Leaderboard

In researching one of the many ambulance crashes last month, I discovered one where the EMT admitted to being distracted and "looking down", and not at the road, just prior to his crash. The newspaper article did not clarify what he was distracted by, but there is no doubt in my mind that he was probably texting someone or reading a text message. This is probably the most dangerous epidemic facing our industry, not H1N1. Is there anyone who agrees with me, that this practice should be banned ?

Funny you should mention a park inside of New York, one of the great ironies that was expressed in this show, is how the MLK "I have a dream speech" brought the parks full-circle. As you know it was held at the Lincoln Memorial, which is a National Park, but what i had never realized was that the tall white police officer standing at MLKs left shoulder, was actually a Park Ranger and not a State Trooper or DC Officer.

Good point. Working paediatrics is especially risky because of all the unique things they tend to carry. The worst pain I've ever had in my life (and there's been a lot!) was from a simple case of Fifth Disease caught from a pedi patient. Kids never even know they have it, but adults will never forget it when they have it! Even if your varicella titer is good, it may well be a good idea to still get the new Zostavax. Shingles is even worse than Fifth Disease in many cases, and much more common in adults. It tends to creep up during times of stress in life, which would include returning to school and changing careers mid-life. Ask your doctor. The best way to protect your back is to let the firemonkeys do all the lifting. Let them earn the big bucks.

http://www.bmj.com/cgi/content/full/327/7405/27 "This feasibility study of autonomous prehospital thrombolysis shows that paramedics can record and interpret 12 lead electrocardiograms and safely administer thrombolysis in the community. The potential average time saved was 48 minutes from the call for help to medication being administered. The physician assisted model was found to be unreliable because of technological failure and areas in which communication was hampered because mobile phones could not work, a problem observed elsewhere.5 We did not routinely collect data for these unanticipated events so their precise distribution cannot be reported. Autonomous paramedic prehospital thrombolysis seemed feasible and safe and was associated with improved call to needle times. Sensitivity may improve with experience and confidence."

I have had one partner fired for texting and driving, yes I walked in the office and said this person is fired and the supervisor did the paperwork. Patient on board you better not touch anything that is not required to get me and my patient to the hospital. If you are driving at all you better not be texting. Texting and driving is an automatic firing offense in my opinion.

Some services now after interpretation of the 12 lead even start the treatment in the field saving many many minutes. Think about it. Even if you go straight to the cath lab you have 10 minutes to the hospital. Get there the cath lab will run additional 12/15/18 leads, draw labs, etc, then start pushing the drugs. Thats 25-30 minutes of dead heart cells. So by interpreting the 12/15/18 lead and treating your patient beyond just MONA you may have given the patient a change of returning to basically a normal lifestyle, and may have even kept them alive. Sadly though many services refuse to accept that responsibility and will not carry the drugs and instead just choose the diesel bolus therapy that has proven deadly in more than one way.

Strengthening your back is great, but if you are lifting correctly... you don't use it much. Focus on lower extremity strength, core strength, and shoulders. One of the fastest growing injuries in EMS, shoulder injuries.

The school's allied health or nursing department should have a list of recommendations and places that are inexpensive to receive them. Depending on when you got your other degree, your MMR may already be up to date. Hep B may be on the recommended list. Keep your tetanus updated. I also have my titers checked which is when I found my immunity from having chicken pox as a kid no longer appeared as it had over several other checks over the past 30 years. Thus, I got the varicella vaccine since I work with kids.

Here's a report on how a vaccine and its effectiveness is determined. For last year's flu season, the vaccine was considered less effective against some strains but the antiviral meds helped with the severity. This year we are seeing a strain that is also resistant to the antivirals. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5715a4.htm The references linked at the end of the article are also worth reading. 2003 was also another controversial year for the flu vaccine, where it was also considered a "miss" by the stats from that season. I remember that year because of Pres. Bush's big production of getting the smallpox vaccine. Many of us were actually in favor of getting the smallpox vaccine since we were made to get it at age 5 just prior to starting 1st grade. Several years later few were thought to have immunity in the U.S. after several years had passed since the last vaccination for smallpox was in 1972. BTW, many health care workers did not get the smallpox vaccine during 2003-2004 as it was not made mandatory as it had been many years ago. Also the vaccine offered in 2003 for smallpox and the one the Pres. was recommending did pose some serious complications and the Advisory Committee on Immunization Practices called for the U.S. to reconsider giving the vaccinations. Since health care workers do care for those with complications, they may see and hear more about the complications than most. That issue has been mentioned in New York (back to my original post starting this thread). However, HCWs also have first hand knowledge of what the disease itself can do. Neither appear to be a good choice especially after you have reached an age where you are aware your body may not act as it did at 20. This is why some are hesitant to get the vaccines. We could also continue with the controversy that has been presented with the childhood vaccines. Even if the percentage is relatively small, it is still there enough for the "what if" factor. People prefer to control what they know or think they know. But then this could lead us to a discussion about HIV. How many know the precautions but yet still engage in activities without any protection or even any thought of the virus? Would a vaccine make a difference if other precautions are cast aside? For the flu, I believe one of the biggest factors in lower numbers is the awareness. It gets people to be considerate when they cough and was their hands for a few weeks.

OK I just watched the pilot (go bootlegging!) and that was the worst pile of shit I have ever seen. - The general interaction between each character is extremely unprofessional - San Francisco uses AMPDS/ProQA; an electrocution would be dispatched as a Code 15, an arrest as a Code 9 rather than a "resus" - Since WHEN do Paramedics talk to 911 callers, that's the role of the EMD - Since WHEN to Paramedics wear chopper pilot style headsets? - Who alerts the hospital of a case before the medics even roll up on scene? - The ETA of the ambulance is NEVER given as per AMPDS protocol over the phone - Since WHEN does HEMS go to a cardiac arrest? - That only-on-TV style "big jerk" at each shock - Somebody says "halt CPR" but CPR was never started! - CPR is NOT performed with ONE hand - "Drop an OPA and start bagging?" - who says that? We know what to do! - Hyperventilate before intubation? - who does that anymore? - Somebody starts an IV but drugs are given via IO (Nancy uses the EZ-IO) - Nobody says "giving epi 1ml" something like "1mg of adrenaline" sounds more realistic - The LP15 showed both a heart rate and blood pressure for thier patient in cardiac arrest (both on the roof and at the freeway) - Nobody grabs the patient's phone and calls thier family, what crap! - Nobody uses backboard, headblocks and a collar when transferring a cardiac arrest - There are several errors with the pharaseology of the chopper pilots - The radio reports when given are very unprofessional and obviously false - Who transports a drunk with lights and siren? - The interaction between Nancy and the physicians upon handing over the ETOH patient is very unrealistic and unprofessional - A Paramedic who went to medical school? Yeah right - The patient in the car who was texting (Bobby) saying "don't touch me" yet the medics treated anyway - Same pt. saying "that hurts" but they continue to treat him! - Several times a diagnosis was made (e.g. telling the lady her arm was broken) which is not something EMS does (diagnose)! - Giving that guy on the board midazolam - No Fire on scene to deal with the oil tanker - That kid with shrapnel in his throat would probably get rapid sequence intubation here - The cricothyrotomy scene is totally unrealistic - Using a helicopter for a broken wriest, yeah, right! - Checking on John Doe - The off duty behaviour of "Rabbitt" is totally false and unrealistic Again, a piece of crap that I would not wipe my arse with; I'd give it 5 episodes before it gets canned or it won't be renewed. My dad knows Cliff Curtis (Rabbitt) I am sure we can all pass along what lowly opinions we have of the show.

Must be the same crowd that tells any and all to take an enema, and pray, to cure all, that always give nonrequested "advice" to my girlfriend.

Well since the rest of the "refugee's" are doing their intro's, I guess it would be proper etiquette to do the same......... Its been a while since I was here, i've been lurking every now and then, but have been focusing my minimal spare time on another site. While I felt like that site was my "niche" so to speak, I have recently lost interest as I feel it no longer provides a needed level of productivity or worthwhile purpose. Soooooooo... I return to the City! Hindsight being 20/20, I should have never left. It will be good to get back in touch with some old friends. So hello again!

I would not expect a physician to also be a plumber, a baker to also be a software designer or a pilot to also be a chef. To that end, why should we expect firefighters to be paramedics or paramedics to be firefighters? You send a bunch of firefighters to school for three years to obtain our Bachelor of Health Science (Paramedic) with the requirement they also meet the con-ed req's to be a Firefighter and I bet you none of them graduate.

Because the resuscitation you would be doing while attempting to package and transport would be of a decreased quality decreasing their already slim chance of survival for no reason other than to have them die somewhere else. For cardiac arrest there is nothing that can be done in hospital that is not done by a Paramedic crew. Not the mention that CPR and defibrillation are the key treatment for an arrest and that is what you're sacrificing for an unnecessary transport.

Beat me to it! From what I've been told, each bus typically has one EMT-P or EMT-CC, who work 12 hour shifts, and get an hour break during their shift where they can actually turn off the radio. My understanding is that when a job comes in, the lone medic will drive the bus to the scene, an LEO crosstrained to EMT-B will come to the scene, leave the cruiser there, assist in pt care, and drive the bus to the hosp. If another medic is needed, another ambulance will be dispatched to the incident. The bus will need to return the LEO to their cruiser after the run is completed. Now, for everyone else..... The privates just hire any medic with a pulse and a patch, the LCD. Every private system is profit driven only, and their medics are slugs, not serious at all about their jobs, and provide horrible pt care. No one cares at a private because they're either skells or waiting to finish a degree or get picked up off of a civil service list, like FD, PD, sanitation, corrections, etc. Hospital based medics think they're superior to all others in every way, they steer insured pts to their home hospital, and dump the uninsured off to city run general hospitals. Third service agencies all use system status management to run their employees into the ground, they all pay lousy, promotions are done only on favoritism, who your drinking buddies are, also hire anyone with a pulse and a patch to replace the frequent burnouts, their employees are only working there because they couldn't hack it or get on at a FD or PD. Every firemedic went to a 12 week medic mill just to get "the patch" to get an easy in at an FD. As such, all firemedics are apathetic towards EMS, and their pt care sucks. Every FD that takes over EMS siphons off $$$'s to the fire side at the expense of the EMS division. these fire monkeys (hose jockeys, or whatever jealous term used) don't do anything but sit around all day on the taxpayer's dime. What good are they doing? Got your attention? Good. These are all generalizations about each type of service. They all sound silly when you think about it. There are real life examples for each generalization, but they're certainly not indicative of the industry as a whole.

Are the Paramedics actually Police officers and pull police duty rotations as well? A service near me required you to do both. And if you were on patrol and another ambulance was needed you were sent to get the other ambulance. So your whole mindset would have to change quickly or so it would seem to me. Yes spenac is turning over a new leaf and is trying to understand other ways of doing things rather than fighting.

Nassau County, NY are mostly covered by a police-based EMS system. One of the better systems in the county IMO.

I'd like to make a couple of points here: Most counties in Michigan (don't know about other states) have a 'Paramedic Division' with the county Sheriff's Department. I have never bought into this 'you can't do more than one thing and be good at it' mentality. Let's be brutally honest here: Municipal Fire/EMS services have different operational/equipment needs. Fire trucks tend to 'wear out' faster than ambulances just by their design and function. The strain that the pump on a fire truck puts on the engine is equivalent of driving it at 55 mph down the expressway. Thats only if you don't pump more than 100 psi. Then we have the whole stress on the frame/suspension due to the fact that there's somewhere between 500-2500 gallons of water on board at all times. Water weighs about 8 pounds per gallon, so we're looking at an extra 4,000-20,000 pounds of weight (on top of the vehicle weight, equipment and personnel). Then factor in that the water doesn't 'stay put', even with a 'baffle system' in the holding tank. This exerts twisting/flexing actions on the frame just by trying to take off, stop or turn. I could see all the 'Fire is raping EMS' garbage if the fire department was driving the top of the line equipment (brand new every other year), while EMS is still stuck in the old Caddillac hearses! Both 'arguements' are more based on personal opinion than on fact, and both have been worn out long ago!

Geez Mobey, your a bigger pervert than I thought.

I get how to use the system... but how do you see details on your "rep" in your profile? I can't for the life of me figure it out. --Wendy

I have been very rural, and urban in my experiences. That did not change my treatment. It does, however, depend on the patient. If the patient is critical, I am getting them packed up ASAP (not including initial assessment of course). For example, if the patient is feeling weak, having minor difficulty breathing, I am not going to rush them out of their house and into the ambulance. I will treat them in their home and calmly get them packaged up for transport. Now, if they are having crushing chest pain, BP is crap, they look like crap, monitor looks like crap, I am not going to pussy foot around with them. They are load and go. I will treat them en-route. Now for most cases where your patient is a few blocks from the hospital, personally, I'd like to have my patient going into the ER with SOMETHING done for them, and have it looking like I know what I am doing. During clinicals, I HATED seeing a patient being brought in, and all the EMS crew could tell us was a chief complaint, no medical history, no treatment, not even a good set of vitals. Just "HERE YA GO SEEEE YA!". I have had a patient, where we were dispatched from the hospital (we were just dropping a patient off) and literally, ACROSS THE STREET from the ER, was the address. We walked across the street, called responding, on scene, at patient, enroute, at hospital, all at the same time. The patient fell over, twisted their ankle, and wanted to see the Dr. We put her on the stair chair, put on an ice pack and roller her across the street. Why people want to load an go everything, is beyond me.

It only lets you give one negative in any 24 hour period, so it shouldn't be easily abused.