craig

Her son would insist that she was wheezing and gasping before we arrived. Since she was over 65 and a little batty, we couldn't RMA and had to tx every time. Of course concerned Sonny Boy would want to come to the hospital with Mom.

Trouble with this is that you were not there to see if she did indeed have SOB. You stated yourself that as she was elderly and not quite mentally with it, that you could not RMA her. so what do you do? of course you transport her and her son rides along with her. Here in lies the problem.

So that's one 911 medic crew, one BLS transport crew, and a couple of thousand dollar ER visit all courtesy of Medicaid and the American tapayer. Every single time this asshole had a dental appointment. :x

When I retire, I'd love to take a job investigating this sort of thing and arresting abusers. I'll do it for free, just pay for my gas.

Again I say to you how do you prove this? Yes she was ok by the time she arrived at the hospital (as you said you had to treat her) no wheeze and no SOB. Still they had to do an assessment at the hospital to rule out that she wasnt in any type of resp distress (she was over 65 and batty remember, so how can you trust her responses)

I agree that people that do abuse the system, any system, need to be held accounable for their actions, It is a little hard when the system is set up in a way that allows this abuse to happen in the first place. It is just unfortunate that there are people that know how to use the system to their advantage.

maybe the hospital should say that when he escorts his mum into the ER he needs to stay with her until she is discharged, seeing she is not 'with it' that way he would not be able to attend the dental appointment. That would help the problem would it not?

stay safe

Craig

ahhhhh

i think the basic reply is

rural is in the country

urban is in the city

im just from a small country downunder, but thats the differences i can see :D/

hey guys

dont believe everything you read in the paper......

it it wasnt sensatioal it wouldnt sell

the service is in dispute with the staff over the number of crews rostered to do the work

the work load has almost trippled in the past 10 years and the crew level has remained the same

the 'strike' action was costing the service over a million dollars a week.

so the paper had to run a story to make it sound really bad (and it was from unconfirmed sources) and by you guyus believing it it worked.

yes we have people that abuse the system, but what service doesnt?

in australia we have the right to FREE medical (including ambo transport on treatment if on a pension or concession card) unlike the states. so some do abuse it.

but like i said iat the begining of this post

dont believe everything in the papers

stay safe

craig

ONE...............ME

I am NOT responsible for what other may or may not do

I am only responsible for MY actions

What my partner does is his responsibility, however i can also be accountable for the things that he may do in the role of the attending team.

HOWEVER it is ME that is responsible for ME

stay safe

Craig

Took a while, but I finally noticed she had a face too!

[/font:9936166ab2]FACE ? WHAT FACE?

Protocols are there for the C.A.R.E principal.

remember this and you will be alright

stay safe

craig

EMS is & always will be a thinking profession.

To that end, providers should always be looking at what their knowledge base is, & how it can be improved.

Having said that, it is how they personally apply the knowledge in the field with their patient that is relevant. It will affect some of their decisions, but ultimately, the protocol, or should they be more aptly named guideline, will be the driving force for treatment.

For example, in my service i have a protocol for vomiting, it says to give an anti emetic, it lists a choice of 2 anti emetics I can use. But should I give an anti emetic to every vomiting patient? No I shouldnt. Should I rush to my drug kit for it. No way.

However, I have a patient post MVA, presenting with neuro-motor defecits, is being treated for spinal injuries, but has no nausea, will I give them an anti emetic, just in case - I would certainly hope so.

Anthony, to answer your question, there is no answer, it is an individual thing, some people will take what they have learned & try to over treat, others, no matter what they learn will always undertreat.

Phil

Just to set the record straight, they are PROTOCOLS not GUIDLINES. by the implacation that they are guidlines also takes away the security of the authorisation of the states medical advisory committee.

by having Protocols (even though we can alter them and report the changes in an variation to protocol form) keeps the STANDARD of treatment that the public expects and deserves.

using your analagy of the vomiting protocol, I remenber last week that we had a female that had an ovarian cyst. she was in pain and had morphine at the local coutry hospital prior to transport to the City base hospital.

Now this patient with the abdo pain from the ovarian cyst and the morphine felt a little nauseous (as one would expect) but had not and did not feel like she was to about to vomit.

however it was sugested by an officer on the car that he would give her some metaclopramide for the trip. when it was pointed out to him that it was not in the protocols scope or SOP, he said that it would be a benift for her (really said "but isnt she vomiting" :wink: )

It was even pointed out to him by the nursing sister on duty that even she could not administer the maxalon untill the patient had started to vomit.

yes Phil, education can and is a good thing, but people must also realise that although they may have a higher level of education than others (or even percieve that) that this does not always translate into the ability to make rational decisions and get that knowledge to the 'finger tips', we all know of people that carry out interventions an drug administration because they CAN, not becuase it is the best thing.

stay safe

Craig

PS

you are not 19

people know where you are from

and you have been in the industry for almost 4 years so you may need to update you bio

Thanks

Cardiogenic shock protocol here......

1: basic protocol 2

2: Cannulate

3: Treat disrhythmias if present

4: ADRENALINE infusion if pulse rate 50-150/min and poorly perfused with BP < 80 mmHg systolic

5: Pain management

6: Consider urgent transport

Stay Safe

Craig

yes sorry to hear that as well

seems to me that afganistan will be the place hwere the trouble will be, not so much iraq

the taliban looks to be reforming to attack when they want

in the past month 3 aussie troops have paid the ultimate price in this fight against terrorism, one of them was the brother o my wife's work colleague

i can only hope it will end before more people have to be lost to us

stay safe

craig

While i agree on your points about vollies

remeber that this guy has done 30 yrs or so as a basic and he is now retiring and moving to a state that doesn't have a volunteer service.

therefore he "wont take money for helping people"

ISN'T THAT WHAT WE WANT?

ONE LESS VOLLIE ON THE STREETS THAT SHOULD HAVE BEEN A PAID POSITION.

if the community sees that they need a paramedical service then it should be a paid one.

not to RELY on the goodwill of others

For gawds sake we supposed to live in first world countries.

stay safe

Craig

Should therefor training be provided by the company who is employing & then the onus is on them to provide the ridealong in an appropriate time frame for the students?

I have to disagree with you there Philip

if the company has employed you, then it is perceived that you already have the qualifications that they seek.

here in NSW

you are employed as a student, with that you are at the academy (AEC, Rozelle) as a student to learn the nuts and bolts of this profession in a clinical sense.

when you leave the school after when ever (5, 6, 7, 8 or what ever weeks) you are PLACED at a TRAINING station with a Training officer to learn the practical aspects of this job.

that is why you here people say at the school "this in not how you will end up doing it on the road" at times. You are placed as a probationary officer to gain and hone the theoretical skills taught at the AEC.

that is why when you graduated as a probationary officer 3 1/2 years ago you were sent to Bathurst to learn the road skills and sent to Kandos as your first posting. After the 12 moths or so it is deemed that you know enough to be able to treat as a primary care (general duties) ambo.

however as this profession is an everchanging one, you will never stop learning, that is why we have recert schools and skill update workshops to enhance the skills that we require.

under the proposed scheme that you have put forward, when you went back to rozelle last year for your P1 upgrade, should you then be made to do the ride along, as you will have to instigate skills that you didn't have at your disposal as a level 2 basic?

no they allowed you to do the schooling and ride with me to assess that you could infact cannulate and know the drugs you were giving and the rational as to why you were giving them. same follows for the mental health course. they teach you and then you are 'licenced' to carry out the role when you get "back on road'

see my point.

remember........the old bull and the young bull..........well phil, lets just walk down the hill ok?..

stay safe

Craig

sure would love to trade a shirt with you

we have just changed our duty uniform and we only use our whites for dress uniform now so i have a few of them left

What is different to the multi car pile ups we see on our tellys in that happen on the freeways, highways and motorways that get reported on that happen in the States and the European countries?

So it is a multi car dingle in an Arabian country, unfrotunate, but no different than the ones that i have seen reported on that cause the same type of damage in the states

stay safe

Just another reminder that some of North America's best and brightest are overseas in combat. I can't wait to see American and Canadian soldiers home and the job done.

I couldn't agree more, however there are more than just North American soldiers doing their part in those areas, I hope they all come home safe

I could care less,as long as the lights are flashing and the siren is activated,I run like a raped ape! Red lights and stop signs don't mean shiit when seconds count.

Yes as others have said...i admire your honesty...

however what troubles me is that with an opinion like yours, i assume that you have the same care and wellbeing for those that you are charged to tend to as the same raped ape.

the raped ape don't care about anything but itself and by your feeble minded and neandethal comment, shows that you have the same high regard for your patient as well.

the biggest problem with your outlook on things is that younger and newer people that come to the ems field see this type of post and think "gee maybe that's how i should do it as well" and putting the good name of the field of expertise that i and many others work in, in question and shame.

My only hope is that some one doesn't get hurt or die due to the irresponsible actions of you speeding to or from a scene to save a "few seconds"

to paraphrase my sign off

PLEASE STAY SAFE

craig

Um, I understand a little of that but that's just scary

please let me translate that sentence into kiwi for the other n-zeders that get on this page

"Em, I endersund a lettle of thut bet thut's jest scary

stay safe

Slightly off topic, but can you explain that a bit better? Do you mean that each person is fully trained in each area you mentioned above, partially trained in all, or trained in one specific area only?

Sorry to mislead you

in nsw ALL ambulance rescue officer are trained to the list levels and more but the FD and the volunteer squads do not have to be trained to such an extent and therefore dont not have all the same level of training that the ambulance service does.

the state govt rescue registration board sets the MINIMUM level required and most services vol or FD/ police meet the minimum level required for the area they are in but the ambulance service stated that all of its trained rescue officers should be trained to the highest level available and that they should be able to carry out any rescue that is required and not have to wait for another response to attend because they are not trained to that capability. ie the volunteer squad here is not trained to SCBA foe confined spaces and does not want to do the SCBA training but is willing to carry out confined space rescue

hope this clears it up a little

my two bobs worth

I am an ALS officer in a paid government service (3000 officers)

our service also supplies the public we serve with specialised services as well

one is our SCAT teams (special casualty access teams) that carry our the treat and access of patients in difficult terrain, high angle access, tactical police back up etc.

we also have dedicated rescue response units (technical rescue) and they are argueably the highest trained rescue units in the country.

yes i have a vested interest in this as i am one of the trained officers that supply rescue to the public.

in my position I 1: care for my patient first and 2: carry out the extrication.

the types of things that our rescue officers are trained in are

MVA's

Heavy vehicle

Aircraft

Domestic

Industrial

High Angle

depth

trenching

CBR (NBC)

SCBA and FE suits

Swift water

just o name a few.

the fire dept in this great state do not have all their people trained in such areas, where as ALL ambulance rescue officers do have to be fully trained in each area that is set out for them.

I feel that rescue is an integeral part of EMS, if a person is injured (in a mva for example) and need extrication, is it not better to have someone that understands what the medics are doing to the patient and what the ripping trearing and lacerating of the rescue will do to the patient whilst they are in the vehicle?

yes the hose monkeys do have their place. that is holding the hose to surpress any fire risk and assist with the lifting of things and carrying of the patient in a long lift. BUT if i was treating in the car and my patient was in a critical condition i would prefer that a person that had traing in ems was dismantling the vehicle, so that i knew that they ALSO had the best for my patient in mind, nad not the time to get the patient out of the vehicle

stay safe

craig

I just gave a lecture on Toxicology last week. The Brady books put snake bites, Black Widow bites, Scorpion stings, and things in this chapter. It was a very interesting class.

We do not get any of those calls around here. Of course the potential is there, especially at the Maine Military Authority. Those Hummers come in with a lot of Black Widows and other pests in them.

Ahhh the humble black widow

pity it is only a girly spider

ooooh i am so scared of the big bad blackwidow................

now if it was a funnel web...then i would be a little afraid............

stay safe. check your boots before putting them on

Craig

Just some thoughts from a 20yr veteran that lives in the country that has the most number of venemous snakes

dont put ice on the bite site.

reson one for doing this is that it does constrict the periferal blood supply and then cause constriction of the underlying tissue. this is not what you want in a LOCALISED area.

the idea that you want the poison to be slowed in the circulatory folw is incorrect as it is the LYMPHATIC system that is the transport agent for the toxins. That is whay you use the compression imobolisation banadge here in Aus. this compresses the lymph system in the whole limb thus slowing the flow throught the lymph system and reducing the envenomation.

I agree that the general population would not think and keep ice on the skin for greater than 20 minutes and could cause tissue damage.

The other main reason for not using ice on a bite (in Australia at leasty) is that the skin can be scraped at 99% of our hospitals to get a sample of the venom for identification.

By using ice then DILUTES this dried venom on the skin making it difficult to carry out this procedure and then delaying the use of the correct anti veniene.

These are standard envenomation treatment guidlines for any envenomation here in the great south land, being snake, spider, octopus, wasp etc.

hope this helps

stay safe

craig.

PS Chuck Norris put all the poisonous stuff in Australia so he could use it as a playground for his kids with out hurting anyone else.

I can never agree wit hrefusing transport to someone, there are too many things that can go wrong.

I do however believe that as EMS is a MEDICAL service (as opposed to an appendage of fire) & we transport to a MEDICAL facitlity, if the person is deemed to have nothin wron, then hit them with a full fee. if they dont pay, chase them for the money.

People call because the have a percieved need, they may not have any physical S&S, buthow many of our elderly patients call because they are lonely? This is an opportunity for us to take a more holistic approach to pre hospital medicine & yr health depts (& mine too) should work towards an ems referal service. One that will in the long run reduce hospital presentations & provide the most appropriate care to your patients.

To refuse to transport is a legal & ethical minefield that I want no part of. At the end of the day ems is also a transport service. They ring, we transport.

Play safe

Sorry dont agree

in some cases to refuse is theappropriate thing to do

phil tere have been times that you have refused to do a job...i've been there

stay safe

Phil

One thing is for sure here: You dingo people stick together on something. It's common knowlege that Paramedics and EMS (modern version) were created in America.It seems to me that you aussies are lacking in the same thing that make American paramedics the best:..TESTICULAR FORTITUDE...Its what made us the greatest nation on earth and we started just like you in Dingoland

Back on point...Im fully capable of managing bad scenes as a Paramedic in my system and will never need some "Dr Death medicine woman" getting in the way and spreading drama. One day you aussies can look forward to making it up to our level of professionalism and self reliance.

Cheers, Beers and Kangaroos!

SOMEDIC

well here in my world we have a term for people like you....BLOODY DICKHEAD

so the great american system is the best.....whoop-dee-f*cking-do

from what i have seen, experienced,heard, read and been shown, that is a hard pill to swallow

in my backward area of service we do not have to

1, be subserviant to a nurse (as my degree has the same weight bearing as theirs, and I get paid more than they do)

2, contact a medical control to administer drugs

3, have basics that can not do anything but put on a band aid (our basic level cannulate and administer drugs & fluids)

4, have to blow our own trumpet to make ourselves feel important

5, we have the ability and the trust of the medical profession to enable us to make the diagnosis of the problem at the scene, treat the patient at the scene (without a doctor authorising) and transporting to facilities that we feel is the appropriate

do i need to go on........................

stay safe

I want one!!!

what the bloody heck would a st john cadet do with one?

stay safe

when someone is sick or injured

In aussie land you either get ALS paramedics or mobile intensive care paramedics or nothing lol!

I don’t see how an EMT/BSL would be beneficial when there are paramedics around.

The only BLS teams we have in Australia would be the CERT Team, there volleys who live in very remote communities were the ambulance response time it very long, normally 20 mins +.

There mainly there for an arrest or MVA. There work load is about 3 calls a month, its not worth having a professional station there. They drive around in little 4x4 cars with debif, 02 and first response gear. They wait at the scene until the paramedics arrive. There basically there to kick off the chain of survival.

Now timmy that isnot entirely true

in victoria you have paramedics and intensive care mica guys

but thats in victoria

the reason you have 'paramedics' in victoria is because jeff kennett, your ex premier did an election promise of have paramedics on every car

the way he did this was to change the name of the guys from ambulance officers to paramedics and wait for it they kept the same skills

he achieved his aim in the eyes of joe q public as there are now paramedics on each car in victoria

and for saying the only bls team we have in aus, well judging by your photos i would say you were part of the biggest bls team we have.....the jonnies

stay safe