rock_shoes

We use two pneumonics in our service. DIVINE for contraindications and SADMC for cautions. DIVINE stands for Decompression(complications with nitrogen narcosis as nitrous oxide is N2O2), Inhalation(people with inhalation injuries need as much O2 as possible because the nature of their injuries has already compromised the bodies ability to perform gas exchange), Ventilation (you must be able to ventilate the space to prevent the gas from affecting the provider), Inability to comply (entonox is self administered so the patient must be able to comply with directions, Nitro in the last 5 minutes (N2O2 has a mild vasodialatory effect on it's own which will have an additive effect to that of Nitro), Embolus (primarily concerned about a PE). N2O2 is heavier than air so it will collect in dead spaces. This also precludes it from use in conjunction with any chest wall trauma. Cautions using SADMC are: Shock (N2O2 has a mild vasodialatory effect. Not really a help with a patient in shock. Shock also affects a patients ability to comply). Abdominal distention (vasodialatory effect, N2O2's propensity to collect in dead spaces). Depressant substances (N2O2 is a CNS depressant which means it could have a greater effect on someone who is already CNS depressed). Maxillo-Facial injuries (Affects a patients ability to use the delivery device. N2O2 collecting in dead spaces). COPD patients (These patients already have a compromised respiratory system).

LEO's should be instructed to do their own blood draws if they need them. That'll keep the chain of evidence really short and avoid tying up an EMS crew.

You can mark me down as a strong possibility. We'll see what I can arrange for a flight.

Any old mucous membrane will do eh. Really it would have the same effect as oral glucose without the associated airway issues. I'll echo precious sentiment and hope you get a line if I'm ever hypoglycemic around you.

DocHarris I wasn't aware that some Ontario PCP's where not allowed IV access. Here in BC PCP's use a 100mL bolus D10W (additional D10W boluses are allowed if needed) with a 50mg push of Thiamine instead of an amp of D50W. I like it myself because it allows us to titrate the D10W to maintain BGL if feeding the patient isn't an option. If IV access can't be obtained or the attendant is not IV endorsed (unfortunate remains of the flopped Paramedic 1 program) we use Glucagon. I find it curious that your base hospital allows for a second dose of Glucagon. Stores are typically depleted by the first dose making it useless and expensive. You'd probably be better putting a patient in recovery position and rubbing glucogel on their gums

http://www.statlock.com/product_statlock_iv_premium.html Tried using the URL feature but it didn't work. Guess it's cut and paste.

I can't say that I've used them but they look like they're well worth a try.

Every single one of us will at some point or have already put ourselves in undue harm. Whether that is due to lack of experience or some other extraneous factor isn't really the point in this instance. I myself have gone in before and at some point in the call thought to myself "Wow that was stupid! I shouldn't have done that.". On reflection there where signs that going in was not a prudent decision. If you really look back on nearly every incident there are signs. Leaving out specialty services like tactical and military, we are all better off reviewing past mistakes of ourselves and others than running around in a vest thinking it's going to save us. Every medic I've worked with or around who wears a vest has, either through attitude or plain bravado, consistently been far more likely to find him/herself in a dangerous situation than the next medic. Coincidence? Not likely. More often than not it becomes a false sense of security. I don't profess to be any more intelligent than the next person. I can only go by my own experiences and observations limited though they may be. So yes I have in the past done "a piss poor job of evaluating scene safety". I most certainly do not exempt myself in any way.

You folks sound as though some of you are working in war zones. If that's the case you need to be trained to operate in a war zone. Have I been in situations where "the hair stood up on the back of my neck"? Sure I have. Anyone who works in EMS for any amount of time will have that no matter what. If I get to the point where I feel the need to wear a vest or carry a firearm I will insist on getting the appropriate training to go along with that. The truth is I probably will come to a point where I need to carry. Not because I work in a war zone but because I love working SAR and remote areas.

Go with the "Stupid Ford Tranny". They really are terrible. Maybe tamper with the welds on the bench press so the bar falls the right way. :twisted: Not that I've ever thought of eliminating certain partners or anything. :wink: I think the better solution would be to request a new partner before you have no choice but to implement an evil plan.

Sorry Dust I think you might have missed that I qualified that statement and exempted specialty resources. I don't feel that people trained only as paramedics should ever need to carry. I feel that people who operate in areas where it's prudent to carry should be trained in the pertinent specialty before being allowed to carry. I should have explained my position more clearly. Tniuqs gave some very good examples of situations in Canada where it would be sensible to be armed. Having worked remote areas in the past I can honestly say there are places I wouldn't go without a rifle.

We better include gravol for PCP's as well if they include morphine. I've had mixed success with entonox so far working in BC. It's very effective with many patients and useless with others. If I remember correctly Tramadol was also up for evaluation as an add to the PCP scope in BC.

I guess you could say I'm pro population control. :wink: I'm pro-choice, pro-death penalty, and pro-euthanasia.

My opinion stands. If people working in the areas you mention have those kind of safety issues maybe the medics/EMT's working there need to be cross-trained as tactical or be combination police officers. Unless you are educated as such you should not be kitted out as such.

If you for any reason feel as though you need a gun or even a vest on duty you're doing a piss poor job of evaluating scene safety. That's what the police are for. LEO, Military, and Tactical people being exempt of course.

Unfortunately not all crews respect other providers the way they should because as far as they know "outsiders" aren't actually paramedics. While that was true at one time (all licensed paramedics in BC had to be BCAS employees) that's no longer the case. It's hard to change people some times. As for ALS coverage in BC you're absolutely right. That is our biggest downfall. I'm working on it though. At least one more of us will be edumucated when I'm done. Don't worry about us too much. We're just all grumpy about contract negotiations. Hopefully that will have sorted itself out by the time the olympics roll around and attitudes will be much better.

Company policy allows us to participate in rescue operations to the scope of our training. If for example a patient requires rope rescue, and the attending paramedic is so trained, then that paramedic may participate to the level of his/her training. From what I've seen so far it's been a very workable policy that allows our members to function to the full scope of their knowledge not just what falls under a paramedic license.

I can honestly say I have never had anything but courteous professional interactions with our hospital docs. Certain triage nurses on the other hand. That's a whole different ball game.

If citizens of a particular area don't see ambulance services as a necessity then in their hour of need they can go without. You get what you pay for.

Resource allocation won't be a whole lot different than any other day for us. We'll just have to put on a few extra dispatchers. Being a provincial service we are centrally dispatched out of three centers. One on Vancouver Island. One for Vancouver and the southern coast area in Vancouver. One in Kamloops that dispatches the rest of the province. In my experience so far our dispatchers are excellent. The MPDS system that determines response acuity on the other hand is far from perfect.

I don't think requirments to work with the first aid team will be overly stringent since BC Ambulance Service is still the recognized EMS provider for the games. BCAS has commited to providing 55 additional ambulances, a dedicated air ambulance, and ALS at each of the venues.

Fixed it for yah. :wink:

My exact words for Paul were… I stand by this 100%. I, like Mobey, don’t believe volunteer ambulance services should exist. The public deserves better and that’s exactly what I intend to provide. What if I went out and did your regular job for free? Wouldn’t you be angry when your employer decided he no longer needed to pay you a reasonable wage because Ed down the street will do it for free? I’m willing to bet you would be flying mad and rightly so. I also said… Again I stand by what I’ve said. If you want to lead then get educated to the highest level you can and provide care consistently at that level. It really is that simple. Education as a boy scout DOES NOT COUNT in this arena. Pissing and moaning isn’t going to get you anywhere around here. Please stick around GVAC-Redneck. There are a lot of good people here from whom you can learn. Read some of the past debates on volly vs. paid. Maybe then you will start to understand our position. Storming off in a huff will be your loss not any of ours. Ed

I should also mention that our dispatcher's first choice is always to send another one of our cars before fire. Fire is always the second choice when no other car is available. I'm not one to put an extra wind in Fire's sails. They seem to do a pretty good job of that all on their own. :wink:

I'm going to have to disagree on this one Dust. You need three people to give an arrest patient the best possible chance of ROSC. Most cars are only staffed with 2 people. Unless you run a 3 man crew that leaves you one short. Personally I would love to have a 3 medic crew for these type of calls but good luck convincing the higher ups that it's fiscally feasible.