Arctickat

Prove me wrong. How many c-sections did you closely observe in paramedic school? Was there a gross anatomy lab in your paramedic school?

Seven, and I did the incision on the last one, yes we did have a GA lab as well as 5 visits to the pathology lab for hands on with the pathologist

Clearly you don't understand that rising through the ranks of management IS a popularity contest, first and foremost, experience and skills are second. Upper management needs to consider one thing when looking to promote an individual. Will people respect his leadership. Clearly your upper management doesn't feel that your coworkers respect you enough to lead them and it's pretty obvious why. You are moaning and groaning about losing the promotion to someone you alone thinks doesn't deserve it rather than looking in the mirror in an effort to determine how you can improve for next time your chance comes along.

Suck it up princess, chalk it up to a life lesson and move on. Pouting about it will just amplify your lack of leadership ability and leave you stuck in the rut you are moaning about.

Another question, are you really Paul, or are you just someone trying to get him into trouble, I can't imagine anyone actually using his real name and location on here to whine about his employer. Unless of course he's hoping his employer will find this post and fire his ass. I know I would.

Oh, and guys, regarding his Myspace page...cut him some slack, those pics are from when he was 16, and his last log in date was over 3 years ago. He's probably on facebook now. I had no trouble accessing it, so it's not blocked.

And if he'd screwed up the defense attorney trying to use the old story that "It's okay! The doctor told him to do it." will stand up for about 30 seconds. As I had stated, he is fortunate it was 25 years ago and not today's court happy world. It is the responsibility of the paramedic to ensure that he/she functions within the scope of practice and does not allow pressure from other sources to compromise that, because the medic will be the one held accountable, not the physician who told him/her to do it. If the doctor was too scared to actually attempt it, the only reason the paramedic did was because he was too ignorant of the risk he was taking. BTW, I know he's your hero and everything, so don't confuse the term ignorant with stupid. They are totally different.

You will also note in the post you quoted that I mentioned my position would change if the patient met my death in the field protocol. A head three inches thick would qualify as such. I still wouldn't slice her open, but I'd makes sure to drive her as fast as hell to my doc...who also wouldn't slice her open.

Sounds to me that you're well on the way towards preventing this. The desire to prevent it is the first step, and you appear to understand the risks involved already.

I can't think of any advice to give you, you seem to already have the information you need.

Remember, folks... this is simple, first day of CPR class stuff.

You cannot hurt a dead person. No harm = no liability.

Somehow I doubt the instructors are thinking the student will be slicing a pregnant woman from xyphoid to pubis though. There is a big difference between trying to save a life and making an error compared to trying to save a life while at the same time causing a mortal injury that will completely prevent the possibility, faint as it might be, of resuscitation. Sure, if they fit within the criteria of my protocol for pronouncing death in the field, my position may change, but if there is a potential for ROSC, I'm all over it. I also suspect that one without the training or skills will survive a legal fight in this day and age. 25 years ago was a different era. Fortunately for that baby, the medic didn't put his brain into gear before grabbing the scalpel.

I saw a survey that said over 90% of men admitted to urinating in the shower on a weekly basis,

I'm in the other 10% because i shower less than once a week.

Not really, since I don't know what that is haha? Do they have ports for MDIs on some BVMs?

Yup, I added a website to my previous post.

You mean an MDI port?

http://www.allmed.net/catalog/item/79/938

http://www.lifemedicalsupplier.com/disposa...000-p-1148.html

http://www.hrsrh.on.ca/portal/uploads/07-0...%20Ventolin.pdf

On the Darker side, most of the Paramedics involved in integrated services will jump ship in a freaken heartbeat, why would they want to stay in EMS even ? one does have a mortgage to pay ... and thats NOT roumer at all, has Calgary or EDM cut the fire budget ? NOPE!

Artickat: Would you take a pay cut? Move your family and relocate in a rural area where in most cases you will work 24 hr x 4 shifts instead of 2 days 2 nights ... without a union to represent you and loose all senority ?

cheers

Chuckle, I actually did just that. I worked in Edomonton back in the late 80's and moved to a rural Saskatchewan service. Granted I'm on 24 hour call, but I'm not doing 20 calls a day either. I was also single and quite portable at the time so it's not a fair comparison. My comment was actually meant to just be a tongue in cheek attempt at sarcastic humour. I certainly hope the city and province realise the mistake they are making, primarily for my own benefit. If Alberta is able to prove that less ALS services are better than more there will be many provinces that will be very interested in what happens there.

The c-section needs to be done within 5-10 minutes of maternal arrest for the best possible outcome Get your IV in and start running like hell. Push meds on the way.

Apologies, I had inferred from this that my, ideally, 10 minute response, 5 minutes on scene, the 10 minute transport, and we'll say 5 minutes to extract the fetus would likely result in the worst possible outcome for both patients. This scenario doesn't take into account that 911 has to be called, the ambulance dispatched, the enroute time to the scene, etc, etc, etc. My only option was to assume these facts. As for the BLS to the hospital...what other option would I have as the lone practitioner in the back of the ambulance? I can't start a line or sink a tube while doing CPR, how do I push meds if we load and go? At best, I might be able to defib, of course if I have an AED I can't analyze with the ambulance moving. Fortunately, I have a manual option. Before we transport I would have to start a line and drop a tube while my partner does CPR before we begin transport. Per my previous post indicating how I would treat this patient, it seems to be the only option I have to be able to "push meds and drive like hell"

BTW, I added some comments to my previous post that you might have missed when you were typing your reply.

I continue to stand by my treatment plan.

Granted, but before conducting those things in the ER that I can't do, my docs are first going to do exactly what I would do, so, why not do it sooner, rather than later? Arriving at the hospital at the time when I have exhausted those treatments so they can move on to doing what I can't do? Why delay the exact same treatment the patient would get after a 10 minute transport to option number one when I can provide that in the field, possibly getting a ROSC that will keep the fetus alive for a little longer? You already stated that after 10 minutes the fetus is dead anyways, do you really think that poor CPR alone in a moving ambulance is sufficient to perfuse the fetus after 20 minutes? If I transport this patient in this scenario, they are both dead according to your statement because the fetus will be long past viable before we're anywhere close to the hospital.

Perhaps this will be helpful...here is how I run a code....

Assess the patient

Determine Pulselessness

Start CPR, usually my BLS partner

OPA and BVM, same CPR partner

Apply defib pads and shock if advised

IV access and first round of meds

Intubate and attach ventilator

Second round of meds

I take over CPR with my med kit right beside me and my partner drives

Several scenarios occur past this point....either my second crew has arrived, we had a 3 person crew, a qualified bystander is able to assist during transport, or I am doing a code by myself in the unit, trying to push meds and do CPR.

I will not simply run any code BLS to the hospital because that is not in the best interests of my patient. Why do CPR alone when I can do so much more that has the potential for a ROSC. I have never spent more than 15 minutes on scene for a code, and by the time I arrive at the hospital the docs are able to consider treatments other than what I have done because I have covered the basics for them.

You may think it is a waste of time to run the code on scene, but it remains my contention that it is a greater waste of time to take the patient to the hospital with no ALS interventions because those will have to be completed upon our arrival at the hospital and the fetus will already be dead.

2 additional comments, per this scenario, the local ED is no better equipped to handle this patient than I am, so why delay treatment just to have them do what I could have 10 minutes or more earlier? Secondly, I am making my treatment decisions based on my experience with my facilities and staff. I've actually talked about this very thing with my local chief of staff over drinks a few years back. He made it clear to me that if the mother to be arrives in his ER with no indication of life whatsoever..ie asystole during a prolonged arrest, the fetus would not be worth attempting to extract, even if it was something he could do. My docs are GPs, our hospital doesn't even perform deliveries, the procedure you describe would have them strung up before the medical board.

On the bright side, if this plan goes through there will no longer be a shortage of paramedics for all the other ALS services out there.

This patient needs a midline incision from xyphoid to pubis. Are you prepared to do that? If not, DO NOT wait on the scene, you will sentence the baby to death. The c-section needs to be done within 5-10 minutes of maternal arrest for the best possible outcome (though literature is lacking due to the inability to enroll many patients in a double-blinded study). Get your IV in and start running like hell. Push meds on the way.

In that case the fetus is already dead long before I arrive, so I might as well try to save the mother. As to the previous post about the medic who did the C-Section in the field. Lucky for him the baby lived. Had it not no doubt that medic would be penniless from all of the court cases for conducting a procedure out of his scope of practice. Not even medical control can authorize something like that. If loading and running like hell was the best practice for cardiac arrest we would be doing that every time rather than sitting on scene running a code.

I stand by my treatment

Good question Fiz,

The local community hospital is a very small ED with 14 beds and 1 MD. THey have always thrown a fit if you bring anything OB to them. There are no OB/GYN docs or dedicated facilities. They also transfer any and all pediatric patients if they have more than a simply stitchable lac, simple fracture, or the sniffles. They rarely if ever give any blood or blood products in the ED. Any remotely significant trauma gets transferred out.

It seem to me that all they really need for an emergency c-section is a scalpel and an MD.

Congratulations, you just described every hospital emerg within a 60 mile drive for me. I stick by my answer because anything we do will be done at the hospital, we will just be able to have it done sooner and arrive at the hospital in time for them to consider alternatives.

The best chance of survival for mother and baby is for me to stay on scene and work her. The time my patient loses by running BLS to out local hospital will be wasted. The nearest facility capable of a c-section is over an hour from me and the nearest NICU is over 2 hours. There is no helicopter service available at all.

More than likely, they are both dead.

Interesting...one wonders, what would have happened if this had been a male social teacher and two female students? I know, it's a "what if' but I have a feeling it would have been a far louder outcry. Or, "What if" the two students had been white instead? The black community is still quite acutely aware of what slavery did to their ancestors, but do that to a couple of white kids and see how they perceive it.

All good points tniuqs, but here's how I see it. Over the past five decades, EMS has progressed from the meatwagon system to one of highly trained professionals who are able to provide advanced medical skills to the patient to save lives. Treatments commonly performed in hospital have trickled down over time to be done in the ambulance. As technology becomes available, smaller, and more portable it tends to make its way to the ambulance. Defibrillators, IV punps, and transport ventilators are all such examples.

As technology continues to evolve into the EMS field, so to do the treatments a medic is able to provide. What did we do with hypoglycemics before we could do a blood glucose check in the field? Many EMS jurisdictions want to use thrombolytics in the field but the powers that be are still reticent because they don't feel a medic has the adequate training to interpret a 12 lead and if one should be sent to the cardiologist for confirmation, the cardiologist still doesn't get the whole picture; also, consider the time this takes to complete. Fax 12 lead, hospital tracks down doc, he reads the 12 lead and gets back to you. Having the ability to conduct a prehospital lab test, whether by ISTAT or the less expensive IVDDs provides one more weapon in the medics arsenal to confirm or disprove the presence of a myocardial infarct. It may even be considered that the medic will then have enough information to be able to determine if thrombolytics are appropriate and have them added to the protocol without having to consult a cardiologist...med control of course, but not the specialist. The problems with the ISTAT is the cost, that the cartridges have to be refrigerated, and it can only do one test at a time. 10 minutes for trops, another 10 for CK-MB, and so on. The IVDDs can do all three in 5 minutes, can be stored at room temp, and have a 2 year shelf life.

Studies listed at AHA and medscape confirm that giving thrombolytics sooner is better than later, the Assent III plus is one example. ExTRACT-TIMI 25 is another. To have the added tool to confirm that it is being used properly is just one more piece of technology that will advance prehospital care.

About 6 bucks for the TnI test and 25 bucks for the combined TnI, CK-MB, and Myoglobin

I did my ems in the USA, not in it anymore. But feel free to lobby Canada for the same.

Canada doesn't have a federally operated healthcare program like Medicare. Healthcare is the responsibility of each province. As far as your rates go, we do have a billing policy in place if multiple units are required for a single patient.

I was admiring the planetary alignment last night. Pretty cool. No Northern Lights here so far, still waiting to see them.

Crotchity, you're in Canada aren't you? Since when do we need to lobby a United States health care compensation program?

Yup, we call it the "Code Two Club" Considering I'm on duty 24 hours a day but get to sleep in my own bed, i have to say yes. Also, since my wife became an EMT after we got married one could say I am sleeping with a co-worker. You trolling for a date crotchitymedic1986?

What about gay medics? Why can't gay medics be included in your poll?

btw the Governor General was appointed by the Liberals .... need a bit of a history lesson their Kat, remenber all the other french speaking laywers as previous PMs ... a patronage scandal, an AirBus payoff ?

cheers

Holy, if you're this antagonistic towards someone who agrees with you I'd love so see what happens to those who dare to disagree. I'll go make some popcorn. I know perfectly well who appointed the Puppet General, perhaps you need a reading lesson there tniuqs, I said I was hoping, she would, not that I said she would. She is also married to a Quebec separatist who has close ties to the Parti Quebecois. Once she's appointed to the Puppet General office, she can't be "unappointed", so she doesn't have to do the bidding of the Liberals, but I'll bet her hubby will be hell to sleep with if she crosses his party.

History door swings both ways, don't let it hit you in the ass on the way out.

The only problem I have with people on soap boxes is that they THINK they know all the facts. For example, the Toronto Stock Exchange hasn't been known as the TSE for years. It was changed to the TSX, as for the lowest level in history? pfft, Even I remember it being below 6,000. What do these have to do with the political agenda of the writer? Nothing, but it does speak to the reliability of his "FACTS" I'm surprised that message didn't come with a note claiming you will have bad luck if you don't pass it on to 10 friends in 5 minutes.

Politicians are of a breed alone, backstabbers and backroom dealers. No, I don't like what the Liberals and NDP are doing either, then again, I didn't vote for Harper. One wonders though....is the Liberal leadership race still going to happen if Dion becomes PM? I'm hoping the Gov Gen dissolves parliament, either way, it's a no win for the Liberals.

I scored 156, I am smarter than a Stephen Harper. Thank you Mr. Foxworthy.