vs-eh?

It's not funny, it's fucking disgusting. Considering on average what 25% (http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/) of the US is OBESE (not just overweight, obese). Seriously people, come on... My GF has been in the US a few times in the last few months. She said that in general, the food options are disgusting (and she's not a health freak). Cheese on everything... I was in Tennessee in the summer, and literally SUBWAY was the healthiest food to be found by far. I was disgusted... Would I eat there? Sure, but I'm not overweight, I work out, etc... Fatties...

We can access PICC, Hickman, Portacath, etc... in critically ill patients. Remembering how to access them on the other hand when you've done it zero times and after a ten minute CME is another matter entirely If you have exhausted all peripheral sites (including EJ, saphenous, etc...), oh well... We don't use adult IO's so...

In general the correct answer will be: Start CPR Analyze ASAP (this is witnessed by you) Do whatever machine says Continue CPR Manage airway with BLS Enter ER You are in a hospital now. Now, unless you normally take part in a lot of patient care in hospital (giving drugs, doing procedures, etc...), you hand off your patient to the hospital and assist if needed (generally with airway prior to intubation and CPR). Paramedics here generally do not take part in "advanced care" (i.e. what they may do in the field), in hospital. I have never started an IV, given a drug, intubated a patient, etc.... while in a hospital room. Patient care while on offload on the other hand...

Dave, I didn't see any votes in my poll. As long as call volume criteria is consistent across the board (province) then I wouldn't have as much issue. This is especially if funding or other EMS related issues are somewhat contingent on "call volume". I am almost certain that basically all other EMS service's outside of mine (in Ontario) include standby's as a "call" and are counted toward call volume. This obviously skews their actual numbers.

Oh, hello... After some recent discussion with some co-workers regarding call volume and such, I have a question. Does your service count standby's (to a post, station, street corner, etc...) as a call that is counted toward your annual call volume? If your service does not, do you feel that it adversely affects funding or gives a false impression of being less busy? Please include your ballpark annual call volume and what percentage is likely standby's or what the call volume would be if it included standby's. We have passed 300k for the year and we do not include standby's by giving them a run number. I would say (probably conservatively) that if standby's were included it would be 600k+. That is for a single municiple service FYI.

http://www.liveleak.com/view?i=f55_1227894806 Ummm.... Ya... Now, I wouldn't have an issue if these were simply bystandards or security-guard-who-got-his-CPR-cert-15-years-ago-and-has-never-used-it guy. However it appears that these are not the aforementioned people... 1) There appears to be 6-7 people who are "involved" in this resuscitation attempt (i.e. don't appear to be bystandards, have uniforms/gloves on, or are digging through bags). 2) They appear to have at least 2 "first responder" type bags. Who knows what is in them, because they don't appear to be using any equipment. 3) There is no airway/ventilation management. Now fair enough, proper chest compressions I consider paramount in a situation like this prior to professional EMS arriving/PAD. There MIGHT BE an OPA in, but given this scene, I doubt it. 4) There is obviously NO ONE in charge of this scene. One guy doing piss poor CPR, nobody switched out, no other a/w management, etc.... Just people who think it's cool being a first responder doing nothing. 5) What were they exactly doing at the end? Someone brought a defib I guess (and has a stethoscope on his belt which is so cool) but chest compressions stop and ummmm what exactly are they doing? Hey stethoscope boy, control the scene and tell someone to continue chest compressions at least while you guys are doing whatever it is you are doing. 6) LULZ @ the guy at the end who is saying "nobody is doing CPR", "nobody is doing mouth to mouth (on him)". I'd be wondering the same thing dude, however I'd punch you in the head if I was on scene and you mentioned mouth to mouth. Also the woman at the end who is like "MMMMMMHHHMMMMMM". Let me guess you are like "nobody is doing mouth to mouth/CPR on a black man...." Anyway everyone in that video is terrible. Everyone. Fin.

Postictal...

Define "improperly disposed of my sharps". Closely followed by "There are many reasons for this but..." 80-90% of the IV's that I start are on scene or in a stationary vehicle. Honestly the 10-20% of IV's that I start that don't fit into the above are "optional" or "difficult". That being said the IV's I use are safety sharps and relatively difficult to poke yourself with.

http://www.emtcity.com/phpBB2/viewtopic.ph...ghlight=#146542 And a post that I started, but went nowhere... http://www.emtcity.com/phpBB2/viewtopic.ph...ghlight=#127616

Is this how things are run outside of the GTA? 1) Refuse the transfer. Or request Ornge/another car. 2) Your ACP "partner" did not want to come in the back with you on a 2 hour transfer as you described? Hmmmmmm..... Sorry... Either people don't like you at all or..... actually I don't even know what the or is. Either way, why are you putting up with that? 3) The sending hospital gave you a monitor (that you have to return) and not an RN? HUGE NONO! You knew how to use this monitor to its full capacity? Basically all hospitals that I know don't have/use LP12 or Zoll E for their transport monitors. You are setting yourself up for DISASTER! And the "I just run the call" thing? Sorry.... I'm a pretty liberal paramedic when it comes to patient treatement/scope/doing this that may be "outside the box" but this one has way too many things that would screw you.... It bothers me that you even took this transfer on many levels.

This paramedic could have administered midazolam/diazapam for patient sedation, if he/she felt it was warranted. Ontario paramedics don't work in the way you are suggesting Kaisu.

Questions... 1) Where do you work? I assume way north... 2) You normally work a 3 man crew or was this specific to this transfer? 3) Why were you the only one "providing pt. care"? 4) Since when do Ontario municipal 911 services do 2 patient transfers (or have 3 man crews)? 5) You have multiple monitors on your vehicles? Really? If not normally, and you took one from the hospital, why did you also not take an RN with it? Where did you put the second one? 6) Why was there no RN with you? 7) Why didn't another car/Ornge do one/both of these transfers? Please answer in the same format.

Pretty thorough on the first form for a simple transfer... Do you seriously put "normocephalic" on your forms? You make several assumptions on your assessment (i.e. diminished air entry secondary to COPD, etc... especially with a dialysis patient). I personally wouldn't be making these assumptions on forms, especially when you are BLS. I read this and I'm like this guy is trying too hard. You try and document all these assessments, make it sound good, but then you use DCAPBTLS. I don't know about that... On the second form you said "AED electrodes in place". Your AED (I assume SAED) has monitoring electrodes and a screen? Or did you put defib pads on this patient?

After several years on the job, I am seeing in myself that I am getting snappy with people (like 80%). The worst is that I think my partners are kind of seeing this too. I just don't understand people anymore. Just as an example... 33 year old female calls 911 at midnight. We are sitting outside of her building for at least 10 minutes before she decides to walk up. She lives probably within a 5 min cab ride (if not 10 min walk) of 3 hospitals (not that she needed one). She is calling because she has felt nauseated all day. Me - When did this first start? Her - I don't know, earlier this afternoon. Me - Did you take anything for it? (I listed several OTC meds). Her - No, I was too busy all day... Me - *I gave a bit of a sigh, and rolled my eyes a bit* Her - Is there a problem? You seem upset... Me - Well.... * I continue asking her standard questions, menstration, prego, etc...and she looks shocked* Just drive me too the hospital. This isn't a homeless person, she was not a psych, she was well dressed and presumably educated. Oh and the woman in her mid 40's a had recently who called because she popped a zit and it wouldn't stop bleeding. This was in a 500k+ condo and she said "I told them it wasn't an emergency, but I have gone through THREE ROLLS OF TOILET PAPER and I FEEL DIZZY". She also lived with a 5 minute ride from a hospital. The first patient wanted to go to the hospital, the second I suggested not. EDIT - The worst is when my partners say "job security" or "an easy call". Sorry...that is not how I feel.

p3, you should sleep well at night. Again, I'll wait for some medical scenario's (not once in a career trauma) that people are willing to step outside their scope of practice for... Clinically the patient appears to be hyperkalemic (and say somewhat unstable) - are you busting out that bicarb that you "know" should be administered? Do you administer 0.8mg of SL NTG to that CHF patient when you can only administer 0.4mg as per your "protocols"? Better yet do you mix a bag with NTG to give IV? I honestly don't know if you can mix metered dose NTG and mix it in a bag to give say a 4mcg/ml bag. This is just for arguement sake. Do you administer glucagon IV to that query betablocker OD without any orders? Wait...That CHF'er was actually a pneumonia patient and you killed them with your awesomeness. Kudos. Go ahead hero...

They can't. The breaks of having a BLS only service. I wouldn't have some delusions of grandeur that just because I am an ACP in X service, that my education and experience should override the policies of a PCP only service. That is the DOCTORS and MUNICIPALITIES decision, not mine. If this paramedic is an ACP in another service they realize going in that they will always be restricted (unless some type of patching system is set up, but it won't be). People die, regardless of what you think MAY HAVE been beneficial, you are restricted to the service you practice in.

Agreed. What procedure's are people talking about that they "can" or "feel they can" do (on whatever level, but apparently were are educated in said procedure), but are somehow restricted based on their current "protocols"? Please give me your grossly hypothetical and reasonably hypothetical situations... I have standing orders to do a surgical cric and needle thoracostomy. Can I do them? Yup. Do I feel comfortable with them? Absolutely not. Will I do it? If all other airway solutions have failed or the patient is hemodynamically unstable secondary to the pneumo then yes. Is it like having a patient in a pseudo unstable rapid afib or something and thinking that giving amiodarone would be of benefit, but you can't? I know that amio can be given to said patient, and I think it would work so I'll just do it? I don't get. Added to the fact that a proportion of US medics with potentially substantially less education have a higher scope to begin with is a little unnerving.

The funny thing is that both the buses pictured (they are the actual buses pictured) are from my service. They are referred to as "support units" and are generally dispatched to all fire and MCI'ish calls (when available, which is probably less than a 50/50 shot on any given call of that type). It's a hassle to work on them, and thankfully I have only been on them once.

Ok, guys are you going off on the fact that I said "I judge the average patient (98%) by putting on the SpO2..." I was talking about the average 98/100 patients, not their oxygen saturation. LOL, anyway... Relax... The fact that Dwayne said that I don't have "the gnads to enter medical discussions" absolutely infuriates me.

And there it is... I don't consider my years doing BLS (PCP with 2 years college) for 4 years "running around doing pressures and bitching..." We'll I did bitch, but not about that... That is a problem with the service and the system, not the education. That fact is that NOBODY (in North America) at any individual paramedic level has the education that we do in Ontario. I spent 1/4 of my PCP career doing first response on a single man car (in a busy city) ALS paramedics know here that there are many BLS medics that have greater education if not the majority) than them.

To comment on your items... 1. I have 3 years of paramedic education and admittedly I judge the average patient (98%) by putting on the SpO2 and palpating their pulse. People are lying if in general they don't. Judging their need for supplemental oxygen will always be subjective. 2. What is a "load and go" situation? I don't recall (even on police shootings) where I didn't have time to get a quick pressure or what not. 3. I don't even know what that means. 4. Admittedly, I only have the same rates (wide open = bolus). I have to "patch" if I want to technically run it other wise. The vomiting 23 year old that should get 125-250ml/h....

Allowed to do? Generally speaking, no health care professional is going to do AR on your classic "I saw this random guy collapse in the street, I'm a doctor/nurse/paramedic/hard core civilian" type deal. Nobody... So the thinking was that HCP are going to back off on this rare scenario because they can't do "vents" on a patient? It is vastly easier to do proper CPR on a patient without any equipment (obviously) than to properly manage an airway and ventilate a patient. How or who exactly is critiquing this off-duty HCP CPR that it somehow would have made a factor in this persons survival? They should be lucky that a person stepped up. Legal action? Total BS, it's impossible.

Sorry? I think you should extrapolate on this more. So witnessed by HCP = compressions only and ? Unwitnessed = upfront CPR prior to anything and then whatever ACLS dictates... Current ACLS (if I'm not mistaken, we do studies around here) is basically immediate defib on witnessed (CPR while waiting) and upfront CPR on not. EDIT - unless you mean compressions only (no vent) until defib. Then you continue with ACLS. We have been doing that for years.

Except a physician can do it legally and over the phone (at least where I'm from). EMS cannot (again where I'm from) force patients to go to the hospital that meet the criteria as outlined in this case. They are not under any "mental health act" or anything. The MD in this case (unless I'm reading this totally wrong) has knowledge of this patient and was likely involved in the reason why EMS was called. The MD and family both likely knew that the patient would refuse. Ya, you're right. Given what the patient was going on about, I would seriously rethink her mental stability too. Obviously the MD did not though (this is all relative).