kristo

This one is pretty good. I have a copy, it's great to have to see what it really looks like. Netter is, of course, clearer and easier to understand, but after you've grasped that and you want to see how it really looks, this book is what you want. http://www.amazon.com/Color-Atlas-Anatomy-...1592&sr=8-1

I thought he was asking for some reading materials to prepare for class - let's give him the benefit of the doubt. By the way, does American college anatomy include histology or embryology?

Since we are discussing EMS history here (among other things), I'd like to know the origin of the BLS/ALS distinction. I've never heard of it anywhere in any medical profession, except EMS. I know doctors and nurses who have never heard of this division. From their point of view, it's all just patient care. If a patient needs a drug, they administer it through the best route practical at the time, be it orally, rectally, IV, IM, etc. They don't consider themselves being "crossing a line" when they decide to give it IV instead of orally. I wonder if it's time to forget about this and merge the two into just one; "emergency care". If a patient needs to be splinted or backboarded, it's patient care. If an IV or an ET tube is needed, so be it. This is also the reason why I've never understood "BLS before ALS" or claims that an EMT needs to be present to make sure the medic doesn't "get to caught up in ALS to do BLS".

Keith L. Moore: Clinically Oriented Anatomy Frank H. Netter: Atlas of Human Anatomy Raymond Chung: Gross Anatomy (Board Review Series) (watch out for this one, though, it's small and comprehensive, but lots of errors, and hasn't been updated properly for a long time) In addition to those, some like Clinical Anatomy Made Ridiculously Simple (MRS series), which I own but I haven't gotten much use out of. My sister uses Grey's Anatomy, student's edition, but I haven't checked that one out. The actual Grey's Anatomy has helped me out a few times when Moore is not sufficient, though. Also, there's a good atlas called Color Atlas of Anatomy, which is a photographic atlas. Not as schematic as Netter, but good for guidance at dissections and to prepare for practical exams on cadavers. That one is by Roher (spelling?) and some others. You could also check out Sobotta's atlas, but I can't really comment on that. Know very few who use it, although many schools recommend it over Netter.

The reason for this is how EMS education (as far as I know, I did the FR level and EMT- is constructed. Instead of going from the bottom to the surface, EMS teaching goes from the surface to the bottom. You start with skills and protocols and the further you go, the more theoretical background you get. In formal education, the usual way is to start with the theoretical background and then how to use it. The thing about starting from the surface is that you can always see the light from above, so you know how far it is to the surface, but you have no idea how deep you could actually go, until you go there. Hence, there is a general tendency for EMS personnel to think they know it all at any point during their way through the ranks.

Yeah, that was pretty much what this thread was supposed to be about - the guy with the sliced head...

This thread is becoming a debate on judicial systems. Anyway, since you ask, no, I have never heard any reasonable rationale for being judged by a random assortment of people, as opposed to an experienced expert on law or a panel of such experts (judges). Anyway, if the jury system is so great, why don't Americans trust it enough to use it for the top-level (supreme court)? 8) I realise that sometimes courts make mistakes. However, the system *should* assume that they are right. Otherwise, their rulings would be moot point and we would effectively have no judicial system. All those cases you mentioned, like stores settling with people who fall on the spot, etc. could be avoided if people had to foot the bill themselves if they lost in court. To cover cases that aren't really frivolous, the judge can rule that the cost of the case be paid by the government, I believe they frequently do that when they feel that both parties actually had a valid point of view and neither was just bullying the other.

While that is true, one must assume that in a majority of cases, the court's ruling is correct and act accordingly. Plus, if you lose the case, paying your opponent's legal cost is usually the least of your worries. Again, one must assume that the majority of court rulings are correct. If we assume that, we can safely assume that the best way to guarantee that the party *not* at fault should not have to lose money on the affair. On publicists and stuff like that - that only works in countries where the judicial system relies on 12 persons with varying education (usually no education in laws) to decide. They have no experience in the matter and are easily swayed by theatrics. In proper systems, an expert (or a panel of experts) on law makes the decision. In the US, the judge at least sometimes retains the discretion to award court costs/legal fees to an exonerated defendant when the plaintiff appears to have bullied the innocent defendant in this way. Btw, I'm not defending either system; it's messy anyway you slice it, whence the Gypsy curse: "May you become involved in a lawsuit in which you know you're right!"

Of course. Why should a plaintiff pay for having to go to court to get something rightfully theirs, and why would someone falsely accused have to lose money because of it? It discourages frivolous lawsuits and encourages poor people who have a valid claim to go after even big companies with deep pockets.

[web:9304d09354]http://www.reuters.com/article/oddlyEnoughNews/idUSHER94722820070829[/web:9304d09354]

You'd be surprised. :-) We also need the literature to pull our patients into our igloo hospitals, staffed by polar bears and penguins (yes, I know).

I can think of a few courses along the way that didn't exactly benefit a career in medicine...Icelandic literature...Danish...German...English, maybe...but then again, an educated person is expected to be able to have an intelligent conversation, right? At least that's how I justify the mandatory 5 courses on Icelandic literature... :roll:

Believe it or not, history was my best subject in college - I loved it. Still do. Maybe I'll get a BA in history when I finish residency, in a decade or so.

Like we said in the good old days of usenet, "don't feed the troll!". I, however, realise you will. Happy hunting. Edit: For those of us who are not into usenet slang: A poster is referred to as a "troll", if he/she knowingly posts inflammatory statements to start an argument. Feeding the troll would be when someone starts arguing with said troll, which will then escalate as the troll replies...

In Europe, we have the European Resuscitation Council (ERC), which sets the standard on cardiac care (and more). The ERC is usually along the same lines as AHA. At least in Iceland, we still have AHA ACLS courses, though.

Hey, Dusty. Haven't seen you in a while. Welcome back. 8)

If you see yourself working in an ER five years from now, maybe you should consider becoming an RN, rather than a paramedic. It's much more useful within the ER, plus, it gets you a job in any ER and pays a lot better. I believe this has been discussed often enough for the "RN rather than paramedic" mantra to be burned permanently in the City server's hard disks.

Nahh, I really don't care that much. I think the rant reeked of unprofessionalism, but it's not like it's going to make it to a global campaign for raising awareness of EMS or anything...it's insignificant.

But is it the reality? Can a paramedic withhold pain meds for the sole reason that the patient "pisses him off"? As for the rest, it still pulls the whacker alert in me...maybe that's just me.

Kinda sounds like somebodies oversized ego. Really, I hate to burst your bubble, but if the smart comments like apply in your system (withholding pain meds just because the patient "pissed you off"), then something is very wrong with that system. Really, we've all dealt with abusive patients. Drunk, drugged, mentally ill...it's just a part of being a medical professional. Another thing. Being "legally allowed" to stop hearts, setting up IV's, etc. is not very special. Being allowed to decide not to do it is equally or even more important than being allowed to decide to do it. Maybe it's just me, but to me, this rant sounds like someone who looks at the NREMT paramedic skill sheet and gets a mini-high from the "power" it gives him through his private link to God, the golden patch. I'll give the author the benefit of the doubt though, probably just a rant to relieve the stress from a tough day on the job.

While it's obvious that no alcohol can be allowed in the system of on-duty personel, I really don't see anything wrong with storing it. I may think differently because of our (ridiculous) system where you can't buy any alcohol (not even beer) anywhere except in state-run liqour stores. Can't exactly pick it up at a gas station on the way home.

Doesn't need to be standard practise. There is some very convincing evidence that shows that if there is no tenderness or palpable abnormalities in the vertebrae, and the patient can move and feel their extremities (feel the difference between sharp and soft touch), it can be assumed that there is no need for spinal immobilization. Contraindications for this kind of assessment would be an altered LOC, overwhelming pain elsewhere or any back pains or tenderness.

I'm not sure I do. I do know that this does not exactly advance EMS as a profession. I'm not even sure if it's necessarily status quo. Rural EMS in Iceland is currently under review, which is what drove me to really start thinking whether there might be any better options. Again, I must stress that I have no influence in the matter and I do not live or work in those areas (I grew up in a rural area, though). I don't even work in EMS, I'm just a student. If what is? The current system or it's review? Or me wondering? The reason for the review that is going on these days is to improve patient care. I would be interested in any ideas you guys might have for this system. I realize it is different in a way from what you may be used to, though. There have been a lot of threads discussing the perfect system, or how to improve BLS-only, even volunteer, systems. They have all ended in the same way; educated paramedics. I believe that, in principle, that is the correct way to go wherever possible.

Didn't see your reply until I had posted the next one, you answered some of my questions in your post. Not mine, dude. 8) An old system, actually under review. But, yes, maybe it could survive. Of course it does. But maybe the physican's education can suffice. This is an old system, I believe this is simply what they're used to. Again, this is often *not* their primary career.

I believe in these cases medical direction as in protocols, equipment, etc. comes from a committee of local doctors, or the senior physican at the local hospital or clinic. The doctor on the call will be the on-call doctor at any given time. Remember, we're talking 1-2 calls a week. I tend to agree. It would not seem that EMTs that are content with being extra hands in the ambulance and/or drivers for the doctor are very ambitious. I would also tend to agree that a medic/basic crew would perform care at a lower level than a medic/medic one. However, and I'm really just playing devil's advocate here, technically, the medical command is responsible for EMS in its area, and if this is how they want to do it, i.e. do it themselves, with the help of (just) a pair or two of extra hands, that's the way it's going to be... Please also bare in mind that EMS is not the career of those EMTs. You can't have full time EMTs for 1-2 calls per week (I would welcome any thoughts on this, though), so they may not see themselves as medical professionals at all(?). That's definately not what's happening. They are being taught certain skills, and as we all know, medical care is not about skills. They're just being taught enough to serve as extra hands for the physican, I believe. Agreed - or semi-agreed. Wouldn't you say that a lot of the education that medics receive is about deciding if, when, how? I think we can agree that in many cases, the actual act of putting in the laryngoscope and placing the tube is a mundane, manual task. Remember, the doctor will always be there to assess whether the patient should be intubated or not, when it's done and how (or if he does it himself or has an EMT do it). I'm not really sure as to how far the EMTs go in this. The state of EMS in the rural areas of the country have been in the media for the last few days and the minister of health just formed a committee to look into the matter. They're supposed to finish their work in October or November, I believe. I'm still a bit torn on this. On one hand, why should we have first aiders pose as medical professionals? On the other hand, a doctor and two techs may be just fine. The call volume is certainly not going to wear the doctor out from always being the primary attendant. Is one doctor and two EMTs as good as two medics? Let's say we had medics there, would they be content with 1-2 calls per week? Would we want to pay them for siting idly waiting for those calls? Would their assessment skills deteriorate because of the low call volume? The on-call doctor is obviously also working in the hospital/clinic. Getting medics to work in hospitals and go from there on EMS calls is another idea. In rural hospitals where there is sometimes just a nurse and a few orderlies (and a doctor at his home, available if called), there might not be a lot to do for two medics, though. I'd like to make it clear that I am NOT advocating that EMTs should be making assessments or deciding treatments - I am merely speculating about a system that has been used for years, and is based on the usage of physicans on-scene, and the role of EMS as assistants for the doctor, rather than semi-autonomous providers. Also, I do not believe that EMS, in itself, should be like this. EMS should be a career for well educated, motivated medical professionals. I wonder, however, if EMS in those areas could be done better - especially considering that a doctor is a very well educated medical professional and should, by all standards, be fully capable of handling this task.