Kiwiology

Try the NYC DOC at 1-212-266-1500 (http://www.nyc.gov/html/doc/html/home/home.shtml) not sure how successful you will be tho

400lb is only 180 kilos, man, five of us lifted a guy who was 297kg (about 700lbs) I usually take in the oxygen, first in backpack and monitor (about 30kg all up) My plan (I suspect this may be some sort of cardiac event) - SAMPLE, vitals, ECG, O2 @ 4 on an NC, maybe get an IV going - Bring up the trusty Ferno stair chair - Fire Department for lifting assistance and down the stairs!

Nah bro this screams too much "cookbook protocol" for my liking; treat the sympton don't worry about the underlying cause. You mention a bunch of advanced interventions but fail to tell us you got a GCS or performed a decent assessment. It's very easy to sit back and play Monday morning QB here but here is my thinking: This patient has obviously had a fairly decent impact to be thrown 30ft so is at high risk for massive internal injuries. The hypotension and bradycardia point me to a brain injury because a) you don't mention any visible bleeding, any internal bleeding sufficent enough to cause her BP to bottom out that low would also cause other signs of hypovolemic shock e.g. tachycardia, tachypnoea, narrow pulse pressure, sweating etc and c) the dialated pupils. Suppose this patient did have some massive intra-abdominal bleed and atropine was given to increase the heart rate, would that not increase cardiac output and worsen the bleeding? If this were my patient I would be looking to do a decent pelvic and abdo assessment to check for internal bleeding, check for shock (pulse px, distal limb temp, colour, resp and heart rate etc) and with the hospital so close I probably wouldn't worry about any fluid. I wouldn't go near atropine.

Damn bro that's bad

Damn thats pretty bad bro

Matt; By this I mean that we can apply some of what we know to guide or somehow change our treatment (e.g. differentating pneumonia from pulmonary edema to give frusemide) however there is a portion of our knowledge we can't apply because we simply don't carry the drugs, have the ability to perform the procedures or tests required or the application of "book" knowledge won't change what we do. Example: A kid falls out a tree and breaks his arm. Paramedic's Sparky and Jim Jim roll up and get to treating the kid. Sparky can tell you the anatomy of the bones in the arm, how bones grow, what happens when they break, the stages of fracture healing and how bones do a bunch of other stuff like erythrocytosis, store some toxins, that tendons tie muscle to bone etc etc. Now ole' Paramedic Jim Jim just knows to reduce and split as best as can be done and maybe get some pain relief onboard, none of that fancy big worded junk. I would say most of what Sparky can tell you ain't gonna change jack shit about how we splint this kids arm. I am by all means an advocate for more education and strongly believe that you can never know too much nor that we should simply educate "skill monkeys" but I was warned that knowing a lot can be dangerous as you can dig yourself into a hole and get "tunnel vision" practicing diagnoistics when the best thing for the patient is for you to take them to the hospital.

I never really liked JEMS they make the research too "simple" and something you can read on the toilet in two minutes. The full, scientific article as published by the AHA is here http://www.circ.ahajournals.org/cgi/content/full/111/16/2134

The degree is only a phenomina of the last decade. Up until then, all EMS education in Australia was in-service technical/vocational style; I believe New South Wales is the only state which still trains some of thier Paramedics this way. Every other state now only hires graduates or in the case of WA, they hire ab-initio and put you on the degree. In New Zealand the degree is far less accepted; the vocational model of education is still used for all levels except Advanced Paramedic (ALS) which is a by-product of our massive (70%) reliance upon volunteer officers; can't have a volunteer spend three years doing a degree now can you? Even for those who get the degree it's an uncertian future within St John at least. Wellington Free is more accepting of the degree from what I understand which is good. Now, as for you, I can't comment upon Australia specifically but I've seen some pretty shady programs come out of US (16 week Paramedic courses and the like) so anecdotially it may not be in your favour if you've got a bare bones six month tech school cert.

Good luck mate

I would consider cardiology my strong point but one thing I can't get my head round is electrolytes and how they effect electrical conduction; if you could cover that some point it'd be wicked Thanks dude

Well I came out at 24 ... (maybe it was 26) .... guess that's why I'm working on becoming a paramedic huh?

Dude who told you my secret? I've heard that one before

Not to sound negative but the reaility is St John is a charity only partly funded by the Government, so, recruits within the confines of budgetary constraints and operational needs (the latter outweighs the first by a considerable degree). All the current vacancies can be found at www.stjohn.org.nz/jobs If you see "Paramedic" it means ILS, if you see "Advanced Paramedic" it means ALS, "Ambulance Officer" means BLS (within St John) for Wellington Free the term "Paramedic" means BLS or ILS and "Intensive Care Paramedic" means ALS. You also need to go through Ambulance NZ (I'm not sure what thier official role is but I believe they are the industry lobby group, not that they lobby very hard) to have your qualifications appriased; this ain't cheap. Check out http://www.stjohn.co.nz/jobs/international.aspx

Yeah but remember bro when you were that age, nothing else had been invented yet

bit 1984ish for my liking .... even coming from a quasi "socalized" country

So you mean to tell me I don't have to pay out of country tuition? Why am I only being informed of this now?

I could not agree more. The problem with my generation (if I were to choose jsut one) is lack of discipline; I went to school with kids who were nothing more than downright little bastards and they have simply left school and gone out into the big wide world with the same mantra. I do not blame the children but nonspecifically I blame society and specifically, the parents. There seems to have been a degredation of the concepts of responsibility and for lack of a better word, punishment. I do not condone physical punishment or the use of force against a child but I can sure as hell tell you that if I got a belt around the head from my old man for something hey I learnt, "man I better not do that again!". Parents seem to be scared to "tell it like it is" or be the disclipinarian because "Johnny might not like me" well newsflash bro your kid is not HERE for you to be a FRIEND; YOU are here to give the kid the necessary skills to cope in the REAL world. I see kids run rampant in the mall and I feel like walking over, grabbing the kid by the scruff of thier neck and telling them "this is not how you behave in public" but does that happen ... no, why, because parents seem to have lost whatever it was they had a generation ago that would make them do that. I mean hell look at Red Foreman off That 70s Show, dont you guys all remember your dad being like that? I also blame the education system; this is where the majority of time is spent by a young person but you don't learn any real skills there about how the REAL WORLD works but hey you do learn art and French and computers and how to have a root in the B block girls toilets before lunch is over. If you told the teacher when I was in high school to "get fucked" (which I have seen more than once) or "I'm not doing what you ask" (daily occurance) nothing meaningful happened; you got sent home for a week, big whoop. My generation is growing up with a very altered concept of responsibility and that one must accept thier own actions. I'm worried because some of these people might be getting into power .....

yeah I've seen kids on leashes but that mother needs to be shot

You'll like ketamine, I've seen good results with it.

We are somewhat different here; authority to practice and clinical governance are in-service run, not by the Government. St John members do not legally have the independent ability to supply or administer prescription medicines to patients, or to use certain pieces of clinical equipment. This legal ability can only be granted by a St John Medical Advisor and as such ATP is a transfer of this legal ability to a member by, and under the oversight of, a St John Medical Advisor. In practice this ability is granted by a partnership between a St John Medical Advisor and St John Management. Employment does not guarantee that ATP will be granted at a particular practice level and conversely, granting ATP at a particular practice level does not constitute employment at, or assignment to, a particular position or roster. A member granted ATP at a particular practice level may not be remunerated at that level until they have been appointed to a vacancy. With less than two years experience you won't be employed as an Advanced Paramedic (ALS), you might be employed as Paramedic (GTN, glucagon, aspirin, LMA/NPA/OPA, IV NS/D10 and manual defib) but this is unlikely; you will be employed as an Ambulance Officer (BLS) which means the skills listed above minus IV acess, fluids and manual defib. From there you can move up to Paramedic then Upskilled Paramedic (Paramedic plus IM adrenaline, IV naloxone, metaclopramide and fentanyl) then onto Advanced Paramedic. This can take well ..... any length of time really, years is not uncommon here. Apart from that we do offer some good benefits; we are totally autonomus (don't have any "online" medical control to speak of) and you could be working metropolitian or rural or anywhere in between really so a good variety of places. Wellington Free is a much smaller system and thier medical protocols are somewhat more advanced (they have thrombolysis as standing order and some drugs like adenosne and corticosteriods that St John does not carry; thier Intermediate scope of practice is also a bit better) so you could try looking there. Email either work@wfa.org.nz or mark.deoki@stjohn.org.nz and give them your details (e.g. what courses you have done, clinical hours required, scope of practice, continuing education and skill revalidation requirements etc) and see what they say. Best of luck mate

Yeah no kidding; I hadn't thought of the dilution of clotting factors and fibrin and whatnot; interesting; maybe we should start carrying blood in the truck I mean what, the military has been doing it is since world war two .... hmm 1: I don't really trust NIBP; treating one with fluids because thier BP is below X is like treating the heart rate simply because it's above Y; seems to me to be a rather broad superficial policy. That said 2: We're not taught Pouselles law per-se (i.e. by that term) but we are taught, obviously, the smaller the catheter the less flow you are going to get through it; that's pretty simple I think even your 600 hour tech school fire-medic could tell you that We are bringing back tourniquets for massive bleeding or bleeding you can't get at; e.g. femoral bleed when trapped in a car wreck. I'm going to have to look that one up. This made for interesting reading -- http://www.nda.ox.ac.uk/wfsa/html/u08/u08_013.htm

Jeff Guy MD does a great podcast on this http://media.libsyn.com/media/prehospitalp...logy/fluids.mp3

Very interesting post. Just read the blong and I'll chip in that we use nebulized adrenaline and salbuatmol for angioedema and bronchospasam secondary to anaphylaxis. I'm told we can't mix them in the same nebulizer bowl however.

are you talking about patients refusing care or EMS refusng them care? if you mean patient going AMA then this is our policy If you are referring to EMS refusing to treat a patient it can be done if it's thought that treatment is not warranted or officers feel at risk by entering the scene, in which case the police would accompany.

does this mean i should feel bad about that $600 i owe inland revenue?