Elite Members
  • Content count

  • Joined

  • Last visited

  • Days Won


Bieber last won the day on May 26 2013

Bieber had the most liked content!

Community Reputation

175 Excellent

About Bieber

  • Birthday 08/27/1986

Profile Information

  • Gender
  • Location
    The Midwest

Previous Fields

  • Occupation
    AAS, Paramedic
  1. Hello from Kansas

    Welcome! I'm from Kansas too. =) Hope you enjoy the forums.
  2. Newbie from Kansas

    Welcome to the forums! There sure are a lot of Kansans on here. =)
  3. Hi all

    Welcome to the forums! Good to see another Kansan here.
  4. Young is good. Naive is good. Naivity is the fountain from which novel ideas flow, unimpeded by the blockage of bitterness and inflexibility. As far as gullible goes, I think the greater harm here is to be gullible enough to really believe that single-digit survival rates are the best we can do, and that's exactly what we're getting out of tubes and drugs. That is the old way. It's time to try something new, something radical, and something which maybe, just maybe, will give us some real, dramatic increases in survivability. As far as anecdote... well, I don't really have much use for it, nor do I think many others on these forums do. I think that's why most people who come to these forums are attracted to them. Because at the heart of it, they come here seeking more than what they're finding in the EMS community today. Something more than the anecdote-filled, unscientific dogma and catch-phrase-filled culture that proliferates our industry... It's awesome that you're passionate about something, but at the end of the day, don't you want cardiac arrest survival and survival to discharge neurologically intact and with a good quality of life post-discharge to be something routine and not just a "handful in a career" type of deal? At the end of the day, most people who die die with good reason... they're old and infirm beyond what is compatible with life. But for some, we have a real chance at returning productive life to folks. Why squander that with unproven treatments like epinephrine, intubation, and transport of active-arrests? If we just start from the bottom, from the very basis of science, that nothing is true until it is proven, and work our way up from there, we will accomplish a million times more and uncover the truth to so much more than we will trying to insist on the veracity of something that (paradoxically) is proving very difficult to prove: that ETI is beneficial. What do we know works? I mean really KNOW, backed by irrefutable evidence? That chest compressions and defibrillation increases survivability. What do we NOT know works? What does NOT have irrefutable or unquestionable evidence? PPV, ETI, drugs. What do we know DOESN'T work? What has been discounted, disproven, etc? Transporting active arrests. Even you have to admit that there is a lot of questions surrounding the true benefit of ETI, when you start quantifying and qualifying it. Should we be routinely practicing that which has not been irrefutably proven true? Or should we strike it out and go with what we KNOW, and treat everything else as "in need of testing" until proof of benefit appears?
  5. We've moved to doing CCR for the first 6 minutes of a code here, combined with a greatly decreased emphasis on intubation (as usual, to the chagrin of many paramedics). As a result of this, our ROSC rate has I believe doubled. As far as intubation or PPV, I'm still waiting to see evidence that they are beneficial to the vast majority of SCA victims... It seems like from what I understand of the science and from having listened to Dr. Ewy (one of the creators of CCR) that there's really not a tremendous need for PPV in the vast majority of SCA patients. (And it sounds like avoiding PPV also helps to avoid a "vomitcano" as well.) The tube is fun, the drugs are fun, but where's the evidence to support their use? We can mix and mash the data however we want, but the fact is cardiac arrest survival rates have stayed dismally low since we first began resuscitating people... the only systems I have heard of who have managed to defy this trend are those with either very high laypeople CPR rates, or places where CCR, therapeutic hypothermia, etc are being done. If we have to get all of the stars lined up just right to try and make intubation of SCA patients something beneficial, and its benefit isn't so great as to be intrinsic to most cardiac arrest scenarios, and if survival rates haven't improved since we've been doing it, is it really this horse we ought to keep beating to death?
  6. What do you do with psych patients?

    Sounds like you need to change your protocols, then. Do you at least have sedatives/antipsychotics available to you by standing order to use if you need to? It sounds like the system isn't working in your area. Protocols, policies and guidelines are meant to make the system work efficiently and effectively; if they're no longer doing that (or haven't ever done that) then it's time to get management involved. How else can you provide the kind of care this patient needs?
  7. chest pain bad, nitrates good

    I share your frustration and I agree with you wholeheartedly. We should not be treating patients with chest pain with aspirin and nitro; rather, we need to get it into our heads that that is the treatment for patients complaining of ACS. Not all chest pain is ACS, and not all ACS includes chest pain. Kaisu, that's pretty messed up. But the only way to combat the anti-clinician mentality is to make that kind of mindset unacceptable among ourselves.
  8. Hello of an EMT from Paris, France !

    Stay and play?! What treachery is this? If patients could be competently managed on scene for extended periods of time by ambulance services... why that would mean that all of us blazing through the streets lights and sirens have been risking our lives for nothing! =) Bienvenue to the forum! I'd love to hear more about the French take on emergency medical/mobile health services. Tell us more about how you guys run your calls. What's your average scene time? What treatments do you provide on scene versus en route? Do you guys have mandatory scene times? What about for trauma calls? What is the criteria for lights and sirens use for you?
  9. Experience with hydrocephalic patients?

    I've dealt with a number of hydrocephalic patients, though the only time it was ever for complications due to hydrocephaly was when I was still in school and a patient was having a shunt worked on.
  10. Drugs for agitated patients?

    Sequel, did you just give Haldol or Haldol + a benzodiazepine?
  11. Antivenoms

    I'm gonna guess probably not. It's not a real common thing around here so I know we don't, but I've never heard of any EMS services carrying antivenom. I think it's frequently EXTREMELY expensive... like tens of thousands of dollars per treatment... but I'm not that up to date on it. Hopefully someone else can come along with more knowledge on this subject than me.
  12. IO access

    We use the EZ IO, and I love it! Done it half a dozen times or so now... Looking forward to us going to that first-line for cardiac arrests. I practiced with the BIG and the manual IO's... prefer the EZ. I've only ever placed them in the tibia, but I know some people have done them in the humerus as well.
  13. Baby Paramedic

    Welcome to the forums!