flight-lp

Cause it looks cool and no one on the block has one...........Isn't that the current trend, instead of relying on sound thought and thorough assessments? Gotta have all those cool toys!

I shot a Llama because I'm sexy and I do what I want................ Oh lord, this is wrong on so many levels!!!!!!!

Horribly inaccurate!! There is a reason why limb leads go on the limbs, this little quick look device is way off with the complexes. It is also very sensitive to artifact, put it in a bumpy ambulance or helicopter and you'll never be able to read it. Plus there is not a print capability. You are basically paying $250 for a fancy $5 stethoscope!!

You are right, but I am referring to my neck of the woods where you are lucky to have a level 4 trauma center anywhere nearby. There is only one level 2 in East / Southeast Texas. In these cases I do disagree, it would be much better putting these patients on a helicopter than going to a local ER which will delay their care and have a high probability of an unfavorable outcome.......

Whoops, so much for attention to detail............... :oops: I still think it is a dumb idea though......... If the patients condition requires an immediate surgical need, then perhaps they need to be at a hospital with that capability, i.e. a level one vs. a local "doc in the box" ER. My point being the medics need to have the thought processes to evaluate the most appropriate facility instead of taking these patients to the closest ER. Distance isn't always the highest priority factor................

I can't believe this is even being debated. Physicians need to be in or go to their hospital if they are called for service. The presence of a "trauma doc" on scene cannot and will not change an outcome. These patients need the OR and a surgeon, not a lighted out BMW on scene with a doc doing the exact same things that can be done by Medics. I also believe that a big problem with outcomes is ignorance on the part of EMS. Crews need to know exactly what capabilities each and every hospital in their service area has and check that availability daily. All too often I get a call picking up a neuro trauma from the local ER to take to the trauma center 45 minutes away because the local EMS didn't transport to the appropriate facility in the first place. This delay in care is a big factor in overall poor income. We have to know what to transport to where. And keep the docs where they belong................. What does this have to do with a doctor being on scene or not? The airway will still be managed by EMS on scene................

"I am amazed that Houston does not have that many required intubations. Although that is a lot of medics. Again, no contriol of the system and flooding the market, I now also wonder with that many, how difficult can the program be? " Rid, this is HFD that we are talking about, so the statistics really do not surprise me!!!!!!!

We do cadavers yearly and I agree, they are great for skills maintenence. You are right on the money Rid, a quality QA/QI program with sound integrity in the numbers is key................

I could provide it, but I'm not to prevent the feeling of false hope. Just as Rid and AK said, you need years of experience below your belt before applying. The competition is fierce, usually 30-50 applicants per job posting. Keep up with your education and get the needed experience. Your time will come..........................................

This is really bugging me because I had read a study recently directly comparing this exact subject and now I can't find it.. The study showed that there is NOT and increase in success by getting OR time, but by continuing to maintain the knowledge base that should be utilized in each and every intubation i.e. proper positioning (if possible, lord knows it usually isn't!), proper evaluation, proper technique etc. I'll keep searching for it, hopefully I'll find it again. Personally, OR rotations did nothing for me as far as field intubations go. Its like comparing apples to oranges. In the OR you get that perfect NPO patient in the perfect sniffing position that has been sedated or paralyzed in a controlled environment. We all know that the patient we are about to tube will probably have a case of beer and about 6 slices of pizza in him. Not to mention having to tube in awkward positions and having to definitively control the airway in a very uncontrolled environment. It just not the same.............................

I have yet to see any air program that utilizes EMT-B's in a patient care role. I know of one fixed wing program that uses EMT-I's occasionally when an extra set of hands are needed (i.e. specialized transports or lengthy intercontinental flights), but the primary care roles are still performed by critical care Paramedics, RN's, and RT's. Most programs are designed as critical care transport services and the fundamental level of care provided cannot be reasonably given by an EMT-B. Angelflight does not provide medical personnel, only the pilot and the plane. Each patient is required to supply their own needs medically and the aircraft is not configured to provide for emergent care.

They must have been late for Grandma's dialysis appointment!!!!

I bet HFD had a field day with this!!! Nate, send me the vid, I missed it on the news courtesy of my wife having to watch Oprah!!!

Last year during a conference, myself and several other flight medics had a lengthy conversation with Dr. Bledsoe about this very topic. The big factors that were cited actually had nothing to do with individual medic skill. The biggest causitive agent was the lack of a commercial tube holder and instead using either tape or a shoelace, both of which have been proven ineffective in securing an ETT. The other big problem is a crew resource issue. We use a saying "first attempt, best attempt", meaning have the best provider utilizing all available knowledge and resources. The skill itself is simplistic, but its the evaluation part that is causing a high failure rate. More medics need to use the Cormack-Lehane scale, evaluate the POGO (percent of glottic opening), and remember the acronyms BURP and LEMON. We need to mindful of the various airway algorithms, if its a crash airway, then medics should not be doing a full RSI. If it is a difficult airway, then further evaluation is needed before introducing analgesics, sedatives, and paralytics. And if it is a failed airway, which WILL happen to all of use sometime in our career, we need to remember to stop with the ego of "getting the tube" and drop a failed airway device, 3 attempts and then a Combitube, PTL, or LMA........ So in short, evaluate before you act, drop the medic ego, and do whats best for the patient based on their presentation....

Damn! And I swore I would never cross AK and screw that one up, I'll go sit in the corner now........... :oops:

They know better than to ask and it is inadmissable as evidence unless properly obtained via subpoena. That information is confidential and disclosure of it can be problematic (can you say HIPPA??). If they want information, then they need to use the proper channels to get it..........

Here is a recent thread covering this topic............... http://www.emtcity.com/phpBB2/viewtopic.php?t=3688

Why would it matter? Both are Paramedic staffed units and both are pre-hospital.................... But to answer your question, they are air services.

Oklahoma, Iowa, Illinois, Kentucky, and Tennessee all have providers who allow Fentanyl administration on standing orders.

Texas qualifications include the ability to balance, lift, and carry 125 lbs. unassisted....................................

Well that definately clears up any questions. No harm or insult intended, sorry the info wasn't beneficial for you.........

If you have time to hook up this gadget to a laptop and then open the program to view the image, then you are overlooking something. $120 is PER ETT. Consider we carry on average of 15 in the airway kit, plus a resupply on the truck, that cost adds up quick! Not to mention they are not reusable! Direct visualization is easier, quicker, and cheaper. ETCO2 is more clinically accurate method of confirmation. And I was completely turned away by a statement on their website indicating that a chest x-ray is no longer needed with this device. Not to mention the possibility of camera obscurity should fluid, vomit, or anything else block the view. Oh yeah, one more, you couldn't use it in many helicopter based services due to FAA regulations concerning portable electronic devices............... Sorry, its an interesting idea, but one that is not practical in EMS.

"Well the clock on the wall said 3:15, March edition of People magazine is on the coffee table, there is an unknown brown stain on the carpet............." You could document all day long, but why. There is no need to, its not pertinant unless you see evidence of the act (powder on pts. nose for example). Why create a situation that potentially doesn't exist?

You have a postictal seizure patient that needs to be transported. You would be negligent in your care waiting on scene for law enforcement. Plus if they arrive after you depart the scene, they can not enter the premises without a warrant. Your job is to treat your patient, not play "CSI" in the apartment. I wouldn't document any illicit drug use unless the patient tells you he used. The ER will know after toxicology is obtained. But as far as the "powders, syringes, and paraphernalia" goes, you cannot make an assertion to their usage and you cannot test the substances to determine their chemical composition. Therefore, until such actions are done and done by the people who need to do it (i.e. Law Enforcement), they are of no concern to you. Any statements that you make, oral or written, subjectively attempting to claim the presence of drugs can be grounds for dismissal of charges if they are not made with sound evidential proof. Leave it be, focus on your patient!

TBS, First and foremost, welcome to the city. I hope you find your stay informative and enjoyable, but I have concerns about your first posting here................. Billing is an entity that REQUIRES sound knowledge of all applicable state, local, and federal laws concerning reimbursement and collections. Such information is not soundly obtainable from an online message forum. You need to make contacts with the agencies involved in such activities. Here are three links you definitely will want to become familiar with........... http://www.cms.hhs.gov/home/medicaid.asp http://www.hhsc.state.tx.us/medicaid/med_info.html http://www.medicare.gov/ I'd start here. The opinions of the people here is just that, opinions. You need facts, rules, and regulations. This is not the place to get them. Opinions given here will not hold water in any legal action and it will discredit your reputation with clientele. If its opinions you want for your own information, then post away. But if your looking for definitive answers to assist you in your collection activities, you need to go elsewhere. If you have an ulterior motive to gain information you seek for purposes of collection pursuits, then you will quickly see that people on this board are not going to help you. I'm not trying to insinuate anything, but there have been several occurrences before where people attempted to obtain information for litigation purposes and have been shut down real quick! Honesty is paramount here! Fail to have it and the wrath of EMT City shall ensue. Good luck with your endeavor.................