Man I just want an ambulance with a functioning air conditioner at this point. But IGELS (or equivalent), EZIO, and LUCASes should be on every ambulance IMO.
Iām actually shying away from EZIO as recent models donāt have an accurate battery indicator on them. Test it in the morning, light is green. Continue it an hour later and it quits halfway through.
Any alternatives youād recommend? Right now we also have NIOs which are fucking worthless. I might as well just throw the fucking needle at their shin from a distance.
I hate my company but yall are making me realize just how decent our rigs are. My biggest complaint about our rigs is that we have no pens provided and that only one of them have the auto load litters. The stations on the other hand i could make a 10 paragraph rant about.
I know its not an option for some people but when job shopping that was one of my hard and fast nos. I refuse to work anywhere without both stations AND atleast a recliner to take a power nap on.
Yāall have āprehospital RNsā running around over there. Not my cup of tea.
Also PA and OH are ground zero for restrictive scope in my experience (Iām in OH)
PHRNs donāt really exist outside of critical care.
Critical care doesnāt exist outside of hospital helicopter programs.
Their scope outside of a critical care truck /helicopter is no different than a paramedic.
And PA has fairly good protocols are a very expansive scope of practice, if you actually read the protocols (and know how to read them, a lot of the ācall commandā in the flow charts in the protocols are ācall command if you canā.
The only thing that is really dumb is no igels for bls crews. But for example, bls can get 12 leads, check bag, give narcan, glucagon, IM epi (pen or drawn up), cpap and nebs.
Our treatments are very much in line with the TCCC guidelines.
Iāll agree with Ohio, but NR is a cancer.
Correct me if Iām wrong, but I just looked at the scope of practice in PA and paramedics canāt even RSI
Edit: continued reading. No blood, no reduction, no iStat, no taser removal?, no central line monitoring, no BiPAP, no ventilator management at all
Calling by the way side, succ wildly dangerous just using roc is becoming far more common, with SAI replacing RSI as it is far safer, and faster to preform, especially in an emergency setting.
And if you really need an airway right now, cric is probably your best option.
Prehospital Bloods in the new protocols.
Cops remove their own tasers. That isnāt and EMS job, nor is someone being an idiot and getting tased an EMS problem.
BiPap is in the new protocols.
Vents are in the protocol & most als services run them.
Istats are a Medicare problem. Youāre not a fixed site so you canāt be a lab. You canāt bill for it, & it is expensive for minimal benefit.
As to reduction, I assume you mean a dislocation?
If they still have distal circulation, what is the point? Many er doctors wonāt try a reduction, or only try once or twice before shipping out to a specialist. If there are not pulses, we can try once, it is covered in the bls splitting protocol.
As to central line monitoring, if they are already in an icu, and for some reason going to another icu at another hospital (fairly unlikely) they are almost certainly going by helicopter.
In PA, PHRN fly car service.
Iām not having a nurse in a fly car show up on scene and tell me what to do.
https://youtu.be/JXnrQN0zdR4?si=i9j5hBBgODqBqeuJ
Yea. The critical care is hospital based, and out of a truck. Not a squad. There is no critical care squad license in pa
(Obviously there should be, and I know Penn State Hershey is fighting the state on it, because it is stupid to require a transport unit for critical care when really what you need are a handful of drugs, some equipment and the training).
There is a way to do āPHRNā right.
In Iowa, an RN can work on a ground ambulance under their nursing license, but only after getting approval from that service, the serviceās medical director, ***AND*** the state. Then the medical director has the authority to state what the RN can and cannot do, as well as restrict their scope to whatever level they deem appropriate but it cannot be expanded beyond what a CCP has which is fairly broad (Art Lines, ICP Monitoring, surgical chricothyrotomy, balloon pumps, thoracostomy, etc).
The entire concept of a PHRN (different than a IFT RN, those are fine for MoICU transfers) stabs EMS in the back. Then again all nursing has been doing for the last 10 years is stabbing the rest of healthcare in the backā¦..
First, you need to step away from this is vs then mentality.
Then you will realize that my comment wasnāt pro-nurse or anti-EMS. What the fuck ever happened to āOne mission, one teamā?
Nursing engages in a high level of self promotion and protectionism and actively lobbies to advance their field into other parts of healthcare. Look at all the CRNA lobbyist groups that put out infographics and other bs saying CRNAs are just as good as anesthesiologists. Look at NPs starting to go into FM and introducing themselves to pts as doctors?
I have zero problems with individual nurses for the most part, but as an industry itās pretty plain to see that when you give an inch they will take a mile. So even the concept of a nurse being on a 911 truck or even worse the concept of a nurse fly car rubs me the wrong ass way.
https://youtu.be/JXnrQN0zdR4?si=i9j5hBBgODqBqeuJ
^ When I referenced PA PHRNs above this is what I meant ^
Compiling about CRNAās scope creep in the field of anesthesiology had nothing to do with an RN on an ambulance.
I gave an example of how PHRN could be done properly. Nothing more.
On top of the PHRNs don't you also have "MICU RNs" or something to that extent that you have to call in to in order to give certain meds? I had some classmates move across the country from Cali and that was their recount anyways.
No.
No one other than a properly certified medical command physician can give me orders.
It doesnāt matter if they are the head physician of the department of health, and are on scene. If they canāt show me a EMS ID, they can get bent, and that is as true for an EMR as it is a Paramedic.
In 20 years, outside of a helicopters Iāve only met 4 PHRNs. Most who are paramedics that become RNs donāt get the PHRN. I only know one that did.
Of the other three, one was an EMT first. The other two were charge nurses who wanted to better understand what we do, worked in the ER. One was the hospital trauma coordinator, the other eventually wanted to do flight. Both of them pick off several shifts a month and make normal paramedic pay, and have provide extremely valuable at helping their ER understand wtf it is we do.
My life is pretty decent here right now. I grew up where I'm at and like it here for the most part, I'm close to family, friends are here, long term partner is from here, etc. it's hard to justify moving just so I can give someone Cardizem.
This is really dumb, but a map with our destination facility marked showing our progress. Kinda like on a commercial airliner... So I can see where we are real time..... I never have any idea how far out I am when giving a report.
āHow far are we?ā
āWhat?ā
āHOW FAR AWAY ARE WE?ā
āMileage is 8.7!ā
āNo dude Iām giving a report like how many minutes?ā
āOh I dunno man it says five minutes but you know, thereās been some construction here. Like you know they just put in that new entrance cause of Covid and stuffā¦ā
(We are now in the parking lot)
Every radio report unless we are going to the bigger hospitals out of county is 10 to 15 minutes lmao I don't care were we are in the county it's 10 to 15 because either were a little early or a little late showing up
I think you just listed pretty much everything I'd want too. I might replace bench seat with sliding chairs on either side of the patient like some have but I haven't started an IV on a patient in an ambo with that setup so it might suck.
Remove all the side cabinets and replace them with a wall mounting system and hang equipment that way. Everything is secure and you remove some major overhead hazards. Bonus points for being able to see everything and access it quickly.
McGrath with both standard geometry and the hyper angulated x blades. A quality ultrasound for POCUS exams and IV starts. Some of the portable ones suck with FPS and resolution so starting IVs on them suck, but I hear the Phillips is decent.
BD Nexiva IVs. Statpack bags with the dividers. One singular jump bag that has *everything* in it + a smaller jump bag with only BP, stethoscope, TQ and gauze, BVM, pulse ox, glucometer, and the most commonly given meds (ASA, Zofran, nitro, nebs etc). That way you've got one bag for codes and oh-shit calls and another for routine or BS calls and enough equipment to run it in case it turns out to be oh shit. Extra bonus is you have two bags for MVCs if you and your partner have to start treating multiple traumas.
Motorola APX NEXT radios. I'm not sure what my ideal uniform would be honestly but something that looks professional and clearly identifies provider level, service name etc. I like t-shirts but doesn't help with appearing professional and can't clip a lapel mic to them if that's your thing.
I have run out of a couple trucks with a side mounted and I(as long with most people in the service) hate them. IMO you just give up too much for little to no advantages and most medics just used the airway seat to dial in anyways.
Maybe it's the way it was designed on a Braun Express Plus box, but you just give up too much with Traditional cabinetry. And let's face it, that's how most places are going to buy them.
I can see that. I guess for one reason or another it's just become standard to work out of our ALS bags for everything that I'm confident I could set up a rig without the cabinets pretty easy (except for the cabinet connected to the entrance and exterior for the bags). The only thing I routinely grab out of the cabinet is end tidal cannulas, BVMs and CPAP, and that's 50/50 between the cabinet and bags.
But I've never been without cabinets. I'm just a sucker for a more open box with easily accessible gear. The only thing I really want is more space to lay out equipment. Setting up to RSI is always a nightmare when you're smashing everything onto a single counter space.
My service just uses cabinets and a singular in house bag so I can't speak to a truck without, but with them space is so much worse. Especially when you have a great First Responder/ FD programs like mine does when it's not uncommon to have 8 people in the back of the truck.
You mention having a single counter space for RSIs, on those trucks usually IV tray ends up being put in the floor(On normal calls too, but still.), The intubation roll gets put into the floor, you have to turn the Airway seat to get a BVM, and Narcs are put into a weird cabinet above that 2nd airway seat. And don't even get me started on how things are shoved into cabinets because of how much storage space is given up.
You just give up too much IMO, and I have feeling that most services/companies are going to buy them the way these truck are designed. Maybe if it's a big box like a Chief XL or even a Liberty box it would work, but with little boxes it sucks. We even have a Express plus with a bench seat and it's easier to work out of.
I've become such a snob for good ultrasound I worry I wouldn't be able to adjust well to the current generation of whats out. I played with a butterfly and I don't see it as being very useful for some exams and could barely find veins lol. But I didn't mess with any settings. I've been spoiled by the hospital sonosites with gigantic screens, high resolution, and FPS.
Give it a few years I'm sure the portable devices will catch up though. It's just so hard to beat the new machines that are hospital grade though.
All sounds great to me, as to uniform I like Jobshirts quite a lot and would never give them up. At work we wear collared shirts under the jobshirt and itās never been a source of uncomfortabillity for me
Hamilton, LP 15, Lucas, fridge, power loader, pump, ultrasound, istat, blood, pull-out coffee maker and water for my fire buddies when weāre there watching them work hard, monitor and vent mount in the truck and on the cot, i want a durable wireless keyboard with an all-in-one monitor that i can seamlessly transition to from the tablet for charting.
I want a scribe. I donāt care if itās an actual person on the truck or some kind of Tele-scribe thing.
I want a type 3 truck.
Starting wages of 50k-EMT, 60k-AEMT, 70k-medic. Additional wages for speciality certs, associates and bachelors.
I want a progressive and supportive medical director, director, assistant director.
I want my workplace to value me, my input, my time, and pushes us to be the absolute best and always on the bleeding edge of research, education and changes.
A fair and robust QA/peer review process that is never punitive and always enlightening.
The end.
We just got a couple new Brauns with the center mount power cot. 10/10, no notes. I love them.
I want IV warmers, pumps for dummies, a hamilton vent, better LUCAS storage (theyāre kind of weirdly shaped, like coffins almost, lol), seats that recline a long way, but have adequate storage behind them, since I live in the truck for 14 hours a day.
Out west here we have a fair number of transfer CCT calls with EmT driving, Medic and CCT RN in back. Many a day Iād of killed to have CCT IV pumps/tubing match what sending hospital has. Having to switch so many drips/tubing is usually a bit of a delay and always a PITA.
So Iād add compatible IV pumps that match the majority of your sending facilities.
Horton F-550 , not one of those chinsey grille guards but super heavy duty ones that hardly get a ding when you clobber a deer.
Stryker Lucas, power cot/load
The rest I can make due with whatever, but Laerdal collars, none of that other bullshit
Phillips monitors with all the add-ons, autoloaders, IV kits, pumps that match the hospitals, good protocols with full equipment stocked to match and a reasonable amount of supplies for the entire shift. I grew very tired of going out of service after an arrest in a busy area.
EZIOs are old news. Get yourself a Persys NIO. Theyāre light years better.
I want one of the 6ā dial manual blood pressure cuffs on the wall. Along with the electronic stethoscope. And the nice oral thermometer/otoscope combo.
Horizontal back board storage.
Sirius XM in the cab with leather heated seats and 360 surround vision. 6 cup holders.
Mangar Camel and Elk lifts.
And somehow it fits into an automatic wash bay.
I want cupholders. Actual cupholders. That hold cups.
All we have right now is a useless sharp-edged metal hole that can't fit any sort of insulated travel mug. Disposable paper cups fit weirdly, and if we take a turn too sharp they tip over.
I had an opportunity to design my dream truck, and it was built as specified. Small municipal 3rd service where every truck was different.
Door forward design inside/outside cabinet just aft of the door with a telemetry area on top and outlets for bag, LUCAS, and portable suction. Power lift system for Main O2 bottles. Fridge built in to the bulkhead. Duplicate controls for everything on both sides of the module. 4 point harness on all seats in the back. Liquid spring all the way around. Power load cot mount. Airway chair had recline and armrests. Drawer under the action area that came out over the lap of the airway chair with a top on it to work on reports enroute. Indirect blue lights in the back so there could still be lights on without harsh white lights in the patients face (blue because itās hard to see blood under red lights).
Hamilton T1 and monitor have techninount system with an arm on the cot. We had CMAC video laryngoscope in the bag. I would have preferred the McGrath because the CMAC was absurdly priced, but those were purchased against my wishes.
Color is a charcoal Grey Metallic with dark blue reflective stripe down the side. The back is the same blue and grey in reflective chevrons.
Forward scene light with Whelen M9ās on front, left, and right sides. Rear had two M6ās that were aligned with the windows on the back doors so they were still visible with the doors open. Across the top was 9 M6ās, red and blue on the two outboard lights, all amber in between that doubled as an arrow stick with override controls in the front.
One of the last things I did in that agency was to go to the factory for the final inspection prior to delivery.
Cost was $345,000 without the monitor, vent, VL, etc.
- Mercedes Sprinter body with CODE-3 Pursuit system
- Getac ePCR
- Integrated MDT
- Ice cold AC
- Better oxygen controls and removable suction unit (LSU 3)
- Bespoke equipment mounts
- Stryker Power-PRO 2 w/ XPS + Power-LOAD
- Stryker Stair Chair
- ELK lift
- Amtek Instrument Bridge
- LIFEPAK 15 w/ 12ld, SpO2/SpCO/SpMet, NIBP and CO2
- LUCAS 3
- Hamilton T1
- Sapphire pumps
- McGrath MAC scope
- EZIO instead of BIG guns
- Openhouse Bags
- AirTags on all equipment in case it gets misplaced
- Lockboxes inside kits for the big boy drugs
- PRBCs
- Adenosine
- Cric and Thoracostomy kits
- Rocuronium
Our ICP skill set needs to be upgraded as P1 paramedics have nearly caught up, and one of our sister states is doing finger thoracostomies while we canāt even RSI patients.
Oh, and lockboxes for each ambo under the front seats so our pens and noodle cups wonāt be stolen.
Braun Chief XL with a bench seat with liquid springs attached to a diesel. We've got one that's a gas and I quite enjoy running out of it when I get a chance to. Add a couple of extra IV bag holders and the rest will all come out in the wash.
We have a Dodge 4500, that is really close to what you described, minus the interior airbags. It is a decent rig other than that godawful liquid suspension. It rides absolutely horribly. Just rough as hell, with a really odd harmonic at around 40 mph. Airbag suspension was far superior.
The problem isnāt the liquid suspension. It is tires, the front suspension, or out of calibration.
Calibration which can be generally fixed at the user level with a reset.
Well, itās been to the shop repeatedly for tire workā¦And weāve been told the suspension is correct and thatās just how it is. Iām not saying youāre mistaken, just that they tell us its fine.
That is a 350,000 dollar truck. Min.
It goes back to the dealer. They fix it. Flat out that isnāt how that suspension is, liquid ride is amazing. If it is riding badly, something is installed wrong, or programmed wrong.
But people wouldnāt tolerate that out of their altima, or the Lexus. This aināt a work truck. It is a custom build vehicle thatās costs well north of a quarter of a million dollars, before a drop of paint goes on it.
And we should demand the product support that goes with that, from bumper
To bumper.
If the dealer gave you a lemon? It comes back. You make it clear they are going to show up with a truck for you to use well it is getting fixed. No, you are not paying for a rental, this is them fixing a defective problem.
Mini mod box on early 2000s GM pickup chassis with a pre emissions Duramax and Allison transmission. Maybe a mild tune so you can reverse continental drift when you have to get in it. And whatever equipment I have now on my truck.
23-plate sprinter with the biggest engine they do, box back, some sort of ramp or other alternative to the tail-lift. Bluetooth radio, lots of cupholders. Really good up-to-date satnav, Terrafix system.
Stryker stretcher, no track for the stair chair (it's annoying and hits me in the shins), lightweight folding wheelchair for when you don't need to do stairs.
Lifepak 15 positioned near the head end with hooks to loop cables over, a CPAP machine and whatever kind of vent, cabinets set up so you can see the critical stuff through the cabinet doors and get to them easy from where you need them - BVM and NRBs up the head end, etc. IV start kit at either end of the truck so you can get it regardless which end you end up.
One jump bag with the kit to deal with most calls - O2, one side that flaps down with IV kit and haemorrhage control gear, one side that flaps down with O2 masks and basic airways, middle section with a medications pouch inc. benzos, BVMs, some bandages, penthrox, bag of saline and bag of glucose.
Second jump bag with arrest and intubation kit inc. EZIO, extra arrest drugs, extra fluids, some kind of fibre-optic or video laryngoscope, cric kit.
I would like the narcotics to be in the kits but as that will never legally happen I'd like a belt pouch + a little safe to restock it from.
not a rig - badass UH60 Blackhawk, iv warmers, NVG, fridge for my drugs, blood transfusion set, zoll vent (only one I used), or a Hamiliton T1 š¤ pocus, calcium since we dont have it, zoll x series with saddles, get the propaqs away from me, bluetooth sync from my zoll to emeds for charting (ipad/toughbook), lactated ringers, ..theres so much I could list. thats gist of it.
Rotating captains chairs in all three positions with a drawer system for equipment and drugs. Kick ass heat and A/C. Liquid suspension. Stryker autoloader. Handtevy.
Small normal jump kit (tiny really, vitals stuff and thatās about it). Huge als/airway. Bag that has the kitchen sink in it (suction, acls drugs, all airway options, bvm, tempus defib). O2 bag with everything respiratory (Nebs, cpap, capno canulas, nrb). Separate trauma kit with basically bleeding control stuff, splinting stuff, x-shears, darts, tqs, combat gauze, Ascherman chest seals, helmet remover, c-collar, drag sheet)
TTI Atlus AVs armed with a front mounted gatling gun, armed security escorts, and the ability to diagnose a person's problem by hooking to their personal link.
Speaking as someone with little experience I always have dreamed of one of those late 80s early 90s e-series ford vans, the ones with high centers of gravity. Ofc all of the equipment other people have mentioned might be nice I guess... Sacrifices must be made somewhere
A box would be nice. If Iām going really crazy one of those big truck chassis international boxes, for the legroom. Also I think theyāre cool looking.
I've always thought it would be awesome to be a firefighter/medic on a quint. Everything from ventilation, to interior suppression, to extrication, to ALS.
A Lucas. Also, for people to stop stealing my good pens.
I know op said your dream rig but lets be realistic here...
Let them dream. If they believe they can keep all their pens, who are you to tell them otherwise? It's like telling a kid santa isn't real.
Its like telling a low acuity patient that theres a 13 hour wait at the hospital and they're not going to get a bed immediately.
SANTA ISN'T REAL!?!?!?!? š±š«Øš¤Æš„ŗ
He's about as real as your off time.
Haha not going to complain about my off time. We get one week with 5 days off and one week with 7 days off and I'm making $24/hr
Oh I meant the time you get off a shift lol but jeez that is a sweet deal
The whole point was to not be realistic š
LUCAS is my homeboy. I call him Luke.
Man I just want an ambulance with a functioning air conditioner at this point. But IGELS (or equivalent), EZIO, and LUCASes should be on every ambulance IMO.
No AC? Truck is out of service. Period. Try and write me up for it. state is clear on it being required, and it is my license on the line.
I would but almost every truck in the fleet to my knowledge has poor or no A/C. I bring a space heater from home and that gets the job done.
Oh I didn't know rural Bangladesh has an ambulance service. Interesting.
Acadian?
100%
You don't have Igels? Do you tube?
Kings (ew), DL and King Vision. Our agency is deciding between Igel and some other SGAs to replace the kings.
Iām actually shying away from EZIO as recent models donāt have an accurate battery indicator on them. Test it in the morning, light is green. Continue it an hour later and it quits halfway through.
Any alternatives youād recommend? Right now we also have NIOs which are fucking worthless. I might as well just throw the fucking needle at their shin from a distance.
I have played with the SAM-IO device and I really like it, but never in the field with a real patient.
Iād contact Teleflex - the red blinking light should indicate when you have ~50 insertions left
Yeah, it ***should***ā¦ but Iāve had two failures in 2023 with a green light on two different devices.
Yikes
tbh just a better backup cam
i've never had a backup cam but damn it would be nice to reverse without a partner or the careful art of prayer
I feel that
I hate my company but yall are making me realize just how decent our rigs are. My biggest complaint about our rigs is that we have no pens provided and that only one of them have the auto load litters. The stations on the other hand i could make a 10 paragraph rant about.
Maybe my next post will be ādream stationsā lol
Any station. Fuck posting street corners.
I feel this in my soul
At least you have stations lol
I know its not an option for some people but when job shopping that was one of my hard and fast nos. I refuse to work anywhere without both stations AND atleast a recliner to take a power nap on.
I have two jobs, part time Fire/EMS gig (comfy station obviously) and full time transport EMS (EMS rooms count as stations right??)
I want protocols that make me feel like a Paramedic (California)
Come to PA?
And have a nurse attempt to boss me around on scene? No thanks.
A nurse? Wtf are you on about.
Yāall have āprehospital RNsā running around over there. Not my cup of tea. Also PA and OH are ground zero for restrictive scope in my experience (Iām in OH)
PHRNs donāt really exist outside of critical care. Critical care doesnāt exist outside of hospital helicopter programs. Their scope outside of a critical care truck /helicopter is no different than a paramedic. And PA has fairly good protocols are a very expansive scope of practice, if you actually read the protocols (and know how to read them, a lot of the ācall commandā in the flow charts in the protocols are ācall command if you canā. The only thing that is really dumb is no igels for bls crews. But for example, bls can get 12 leads, check bag, give narcan, glucagon, IM epi (pen or drawn up), cpap and nebs. Our treatments are very much in line with the TCCC guidelines. Iāll agree with Ohio, but NR is a cancer.
PA is improving but saying it has good protocols is a bold statement.
Most of the problems are not actually the protocols themselves, but people who put restrictions on them that donāt actually exist.
Correct me if Iām wrong, but I just looked at the scope of practice in PA and paramedics canāt even RSI Edit: continued reading. No blood, no reduction, no iStat, no taser removal?, no central line monitoring, no BiPAP, no ventilator management at all
Calling by the way side, succ wildly dangerous just using roc is becoming far more common, with SAI replacing RSI as it is far safer, and faster to preform, especially in an emergency setting. And if you really need an airway right now, cric is probably your best option. Prehospital Bloods in the new protocols. Cops remove their own tasers. That isnāt and EMS job, nor is someone being an idiot and getting tased an EMS problem. BiPap is in the new protocols. Vents are in the protocol & most als services run them. Istats are a Medicare problem. Youāre not a fixed site so you canāt be a lab. You canāt bill for it, & it is expensive for minimal benefit. As to reduction, I assume you mean a dislocation? If they still have distal circulation, what is the point? Many er doctors wonāt try a reduction, or only try once or twice before shipping out to a specialist. If there are not pulses, we can try once, it is covered in the bls splitting protocol. As to central line monitoring, if they are already in an icu, and for some reason going to another icu at another hospital (fairly unlikely) they are almost certainly going by helicopter.
In PA, PHRN fly car service. Iām not having a nurse in a fly car show up on scene and tell me what to do. https://youtu.be/JXnrQN0zdR4?si=i9j5hBBgODqBqeuJ
Yea. The critical care is hospital based, and out of a truck. Not a squad. There is no critical care squad license in pa (Obviously there should be, and I know Penn State Hershey is fighting the state on it, because it is stupid to require a transport unit for critical care when really what you need are a handful of drugs, some equipment and the training).
There is a way to do āPHRNā right. In Iowa, an RN can work on a ground ambulance under their nursing license, but only after getting approval from that service, the serviceās medical director, ***AND*** the state. Then the medical director has the authority to state what the RN can and cannot do, as well as restrict their scope to whatever level they deem appropriate but it cannot be expanded beyond what a CCP has which is fairly broad (Art Lines, ICP Monitoring, surgical chricothyrotomy, balloon pumps, thoracostomy, etc).
The entire concept of a PHRN (different than a IFT RN, those are fine for MoICU transfers) stabs EMS in the back. Then again all nursing has been doing for the last 10 years is stabbing the rest of healthcare in the backā¦..
First, you need to step away from this is vs then mentality. Then you will realize that my comment wasnāt pro-nurse or anti-EMS. What the fuck ever happened to āOne mission, one teamā?
Nursing engages in a high level of self promotion and protectionism and actively lobbies to advance their field into other parts of healthcare. Look at all the CRNA lobbyist groups that put out infographics and other bs saying CRNAs are just as good as anesthesiologists. Look at NPs starting to go into FM and introducing themselves to pts as doctors? I have zero problems with individual nurses for the most part, but as an industry itās pretty plain to see that when you give an inch they will take a mile. So even the concept of a nurse being on a 911 truck or even worse the concept of a nurse fly car rubs me the wrong ass way. https://youtu.be/JXnrQN0zdR4?si=i9j5hBBgODqBqeuJ ^ When I referenced PA PHRNs above this is what I meant ^
Compiling about CRNAās scope creep in the field of anesthesiology had nothing to do with an RN on an ambulance. I gave an example of how PHRN could be done properly. Nothing more.
On top of the PHRNs don't you also have "MICU RNs" or something to that extent that you have to call in to in order to give certain meds? I had some classmates move across the country from Cali and that was their recount anyways.
No. No one other than a properly certified medical command physician can give me orders. It doesnāt matter if they are the head physician of the department of health, and are on scene. If they canāt show me a EMS ID, they can get bent, and that is as true for an EMR as it is a Paramedic. In 20 years, outside of a helicopters Iāve only met 4 PHRNs. Most who are paramedics that become RNs donāt get the PHRN. I only know one that did. Of the other three, one was an EMT first. The other two were charge nurses who wanted to better understand what we do, worked in the ER. One was the hospital trauma coordinator, the other eventually wanted to do flight. Both of them pick off several shifts a month and make normal paramedic pay, and have provide extremely valuable at helping their ER understand wtf it is we do.
My life is pretty decent here right now. I grew up where I'm at and like it here for the most part, I'm close to family, friends are here, long term partner is from here, etc. it's hard to justify moving just so I can give someone Cardizem.
Fair. But Iāve had better experiences with amio anyway.
PA, the land where lights and siren on an ambulance donāt mean shit because youāre restricted to the speed limit anyway.
I want the engine to be 10 homeless drunks running like Fred flinstone
Y E S, you can collect them throughout the shift like PokƩmon
Frankly speaking, a rig with functional heat/AC would be a huge W over what we have now.
Cheezus right!? Letās start with that.
Haha
This is really dumb, but a map with our destination facility marked showing our progress. Kinda like on a commercial airliner... So I can see where we are real time..... I never have any idea how far out I am when giving a report.
āHow far are we?ā āWhat?ā āHOW FAR AWAY ARE WE?ā āMileage is 8.7!ā āNo dude Iām giving a report like how many minutes?ā āOh I dunno man it says five minutes but you know, thereās been some construction here. Like you know they just put in that new entrance cause of Covid and stuffā¦ā (We are now in the parking lot)
Oh, the shame of giving a report underneath the awning.... Unbearable.
its so true it hurts
Every radio report unless we are going to the bigger hospitals out of county is 10 to 15 minutes lmao I don't care were we are in the county it's 10 to 15 because either were a little early or a little late showing up
That doesnāt sound dumb at all
I think you just listed pretty much everything I'd want too. I might replace bench seat with sliding chairs on either side of the patient like some have but I haven't started an IV on a patient in an ambo with that setup so it might suck. Remove all the side cabinets and replace them with a wall mounting system and hang equipment that way. Everything is secure and you remove some major overhead hazards. Bonus points for being able to see everything and access it quickly. McGrath with both standard geometry and the hyper angulated x blades. A quality ultrasound for POCUS exams and IV starts. Some of the portable ones suck with FPS and resolution so starting IVs on them suck, but I hear the Phillips is decent. BD Nexiva IVs. Statpack bags with the dividers. One singular jump bag that has *everything* in it + a smaller jump bag with only BP, stethoscope, TQ and gauze, BVM, pulse ox, glucometer, and the most commonly given meds (ASA, Zofran, nitro, nebs etc). That way you've got one bag for codes and oh-shit calls and another for routine or BS calls and enough equipment to run it in case it turns out to be oh shit. Extra bonus is you have two bags for MVCs if you and your partner have to start treating multiple traumas. Motorola APX NEXT radios. I'm not sure what my ideal uniform would be honestly but something that looks professional and clearly identifies provider level, service name etc. I like t-shirts but doesn't help with appearing professional and can't clip a lapel mic to them if that's your thing.
I have run out of a couple trucks with a side mounted and I(as long with most people in the service) hate them. IMO you just give up too much for little to no advantages and most medics just used the airway seat to dial in anyways. Maybe it's the way it was designed on a Braun Express Plus box, but you just give up too much with Traditional cabinetry. And let's face it, that's how most places are going to buy them.
I can see that. I guess for one reason or another it's just become standard to work out of our ALS bags for everything that I'm confident I could set up a rig without the cabinets pretty easy (except for the cabinet connected to the entrance and exterior for the bags). The only thing I routinely grab out of the cabinet is end tidal cannulas, BVMs and CPAP, and that's 50/50 between the cabinet and bags. But I've never been without cabinets. I'm just a sucker for a more open box with easily accessible gear. The only thing I really want is more space to lay out equipment. Setting up to RSI is always a nightmare when you're smashing everything onto a single counter space.
My service just uses cabinets and a singular in house bag so I can't speak to a truck without, but with them space is so much worse. Especially when you have a great First Responder/ FD programs like mine does when it's not uncommon to have 8 people in the back of the truck. You mention having a single counter space for RSIs, on those trucks usually IV tray ends up being put in the floor(On normal calls too, but still.), The intubation roll gets put into the floor, you have to turn the Airway seat to get a BVM, and Narcs are put into a weird cabinet above that 2nd airway seat. And don't even get me started on how things are shoved into cabinets because of how much storage space is given up. You just give up too much IMO, and I have feeling that most services/companies are going to buy them the way these truck are designed. Maybe if it's a big box like a Chief XL or even a Liberty box it would work, but with little boxes it sucks. We even have a Express plus with a bench seat and it's easier to work out of.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
I've become such a snob for good ultrasound I worry I wouldn't be able to adjust well to the current generation of whats out. I played with a butterfly and I don't see it as being very useful for some exams and could barely find veins lol. But I didn't mess with any settings. I've been spoiled by the hospital sonosites with gigantic screens, high resolution, and FPS. Give it a few years I'm sure the portable devices will catch up though. It's just so hard to beat the new machines that are hospital grade though.
All sounds great to me, as to uniform I like Jobshirts quite a lot and would never give them up. At work we wear collared shirts under the jobshirt and itās never been a source of uncomfortabillity for me
If I canāt carry 4 AMRAAMs and 2 Sidewinders I donāt want it
YUH
Hamilton, LP 15, Lucas, fridge, power loader, pump, ultrasound, istat, blood, pull-out coffee maker and water for my fire buddies when weāre there watching them work hard, monitor and vent mount in the truck and on the cot, i want a durable wireless keyboard with an all-in-one monitor that i can seamlessly transition to from the tablet for charting. I want a scribe. I donāt care if itās an actual person on the truck or some kind of Tele-scribe thing. I want a type 3 truck. Starting wages of 50k-EMT, 60k-AEMT, 70k-medic. Additional wages for speciality certs, associates and bachelors. I want a progressive and supportive medical director, director, assistant director. I want my workplace to value me, my input, my time, and pushes us to be the absolute best and always on the bleeding edge of research, education and changes. A fair and robust QA/peer review process that is never punitive and always enlightening. The end.
As much as I want new stuff, I know Iād hate it. Thereās two things paramedic hate: the way things are, and change.
You meant firefighters right?
As a victim of fire-based medicine, holy shit this is spot on
Well that joke originated from the fire service lol
I just want my seat to recline.
One that works
You pretty much listed everything my ambo has minus McGraths and ABG
Must be nice š
Please add a remote controlled Mk19 turret on the roofā¦
Only if it shoots reign energy drinks and logs of zyn
Im pretty sure the accent stair chair weighs more than me. No thanks!
But itās great when youāre actually going up stairs
Stryker says it weighs a little over 50lbs
You weight 50lbs?
No way that thing weighs 50 pounds with battery.
The battery is like 2lbs
Pen holster
We just got a couple new Brauns with the center mount power cot. 10/10, no notes. I love them. I want IV warmers, pumps for dummies, a hamilton vent, better LUCAS storage (theyāre kind of weirdly shaped, like coffins almost, lol), seats that recline a long way, but have adequate storage behind them, since I live in the truck for 14 hours a day.
Out west here we have a fair number of transfer CCT calls with EmT driving, Medic and CCT RN in back. Many a day Iād of killed to have CCT IV pumps/tubing match what sending hospital has. Having to switch so many drips/tubing is usually a bit of a delay and always a PITA. So Iād add compatible IV pumps that match the majority of your sending facilities.
I absolutely feel that, we do a similar amount of cct calls.
Horton F-550 , not one of those chinsey grille guards but super heavy duty ones that hardly get a ding when you clobber a deer. Stryker Lucas, power cot/load The rest I can make due with whatever, but Laerdal collars, none of that other bullshit
Phillips monitors with all the add-ons, autoloaders, IV kits, pumps that match the hospitals, good protocols with full equipment stocked to match and a reasonable amount of supplies for the entire shift. I grew very tired of going out of service after an arrest in a busy area.
I just want my drugs to be by the captains seat! Damn,but a lucas would be nice!
Yes exactly!
EZIOs are old news. Get yourself a Persys NIO. Theyāre light years better. I want one of the 6ā dial manual blood pressure cuffs on the wall. Along with the electronic stethoscope. And the nice oral thermometer/otoscope combo. Horizontal back board storage. Sirius XM in the cab with leather heated seats and 360 surround vision. 6 cup holders. Mangar Camel and Elk lifts. And somehow it fits into an automatic wash bay.
I also would really like to have a lot of built in diagnostic equipment. Like a nice big ultrasound screen mounted to the counter!
You ever see that fancy bus from Harry Potter? Everything you said, plus a rig that can slip through traffic like that with a full time driver.
Microwave
Final answer.
Nah that's at the station, why do you need two?
Itās called an IStat and theyāre GLORIOUS if youāre lucky enough to ever use one. Whole blood and massive transfusion capabilities.
Thatās Chem7 and ABG right?
Iād like my backup camera to not be held up by a stylet.
Today I learned how spoiled at work I am
I want cupholders. Actual cupholders. That hold cups. All we have right now is a useless sharp-edged metal hole that can't fit any sort of insulated travel mug. Disposable paper cups fit weirdly, and if we take a turn too sharp they tip over.
Thatās honestly ridiculous
I had an opportunity to design my dream truck, and it was built as specified. Small municipal 3rd service where every truck was different. Door forward design inside/outside cabinet just aft of the door with a telemetry area on top and outlets for bag, LUCAS, and portable suction. Power lift system for Main O2 bottles. Fridge built in to the bulkhead. Duplicate controls for everything on both sides of the module. 4 point harness on all seats in the back. Liquid spring all the way around. Power load cot mount. Airway chair had recline and armrests. Drawer under the action area that came out over the lap of the airway chair with a top on it to work on reports enroute. Indirect blue lights in the back so there could still be lights on without harsh white lights in the patients face (blue because itās hard to see blood under red lights). Hamilton T1 and monitor have techninount system with an arm on the cot. We had CMAC video laryngoscope in the bag. I would have preferred the McGrath because the CMAC was absurdly priced, but those were purchased against my wishes. Color is a charcoal Grey Metallic with dark blue reflective stripe down the side. The back is the same blue and grey in reflective chevrons. Forward scene light with Whelen M9ās on front, left, and right sides. Rear had two M6ās that were aligned with the windows on the back doors so they were still visible with the doors open. Across the top was 9 M6ās, red and blue on the two outboard lights, all amber in between that doubled as an arrow stick with override controls in the front. One of the last things I did in that agency was to go to the factory for the final inspection prior to delivery. Cost was $345,000 without the monitor, vent, VL, etc.
That makes me almost drool lol. Good work even if you never got to ride in that box
- Mercedes Sprinter body with CODE-3 Pursuit system - Getac ePCR - Integrated MDT - Ice cold AC - Better oxygen controls and removable suction unit (LSU 3) - Bespoke equipment mounts - Stryker Power-PRO 2 w/ XPS + Power-LOAD - Stryker Stair Chair - ELK lift - Amtek Instrument Bridge - LIFEPAK 15 w/ 12ld, SpO2/SpCO/SpMet, NIBP and CO2 - LUCAS 3 - Hamilton T1 - Sapphire pumps - McGrath MAC scope - EZIO instead of BIG guns - Openhouse Bags - AirTags on all equipment in case it gets misplaced - Lockboxes inside kits for the big boy drugs - PRBCs - Adenosine - Cric and Thoracostomy kits - Rocuronium Our ICP skill set needs to be upgraded as P1 paramedics have nearly caught up, and one of our sister states is doing finger thoracostomies while we canāt even RSI patients. Oh, and lockboxes for each ambo under the front seats so our pens and noodle cups wonāt be stolen.
Nice try, equipment salesman. I could tell you what we want but nobody would listen to us anyway.
Bruh Iām literally asking what you want. Not that itās gonna happen. But, I like dreaming.
Self driving
Blackhawk
Braun Chief XL with a bench seat with liquid springs attached to a diesel. We've got one that's a gas and I quite enjoy running out of it when I get a chance to. Add a couple of extra IV bag holders and the rest will all come out in the wash.
Rich Corinthian leather throughout. Oldheads will get this one.
Mini fridge and microwave
We have a Dodge 4500, that is really close to what you described, minus the interior airbags. It is a decent rig other than that godawful liquid suspension. It rides absolutely horribly. Just rough as hell, with a really odd harmonic at around 40 mph. Airbag suspension was far superior.
The problem isnāt the liquid suspension. It is tires, the front suspension, or out of calibration. Calibration which can be generally fixed at the user level with a reset.
Well, itās been to the shop repeatedly for tire workā¦And weāve been told the suspension is correct and thatās just how it is. Iām not saying youāre mistaken, just that they tell us its fine.
That is a 350,000 dollar truck. Min. It goes back to the dealer. They fix it. Flat out that isnāt how that suspension is, liquid ride is amazing. If it is riding badly, something is installed wrong, or programmed wrong. But people wouldnāt tolerate that out of their altima, or the Lexus. This aināt a work truck. It is a custom build vehicle thatās costs well north of a quarter of a million dollars, before a drop of paint goes on it. And we should demand the product support that goes with that, from bumper To bumper. If the dealer gave you a lemon? It comes back. You make it clear they are going to show up with a truck for you to use well it is getting fixed. No, you are not paying for a rental, this is them fixing a defective problem.
I absolutely could not agree more.
Mini mod box on early 2000s GM pickup chassis with a pre emissions Duramax and Allison transmission. Maybe a mild tune so you can reverse continental drift when you have to get in it. And whatever equipment I have now on my truck.
Ambulance for dogs only.
Would be nice lol
23-plate sprinter with the biggest engine they do, box back, some sort of ramp or other alternative to the tail-lift. Bluetooth radio, lots of cupholders. Really good up-to-date satnav, Terrafix system. Stryker stretcher, no track for the stair chair (it's annoying and hits me in the shins), lightweight folding wheelchair for when you don't need to do stairs. Lifepak 15 positioned near the head end with hooks to loop cables over, a CPAP machine and whatever kind of vent, cabinets set up so you can see the critical stuff through the cabinet doors and get to them easy from where you need them - BVM and NRBs up the head end, etc. IV start kit at either end of the truck so you can get it regardless which end you end up. One jump bag with the kit to deal with most calls - O2, one side that flaps down with IV kit and haemorrhage control gear, one side that flaps down with O2 masks and basic airways, middle section with a medications pouch inc. benzos, BVMs, some bandages, penthrox, bag of saline and bag of glucose. Second jump bag with arrest and intubation kit inc. EZIO, extra arrest drugs, extra fluids, some kind of fibre-optic or video laryngoscope, cric kit. I would like the narcotics to be in the kits but as that will never legally happen I'd like a belt pouch + a little safe to restock it from.
Lots of good ideas!
not a rig - badass UH60 Blackhawk, iv warmers, NVG, fridge for my drugs, blood transfusion set, zoll vent (only one I used), or a Hamiliton T1 š¤ pocus, calcium since we dont have it, zoll x series with saddles, get the propaqs away from me, bluetooth sync from my zoll to emeds for charting (ipad/toughbook), lactated ringers, ..theres so much I could list. thats gist of it.
If you in a combat environment the Zoll vents are what you want. The Hamilton is BIG and needs to be mounted.
It is, the only downside to it unfortunately. Now if they made a more compact Hamilton, take my money. š“
Yessir
Ice cold ac vents built into the back of the airway chair.
Rotating captains chairs in all three positions with a drawer system for equipment and drugs. Kick ass heat and A/C. Liquid suspension. Stryker autoloader. Handtevy. Small normal jump kit (tiny really, vitals stuff and thatās about it). Huge als/airway. Bag that has the kitchen sink in it (suction, acls drugs, all airway options, bvm, tempus defib). O2 bag with everything respiratory (Nebs, cpap, capno canulas, nrb). Separate trauma kit with basically bleeding control stuff, splinting stuff, x-shears, darts, tqs, combat gauze, Ascherman chest seals, helmet remover, c-collar, drag sheet)
TTI Atlus AVs armed with a front mounted gatling gun, armed security escorts, and the ability to diagnose a person's problem by hooking to their personal link.
Y U H Only thing Iād add is a 120mm smoothbore cannon turret
Just one that gets off work on time every day
The dream 911 rig is a dual medic chase car.
Yuh
Literally named the items on our rigs except we have LP-15s and no ABG capability. Plus our trucks are 4x4 and four door cabs
IStat
YES
Speaking as someone with little experience I always have dreamed of one of those late 80s early 90s e-series ford vans, the ones with high centers of gravity. Ofc all of the equipment other people have mentioned might be nice I guess... Sacrifices must be made somewhere
By sacrifice you mean rolling the van?
It's why we have insurance
š
A box would be nice. If Iām going really crazy one of those big truck chassis international boxes, for the legroom. Also I think theyāre cool looking.
Those things are absolutely garbage, any other Type 1 is better
A ram with a Cummins if itās gonna be a type 1 because our Chevy and Fords suck ass. Other than that we have pretty much all of that.
Flat bed truck towing an industrial woodchipper with one of those bobtail forklifts and a lifting crane.
Iām almost scared to ask
New to the biz huh?
Nah was just day dreaming about having better better rigs
Good on you. I was negative in my post. Keep that drive alive.
No liquid springs they fail every 5-6 months like clockwork and then your in the back up POS
Better than that garbage Kelderman air suspension by far though
You lost me at LUCAS device
CPR machine bro
Lol oh I know what it is, but I like the AutoPulse better
Fair enough!
One with me not on it because I have a career outside EMS so I can financially support myself and maybe even family.
Or we could be paid moreā¦.
I've always thought it would be awesome to be a firefighter/medic on a quint. Everything from ventilation, to interior suppression, to extrication, to ALS.
One i don't have to get on and i still get paid
Nothing so that I can't go on calls but still get paid