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paramedicmike last won the day on November 6 2017

paramedicmike had the most liked content!

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    Pragmatist, Resident Cynic

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  1. last post was Feb 22

    Kemper Arena. Got to play soccer on the floor before a Kansas City Comets game there when I was a kid. Fun times. Good on the Eagles for still touring. Would like to see them. Not sure I want to shell out the bucks to do it, though. That might be one of those "once in a lifetime" events, though. Glad it was a good show.
  2. Another new guy, but perhaps a little different

    Welcome. Good luck.
  3. High Utilizer Care Plans

    In areas where I've worked these types of care plans have been individualized for the person in question. There was no template used as a basis for patient interactions. And honestly? Most of these care plans were "ensure patient and crew safety, transport to the ED". For some of these folks social work at the receiving hospital has had to get involved as the ER was seeing these folks as often, if not more often, than we were. If that's not a resource you've looked at yet they may be of help. Sorry this is not of more help. These are tough cases that usually don't follow a global script or fit into a neat template.
  4. Old folks Still here?

    Dude. I am sincerely glad to hear you're still out there, kicking and doing well. I do hope this means we'll start seeing more of you around here again.
  5. Old folks Still here?

    Hey man! I wondered what happened to you. Glad to see you're still out there and doing good in the world. When did you finish residency? How've you been?
  6. Old folks Still here?

    Vent seemed to have some issues that came through in her posts. AK called her out on a bunch of stuff when it started. She's come back a few times under various pseudonyms usually to demonstrate some pretty angry behavior only to get called out again.
  7. Old folks Still here?

    He left a message at one point saying that he was stepping away from the site. Tried to find it but don't have a lot of time to dig for it at the moment. Looks like he last stopped in sometime last year.
  8. The aggressive methamphetamine patient

    Codeine products OTC? Interesting. How does that work? How's it regulated? Sounds like it's going away from your statement. Abuse issues with this kind of availability?
  9. The aggressive methamphetamine patient

    All of our folks used to be prescription opioid abusers. We've been clamping down on prescription narcotics for a while now. While we still get some folks who are angling for narcs from the ER it doesn't happen nearly as often as it used to. When oxys and percocets became more expensive due to decreased supply they started going to heroin. Or going back to heroin.
  10. The aggressive methamphetamine patient

    Meth isn't a big thing in my area. I'm in heroin central. Heroin, heroin and more heroin. It's cheap, plentiful and potent. At one of the ERs where I'm working we get pretty regular drive up for the unresponsive respiratory arrest from heroin OD. The few meth patients we have seen can get pretty scary pretty quickly. They'll flip like a switch and become wicked violent. Ketamine has worked well as, similar to your experience, midaz wasn't doing much.
  11. Old folks Still here?

    Bushy, Am also glad to see you came out on top. Sounds like an interesting ride. Hope to see you around here more often. 'Zilla, Texas is supposed to be a good practice environment for docs. Congrats on the new gig!
  12. Old folks Still here?

    Bushy! It's been way too long, mate. How've you been?
  13. Anyone ever done this?

    Paramedics don't have the educational foundations to do the things mentioned. Having worked in more than one arena within health care (paramedic and PA) I don't know that EMS providers are necessarily the best people for the interventions that are mentioned. This isn't to say that paramedics can't do those things and more. As Ruff mentioned education is ridiculously poor. This lack of education is a significant barrier. Many of the PAs I work with currently are former EMS providers. Several of them are current EMS providers outside of the ER setting where we work. PAs, and to some extent NPs with an EMS background, would be best suited to work in that community health role doing the things needed to help reduce ER overcrowding and all of the complications that arise from that. Unfortunately, there are barriers to this as well. Who is going to pay for that PA to be out on the street? I guarantee I'm more expensive as a PA than I am as a paramedic. Will call volume change when people realize the "ER will come to them"? How long until that becomes overburdened? There are logistical issues involved, too, never mind the legal issues that need to be considered. The EM group for whom I work has talked about doing a community medicine response with the local 911 providers (both BLS and ALS). There has been talk about putting PAs into a street provider role to start providing care outside of the ER. I'm fortunate to work for a group that employs the state ALS and BLS medical directors as well as the county medical directors who could help make this happen. I've volunteered my services as have several of my colleagues with EMS backgrounds. If anything comes of it I'll keep everyone posted.
  14. Old folks Still here?

    Crazy, isn't it? The more you learn the more you realize how little you know. Why stop there, thought? Paramedic school?
  15. Anyone ever done this?

    I don't know that I've cooked but I've made sandwiches for people. I've bought food for people. It happens.