Ridryder 911

We said your prison name...LOL !

Oh boy.. backroom baller.....oops there goes the soap! :ky: :bootyshake: R/R 911

Wow..I was killed by a hay bailer.. and a goose gun.. then by an Iraqi troop in the English war.. Be safe, R/R 911

Ditto with the rest... the rate is pretty fast for a accelerated junctional rythm.. although when I first lookes at it, I thought the same. I believe it has some fusion beats or ectopic beats to convert the pattern. Funky pattern, but with the age of the patient who knows.... I am sure there is an electrolyte imbalances etc... also, my rationale is ... he is 98 years old .. he has earned any funky pattern he can have.. :wink:

We have "quit" doing for the community. Like other healthcare workers week...(i.e Emergency Nurses Week, Physicians Week) we have turned the focus on "us". This is a time to honor those that work in EMS. I don't believe this selfish to ask one week during the year. I know in Emergency Nurses week, drug reps. brought us lunch daily, as well as administration issued gift certificates and passes to movies etc. i appreciation for the work. Of the course the T-shirt, cups, etc.. was given as well and a nice article about the role and spotlight on the nurses themselves. I have been trying to endorse EMS to do the same. A week during the year to honor those that give unselfishly, and really do try to make a difference. God Luck, R/R 911

The way they see it is, why should the insurance and government pay for an ALS unit when it only provided a taxi ride. The same is true in hospital billing, you have base rates and different level of care. A cardiac arrest is not the same price as a splinter removal etc.. you are not paying for the knowledge but the services rendered. Most services has 2 means of billing individual ( base rate with individual line billing -procedure and equipment used) or a capitulated rate ( inclusive) one set fee that you have agreed that you will charge for certain calls... i.e basic =$; ALS =$ all the time no matter if you use a little bit of equipment or empty the drug box is the same rate. It usually equals out the same .. mangers and the government know this as well. One must remember that the most EMS services can receives is about 80% of rate from medicare. Then collection rate from the provider contracted out to the medicare rep is all dependent on how well things are documented and coded. I believe EMT's should be aware of billing procedures and regulations. It would make EMT's more appreciate of managerial staff and have an understanding the need of proper documentation. Be safe, R/R 911

Uh.. EMS is week is sometime away.. but, good to get a head start. Might want to check out ACEP web site and see if they have the " theme" out yet... We are going to have a big "blow-out" this is our 10'th anniversary for the service. Good luck, R/R 911

We operate about the same. Out of the 24 full time 2 are below Paramedic level on the trucks so most of the time it is a Paramedic-Paramedic unit. However; I find it ironic that the billing be ALS if no ALS procedure was performed or justified. A company should and technically can not bill for ALS runs because of staffing and licensure level. We rotate calls and the basic or Intermediate attend patients that so not need ALS intervention. This allows them to get patient experience and allow the medic a break. If you are really concerned about the issue, you might want to contact medicare fraud for investigation. They have an anonymous clause and "whistle blower" protection. Patients should be treated according to illness not for billing purposes. Again, medicare is quite aware of some of the unethical practice and this type of performance needs to be stopped. For staffing, have the medics met formally with management and discussed this situation?.. If this is a private company I am sure there is a chain of command to follow, up to board of directors etc... I wish you the best of luck. R/R 911

Our protocol is similar to Vs-Eh. We observe MOI, and neck pain. If no parathesia, clearance of similar to NEXUS is determined. We will never be faulted for immobilization. As time has progressed, we are less and less back boarding those that do not have MOI or potential neck injuries. I am finally breaking most of the crews habit that every fall does not need LSB & CID, if it quite apparent there was no cervical pain or potential injuries. I do look for things to change.. and here is why. Within the next 3-5 years they are expecting triple the number of ER patients nationwide.. so you can see the wait and delay before clearance occurs. Either they will educate ER nurses to manually clear non-spinal injuries or enforce and educate EMS personal when it is truly essential and worthy. Be safe, R/R 911

I understand that Dusts wants scientific proof in the field and this would be nice. But Dusts is quite aware that are very few scientific researches that has been studied in the field setting. There are many reasons and he is quite aware why, with so many variables. I don't believe there was any persons post that discussed that LSB & cervical immobilization should not occur in true suspected spinal injuries. The difference is that routinely immobilizing, because that has been the usual S.O.P's should be investigated more and maybe eliminated form our teaching. Again, not disregarding MOI, and other significant attributes that has been discussed. My main point was the routine use of LSB on these patients. Again they are used routinely without thought, and application usually has no foresight of the complications. Yes, I doubt there are any articles that actually describe field clearance... that was performed solely in the field. In comparison there are very true field studies validating medical procedures and medications we administer. If you want more references here are some... sorry they are from trauma centers, which also actually deal with spinal patients as well. http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Abstract and for studies of pressure sores... http://emj.bmjjournals.com/cgi/content/full/18/1/51 Yes, I am aware of your opinion of removing the patient ASAP when entering the ER. This would be great if it was practical, but realistically will not occur, for possibly several hours. Thus the inquiry of placing patients to begin with that does not really need to be on one. Not to open a can of worms but sport trainers and sport physicians have been "field clearing" for years, with apparently successful rate (not high school trainers) This may be one of the cases we have to agree to disagree... Respectfully, R/R 911

Use it a lot for major epistaxis... if they are not hypertensive... replaced the old stick, that some might remember. Use the IV form for spinal/neurogenic or septic shock.. with its alpha effects. Similar to the old Levophed. Be safe, R/R 911

Wow to have that much deformity and displacement, I doubt they would have any feeling .. as far as laying posterior there are very few times that patients feel better in a prone positon with back injuries. In fact that is usually a tell-tale sign of of a true muscular injury or crock... usually, clients with true back pain cannot stand to be placed into a prone position. Be safe, R/R 911

Impailed stabbing or any impailed object to C-spine post cervical or to the back.... etc...I would probably use the scoop instead of a LSB. Be safe, R/R 911

Anthony I respect your opinion and like everyone else is entitled to one. But in educated debates, reciting personal anecdotes never really solves an educated question. When citations has been provided and one refuses to acknowledge and to question is okay, but to continually debate is frivolous. This has been an re-current response whenever someone disagree or tries asks for more specifics on the thread question. In most of the EMS forums there are of us that are aware of those that perform client care and those that talk about it, and our up to current standards. Over-all as a member of several forums it is usually the same members.. and we have become professionally close. Yes, we may criticize and praise each other ;this is what makes forums work.... other wise they become VERY boring. Don't believe me look at other EMS websites... without debates.. they get gooey and no educational debates occur. As I again state, I respect his opinion not the "attitude" or belittling. Which is a direct violation of this forum, in which he likes to direct to others. When all the dust .. settles ( no pun intended) I hope we still respect each other... I do. I know I have thick skin from bigger & more important tomcats..lol oh... another thing is it is a pulse- oximeter ...not ox-meter... :wink: Respectfully, R/R 911

Dust I take offense of what you said and described. I consider myself and others VERY educated and maybe it is you that should reconsider on learning on how to improve your communication skills. Obviously, this is a re-current problem as reference to other posts. (CCEMT/P debate etc...) Forums are just a way to voice personal ideas, suggestions to others and references. Like anything here really changes anything in EMS, especially from ex-EMS personal and those not involved in State and National policy making. Hopefully, we spark interest to make others aware of situations or to be able to get involved to change things. Like I said I respect your opinion due to your knowledge and past experience. Respectfully, R/R 911

Very good points... just like those that believe cervical collars provide immobilization. Laying a person on a solid piece of plastic really provide immobilization?.. and whom to say laying them on a padded firm bed would not do the same thing?... as long as the patient maintains neutral alignment. From what I have recently seen in a lot of EMS there is very poor immobilization. How many out there actually place blanket rolls between the straps and curvature of the patients?.. The last time I seen a KED used on a adult has been years... The same being of truly immobilization of patients in major trauma.. due to most of the cases need rapid extrication they are rapidly placed onto a LSB and "pulled" out. These are the ones that need spinal immobilization the most. But understanding, spinal injuries is usually the last priority and worry of these patients, one's attention is usually geared to keep them alive. I agree with DG.. there has been research for several years showing the B.S. of most LSB & CID. Dust your a big fan of Brian Bledsoe, I suggest reading some of his articles on debunking spinal immobilization. As far as pressure sores, it does not take a rocket scientist to understand ... if one laying immobile on a nicely padded bed, for a couple of hours in a surgical suite can cause nerve and decreased tissue perfusion. Surely an educated person can deduct laying on a hard plastic board immobile would cause the same, maybe worse damage Why does one think hospitals spend several of thousands of bends on rotating and air beds. Surely an educated medical person understands decreased capillary pressure in tissue perfusion even in a short period of time. The same is true when immobile or restrained clients, damage can occur. Since the clients cannot move or adjust , roll-over which the normal person does to prevernt injuries. Although the studies was not for pre-hospital clinical prat-ice, immobile and restrained is immobile and restrained no matter what type of room the client is in. Dust, I usually agree about 95% of your post and respect your opinion and knowledge with experience. However, this like the CCEMT/P post; I believe you are not clearly presenting your question or thoughts. Be safe, R/R 911

Oh the stories... the one of turning their head in x-ray ..yadda, yadda.. I could go on about patients that angiogram was clear and enzymes negative and walked out the hospital and went into v-fib... so poop happens, and we will never solve everything. I believe the main point is to use good common sense, and rational judgment. I am definitely not against immobilizing, but when needed. So many times I have seen clients brought in with no rationale of LSB & CID, except it is our protocols and tat is the way I was taught. I have the same feeling with any medical procedure or medications administered to the client. I feel like any other medical procedure and medication there should be an indication and rationale for it as much as not using it. Blanket treatment does cover your ass, but does not always represent the best for the patient... Be safe, R/R 911

I agree, that the days of LSB routinely are over. This procedure is way overdone and really causes more damage and pain than the protection is set for. Mainly, we have not educated our medics to when there is really a risk versus CYA. Grandma falling in the floor onto her butt versus the high speed MVC. As well as clearing C-spine manually. We have specific C-spine clearance protocols and with the specific of "suspicion of c-spine, one can immobilize".. the only difference I have seen is the B.S. low impact fender bender calls no-longer get boarded as often, and the knee pain, no longer get CID etc... more focus on the C/C . When potential c-spine injuries the medics still perform LB etc.. as usual.. Cook book medicine and unwarranted procedures need to be curtailed. The same as EKG monitoring and I.V. .. for patients that do not warrant them... Be safe, R/R 911

Awwww.... guess what they just studied AZEP..? The effects of neutral positioning with and without padding on spinal by Prehosp Emerg Care. 1998 Apr-Jun;2(2):112-6 The effects of neutral positioning with and without padding on spinal immobilization of healthy subjects. Lerner EB, Billittier AJ 4th, Moscati RM. Department of Emergency Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo 14215, USA. lerner@acsu.buffalo.edu OBJECTIVES: To compare the incidences and severity's of pain experienced by healthy volunteers undergoing spinal immobilization in the neutral position with and without occipital padding. To compare the incidence of pain when immobilized in the neutral position with the incidence in a non neutral position. METHODS: Thirty-nine healthy volunteers over the age of 18 years who had no acute pain or illness, were not pregnant, and had no history of back problems or surgery voluntarily participated in a prospective, randomized, crossover study conducted in a clinical laboratory setting. Appropriately sized rigid cervical collars were applied to the subjects, who were then immobilized on wooden backboards with their cervical spines maintained in the neutral position using towels (padded) or plywood (unpadded) under their occiputs. The subjects were secured to the board with straps, soft head blocks, and tape for 15 minutes to simulate a typical ambulance transport time. The straps, head blocks, and tape were removed, and the subjects remained on the board for an additional 45 minutes to simulate a typical emergency department experience. The subjects were then asked to identify the location(s) of any pain on anterior and posterior body outlines and to indicate the corresponding severity of pain on a 10-cm visual analog scale. The subjects were also asked questions about movement, respiratory symptoms, and strap discomfort in an attempt to distract them from the true focus of the study (i.e., pain). A similar survey was given to each participant to complete 24 hours later. The same subjects were immobilized with the alternate occipital material a minimum of two weeks later utilizing the same procedure. They again completed both surveys. RESULTS: Pain was reported by 76.9% of the subjects following removal from the backboard for the unpadded trial and 69.2% of the subjects following the padded trial (p < 0.45). Twenty-three percent (23.1%) of the subjects reported neck pain after the unpadded trial, while 38.5% reported neck pain after the padded trial (p < 0.07). Occipital pain was reported by 35.9% in the unpadded trial and 25.6% in the padded trial (p < 0.29). Twenty-four hours later, pain was reported by 17.9% of the subjects following the unpadded trial and 23.1% of the subjects following the padded trial (p < 0.63). Eight percent (7.7%) reported neck pain 24 hours after the and unpadded trial and 12.8% after the padded trial (p < 0.5). Occipital pain was reported by 7.7% of the subjects 24 hours after the unpadded trial and 2.6% after the padded trial (p < 0.63). This study had a power of 0.90 to detect a difference of 30% between the trials. The authors found a significantly lower incidence of pain (p < 0.01) and occipital pain (p < 0.01) in their unpadded trial compared with that reported by Chan et al., who used neither padding nor neutral positioning to immobilize subjects. CONCLUSIONS: Pain is frequently reported by healthy volunteers following spinal immobilization. Occipital padding does not appear to significantly decrease the incidence or severity of pain. Alignment of the cervical spine in the neutral position may reduce the incidence of pain, but further studies should be conducted to substantiate this observation. ******************************************************************************** ************************************ I believe this area should be studied definitely more. I think it is ignorant to state immobilization is not effective. Although probably >90% of immobilization is done for prophylactic use, the 1% is worth it. The same is true in any medicine such as x-rays, lab etc.. I do agree there should be more emphasis on "clearing C-spine".. there are too many times I see grandma type "fully immobilized" from a fall from chair to carpeted floor, with the chief complaint was in the coccyx... now they are hurting of course "all-over".. and now have to be "cleared".. before placing off the back board. Pressure or compression of tissue while laying on a LSB is a significant risk, causing poor circulation of tissue and possible nerve damage. If one has ever worked in a surgical suite, one knows the importance of positioning & padding to help prevent nerve damage when a patient is unconscious. These things should be addressed in medic school if we plan on continuing to place patients on LSB & CID's. Even transporting an immobilized patient, an EMT should consider these. I am wondering a well how many actually truly pad and immobilize or simply place the patient on a LSB & simple CID. I too am guilty of this for most of my clients in simple MVC. I do attempt to blanket roll and pad the sides and joint areas on truly spinal injury presentations. I am shocked on how many EMT's and Paramedics that are familiar with proper packaging of patients. Be safe, R/R 911

Out-of-hospital spinal immobilization: its effect on neurologic injury by Out-of-hospital spinal immobilization: its effect on neurologic injury. Hauswald M, Ong G, Tandberg D, Omar Z Department of Emergency Medicine, University of New Mexico, School of Medicine, Albuquerque 87131-5246, USA. mhauswald@salud.unm.edu OBJECTIVE: To examine the effect of emergency immobilization on neurologic outcome of patients who have blunt traumatic spinal injuries. METHODS: A 5-year retrospective chart review was carried out at 2 university hospitals. All patients with acute blunt traumatic spinal or spinal cord injuries transported directly from the injury site to the hospital were entered. None of the 120 patients seen at the University of Malaya had spinal immobilization during transport, whereas all 334 patients seen at the University of New Mexico did. The 2 hospitals were comparable in physician training and clinical resources. Neurologic injuries were assigned to 2 categories, disabling or not disabling, by 2 physicians acting independently and blinded to the hospital of origin. Data were analyzed using multivariate logistic regression, with hospital location, patient age, gender, anatomic level of injury, and injury mechanism serving as explanatory variables. RESULTS: There was less neurologic disability in the unimmobilized Malaysian patients (OR 2.03; 95% CI 1.03-3.99; p = 0.04). This corresponds to a <2% chance that immobilization has any beneficial effect. Results were similar when the analysis was limited to patients with cervical injuries (OR 1.52; 95% CI 0.64-3.62; p = 0.34). CONCLUSION: Out-of-hospital immobilization has little or no effect on neurologic outcome in patients with blunt spinal injuries. Dec 21, 2005 So are we doing more harm than good? Be safe, R/R 911

Okay...uhh.. maybe once or .... they tasted like fruit roll-ups.. :oops: the person below me wears edible underwear.. R/R 911

Don't know about NYC, but most states require course afer 3 years of inactive service.. Good lcuk, R/R 911

Reading another post makes me wonder... How many EMS is actually recieving the Federal HIPPA in-services... and handing the HIPPA policy and having each patient sign they recieved it ....... (actually a Federal Law as well). Be safe, R/R 911

Actually, Pronestyl is still considered. Although, it is not mentioned it & other medications has not changed.( except Isuprel which has been totally removed) Yes, they are still trying to push Cordurone ( which is very expensive) and they cannot show any difference in outcome measures. For more info on all the recent changes BLS and ACLS here is the AHA newsletter with comparisons of old & new... http://www.americanheart.org/downloadable/...2Winter2005.pdf

I have heard various reports good & bad, be sure to not the under carriage holder is made of vinyl. In which I was told rips easily. Be safe, R/R 911