vs-eh?

I agree, I roll my eyes every time I see another "BASH XYZ" scroll across my screen. Yes, I know I don't have to open the thread (which I don't except this one), but again when half of the "recent threads" are "bashing threads", it clutters the other topics. Myself, along with probably the majority of people, only read/respond to the newer scrolling topics expressed on the front page. The "all in good fun" has worn its course I think. Now it is just annoying... I agree with the points VentMedic made as well. As for the "clique" thing? Whatever...This is an EMS website with 15,000+ members, where I'd say less than 50 members who post even pseudo-regularly have any practical knowledge of EMS and that I'd trust their medical opinion on. For the most part this forum tends to cater to students, wannabes, drop-out's, and people who want to artificially inflate their position in life. Adding the continuing onslaught of these "BASH" threads gives a poorer overall impression to newer members who are educated (IMHO), and invites the aforementioned. Hell, even Rid I've noticed doesn't post with the frequency as he did before on this site. Where is Asys? Kevkei? Etc... Perhaps it is the banality of these threads and the never ending idiocy of the "why can't I do more with less" mentality that is sending good, knowledgeable people to post less and less...

From the literature that I have read, CHF can be a difficult diagnosis even in hospital and with a chest x-ray...That is why I believe they (generally speaking) are shying away from diuretics prehospital. The risk/benefit in the face of a difficult diagnosis (electrolyte imbalance, etc...) leads to less use. Generally speaking, our doctors do not want us using a bronchodilator with a prehospital diagnosis of CHF. Obviously if there are underlying pulmonary issues (COPD, etc) in addition to the query CHF, then the case by case basis comes into play. Oxygen and nitro (single or double dose BP dependant) are our first line drugs and basically the only intervention that we take on CHF'ers +/- assisted vents with a BVM. Nasal intubation has grossly fallen out of favour and generally people will not use our ghetto PAI (midazolam and morphine) to knock a bad CHF patient down. Generally try to manage as best you can (unless pre-arrest) for more definative tx in hospital (CPAP, BIPAP). Sulpha allergy and furosemide use are contraindications, no?

As always I will critique based on things that I don't think "jive" with the scenario as you presented... 1) SOB for 8 hours, but had only taken her puffer twice total and only in the last 2 hours? 2) I assume progressing to profoundly hypoxic (pre respiratory arrest) but her vitals are "ok", she is till moving air and speaking and (it appears) is not obtunded or anything (takes a neb mask). 3) She took a "gasp" within "seconds" following IM epi administration and basically was now not tolerating an airway and breathing better? I don't think so... I'm just wondering if she simply had a vaso-vagal response from this chronic vomiting, went unresponsive, and it appeared that she went into respiratory arrest. She might have had an asthma exacerbation as well, but that was not her main issue. Possiblity anyway... A good time though to review ventilation strats for the critical asthmatic...You could end up causing more harm than good...

Potentially the greatest response ever to a thread on this forum. Cheer's to you man.

I truly don't know what to say. So any (I assume adult and I hope at least it's non-traumatic) patient that says "chest pain" gets asa and nitro REGARDLESS of anything else? Assuming no contraindications? WOW... Do all patients who say they are "short of breath" get a salbutamol (albuterol) treatment or any other "breathing medication" that you carry? If not, why not? It's basically the same type of deal. Screw this whole clinical evaluation thing and actually assessing the patient. "Medic" - Hi sir, what's the problem. Patient - My leg is bothering me. "Medic" - Are you having chest pain? Patient - Yes, but... "Medic" - Ok, I'm going to start an IV and give you some... Patient - Wait a second, I always have chest pain. Doctor's tell me I have something wrong with the cartilage in my chest. It's not my heart, I've been investigated many times. I take Tylenol... "Medic" - Sir you are having chest pain, I have to do this. You could very well be having a massive heart attack. LOL... My time on this forum has shown me that there are educated EMT's and paramedics in the USA. Unfortunately, every time American EMS is brought up in my place of work, people think that the above "chest pain protocol" is how your system operates. Give the red drug to the red (heart) patient. I know this isn't necessarily true, but the fact that things like this still exist and the grossly inadequate education that is routinely available to those in EMS solidifies this stereotype.

Now, if that's not a great argument, I don't know what is... Wow...

But can they do RSI? In the end, that's all that matters... Skills to pay the bills. Anybody that doesn't advocate breadth education in a health science post secondary environment isn't the sharpest knife in the drawer to begin with. I will give this example only because it is fitting. With this, I also admit that I am a terrible speller and that at times my grammar isn't the greatest. I do however generally understand what the word itself means... A couple of days ago, a person was in chat who stated (as I recall) they worked in an ER and was an EMT-B. To me anyone that functions in an ER and is involved in patient care and assessment should be an educated person. This person stated they recently had difficulties with a patient who was (and I quote) "death and mute". Now, I paused for a second...Perhaps I missed something or this was said as a farce. It was said again, and I said "You mean deaf, not death". The person retorted, "No, death". This went on for like a minute or two. I asked what attributes a person who was "death and mute" possessed. They said they can't hear or speak.... I lost it... After about a 10 minute rant on my part, I was received with the "sorry I made a spelling mistake" and people actually defending this person as a "people make mistakes" or "nobody's perfect". Come on people...Death mute? This is not a simple spelling mistake (even when asked multiple times and in the end what that patient indeed was), this is a total ignorance of words. Honestly....People were defending this. This person functions in patient care in an ER and thinks that a "death mute" patient is hard to handle. Personally you have to take people in chat with a grain of salt, but that incident (and the defense people came to it) spoke volumes.

I don't know where exactly that was said, but anyway... Calgary is an exception to the rule, and obviously should not be taken to reflect Canadian salaries as a whole. People are making it seem that it's a hard knock life for paramedics (BLS or ALS) in Canada. I assure you, its not. The fact of the matter is that anywhere else a "fast food job" will be paying like $10 an hour. So to make an equivalent living (based on a 40 hour work week) that "fast food employee" would have to work 120 hours MINIMUM to equal what your average PCP (entry into the field) made here. I'll take my averaged out 40 hour work week and go home happy thanks. Calgary EMS just hasn't "caught up" to the demands of other jobs thats all. They can't scale wages that quickly. And PS - I live in the most expensive "cost of living" city in Canada (generally speaking). I'm doing ok I think....

While rare, there are provincially qualified PCP/ACP's that work either part time/full time fire and vice-versa. However, when working as a FF, they can only function within that scope of practice (ie, very minimal, their knowledge is by far their greatest asset). It really makes little difference, because they don't have the equipment. I HIGHLY DOUBT doctors are simply going to allow them to function as paramedics while working fire. Beside's where are they going to get the equipment or drugs they would use on an ambulance? How are patients going to be transported? On a pumper or ladder truck? That will last long...LOL.... In the end it won't happen. But I honestly would like to see an EMS strike in a major Canadian system. Perhaps it would wake people up....

Something should be noted though... My general understanding of US EMS systems is that (especially in a large city) there are multiple (if not quite a lot of) EMS agencies and ambulance services that can respond to a call in that given area. For example, I assume in New York that FDNY EMS is not the only service that responds to 911 calls. There are probably many EMS services that are available to respond on a normal basis, and obviously if FDNY EMS (or Kansas city FD or whatever) went on strike they could "cover them" for a period of time (perhaps days). While I don't know much about Calgary EMS, I am going to assume they function similar to Toronto EMS. In that it is a municipal system and the sole provider of EMS to the city of Calgary. You see if Toronto EMS went on strike (serving 3-5 million people depending on the day) there would be ZERO EMS SERVICE'S within the city to respond to 911 calls. None, zip, zero. Municipal emergency services are the only ones who can legally respond to a 911 call. We can't fall back on private or hospital based services, well because, there aren't any. The only way to service 911 calls is by pulling ambulances from a neighboring municipal service which obviously could not handle the load. Simply put, 911 would collapse very very quickly in any decent sized+ Canadian city if ambulance went on strike. Period.

I love when things like the first sentence are said, and then immediately followed by the next. So, they are one of the emergency services that, if they went on strike, it would be deemed a threat to the health and safety of the citizens they serve? Sounds pretty essential to me...They know that if ambulance went on strike that 911 would collapse within the hour in any major Canadian city (there are very few fire based systems compared to the US). I honestly don't know why it's so hard for people to recognize EMS as an essential service. I say just strike, warn your friends and family, and watch it be over in an hour. The mess will only take about a day (hopefully) to clear up. It would actually be interesting if people knew that EMS was on strike and you couldn't get transported to the hospital by ambulance or receive proper pre-hospital treatment, if call volume would change during that time. Would people still call for benign complaints? Or would they only get "high priority" calls CP/SOB, cardiac arrest, major trauma, etc....I just think it would be funny seeing fire show up and be like "Here is some O2, ummmm you want us to call a taxi?" I have nothing against fire, but here they function as VERY BASIC responders very brief history, very basic interventions, and (outside of MAYBE a radial pulse) no real vitals. It would be interesting.... Pay seems on the lower end though. For comparison, PCP's start here at ~$30 an hour and ACP's around $35 an hour. Cost of living factors in but not to validate a ~50% starting wage increase. Hope you guys get everything you want.

Listen man, I don't want to bash you, but you seem to be attempting to fight the good fight. Here is a novel thought. Instead of adding procedures or drugs to a person with 200 hours of education, why not simply add education to make them better at (oh, I dunno) BLS? Why must adding to a very minimal amount of education = adding ALS scopes of practice? How about making EMT-B programs 600 hours. Educate on core concepts of BLS - CABC and their associated patho/normal physio/anatomy/etc...Have 240 hours (minimum) ride out time and 36-60 hours in an ER? This that really that hard? It will probably take ~ 6 months, but be far and away better than what I read as the current state. Don't add chest needles, intubation, whatever...Add core skills and good BLS procedures, so that people aren't listing placing dots and setting up lines as what they look for in a good BLS partner! That is seriously an embarrassment folks. Let me tell you something...When I did my ALS OR rotation with the anesthetist(s) one of the major things they look at is GOOD BLS AIRWAY MANAGEMENT. They often use flow-inflating bags (amoung other things) which simply do not inflate/give adequate tidal volume unless you have a good seal/aw adjuncts prior to intubation. The doctors praised those who could accomplish this, and these are the "airway masters". It gave me a sense of satisfaction knowing my BLS airway maneuver's had been solid all that time. I honestly don't know what else to say. Stop adding procedures and add to your education that is adequately needed to do your job. It is grossly apparent that those who are arguing for adding procedures don't really know how day to day EMS works.

Advocating intubation at the BLS level is a losing argument, period. Intubation does not save lives. Proper BLS airway management with good BVM skills will manage 99% of airways prehospital. You need/should have a dedicated airway course will ER/OR rotations with an anesthetist. Not simply placing a tube in a mannequin. Even if you are saying you will intubate only dead people, reading the new ACLS you will see that intubation is deferred and (in the end) isn't necessarily needed. CT is the same argument. Needle decompression? Maybe in Combat lifesaver (I'm not familiar) where I assume you see a tonne of trauma/chest wall injuries. Decompressing a potential pneumothorax is a lifesaving procedure, however...Generally speaking this is going to be quite rare for a normal EMS provider. You are probably going to see as many medical pneumo's (asthmatic, barotruma with PPV, etc) as traumatic ones, and these aren't exactly easy to recognize with 200 hours of education under your belt. IV's? Again don't save lives, especially if you aren't giving IV meds. Again in this "combat lifesaver" roll where you are seeing a lot of trauma and hypovolemic shock it may have its place. Normal EMS work for BLS? Probably not. Glucose injections? Like what glucagon or are you saying giving D50 (pretty vague)? Again, do you have a reasonable amount of pharmacology within that 200 hours? Meh, I think not...

See but that's the problem whit. It would be the teeny tiny minority that would do what you are suggesting. I had to do 2 years education for BLS prior to ALS - psychology, writing techniques, all the sciences, etc... But as a PCP my scope of practice is very similar (with regard to actual skills) to the EMT-B. "LUDACRIS!", they'd cry. Why should I have to do all that for BLS? You would do it, or had to, others would not. People don't do ER rotations or ride out time for EMT-B? Maybe sticking dots in the right places is a plus then...

Any level of EMS provider, at least superficially, will appear similar. This is especially true to the skills driven, "I can do this and you can't, ergo I must be better/more educated" EMS provider. That program that a PCP has to graduate from is a highly competitive 2 year college program (within the last 7 or so years). That A-EMCA exam is a 6 hour provincial exam. Both of those (generally) are needed prior to employment. Employment itself is also very competitive, and certainly no easy walk. EMT-B programs seem to range from 120 to 200 hours. Ambulance practicum hours ALONE in most programs in Ontario are double to triple that time. If all a BLS provider (PCP) needs is the education that EMT-B's get, then why doesn't Ontario simply only require that? Why is EMT-B training useless in Ontario and basically throughout the rest of Canada? Why did Ontario move from a 1 year to 2 year program 7'ish years ago? I don't know what type of education Alberta requires for their EMT-A/PCP, but I assume it is 6 months to 1 year. Would you be ok with allowing people who picked up their EMT-B to simply challenge your process and be PCP's in Alberta? Would you want a provider that is heralded for being able to put on a cardiac monitor or say "Hey, that box is purple" as some type of star of BLS EMS? If you think all of this is ok, then well.... I still can't believe that people argue this and say that EMT-B sounds pretty similar to PCP, hey they are both BLS, etc...It's not the same. The list for what makes a good PCP would not include what people have mentioned and would likely include being able to discuss treatment options, patho, drug interactions, etc... THAT IS A GOOD BLS PARTNER, not setting up a bag.... Come on...

People, people... Again, you are advocating RECOGNITION OF COLOURS, sticking dots on people, and sticking a thing in a thing and running a bit of fluid (setting up a line) as POSITIVES you WANT in a bls partner! I could show john q. nobody on the street that in less than an hour and then get them to run a dynamic arrest with me. John pass me the brown box, ok, pass me that vile... Honestly, that is a joke. And people are like WOW, Steve can stick 3 leads on that guys chest or know what colour purple is! WOW....Sign that man up....EMT-B of the YEAR!

Silly me....That whole 6 R's thing. Come on. Honestly, you are using recognition of colours as a strong attribute in a good BLS partner? Nobody will argue that the majority of EMS calls require only "BLS". However... If placing leads, setting up a bag, driving safely (seriously), or knowing that epinephrine box is grey (or brown or whatever) is seen as a sticking point for a good BLS partner, how can I expect them to know how to auscultate a BP properly or ventilate someone properly? The answer is, I can't... PS - I don't work in the USA. Here, at my place of work with the majority of paramedics (PCP, ACP) these are moot points. Of course this might have to do with (amoung other things) 2 years college education for BLS, 800+ hours didactic, 500+ hours on ambulance prior to working, etc...

Setting up a drip set, attaching leads, driving safely, or knowing what colour boxes are for what! (WOW, my opinion of US EMS system went down a tonne if you honestly use colours to designate drug orders). If these are some hallmarks for a good BLS partner, you my friends have much bigger fish to fry... Seriously, that is sad... And sorry the 75% of EMT-P is EMT and the BLS before ALS garbage? Refer to the above. If people are considered "good" EMT-B's for the whole hour to takes to show them how to place leads on, set up a bag or know what colour brown or purple is, I don't expect them to know how to properly manually manage an airway or bag some one. Yikes people.

Considering I am on an ambulance with these decals... I would prefer them not being an my ambulance. Why? I was not given a vote nor a choice for these decals being on the ambulance that I have to do my day to day job on. I don't see postal employee's having these decals on their vehicles. I don't see garbage men (sanitation engineers) having these decals on their vehicles. Both of these divisions are municipal/provincial. Why are emergency vehicles obligated to HAVE TO HAVE these decals? No choice, done. It has nothing to do with any personal belief system with regard to supporting the troops or (and as much as people will say, there is at least a fine link to) supporting the war. Even though it has never happened to me on the job, I have little doubt that it will be brought up by the general public or by a patient in the near future the recent controversy regarding these decals. It should also be noted however that our ambulances have had these decals on for many many months. Why should I then be FORCED to engage/decline a conversation starter based on a political statement on a vehicle that I drive because of political forced action. Can I force all politicians to wear a yellow ribbon at all times when at work? Hmmmm....

1) What is a stretcher? Everyone walks... 2) Seriously, this is a ridiculous conversation.... 2.a) You would call a doctor regarding securing a patient to the stretcher? WTF would they know? 2. You never have any ambulatory patients? I.e. jumpseat seatbelt only? 2.c) So people either get tickets for lack of a seatbelt in their personal vehicle due to their anxiety or are they somehow exempt? 2.d) I like how "being partially sedated is not sufficient" is mentioned. Please tell me you have been in this situation and THEY ACTUALLY SEDATED YOU....The "rendered unconscious" thing is equally ridiculous. I don't use the shoulder straps on 99% on my patients.

Just to let you know dude, I believe there are only 2 BC guys who post here even remotely regularly. $30k a year as an EMR (like EMT-Bish education? What like 120 hours or something)? Dude, that's pretty good. In my province you would be making zero dollars a year as an EMR because they don't function in EMS here. In fact, EMR is generally worthless here, but I digress... My application is in process for BCAS as an ACP. I'm good (they have told me, at least education wise), I just have to wait. I hope I don't have to do a "behavioral based" interview though...It may bring back those unfortunate incidents in the past... I've said too much...

For those that have given D50 PO..... 1) Do you have a standing order/patch order that allows you to give this solution by this route? 2) If you do not, do you inform your medical director prior to administration (i.e. patch) or inform them ASAP following the call? What do they say? You are administering a medication (regardless of its "flexible" definition for D50) via an unapproved route I assume by both the manufacturer and by your standing orders. If D50 was "ok" to give PO, then you would have orders saying so in your "able to follow commands, hypoglycemic patient". This would be given of coarse that you don't have ready/reasonable access to a food source/glucose gel, and basically as a last resort. I hope people aren't regularly giving "ok", but hypoglycemic patients D50 orally... I would think if administration PO was "acceptable", even in a "no other option" scenario that you would have orders/manufacturer guidelines saying such...I assume most/all do not.

Worst show ever. I should have had an idea that it could be shite based on the first call. A call to an obvious death where the paramedics say they could "smell it" and they said that he was likely dead 24-48 hours. Yet, here they are auscultating for something on this guy? Hmmm... Another noodle scratcher was this asthmatic call. Obese woman who looked like she was in her 30's max, known asthmatic, and apparently had be intubated in the past. She had "wheezes in all fields", nothing audible (from the TV anyway), and appeared in mild distress. They gave her an albuterol (salbutamol) treatment and then said they need a driver(!) because she had been intubated in the past. Keep in mind this is as the patient is walking to the stretcher with no mask or anything on her. THEY HAD 3 PEOPLE IN THE BACK WITH THIS WOMAN! But that isn't the kicker...They gave this woman epi SQ. Now, I don't know what it takes for you to give epi for asthma (or what your standing orders allow), but this woman certainly didn't meet it. She looked more status dramaticus, than asthmaticus... When my asthma patient is talking frequently and speaking in full sentences (12-13 words I counted at one time), they are not that short of breath. Anyway...About the only thing interesting about that show was their stretcher.

WARNING - This video is not safe for work. It displays a man getting mauled by a lion with corresponding injuries (gore isn't bad at all) and (far and away more disturbing/graphic) a lion getting shot and killed by a police/army officer. Found this on a humour forum I peruse. It offers and interesting look into an unusual mechanism of injury and an equally unusual look into priority of treatment. Make sure you clean that leg injury well there boys, it's not like bystandards were just doing chest compressions and AR on this guy... EDIT - MAYBE I SHOULD ACTUALLY LINK THE VIDEO... http://www.videotiger.com/lionmaulsmanvideo.shtml PS - Yes, I realize that this isn't any "modern" EMS system. Yes, I realize that this patient was likely not in cardiac/respiratory arrest...This is still how EMT-B's function is the US though right? They probably stopped filming just before the epi-pen was busted out...

That is promoted here and often seen in "doctor's evaluation scenerios" in a pre-arrest/arrest asthma case. When I say "promoted", I mean to the extent that you may not pass if you do not do this maneuver.