rdenman26

Jumping gates or stopping on rail crossings goes waaaaaaaaaaaaayyyyy beyond stupid :shock:

I gave up watching EMS and medical show, as I just keep hurling abuse at the TV because they wee doing it wrong.

May be because we give the drugs under our licence as paramedics, with out referecne to an MD, there is a reluctance to add drugs to our list at times. This may be because the UK has been behind educationally in EMS the wider medical community does not trust us with extra drugs. However UK paramedics are now far better trained and educated than only a few years ago. There seems to be a resitance to accept further medical oversight in UK EMS, which aint nesseserily good for the patients. For example, my service was one of two in the UK that decided to require (untill recently) paramedics to refer to a senior clinican before using tenectoplase. Because we did this we were able to treat far more AMI patients than other services that were working to a restrictive protocol.

we can have other drugs and procedure introduced at a local level through various standing orders etc. For example the helicoper people have extra protocols for ketamine, midazolam, flumazanil, surgical airways, thoracostomies and the PASG.

But mostly we are get excuses such as,

Cost, safetly, education, cost, evidence of benifit, cost, and did I mention cost.

To take the above dysrythmia as an example. At the moment we are told if the patient is stable then its safer to be treated in hospital. To change that and bring ambulance practice in line with national guidlines would mean investment in research and education in the use of the other drugs. Changes in legislation or development of protocols to allow us to use other anti-dysrythmics. As for the unstable patient, who ought to be cardioverted! We start getting into conscious sedation.

Actualy come to think of it the air ambulance guys use consious sedation at the moment and most of them are no more qualified than us ground staff. But then there are plently of people that I would not trust with a band aid.

Things are improving here. Critical Care Practicioners are being developed and will improves (we hope) gaps like this.

Anyway Im going on to much now so I had better go, becasue Im not sure what I wrote made any sense.

Transport time can vary 5 mins to an hour. Of course planned transfers can be longer. We have paramedic thromolytic threapy in the vast majority of the UK, and I can fast track ACS patients to CCU. Some areas are taking patients to cath labs, but in my area we dont have enough cardiologists to set up a primary angioplasty servise at the moment.

Could not possibly say what we call them. But like every were system abuse is on the increase.

Traditionally in EMS we carry people right? A good friend of mine traveled to England three years ago and he actually was allowed to ride along with EMS in London. He said the most interesting thing he witnessed was the fact that medics in Europe rarely carry anyone from the residence. Even patients experiencing chest pain walk to the ambulance. He also said that back injuries are virtually unheard of in European EMS.

Whilst its true we dont carry people that dont need to carried. I sure as hell would not want the be walking a cardiac patient to the ambulance. That said the construction of a lot of building in the uk makes it difficult the get the equipment in to carry people even when we want to. We some times have to help walk people to where we can get a trolley or carry chair too. I was in carrying a sick patient from a 17th centuary farm house and one of the steps broke. My crew mate suggested this was because I eat to much pie.

Back injury is VERY common in UK EMS. Its costs the country millions each year. But that is why we dont carry people unless there is a clinical need. The down side to that is that when we do carry people we are out of practice.

We often get called to non injury falls just to lift people. Including from care and nursing homes. Apparently every one seems to have a no lifting policy. A couple of years ago we got a bit of kit call a manger elk. Its like the airbags used by rescue personnel, very useful.

Do you have stuff like that in the US and Canada?

Making driving blindfolded illegal doesn,t sound that bizarre to me. Does it mean its OK in the other US states.

Whilst I cant comment on you training, one thing that is common to ems around the world is that a lot of what you learn as you progress cant be taught in the class room.

I would advise you to recognise that the classroom only gives you the basics on which to develope your self an em EMS provider. Do that and your less likely to fall flat on yuor face. I have seen and awful lot of newbies (especially FRs) end up looking very silly because theu think they know it all.

Were you thinking of making a career in EMS, have you thought about the full paramedic training?

Did that make sense to anyone other than me.

There is evan an address on the front of out national clinical guidelines to write to for questions, challenges, suggestions etc. The medical director of the service encourages sensible questioning (rather than obvious moaning and winging) as a way of learnigng.

Dont take this the wrong easy people, but 120 hous does not seems a lot for front line EMS. Does this include, both driving and clinical stuff??

Just trying to understand your system a bit better.

[quote="fiznat

I've never actually done this before, called a doc with an ECG and asked for advice. I imagine it would be really hard to describe the ECG over the radio to the point where the doc's determination would be THAT much better than mine. What do you do, sit there and say "...the deflection of the QRS in V1 is negative. It is approximately .17s in duration. There is some minor slurring on the terminal aspect of the wave.... blah blah..."

Ihought you guys had telemetry if you needed to discuss an ECG, ETC. If I had an ECG i needed advise about I can fax it to the reciving hospital CCU for advise. I thought you guys had beed doing that for years.

We are restricted on what we can do for a patient like this. We cant cardiovert, and we can only use the amiodarone on the unstable patient. This is contry to national resus council guidlines. When I have to have such a patient under my care for 45 mins, it can get a little worrying.

Fifty bucks says he will rapidly re-think the process the very first time he is actually faced with that decision.

Indeed! Its amazing how quick a persons view of such things changes, when faced with a situation you might not walk away from if you screw up. I was just the same, at first. I suppose many people are!

Now have a got enough posts for another star yet. I envy the likes of Dustdevil with all those stars.

Too bad he wasn't in Floridia to save "Chubby" last week. We could have put his theory to the test!

Before any one points it out, I know I put the puntuation mark in the wrong place in my last post. I really must learn to concentrate more when I'm typing. :oops:

Hehe... yeah, anything I preface with, "Go big or go home!" is meant to be taken tongue-in-cheek.

Right, Ill try to remember that.

"]I would called the the first trace ventricular bigemany.

And you would be called in front of your medical director immediately after doing so. It is TRIgeminy. :wink:

Good point well, presented

Not if getting to the hospital two mins earlier means an intervention that prevents them from dying. However TV news seems to suggest that your traffic is worse than ours, so Im sure that would make a difference to how much time could be saved. When I worked in central london there was plenty of time whe no amount of noise and flashy lights were going to help, as there was no were for the other vehicles to move to. London is the only place I have been to where you can get stuck in a traffic jam at 3am.

What I mean is; armed Response Units (ARVs) normally carry their weapons locked away in the car, and not on the officer themselves. So the officers them selves are not acually armed. In the event of an armed incident, they are authorised by a senior officer to "arm up" or in an emergency may "self arm". Maybe its just local terminology.

There is a lot of paperwork for UK officers who deploy firearms, but then they have a lot of paperwork if they need a new role of toilet paper.

the movie you were refering to is HOT FUZZ, and it is indeed a top film. The real police are becoming mor heavely armed. For example due to the increase in body armour on the streets, the ARVs in the area I work in now went from carrying MP5s and Glock17s to Assault rifles, Glock17s, baton gun and the x26 taser. Our SWAT teams then have various other weapons.

Things seem to be taking a worring turn in this country. Police getting chased with samuri swords, poster about the dangers of meth labs appearing on station. People often think (in the UK) because I work in one of the most rural counties in england we dont get guns. But theyre are a hell of a lot of people with firearms, both legal and not. My station is a conveted part of the local police station, and we must be the only staton in the UK with an armery. Although for some reason the police wont let us in there.

we are told that amiodarone is incompatable with saline and should not be given if lidocaine has been given. Are you guys joking around or is this a difference in medical opinion and procedure between our countries. Maybe I should go to be, it is 23:10 over here.

I would called the the first trace ventricular bigemany. Second wide complex tachycardia.

O2 and IV access, regular monitoring of ECG, pulses BP etcetc. FAX ecg to recieving hospital and rapid transport. As the patient remains alert with peripheral pulses just monitor and reassure. Of course the fact that not all the QRS complexes have a pulse attached if significant. If the patient became, more unstable; reduced LOC, SOB, CP etc and rate is over 150, I can give amiodarone 150mg over 10 mins. UK resus council guidelines for unstable wide complec tachy are cardioversion and referal to expert advise. But at the moment UK paramedics cant do sync cardioversion.

I have seen this sort of dysrythmia converted by speed bumps (do you have those in the US?). Had one VT pt loose consciousness and pulse, gave pre cordial thump whilst mt crew mate was pulling out the defib pads. He came round pretty quick, did the same in hosp. They shocked him so quick he must have still been semi-conc judgeing by the scream and how much he jumped.

Still the point Im trying to make is these patients can become very ill very quickly so dont piss about.

Depends on the situation. If a parmedic intercepts a crew and can deal with the patinet them selves then the spare crew will drive to the hospital. Otherwise the car will be locked and left (with out leaving the drugs in it) and collected later. Luckely I have never had a car vandalised or stolen. But it has happended when the medics are in a patients house treating them.

Has their been any proper reasearch that indicates how hot running to hosp affects patient outcomes?

Last time I got hassle from a Doc, I just gave him the thousand yard stare and walked off. He wouldn't look me in the face for the rest of the day. The nurses later told me he new he has pissed me off.

Other lines I have used are; fair enough but you were not there

Id rather be called a fool by you than the coroner,

I appreciate your point -about not cutting umbilical cords- but Im not about to carry a mother down a flight of stone steps covered in sheet ice, whilst the baby is still attached.

Or when I alerted the hospital to an agitated head injury patient who had fallen down a flight of stairs, I was told by the nurse, well maybe you should take the collar and board off then! A simple "thats not an option right now" did the job.

Luckely we generally hve a pretty good relationship with the staff at my usual hospital. In fact after a particularly serious patient I often ask if there might be anything I can do better, and most of the time the Docs are happy to help and advise.

But we are health care professional and expect to be treated as such;

Iv'e hot my self all worked up now

Most ambulance personnell dont get resuce training here. There is familarisation with rescue procedure and equipment that may be used by the fire service so we can operate safely at and incident. We are starting to see the development of special operations response teams, who have training to deal with incidents such as HazMat. Also we are developing USAR teams with the fire service and even tactical medics with the police. But mostly rescue is handle by the fire service, cave and mountain rescue, the coast guard, Royal National Lifeboat institution and RAF SAR teams.

We used to have light resuce kit such as, prybar, saw boltcroppers and scredrivers but it was taken from us. Because of this I one had to call the fire service to free someone who had fallen and got stuck between there bath and toilet. They sent two pumpers and a heavy resuce truck, which is apparently the standard response to a persons trapped call. Funny thing was only two firefighters could fit in the bathroom, and only one of them at a time could use a small saw to cut the side panel of the bath away. When me and my crewmate wheeled the patient out to the ambulance there were firefighters every were.

Another time I had t call the fire service to force a door, luckely the patients friends managed to find a prybar.

So basic rescue kit and training is very useful but the use of specialised tools is, well, specialised. This sort of thing needs to be left to people who have extensive training in its use. Which aint the ambulance service. Of course I can only speak for the UK.

Got to be falls, CP and SOB, often ETOH features somewere inthe picture.

Over hear basic level ambulance personnel (the NHS one at least) can in addition to the usual BLS, bandageing spinting, O2 etc;

Laryngeal Mask Airway

Basic Ventilatiors

Automated and manual defib of adults and automated defib of paedicatric pts

12 lead ECG

Glucometry

Aspirin

GTN sublingual spray

IM Glucagon, Naloxone, Epi (for anaphylaxis)

Hypostop gel

Entonox (Nitrous Oxide/Oxygen)

Nebulised Salbutamol (albuterol??) and ipratropium