Bieber

An addendum to Rock's post for Dilaudid, since you mentioned it in your post about oxygen usage per your class: the AHA does not recommend routine use of oxygen in uncomplicated MI's. Theres evidence that it increases the size of the infarct and increases mortality.

I think it's not so much about what you "should" do (because that's an incredibly subjective term; no one can tell you what you "should" do but yourself), but rather what you "can" do and what you "want" to do. If EMS is where you're happy, and you feel like you belong, then stay here. If it doesn't appeal to you anymore or if you feel like there's something else you'd rather be doing, then go that route. It's YOUR life, and you live in the land of opportunity--make it whatever you want it to be.

-Chest Pain - Give 4 baby aspirin if available and get an ambulance. -Difficulty Breathing - Help with inhaler if person has one and get an ambulance. -Severe Stomach Pain/Vomiting Blood/Black Stool - Give nothing by mouth and get an ambulance. -Acting Strange/Not Themself - Get an ambulance. -Not Awake - Roll person onto their left side and get an ambulance. -Paralyzed on one side of their body - Get an ambulance. -Severe Bleeding - Stop the bleeding with pressure over the wound. -Broken Bone - Help the person get comfortable, get an ambulance. -Not Breathing - Start chest compressions, get an ambulance. Something like that, maybe, Dwayne?

To be honest, I'm not educated enough to really have an opinion on the matter, but I tend to think that having formal degrees and education will create a more mature and responsible staff than simply "time on" in life. Don't really have any studies or anything to back up that view, just seems to make more sense to me.

+100 Hallelujah! We're going to selective spinal immobilization--thank god--but I anxiously await the day when we will say goodbye to death boards forever.

I expect our new protocols to say something to the effect of "maintain spo2 at 94% or greater". Not even quite sure what our current protocol says... I just give it when I think it's appropriate and don't when I don't.

Touche! Still, it's very disheartening to see the squad being sued, even if NJ EMS is just awful from everything I've heard...

The only thing I know about it is that Kansas educational standards already met the new ones, so the only thing changing for us is the title (from Mobile Intensive Care Technician to Paramedic); no transition course. Not sure if that relates to the CAAHEP accreditation or not?

Dead Patient + CPR + No Response = Dead Patient Dead Patient + CPR + No Response + Transport = Dead Patient

I hear you man and I sympathize with you and share your concerns as a provider who frequently attends to patients who have simply surpassed the size limit we are typically equipped to deal with. We don't like to think or talk about it, but the truth is in many EMS systems across the country, there are patients who, due to their size, will suffer adverse outcomes because we simply do not have the ability to provide the same level of care to them as we do others. We've all been in the situation where we could not get an IV on an obese patient; and some of us have even been in the situation where not even our IO's are large enough to deal with it. As we as Americans increase in size, we will have to work faster to find solutions to this difficult problem. The most effective solution would be for everyone to be more conscientious about their weight and health, and to take preventative measures to avoid obesity and to get help for it if they have already crossed that bridge. Unfortunately losing weight--especially a lot of weight--is a lengthy and arduous process and while I haven't seen any numbers, I don't imagine that the rate of obesity is slowing down anytime soon. We in EMS can be proactive in tackling this problem by first and foremost recognizing the need for bariatric equipment and making sure that we have access to it. We can also be a force of good by implementing community health initiatives designed to identify, prevent, and treat obesity within our communities. The sad fact is that people have and will continue to die not for lack of effort on the part of EMS agencies, but due to the simple lack of ability to deal with severely obese patients. That should frighten people. That should mobilize EMS providers and their medical directors to immediately take actions to address the problem; it should also frighten those patients, and make them realize that their obesity can not only cause them to have serious and life-threatening emergencies, but also prevent them from receiving the needed care due to equipment and provider limitations. I commend you for taking steps to make yourself healthy, as well as for your recognition of the need to take a proactive stance in preventing future patients from experiencing the same issues as you did. I would suggest to you to approach your local EMS system and to talk to them about what their capabilities are for bariatric patients, and where their weaknesses are. From there, you can help mobilize your community to provide whatever support the service may need to ensure that they are properly equipped to handle patients of every size, no matter what their emergency is. Take care, -Bieber

Unbelievable. This is a terrible tragedy.

No immobilization unless suspected spinal injury.

Ahem... don't forget about Kansas and Oregon! We require degrees! As for the OP... I would normally say do whichever one you think you'll like better, but if you're planning on doing both regardless, I'd say go for nursing first. More options, better pay, much better respect. Most EMS schedules make school difficult, but there are literally endless scheduling options as a nurse from the 9-5 route to 12 hour shifts.

Thanks ER Doc and Kiwi! I'm still working furiously to try and get this paper done. I hate essay analysis. Just read it for yourself if you want to know what it's about!

Hey guys, I'm looking for some "scholarly" papers on ethics in EMS, especially those that deal with provider-initiated refusal of transport. I've been googling like crazy, but not turning up a whole lot. Anybody got any suggestions? This is for a class paper I'm doing for my bachelors.

So, the city's been a little lax lately, and while this isn't a particularly exciting topic, it's something I've been thinking about and maybe it'll get people's brains stirring. Today's topic is extreme environments! We work in every flavor they come in. For me this summer, it's all about heat. It's been 100+ F lately (average heat index ~110 F) and looking to stay that way at least through the next week. I just got a couple of cotton blend shirts (Elbeco T2, if anyone cares) and I also just bought a pair of black cargo pants (fewer pockets and layers, and also lighter than traditional EMS pants) and low rise boots (my old ones were like 9" or something like that) so hopefully that will help. So, with most of us residing in the northern hemisphere and enduring this hot summer, what are you doing to stay cool? Any tricks you've picked up along the way? Any uniform modifications you make or that your service implements on the really scorching days? Do your supervisors make water deliveries? For those of you in the southern hemisphere, how are you staying warm? It seems like it's easier to stay warm than cool (you can add layers to your uniform, but people start to complain when you try to lose too many layers). Any tips for those of us up north to keep in mind for when winter rolls back around our way? Also, how do you keep from falling off the earth? Also, any other exceptionally adverse weather conditions you're exposed to on the job?

I'm guilty of doing the pat line (though I usually say we haven't dropped anyone for at least an hour). In my experience, though, my patients seemed to appreciate the lighthearted humor. I try not to just regurge every conversation over and over again, I just like to try and give patients a sense of ease and comfort.

Great response, Systemet! Thanks for pointing those out. You're right, it could very well be one or more of those things that the medical society is thinking about; unfortunately we weren't given much of an idea of what situations/statistics/cases where patients have had a poor outcome following diltiazem therapy. Maybe I'll be able to find out more when we have our new protocol training. Thanks for giving me some ideas, though.

"What's up?" "What's going on today?" "How are you doing today?" "How can I help you today?" I'm thinking about transitioning soon to "Please state the nature of your medical emergency."

So, I dug through some of the old memos by our medical director about the issue of diltiazem. Her rationale for it was that the physicians in the area felt that "there were enough patients that had been turned from stable to unstable by treatment with diltiazem" that it didn't meet the risk-benefit criteria. I haven't ever heard of diltiazem causing stable atrial fibrillation to become unstable, and as quoted above the risk of thromboembolism is the same as electrical cardioversion (which is still in our protocols). Anyone have any idea what this might be about? Anybody ever heard of diltiazem causing stable patients to go unstable?

Addendum: And I'm not just talking about the "woe is me" forgotten EMS folks, either, but the average everyday person who has done something heroic or lived an exemplary life. The computer programmer, the waitress, the bank manager, the construction worker, etc. The other thing about it is, we try to make so many people heroes that I'm not sure anymore if I would recognize a hero when I saw him/her. I have no clue anymore what constitutes a heroic act by societal standards.

I completely understand where you're coming from, man. I get frustrated with our need to idolize people based on their titles irrespective of what acts they may or may not have actually done. Unfortunately, there's not a whole lot that can be done about it, and in the end it's really more about the people who are mourning than about the person who has died. The only thing I truly dislike about it is that people who really are heroes may be overlooked simply because they did not serve in one of the traditional "hero professions" (police, fire, military).

Thanks, Mike. Yeah, it's kind of a tough situation around here when it comes to response standards and shit like that. Unfortunately, a lot of our supervisors have this crazy idea that having two paramedics and an engine of EMT's isn't enough for critical (code red) and code blue calls. We are seriously over-saturated on paramedics around here, and whereas two medics might be too many for most calls, adding that third just seems to make the whole situation worse. I'll try to see if there's anyway I can let him know that we don't really need his help on critical calls without being untactful.