AZCEP

With the scope of practice you describe, and the short transport times having paramedics around won't be of much service. You are currently providing an ALS service, and unless you also do transports outside of your 5 minute time frame you will have a tough time getting the information you need. Good luck to you in the meantime.

The push for short scene times may be one reason. Working someone until they are good and dead takes a while. We already can, with a medical control contact being made. We are allowed in the event we can't make radio/phone contact and there are obvious signs of mortality. Absolutely not. Considering my average transport time is 40 minutes, if I don't get a response to what I'm doing, no one will short of an Eternal waiting room consult. Due to the lack of resources to support the family, it is much easier to allow the ED to do the dirty work. If obviously dead, I have no problem making the pronouncement/announcement to the family, but it does take up resources while waiting for the coroner to make an appearance.

That would be 65 mg/dL, and it is a bit low but not dangerously so. A little D50 would be a reasonable idea with this finding. More concerning would be the lack of improvement following the D50 administration. I'd like to know what was on his "cart" that he would be able to drink. What is his job at the hotel? What kind of things is he around while at work? I'm guessing he did not drink the standard mini-bar type solution.

Do the paramedics in the areas that are considering this procedure getting enough airway management practice to maintain their ability? If they aren't, and most places don't, adding one more set of providers with an advanced skill that will not be practiced enough is not the answer. Educate the medics that need more practice so the EMT's won't need another add on skill.

Perhaps you should explain what makes this "something good". How is adding to a provider's procedure list good when the base understanding of when and why to use the procedures they already have is so poor? Adding an advanced skill to and under-educated group is going to cause all kinds of problems when it comes to application.

This is the single best thing a provider with less experience can do. Often you will find that when you start building your differential, you end up with 80% of your textbook running through your head. As you build experience you find out that you can eliminate most of those possibilities with a couple key questions. Sounds like you are well on your way. As an aside, if you do write your book, every student would be mildly interested.

Did your "word of mouth" indicate why you shouldn't buy them? I've used one for the last 3-4 years as my personal OH S#!T kit, and I've never had any issues with it. Plenty of room for what I need, easily compartmentalized, very durable, etc...

Whoa there akroeze. I've never bought into the "EMT saves..." argument. Eliminating the EMT has already been done for us. With all of the add-on skills that seem to be so important to so many, there are very few truly BLS providers anymore anyway. Now we just need to make it official. Use the 120 or so hours as an introduction to prehospital patient care, force these people to use it as a prerequisite in a degree pathway, and move them into a level of provider that can actually be useful.

What is so difficult about the skills you mentioned that they couldn't be included into a full paramedic education? The items that paramedic students get hung up on already needs more time to ensure that they are well understood. A few of the simpler skills, which should not have any bearing on the educational content provided, will not cause the current paramedic education to slide off the rails. Force the incoming students to dedicate themselves to a full degree program from the start. Require a degree prerequisite courseload to be fulfilled prior to entrance to the paramedic program. Use the EMT, or BLS program as an introductory tract to give a taste of what they are signing up for. Your EMTs would still be obtaining their magical year of experience prior to their paramedic courses finishing, and they wouldn't be wasting their time with something they don't want to do. As a bonus, they would have a full, or associate's degree upon completion.

RN and paramedic are two vastly different fields. You really can't compare the two. Just as you really can't consider an EMS provider educated with the current system in place.

This is the single biggest obstacle to EMS being recognized as anything other than a refuge for those that can't find gainful employ in anything else. These rural areas need ALS significantly more than the urban centers do based on the proximity of the residents to a medical facility. The volunteer argument has been well documented elsewhere, but it too needs done away with.

I'm going to guess/hope that this is sarcasm. If not this post is a good example of much that is wrong with the current method of EMS education.

Going to the Caribbean mahn. www.sjsm.org to be more precise. Cheaper/faster/same end result/I know how much work it will take so the instructors aren't quite as important. Hopefully I'll be able to drag myself into a classroom with all the world class diving available.

Dang, I wish I'd gotten into this discussion earlier. :roll: I've been a paramedic for 12 years this coming April, and have completed all the prerequisites for medical school. This last summer all of the stars aligned, and I've been accepted starting in the fall of 2008. The reasoning is quite simple, and eerily similar to Doczilla's, if slower in developing. I'm tired of being limited in what I'm allowed to do by someone that does not understand the situation I'm in. Yes, that is quite possibly the most ego-centric statement made in quite some time, but such is the environment I'm in. My medical director dared me in not so many words to do it, so the chip is firmly planted on my shoulder. The wife is an ICU RN, and she has been telling me to do this for a few years now. My mother-in-law is finishing her FNP as we speak, and she is of the same mind. Could be they just want a doctor they can boss around a bit though. I'm really looking forward to the challenge.

You did not fail the test by one question. Percentage point perhaps, but not question. Another medic class is not the answer. Enroll in a nursing program and forget you ever thought about becoming a paramedic. We have enough people doing this as a "hobby" already. We don't need another one passing through.

AMR in Las Vegas does NREMT testing on a monthly basis. You just have to schedule with them. Now the real learning begins.

In that case, kristo, the duration of the ventricular fibrillation will be so short that you will likely be unable to apply and analyze quickly enough to be of therapeutic benefit.

Nope, that's a new one for me. There are a great many things that will help with this, and calcium is near the bottom of the list. Nope. The vagal effect is not blunted by calcium. In fact, the increased contractility can cause the heart rate to slow to the point of asystole. Was anything else done during/after the intubation attempt? Fluid boluses, other medications, maybe a pressor agent? That will depend on your area, and what liability your medical control is willing to accept. On the whole, calcium is not a recommended premedication agent for intubation. Unless there is an underlying pathology, leave the calcium alone.

I think you may have found the problem there Dust. :wink:

CPAP may help some, but all in all the best thing to do is to use high concentrations of oxygen and support vital functions until the hemoglobin is willing to release the CO into the exhaled air. Using 100% oxygen will effectively quarter the half-life of the CO. Using VentMedic's numbers, five hours is cut down to roughly 90 minutes. CO monitoring would have been nice, but the patient presentation indicated a significant exposure, so it wasn't going to change what you were going to do in the setting you were in.

The QT interval is going to change with the patient's heart rate. A rule of thumb is it should not be longer than half the previous R-R. This works for rates from 70+ beats per minute. Once the rate is faster than about 140/min, you really begin to split hairs on where the half way point should be. Faster rate = shorter QT Slower rate = longer QT As for the ST segment, unless the QT is lengthened with it you shouldn't worry too much about it.

There are no regulations for the patient compartment whatsoever. Occupational Safety and Health Administration (OSHA) views it as a transport issue, and therefore it falls under the D.O.T.'s perview. D.O.T. only regulates up to two feet behind the driver's seat, so nothing is mandated. The amazing thing is that it takes a fairly minor overall incident to to significant structural damage to the interior of the patient compartment. Crashes at <40 mph have had the module torn clear of the frame.

New form of "Ultra" sound therapy perhaps.

I'm going to guess that this type of envirnoment is a by-product of the fire service academy mentality of the instructors. As already mentioned, not necessarily good or bad, just a bit different.

I put it in "Funny stuff" because I couldn't stop laughing at the school board when I first read it. Perhaps it would be better suited somewhere else though.