scott33

I'm not opposed to the concept of practising as you fight. We do the same thing at MCI and disaster drills, responding lights and siren, just like a real emergency. I just don't buy this BS justification they are using. It doesn't add up.

As a driver-trainer and recently appointed examiner myself, I have often seen the other side of someone who has performed very well on their driver training, and aced their final exam, only to see them get a flap on when they get their first live call. Hands all over the place trying to find the toggle switches, taking the fact that they are driving to an "emergency" way too literally, excessive speeding, agressive braking, and generally just panicing.

Had they previously been exposed to live runs, under a more controlled condition, with immediate feedback and knowing there is no life at stake, they would be more prepared for genuine emergency runs. In the UK, that is the law, something they need to prove proficiency in prior to passing their road test. It has nothing to do with trying to fake the public.

There are a million-and-one other analogies where live practice is favored over simulation, due to the element of realism it gives the student.

But it seems you will always get those who will oppose any sense of realism in a training environment. Such as weapons drills on live firing ranges, test flights on anything other than a computer simulation, IV access on anything other than a plastic arm, etc etc.

Proven fact; the best way to learn, is by doing

Still not 100% what he is getting at, but I know in the UK, ambulances routinely practice simulated emergencies as part of their driver training. This involves runs with lights and sirens with no patient. Their driver training involves a little more than what is taught in CEVO, and a comercial vehicle license is mandatory.

Perfectly legal, and much safer than having your first EVER emergency run with a patient in the back (something I have always found a little dangerous). Not to mention the real-time feedback given by instructor sitting beside you. Police and Fire do it to.

The OP here, and on you tube, is displaying yet another example of showing the inability to see further than their own borders.

Taking your logic a little further, do you think it is right that military aircraft are allowed to practice simulated / fake operations in the skies above (some of) our homes?

I will take it a step deeper: Just like in the cellular level in the body, every body cell has a purpose or "job", what if we (humans) are just cells in a much larger creature. Maybe we EMTs are the red blood cells of this being, charged with transporting oxygen to an fro.

"Pass the Dutchie on the leaft heand seide..."

As the Doc has already mentioned, viruses need a foreign host in order to reproduce, so they don't fit the typical criteria of a living organism.

Calling viruses "less evolved" than ourselves could also be argued, seeing they are responsible for wiping millions of us out, throughout the dawn of man, and will continue to do so as long as we walk the Earth. What viruses lack in not having opposable thumbs, they make up for with the ability to survive higher altitudes, lower depths, as well as being able to withstand a greater variation in temperature and pH. They are everywhere we have ever been, and everywhere we will ever go.

Viruses are here to stay, and yes, I would call them living organisms - atypical living organisms.

So let me get this straight. Europe isn't a town?

I'm a little late to this one but I think I'm joining the "would give cardizem" camp

Me too.

For those who don't know, or don't care - Cardizem would be one of the first medications that would be given in the ED in this scenario, whether the patient presents "completely stable" or otherwise.

Judging by the information on them, they are similar in some ways to a PA or NP in the US. Except Europe does not have PAs and NPs

Sorry, don't think I am picking on you here as I am not. But PAs and NPs do exist in Europe (UK), just not to the same extent as far as numbers go.

Googling it basically finds what Britain calls a "superparamedic." This person works under the authority of a physician.

No they don't.

They are autonimous practitioners in their own right, employed by the NHS. No such thing as medical control in the UK. They are required to carry their own controlled substances (as are all UK paramedics) which they are lawfully allowed to obtain, independantly, from a pharmacy. This can be stored in their own homes / vehicles if they wish.

Usually a loaners job in the responder vehicle, they can request ambulance backup for transport, treat and release, or order follow up work / lab tests off their own back. They can even "admit" patients to specialist units if needed, all without the need to "ask mummy".

This is just one example of where US EMS should be.

What's the smartest thing ever to come out a woman's mouth?

Einstein's C*ck!

(sorry laydees) :oops:

If at some point in the future higher-ups decided to allow field decisions to be made regarding denial of transport and/or field treatment alone, that would require a true-blue differential diagnosis. That would require a doctor, not a pre-hospital allied health provider, and thus would spell the end of all of us. So we should be careful what we wish for.

It wouldn't require doctor. Works perfectly well in other systems, and frees up much needed space in EDs. Try Googling - "Emergency Care Practitioner".

I was always taught that EMS workers or nurses were not allowed to diagnose.

It's a field diagnosis.

However, I have seen CPAP used for patients with pneumonia before. In fact, I have seen it work well and prevent the need for intubation for some frail patients that would be next to impossible to wean.

Did you happen to know if the causative agent was viral, or bacterial (or other) with these patients? I believe there is a difference with the indication of CPAP / BiPAP in hospital.

My point being however, that apparently, many EMS providers have treated the pneumonia patient as a CHF'er (yes you can have both at the same time, which goes back to ruling in, and ruling out). This is supposedly one of the reasons for CPAP being slow to get off the ground nationally, and one of the reasons we will be moving away from Lasix - too many febrile, tachycardic, and dehydrated old ladies being diuresed in the field :shock:

We can't do complete rule-outs in the field. We have neither the equipment nor the education to do such a thing, which is why nobody but the very few with extremely liberal protocols can do it

Yes we do, we do it all the time. Some of us just don't realize it.

Take your "diff breather" call. A basic assessment should point to whether it is an asthmatic, COPDer, CHFer, PE, pneumothorax, pneumonia etc, even with PMHx of "all of the above". We should already have ruled out some of the other possibilities prior to treatment beyond that of positioning and O2. The reason the poorer providers out there give nitrates and lasix (and God forbid, CPAP) to patients with pneumonia, is down to poor assessment skills, which neglects a consideration towards other co-morbidities, which present with similar (go figure :roll: ) initial findings.

This is the principle behind what AMLS are trying to endorse - possibilities to probabilities / ruling out and ruling in. It makes perfect sense if one knows what to look for, and it also encourages clinical development and a further understanding of common disease processes...

…or we can just load and go.

we are talking about the kind of call Kaisu referenced today where lazy medics dont do their job and talk someone out of going to the hospital.

It is actually a lot more "lazy" just to blindly transport every single patient, every single time. Those who would treat and release / treat and refer (for those fortunate enough to have that privilege) are those who have done a complete and thorough assessment, ruling out all your "what ifs".

It takes a little more effort and clinical skill than sticking the BS patient on the pram and transporting.

The French are working on a similar idea :?

Welcome.

Only stopped off in Keflavik once. Didn't realize that the Icelanders had so many B52s :wink:

Hang on a minute.

Are you honestly saying that any time someone sees someone in a bar, at a football game, or a concert, who appears to be under the influence of ETOH, they should immediately dial 911?

That's the kind of mentality which contributes to the bottlenecking in the EDs, and causes a delay in care for the more acute patients.

Unbelievable ](*,)

scott, does your doctor perform ABGs on hyperventilation patients ? Same thing.

No.

Although occasionally the RT will, depending on the clinical presentation of the patient.

Someone who transports patients to the hospital who have suffered and altered level of consciousness indicates poor ethics ?

No, and in general, AMS patients who continue to be so, should be checked out.

But someone who willingly, and without question, transports a patient who is alert and orientated x 3, with no complaints, and no desire to go to the hospital for the umpteenth time, only to receive a sandwich and discharge, following a transient change in MS, consistent with a long-standing co-morbidity (long sentence)...does indicate poor clinical judgement.

Or perhaps you are advocating taking every piss-head into the ED for a CT brain, because they were slurring their words the night before having downed their 7th Jack and Coke.

Your rational is flawed and outdated.

Misfeasance perhaps...

The ER I worked in routinely did CBC and a pre and post chem panel (usually just a chem 7)

Isn't that known as battery?

I have no responsibility over what happens at the hospital, that is the hospital's problem. My responsibility is to do what is best for the patient in front of me. In the absence of lab and xray you are taking a "gamble"

What labs and x-rays do you think we do on a S/P hypoglycemic, who presents to the ED alert and orientated, with no complaints, and no real desire to be there? Having previously received either oral glucose or Dex by the ambulance staff - None! It's repeat FS, a sandwich, D/C home and follow up with your PMD. Job done.

The problem is that often times, transport decisions are not based on what is best for the patient. Just google "paramedics / emts / ems / ambulance blamed in patient death".

You will get a lot more results if you Google "Nurses / Doctors / surgeons / anesthesiologist blamed in patient's death". Simply offloading the patient doesn't solve the problem, or even begin to look at the big picture.

Bottom line is, that many of the people we transport to the ED, do not need to be transported to the ED. As someone who is employed in both EMS and Emergency nursing, I know that sometimes the "home remedy" is what is really best for the patient.

Doesn't generate much $$$$ though does it? :roll:

You are administering a medicine to a patient and then leaving them behind with untrained personnel to monitor the patient. I doubt that you routinely leave a chest pain patient at home whose symptoms were relieved by 1 ntg tab that you administered. Why not give 5mg of Valium to a seizure patient and then leave them at home, or give 5mg of morphine to that chronic back pain patient and leave them at home ?

If you are referring to the comments made by "Hetzvanrental", you may wish to do a bit of research on "treat and release / treat and refer" pathways which are currently the norm in the UK (which is where he practices) and you will realise just how ironic your comments are. The reason people transport everyone in the US, as already mentioned, is that it generates more money, and covers the arse of the provider legally. Give the provider as much scope, and tools at their disposal as the in-hospital staff (to a degree) for the types of calls mentioned, and many of these conditions can be treated at home. Paranoia over the "what-ifs" does not stop at the hospital doors.

Most services are operating at loss or razor thin profit margin, and it is expensive to send a crew to the scene, administer meds, and wait with that patient for 30-45 minutes. Insurance does not pay for no transports, and most patients do not pay if you do bill them some minimal charge.

Again, nothing whatsoever to do with "HVR's" comments as "billing" does not exist where he practices.

Oh my God, it's not that "Slider" that I designed to stop the cables of the monitor from getting entangled. A simple design, based upon the Sliders used on ram air parachutes to stop line entanglement during deployment, it is cheap and simple to use. The slider is pulled down for stowage (which stops the knotting of the cables) then slid up for use. No more embarrassing untying of knots when time matters.

I even named it the Scott Slider

...and no, I have no idea how to go about patenting or marketing anything.

I only got married because I knew I would never get divorced.

Ouch...

I don't want to rain on your parade but that is a little bold. I hope you are right, but I have heard more than a couple of friends and relatives say the same thing in the past. They are normally the same people who end up having the mother of all legal battles when, guess what, they file for divorce.

Saying you will never divorce, is like saying you will never get cancer - in spite of the best of intentions, there are no guarantees. Branding that about also opens the door for ones "significant other" (not saying yours) to behave however they please.

I don't see why there is still a social taboo with divorce, although I agree it isn't something to be taken lightly, nor rushed into at the first bump in the marriage. Ultimately though, the failing isn't in the actual separation and divorce, but the marriage to the person in the first place.