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The article regarding response times of STARS being slower in 20/21 responses than ground ambulance is an interesting one. I wonder how they would compare in Saskatchewan or Alberta. I agree that the training should be expanded from a 10 week program to a minimum of 6 months.. I find it hard to believe that there is such a large time difference between the BCAS/ORNGE and the STARS Critical Care transport program.
The one about running out of epi is something that shouldn't have happened at all..The ground ambulance service was 5 minutes from a hospital and STARS insisted they intercept them enroute?? I sure hope Dr. Wheelers report sheds some more light on these issues.
Change your attitude right now or you'll go down the path to becoming what the industry refers to as a 'paragod.' Inflated ego and self importance are a dangerous thing in this industry which Paramedicmike is trying to point out.
Its great to be prepared, but its also wise to understand your limitations, especially as a first responder. I was told once that only around 2% of calls the ambulance responds to are true life threatening emergencies where immediate intervention by the providers would make the difference between life or death (early cpr included).
The industry is evolving to more community oriented focus, so if you want to get into the industry for the 2% of true emergency calls, you won't last.
Your passion is much appreciated, but maybe just a bit misdirected that's all!
Our organization is trialing the X-series and I planned to ask the rep about this during our in-service.. EMS being the way it is, I made it to about 5 minutes of the session before getting called out. I asked my boss if he could follow up with the rep and try and get an answer as to whether the problem has been rectified with the newer versions.
In Saskatchewan we unfortunately do not have the scope of practice yet to use paralytics.. Our options include Ketamine, Midazolam, Etomidate, and Fentanyl. Protocol is only a couple years old and has had mixed reviews so far.
I've heard of Ketamine causing an idiosyncratic reaction similar to the one you described. I believe Ketamine was used as the primary inducting agent causing a trismus type reaction. I believe Midazolam 5 mg completely reversed the reaction with no complications.
Yeah, I wasn't really looking at is as a tool to rule out MI, rather use as another tool to justify rerouting to the nearest cardiac center with a positive result.
Thanks for the info on TXA! It was very helpful. Once this licensing exam business is finished, I'm definitely going to do my research and draft up a proposal.. Maybe once its completed, I could post it on here for some tips/feedback being that it will be my first one.
I'm going to talk to my boss about getting one, or at least trialing one to show how beneficial it would be.
The company I work for services a large geriatric population and is 45min from a cardiac center. Our air ambulance is also located 30-45 minutes away, so it would be hard to justify taking the only helicopter for the region out of service when the patient could be transported just as easily by ground.
Our college of paramedics has also drafted a proposal for ACPs to be able to administer Heparin and Plavix for patients that show clear STEMI criteria. If we were able to get an trop reading, we could bypass our local hospital and travel straight to the cardiac center 45 minutes away instead of being called back 2 hours later to transfer them code 4.
I also think a istat lactate level would have its place for those with a sepsis protocol in place. As stated in a previous post, we are now able to administer 325mg acetaminophen, 3L fluid challenge, and progress to norepi/dopamine as well as hang broad spec antibiotics. This could likely be managed by most local ERs, but the faster we can confirm sepsis, get that fluid, and administer antibiotics (for bacterial sepsis), the less likely they are to develop MODS.
I've skimmed over the CRASH2 study and did find it helpful. The best info I've gotten was through informal conversations with the Anesthetists while doing my mandatory intubations in the OR. Learned a lot more through that than I ever did in school looking at power point slides.
Do you guys have an i-stat machine for Trop, Hemoglobin, and Lactate levels? STARS air ambulance here in SK has capabilities of testing for Trop levels, and a clinic I worked at up north had a Hemoglobin one, and I thought it was the coolest thing.
Also, I heard the next step may be to align Sk ACPs with the NOCPs as well, which means a few more meds in our drug kit like Magnesium, Calcium Gluconate and possibly a beta-blocker for cases of A-fib with rvr. Not sure how reliable that is, but it would be nice to have a few more treatment options.