crotchitymedic1986

I do not practice in canada -- my part-time job i took in sales 10 years ago ended up paying more than my fulltime medic job --- i got transferred to the canada office -- havent been on a bus in 6-7 months.

ERDoc, i respectfully disagree about having a white count in atleast one specific area -- pediatrics. Medics and EMTs are sometimes to quick to diagnose fever as something minimal (ear infection / teething) with no data to back up that theory (we cant even look in their ears to see if they are red). I have a friend who worked in the local pediatric hospital ER, and he claimed that they easily did LPs on about 10-15 kids per week. Although the majority were negative, the test was indicated by the high white count, usually found at the doctors office or other ER, after an EMS crew told the parents to give tylenol q4 and follow up with their pediatrician. He claimed that the vast majority that tested positive for menengitis did not have a petechia rash or stiff neck (he claims that is usually a late sign, you also have to figure in the fact that small children are scared and reluctant to admit symptoms if they are old enough to understand). It might also be useful with some nursing home patients to determine a diagnosis. Will it change field care, probably not, but it might mean someone gets transported that wouldnt have before --- damn, did i just make the point for keeping 12-lead ? hate it when that happens.

It doesnt do it any faster, but it does it in the field --- so again, much like an initial H&H after trauma, the receiving facility would have an initial level to compare to. Those that are already elevated, but have asymptomatic pain, might be discovered and not left at home or told to follow up with private MD. It does most of the basic lab levels (chem panel, CBC, Enzymes, etc..), the last time i used one, which was 8-10 years ago, it didnt do drug levels or a CMP (if that is the right letters for the CHF test).

Unless the ambulance is left running, or you use some type of space heater, the drugs will be 30-40 degrees. Thats why i said, use a meat thermometer on a few random days and you will shocked. When i looked at this, we were specificially looking at IV fluids, and even though our trucks were housed in heated bays, the IV temps were still in the 60-70 degree range. Now you take your person struck by auto thats been laying on cold pavement for 10-15 minutes, in 30 degree weather, then pump 60 degree fluid in the patient.

I would argue that if you need a pulse ox to treat respiratory distress, you should go back to school. But I was trained before there was such a thing, so i am biased. And you have a good eye -- i am a yankee american in canada.

Most drugs are supposed to be kept at a temperature range of 65-80 degrees, which is problematic for EMS in hot or cold climates. It is also another reason that many trauma patients arrive at trauma centers in a hypothermic state --- you cut all their clothes off, cover them with a thin sheet --- then pump in 1000 cc of 50-70 degree normal saline into a 98.6 degree body. The problem is that the drug breaks down in temperature extremes, so it may not work as well when you need it too. The problem is that most of the heater/coolers that we have tried to use either break down alot, or werent designed for medications (usually food/drink designed). If you take your average meat thermometer to your drug box in summer and winter (even those who house vehicles indoor), you will be shocked at the readings you get.

OK, after reading another post, i have to change my answer. having an ISTAT machine (for those that do not know, it is a handheld lab machine that is accurate but expensive) on my truck so that i can get troponin levels, H&H, or a white count. That would definitely change the quality of care provided in the field.

That is the day i am dreaming of -- ISTATs that are cheap enough to be put on ambulances -- think about troponin levels, knowing an intial H&H right after a traumatic event, being able to get a white count to determine if an illness is viral or bacterial. That will be a happy day in EMS.

I feel your pain -- and although changing training standards seems reasonable, i doubt it will have the outcome you desire (not all nurses are certified emergency nurses). Here is what we did instead: we met with the ER that we go to the most and talked with them about trying to purchase the same monitor (either us transition to theirs, or they transition to ours), but that didnt work, as the monitor they preferred didnt work well in the field. JCAHO had recommended that hospitals who had different styles of monitors make sure that they moved to a single type of monitor for the whole hospital (employees would only need to be trained on one monitor -- not a different monitor for every floor, crash cart and unit). Our hospital had already spent alot of money on that improvement, and werent interested in switching to another brand after that expenditure. So what they did do, is go in with us to (half/half) to purchase another spare monitor for us. That way when we arrived at any hospital, the monitor could remain on the patient as long as necessary. A supervisor would bring us another monitor, and wait the 30-40 minutes it usually took to safely transition the patient to the hospital's monitor. After the purchase, we attended a monthly ER staff meeting, and had a training session (which all ER nurses took and signed off on the training) with the staff. The bad news is that with turnover, you have to go back ever so often to review with the new staff. But ER managers generally are receptive to it, because it is training that looks good to JCAHO.

I always think more education is a good thing, but let me play devil's advocate for a moment. In my area, the hours (class room) needed to gain paramedic certification was significantly increased a few years ago. The result was, emts who might have went for medic decided to go for nursing instead (more money, better benefits). The medic shortage got worse in the rural areas, so EMT B was allowed to occur (previously we only allowed EMT I). So the end result of longer educational requirements was "less" educated personnel in the field. If this were implemented nation-wide, why do you believe the result would be different ?

I agree with taking another look at "who gets flown". I can remember when there was only one helicopter in my city, now there are 8-10. A good many of the trauma patients are not salvageable and are only being flown because no local hospital will accept them. Much like it doesnt make sense to start CPR on a 98 year old with contractures, I think we need to ask is it worth the lives of helicopter crews to transport brain injury patients that have no hope of recovery, burn pts with greater than 75% BSA, or patients that dont have a scratch on their body (or minimal injury) but have "mechanism". This is assumming that a trauma/burn center can be reached by ground within the golden hour. But remember, on the vast majority of helicopter calls --- you have a 10minute ems response time, the chopper is called and has 10-20 minute response time, then they have to assess and package the patient so they spend 10-15 minutes on scene, and then they have the flight time to the hospital, which pretty much eats up your golden hour anyway.

i know reaper, but its still a box on the back of a pickup chassis --- I am talking about something new from the ground up. Like UPS has their own truck. My idea of an ambulance may not look anything like what we have on the road now, maybe it would be the same, just safer --- maybe it would be on a special toyota/lexus chassis to give us better reliability.

I am new, so forgive me if this is a stupid question, that isnt worthy of the room, but i see quite a bit of experience and ems genious in the membership of this forum. So if I were the magic genie in the bottle that you rubbed, and i granted YOU ONE WISH, and only one wish that you could only use to change ONE THING in the EMS Industry, what would you change ? Think hard, you only get one wish ? Personally, I would like to see an ambulance that was built from scratch, from the ground up, designed by and for medics in the field, with all aspects of ergonomics and safety considered. Instead of whatever is the cheapest way to throw a box on the back of a pick-up chassis.

I am new here, so forgive me if i ask a dumb question; but wasnt the original posters question about getting a refusal on an intoxicated patient ? If a person made out a new will and testament while intoxicated, i am pretty sure it would be thrown out of court (I recall the phrase I ____________ being of sound mind and body). So if the signature of that document was not legal, couldnt the same arguement be made for a medical refusal of care ? I dont know of an EMS system in my area that hasnt at one time or another had their horror call, where the drunk was left behind, and something bad happened. I agree that i hate policies, procedures and protocols that are written for the "one" bad call that occurred 10 years ago, by the rookie or idiot, are a bad thing --- but lets face it, medics are human, and do make mistakes. As one respondent put it, you should ask what is best for this patient ? If you always do that, you will be able to defend yourself in court.

Reaper, your system is obviously more advanced than mine --- how does the location of the MI change your "field" treatment ?

OP was abit antagonistic, but I think this is a valid question. Let me put my spin on it. Reasons for removal: 1. If you have a symptomatic 50 year old male, with a normal 12-lead, you still treat the symptoms. So a negative 12 lead does not stop or start the care that was provided prior to the introduction of 12 leads. 2. It was thought that field 12 leads would quicken the treatment in the ER. Most credible ERs have their own door to needle time parameters, that occur regardless of what a prehospital 12 lead shows, and regardless of whether or not the patient comes in by ambulance. Even in the presence of a positive EMS 12 Lead, the ER will still do their own 12 lead prior to beginning treatment. You could make the arguement that a positive EMS 12 lead may make the ER staff move a bit faster, but how many minutes are actually saved ? At the ERs I usually transport to, they must complete a 12 lead within 5-10 minutes of the patients arrival. My heads-up, may mean that the 12 lead machine is in the patient's room and not in the hall. I realize your anectdotal experience may be different. 3. The technology is expensive, and with what i perceive to be little return, I ask if those thousands of dollars would be better spent on capnography, CPAP, salaries, or benefits ? 4. I dont want to speak for everyone, but i dont know that i can claim a 12lead has saved the life of any of my patients, whereas, i know that CPAP has. My arguements for keeping the technology: 1. It does help you identify the asymptomatic (i just feel weak or sick, or i have right arm pain) patient or the unusual symptomatic patient (26 year old with chest pain -- or female in her 30s), that you might have missed. But this is a small percentage of cardiac patients. 2. If you live in a rural area, based on a positive 12 lead, you may decide to transport the patient to the more distant hospital that performs CABG, versus the local hospital that can only do thrombos. Then again, if you live in a rural area, you may not have the EMS resources to have your ALS ambulance out of county for 2-3 hours. What are your thoughts ?