Medical skills preparedness

[Tower43]

Exactly. Easy to jump to conclusions though when someone has the appearance of a potential addict... Could possibly be anaphylactic shock or hypoglycemia. I've had to intervene when a medic was trying to give narcan to a guy having an allergic reaction that was swelling his tongue. Narcan itself wouldn't hurt, but not treating the actual issue could kill the patient.

A problem here "narcan itself doesn't hurt."

No medication is 100% benign and "doesnt hurt." ALL meds have a potential to cause harm.

In fact there's a reason we're pushing to get ems providers to stop just slamming narcan.


Give it when it's needed, but not just because.


A local ED also asked my agency to stop slamming these people with narcan... apparently theyve had a rise in OD calls that develop Flash Pulmonary Edema 2ndary to rapid narcan "slams"

 

[teratos]

In your office, perhaps you have dozens of doses. Few people have access to more than one dose - period. Most ambulances only carry one or two on the road.

I still disagree as personal experience proves you wrong. Feel free to continue bloviating, as per usual.

Doc... Ive been a paramedic for 12 years. an EMT 3 more on top of that. I'm not wasting my time with some watered down nonsense from some clerk at the health department because theyre too inept to realize I'm much higher trained than they are....

I’m just telling you how to get free Narcan. I didn’t once pull out a ruler. I took the class. I’ve been a physician for 23 years. I got free Narcan. I carry 2.

 

[Tower43]

In your office, perhaps you have dozens of doses. Few people have access to more than one dose - period. Most ambulances only carry one or two on the road.

Wrong. The standard is more than 1-2 doses... In fact....Bare minimum BLS is 4 mg (and we dose at 0.4mg per "dose"), and 6 mg for ALS. And in MoCo we carry double that PLUS we have leave behind kits (MoCo piloted the leave behind program that MIEMSS just approved for the entire state). On any given call, with the ALS Engine and a BLS transport, we have AT LEAST 10mg of narcan available. Not sure where you got your #s, but I literally live this shit day in and day out.

 

[Tower43]

I still disagree as personal experience proves you wrong. Feel free to continue bloviating, as per usual.

I’m just telling you how to get free Narcan. I didn’t once pull out a ruler. I took the class. I’ve been a physician for 23 years. I got free Narcan. I carry 2.

That's ok if you've got the free time.... The health dept here GOT THEIR NARCAN FROM US initially... I am a single earner income and very busy, taking time out of my day for a 4hr class on narcan that I could teach without even preparing for it... isn't worth my time. I keep a BVM and Pocket mask in my car... better options anyway because I can assist more than just opiate ODs

 

[Tower43]

It's not uncommon to roll up on an OD that PD or Civilians got there first and they've jacked these folk with 16mg + of narcan before we got there... frankly, narcan needs to go back to being higher level clinicians only.
Everyone always talks about the accidental child or elderly overdose... know how many of those actually are calls? Statistically very few.... if any, per jurisdiction. MoCo runs 90,000+ EMS calls a year, I think maybe 1 or 2 last year were accidental overdoses to opiates

 

[teratos]

That's ok if you've got the free time.... The health dept here GOT THEIR NARCAN FROM US initially... I am a single earner income and very busy, taking time out of my day for a 4hr class on narcan that I could teach without even preparing for it... isn't worth my time. I keep a BVM and Pocket mask in my car... better options anyway because I can assist more than just opiate ODs

I have an intubation tray, a MAC 3 blade and a Miller blade. I need to buy an ambu bag.

 

[BurkeM]

Wrong. The standard is more than 1-2 doses... In fact....Bare minimum BLS is 4 mg (and we dose at 0.4mg per "dose"), and 6 mg for ALS. And in MoCo we carry double that PLUS we have leave behind kits (MoCo piloted the leave behind program that MIEMSS just approved for the entire state). On any given call, with the ALS Engine and a BLS transport, we have AT LEAST 10mg of narcan available. Not sure where you got your #s, but I literally live this shit day in and day out.

Location, location. You’re working in one of the wealthiest counties in the nation.

Many other jurisdictions are less generous with meds.

Private ambulance crews typically have none.

 

[BurkeM]

I still disagree as personal experience proves you wrong.

What ambulance do you ride? What station in what county?

You’re experience as an MD is different from what an EMS crew deals with in the urban and rural areas of the nation, other than in the wealthy jurisdictions (like Howard, MOCO, Arlington).

 

[BurkeM]

I'd beg to differ. I do QA/QI... and Im now working on a quick refresher on narcan for our 1200+.providers.... bc we suck at giving it only when appropriate...and we're the "professionals"

The quality of care in Montgomery County is extremely high. You and the other Paramedics there are world class, and deserve more recognition than you get.

Many other jurisdictions are way below your standards.

You would be appalled if you were allowed to do ride-alongs in DC, Baltimore and some rural jurisdictions in the greater DC Region.

 

[Tower43]

The quality of care in Montgomery County is extremely high. You and the other Paramedics there are world class, and deserve more recognition than you get.

Many other jurisdictions are way below your standards.

You would be appalled if you were allowed to do ride-alongs in DC, Baltimore and some rural jurisdictions in the greater DC Region.

I worked EMS in the city.. it's a mess up there (Did Johns Hopkins)
I volunteered in PG and Calvert, worked mutual aid to St Marys.... the first two aren't horrible, the last... you'd be better served hitching a ride with the amish

 

[Tower43]

Location, location. You’re working in one of the wealthiest counties in the nation.

Many other jurisdictions are less generous with meds.

Private ambulance crews typically have none.

If a private EMS crew doesn't have any, they're not legally operating as an EMS unit. BLS is required IIRC 2mg, ALS is 4mg; I dont want to pull up the SOCLAR atm lol... but they're required to maintain those to be licensed... if you find one without you should drop a dime to MIEMSS

 

[teratos]

What ambulance do you ride? What station in what county?

You’re experience as an MD is different from what an EMS crew deals with in the urban and rural areas of the nation, other than in the wealthy jurisdictions (like Howard, MOCO, Arlington).

My experience absolutely is different. That does not make my opinion on this matter invalid.

 

[BurkeM]

I worked EMS in the city.. it's a mess up there (Did Johns Hopkins)
I volunteered in PG and Calvert, worked mutual aid to St Marys.... the first two aren't horrible, the last... you'd be better served hitching a ride with the amish

Ah, you do understand.

 

[Nosce Hostem]

In light of the Texas shooting, brush up on your skills and kit.

I EDC a large CLS pack in each of my vehicles that I put together myself as a just incase. I'm still trying to find a good source of pre-packed kits that aren't complete garbage.

I picked up a highly reviewed "large" trauma kit from MedicalGear Outfitters to use with my range bag, was a total waste of money. They took forever to deliver and then had a hand written note that they were out of chest seals due to supply chain issues that they would send when they can, that coupled with the really poor quality of some of the supplies, and needing to add some quick clot and wound packing gauze, and more tourniquets (only comes with one in a supposed trauma kit) it left a heck of a lot to be desired.

But to the Texas thing, have also started teaching my oldest who is 5 1/2 and about to start Kindergarten the very basics of traumatic injury management, HATE that I have to teach him what to do incase he or a friend is seriously bleeding in school and no one is there to help, but its the world we live in I guess.

 

[BurkeM]

My experience absolutely is different. That does not make my opinion on this matter invalid.

Perhaps you misunderstood my earlier comments.

Every life is important, every patient deserves the best treatment possible. Even if the life threatening condition may be self inflicted. We save who we can.

 

[Glaron]

I will ignore Doctors when I think they are wrong.

 

[smokey]

I EDC a large CLS pack in each of my vehicles that I put together myself as a just incase. I'm still trying to find a good source of pre-packed kits that aren't complete garbage.

I picked up a highly reviewed "large" trauma kit from MedicalGear Outfitters to use with my range bag, was a total waste of money. They took forever to deliver and then had a hand written note that they were out of chest seals due to supply chain issues that they would send when they can, that coupled with the really poor quality of some of the supplies, and needing to add some quick clot and wound packing gauze, and more tourniquets (only comes with one in a supposed trauma kit) it left a heck of a lot to be desired.

But to the Texas thing, have also started teaching my oldest who is 5 1/2 and about to start Kindergarten the very basics of traumatic injury management, HATE that I have to teach him what to do incase he or a friend is seriously bleeding in school and no one is there to help, but its the world we live in I guess.

Kids learn well through role playing. I taught my sons very young(like 4 young) how to use TQs, splints, and some basics about wound care(burns vs cuts and all). We just did some games where they'd be in charge of medical response(after a brief lesson on TQs).

My 7 year old is a very good reader, so I just bring him home my medical training books whenever I get them from a class or stuff at school. He's got a few in his bookshelf and a quick reference book for 1st aid in his school backpack with his kid version of a 1st aid kit(pretty much a mint tin with various bandaids). He brings out the books fairly regularly to read through at bedtime and likes showing off knowledge when we're going on walks or playing.

Kids suck up knowledge so damned readily that there's not much need to make the knowledge transfer scary or dry. Hiding it in play works well... with the caveat that I need to be there if they're using anything more than a bandaid.

 

[Crosseye Dominant]

If a private EMS crew doesn't have any, they're not legally operating as an EMS unit. BLS is required IIRC 2mg, ALS is 4mg; I dont want to pull up the SOCLAR atm lol... but they're required to maintain those to be licensed... if you find one without you should drop a dime to MIEMSS

MIEMSS told me to sniff alcohol pads whenever nauseous. Good to know since I was using narcan to help with carsickness.

 

[DadOSix]

naloxone training classes can now be done virtually.

Google : orp training (county) Md.

Allegany runs once each month.

Several others run weekly sessions.

Not sure how long a session runs.

And - many pain management practices issue narcan rx on the first visit and renew that each year, or sooner, if the dose was used.

 

[Tower43]

MIEMSS told me to sniff alcohol pads whenever nauseous. Good to know since I was using narcan to help with carsickness.

The isopropyl alcohol thing actually is based in science lol