defib_wizard

dwayne why are you so insistent on this? I am missing something here. I have sat in the medical directors office before for doing a skill that is in my scope of practice in a situation that is bizarre. The pt did have a good outcome from it and 2 weeks later the MD was in the same situation. I was the one that notified the director of the situation and requested input. What sort of situations are you talking about that you would consider going out of your scope.

Heres how I do it. If by triage this pt is unsalvageable ( I only have 2 ambulances available) she will be left until any immediates are transported.However final confirmation will be done before I leave. Even if I have to have a basic emt hook up the leads while I am attending to a viable pt. If she was breathing then she is not deceased! If neccesary to leave to transport the other patients. This pt will be left with a flight crew or if not available I will patch to medical control to let the bls crew take the least critical. While I remain on scene with this pt. This is rural ems's solution to a difficult problem ( multiple immediate pts and 1 medic ). That this occurred in a urban system with multiple als providers is an outrage. Now for the rant- If you are becoming a paramedic to increase your chances to get hired on a fire dept then I have NO respect for you! Between all of the daily fire duties other firefighting requirements, your medical skills will suffer. Do the career paramedics a favor go to your taxpayers and request to go back to bls engines and bls rescue trucks. The ce requirements are less so that reduces your operating costs that should also keep you out of court on calls like this. Also a cheaper alternative to the multi-million dollar lawsuit that this will cost. Maybe someone needs to remember the old cliche " A jack of all trades is a master of none!" I may not know the entire story but here is a simple formula- 3 pts, 2 were transported. 4 paramedics in trouble- somebody didn't assess a pt ( damn she looks dead is not an assessment ) To the person who said we shouldn't judge these paramedics. That is what the definition of the standard of care is- What similarly trained individuals would do in the same circumstances. I will tell you I WOULD CHECK FOR A PULSE ! And get an ecg to prove the pt is dead. That is how negligence is decided, they deviated from the standard of care therefore the taxpayers get to write a check. I know if I lose my certification I'm unemployed That these people were put on a different engine is BS they should be sent down the road kicking rocks and collecting cans for rent!

no a stair chair is not required equipment where I work. We have one so if it is needed it can be brought to the scene. But that delays transport.

we run out of type 2's. It can get a little cramped with 2 patients on backboards but the only thing I wish we could carry is a stair chair. Other than that we have a lot of equipment on them.

I have believed for a long time that there should be a different name for fire medics and career paramedics. No dustdevil, monkey medic is not an option! ( It would cost too much to print that on their shirts )

You know you just can't fix stupid!

From the mouths of babes!

I'm curious what meds were pulled. Does anyone know?

While I respect the opinions of Dr. Bledsoe in this case I will have to disagree with him on some of its points. I remember a comment by another Dr. years ago that stated the public is just as well off to get a ride to the hospital in a cab than in an ambulance. That comment was ignorant and so are some of the comments in the article. Evidence based medicine is a good thing but it is difficult to get this evidence. You have to consider how the evidence is gathered, along with the results long term and short term. Remember when we gave bicarb to all codes then thought we must be doing good, look at the pts blood gasses. Nevermind that inside the cells we just increased the acidosis. Emts with defibrillators can and do save lives. The majority of our calls can be " handled " with a bls provider. Its the ALS patients that need a paramedic and there is no way of knowing what type of patient it is without an assessment. What can you do besides drive really fast with a patient in complete heart block and a pulse of 20! I can treat it and go to the hospital in a safe manner. The unstable patient in SVT at 220 needs cardioverted, an AED isn't going to work because the patient is still alive. So I disagree with an EMT I with defibrillator impacts patient outcomes as well as a paramedic. Intubation on trauma patients; if you are unable to protect your airway due to trauma your prognosis is already poor. Does intubation increase your mortality. That would depend on multiple factors. Medicine is a risk verses benefit art treated like a science. How do you do this study? Every trauma patient is different, do you not intubate certain pts. How do you obtain consent to be included in the study if the pt has a GCS of 8 or less. If your patients becomes hypoxic due to multiple ETI attempts the you are doing more harm. The system I work in gives you 3 tries then an alternate airway management is to be used. The trauma patient needs 2 things - blood and surgery & they are at the hospital. but if the patient has no airway then the patient is dead. Aspiration is also deadly. By me being able to secure a patients airway that patient can go into surgery much faster. But if my ET tube helps prevent aspiration then that can improve the patients outcome. I am not talking about RSI. In my area the closest trauma center is approx. 60 miles away air transport to that facility can and does make a difference in patient outcomes. The community hospital has a 5 bed ER an 1 DR. with 1-2 nurses to staff it. We fly a lot of patients to higher care. Ok I hit it back across the net. I'll get ready for the incoming comments.

I can not for some reason think of a situation that would make me want to exceed my scope of practice. The idea of what if it was someone in my own family doesn't wash with me. Because if I am helping them I am not a medic I am a family member. And what I do (within reason ) is covered under the good samaritan law. Besides if I'm on duty I have my als equipment and pretty liberal treatment guidelines. If not I have no equipment and we are back to the good samaritan law again.

real simple: because we have to. Why do you try to save the drunk that just wiped out a family? Because you took the job thats why. We are not to judge what is right or wrong. However-We have the right to vent about the things we see to coworkers and now to0 colleagues in this forum. This event if true is a tragedy not for the mother but for her children.

:shock: 4600+ calls in 2005 probably that many or more last year and not one time did they use an als medication! Fire depts like to state that they can deliver faster care than ambulance medics. What do they do? wait for the ambulance to show up to do this. I'm sorry dustdevil that they are now doing the refresher. If the news article is telling the truth they are lucky thats all the md did. In my opinion they should have their certifications revoked. Not giving a medication when it is indicated is almost as bad as giving the wrong one. I know what would happen if my wife was having a low blood sugar or an MI and the ALS engine showed up and didn't give her D50,or ntg, aspirin and morphine. I guarantee the result would involve lawyers. Just my 2 cents!

hardcore wrote well I, like a few others on here that have clothes older than you; Would like to remind you all. Old age and treachery will always overcome youth and skill! We who worked in the past have paved the way for all of you noobs. examples: 1 man power gurneys! ha how many remember the old three position fernos that we had to lower to load? disposable suction! remember having to change liners? yeah they worked NOT! blanket rolls instead of disposable headblocks. remember having to roll them for you shifts cleaning with bleach water then having to touch up the polka dots on your pants with a sharpie. Firedoc im a few years behind ya in ems but i did my first drowning as a boy scout 30 years ago. Congrats and thanks for being there when the tones go off.

I Know a few rrts and lots of rns that do scene calls. Most are flight crews and are very competent. It is interesting how many turns this thread has taken.

I think they should have to take a refresher course plus retake the exam, and do mandatory clinical time in the ed. These are als providers who have been working out of those drug boxes. When I precept a student the rules are if you want to give a medication; you had better know it or you don't get to give it. The medical director has the same right as we do except these are not students.

Can't we all just get along?

Then there's the question of how much education the basic light bulb changer should have. Or should there be only advanced light bulb changers with a 4 year degree?

Ok time to add a little fuel to the fire: :twisted: To the people that support doing away with emt certs: 1. What do you do with the already certified emts? Are they now unemployed? If not then what do you do with them? 2. If they are required to upgrade to paramedic can they work while going to school. The cost of this would be paid for by whom? If the emts can't work they will have no money for school. Will there be enough schools to handle this influx of students, or will we be creating medic mills? That just teach what you need to pass national registry. To the people that support keeping emt certification: Should the education requirements be increased to teach advanced assessment skills. Just some food for thought, we can complain all day long but unless we come up with answers to our questions. We sound like a bunch of whinebags on ritalin.

Why would you worry about a person faking if you treat what your assessment shows? This is very simple, you can give painful stimulis to determine a response. Some of the stimulis is a treatment; i,e- The patient takes an opa or doesn't gag when suctioned; it's intubation time! If you want to give noxious stimuli in a pts nose put an npa in. If they accept it your helping support their airway. I've never seen 2 cc of alcohol IN . But I have seen laryngospasm from ammonia ampules. :shock: You perform an assessment, administer treatment, Then reassess and document the response. Rule number 1 of all forms of medicine- First do no harm! plus if you determine they are faking unresponsiveness your pt won't be annoy you on the way to the hospital.

But you get to kick in doors, shoot guns and blow stuff up.

Ok I will tell on myself. I have on occasion been driving off duty and caught myself checking an intersection to go through a red light. My last career was a propane truck driver. One day in the family car i went to cross some railroad tracks and pulled over first as required by law at work. My wife made me ride the rest of the day while she drove. This is not an excuse for the whacker "ambulance driver". As my problem was I had my head seriously lodged in a small orifice. :oops: :oops:

:shock: :shock: HA! I like it thats better than- Help wanted: If you've got a pulse and a patch, you've got a position .

Who decides ALS vs BLS? I am sincerely asking. Explain your system so I can understand its "differences". We run (if possible ) 2 full time paramedic / emt crews. they trade calls and back each other up. If only one crew is acls and the other is dual bls then the medic unit is first response on all 911 calls, bls takes non-emergent transports ( if bls level ) and 2nd out 911 calls. if the bls crew is responding to a critical call they have some choices. If the medic unit is able to respond ( drop their pt and go they will do an intercept. If not a helicopter can be called or they can load and go to the hospital ( the ever popular diesel bolus ). Sometime we only can staff two bls crews, they take turns and back each other up. Not the best system but you do the best you can with what you have. We are also private and paid.