Arctickat

We've been doing Prehospital 12 leads for 8 years, we transmitted them for the first 3 years but after that the docs were comfortable with paramedic interpretation. About 2 years ago we started doing point of care blood tests like these to identify elevated cardiac markers in the prehospital setting and also forwarding those results to the hospital prior to our arrival.

Currently we are conducting a pilot study comparing the advantages of tenecteplase in the field to immediate transport to a cardiologist.

The specs on it look better than some so it might be able to do decent CPAP and ventilate post code on an unresponsive patient.

The thing with ventilators, if the patient is trying to breathe spontaneously and the machine isn't sensitive enough or doesn't have the capability to meet flow demands, few 911 ALS or even some CCTs have the ability to provide adequate sedation.

I've had good luck with it in all aspects of care, it has a -5cm/H2O demand valve trigger for the spontaneously breathing patient, a nice variety of settings for the ventilator. and as a test I set the CPAP to the highest setting and it uses about 700 litres/hour. I'd have preferred one with separate respiratory rate and tidal volume controls, but there was a cost vs benefit issue in there. I'd have also preferred something a little lower than the 60cm/H2O pressure limit, but it's also not adjustable. 50 would have been my choice.

You may have been introduced to CPAP.

Man, I wish I would have thought of that.

Here are a few I've seen in use with a couple of agencies or have heard being used.

Carevent ALS (near the bottom of the page)

http://www.otwo.com/prod_atv.htm

So can I consider that as an endorsement that the ALS is a good machine?

All it did was blow continuously. I even attached it to myself. I let it breath in for me, but I had to tear it off since I could not exhale

I'm not being facetious, I'm just wondering, was it a ventilator with CPAP capabilities? In my service we use the Carevent ALS+/CPAP http://www.otwo.com/prod_atv.htm

Since it is all I've ever used I'd be interested in getting input from others who have an informed opinion.....Vent?

It says in the heading that "We lost one of our own" but the story mentions nothing about a fatality.

ETCO2 is available in many areas but not all. If one was to look at its use throughout the entire U.S. you might be surprised at the numbers that do not utilze it. Just because the LP12 is capable of ETCO2 that is no guarantee it will be used or that the Paramedics will be trained on it. The same can be said for 12-Lead EKGs. I am still rather surprised at the number of departments even in the larger cities (mostly West Coast) that have no intention of using 12-lead EKGs.

That's what I am trying to express though. If etCO2 were mandatory on all intubated patients it would go a long way to confirming and more importantly, monitoring tube placement. I suspect that many cases of those esophageal intubations are actually properly placed tubes which became dislodged following movement.

IMHO the intubation skill is not something that is broken beyond repair. Until something better comes along, endotracheal intubation is still the definitive airway treatment. Perhaps rather than consider abandoning it altogether one should consider adding more opportunities for confirmation of proper placement, etc. For example, all of our LP12s include capnography. It is placed on every one of our intubated patients to continuously monitor respiratory status. As with a suddenly abnormal ECG, first thing you do is check the leads, if a suddenly abnormal etCO2 develops, we check the tube placement.

Additional practice on mannequins may not be ideal and access to operating theaters to conduct intubations on real people may be unrealistic in some instances, but I haven't seen anyone yet suggest cadaver training as an option. Many years ago I even had one doctor approach the family immediately following a code to inform them of his death and request permission from them to allow us to practice intubations on their loved one. I was surprised when they didn't rip off his head, but rather, allowed us to each take turns dropping a couple of tubes. Many people dedicate their bodies to science or education, these are who should be sought out.

In short, practice makes perfect. Higher success rates are a result of experience and tools are available to maintain confidence following tube placement. Use of these tools and opportunities for practice should be considered.

I know, I'm resurrecting a semi-dead thread, but that's what we do, right?

Just wondering, has anyone seen or used the Res-Q-Scope? I'm considering adding this to my airway kits and some experienced input would be nice.

I've put them into my transfer units, the 911 response units still have the old MX-Pro because they are 80 pounds lighter to go up and down stairs with. Given time my staff may decide the convenience is worth the added weight. Recently Saskatchewan EMS services got a grant for "recruitment and retention" Applications could go as high as $70,000.00 Most services applied for and received a grant for the power cots. One health region bought 28 of them.

I would take a little more credence in anonymous attacks.

Okay, I really don't know if people are not bothering to read my entire post or being deliberately obtuse and antagonistic. I thought it was pretty clear. I don't give credence to anonymous complaints in that I will not accept them as true and discipline an employee based on them alone. I thought that was pretty clear in my second paragraph. I look into them, I'll review the applicable video if it exists. (my units have patient and dash cams) I ask about them, and if the employee fesses up, then I act on it. But I will not ever put a black mark on an employee`s record simply because some ex girlfriend is trying to start some trouble to make his life difficult.

Where is the attack in that? I see what I stated to be no worse that Herbie's comment. Regardless, I've given all the advice I can to this thread. Nothing left to add. I'll be sure not to defend myself to further attacks to avoid sullying your thread.

I thought you said that you don't give anonymous complaints any credence?

I'm sorry that you are unable to understand a post which includes a qualifier. I will try to dumb it down for you in the future.

If you like Wii Fit, you should get EA Interactive for Wii. It's more adult exercise, yet still interesting and fun.

oooo, thanks, I've been watching for more Wii Fit compatible games and could only find the Jillian Michaels one, and it's only compatible with the board and not the software which keeps track of time and such. Does EA sports intergrate with the Wii fit software?

Anonymous complaints are worthless. As a high level manager I see them often, and I will not give them credence. If the complainant is too much of a coward to take responsibility for his accusations then I will not do anything to followup on the incident. I've even told this to people who have phoned me up to complain. The very first question I ask is their name. If they do not provide it I tell them that they are unlikely to see any satisfaction from their complaint because anyone can make false anonymous accusations without fear of repercussion. If they are willing to give their name so I am able to follow up with them, it's a different story and I take it very seriously.

Either way, I do follow up on all complaints. If anonymous I tell the target of the complaint about it and ask if there is anything to it. Sometimes they admit that something may have happened, other times they deny it. I do not put anonymous complaints on the record. The only time I might ever consider an anonymous complaint to be valid is when I get inundated with them regarding the same incident.

So, in your case, if you're going to make an anonymous complaint, make several. Make them via different media as well, phone call, letters, etc. That might get some attention.

Shrug, I just do the Wii fit workouts. I complete the entire Yoga and the entire strength training in about 90 minutes. Once in a while I'll do the aerobic workout too.

Call me a geek, but I have been getting more toned and lost weight. I think it's because I can't eat junk food while i work out for 90 minutes a day.

I think we can find PA/NP types that want to work rural systems, and who are interested in pre-hospital as well as clinic settings; the trick is setting up programs specifically to recruit those individuals and adequately prepare them for those roles. I think the interest is there, we just don't have the structure set up yet to bring both sides together.

Wendy

CO EMT-B

Unfortunately, there are a couple of flaws here. First, some jurisdictions, like mine, do not have PAs. A simple change in the law could enable that, but the College of Physicians and Surgeons have to make the amendment, not the government. Secondly, we have paramedics filling vacant NP positions in the clinical setting. Where are we going to get NPs to work the EMS field when they can't even staff their own?

The Saskatchewan model dictates that an individual should be no more than 30 minutes from a ground ambulance base, thus multiple EMS services in a 30 mile radius from one another would be too many. Rather than have a multitude of volunteer services, only one is provided with government funding. A program which started over 40 years ago and has worked quite well to regulate the quality of practitioner, EMS services, and eliminate competition. Since half the population of the province lives in a rural setting in communities under 5000 people, this seems to be a pretty good model for providing EMS services, considering the longevity.

The fact that we are already working in the clinical setting shows a strong progression towards a Clinical Care paramedic or Paramedic Practitioner. The classic paramedic of the past has to adapt and evolve to the needs of today's health care. There is no reason a Paramedic couldn't be doing primary home care rather than a poorly trained aide who can hardly recognise a medical emergency. With patents being sent home from hospitals to recuperate there it's not a far stretch for the medics to make daily rounds within their zones to change dressings, conduct followup care, or do simple welfare checks. It's just not glamorous enough for those in EMS because they can't use their lights and sirens. A progressive EMS manager will make changes like these, the rest will be lost to attrition.

I just returned from a vacation to BC. During my travels I saw one sign with the slogan, "Save Our Paramedics". When I got home last night I flipped on the BC - Hamilton CFL game. Imagine how stunned I was to see a BCAS unit in the background serving standby at the game. In my experience this is a volunteer posting and also that the CFL can not conduct a game without EMS standby.

If the medics of BCAS want to be noticed, perhaps not showing up to a game would put a national spotlight on their situation. Not to mention probably piss of a few thousand fans.

One of my medics was just e-mailed from Red Deer. They are looking for 50 paramedics.

Truly unfortunate, Prayers to the family and to the EMS crew. There are gonna be many questions for this investigation, such as

• Was there an audible reverse warning device?
  
• Was there a rear view camera on the ambulance?
  
• How fast was the ambulance backing up?
  
• How quickly did the woman move behind the ambulance?
  
• Who was guiding the ambulance as it was backing up?
  

Okay cool, cool, so with 5 mg of midazolam on board I would follow with benadryl or some other form of a anti-nausea specific med like zoran,

Forgive my ignorance please. Is Benadryl a commonly used anti-emetic? I had no idea an anti-histimine would function as such. How much would you give in this case, taking into account the additive effects Benadryl has on alcohol and benzodiazapines?

Shrug, in a few short years we'll have something new to worry about because influenza will be gone.

"...Because these antibodies kill a range of influenza A viruses — 10 of 16 influenza A subtypes ..."

"...The authors believe corresponding antibodies can be found to neutralize the six other known influenza A virus subtypes and the influenza B viruses."

http://www.cbc.ca/health/story/2009/02/23/...antibodies.html

Perhaps the attached file will be of benefit. Regardless, don't panic. even the CDC admits the reaction to the H1N1virus outbreak was over the top. If you did get it and don't have any other complications you'll likely be fine. Simple use of coughing etiquette and washing will significantly limit transmission.

Yup. replace the circuit breaker first, then go for the relay. If it continues check with an automotive wiring technician who would be able to determine what amp load the wiring can take without burning up, then increase the circuit breaker amperage.

Silly question....isn't this vehicle still under warranty?

What are its limitations?

You'd think they'd be using that more in ERs where they need lab tests quick.

The ones I'm using give qualitative results rather than quantitative. It looks similar to a home pregnancy test. Two lines means elevated cTnI, one line means not. The cutoff values range from 1.0 to 1.5 mcg/ml. Even works on capillary blood samples. We've used about 100 over the past couple of years and they have never been wrong yet. The docs love knowing if trops are elevated now even before the patient is in the ED.

But really cool tool for future. Blood work is what holds a lot of patients up in ER. If we have this during transport, I'd speed things along for everyone.

We already have this available to us though. Have you checked the TnT Diagnostics website?