craig

How do you think I feel? I'm a degreed RN and I still get called an EMT!

From the way I read the posts here, a RN seems to have more creedence than a paramedic.

It seems to be a RN puts you 'higher up the food chain"

come to Australia (Sydney or NSW), you still might get called a driver occasionally, but you are treated as an equal with the RN and Nurses and at times with the doctors.

to quote a director of the ER at one of our trauma centres, he told a resident doctor "listen to the ambos they know what they are talking about and you might learn something"

so being called a driver, yes at times gets to me, but I KNOW what I am and what I can do and how good I am (FIGJAM)

so I dont let it get to me...people still appriecate it when I help whether I am a driver or not...........

stay safe

How do you think I feel? I'm a degreed RN and I still get called an EMT!

From the way I read the posts here, a RN seems to have more creedence than a paramedic.

It seems to be a RN puts you 'higher up the food chain"

come to Australia (Sydney or NSW), you still might get called a driver occasionally, but you are treated as an equal with the RN and Nurses and at times with the doctors.

to quote a director of the ER at one of our trauma centres, he told a resident doctor "listen to the ambos they know what they are talking about and you might learn something"

so being called a driver, yes at times gets to me, but I KNOW what I am and what I can do and how good I am (FIGJAM)

so I dont let it get to me...people still appriecate it when I help whether I am a driver or not...........

stay safe

FD is pure voluteer, all area EMS is paid, from minimum wage to around $8/hr

WOW GLAD I DONT WORK FOR YOUR COMPANY

8 dollars an hour is just over minimum wage anyway

even with the exchange rate that is about 10 hr here

im on 25 a hour and am by no means on the 'top' money that some guys can get.

stay safe

The Sprinter is made by Mercedes (I believe). I believe they offer a turbo diesel 4 and 6 cylinder. I do know for a fact that they offer a dually model of the Sprinter. I know that FedEx, UPS, DHL, and a ton of expedited freight companies are buying up the Sprinters.

true they sprinter is made by mercedes

they have a 5 cyclinder turbo charged motor

yes they do make a duel wheel version for the longer wheel base model

we use them each day and they have a 100 000 km waranty on them with road side assistance if anything does go wrong

our service dose over a million cases each year ina area bigger than texas (literally) on roads that would be considered less than what you guys considered ideal

stay safe

nothing wrong with sprinters

here in nsw australia, they are our first line response vehicle

our roads are normally rougher than those overseas, our response area is normally greater than most o/s areas

all level of training can use them

in australia where fuel costs are now high (135 cents per litre for diesel) makes good sense to have a reliable and economic ambulance.

theu are cheaper to purchase than that of an american built truck with a purpose built back

check one of ours out at

www.asnsw.health.nsw.gov.au

stay safe

over here we follow these pharmocologies

ADRENALINE

TYPE:

A sympathomimetic

ACTION:

Stimulates the ALPHA and BETA subdivisions of the sympathetic nervous system to produce the “fight†or “flight†reaction.

· ALPHA stimulation causes peripheral vasoconstriction. It raises the perfusion pressure of vital organs during cardiac arrest. In anaphylaxis it decreases capillary permeability

· BETA 1 stimulation causes increased myocardial excitability with tachycardia and increased myocardial contractility

· BETA 2 stimulation causes bronchodilation

USES:

· Cardiac arrest:

o To improve perfusion during external cardiac massage

o To stimulate myocardial excitability and contractility

· Bradycardia if pulse rate <50/min, poorly perfused and unresponsive to two doses of atropine

· Cardiogenic shock if pulse rate <150/min and poorly perfused with B.P. < 80 mmHg systolic

· Asthma if “in extremis†with decreased LOC or minimal air movement

· Anaphylaxis with upper or lower airway obstruction or shock

· Severe croup in children with stridor at rest and any one of:

o altered LOC

o retractions

o cyanosis

ADVERSE EFFECTS:

· tachycardia

· dysrhythmias, including ventricular fibrillation

· hypertension

· pupillary dilatation

· anxiety

· nausea and vomiting

PREPARATIONS:

1:10,000 adrenaline (Min-I-Jet preparation) – 1mg per 10ml Min-I-Jet

for IV/ET/Intraosseous use

1:1,000 adrenaline (ampoule) 1mg per 1ml ampoule

for subcutaneous, IM and nebulised use only

Because two concentrations are available, check the preparation you

are using carefully to ensure the correct concentration and dose are used.

DOSE:

ADULT

· CARDIAC ARREST:

Routes of administration: IV, ET

10 ml of 1:10,000 (1 mg) ADRENALINE IV as a bolus according to Protocol 15 and Protocol 16.

Repeat every 3 minutes while in arrest - there is no maximum dose.

Endotracheal dose: Give twice the IV dose (2mg) down the endotracheal tube if a vein is not available. Can be repeated 4 times.

· BRADYCARDIA:

Route of administration: IV

Bolus of 1 ml of 1:10,000 (100 mcg) ADRENALINE IV EVERY 30 SECONDS until pulse rate >50 or perfusion adequate or ADRENALINE INFUSION is running.

Commence a continuous ADRENALINE INFUSION:

o 10 ml of 1:10,000 (1 mg) ADRENALINE diluted in 90mls Hartmann’s in a burette

o Administer via a paediatric microdrip

o Commence at 30 drops a minute (5 mcg/min)

o Titrate to maintain a pulse rate of >50/min or perfusion adequate

· CARDIOGENIC SHOCK:

Routes of administration: IV infusion

ADRENALINE INFUSION:

o 10 ml of 1:10,000 (1 mg) ADRENALINE diluted in 90mls Hartmann’s in a burette

o Administer via a paediatric microdrip

o Commence at 30 drops a minute (5 mcg/min)

o Titrate to maintain a B.P. of >80 mmHg systolic

· ASTHMA OR ANAPHYLAXIS:

Routes of administration: IV, IM, SC

IM or subcutaneous administration:

0.5 ml of 1:1,000 (500 mcg) ADRENALINE SC or IM (into the deltoid muscle)

Can be repeated every 5 minutes if no response

IV administration:

If in extremis (signs of severe shock or impending arrest) 1 ml of 1:10,000 (100 mcg) ADRENALINE IV every 30 seconds or until patient is no longer in extremis.

PAEDIATRIC

· CARDIAC ARREST:

Routes of administration: IV, IO or ET

IV, Intraosseous dose:

o Initial: 0.1 ml/kg of 1:10,000 (10 mcg/kg) ADRENALINE IV as a bolus according to Protocol 15 and Protocol 16

o Subsequent: 1 ml/kg of 1:10,000 (100mcg/kg) ADRENALINE to a maximum of 10mls. This can be repeated every 3 minutes while in arrest. There is no maximum dose

Endotracheal dose:

0.4ml/kg OF 1:10,000 (40mcg/kg) ADRENALINE

This can be repeated 4 times

· BRADYCARDIA:

Routes of administration: IV, IO

0.1ml/kg of 1:10,000 (10mcg/kg) ADRENALINE

To be administered over 3 minutes, repeat as required whilst bradycardia persists, to a maximum of 4 doses

· ASTHMA OR ANAPHYLAXIS:

Routes of administration: IV, IM, SC

IM or subcutaneous administration:

0.01 ml/kg of 1:1,000 (10 mcg/kg) ADRENALINE SC or IM (in the deltoid muscle)

Can be repeated every 10 minutes if no response

IV administration:

If in extremis (signs of severe shock or impending arrest) 0.1 ml/kg of 1:10,000 (10 mcg/kg) ADRENALINE IV over 3 minutes or until patient is no longer in extremis.

Can be repeated every 5 minutes if the patient is still in extremis.

· CROUP:

Route of administration: nebulised

0.5 ml/kg of 1:1,000 (500 mcg/kg) ADRENALINE NEBULISED to a maximum of 5ml (5mg)

Can be repeated after 30 minutes if symptoms recur

Paediatric dose should not exceed adult dose.

Adrenaline and Sodium Bicarbonate precipitate when mixed together. Flush line between these drugs.

IPARTROPIUM BROMIDE (atrovent)

TYPE:

Anticholinergic bronchodilator

ACTION:

· Causes bronchodilation.

· Blocks vagal reflexes which mediate bronchoconstriction

· Synergistic when used in combination with salbutamol

Inhalation: Onset: 3 – 5 minutes Duration: 2 – 4 hours

USE:

Relieving air flow limitation as an adjunct to salbutamol

ADVERSE EFFECTS:

Mild anticholinergic effects eg urine retention

CONTRAINDICATION:

· previous adverse reaction

· glaucoma

PREPARATIONS:

· 500mcg in 1ml ADULT- nebule

· 250mcg in 1ml PAEDIATRIC - nebule

DOSE:

ADULT

500mcg (1ml) – mixed with first and third dose of salbutamol. Give via nebuliser with oxygen flow at 8 l/m attached to either a therapy mask or the “T piece†connected to the demand resuscitator or resuscitation bag

PAEDIATRIC

250mcg (1ml) - mixed with first and third dose of salbutamol. Give via nebuliser with oxygen flow at 8 l/m attached to either a therapy mask or the “T piece†connected to the demand resuscitator or resuscitation bag

TYPE:

Beta 2 agonist

ACTION:

Causes bronchodilation

SALBUTAMOL

USE:

To relieve bronchospasm

ADVERSE EFFECTS:

· Dysrhythmias in large doses

· Shakes and tremors

PREPARATIONS:

Salbutamol – 5mg in 2.5ml ADULT nebule

Salbutamol – 2.5mg in 2.5ml PAEDIATRIC nebule

DOSE:

ADULT

2.5ml (5mg) SALBUTAMOL ADULT NEBULE

Via nebuliser with oxygen flow at 8 litres/min attached to either a therapy mask or the “T piece†connected to the demand resuscitator or resuscitation bag

May be repeated when the nebuliser is empty, approximately 10 minutes

DO NOT wait at the scene to see if Salbutamol is going to be effective

PAEDIATRIC

2.5ml (2.5mg) SALBUTAMOL PAEDIATRIC NEBULE

Via nebuliser with oxygen flow at 8 litres/min attached to either a therapy mask or the “T piece†connected to the demand resuscitator or resuscitation bag

May be repeated when the nebuliser is empty, approximately 10 minutes

DO NOT wait at the scene to see if Salbutamol is going to be effective

Adult dose may be used in children over 5 years of age.

Stay safe

Clearly, you haven't seen many of these teams! Dominicans, Venezuelans, Mexicans, Japanese, Cubans, South Koreans, Australians, Germans, and French, just to name a few countries that have players in the League! They said there is a 1-9 ratio of Dominicans to other Nationalities in the almost 900 player League! Hell, they even have a guy from the Netherlands playing!

goes to prove what im saying

how can it bee a "world series" if the different nationalities are playing for teams in america and canada?

now if those players ended up playing for the contry that they originate from, and plat as a japanese, mexican, cuban team etc then it WOULD be world series.....

stay safe

Craig,

that is something I've always been wondering. Thanks for asking the question though.

SA

your guys did well in the trinations tonite (worst luck)

ah well the boks have to come to sydney dont they....

stay safe

who really cares?

bit weird to call it a world series when only two countries are in it

america and canada (thats were the teams are from aren't they?)

not like the;

1: Soccer world cup

2: Rugby Union World cup

3: Rugby league world cup

4: cricket world cup

just to name a few

stay safe

guedal everytime - most places in the Uk only use guedal for OP - bermans don't look as easy to suction through or even 'flick clear' ( extract, sharp shake to clear and re insert - somewhat dodgy from a flinging body fluids about POV)

suction through?

if we did that here in nsw we would be in such trouble...

we take them out and flick them clean and then reinsert.

if we cant get the blockage out we put in a new one.

stay safe

Guys are you saying that salbutamol (albatross) id an ALS only drug?

here in australia it is BLS. heck even the trainee can give it.

it is a pretty safe drug to give. so it may cause tachycardia in cases where it is OD

btu relative safe drug for all to give

stay safe

bloody spell check

albuterol and but

stay safe

Guys are you saying that salbutamol (albatross) id an ALS only drug?

here in australia it is BLS. heck even the trainee can give it.

it is a pretty safe drug to give. so it may cause tachycardia in cases where it is OD

btu relative safe drug for all to give

stay safe

FITH Syndrome - F*&JED IN THE HEAD

FPO - Pissed and fell over (as in very drunk)

WAFTS - waste of F*%ken time and money

more to come

stay safe

Here we use Hartmanns solution (ringers lactate) for all cases

we used to have D5W but phased that out, we also had NS but realised that why have it f we were using RL

we did have haemaccel (a colloid) for major hypovolaemia but due to the 1/2 life and chances of reactions and also the rationale of infusion this was phased out last year in favour of RL only.

we do use NS just for 10ml flush and NS for flushing eyes (set up in 500ml bag and pump set ) at bush fires etc.

stay safe

down here in Australia fire does the rescues in cities and towns, either proper FF's or volunteers, but in the country it is done by the State Emergency Service (SES) who are all volunteers. SES are also responsible for searching for missing people in the wilderness and helping after serious storms, like helping to remove trees and stop roofs from leaking.

Not all Australia

in nsw the (perm full time) ambulance service and the police and the fire brigade do it in the metro areas (tech rescue) the police and ambulance do vertical rescue

in rural areas there are some full time ambulance police and fire but in most cases it is vol squad that do tech rescue and vertical.

All ems is done by the full time paid ambulance service

stay safe

that would be hard to see happening here as we are a state run service and the fed law wouldn't over ride the state law...

still as long as i get paid

stay safe

no the cost of living is better in most cases than the states except for gas

so it can cost more to fuel your car

yeas this year i will get over 100K just for being a ALS officer (similar to you EMT-I) and i don't hold rank

stay safe

and if i get to do o'nite at another station i get an also 79 dollars living away allowance each nite

we don't do fire calls all we do is ems

i am on about 25 dollars an hour. penalty rates of 12 1/2% on OT

6 weeks a year paid leave

3 months paid leave after ten years service and bout three weeks year after that

15 paid sick days a year (and 10 carry over each year if not used)

allowance for being ALS

allowance for being tech rescue

allowance for being on call and about 200 dollars for each call after shift end

don't know what the fire dept wage is like

stay safe

if the patient was conscious and needed ventilation due to oedema

there is nothing wrong with sitting them upright on the bed and ventilating them from behind.

you don't need to be supine to bag some one

stay safe

thanks guys

our service is going to LMA's for LBS use the AL'S still have the option of ETT

I was on the working party that researched the combitube and the lardeal tracklight and we suggested the combitube.

but i think due to doctors feeling that medics are 'encroaching' on their skills, vetoed the combitube at the medical director level.

(our medical director sits on the state advisory panel for ALL medical applications....doctors nurses,medics etc)

thanks all

stay safe

just asking for some information

i have been asked to write a report about the advantages of the combitube over a LMA in the BLS prehospital situation.

if anyone has any sites that have the percentages and comparisons of these could you please let me know. or you could email it to me at

parsons@hwy.com.au

the more information i have the more thorough the report

thanks

stay safe

As for why I don't get my NREMT-P....I have other priorities- I don't want to be a paramedic for the rest of my life. I don't want to be a fire department employee, I don't want to work 24 hr shifts as a paramedic, and in any job other than perhaps flight nursing, my EMS credentials don't mean crap inside the hospital. I don't make more money as an RT for being EMS qualified, I certainly won't make more as a dentist if I happen to be a paramedic. Yeah, I could probably smoke the course without a problem, but I simply don't want to. EMS is no longer my career- it's a hobby more or less.

I don't see why I should delay finishing my degrees and going on to dental school just so that I can be an EMT-P instead of an EMT-I. As for making more money, trust me Dixie, I can make far more as an RT by working in a NICU in a large city than I could ever do as an EMT-P even under the best of circumstances. Or better yet, I can finish my degrees go and get my DDS and pull in $100K a year more than any paramedic.

That answer your question about my reasoning?

I also understand that getting published is exceedingly difficult. I was just tossing around an idea when I started this thread. It probably won't go anywhere, but oh well. I have bigger and better things to do with my time.

As for my attitude....sorry, didn't mean to offend you.

Steve

i see no problem with you writing a new text book, i say go ahead enjoy it.

there is always room for new texts on any subject and to have another for the prehospital field can only aid others in that field during their studies.

what i don't agree with is that you treat ems as a "hobby"

this is a career, whether you are paid or a vol. to treat it like a hobby s akin to making model planes.

ems is for people that are dedicated (of that i think you are) and not those that want to 'play' at saving lives.

if you know more than the 95% of others here, please at least back up your claims by not belittling ems by treating it as a 'HOBBY'

stay safe

as i stated before our service handle about 6 million or more residents has over 450 ambulances on the road each 24hr period

there are approx half that in the greater metro area alone

stay safe

with out getting too philosophical about it

if we are stepping in to save a life and 'taking gods place'

why do we do anything at all.

if we are badly cut and bleeding o death surly by stopping the bleeding we may be stopping the person from dying and 'taking gods place'

opens up a big can of worms

reminds me of the show 'Tru Calling"

stay safe