paramedicmike

Did you look here? If you don't find the information you need on the web site there is a phone number for the office. I'm sure a phone call can clear things up quite nicely. Good luck. -be safe

Hindsight is 20/20. It's easy to sit back now, based on one side of the story, and bash the cop for being wrong. But until the investigation is complete we can't say anything for sure. It will be interesting to see if the officer had a camera in his cruiser and had it recording... -be safe

You've done the research so I won't go into that. I can only comment on our use. We use analgesics for all our RSIs regardless if it's trauma or medical in origin. The logic behind our using it is that even though the patient may be sedated and paralyzed it doesn't mean they can't feel pain. We also argue, like you did, that placing and maintaining a tube in the trachea can be quite an uncomfortable process for the patient. If we can minimize that discomfort, or any discomfort, and help keep them comfortable then we will. Hope this helps. -be safe

Don't take this personally, but I'm going to take issue with you claiming that you're starting to feel comfortable with assessment and treatment flow. This is a case of not knowing what you don't know. Sure, you may feel comfortable in class. But when you get to the field and patients aren't presenting the way they did in class (which will happen the very first day you're out of class) then you're going to wish you'd spent more time in school learning to be able to think on your own instead of throwing back acronyms and hoping that'll pass for an assessment. You need to very quickly realize that this isn't about "skills". Monkeys can be trained to do "skills". They can't be trained to think objectively. Objective thinking is the biggest "skills" you'll need. The "anything in particular" that jumped out at me was that there is no such thing as too much education. If you haven't already, enroll in some good science courses (Anatomy and Physiology, Biology, Chemistry, Microbiology) as well as some good human studies courses (psychology, developmental psych) and go from there. If you're planning to do this for real and not as a hobby then the educational foundation will serve you, and your patients, much better in the long run. Good luck. -be safe

Consider this. May the force be with you.

Really? Because you always get to assess your patient's while they're sitting up and able to get into the sniffing position? Otherwise, you make some good points. The problem we're facing, once again, is education. Fix the educational shortcomings and I think we'll see immediate changes in the practice of prehospital medicine. -be safe

It's interesting that shortcomings are identified and problems noted with even possible solutions discussed but no one is willing to start advocating or implementing those solutions. Prehospital intubations have been routinely identified as being problematic. Education and limited practice have been pointed to repeatedly as issues contributing to these problems. Yet no one, not the people identifying the problems, not those point out and lamenting the problems, not those saying, "This is a problem so we'll just remove the problem", not those who directly control our ability to practice on a day to day basis have taken any steps to address the issues directly and work to correct them. There will always be patients who will need to be intubated in the field (but not every EMS provider should be able to intubate). They may be few and far between but that only reinforces the idea that there are many major changes that need to be affected within the EMS segment of health care. And those changes need to be affected yesterday! The evidence is damning. There's no getting around that. But let's work to change the evidence instead of working to remove the evidence. This isn't ego. This isn't crying over taking away a "toy from the toy box". This is a genuine desire to see a major overhaul of the system from the ground up. -be safe

Close, but not quite. It is true that there are quite a few private enterprise air medical transport organizations spread throughout the United States. This particular aircraft was owned, operated and staffed by a governmental agency, namely the Maryland State Police (MSP). In the State of Maryland, MSP is the primary resource for scene flights within the entire state. There is very little, if any, helicopter shopping that takes place in this area. (While there are private services in the area, they are pretty much limited to interfacility transfers.) MSP is also well known for their excellent safety record. That's partly why this accident was such a shock to so many people. I don't want to defend the institution as I wasn't there, but Shock Trauma (as it's widely known) is a busy place. Like many big city hospitals, staff can become, shall we say, less than friendly. Being assertive counts. However, given the facility status as the prime trauma center in the state and as a busy teaching hospital, observers do tend to be shuffled to the side. I'm sure your colleagues didn't want to make too many waves. But sometimes a good wave is all it takes. Although, I do regret their experience wasn't what they hoped it would be. -be safe

Well, the easy part is answering what the "Shock Trauma Center" is. It's full name is the "R. Adams Cowley Shock Trauma Center". It is run by the University of Maryland in Baltimore. At one time it was the preeminent trauma facility on the US east coast if not the country. As to why this aircraft was in the air, well, that's another story entirely. There's been a lot of news coverage questioning why they flew. If you Google "Trooper 2 Crash" (the callsign for the aircraft in question), you'll find a lot of information regarding this particular incident. If you come across the transcripts between the pilot and the dispatchers prior to the aircraft departure, you may get an insight as to why they decided to fly. While I know you, Bushy, are smart enough to know this, I feel compelled to throw this out for the masses. Of course, none of us were there and speculation is pointless until the final results of the NTSB investigation are complete and released. HEMS in the US is in a pretty bad way at the moment. I guess the upside to all this negativity is that with so much attention being focused on the industry, complete with congressional investigations and hearings, we can only hope that some positive changes will take place to make this safer for those who fly and those who are flown. -be safe

Actually, I found the practicals harder with an examiner I knew than with an examiner I didn't know. You've been doing this a while. You know what you're doing. Just take a slow, deep breath, visualize yourself going through the call, say out loud what you're thinking and doing and you'll be fine. The hardest part about it is dealing with the stress we create beforehand. The exam itself isn't that hard. Seriously! Dealing with the stress is the tough part. And the stress is what trips us up. Find a good stress reliever for yourself and go from there. Good luck! I'm sure you'll do well. -be safe

Given some of the drama playing out on internet forums world wide, the US Department of Homeland Security has established a new "Attention Whore Advisory System". In an attempt to alleviate further confusion, please use the following as a guide: We hope this will make enjoyment of the internet much easier for all involved. -US Department of Homeland Security

I can, and have, refused flights based on weather. I have been questioned about it but have not received any disciplinary action as a result. I won't deny that there is pressure for crews to take a flight. But every place with which I'm familiar has a similar policy allowing flight crews to refuse a flight for a variety of reasons. I do find it interesting that Canada has over 230,000 HEMS flight hours since 1977 without a single fatal accident (source). While we in the US are killing ourselves off at a fanatical pace. We are doing something very, very wrong. And it needs to stop. -be safe

Don't let the REMCS system fool you. It is inefficient and dysfunctional. What's more, they interfere and meddle in areas which should be outside their sphere of interest. Now, if it was operated with no bias towards any program and dispatch was handled with the best interest of the patient in mind, it might work. It's current incarnation, however, leaves everything to be desired as it is almost completely worthless. -be safe

Or the repeated head injuries.

As was mentioned previously in this thread, and what should be the real concern, is that some lawyer will take the money up front and attempt to bully his/her way to a quick settlement based on fear of a long drawn out legal process. Given that no laws were broken and there is no apparent or obvious legal standing for the drama queen party, telling the bully lawyer to buzz off shouldn't be that big a deal. Another concern, since they have some personal information with the ability to search for additional information, would be some form of identity theft. A fraud alert on the involved accounts with the credit reporting agencies would be a prudent act. They've already demonstrated their willingness to (quite horrifically) lie in a desperate grab for attention. It wouldn't be a big jump to move on to other desperate attention grabs whether they be legal or not. -be safe

Am I? Let's break this down. So you spend enough time on an ambulance to catch approximately 1500 of those 3000 calls. They're not all ALS calls. So you aren't the primary care provider for probably the vast majority of those 1500 calls. Ok. So maybe you get there before the ambulance. Maybe you don't. Either way, what calls you do arrive on scene on are spent trying to figure out what's going on (which needs to be done before any interventions are started). Now, when you're on the ambulance, you're competing with the medic on the engine for assessment and skill proficiency on an already small number of calls because you spend half of your time on the ambulance running, if national trends apply to your area, a majority of BLS calls. But when you're on the engine, you're rusty because you don't get the assessment and skill proficiency because you're "losing out" (a loose term as the patient is the one really losing out) to the medic on the engine. So you don't get the experience on the ambulance because you're losing out to the medic on the engine. But when you're on the engine, running even fewer calls than on the ambulance, you're proficiency is lacking because you don't get the practice while on the ambulance. It's a vicious circle with no good outcome. For the sake of your patients, I would hope so. No ignorance on my part is involved. I've worked in an environment similar to the one you describe. It sucks. Providers stagnate then begin to provide poor care. Patient's lose on a daily basis. I refused to become a mediocre provider so I moved on to organizations that focus all their energy on providing EMS. Yep. I am well aware. And every single one I've come across or had any dealings with spanning eight states (not counting all those I've read about in quite a few more states) and the District of Columbia, including Virginia, fail when it comes to running an efficient EMS system. -be safe

You do know it's spelled "diazepam", right? -be safe

Yes, it does. That "ALS provider" on the engine is stagnating as an "EMS provider". I would much rather have someone arrive who provides patient care on a daily basis, who can perform a complete assessment, who can quickly identify what needs to be done, who is proficient and efficient with his/her equipment due to repeated and daily use, who won't fumble with equipment or assessment or treatment interventions because of gained proficiency/efficiency than someone who may, or may not, have checked the equipment on the engine that morning because he'd rather fight fire than provide patient care. All that "nice ALS stuff on board" isn't going to do anyone any good if the "firefighter/paramedic" can't work the equipment because he's rusty. Trained? I don't want anyone who's trained. I want an *educated* EMS provider. There is a difference. So why not, on every call, dispatch the police because it might be violent? Why not dispatch the power/gas company(ies) because there may be a power/gas problem? Why not dispatch the Red Cross because it might be an MCI? After all, you never know how many hands you need, right? Further, by continuing to argue that point, you insult the intelligence of every EMS provider out there. Do you honestly not think we are capable of identifying when we need additional resources? Do you honestly not think we are capable of calling for those additional resources? What a condescending, ignorant and arrogant attitude to take when you think you know automatically know more than EMS providers simply because you work for the FD. -be safe

If anyone asked this already I missed it. What's a 10 year old boy doing being that attached to a teddy bear? I think there are deeper issues at play than him simply throwing it away and having mom and dad go after it. -be safe

Treating the pressure depends on the cause. Too much, too soon, too fast and suddenly that HTN patient just turned into a hypotensive puddle or worse. If you're not careful you wind up hypoperfusing the brain. Depending on the cause of the hypertension you've just added the insult of hypoperfusion to an already injured brain. Technically, I can treat HTN (stroke or TBI related) if the pressure is greater than 220 systolic and greater than 120 diastolic. My choices, depending on other factors, are labetalol or hydralazine. But even if I choose to treat the HTN I can only drop their systolic pressure by 10% and need to maintain a close eye on their MAPs. For something like CHF related HTN it's CPAP, NTG and we just recently started using ACE inhibitors. For pre-eclamptic/eclamptic patients it's Mag Sulfate. We may see some changes in the near future with regards to head injuries and HTN but it won't be anything drastic. -be safe

I was thinking the same thing...

I believe the "something to back this up" dealt more with studies that have shown or disproved it's effectiveness. Common sense is not a legitimate answer to the question. So, do you have any studies that you can cite, completed independently of the company that pushes this style system, that supports it's use? -be safe

Here's the story. While I can't question the stupidity of the acts leading up to the charges filed, I can't seem to be able to wrap my head around the charges that were filed. Thoughts? -be safe

Isn't this just another name for SSM? Haven't these types of "prediction" software packages been shown to be totally unreliable and ineffective? -be safe

The non-science, non-technical classes may not play a part in how you perform the technical components of your job. They can, however, provide an individual with enough of a general knowledge background so as to better interact with people encountered on the job. I remember reading somewhere that physicians who have an English degree scored much higher in patient satisfaction surveys due to their ability to effectively communicate with their patients as opposed to talking down to their patients as the strict science majors had a tendency to do. A balance in education is just as important as balance elsewhere in life. The more broad the education, the better the balance. This should apply to EMS education as well. -be safe