aussiephil

Hallejulla brother!!!!!!!

Too much responsibility for that crap. Although now we have the Reverend Doctor Turnip.........

Richard, if I caused offense, I offer my humblest apologies, it was not my intention. Put simply, fighting fires, as we are so often reminded, is a profession. As such, FF's demand respect. Respect from all, especially EMS. EMS is also a profession, albeit one in many cases in need of reform. Reform in education. Reform in the way it is managed & run. To see the IAFF want to take MORE control in all these areas, IMHO, shows complete disdain for EMS as a profession. For EMS to move forward, there firstly needs to be a complete disassociation from fire, to recognize the independence of both professions. There needs to be a national steering committee to address the skill levels within EMS with a view to upskilling everyone & abolishing EMT-B as we know it today for all but vollies or CFR's. This will never happen if fire control the powers that be. Again Richard please accept my deepest apologies as I don't want to have my comments seen as attributed to you.

Reverend Dr Turnip, I face the same situation on a regular basis here myself. This does not alter the fact that the patient, especially in the extreemes of cold that you face in the place you are, is acontrolled environment. One that can provide some fluid resus as needed. In these environments, we need more than paramedics, we need Paramedics trained to work with a trauma centre. One of the initiatives that is being implemented here, considering a Trauma Centre can be 400Km from the incident with no aero back up, is internet based video conferencing. This puts equipment into the smaller hospitals, with the diagnostics available in real time to the trauma team in some cases, 1000Km away to make the most appropriate decisions for that patient. My point, Reverend Dr Turnip is to delay time on scene, to delay moving a patient to more difinitive care because a Paramedic has too big an ago, is putting patients at risk. Phil

Its OK to call them retards Richard, really, it is. Just another example of these retards trying to build their empire & stack the decks in their favour. When will people realise that this is just a big masterbation session. Maybe, as a thought, we should tell all the FF's that they now have to run ALL EMS. Then sit back, watch them stuff it up, & have it taken off them again. Just a thought.

Army, IMHO, we need to beat the crap out of medics who like to think they are more than medics. Minimisation of on scene time does not put a time frame on it. If you have a patient who is out of the vehicle, & can be stretchered, treated for spinal precautions (not all spinal patients need a LBB, but I have posted about this elsewhere), why not scoop & run, a line can be inserted en route, fluids can be set up, again en route. pain managment can be done, en route. Stop me if I am wrong, but lets complete a primary survey, detailed secondary survey, get them into the ambulance, then lets do another survey, once we have the other shit done. Too many times we hear that all this should be done prior to departure. WHY? WHY? WHY? Our patients, & one has to assume because this is a discussion on the Golden Hour that it is about trauma, need the difinitive care of an ER under the care of a Trauma Team. Not a bacteria infested back of an ambulance with a medic. Lets get rid of the attitudes that we are the greatest, yes we save lives, we save lives by delivering them to hospital in a stable condition. Nothing more (with the exception of a tension pneumothorax). We do a lot of nivce to stuff, but at the end of the day, if we do nothing more than maintain an airway, ensure breating & monitor circulation, deliver the patient to hospital, where have we failed?

Our protocols now reflect this as part of our practice. No longer do we simply pump fluids into trauma patients, but manage the patient to a palpable radial pulse through small bolus of fluids to maintain said pulse. Lets maintain the clots that are there rather than blow them through over exuberence with fluids. A lot of this argument also stems back to what i said earlier about Trimodal death patterns. We are not God(s) (although some like to think otherwise). If a person is going to exanuate, then chances are they have injuries to their Spleen, Liver, pancreas, probably pulmonary contusions, some renal issues as well. At some point we need to accept, as harsh as it sounds, that some patients will die. Regardless of our actions. Blood products have a short shelf life, so it is not practical to be carrying them, just in case, as we do with saline or ringers.

The only problem with this is that you have not stemmed the source of the bleeding. You can pump in as much blood product, fluids, gel-o-fusion or whatever, it will not make any difference until the liver, spleen or other source of bleeding had been contained. Nice idea tho.

Trauma or medical we need to remember Airway, once patent, Breathing, once ok Circulation. Eberything else is a nice to do, but without these 3 we have lost our patient. We are advanced first aiders. We are not trauma specialists. Our aim is to get the patient to hospital alive for them to take over & assume full ongoing care of the patient. Our part in a patients journey is only a small part. We need to remember that.

I have used both. An epi pen, especially for anaphalaxis, is far quicker & effective as it can be used through clothes. We are encouraged to use a pts epipen before we draw up our own.

Trauma patients need definitive care. Difinitive care is not in an ambulance. We do however need to minimize on scene times. Trimodal death patterns are now accepted practice in hospitals for trauma. Minutes. Hours. Days. The underlying principal here is that if the patient dies in the first hour, they had multiple system trauma with little chance of survival, regardless of interventions. Those who die in hours have done so due to the laziness of a doctor in properly assessing their patient & getting them to theatre. Those who die in days usually die from sepsis and this is a failing of the hospital & their infection control measures. Does this give us an excuse to be on scene for extended periods (with the exception of a patient trapped)? NO NO NO We provide emergency pre hospital care. Nothing more. Get them To hospital. The golden hour is complete BS. The knowledge of this though should not allow us to waste time on scene. Here endeth my sermon!

How could I not enter this debate!!!! The Golden Hour is specifically for Trauna & has been debunked as a mylth by many people including the well known Dr Bledsoe. I have referenced this in other threads. The accepted principal now is that people are clasified in a Trimodal death sequence if they die, minutes, hours & days. This said, there is no excuse for mucking about on scene. Minimisation of scene times are essential, the most appropriate place for a trauma patient is not on an ambulance stretcher, or in the back of an ambulance. It is in a hospital, with trauma specialists, this ensures the best chance of survival. Lets look at how we can achieve this (paragods take note - WE ARE NOT DOCTORS) for the betterment of out patients.

Wanna bet?

Sux to be them then

I so want those epaulettes - they mean NO RESPONSIBILITY!!!!!!!!

Touche!!!!!!!!! Even when they do their road time an attitude adjustment is needed for some

Same as any other iPhone/iPod ap, it is just a big iPod touch screen after all.....

me either

You sure, I heard he was volunteering to have the Chuck Norris' love child........

I think what we need to remember here is that there are a number of factors involved. Firstly the assessment must be made of the patient & the possibility (probability) of them causing actual harm to people. Whats to say that a normally sane person, with no mental health history doesnt freak on a helo or aircraft? Secondly we need to remember that they have a diagnosed illness. Just as a person with Cardiac Illness, Respiritory illness etc. They still deserve to be treated with respect. We need to ask is chemical restraint the most appropriate first action for mentally ill patients, or would a mechanical restraint be more appropriate. Mentally ill patients have the right to refuse medication, they also have the right to refuse an injection, or any meds we want them to have, just like any other patient. Coupled with the fact that a proper psych examination cannot be done until the effects of any drug have worn off, therby delaying proper assessment. Surley this is not in the best interest of the patient. Mechanical restraint can have a calming effect on the patient, allow for an earlier assessment & for appropriate treatments to begin. They also offer suitable protection to staff & if necesarry, lower doses of chemicals for further restraint.

Prenup!!!!!! Divorce is really expensive cause its worth it. Maybe I am just bitter, jaded & hateful..........

firedoc, can I start by saying I read your posts with respect & admiration of a seasoned & knowledgable professional. Medicine as we know it today has gone through many, many changes in the past 30 years. Most of this has been in improved drug therapies, improved in hospital treatment routines in hospitals, surgical advances. This is still continuing on today. Pre Hospital medicine, EMS, is now staring to move forward in leaps & bounds with the past 10 years seeing major changes in many Ambulance services worldwide. The past 30 years, for example has seen the introduction & standard use of ASA (Aspirin) & nitrates in the primary treatment of suspected myocardial ischaemia. Now, many services either are useing, or are trialing thrombolyasis treatments & hopital bypass to cath labs for STEMI patients. People like you, firedoc, have the ability to pass on knowledge, because the basic of what we do dont change, no matter what treatyment options are given to us by the powers that be. We are all committed to continuing education, to better understanding of the illnesses we treat & the rationale behind our treatment regimins. The secret we have to remember, and this was shown to me by a respected trauma doc, is to start with Airway, the if it is clear, Breathing, then dont ove on untyil you have that managed. Once that is done, Circulation, Dysfunction & Disability, Exposure & Environment & Focused history. By following that & continually redoing that, you will do the best for your patient. Your posts, your attitudes reflect patient care as a primary focus. Keep up the good work, I will wait to see the next firedoc installment next week!!!!!

Welcome to the city. We dont bite too hard.

A TOUGH OLD COWBOY FROM MONTANA COUNSELED HIS GRANDSON THAT IF HE WANTED TO LIVE A LONG LIFE, THE SECRET WAS TO SPRINKLE A PINCH OF GUN POWDER ON HIS OATMEAL EVERY MORNING. THE GRANDSON DID THIS RELIGIOUSLY TO THE AGE OF 103 WHEN HE DIED. HE LEFT BEHIND 14 CHILDREN, 30 GRANDCHILDREN, 45 GREAT-GRANDCHILDREN, AND A 150-FOOT HOLE WHERE THE CREMATORIUM USED TO BE.

Bushy, if they cant stand mediocrity, why do they put up with me, I mean, I strive for mediocrity!!!!!