melclin

Sure does. I gotcha now

Ah yes I see now that it was "secure the airway". I read it as "secure the airway adjunct" for some reason (I was imaging tying some tape around an OPA to hold it in place). I'm still curious by what exactly medichopeful meant by "secure the airway" though.

They look even better on your plate covered in BBQ sauce. But don't even mention the drop bears. Those things are bloody vicious. Nasty as Bob Brown's wife I reckon.

Since when do you secure an OPA/NPA?

Is this not high school chemistry in the states? I sure hated it at the time (electron shell filling patterns and I did not get along) but I'm glad as hell I did it.

In vents absence, this is an absolutely brilliant website (1). It took me a while to truly understand some of it. You may need to sit there with another google window open while you're reading it to plug in terms and ideas as they come up. I haven't looked through most of these links, but there's some good stuff there not specific to resp physiology but just good links in general (2). (1) http://www.ccmtutorials.com/rs/oxygen/index.htm (2) http://forums.studentdoctor.net/showthread.php?t=16494

I call shotgun on the term "Astromedic" ... for when space nannas NOF themselves.

As a point of uninteresting trivia... Oxygen concentration does change with altitude above the turbopause because the thinning atmosphere reduces molecular interaction, allowing the the elements to stratify based on molecular weight. I was talking about altitude related physiology with an atmospheric science major friend of mine after reading Into Thin Air and she broke out that gem after I stated emphatically that FiO2 does not change at altitude, to which I replied with a barrage of Doritos. ...Prrrobbbably not going to affect Denver though...

And how! +1

Ah! But would you look as pretty doing it? We'd have to hide you in a box and give you a darth vader voice changer - wizard of oz style - and setup a projector with a windows media visualization on it that responds to your voice.

Maybe I missed it, but are they talking about using Siren Live? We use that here. It doesn't seem to be particularly popular. I don't know anything about its efficacy. Sure does make impressive visualizations to project on the walls of comms centres for PR shots though

This has already been said, but in the midst some complexity, so just to be clear, PaO2 is the partial pressure, not the amount, of oxygen (although they do obviously share a relationship). Do you understand the various gas laws and the concept of partial pressures and equilibrium reactions in chemistry in general? That's something you'd wanna cover before hand, other wise half this stuff won't make any sense. I don't know where you stand educationally; I don't mean this to sound condescending.

I like to take opportunities like that to figure out why it is that it was the right thing to do - its always more interesting just after a 'realistic' scenario. Grab a textbook, or Google some terms to get familiar with a few of the important concepts involved. 'Tidal volume' and 'anatomical dead space' are the things to be Googling if you don't understand them already. I don't don't know where you're at education wise, but the difference between 'hyperventilation' and 'tachypnea'; and 'ventilation' and 'oxygenation' are fundamentally important to understand too. There seems to be a lot of conflict regarding these relatively simple ideas and it is potentially very dangerous for the pt if their EMT acts on a faulty understanding of these ideas.

Sgt Pepperpants strikes again eh Ben?

Yep, every type of HCP with access to narcs will end up with a few bad apples getting nicked for sampling the merch. Its unfortunate but at least there has yet to be a case of paramedics here treating pts while being heffed up on their own goof balls. Fingers crossed it stays that way.

Man the ROFL copters, we have incoming LOL. hehehe, golden.

That's not terribly different to what we have now. Our Red ('priority zero' is only for cardiac arrest to my knowledge), and there is too much in our Yellow (Code 1). It would be good to see one or two things moved from Code 1 to P0, and from Code 1 to Code 2. I feel like Code 3s are the domain of the NEPT people/primary care referral and for the most part they seem to be. The ambulance service doesn't seem to get that many code 3, not so many that it cripples us. Although there are a great deal of Code 2 that should be Code 3s or nothing at all. I went to a job recently, where the guy had fallen over and grazed his knee the day before at the market, he got up finished his shopping, drove home, put a band aid on it and took some panadol. The next day at about 13:00 one of his friends calls the ambulance (I get the feeling she thought they'd get in quicker if she did). No pain, no dangerous body area, no problems with mobility and ample opportunity to to seek help themselves. He could drive and he had three other people there who could drive. How is that a Code 2? I would very much agree with this although I think it depends what you mean by public access. I think AEDs have a place on first aid teams at big events, with life guards at big beaches etc. As for having one tucked away in the first aid cabinet at a shopping centre...I cant see that helping to be honest. In any case I think this will become less of an issue as AEDs become cheaper. Eventually they'll be so cheap that diverting money away from them would be a drop in the ocean when you added it to the budget of the an an ALS service. In that case what little benefit they do have may become worth it if each unit only sets you back an insignificant amount of money.

Timmy, Yes public health is difficult. Its a long hard slog, but it does work. I would dispute you evaluation of the efficacy of slip, slop, slap and a few others. 15 or more years ago, it was just a given that when you went to the beach you got burnt. I think for the most part now, people use sunscreen much more, in no small part due to things like the cancer and slip,slop slap campaigns. I think they work, but that's not the only thing I was talking about. I mean long term strategies like teaching appropriate ambulance use in schools. AV currently provides day seminar type things for school kids of different ages, which is good, but I'd like to see more than that. Understanding the role of all the emergency services is important. Maybe it should be part of a "now you've turned 18/21 and you're a real person here's a stupid course/test (cert 2 first aid, P's driving test, knowledge of welfare/health and governmental systems, including appropriate activation of 000 services, resume writing, making sure you can bowl properly so you don't end up making a d**k of yourself when you become a politician and visit the troops in Afghanistan, you know .. the basics). Until you pass it, you don't get to be an adult (drink, drive, be a bloody idiot). It could be quite a significant milestone to pass, like VCE/HSE etc and probably more useful to some. Probably a stupid idea, I'm not sure, I'm no educator, but I'd like to see more educations on the fundamentals of our society in high schools. PS Sounds like great experience in the ED. Mind PMing me your location, just out of interest? Kiwi, I agree with you mate, and we've talked about this before. What I was getting at was how you apply an evidence base to figuring out what the balance is between, as you say, 1, the fact that few things really require an L/S type quick response; and 2, not letting the previous notion become an excuse to degrade the quality of services. Actually having a system of response time based on evidence, seems immensely difficult to me. Not saying its impossible, but I sure wouldn't like to have to write the ethics approval forms for the studies required, that's for sure.

I wasn't me that they are "killing patients", it was a heading for the post, paraphrased from the articles; a sentiment that I happen to disagree with. The quotation marks at the very least suggest that I am quoting/paraphrasing someone else, and also infer a certain amount of sarcasm, which I would have thought would be obvious given the context. REGARDING THE ARTICLE POST I think given the different types of cases seen in EMS, its difficult, if not impossible to suggest certain single response times are better overall. As you have said, different conditions may require different 'ideal' (what ever that means) times and I think it may be worth putting a greater emphasis on response times to different conditions. Putting "respiratory distress" in the same category as "MI" and as "cardiac arrest" is probably not the greatest of ideas. But then how you apply all that to practical issues like whether or not you should spend the money on ambulance station 1.5 when 1 and 2 can't cover their areas, I don't know. One thing I do think is that it is completely impractical to spend the money on putting enough ALS ambulances around a given area to provide adequate response times for satisfactory (what ever that may mean) cardiac arrest survival (probably..what? 2-4 minutes). That's just impossible in most modern cities, let alone rurally. This, I think (especially with the new emphasis on good compressions instead of drugs/intubation etc), is where better public CPR education and more initiatives like Community Emergency Response Teams/Workplace Response teams (O2, AED, Aspirin, Albuterol - first aid) would be better than adding to the professional emergency Ambulance compliment. eg maybe it is okay to have a 25 minute response time to a (?)AMI, if the work place response team can get there in 3 minutes to be there to give ASA/resuscitation should the person peg out; maybe a 15 minute cardiac arrest response time is acceptable if the School First aid team get to the teacher in 1:30 with a pair of hands and an AED. How you get evidence to validate or disprove that kind of idea, however, seems like an ethical and methodological nightmare. As an aside I always thought the idea of the golden hour was an.. ah, metaphor isn't the right word (but you know what I mean) for the fact that reducing scene/transport time for trauma patients was often an important consideration. I was so surprised when I started coming on these forums and people talked about the golden hour like 60 minutes was literally the amount of time a 'trauma pt' (specifics and severity of their injuries be damned) had before their injuries got the best of them. Then that people felt the need to refute the idea. Was it ever seriously suggested that specifically 60 minutes was the be all and end all (I mean by educated people, I can certainly see some 'EMT instructor' somewhere suggesting that to be the case)? stcommodore - I think you're right to a certain extent. The problem though is that they do call for those things. So how do you reduce the unnecessary waste of resources without sacrificing patient care. - Firstly I think public education is a good idea. There is almost no decent education out there to teach people when calling an ambulance is appropriate. You get those adds from time to time that say "If chest pain dial 000" but that's not really what I'm getting at. They need to know that they won't be seen faster if they go in on an ambulance. They need to know that we are not a taxi service for the mildly unwell and barely injured. At the same time they need to know that when grandpa's left arm stops working and he can't speak properly, that they shouldn't make a Dr's appointment for three weeks down the track. I don't want to turn everyone into MDs but people should be provided with the education to manage their own healthcare to some degree. How exactly, I'm not sure, that's one for the public health boffins. - Secondly, an evidence based (not litigiously based) primary care referral system via 911/000 would also be good ie, "Sir, do you feel that the back pain you have had since 1972 would be better addressed by your GP tomorrow instead of by an L/S Ambulance right now? You do? Good. Now here's an appointment with your GP and don't hesitate to call again " (we have one now to a certain extend, but you'd never know it from the paramedic point of view). - Thirdly, increased scope for paramedics to refuse transport, perhaps not in the US yet, but here, increasingly paramedics have enough education such that we really should be protected if we say, "Look I'm sorry you fell over an grazed your knee yesterday, but this is the only emergency ambulance in the rural-town-of-where-ever and it will take ~40minutes to transport/hand you over/do your paper work, time in which we will not be adequately prepared or positioned to deal with a more serious case. You can walk well and there are three people here who can drive you to hospital/your GP, have a nice day and don't hesitate to call again". (again we have this sort of, in theory, partly, maybe. We aren't specifically allowed to say NO to a person who really wants to go to hospital, but we can convince them (with varying degrees of enthusiasm, depending on who you talk to) that they don't need us. It seems, though that most paramedics just don't want to put up with the arse kicking they'll get from their SO if a complaint is made and that's fair enough, nobody wants to sacrifice their career progression over it). The third is something that needs to happen more often in health care in general. People need to suck it up, and health care professionals need to be able to tell them that, politely of course, without suffering from the repercussions of complaints or, god forbid, litigation. You grazed knees, you sore throats, your itchy arms your flus etc. I must say that, while I agree with universal health care one of the problems in our system is that patients and HCPs alike seem to think that because they never see money change hands, that the $1000 worth of blood tests they ordered for a pt with the flu are actually free, but that's another discussion.

To be clear, I wasn't saying that poor response times are killing people. I was commenting that the old horse has been brought out for a little more flogging. Every now and then something like this happens and gets on the news and everyone crows 'response times', 'response time', "Wont someone please think of the CHILDREN', then someone orders an inquiry and some politician in a suit and a carefully chosen hard hat or reflective vest on a work site somewhere announces a new response time target which gets forced upon the service, ignoring more pressing issues.

Recently there have been a run of stories making the news about poor response times having negative effects on patients lately. I know from having spoken to some of the people at the branches involved that there are mistakes in the news articles, so just be aware that all the details are not necessarily accurate. To my knowledge this high profile case got the recent wave kicked off: http://www.perthnow....c-1225811325666 followed by this: http://www.heraldsun...x-1225811523632 and this and probably others: http://www.heraldsun...x-1225811906644 To a certain extent I think you have to accept that if you live in the sticks, you just aren't going to get an ambulance when you click you fingers. Still, from what I've heard there are some pretty significant resourcing difficulties all over the service but especially in the rural sector.

Yeah that sound pretty much right. I always bring a extra pair of undies lest I do something wrong and get a new arse hole torn for me . I sat in one of my medic's seats at the branch once and got chewed out for about five minutes. I reckon there's more room for us to use the cases we go to for extended learning. I like to look the up whatever the issue was, go over the differential and treatment and look at what I should do next time. Its a more interesting way of learning when you've just seen the problem you're now reading about. I'd like to see that sort of thing as an official assignment, rather than the short thesis of a bloody reflective journal that I have to write. "How did you feel about you placement"

So I just got back from placements in Traralgon and I asked everyone about this question and talked a little about the "student issue". First of all, every single one of the ~9 paramedics I asked were unequivocal when I asked them VU or Monash (Monash was the winner there), and they all seemed to have a nasty anecdote about a VU student. To Bushy, re that discussion we had a while back, one of my CIs told me about a student (VU) who wouldn't check the truck, wouldn't run scenarios, wouldn't do signal threes, had a massive superiority complex and was generally unlikable (basically all the stuff you were talking about, so nothing new there, but I was still a little shocked that is seems to happen a bit more than I expected), but get this, she wouldn't go out on a code:1 severe resp distress because she had quote "seen respiratory distress before". I'm not questioning the accuracy of the story, but I find it so hard to believe that their are people out their like that.

hehe speak of the devil, thats funny I would have said that Monash could stand to have a little less fluff and more science (not compared to VU, just in general). Some of the fluff is good. Health theory and health systems, were really good looks at the global, national and grass routes influences of health as well as how the systems, whether it be medicare, PBS, primary care etc, all fit together, what actually out there and why. I note that, as of this year, VU appears to have a first year far more similar to our first year than previously, in regards to a subject like this. All in all though, the actual quality of the education that you get in those classes really depends on the people teaching them, and its really impossible to figure all that out before you start. That difficult-to-quantify 'better education' is something Monash does better I feel. Peavey do a high gain amp with all the same stats as a Mesa/Boogie Dual rectifier, in fact the Peavey has a few more features (analogous to VUs better facilities), but 'on paper' stats and features does not a Mesa/Boogie make. M/B have been making high quality gear better and for longer - its worth the extra cash - and Monash doesn't even cost more. Forgive my amplification metaphor, it had to happen one of these days. Just wait till I use power amp negative feed back as a metphor for biofeedback. But chaser, you should speak to someone who bats for the other team, so to speak, to get the other side of the story, just try not have it be the VU sales rep.

First of all, as you probably know, I go to Monash so I have an obvious bias. In terms of how the universities are regarded, Monash is the 4 best uni is Australia and ranked 45 in the world. VU doesn't even make the top 20 and from memory it doesn't make the top 500 in the world. While this may not have a direct relationship to how good a paramedic program they have, it still counts. If you want to do a nursing crossover, post graduate work, research, are applying for a job in other areas, maybe even paramedic jobs in other states, go on to do ECP/paramedic practitioner/M-Physicians Assistant, the fact that you went to Monash will probably count in your favour. VU was a technical college until not that long ago; most people don't even realize you can get a degree from there. I hear (and this is only hear say) that their recent history is reflected in their teaching ethos. They apparently are very skills orientated and tend not to teach the underlying A&P very well. I notice that they have recently put together a few pretend subjects (although Monash has been known to do this as well) to bolster the appearance of a broader education. They recently have started a system where by they rush you through in two years, I've heard nothing but bad things about those graduates (that said I don't hear a lot of good things about any graduates). I said to Mr.Brown/Kiwimedic a little while ago, that VU appears to be considered by some to be the Victorian "medic mill": massive program, focus on skill, not education and they churn out as many as fast as they can. That said, I don't think the reputation of the uni will affect you directly in the selection process for AV, but obviously a better program will provide a better education, and you will be better prepared for selection. From one MICA paramedic: "VU students seem to get on the road saying I can tube, I can suture, but you put them in front of a pt and they they're stuck. They're all skills and no knowledge. They get little bits of paper saying they can tube, which is useless, but they can't even do a GCS". From an ALS CI: "Yeah you can tell the difference between a Monash student and a VU student. The VU guys they know how to do everything, you tell them to set up a nebuliser and bang its done, but they don't know why. You can see Monash students thinking, trying to figure the pt out." (I've seen this myself running scenarios along side them. It was a triage exercise and they just really didn't seem to have a lot of important underlying knowledge that we take for granted at Monash. The affect of other disease processes on the pt chief complaint seemed to be a big one, eg diabetic neuropathy affecting the presentation of an AMI) You can kind of see how there is a running theme there. They undoubtedly have better equipment and facilities (although that's going to change in the next few years because Monash is getting worried about the competition from VU, but not by your first year), but that's not really what a degree is about. Do you choose a business degree because the uni has better desks to simulate the office work space? I think Monash has less quantifiable advantages, like the fact that many of our lecturers in other fields are more distinguished than VU, because Monash has more distinguished alumni. We've had a lot of input from the school of preventative medicine/epidemiology, simply because they're part of the same institution and its easy to do. Want ask a question on oxygen metabolism? Easy, just toddle over to the physiology department. Also handy is the fact that because we have a smaller program, most of us have easy, familiar relationships with our lecturers, which makes learning, getting extra prac/tute time, asking questions and getting involved in research much easier. You can make up for the inadequacies of either universities by your own effort. But trust me, it's a lot easier to make an effort to get a bit more practical time (like we do at Monash) than it is to make an effort to learn entire areas of important academic knowledge that are missed by lecturers (often because you're not even aware that they exist). As far as employment, be careful with what people tell you when it comes to numbers. There are many ways to warp the truth. For example, VU has a bigger program, so of course a higher percentage of the graduates that get employed are from VU than Monash. I'm not sure what the stats are on employment. We had 100% employment, before VU swamped the market with both 3rd year grads and 2nd year grads. Now its less, but I don't know how it compares to VU, to be honest. BushyFromOz would good to speak to on the topic of how Monash vs VU grads are viewed by the ambulance service, hopefully he chimes in for this thread. As far as Qualified paramedic/grad/student paramedic. The terminology got a bit skewed when the uni model came along and there was different terminology/programs used by MAS and RAV (from memory), and its been further confused from the uni student point of view, by the merger to form AV. Don't worry about it when choosing you degree, it makes no difference. But as to your question, when they are hired they are transition/grad/student/whatever paramedic, you have to complete your grad year/s (on the road with a Clinical Instructor ...theoretically) and satisfy the various outcome measures to qualify fully. Again Bushy is a much better person to be answering the post grad questions than I. I'll take the question about choosing degrees to mean your ENTER was high enough to afford you the choice...congrats.