HERBIE1

My comment was completely apolitical in nature. Only social commentary on the vagaries of what is "right" and what is "wrong." I am neither Democrat, nor Republican.. I am not Independent, and I don't belong to the Green party. Libertarian I am not... and in case you were wondering, I have no love for the Tories or the Whigs. I dislike all politicians equally...If they had any honor or redeeming value, they wouldn't be politicians.

Except... well... I was watching C-span yesterday trying to fall asleep and they were re-airing the house committee on Health Care reform. John McCain was offering up his bill on foreign prescription drugs again... he forced a vote on it... basically told everyone in the room that if you don't vote yes, you are a shill for the pharmaceutical companies... and then he left before the vote... He did everything but give them the middle finger as he walked out. That man is a Bad-ass, and I think I might like him. Oh... it didn't pass... so you Canadians get to keep your cheap drugs to yourself for a while longer.

Apolitical or not, my reasons stand. The pendulum will be stuck on the left for quite some time to come, and

in cases such as this, "right and wrong" is completely dependent on your political and social ideology.

As for John McCain, I could not get past some of his ideas like Immigration reform. Problem is, a pure liberal or conservative is hard to come by these days. Politicians hate to alienate even one voting bloc for fear of losing their chance to get elected. In many ways, this blended politician can be a good thing, but some of the hot button issues like abortion, immigration, and affirmative action are deal breakers for many people. They have such a strong opinion, they simply cannot get past that one issue.

It was only a matter of time before the pendulum began to swing back the other way. The world is round, and everything goes in cycles.

Don't count on that-at least not for a long time. We have a Democratic president, a majority democratic Congresss, and Sotomayor

will soon be confirmed as a new justice. This will be the last ruling of this kind for quite some time.

A rogue maple tree was booked into the local jail on at least two counts of murder. A sheriff's department spokesperson was quoted as saying that additional charges of 'leafing the scene' could be filed as early as next week

LMAO

Very clever, Lone Star.

OK, because the prior string has gotten pretty long, I decided to break out with a new one- with a different spin. Describe a case that involved a spinal injury- suspected or not and we can discuss.

Here we go-

Recently I had a relatively minor crash- although it was at highway speed. A 21 year old man was clipped in his left rear and spun out, striking a guardrail head on. No different from thousands of similar scenarios I've seen. Damage to the car was minimal to the L rear, the front end damage was moderate. No intrusion, windshield was broken from the airbag deployment and he never lost consciousness. The driver was restrained, airbags were deployed. We encountered the victim sitting behind the wheel alert, with a bit of blood at his mouth- from the airbag deployment and this was the only visible injury. His initial complaint was he could not feel his legs- he had no other complaints. Based on the MOI and the condition of the car, his complaint seemed suspect- I've had hundreds of people with the same complaint and it turned out to be initial hysteria or panic. Looking at this guy and the look on his face- the look of absolute terror. It was clear this guy was legit. We did an initial survey and he indeed had NO feeling from the waist down. Strangely, he also had point tenderness at the base of his skull. Of course an injury at this level would make you suspect deficits higher up than his waist, this could have also been a muscular/tendon injury- but nevertheless, this was his presentation.

Obviously we proceeded very carefully, his vitals were rock solid and steady, and we transported him to a Level 1. Later, I learned they could not find any physical damage via Xrays, MRI, or CT or an explanation for his paralysis, but they immediately started him on steroids and transferred him to a spinal cord center. Cord shock, a missed injury- who knows. The hospital could not provide an explanation for his problems. His only PMH was HIV(not AIDS yet) and I have no idea how that condition may figure in this.

I will be following up to see what has happened to him.

So, I was thinking-of all the cord injuries that we see, how many occurred BEFORE we encountered them, and how many were the result of a missed vertebral injury that is made worse by handling or improper or a lack of immobilization?

What say you folks?

There was a local radio show here that had a guy who was a frequent guest and he played the part of Jefferson. Heard it a few times- the guy is very knowledgeable about Jefferson and even takes calls from listeners about Jefferson's opinions on current events, staying in character. The bit started out on radio but the guy actually does public appearances as well.

Fascinating stuff.

I left the street side of E.M.S. after 5 years in a high crime area. I have worked in hospital, industrial, and psych institutions. I still have enormous compassion and hopefully gained skills and knowledge in all those arenas. I feel like I am in a rut. Anybody else have ideas, other than Nursing? Nursing is not appealing to me at all. Going back to the street isn't either. Thank you for any feedback.

5 years isn't very long- even in a busy area. Are you just a restless spirit?

In the business- teacher. Have a Degree?

What about transferring to a slower area if possible?

Another provider in a slower area?

What about the Allied Professions- Xray tech, MRI tech, ultrasound, Respiratory tech?

Out of the business? What are your interests? Pick a hobby or interest and expand on it.

The jails are full of innocent people- just ask them. How about the countless interviews of moms when they cry and complain that their gang bangin child, full of tatoos and an arrest record as long as their arm claim their cherub is not involved in gangs, they are a good boy? Should we believe them at face value?

The man has admitted to "sleeping" in the same bed with children, had countless private encounters with kids at his ranch, yet we're supposed to believe he was just some pathetic, innocent "man-child"?

Were some of the accusations money grabs- I'm sure. Problem is, a couple hundred grand easily could make them go away if he was truly innocent and only worried about bad PR. Tens of millions of dollars AND a confidentiality agreement means he was buying his freedom.

I was born at night, but not last night.

I call BULLSH*T.

If someone wants to give him the benefit of the doubt- be my guest, but we're talking about children here. I truly hope he was innocent or there are some really screwed up kids in the world because of him.

Add my thoughts, prayers, and best wishes to Dale and his friends and family.

Well, mostly off topic, but how many people place a collar in non-traumatic intubated patients for tube maintance (to prevent tube dislodgement).

For us its "strongly encouraged".

Done it a couple times- before the days of snazzy plastic ET holders and we only used copious amounts of tape to secure the tube. If the patient needed to be moved alot- carried around corners, tight spaces, etc, the collar came in handy.

Was never told not to or even discouraged. If it prevented a tube from slipping out, it was worth it.

Not responding to this string specifically, but the idea of an ALS "flying squad" that evaluates patients so that an appropriate response is made_ALS or BLS- sounds good on the surface. Problem is, like all stop gap measures, the bottom line is you still need a transport of some type. It's always the limiting factor. You can have fire based EMS that relies on a private transport or even an EMS unit within the department, but there are never enough ambulances.

Where ALS resources are limited, an initial ALS responder is better than nothing.

Depends, how "technical" do we want to take this? Do we talk about calcium ions, the sarcoplasmic reticulum, and the actin/myosin cross-bridges? Unfortunately, the level of education in this forum is all over the place. Therefore, a balance can be tricky to accomplish.

Take care,

chbare.

I agree, but in this venue, I'm thinking people are more apt to want to learn/refresh their knowledge.

Ahhh- memories.

I honestly never thought I would hear anyone talking about that stuff anymore.

I need to break out my old physiology books. Been too long.

Nice, that all makes sense. Now I think I should have figured that out.

A few days ago we had another DOA who had just begun to rigor, and her eyes were closed but her jaw was locked and her neck was stiffening...confirming what Herbie said.

Thanks for the info folks!

My pleasure.

I was doing this job for years before I learned about the jaw thing. A coworker who went back to school to be a funeral director told me about how rigor starts and progresses. Many times a body may remain under a blanket so the limbs may be still warm and supple, but the head/jaw is exposed. Checking the jaw on a suspected DOA accomplishes 2 things immediately and takes no extra time-it confirms the rigor, and whether or not an airway/ventilations are even possible. Obviously you confirm in the usual manner,pulses, EKG, lividity, pupils, etc.

I could have gone into the whole physiology stuff but I have been criticized for talking too technical to "show off".

Well, I think that in a forum such as this, the level of education is generally higher than other forums. In this case, a "technical" description seems perfectly appropriate to me- context.

ANy trauma center worth it's salt needs volume- both critical and not- in order to stay sharp. They also need a certain patient volume in order to receive certain state and federal funds and to keep their trauma status. Does this wide net mean some paitents are brought to Level ones unnecessarily? Yep, but a quick look by the trauma team should be enough to "deescalate" the trauma activation and keep costs down.

This is part of the rigor mortis process which causes the muscles to contract and stiffen with the chemical changes in the body with death. It tends to affect the smallest muscles first, and then spread throughout the larger muscles. If the body is unable to complete the cycle of muscle contraction, the muscles are stuck in contraction.

Basically true.

Actually, on a cellular level, rigor occurs when the ATP(the compound muscles use to contract) is not released. You need energy to release that chemical bond and in death, that energy does not exist, thus rigor. A funeral director once told me the first muscles to begin to stiffen are actually the jaw muscles.

Can't help and wonder that if they wern't a private ems unit that this would have happened in the first place, I mean LAPD wouldn't pull over any of our medic units.

Unclear. Depends on the system since in some areas, the only transport crews are private providers, so they would be the only people LEOs would deal with.

It's called professional courtesy. If- and it's a big IF- the driver actually flipped off the cop, the cop could have lodged a complaint with the company, confronted the person later, or both. This cop clearly got his feathers ruffled and he screwed up. BIG TIME.

I wonder what the cop does for John Q Public that fails to yield to him if he has no problem pulling over and hassling an ambulance crew?

Transport the child- regardless. Hospitals have the required social services and clergy, etc to deal with a very difficult situation like this. Let them rule out any possible foul play- shaken baby syndrome, abuse, neglect, etc. The parents need to know that everything possible was done for their child and in most cases, merely transporting the child is better than leaving the baby in the home. Don't give the family false hope-explain the probable outcome, but make the effort. Unless it's clearly a crime scene, even with lividity and rigor, bring the child in, and notify the hospital of what you have.

A deceased infant is a special circumstance which is not something you learn from a book. Emotions run high for the family and the rescuers in these cases.

Welcome!

LOL! The thief looks like he was lifted straight from that "Faces Of Meth" website.

The crew needs to join the unemployment list, alongside the thief.

The crew should be fired? How about letting the punishment fit the crime?

They made a mistake. A stupid and totally unnecessary mistake, but that was all it was.

Let it cost them time off, reeducation, and I promise they(and their coworkers) will get the message- it will never happen to this crew again.

LMAO

Seems like he was harmless, but clearly the guy needs a stay at the laughing academy for awhile.

As far as being threatening or menacing- that's a pretty subjective thing. I guess it depends on what the guy said to people. Simply sitting there, wearing that bathing suit is certainly weird, but it doesn't seem to rise to the level of criminal behavior.

Gawd knows if we locked up all the people around here that are half a bubble off, the jails wouldn't have room for anyone else, (nor would there be anyone left to do prehospital care...)

Cool idea for a special student, spouse, friend, or a partner. I certainly wouldn't use it at work- been known to lose a few pens.

Personally, I now prefer using the Gel-type pens because I like the way they write, and since we use a lap top for our PCR's I don't need to worry about bearing down to make 6 copies of the report. The smoothness and flow of the ink is like an expensive Cross pen, at a fraction of the cost.

This video made my laugh and smile quite a bit. Sorry it is in French, but the video speaks for itself.

http://www.liveleak.com/view?i=d4b_1244756800

LMAO

That's one of the funniest videos I've seen in a long time.

Thanks for the belly laugh.

In my neck of the woods there is no trauma hospital closer than a 1 hour flight. A FAST exam will help determine if we let bandaid ER deal with patient and ship or if we meet a plane or helicopter to take them. It is not hard to learn basic use of US. We are not doing extensive exams. If we wait till shock signs present delay to higher level can and will occur. For frontier medicine a definite plus. In the city where choice of hospital only changes transport 5-15 minutes MOI could justify just going to trauma hospital, so not a real need for spending the money.

I agree that the potential benefits would be more for a rural area and a long transport time. Problem is, I would hate to be the one who has to "decide" whether or not to transport to a Level 1 based on the findings of an US exam. I would think that like any skill, you would need to be pretty darn proficient in not only your technique to obtain a quality study, but your ability to interpret the results. Like was mentioned, that would mean using the device on multiple patients to keep you sharp.

As you mentioned, by the time you could see fluid/air/blood on an US, wouldn't the person already be exhibiting signs of an internal injury and warrant a trip to a trauma center or you would already suspect such a problem based on MOI?

I'm also am certainly no expert on US- I could barely make out pictures of my unborn kids much less an internal bleed. LOL

In my EMT-B class in MI, we were taught that slow steady traction would be applied (only one attempt), and then when the pedal pulse had returned, you slowly release the traction, splint in place and transport.

We were further taught that ortho only needs about a 75% overlay to consider the fracture 'properly reduced'. Anything above the 75% was just 'gravy'.

I don't know what the 'rule' is here in GA, as we haven't covered that yet.

While we're taught this information, it was explained that the muscles contracting is what has caused the fracture to become misaligned, and that by slowly providing traction, we get the muscle to lengthen, and thereby allow the bone ends to relatively 'fall back into place'.

In 12 years, I've never had to perform this procedure, but I'm sure that it's gonna hurt like hell!

As far as a pelvic fracture, we're taught that an inverted KED works well to stabilize the fracture long enough for transport.

I was also taught that traction splints like the Sager and Hare were for simple femur fx, and that for simple tib/fib, we should use a long padded splint to stabilize the joint above (knee) and joint below (ankle).

An inverted KED for a pelvic fx? Interesting. I never heard of that before.

I have never actually used a KED in a strictly auto accident setting- the method I was trained for. I have used it to immobilize guys who fell into elevator shafts or holes- works great for that.

I've used a KED/long board for immobilizing infants many times- akin to the "Papoose board" used to keep kids still in an ER. Works great- the kids don't move at all.

Thanks for the tip- I'll need to consider the KED the next time we have a pelvic fx.

Herbie, you make some good points. A strike is always a dangerous situation, and there is always collateral damage.

One of the dangers is that like any business, when a business starts to fail, it isn't the good employees who stay.... they are the ones capable of finding employment elsewhere, and generally have the drive to do so. In the long run, if things continue to circle the drain, the employer is left with those employees who are not the cream of the crop. This is a very real situation in this case, especially with the TILMA regulations which include EMS workers, making it easier for those certified in BC to move to Alberta to work in EMS (I am not getting into the whole ACP thing - I will let squint do that - he is so much better at that than I am).

That being said, we must remember the scope of this situation. This strike is regarding the ambulance service which covers an entire province. Some stats:

Serves a population of 4.3 million, and an area of 929 730 square kms (358,971 sq.mi).

3471 paramedics

470 ambulances

187 stations

9 aircraft

http://www.bcas.ca/assets/About/PDFs/Stati...mber%202008.pdf

The land base they cover is more than twice the size of California; the population may be less, but the coverage area is significant.

It is pretty easy to say "if you don't like the current wages where you work, then GET OUT, plain and simple."

So, if every medic was to quit, and move somewhere else, there would be a land base more than twice the size of california without emergency medical services. Although this would get the point across to the politicians involved here, the logistics of getting all 3500 medics out of BC is not possible.

The medics are working to provide a longer term solution; they are continuing to provide services to their communities - I have to give them credit for that.

Again- I'm not debating the merits of what these medics are asking for. The issue is, if the area has been doing without adequate EMS coverage for this long, for the standpoint of "management", I'm guessing their opinion is they can do without it at all.

Who is picking up the slack and providing care- ie nonunion providers, and if so, how many are there?

Obviously I'm playing devils advocate here- that's all I can do without knowing a lot more details.

This is a classic labor/management issue, and it's up to each provider to decide what's best for them. It's great to take a stand on something but if you have a family, they must come first and do what's best for them. If someone chooses to pick up and leave, that's their business.

I'm not equating sports with medical care, but some years ago, we had a football strike here and the owners simply hired replacement players to play for them. From a management standpoint, if they can hire "scabs" and not meet the demands of the strikers, that is exactly what they will do. Unless the medics can generate enough public sympathy- and in our business, PR is not our strong suit-I'm afraid that management has the upper hand here.

I wish them luck, but I think they also need to be realistic as to their expectations.

Well, after being on both sides of the labor/management issue, I think I am qualified to make a couple observations. First, I will not debate the specifics of the issues- it's not my fight, but I will always advocate for more money. Too many in this profession make a pittance, compared to what their job responsibilities are.

The problem with any job action is you need to know what is at stake BEFORE you make a move. If there has been no movement in 2 months on this, then clearly the providers are not in a very strong bargaining position. In a nutshell, I think the providers need to reassess their goals or they can very easily need to find a new career.

Strikes may be necessary in some cases, but there are very real consequences. The hard feelings, animosity, distrust, and angst never really go away and do a great deal of harm to the organizations involved.