paramedicmike

Dude! Welcome back! How've you been?

Actually, it's not. Education will fix everything that ails EMS. It really is that simple. Fix education and you fix the problems facing the industry today. As I mentioned previously, the fixes won't happen overnight. But they will happen and they will only happen after our backward and damaging attitude towards education is fixed. -be safe

Fix education (read that as change the minimum standards to a four year degree for entry level paramedicine) and everything else will follow. It might not follow overnight. It might not follow in a month or even a year. If you fix the embarrassing educational requirements, everything, and I mean *everything*, else will follow. We are not only fighting ourselves within the profession about this. We are fighting for respect of the rest of the healthcare community...the rest of the healthcare community that requires a four year degree to enter the field. We are being judged on their standards (standards, by the way, which apply to every other field as well.) Failure to live up to these standards will continue to see us left in the dust. It doesn't matter if you like it or not. This is the way it is. Fix education and everything else will follow. It really is that simple. -be safe

Good discussion! My service also uses Etomidate (0.3 mg/kg) for initial sedation in RSI (followed by succs, intubation, vec, versed 0.06=5 - 0.1 mg/kg and fentanyl 0.5 - 1 mcg/kg or morphine 0.05 to 0.1 mg/kg). For RSI sedation purposes, the Etomidate and versed/analgesia follow up works well. After intubation we can re-administer sedation meds as we feel necessary and in line with patient condition. I agree with CHBARE in his assessment of Etomidate. There is talk of studies showing adrenal insufficiency with as little as one dose of Etomidate. However, given the circumstances in which we give this drug, there is really little else that offers the protective qualities demonstrated by Etomidate. For non airway management patients, we rely on a variety of medications. Versed (by itself or in combination with analgesia at the same doses listed above) or Ativan (0.5 - 2.0 mg) are our standard. Again, we can re-administer sedation meds as necessary. It's not common but we do occasionally transport sedation infusions (e.g. Versed) usually deferring to bolus administration to free up a pump. During IFTs we can maintain Diprivan but cannot initiate it. I like Diprivan. However, it needs to be constantly infused with a pump, there is a real risk of hypotension even in small titration amounts (patient dependent, of course), it offers no analgesic effects, and if, for whatever reason, it stops running it doesn't take long for the patient to begin to wake up. Hope this helps. -be safe

Wait until someone reaches up and grabs your arms while you're doing compressions on his/her chest. The first time that happens will really throw you for a loop. -be safe

What does medical school being so competitive have to do with either the two studies you're working on or your request for assistance in completing them? -be safe

My condolences to you and your family, Dwayne. I am sorry to hear of your loss.

I know, I know. Just look at number one on the provided link. Yahoo!News story. -be safe

Dwayne, Not only would I have taken the same actions as you did with this particular patient, I have done this very same thing in the past. I do not believe it violates a patient's right to refuse. You acted in the best interest of the patient taking into account extraneous factors that affect this patient outside of his medical condition and presentation to you. Nice job. -be safe

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If what happens on a relatively anonymous discussion forum bothers you this much I suggest some therapy. If you get this bent on stuff that happens here you need some serious help.

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Interesting piece in the NYTimes. I think it's interesting the comments some of the FFs are making. I find the balance the article attempts to strike is interesting, too. I don't agree with that balance. But whatever. -be safe BTW, can we no longer insert the page so it shows up in the post? NYTimes story

How do you know it was "bumped"? You don't. So, for the purposes of the article, the title is sufficient. Further, if the a/c was not flyable out of concern for the integrity of the rotor blade, no matter how slight the impact, it was not a "bump". And for all intents and purposes, for something like this that blade should have been replaced before the a/c was flown out. This actually happened it NJ earlier this year or late last year. Some stupid moron drove past the a/c while on the ground with it's engines off and rotors stopped and hit one of the main rotor blades. What are people thinking? And what's with all the "hobbies/interests" that takes up half a page? -be safe

Please do. Even extend the invitation to come and chat with us here in the City. I'm sure, judging by the sounds of it, that he's too busy fighting this battle to stop in, but at least he'll know he has some support. -be safe

I think Dust pretty much summed it up. There is one question, however, which hasn't been addressed. How is the on call medic normally summoned? Is a cell phone call the normal means of notification? Or does that request have to go through the same system that dispatched the BLS crew for a formal ALS dispatch? If it's the latter, then the crew failed and should be disciplined accordingly. If the former, well, then your system needs some serious work. This would then go back to how the BLS crew described the situation to the on-call medic. -be safe

Welcome to the City. Your post only seems to reiterate chbare's post. All those extra ways to "screw up" are not the result of the aircraft or the physics behind it. Those extra ways to screw up are a result from the pilot at the controls. I am glad to hear that everyone is ok. Two pilots with whom I have previously worked now fly for the program in question (although neither were involved in this incident). So this hit rather close to home. And I must object to the thread topic as well. We did not lose anyone in this incident. Saying we lost one of our own was an exceptionally poor choice of words because my first thought was, "Dammit, how many were killed *this* time?". -be safe

Not entirely true. He knew something was up but didn't know specifics. The Senate Committee lead by HT, ultimately known as the Truman Committee, was, among other things, involved in trying to prevent fraudulent and wasteful spending with regards to the military and war. The investigators who answered to the committee kept finding evidence of a major project (the Manhattan Project) but couldn't get details. Truman, in an attempt to find out what was going on, spoke via telephone with Secretary of War Stimson. Stimson told him, "It's part of a very important secret development." Harry Truman replied, "You assure that this is for a specific purpose and you think it's all right. That's all I need to know." Truman then let it drop. Committee investigators continued to pick up bits and pieces that allowed Truman to figure out what the project was doing but not what kind of specific bomb they were building. He even went so far as to refer to a "terrific explosion for a secret weapon that will be a wonder." in a letter to former Senator and then District Judge Schwellenbach. (Not only was it a letter sent via the US Mail but it was dictated to his secretary. Think of the security breach!) So, he knew something was there. What it was and what it was doing he had only the slightest inkling. Only when he was briefed after FDR died was he able to put it all together. -be safe

Unfortunately, as seems to be so often the case, you have completely missed the point.

A lot changes in 40 years... Abbey Road Studios even has a web cam if you're interested in watching the crosswalk for poseurs and the occasional auto-ped. Abbey Road Studios webcam

Why are you having such a hard time defending yourself here? You listened. The boss didn't. You acted on your assessment findings. Your boss reacted to an assessment he did not complete. The doc at the receiving facility didn't believe there was need to decompress. Initial assessment findings by the receiving facility supported that position. That looks like enough to support your clinical decision to me. You need to approach your boss about this with the above information. It would work better for you if you also had the support of the receiving physician...so go talk to him. Tell your boss you would appreciate it that if he had problems with you he discuss them directly with you. Discuss your decision and bring in the support of the doc. You need to get on the stick with this because the boss is being a jerk. But he will win if you let him. Make notes of everything. That way if he continues down this road you have documentation to refer back to when you go talk to a lawyer about a hostile work environment. And start looking for a new job. -be safe

A professor at the University of Mississippi was giving a lecture on 'Involuntary Muscular Contractions' to his first year medical students. Realizing this was not the most riveting subject, the professor decided to lighten the mood slightly. He pointed to a young woman in the front row and said, 'Do you know what your ass hole is doing while you're having an orgasm?' She replied, 'Probably deer hunting with his buddies.' It took 45 minutes to restore order in the classroom........... -be safe