Kiwiology

Couple weeks ago I heard something like this from a cop I know.... "1-1-1 Emergency: fire, ambulance or police?" "Police" (brief disturbing pause for connection here ... ) "Police emergency, where is your emergency?" "Yeah hi there are some guys running round outside my house trying to get in!" "Do you know what they look like?" "Um, yeah, they are a bunch of guys in black clothing with guns!" "Sir are you at XYZ address" "How did you know?" "That's the police sir, you need to let them in"

Looks like the AMR ambulance I saw parked at 42nd St and Times Square .... begs just one question, was Kool Aide man driving?, ooooh yeah

Allbuterol Amiodarone ASA Atropine Dextrose 10% Glucagon Lasix Metaclopramide Midazolam Morphine Ketamine Naloxone Nitro N2O .... pretty crappy really

Hey I called 911 instead of 311 once, whoops

First choice would be Seattle/King County medic one - I know they had (and may still have) the highest cardiac arrest survival rate in the nation, must be doing something right. Second choice would be Las Vegas - America's playground should bring some interesting calls. Third choice would be Los Angeles County - I mean, who can say no to riding in the footsteps of Johnny and Roy? LA clear - KMG941

I was shooting the bull with the FDNY on 4th of July and they pretty much said best route was to become a Paramedic. They also said Rudy shut down illegal fireworks sales, they've gotten much less business on the 4th meaning they can stretch out a bit until the next bum comes up and hassles them for medical attention NYC Methodist offer a two day a week program, St Vincents and BMCC run full time programs.

Our EMS thrombolysis indications are: - 75 years of age or younger and, - A cardiac clinical history and discomfort for less than 12 hours and, - No history of recent trauma, injuries due to falls, or extended CPR less than 2 weeks ago and, - No CVA or head injury history within the last 6 months and, - No major surgery within the last 2 months and, - No GI bleed within the last 2 months and, - No peptic ulcer disease within last 3 months and, - Not be taking Warfarin and, - No uncontrolled hypertension greater than systolic of 200mmHg Assuming this guy check's out and because he has anterior ST elevation (5mm in V1, V2 and V3) I'm gonna get on my trusty radio and check in with the doc's at medical control about warming up the heparin and reteplase. Is he still throwing PVCs?

I personally think it's just about finding the right person and the right balance. My uncle is a 27 year veteran of the fire department and has been married all that time. Friend of mine's wife hated him being a firefighter and they got divorced in about 6 or 9 months. My dad was also a firefighter (engineer); he and my mother have a terrible relationship which has nothing to do with his involvement in the fire service, so it goes to show it can be everything or nothing. If you find the right person I don't think anything is impossible, even if you're both working opposite shifts and never see other. The future Mrs Kiwi also plans to become a paramedic; so I hope for sleep's sake and mine we can make it work with our partners

A brave man once requested me to answer questions that are key: is it to be or not to be? And I reply, oh why ask me? A wise man once said to find a job you love and you will never work a day in your life.

Sure got that right, damn I haven't heard any of those drugs used in ACLS for years

Our protocol says a witnessed arrest gets up to three shocks at max joules before CPR is started. Without oxygen and nutrients, the fibrillating heart will loose its electrical activity (coarse VF) due to acidosis and hypoxia and degrade to fine VF and eventually to asystole. Research (pg. 16) has shown that 1.5-3min of EMS CPR PRIOR to defibrillation (if call-to-arrival time was 3-5 minutes or more) improves survival rates because it delivers oxygen and substrate to the heart muscle (and as said above, may convert fine VF to coarse VF) thus increasing electrical activity (and size of the VF waveform) making defibrillation more effective at eliminating VF. Dunno about you but I found that interesting 8)

The pt has the right to refuse any treatment, including life saving treatment if they wish. We have to transport if we do something major (defined as giving mediciation beyond tylenol) or any fluids (exceptions are febrile seizures or simple hypoglycemia) If we feel medical intervention is not required we do not have to transport. A lot of our funding for accidents comes from the Government hence we only get paid if we transport, so we do a lot of absolute crap transports so we get paid.

See here http://www.health.wyo.gov/Media.aspx?mediaId=3166

I was in ED the other day - its the same story, lack of beds and lack of staff. Some mystery QI/PR suit doesn't need to tell me that. I can see this going down the gurgler when somebody dies in chairs because some jagoff mystery shopper was occupying a bed with a fake illness. See, "mystery shopper" implies that a nice, friendly, joyus customer satisfying occasion is to be had at the emergency department, yeah right. As the Horse on Ren & Stimpy said "no sir I dont like it!"

Weird, not sure why the BLS crew legged it but maybe they though this was a movie and the double slap was to go. But, then surely they can look out the window and see paramedics with thier gear wanting to get in or do you not have windows? Autolocking doors eh, we don't have that but our ER does require a key code to get in thru the ambulance entrance. Really annoying when you don't have one and you just went back to get a ryhthm strip and get locked out in the cold in short sleeves!

Yep valid DNR is final here provided we act in "good faith" and "resusciatation attempts are not in the best interests of the patient".

Stewie from Family Guy coz he's articulate yet evil, blast!

GRRRR every video I try and view it says "sorry this video is unavaliable" The BP cuff is about to burst off my arm!

I carry a basic kit (including a steth & BP cuff) in the car and on my person I always have a CPR mask and gloves. Not to say I go looking for disasters but if I am out in the middle of nowhere and happen across a wreck its handy to have something with you. There was a presentation at a trauma conference I saw about exactly this - some people carried all sorts of stuff in thier cars (AEDs, airway kits, O2 etc etc) I mean good on them great thinking but I think its a bit of overkill personally.

My brother's girlfriend had a tonsillectomy so she could take a size 10 ETT and er, other things, w/o gagging Maybe I should try this on her!

It seems to me anyway, the cookbook is being rewritten from an evidence based approach (which if you read Circculation the 2005 AHA guidelines admit that randomized studies with cardiac arrest pharmacologics are few and didn't seem to show any great results) Let's take bicarb as an example: The 1974 AHA guidelines said that along with Don McLean, Chevvy hightops (not sure if KKK-1822 was in force then) and really high gas prices all ACLS providers were to administer two 50mEq amps of sodium bicarbonate. 30 years later, we know that acidosis does not automatically occur in all cardiac arrests, so the guideline was changed. We don't use it at all (not sure how good/bad that is). It seems to me that this is a bit of a grey area. I just want my paddles back!

All our ambulances sit at the station and wait for a call. Our maximum urban response time to "priority one" is eight minutes. We often have fly cars driving around who get to a situation first and call for transport as appropriate. In a mixed fly car/transport system the truks generally are ILS or BLS and the fly cars provide ALS whereas in our city (~80,000 people) we run 3 or 4 trucks (two ALS and two ILS or BLS) during the day and 2 or 3 at night (2 ALS or 2 ALS & 1 BLS or ILS). The paper pusher managers (all of who are medics) also have fly cars to go out to jobs in rather than push paper if needed. I love our dispatches, they always make me laugh, here's an example Us "Comms, we're clear on a one alpha one (or whaterver the AMPDS detrement is)" Dx "Roger, return station" Like we're gonna go anywhere else? That would burn gas, something that costs money, money our company doesn't seem to have! They even took our intubation manakin!

We don't use vasopressin so no comment there. It seems our protocols have been change a lot recently: no more atropine or bicarb, only epi and we still have ETT drugs for some reason. I remember back in the day standard cardiac arrest included lidocaine, epi, bretylium, atropine, maybe bicarb and Mg SO. Seems times have changed.

For United: AUTHORIZED USE ... Medical Kits all require Captain’s consent to be released to a medical professional after their credentials have been verified. If credentials are unavailable, the equipment may still be released at the Captain’s discretion CONTENTS Atropine 10ml 0.1mg/ml 21ga x 1 1/2” (1) Atropine 1ml 1mg/ml (1) 3ml w/o needle (1) Dextrose 50% 50ml 500mg/ml 18ga x 1 1/2” (2) Benadryl 1ml 50mg/ml (2) 12ml w/o needle (1) Epinephrine 10ml 1:10,000 21ga x 1 1/2” (2) Epinephrine 1ml 1:1,000 1mg/ml (3) Lidocaine 2% 5 ml 20 mg/ml 21ga x 1 1/2” (2) Lanoxin 2ml .25mg/ml (1) Sodium Bicarbonate 8.4% 50ml/ 50mEq 18ga x 1 1/2” (1) Metoprolol 5 ml 5 mg/5 ml (1) Foley Catheter (1) Naloxone 1ml 0.4mg/ml (2) Tourniquet (1) Inhalant Nubain 1ml 10mg/ml (2) Albuterol Inhaler 17g (1) Phenergan 1ml 25mg/ml (2) Airway, Small (1) Acetaminophen tabs (4) {Nonaspirin} Calcium Chloride 10% 10ml 100mg/ml (1) Airway, Large (1) Aspirin 2 pack 325mg (2) Diazepam 10ml 5mg/10ml (2) {Valium} Clonidine Tabs 0.1mg (2) w/22ga x 1 1/2” needle; 3ml syringe (2) Diphenhydramine tabs (4) Furosemide 2ml 10mg/ml (1) Stat Kit Reference Guide (1) Nitrostat Tabs 25 tabs 0.4mg 1/150gr (1) Procainamide 10ml 100mg/ml (2) w/21ga x 1 1/2” needle; 12ml syringe (2) Solu-Cortef 250mg 125mg/ml act-o-vial (1) Treatment Tag (1) 18ga x 1 1/2” (1) 20ga x 1 1/2” (1) 25ga x 1 1/4” (1) 25ga x 5/8” (1) 0.9% Sodium Chloride 500ml (1) Endotracheal Tubes w/stylets 1 x 3,5,7mm Alcohol Sponges (2) I.V. Set with 2 Y-connectors (1) Gauze Sponge 3 x 3 (2) I.V. Catheter 18ga x 2” (2) Gloves, Nitrile, Non-Sterile (12) I.V. Catheter 22ga x 1 1/4” (2) Gloves, Latex Free, Sterile (2) Laryngoscopes x 1 ea. large and small Hemostat (2) Monitoring Equipment Needle Holder (1) Aneroid Sphygmomanometer (1) Scalpel (1) Stethoscope (1) Light Source (1) Scissors (1) Thermometer, oral strips (2) CPR Microshield Plus (1) Sutures, Prolene (1) Sutures, Vicryl (1) Miscellaneous Equipment Tape, Hypoallergenic (1) Contamination Bag, Blue (1) Thumb Forceps (1)

If we can, we perfer to get the patinet into the ambulance as quick as possible because its easier than lugging all the gear around. When that's not the best option I personally like to take O2, Lifepak 12 and trauma bag. The only time I'd take the drug and airway bag (ie ALS kit) is for things like arrests, severe asthma, anaphalyxis etc.