TechMedic05

Thanks Rid, and well put. Also... :"as long as your not hurting anyone, LIVE IT UP!!!! " Live it up? So, if you work in an EMS system that's "You call, we haul, that's all" Technically you may not be hurting anyone, however you're also not helping out. Live it up? That sounds almost too professional for me to continue working in this field. There's a time and place for 'Living it up', and a time for work. I always found them to be rather apparent.

Ourselves. It's tough to try to act as a professional EMT-Paramedic, being well thought out, progressive and attempting to be remotely well educated while many other prehospital providers, well, are all about the red lights, driving fast, and blood and guts. In several areas I have and do work, professionalism is a huge issue. Things like a former partner of mine driving with lights and siren through a school zone while it's being let out...for a patient who is no where near critical, and then turning to the patient's family member in the cab and saying "God, I love my job." yeah, I have issues. I guess I'm weird. And I also don't work there anymore. Silly me.

eh, picky picky.

"or even monitor ECG....opps sorry EKG (do yalls spell it Kardiac?)" I believe EKG was just adopted from the German translation of EKG: Elektrokardiogramm I dunno, I just find it easier to say

This is a good one that drive me up walls. I hear it constantly from Basic and Intermediates [please, not to be taken as insult I just don't get the pleasure of working with another Paramedic -ever- in NH or VT...] but talking about training, and here's a great example: talking about CHF and COPD, and cardiac asthma, and explaining a possible misdiagnosis. An Intermediate and a Basic then mention albuterol, and 'What can I then do if they go into flash pulmonary edema?' -- "I can't do anything for that." So, before I try to strangle them [honestly, I didn't really try. I'm not that malicious] I take a few seconds, and explain different options that they have. including up to ::makes motion of ventilating a patient with a BVM:: "There's --NOTHING-- I can do for this..." etc. Drive me nuts. Sorry for the rant. :wink:

Cosgrojo: Shadow? ... Shadow?

Yeah. fortunately, if AMR is the same everywhere...you won't have to worry about 911 contracts for long. Here in NH and Mass. areas, AMR has never actually won a bid for a 911 service area. They've kept some, lost a few. Any that they do want bad enough, well...they just bought the company that had it. Bingo, instant 911 service areas.

Wow, I murdered a banana because I'm sexy and do whatI want. no, really. I did. Honest.

Rid, I agree with you there, we just need to find a way to correct issues, then re-run studies. I'm finding with EMS research, which is new to our relatively new field, one study is all it takes for everyone in medicine to whiplash and change what's been done for what, 40-50 years now?

Rid, Do you have a link to the original study? Just reading that abstract I found it to be, well, one sided. They come out explaining an incredible number of failed ETI's, but don't explain very well if - were dislodged tubes corrected prehospitally? Or were misplaced tubes immediately recognized? What did they define 'Multiple attempts" as? And what were they defining an attempt? Also to be considered, as I believe was covered in an article in Jems this month, March 06, was San Diego FD's new intubation protocols, which state the intubating paramedic remains at the airway until the ED Physician evaluates the airway, as they claim ET tubes are being dislodged when patients are transferred. I'm not saying prehospital providers aways do a great job, but perhaps more education, documentation and full use of etco2 monitoring will bring these numbers where they should be, 0.

12 lead? Just for good measure, and and edema present? Possibility of an Inferior MI, or just R sided failure secondary to the Lung CA.

"Head over to the [insert favorite wondrous Nursing home, perhaps one in Fremont] For an eval, going to the emergency room, non-emergent, to Rule Out Death. Copy?

Rid- I agree with you completely. Doc's and nurses still come up with silly reasons to not use a PICC line, like, "How can you know if it's correctly placed?" - Aside from being D/C'd from the hospital/ nsg home with it? As far as local option/ protocols, NH's trying to eliminate all local options, and sticking with a statewide protocol. Although generally aggressive and progressive, [except for removing RSI for all but maybe 3-4 services...and high does Solu-medrol for SCI's] they haven't addressed usage of central access. They try to base protocols off of emergent work, and neglect the rapidly growing 'interface' of still-sick patients going home or to rehab/ nursing facilities. And- If it's a PICC line, isn't that a Peripherally Inserted Central Catheter? NH consideres it Central, so generally hands-off for me.

Up here in New Hampshire, that's a rather gray area [heh, it's EMS, what isn't?]. Typically, we do not use them for access unless it's an inter-facility transfer and the access whether it be PICC, CVC, etc., in which we can continue it. NH's protocols allow for -any- facility initiated treatment to be continues, except for blood products...but that may soon be changing. I have not heard of anyone carrying non-coring needles for indwelling central lines. Our medical control has mentioned if encountered with someone with already in place access, and peripheral access isn't obtainable, or difficult, and you kinda need access,to contact them for options. The adult IO access is becoming much more popular up here, however.

New Hampshire carries Fentanyl as well, and has for about 8 or-so years now for some agencies. Currently, it's standing orders for adults (25-50mcg q 5min x3) and pediatrics (0.5mcg/kg q5 min x3) statewide. I feel are a bit under dosing, but there's always med control for options of more. NH State Protocols Pain Managment is Protocol 2.9