scratrat

That happened about 75 miles west of me. That's exactly why I would never trust a school to handle my child's life. We got tornado warnings shortly thereafter. For those who don't know, a warning is worse than a watch. It means conditions are favorable and likely to produce tornados. Our daughter was immediately pulled from school. At least if something happened, we could be with her. Maybe it's stupid logic, but I'd rather she be with us then alone. I don't care what the school says. If I tell them I'm picking up my kid, then that's what I am going to do. They don't get a say in the matter.

It is also the day the welfare and social security checks arrive. Coincidentally, it also seems to be the day in which a higher number of heroine overdoses occur. Hmmmmmmm......

Guess what I found out? If a registered sex offender has a child attending school, he or she is allowed to attend school functions with said child? Even if they are a registered predator......scares me to death. That's why I moved to Florida, so the minute they step foot on my lawn I can shoot them God help the person that looks at my daughters funny...

I think that's where the tread went to crap Doc. The forcefull part was the biggest issue I think everyone shared.

What about when your partner says they recognize someone and then asks the person "Who's your ma and pa?" And when they answer, your partner knows who they are.... Notice it says MA AND PA, not parents, not mom and dad, but nothing like a reasonable facsimile of the English language.

Thunder, sorry for the confusion. I wasn't referring to this post, I was using another example just for poops and giggles. I didn't mean the one originally in this post. I just threw a quick one out there to get to the point I was trying to make.

Nice signature ruff...

Sorry, I meant to say calcium channel blockers. I messed that one up..

I have heard of beta blocker use but I also remember something about sodium bicarb. I could be wrong but I swear I remember hearing something about that? Maybe...anyone else know?

Ok, my bad. That was an EXAMPLE. Judging from your replies, you infer that if someone has a tachydysrthymia, no matter what, you would correct the rhythm first. But you are still not answering the correct modality. If he's wheezing, why give adenosine assuming there are in fact discernable P waves? Wouldn't want to start with B before C? You know, breathing? Anyway, I'm done with you because obviously you can't have a conversation without getting all pissed off and derogatory. Here's a website you should check out. www.hpso.com They sell reasonably cheap malpractice insurance for EMT's and paramedics, I think it'd be a good investment for you.

If someone is wheezing and SOB and has a HR of 150 then what? Just immediately give adenosine since it's tachycardic and nevermind the fact that he's wheezing? Cause you know, you have to treat the dysrthythmia first...... So no matter what the pt presentation is, if they have a dysrthythmia, you MUST fix that FIRST? Answer the only posters questions.....how long have you been a medic again? Just morbid curiosity....

PROBLEM: Medicare reimbursements reduced FORBIDDEN: MONOC can't transport patients Paramedic cutbacks slow response Posted by the Asbury Park Press on 02/25/07 BY JAMES A. QUIRK AND MARGARET F. BONAFIDE STAFF WRITERS Post Comment You're having a heart attack. You dialed 911 — 35 minutes ago. Where are the paramedics? This scenario may become increasingly common this year, as the Monmouth-Ocean Hospital Services Corp. (MONOC) has closed its mobile paramedic response unit centers in Marlboro, Lacey, its summertime paramedic center in Seaside Heights, and its Belleville unit in Essex County. MONOC also has petitioned the state to end nighttime service out of Middletown. These cutbacks will result in longer response times from highly trained paramedic crews, and an increase in emergency response calls that are not answered at all, conceded Vince Robbins, president and chief executive officer of MONOC. Robbins blamed the closures on the decreased reimbursement rates for the treatment of Medicare patients, and predicted MONOC will be operating in the red by the end of the year. The future of the $57 million hospital cooperative serv-ice is unclear, he said. "These towns are only the beginning of what has become a frightening state health crisis unless the government makes immediate changes to our current system," Robbins said in a prepared statement. Scott Kasper, president of the New Jersey Association of Paramedic Services (NJAPP), said the problems experienced by MONOC are also being felt throughout the state. As Medicare decreases its reimbursement rates, it won't be long before many of the state's 21 hospital-based paramedic programs are operating at a loss, Kasper said. Yet MONOC's decision to scale back the availability of its paramedics has left many first aid squads in Monmouth and Ocean counties crying foul at the increased risk put on patients' lives. Lacey Police Chief William Nally is concerned with the way MONOC closed its doors in Lacey without warning. MONOC used to staff a paramedic rig at the Lacey First Aid Squad near Route 9, and could respond to a call within three to five minutes. Now the response could take 10 to 15 minutes — and could mean the difference between life and death, Nally said. Toms River Police Chief Michael G. Mastronardy said that if MONOC can't meet the needs of the community, something must be done, and if people's lives are at risk because of a lack of paramedic service, the problem has to be fixed. To do so, "we would have to address the law and legal issues and look at the training issues," Mastronardy said. When volunteers in Toms River could no longer meet the demand of providing basic life support services around the clock, the township started its own paid service. Led by Patrolman Kevin Geoghegan, the program has become the model for towns such as Brick, which also has started a paid municipal ambulance service, staffed with emergency medical technicians. "We have to respond to the needs of our residents," Geoghegan said. "They are our priority." Two-tier system Even as it shutters some of its paramedic service centers, MONOC remains the largest provider of advanced life-support care in New Jersey, with its roughly 800 employees responding to 25 percent of the state's population. Its operating budget in 2005, the latest data available, was $57 million. Three factors create a problem for MONOC regarding reimbursement for service to patients with Medicare, which Robbins said typifies the majority of people MONOC treats: New Jersey is the only state that requires a two-tier emergency response system. The first tier, called basic life support or BLS, is provided by a mix of volunteer EMS workers and commercial ambulances. The second tier is the sole domain of trained paramedics — like MONOC's service — who provide advanced life support, or ALS. Only paramedics can perform invasive medical procedures, such as inserting IV lines and placing tubes down a patient's throat. The state prohibits paramedics like MONOC from transporting patients to hospitals. Paramedic services are not publicly funded. This means MONOC is a fee-for-service organization that bills every patient. Under Medicare's regulations, it will reimburse only a bill filed by the service that transported the patient to a hospital, Robbins said. And in New Jersey, in nearly every instance, that means a BLS provider. Paramedics can't bill For MONOC, these regulations were not a problem until 1996, when Medicare began to strictly enforce its billing regulations in New Jersey. Before 1996, Medicare allowed the paramedic programs in New Jersey to submit bills directly to Medicare, even though they weren't the transporters. This changed when a federal auditor realized that a growing number of BLS and ALS agencies were submitting separate bills for the same response, Robbins said. In the summer of 1996, ALS paramedic services like MONOC across the state received the same letter: Stop billing Medicare for transporting patients. This prompted paramedic companies to enter into billing arrangements with local BLS providers to insure that everyone could get paid from Medicare reimbursements. For MONOC, between 1996 until 2005, the math was simple, and the arrangement worked for all parties involved. According to Robbins, MONOC would receive an average of $1,100 per response, and give a $200 cut to the local BLS provider. The cost for MONOC to provide each response was about $600, so every time someone dialed 911 for a paramedic, MONOC could expect to earn at least $200 in revenue. But that situation has changed. By 2005, Medicare decreased the amount it would reimburse for patient transport. Medicare now pays $400 for each transport response, and when paramedics are involved, the cut to the BLS provider is $340, Robbins said. The cost for MONOC to provide each response has risen to be $700 to $750. So with only $60 coming in from each response, Robbins said MONOC is staring down the barrel of operating the service at a loss by the end of the year. In 2005, MONOC managed to cover its $50 million in operating expenses while earning a $200,000 surplus, Robbins said. The company broke even in 2006. "It has forced us to try and get people in Trenton and the Legislature motivated to change the structure of the system in New Jersey to get around this conflict," Robbins said. "Either we find other subsidy money — either towns step up and pay, the state steps up and pays, or the county steps up and pays, or you give ALS the right to transport — something has to be done. But the problem is, nothing has been done. We've been in Trenton since 1996." Service cutbacks Robbins explained that so far, all of the service centers that have been shut done are "extras" that were added to MONOC's service area in times of less financial strife. MONOC wants to curtail nighttime operations at Unit 206 in Middletown because "at night, the volume (of calls) is half of what it is during the day," he said. "Two-thirds of our calls come in before 7 p.m." Robbins emphasized that MONOC has never refused to respond to a call within its coverage area, and will continue to service all of Monmouth and Ocean counties even as it closes the doors of its service centers. Marilyn Riley, a spokeswoman for the state Department of Health and Senior Services, said that the state granted MONOC permission to close some of its service centers "after assuring us there would be not decrease in the level of service provided. We will continue to monitor the situation closely."

I am sorry for your unfortunate situation. I really am. I am not trying to be cruel, but if they know it has already metastasized (sp?), um, the prognosis is generally poor. Once that happens, it is usually too late for intervention. At this point, it is usually comfort measures and life what you can. Unfortunately, it sounds as if it spread too quickly, and it may be mute to continue running tests and subjecting him to torture. Just my thought, if he refused chemo, I think he is already at grips with the situation. I think the best thing you can do, is comfort him, and just be there for him as mush as possible.

I am going to venture to say that, judging from the scene name, he's a firefighter by trade, and a medic by mandate. Goes back to why I think fire and EMS have no business being together, but that's just me. What's a mneumonic? Is that something they teach on how to pass an exam? I can't remember any mneumonics...I always treat my pt instead of thinking of phases...

Thanks JP, you beat me to it! And Fire, read what you type first, man. You're all fired up now and not paying attention...

That's AWESOME!!!

No way!!! It's cold there..and it snows!!!! YUCK!

From experience using both medications. Versed has crashed pressures many many times. And this is while puching VERY VERY slow. Etomidate rarely does ever. Research or not, experience prevails.

678? That's pine Hill or Clementon, or sonething isn't it?

At least I didn't say funnier!!!!

You are 1000% correct. I worked for three projects in New Jersey, two with it, and one without. The two with RSI protocols, took FOREVER to get them. Then, once in place, they Q&A'd the CRAP out of our PCR. To the tune that not very many medics were eagar to use RSI. It actually made it a good thing. People weren't using it like a badge of honor, like someone else above me mentioned, because they knew the medical director would be Q&A ing their chart. Also, the project that didn't, the medical point blank told me that it was because of poor intubation skills as a whole. Now, of course, he only said "missed opportunities" of intubations, but wouldn't tell me if they only tracked unconscious airways, or airways in need of assistance with drugs (IE head injury - fighting), that we couldn't establish with only versed (all we carried for sedation). Did I just explain that correctly? Now in Florida, the same problem exists. Only this time, the medical director stated that it was in fact, unconscious airways that were successfully tubed in the ED without problems. So, I understand this doctors reluctance, if that's the case. Still wish I had it at times though.

Now I see where the problem lies fire. You are grouping senarios together which is causing people to think and reply the way they are. Take the above example :If at pt is CRITICAL, UBTUNDED, UNRESPONSIVE, and is ready to die, ie..... Low sugar, high sugar, increased ICP, anykind of shock, OD, unstable tachy dysrhythmia.... am I hitting them all? Well, if they're critical, that's not implied consent. If they are obtunded, yes. If they are unresponsive yes. If they are ready to die, NO! Low sugar, not necessarily. High blood sugar, probably not. Increased ICP, not by itself. Shock, not necessarily. OD, nope. Unstable dysrhythmia, nope. Not unless they are unconscious. Just because they are critically sick, doesn't mean it's implied consent. Obviously some of these things we certainly take for granted daily. I think this is why so many people are getting angry with your statements, because it SOUNDS like you think that anyone who is critically sick warrants whatever treatment you deem necessary. I know you don't care what I think, and that's fine. All I'm saying is, read it after you type it.

Both actually. I'm sure you know me...

http://www.aedhelp.com/op_instructions/3010012-017.pdf Took me a little while, but I found it!! Starts on page 195. MAKE SURE YOU KNOW WHAT YOU ARE DOING FIRST!!!!! Whatever you change, will stay that way until you change it back, read it first in case you mess with something you shouldn't have. Sorry, I was going to delete all my previous posts, but admin says NO!

Enter the setup menu; by pressing and holding the OPTIONS key and the EVENT key, while turning the unit ON. • Enter setup mode Pass Code (typically “0000”) to get to the Setup Menu