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[audio:26_MoreConference.mp3] (55:54) We talk some more about things Ron learned at the Texas EMS conference. He asks, “Doesn’t anyone know how to take a BP?” Find out what Ron’s favorite condition is, and everything you wanted to know about it.
We also discuss drawing blood on the ambulance and how hospitals feel about it. And to stir up some controversy and reflect on another EMS conference panel, we talk about paramedic initiated refusals.
Listener Questions
I’m in training to be a paramedic in Perth, Wsestern Australia, with St Johns Ambulance. Our program seems to run very differently from yours, in that we have 6 months and 4 rounds of interviews and fitness tests to get into the program. On top of that, you cant study to be a paramedic outside of the program. The benefit is that once you are accepted, you have one year of full time university study, then you have a mixture of practical and theoretical studies over years two and three, while working full time in an ambulance as an ambulance officer, working under a paramedic. We dont have levels of EMT here, you are either a paramedic, or you arent. Technically we do have patient transport (a touch lower than EMT-B), and critical care paramedic, a fairly standard role. So at the moment I am at the end of my first year on the road, I have 18 months of university left, then a year of internship, then I will (hopefully) be a paramedic with a Bachelor’s Degree in Paramedical Sciences.
Anyway, enough blathering, my question is probably not isolated to our fair city, and it is about the handover. We supposedly follow the DeMIST procedure, which is patient details , mechanism of injury, injuries sustained, and treatment given. My problem is that I usually get about halfway through it when the triage nurse cuts me off, with a 50/50 chance of them making a bored/sarcastic comment about . What is the key to giving a good handover? How do you keep the other people interested enough to listen to the whole thing? And how the hell do you remember everything and not get lost halfway through? Have fun at the EMS conference, cant wait to hear the next update.
Simon from Australia
Mentions:
EMSCat.com
JBLearning.com
NREMT
EMT Achieve for both Basic and Paramedic.
Happy Medic
Excited Delirium EMSEduCast episode
Subscribe or review on iTunes.
Some great information on Excited Delirium on Episode 72 of the EMSEduCast http://www.emseducast.com/archives/444
Yeah Greg that was where I first heard about it. I’ll add a link to
the post. We mentioned that episode a few weeks ago as well.
Ron
Ron / Kelly
Don’t get me started about the problems with EMSCat. I understand the premise of the program ( as a tool to help you prep the written portion of national registry). The only problem with the program is that it just tells you if you “pass”, “maybe” or “fail” for each module. It does’t tell you what questions you got right or wrong. We use it extensively at the college I go to now while I’m taking EMT-B course. Our basic lecture instructor uses it to write his Module exams instead of the text book we have. It it really hard to prep for a module exam using EMSCat when you dont know what questions you got right or wrong or how to work on any weaknesses. Fortunately, one of the owners of EMSCat just became our clinical coordinator this fall. When I have our required meeting as part of my class, I intend to have a discussion with him about this. I also know from having talked to other classmates & even some paramedic students, they all have the same fustrations with the software.
Question – BP cuffs. Is there a trick to fitting the cuff around the arms? I know this seems like an oddly basic question, but let me explain… the cuff, when you wrap it around as intended, is a cylinder. In my experience, about 80% of pt’s have arms that taper drastically from the shoulder to the elbow. So, the cuff is tight around the proximal arm, but REALLY loose towards the elbow. In a lot of these cases, the cuff just slides down the arm while you are inflating it. So, is there a trick to this or is it just one of those things you have to deal with?
Since Scott has not only shot himself but been tazed before, I thought I would ask his opinion on the pain question. He says it hurts more to be tazed (he was tazed in a class, for the record) UNLESS there is bone involvement with the GSW. He shot himself through his leg, but did not hit the bone and says he did not feel the wound for several minutes. Long-term though, a GSW ends up hurting more. Hope that helps!
Thanks for sharing that info, KJ! I am prepping for my EMT NR test and was going to go check that out, but if you don’t get feedback, I am not too sure it will be helpful.
Interesting KJ. They were primarily there to sell the EMSTest(?) product for educators, but when I mentioned I was a student he told me I should check out EMSCat. Looking at the site it was hard to figure out how it would work.
I used JBLearning for my EMT-B studying and one of the things I liked about the review exams was it not only told you if you were right or wrong, but gave you explanations about what was right and wrong about each answer.
CAT testing is pretty strange and I’m not sure it would even work in an academic situation. How do you determine a grade if not everyone gets all the questions?
No expert, but it seems you could attach the cuff with a bit of angle in the distal end. So the artery line would be straight, but at the end of the wrapping you’d angle up as you Velcroed it in place.
Kelly’s idea of putting it on upside down may help too, though you get funny looks and the occasional comment. I also always seem to end up with the tubes running right down into the AC when put on right side up.
I would in Victoria (Australia), We have been running a trial with Ketamine. Unfortunately I am unaware of the current results of the trial but will try to find out if your interested
ems-national-training.com its a great prep source for nremt good luck
Great! That’s what I am currently using.
Well, I tried the upside down thing and that works great… if they aren’t cylindrically challenged. Gets all the tubes out of the way very nicely. I wasn’t sure if angling the cuff would impact the pressure readings…
Ron
If I understand the testing making portion of the program, you can select which module you want to get the questions from & how many questions you want. All our lecture prof does it print all the questions from a particulal module and use that as our test. I will have to look at JBL learning and the other test prep programs. BTW who did you talk to from EMSCat??
KJ:
Thomas Gottschalk. I also gave him a number of Newbie CDs that he was going to give to his students.
I updated the post to include two other test prep sites and a book that was mentioned in the podcast.
I know Tom he is the interm clinical coordinator for the college I go to. Tom is a great guy & very helpful for me. I’ll have to ask him about you meeting him
We use Ketamine (pronounced Ketameeen here 🙂 in Western Australia (and yes, I am one of Simons colleagues!). We are only allowed to use it in pain originating from traumatic injury…but boy does it work wonders there. Can share a little more if anyone is interested.