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Letterman

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    Somewhere over the rainbow...

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  1. I search psych patients based upon their affect, past history, and current complaint. If the patient shows any sign of aggression or offensive gestures I stand back and allow the police to take care of such measures. A patient who feels depressed and voluntarily wishes to be seen at the hospital may bring a travel bag with them, but I do not feel that I have any right or duty to arbitrarily inspect all of their possessions. If I suspected the possibility of foul play, I would and do so in front of another professional from another allied agency as a witness of what was done, or get a cop to do it. I just hate when I am accused of stealing my patients dentures from their personal belongings. :shock: Maybe the urban environment that I work in is not that of LA, NY, or Detroit... Any offensive gun or knife waving patient of mine in the past has not hidden it from me, it was already on them and visible when I happened to unknowingly walk around a corner into their area.
  2. Interesting scenario... It is not as if we were following the orders of a communistic leader where we would be an instrument of genoside. But, on the world united nations view would we be seen as an accomplise of murder through corrupt views of crime in some cases by some countries. Having recently seen a documentary on the holocost where hilter's men were held liable for such crimes against man, they were held accountable. This is similar to the war crime tribunals that are still ongoing with the government leaders and their military activists who were in Rwanda. Yet their punishment as facilitated by the UN is/was a death sentance in most cases. Yet again, being that the crime was done as a punishment on a known criminal beyond a shadow of a doubt verses the innocent public, there seems as if there is general public support internationally for such acts of justice. The question for each person I suppose is will their conscience allow them to get away with such acts of violence. Innocent or guilty the act of killing someone is still violence causing death. Is the killing an act of violence or an act of justice? Thus we get the case of a firing squad where one person shoots a blank shot and therefore all the shoters have a reasonable doubt as to their actually firing the deadly shot. And there again an out for a person to have any guilty feelings as to their part in the crime not knowing for sure that their shot was the blank. Personally, I would not have issues taking the lead role in such an act of justice (what I call it) as it is greater for the whole, a sentance that was determined by a legal approved democratic government process, and that was appropriate for the premeditated crime that caused such a sentance. Please advise when such an opportunity arises.
  3. Ambulance driver is a step up to what I have been calling myself. You know those times at social gatherings when you introduce yourself and at some point your occupation comes up. Thereafter the questions start, "what's the worst thing that you have ever seen?" "your job must be hard?" "how do you deal with it?" Beyond telling them that their face is the worst thing that I have ever seen, that my job is actually easy getting paid to watch Oprah, and that I deal with my troubles with a hell of a lot of alcohol, there is an easy solution to what my job title is. "Oh and what do you do for a living letterman?" I drive a truck for the city and yourself. Discussion ended, topic over, and no repetitive stupid questions.
  4. I am not sure where you can find the study results now... maybe the prehospital research department at sunnybrook hospital might have them. But in the mid 90's toronto ems did a double blinded study with lidocaine and amiodarone with cardiac arrest patients. The results may have been scewed a bit as the amiodarone was pretty obvious to identify being that its viscosity was thicker than the placebo and it tended to foam on drawing it up. Regardless during a cardiac arrest after we opened up an envelope we used whatever the directions said lidocaine or amiodarone. I have had two viable survivers back from lidocaine, no survivors back from what I thought was amiodarone during the trial. ACLS courses in our area are suggesting that amiodarone has better antiarrhymiant qualities verses the lidocaine, and eventually we might see a switch in amiodarone going to a more effective ACLS class of antiarrhythmiant over lidocaine.
  5. 'Alberta', Are we arguing semantics here with Squint? Stab... vertical incision... Instead of defending yourself with the argument at hand, you are reverting to discrediting with terminology. That's rather cheap. The surgeon who taught me suggested two transecting 'slices' into the cricothyroid membrane and then blunt dissection 'southwards' (meant as inferior) with the index finger. Go figure he meant an incision. Layman's terms. Watching him demonstrate it, I knew what he meant. Hearing what Squint said, and knowing how it's done, I knew what he meant. Terminology... I would prefer you arm wrestle with squint rather than try and discredit him by semantics. You'll loose. The bottom line were arguing what is appropriate in the prehospital field. There is a line between inserting an oropharyngeal airway and doing brain surgery. The line is doing what is appropriate for the best interests of the patient with the appropriate skills that can be maintained with a considerable amount of competency. I am not sure when your Province resembled the streets of LA or Detroit, and there is not one prehospital location in Canada that can rationalize the performance of pericardiocentesis. The skill can not be maintained! I will agree to chest tubes. Having dealt with hemothoraxes on occasion, a 14 gauge cath (and even a 12 gauge 8 inch chest needle cath) will become clogged. In the instances where travel time to a hospital is greater than 1 hour from the time of decompression, a chest tube in the prehospital field 'may' be appropriate. I recall a retrospective chart audit study from Calgary in the mid 90's that indicated that there was a lot of cric's being done in the field. This was because the percentage of successful intubations were in the 70% range. Medics thought to needle their patients verses reverting back to basic life support methods of a good face seal and effective ventilating. Was the low success rate due to poor problem solving or the ability to needle cric when needed? This is why pericardiocentesis and intracardiac meds are way outside the ability and scope of the paramedic in 'our' prehospital setting to do it with a degree of success. In or near an urban setting, a chest tube is not appropriate as needle decompression works effectively to buy the time that is necessary until someone who is trained for surgical techniques is available. Chest tubes in the aeromedical environment is not only appropriate but mandatory due to the expansion of gases at altitudes. Let's not get outside our respectable abilities as paramedics. We are not surgeons. A plethora of skills are inappropriate in the prehospital field, and to recognize this shows due respect for the patient not wanting to practice skills on them just because we can. I would like to ask where you would draw your line with what skills are appropriate and responsible in the prehospital Field but fear the reply of you doing surgery in your ambulance. We can argue the skillset that you have mentioned and noted on paper with endless replies. Fact is... outside of critical care aeromedicine, its not done on the street. Dreaming in your private time is one thing, leading others along thinking that your dreams have come true is another.
  6. Great come back Alberta! Kudo's to you, you saw my heart transplant and raised with an Alberta Occupational Competencies Profile (AOPC). I still think that your bluffing. The poker hand is not over though. The shame is that the AOCP has little to no relevance in the Province. It's not used in the teaching colleges, the emergency services, by the licensing college, or by the physicians that direct Alberta's medics. It's a working document that is finding its way into the fireplace. Think of it like a wish list letter to Santa that never quite made it to the north pole. Proof of this is the Alberta Health & Wellness Standards for Regulated Ambulance Equipment and Supplies (also found on the web) that mentions the need to stock booster cables, a bed pan, urinal, portable O2, cold packs and an advanced airway kit for just such an occasion. I missed seeing the arterial line adapter, the central venous catheter, the selection of chest tubes, the pulmonary catheter, and even the pericardiocentesis needle. It's not a wish list, but a Provincial law. The previously noted intensive care items are not on the Calgary, Edmonton, Canmore, Lethbridge stock orders. Their not given to the EMS services from the regional governments or the associated hospitals. Are the medics purchasing the equipment on their own accord? That's just wrong. And if your getting paid less than the Ontario wages of 85K annually to do this stuff your getting robbed. Take a few moments to re-consider Squints posts. He's probably been doing the job in a multiplicity of capacities when you were just a toot. He has nothing to prove, but just words of experience knowing the health and EMS system in Alberta. He's possibly even pretty well connected at the College as well. I hear the CEO & Registrar position is open, he sounds more than qualified to take that. Does your employer and directing physician know that your ready and able to perform pericardiocentesis? You could be deemed as being overqualified to work in Alberta EMS. Any questions?
  7. This 'Squint' guy makes sense Alberta! I wonder if he's been around for a while and knows the in's and out's of paramedicine. Probably a guy who you should discuss your Albertan related conclusions with before embarressing the medics there. If pericardicentesis is in your skill set, I'll match that and raise you an onscene heart transplant. Ontario medics have been doing them for years and carry an extra pigs heart on ice in the bus for just such an occassion. I'll admit that I'm bluffing if you will.
  8. It has been said previously, "We decide to needle a chest, they will be getting a chest tube whether we were right on our clinical assessment or not." And " As a side note, how about pericardialcentesis too? It's within our scope of practice to do it here." Hmmm... as far as the National Occupational Competency Profiles Curriculum for Canada's Paramedics that sits in front of me, pericardicentesis is not done in Canada or any one of its Provinces or Territories. It is not approved as a paramedics scope of practice by the Canadian Medical Association or any College of Paramedics, Physicians, Surgeons or the like. Unless Dr. Kavorkian is back in business and is serving as your base hospital physician you do not want to advertise that you have a scope of practice that includes pericardicentesis. One stabb and your in the bighouse defending why you poked a patients heart as a paramedic. And how often does a paramedic come across cardicardial tampanade? And we are supposed to maintain the competency how? Respectfully from Ontario
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