jmac

none air, strictly a once off, may change in the future but now just suspected cases men-sep, AB's and fluids, the thinking is to get it started because of the wait in A&E, better to have it started.

air, what i was speaking about was dust referencing TB, he is right, but we do not admin AB treatment for TB, we have cases here also, previously eradicated versions that have not been seen since the 50's and 60's , but the difference is that Meningococcal Septicaemia is a rapid killer, therefore AB admin in the field is important while TB, just as much a killer but slower. This is a thread about admin of AB's and recognition for admin of said AB's. while infection control is of the utmost importance, it should in my opinion be a done deal, it is here. It is the doc's here that called for pre-hosp admin of AB's, we have our own guideline on recognition and admin and is part of our training, also we are licenced practitioners and the onus for continued medical education is on ourselves as professionals, to the delight of management, and we have a requisite amount of hours training per year, not a couple of hours in a firehall as dust says. (thats a quote dust not a slag off) To us it makes sense, i am all for education, actually have some myself, but the approach is different here, and the recognition, different strokes for different folks, i have respect for all my fellow professionals in the states at all levels, but things changed here, it seems by all acoounts in discussion that things are not changing in the states, and if there are some, they are not across the board and vary from state to state, though the US started pre-hosp care, countries outside have picked up the flag and are trying to carry it forth, gone are cook-book medics and big overflowing drugbags, today its more if it looks like a duck, walks like a duck and quacks like a duck....hit it with both barrels and break out the plum sauce, back to basics and build on it........agree to differ here.

dust, first things first this is not a personal attack on you, the stats i left up were for you because you like fact, the rest was just my opinion, as for TB, this is a thread about meningitis so what use are all those stats. CC, if you feel i am ignorant, thats your opinion, you are entitled to it, in the context of being with a sick child, sorry lab work for the lab, don't have one on me at the time, i treat my patient, not guess about what results may or may come back from the lab. dust, we don't use protocols or medical direction for these type of cases, we use Clinical practice guidelines, something i have heard you call for in the states, if we feel clinically justified to administer we do, for anything above or outside our CPG's we can call for medical direction. throm's and AB's, these are time related, as hertz says needle to door time is essential, some on here (relax dust, not singling you out) seem to go for the negative aspects of of pre-hosp care in the states, though it was the US that was in the forefront of EMS, it has taken a backseat but i have a lot of good friends in the states at all levels and in discussion it appears that the education that has abandoned them, not their own laziness, CC, in my opinion all the lab courses and such are NICE to knows, well and good to have them but not worth a toss in the field, experience and judgement count, along with clinical responsibility first rule of EMS, treat the patient following the four ethical principles, and staying within my remit, i have respect for a lot of people on here (you too dust ), but there is a lot of negativity, some things work here, why not the states, life goes on, air in air out is a good thing.

wow looks like this thread is going the same way as most here, full blown anaphylaxis???? according to the stats on deaths from anaphylaxis due to allergy to penicillin in the UK over a period of 10 yrs is 27, those are good odds. this is an international forum, why is it if something is done outside of the US it is either done badly or is inappropriate to some here, and why do some here, for all their preaching on the need for education, cut most EMS providers off at the knees in the US and say that they " don't have the education or are too lazy to get it " In other countries (non-US), pre-hosp providers are giving anti-bi's, thrombolytics ect, this is advancement, this is education for the pre-hosp environment, no matter how much time in the lab doing courses on micro or lab work, maybe good education but ain't really gonna help you in the field. why does every thread on here go down the line of a few philosophers telling their opinion on what should be, maybe they should take a leaf from their own books and look outside the box, not stay in the tunnel

ok, don't really like to comment here but lets just say have to say something, better minds then mine outside of the states that are attached to medicines advisery groups have stated passed and allowed the use of IV antibiotics for "suspected" cases, as phil said better to get it then wait. Dust, some cases are more then a 15 min ride to hospital, while the use of steroids as doc says is great, benzy and fluids is all that we are permitted, what i cant understand is those that seem to advocate better education in a system seem to go out of their way sometimes to downplay advances in other systems, this is not an attack on any individuals, just a sit back and watch, in our case, it better to have it and give it then not have it and ponder, hey its up to the labs to diagnose anyway.

we give the benz here pre-hosp as well

just to explain the system http://www.emc.maricopa.edu/faculty/farabe...kINTEGUSYS.html

in my opinion its the carry out that is the problem and not treatment, most of the treatment is basic skills except IV and pain relief, and even that is a basic skill in some areas, good scenario, how did it work out in the end. as i stated at the start of the post this is my opinion.

her weight would not have made any difference, she still has to be extracted, with the firecrew assisting form one end and vehicle making way from another just carry her out, many hands make light work, no point screwing around achieving nothing, get her to definitive care.

immobilize spinal..O2 monitor IV with fluid to maintain BP, light turniquette to delay toxin spread, pain relief, stabilize with standard measures of #, anticipate possible spont- abortion and carry till meet appropriate transport, co-ordinate fire crews to carry and keep contact with patient and monitor.

RD, i am not doubting you, i only asked as there is no mention of a pre-hosp ECG with the rate i wondered if it was Junctional or controlled A-fib. , but as you say you were there, thats why it is hard to try to visualize someone else's patient Just like to bring your attention to the last line of my post "good call anyway", cheers.

Just one question? the patient had a history of A-fib 5 yrs ago, how was it controlled?? Pulse of 56?? good call anyway.

Happy birthday stacy :wink:

ok, now we know that some people here can sling some serious ****, but can we diagnose in the field :roll: :roll: :roll:

whoa whoa whoa whoa, jesus people, does anyone actually read the rules of the forum, http://www.emtcity.com/phpBB2/siterules.php with ref to para 4 and 6. I am not American, i dont hate Americans, I am professional EMS, and could someone please tell me what has all this got to do with diagnosing in the field, before someone tells me to butt out, i was one of the original posters in this thread and it was an interesting discussion before all the **** throwing and defensive posturing, can we get this back on track and act like professional medical people and leave the political debate to those that get the bucks. Jeez guys, you would seriously want to stand back and re-read all these posts.

it is the right thing to do to let them assist, speaking personally, augestst just gone my mother arrested in front of me, i started CPR and the doc arrived within 4 mins and two ambulance crews within 10-11 mins, and we worked on her for approx 40 mins, alas the outcome was not good, but i can honestly say that being involved really helped with the healing process. Just because they are a family member do not rule them out because of it, remember that there are more then them to try to come to terms with a sudden incident like this, and being part of it and knowing ( if it is a sad outcome ) that everything that was possible was done, can be passed on internally through the family, ACLS states that if a family wishes to witness resus they should be allowed, in pre-hosp, a trained pair of hands, so long as they know (like i did) that that is all they are, an extra pair of hands. it really helps, plus the fact you have someone that understands what and why things happened, i know that litigation is a big issue over there, not so much here, but family member help should not be discounted in my opinion. PS: sorry mike , i just read your post again and saw that is was very similar to mine

now that is some statement for someone that wants to enhance EMS, if an emt is responding to trauma and ALS are dispached after them, it would be nice to know enroute that the Pt has decreased breath sounds, if the EMT wants to invest let them, it can only do more for them, cheap is wat it says on the tin.....cheap.

any family Hx of huntingtons or multiple schlerosis also on his summer time off did he do any water sports ie scuba and is he part of a swim team ??

Any course that will indicate to you as a professional possible problems and indicate to you possible underlying factors, ACLS, ATLS, PEPP, NEO-NAT, STABLE, anything, while academic courses that give you the piece of paper for your vast CV are well and good in my opinion workshops in individual fields are the best way to learn, to shadow another healthcare professional while they are doing their job can give you an insight into all sorts of diagnostic skills. When i started i was taken aside and told that i will get a lot of facts and theorys, and to make a diagnosis i should try to make the theory fit the facts...not the otherway around, i may come up with a couple of things pre-hosp...suspicions and an old doctor said...a spade is a spade, the same way an MI is an MI regardless of what artery it is it is still treated the same way, if you have a 12 lead well and good, just give the info that you have, dent get pissed off because the first thing the ED does is another 12 lead, they are just confirming your findings, i have seen a lot of young newbies messed up because the think "I told them it was an MI" . In my opinion never be afraid to follow up on a Pt..regardless of what level you are, and you never stop learning, and if there is not a piece of paper and the end of your course what the hell, its nice to have it but i am there to share the experience of those there trying to teach me, its a personal thing, i just want to do my job to the best of my ability..not paper a wall :wink:

This is just my opinion but if we do not diagnose are we doing the best for our Pt's. Is it not better to make a provisional diagnosis and be proved wrong then to come in with dust's "pain in the tummy", take a Pt that you have been called to for ? a CVA ( i am not going to use any ALS interventions for to show my point), you arrive and all the indicaters are there, but on your work-up you find that the Pt is in SVT (A-fib or flutter). The Pt has no previous Hx of cerebral events or cardiac and has been feeling unwell for a number of days ending in collapse and LOC a number of hours ago, so you arrive at the ED with an obvious CVA Pt and a possible heading towards unstable SVT that you have a diagnosis for and evidence (ECG) and event Hx, so that you have a probable cause of the CVA (washing machine effect) that can be addressed straight away where the CVA has to be worked up (CT ect). I know most here could look at this and say that this is a simple example, but hey this is pre-hosp diagnosis at its best, the obvious and the underlying, and because of the diagnosis the Pt's cause can be addressed there and then. I hope this makes some sense, i have been up all night and this piqued my interest, our provisional diagnosis on the ground is the thing that actually directs the ED, regardless of your level towards a Pt's better clinical care, no staff in an ED is going to ignore or discard your diagnosis without investigation, so long as you have the facts.

in my opinion, and following our guidelines, even if we do not even reach the Pt it is documented, one of the worst things in this job is communications, so if you are stood down half way there you still need to document. All Pt's get a PCR, as you described in your scenario you made interventions, (suction, loading), though BLS you have treated the Pt even though the ambo is on scene, you can be damn sure that your interventions are stated on the ambo's PCR. And if there is a PM for whatever case, you may be obliged to attend, is it not better to show some documentation, however little it is then to sit there trying to piece together events, documentation should always be a part of your ongoing professional development regardless of what level, better to start good habits then get caught out and embarressed. in my opinion there are no onlookers at a scene, if you work, put it on paper then nothing comes back to bite you in the ass :wink:

just a couple of things i noticed here, 1. this happened over 5 years ago. 2. the city settled out of court. 3. this is a rehash of a similer case from 1993, where a non-profit organisation deemed that agreements made were not made and that the training that that the city promised was not (in the eyes of the organisation) given, and all this started when hardly anyone understood where why what about HIV-AIDS. 4. this is a dramatisation to prove a point, 5 yrs ago, they get their ruling now, the EMT's that attended are either gone from the job or medics now, and in my opinion were not at fault, politics are, this stinks of being about the money and a political agenda for a small miniority, yes they are a small minority when you look at africa, this is not about lifestyle, its politics.

ruffems,in reply to your question, yes it is my own personal gluecometer but the calibration chips and sticks are supplied by the service and we use ten packs so it gets calibrated very often. the reason we got them is because we are the ones training BLS in the diabetic clinics so its very easy to get them replaced, the meter not the sticks they have to come from the service. as for the ER, they see what we treat, and if i brought in a diabetic after treating them what would be the first thing they would do regardless of what a previous reading was ????. hope that answers your question.

no prob AK, i have had a newbie 1 1/2 mins from the ED and an anastesiest working on a Pt with hypoxic seizures because someone had told him that hyperventilation will always ease the clenching,.........sometimes commen sense can go out the window. remind me to send Irish/American dictionary to Admin

everyone in this buisness does better to have it on you and know it works then to have the one in the ambo go tits up.