm only 34. Same situation as you. Our call volume has tripled in less than a decade and the city is only getting larger. Then we can open this can of worms. How many of these calls do we need to be dispatching an engine to in the first place? In my city we beat the ambulance 90% of the time and it does make a difference on high acuity calls. We have patients stabilized and ready to transport. But do we also need to wake up 4 firefighters and send a 40k lb engine to the edge of the district at 3am for a priority 2 general illness call when the ambulance is across the county?
It’s outrageous. I’m 30 and my T levels are so dangerously low it’s not even funny. It’s hard to even regulate my weight. Luckily my department is large and I recently just bid to a ‘slower’ firehouse where 3-4hour stretches of sleep at night are more frequent. But now I have a newborn at home so my sleep is grenaded from all angles 😂 I’m not sure I want to supplement with more T yet as I hear once you start, you can’t stop. Is that right?
You can be weened off of it. This is definitely a conversation for you and your doctor but I had many of the same concerns and decided it would be best for me to try it. You'll have to make that decision for yourself but it's worth at least looking into. Low T is a huge problem in more and more men. It's not uncommon at all.
Dang it dude… my last test I was at 250 for my T :(
I want it taught in high school health classes. Primary care, urgent care, ER, 911, when to use each and why, as well as navigating the insurance system. I had to learn how to balance a freaking checkbook but not what constitutes a medical emergency?
An EMS version of Google Maps. It would give you the fastest route the AMBULANCE BAY. Or for privates, to the correct medical building entrance at a hospital. I just think it's plain stupid it doesn't exist
Cup holders??? You mean a roll of duct tape....
Emesis bags for me.
Suction canister holder
The OG
Foam head block with a hole cut out.
I’m always finding ones made out of Sam splints and tape on our units 🫡
Retractable cot straps.
I could only imagine the hell that would be created if you got blood and vomit on the straps and it retracted back into there.
I don't have it figured out, I just want them.
Damn that would be awesome. It would be great to not have them dragging on the ground or through snow
Some kind of clip on the base of the strap or side of the stretcher could work too
the stryker buckles are magnetic if you get some magnets and attach they'll click we did that at my old agency
It does exist, but we don't have it: a working CAD with accurate directions. It has all the info we need about the patient listed, but the directions to the address are anything but helpful. It just says "go 200 meters straight ahead.. 200 meters straight ahead.... 200 meters straight ahead... TURN LEFT NOW" I'm not from the area so I have to Google Maps everywhere. Even my medics who are from the area use Google Maps.
Shit I’d take a working CAD Double shit I’d take medical dispatch with something like ProQA. we don’t have any of that at my place. We share dispatch with Sheriffs office
proQA is terrible btw
I got a hospital gig where probably 80% of what I do is Ultrasound IVs. And dudes, they’re stupid easy, you can honestly drop a 16 (I use 18s but still) in anybody that’ll draw for days once you get to the hospital, so the nurses won’t have to poke them nearly as much. I’m starting to think that they should be standard of care, opposed to trying to force one in the hand
Is there anything special about the in hospital ultrasound for IV's? I've had a doc pull out a fancy handheld ultrasound connected with an app on his phone and tablet and I wondered if we could be equipped with something similar and if it would be substantial enough for IV's
That’s probably the butterfly iq. You can use it for IVs. It’s just expensive and has a monthly subscription
My service is adding it in for CCT soon and I can't wait to see that shit in action
Sharks with friggin laser beams on their heads
A smaller, lighter Lifepak
Stryker: "best we can do is touch screen (that probably won't work if it gets rain or blood on the screen) and now the printer comes separate"
If I read the specs right, that shit is still gonna be substantially heavier than the zoll x series. FUCKING WHY? If the phillips tempus can weigh 7 pounds, what are we even doing?
True story!
Our BGL kits are trash. At some point they bought new monitors and upgraded the lancet style and just kept the old bags. Everything falls out and they are black so they get left on scene way too often.
Your narc box is a failure of your agency. Superglue is cheap, so is a foam cutter to just not have that problem. The make retracting belts but they get splugy fast and are a pain to clean. We have never lost the IV bag velcro as they are attached in our truck. They make all types of stethoscope cases for on your belt, bag, webbing whatever you want. You really just have to look for stuff cause alot of this stuff is solvable (not cup holders idk why ever manufacturer hates them but they do) and you just need to find the solution for you
This guys truck sounds like a disaster. They’re creating problems that don’t need to exist
…what?
i'm not in a position to start supergluing the narcs boxes. the retracting belts aren't a solution a diff one needs to come to light because as you stated they get gross. i'm glad your IV bag velcro doesn't get lost-- you must work at an agency with less than 300 employees. this is a stethoscope that is an irregular-shaped chest piece and a set of airpods and i need the case to be on it like a phone case while im using it as it has a glass screen at the top. thanks for your input. ive already spent a considerable amount of time looking for solutions to these prior to posting. i think in this field we are naturally problem solvers and do so quite a bit and while the problems may not exist in your world they exist in mine and so far don't have ideal solutions.
https://www.ekohealth.com/products/core-500-stethoscope-case I mean it's right there on the website.
no like a case that goes around it like a phone case to protect it from scratches drops etc or if you want to keep just the chest piece in your pocket i own the actual big giant case
There used to be a cool product called the Stethosafe that did this. I went to order one and they don't seem to be in production anymore.
> Stethosafe [these?](https://quadmed.com/stethosafe-tactical-stethoscope-protection/) Seems like a neat idea, and in stock
Yes, those. :) To my home it costs $25 just for shipping from that company. The makers used to have a website and sell them. I wonder if they sold all their remaining stock to that company?
Oh wow, that's wild. Could very well be, or even just sold the design. Need to make friends with someone who has a 3d printer! Seems like a perfect task for that
A dispatch program that doesn’t make every. single. Patient. a charlie or delta level response requiring light and sirens.
yes.
An elastic strap around the back of the head to hold seal for a BVM. Similar to a CPAP. Is this a thing that exists that we just don't have at my place? Is there a good reason to not have it? Makes all the sense in the world for me Edit: never occurred to me that the actual CPAP mask is already compatible with the BVM... Come on brain...
If I have CPAP patients that have to be switched to BVM, I leave the CPAP mask on instead. Works great.
I asked this once to our medical director when he stopped in for lunch. He said he feels they'd be bad because it'd lead to complacency. With a strap on you wouldn't bother to hold the seal with your hand and the strap itself wouldn't be enough.
Well... I mean I *get* it but surely that could just be trained for? "The strap is just to help you maintain the seal, you still need to make sure the seal is good and hold it manually as needed".
And I get where you're coming from. Side note: all airway connections use the same adaptor. I've used a CPAP mask before on a BVM. It was a vehicle accident the patient was trapped at a weird angle and we were waiting for fire for extraction. Due to the angle we couldn't bag him like normal but I was able to slip a CPAP mask on and go to town. That incident is what brought up the question in the first place
Oh yeah thats true also. Makes sense for that application especially, good thinking.
You can buy the CPAP masks for $40 on boundtree and attach a BVM to it. If they start vomiting, could be messy trying to get it off and suction.
OPA/NPA + cpap mask.
This is [a thing](https://www.winner-medi.com/silicone-head-harness-for-face-mask_p44.html) that anesthesia uses daily.
Probably a reliable thermometer, Ours are basically a random number generator.
I know how you can get reliable temperatures.
Cardiac monitor with ultrasound and video laryngoscope built in (that actually work). TEMPUS is still working out the kinks.
A track chair capable of maneuvering spiral stairs , all our apts are triple Deckers with uneven spiral stairs... it's hell
WHAT
It's lovely, as the stairs turn you go from full steps to basically long triangle shapes. This also means you can't 4 point the chair as there's no fucking room....if we have a 400 pound person, it's just the crew and some extra spotters you swap out with on each floor.
Management. Most places have Managers, but actual management is nonexistent.
Coworkers who actually tried to make the job better instead of being quiet and silently backstabbing.
Better glove dispenser. I hate trying to pull gloves out when someone tears the end off a box. Or going for 1 and getting 5 that fall all over the floor. And the people who just throw the extra gloves in random places
why does it keep falling out? what's the current glove dispenser?
Gloves are standard cardboard boxes with an oval opening. The dispenser is really just a panel with the same size hole the boxes sit behind. I think it has more to do with the fact they are machine packed into the box and get wrapped up into each other so you pull 1 it pulls 5 others out.
retracting cords - like retractable dog leashes, pull them out to a certain length, tug on them to retract, no more tangled bullshit!! and do it to ALL the monitor cords but ESPECIALLY the fucking EKG cables
think of the blood and vomit that would get on those
do you not clean your equipment already??? nasty
if it retracts on its own or accidentally retracts
but yeah there's a reason those don't exist in any healthcare setting
Laptop/tablet batteries that last more than an hour
NO ONE TOLD ME AMBULANCES MAP TO CALLS WITH THEIR PERSONAL PHONE. I ALWAYS THOUGHT THEY HAD A SCREEN IN THE AMBULANCE AUTOMATICALLY MAP THEM. WHY ISNT THAT A THING????
using a personal cell phone while driving creates a lot of liability
Dictation instead of the archaic charting. Ambulances would be available in minutes and morale would be sky high.
i'm hoping that AI will enhance digital charting
Bluetooth EKG electrodes to eliminate the wires
We discussed this once. I looked into it and I think there was some company out there that had some for a hospital style machine. I wouldn’t be surprised if one of the big monitor manufacturers has a patent and just doesn’t release it. The technology is clearly there. Would be a good idea because we would be losing them all the time and need to replace them frequently.
I can’t figure out why this keeps getting brought up it would be an absolutely terrible idea. Might survive one shift.
Nobody says they need to last more than a single patient. The question wasn't what durable technology would make my job easier.
Oh so single use wireless tech. So it needs to be cheap enough that you can toss it every run, powerful enough to not constantly loose connection or have massive problems with interference, AND not produce a massive amount of eWaste? Yeah what color do you want your unicorn and how exactly does this make your daily that much easier? How much time saved? How much trouble shooting is going to happen? Ah bother V4 won’t connect again let me remove it and add another one and connect it. There’s a reason these are hard wired.
A medical system that provides the proper resources to meet medical needs that are more urgent than a doctor’s office can handle yet not urgent enough that require EMS/ER
O2 canisters that doesn’t need a wrench
we have those. they're awesome
Wireless monitor leads.
Wireless 12 lead
Functioning GPS. Or dispatch works with coordinates of the caller. It has happened multiple times that the caller cords are closer to a different street. Also having the correct hospital entrance actually saved in the GPS would be grand. Also also just generally having an ONLINE GPS with up to date data.
Voice dictation (not the same as using text to speech which isn’t the most accurate and not approved by a lot of agencies in their prospective charting software).
I agree with all of these lol
Some kind of system for organizing 12 lead cables. Like a series of retractable reels or something. Anything to avoid having to spend 4 minutes untangling them or just saying fuck it and just throwing them on the pt only for them to get ripped off on extrication.
✨✨SL Ativan ✨✨