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Posts posted by Doczilla

  1. There is the "tyranny of distance" as it is referred to in combat medicine, where the tactical situation prolongs extraction of a patient to definitive care. I have seen tactical situations where an ambulance was parked 100 yards away but took 30 minutes or more to reach the patient because of safety concerns and volatility of a situation. For extracting the patient, who will do that when the officers on the SWAT teams are engaged in a search for the subject or explosive devices? That's not a setting the average street medic is trained to be in. TECC training and the Rescue Task Force concept gets us closer to where we need to be, but this trauma care at the point of wounding is a small portion of what the SWAT medic does.

    Many SWAT teams, mine included, do foot patrols to locate subjects in wooded areas that are a significant distance from a road or other route of extraction. Those medics have to carry not only their tactical protective gear (body armor, helmet, gloves, gas mask) but also water, snacks, and medical supplies. If you look at the average "first in" bag on an ambulance, it is not in any way designed for being carried a distance over rough terrain for a long period of time. So they need to have a kit that is specially designed with that in mind (it's more than throwing stuff together. Much of the kit has to be repackaged altogether, and interesting choices made to reduce size and cube.) And that whole time you are advancing on a subject that may be lying in wait for you. The average street medic has probably not been trained in tracking, terrain selection, and counter-ambush techniques. And then there is the prolonged field care during extraction from that scene. Carrying a grown man over rough terrain takes a lot of time, a lot of people, and cannot be done easily.

    The SWAT medic is also responsible for team health, preventive medicine, minor injury care, sick call, medical contingency planning, and analysis of medical resources. No mission goes out the door without a medical plan and the SWAT medic is the one to create it. Appropriate hospitals for various issues, casualty collection points (primary and secondary) unconventional means of carrying patients there from and possibly through a hostile environment, conventional prehospital medical systems (EMS, flight) and their capabilities. Commo plans are an achilles heel at all times and need to be vetted, but no cop knows how to get hold or a hospital, so that falls to the medic.

    A team that has a mishap grilling food for the group may find itself completely combat ineffective for the mission if there is a case of food poisoning. Someone has to think about that, and someone has to treat it to keep guys on the line. Something as simple as a dental issue can be a distraction for someone at the wrong time. A corneal abrasion, properly treated, is the difference between the operator finishing that mission or not.


    SWAT medics fill many responsibilities other "take care of the guys that's shot."

    • Like 1
  2. You don't actually need to be in the military. There are plenty of non-military SWAT medics. You don't necessarily have to have police training. You have to have solid EMS skills and know someone on the department to get on board, typically.

  3. I've been heavily involved with this in our state and elsewhere. SSI has been around for a long time, but where we are changing the thinking is in not having the patient remain on the backboard once moved from point of injury to the stretcher. I've had emails from several states asking for our protocols, clinical justification, and training materials. NAEMSP came out with a position paper on it last year as well. The original position paper was pretty strongly worded about doing away with the LBB as much as possible, but a consensus document with ACS-COT was created, and it was softened to get buy-in from the surgeons. Some have gone on a system wide basis, while others are doing it at the state level. It's been very well accepted, and I'm getting emails on the ACEP EMS list indicating that more areas are doing it. It's widespread enough now that adopting the protocol is no longer "outside" the usual care, but an accepted practice.

    It's a tide, hopefully for good.


    • Like 1
  4. I like Beverly UMP for post-workout if I don't have access to decent actual food. Mixes up very well and tastes good. For straight meal supplementation, nothing wrong with Ensure or Boost High Protein. Balanced nutrition that I can grab and go, usually on the early mornings.

  5. When you are typing out a long post such as this at home on your tiny android tablet's virtual keyboard, and then u save it to a word processor so you can paste it from there to the board, and the paragraph formatting doesn't transfer, um, no, paragraphs are not your friend, apparently. But i'm so sorry to have put you out so terribly there, sport.

    *more drivel*

    Think you can follow *that* idea? See, i even put that last sentence into a brand new shiny paragraph for you.

    Are you freaking kidding me? You drop that monster flight of ideas you call a post to ask a very basic question and assume a smartass attitude with a vetted member who has had years on this forum who takes the time to bang out a reply to you?

    Get lost.

    • Like 3
  6. Vecuronium (Norcuron) usually takes about 3-5 min to work, so that's why you won't see it as an initial paralytic. The point of RSI is to sedate and relax the patient and intubate them before the hypoxia sets in from ventilating them without a secure airway. Succinylcholine and rocuronium are both good agents for that.

    Rocuronium lists for $50 a vial and has to be refrigerated, or changed out every month if stored at room temp. Succinylcholine is 90% effective at 90 days at room temp. That's room temp, not the temperature abuse that is common in ambulances.

    We carry succinylcholine, changing out the vials every 3 months, as our initial paralytic. We carry vecuronium to keep the patient paralyzed once intubation has been achieved. Keep the patient sedated and still for the ride to the hospital and keep them from coughing or pulling out the tube or fighting it so hard they get a pneumo. Vec is cheap, and is packaged as a lyophilized powder that is shelf stable.


  7. This video is admittedly kind of hard to watch. Barry is an excellent fire officer and paramedic, and is well respected in and out of the department for good reason. The weather that morning was not predicted, as we have been hovering around freezing most nights. He had a fraction of a second to see the car coming for him.

    Fortunately, he should do very well, and has been discharged from the hospital.




  8. We had some of the PMC medics in Iraq fall in on us at the CSH during our con-ed classes. We typically did a class every other night or so, and the training OIC ensured they got certificates of attendance. They were always welcome. We also ran some training evolutions (casualty simulations, MASCALs) with one of the larger PMCs there.


    • Like 1
  9. No, yes, and no.

    A medical student does not have an MD degree, and therefore no license. They cannot bill. A first year RESIDENT (and that may be why they identified themselves as a student) can see and treat patients, but not independent of oversight by an attending (typically has to review each case directly, as well as any diagnostic adjuncts. Many don't necessarily see the patient themselves.). They also have no license until they have completed their first year of residency, Step 3 of the USMLE, and complete the state's licensing process.

    Billing for this without being seen by a physician is fraud. Without a physical examination, you can't bill at that level either unless you are a psychologist. A level 5 coding requires examination of a certain number of body systems, history points to include medical, family, and social history, and a review of several body systems (ROS). Call the billing company and explain this, and they should write it off. If they push back, mention the fact that an actual doctor found it was due to a dangerous condition, and that should also make them lean toward writing it off.

    What probably happened is that the doc probably got busy, staffed the patient with the student, then didn't see you though the medical student thought he did.


    • Like 2
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