celticcare

That's great to hear... I haven't heard from two friend who are in Christchurch currently but I am hoping that it is due to the internet being down right now. My parents were supposed to fly from Syndey to CC today but their travel plans have been postponed.

Really happy that you guys are all safe...any word from Kiwi??

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*

2nd degree type 2 AVB with junctional escape beats. Look at the pattern of QRS complexes. Some are closer together, and some farther apart (escape beats). You've got some nonconducted P waves, but the PR interval is regular on the P waves that are conducted.

The QRS itself is not particularly wide as you would see in a LBBB. It's narrow right up until the notched terminal portion of the QRS. This would be typical for early repolarization. With as slow as it is, this may be an early osborn wave of hypothermia. Although, all the osborn waves I've seen were wider than this, so I'm betting on early repol, which was probably preexisting to this presentation.

'zilla

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

Around here, I'm not especially convinced that the nurses have much of any idea of who we are or what we can do, and as far as I know I've never heard of any nurse doing a ride along with EMS (or having any desire to). Also, around here nurses don't intubate or place central lines.

On a side note, I love ER!

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

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

OK lets split hairs, two levels with the word "Paramedic" in them then.

Weren't you the one who told me WFA changed there patches to brand everybody a "Paramedic" because the public didn't get the whole Proficiency / IV-Cardiac / Paramedic thing? You're contradicting yourself.

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

Maybe they bought a stethoscope for two bit from the Johnny n' Roy store eh?

I have to agree with the frozen turnip, fund more ambulances and don't get the fireys to plug the gaps, I don't see a problem with firefighters having some base knowledge say EMR or First Responder to be able to render immediate aid at a scene before the ambo's roll up but that should be it.

The term "Ambulance Officer" is pretty common here too, it's widely known but I think the public are confused by the whole "Ambulance Officer" / "Paramedic" / "Advanced Paramedic" thing, we also have people with patches that say "IV/Cardiac", "Intensive Care Paramedic" and "Primary Care" but as I understand those are going away.

Personally I feel quite viscerally that the term "Paramedic" for the BLS level (if we are being purist and talking no manual cardiac interventions, IV fluid or parenteral medications) is inappropriate. As to what to call this level, eh, you tell me because its going to become "Ambulance Technician" and then we'll have two "Paramedic" levels. Was this deliberate on-part of the services to distinctly separate the two because the Paramedics levels are in-line for an expanded scope of practice so as to avoid public confusion, could be, wouldn't surprise me in fact but I'm not sure. Personally I hate the term "Ambulance Technician" but you'll be hard pressed to find an alternative from me!

Rightyo, BEN, there is a public education plan over the next few years as Technician is introduced to explain the new levels and its talked about during first aid courses. There will be ONE paramedic level and an intensive care paramedic level. The majority of public are aware that someone who works in the ambulance are often called paramedics and don't know the skills. When I was with WFA, there wasn't issue from the public as they saw they were getting an ambulance and people aren't stupid, majoriy of people know that there are different levels for everything. Please get your facts right before making comment about New Zealand EMS unless you work in the service.

Scotty

12 lead acquisition is currently a Intermediate Care skill and interpretation is ALS here. I agree with Doc on the elements of GTN and inferior infarcts. Do I really want to bum my patients pressure out and cause more issues because I didn't do a 12 lead and interpret it? Anyone can pick up the basics of ECG and look and see a big wave that shouldn't be there, but the basis of interpretation does have to include knowledge specific to cardiac anatomy.

Ben, please bear in mind that the process of BLS is not PHEC any more, it is acquisition of the National Diploma of Ambulance to practice at technician level. All new entry staff will be doing this process, which DOES include anatomy and physiology modules. And they are on a par to what I learnt during my Bachelors of Nursing.

Please refrain from comments such as you wouldn't trust BLS with meds or a BVM, as that is an insult to those who have actually achieved the qualification or the skill level.

And now back to topic....

More and more paramedic students *including degree and roadstaff upskilling* are required to spend time in Cath lab, CCU, ED and those areas to recognise STEMI's, interventions and bypass therapy options. The education is getting there and will increase, perhaps we are on a lucky level because we are a smaller population we can implement these strategies alot easier.

Scotty

RN /ACLS L6/ EMT / EMD

Hi, New Zealand RN here, also EMT and EMD. *I am using the terms EMT purely for the fact of that its an American forum*. I like the original poster, have desire for Paramedic *our Intensive care scope* career and future. However, I am going to say get RN first, with the base of being an RN and working in the field as a nurse, it will set you up alot clearer for being a medic.

I disagree with the comments that Nurses have limited scope, remember we do have clinical nurse specialists and nurse practioners, who like EMS staff, were once Basics, then intermediates and then medics.

We are bringing in cross converstion and post grad registration/qaulifications for RN's to become medics. Honestly become an RN first, get your degree and a new grad year under your belt then look at becoming a paramedic. You will have an established course that frankly here in NZ we don't have for medics. And will always have a qualification you can travel on, Paramedics at this stage you are limited, RN you can have the world as your oyster.

ED nursing isn't easy to get into though and you will have to work your way into it, which is better trust me.

Send me an E-mail if you want any more information, I started my training at the same institutes as you

Scotty

RN/ACLS (L6)/EMD/EMT