rock_shoes

It could be that was the year the unit was last inspected which doesn't necessarily indicate a lack compliance. I would check into your states inspection requirements and reporting standards before pursuing this any more aggressively.

Damn. Two engine, two pilot, IFR rated needs to be the minimum standard across the board. Since I've started with air ambulance operations I wouldn't want to be in anything less. For the sake of my family. Fly well everyone.

They're up for consideration in the next RFP. Knowing the usual pace of government, if they're a success they'll be at least one model year behind. BCAS is an enormous contract by Canadian standards (100+ units a year) so you can be sure Crestline and Demers will be solidly duking it out.

Welcome Sheri. Rather unfortunate your introduction to the place was a number of armchair quarterbacks/backseat drivers. I hope you'll give the city a second chance and take the opportunity to look around while you're here. Ed

It's a policy change referred to as presumptive coverage and it's slowly been working its way through the provinces (same concept as many types of cancer being considered occupational related for fire fighters). Alberta was actually the first and now Ontario has followed suit. Various advocacy groups in Canada have been pushing hard for this in since an independent group started tracking first responder suicides. Only those confirmed and reported are counted. Like anything of this nature the true numbers are likely higher. TEMA Resiliency Tour Press Release

The obvious bit doesn't surprise me a whole lot. Mastery takes practice. Opportunity for skill mastery and the resultant patient outcomes are the single greatest check mark in favour of tiered and targeted deployment of urban EMS systems. The interesting piece here, is that greater exposure was corollary with a lower propensity to work any given arrest. The assertion I read from this wording is that more experienced providers are more likely to recognize both viable and non viable resuscitations.

I'm genuinely curious to see how the liquidspring technology works out. My patient's ride quality over government maintained roads is hoping it's a winner.

If the OP does return... Why jump in guns-a-blazing? You might shoot a potential ally working that way. If something frustrates you the answer isn't necessarily leaping in and right fighting before taking the time to understand the animal your taking on. Particularly when it comes to EMS, things are dramatically different state to state, country to country, province to province. The US, Canada, Australia, New Zealand, South Africa, Mexico, UK... all have dramatically different systems for better or for worse. If you want to enact positive change in EMS you need to study it across the board. Look at what's working in places like Canada, Australia, and South Africa (I'll give you a giant hint in that it largely comes down to significantly higher minimum education standards). Look at what isn't working in those same places. After completing your research come up with an action plan to meet the positive targets and avoid the identified pitfalls. None of it is easy. Flying off on a rant on an EMS page is easy but inflammatory and ineffective. Real change takes elbows in, skinned knee, bloodied nose labour. If you have what it takes do the labour.

The problems you mention are why it isn't reliable for absolute values. It's still useful for establishing a waveform, respiratory pattern, and even trending. If a patient's anatomy results in a false low for example, it will consistently do that. That means changes in values over time will still tell you if EtCO2 is increasing or decreasing. If you want actual blood values do an ABG.

I think front wheel drive is a huge no no for light industrial vehicles such as an ambulance. The Sprinter is probably the better choice for a service seeking out lower cost and or more nimble alternatives to the traditional type 3 unit.

When dealing with a soiled/fluid airway it's often better to go in DL first to clear out the offending substance(s). If you were to go straight to VL you would just soil the thing and have no advantage over DL. That said, I have definitely gone in DL, cleared/suctioned the airway, then intubated VL after ventilating them up.

Think about the typical injury patterns paramedics experience and go from there. Back injuries, shoulder/rotator cuff injuries, hip/knee injuries. For the most part all of them are joint injuries of some form or another. Now consider what exercises you can do to strengthen the muscles supporting all of those vulnerable joints. If you work to strengthen your back/core, back injuries are less likely to plague you etc. Focus on strength training that will enhance joint stability and form when performing lifts. Cardio can be whatever you choose as long as it brings your heart rate up for a decent length of time.

Phenylephrine, ketamine, sux, consider fentanyl as an analgesic adjunct but the ketamine should do the trick. Plasmalyte would be preferred if any fluid resusc. ends up being required. TXA. Strictly talking the pharm not the technique at this point.

If you have time/equipment prior to evacuation stabilizing the femur fracture should be a priority (huge potential blood volume loss). The other two should still have a full trauma survey before going with the probable drunk/stoned theory.

I've used both the Glide scope and the King Vision. Out of the two the King Vision required the least muscle memory adaptation versus direct laryngoscopy. The Glide scope was definitely the more versatile tool due to the screen being separate from the blade (making a side on intubation possible in the aircraft). If I had to pick only one I would go with the Glide scope due to the increased versatility. Within my service ground ALS units carry the King Vision while flight units carry the Glide Scope. This seems to have worked fairly well as ground providers never have to intubate from a non-standard position making the lesser degree of muscle memory adaptation required for the King Vision an advantage.

I suspect he's referring to the nasal end tidal CO2 sets available for use with non-intubated patients. They're good for a waveform, respiratory rate, and trending but the absolute ETCO2 numbers aren't all that useful (not a closed system so typically gives a false low).

Based on the OP's information it definitely appears as though company policy is encouraging both fraud and unethical practice then. As others have already mentioned I would steer clear of this potential disaster, document the hell out of everything, and be prepared to speak to the appropriate authorities.

Tossing on a few monitor leads and taking a set of vitals? No big deal even if it isn't particularly relevant to the patient's complaint. Starting an IV without any clinical indication just because management said so? Big problem. That's an unjustified invasive procedure which, though pretty routine for most of us, is not without risk. Now as to the billing side of things, I don't fully understand the relevance. I work in a provincial system. The bill is the same ($85) heavily subsidized amount whether the patient is a 5 minute transport for a stubbed toe or air lifted. Do US services charge by procedure (ie. basic transport fee plus $15 for the IV, $20 for patient monitoring, $300 for an ET tube...)?

The crew wearing appropriate PPE for the conditions was taking their own safety for granted? It was a close in shot. For all any of us know fire was performing traffic control and some inattentive jackass blew through anyway.

I'm not suggesting you replace the soft squishy thing between your ears. That's what will tell you whether or not you can trust the numbers. Having an end tidal certainly doesn't mean you shouldn't have a listen either. SPO2 and EtCO2 do however remain the only quantifiable numbers you're going to get on an ambulance anytime soon. If you have access to them and you refuse to use these well vetted and studied tools at your disposal your being a prat. Don't believe me? Here's one of a great many papers regarding the use of EtCO2 to mitigate unrecognized esophageal intubation. http://mastertrain.8m.com/masterimages/2013articles/The Effectiveness of Out-of-Hospital Use of Continuous End-Tidal Carbon Dioxide Monitoring on.pdf

If you have it use it. In the absence of blood gases SPO2 and EtCO2 are the only guides we have with respect to oxygenation/ventilation. We should be using them to guide our ventilation strategies.

For the love of god ventilate them first is all I ask. For you and your partner's safety. Other than that, fill your boots. I don't care if I never bring around another opiate overdose because the PCP/EMT/FR did it prior to my arrival. The part about this whole debate that makes me laugh (at least in western Canada) is what brought it about. BC and Alberta have been experiencing a rash of overdoses involving Fentanyl (either directly or laced heroin). As a result of the increased number of overdose deaths public outcry has pushed the agenda. The funny bit is the dosing. The doses given either with home kits or by responding FR's/EMT's/PCP's are too small to be effective in a true fentanyl overdose. The doses these people are giving will rouse the average heroin user who took 2 points instead of the usual 1; not a fentanyl overdose. Dealing with true fentanyl overdoses I've been having to use in excess of 6mg of naloxone to bring them around to an effectively breathing state. Many of these patients end up on a continuous naloxone infusion while the fentanyl runs its course.

This my friends is exactly what I'm getting on about with one small difference. I would advocate the development of a Paramedic Practitioner group along the lines of what has been done in the UK as opposed to a PA/NP model. It might seem far fetched state side were paramedic education varies wildly; in countries like Canada, Australia, New Zealand etc. where paramedic education involves a significant post secondary commitment, it's merely a natural progression of the profession. Interestingly enough PA programs are just starting to come to life on the civillian side of things in Canada (currently there are two producing practitioners). Presently the overwhelming majority of accepted applicants are paramedics with a smattering of RN's and RT's tossed into the mix. I can't think of a better pool to draw from when implementing a pilot program.