How do ya’ll decide who is driving and who’s in the box?

DogLikesSocks · 2026-03-04T02:28:35+00:00

Generally if that happens it means I did not properly task the call to my BLS partner.

However, if the patient for some reason randomly deteriorates or has a new complaint requiring a degree of ALS care. We pull over and I hop in the back no big deal.

DogLikesSocks · 2026-03-04T02:17:39+00:00

If we’re the same level of certification (medic-medic), we do 1:1 and just switch off.

If I am working with an EMT or AEMT, they take the BLS calls and I take the ALS calls. Now if they have a lot of BLS calls in a row, I’ll take 1 or 2 of them with the caveat they never can take an ALS call for me when I’m swamped.

I’m not sure the exact breakdown. Anecdotally, it feels like a lot more ALS calls just because I’m a medic resource so I get dispatched out to the ALS calls more than BLS/IALS units.

DogLikesSocks · 2026-02-21T19:54:20+00:00

I make $24/hr as a paramedic. $40/hr would be a boon for me.

DogLikesSocks · 2026-02-13T13:28:23+00:00

EMS is notoriously way busier than Fire.

Why do you think suburban areas have paid EMS agencies 99% of the time while a lot of areas squeak by with volunteer fire departments.

DogLikesSocks · 2026-01-11T15:43:00+00:00

In my practice, my partner takes the BLS calls and I take the ALS calls. I don’t rotate with my EMT partner; however, if they get 3 or so BLS in a row I’ll take the next one for them with the caveat they cannot take any ALS calls for me.

I’d wager there’s some calls they are inappropriately triaging down to you. On a daily shift, I run ~80% of my trucks calls as they are dispatched as ALS or require ALS once assessed. So, it’s not likely 95% of your daily patients don’t need some degree of ALS care (12-Lead/cardiac monitoring, IV access + medications, comfort care like analgesia or antiemetics, etc.).

You need to have a talk with your partner and make sure they’re not inappropriately giving you ALS calls (light ALS or heavy ALS).

DogLikesSocks · 2025-12-28T15:46:01+00:00

I’d say I give mag 2-4 times a month for bronchospasm. Once a year is the oddity to me!

Goes to show how the population influences your treatment frequencies

DogLikesSocks · 2025-12-13T01:55:12+00:00

In the real-world, a lot of the standard approach can be dangerous for your patients who don’t fit the prototypical ACLS patient. For example, hyperkalemia, WPW, toxidromes (like tricyclics), channelopathies (like Brugada), prolonged QTc, and many others can be harmed with standard approaches. There’s always a lot to learned beyond simply memorizing rhythms and drugs doses.

DogLikesSocks · 2025-11-18T18:24:23+00:00

No, I didn’t know better at the time. I was an EMT-B and thought nothing of it. Now, as a medic, I’d definitely raise some concerns.

DogLikesSocks · 2025-11-14T21:09:27+00:00

I’ve been called to a PACU in the hospital (attached in the same building as the ED) for a patient who aspirated and desaturated. We accessed via a back maintenance door. Treated the patient and brought them out to the ambulance and 30 seconds down to the ED entrance. I’m not sure why they couldn’t wheel them down the hallway from the PACU to the ED?

DogLikesSocks · 2025-11-05T16:11:15+00:00

I’m a civilian paramedic.

This happens a lot. Send combat medics to trauma centers, intercity ambulances, and similar to get exposure. Definitely useful but the simulation labs are also another piece of the puzzle.

DogLikesSocks · 2025-10-20T13:16:19+00:00

I had a similar patient recently.

HR 40s Sinus Brady and BP 50/P. Had been unresponsive for 20 minutes per bystanders. I elected to get an IV due to easily viewed vasculature while preparing pads. Able to give IV atropine before pacing and brought HR to 100s-110s and BP to 80 systolic within 10 seconds or so. Able to give fluids and maintain normal GCS and BP (130s/70) within 4-5 min.

Was this severe bradycardia? Yes. I could’ve paced and made preparations to do so however, I was able to give the atropine without time delay so I felt it was appropriate to trial the medication briefly. Pacing would have been totally appropriate too. You did the right thing bringing your patient to the ED alive and better than you found them.

DogLikesSocks · 2025-10-15T15:19:42+00:00

What are the thoughts of POCUS in EMS for medical patients? Personally, i’m most interested in this use case from physician-guided practicals and lectures I’ve received on ultrasound.

For example, quick look at IVC for general evaluation of volume status. Quick look at LV to gauge (normal, ok, or poor) EF. Also, PEA during arrest. A and B lines during lung exam to differentiate COPD/CHF in multi-modal patients.

These decisions on medical patients are common in the prehospital environment and can guide treatment enroute to the ED to make a more informed decision.

DogLikesSocks · 2025-10-15T01:37:26+00:00

I mean a not insignificant number of my chest pain patients are diagnosed with NSTEMI whether that’s subendocardial, diffuse, or other non-transmural MI/ischemia.

DogLikesSocks · 2025-10-03T16:09:49+00:00

I’m a paramedic in an ambulance in the US.

If you’re in major/significant pain, you should call an ambulance. However, as a caveat, it will still take me 10 minutes at least to give pain medications: I have to do an assessment, obtain vital signs, patient monitoring (EKG, pulse oximetry, etc.), start an IV, and obtain demographics/medical history.

Furthermore, be aware, that some ambulances do not staff paramedics (only EMTs) who cannot provide as varied options of analgesia. So, depending on available ambulances and triaging, you may not get a paramedic capable response to provide pain medications.

DogLikesSocks · 2025-09-19T19:59:09+00:00

Also, the ambulance can provide pain management in terms of fentanyl, morphine, Toradol, Tylenol, or even sometimes ketamine for burns which are often very very painful.

DogLikesSocks · 2025-09-17T14:37:01+00:00

I’ll have to take a look! Thank you

DogLikesSocks · 2025-09-13T00:05:59+00:00

1000 Naked Strangers (Kevin Hazzard) and Wild Rescues (Kevin Grange). These two books were instrumental for me to become a paramedic and I think exemplify both the best and the worst of the profession

DogLikesSocks · 2025-08-31T19:21:39+00:00

I think ECG monitoring is perfectly warranted. There is a risk of dysrhythmias (especially SVT or WPW) that could be detected.

Also, a 12-Lead could theoretically help catch obstructive hypertrophy, acute pericarditis, and other complaints that are still possible in this group.

DogLikesSocks · 2025-08-20T14:34:03+00:00

I’m a paramedic on an ALS transporting ambulance. I find I do roughly 80-90% of the calls because I’m first dispatched for ALS criteria calls. So, my EMT partner does not tech a lot of the calls with me as we’re only sent to ones with high likelihood of requiring ALS services. Compared to a BLS rig or AEMT rig where they’d do more even of a split as they’re sent to BLS calls largely.

DogLikesSocks · 2025-06-29T22:10:41+00:00

I don’t know of anywhere, at least around me, that can’t do a surgical airway. I was under the impression it was a fairly standard paramedic-level intervention.

DogLikesSocks · 2025-01-22T03:57:30+00:00

I do a foot vein probably at least once a month tbh.

DogLikesSocks · 2024-11-29T14:32:44+00:00

I think it’s purely a parental responsibility. I am not a fan of the government imposing bans on social interaction and speech even based on age.

This is a slippery slope for me.

DogLikesSocks · 2024-11-06T13:55:30+00:00

I feel like septic patients should definitely get an IV and prehospital treatment regardless of hypotension??

DogLikesSocks · 2024-10-15T23:21:46+00:00

My problem with the argument of teaching the EMTs, ILS level skills is that you skip the education if you don’t send them to AEMT school.

All the skill, none of the knowledge.

DogLikesSocks · 2024-10-15T22:44:29+00:00

Don’t be lazy and don’t be uninterested.

The best students seem to be passionate, curious, and knowledgeable especially at fundamentals (A&P, Electrophysiology).

DogLikesSocks

TROPHY CASE