jonas salk

There was a was Wall Street Journal article I read a few years ago about how the US armed forces has, in an effort to cut costs, established a program to determine how long drugs last post expiry date. What they found was that the vast majority were fine. Though the article also mentioned something i found interesting, that there were some drugs which the military made a conscious decisions not to use post expiry date due to possible PR ramifications. the main one being saline and ringers, that it would look absolutely terrible for an injured solider/sailor to look up in their bed to see that the NS drip running into their arm expired three years prior.

http://online.wsj.com/article/SB954201508530067326.html

what was his pressure? And what exactly is 'almost unconscious'?

For awhile there was a push from management (well the QA Sup) at my local service for Code 4 return on all CTAS 2 patients. The crews fought and fought, resisted and refused and eventually it was dropped with the BS CYA remark of: "fine but you could wear it as a result."

Where I work there's no policy at all. Code 4 return is entirely crews discretion and I've never had anyone question it. As a service, culturally we very rarely transport Code 4. CTAS 1, STEMI's and CVA's and non-STEMI ischemic CP's are usually it.

Code 4 response is at our discretion to but we tend to error on following dispatch since we've all been burned before. My last call of my last shift was a possible UTI, Code 4 due to drowsy. Arrived to find Pt GCS 5 x24 hrs, per-arrest. She was DNR but by moving quick and getting her in she was able to get BIPAP before she arrested and did end up being weaned and survived fr at least a few days. Extreme case certainly but I prefer arriving in a timely manner just to be sure.

I also had a big disagreement with a colleague on transporting active labour Code 4. I refuse in the case of uncomplicated labour. If we need to deliver we need to deliver but it's not worth the risk. He expressed not wanting to deliver in the Ambulance as justification. I pointed to the almost regular cases of unassisted home and side of the road births and that even contractions 2mins apart may be hours from delivery.

Things have changed with your service from when I was there, unless there is a cultural divide between the north and south with code 4 returns.

I would question whether this is truly a formal policy. It seems like in many services, things simply become accepted as the way things are done. Sometimes this is so strong that people will refer to a policy, but if you go digging you will find that none actually exists.

Certainly, the social pressures alone (without any formal policy) can still be quite strong. I am guilty of turning the lights on to call it a code 4 return with a chest pain patient when we're literally three blocks from the hospital. Why? Because it is the accepted practice at that service and to deviate from that would have either ruffled the feathers of my partner, the service, or the base hospital, despite there being no explicit policy requiring a code 4 return for all CTAS 2 patients. I know that that is not a good reason for a professional paramedic to do something that carries a degree of risk, but I have gotten to the point where I try to avoid conflict sometimes rather than trying to initiate change.

Yeah I'm certain it's not an official policy (hence the 'informal' part of the statement lol). The culture of my service is one where we rarely return code 4, whereas other services are on the other side of pendulum.

In four years I have seen only four people returned on a priority one

1) an anterior infarct who was crook

2) a young girl post seizure who was very unconscious

3) post cardiac arrest

4) a guy who amputated his atm

In the 1000+ hours I've worked already this year, I think i've done 4 code 4 returns.

I was talking to a friend from paramedic school and she was saying her service (in eastern ontario), any patient who gets SR of any kind is an automatic 4 return. Personally i found that insane, but each service has their own formal and informal P&P I suppose.

first thing i noticed while reading the article was that the patient was released the same day. On the surface it sounds like the crew was driving L&S with no real clinical indication for it.

Personally my threshold for a code 4 return is pretty high.

best piece of advice? Go to university, get a degree then come back to EMS when you're older.

kinda draconian to suspend a licence for drinking when it didn't involve driving. But that's just my opinion.

check out the OPALS study. You might find some decent information in it.

I had heard that service positions were paying better than they do in Ontario but i never expected that Tim Hortons would pay 18 bucks an hour.

The adage is true, the more you make the more you spend.

Jonus, what is your tax rate there? Do you get mugged, or is it comparable to the U.S? (25%-35%ish depending on income) where we also get mugged....

My tax rate is around 30%

I just did my taxes for 2011 and my total for the year (not including the non-taxable missed meal breaks awards etc) was $89k

~90k USD

~56kGBP

~109k NZD

There have been plenty of studies that show families are happier when they are involved with the resuscitation, even if it is just as a bystander. You have to judge the family you are dealing with. I can't say I've had family bag someone but it is an interesting thought.

they might do better than fire...

The lights on the truck look like ambers to me.

We have Ontario's DPCI 2 system. The call taker asks a few questions and then assigns a priority, code 3 or code 4 for 911 calls. Code 4 is L&S, code 3 is not. One of the questions the call taker asks is "is the person breathing normally". A surprisingly enough the majority of people will usually answer no. This makes the call an automatic code 4 SOB, and with it fire gets tiered.

We don't really have much option, if a call is classified as a code 4 we are supposed to drive L&S. Personally I hate driving code 4 for BS calls and will typically leave them off as long as possible. I'll also turn them off as soon as I get on side streets.

Family always* rides up front and as such it's physically impossible for them to interfere in patient care.

A few years ago I had a snowmobile vs tree call. Two guys were out having fun, one miss judged something and ended up hitting a tree at around 100 km/h. Severe chest wall trauma; pt was vsa when we arrived. HIs snowmobile friend identified himself as trauma fellow and insisted that we transport his friend. He was unable to produce id, but i took him at his word that he was a physician, i asked him what the prognosis would be for a patient with similar traumatic injuries who was 25-30 minutes away from a trauma centre, he agreed that it would most likely be called when we got there and accepted our field pronouncement.

Personally I find that if you act professionally and discuss the situation with the family member who identifies themselves as a HCP that usually reason prevails. It also gives you the opportunity to gauge if they're full of shit or not as a lot of people like to identify themselves as HCPs regardless of their educational background (or lack their of).

I also remember a situation a few months ago (thankfully i was just first response on this one), where a woman called 911 for her 13yo daughter because she was in SVT. Long and short of it is, the mother is a cardiac tech, her daughter had WPW in few months prior, had successful ablation, on this evening the daughter was a little jittery (admitted she had a 5 hour energy drink earlier in the day). When the daughter by herself she was in a a sinus tach at about 110, as soon as her mother would come back she would jump to 125. The mother kept on panicking and it made the daughter freak out a little as well.

Once the transport arrived, the mother obviously insisted on coming in the back of the truck but she also had her 6 year old son with her, so the as a safety compromise the mother rode up front and the son in the captain's chair. This also had the added benefit that the daughter was separated from the nervous mother.

*If the patient is a paed then I will allow a family member in the back.

She said he was initially alert but in pain. He went into cardiac arrest after being loaded into the ambulance. Morse said she performed cardiopulmonary resuscitation on him. The ambulance left for the hospital with her in the front passenger seat but she alleges ambulance personal left her on the side of the road after she asked to sit in the back and hold his hand as his condition worsened. She was told he died a few minutes later. SO Which was it???? Was she in the back doing CPR on her husband when he went into arrest""" OR was she in the front seat and asked to get out and get into the back to hold her husbands hand when his condition worsened ????? Way to many conflicting stories out there in the press.

I'm going to guess that he was c/o abdo pain, arrested as they loaded him into the truck, got a rosc, she jumped up front. Something changed, she asked to go to back, and then got left at the side of the road.

A lot of details are obviously missing. Somehow she ended up at the side of the road. Personally, regardless of how much of a bitch she is, i can't really think of any situation other than her physically assaulting the crew for her to end up at the side of the road. Particualrly since this was a mountain road during a snow storm.

The article referred to them as EMTs.

Also, wasn't the article a from an Ontario newspaper? If so, then the author may be assuming that the EMS system here is the same as Maine where we are all titled paramedics regardless of level (primary care paramedic, ACP, CCP).

Hello, The patient's wife is a NP with critical care expereince. Here is a better article:

http://thechronicleh...-ns-man-s-death

Personally, leaving the wife on the highway and returning to the ski hill was odd.A very sad case.Cheers

No one disputed that she was an NP. Personally if a loved one needed ems and all i got were 240 hr EMT-Bs i'd be pissed too.

Still 240 hours is not even close to being adequate; that's just a first aid course.

I find this unusual; many times we've taken the family member with us to hospital; it's just something normal here; in fact it's a breach of the patients legal rights not to allow this (unless they endanger the crew) and I think its unethical even if wasn't part of the law.

I'd say about 75% of the time I'd have no issues with taking family with us, however I often do suggest that it's better for the family to take their personal vehicle (if they have one) as it gives them better options to get home.

I was also thinking about this story as I was driving into work last night, one thing that struck me was that crew and the hospital stated that the weather was particularly bad, yet they opted to leave this woman at the side of the road during blizzard like conditions?

Personally I have issues with taking family in the ambulance with me, but my service demands that we do it unless there are specific criteria met (essentially there has to be a imminent danger to the crew to not transport a family member).

As for this case we don't know enough to pass judgement.

What is the educational requirement to be a basic EMT in Maine anyway?

Currently in Ontario we are phasing in our latest batch of medical directives, which includes medical TORs for BLS providers. Three no-shocks and we're on the phone getting the order. This new directive came about after a multi-year trial with several services in the province, where one of the questions the researchers were looking at was how patients families would react. What they found was that the majority of families preferred having the pronouncement done in the home. Families that had their loved ones transported, only to be pronounced within minutes of arriving, were mostly frustrated and reported having a sense of false hope that was destroyed once they arrived.

My ringtone is 'shipping up to boston', and typically speaking i never put it on silent. I've had a couple occasions where it's gone off while actively involved in patient care and when it does happen i typically just hit the silent button through my shirt.

I have answered the phone during a call before but it was for an overtime shift, I wasn't doing active patient care, just "monitoring" a CTAS 4 patient while enroute to the hospital. It may seem rude, but $60/hr is hard to turn down

As for the possibility of offending people, it's a fact of life. I'm not going to whip out my cell phone and have a ten minute conversation with my girlfriend while running a VSA or any type of call for that matter. In the case above the phone conversation lasted less than 45 seconds and it was a quick 'hey, i'm on a call.... ok i'll take the shift".

As for offending people, we recently had a patient file a complaint because while on offload delay one of the medics did a coffee run down to the cafeteria.