VentMedic

If you going to intentionally drive in a manner that may cause pain, then may the patient should have something for pain. If you hit the pothole unintentionally then there shouldn't be a need. We do medicate patient before and during a transport that will be painful. That includes a variety of scenarios be it in the field, on a helicopter or a CCT truck. If a procedure causes a patient pain, we do not allow the person to remain in pain if at all possible. Yes, some examines are painful and some patients may not get medicated before but one would hope they will get some relief after.

If you don't have IV acces and meds to alleviate the pain you cause, may one shouldn't do something intentionally that will cause pain to exacerbate. If you are purposely looking for tenderness there is a chance you'll find it or create it.

spenac, Since that CE course discusses IVs, isn't it found in the ALS section on RapidCE? Of course that is not to say that your state won't recognize it for EMT.

This video would represent a direct head on without a swerve.

I believe both EMTs were discharged either that same day or the day after. I would say the patient was probably secured and the stretcher may have been in a semi-fowlers position. However, I would also bet that the EMT in the back was not secured which may have caused most of patient's injuries as he flew into her like a missle and had her body to cushion the blow preventing him from being more severely injured. Sad no matter what and the two EMTs probably won't be able to get it out of their minds for a long time and will replay the should have, could have and would have for awhile.

Probably for 2 reasons: 1. They may still rely on mechanism of injury. 2. I forgot that this Atlantic Ambulance Corp is not the same one that used to be around before AMR and that this company also has its own helicopters.

Another article: http://www.lehighvalleylive.com/warren-county/express-times/index.ssf/2010/01/carol_porphy_68_identified_as.html Carol Porphy, 68, identified as victim in White Township ambulance accident - UPDATE By Colin McEvoy January 15, 2010, 11:19AM Carol Porphy, a retired special education teacher from Oxford Township, was identified as the fatal victim in Thursday afternoon's ambulance crash on Route 519 in White Township. Porphy, 68, was being transported to the Warren Haven nursing home in Mansfield Township about 3:30 p.m. when the ambulance veered off the road and crashed into a tree, state police said. Porphy, who was in a stretcher at the time of the crash, taught mentally handicapped children at the Mountain View School in Flanders, N.J., according to her son, Jeff Porphy. "She was a wonderful woman," he said. "We're deeply saddened by this and we're grieving about this." The ambulance driver lost control while trying to make a left turn, said Detective Brian Polite with the New Jersey State Police. An investigation is ongoing, he said. Porphy suffered extensive injuries and was pronounced dead at the scene, Polite said. The ambulance driver, George A. Morris Jr., 62, of Mine Hill, N.J., was trapped in the vehicle and suffered minor injuries to his leg and face, Polite said. He was treated and released from Morristown Memorial Hospital, officials said. Glenn L. Brodt, 36, of Allentown, an emergency medical worker in the rear of the ambulance with the patient, was flown to St. Luke's Hospital in Fountain Hill, for treatment of pain in his right arm and a cut to the head. Porphy worked at the Mount Olive School District from 1973 to 1992, when she retired, school officials said. She is survived by her sons Jeff and Bill Porphy and her daughter, Dawn Schnezler.

In the U.S., one of the best ways to volunteer is through DMAT. Your license is then maintained on a national file that can follow you to where you get deployed. You are also afforded Federal Benefits. ACEP statement for doctors: http://www.acep.org/practres.aspx?id=29514 DMAT http://www.hhs.gov/aspr/opeo/ndms/teams/dmat.html Right now on the EMS forums (including the "other" one) there are brand new EMTs that want to run off to Haiti to become part of the action be it for the excitement or they really want to do something. Few understand that the doctors, nurses, EMTs, FFs and all the other professionals from many different backgrounds have gone through extensive training before the disaster happens. It takes years to put an effective relief effort together such as DWB or even DMAT. They are not going to take the naive who gets caught up in a moment of "gotta do something". We have doctors, as well as other professionals, that do belong to Disaster Response Organizations and all must have a backup plan arranged with their medical group or department to see their patients and shifts are covered for at least 2 weeks. It can also be a personal monetary expenditure which many inexperience EMT(P)s are not prepared to deal with. There are many factors that require careful consideration for whatever organization you join and even more when the disaster hits your area. No doctor or nurse wants to be charged with murder but Katrina was not the only hurricane or disaster where accusations have been tossed at medical professionals. Even in Florida we have had our share of patients being unaccounted for in the evacuation process or being moved to a facility with inadequate resources. There have been occasions where nursing home patients have been moved to jails and inmates have been their providers of care. We've also had patients that didn't survive the many moves and an investigation had to be conducted for each after the storm. Sometimes agencies and facilities have faced penalties for not having appropriate plans in place. I will say getting Florida's disaster plan in order can be credited to Jeb Bush dispite the ineffectiveness of his father during Andrew and of course that other brother... Jeb did also learn a valuable lesson during Andrew by nearly getting himself and his family killed by refusing to evacuate.

I have stopped using my backpack because of being searched so many times be it the airport, ballpark or concert events including the freebies in the park. But this actually started after the Alanta bombing at the Olympics and picked more popularity after 9/11. However, some of the terrorists in the U.S. have hid in plain sight. That includes Oklahoma and 9/11.

DWB is a great organization and has "organization". They did respond to Katrina here in the U.S. but did not set up an operation. They also have not made the U.S. part of their plans for major rescue operations. The U.S. is a strange creature to deal with and Katrina showed how so much work is needed to even get qualified licensed people accepted into a state to provide assistance. It also showed our President's arrogance when he snubbed the assistance of doctors from other countries namely Cuba which was able to immediately mobilize 200 Physicians. Right now Cuba has about 400 Physicians in Haiti. Never underestimate the little countries and the humanitarian efforts of their people because of issues with your President.

So what is stopping more Paramedics from becoming a PA? If you look at websites for the national associations of the NP and the PA you will see their accomplishments. As far as the Paramedic vs Nurse with the nurse apparently the loser in your mind, you are comparing only the "well" educated Paramedic to the nurse which is one who has a degree with the prerequisites, correct? You are not comparing all the medic mill grads or the FFs who were forced to be a Paramedic, correct? You do realize that nursing is a vast profession with many different specialities and not all are based around "EMS", correct? Thus a nurse who specializes in chemo patients may not need the same education specialization as the RN in the ED. As well, RNs are very aware of their weaknesses and the need for more training and education when they come out of school. Paramedics believe they have it all mastered and they do in their one area of specialty. They (average) do not have the basis or foundation education to specialize and build upon as nurses do. You do realize this also describes some Paramedics as well. We already have nurses who go through nursing school and then specialize in EMS. Some even have their own credential in a few states. If you read my earlier post you will see that "been there and done that". Paramedic education was at one time considered above that of an RN with very well established degree programs while the RN was still trying to emerge from the diploma error. Greed and ignorance took over and that concept went to hell by 1990. Nursing and many other professions flew past the Paramedic to establish their own professional standing and recognition. That is something the Paramedic still has not been able to establish because even the word Paramedic is not used by all states and all 50 states have their own defining scope and education for the "Paramedic". Plus, there are many more EMS levels still trying to define themselves. So if EMS does not actually know how to define a Paramedic, how can you adequately compare it to nursing which has a nationally established standard for education and testing? Also the majority of allied health care professions are also well established with high minimum national education standards and testing. Nursing has already realized some of its weaknesses and it has taken a clue from the other professions which is why many employers seek out the BSN rather than the ADN. EMS still hasn't gotten the message to at least seek out the A.S. degreed Paramedic and many agencies have their own medic mills to crank out Paramedics faster.

I don't know where you work Wendy but I suggest you quickly change employers. In over 30 years I have not come across any ambulance service, FD or hospital that would ever tolerate an employee to be spoken to in that manner either at the bedside or behind closed doors. Once the foul language comes in, they are out of there. That also includes doctors who once tried such stunts and quickly learned the expectations of their peers. If you can not stand up and state that you can not push 20 mg of morphine when 2.0 is appropriate or if you don't know one may not be correct, it is the preceptor's job to learn what you may not know before you kill someone. The "instructor" should already have taught you this. There is a big difference between the instructor managing a clinical situation and a preceptor in a hospital or on an ambulance orientating someone who already should have some basic knowledge of their job if they now hold a license and had a decent instructor. However, too often some instructors are overly nice for a popularity contest to get good marks on their evals from the students and will pass some who don't know crap probably because the instructor didn't want to hurt their feelings by pushing them a little. However, again, a preceptor or instructor can only do so much if they don't have much to work with due to inadequacies in the EMS education system. I have run into that quite often when precepting new Paramedics on intubation. If their training and education in their program was subpar, I will then have to take time to play the role of instructor and preceptor which then takes time away from other things and other Paramedics. If I am trying to show them how the medication system works within our protocols and they have no clue what epinephrine is, then there has been a failure on the education system. If I am given 30 minutes to teach CPAP to Paramedics who have no clue about hemodynamics but I am told by their employer to just show them how to hook it up, am I a bad instructor? Part I can blame the education system and some reponsibiity also has to fall upon the new hire. If they were through a spoon fed program, they may expect the same spoon feeding and coddling in the work place. They will soon have to realize their own responsibilities. This is also why I would push for more educators in EMS rather than just instructors. However, again, it is never acceptable for someone to call another a F**ing moron in the workplace. But this should not be confused with a stern lecture which the weak may perceive as be a horrific thing.

There are also many good reasons for a firm hand and even what some take as "bullying". I personally have been greatful either as a new Paramedic or RRT when someone prevented me from pushing the wrong med or inserting an A-line in not the best location because I didn't check other meds or history. I didn't forget those lessons. As well, if you crawl off to a corner each time someone raises their voice to you, how are you going to handle difficult patients, families and doctors who might want you to do something that clearly is either not within your scope or give a medication that may harm the patient? Also, if you resort to foul language or just being defensive about everything, are you really going to accomplish anything? The "bullies" will teach you self control and how to plan your approach to where there will be very few situations in your career you can't handle. If you have even seen some that have been chased off in nursing, EMS or RT by the "bullies", you might have to change over and defend the bully a little. While there are some really good mentors in all professions, the better ones are not those who help you find excuses for your incompetencies. If they know you've got the right stuff they will push you to reach your fullest potential. No one wants to work with someone who can't stand on their ground and do what is right for the patient and their co-workers. That should include EMS as well. Why do we continue to make excuses and baby this profession like it was born yesterday when it is very much middle aged? If you want to do a "skill" you should have the education to back it up for at least the hands on part even if you don't understand all the pathophysiology. You should also have enough education and training to know when not to do a skill. If a knife is protruding from the abdomen are you going to palpate because your protocol says you can even if you waste time and can do more damage pushing the organs into the blade? In the original post there is a visual of the situation and a good description from the patient. Do we really need to poke at the belly to make sure it really hurts or if another lump will appear? There are other situations in EMS where one will have to make a decision of what to do and what not to do. Trauma brings in many factors with "stay and play" or "load and go". For years we were taught we HAD to get to the hospital real fast and then it changed to where we HAD to do everything on scene. Then it changed again for some to where those who had a proper education could decide what was best for the patient. We've seen this with IV fluids, intubation and now backboarding GSWs.

Those born earlier than 1970 should remember the elementary school snickering when June Cleaver said to Ward, "You were a little rough on the Beaver last night".

Maybe this Paramedic shouldn't try to push his luck to see just how far he can go against law enforcement. He may have won one battle against law enforcement but that doesn't mean he is immune to the laws that apply to everyone. Doesn't that sound familar? Haven't most of the EMS forums on this topic been stating just that same attitude amongst EMS providers? How many have stated, "Just wait then an LEO gets hurt and needs EMS"? Enough with the cop hating and bashing of the many good LEOs who are out there giving EMS a hand when called.

Once name calling starts in attempts to invalidate education, it just provides more evidence there is a need for increasing the education at the entry level. There reason most of us moved on from being first aiders at an EMT level is to provide a higher level of care with more indepth understanding to our patients. BTW, you are the only one who has directly used the word "ignorant" in reference to the EMT.

When working on a truck when have you gotten an indepth discussion about A&P exactly as you would in a college classroom and a lab? And if it was you palpation that caused the pain or aggravated the condition due to uneducated and untrained hands? On a sick patient in the back of an ambulance is not a good time for someone who has knowledge of A&P to get their first practice. What do you call the cadaver lab they get in med school? How about the pathophysiology classes they get in med school? They don't just take basket weaving classes in med school or at least those in the med schools in Florida don't and I'm pretty sure the UC med schools don't either. Somewhere they are taught what the body is made of. Have you been to their lectures? Their cadaver labs? Med students still look pretty ackward trying to figure out a ventilator even after we lecture them for 40 hours. Howe much lecture and lab is done for the EMT on "medical conditions"? Medical illnesses are the weakest link of all for the EMT as their primary focus is first aid and CPR. You are comparing med school to a 110 hour EMT first aid course?

It isn't a danger until the patient decompensates quickly on you which can also be from pain as well as increasing the leaking. I have seen this and it isn't pretty. Med students have several semesters of A&P as well as a cadaver lab to know where the organs are. They do get supervision during this process which can be very lengthy even if it is in some of the undergrad labs. No other profession would allow their students to just do whatever after just a few hours of training and especially without any prequisites. What the student can and cannot do should be established by the preceptor and the student should respect that.

Why did you become a Paramedic if you felt being an EMT was more than adequate and so did the medical director? Do you still work only on BLS trucks? If you work on ALS, as a Paramedic can you do anything that you couldn't do as an EMT? Any meds that improve BP and perfusion? O2 needs a little help sometimes getting to where it should be.

I have seen a few NPAs and OPA secured by tape to where they obstruct the airway. The OPA is taped over to where the mouth is not visible. The NPA has tape around it constricting the airflow or over top of it to where, again, restricted air flow. Securing an airway: one in which you are able to move air in and out of the lungs freely and that you feel you are effectively ventilating and oxygenating the patient. I had used the word "comfortable" in earlier years but there have been patients that I am not always comfortable physically but do feel that I am providing ventilation and oxygenation. This can be with either the ETT or BVM with an OPA/NPA.

The listing of "titles" or levels in the U.S. EMS system always disheartens me. One of the forum members (JPINFV) has already compiled a list for the U.S. http://en.wikipedia.org/wiki/Emergency_medical_responder_levels_by_U.S._state EMS magazine also has updated their state survey as of 2008. http://www.emsresponder.com/survey/ And, by 2014, the NREMT will unveil its new levels. I had thought Washington State was going to change their levels but they still have all 8 or 9 listed on their website. Florida is only 2 levels...as it should be. EMT-B - NREMT Paramedic - State exam

YOU know about some of the weaknesses in EMS but not everyone does or they care to ignor it especially if they already have the benefits of a FD. We've had countless people on the forums, including those that claim to be "CCEMT-P or FP-C" that will say a few hundred hours are adequate to do a few skills. Do we just not talk about it and pretend the problem does not exist? This has absolutely nothing to do with "they suc more than us" so this whole us against them mentality needs to disappear from EMS. EMS has tried the "we're so different" attitude for too long and has alienated itself. Other professions decided it was easier to play nice...until they got stronger. When Rid, Dust and I started in EMS, there were already established degree programs in EMS and it was thought that the Paramedic would be THE health care professional of the future. There was not much competition since many of the allied health programs were just starting out or has not started at all. Nursing was still trying to come out of the diploma era. Some of us who got our Associates "because that was the future" and enjoyed the respect of being "physician extenders" by some definition, got to experience a different level of professionalism. Then, greed and ignorance tore apart over 15 years of progress for selfish agendas that had little to do with patient care. Yeah, let's just stop talking about it. Those who are leading the mergers and churning out mediocre medics at a rapid fire pace would rather not hear about educated EMS providers.

There's also the DPT, Doctor of Phyical Therapy which is 3 years in length post Bachelor's. Let's not forget the SLPs, Speech Language Pathologists, which is now a Masters. I believe that is true for OTs as well and anything less is an assistant. Athletic Trainers are a minimum of a Bachelor's with a Masters preferred. Exercise Phyiologists have a Masters. Dieticians have a Masters with some heavy Chemistry and math prerequisites.

The term "Respiratory Epilepsy" has been used to describe the seizures that accompanied hypoxia from asthma. Although not that common, kids and pregnant women are most prone to suffering these seizures.

I applaud nursing for having high educational standards for the educators. I personally feel that EMS is lagging because it has not set the bar higher for its instructors to become educators. Once education becomes more visible to the students, an example is set rather than "look at the cool things Bubba has done and he only had 4 months of trainin'". For RT, I am really impressed at the support for education but then after having all the other health professions looking down their noses at the RTs in the 80s when the tech mills tried to ruin the profession, it is nice to see this profession emerge stronger than the weakest link. Unfortunately, EMS is still catering to the weakest links. RT combines the best of two worlds; technology and health care. For those who love gadgets and taking the human body to extremes with technology, it is a fascinating career. However, Physical Therapy ranks up there in gadgets and a fascinating profession with many different opportunities as well as being one of the better paid with sign-on bonuses that make even the RNs drool.