VentMedic

http://www.1010wins.com/NY-Officials-Rescind-Mandatory-H1N1-Flu-Shot-Order/5502143 New York Officials Rescind Mandatory Flu Shot Order ALBANY, N.Y. (AP/ 1010 WINS) -- New York state health officials have suspended a ruling that would have forced health care workers across the state to get vaccinated against the swine flu by the end of November or risk losing their jobs, saying in a decision issued Thursday that they did so because the vaccine is in short supply. 1010 WINS Swine Flu Resource Center New York will be getting only about 23 percent of its anticipated supply of the vaccine for the swine flu virus -- also called H1N1 -- by the end of the month, and that should be reserved for those most at risk for serious illness and death, according to Gov. David Paterson's office. "New evidence is showing that H1N1 can be especially virulent to pregnant women and young people -- so they should get vaccinated first,'' said Dr. Richard Daines, the state health commissioner. Workers had protested Daines' earlier order that health care workers receive the vaccine, arguing it was unfair to force them to put a substance into their body. Unions and health workers sued the state, and a judge issued a temporary restraining order last week. "This is welcome news,'' said Carl Korn, a spokesman for the New York State United Teachers union. "This suit was never about the safety of the vaccine, or the merits of it. The suit was always about giving individuals the choice, as adults, as to whether or not they wanted to be vaccinated without the threat of termination.'' It's unclear what will happen with the lawsuits. Thursday's action was a suspension of the order, and the Health Department plans to pursue making the order permanent in 2010, as long as there's enough vaccine for that flu season, said Diane Mathis, an agency spokeswoman. The Health Department initially had said the workers must be vaccinated by November 30. Institutions had to determine how to enforce the mandate, leaving some workers concerned about possible disciplinary action, including dismissal. "This was the proper and appropriate action for the state to take,'' said Kenneth Brynien, president of the Public Employees Federation, one of the unions that sued. ``This was an extremely passionate issue for many of our members.'' PEF said it encourages members to get flu vaccinations, but opposes the emergency regulation requiring the vaccine as a condition of employment. This week the Centers for Disease Control and Prevention allowed the state to order 146,300 doses of vaccine, but health care providers across the state have requested more than 1.4 million doses.

Still love you... Now, do you want me to help you remove the forum from where I told you to stick it the other night in the PM?

Yeah I double clicked on the reply button. Still getting used to this new site and I don't like the center default.

You can crook and hook one finger to tube a baby. I don't recommend DI for pediatrics because they have "teeth". If they awaken during intubation you will think a shark has taken your fingers. Adults, I have used a tongue depressor to assist in a frontal intubation if there wasn't room to maneuver a blade and handle. Everyone should not allow not having a stylet stop you from intubating and should be confident in your skills if you didn't have one especially for neo/peds. Just try not to keep the tubes in the warmest part of the truck. Also, if given the opportunity to intubate in neo/peds, don't place the tube under the warmer while getting into position. I guess one of the arguments with the whole ETI situation is that some don't utilize all of their options. Whatever you have in your tool box or your hands, you should be proficient at. That includes the BVM and all the alternative airways. Of course, for neonates, one would have to sink an OG if using the BVM for a prolonged time.

The difference is you can feel the structures and the mouth giving way as where a cold metal blade could care less. I've seen FFs, RRTs, RNs and doctors with massive fingers master this skill. Do a little research and pull up some stats from the literature. Some have found DI to be faster and with less failure rate. It is a shame EMS has also watered down its training for intubation to not include more anatomy, assessment scoring and alternative methods rather than what the latest gadget is. As I mentioned, you probably won't find it in the NRP book at it is designed for everyone and does not specifically teach intubation except for an overview as did ACLS a few years ago. I first learned about it 30 years ago in Paramedic school and then learned it again an an RRT doing NICU and transport.

Yes you can suction. NRP is watered down as in the past it had been 2 full days in length and not just 6 hours. Also, anybody can take it. The nurses and RTs that intubate will have more extensive intubation training than just that course which is not designed to teach neonatal intubation for real situations no more than ACLS was. Specialty transport and neonatal resuscitation teams are taught all forms of ETI and airway management. We are also taught not to rely on a stylette as just when you need one, it won't be there. Even for meconium babies, we can not always depend on that cute little adapter to be around. Digital intubation, especially for neonates, had been mentioned in EMS training for many years. I know for adults alternative airways have lessened the need for DI.

Anybody ever hear of digital intubation for the newborn? It is much safer than placing something too large and that you have little control over what parts of the soft tissue it will destroy. A baby asphyxiated by blood from a palate tear in not a good thing.

I believe TFD has some trucks that are transport capable but are not being used as such. That is similar to the way many of our FDs are set up. ALS engines of course are popular. I also believe the article was referring to the training of the FFs as Paramedics as most should already be EMTs.

The State of Florida provides all ALS 911 service to its citizens. Leon County EMS is the other EMS provider for Tallahassee. Both TFD and LCEMS have ALS capabilities. http://www.leoncountyfl.gov/LCEMS/911Services.asp http://www.talgov.com/fire/ Here is a little more info about the arrangement. http://www.tallahassee.com/article/20090930/NEWS01/909300321/1010/NEWS01 Residents reminded of new fire, EMS service fees DEMOCRAT STAFF WRITER • September 30, 2009 No home is fireproof, and almost no citizen in Leon County or the city of Tallahassee will be exempt from fire fees starting in October. Leon County Commission Chairman Bryan Desloge and City Commissioner Andrew Gillum held a news conference Tuesday to remind citizens of the fees, which are a part of the recent union of Leon County Emergency Medical Services and the Tallahassee Fire Department. City residents, who already pay a fire fee via their utility bill ($13 per month for single-family homes), will experience an increase of $.42 to $1.92 per month, Gillum said. Unincorporated county residents on city utilities, who did not pay a fire fee previously, will incur the new fee on their monthly utility bills. County residents not on city utilities will receive a quarterly bill ranging from $40.25 to $44.75 per quarter. Businesses will also be charged, but places of worship will be exempt. "Through adversity comes triumph," Gillum said in regards to the work it took to put the consolidation and fire fees in effect. "And today is a day of triumph." The fees will generate $6.8 million annually to be used by the Fire Department for staff and equipment. In addition to the fees, county residents will have better coverage with the addition of an extra person per shift at five rural county stations. This will mean 18 new responder positions. Previously, Leon County paid a fee to the city of Tallahassee for fire service in the county. Leon County EMS covers Tallahassee emergencies without charging the city. Its operating budget comes from property taxes. "Taxes are taxes. And the people that pay taxes could care less if they are paying a city tax or county tax or a state tax. They want a service," Desloge said.

Let's clarify a few things about what the Ryan White Act actually does. For the large part, the IAFF should have spent their money lobbying at the state level for improved state regulations about testing and seeing their own departments had effective DICOs. In 1990, largely at the insistence of the IAFF, this section was added. Its purpose was to get money to set up some education for employees and a Designated Infection Control Officer in EMS/FDs. Since this was not the primary purpose of the Act, EMS/FDs did establish a DICO but it was usually just a title and not necessarily a working job description. Policies should have been written but often they relied on those from a hospital for exposure on a case by case basis. However, Public Health laws are enforced and if the DICO of any agency taps into them with their policies, the blood and airborne pathogens that are worrisome are covered. In the states that have OSHA, they can also be used for policy making guidelines. Hospital infection control officers will also contact an agency but they can not force the DICO of EMS/FD to do whatever. Public Health notification for certain diseases are there to also assist and enforce certain regulations for that state. The other thing the Ryan White Act does not do is mandate testing without consent for an exposure to a blood borne pathogen. If the state does not allow it, then you again have to rely on your department's policy for prophylactic treatment or to obtain a court order if the exposure is serious enough. OSHA does spell this out and in the states that don't have OSHA, they either a specific state statute or a section in their Public Health laws that addresses this. The DICO should be familiar with his/her policy to get the employee whatever care is necessary. The employee should also make sure they understand their policies. If neither the DICO or the employee take some responsibility, it doesn't matter how many people notify them. Since the Ryan White Act is almost a $3 Billion/year expenditure for People With AIDS/HIV over the next four years and it has been each year for 20 years, EMS/FDs departments would be foolish to rely on those few paragraphs buried inside this Bill. The intent of this Bill was to provide health care and housing to people living with HIV/AIDS. It is a good piece of legislation that is needed and actually $3 Billion in not nearly enough. But, any health care reform could again repeal this Act. It is also sad when most in EMS/FDs only know a couple paragraphs of this Act and believe the Ryan White Act is solely about them. Few even know who Ryan White is. If EMS/FDs fail to establish an effective DICO and have the necessary policies in place to protect their employees there is no assurance that anything from the Ryan White Act will even be followed by that department regardless of the hospitals' part per the Public Health regulations. Most of these regulations are stricter and can be enforced more easily. However, there is no guarantee that the hospitals will test for some diseases if it does not pertain to the immediate illness/injury. Even TB has gone undetected for several ED visits because the symptoms were not all present. So, if you are waiting for an engraved letter from the hospital, you may be waiting a long time if there is no reason to notify you because testing was not done. That doesn't mean you do nothing for a needle stick or when you feel you may have been exposed to something. Again, that is what your DICO is for. He/she should have a relationship with the various hospitals and a policy to see you are covered quickly for whatever exposure. There is also nothing more frustrating than when the ED doctor already knows what he/she is going to diagnose a patient with and asks the EMT(P)s who their DICO is so they can be contacted and prophylactic treatment can be given but all the doctor gets is a blank stare. Sometimes that blank stare is even from the EMS supervisor when approached about a situation. Side note, Florida does have a section in its statutes for testing without consent. California leaves it to the discretion of a doctor and the written informed consent is no longer required. I believe NY still requires consent before blood can be tested for HIV. The same for the Veteran's Administration system which is Federal. The hesitation of some states to have testing without consent is for the protection of the employee and everyone else who enters the health care system. Many states do mandate that if you have HIV or Hep C and are working in health care that you disclose this. However, mandatory testing for health care employees has not yet been legislated and enforced.

ECMO? I merely stated that some CHDs do not have to be surgically repaired immediately. Some are also missed until they present a problem. This situation you describe is fixable. A diaphragmatic hernia is sitll considered viable and ECMO is NOT used for all diaphragmatic hernias. We can manage them to the OR on a conventional ventilator most of the time. ECMO is one of the last options but even at that many of our babies, pediatrics and adults still survive for a variety of disease processes including H1N1. Try the back of an open jeep to get to your helicopter several miles away. I have no clue about what your knowledge base is about babies. Your post did not reflect that. Are you threating me? Not once did I question his care. I questioned his reasons for assuming the doctor is guilty of gross negligence when he clearly stated the family could not provide any information due to a language barrier. Actually I have worked under some less than ideal situations since I do transport babies to and from many countries. On a 24 hour transport to some islands, you have to be prepared for a lot of things including your own technology malfunctioning. As well I have gone with the pedi team to South America for surgical procedures and you probably have not seen surgery under those conditions on a baby. Or, maybe you have. I also don't believe they had much of an EMS system in that part of the Honduras. I have also worked in hospitals very crippled by hurricanes and in tents to provide care to sick babies and children. So spare the "you don't know" since you don't know my whole resume. Again and again, SA's skills are not on trial here and never have been. The question was about the doctor. Why are you turning this into a pissing match over something that was never an issue? What is with the "fucks" word? Why are you swearing at me for offering some educational information? Geez! Now you bash me for adding a little extra information about managing a CHD. This may or may not even have anything to do with this baby but since we were talking about CHD and SpO2, I tossed it in. The baby is intubated and on a ventilator with a pneumothorax existing in a preemie lung. Considering the age and weight of this child I am surprised this baby did't have some type of tube at home to supplement feedings. But then, again the intent of care at home has not been determined.

There are some universally accepted standards for viability such as gestational age and weight. We will not resuscitate a 22 week baby but may one that is 22 5/6. A Grade 4 ICH and other preemie conditions are a bad situation and the parent will be told straight out the prognosis. The same for some congenital heart defects and syndromes. If the surgery is not an option, there will be a serious discussion toward comfort care. Some syndromes are not compatible with life for very long but may be discharged to live with their family until death with the knowledge nothing can be done. Anecephalic babies have been an issue in the courts especially when there is life support involved and some parents have opted to take their baby home. They are told of the prognosis and the baby could live for a long time. However, there will be no hope given that the baby will be normal. The same for a baby with a grade 3 ICH. We also now have organ procurement where the baby or adult does not have to meet brain death criteria but must have a poor prognosis or will die without the ventilator. With any ventilator dependent baby whether it goes home or placed in a nursing home, the parents are told up front there are no guarantees and what to expect. While parents can have hope, they must be aware that medicine can not fix the problem and will only be able to resuscitate the baby just so many times before realty must realized. It the parents have trouble with this, in the U.S. we have ethics committees that can help make that decision once the parents' wishes for "everything done" becomes to unrealistic. Yes, the hospital and those working there will become villains in the eyes of some but sometimes the suffering of the baby and the prognosis must be realized. Someone finally has to say enough is enough. Some of our U.S. hospitals, including the one I work for, have the reputation for being able to resuscitate a rock and prolong the life or death of an adult or infant indefinitely. Our egos allowed us to fill up nursing homes with both adults and kids from our heroic saves. Now, doctors are starting to take a more realistic approach with some patients.

tniuqs, I did NOT bash any of SA medic's care. I merely pointed out there were too many unanswered questions about what transpired prior to his arrival and during the life of this child to charge this doctor with gross negligence. We also do not know what happened during birth. One can not say the doctor did not act in accordance of the family's wishes, which would not make it negligence if that was minimal care, until they panicked when death was close. If a baby is sent home under 2 kgs, it is usually for comfort care. That would depend on the CHD. Yes, we have had adults dx'd with a coarctation of the arota and have come to out Pedi surgeons for correction. The actress Kate Jackson did not have her ASD dx'd and repair until she was in her 30s. We also have to "grow" LBW and preemies to a suitable weight for before some cardiac surgery which we do that with a very low SpO2 to keep the ductus open. If the baby is able to maintain on just RA without the need for subambient and in some cases when communication for passage of blood between both sides of the heart is made by balloon spetoplasty(septostomy), the baby may be allowed to go home for awhile. However, we would not discharge a baby under 2 kg unless it was intended to be comfort care. This is in reference to the PMI from where you quoted me. A PMI should be marked on any infant you can see or feel it and most definitely if intubated. This can tell you if the baby is over inflated, develops a pneumothorax or possibly the tube slips down the right main stem. ETCO or TCM may not immediately reflect this. Thus, in the ambulance or helicopter where noise is a problem, we can watch the PMI. Now for the SpO2. If a baby does have a PDA or even a CHD, the SpO2 might be low. For some CHDs we may run the SpO2 65% - 75% and will use nitrogen to low the FiO2 below 21% to obtain it. The placement of the probe pre or post ductal can also make a difference. Pre is usually on the right hand and post is the foot. You can even see a gradient on healthy newborns for about 15 minutes but we rarely bother with SpO2 right after birth in L&D unless there is a known problem and we are titrating gases and/or meds. But again tniuqs, I did not pick apart any of the care SA provided. I just merely can not hang a doctor who may have been caught in the middle of the parents conflicted emotions. "Saving a life" can have different meanings. If there is no facility to care for a ventilator dependent trached child, this child is not going to have an easy go of it.

Nobody is doubting your ability as a Paramedic. But, you titled the thread as "Gross Negligence?" and seemed to want us to agree that doctor was grossly negligent. I can not condemn a doctor without knowing what was his intent and that of the parents throughout this baby's life. Parents do change their minds when it comes to life and death decision with DNRs being revoked at the last minute. However, that is no reason to say the doctor is grossly negligent. The doctor may have been been giving you bizzare explainations for the HR and condition of the baby because he may have learned something as I have about some EMTs and Paramedics. That is, I avoid all ethical conversations with them about terminating life support on babies or even adults. I don't like to be called a murderer and it is often useless to continue any discussion with some. We also see their reaction when the ED doctor terminates a code that they have worked in the field for an hour thinking "he just doesn't care" about either the patient or them and their hard work. Sometimes we have even avoided terminating a code until a couple of the more "emotional" Paramedics have left the ED. Now if the conditions are as bad as you say, I do not see a good future for a child that is ventilator dependent with a trach and peg. The U.S. health care system is far from perfect and you will have less than perfect employees in every system. The U.S. also has its share of horror stories and I see many of them in the ED or by doing Neo/Pedi Specialty transport. I also pick up babies and children in regions that I sometimes find it hard to believe those primitive conditions exist in the U.S. The U.S. stats are also extremely poor for infant mortality. Even with all our resources we can not prevent some of the issues that lead to a high death rate because they often happen before the baby is conceived and while still in the uterus.

Again the information is not there. We do not know the course of treatment this baby had just prior to this event or at any part of his life. We do not know what course of action the parents has agreed to prior to calling the ambulance when death may have been near. The parents of a preemie learn quickly about medicine. This was NOT this baby's first day in a hospital. But, many in EMS are reluctant to agree about death when it comes to children. This is why we get Paramedics coming to the ED hysterically wanting us to do a miracle on a cold dead baby who died from SIDS. At the scene they will give the parents all sorts of hope. Some must work every child regardless of lack of life signs because of protocol and others because they can not deal with the death of a child.

More details from the local paper: http://www2.tbo.com/content/2009/oct/20/201050/tampa-man-dies-after-head--crash-ambulance/ By JOSH POLTILOVE | The Tampa Tribune Published: October 20, 2009 Updated: 42 min. ago TAMPA - Jerold Dale Hager was three or four blocks from dropping off his grandsons. They had stopped by an Arby's to grab milkshakes after a Boy Scouts meeting Monday night, and Hager was behind the wheel of a Ford pickup, heading west on Busch Boulevard. Heading in the opposite direction on Busch was an ambulance owned by American Medical Response West Florida. Authorities say ambulance driver Justin McKenzie hit the brakes and took evasive action when he realized traffic ahead of him had stopped. But Unit 21 crossed the double yellow line and struck the Ford near Ola Avenue. Hager, 64, had to be cut free from the wreckage. The Temple Terrace man was transported to St. Joseph's Hospital but was pronounced dead this morning. "He was a really great man," said his daughter, Beth Tarantola. "He was always there. He was always, always there. He took care of everybody. It's going to be hard." Tarantola's sons Jamie, 13, and Joseph, 11, were taken to St. Joseph's with minor injuries. "My little boys are doing all right – bumped and bruised, but they're doing all right," she said. The ambulance crew, which also included 28-year-old Ashley Prazza-Odom and 18-year-old Jasmine Alcantara, both of Tampa, had minor injuries. McKenzie, 28, of Palm Harbor, has been cited for careless driving. The crew tended to Hager and his grandsons until emergency crews arrived, authorities said. The initial police report does not say whether the ambulance was responding to a call or if its lights and sirens had been activated. It does not appear that either vehicle was speeding in the 45 mph zone, Tampa police spokeswoman Laura McElroy said. McKenzie has worked for American Medical Response West Florida for about two years. The company serves Hillsborough, Pasco, Hardee and Highlands counties, according to its Web site. It handles about 50,000 calls a year and employs about 250 paramedics and emergency medical technicians. McKenzie's file shows a clean criminal history. The only points he has received on his license came in 2000, when he was cited for driving 92 mph in a 65 mph zone in Taylor County, said Mario Tamargo, chief inspector for Hillsborough's Public Transportation Commission. In a statement, Tom Diaz, general manager of American Medical Response West Florida, said: "As an organization dedicated to protecting and saving lives, we are sincerely saddened by this tragic death. Our thoughts are with the family at this time as well as our crew members." Diaz said the company is cooperating with the investigation and "cannot release any information regarding the persons involved in the collision due to federal and state patient privacy laws." Hager repaired diesel engine components for a living and did a lot of volunteer work for the Boy Scouts, his daughter said. He leaves behind three children and three grandchildren. "We expected him one day to be 85 years old, puttering around and on the Boy Scout range," Tarantola said. "We kept waiting for him to retire because he was getting close."

Let me tell you have the process will work as all the other health care professions have gone through this. Again, EMS should not alienate itself from the world of medicine and should learn a few things about the health care process. Just like in Business during the 70s when the job market was very competitive, people went to college to have a better chance of securing a decent job. The companies liked having well educated applicants to choose from and eventually higher education standards became the norm in many industries even without a State or Federal mandate that they must go to college. In healthcare, many saw the need for higher education longer before it became mandatory and got higher education. Before long the employers just started to expect educated professionals and not those from tech mills. That is how RT got rid of many of its tech mill in the 90s which was over 10 years before the degre became a requirement. However, once a profession does change, there is a grandfathering period. For diploma RNs who held the title of RN, they were still allowed to maintain their positions. But, for the LVN or CRTT, which are low levels of nursing and RT, they had just a few years to upgrade or get booted from the ICUs in some places. A few hospitals kept them on but did not hire anymore lower level credentials for those professions. Thus, if the Paramedic is already credentialed with a cert from a medic mill, the profession will probably be stuck with that person and for a long time even with the standards raised, EMS will still be viewed by that weakest link. Of course, in the FD, that Paramedic could also lose his/her ALS privilege and become only a BLS provider. That is the medical director's option especially if they do not meet standards as we saw in Collier County, FL. Of course it will have to eventually be required. but, that doesn't mean people can not take responsibility for their own education and their knowledge for patient care. To sit around and wait for something to happen even if you know it is the right thing just puts you in the same place as all the nay-sayers. Once there are more examples of well educated professionals in EMS, medical directors may be able to gain some confidence in their employees. Eventually change will happen even if just in the well educated and well trained agencies. Those who are weak links and refuse to gain momentum to keep up with progress will start to disappear from patient care. This has been witnessed in many professions and not just in health care. You either become part of the change by doing what you believe in or you become part of the problem by just waiting around to be told what to do with your own professional development for providing patient care.

Ruff, I did not call for them to be terminated, but they do need a serious re-training on vehicle safety although I find that ironic since these same FFs preach this very same safety issue to the public at the health fairs. Other departments in urban/city areas have no run over people because they do take precautions. What should have been passed on in their safety training when they were rookies may not have as it has been for others. Are you telling me no one has never told you about checking around you vehicle either at the station or at the scene for bystanders or equipment and doors not secured? This is fundamental safety lessons. Now they have a written policy or recipe written to tell them step by step how to perform one act of safety. BTW, did you read the comments under the first newspaper article? What has been said here is definitely not anything near the stance those that signed FF/EMT to their ID. That is incredible as is the fact you do not want the FFs to accept any part of the blame for their their actions. Part of being a professional is admitting you screwed up and learning from it.

He also admitted he did not know all the facts or the prognosis. The doctor may also have thought if was futile to reason with anyone at that point about the prognosis as now the Paramedics have arrived to override any points of reason. There is just too little information here. No labs, birth history or history of the parents are available. 1.2 kg for a baby at what should be term term gestation now is not good. We haven't even gotten into other issues such as HIV status or mental status of the baby before the PNA. You are only addressing the obvious without knowing any other details. "A" treatable condition and the bigger picture may be two very different views. Thus, with so little information, I would have to give the doctor some benefit of the doubt that this baby could have been a "do not accelerate care" issue and the parents had second thoughts. The CPAP can provide some comfort to the parents as the gasping breaths are not as prominent. We have many babeis that our technology and expertise "saved". However, they will never be off the technology nor will most even live close to their parents. The children go to the guardianship of the state and the parents my at first try to make the several hundred mile trip frequently and then it is just for the birthday and maybe a holiday. Before long the baby is alone as the parents have found they must move on with their lives which no one faults them for that. And again, this is the U.S. system. Possibly your healthcare system is better and can warehouse everyone but realistically, just becaue we can does not always mean we should. I however do understand a Paramedic may not be able to make any ethical choices even if there is a doctor there to tell them otherwise. They may have to follow their own protocols. Thus that is why in the U.S. we do have specialty Neo and Pedi transport teams. It is rare we (specialty team) have walked away from a baby or a child at another hospital since we don't fly unless someone has determine the baby or child to be viable. However, at the hospital we may find a different story and after some COMMUNICATION between the physicians and the family, we do leave with an empty isolette.

Quality of life should come to reason here. You do not know anything about that baby's birth but the doctor does. You do not know what the prognosis of the child was or what was discussed with the parents. There are many issues that must be considered here which may already have been by the doctor and the parents. Unfortunately parents do not always agree with doctors in an emotional state. Being heroic and creating a lifetime of pain and suffering for a baby and his parents versus allowing reality of nature to proceed are factors considered everyday in neonatal units around the world. While he did the technical apects of resuscitation and did what he thought was best, certain questions should have been asked of the physician AND the family prior to transport. One question would be what are their expectations? Giving a family false hope is just at tragic. This may sound harsh but even though this is a baby, one has to face some hard realities when dealing with emotions and weigh all the facts. This family may now watch their child die many more times while hooked up to life support. I hope I am wrong but this family is in for a lot of hardship and that includes the baby.

Infant CPAP can be achieved through several different machines that are up to 40 y/o. The fact that there are no facilities that can care for a medical needs child is why I am leaning towards the physician nudging the parents towards a more realistic decision. That would also explain the noninvasive ventilation and slow to treat. He was probably hoping nature would take its course but then the parents may have panicked. Even if they find a nursing home hundreds of miles away, the baby will be alone as the parents would have to move on with their lives. The baby will be prone to many more infections and any of them at any time can end his life. This is a tough road even in the U.S. as we often end up placing a child up to 300 miles from his parents. Often the parents divorce and the other siblings will be alienated so all attention and resources can be spent on one child who will endure a life of physical pain and illness while attached to technology that may be barely adequate at best. And yes, that also applies to the U.S. So if this happens here in the U.S., I can not imagine what the baby and his parents have to look forward to in the future. Sometimes saving a life may not always be in the best interest of that baby. When we do end of life on some patients, the physicians remove themselves from the area so there can be no option of the family begging for life support to be returned. We also don't tell the families RTs intubate. We have had families call for a private ambulance when their loved one is made comfort care. They pay to have their family member transported to an ED at another hospital. We also hear for days through the EMS/ambulance grapevine about what a horrible hospital our facility is. But, they don't know the facts. Nor do they know that the person died at the other facility. The only difference is they were deprived of the comfort measures we had instituted to make their death easier.

JW, you have listed all the classes and then some for at the very least an Associates degree in EMS and that is without your Business classes. I would just like to see half of those, which would be included in a quality Paramedic Associates degree. As you know from being in a business school, many of the students know they are not qualified for most jobs with just a Bachelor's degree and continue to a Masters for even an entry level position. The same is now happening in many of the health care professions. Some are finding that they must not do just the minimum required to stay competitive for a good ICU job or work in a progressive SCI/TBI Rehab. How many Flight Paramedics have you interviewed over the years who thought they were going to get the job by looking good in a flight suit? How many have showed up with just the bare minimum of certs that wouldn't impress even some of the worst ground trucks that only do basic ALS IFT? There are those who just talk and make excuses for themselves and EMS. Then there are those who believe they can make a difference by becoming a role model for education and patient care through obtaining the degrees whether they are required or not. I think you already know which category you fit into.

I am not talking about a children's hospital but rather a pediatric nursing home that takes ventilator kids until they are 21 y/o. If they do manage to save this child in terms of the body, the baby will probably require special care for the rest of his life. Unfortunately even in the US those facilities are few and often very crowded.

Because the article is about the FD. However, remember how FFs yakked about the St. Lucie county LEO that ran over a patient? The SO took their share of abuse but learned from their mistakes. What about every time AMR does something stupid with one of their trucks like rolling it on I-95? Don't the FFs bust a gut laughing at them? Depending on where the truck is parked, one checks the front and one checks the back. Of course I also work with helicopters so we MUST check and have spotters for most areas...Period. Safety is not something to be done only if you feel like it. It should be a habit or you could find yourself as the one in harm's way someday with a careless co-worker who is in a rush to play with the L&S.

This baby will probably not survive. Was that the prognosis the doctor gave the parents that made them unhappy? What type of long term pediatric care facilities do you have in SA to care for a baby on a ventilator with a trach and peg for the rest of his life if he does survive?