Doczilla

North American Rescue Products Hasty Harness. Used properly, you have multiple purchases for providers to grab, and can use it for a variety of applications. Costs very little in terms of weight and cube. http://www.narescue.com/Hasty-Harness-P147C140.aspx 'zilla

XL 'zilla

Something else to add here is to question the diagnosis of "GI bleed". There are plenty of care providers who would see a small amount of blood in vomit and label it a GI bleed, when that's really not the problem at all. "They vomited twice, then the third time there was blood in it. It's a GI bleed." I agree with the other comments here about significant bleeding being a stress test. If there are ischemic changes on the EKG, this is cause for emergent transfusion of uncrossmatched blood. The EKG can tell you to some extent if the patient is tolerating the anemia or not. No, the 12 lead shouldn't take precedence over basic stabilization, but should be on the list. Regarding EMS49393's post, perhaps it was NOT a gut feeling that prompted them to recommend transport, but appropriate assessment. The patient had patently abnormal vitals. Unless you're a screaming 4 month old, a pulse of 130 is abnormal. RR of 24 should raise red flags too. Unless I'm reading too far into this, it sounds like appropriate advice was given by the medic to accept transport and the patient refused (we can only go so far to encourage people not to make stupid decisions). 'zilla

This was in extremely poor taste. 'zilla

Hopefully this case didn't play out in reality as badly as they make it sound in the newspaper. The MD has say over whether or not a clinical employee can practice, and should have say over those in the agency that oversee training, con-ed, QA, etc. I don't think it is up to the MD to fire employees for reasons other than medical practice. It really shouldn't be up to the MD to "fire" someone at all. It's not uncommon for the agency to use the MD as the "hammer" to get rid of problem employees, largely because the MD's authorization to practice falls outside the usual work contract, union rules, and human resources rules. When the MD says, "this employee is not safe to practice," then there is very little the employee can do to get privileges reinstated. It is therefore easier to do this than to document the monster paper trail required to make a watertight case to get rid of someone. I think this puts the MD in a very difficult position, and unfairly so. Bottom line, the MD should only be looking over the clinical issues. With this case, there are plenty of medical issues that warrant the revocation of clinical privileges, but firing the employee is ultimately up to the agency. 'zilla

But I'll have all my big bad MD type dude friends with me. 'zilla

The class is full, and registration is now closed. The timing of the class is somewhat dictated by the medical school. Some of the cadavers we are using were used by the med students, so we have to time it when they are not using them but before they are taken off and cremated. That pretty much puts it late Nov/early Dec. We are planning to do it again next year, as long as I can browbeat more residents to do the administrative portion. As far as Dr. Bledsoe's concern about cost goes, all of the instructors are volunteer, much of the equipment is donated (which is why I and my squads buy all our stuff from Boundtree/TriAnim and NARP now. Quid pro quo.), and we get some funding support from the hospital. We end up breaking even overall. If he wants to put one on down there, we are happy to share our curriculum as well as lessons learned. The force behind this program really comes from the residency, though. The residents have the greatest interaction with attendings from all the different hospital systems, and are able to garner the needed support. The amount of administrative stuff to do also lends itself to a small cadre of dedicated individuals. Dust, akroeze, BEorP, and someone else (who didn't put their EMTCity name on their registration), see you then. Ruff, sorry you can't make it. Will beat you when you come next year. 'zilla

If Jack Bauer were gay, he'd be called Chuck Norris. 'zilla

My female colleagues complain of a certain amount of prejudgement from patients based on their gender. All of them have been repeatedly called "Nurse". They are rarely seen as the attending physician, usually the resident, intern, or student. The ones who are actually seen as the senior attending physician are not far from retirement age. "Scrubs" has addressed this as a recurrent topic. A lot of this has to do with the fact that we are essentially one generation into a massive paradigm shift with gender roles. Thirty years ago, women were a very small minority in medical school classes, and the generations of patients we are seeing now grew up during that time. Now, women make up 50% of medical school classes, so I think as my generation ages, we'll see a lot less of those preconceived notions regarding women in careers that have, up until fairly recently, been filled almost entirely by men. Just in the last 10 years, we have seen the growth of women in combat roles with the military. One of my SWAT teams just got its first female entry team member. These ideas that we have of who fills these roles will not change overnight, but will change with the generations. I think my generation is seeing the biggest changes along those lines (although the previous 2 generations heralded the growth of women in the workforce, partly as a matter of necessity during WWII, and the one before that, voting rights. You could argue that I'm wrong.). Old ideas die hard, and some of these notions will be passed from one generation to another in spite of ample evidence to the contrary (racism continues to thrive along similar lines, and I think it is dying away, but more slowly). The idea of a two income household was controversial 50 years ago; now it's so common we don't even bat an eye. There are women that I prefer not to work with, just as there are men I would prefer not to work with. There are plenty of my female colleagues that I am glad to have around when things are going to shit and I need help, or when I have a complex patient and need advice. I have been fortunate to have very knowledgeable preceptors who happened to be female, and that's as a medic and as a physician. I recognize competence, work ethic, and compassion, and I don't care what you look like. Pretty much everyone I've worked with seems to feel the same way. So when a patient verbalizes their outdated notions of what they think their doctor should look like, we don't say a thing. We don't have to. 'zilla

I vote for vampire zombie ninjas. 'zilla

December 4th class is now full. December 3rd is 90% full. 'zilla

At the rate you're going, by that time, you'll be completely petrified. Better bring a carbide saw. :bootyshake: 'zilla

Concur with the above. The highest cert is the most liable, and in charge from a medical standpoint. From an operational standpoint, it's the highest ranking officer. For example, a Batt Chief with EMT-B can give the orders about how to cut the car apart or how to attack the house fire, but not the order of transport of patients or where they should go or what treatment should be provided if there is a greenstick paramedic present. 'zilla

The funding is complicated. The EMS covers several different municipalities, which all support EMS through tax levies. It's a separate municipal service, with oversight by a board consisting of city council members from each of the jurisdictions served. The board oversees budget and finance, approves new equipment purchases, and looks into any problems with the service, with advice from the Chief and operational supervisors and medical director (me). Each jurisdiction pays a certain percentage of the EMS budget. Since the EMS is not under direct control of the city, and since there is a limit that the city will pay to the EMS, billing EMS for these responses will put more money in the FD's coffers. That money coming from the EMS's coffers comes from 3 different cities, so they are essentially robbing the other cities. It's a way to rob Peter to pay Paul. It's also a preview of how EMS will be treated if combined with the fire department. 'zilla

The argument they are making is that if that's the only reason they are there, "that's not the business we're in", to quote the email from the city council member. They feel it is not worth their time and the expenditure of fuel. It's a crappy argument. I can think of plenty of things that we do in EMS (and emergency medicine, for that matter) that aren't conventional or lifesaving, but are part of the job nonetheless. 'zilla

Got to take this one to the quorum here. The FD that covers part of the response area for one of my EMS agencies (government 3rd service, unaffiliated with the FD) and the city in general is a bit strapped for cash. For the past few years, the FD has made moves to try to take over EMS for their piece of the pie, believing that the revenue from billing will help some of their financial woes. They have had the support of several in the city council as well. EMS performance has been great, and part of the reason this change hasn't gone through is that the constituents are overwhelmingly happy with the EMS agency (95% satisfied in recent survey). In fact, when they tried to push through the change, the council hall was packed with angry voters. The council and manager see this as a way to reduce spending. At present, the FD does not do first response on medical calls, and does not require EMT certification for their firefighters. They used to do first response, but the chief decided that this was not a FD function, and ceased the practice. The relationship between line personnel is very good, and many of our employees are also firefighters for the FD. Recently the FD has stopped going to MVCs that don't involve some kind of rescue function or fire. The city manager and one city council member have argued that trucking out a large fire truck just to block traffic on the interstate is not a FD function. They have proposed that every time they do that, the EMS agency should be billed by the fire department. I personally believe that having the fire truck there serves more function than blocking traffic, and I've stated as much to the interested parties. I want to steer clear of the whole fire-based EMS debate here, as I think that is a separate issue. The questions I have are these: 1) Does anyone else work at an EMS agency that gets billed by the FD for responding? 2) Is there legal precedent or IAFF policy recommendations that state that crash response is a FD function? 'zilla

You are describing global weakness rather than focal neurological deficit, and this would tend to argue against a typical ischemic stroke. I don't think you should call a "stroke alert" on this patient and bypass a hospital for a stroke center based on these findings. What you seem to have is chest pain, weakness, and altered mental status. I agree with ERDoc with regards to a possible dissection, as well as pneumonia or UTI. Other stuff on my list: hemorrhagic pericardial effusion (like from a dissection) pericarditis, with or without effusion (small QRS can suggest effusion) myocarditis any infectious process, really intraabdominal disaster (perforated viscus) acute heart failure pneumothorax (does she have COPD?) Always beware the "chest pain AND" syndrome, like CP and headache, CP and back pain, CP and stroke-like symptoms, CP and weakness of the legs, CP and hematuria. This should get you thinking along lines that are not strictly cardiac. 'zilla

There's a nice little EMT City contingent coming. 'zilla

Bring her something nice from Dayton. The Ester Price Chocolate Factory is a good start. 'zilla

The point of the class is not simply to practice procedures (though that's a big part of it), but to give a better grounding in principles of anatomy and pathophysiology as they relate to emergency care, which is relevant to all levels of prehospital provider. 'zilla

Jake, Ruff, Dust, got you on the lists. CB, reschedule your performance review. 'zilla

No. ATLS teaches a regimented approach to patients of a certain type. ATLS also is regimented, as dictated by the ACS, whereas our instructors can "freelance" and discuss topics they have a particular experience or knowledge in. The CAP Lab is teaching more general principles applicable to patients of any type, and it is entirely hands on. The principles of anatomy are taught as they relate to common diseases and complaints in the prehospital setting. It is not by any means "comprehensive", and will not take the place of A&P, but rather illustrates concepts that the provider may have heard about but not seen in detail. In the cardiac station, each student has a cadaver heart along with a selection of EKGs. The instructor takes the students through the heart, illustrating the various coronary arteries and showing what lesions in these arteries look like on EKG while reinforcing principles of cardiac care. In the neuro station, the students will handle several brains, spinal cords, head hemisections while the instructor takes them through various injuries and disorders of the neuro system that can present. This year we've added a comprehensive simulator scenario as well. I won't give it away here, but it will challenge both BLS and ALS providers. Students will also have the opportunity to practice procedures that they rarely have the opportunity to practice in real life. For example: We will take a cadaver and induce a tension pneumothorax. The student will be able to appreciate the subcutaneous emphysema, tracheal shift, and JVD (no kidding, it happens on cadavers) that accompanies it, and will be able to decompress the chest with an angiocath and intubate the cadaver. In the airway stations, students get to try out the various rescue airway methods (King, LMA, Cobra, Bougie, AirTraq, Glidescope) on airway simulators, then perform surgical cricothyroidotomies on pig tracheas using open surgical method, Pertrach, Quicktrach, Nutrake, and Melker kits. For tactical and remote medicine, various hemostatic agents are illustrated along with battlefield tourniquets. The students will then participate in field amputations on cadaver limbs. The instructors are some 30 odd emergency physicians and PAs from the Dayton area, all of whom have volunteered their time to teach the course. And we're serving a hot lunch. 'zilla

To say, "this won't help me during the transport" is too myopic. EMS providers MUST think of themselves as part of the continuum of care from the field to the ER and the OR or cath lab or patient care floor. 12 lead may not improve care during transport, but it cuts down overall on door-to-balloon times. Same thing with trauma team activations. There is no trauma team that will meet you by the side of the road, but patient care improves nonetheless by expediting specialized trauma care. Interventions performed in the field (aspirin for ACS, beta blockers, etc.) help ensure that they are performed in a timely manner. Proper assessment ensures appropriate transport destination, and also provides vital clues that may affect disposition. I have admitted patients based solely on findings by the EMS crews, such as the patient who had an abnormal EKG in the field that normalizes by the time they reach the ER. This piece of data is the difference between a patient going home after 2 negative sets of enzymes, maybe to die, and the patient being admitted and subsequent cath. You may not always see the difference you make, but we do. 'zilla

The weather will probably be around the mid 30s to low 40s. +/- some snow (most of ours comes after New Year's, but the last 2 Labs we had around this time had some flurries). The beer will be cold. The Arroz con Pollo at El Meson will be steaming. You absolutely can do both days but you'll need to register for both to guarantee your slot. I'll be there both days, giving the lecture portion and then teaching an as yet undetermined station. 'zilla

Cleared hot by EMT City Admin to post. I wanted to give a heads up to the board here about a training op in Dayton OH at Wright State University. It is our 3rd annual Cadaver, Anatomy, and Procedure Lab for EMS (CAP Lab). It is an all-day (one day) seminar on cadavers, live tissue, and simulators covering a variety of topics, held on Dec 3 and 4. We are offering it for $20 to EMS providers of all levels, and it's good for 6.5 Cat 1 CEUs. The Lab starts with a 45 minute lecture and anatomical review. The students (usually about 100 per day) are divided into groups of 10 to rotate through several stations, which are all taught by residents and faculty from the Dept. of EM as well as PAs from the EM PA Fellowship at WPAFB. Students get to practice procedures as well as get hands-on with the cadavers for close instruction. Stations include: Surgical airways Rescue airways Field amputation Tactical/battlefield medicine Neuro, with cadaver brains Cardiac, with cadaver hearts and EKG review Cadaver airway, chest decompression Vascular access Chest and abdomen anatomy Musculoskeletal anatomy Website: http://www.med.wright.edu/em/caplab/ When you register, put EMTCity and your username in the "comments" area. Attendees must register to receive directions and important info, including disclaimer forms. Email address is on the website if you have any questions. Slots are open until they are filled. No, you can't stay at my house. 'zilla