Kiwiology

http://www.snagfilms.com/films/title/tell_me_and_i_will_forget

This is a documentary about Paramedics in SA, from what I understand talking to the mates from SA it's pretty much as it is

The only rotating Dwayne does is when the goat says "baaaaa baa!" which is goat for "its your turn to do reverse cowgirl up the ass now bitch!"

AK is a pretty badass straight up bloke if he says it's not for him to be here no more then I have no reason to doubt him in any way, he is not one to pander to internet emo bullshit so he wouldn't start it.

Speaking of rotating, excuse me, must nick off ...

Beacon, on

Strobes, on

Torque, 100%

Doors, closed

Morning Cleveland it's Medevac, helicopter mike echo, got some crook bloke who needs to be taken to the hospital, we're eh .... stupid VFR sectional is too small to read, lets play with some knobs here, oh yes, we're at about 10 DME on the 300 radial of um, eh, Pullman, we'd like IFR clearance to ... hang on, oi Emergentologist! where the bloody hell does this guy need to go? Chicago? righto, done, maybe if I fiddle with with this joystick here we'll get there, I told you I am not a rotary wing pilot!

Greetings mate

Quite a few SA ambo's out here in NZ; worked with lots of ex SA and they are very nice people, their stories are pretty intense thats for sure

By EMTB do you mean you're a BAA or an ECT?

Excuse me, I must now go familarise myself with when the next date the AB's are going to trash the Boks

Clearly it is the stress of not having come to New Zed and had a BBQ with us ... well its kinda rainy here this weekend, might want to come next week.

I think ability to use the information gained in clinical context vs. being able to pass a test is a much better way of evaluating the two methods of teaching personally.

Good on you for having a look at this mate, it's a topic very near and dear to my heart and I know you feel the same way

As has been said, can the people who took the integrated course pass the same exam as the people who took the stand-alone? I think that is a better test, or an even better test is how they can apply the knowledge they have learnt in clinical context of pathophysiology and rationale for signs/symps/treatment etc

Certainly I am vehemently opposed to anything other than stand-alone anatomy and physiology taught by a subject matter expert but then again I suppose I only have empiric evidence to support my view.

Carry on.

As has been indicated earlier, respiratory rate is an often missed vital sign that can be a subtle indicator of a patient who is very unwell (the same goes for temperature) however I have seen this is not routinely done in my experience including in hospital

There is benefit to recording respiratory rate in all patients at least initially and then continuing to do so in those patients where clinical judgement indicates it may be helpful

There is no equivalency for non-US trained Paramedics. I researched this topic long and hard and the answer was simply you have to go through training again. There was talk of being able to prove equivalent knowledge and skill to enable taking the NREMTP exam but nobody was willing to help. You may be lucky and be able to gain recognition of prior learning from a community college Paramedic program for your PCP and ACP college credits and then have to complete some classes at that specific institution to get a Paramedic certificate or associates degree that would enable you to take the NREMTP test.

I am extremely curious why you would move from Canada (specifically Ontario, which is one of the better provinces) to the US, in particular California, to be a Paramedic. Have you researched pay and conditions and clinical context of the local area?

Damn it AK this is just because you were sick of hassling you because I want to get the hell out of New Zed isn't it? Dude you could have just told me to stop!

I know exactly how you feel mate; this place seems to go round and round in circle and eventually you get dizzy, oops, no thats the valiumz and multiple psychological infarcts I've had ... ooh look valiumz, mm num nums.

You are a person whom I have much greatness of the respect for and I wish you well; it is certainly my hope that we get the chance to meet one day; now that i am no longer wanted in Hillsborough or Duval Counties it will make my coming to visit much easier, I make a mean burger and offer of a BBQ still stands or if you don't trust my cooking I know a mean restaurant in Brevard County, but you will have to trust my driving ...

My sincerest best wishes to you and the rest of the AK clan

Kiwi the Kiwi

Yeah, cos we all do pericardiocentesis on a patient who we supposedly have on a non-rebreathing mask that has a deflated reservoir bag and is being monitored in 2012 with a Lifepak 10 cos you know that "bag" around the heart might be full

Whatever, waste of bandwidth, wasted 15 minutes of my life I can't get back and could have spent cranking out a good shooter to an awesome lesbo porno or something instead of making me want to bleed vomit from my eyes ....

I'm going back to forum retirement ...

I know I am probably going to sound like a right cock but death is just part of reality.

I have seen people die in road crashes that were just absolutely fucking horrendous and looked like somebody had been put throuogh a sausage machine and I mean you sort of stop for a second when it is all done and dusted and think "ew that was quite gross" but ironically the one death I found that got me the most was not nasty road traffic crash victim but the little old lady who died alone on the loo in her tiny miserable granny flat with no friends or family around when it was fairly obvious that she had no real form of human contact for weeks on end and died all on her own.

Really I think anybodies death is unfortunate, even moreso if it is premature, even moreso if its premature and violent or traumatic

Suicide never really bothered me to be honest, its horrendously unfortunate especially if it was over something seemingly trivial (to the outsider) but I dno I've tried to commit suicdie twice so who knows, I certianly wouldn't have thought it unfortunate if I'd succeeded, for me anyway.

I'd come help you out but eh ...I think I am still wanted in Tulsa County

True that shit bro

http://vimeo.com/29585863

The new generation are a bunch of bitches who can't handle shit and need to harden the fuck up

<Chopper Reid>

This is Kiwi .. he just ate a bunch of artery hardening ice cream, then had his mother call and say she found the porn him and his ex wife made on his old computer he gave her that he was 100% positive he had formatted the hard drive on, is watching a graphic presentation on trauma including shattered femurs and burns, went to the dentist today with no pain relief, and ... just pulled his cock even though it hurt because it was only an hour since the last time. Fucking spot on Kiwi!

</Chopper>

1.6 mg intranasally here in Kiwi in 2 divided doses (1/2 each nostrial)

I still think there are far more useful things they could be teaching their people .... but eh w/e

Interesting that it is not indicated for opiates prescribed by a Physician (those dang physicians and there prescribing, can't they just be happy using that thing they carry aound their neck and sending people a bill?) ... does Nana whos back pain is abit worse today so scoffed down too much oromorph not need some naloxone?

I am torn about the usefulness of naloxone TBH, espeically in somebody who has an unknown or prolonged down time and might have a tinge of blue noggin so we go waking them up probably not the best idea ...

Also interesting that they decided to trial naloxone and not something far more useful like GTN, salbutamol or some form of non narcotic analgesia.

Gosh I am just so much fun to be around aren't I?

Excuse me, I am late for my lunch date with Buzz Killington ... I have to use my gift card for Hooters and that Consultant Emergency Physician never showed up ...

While you were taking a slash in the sand I figured a more inconspicuous method would be to go for a sly piss in the deep end of the pool

Damn Lifeguard blew his whistle so loud I almost fell in!

Yep, somebody very near and dear to my heart told me I can come off at time sounding a bit "lecturing" or like a "know it all"; I have to say that over a year later that this still hurts me very much and for a time greatly affected my confidence generally and specifically my clinical confidence, particularly because truth be known inside I am almost the exact polar opposite.

I think that, like you Bushy, the Ambulance Service teaches you to be very self confident in your knowledge and ability, not in an arrogant one-upmanship way, but just because that is sort of how you have to be to survive on the road; it's no good going to somebody who is crook or where the family are all crowded around the patient not letting you at him that you just stay in the corner and go to pieces with all the bystanders or are not confident to treat the patient because you are not sure what is going on etc.

A part of it I think too was that in speaking to people from other jurisdictions I would get internally so frustrated and deeply disheartened with the disparity between various systems both operationally and clinically and the lack of progress that maybe a little bit of it slipped through because Ambulance is something I care very much about.

How did I change? Honestly mate I went and spent many, many. many months in the corner, just stopped talking to people that were once very good friends and just had a bit of a total meltdown ... I dno it might sound a bit childish or foolish or whatever but I dno, I am not sure if "think before you open your mouth" is the right thing to say because I think we all do this anyway, but I dno, I guess in the heat of the moment it can be a bit of hard task to do, but you just gotta be more self aware maybe?

Or clearly the answer is to become an ICP then nobody questions you (and you get teh ketaminez)

As a former legal resident of the State of New York it is my job to hate on Jersey and I take my responsawbahlity seriously yo!

Back in the day things weren't too great here in NZ either as out in the boonies you might have gotten an ambulance with two Primary Care Officers who had a week long course (essentially First Responders) but certainly 10 circus freaks with first aid cards didn't show up.

Now that there has been a bit of a crack down both from within the Ambulance Service itself and from the Ministry of Health the lowest possible crew skill mix is Emergency Medical Technician and Ambulance Assistant. The Technician course is about a year long as as I've stated many times is more aligned with (and in many cases exceeds) the new Advanced EMT but without IV cannulation. An Ambulance Assistant is somebody who has done the five day course and who will be undertaking the Technician Diploma.

Again, such a skill mix is very rare and would only be used in rural areas.

We do have a number of First Response groups who provide an initial response in very rural areas where there is no ambulance station, paid or volunteer. First Responders are not permitted to crew a transporting ambulance.

The side effect profile of ketamine is no more bothersome than any other analgesia in common use. The most common side effects are easily managed with commonly carried ALS drugs such as benzos or atropine (or glycopyrrolate , but I'm picking not many ambulances stock that)

Knowing the side effects and having had a fair amount of experience with various analgesic options, I still think ketamine is the best drug ever.

I agree, ketamine is quite handy and very effective; I have seen people go from screaming in wretched agony despite appropriate doses of morphine to happily thinking they are a banana and have forgotten all about their pain in two minutes, it can also be used for induction and restraint too, and it is particularly useful in the crook / hypotensive pt as well which makes it even more handy

The only downside is that 200mg/2ml is awfully wasteful I wonder if another concentration is available ....

Ketamine has a rather large side effects profile. Also, it's a direct myocardial depressant. However, those effects are usually negated by the increased sympathetic tone associated with ketamine administration. That is until you administer it to a catecholamine depleted patient...

Ketamine does have side effects yes, most noted are transient tachycardia and hypertension, nystagmus and there are varying reports of frequency and intensity of hallucinations. I personally have never seen hallucinations in the patients I've attended where ketamine has been administered however I acknowledge they are a possibility.

In saying that, ketamine is the worlds bestest analgesic ever where it is not contraindicated

Unfortunately Rock Socks in US "opiate or nothing" is the default standard and I have yet to see any service that carries paracetamol, nitrous oxide (owing to the FDA single cylinder ban) or ketamine for analgesia. MCHD in Texas carries ketamine for induction but not analgesia.

In New Zealand we have paracetamol, entonox, methoxyflurane (where carried*), morphine, fentanyl (including intranasal fentanyl), opiate plus midazolam and ketamine (including oral ketamine).

Our indication for pain relief is "pain" without no exception or dosage limits, we can give as much analgesia as is required and professionally prudent to give with the only limit being the physical amount we carry (40mg morphine, 400mg ketamine, 200mcg fentanyl per Officer)

Entonox is fantastic and I've used it pretty liberally, I never finished Upskilling so could only give morphine when supervised but I mean nobody ever disagreed about it, I am aggressive when it comes to treating pain, firmly believe no patient of mine should be left in acute pain and will adequately treat my patients' pain to their satisfaction.

Anybody who does not adequately treat their patients' pain needs to be banned from practising, be cloned, have both their femurs horrendously shattered and angulated, and then be treated by their clone, and any medical director who does not give their paramedics' adequate tools to treat patients' pain needs to be subjected to the same treatment.

* methoxyflurane is carried instead of entonox in space limited situations such as Ambulance Rescue (SERT), Rapid Response Unit and Motorcycle Response Unit vehicles and in very rural stations where re-supply of entonox is problematic.

Carry on.

KIWI!!!!!!!!!!!!!!!!!!!!!!!!!

Welcome back buddy!!

Hey settle down, lets not be getting any ideas that I am back, I just couldn't bare to see a fellow Kiwi needing help ...

There is much conjecture about which is more effective between IV salbutamol or IV adrenaline but at any rate IV adrenaline is pretty badass; I have only had one life threatening asthma she was a 19yof who later complained "the adrenaline that got put in my drip made me so high!" lolz

RSI in an asthmatic patient is a dubious thing AFAIK and it is best left to the hospital for now, in the future this may change. RSI is road based now as well, calling for RSI for an asthmatic patient is pointless tho, Tony Smith has specifically said he does not want it used in asthmatic patients.

To answer your question more completely tho your game plan should be nebulised salbutamol and ipratropium; if the patient is status one or two give them some adrenaline. Magnesium and steroids probably confer benefit but I am not aware of randomised trials which support this hypothesis but I know they are popular in hospital and in many US ambulance services' for asthma.

Now as ... hang on, *takes a squiz at pager, hmm, R50 required, be back later

Adrenaline is a high priority, put 1mg in a one litre bag of 0.9% NaCl, shake well and label and give as an infusion starting at 2gtt/s

I am not sure but unless things have changed in the last week we do not have hydrocortisone in New Zealand; and yes an immunosupressant is relatively contraindicated in somebody who has an active infection however you need to balance it with the therapeutic effect.

Permissive hypercaponea is critically important, ventilate the patient at a very slow rate (6/min) to prevent dynamic hyperinflation

Do not waste time calling for RSI qualified R50; asthma is not an indication for RSI and Tony Smith has said he doesn't want it used in an asthmatic patient but as an aside ketamine is a brilliant induction agent for an asthmatic patient because it is a bronchodilator

Helicopter eh? where are you? Northland or something?

Have you talked to one of the Clinical Standards Officers at all?