PRPGfirerescuetech

Ok, EMT-Bs are organic blood pressure machines...

Shhhhh fella...not what were talking about.

two simple words.....: Respondeat Superior...Let the Master Respond. The E/D phsician/medical control director must make the call after the EMT(?) brings the pt into the Emergency Department and transfers care to the E/D. If we do everything possible in the field that our license lvel allows, we are 'saved' from any and all liability incurred during treatment in the field.

Wrong.

Physicians cant be responsible for patients they cant see.

WE, and only we, are responsible for the patients we see in the field. Think im wrong?

http://www.defrance.org/artman/publish/article_167.shtml

http://www.merginet.com/index.cfm?pg=asses...atientInterview

Theres more...but try these first.

if a traiing coordinator at a service or facility is using "internet" as the sole source, why have that position??? Heck anyone with a checking account or credit card, an internet hookup and a computer can do that. Live training shoud be "live"

Well put.

Computer based education is a creative way for students to get their "tickets punched" without having to go through the effort of actually educating themselves.

This type of education promotes one thing. Laziness. Anyone who got the email with the answers for every fema IS-100 through 700 answer can attest to that one.

PRPG

No...such drips arent on the state list.

But...

This wasnt out there when the state list was last reviewed...

thus...

maybe thats an idea.

but...

In the mostly urban areas it seems to be prevalent, 2 minute or three minute transport times negate getting that far.

Im aware of what it is.

But should it be this way? Should it be a joint venture?

New people here, so im bringing this post back for another round...good discussion last time.

Should RESCUE be an EMS or FD function?

Base your opinions on some sort of tangible reasoning.

XoXo

PRPG

Take my freedom, take my heroin/fentanyl...just dont take my porn

The AHA 2005 guidelines have been in effect since January 1, way to go Whit. You got something right. Since that statement, you've accomplished nothing in the form of usable information.

The AHA guidelines are the recommendations that most services use for cardiovascular emergencies. If your medical director wants to allow something that is not in the AHA guidelines, then that is the authority that you must follow. Your agreement or disagreement with your protocols is a non-issue. You follow your medical direction's wishes, or you find other medical direction.

If your agency/department/medical control has enlisted in studying how the new AHA guidelines work, then most of the narcotic based cardiac arrest patients will be eliminated from the study. If you want to study the effects of Narcan, on a cardiac arrest population due to narcotic overdose, this would be the perfect sample to include. Don't you think?

In an attempt to return to the original question, luckily, most of the southwest hasn't had a significant spike in narcotic overdoses. Our overdose of choice would be prescription narcotics, or homemade concoctions of items that are easy to come by. Jimson tea, and methamphetamine issues occur much more often.

If you would like, I could send you a care package with my Narcan supply. It sounds like you have more opportunity to use it than I do.

AHA shouldnt be including narcotic based arrests in any study. Too many additional variables in regarding to cause that would inappropriately adjust results.

Side note:

Any one wishing to send the eastern states narcan care packages, please send them to my newly developed for profit foundation.

"Save the Smackheads"

c/o PRPG Firerescuetech

1 PRPG Place

Philadelphia, PA 12345

XOXO

the second post whit made with a second article is a touch more written to the responder and clinician levels...

more trustworthy as well. Good link whit.

Alrighty, that makes a bit more sense. Quotation marks and citing are helpful when trying to determine credibility and all. Speaking of which, has anyone read anything else regarding potency, volumes, etc.? I'm just doubting the credibility of a news article here...

I dont disagree...anyone got any information on the authors background?

Nownack to the oroginal post, they are mixing Heroin and Fentyl?... any nickname to this?.. I know it is common for them to steal Fentyl patches and freeze them.. then dilute them soen to inect them..

R/r 911

Yes...they are getting their hands on hospital grade fentanyl, mixing it with powdered herion, and re drying it. At least, that was the description of the junky that lived through thew experience today...

Nasty ish rid...

PRPG:

Here is an article from one of your local papers.

http://www.nj.com/news/jjournal/index.ssf?....xml&coll=3

This Steve Marcus executive director of the New Jersey Poison Information and Education System was also quoted in a piece of literature, that was used in our in service/notifications.

All I was stating is it was going to be a fun summer. Deputy ACE decided he would chime in with more of his useless garble.

By the way he will let us know when he sees fit for us to begin implementing the new AHA guidelines.

Whit. Thank you for posting the link. Good read. Everyone re read the link he posted about this stuff...

AHEM!

Scroll up.

Yes. Dispatched to the cardiac arrest, and arrived to find the patient on the phone still talking to dispatch....

"Dispatcher XYZ, this is PRPG. Guess what, the arrest you dispatched us is null and void when the patient is telling you about it. Your dumb."

Had another call different patient ,where she wanted us to help wipe her #$$ after she did #2 on the potty,and then several shifts later dispatched to same residence for patient assist. She needed us to tuck her into bed.

HAHAHAHAHAHAHA

I think that was you and I at the nursing home on state road when that went up....loooooool

My worst was old man Sinsowetz, who called us to turn on his air conditioner, he didnt feel like getting up....

[marq=left:8c0c97321d]OK EVERYONE SHUT UP [/marq:8c0c97321d]

Whit: Please present some sort of documentation regarding your 4 grains of table salt statement. I would be curious as to this information, relating to the 14 or 15 odd arrests and countless narcan express jobs we've done related to this stuff. Use and amount of use would certainly relate to the etiology of the event.

That being said...if you dont present it, im going to release the hounds back on you again for attempting to BS me. Heres your chance to shine squirt. No numbers, just printed, posted evidence.

Ace: Your my boy, and I agree with what you said, just learn to pick your battles. Thats all.

Rid: Yes his use of the word skewed misplaced. Good catch. I actually didnt know that until you referenced it, and i looked it up, and the appropriate use. Thanks for teaching me something today.

This thread seems to need a readjustment.

That being said...

[marq=left:8c0c97321d]HAS ANYONE ELSE HAD A RUN IN WITH THIS NASTY OLE Fentanyl / H mixture? [/marq:8c0c97321d]

So...

Whats everyones experiences with this new cut of heriin? Were killing people here left and right...

4 arrests last weekend...all under 30....

Im sure im not the only one...

Online based EMS continuing education programs...opinions?

Pale skin color indicated poor perfusion. This may be because of inadequate oxygenation, or due to decreased blood volume in the circulatory system.

Pupils are constricted.

I cant shake the feeling this is trauma 2ndary to a medical issue.

CO poisoning if im right. Or...im reading too far into it.

Expose, intubate, bag, IV large bore, monitor

Otherwise, normal trauma care.

...im missing something here.

Personable

Also personable.

Extrication takes about 8 minutes. You do your best to maintain C-spine and then perform a rapid extrication onto a board. (Note: the medics in the scenario that this situation is based on used a combi tube to initially manage the airway with success. The patient was completely unresponsive and had no gag reflex. This is not to say that other options are wrong however.)

EDIT: Oh no, I am going to have a bunch of firefighters mad at me. Disentanglement takes about 8 minutes, then rapid extrication onto a board takes place.

Take care,

chbare.

My opinion has always been to start simple.

However... the combi-tube is a nice option considering the situation.

Extricate to spineboard. Pad void spaces. Extricate to truck.

Expose?

Reevaluate ABC?

General evaluation findings?

Physical exam?

Actions to follow exam.

A folded cot sheet I attempted to cut today to splint a hip split the standard shears in half.

Otherwise...its fairly rare...

I will try to answer all of the questions. You are 15 minutes from a level II trauma center. You do not have air evac assets due to the weather. (heavy wind and rain with poor visibility) You can operate at what ever level of care you would like for this scenario. The scene was secured by state police, there are no known hazards with the exception of sharp metal from the vehicle. BGL is 130 mg/dl. He actually appears very diaphoretic and pale. No medic alert tags are noted. Only one patient and you have all of the BLS and cool guy ALS supplies at your disposal. You ambulance is staffed with two people and the extrication crew will have 4 people trained at the first responder-EMT-B level. Due to a county wide mutual aid agreement one of the fire fighters can drive the ambulance or assist in the back if needed. Severe damage limits your ability to care for the patient. You cannot enter the cab and you are having extreme difficulty managing his airway through the window. Intubation will be difficult to impossible until the patient is extricated. Let me know if you need any more information.

Take care,

chbare.

C Spine, 02, and do your best to manage airway. Nothing more can be done safely it sounds.

How long does the extrication take?

Cold

smart fella.

omnipotent

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