Scott

Just a question: are talking about a true reduction, aligning bones, etc... or are we talking about having absent lower extremity pulses and aligning the limb to restore the pulse and subsequently, blood flow? Most protocols in our area allow for the re-positioning of angulated limbs in an attempt to restore pulses x1.

If I understand your question, you are basically asking why having field experience provides for a better educational experience for an EMT/Paramedic than going forward with the education in school didactically with training in the research and science behind the processes. You can get the education either way, its the understanding, critical thinking, and value I am speaking of. I have always seen the classroom as very controlled, the situation falls into the perfect classroom scenario. Depending on whether your educational institution buys into the scenario based or problem based educational aspect, there is just no substitute for gaining the education necessary at the level you will practice at, and then put it to work in the real world, patient care. Being in class and working simulated patients, is not the same as seeing the real thing in front of you. Would you be confortable with an individual who has all the classroom experience necessary to perform the job, be placed in your living room as a new medic working a true code on a family member for the very first time. Having experienced this with a mentor while obtaining the education allows for a much more well rounded, critical/clinical thinking, and rational acting individual. You can put the science behind the process to work with solid hands on experience. The book part of EMS education is this; you have this, you do that. Having touched a patient, felt an irregular pulse, heard wet lung sound, administered a drug, dealt with a psychotic patient, worked a code under the auspice of a seasoned medic; all of these things, although they can be practiced in a scenario based situation, cannot be truely comprehended without experiencing the real thing at some point. This is where the individual learns to make the quick decisions in life or death situations. That can't be taught in class, it has to be experienced.

Might not be a bad thing to have in the tool box. However, as this has been a fairly recent addition to the SOP for Paramedics (within the past couple of years), there probably is not a lot of records available in which to review, it is still not utilized on a regular basis, and to be honest, I am not sure services are even carrying this on the rigs. The vast majority of medics will still utilize the standard Epi, Albuterol, etc..I have used Mag Sulf. as a smooth muscle relaxer on a couple occasions with severe asthmatics and had excellent results. That being said, although it is written in the protocols to consider, many docs are still not fully on board with the Mag Sulf. issue.

My opinion, and only my opinion, however, having been in EMS almost 20 years and holding positions as a field medic, QA/QI, and Director of Operations, as well as an educator, I have very strong feelings in that experience is what will build a truely good, well rounded medic. Many educational institutions and services used to back the idea of entering at the Basic level, getting experience, then moving to Intermediate, getting experience at this level, and then making the move to Paramedic. Now, the thought (for whatever reason) is either enroll in a degreed program and get the Paramedics license, or get your Basic and then apply straight to Paramedic, no experience necessary. I've seen both. I am a true believer in that a good Basic makes a good Intermediate, makes a good Paramedic. The opposite is also true; a bad Basic, makes a bad Intermediate, makes a bad Paramedic. Do yourself a favor, take the time, go throught the level process and get the experience. You not only gain valuable insight for the next level, you prove your ability and knowledge to your peers, service, and the medical professionals you will work with (co-workers, nurses, & doctors) and gain respect from them. There is no substitute for experience. Alot of what you will see when you "play" at each level prepares you for the next. You also get to work with the providers at the higher levels and gain valuable insight to the "real" street world, as opposed to the book world. Whichever way you decide to go, best of luck!

The classic irregulary irregular gives the distinct indication of Afib. There appears to be numerous occasions of either absent, weak, missing or random (another words, could be, but then maybe not) "P" waves present in all 3 leads. But I would go with Afib. Just curious but why an avf lead as opposed to a standard lead I? If you march out the rhythm from beginning to end, the first 3 complexes are not regular either.

Pads hands down. We use them on our Lifepak 11's and Lifepak 300 AED's. Both use the same pad and are much more convienant to use.

Our service is looking at working RSI into the protocols. I am looking or anyone that might be willing to share their protocols for RSI so we can see how and what other services with experiences in this method work it. Anyone willing to share their RSI protocols???