celticcare

But with the back breaking labour twist, just remember the other elements of being an RN, drug equations, assessments, adhering to district health board policies, cannulating, intubating, defibrillating, medicating, x-raying, interpreting lab values, mentally and emotionally taxing. Oh of course we aren't back breaking to do the job, heaven forbid we log roll the 400lb fat bastard who ate twinkies and cheetos all damn day and came to us with an ulcer on his fat ass! I slaved, like Timmy, for four years to become an RN, we have one level here in New Zealand, we don't have LPN, you do your training and are an RN and then from there, you enter your levels and stages dependant on your years experience. I have over 50,000 in student debt to pay to become an RN and I do it because I love it. I work in a level 2 trauma centre and we are constantly swamped with cases that should be at a primary health clinic. We have many patients coming in through our doors and the acuity level of care is increasing with an aging population and multiple co-morbidities. For a long time, a street sweeper earned more than an RN. Yes Crotch, you may think we don't have a back breaking job, I am sorry you are that elite that you didn't break a sweat, but you are but one of a million and more of us who do this job. I hope to learn your ability to do this... oh wait, no thanks, I actually ENJOY having the ability to think, have a heart and yes, bust a f***ing sweat doing my job, because I know at the end of the day I EARNT my wage. With the increasing demands, the advancements of medical care and the need for further interventions for patients, I support my fellow RN's on strike, because at the end of the day, it isn't the doctors who are going to care for you when you are in hospital, its the nurses. And in regards to unions, we are lucky to have a good one here in NZ that provides many services. We don't have to worry about health insurance as we are free medical service here in NZ. So yes whilst not arguing for the same points as the RN's the fact that we have an increased workload, an aging population, mutating forms of diseases to deal with, we still do it. And so my response, is it ethical - of course not if you want to look at the holistic care of a patient from an individuals point of view, very few nurses would actually want to get out on the picket lines and strike, but is it fair to have to work with crap conditions *damp, old, no security for abusive patients etc* or have to work an unsafe nurse/patient ratio? Hell no. Who is going to stand up for it? One nurse is often swept under a carpet, two nurses are bundled in a cupboard, but a whole group with the same concerns and issues, something has to then be done. Because act now, save and help patients and each other better. Would you rather a hospital that you have to sit for hours waiting to do a handover of care, which means a rig off the road which means more workload on your collegues? Or would you rather a hospital, that thanks to making the employers listen and take into account the issues, has enough staff to provide safe patient to RN ratios and also means you can deliver your patient, recomission your rig and then be back out there being paid to do what you do? Scotty RN

Kiwi is in the same city as me so dont worry he is safe and far from the disaster scene. There is no power to many parts of the area and phones. PM me and I will try my best to get through on our systems here.

Just wanted to send a message to you all thanks for your concern re the Christchurch Earthquake disaster. My family and myself are ok as we are in another part of the country but the effects are rippling through our nation as we speak. There is talk from the Emergency Department I work in that some of us may be deployed to the area or surrounding areas to help. We are ok, thank you for your messages of concern and will keep you posted. Scotty, Laura, Nicole and Oscar *the dog*

I didn't even think of hypothermia here with the Osborn wave. I picked up on the second degree av block and JER *junctional escape rhythm* but not the osborn wave. Thanks *zilla

That I wish was what some of my calls ran like when I was an EMD. Most of the kids I got calling were prank callers saying they were going to kill us. Seems the calmest though are either the kids or the very elderly, and the concern of what the paramedics will see them in too lol. Thanks for posting, has made my day. Scotty

http://www.emtcity.com/index.php/topic/14798-wearable-defib-vest/page__p__210598__hl__zoll__fromsearch__1#entry210598 This is the thread related to the Life vest we discussed on here when they first came out, and I am sorry, in my reply in that thread, I have some spelling errors. The brain was in mode that point lol. I had to do a double read of the OP's post just to break it down to see what it was that they were saying. I am sorry I do have to back Dwayne on this one, purely on the fact that as a profession, there is enough knocking at EMS being the backwards boomwop hospital truck riding hillbillies in the medical world. So in a public arena where information can be read and seen, just take that extra few minutes which will then turn into extra few seconds, to proof read and grammer check, as you will be using that in your courses for assignments, learn on here and in the class, apply and save in the real world. Take care Scotty

Other posters have beaten me to the online groups but here is the link for the MRX training package if anyone wants to use it also. The log on code it mentions is the following: meetMRX Hope this helps, it was fun to do this training package actually Scotty

Does your job accept online learning modules, there are some good ecg and cardio ones, I'll dig the links out unless someone beats me to it. Is there anything at your local hospital like a quick course that you could do or an inservice on new equipment? Are any of the defib manufacturers doing in service sessions in your area on new equipment etc? If you use the MRX, there is an online training module that is worth some continuing ed credit. I'll be back soon to post some links. Scotty

Thank you all so far for your replies, one of the other nurses and I in the department have been talking about having ride along time as a mutual agreement time between us and the ambulance service. We want to see more of the ambulance officers world and they see ours. And work it into our technical competencies to maintain ER nurse credentials. Mainly in the aspect that to understand things like MOI, further develop our IV skills *like majority of us can cannulate bloody well in the ER, but work on enhancing them out in the patients home*, acute coronary presentations in patients homes etc. It's also an aim to strengthen relationships between medics and RN's and move out of our comfort zones. I would love to achieve ECP status one day as an NP working on the rapid response units with the advanced paramedics and nurses and Medics working together to get patients stabilised and perhaps with the NP scope of practice, doing things in the homes to minimise ER admission and patients can be followed up by distric nurses etc. Look forward to more input, thank you all again Scotty

If the nurse has done the ACLS course, we are able to intubate if the need arose, I had a code I was doing and had the laryngascope in hand, blade in mouth, bout to place the tube *visualised the cords beautifully* and then bang some upstart intern puhsed me out the way and took over. Bastard. Added another 30-40 seconds without oxygen despite protesting and saying for me to at least bag the patient. There is some attitude still that nurses are only good for bedpans. Hey tnuiqs, I think that is very true Mainly the triage nurses Scotty

Hi guys, look I am really sorry about this if this is in the wrong area or if its been brought up in a forum before but as you guys and gals know I'm now an ER nurse and whilst doing some research...... ok I was bored on the weekend and watched season 2 of ER on dvd, I'm human, I have needs and on the show, Carol Hathaway had to do ride along time to maintain her ACLS certification and trauma nurse certification. Now I am actually curious do any of your services do this taking nurses with you on the truck for a few shifts and they have an agreement that with certain things the nurse can do some of the work, like at a code, they can cannulate or intubate or defib seeing as we do it in the ER anyway? I am wanting to know if anyone does this or if there are any programs set up with services for RN's to maintain ER creditintals to go on the road like say one block of shifts a year or something like that, I think it would give the ER nurses an insight more into what the patients present with, assist in getting the patient triaged more effectivly, be able to start the hospital documentation side faster as we know what has to happen on the other side, and do some things to shorten the wait time like draw bloods or something like that. Please leave the ER nurse vs paramedic crap out of this also, I am looking at just plain and simple.... do you guys take ER nurses out on a ride along basis with you to maintain their ACLS/ATLS etc credentials? Thanks look forward to some good replies Scotty

Go the physio control pages link on youtube and check out the lifepak 10 one, that is even more flash patch 80's lol

Hadn't actually thought of the jolt dislodging the tube with the BVM attached, its always drummed in that its a closed circut in an essence so O2 sparking isn't an issue. I assumed also that the tube would remain in situ once a thomas holder etc was applied. If non intubated I just put the bag and mask behind me and aim it away. then swing it back round post shock/shocks and then continue on

Hospital policy to cool on ROSC and transfer to ICU and its national ambulance policy in the procedures to cool post ROSC as well. I know people that cool during resuscitation period just to facilitate the decrease of neuronic damage. I look forward to more of the research from this Scotty

Put the mast suit on upside down?

Bearing in mind I am looking at this from a perspective of a foriegner with different procedures and policies in place, I think you did do the right thing. From reading your post, I think you didn't tech the call for the same reason I wouldn't of, because I would have been in the back, heart broken trying to think of anything to help make this guy change his mind, and if you had done that and posted it, there would have been people posting on here saying that you forced the patient into something that they didnt want or you co-erced them etc. Yes you are as responsible as the person driving or teching, but you have something that unfortunatly isnt there with alot of Paramedics and MD's and RN's I have worked with, compassion and a human heart. Yes we have to become a bit tough and "that is the life" perspective on some things, its like frequent fliers at work coming into the ER, as an RN I want to do everything I can to assist them and help them and nurture, but I know the decision is theirs and I can only know in my mind that they will come back again. I guess I am lucky to work in a country where you have an ability to speak out and I have had EMS staff say they aren't comfy taking this patient back and we work out things, but then, again, a different country, different population and different perspective in that not everyone is out to fire or sue your ass here. God Bless New Zealand Stick true to your guns, you have a heart, hope to see more of your posts and your growth on here Scotty

Not seen them used in the field here, however dropped them in at work. Not seen it routinely done for intubated patients either. We use charcol here and its not used that much, but still use it time to time. Had a run of three days where I was giving charcol and there are some nurses been there longer than me haven't yet given it. One was for an anti-depressant OD that we caught early enough, *like took the pills, called 111 and then had vomited most of them up so was within 30 mins* and so gave her a big ol cup of charcol to swig back and she did it like a trooper. I am going to ask about NG though in arrests, and also about OG's as haven't used or seen one of those. Scotty

Good early morning to you all, coming to you live at 1140 hrs, the sun is finally shining and its not too bitterly cold here..... but I digress I am curious and asking for help from anyone that writes course materials. Predominantly writing pre-course reading and also class work books. The content I have no issue with, its the following... 1) how do you start - whilst trying to convey the topics without sounding patronising? 2) How much is too much with information and words? 3) How do you lay out your materials? Do you have words and pictures or pictures after each topics etc? I am working on a project with my dad for his training company and am writing the pre course material, the powerpoints and class material and assessment/work books. But my brain has hit a brain fart stage in terms of how to format and write the books. I know what I want to say, but how do I do it or say it in a way to get students engaged in learning but not patronise them at the same time? Thank you for your advice and help Scotty

Had one patient that still makes me gag to this day nearly 5 years later, been unkempt for weeks, urinated on himself, body odour and then when taking across to the stretcher, defecated himself and also had pressure ulcers and what looked like Nacrotising Fascitis on the lower extremities. Liquid bowel motion coupled with decayed skin and all the other smells, in the back of a small ambulance, it made me reetch big time. Working as an RN, nothing can compare to that smell. I still remember my first major burns patient, but the adrenaline was going that fast that I didn't notice it at the time, it wasn't until they were transported it hit. Of course it was my own father so I think it all hit at once when the truck took off to the trauma centre. Nearly 10 years ago that happened, still smell it this time later.

*sits on the deck, looking out at the pool and sipping on a beer, looks to the sky and hears the northern hemisphere folks bickering and yelling* Oh thank god/allah/mother earth/the aliens.... that I live in New Zealand, no issues here Scotty

I am pleased that I read this all the way to the end before posting and admit I was surprised to think that Chris would be writing from an asshole point of view, as I know that is not Chris's personality. There are plenty of gung ho nurses and EMT's out there that will chop and hack clothes off for the sake of it. I hate to do it too, I had a patient in the hospital who'se clothes I had to cut off to get the ecg electrodes on post seizure. I wanted to cut up the seams on the side but the Docs yelled to cut up the middle, so did that. I've always been taught that treat everything as if it was your own and you didn't have insurance to replace it. One I've come across is medics cutting the gang patches on peoples vests. Whilst not advocating some of the activities the gang members get up to, I still will never cut through the patch unless it is necessary. Its not for fear of repercussion, but more for the fact, that for those individuals, that is their one thing that they have earnt in their life, whilst not being a great thing to earn in many people's eyes, it is still their own thing *granted that the gangs here in New Zealand arent to the same extent as the USA etc* I'll slip off the vest or cut the seams up the side if need be. There are alot of people out there with the shears that treat them like they are their own lightsabres and gods gift to EMS. If it is comprimising, remove it, and I emphasis remove it, but cutting isn't always the need to be way. Scotty

Who knows what will come of this, the one in the office looks like a posed photos maybe it was all part of a joke that backfired. Joys of pictures, always will bite you in the ass.

2wheelie, you have thoughts for you and your family from down under also. I can empathise with your husband with a family being seriously ill with a condition that could be unpredictable *brother is immunodeficient* but supproting in the achievement of a normal life. never loose faith in the reality your son will recover, and sins and debts are repaid in various ways. Keep strong to your heart and soul that there is light, you will get through as will your children and your hubby. only an e-mail away matey, don't be scared to send out a message when you need a loopy pick' ya upper ok Love and blessings be to you and your kin Scotty

They changed the term to Paramedic to give one title to all staff, remember the uniforms changed a few years ago, and yes the public didn't fully understand the different terms, but then education has changed and ambulance is no longer this behind the scenes little group that no one understands any more. It has come to the fore with introductions of shows like Rapid response and Emergency Hero's etc as shown on our tv networks. And in reference to fireys having skills skills, it is standard to be advanced first aid/EMR here in NZ. The resistance to them having the skills doesn't come from fireys, it is from other health sectors against fire having the skills/gear to deliver care. The term technician has come in to show we have a technical skill base and knowledge and move away from officer as it is still the regimented military standards. Same as nursing has moved from the "stripes" ranking and we are gauged on our level of practice with our portfolios of practice, like I am level 2 RN but working on Level 3 which would have been a couple of bars on epualettes. The public would understand that an intensive care paramedic would have more skills than an average paramedic, and perhaps its just Auckland, but you speak to alot of people, they know that an advanced paramedic/intensive care paramedic is that - a higher level of advanced life support than an average paramedic. If you read the basic scope of practice for ALS in the ACLS course guides - Manual Defib, Cannulation, LMA and meds are the basic skills to be certified at ACLS level - so does that not make ILS practitioners competent in ALS and then Intensive Care Paramedics, are further skilled in extra skills for Trauma as well as Cardiac Advanced Life support. Just putting it out there Scotty