AZCEP

Very capable in their area of expertise perhaps, but that is poorly translated to the civilian world.

you deck the fire chief - you can keep your job

Are you saying that the chief doesn't REALLY deserve it?

Thank goodness for union protected jobs. :shock:

That's nice. AHA made a recommendation.

Doctors and the state wrote these things called protocols that govern my actions during many types of emergencies, including, as you might imagine, cardiac arrest.

You asked for someone to put it in writing. You did not specify who needed to do this so that you would be better able to do your job.

I'm all for out of the box, critical judgment thinking, and use it daily... except when it comes to deciding whether or not somebody's dead enough to stop trying. Which, according to those doctors and state agencies I mentioned, I'm not allowed to do. AHA recommendations give me no authority to violate established protocols.

I never said, nor implied, that they did. I'm willing to bet, however, that most of your current protocols are based on the recommendations from American Heart, right? The fact that you are not allowed to terminate resuscitation based on this recommendation and a medical control consultation seems rather piece-mealed together.

Since the state can do many, many things to me that the also AHA has no authority over, I think I'll stick to the rules. As soon as the state and their doctors change the rules, I'll be happy to adjust my practice appropriately.

Perhaps the providers in your area should consider bringing this up, rather than just accepting it at face value. Your safety, if nothing else, should push you to ask why you can't terminate resucitative efforts instead of transporting the obviously dead.

Dear Sirs,

I've read with great interest the recommendations that have been made in regards to the EMS Education standards. This upgrade is one that is long overdue, and comes at a critical time for the advancement of the EMS profession.

Unfortunately, I do not agree with the steps that are being proposed in this document. These recommendations seem to agree with the current ideology that the general public is deserving of less than the highest level of prehospital care that is available. I'm reasonably sure that this is not the direction the members of the panel ascribe to, and are trying to appease the many basic level providers that currently find employ in the emergency services.

While this may be admirable, it does not address the problem directly. Allowing for multiple levels of a decreased educational standard does not rectify the issue at hand. The era of having providers with minimal educational background entering our profession has long passed. I would hope that the members of this panel could see that the general public does not recognize the differences between the EMR and the paramedic, and the educational community should not allow for lower levels to encrouch on a lower standard to what is deserved.

The guidelines, as written for the paramedic level, are well thought out. It is with the lower levels that my concerns lie.

Thank you,

I hope your pleased spenac.

I'll wait for somebody to put it in writing, thanks anyway.

American Heart already did. The recommendation is to perform 20 minutes of adequate resuscitation, to include vascular access and airway management with appropriate drug administration. IF there is no response the suggestion to terminate efforts is made.

http://www.medscape.com/viewarticle/555229...&uac=4700ER

Stimulant Abuse May Increase Stroke Among Young Adults

There you go Dust. That should appease you for now.

I'd like to see DOT/NHTSA/DHS/DHHS or whomever is holding the leash at the federal level this week to mandate a change in how resources are allocated.

It makes no sense to have urban centers with short transport times oversaturated with ALS providers that don't get enough exposure to calls when the rural areas try to make due with a BLS crew. Move some of the urban providers into the rural setting where they will actually make a difference.

Probably a discussion for another thread, but it just came to mind again. :roll:

Hey, what do you know? I didn't think I'd live to see the day that the FDA put out something that acutally made sense.

Way to go Feds! :roll:

What happens when these "fast-tracked" providers decide they don't want to work in a rural environment? There isn't a shortage of urban medics, and there isn't enough pay to keep experienced providers out of the cities.

It is a good thought, but it sounds like it wasn't quite thought all the way through. :roll:

At an MCI, you could still park them side by side. You'd just have to make sure that everyone had their doors open. Move the patient through however many ambulances until they get to the one on the end with their door closed.

Sounds sort of Wile E. Coyote, but it could be done.

It is dumbed down to get people to take these low paying jobs. Why increase pay when we can just run a cheap quick class and hire these new people cheaper?

This is an extremely insightful statement spenac. Thank you for that.

Does the phrase "No student left behind" ring a bell for anyone? Students don't have to work to achieve anything all through their elementary/secondary education then enter the professional world only to find that they won't be "given" the same breaks.

This leads rapidly to students complaining to administrators, which in turn leads to problems for the instructors that expect more from their students. It is pandemic in the entire educational system.

They are, at their base, giving you the same information. If you've taken PHTLS, you might consider giving the ITLS version a try. There are some differences, but mostly from a presentation stand point.

ITLS comes from ACEP, or emergency physicians. PHTLS comes from ACS, or surgeons. This is the only real difference between them. The instructors will make more of a difference than the information.

Hmmm, today must be the day of stupid instructors? (See the SALI thread.) No offense AZCEP.

Why would I take offense from an RN/EMT-I.

Honestly, this is one of the reasons I don't participate in education nearly as much as I would like to anymore. The students come in thinking they will leave with a course completion card without proving they understand the material. Between the LCD regulation and the inability of students to want to work, "no student left behind" has created an untenable situation trying to educate these people.

Reread the answers you got if this is what you really think.

Each and every one of them stipulated that the memory aid is garbage without knowing the anatomy and physiology of what you are looking at. Move past wanting a memory aid that will not help you understand what is going on.

Just because your service doesn't use 12 leads doesn't mean that you should not learn how to read them. After all, you may decide to go somewhere that exects more from their providers.

This isn't really new, just since the 2005 guidelines were published before this could be included.

Two minutes of uninterrupted compressions prior to ventilation for unwitnessed arrest, or if there is any delay applying the defibrillator. ACLS recommends performing compressions while doing other interventions whenever possible. IVs, medication administration, intubation-if possible, while compressions are underway.

Two minutes of compressions, then rhythm check, decision making, and continue.

This acronym is garbage. It doesn't relate the information to what you are trying to remember at all.

Think of the individual electrodes as cameras, and decide which portion is being viewed by the direction the camera is looking.

My god, is it really this difficult to understand where the anatomy and physiology come into play? :shock:

Ah, hell.

Another point for a "paper" presentation sake would be that Lido is CLASS 1b, and Amnio is Class 3 so different mechanisms of action.

Excellent point.

A time frame could be introduced as well, Lido has been around for quite some time where as Amnio has not .... I bet the next NEW standards will change the fuzzy warm protocols that we all must "consider". :roll:

Not to go all spelling Nazi on you, but it is AMIODARONE, not amNiodarone.

Just what ever happened to Procainamide its still classified as 1a ?

Procainamide is still the drug of choice for stable VT. It doesn't get much press because, like lidocaine, it has been around a long time and most people don't even consider it anymore.

It's amazing how 2 Paramedics and 2 EMTs can run a cardiac arrest better than most doctors and nurses.

This is because there is actually very little education time spent teaching doctors or nurses how to perform this task. Paramedics and EMTs are exposed to cardiac emergencies almost daily from the beginning of their training.

Could the foul ups come from having so many people available to help that everyone loses track of their assigned tasks? Just a thought.

It is my understanding that dextromethorophan is a synthetic opiate, and i do know through practice that in the event of an overdose you do get the classic resp depression, and naloxone will work to reverse the effects.

DM is not an opiate in the true sense of the term. It does not come from, nor bear the same chemical makeup of true opiates. It will bind to narcotic receptor sites, but it is poorly antagonized by naloxone/nalmefene/naltrexone. It is reasonable to try some of your available antagonist, just don't expect it to work very well.

More reading needs to be done on the few studies that claimed that amiodarone was more effective.

1. Because they were driven by the manufacturer, the articles that got amiodarone placed in the 2000 guidelines were at best suspect in accuracy.

2. Amiodarone has been shown to have more patients survive to hospital admission, but no more survive to hospital discharge. The parameters for this are suspect as well, as the definitions are poorly adhered to, or non-existant.

3. Long term survival for both agents is identical. Amiodarone has more deleterious side effects, and lidocaine is more commonly mis-dosed. At one years time, no patients survived no matter which antidysrythmic was used.

4. The use of research to guide practice is evidence based practice. Your description of the use of lidocaine seems to suggest that you are discussing anectdotal evidence, not true evidence based recommendations.

i am not one to be redundant but the outlook so far is cook book, i agree with the current ACLS guidlines that state to use it in place of first or second dose of epi however i have heard alot that people are using epi first because it is easier and this is bull.

Which is easier, to open a vial and withdraw the medication or screw together a prefilled syringe? How exactly is it "bull"? I disagree with following protocols by rote, but faster is faster regardless of which drug you are using.

what is the most important thing to a pt in cardiac arrests? CPR if this is going on then you have time for getting the appropriate drugs. And as to which one to use, treat it based on how the drugs work, if you dont know how a drug works dont push it.

You need to take your own advice on this one.

Epi is a beta and alpha stimulator...

In the doses used for cardiac arrest the alpha effects predominate. Beta effects are more useful for someone needing smooth muscle relaxation, not cardiac stimulation.

where vasopressin is a sellective alpha stimulator, in the protocol for V fib you are giving your first dose as a pressor to increase vascular resistance and you are already dealing with and irritable heart so why increase your automaticity with epi. however in asystole you are dealing with no automaticity so increase it with epi. dont be a cookbook medic, think every call through, and know exactly how the drug that your are going to give a pt is going to work.

Here again, take your own advice. Vasopressin has no alpha effects. That is a sympathetic nervous system receptor site that will not respond to an anterior pituitary hormone. Vasopressin has it's own receptors which chbare already discussed. Every dose of epinephrine and vasopressin are used as pressors. You will get the same response from the two drugs no matter how many times you give them.

Upton, you have restored a bit of my faith. Thank you for that. I would suggest that you take it easy on the use of the tired cliche, but on the whole a quality post. Take a nap and clear some of the cobwebs.

Looks like an engineering design study rather than anything that could actually be used. Very rare are the occasions when you can manage an airway from the side of the patient. I suppose it would be an impetus to purchase more high dollar equipment, but why would someone do that?

It is a neat idea, just not very practical.