Ridryder 911

I will see if he will write it... I know he is in school & works a lot. but since there is a interest.. I can see... Be safe, R/R 911

I agree with most of the post however, simple chest decompression over 7-10 minutes usually is occluded & re-needle decompression is needed again. No, not all medics need need to perform this procedure as well. I hope no physician waits for a X-ray to perform a decompression or chest tube placement.. and yes, it is recommended not to wait for X-ray to confirm a pnuemo or hemo.. Be safe, R/R 911

Okay, off a similar thread. As I described the local AMA did an informal poll of local physicians that would participate in administration of the lethal drug. A shocked AMA received that a large percentage responded they would and also do it for free. So here it is . You are offered through the corrections department to administer the lethal dose of the medication to cause death to the convict. He/She has admitted guilt of a brutal murder, even video taped the incidence so there is no wrongful accusation. Be safe, R/R 911

Alco.. .. look who is bashing whom, there are a lot of us that remember things on EVERYBODY that has been here for a while and their oddities....so can we please stop?... Be safe, R/R 911

I know in Oklahoma, there are several criteria you have to meet. A large upfront trust or insurance (I believe it is at least a 1/2 to 1 million) and there are no competition rulings as well. I am sure Tx. has similar laws to make sure someone does not start one, just to go debunk.... EMS is not an easy business, especially workman's comp, coding and billing or medicare and insurance, equipment and insurance liability. As far as I know there are no " special grants" for private EMS. Ubnless you are VERY specially skilled in management and healthcare administration, I advised not to go into EMS business. Be safe, R/R 911

Duh!... hello look at the post dates !.. geez: he has not posted here for several months.. please when replying to posts try to at least make it from the last post less than 4 months ago.......digging dead posts ... There is reasons ( in which you do not realize or even it matters why he did not continue) Be safe, R/R 911

Hmmm...interesting comment , never realized we are over educated...especially since EMT & Paramedic education is based upon junior high and high school equivalent level ? Be safe, Ridryder 911

At this time do not see any implications that would change outcome in treatment. You would still have to have a radiologist review, and to see fxr or not is no diference in treatment. Not to speak of the radiological implications. Ultrasound is a lot bettter idea, check for AAA and abdominal wounds as well as cardiac disorders and true psuedo PEA, and fetal movements as well. Be safe, R/R 911

I say let us start a petition to scrap the entire education and training programs ! Clean sweep, all of them ! Let's go like every other healthcare agency... 2 yr minimal college, then about 1 yr experience. Hey, it works for everybody else, and apparently what we have does not work..... The guys giggle and laugh when they watch old Emergency episodes .. and how dated they are.. then you, think.. there are some communities that still can not offer what they did then... 32 years ago.. so how far have we really become ?.. the system to be point blank sucks! .if we analogized EMS as a patient we would had signed a DNR long time ago...... Be safe, R/R 911

I hope I did not read that you were going to flag a female responsive to stimulus... this is how Paramedics get on the front page of the paper.. flagging someone that is not dead... love to be the plaintiffs attorney! You have 3 ALS truck which should = 6 medics.. 6 patients. Not all the patients are critical and can be doubled up. Be safe, R/R 911

As a former bureaucrat I am assure it is being used as a political ace in the hole. ...Some reason or another some one (or group) really wants this pushed through. I too do not agree with basics using a vent and the EMT Advanced administering NTG... ( oh great her comes the hypotension!) I see they are trying to introduce licensure to each state with allowances of credentialing. This will be a shot in the arm for our professional status. Like Dustdevil said this has been kicked around... we will see since it states it will have no jurisdiciton ... then describes states training shall adhere to minimal standards as close as possible. ... hmm a little double talk? Be safe, R/R 911

I believe one has to be very careful especially in the first trimester with all the exposure(s) and lifting. This can not be compared with nursing, with assistance in lifting, and usually patients are screened to help reduce exposure of communicable diseases etc. to expectant mothers.I have just found out OSHA actually has a sound decibel restriction for expectant mothers as well. This needs to be investigated as well for women in EMS. Be safe, R/R 911

I agree, facilitating intubation is only half the correction... ever have laryngeal spasm on a patient ..?. If you are going to do it .. then do it right.. Also, please to be sure sedatives are used correct and should be routinely administered to prevent "awakening" of a paralyzed patient. If Paramedics are educated well enough and have a true pharmacological understanding of the medications cannot be over stressed... ( including lab.. etc such as K+ etc..) Be safe, R/R 911

Ditto, what Dustdevil said. This is similar study they have been doing to display shock syndromes and the effectiveness of fluid resuscitation. This method has been shown to be flawed and I really do not know why they they would pursue such a study? RL or LR or Hartmans solution has been utilized because of it components and the lactate in the fluid. Some even prefer the D5RL with the dextrose needed in metabolism of shock. Be safe, R/R 911

I have seen this type of activity for the past 27 years in EMS. I have even tried to have researchers study why Fire, EMS & Law Enforcement has a higher infidelity issue. I believe that yes, it is some of the behavior patterns that enter the field. Some of it is based on tradition that re-enforces this behavior and even praised. But mainly I believe it is mainly based on personality and maturity level as well. No, I am no angel and I too have had many errors in life. The psyche of the some EMT's are definitely askew and some have some very big issues of closeness, companionship and allowing of open of feelings. I find it ironic most in EMS will criticize some patients behavior pattern and at the same time condone and actually brag about infidelity and promote it, with no regards of the consequences to others emotionally, physically, and the long term effects such action has. I have always heard the excuse....."It is just part of the business"... "It happens everywhere"... unfortunately, it appears this might be true, and I believe many use this as an excuse and a cop-out. However; should we still condone this behavior ?.... If one can not be honest and be faithful to a mate, what type of personality trait does this reflect in general. I hope to see EMS shed some of this behavior. We will never be respected as a profession if the people that make up the profession do not present ones that cannot be trusted. Yes, it does occur in other professions, but I do not believe it is promoted as much as it is in EMS. Be safe, R/R 911

http://www.emtcity.com/phpBB2/viewtopic.ph...p;highlight=chf & http://www.heartsite.com/HS_CHF/Index.html Ditto, more education........ Be safe, R R 911

Highly suggest you study the Cordorone study that AHA used in comparrison. There is rumor that the study might have been tainted also suggestions that Cordorone wil still suggested but not "endorsed" as before. Alas, sounds like Bretyllium, etc.... Be safe, Ridryder 911

I have several friends that are now physicians that was field medics for many years & yes many are still involved in EMS as medical director or advisory at local Paramedic programs. However; most agree to keep their license is futile and would be asinine. Physician level definitely supersedes the Paramedic level, similar to keeping LPN when you receive an RN....hmmm maybe we should consider this as a Paramedic with removing the EMT recognition ( okay we have discussed this before). Norman, has his EMT/P for many reasons since he has been on the NREMT board since it concept & followed in his fathers footsteps 30 years ago.I believe this is a PR issue more than true level of performance. Be interesting to see when his last refresher was.... as a trauma surgeon I sure he does not include that title for reference in research etc... As far as sitting around, I have been involved in trauma studies and EMS research for the past 25 years.. ( yes, some of us of worked in other areas than in the back of rigs) and yes I have been published. Again, until we have such publications we will not be considered or respected as a profession and rightfully so. I agree we need them but as others has stated probably very few would actually read or even be able to read such journals. Maybe we could contact JEMS publishing and ask if research & professional journal would be feasible. Surely there are enough that would make it marketable. Whenever EMT's; want more than picture pages and learn how to actually read studies and interpret them we will have policy and protocol development based upon others telling us what to do and how to do it. Like as many other posts have describeduntil we have increased education level and teaching scientific methods, we will be considered in the technician phase of only knowing & performing procedural tasks. Be safe, Ridryder 911

I agree with ER Doc, I too don't feel comfortable with "most Medics performing this skill. Again, just because you dropped a lung does not suggest a chest tube, especially in the field setting. Yes, by all means one has to be specially trained "when it is appropriate" as much as "how to perform" this procedure. I don't want to reflect that I am in favor of scalpel toting medics. I too have seen the consequences of improper tube placement and even difficult ones to place, with seasoned ER & thoracic surgeons. Again, incidences with prolong transport to a surgical theater or aggressive ER and those with obvious traumatic tension pneumo ( with high predictability of poor outcome) this may need to be considered & introduced in education. Be safe, Ridryder 911

My technique is similar of that in ER, basically follow the same guideline(s) as outlined in ATLS. (of course this is someotmes dangerous without CXR confirmation). Some prefer trochar approach, I myself do not, I prefer making the incision and locating the pluera lining, spreading the opening with hemostat or clamp and manually inserting the clamp/tube, I also prefer to suture my tube in place as well and of course, secure as with any chest tube, the flight service I worked in had modified helmich valves in lieu of plera-vac. Understand most of these cases were obvious pneumo's with high percentage of lung involvement. Not all medics or RN's were blessed only those that attended and completed ATLS and Advanced Trauma Care with respective lab and cadaver and sucessful clinical performance observations. As with any high risk procedure strict QI was monitored as well. My feeling though that this is not a procedure for every Paramedic to perform; it should not be limited to the hospital arena. Especially when considering long transport time or expected delay > 30 minute to regional trauma facility. Repeated decompression to prevent or reduce tension pneumo's sometimes is not adequate enough and is not in the best interest of the patient. Be safe, Ridryder 911

I am not aware of any M.S. or even Doctorate in EMS, there are M.S. & Doctorate in applied areas such the science or business area but not EMS. There can be research in EMS without physician participation although albeit not in patient care. When was the last time you seen an article of study of Paramedic Instructor education level, the best working habits and productivity of EMT's, or even cost containment of and risk prevention in EMS. How about the level of patient assessment we perform, as well theories of Paramedic care ? Yes, we have to have a physician to oversee medical research, we do not have a medical practice license and therefore cannot practice medicine officially. This should not stop us from looking into or developing and performing research in the medical aspects of EMS, under their guidance. True, there are VERY few EMT's and Paramedics that understand research process and procedures. This itself is a flaw in our profession. I agree some of the journals are not directly related but medicine is medicine. The next patient I see may be the patient with a pancreatic carcinoma. It really upsets me to to work or see medics that have not a clue of any other medicine than just what was taught in that one EMT book. I have authored a few articles in Paramedic International then after in JEMS when it was changed. I also had some published in EMS and then in some might remember the rag EMERGENCY. These are a nice trade magazine, but are a far cry from a professional journal. I know some of you might remember when the NAEMT had a publication of EMT Journal this was a very good journal with current research and new standards. Then .........poof ! We regressed...Unless things have changed very recently, you cannot author an article in JEMS or EMS that is written over the 11'th grade reading level, since most studies have shown that Paramedics only have a 10'th grade reading level. What a tragedy! After review and re-review, of your query, it becomes so discouraging that is has to be watered down, most of the writers get discouraged that it has lost its main content. I agree, we need several true journals; to begin debate and spark research. In EMS we need to take off the rose colored glasses and quit having the idea we cannot perform research other than patient care. EMS has multifaceted parts that's need to researched and be developed in other than patient care. Be safe, Ridryder 911

I have discussed this with my ADminstrator and I agreee evidence medicine is going to be VERY hard in EMS. Performing emporical studies in the field with very many variables, will be hard to prove. I am not saying it should not be done, but will be very difficult for true scientific studies. Be safe, Ridryder 911

Basically, trauma is a surgical disease. There is really very little we can do at the present time to actually "treat" shock. I do agree to maintain a perfusion level of < 90 and > 40 mm/hg. If one studies the physiology of cerebral/coronary circulation, one should realize we do not want to increase pressure much more than this to prevent increasing pressure opening or causing increased bleeding. The inital education of fluid resucitation was taught in most medical schools, were a dog was placed in hemmoragic shock then fluids rapidly bolused and pressure was increased. However, post studies of shcok syndrome was never rreally evaluated. Fluid resucitation has been proven not to be sucessful in after 2 liters. Until we can provide oxygen carrying fluid such as the proposed Polyheme or something similar fluid therapy is basically futile. Be safe, Ridryder 911

I call JEMS & EMS toilet reading material, very simple and non-scientific. Basically a review of what you should had known already and if you read true Journals you would had already known this informatiop 2-3 years before their publication. I read American Journal of Trauma, JAMA, New England Journal of Medicine, Emergency Physician...etc. I wished EMS had a a true Journal such as Emergency Nursing from ENA. They have at least abstract papers and researc articles, something we should learn from. Be safe, Ridryder 911

When performing needle chest decompression the occlusion rate is about 5-7 minutes, before you have to dart again.. some of my patients looked like a porcupine when I arrived. Chest tubes would not occlude as fast... might as do it right the first time....and be done with it. Be safe, Ridryder 911