armymedic571

QUOTE (Dustdevil)The unfortunate truth is that, no matter how fast your connection is, EMT City is quite possibly the slowest website on earth. :?

Loads quickly here and on my verizon card.

Just goes to show that Verizon is Evil........

But then again. My Verizon DSL works pretty good.

In large parts of the country, that answer is a resounding "No!"

Isn't that kind of pessemistic?

OK, folks, we all know and understand (or at least I hope we do), every jurisdiction has different numbers of "Standing Orders" available before contact to their On Line Medical Control is mandated. Somewhere they all end up in a "Mother/Father, May I?" scenario.

OLMC is a nice thing, and is there to be utilized.

I also understand, some jurisdictions do not have an OLMC, and field personnel are trained to higher levels to make up for that. Army Medics and Navy Corpsmen (and presuming that the word exists, Corpswomen) fall under that classification.

I am not following your point? Isn't that what we've been saying?

The problem is that then you have the exact opposite. Places where all of the standing orders can be fit on a single page or two with mandated online medical control for everything pasted a stubbed toe.

Still......a little extreme. I hope there aren't any systems really like that.

Are you not allowed to think for yourself? While laws may vary by jurisdiction I think that this is totally unnecessary. I am a very strong advocate for patient rights, if somebody does not want something done then they do not have to be subject to it; whether its taking a blood pressure or resuscitation from cardiac arrest.

Whilst our legal system is more flexible and we have no "online medical command" to speak of, let alone call up, here is how we are directed

Quite the contrary, Kiwi.

We are able to think, which is why we can call Medical Command. The point here is that we have several types of DNR's, advanced directives and Living wills. But, as EMS providers we are only "Legally" able to accept a specific type. In which it must be filled out exactly as prescribed with original signatures.

Because we very seldom come across patients that actually have this, I was trying to say that based off of Patient/Family wishes, presentation and pt status. You should call Medical Command, paint your picture (argue your case) and allow the MD to allow you to Cease efforts if that is what has been decided.

This is about not only knowing our protocols and standing orders, but having good assessment and history taking skills, and the mannerisms to communicat effectively with Medical command to do what is in the patients best interests when our protocols would otherwise not allow it.

Sorry for the confusion.

so if i remember right there different levels of the DNR. Are there? Do they very for each person?

Not different levels. Just different types. BUT, this depends on the state.

In the end, what is important, is that depending on pt status, presentation and wishes (or family wishes). Call Medical Command, and let them make the decision. Most reasonable ER Docs will see your case and grant the patients, or families wishes.

Oldman,

Welcome to the NR. You got audited......

Is it supposed to be random, but I have been audited twice. Once as an EMT-B, and once as a Paramedic. It happens. The only people that really ever seem to have problems are those that pencil whip their forms. Which in your case, is not the case........lol

OK Jake, you got me.......Especially since I amin the Army, and I know how true that is...........hahahaha.

I don't see how a DNR can not be honored. Its a legal doucement and who is the county government to say that a EMT B can not honor it that is just stupid!

As I had previously stated, in some locales, there are specific protocols and types of DNR's that EMS can/cannot accept. Also, there are rules, like the document must be signed and that it must be present.

Furthermore, one can always call Medical Command and run the situation past him/her as to the patients current status, Hx and family wishes.

I see your point, but it is not stupid. Its the law.

This is a very complex issue. Mostly because laws are so various between states. Also, because it is an emotional issue.

I believe it was AK that said , you need to keep your emotions and feelings out of the equation. Regardless of what you believe, everyone owes a death. PERIOD.

I find that the issue is more of patient education and advocacy by the pt's family and family physician. In the state of PA we have two types of DNR's (IN-hospital and Out of Hospital)

By law, EMS is not legally bound to honor in hospital DNR's, Living wills and the like. As a matter of fact, we can be found negligent if we do. Now, if we arrive on scene and the family has the paperwork and is insisting, do the right thing. Start BLS and call Medical Command. Ultimitely, the ER Doc can honor those wishes.

The second is that many families and patients don't ever know about the Out of Hospital DNR. This is one that must be requested from the Department of Health, and has the Department seal on it. It must be filled out in its entirety, have all original signatures, and be physically present upon EMS arrival. Now, how often do you think that actaully happens.

At the end of the day, you have to ask yourself, are you a patient advocate? Sometimes, it is just time to let them go. Just know the rules surrounding DNR's and Living wills in your area!

Remember, don't mourn death, celebrate life.

Holy Crap. I have been reading this thread for a week or so now, trying to decide when to interject my opinion? Forget it, I've got nothing .........................................................................

Avoid "palming" the breast. Try to only contact with the back of your hand and use clothes, towel or sheet to move the breast or have the patient move it.

This is an excellent point. If anyone watched the video, you will notice that the provider on the video did just that.

As Vent has already stated. The key word is "Professional". Something that seems to be lacking........

Good Topic.. Hope everyone has a good day.

J

This is an issue that goes far beyond what language an EMT test is given. It speaks to the overall settling for sub-par standards that has become epidemic in this country. The number one topic for discussion on this site is the struggle to gain respect as professionals, the lack of consistency in education, how the EMS industry needs to change it's perspective and focus, to take charge of it's future in professional healthcare. Well, providing education and/or professional certification/licensure testing in languages other than English is in direct opposition to all of those goals. It's a broader issue than simple testing - it's about professional standards and it parallels the standards for our society. Any state or national governing body that bestows certification and/or licensing of medical professionals should require candidates to possess the ability to "read, write, speak, and understand words in ordinary usage in the English language." (from the Requirements for US Citizenship) This is not asking anything remarkable as those same skills are necessary to perform the duties of an EMT in this country. (All legal documentation in the US must be filed in English.) Rudimentary English performance (i.e. high-school level) is required for entry to Paramedic program offered through any community college, as it is for entry to any secondary education institution. Why should not the same standards be met at the EMT level? When it comes right down to it, this is just another reason why we need to officially designate English as our national language. But, oh no! Can't do that!

Apparently, it is okay for other countries to have an official national language, but if the United States tried to establish English as its official language it is racist. One must see a paradox here. The problem with a bilingual society is that it causes a division in that society. I am sure we would all prefer a united country, but if we continue to accept this idea that it is racist to even consider the possibility of an official national language of the United States then our society will split in two.

Liberals and groups that accuse people like me of being racist, and xenophobic (If you know what xenophobia is then you would see how ridiculous this accusation is) support division in our society. These people support segregation. Liberals see African-American, Asian-American, Mexican-American, ect… I just see Americans united as people of one nation under one flag. For the sake of keeping our society united why is the concept of an official language so difficult for some unless their true intentions are to segregate society, and to divide our country? This problem has nothing to do with ethnicity, and the only people making this a racial issue are those who continue to throw in the race card.

P.S. While I agree, in some respects, with the OP's standing, he/she has a long way to go in presenting a respectable platform. I would highly suggest that, before again attacking anything language-related, you invest in your own literacy. It is in extremely poor taste to question another's intelligence based on language ability when you seem unable to communicate in a complete sentence yourself.

And as to whoever it was that felt the need to resort to vulgarity in their post - if you don't have enough command of the English language to find a more appropriate and intelligent way to get your point across, than your statements lose any efficacy.

Maverick,

That was an excellent post. As you and I have traveled some of the same scenery, I cannot agree more with your opinion on this subject. It would be nice if we (professional EMS providers), could all get on the same page and uphold the standards in which we are attempting to set.

I see several problems with this.

1. Many soldiers/marines with PTSD are already on multiple medications that they must self administer in austere environments. Initially, they (the military medical community) will try to treat these patients in theatre while many are still actively doing their jobs.

2. The addictive nature of morphine, combined with the fact that soldiers/marines are already at risk for substance abuse only raises more questions. Expecially in light that substance related suicides and serious incidence has risen dramatically over the last 5 years.

3. Having had first hand experiences with PTSD, medicated soldiers and the military medical community, I think knowing what the mechanism of action is before more trials are done is the most appropriate thing to do. This is for the safety of everyone concerned.

"Researchers have been testing ways to treat it, and the new study looked at whether fast and strong pain relief can help prevent it"

It sounds to me that some Navy MD is ust giving morphine to see what happens. Sounds crazy, but I have seen this happen.

Otherwise...This is interesting material. I just wish we weren't being used as test-rats.

Your best bet is to establish a line at KVO of an isotonic (non-dextrose ) containing solution assuming a normal blood sugar. While the concept of HHH therapy may apply in some cases, doing so in the pre-hospital environment is not a good idea. In fact, staying away from messing with blood pressure is a good idea. If hypotension or a fluid volume deficit exists, give fluids by all means, but overhydration with IV fluids and all that crazy stuff is not for the pre-hospital environment.

Do not get crazy with fluids guys unless you need to correct a deficit.

Take care,

chbare.

Tsk,

To add to what chbare was saying. Here is the basic concept: CPP (Cerebral Perfusing Pressure)=MAP (Mean Arterial Pressure)-ICP (Intercranial Pressure).

The basic theory behind the HHH therapy is to increase CPP to keep an appropraite level of perfusion going by increasing the MAP through IV therapy. This is important because in the case of a stroke it will help reduce the size of the penumbra. HOWEVER.....this is not something that should be attempted in the field. An ICP monitor needs to used, and we have to differentiate between a bleed or an occlusion before we start messing with the blood pressure. Not to mention other factors, like ( heart failure, Beta blocker use by the pt, etc).

Like I said, this a basic overview. There is a lot more to it, and to be honest. I don't think I fully understand it. So, I may not be the right person to try and explain it.

My system discussed this type of therapy in the past, and you can call Medical command with the request but, this is not something I would do lightly. Your exam needs to be extremely thorough, and depending on transport times and such you could be taking away from pt care trying to accomplish a full neuro exam.

Anyway, just a thought. This could have something to do with what you read.....Or I could be in left field. Which wouldn't be the first time.

Scott,

Your right. The facts of this incident are not clear. Either way, it's a shame that things like this happen.

If I recall correctly, wasn't there a story in the paper a few weeks ago about a similar situation in which a pregnant female sat in a NY ED for a few hours, then went to a coffee shop where she dropped dead. And in that shop were two in uniform Dispatchers. Is this the same story or a seperate incident. Or....have the facts of this incident been skewed to the point of ridiculousness?

Regardless....This is poor, and criminal. The fact that they couldn't even be bothered to call for an ambulance is bad. Whether they were dispatchers, EMT's or Dr's of the year. Once they were asked to elp, they had a duty to act.

I know that every state has their own laws, but this goes to show. If you are not in this business to help people...Then why the hell are you here? Go work for Taco Bell.

I am going to have to agree with the don't treat theory....But, I am curious as to those who say that the pt was Asymptomatic? Are palpatations a symptom? That was the chief complaint that was used to summon EMS. So.....you really can't say that the pt was asymptomatic. Remember, what the patient, MS, Nurse considers an emergency may not fit your criteria, but that is not the point.

Once again, I would not have treated this pt. I don't think this should be symptomatic vs asymptomatic, but stable vs unstable.

Also---> why would you give adenosine to a 50 y/o with a HR of 130???? Sinus Tachycardia is not SVT. I think we need to start teaching some people how to sit on their drug boxes......

According to the President, we should get Hope and Change.......but I think that's pushing it......

for us here in central PA, we went to a mixed MICU/squad system from a squad system. This let us hire more Paramedics, but we had to lay off 9 EMT's. Because the new system went into effect on the first of Jan, guess when those EMT's got their pink slips.........YUP BOHICA.

Other than that, the new EMS act in PA is well, different. I am more interested in the new educational standards. Hopefuly, we go forwardds, and not backwards.

Whoops, there I go with hope and change again............

Croaker....nice clip. I like that movie.

I see your point about fire superiority, but it also encompasses speed, and violence of action. Meaning (as Maverick put it) some well placed shoots at the right time.

I think the point that you were trying to make before about weapons in EMS as a whole is this: we as pre-hospital providers stand at a pivotal cross-roads in the civil sevice-medical field. Albeit you may be a exceptional provider, clinician, and mentor. But, if doing the job at 0300 in the snow at 0 degrees on a Friday night, while you drunk patient swears profanities and this upsets you, unnerves you, or is just to much stress for anyone person. Than perhaps you are in the wrong career field.

I think the same analogy can be made for the tactical side. It is part of the job. Don't like it: 1) Become a nurse, or 2) Join the peace corp.

Anywho, just my 2 cents. Time to sleep. I have to get up at 0300 to bring some drunk guy to the trauma center.. Oh yeah, there's snow on the ground, and I am going to bring my Thesaurus.........haha.

Matt,

There is data and research on this. I would recommend searching "point of wounding care". The US military (for obvious reasons) has done quite a bit of research on this topic. There are some published reports that are unclassified. A google search should yield them.

I will state that these are military studies, and may/maynot correlate to the civilian tactical system you are looking into.

Also....In most tactical medical references that I have read, and practically every class on the subject I have ever taken or taught-----> Fire Superiority is the BEST Medicine on the field.

Let me know how your search goes, I will try to PM you with some of the studies that I have, although they maybe a year or two old.

Croaker....

Didn't realize that this was such an emotional issue for you..... . I re-read all the posts, and don't see where this was an emotional issue?

I am not really sure what you are getting at?

If your a Medic look here...

http://www.evanhospital.com/jobs/

Central PA. Nice area, good call volume. 911 hospital based system that is Squad truck/MICU based. Decent salary/benefits from the hospital.

In my area we have done both.....

Providing tactical medical care in both the military and civilian settings, I can say that haeing medics on your team works either way.

As chbare already stated. 97% of a tactical medics works is done in the planning process, preforming day-to-day routine care for the team, preparing the medical threat assessment, and ensuring that your team mates are fit to do their jobs. If you are on a team that employees medics that stack. I find that most common theme is that these providers are cross-trained.

Specifically, in my area we (Medics) train with the LEO, and up to a certain point must have professional LEO training (to include lethal weapons training). When we started this, our medics did not carry, but becuase we had trained with our counterparts, we knew that if we needed to utilize a weapon, then we were properally trained and proficient on that piece of equipment.

Now that some of us are fully trained, we carry when ever we are performing as SWAT Medics.

Once again, your SOP's and procedures need to be set. Cross training is key. I always argue for having medical personnel associated with the team carrying a weapon, because the best medical care under fire is fire superiority.......

At least that is my $0.02....

Ahem...

Canada...

That is all...

It still amazes me the discussions that persist on the need of EMS education in the USA. These discussions don't happen in Ontario (and I would imagine the rest of Canada). You don't hear people trying to rationalize away the need for a 2 year college diploma to be BLS in Ontario. The need for a further 1-2 years to be ALS or critical care. You don't want to do the education? You aren't in EMS, period. There is NO ONE educated in Ontario in paramedicine in the last 10 years (well, there are a very small minority with less but anyway) that DOES NOT have a 2 year college degree MINIMUM to work BLS in the province.

The fact of the matter is that the vast majority of the people that post on this forum would never be able to work in Ontario, or a large portion of Canada without totally restarting the educational process.

Oh, and save the "arrogant Canadian" post that I'm sure will come up.

HAhahahahahahahahahahaha. I love this.

More to the point, I think your proving our point for us.

What some people on th is forum fail to realize is that, yes you can JUST get a cert. and play paramedic, but doesn't make it right. Increasing our professional standards is the only way to improve our profession.

It is the only way to improve scope of practice, patient care, and yes pay/benefits.

Maybe my rep will go to hell like Diazepam for saying this, but maybe we can learn a thing or two from our friends up North.

PS-I served with some brothers in arms from the Canadian Military. Arrogent.... Never. You just have to understand the sense of humor.........

You also failed to calculate what advancements in education can bring someone in terms of salary. You are essentially calculating on a blue collar basis. Someone who holds a degree can advance quickly through the FD ranks to an impressive salary toward their retirement, much more than a basic FF. Those wages that even a FF makes now may be small fry in 10 years. Also, as far as Southern CA, one can just pull all that OT just so long to make ends meet as a FF. They are by far not the better paid in that state when compared with other places.

Vent. This is a good point, but I need to remind everyone that there are still areas in th is country where your education, no matter how impressive, means nothing....

Unfortunate, but true.