Kiwiology

Um, .... hell even with ME driving the freaking thing I could see a mile away, ME!!! so I dno HTF they managed that.

Dispatch er, we'll be out for a while on a, ahhhh howinthefuckdidwemanagetodothat? job

ive seen that before its pretty good

As a "young" provider (at 23) I am going to play devils advocate here for a moment. There are a lot of young people out there in EMS who are very confident, competent and trustworthy EMTs and Paramedics.

There are also some who do raise a few genuine issues such as ...

- Very little (or zero) life experience and argubally associated to this, maturity

- Lack of English composition and a professional level of grammar

- Some just cannot talk to people on a professional interpersonal level

- A few I've seen just do not inspire confidence that they know what they are doing

I'm not saying I am some supermature, experienced, seen it all three times and done it twice burnt out old relic (not by any stretch of a dream, that's Dust's job ) but I've seen EMTs my age who lack the life experience to be able to think on thier feet or outside the box without calling telemetry or just sort of staring blankly going "ummm......", they get freaked out really easily because they have never come across the sight of guts, blood, death, gang members or some meth'd up bash freak being held down by the cops while you have to examine him.

While you can't generalize and lump all the eggs in one basket some of the young providers (and some of the older ones) I have seen just scare the crap out of me; I wouldn't let them near me with a band aid or fully authomated defibrillator if I were in the biggest, most coarse and detectable VF ever. They just don't have the maturity and what I'd call common sense to be out in the street dealing with crazies and sick people making complex clinical decisions.

Peachemt

What can I say, this doesn't come as a suprise ... this is pretty low mate, I suggest you go somewhere far away from here, fast, do it now.

Ah, perfect idea, I mean who has anything better to do but sit up at 1am reading the journals?

What, don't look at me like that ... we all need hobbies

Is this a scenario you want us to solve or are you fishing for answers to something you saw or happened to you/somebody you know?

If it's the latter you won't find many people here willing to second guess and judge what others have done with limited information.

I'd want a complete medical history, 12 lead ECG, detailed physical exam and just because this guy "wants" to go to a particular hospital; well it dont work like that here, you go where we take you IF we think you need to go there in the first place.

For 2/10 chest pain I'd barely be inclined to give a tab of nitro let alone morphine.

From our protocol/SOP

[Ambulance Officers] are to conduct an appropriate examination of all patients who have a medical or injury related complaint, which will include, gathering a history and a physical examination, unless refused by the patient ...

Whenever personnel are called to

a patient they must make three decisions:

1. Is treatment required?

2. Is transport to a medical facility required?

3. If transport is required, what form of transport is most appropriate?

...Obligations of personnel

Personnel must convey these decisions to the patient, as firm recommendations, along with an explanation of any benefits, risks and alternatives.When making decisions and conveying recommendations, personnel must always:

• Fully assess the patient, including their competency, taking into

account all available information.

• Act in the patient’s best interest.

• Allow competent patients to decline recommendations.

• Insist on treatment and/or transport if it is in the best interest of an incompetent patient.

• Fully document their assessment, interventions, recommendations and interactions.

• Contact [the emergency department] for advice if the situation is difficult.

...There are some situations where a treatment or significant intervention can be administered and then a recommendation made that transport not occur. They are restricted to the following:

• [The emergency department] has been directly consulted with (at the time and by personnel dealing with the patient) and has decided that transport is not required.The name and contact details of the [ED] doctor must be recorded on the PRF.

• Paracetamol for minor discomfort, uncomplicated hypoglycaemia or epilepsy, and palliative care patients. Details are in the relevant sections.

...When the patient or family insist on transport

Competent patients have the right to decline recommendations, but patients and families do not have the right to insist on transport that personnel do not think is clinically indicated.

If the insistence of the patient or family appears to be based upon genuine concern, and no other reasonable transport option is available, then the patient should be transported. If the insistence of the patient or family appears to be based on maliciousness, convenience or petty concerns, then personnel may decline to transport the patient provided they:

• Continue to treat the patient and family in a polite manner and

• Explain the reasons for not providing transport and

• Fully document their involvement with the patient and family

...Comprehensive documentation must occur and include:

• Details of patient assessment and findings.

• An assessment of the patient’s competence.

• All treatment and interventions provided.

• What was recommended and the reasons why.

• A summary of what was said to the patient and/or family.

• A summary of what the patient and/or family said.

If the patient is not transported then the front copy of the patient report form must be given to them.

Looks like a bunch of electrical alternans or some whacky axis thing .... I'm going with cardiac tamponade.

WTF that guy needs putting down ...

Back in the 1980s, the David Clark Company -- makers of MAST pants and communications headsets -- gave out little plastic cards at the trade shows (JEMS, NAEMT) that had a "mood" circle on them. Basically, it was the same colour-changing crystal that is in mood rings, on a credit card sized card, and it had a colour scale printed on it for interpretation. You were supposed to hold it between your thumb and forefinger for a given amount of time, then look at the colour to interpret your mood or stress level. It was labelled as a stress monitor or something like that. My partner and I had a lot of fun with those things, checking our levels before and after every run, and anytime someone pissed us off. I finally burned it out by leaving it under a halogen map light for too long, lol.

Who knows if those things really have any validity to them. But anything to get you thinking about your stress level, and means of reducing it, is a good thing.

Can they be used instead of the Wong Baker faces?

(I really like the Wong Baker faces.....)

Here's the latest episode -- the audio in part 3 is a bit out of sync, best I could do sorry guys.

I recently had the pleasure of spending some time with one of the Advanced Paramedics (EMT-Ps) who is in this episode; however alas the cameras didnt turn up (probably a good thing )

Episode Six

Part One

Part Two

Part Three

Mayb it was Kovach from ER, wasn't he Croatian?

We don't have to call for orders for anything but we do provide status reports (an R40) to the hospital if we are bringing in a statue 1 (critical) or 2 (unstable) patient; or if we need Police there or something like that.

Example from Thursday:

"Shore ED, Shore 1 how copy?"

"Loud and clear"

"Roger, seventy six year old female, cardiac chest pain relieved with O2 and GTN, our ETA with you is five minutes and we're calling the patient status two"

I've read the examples in textbooks like Brady/Mosby that are about two paragraphs in length and contain a novel of events that we record on the PRF or give at handover so we only give very short reports.

BGL is normal at 5 mmol (90 ml/dl)

Are you sure you want to give this pt. an NSAID given she has asthma?

You give the pt. 3 x .4mg nitro's but she said it makes no difference

Try the AVI Codec Pack http://www.avicodecpack.com/

More action from down under; New Zealand's Advanced Paramedics take to the skies with Auckland baswd Westpac Resuce (HEMS).

Unlike the rest of the country (which uses a roster of regular road medics) the Auckland service employs its own Advanced Paramedics (EMT-Ps).

We're a bit quirky in the way we do things down here; so just a recap. Most of these jobs are way out in the whop whops where the road crews seen here are "Primary Care" officers who are "pre-BLS" studying toward the BLS qualification and are trained to what the US call "first responder" (40 hours) - basically O2/AED. You also see some weird looking vanbulances

Yoiu'll also see some "ambulance officers" which are BLS and "paramedics" which are ILS. One job uses what is called PRIME (Primary Resource in Medical Emergencies) which are ALS trained local doctors and RNs used in areas where ALS is more than 30 minutes away if the patient is critical (this program has been met with some mixed results here and outside it, doctors haven't been used on calls since about the early eighties).

More as I get them.

If you want to see our road ALS in action, watch these videos (links are spread thoroughout the post)

Episode One

Part One

Part Two

Part Three

Episode Five

Part One

Part Two

Part Three

I dno if there's a dealie that does it contionously; I made that up so the scenario based off things I read in two journals at 1am would work, shudddddupa your moutha!

You're dispatched to a neighbourhood medical center for an old lady who says somebody stole her breath. Upon arrival you find a police officer standing in the triage bay; he tells you he has not been called to take a theft report and points you to one of the nurses.

One of the nurses leads you to one of the rooms where you find a 75 yof cc sob. Over an hour ago the CNA put her on salbutamol and it's been running ever since because they are busy the CNA was needed elsewhere.

S - SOB, diaphoretic, skin cool/clammy and feels light headed

A - nil

M - atrovent, nadolol and januvia

P - mild asthma, HTN, NIDDM

L - breakfast q 6hr ago

E - nothing remarkable

Vitals

BP 140/90

RR 24 with insp wheeze spO2 95% CR < 2 s.

PR 100

GCS 15

LMAO that was good for a laugh

Episode Four

Part One

Part Two

Part Three

Driving is dangerous enough at is it when contending with all the stupid people out there on the road; the cellphones, drunks, bad drivers, old people and foreigners without putting you in a big, shiney vehicle with lights and sirens ... did I mention stupid people?

The days of the "ambulance driver" in his big powerful Cadilac going like a bat out of hell are loooooong gone.

Thanks for the videos they were both educational and entertaining. I know how much of a pain in the butt it can be to format the files correctly so thanks.

So are the ambulances staffed with basics and intermediates? Or is advanced care paramedic really advanced and there are basic paramedics?

This shows the service in metropolitan Auckland; which is not representative of the rest of the country. Also of interest is the fact that metro Auckland staff are 100% paid full time officers.

Yes, in a nutshell within the Auckland metro area trucks are staffed with either a basic ("ambulance officer") or intermediate ("Paramedic" or as us old timers call them. "intermediate care officer") or two basics. There would also be one or more trucks (from my experience (which again, is not within the Auckland service) usually one) on a station which is ALS capable ("Advanced Paramedic" or as the old, old timers call then (I aint that old) "advanced care officer"). On that vehicle the ALS officer would generally be paired with either an ICO or a basic AO. All other ALS (Advanced Paramedics) are in the 4x4s as you see here.

Outside metropolitan Auckland the service is "composite" meaning paid staff work alongside volunteers to make up crews. Vehicles generally follow the BLS/ILS/ALS forumla. The system of chase-car ALS is replicated in one or two large cities (like Hamilton and Christchurch) while outside those the ALS are on a truck on station. Our station for example has one ALS truck and 2 or 3 ILS trucks (depending on workload; you obviously roster on more people for saturday night than a tuesday morning). The Team Manager is also an ALS officer who has a chase car, this is generally true in most of the smaller cities where the managers are ALS and operate either on a watch or on a watch then on call.

Our "Advanced" Paramedics are not any more "Advanced" than what we think of as a "Paramedic" (EMT-P) it's simply a name used for marketing purposes. They are simply run-of-the-mill ALS; basic run down is ...

Ambulance Officer (BLS) has O2/AED/nitro/glucose/LMA/methyoxyflurane/n2o

Paramedic (ILS) adds IV NS and dextrose/manual defib/IM epi/morphine/naloxone/metaclopramide

Advanced Paramedic (ALS) adds amio/ketamine/midaz/lasix/IV epi/12 lead/TCP/SCV/ETT/cric/IO access

There are some changes going on here which hopefully will make all paid staff up to the ILS level and exapnd the ALS level to extended care/primary care paramedic practitioner level (ECP - extended care paramedic) but this is several years off from the limited information I have.

Hope you find this interesting!!

two thumbs up

Driving over the speed limit is illegal and dangerous; remember the kinetics of high speed impact on organs like the liver, spleen and heart? I'm not getting all soap-boxish here but sure, I speed in my persy vehicle (barely possible, cheap POS Nissan that my mate totalled anyway) but we're talking like a mile or two over the speed limit.

When it comes to driving the ambulance I don't see the point; is the patients condition really that serious that shaving thirty seconds or a minute off transport or enroute time really going to make a difference? Bledsoe says no. I'm inclined to agree with him.

Our most effective tool here is the red and white lights; they do a good job, air horn works marvel (I love the air horn) and the siren prn (read: not all the bloody time!)

Woohooo!!!!!

Good going mate, I'm happy for you n' the mrs