DCMed124

I imagine you can't work your shifts AND their shifts in the same week. Too many hours by regulation? Too much overtime? <shrug> The boss said "no". How dare you question authority.

Isn't that called a helicopter? Instead of driving it like you stole it, drive it like you own it.

cops prone in the drive usually indicate something interesting... "Never walk pass the blue canaries"

Anyone out there have examples of their billing agreements they'd be willing to share? I'm looking to not have to reinvent the wheel, but it's time to update some old, out-of-date agreements we have, and I'm looking for more "mutually beneficial" language. Specifically, any documents related to an ALS provide providing assist to a BLS crew that operates both ways. Squad A might be ALS today, and Squad B would be ALS tomorrow.... that sorta thing. Thanks in advance for any help y'all can provide.

for those that don't know why all the adulation for Dr. Bledsoe, he is, in the vernacular, an EMS Stud (note the capitalization of Stud). from www.bryanbledsoe.com Dr. Bryan Bledsoe is an emergency physician and EMS author from Midlothian, Texas. He entered EMS in 1974 as an EMT and attended one of the first paramedic programs in north Texas. Dr. Bledsoe worked for several years in Fort Worth as a paramedic and went on to become an EMS Instructor and Coordinator. Dr. Bledsoe has a B.S. from the University of Texas and a D.O. from the University of North Texas. He completed a residency at Texas Tech University Health Sciences Center and at Scott and White Memorial Hospital/Texas A&M College of Medicine. He is board-certified in emergency medicine. Dr. Bledsoe has served as the Medical Director for two hospital emergency departments as well as for numerous EMS agencies in north Texas. He is the author of numerous EMS textbooks including: Paramedic Care: Principles & Practice, Paramedic Emergency Care, Prehospital Emergency Pharmacology, Anatomy and Physiology for Emergency Care, and many others. He is a frequent contributor to EMS magazines and presenter at national and international EMS conferences. He is married and lives in Midlothian, Texas. He enjoys salt-water fishing. Dr. Bledsoe is an Adjunct Associate Professor of Emergency Medicine at the George Washington University Medical Center in Washington, DC. He is co-chair of the Curriculum and Education Board for the United States Special Operations Command (USSOCOM) at MacDill AFB, FL.

disposable CID works great for compound tib/fib.

I'm on a roll today. QUICK! Someone ask me another one that I can actually answer. http://www.dsf.health.state.pa.us/health/l...4so_(02-04).pdf (for some reason the (02_04).pdf part isn't a "link", but you do need to put that in the address bar of your browser) oh and btw.. according to the squad legal-eagle, there's no indication of a "duty to act" based on vehicle markings. That would be, in his words, "like having a star of life tattoo (no comments please, I don't), walking down the beach, and being compelled to provide first aid all day long".

porn ... SOMEONE had to say it, or the thread was dead.

PRPG... you said... "Id rather have a president who knocks a piece off from a secretary in the back room but actually acts in the interests of the country." Like in 1996 when the Sudan offered Bin Laden to US Officials, but Clinton didn't think it would be "legal"? Like the August 7, 1998, bombings of U.S. embassies in Kenya and Tanzania. More than 200 people, including twelve Americans, were killed? The October 12, 2000 bombing of the USS Cole that killed 17 American Servicemen? What was the standard Clinton response? Nothing. I normally disdain threads like this, since nobody ever changes their point of view, it normally just turns into a pissing contest. That having been said, NO other president in history LOST the codes to unlock the "football" satchel. Just Clinton. or maybe they were stuck to Monica's dress. C'mon man... I have a ton of respect for you. Don't blow it with statements like that. Like Clinton? ok... Hate Bush? not a fan of hating anyone, but ok... Don't take this the wrong way please, just look at both sides. oh and PS... Soldiers aren't cops. They're trained to kill people and break things. Not to make lunch for foriegn nationals. Let them do their jobs and come home.

it's a fairly typical multi-floor office building. I'm the only one that can even spell EMT. The canisters are in the coffee rooms alongside the first-aid kits. Since posting, I've spoken with the local fire mashall. His comments were <paraphrase> "nice if you could get them out to actually use them on anyone exposed during the fire, or to at least placard the general area alerting first responders to their presence, but getting the people out remains #1." so I'm sticking with that unless someone else can give me any better ideas. I hate the idea of Emergency Services running into 1200 psi missles, but there you have it. /DC

my company has oxygen canisters on each floor of the building. The following question has arisen around this... should they canisters be removed during fire drill and / or actual fire. I made a somewhat off-handed remark that in an actual fire, those canisters could become ballistic missiles... this has prompted no small amount of debate amongst the C level folks about liability in delaying exit from the building, etc... does anyone have any experience in this? I was thrilled the day I started to work here that they had the O2 (no AEDs, but I'm working on it). The company is in Chester County, PA. I'm not sure if there's any legal background on this or not. Any input would be appreciated. Thanks DC

VS did you just admit to having done that for more then 10 minutes straight? omg read a book, eh?

there's an old saying amongst the <cough> smarter riders out there... $10 helmet means a $10 head. ... so what's a $0 helmet mean? Social Darwinism if you ask me. If you're stupid enough to ride without a helmet, get the hell outta my gene pool. Problem is I still gotta clean up after you. my first due has some REAL nice bike roads... long, windy roads along the river... beautiful. Until, get this, they pull outta the local watering hole (significant AOB) and race in a pack of 8 or so bikes up the road and 2 of them wind up running over the guy that just laid down his ride. Helmet-less trauma + getting ridden over = groovy ride on a helicopter.

I don't wanna hear any more of this "we can't win this war" crap. Dust will take of it. /pity the insurgents be safe, Dust. You first, your partner second, and shoot the rest. oh... don't forget. bandaids go sticky side down. least, that's what I've heard.

we go through a lot of training to make little money. (please see 7th point below) we're not firepersons (I hate political correctness, but there you have it) we're not cops (tell me you OD'd... it'll go better for you and I could give a @#*% what you do with your spare time) Yes I like sitting in a hidden driveway and flipping the red lights on when you go speeding past. It's freakin' hysterical watching your brakelights come on as you nosedive your vehicle to the proper speed. (and you shouldn't be speeding) (just kidding about this one, but it was amusing) when we gotta go, we gotta go. please act accordingly. (I swear I won't cheat you outta your check, Mr. Restauranteur.. can we settle up later?) when we gotta go, we gotta go. please act accordiingly (like someone said earlier, move CAREFULLY to the right. I can't stop and help you too) Thanks for the free coffee. (you saved me a dollar, but the thought is priceless) that 3 year old little girl that died in the MVA? rips me to shreds by the way, but I'm a professional. My partners will get me through. (be thankful I don't take the uniform off and beat you to death too for not using seatbelts on kids) Yes, we CAN all get along. just need more people to want to. It's mostly man's inhumanity to man that keeps us in business. We spend our time pulling silly people outta bad places. Please act accordingly. (no witty rejoinder here. statement stands on its own) I imagine I'll think of more. The sad thing I've noticed is that people treat us like dialtone. When you pick up a phone, you expect to hear it. You don't really give it a second thought until it's not there. I think, if not walking a mile in said shoes, just some base understanding would go a looong way. heaven knows this stuff ain't for everyone. Hope that's what you're looking for Dust... but probably not.

I personally comb my hair with a towel. but there's still SOME left up there. unless you're a 6'4" muscular black man, bald is usually NOT beautiful. Having seen some of the alternatives however, I'll happy take a beard trimmer to most people I see.

PRPG... drop me an email. I'll hook you up with the guy that used to run tems in bucks. It's my understanding EMS can't carry in PA, so they're supportive only. Personally, I wouldn't stack unarmed, but that's just me.

errr... how's he going to the bathroom? I'll add constipation to dehydration.

dehydration.

FDA AND NIOSH Public Health Notification: Oxygen Regulator Fires Resulting from Incorrect Use of CGA 870 Seals (You are encouraged to copy and distribute this information) Issued: April 24, 2006 Dear Colleagues: This is to alert you to the danger of fires at the interface of oxygen regulators and cylinder valves because of incorrect use of CGA 870 seals, and to point out an important precaution you can take to avoid such fires. Background FDA has received 12 reports in which regulators used with oxygen cylinders have burned or exploded, in some cases injuring personnel. Some of the incidents occurred during emergency medical use or during routine equipment checks. FDA and NIOSH believe that improper use of gaskets/washers in these regulators was a major factor in both the ignition and severity of the fires, although there are likely other contributing factors. Two types of washers, referred to as CGA 870 seals, are commonly used to create the seal at the cylinder valve / regulator interface: The type required by many regulator manufacturers is a metal-bound elastomeric sealing washer that is designed for multiple use applications. The other common type, often supplied free-of-charge with refilled oxygen cylinders, is a plastic (usually Nylon ®) crush gasket suitable for single use applications. The nylon crush gaskets require higher torque than the elastomeric sealing washers in order to seal the cylinder valve / regulator interface, and if they are used again, they require more torque with each successive use. The cylinder valve / regulator connection is designed to be hand-tightened. If the crush gaskets are re-used, the need for increased torque may require using a wrench or other hand tool, which can deform the crush gasket and damage the cylinder valve and regulator. This can result in leakage of oxygen past the cylinder valve seat and across the nylon crush gasket. According to a forensic analysis supported by FDA and NIOSH, “flow friction†caused by this leakage of compressed oxygen across the surface of the crush gasket may produce enough thermal energy to spontaneously ignite the nylon gasket material. Recommendations FDA and NIOSH recommend that plastic crush gaskets never be reused, as they may require additional torque to obtain the necessary seal with each subsequent use. This can deform the gasket, increasing the likelihood that oxygen will leak around the seal and ignite. The following general safety precautions should also be taken to avoid explosions, tank ruptures and fires from oxygen regulators. ·    Always “crack†cylinder valves (open the valve just enough to allow gas to escape for a very short time) before attaching regulators in order to expel foreign matter from the outlet port of the valve. ·    Always follow the regulator manufacturer’s instructions for attaching the regulator to an oxygen cylinder. ·    Always use the sealing gasket specified by the regulator manufacturer. ·    Always inspect the regulator and CGA 870 seal before attaching it to the valve to insure that the regulator and seal are in good condition and the regulator is equipped with only one integral metal and rubber seal that is in good condition. Avoid plastic seals. ·    Tighten the T-handle firmly by hand, but do not use wrenches or other hand tools that may over-torque the handle. ·    Open the post valve slowly, while maintaining a grip on the valve wrench so that it can be closed quickly if gas escapes at the juncture of the regulator and valve. Figure 1 : Examples of crush gaskets available for CGA 870 type medical post valves .Figure 2: Examples of some sealing washers available for CGA 870 Style medical post valves. Reporting to FDA To report your experience regarding the devices in this Notification, please use MedWatch, the FDA’s voluntary reporting program. You may submit reports to MedWatch by phone at 1-800-FDA-1088; by FAX at 1-800-FDA-0178; by mail to MedWatch, Food and Drug Administration, 5600 Fishers Lane, Rockville, MD 20857-9787; or online at http://www.fda.gov/medwatch/report.htm. Getting More Information If you have questions about this notification, please contact the April Stubbs-Smith, Office of Surveillance and Biometrics (HFZ-510), 1350 Piccard Drive, Rockville, Maryland, 20850, by Fax at 301-594-2968, or by e-mail at phann@cdrh.fda.gov. You may also leave a voicemail message at 301-594-0650 and we will return your call as soon as possible. FDA medical device Public Health Notifications are available on the Internet at http://www.fda.gov/cdrh/safety.html. You can also be notified through email on the day the safety notification is released by subscribing to our list server. To subscribe, visit: http://list.nih.gov/archives/dev-alert.html.     Sincerely yours, Daniel Schultz, MD Director Center for Devices and Radiological Health Food and Drug Administration Nancy Stout, Ed. D Director, Division of Safety Research CDC, NIOSH Updated April 25, 2006

gratuitously cut and pasted from a local thread... Study published that shows rationale for changes in AHA guidelines... Summary, for those too lazy to read the whole thing: "When paramedics in Wisconsin employed the new protocol, with chest compressions before and after defibrillation but no intubation or ventilations, they achieved a 300% increase in survival compared with use of traditional CPR. " Cardiocerebral Resuscitation: A Newsmaker Interview With Gordon A. Ewy, MD Laurie Barclay, MD Medscape Medical News 2006. © 2006 Medscape April 17, 2006 — Editor's Note: Cardiocerebral resuscitation (CCR) — employing chest compressions but no ventilations — improves survival of out-of-hospital cardiac arrest, according to the results of an observational study published by Michael J. Kellum, MD, and colleagues in the April issue of the American Journal of Medicine. Unlike traditional cardiopulmonary resuscitation (CPR), which was designed both for cardiac and respiratory arrest, CCR is designed only for unexpected, witnessed, cardiac arrest, which is by far more common than respiratory arrest as a cause of sudden collapse in adults. Animal experiments showed that the most important factor determining survival after CPR is cardiac perfusion pressure, achieved by continuous chest compressions. Ventilations may actually be harmful because they interrupt chest compressions, decrease venous return to the heart, and increase intrathoracic pressure. When paramedics in Wisconsin employed the new CCR protocol, with chest compressions before and after defibrillation but no intubation or ventilations, they achieved a 300% increase in survival compared with use of traditional CPR. To learn more about the clinical implications of this new protocol, Medscape's Laurie Barclay interviewed study coauthor Gordon A. Ewy, MD, director and pioneer of the CPR Research Group at the University of Arizona Sarver Heart Center in Tucson. Medscape: What was the rationale behind the CCR protocol? Dr. Ewy: The major rationale is that CPR hardly ever works. The survival of out-of-hospital cardiac arrest is dismal, averaging 1% to 3% nationwide. And in spite of periodic updates in guidelines, with the exception of early defibrillation, survival has not improved. Several experimental observations, when correlated, provide the rationale for a new approach to cardiac arrest, which we call CCR. It is well known that in patients with cardiac arrest secondary to ventricular fibrillation (VF), early defibrillation is the most important intervention. This is why the defibrillation shock from an automated external defibrillator (AED), when promptly applied, has been shown to improve survival in selected locations such as casinos, airports, and the like. But it turns out that this early "electrical phase" of VF arrest lasts for only about 5 minutes, and emergency medical personnel hardly ever arrive during this time frame. After this so-called electrical phase of VF cardiac arrest, the patient enters the hemodynamic or circulatory phase of VF arrest. And during this phase, applying an AED hardly ever resuscitates the patient. During the circulatory phase of prolonged cardiac arrest due to VF, the factor critical to survival is the prompt restoration of cardiac and cerebral perfusion pressures by chest compressions. Restoration of blood flow might slowly reverse the adverse effects of cardiac arrest so that the individual will again respond to defibrillation. Our interest in alternative approaches to the international guidelines began with the realization that most people who witness a cardiac arrest will not initiate bystander CPR because they do not want to do mouth-to-mouth resuscitation. Therefore, about 80% just call 911 and do not begin bystander CPR. By the time the paramedics arrive, it's too late. So our original question was whether doing chest compressions alone on people who collapse is better than calling 911 and doing nothing until the paramedics arrive. Our swine studies in 1993 showed that during prolonged VF arrest, chest compressions alone are just as good as ideal, standard CPR when we took 4 seconds for the 2 recommended ventilations before each 15 chest compressions, and much better than no bystander CPR. Since 1993 we've been saying that we should encourage the lay public to do chest compressions–alone CPR on adults with witnessed, unexpected collapse. Between 1993 and 1998, we published 6 different swine studies, including one study with the endotracheal tube clamped, all showing that chest-compression alone was equal to ideal standard CPR, and dramatically better than doing nothing. After the 2000 guidelines came out, Dr. Karl Kern, who is part of our University of Arizona Sarver Heart Center CPR research team, participated in a study with Dr. Chamberlain and colleagues from England to determine how to get lay people to remember and correctly perform CPR after they've been trained. As part of this study, they did videos on certified lay people doing rescue CPR, which showed that after they did 15 chest compressions, it took an average of 16 seconds for them to lift the chin, close the nose, take a breath, make a mouth-to-mouth seal, blow and watch the chest expand, repeat rescue breathing for a second breath and return to chest compressions. So they were pressing on the chest for only half the time that they were doing CPR. In a subsequent swine CPR study published in 2003, we showed that when chest compressions are interrupted for 16 seconds between each 15 chest compressions, 24-hour survival after CPR was only 13% compared to an average of 70% in our swine given continuous chest-compression CPR. This is one reason why we have advocated and continue to advocate chest compression–only bystander "CPR" for witnessed sudden collapse in an adult. The next observation was published by our colleague Dr. Valenzuela. When paramedics perform CPR following the 2000 guidelines, they spend only half the time on chest compressions because of the time they spend on other guideline-advocated activities, including intubation and ventilation. We therefore concluded that the recommended alternating chest compressions with breathing should be revised to improve coronary perfusion. The next observation was that in Tucson, the emergency medical personnel arrived at an average of 7 and a half minutes [after collapse] — not in the electrical phase of VF arrest, but in the circulatory phase. Thus, following the guidelines which advocated immediate defibrillation and 3 series of defibrillation was deleterious, as chest compressions were interrupted for inordinate periods of time while the AED analyzed, shocked, and analyzed. Because of these and other observations, we concluded that there is a better way to do resuscitation than the standard CPR advocated for the last 40 years. We called the new method cardiocerebral resuscitation, or CCR, to emphasize the importance of saving the brain. Medscape: What were the findings of your recently published study in humans? Dr. Ewy: We taught Dr. Mike Kellum and associates in Wisconsin the new method of CCR. When they implemented it, the paramedics would comment that they were having "saves" that they would never have had before. When Dr. Kellum and associates looked at the data, they found that neurologically normal survival improved from 15% with standard 2000 guidelines CPR to 48% with CCR. This 300% increase in survival in this study is almost too good to believe, but there is no doubt in our minds that CCR is definitely better than CPR. Medscape: How does this protocol differ from standard CPR? Dr. Ewy: One of the reasons that the CCR protocol is better than the standard CPR protocol is because it recognizes the 3-phase, time-sensitive model of VF articulated by Drs. Weisfeldt and Becker. The most important intervention in the first 5 minutes is defibrillation, which is why implanted cardioverter defibrillators and AEDs are effective. After the first 5 minutes, the fibrillating heart continues to use up its energy stores, becomes weaker, and cannot generate a perfusion pressure even if defibrillated. Studies in humans by Dr. Cobb and associates from Seattle, and Dr. Wik and associates from Norway showed that if one does chest compressions for 90 seconds to 3 minutes before defibrillation, survival is better. Therefore, rather than immediate defibrillation, the CCR protocol incorporates 200 compressions at 100/minute before defibrillation. Equally important, it also incorporates 200 chest compressions immediately after the defibrillation, prior to rhythm analysis and pulse check. The reason for this is that in our experimental laboratory, after prolonged chest compressions for VF arrest, the shock almost always defibrillates, but defibrillates the rhythm to pulseless electrical activity and not to a perfusing rhythm. In our experimental laboratory, we are looking at the pressure waves, so we immediately restart chest compressions to perfuse the heart, and the cardiac-generated blood pressure gradually returns. The most controversial aspect of CCR is the elimination of active positive pressure ventilations. We first delayed or eliminated intubation by the paramedics.This is a hard sell to paramedics. But this eliminated one intervention that resulted in a prolonged interruption of chest compressions. But why not let the paramedics or emergency medical service personnel ventilate with bag-valve-mask ventilation? The rationale for our approach of placing an oropharyngeal airway, a nonrebreather mask, and high-flow oxygen without positive pressure is as follows. With normal breathing, intrathoracic pressure decreases, but positive pressure ventilating increases intrathoracic pressure and thereby decreases venous return. The result is decreased cerebral and myocardial perfusion. Thus, chest compression without ventilation results in better myocardial and cerebral perfusion pressures and increases survival. Another important factor is that we and others have shown that physicians and paramedics are so excited during a cardiac arrest that they overventilate — an average of 37 ventilations/minute. It is very difficult to get these individuals to ventilate less, unless you do not have them ventilate at all. Another observation that taught us the importance of cerebral perfusion was listening to a recording of a lay rescuer in Seattle doing dispatch-directed CPR. After a while, the woman returned to the phone and asked, "Why is it that every time I press on his chest he opens his eyes, and every time I stop to breathe for him he goes back to sleep?" Out of the mouths of babes! That woman learned in 10 minutes what it took us 10 years to find out. Whenever you stop chest compression to do anything, including breathing, it is bad for the brain as it reduces blood flow to the brain. The question that I am most often asked is what happens to the blood oxygenation? My answer is that if one does adequate continuous chest compressions, the individual often gasps and this agonal type breating provides reasonable oxygenation. In the absence of gasping, the blood gases are very bad — but guess what, the individual survives. Thus, the medical and paramedical obsession with blood gases and thus ventilation, and not looking at neurologically normal survival as the most important end point, has been one of the major impediments to progress in resuscitation science. Medscape: Why doesn't CPR work well? Dr. Ewy: The fallacy of CPR is that it was designed for 2 totally different pathophysiological situations: respiratory arrest and cardiovascular arrest. What is beneficial for one may not be for the other. The reason for a single approach is that it was, and to many still is, thought that the lay public cannot tell the difference between a respiratory arrest and a cardiac arrest. I think they can. If you pull someone out of a swimming pool, or if they stop breathing after a drug overdose, that's a respiratory arrest. But an unexpected, witnessed collapse in an adult is almost always cardiac arrest. The most important intervention for cardiac arrest is continuous chest compressions to perfuse the brain, to keep the brain and heart alive until you can shock it. If one can use the AED in the first 5 minutes, that's fine, but there are 2 major problems: the first is that the paramedics usually do not arrive in the electrical phase of VF, and the second is that the lay public does not use the AED. In Arizona, over 2,500 AEDs are registered, and we have knowledge of only 10 being used by the lay public. Medscape: Are there situations in which the CCR protocol should not be used? Dr. Ewy: For respiratory arrest, you need to breathe for the person. The new CPR guidelines should be followed: 2 breaths alternating with 30 compressions. But the major problem is that most lay people won't do mouth-to-mouth, so they just call 911, and by the time the paramedics get there, the person is dead. Medscape: Are there any negative effects of CCR? Dr. Ewy: Not that I know of, if it is used on adult subjects with witnessed, unexpected collapse. Medscape: What additional research, education, and training needs to be done before this protocol is widely adopted? Dr. Ewy: I think CCR should be widely adopted right now for unexpected, witnessed collapse in adults. In fact, I think it should have been adopted in 2003, when we did. As for teaching, we should emphasize that CPR should be reserved for respiratory arrest. But for witnessed, unexpected collapse in an adult, we teach laypeople a 3-step protocol: first, call 911; second, start chest compression–only CCR. If another person is available, each do 100 compressions and trade off, as continuous chest compressions is hard work. Third, if there is an AED around, put it on and follow the directions. I think this approach should markedly increase the prevalence of bystander CPR, and bystander CPR significantly improves the chance of survival. For paramedics, I think we need to do more research to determine when assisted ventilation is absolutely necessary. We are doing such studies now. Medscape: If the protocol is widely implemented, what effect do you believe it will have on public health? Dr. Ewy: The most common cause of death in the United States, Canada, and Europe is sudden cardiac arrest. CCR is significantly better than CPR, and if it's widely adopted, it will have a significant positive effect on public health. We now have data in humans to support what we've found in our animal experiments. Our recently published observations in humans showed a 300% improvement in neurologically normal survival in patients with witnessed out-of-hospital cardiac arrest and a shockable rhythm when the paramedics arrived. This study is almost too good to believe, but if we can improve survival even by 10%, there will be a huge benefit worldwide. I know if we follow these CCR guidelines, survival is going to be a lot better than it has been for the last 40 years. Am J Med. 2006;119:335-340 Reviewed by Gary D. Vogin, MD

ok... that's just sad and a good rationale why tigers eat their young.

I'd like to throw 2 cents on this one... with the understanding that I'm still the new guy in EMS and whatever I say is solely applicable to myself. Dust.. I respect the hell out of you. you've proven yourself to be amzingly smart, talented, and experienced. that having been said, you posted the following in the medic thread... (in the interest of brevity, I'll only paste a few) /quote EMT argues with paramedic who chooses a scoop stretcher to move a patient instead of a long board. EMT argues with medic who places high flow oxygen on a distressed COPD patient. EMT argues with medic who gives only D50 to the unconscious diabetic instead of the whole "coma cocktail." EMT argues with medic who intubates a patient who is not in full arrest. EMT argues with medic who runs a non-rebreather at 12 lpm instead of 15 lpm. EMT argues with medic who doesn't let him drive hot to the hospital with non-critical patients. /endquote ok... I can certainly see how those would grate on you. I'd ask you though (while hiding behind the garbage can lid) did you intubate the patient not in full arrest while the EMT stood around doing nothing? or was there some verbal discourse along the lines of "hey EMT, I'm going to do <insert procedure here> 'cause <insert intructive reasoning here>. I guess what I'm asking (and I have to ask since I've never ridden with you and have no other way of knowing) do you teach your EMT as you're doing a procedure? I'm seriously thankful for the medics I run with. They always will give me a running dialogue of what they're doing and why. I catch and comprehend about 75% I'd say, and we debrief afterwards for the rest. I can't agree enough that education is paramount (not just in EMS by the way). I'd also submit that education occurs more outside the classroom then in (also not just in EMS by the way). I can't tell you how many times during EMT class I thought to myself "self... remember when Medic001 did THIS? HERE'S why..." or some such thing. I'll admit to probably having more to learn about EMS then anyone else on this board. However, I DO know how to learn. I'm pretty good at it. Not for nothing, the trick is in finding the good teachers. /flame on... got my garbage can lid deflector firmly in place.

gratuitous bump. I'd love to see more opinions / commentary on this product and / or similar products. if you believe their website, the clinical trials they've done are impressive http://www.revivant.com/pages/prod_studies.html Human Short-term Survial Study4 AutoPulse improved field ROSC rate by 74%, regardless of the initial rhythm - *4. Ornato JP et al. Improvement in field return of spontaneous circulation using circumferential chest compression cardiopulmonary resuscitation. Prehospital Emergency Care. 9(1):104. Human Hemodynamics Study2 AutoPulse-generated CPP was 33% better than manual CPR Human Short-term Survial Study5 AutoPulse improved the rate of delivery of patients in ROSC sustained to the ED by 35%

EMT-B in PA? we can drive... IF we have EVOC. oh.. we can lift heavy things. occasionally. of course, my favorite... I get to play with the lights and the air horn. weeeee! ok, seriously... administer 02, assist with oral glucose, epi pen, inhaler and nitro (charcoal after med command / poison control says so). most of the standard BLS stuff. package, transport, etc. can't check glucose levels, can't take a pulse ox. we can assist a medic with a combi-tube (read as take it out of the packaging). oh wait.. yeah... we can take vitals! there are some fairly active BLS squads around here, albeit normally covered / assisted by an ALS crew. PA doesn't recognize the EMT-I cert. you're a B, a P, a PHRN or a Doc.