vs-eh?

http://www.emtcity.com/phpBB2/viewtopic.php?t=10462

Is this like a Festivus pole? Or is it just one that AK can wail on people with? Wow...

PRPG's old EMS radio show with NREMT-Basic, Rid, and myself > this. /thread

Ummm.... Sorry, did you speak to this patient or did the RN simply tell you about the toes and increased SOB on exertion? What did the patient say about these episodes of apparent severe dyspnea? Normal? Past hx of same? Any pain/discomfort/"funny feeling"? Why is she doing this? Etc... Standard hx questions...

Agreed. Or should you be a provider that can "run" a cardiac arrest and call for pronouncement? In Ontario, all ACP services (and some PCP only services) can call for pronouncement on medical cardiac arrests (trauma is basically a given). This is pretty much status quo for medical cardiac arrests without a ROSC, though there can be exceptions - ACP discretion and pediatric patient being at the top of the list. I personally have never experienced nor heard of a paramedic not pronouncing on scene due to something like family refusal or physician telling to transport for some reason (that the paramedic didn't recognize). Jake, I always talk to the family during the arrest, usually after the 2nd epi in a non-dynamic cardiac arrest. This can be a pretty difficult thing to do, especially in Ontario as you might be the only provider that is allowed to administer medications. Hopefully your system allows another to administer if you should still be in conversation with the family. Personally, I don't think it is a good idea to start explaining the pronouncement and whatnot to the family AFTER pronouncement. I realize that the physician basically always speaks with family after, but the ER usually has the luxury to remove family to the "quiet area", get a pronouncement, and then talk. With family on scene of an 911 call, it generally isn't that easy with active spectators. My opinion.

A couple of points... 1) It might just be me but the educational requirements to function in patient care in an ED seem quite low in the US. A 120 hour course or 4 month'ish program doesn't qualify you in ANY capacity to be involved in patient care (especially in an emergent setting). As akroeze said PSW is 1 year fulltime, RPN is 2 years, and RN is 4 years. As far as I know, only RN's participate in patient care in the ED. Floors are different, but not the ED. 2) I won't expect any equivalency for a profession just because it is in the same blanket field. I don't expect primary care paramedic's (2 year college) to be able to write an exam or something and BOOM are now an RPN, and certainly not vice versa. I even have some issue that they allow RN's to challenge the PCP process, but I can potentially see (at least from an educational standpoint) why it can happen. I also don't expect me as an ACP to be able to take say a 1 year bridge and become an RN....But I digress... Wendy, if a 4 month course will get you a job that you want, why not do it? I dunno that's just me... For reference - http://postsecondary.humber.ca/07041.htm http://postsecondary.humber.ca/07741.htm http://postsecondary.humber.ca/07061.htm http://postsecondary.humber.ca/07651.htm (PCP or BLS)

I dunno.... Dopamine calcs? Want/have calcs? X fluid over X time? These are pretty standard... concentration? %? serial dilution?

On "Who want's to be a 5th grader?" or whatever they had this problem as 5th grade math... What is a common factor of 12 and 36? Miraculously, Mrs. USA knew this, but thought that the heavenly body that made up 99% of our SOLAR SYSTEM'S MASS was (her answer) THE UNIVERSE...She answered both question's with certainty... I think she ended up winning like $175,000. People applauded... *Gun to head* Most EMS math is pretty quick and easy... EDIT - If anyone here doesn't know within 3 seconds what the answer is to my above "math question", you don't belong in EMS or any job that needs an education above a 6th grade level.

310,000ish, for a single city, single EMS service city.... I don't remember what my pager said prior to hitting the new year... Keep in mind that certain calls (like standbys) don't count in the call count.

See this is what I don't really understand. I would hope that most people (regardless of their religious beliefs) see how ridiculously wrong this statement is. It is obvious that the above poster and spenac have belief systems that generally don't coincide with any type of secular and moderate religious belief. I should digress on the above quote, but I won't... I'll try to give this arguement point by point, it is easy and I'm not the first, but think about it (oh wait.....you can't).... 1) You believe in God (obviously a Christian and not abstract philosophical God) and obviously all the properties that God encompasses (the "omni" properties) 2) You also believe in the tennants of said faith 3) You also believe in "free will" and what God has granted us 4) You also believe that God (in the Christian sense) is right 5) You believe that other religions (at their core) are incorrect ergo... Why would your Christian God (or any religion's God) who is an "omni" God want me (or even allow me) to make a choice (I'm agnostic leaning toward atheist) to disbelieve in it and subsequently "go to hell for disbelief". Pretty evil God you are following, when their are BILLIONS who don't...and besides, it can do (if it exists) whatever it wants anyway.... When people think about "God" and the "omni" factor, you should see how silly it is... EDIT - Oh ya, and you shouldn't be bringing your children up in the supernatural religion that you (not them) believe is right. This may come as a shock, but Hell and heaven are not real factual concepts in any sense of the word. Leave them alone, they are children... I hope they become evolutionary biologists that have the same good sense as me... Peace.

You are 18 years old, are an EMT-B, live in small town USA, and you are "sick of EMS"? Find a new hobby, please.

So, I assume that all my points regarding children and God as per spenac's post are either not worthy of him or are points that he/others cannot rational argue. I'll assume the latter. Thanks for your conceit. Hopefully, others see the error in their way. I will wage that these 9 year olds that you see that can "clearly articulate their faith", are articulating the faith that they were brought up in. The faith of their parents. This 9 year old has independently, without hard influence, "knows" things that I may not know? They have weighted the evidence, and have come to a conclusion? If anyone can show me a 9 year old that was brought up in a "religion neutral" family or even say a very religious family, but chose another religion or is agnostic or atheist and can articulate the reasons why...Well kudos... You won't win the above bet.

ccmedoc, We're talking about children here, not adults. We're talking about what adults believe is right or wrong based on interpretations of supernatural religious faith, not fact or general secular consensus. A child does not have the mental capacity to contemplate, weigh evidence, and make decisions on some of the deepest questions that we as humans are able to contemplate. There are no "children of this faith" (whatever that faith maybe), they are children of their parents faith. So you respect beliefs of different cultures and religions carte blache? Or do you "respect" them on a superficial level, but on a real biological and secular level see the wrongs on certain aspects of their culture or belief system. I'm sure you think the latter (or hope). I sure you don't think that all aspects and deeds carried out in the name of "culture" or "religion" today are to be "respected". There are core of biological altruism that hold true for every (intellectually stable) human being. People go on and on about how their faith or religion is personal. That what they believe guides them in their life, on their personal journey (JW's don't actively impose their faith on people right...kidding). In cases such as this (and in countless others) you are imposing your belief system that is based on such supernatural subjectivity, none of which has an ounce of fact or truth, on the life and mind of a child.

This may surprise people, but a child born to a JW, Christian, Muslim, or Scientolgist is not inherently a person of that faith. There are no allele's that are expressed in DNA that give the person all the inherent tenants and beliefs of a religion. The reason I have blue eyes is because of a predictable genetic combo from my parents. That same genetic predictability does not give me my religion at birth. They are born into the religion of their parents. The religion that their parents chose for them. Children are born atheists, pure and simple. Children won't have any real concept on any religion or God until well into life. And if they are lucky enough, they will have parents that either allow them to choose their faith (beyond their parents, and without contempt) or offer a neutral stance and educate on all options. The vast vast vast majority will not have these tenants. They will have parents that since conception will "guide" their child through their own "personal beliefs". I don't care if adults chose not to do XYZ because of their faith. As long as it does not effect me, the people that I care about (who don't follow that faith), or those on a global scale that maybe more naive about certain matters. Vent's patients in the NICU/PICU are atheists. They have no concept of faith or God. As such they should by default be treated by secular medicine and whatever the most reasonable and effective course of action is as dictated by medicine at that time. EDIT - And any arguement regarding that the procedure may have killed them anyway (through allergy, reaction, infection, etc) is moot. These are core aspects of medicine and a procedure that is reasonable, rational (secularly and scientifically rational) , and provides the quickest care with the most predictable outcome/safety profile, should be chosen for children.

Why does the side door appear to be ripped off (I'll assumed jaws of life style), yet it is obvious that the rear door (at least one) is easily opened. The accident does appear to be fairly minor and restricted to the cab of the ambulance. LOL? WTF does that mean? I'm going to ask the city to rename us a "relief association". What a joke...

What is an "insulin reaction"? "Slamming in the meds"? You are an ER/CCU nurse and just used this terminology? Hmm....

Was that block of text asking if that person should go into a 6 month "medic class"? Seems to me they already have a foot in the door...

http://www.emtcity.com/phpBB2/viewtopic.ph...ghlight=#127616

I am assuming (hoping), that you are making an error when you say "compound fracture". This patient had one of the bones of her arm physically visible through the skin? Hmmmm... No dressing, no splint, no padding, nothing? Just a bone sticking out of the arm and a 6 year old sleeping on mom? Hmmmm.... I assume the "IV needle" was a lock or something... 1) Did your crew not ask the MD/RN why the arm wasn't in a splint? 2) Did your crew not ask if she had been given pain management? I assume she was given this scenerio and the fact she was "sleeping on mommy" with a open fracture. Just because a child rolls into an "adult hospital" does mean the staff forgets everything including basic first aid. Something is amiss somewhere...

Well, obviously with that I am going to assume it is some sort of spotaneous pneumothorax/bleb. But spontaneous bilateral simple/tension pneumo's leading to a pre-respiratory arrest? Hmmmm...

Tell the patient that next time he should chew his food. 1. Manual maneuvers 2. Laryngoscopy with the McGill forceps 3. Surgical airway (depending on where the FB is) or advancement down into a mainstem (likely right) bronchus. Ask for pat on back for saving life and a little lovin' from hot Asian-American daughter... Dare to dream...

This is for PCP only, I assume. I don't know anyone who has done this. I know of (I think) RN's and RPN's who have done the 2 year PCP in addition to their 2-4 year nursing education. Education for (degreed) RN's wouldn't be a problem. Putting into practice I could potentially see as an issue in the EMS environment especially for a non-ER nurse. I do see an issue as possible only needing 10ish shifts and being able to challenge. Meh, wouldn't really matter anyway. You still have mass competition to get hired and stuff.

I agree 100% with p3medic. I don't think the analogy that ERDoc made is valid. I have said this multiple times in multiple threads. Yes, I am in a different country/province, with different didactic, clinical, and preceptorship requirements (more, basically on all counts), but that doesn't mean that core aspects of the job are different. Without repeating myself for probably the tenth time, there is more to EMS than just assessment and intervention. Other core aspect that encompass all levels of prehospital care need to be honed IMHO prior to being the hero. mobey - Are you ALS? You certainly don't appear to have a high opinion of Alberta's BLS system it seems. This seems odd considering I believe there was a recent post praising PCP/EMT in Alberta and saying how much they exceed the CMA PCP and should be recognized as such. What you are saying is total BS. Any PCP worth anything will not see the move between PCP/ACP as "completely different entities". It is not a "crock" to learn a good BLS assessment prior to ALS. Maybe it's just me and the system that I am a product of. My formal paramedic education (2 years PCP + 1 year ACP) exceeds 99.99% of this board, and I still think it's bullshit when this point comes up. Sure, go straight to ALS with your 24 hours road time as an EMT-B and your 300 hours road time as an EMT-P. I'm sure your interaction with patients, reports to hospital, patches, dealing with family, dealing with allied services, making non-medical decisions (or even medical),etc will be top notch.

MedicMal... And keep in mind that I will refer to all Ontario "patient transfer services" as PTS from now on. Why would a person who transfers patients HAVE to evaluate a patient that they are transferring? You don't, that is up to the MD's, RN's, and RPN's (and others) that have handled this patient from the patient of their care to yours. You are not paid to assess patients, you are paid to transfer patients that cannot go by personal means, cabs, or wheeltrans. That is the simple truth. Now, keep in mind if you are not comfortable moving this patient (as with any of the above services), then by all means express your concern prior to transport. Please do, but realize that PTS are not bound legally under the MOH or their basehospital to use discretion when transferring patients. It's more of a moral or common sense thing (that PTS employee's should have more knowledge about). Why would a PTS employee REALLY care about assessing a patient or "getting a history" or "evaluating" a patient. Anymore than wheeltrans or a cab? I'm being honest here, it's more of a moral obligation, than a professional one. So if as a PTS employee you had a patient breathing at 40+ breaths per minute and (after asking the staff about their stability) you transfered them, did you call 911? Did you get into your vehicle, and then call 911? If not, then why?

Two points that MedicMal stated that I didn't think of... The airport thing...I forgot that transfer companies do airport (i.e. island and Buttonville, I assume not PIA) transfers, and are required to use "lighting". The jeeps that usually escort you only have bar lighting I believe. Fair enough, I would have dedicated vehicles (say 1 working around TIA and one near Buttonville) that would be equipped with adequate lighting. These would be the only 2 vehicles that could do these transfers. They would also only be staffed with (pref) AEMCA/PCP students WITH their F class. The 2 stretcher transfer thing? GONE! I think it is ridiculous that it still exists, and every time I see it, I'm like wow...