That is all.

After a heavy trauma call my partner brought in our saving grace… maybe next time Ivysaur will help us.

So I have FINALLY gotten my reciprocity recognized for Pennsylvania. I started this process in December of 2023...

Just to be clear, PA is the state that I went through. However they are not the only state that has this process or something similar or just as difficult if not more. Also I would like to note that the staff at PA-OEMS that did help me get through this process literally bent over backwards helping me, and I will give them a by name shoutout if they request later.

I had to get a federal background check (Standard, so no problem) AND a state background check for every state I held a EMS certification in. I only had 3, but this was a SERIOUS pain in the rear. I had to call 2 of the states, and found out one of them the clerk did not submit correctly, and the other had cut off my apartment number on my address when I sent it in. Nobody ever followed up with any information, it was 100% my problem if something got kicked back and no information was provided as to why.

I also had to get a Verification" form signed by the state office of EMS for each state that I held a certification in. I was informed that this is to ensure that no action has been taken against any of my certifications. While I understand this policy, it seems cumbersome and a big pain in the rear, especially considering we have a national certification! This was actually the shortest part. 2 were done through email and 1 was done by regular mail because they are old school like that.

Proposed solution:

Every station/school/company has a training officer that SHOULD have access to NREMT to submit training rosters. What if we had a state specific class that you take (Possibly once, or every 2-5 years?) updates for protocols, state specific training, and other such stuff, and your NREMT certification gets a "State endorsement" box checked for that state.

Now you lets say you were a bad clinician and need to have your certification suspended. Instead of suspending your "Pennsylvania" certification, you only have a National certification to suspend. Only need 1 background check. Only need to verify licensure with 1 entity. Only need to submit continuing education for 1 certification.

Stop me if I am going too crazy here. Please keep the humor mild, but does anybody have input for how we can ACTUALLY make this happen? Petition or something? Or any suggestions for improvement on something similar to this?

I have an Associates in Applied Science in EMS and a Career Studies certificate on Critical Care from Tidewater Community College. I'm a veteran with some GI Bill left. I'm also a practicing paramedic with Virginia Beach EMS.

I recently learned that Radford University in Virginia has an EMS program with a bachelor's degree, but I can't find much other information about it. I'm waiting for them to call me back.

I would like to know: Can you do it remote? How much does my past experience and education contribute to their program? Was it good, how was the training, and did you feel it actually did anything for you and your career? Anything else you'd like to contribute...

Thanks guys!

From my knowledge and training in NJ, shoulder straps are mandatory protocol for patients. I always use them, and have for 8 years now but over my career I'd say 1% of squads, private IFT companies, what not ever actually use them. I've literally seen shoulder straps on stretchers taped up in a roll on the back of the stretcher to eliminate them from "being in the way". It literally seconds more to apply them but so many act like using them is like putting on a KED

Hello all! I'm a regular here on my main account but figured this question for my fellow NYC peeps might deserve a throwaway.

I just finished a job interview for a 911-participating hospital in NYC... I have the job if I want it but now have a dilemma. I am on track for FDNY EMS academy in the fall and apparently (per my job interviewer) I need permission from FDNY to work per-diem for a 911 hospital at the same time as FDNY. The hospital also can't be in the same borough as my eventual FDNY station but that shouldn't be a problem for me. Basically it sounds like I may have to choose between taking this hospital job and moving forward with FDNY EMS, at least for the time being. The starting pay is (much) better at the hospital and they do have benefits, but i wonder if FDNY might be better long term. Anybody got any advice?

Thoughts on how to handle this situation better. What do you think could be the clinical diagnosis. Constructive feedback is appreciated.

I am in EMT school in Alberta and I did my first ride along shifts recently.

Responded to an call for a 17 yr old female with the report of seizure.

Once arrived at scene, found the female in her post-ictal phase. Was advised by her friend she is combative once coming out of seizures. The first seizure lasted for 7 minutes.

Her BP is 150. O2 at 92. She is breathing normally. Looks slightly pale. Hasn't lost control of bladder. Pupils are reactive. Eyes were closed initially - more like forced.

Once she regains her consciousness, she start to getting a panic attack for seeing the paramedics. I stepped back because I didn't want to result in additional stress due to our presence. She talks to my partner. He tries explaining her what happened. The other partner - She was a lil upset because our patient was behaving like a Karen. But she started having a panic attack before losing her consciousness again and having a seizure in front of us.

The presentation of the seizure is fairly different. The friend told us she has pseudo-seizures - better term PNES.

Fists clenched towards the chest. Back arched. Asynchronous movements of limbs. Slight jerky movements. Breathing normally. Good pulse rate (carotid). Seizes for another 3 minutes. No medications were given at this point as my partner discussed that if it lasts for more than 4minutes, we will administer Benzo.

This time we moved out of the view so as to not stress her. She was confused and didn't had no recollection of what was happening. She could recall her name and location.

We approached again and she got verbally aggressive at us which is understandable. My partners were trying to explain her of what happened and trying to convince her to go to the ER.

Clearly refused and explained its normal. Tried fleeing the scene only to end up again having a seizure. We just decided to load onto the gurney and transport her. ETA to hospital was about 13 minutes from scene.

Her 3rd seizure lasted only for a minute long. While En-route once aware of the transport, suffered a breakdown again and stated her trust issues with Paramedics and transportation against will. Figured its too late. Didn't talked to us at all. Ignored us even when my partner was trying to talk to her and just trying to support her. Maintained completed silence. When arrived at the hospital, during the handover, told me she wished that She was let gone home with her friend as it is normal for her and has been diagnosed with PNES.

I am left wondering on if there was something we could have done as team to deal with this better. Especially given that she doesn't appreciate Paramedics response unless the situation was more serious. The friend did mentioned to us that it is fairly common for her seizures to last up to 15min.

Secondly, I never gotten an update but do you think it is PNES. ofc, the latter seizures were triggered by our presence which could be a stress trigger for her. But such a long post-ictal phase in PNES - Isnt that not normal?

Appreciate all the responses!

Please observe the canned mandarin orange slices, undercooked rice, possibly canned chicken..

Was just reminded of a call I had a while ago. PT states he had a seizure I don’t remember the full thing cause this was a while ago but long story short he ended up “seizing” again while we loaded him into the ambo.

His seizure was basically just him looking up and to his right and kinda leaning over and he would stare off into the distance. When this started happening he exclaimed “I’m having another seizure” and remained AOx4 during the whole thing which lasted about 30 seconds.

We get to the hospital and medic states he thinks the guy is faking it. Medics leave (ALS and BLS are separate where I’m at and they just left without giving report) and I give report to Doc and he basically calls me an idiot and says people who have seizures aren’t conscious / are not alert and oriented while they happen.

I’m not going to deny that it’s possible the guy was faking it cause that seemed plausible, but can’t a person remain conscious while having a seizure such as a focal aware seizure?

Im doing my ED rotation as a nursing student/current EMT. When a older man in scrubs comes up to me to “teach me something”. I stutter and look around to see if i should be doing this but follow him into an empty room that is full if airway supplies, tourniquets, bandages and IV supplies

Then he tells me that he’s been a paramedic for 30 years and have worked air, ground and in the ED and that he takes every nursing student aside to teach them as much as he can because they “dont go over enough about IVs in nursing school”

I understand that this sub loves to complain about ER nurses who don’t know anything and that “medics practice medicine nurses practice nursing theory hurr durr”. Which is stupid, the issue with nursing is that you can work in 100 different specialties and there’s only so much time in nursing school to become a jack of all trades.

So over the next hour he taught me IV tricks that he likes, tells me to I gel everyone, and naturally some prepper tips for the impending world end. I thought it was all so helpful and wish i got more cross training time with more none nursing jobs. But in the meantime Steve was awesome.

I’ve had some recent calls where patients ended up suffering massive CVA’s or other life-altering injuries that will debilitate them for the rest of their life. How do you manage feelings of knowing you may have prolonged someone’s suffering? I’m a chronic overthinker, so maybe I should just care less, but I’m curious to know what other think. Thanks and be safe out there.

Out of genuine curiousity… The NREMT website has patches for sale and one of them is for a US Airforce Paramedic.

Does anyone know who actually uses these patches lol. Is it PJ’s?

Had a guy I transported. Saw him outside of work at my second job. EMT salary lol. I feel like it would be weird seeing the EMT that transported you at Home Depot lol😂

Which do you prefer and why?

Unfortunately after three years in the field I was on the other side of the scene and my father died. AMR responded (I worked with a different company) and he was pronounced on scene by the coroner. My family is worried about billing and though I’d like to say for certain they won’t get a bill but I was not in it long enough to say for sure. Does anyone have any idea on whether or not we will get a bill for all of the interventions done? (He was coded for about 20 mins, LUCAS, igel, everything.)

What have you learned from your unicorn patients about anything, whether it’s learning what life looks like from their perspective, how they would like to be treated, or just general life advice? Specifically patients faced with very rare conditions that have disabling impacts. Think sickle cell, cystic fibrosis, polio (super rare now I know but they’re out there!), congenital malformations, etc.

A few questions for people who have done any contract jobs. Are they worth it? Did they provide health insurance, and if not what did you do for insurance? Once the contract ended did they offer to keep you on or did you move on to the next one? I’m nervous mainly for the health insurance portion mainly since I would need to either leave or go prn at my current job which my insurance is through

Yeah, that's me. I did 32 hours -- picked up the second half of a shift, then a 24. BLS ambulance, but for once there were no "low acuity" calls.

It was non-stop. It just. Never. Stopped. Calls calls calls. We had strokes, seizures, a standoff between a neighborhood and police, and a high speed collision into a building that ejected two people. That last one we transported the lowest acuity patient as the sole BLS provider out of about 6 medics on scene. It was pretty wild.

Anyway, it was after that last call that I just went outside. It was dark and foggy. I hadn't slept since I started, save maybe a power nap in between. I was contemplating my life choices. My partner and I just took drags of shitty cigarettes we found. They weren't even ours, just sitting out somewhere. We said not a word.

You ever have one of those shifts?

EDIT: "The Shift", recounted in no particular order:

• A seizure that became an arrest (I didn't work the arrest though, I just learned of that later)
• A COPD lady claiming her concentrator was broken, and that her H-cylinder was busted too. Sure enough, the H-cylinder had a nasty mechanical problem of "out of fucking air". I youtube'd the concentrator and... flipped the ON switch and turned the dial. Miraculously, it worked. We (my BLS crew, the medics, and the residents of this house) then held hands and prayed for our continued protection at the behest of the patient. Yeah, thanks lady, you clearly gave me some kind of gypsy curse the rest of the shift.
• This bullshit, which in the aftermath I am now pissed off about because my partner was being spineless and apologizing profusely. "I didn't want to call you guys", yeah because I, me, this EMT right here did. Yes, lessons learned and all.
• The aforementioned riot in the hood, in which our patient accidentally got iced with pepper spray by her friend. While on scene, the entire fucking hood came out to jump this patient, while police rolled in hot with rifles and non-lethal implements. Hood kids were clutching at guns and things. We got the fuck out of there quick.
• The aforementioned stolen vehicle into a house. 6 people total, two ejected, one traumatic cardiac arrest. No idea if anyone died, I'd be surprised if one TBI or death didn't come out of it. Our patient was fine-ish, just a nasty head wound that you could see to the skull with. Completely CAOx4 as far as I saw though.
• Stroke-like symptoms, but the lady also vomited all over herself. Not a small amount at all. I am proud to say that I did the most perfect leg sweep ever before she got our bags. Then she shit herself. Thank you medics for transporting that one.
• Called out for "bloody vomiting". Old boy was struggling and speaking in tongues when we showed up. His sugar was super high, his BP through the roof, all the classic "oh no" symptoms. Medic shows up and says "okay, I actually don't know what's going on. Priority 1". I got to drive our ambulance for the first time though, which was neat, except for the part where I nearly took out a street's worth of side mirrors while I backed out.

There were many more but frankly those were the highlights.

For the longest time, I’ve heard that when you apply hemostatic dressing, you scoop put blood and clots until you can get to the source of the bleeding and apply the dressing directly there; but now I can’t find anything to support that online and I’m wondering if I’ve been misled. Does anyone have the answer?

For me it’s got to be 3 for $8 redbulls(strawberry apricotx2, juneberry), 3mg spearmint zyn, body armor(blackout berry), and some sort of small snack. These are the absolute needs to keep me alive at this point, and I’m not okay lmao

Zoll Z vent

Biggest draw back slid that it’ll has no bias flow, and those no Vte(exhaled tidal volume).

The manual has no clinical context and is difficult to find key information that is in a single caution or warning line.

CPAP only is a demand valve and the rise time works as a level of restriction applied to the patient from the demand valve. Not a good mode for pre hospital

CPAP+PS is Bi-Level assuming all values are equal it delivers the same breath to the patient. For example if you switch between the modes the only change is how you would manipulate the values of the parameters delivered to the patient.

Zoll charges and extra $3k to reverse I:E and SiMV.

The volume breath is a constant flow breath (slowly gives the volume over the I time or until pressure limit is hit) which is not as good as a deaccelerating volume breath like the revel ventilator.

All non invasive modes have an alarm of insufficient flow that is dumb. It looks at 2 breaths extrapolates that data over 60 seconds and decides if it can maintain that and if it can’t it alarms.

The tidal volume and minute ventilation in non-invasive mode is an over estimation from the machine. Which isn’t convenient.

It’s a great durable ventilator. But there are other options in the same price range have a bias flow and will tell you a Vte.

If love to hear about your journey and any advice or tips. I have an idea but it's hard to get crowdfunding for such a specific market. Any fire service/ems/medical grants I find are for departments to buy the product, not for funding the inventor to help the manufacturer.

Hi guys, just wanted to ask you a very quick question. Have you ever had a patient who eas extremely bothered my the IV cathether? Yesterday me and my friends (a bunch of medical students) were practicing on each other and one of them almost passed out, as he said not from the pain or the sight of blood, but the feeling of the cathether inside his vein (22G).

Hey there everybody, I was just kind of sitting over here working on a project when a question crossed my mind: what would you say are some noticeable differences between a rural 911 service and an urban 911 service? I've personally worked at both and I have my own opinions (especially in the way of culture) but I was curious what other people thought.

What sorts of things are you guys doing to recover after shift? Obviously sleep is the best solution for lack of sleep but sometimes working a day and then sleeping a day isn’t feasible. I’ve got a life to live as well!

Which do you prefer and why?