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I've bumped into a few little oddities or inconsistencies recently, and I figured I'd roll them all together and ask for input on them. Interested in any thoughts. 1. I was originally taught that during a field birth, you suction the neonate's mouth and nose as soon as the head becomes available. This is to prevent aspiration of meconium once the little bugger starts breathing. However, I've been flipping through the 2005 AHA recommendations and I note that they actually do not recommend this practice, called "intrapartum suctioning"; according to their review of the literature it shows no benefit to either decreased infant mortality or decreased aspiration. Some poking around on my own seems to confirm this. What do you guys think? My service still stocks little bulb syringes for exactly this. I'm not 100% clear, however, on whether the AHA et al. are contrasting intrapartum suctioning with NO suctioning, or with suctioning after completion of the second stage of labor. 2. CPR and PALS guidelines recommend chest compressions on an infant with signs of inadequate perfusion and a HR below 60. This is because, well -- that's not good enough. My question -- why isn't this an option for profound, symptomatic bradycardia in ADULTS? You medics can go to town with pacing or meds, but if you're BLS and presented with a patient showing shock and a very slow pulse (I'm thinking, for instance, a drug overdose or a hypothermia case), why can't we use the above logic to begin compressions and increase circulation manually? I've never seen this recommended but it's not clear to me why it wouldn't work, except maybe minor paranoia about commotio cordis. 3. Just what on earth is Cushing's triad really supposed to be? I thought I knew, but I've seen three versions: hypertension + bradycardia + irregular respirations; hypertension + bradycardia + widening pulse pressure; widening pulse pressure + bradycardia + irregular respirations. The second is the one I knew but apparently everyone has their own version. Try a quick Google -- it's kinda funny. Thoughts?

The more I learn the more I find inconsistencies in everything to do with medicine. I guess that is why it is rare to find two doctors, nurses, paramedics, emts etc who will agree on everything. I usually end up researching as much as I can and then go with what makes the most sense/logic to me. I just agree to disagree and as long as someone has a good rationale behind why they are doing something I don't try to change their opinion to agree with mine. I think part of the thinking behind the not suctioning the mouth if there is meconium staining present is, as someone said, that it actually stimulates the baby to breathe when you want to avoid that and intubate them before they start breathing if possible. The Cushing's Triad is more the widening pulse pressure being manifested by a sudden increase in the SBP along with the bradycardia and the irregular respirations leading to apnea. The interesting thing I have found in kids who are actively herniating is that they actually become suddenly tachycardic followed by bradycardia and they often like to code at the time of herniation. With a more gradual increase in ICP I see more of the bradycardia (usually a junctional rhythm). We had a baby who lived the first year of his life in the PICU and we had to do chest compressions on him at least once a shift for a while because of bradycardia. He would go bradycardic, you'd do a few compressions and he was fine again. Didn't even have to use epi or atropine every time. If I remember correctly they found out that he had a pulmonary artery sling around the trachea along with his 101 other congenital defects. He was totally FUBAR! I also think that compressions are more of a first line in peds with bradycardia because it is usually related to hypoxia or a more immediately reversible cause other than a cardiac arrhythmia or heart block like it is in adults.

Peterborough County Council just approved $7000.00 to cover costs associated with Paramedics running flu clinics for Police and Fire by Peterborough City-County EMS Paramedics. (This is not the service where I work, just the county I live in. Was reported in the local paper today.)

I wish you could attend some of the training sessions we have with our quad patients so you could hear about their "stresses" as well. Unfortunately for them they don't have the option of leaving the business but rather just want to leave life. Some patients do learn the hard way that they must be thankful and express it often for whatever help and attention they get. The mad and unhappy ones will not get that drink of water when they want if if they are thirsty or will get decubitus ulcers. They also will not get their glasses placed on their face to watch TV or their eyes rubbed when they itch or get something in one. When working in the rehab center I may get as many as 10 STAT calls a shift for everything from misplaced glasses to a dislodged trach and a very apneic patient. I take each one as that patient's own emergency with a little coping education from myself and the other highly trained/educated professionals I work with. Hopefully each "emergency" will better prepare the patient for life on the outside. But, many find out all about the struggle starting from the transport home with a couple of poorly trained/educated EMTs. Thus, we teach our patients to become educators to teach the less educated/trained for their own survival.

So far I swear H1N1 is tied to the full moon (very long night) but regardless of the tides flu season seems to be in full swing so I figured I would ask a few questions find out whats going on out there. For your confirmed (or heavily suspected) cases What seems to be our average time for onset of symptoms What do you wear for BSI? Are gloves good enough, do you wear a mask from the second you get out of the unit? after initial assesments? N95 or Surgical? Mask your patient as well? What similarities are you seeing Did you get innoculated? Just H1N1 or both? were you required? What are your disinfection policies regarding your unit after transporting these patients? Anyone else have any questions?

You've started your 0600 shift on a bright sunny Sunday morning, and are now settled down at your post, relaxing and waiting for the first usual 'church' call that eventually will come. However, the day is somewhat different as you fall asleep in the recliner, then wake just as the first NFL game begins. It's about 1300 hours and your enjoying watching your partners team get slaughtered when the tones go off......"EMS Engine 5 and Medic 4, respond Code 3 to (insert address) for a Lifeline call. Wow, first call of the day. Atypical Sunday. Easily getting up from the recliner, you get to your rig and go responding. Enroute to the address, Comm Center advises that the entry to the residence may be hindered as there is a coded lock system to the door. Upon hearing this, I look at my partner driving hot to the call and said, "OOOOOKKKKKKKay, this is going to be interesting". The response is approximately 2 miles, and upon getting to the scene, you see the FD/EMS engine crew getting their first response gear and starting to walk to the residence. The captain is already at the door and is now getting on the radio calling Comm Center (which we overhear/monitor), "AAhh, Comm Center, could you advise first, where is the code pad, and then if we can find it, what is the code......" Now exiting Medic 4, I'm thinking, "Great, I'm going to have to get my lard ass through a window.....this is going to suck!" Whoops, the captain gained entry. OK, go up the sidewalk and enter the house. Upon entering the kitchen area, I see the 3 fire personnel surrounding a patient reclined in a chair, blanket over them, TV blaring (with the same game we were previously watching) and the Captain asking/stating/inquiring....."You can't find your glasses?" I freeze and view the scenario from a small distance. Yup, the patient pressed the Lifeline, because their glasses fell off there head and they couldn't find them to put them back on. Sheesh..... I from across the room ask, "Do you need us?" The Captain smirkingly looks at the patient then us and states, "I don't think so...." He asks the patient, "Do you need the ambulance?", where upon the reply is a resounding "NO, I just need you to put my glasses on my face" (Subnote: the patient is a quad patient) I'm snickering internally now as the FD finds the glasses buried in the blanket and effectively and properly place them on the bridge of the patient's nose. Prior to leaving, I state from across the room to the patient, "Are you sure you don't need the ambulance?" Again a resounding "NO, I just need to see the game!" Exit, stage right...... Leaving the house, I'm giggling as my new partner looks at me, "Do we get a lot of these calls?" I look at him stating, "You bet, this is the first one of this type of complaint in my 30 years of EMS!" He stops, ponders with perplexed look and then starts laughing. Let's see, how am I going to write this one up.........hummmmmmm.........ah, patient had visual disturbances keeping them from seeing football game on TV. Yeah, I am sure administration will like this. Well, back to the rig. The shift was not a total loss, had 3 more calls, all refusals for total of 4 refusals in a row. Ah, the life of EMS.......

LOL. I had to sit and reread your post a few times to follow it! Still not sure if I understand exactly what you were trying to say so forgive me if I have misunderstood something. I think the reasoning behind giving atropine pre-RSI is that it is better to prevent the bradycardia than try and get a kid back from bradycardia although we never used it with our intubations in the PICU. We would have it ready on infants but I rarely ever gave it. In my flight program it is protocol to give it for under 6 years of age (and no I don't agree with it!) The increase in the SBP by widening the pulse pressure in herniation is an autoregulatory mechanism to increase cerebral perfusion pressure to a brain that has decreased blood flow due to increased ICP. The bradycardia and irregular and slowing respirations is from pressure on the brainstem with ensuing ischemia as the brain herniates downward through the foramen magnum. The brainstem is the where the vital cardiovascular and respiratory centers are. It's funny you bring up "coning" because when I first came to the States people had no idea what I was talking about when I would say someone is "coning". As a tidbit that term comes from the way the brain is pushed down through the foramen magnum like down an ice-cream cone. I was not referring to neonatal head bleeds when I talked about herniation in pediatrics. We used to see a lot of TBI, shaken baby syndrome, near-drowners and cerebral edema from any other variety of insults to the brain (including mismanaged DKAs). I have certainly seen my share of herniations and taken care of way too many pediatric organ donors. The child I was talking about was not a regular preemie with apnea/brady spells. This pt had multiple congenital heart defects (coarctation was not one of them) as well as a number of other defects and was on a rate on the ventilator. His episodes were related to the tracheal sling not necessarily hypoxia. We managed the plain old apnea/brady babies with stimulation, O2, bagging and usually caffeine or maybe stronger meds as needed. CPR was rarely needed on these infants as they usually respond before you get to that point. I am a little confused as to what you agree to disagree on and exactly what relevance to my post your links were (interesting though they were!) Have a great weekend and feel free to disagree or agree as much as you like. I am always open for good discussions and learning new things. I just reread your post and I think you misunderstood what I meant about compressions being first line treatment in peds versus adults. I am not talking about the apnea/brady spells in neonates where you don't do compressions first. I was responding to the OP's thoughts about compressions being used earlier for bradycardia in pediatrics in general (i.e. PALS guidelines) and more as a last resort in adults (per ACLS guidelines). Cheers!!

I've practiced the "tomahawk" in airway labs. It is not a blind technique and is not as difficult as it sounds. (of course, I've practiced yoga for 30 years )

All of these agencies answer to the single authority of the medic one system. Up until recently that has been the Iron Hand of Dr. Mike Copass. His influence is still quite substantial. For decades King County has subscribed to the idea of a "high Acuity" EMS system. They run a very low amount of paramedic units (medic units) , but those units only go on critical calls. Add to that the INTENSE training (initial and ongoing) that is phsyician led from the UW school of medicine out of Harborview Hospital...and you have a small core of Highly Trained, highly experience medics unlike most anywhere n the nation. To put it in comparison, today a medic is lucky in most systems to get 12-24 field tubes a year. In many "high availability" systems (like many of the fire based systems in California and Florida)are lucky to do a couple a year. Some places get even less than that. A few years ago a friend of mine got over 50 tubes in the field. So when I say they are a tiered response, high acuity system, they take it to the extreme. The whole system is built around this concept. There are no ALS engines in the county. If you are working as a medic, you are WORKING AS A MEDIC. And unlike most fire based systems, working as a medic is a PROMOTION and an HONOR in that system. Whether you are working for SFD or KCM1, turnover is low, pay/benies/retirement is very good. The other main difference is the emphasis put on the BLScomponent (i.e. the BLS engine first response). My understanding is that these guys are fully bought into the "high Acuity" concept, but also understand that they are the safety net. They also are trained and empowered and over seen by the medic one system. f they get on scene of a "ALS" call that isnt, then they are empowered and even expected to cancel the medic unit and request BLS transport (either an "aid car" -FD BLS transport ambulance or private BLS). On the flip side if they get to a BLS call, and its ALS, they are expected to request the Medic One response. This ensures the ALS rigs are teir for those who need tem, and arnt wasted on toe pain. As far as being a paramedic in the system. it doesn’t matter if you are a 15 year paramedic or a 1 year EMT, you all take the UW paramedic program. This program too is different. It approaches 3000 hours, double what 99% of most program in the US are. It is 99% taught by Doctors. If you dont go through that program, you don’t practice as paramedic in King County. Period. You can work on a BLS ambulance if you want. Or go into one of the neighboring counties. Hope this helps.

See now, you can take a few words out of the context of the entire statement and score "points" in the debate. You would score a lot more points if you attempt to understand the meaning of the entire post in the context of the discussion. You are upset with the tone of Vent's posts. Matty is suggesting you look beyond that tone and perhaps learn and grow. Fundamentally, that is what this site is for. The lady knows waaaaaaaaay more than you do about respiratory pathology AND has spent more years than you've been alive trying to get to real solutions to the delivery of emergency health problems. Use the information to become a better provider.

Brandon, YES, Pretty much an ACLS thing, although, when i teach BLS to healthcare providers, I will go over it as well.. I am an AHA BLS/ACLS/PALS instructor, and I find there are quite a few ambiguous areas unfortunately. ACLS standard for symptomatic brady is , atropine .5-1mg IVP ( Unless a 3 degree AV block exists), Transcutaneous Pacing, and CPR if none of that works or no pacer available. Your only other alternative is to sit and watch them progress from bradycardia to asystole by doing nothing. Take your pick? PS. AND you must make sure you have ruled out any reversible causes. 6h's and 5t's Respectfully, JW

I have had 40+ potential expossures and 8 confirmed cases including 2 severe. I had my seasonal flu shot as well as my H1N1 shot last week. It seems like many of the rural public health providers are not including EMS here in BC but so far I haven't seen this to be the case here in Vancouver. I would we have actually had a better immunization roll out than most of the hospitals for staff. Since last friday I would estimate we have vaccinated over 800 staff. There are some mobile vaccine vans starting up this week to hit more of the rural stations. The public health department response so far seems to be less than coordinated. Rock Shoes, You should be kicking up a fuss with your local public health since they are supposed to be including EMS with the rest of front line health care staff. I suspect this is a small town mentality as I haven't seen this at all in any of the urban areas to date.

We have some mobile vaccine vans starting in the GVRD for staff this week. There has been mass innoculation going on at holiday picks over the past 5 days. The public health clinics seem to be completely disorganized. Some are over run and others don't have a single person in line. Several hospitals have vaccinated have their staff here in Vancouver but then have run out of vaccine until friday.

Brandon, Hopefully, I can clear some of this up for you. 1. When delivering a baby, NRP recommends the oropharynx to be suctioned first, followed by the nares. The theory behind this, stimulation of the nares may cause the infant to gasp and aspirate secretions which are present in the oropharynx, ( Meconium being one of them). Also, remember not to suction too vigorously, no more than 100mm HG of negative pressure to avoid common injuries. Also, too much rigorous suctioning could overstimulate the vagus nerve and thus produce profound bradycardia.. 2. Adult SYMPTOMATIC Bradycardia can be treated with the following options. Atropine ( unless 3 degree AV block), Pacing, and finally CPR.......SO, YES, you can do CPR on an adult in this situation.... 3. Cushing's Triad is when you have an increase in ICP ( Inter-cranial Pressure, ) which causes compression of the cerebral blood vessels causing ischemia to the brain. This may be represented by Increase in Blood Pressure / Decrease in HR / Decrease in Respiratory Drive. This is a real event that you can easily witness in the field, as I have seen it many times both in the field and during my days First Assisting in the Operating Room... Hope this helps. Respectfully, JW

Ok you say 1% are hospitalized, is that an estimation, no offence but following that how many die ? Best advice would be go to an allergist, and be evaluated ... a child in Canada would NOT be allowed to attend public school If you did produce a daughter (I don't know family history for cervical cancer and genital warts) http://en.wikipedia.org/wiki/HPV_vaccine No one stated there was no side effects ... I have observed an anaphylactic response to Benadryl ... go figure. Hey no one said its a perfect system, I observed a TV interview where it was clearly written on the consent form allergies and someone missed it and gave the vaccination ... curious the child did NOT have a reaction = no lawsuit. this is actually a very mild response they hospitalized you for this sound like your first statement ... if your that sensitive to pain, maybe think about making a child ... just saying. Patient benefit vs risk always an issue in any medication more risk from taking a cold remedy off the shelf. Meanwhile in our British Columbia the Professional Firefighters are bitching in the TV news because they got excluded by their provincial government .... rock_shoes is going to love to hear that, CUPE and IFFA joining forces; Quote same scene same pay ... maybe add same PPE ? cheers

Here's a story that illustrates my reluctance to accept the premise that we are somehow obligated to solve a patient's social service problems. A few years ago, our area came up with a program to assist seniors at risk. A department of aging/gerontology expert was paired up with a police officer liaison for community outreach. As a result, we were informed that we needed to respond to these calls to medically assess and transport these patients as needed. We were also instructed to make every effort to comply with this advocate's wishes. One day we received such a call in a VERY expensive area of town. We were met at the door of a nice 2 flat brownstone by a frantic senior advocate and a LEO and told that they received a call from a nephew of this woman who lived out of state. He claimed his aunt was no longer able to care for herself, was not eating properly, and lived in a dangerous environment. As the outreach pair arrived, they knocked on the door, and announced they were there to help. The elderly woman let them in and went to her kitchen- she said she needed to finish doing her dishes. As they explained why they were there, the woman was first incredulous, then became afraid. She grabbed her coat and ran out of the house, screaming that nobody was going to take her from her home. As we looked around the home, it was IMMACULATE. Not a speck of dirt anywhere. Full refrigerator and shelves, vitamins and an aspirin bottle neatly lined up on her counter. This advocate said we HAD to go after this woman. I asked the officer her opinion, and she said this seemed like a family matter. The woman had apparently lived in this area all her life- around 80 years, which means she bought the building when the neighborhood was very seedy. The house and lot were now worth well over a million dollars and the officer thought- and we agreed- the nephew was looking for a windfall by getting his aunt put in a nursing home. We obliged, drove around looking for the woman, and we did catch up with her a couple blocks away- briefly. She was crying, saying that her family was trying to put her away to get her property and money. We could not examine her, but standing on the street, we asked her a couple quick medical questions and she said she had glaucoma- nothing more. She refused to allow further exam or transport and suddenly ran away from us as soon as she saw the advocate again. By this time, the advocate showed up and was yelling that we had to "grab her", and that the patient needed "help". I explained that we had no legal authority or medical reason to do that unless the officer placed her in protective custody, but the officer refused, saying she had no reason to do this.. I was asking the advocate the basis for why we needed to kidnap this patient- what she saw/knew that made her believe the patient was in danger or needed help. The advocate became irate with us, telling us to "do your job", threatening to call our bosses, the mayor, everyone else she could think of, and even threatened our jobs. We should take her in and the appropriate papers(I assume she meant involuntary commission) would be provided later. This is what the mayor wants us to do, she told us. As we left the scene, the advocate was frantically dialing her cell phone. I documented the encounter and within a few minutes, I was indeed explaining to bosses via phone, what happened. I have no idea how this case turned out, but this is my point. We have NO idea the back story of situations we walk into and how complicated the family components can be. We had a supposed expert on seniors who took the word of an essentially anonymous 3rd party call as enough evidence that an intervention was needed on behalf of someone, even though all the claims of this concerned family member seemed to be BS. If we find someone living in squalor or an unsafe situation , then yes, it is our moral and legal obligation to help rectify that situation, but our jobs are about immediate care and life threats. We medically assess, describe our concerns, and relay the info to the APPROPRIATE people to follow up. I think it's the height of arrogance to walk into a situation and within a couple minutes assume we can "fix" or even correctly address what may be a very complex problem. That's like treating a chest pain patient with a couple of nitros and tell them not to worry, we don't feel it's necessary for them to go to the ER. There is ALWAYS more to the story, and like the doctor's creed, we must first do no harm. I am NOT an expert on gerontology or social services but know enough to point someone in the right direction for help, or at the very least notify someone who is qualified to provide that help.

It seems we all pretty much follow the same procedures when it comes to spinal immobilization. I will however concur with everyone above thus far, it's a complete waste to go through the motions and do a spinal immobilization and not follow the same precautions on the C-Spine. In my service we have the good old Scoop (can't remember what you guys call it across the waters) and the LSB (sadly it's still wood, apparently it's illegal there???) I personally prefer using the scoop with the spider harness. We also have access to vacuum mattresses, I have used them on more than one occasion on flights in and around Namibia brilliant piece of equipment if used properly. the part I like about it would be the fact that it forms to the patients body when suctioned.

It truly sucks to be a patient advocate in EMS. You can always expect to be bashed if you offer the views from the patient, hospital or HHA's side on some situations. Tell us about your experience with disabled patients and home care situations. Have you done anything to improve the situation? Have you talked to quads, paras and the elderly about their frustrations? Have you talked with the reps from LifeLine or whatever company in your area? Have you offered training to the home health agencies? It may sound like I'm over the top because I provide additional information and not just find someone or something to blame. Seeing the situation in only one dimension does not give you a full view of the problems. Blaming the patient is the easy way out. Of course, some in EMS would rather just piss and moan on an EMS forum about their dislikes about the system and patients rather than attempting to assist companies to find a better solution for their clients and patients. Thus, you become as much of the problem as those that "abuse" the system. As least HERBIE is consistent. However, he doesn't consider the budget cuts that have put patients into home care situations with inadequate resources. I seriously doubt if he has participated in any petitions to get more funding for Medicare. EMS is a "me first" profession which is also why it doesn't get much support from other healthcare professions in some of their efforts for better funding. Other professions (NP, PA, RT, OT, SLP, RN, PT, MD) include the patients when they are lobbying for better reimbursement and funding. They don't criticize medical needs patients or the agencies that attempt to provide the with care. They try to work with these companies to see how the patient can be benefited and in turn, it usually benefits them as well. But for some opinions here, it would probably be easier just to build large nursing homes warehouse style instead of trying to work out some home care situations. Now, for those who want to say "I'm over the top" again, please for to the national association websites for any of the professions I mentioned and see what legislative actions they are working on. I don't just pull this stuff out of thin air. It comes from many years of being active in both of my chosen professions. Unfortunately, EMS has been the toughest for legislative issues largely because of the "me first and only" attitudes that exist in this profession. This is true for some individuals and the many different agencies that do EMS. It is also evident by the 50+ different certs this profession has just to please some and not for the benefit of either the profession or the patient. The new big screen TVs, patio furniture and barbecue sets are a pretty nice also. I also find that those who run only 2 calls per 24 hour shift complaining the loudest about being overworked with LifeLine calls. Those in busy areas are usually relieved when it is a public assist patient where the lifting and paperwork are minimal.

Yes I know this is in the funny section but I have spent many hours getting patients with severe disabilities home and have tried to work with various agencies and professionals to make the transition go as smoothe as possible. It is not always a matter of "coping" but rather results of a traumatic brain injury that can bring about a personality change. Many family members are often shocked or ashamed of their loved one's different behavior when they do start responding after a traumatic injury. Some abandon their loved ones to where some of the rehabilitation is affected without their support. Let's look at this from the perspective of a rehab facility. Having our patients laughed at is one of the fears we do have when we are preparing our patients for as much independence as possible. Unfortunately services like Lifeline are not perfect and instead of notifying their appointed primary care giver, they call 911 only to put our clients through a situation like this. While the patient may seem to take this in stride, the remarks made on scene do affect them and they try to make light of it in spite of their embarrassment. When they gather for more training or group support, I am often saddened to hear how some have been treated especially when they are not always in control of who their Life Alert or LifeLine system notifies. Instead of taking it as a big joke, especially with the new EMS provider, maybe some education and some notes on how the notification system could be improved might be in order. We are always looking for suggestions to work with the various agencies such as Life Line (or whatever in the area) and EMS to make our patients' transition back into some type of independent living successful. Nothing like a bunch of snickering FFs to undo months of work toward building the confidence of someone who must live with a broken body. Do whatever you can to improve the system instead of just complaining or laughing about it at the patient's expense of possibly losing what freedom they do have because of a poor system function. We still have a lot of patients and are getting more each day that would like to have a chance at independence even when severely disabled.

That applies to every patient you see throughout your entire career. Doesn't matter if you did everything right or not. That won't stop a blood-sucking lawyer from going for a settlement anyhow. But I don't mind noting that, in thirty-five years of practice in both EMS and nursing, I have yet to ever be involved in a medico-legal suit over a patient. Not that I don't make mistakes. I do. But even today, the chances of actually ending up in litigation over a critical EMS run are practically non-existent. It's the little runs, where they live, that you have to worry about. Dead people don't sue.

Personnally, I would take the time to clean and linen the bed. This is the way I perceive the job, to help those in need. However, this also can be a potential elder abuse situation, that in our state must be reported. Do not confront, but realize the situation and try to do the best with what you have. If the primary care giver cannot do the job, or is unwilling, this needs to be reported. Provide what the patient needs. Yes, I know, not all services will do this, but do what you can for the patient.

Well it always takes a "BOOB" to want to photograph a 'Boob'.

Avoidance of addressing issues concerning everyday healthcare situations do not make them go away. Every other profession has had to expand their knowledge, education, roles and ways of thinking to meet the challenges.

So I am not allowed to have a tone but herb can? You don't have to read my posts. However, you should not criticize patient care issues that you do not have much information about or very experience with. Herbie has taken this to a very personal level and has bashed me on almost every thread I have posted on this forum for the past year. So yes, my tone with him will be cold. And yes, when I am discussing various quotes from the literature and formulas, the post is dry and not exactly warm and fuzzy. I also don't care to dumb down all of my posts as there are mature and intelligent people on this forum who can handle a discussion that is full of medical, government and welfare issues. We have had numerous discussions here about treating and leaving patients at scene but yet some are not willing to even tell the ED RN to check the "consult Social Sevices" box on his/her paperwork or fill out a little piece of paper in the ED. Thus, it appears some are not ready for EMS providers to take the next step in the numerous health care issues this country has and it isn't because of inadequate training but more the attitudes that continue to prevail. Thus, instead of being a health care provider, some will always have the "tech" mentality of just doing A task. Eventually, EMS providers will be recognized as health care professionals but there will always be those opposed to change and will continue to just destroy the patient's equipment rarely than doing a little "thinking" to find the correct channels to find a solution. Of course once one has destroyed the patient's LifeLine property, you can not follow the correct channels to correct anything. For this reason some in EMS will always have recipes to follow instead of guidelines. For some, there will also always be a union to tell you how to vote or think a certain way.

It's relevant to any thread she chooses to reply to in that, at the risk of repeating myself yet again, you can learn something. There will be a lot of good information coming from people whose "tone" you may not like. Get over it - put on some big boy pants and read material that may not be fun, or ego stroking, or make you feel warm all over. And if you had read Vent's posts with an open mind, you would understand by this late date in this thread that the woman is trying to give you information that; 1- gives you perspective on the big picture - re: the fact that these people need something, and inadequate as it is, 911 is what they got. So sorry that not all calls are codes or major gory traumas or challenging to you or even fun. What else would you be doing anyway? recliner time? and 2 - gives you some ways to begin thinking about the solution as opposed to just plain whining about it.

I guess this has been moved into the Students forum. I have to admit that I find that vaguely offensive, since I'm not a student (except in the loose sense that we're all students...), and since in my opinion these are "questions" not because I haven't flipped to the right book but because the books don't seem to agree. Maybe these are all obvious issues to whoever moved this, but if so I'd appreciate them sharing with the rest of us, because they are non-obvious to me; and yes, I am a working EMT.

Yes, I took that into account scottymedic, and thank you for pointing it out. I'm sure someone will use the information you provided as a reference point for their own mismanagement.

Of COURSE they back fire based EMS, it means less firing for fire departments! It's not about providing good services, it's about maintaining the bottom line, and for the IAFF and IAFC, that's firefighter job security. I love the first comment on the article: Shame on JEMS for posting this propaganda. It'll probably get deleted, but props to whoever had the balls to post that up!! Wendy CO EMT-B

+ 5 on the dust devil scale. Just one addition the neonatal is an obligatory nasal breather agreed very vagal responses if suctioned excessively but well this thing we called birth process has been quite successful without any suction intervention before EMS. Most cephalic presentations, well as my pilots used to say (Gravity Sucks)the hang them by the feet thing its a darn good way to hang on to those slippery slimy things too, just a little WTF where is the suction If meconium is detected this is the time to actually intubate while body of child has not delivered and use a mec aspirator and remove the ETT while sucton applied, that said far easier in a proper birthing chair. As if that is likely where we work ... more like a taxi and a damn door that will NOT open up wide enough ... oh hose monkeys go get the Hurst tool fired up would you ? j/k. to the OP with good queries like these ... you are on your way to becoming a Paramedic cheers

yea I can see how you didn't interpret her intent.

As I said earlier which you obviously didn't bother reading ... 3500 calls a day Average day is 12 calls in 12 hours, with each job lasting 50-60 min, the assorted few minutes in between goes to restocking and other admin. The only place we sit even if there are 0 calls is in the ambulance on the street corner waiting to go. There is no fire house or station, there is no TV or BBQ etc... I don't need a gory trauma or a code to justify the purpose of using 9-1-1. Every call has its own challenges, ie: not being like the idiot's who broke a patients lifeline box regardless of how ridiculous the current call is. It's a challenge not to get upset with the misuse of the system, its a challenge to remember its the system, not the user. To repeat and quote myself,"I still do not, and can not agree there is justification for life line any other system similar to life line, or even the geriatric community calling 9-1-1 because their milk is sour, can't find their glasses, etc..."

His tone in his comments towards you may not be appropriate either, now we are making the thread about something unrelated. To say I don't have information on, or experience with anything is very poor judgment on your part. You have no way of knowing what I know or what I have experience with. As I do not know of you. If you make this assumption based on forum posts, well its just a poor idea. ____________________ Thread is dead to me. There is nothing good to come of anything else said. Let it fade to the depths.

Last post edited, and the avoidance began with you talking about herbies tone instead of responding to the content.