rock_shoes

Anecdotally I can say I've only ever had to sedate one overdose patient after administering naloxone in the last 7 1/2 years. As we later discovered this particular patient had a long standing history of violent/aggressive behaviour directed toward LEOs and Paramedics. In my own experience the key to preventing violence and aggression with these patients is to correct hypoxia prior to bringing them up. This however does beg the question as to whether or not a lay person should be administering naloxone. Lay people won't be providing ventilation or oxygen prior to administration.

Why are you yelling at everyone? All caps is the forum equivalent of yelling.

Oh we all know the dumbest question people ask. "What's the worst thing you've ever seen/had to deal with?" My usual response is that they don't want to know.

We lose too many too early. If it isn't shift work related or worsened illness it's PTSD. You will be missed Island. I knew you only through your contributions here, but based on what I've read over the years I'm certain your passing has left a giant hole in the hearts of your loved ones. Your shift has ended. Just leave us the keys mate. We'll take it from here. Ed

Since when is it acceptable to just rip through an intersection on a red light without clearing it first? Either the ambulance in question had a brake failure or the driver was an idiot.

I expect the Edmonton unit may have more of a positive effect than some of the other similar units because of the deployment plan. AHS plans to send this unit to intercept potential hot strokes coming in from rural areas which could make the difference for a number of patients (two units travelling toward each other at 100km/hr would equate to one unit running toward the stroke centre at 200km/hr).

I can't speak for other programs but CAMATA was included in my ACP program at SAIT. I suspect the best thing would be to approach the local schools directly and offer the ride along/practicum space for students on final practicum. Perhaps it could be an additional two tours/blocks at the end of a successful students practicum?

Intuitively the reported results make sense. In my own experience with enough epi and bicarb you can get ROSC out of a rock. That doesn't mean the person will have survival to discharge. At this point it appears that epi is more beneficial than harmful in cardiac arrest. I would expect the next logical step regarding epi will be dosage determination. Is 1mg IV q 3-5 minutes the ideal dose? Should it be more? Less? An infusion instead of bolus dosing?

If you're starting entirely from scratch I would suggest finding a CAMATA course to put your people through. The course is fairly old and certainly due for an update but it's the best primer I know of without putting them through a full Critical Care Paramedic program (The 1-2 year Canadian version of the CCP I mean). http://www.camata.ca/educationoverview.htm A lot of it will come down to the basics. Teach Loading/unloading using whatever system the aircraft is equipped with; flight physiology and how you can expect it to affect you and your patients. Racking equipment for the flight environment; Modified patient assessment for the flight environment. It doesn't sound like you'll be flying any vented patients so that should make things a little easier. If you're flying psych patients BC actually has a fair amount of experience with this and a well developed sedation policy. It's a policy that has come under some heat over the years but is strongly backed by a record of zero patient harm incidents.

Island I am sorry for your loss. Preventing the drugs from ever landing on home soil is certainly a valid avenue to try and prevent addiction all together. I was speaking in reference to treatment cost reduction for those who are already addicted. Sent from my SM-G900W8 using Tapatalk

"Supervised shooting galleries" as you refer to them do not really assist anyone in getting off drugs. What safe injection sites do is reduce the amount these people drain out of the public system (remember Canada, and in fact most of the developed world, has some form of publicly funded health care). Safe injection sites reduce 911 responses for overdose, they reduce infection due to the sharing of dirty needles, and for a very small number they provide access to rehab facilities. From a study in Quebec looking at the cost of caring for septic patients (a frequently occurring malady amongst the IVDU population). "The mean cost for all patients abstracted was $11,474 per episode of care ($1,064/day). The survivors had a mean cost for their treatment of $16,228 per episode of care ($877/day). The total cost per episode was $7,584 per nonsurvivor ($1,724/day). An average cost of $27,481 for survivors after day 28 through 1 year was calculated. The burden of severe sepsis was estimated to be $36.4 to $72.9 million per year, but higher if costs beyond day 28 are included." http://www.ncbi.nlm.nih.gov/pubmed/12040548 From the CDC regarding the cost of HIV treatment "The most recent published estimate of lifetime HIV treatment costs was $367,134 (in 2009 dollars; $379,668 in 2010 dollars)." http://www.cdc.gov/hiv/prevention/ongoing/costeffectiveness/ In a country with a publicly funded hospital system the tax paying public is on the hook for Sepsis and HIV treatment cost. In the end I don't support safe injection sites because I think they help people get off the drugs. I support safe injection sites because I'm a responsible tax payer who likes seeing the impact of junkies on the public purse reduced as much as ethically possible.

I salute your inner whacker! You however are a very rare form of whacker. You are the nearly extinct productive whacker who uses his powers of whackerism for the betterment of human kind.

Assuming of course your Paramedic crew has sufficient A&P knowledge and the willingness to learn the FAST system.

Any idea what the reasoning was behind the decision to sedate and fly an unwilling but competent patient? The situation reminds me of a STEMI patient I picked up one time. In the greater Vancouver area there are 3 Cath hospitals within a 20 km radius. My patient refused to be taken to the closest of the 3 but was otherwise a willing patient. Rather than argue with him I broke standard policy (take all patients to the closest appropriate hospital) and drove him to one of the other Cath hospitals another 10 minutes drive away. True I broke service policy, but in the end my sick patient received appropriate care instead of refusing life saving treatment. The point being, sometimes it's better to be inventive than right. As it turned out he refused transport to the closer Cath hospital because his life partner died there due to similar circumstances. I was always prepared to defend my decision but oddly enough nobody ever questioned me on it.

What do you have available to you for blood products? What has been done with the patient thus far (ie. has the patient received TXA or perhaps octaplex)? Past medical history, allergies, medications? Regardless, the picture you've painted so far tells me this gentleman requires a vascular surgeon yesterday. Oh and what about the other patient? Anything to indicate the other patient may also require medevac?

That would be my question.

Bingo. I participated in this study. The ITD was of no benefit and actually had slightly worse ROSC rates in absolute numbers (not statistically significant).

Fair point. Currently I work close enough to trauma centres I no longer have to transport these patients to small local hospitals. That said, even when I did have to transport to smaller facilities I typically had time to either call in a medevac or do everything on route with the wheels turning.

To be honest, it is extremely rare I deliver a major trauma patient without a secured airway and vascular access though it certainly isn't for lack of trying. It's tourniquet if necessary, load, and transport with everything else done on route. Our local trauma centres have been excellent about accepting that we may not have time to intubate etc. prior to arrival. I find it comes down to the most basic of assessments. Does the patient require or potentially require hospital based interventions on a time sensitive basis? If so move your ass and do what you can with the wheels turning. I find this is something we frequently over complicate.

BCAS has had the KingVision video laryngoscope on car for a little over a year so far. It's an excellent tool when used appropriately. I've found suctioning technique is critical with video laryngoscopy. Sometimes you'll still have to go in with a mac/miller to suction first even if you are unable to obtain a cord view. I've developed a few different techniques for wet airways and have used it as a back-up (or sometimes primary) for the last year. With one technique I will go in direct with suction, leave the suction in place, then insert the video blade as I pull out the standard blade (works well with a severe fluid airway but requires a decent size mouth opening). With another technique I use a channeled blade and advance the suction just ahead of the camera lens to prevent it from being obscured (works well for moderately "wet" airways). Small mouth openings can still be difficult because the blades (both channeled and non-channeled) are a bit bulkier than standard direct blades. The McGrath appears to be a very similar design but likely somewhat higher quality.

This strikes me as a much safer option for all involved. Relatively few aeromedical services have specific procedures for transporting potentially volatile psych patients. Levels of sedation in the aeromedical environment can range anywhere from dimenhydrinate for air sickness/mild sedation to having the patient sedated and intubated for the flight. The level of sedation targeted is varied depending on an individual patient's needs as assessed by the sending physician, air medical transport advisor, and attending flight crew. The following article gives a brief outline of the psychiatric air medical transport program used in BC as it was first implemented. http://www.bcmj.org/article/criteria-sedation-psychiatric-patients-air-transport-british-columbia The initial implementation of these procedures was heavy handed with regard to sedation levels and came under much scrutiny. As procedures have been adapted over time the levels of sedation used have become increasingly adapted to individual patients instead of a more blanket policy. It is worth noting that as of now not a single psych patient transported has been diagnosed with adverse effects attributable to being sedated for transport. http://www.theglobeandmail.com/news/british-columbia/bc-rules-requiring-sedating-mentally-ill-for-transport-risks-lives-mds-say/article4186567/

I didn't know Greg but I know Greg. I have watched colleagues suffer as he obviously did for my entire career in the field. I have been incredibly fortunate thus far, but in the back of my mind I know I'm likely only waiting for the moment it all boils over. Recently I spoke with a colleague about his PTSD experiences. His suffering focuses primarily on a single incident but it took 18 years of further incidents to put him over the edge. 18 years of the worst of the human condition and he was doing well. He would go home to his loving family, work his beloved trap line, and sleep soundly at night knowing the value of his efforts. One day, one call, later he is a broken man completely unable to function at home or as a paramedic. How will it strike me if it ever does? Will it be a slow building cumulative form? Will it be cumulative with a hyperfocus on a particular incident randomly set in motion by another separate incident? Will it be a single incident? We should all be asking ourselves these questions. We should all be seeking ways to mitigate these risks. Perhaps I will be the fortunate one who is never struck down by the acquired mental illness that is PTSD. Perhaps I will not be so fortunate. Regardless of my own fortune, I find it my duty to stand with my brothers and sisters who are suffering for as long as my legs will hold me. Greg, you have my respect. Ed

I think it depends on how the course is accelerated. Medical school at the University of Calgary is a three year program for example. It's 3 years because prior to entry applicants are expected to have completed a minimum of two years post secondary (the majority have a Bachelors) and the program itself runs straight through without taking summer semesters off (3 semesters a year instead of 2). It's accelerated not because instructional time is less but because there is less time between instructional periods. An EMT program could do the same to some degree. Pre-read the material and have class 5 days a week for the duration instead of just on the weekends. Please don't mistake this as my defending the pitifully inadequate EMT education requirements. I'm speaking strictly in terms of delivering an equal volume of material over a shorter time frame.

As in mounting your old boxes onto a pickup instead of a van chassis? If that's the case you should see some serous benefits as long as you don't need the tighter maneuverability of a van. Pickups are easier to work on which should help reduce maintenance costs. Also if you have need for a 4x4 unit it's dramatically easier/cheaper to put it on a pickup chassis than have a van chassis modified.

I was a little confused by that part myself. I think the intention is to use them as a reminder for the patient not to move their head around. Basic towel rolls add almost no mass about the patient's head so the risk of secondary injury as a result of their use is relatively low.