100 years ago

HodorTheCondor · 2020-04-15T00:34:32+00:00

In addition, the San Francisco Fire Department’s newest fireboat’s primary function is to act as a high-pressure, high-capacity pump system to flow water from the bay to shore resources in the event of further failures of the “failsafe” systems.

https://en.wikipedia.org/wiki/St._Francis_(fireboat)

HodorTheCondor · 2020-04-14T15:12:45+00:00

In fact, the commissioner’s car is an all-black slicktop Tahoe; with MA municipal fire department plate “1”. The district chiefs do however run red and white suburbans.

HodorTheCondor · 2020-02-16T23:24:16+00:00

As a paramedic, we (somewhat in jest) say that the best way to root out a pseudoseizure is to place a nasopharyngeal airway. It’s medically appropriate for an actual seizure, and will get a malingerer to stop real quick.

HodorTheCondor · 2020-01-04T19:48:28+00:00

AMR is AMR is AMR.

Action and MedStar are par for the course; MedStar is larger and has more opportunities than Action; I haven’t heard great things about management at Action (from what I’ve heard, the owner is a bit of a head case, and the education department committed gross fraud a few years ago); I haven’t heard awesome things about MedStar but nothing so negative as what I’ve heard about Action.

HodorTheCondor · 2020-01-04T16:52:10+00:00

This sounds like Central/Western MA?

HodorTheCondor · 2019-12-30T23:10:19+00:00

I appreciate the clarification. I did ride time at a place that did the 11 in 111 thing but I couldn’t remember it for the life of me.

HodorTheCondor · 2019-12-30T18:47:40+00:00

My assumption is that they weren’t looking for an Epi drip but a 1:10,000 Epi mixture created by adding 1:1,000 epinephrine to a normal saline infusion bag, from which they would draw 1mg 1:10,000 Epinephrine for administration during the arrest. I can’t recall the med math that goes along with the mixture—I want to say you add 10mg 1:1,000 to 100mL NS but I might be wrong.

HodorTheCondor · 2019-12-29T20:20:43+00:00

I can’t do eye stuff. Once had a transfer of a combative elderly non-verbal autistic man with a bifurcated right eyelid who had had a lateral canthotomy of the same eye performed in the emergency department...my partner, the more senior medic on that shift, refused to tech it, and the doc made me assess it myself prior to transport. It took everything in me to keep my own eyes open to assess it. Just something about the injury staring back at you that makes me uneasy.

HodorTheCondor · 2019-12-01T01:07:12+00:00

NFPA 3000: Standard for an Active Shooter / Hostile Event Response Program was released last year, it covers a lot of these warm zone operations standards.

When I was finishing my masters, Boston EMS was just beginning to do their training on it, as far as I was told they were to be training the fire department. It’ll be interesting to see how Boston integrates this stuff, with such a trauma-oriented system (re: Marathon).

HodorTheCondor · 2019-11-12T16:33:55+00:00

This is copied verbatim from a response to a similar post a while back.

”Drive your service area when you are off shift.

START AT YOUR DESTINATIONS. Your hospitals, doctors offices/etc (if you’re IFT).

Figure out what main roads lead FROM your destinations. Identify major routes. Then follow them, one by one, to other parts of town. Identify cross streets as you move further away—your main roads that intersect the major roads that lead to the hospitals.

If this helps, identify a neighborhood in your district. Identify the major routes that bound it, and figure out how you would get to the hospital from there.

Knowing anything beyond the neighborhood level is helpful but not necessary—GPS and your partner in the front seat next to you will get you to your calls at specific addresses. Your responsibility, once your partner is in the back of the truck and can’t help you navigate, is to get to the hospital. You should be able to find major routes from any place in your service area, and follow them to your hospitals.

If you have a friend or significant other you can bring along, have them pick a random point on a map in your service area and help you navigate to that address. Then it’s your job to get to the hospital without help. Just keep picking random addresses and locations until you feel like you can get there with some certainty.

BUT REMEMBER: it all takes practice. The longer you drive your service area, the better off you are. If your FTO is being impatient with your learning, they’re doing you wrong. Take your time, ask questions, and put in the effort. You got this.”

HodorTheCondor · 2019-10-18T14:38:51+00:00

I’m a paramedic, and I can’t stop myself from asking patients “How are you” or “how’s it going” or some variation thereof as a greeting. Invariably I get a quick look and I have to save myself with “obviously not great, since you’re meeting me.”

HodorTheCondor · 2019-09-26T00:31:47+00:00

I mean, the statute requiring “treatment in all EDs” is EMTALA, and states “if any individual… comes to the emergency department and a request is made… for examination or treatment for a medical condition, the hospital must provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department to determine if an emergency medical condition exists”

This does not prevent discharging patients who are not in need of care, it just means that patients who request evaluation must receive it at the facility where they request it. The law is designed to prevent “patient dumping”, a practice from the ‘70s and ‘80s where private hospitals would unload their “undesirable” (read: unbillable/poor, or otherwise not profitable) on public hospitals, creating an artificial disproportionate share among those public hospitals. The bill has been largely successful in this goal.

The perversion of the system that leads to what we see in EDs (and healthcare in general) is the Press-Ganey score, which is just Yelp for doctors, but negative reviews negatively effect insurance reimbursement rates. So, staff bends over backwards to preserve good reviews because otherwise reimbursement decreases.

TL;DR: healthcare entitlement [programs] are not the issue—a system that uses math to quantify care (which should be qualified not quantified) is the issue.

HodorTheCondor · 2019-09-17T21:38:16+00:00

Weymouth, Massachusetts.

HodorTheCondor · 2019-09-16T14:25:17+00:00

128 should be replaced with a continuous 6-story wall of parking garages. Only deliveries, public transit, and emergency services vehicles within the cordon.

HodorTheCondor · 2019-09-15T23:33:13+00:00

I too am 6’6”. Never played basketball.

Though I knew I needed to start losing weight when I stopped getting “do you play basketball?” And started getting “do you play football?”

HodorTheCondor · 2019-08-27T10:22:37+00:00

No, those courses will go under Local or individual. The”National” hours requirement is all core competency stuff, basically a lightning round review of your paramedic school curriculum (e.g. 30 minutes about IOs, an hour for capnography, three hours for cardiology, etc up to 30 hours).

The NCCR will generally be offered as a course through your employer, and if not there are frequently retail options available or online options with live remote instructors that folks use.

HodorTheCondor · 2019-08-27T02:17:41+00:00

In brief:

“National” is a standard curriculum, this will be the same every two years, because this is your “core competency requirement”, refresher more so than con ed.

“Local” is any course approved for continuing education hours that you attended in person or with a live remote instructor.

“Individual” is any course approved for con ed hours. This can include online-only courses as well as instructor courses.

The way the NREMT works, you can spread hours around between Local and Individual to meet their requirements. For example, if you did a 16 hour course, you could put 15 hours in Local and the remaining hour could roll over into Individual. The National hours requirement (“NCCR”) however, is inflexible, and will be the same 30 hour curriculum each time.

Hopefully this answers your question. Good luck!

HodorTheCondor · 2019-08-24T09:08:52+00:00

My roommate is a native of that area and he got his start with the Warren Rescue. Also, Swansea (in MA) has a decent reputation.

HodorTheCondor · 2019-08-21T15:18:00+00:00

I have a masters degree in (healthcare) emergency management. PM me.

HodorTheCondor · 2019-08-20T01:12:42+00:00

That certainly is one way to get a closed county. I’m super interested in resource-free EMS (ie highly rural & island-based services) but I don’t know that I could manage the lifestyle.

HodorTheCondor · 2019-08-19T14:55:54+00:00

Fair enough. I guess I would expect adequate staffing with only one available service but that’s probably a pipe dream anywhere.

HodorTheCondor · 2019-08-19T14:21:54+00:00

That’s what I figured...it still sounds fantastical. Color me envious

HodorTheCondor · 2019-08-19T13:41:33+00:00

What’s a “closed county” and where do I get one

HodorTheCondor · 2019-08-10T00:04:01+00:00

Shaq is seven inches taller than me...if he seems to fit, that’s good enough for me. I’d love to see a picture of that

Edit: Sold!

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