What training and certs do you have and maintain.

[claren]

People who do this professionally never seem to understand the delineation there...

Ahem. -Some- of us are aware that "lay rescuer" does not equal "hopeless child", and stand up for y'all accordingly.

[combat_medic]

I agree with everyone that says gear without training is useless. But I have meet many "trained" people that I wouldn't let near me with a band-aid.

What do you call a person that took 10 times to pass the NREMT-P exam? Paramedic. (think about it)
What do you call a guy who graduated last in medical school? Doctor.

[Kutter_0311]

The point is, without proper training and or direction the gear in question can do more harm than Basic Life Support (BLS) alone.

I understand. I also have a basic level of training on both my prospective additions, and a Corpsman...

My oldest almost died of dehydration as a baby, and that made Mama pretty paranoid about it. Babies have a low tolerance for shit. I have no interest in sticking a baby, my training was on myself and other Marines.

Sucking chest wounds are a messy bitch. I have a few Ashermans in each trauma bag, but sometimes you gotta vent tension pneumothorax via needle decomp before you can evac. Not really excited to do this, either, as my experience in poking people is limited to that IV class. All my training in this area has been no-poke.

[crypto]

People who do this professionally never seem to understand the delineation there...

Ahem. -Some- of us are aware that "lay rescuer" does not equal "hopeless child", and stand up for y'all accordingly.

Sorry, I didnt mean 'all medical professionals', rather 'professionals who look down their noses at laymen'. I meant no offense.

[Bubba Enfield]

I'm a full-time paramedic. I do advanced life support at work, not at home. My FAKs are basically basic. My prepping scenarios don't resemble offensive operations in Fallujah, and my FAKs reflect that. As far as carrying "extra" tools in case you encounter a doctor, I suggest ensuring that you are equipped to do EVERYTHING you are trained to do first. I figure why carry stuff a theoretical RRT can use, when I'm not carrying everything that I can use?

/slight thread hijack

i have a question guys and i'm wondering if some of you here could shed some light on it. what level of training do you think is good for John Q. "Concerned Citizen" Public? i ask because right now i consider myself to have no real formal training. i took an ARC basic first aid/CPR course, that was all most 3 years ago and i'm sure the some of the techniques are outdated now.

how far up the ladder can one go w/o getting into the medical profession? i really have no desire to play doctor or change careers, but i have a major hole in my preps in the FA department and it keeps nagging at me?

I suggest Wilderness First Responder, like others have already. FR is quite close to EMT-B, minus some stuff that only applies to pros. The Wilderness aspect covers extended care in a difficult environment, which is what this site is all about. I did my WEMT years ago, (lapsed by now), and found it to be an excellent use of time and money. Just don't talk about TSHTF or the PAW at your class. Tell folks you like to go camping.

[Prepared American]

The point is, without proper training and or direction the gear in question can do more harm than Basic Life Support (BLS) alone.

I understand. I also have a basic level of training on both my prospective additions, and a Corpsman...

My oldest almost died of dehydration as a baby, and that made Mama pretty paranoid about it. Babies have a low tolerance for shit. I have no interest in sticking a baby, my training was on myself and other Marines.

Sucking chest wounds are a messy bitch. I have a few Ashermans in each trauma bag, but sometimes you gotta vent tension pneumothorax via needle decomp before you can evac. Not really excited to do this, either, as my experience in poking people is limited to that IV class. All my training in this area has been no-poke.

OK then. You have CLS. How much fluid do you give an infant intravenously? Where do you insert your needle for chest decompression and what is the proper procedure to minimize the risk of vascular and nerve damage during a deco.

With out proper training you can definately do more bad then good in an infant or child, and even an adult. CLS is a great course and teaches you some lifesaving procedures, but does it teach you the methodology behind it.

Even trained pros can screw this up and I don't look down my nose at the lay rescuer, as long as they are able to recognize their limits and not dive in over their heads.

[Medic77]

I'm not wanting to sound critical of anyone's decision. You all can acquire and carry whatever you want. I'm just putting it out there that advanced equipment and procedures are not without risks and the performance of such are not so simplistic as most are making it out. You can't justify it either by saying that this stuff is only for when the world is ending.

Im all for being prepared and being self-reliant and taking it upon yourself to ensure yourself and family is provided for and protected. But I do sense some blind leading the blind. Many think starting an IV and giving some fluid is benign... and most often your right it is. But it really does require an understanding of the body's physiology and pathophysiology of what it is your treating.

Are you confident with understanding fluid tonicity? How to monitor a patient to prevent fluid overload and sending a person into CHF? Which patient populations are more sensitive to fluid overload? Which patient's are more sensitive to fluid depletion? What part of the medical history or meds may clue you in? How much fluid should you even give to children and adults? Is it the same amount? Different? What rate are you going to infuse the IV fluid? How do you set the drip rate for mL/hr? What different drip sets are available? What is a drip factor? If your giving a bolus how much fluid per kg are you giving? What physical assessment parameters are you looking at to titrate the fluid? Should you repeat the fluid bolus? In a bleeding patient should we maintain a permissive hypotension or pump em full of fluid? Why or why not? What is permissive hypotension? What are signs of infection at the IV site? How do you troubleshoot an IV line? Which parts of the IV extension set must never be touched or contaminated? Do you know that 22g and smaller catheters are really prone to clotting off and preventing the IV from running? Are you carrying saline flushes also to gain patency of the line?

Hopefully I am illustrating my point. If your trapped in a building, basement, wilderness, etc with your family and deem they need an IV are you gonna be able to answer all the questions above to safely care for your loved one? It would really suck that your best effort caused your loved one to die of pulmonary edema cause you fluid overloaded them or they later died due to an infection you gave them in a less than desirable environment and had no access to antibiotics.

The above questions are very basic so if you can't answer them than maybe reconsider or get some training. And by training I mean formal or self-study. Google and YouTube are awesome... just learn the ins and outs.

[ehunter72]

I just had a spat with a few members here, just like this one,

The above is heavy with medical terminology,

Here are a few more examples of, If you dont know what this means do carry the stuff to do it.

Explain the difference between Normal Saline (NS), Ringers lactate (RS), Hartmans soulution (HS) and Dextros (D5W)

In the case of volume replacement GSW (vs rehydration) what factors determine which fluid to use?
what is Metobolic acidosis and why/when is it a concern and with which blood volume expander
What are your low/high blood suger contraindicators? what are your hypo/hyper sodium contraindicators.
what generally the hemoglobin level at which you would go to RL over NS. Which solutions can you rapid infuse, when should you rapid infuse (bolus has been coverd above)

Its really not as simple as sticking a bag in your wife or child, an IV can kill someone.

Chest decompression needles: what artery can you hit if the needle is placed wrong? how do you tell the difference between a tension hemothorax and a pnumothrax? what are the treatments for each.

Treating a simple arterial bleed incorrectly can kill from the TX alone.
I saw a post here suggesting a magnet for removing foreign objects from the eye, what if the object has pierced the eye? Hint. while aquious humor (fluid in the front of the eye can grow back, the Vitrious humor, fluid in the big part of the eye is not ,its stagnant and does not grow back. for that matter pulling an foreign object that has pierced the body can kill.


Its not looking down on any from above as was stated, its tryng to get folks to understand gear does not mean anything if you don't know how to use it.

As I was already chastised for saying, in response to being told that haveing drugs/narcs/IV's in your bag and you don't know how to use them was still "prepping" " if you have gear/drugs you dont know how to use your not prepared for anything.."

We dont call them "whackers" we call them "Ricky Rescue",

[Drakon]

thanks everyone, i'll probably go and check what courses are available in my area when more funds open up. paying for training on a college student's budget is kinda hard

with all the talk of IVs i have another question. why would a layman even need to start an IV? besides the obvious risks like pulmonary edema or screwing up the patients osmotic pressure; there doesnt seem like a lot is gained if a layman takes the risk to start an IV in someone if proper medical treatment is either significantly delayed or nonexistent.

someone tell me if my thinking is wrong, but the way i see it IVs are used to replace fluids/administer medication. here are the problems i run into:

fluid replacement-

dehydration: why cant fluids be taken orally?

burn managment: i dont remember the formulas at the top of my head, but lets say a 170lb adult with a BSA of 36% that comes out to about 340cc of fluid an hour? that's 2700cc in the first 8 hours alone, i dont know about you but that looks like a lot of ringers lactate (or normal saline for that matter) to be carrying around in an aid bag.

hemorrhage: i assume the patient's bleeding for a reason, isn't that a surgical problem that you probably cant fix in the field? you can pump as much fluid in him as you want, but if he's still leakig like a seize it isn't doing much good.


as for medications, the biggest problems are they're controlled substances.


your thoughts?

[Ovationman]

Don't discount alternative ways of getting fluid into people. Rectal hydration is simple and by all accounts can be effective(also you can give non-sterile/isotonic solutions).

[Medic77]

fluid replacement-

dehydration: why cant fluids be taken orally?

burn managment: i dont remember the formulas at the top of my head, but lets say a 170lb adult with a BSA of 36% that comes out to about 340cc of fluid an hour? that's 2700cc in the first 8 hours alone, i dont know about you but that looks like a lot of ringers lactate (or normal saline for that matter) to be carrying around in an aid bag.

hemorrhage: i assume the patient's bleeding for a reason, isn't that a surgical problem that you probably cant fix in the field? you can pump as much fluid in him as you want, but if he's still leakig like a seize it isn't doing much good.

Dehydration: A lot of people who are dehydrated become that way due to severe nausea and vomiting. They just aren't able to take fluids orally which makes IV fluids necessary to replace what was lost. Then we have the electrolyte issue. A lot of electrolytes (in addition to free water) can be lost through vomiting and diarrhea which necessitates replacement through IV fluids. Again, knowing your IV fluids will enable one to know the electrolyte content in each.

An example is someone being out in the hot sun after a disaster situation and becomes dehydrated and succumbs to heat stress. This is one case where an IV can mitigate the issue and make the person feel worlds better. DKA also presents as profound dehydration and these patients require LOTS... as in 6-7L lots of IV fluids in many cases. Granted they really need insulin by IV infusion but addressing the fluid issue may buy some time and can reduce glucose concentration even if just minimally.

Someone mentioned rectal fluids. Maybe that will work. Honestly as a Paramedic with 15 years of EMS experience I have never once even remotely heard that mentioned. If you have someone who is dehydrated because of severe gastroenteritis due to something contaminated they ate or drank, replacing water loss by squirting water up someones ass isn't gonna work out so well. Sounds like a nice in theory but real world good luck.

Burns: IV fluids are very crucial however, without being able to get the person to a burn center giving IV fluids for a severe burn is pretty futile. The Parkland formula for calculating the amount of fluid to give is 4mL x weight(kg) x BSA(%) burned = TOTAL FLUID. Give half over first 8hrs and remainder over 16hrs.

Bleeding: If the bleeding is internal then giving IV fluids without surgical intervention is futile also. Especially if your giving too much fluid which causes hemodilution (dilutes the clotting factors) and increases blood pressure which prevents or breaks open clot formation. Now if it's an external bleed and you get to a person and control the bleeding, then IV fluids can be of benefit in and of themselves.

[Ovationman]

I guess my point is that there other ways to get fluid into people then by IV. It is far from ideal ,but this forum is based on the idea of the less than idea.

[silentpoet]

I am a cna, I do combat ass wiping. That is the limit of my scope of practice.

On a more serious note I am CPR certified. I also start RN school in about 2 weeks. I do carry a very basic FAK, probably more what others refer to as a boo boo kit. About the most advanced item is super glue.

[98pointsix]

I dont maintain any certs, unless my Johny, and Roy fanclub membership counts??

For the folks considering getting a cert just for grins and giggles should consider 2 things
1 this will not allow you to own, buy, or use any thing that any other civilian could.
2 You really should check your states Good Samaritan laws and see if having such a certification changes the way those laws effect you. Im not saying you shouldnt get the training just dont waste the time and money sitting for the test if you dont intend to use it professionally

[Spectre0311]

Sticking with the original query, currently I must maintain all of the following certifications, as none are any good if even one happens to lapse.

NREMT-P
ACLS
PALS
ITLS
CPR

Personally speaking, Prepared American's concerns are legitimate and valid. I realize of course that this is the internet, albeit a much more informed corner of it, but the internet nonetheless. Simply perusing public domain medical manuals or hearing "from a guy" will never replace classroom instruction coupled with practical lab exercises ad nauseum, many of which are dynamic, and verbal only to insure that you are able to run through every minute step mentally before ever actually attempting an invasive procedure or Rx intervention. Take it from a guy who has to put his hands on something to sort it out, it's harder than it sounds, as rote memorization is not my forte'. For those of you who scoff at the perceived simplicity of the memorization aspect to learning procedures, it's damn near guaranteed that many students who excel with the linear aspects of the classroom stumble when faced with a chaotic scene.

And that just covers the classroom. Practical experience in the field will trump all of the knowledge your noggin can store. There is a reason that 2nd and 3rd year medical students are considered dangerous. They know just enough to really fuck someone up. It's the much same reason the "Rescue Randys" in my area are treated with derision, minus of course the 2-3 solid years of bookworming that medical students attempt to prop themselves up with. If you are not qualified (certification on your person is required in my state), or "on the clock" (your license, if you have one, is only valid because you are working under the medical license of your Medical Director and he/she can take it away at will), do not carry anything remotely ALS in nature. Depending on your local laws something as simple as a routine terry stop by a LEO in the middle of the night can get you in hot water. Fact.

Overall I'm impressed with the simplicity and effectiveness of the IFAKs that I've seen here. Granted they all follow the pattern of GSW stoppage, but the items needed for that are applicable to nearly every major trauma even I would come across while working. Simple, effective, noninvasive. Kudos.

However, in the multitude of souped up BOB sized FAKs on here that are stocked with ET tubes and LMAs but negligently no oxygen, or the 3 inch 14 gauge catheters that will clot off long before the lung miraculously heals itself, there is one item that all have overlooked. Definitive Medical Care.

I'd like to avoid a hypothetical scenario debate, as they can be as endless as the imagination, but the fact remains that any and all treatments in a FAK, no matter how slight or in depth, are merely stop gap measures taken immediately to prolong whatever chance the person being treated may have. Fail or flub these interventions, and you just killed the patient. That's only the rules as they apply today.

Pull a stunt like an intubation, crychothyrotomy or decompression in a PAW scenario and you just fucked your buddy by serving up a slow and painful death.

[skyreep]

Some of the stuff I've seen posted quite literally scares me cause I know there is no education or training to back it up. I understand wanting to be self sufficient and prepared in case of a major, major incident where normal day-day help systems are not able to come through but some of the stuff people are carrying can really mess someone up and make them worse off.

People who carry fancy shit like tubes arent going around treating random people. they're in the kit in case someones loved ones are dying and theres no EMT's around.

People who do this professionally never seem to understand the delineation there, and I resent it. I also resent the whacker label being used on these forums.

QFT! IF I add IV/needle decomp gear, it'd be for me, my wife, or my kids. PERIOD.

Not willing to lose a loved one when I could possibly save them.

As Danus mentioned, "You can't really fuck up a GSW, it's already pretty fucked up."

If you have time to wait for EMS/evac, awesome. Sometimes shit can't wait...

Here's my problem with his scenario. I understand that you're loved ones may be in trouble and you think you can help them but some of this is just ridiculous. For instance, in a EOTWAWKI situation if you have the need to intubate someone, what are you going to do from there? You can only squeeze a bag valve mask for so long before they need a hospital with a full range of medications and a respirator. Even if by some chance the person you intubated magically starts breathing on their own after an hour of intubated BVM pumping, what are you going to do about the pneumonia that's more than likely on it's way?

Come on people, I know you're trying to be prepared, I am too, but to think that any one you intubate in a situation where there is no definitive medical attention within say 4 hours will have a survival rate is ridiculous. Especially if there IS NO definitive medical attention. I've ridden in an ambulance for 45 minutes manually using a BVM to keep someone alive, and that was a serious test. What happens when your hand gets tired? Starts cramping? What about when you're dying of dehydration because you're too busy pumping a BVM to get any water? When you pass out with heat stroke, the person on the end of the BVM is gone and maybe you too.

And more importantly, how much are you going to blame yourself when you realize there is no help and you're going to have to stop pumping your comatose loved one's BVM? In some situations it's better to let someone die in a few seconds than to prolong there death by hours or days when there's no way they can be saved (EOTWAWKI). It sounds horrible but watching a wife or child die because your hand has cramped around a BVM after 4 hours of pumping is worse IMHO.

EDIT: I know in some situations intubation gear is appropriate. For instance, medics on standby, high adventure leaders who have communications with evac, and tons of other situations as needed. I also am fully aware that adrenaline, especially that accompanied with the fear of losing a loved one is more than enough to make you keep pumping a BVM long after others would stop. I just worry about how it's going to work in a long term situation.

[Ech0Sierra]

I don't see anything besides basic first aid and wound care being useful if the world truly ends. However, extended/delayed evac times are a definite possibility with any outdoors enterprise. Shit weather or completely bent communications may lead to a scenario where there will be definitive medical care, but at a point farther than BLS and basic first aid can reasonably sustain. If the helicopter is going to be a while, then I can see the point for having a reasonable selection of ALS tools on hand only for dire circumstances.

[skyreep]

Agreed, those both good reasons to support ALS use. Still though, trained ALS use. A layperson doing their first intubation on their wife or kid isn't going to end well. Hell, a well trained paramedic with hundreds of intubations under his belt putting in an ET tube may not end well. I at least trust a paramedic to have the training to at least give me a chance of survival with intubation. I'd rather lay down and die then lay down and die while a layperson attempts to tube me. Just as clarification, if you have no training and you come across me not breathing on the side of the road, let me die before you try to tube me. Much less painful

[Ech0Sierra]

Agreed, those both good reasons to support ALS use. Still though, trained ALS use. A layperson doing their first intubation on their wife or kid isn't going to end well. Hell, a well trained paramedic with hundreds of intubations under his belt putting in an ET tube may not end well. I at least trust a paramedic to have the training to at least give me a chance of survival with intubation. I'd rather lay down and die then lay down and die while a layperson attempts to tube me. Just as clarification, if you have no training and you come across me not breathing on the side of the road, let me die before you try to tube me. Much less painful

I'd like to assume that most people would try to master using a tool before putting it in their kit...though now I'm not so sure. If I had the inclination to put ALS equipment in (which I currently don't), I'd be sure to practice the skill until a level of proficiency exceeding that of a professional rescuer is attained. They have a medical director that can take part of the hit if something goes horribly wrong. Regular joes are going to be practicing medicine without a license and possibly committing aggravated assault. Master what you use to a higher standard than the professionals if you choose to have it for personal use and DON'T make a career out of using it.

[AlmostJesus]

I maintain:
NREMT-P/Iowa Paramedic Specialist
ACLS/BLS
PALS/NRP/PEPP
PHTLS
AMLS
My kit contains BLS equipment only, the biggest advantage of being an ALS provider in these cases is the fact that you have advanced assessment skills which will help you to triage/treat patients
That being said, many medical professions I encounter(Medics/RNs/etc) tend to have a small stock of equipment such as IV supplies at home for their own use in cases such as moderate diarrhea/nausea/dehydration or hangovers to avoid a $700 ER charge. I had a patient who came in today that had a husband who was a CRNA at the hospital I work at and he tried a liter of fluid first before he brought her in and we didnt question it at all... in fact we sent them home with a bag of fluids running.
The other question is depending on the system you work in as a paramedic, the medical director may be okay with doing things like that, if he trusts your clinical judgement he may be just fine with you having the equipment at home for use in situations like that. In fact some places have protocols for employee dehydration. I have ran across cases where I was observing as a student where the medic got sick and the other one gave him fluids and zofran.
Thus, if you REALLY feel that you would be comfortable using this advanced equipment and are understanding of the consequences then feel free to have it and if you dont then dont worry about it. The best care you are going to provide is basic.

[claren]

ACLS
PHTLS
PALS
Wilderness-EMT from NOLS

and as of today...

NREMT-P, son ! w00t and whatnot.

[98pointsix]

ACLS
PHTLS
PALS
Wilderness-EMT from NOLS

and as of today...

NREMT-P, son ! w00t and whatnot.

Congratulations Bro
May your yelllow caps fly high and far
And Johnny and Roy always smile upon you.

[Prepared American]

ACLS
PHTLS
PALS
Wilderness-EMT from NOLS

and as of today...

NREMT-P, son ! w00t and whatnot.

Congratulations Bro
May your yelllow caps fly high and far
And Johnny and Roy always smile upon you.

Congrats also. May your yellow caps also make perfect synchronized arcs.

[DannusMaximus]

People who do this professionally never seem to understand the delineation there...

Ahem. -Some- of us are aware that "lay rescuer" does not equal "hopeless child", and stand up for y'all accordingly.

This.

Likewise, somebody with 1000 certs or fancy letters behind their name won't necessarily be any more useful in an emergency than a person who is basically trained and can keep their heads about them.

Basic first aid (EMT level stuff) is monkey work. Seriously. You learn the same shit in Boy Scout first aid. The main difference is you learn to take a patient history that will be summarily disregarded by whatever transport paramedic unit shows up on scene, AND you have to learn to get a 'big picture' of a trauma patient and not just focus on the the obvious injuries. Learning physical assessments is very useful, actually, but it's not the least bit hard. You also learn a bit of theory that is helpful and gives you a better understanding of why you're treating the way you're treating.

The theory and classroom work for Paramedic is much more extensive, but there is a disconnect between all the theory and the care that is actually given at the street level. This is neither good nor bad, it simply is. For example, with regards to IV starting and maintenance, Medic77 wrote a long list of complicated shit that you need to consider, all of which is really good classroom knowledge, and probably very important for hospital IV management. I have NEVER, IN 15 YEARS seen any field medic do anything other than stick an IV and let it run wide open, or simply eye fuck the amount of fluid coming out of the bag. Medication amounts given in the field are either based on a pre-set cookbook developed by the agency medical director or GUESSED based on the percieved weight of the patient ("Shit guys, how much you think she weighs? 350, 325? Eh, let's call it 330 and go from there...").

This stuff is done by GOOD paramedics, and they can get away with it because they have street experience and they know that:

A) 85% of the patients we come into contact with are not in that bad of shape and could probably wait until they got to the hospital before any real treatment is begun (or they don't need any treatment to begin with).

B) 5% of the patients we come into contact with are in such bad shape that nothing we do is going to make any difference at all (major trauma, sudden heart attack, etc.), they're probably going to die anyway or be so fucked up that they might as well be dead.

C) 5% of the patients that don't fit into either category will get the most help from Boy Scout level first aid skills (stop the bleeding, basic rescue breathing or CPR, treat for shock) which is monkey work that I could teach anybody with 1/2 a brain to do.

Now, that leaves 5%, doesn't it? The remaining 5% is where a good medic will REALLY shine. Those are your bona fide situations where knowing which drug to push, or knowing which advanced technique to perform is going to make a HUGE difference in a patient's outcome, and that is where all the training and theory really pay off.

This post is absolutely not a shot at paramedics. We have some really great ones in my AO. The training to become one is something I would NOT have to deal with, and the amount they are paid is simply criminally low, especially considering the situations they are asked to deal with. All that said, we need to be very careful that we don't turn street level first aid into something far more complicated than it actually is. The first aid forum can be fairly off-putting for me because the conversations can very quickly turn esoteric when all the paras, RNs, combat medics and such start talking amongst themselves. It is probably doubly so for people who DON'T have any field experience. A brief conversation about the possible dangers of an 'untrained person' performing Technique X is good. An annoying lecture by the medical priesthood that makes a layperson feel stupid or incapable is not.

ETA: Congrats on the new cert, Claren. Definitely w00t worthy!