flight-lp

One thing I can't stand is a dishonest Paramedic Instructor who thinks he is above the Law. If one of the untrained students killed someone, he would cover his ass, at the expense of the student he chose not to train.

One thing I can't stand is a student who fails to appropriately prepare for a practical skill and then places all blame with the threat of regulatory action on the instructor.

Please tell us EXACTLY the nature of this "highly technical" skill that you feel was not presented to you.

While you are at, please validate as to what part the strike played. I feel it to be completely irrelevant.

Maybe then we can adequately have enough information to answer you appropriately.

You can also use non-selective beta blockers to decrease the overall cardiac output and splanchnic blood flow. We use IV Inderal in severe cases, along with a nitrate to keep the pressures down. We get Sandostatin from the sending facilities and will occasionally keep a spare dose or two on our CCT units. We also carry the SB tubes on these units for uncontrolled hemorrhages. These folks are definately a handful, gettting them tubed is a priority, trach / cric 'em if you cant pass the ETT or ventilate them due to blood obstructing the airway.

Vasopressin is an alternative, however bear in mind that while the V1 receptor will increase venous BP through increased SVR, this can cause potential for cardiac ischemia. Risk vs. benefit has to be heavily weighed.

Any palpable abdominal masses? Varying BP between right and left sides? Back or chest pain?

Anyone else heading to San Antonio next month for CCTMC??

The military and fire services were there, did you watch the news at all. Also Homeland Security grants are mostly for the municiple/county/state and not for private for profit companies. Homeland Security grants help municiple departments, without raising taxes. For profit companies if they want to have extra gear can raise their rates. Where I come from our third service EMS can not just raise our rates, we have to go before the board of selectman.

Yea, I'm calling BS on this one too.............

The 82nd Airborne Division had several Batallions on site within 72 hours of the storm. As far as the jeans and t-shirt issue, those were not civilian air medical nurses. All civilian flight crews in the region were in their required duty attire. Perhaps you were seeing hospital based nurses flying on military aircraft?

As previously stated, be thankful you have an employer that provides these items to you as most don't!

What would you suggest the answer is?

x2.

I'm also curious how and more importantly who would be responsible for enforcement.

Apparently SW Medevac lost a bird on a training exercise over McGregor Range near Ft. Bliss. It sounds like it was taking part in a military training.

http://www.elpasotimes.com/ci_14344903

No official word on crew or pt condition or if they had a pt. One of the comments says that three fatalities of the crew...

Prayers go out to them, I've dealt with the SW base several times when working IFT.

The three crew members on board were fatally injured. My prayers go out to the families of my co-workers, godspeed and rest peacefully my friends. You will be missed..............

"This is a medical problem, not a police problem. We don't take people to the hospital, that's your job."

Back to square one. Not saying it happens everywhere, but some people do in fact have cops like that.

Fortunately, our local PD agencies do psych transports in the case where a non-medical psych person has issues with safety.

An uninjured person with no complaints who is competent is not a patient, regardless of the opinions of others. If someone is impeding on my personal safety and for some reason I was not able to manage that person, then they will not be in or remain if already in my ambulance. PERIOD.

But again, chemical restraint and RSI are wonderful options to have........................

Tyson - Your local PD may refuse, but see what happens when you or one of your co-workers gets their ass whooped. You need to address this issue man.

While I firmly agree that this situation could have and definately should have been handled more diplomatically, I have a couple of questions.

Were these two employees on an ambulance when they took this break? Or were they non-field employees working upstairs?

They definately should have immediately called for medical resources and made contact with the patient, but before we are judge and jury, the question lies in whether they had the immediate capabilities to address the emergency. Even if they had assessed and interacted with the patient, would the outcome have changed?

There is also the culpability of personal responsibility. Did the deceased have a history of asthma? If so, why did she not have her rescue inhaler with her? Was she compliant with her other medications?

This absolutely was an atrocity by the hands of two lazy ass self centered EMT's. From an administrative standpoint, they should be held liable. I do however question the criminal liability.

I have worked as a psych tech for 10yrs now as well as a EMT, i worked for a behavioral ambulance company for awhile and that what we specialized in was those types of calls, really all u can do is restrain all limbs, spit mask if u have one or just a regular Tb mask works just fine. As a medic u have the option of giving them a IM considering patient wouldn't allow u to give them a IV. Sedate and restrain. That's all you really can do.

Actually, no that is incorrect. As Dwayne pointed out, once they move onto becoming a threat to your personal safety, the bets are off. A combative individual can "decline" an IV all they want, if they are a danger to themselves and / or others, they are getting an IV providing it can be accomplished safely and efficiently. In many cases, asinine behavior can be predicted in the attention seeking population. Because of this and the very nature of psychological disease, I will usually establish an IV while on scene with adequate assistance available should the individual have a differing belief of the appropriate course of action.

One that really sticks in my mind was an addict high on PCP. Dude was carrying 4 cops on his back. 10mg of Versed

IM didn't phase him.....................But the 200mg of Anectine IM eventually did. Sometimes you just have to improvise to insure you go home safely at the end of your shift.

Again, the OP needs either appropriate sedation options or a better transport policy.

Combative person + no chemical restraint protocol = person going with PD.

It's 2010, time for your local EMS to catch up on the times and offer interventions appropriate to the patient population.

Personally, I would have offered this kind individual a nice cocktail of Ativan or Haldol and Benadryl. Should he politely decline and continue his demonstration of low level Darwinism, he gets a consolation gift consisting of Anectine and an endotracheal tube. I am a firm believer in prophylactic RSI.

I get all of my flight, ground CCT, and FD 911 calls sent directly to my Blackberry. I like it as it is convenient and I don't have to lug around additional pagers or phones to lose.

Yeah, epic fail...............

Shouldn't have been driving with his history and, if he was still alive, should be fully liable for negligence from not taking his medications as prescribed. Shame on Rural Metro and that FD.

My personal thought is that you get what you pay for. With that in mind, my personal recommendation is a Citizen Eco-Drive. Very durable, you never have to worry about replacing the battery, and most come with a perpetual calandar that never needs to be set. You will also find that the lume is great and lasts for hours. I have two that I wear in the field (Nighthawk and Calibre 3100), one of which i've worn for 6 years without an issue (Nighthawk). The best quality for the price IMHO.

Say goodbye to all liquids and powders since the TSA can't keep people on the no fly list from getting tickets.

Yet another intel epic failure. Mutliple agencies knew about this dip shit, yet once again being PC reigns victorious. Utterly pathetic.

Unfortunately, TSA has no say in this one, the ticket and the flight originated outside of the U.S.

I want to know how he "refused" to respond? In my system a first responder company can place themselves on "fire duty only" typically after a fire or to do drill activities. Many "bad" medics to have found ways to avoid calls after being dispatched to one. Ie being "flagged down" for a "patient" on the way to the first call.

Because he was on duty as a paid responder; one that failed to perform his duty. He got exactly what he deserved, although I wish he wouldn't have received the option to resign. Hopefully, he isn't eligible for re-hire. That would be a strong indicator to future employers to think twice before offering him employment.

If an apparatus is incapable of functioning as required, then I could see going into a delayed response mode or possibly being out of service. Going to a personal appointment, unapproved by the higher ups, on the company's dime is fraud.

So my question to all of you Floridians out there is this................................

Is this particular piece of apparatus paid for with public tax funds? Are the tax payers forking out the money for this?

17 total, 16 successful oral, 1 unsuccessful with a King LT placed.

3 unassisted intubations secondary to respiratory failure / cardiac arrest.

14 by PAI / RSI.

Air Medical - 3 intubations required per quarter.

Ground CCT - No current requirement, but will soon mimic the air medical requirment.

911 - No requirement, usually a sufficient number of patients volunteer their services, lol.

Did you read the links I posted earlier in this thread? If you follow the links on those pages you will also see some of the clinical data collected. Also, the manufacturers of ResQpod were the sponsors of most of these clinical trials.

Honestly, no I didn't. Sorry if this was information was included.

I'm not surprised by ACS's involvement in the trials, does it really surprise you????? Remember when Amiodorone came onto the market?

I've seen the results first hand. I've seen these cardiac arrest victims leave the hospital neuroloically intact. I believe in the device and support its routine use during cardiopulmonary arrest

Was this apparent validation of the ITD published? I'd love to take a read of the study. What do you think of the latest information from ROC PRIMED suggesting that the ITD is not beneficial?

http://jap.physiology.org/cgi/content/full/104/5/1402

http://linkinghub.elsevier.com/retrieve/pii/S0300957205001917

http://linkinghub.elsevier.com/retrieve/pii/S0300957205003679

http://www.medscape.com/viewarticle/493668

A few recent articles over the last 5 years concerning the ITD, specifically the ResQpod. I'm not sure if my former agency published their study yet or not, they were collecting data from the Lucas when I left for Iraq. I'll check and see if I can find that out for you.

It does seem like he has something against HFD. I've worked with HFD many times on my scene and even a few of them work PT over at my department. They are good paramedics.

-Nate

Now Nate you know better than that, we've discussed this very topic to some length a couple years back......................

Diazepam - Your right, I do not like HFD as an EMS entity. They're great firefighters, I don't contest that or the ISO 1 that the department holds. While some of my semantics earlier may be perceived as opinion, I can attest from having directly working with quite a few of their Paramedics for the better part of the last 20 years, I can attest quite a few shortcomings. Especially when you compare them to some of their neighboring counterparts which are rated as some of the best in the nation.

1. Equipment - Their Frazer boxes are old and remounted several times over. Most generators are inefficient in providing climate control, many have base frame damage from previous MVA, many also lack appropriate working restraint systems in the patient compartment. I have seen several stretchers that fail to operate as specified by the manufacturer, Sharps containers simply taped to walls or mounted on bars, and they lack equipment that is standard in all hospitals in the Houston area such as saline locks and needless IV systems.

2. Education - As a former preceptor for Houston Community College I can tell you that compared to both Lone Star College and San Jacinto College, their NR pass rates are lower and that the overall cirriculum is watered down, even compared to their civilian paramedic program counterpart. Their CE requirement is minimal, their protocols minimal to bare-bones ALS care, and on more than one occasion as supervisor had to be present to utilize their ALS skills.

3. Morale - Ask most Paramedics about their career goals and being on the medic unit or squad is not their answer. Most do it because they have to and because they get paid more to do it. If you look at their internal statistics, not many paramedics are career ones, most are out the door when they test for EO.

Now granted, Dr. Persse is trying some new things and listening to some new ideas. Slowly over time, things may improve. To me this is objective fact, I appreciate your view and perception of it being opinion. But I stand behind my belief either way.....................

Why do you think it has such a poor execution? What are the specific problems associated with that system? I've heard that EMS runs a high call volume with not enough rigs. Is that still the case? Didn't TriData do a study of that system some years back? DId they actually address the problems the report brought up, or correct any deficiencies?

I'm not arguing, just trying to compare problems. I would bet the HFD's problems are not unique to that city either.

1. Piss poor medics that were thrown through a minimalistic half assed run course with piss poor preceptors.

2. Piss poor equipment, crappy protocols that do not address even the basics of patient care.

3. A Fire Department that places little emphasis on caring about the medical needs of the community.

4. Poor and minimally involved medical direction that is not current on evidence based medicine.

5. A city that has decreased faith in the department due to multiple political and racial scandals.

Need I continue????

The study did try to address the logistic issues, but many turned a blind eye and listened to a Fire Chief with no EMS background and one who had no interest in EMS. Add to that a time where medical direction was weak and with its own scandal, it all added up.

These folks are over worked in an undercaring system. I'm not sure it can be saved...................

Tell your bosses to save their money. I have some snake oil that will do just as much for cardiac arrest patients.

I never knew snake oil could increase preload!?! Learn something new every day...............

I second the Lucas suggestion, but in addition to an ITD.

Back in '06 and '07, I was with a local agency that trialed both products and we saw statistically significant increases in both ROSC and neurologically intact discharges. Specifically an 85% in-field ROSC rate and a 19% discharge rate (Non-Upstein criteria; which most use to boast their 20%+ survival rates). Considering the national discharge survivability rate is around 5%, I am pretty convinced of the efficacy of these devices. I've seen their successes first hand and highly recommend them both.

Outside of sheer negligence or stupidity, it is rare for civil litigation to reach a courtroom. Texas got smart a few years ago and put a cap on medical litigation. Very few go directly for the EMT or his / her company as the lawyers realize that's not where the money is. Hospital systems and physician groups on the other hand...............

The Houston Fire Department has primarily BLS ambulances with ALS squads (Suburbans, Excursions, etc.)

Basically in the urban downtown area where the most calls come in, the cluster the ALS squads and BLS ambulances, and outside the downtown area where lower call volumes are encountered, they have ALS ambulances. It seems to work pretty well for them...

They have two paramedics in the squad, and an EMT and a driver on the ambulance. The only downside is that the squads get the crap run out of them. Some have volumes around 25 or 30 per 24 hour shift. They may only do 2 or 3 transports, but they run all day and all night...

It may work great for the FD, but it sucks for their patients! HFD is a prime horrific example as to the bad reputation Fire based EMS has. Decent concept, piss poor execution and QA.

I wouldn't uproot everything to come down here on a blind ad from career builder. There are a lot of staffing agencies that are promoting the "disaster response" positions. They do this to secure federal funding and most will NEVER deploy. If they do, it is usually only for 1-3 days, and will be limited to maybe 1-3 times per year when a natural issue presents. On top of that, the entire state is covered by State Guard, National Guard, local contingency resources, DMAT teams, the Civil Air Patrol, and RAC agreement resources. So to sum it up, the chances of you making a decent living or gaining experience from this "opportunity" is nil. You will spend 99% of your days doing IFT's (if you can even find a position) or volunteering as an EMT-B.

Staying put and gaining experience and advancing your education may be your best bet.