Ridryder 911

Good show, John.. tried to get in live chat room.. maybe try next week. Keep-up the good work.. Be safe, Ridryder 911

Sorry, no bleeding heart here. Yes, I was thrilled the day McVeigh was executed for the OKC bombing. Does it decrease criminal activity, probably not, except at least by one. Did it bring closure.. yes for most. These persons morays are not as most of the civilized western civilization. What do you think other countries would do ? Let Mousaui, get his wish. He performed this crime before act of war started. Sentence him, just like any act of violence. Sorry, I have NO tolerance for planned, thought out, ruthless killing & terror on our country. Be safe, Ridryder 911

Truth, probably save my sibling. I could deal with therapy of the others. However' it is one of those philosophical questions that no-one really knows until placed in that position. Be safe, Ridryder 911

Isn't that strange ? Some of the opinion is not to trust our own co-workers. Is this because we may know too much... or they know too little? Are we trying to educate or encourage others to seek or improve their education or even maybe just to maintain their current level? This scares me knowing the over-all (including mine) opinion is that we do not trust the ones we work with, we would not trust with-our own lives. If this is the case, what do you think the general public opinion is ? Just something to think about.... Be safe, Ridryder 911

Are you sure, you want to do that ? Look at some of the older post.. most medics, was not impressed with the show. Some displayed some unprofessional conduct & ill treatments. May want to re-consider.. only a suggestion Good Luck, Ridryder 911

Most management, frown upon personal relationship(s) at place of employment. If there becomes a problem in relationship, there is a problem at work. This does not make good working relations with other crew members & patronization can soon be indicated. I have worked in EMS for over 25+ yrs, & I have seen nothing but trouble with on-crew relationships (married or other wise) resentments build among crew members very fast & some consider unprofessional ism can be accused. Be safe, Ridryder 911

I agree with Paramedic Mike, I used to be with FD. I went into medical field, (my patients aren't on fire). I believe the F.D. has a definite role as a 1'st responder & rescue. Yes, there are some EMT's & Paramedics who has no desire to be associated with Fire Departments. It wasn't that long ago, & still some services today, are strictly fire suppression. When city cuts & budgets was enforced, & the fire department needs good p.r. & productivity, they adopted EMS. But, I wonder how many are really interested in just the EMS. No rescue, no fire suppression, just strictly patient care. Do they give same benefits, career ladder, & pay as the non-fire suppression employees? Be safe, Ridryder 911

Yes, most EMS consider, < than 48 hrs safe. I prefer to use another paralytic, such as Pavulon, etc.. Be safe, Ridryde 911

As a an old burn center nurse & flight nurse, some services are hesitant to use sux. Sux is a negative isotope, which can cause an histamine response. Not only that post burns or crushing injuries ( > 24 hrs to 7 days )The upregulation of acetylcholine receptors (AChRs) after burns occurs at sites immediately beneath and distant from the burn; a positive correlation between AChR number and the intensity of the hyperkalemia after succinylcholine has been confirmed. The upregulation of AChRs that occurs in muscles beneath the area of the burn is as profound as after denervation and occurs as early as 72 h after burn.* Evidence for upregulation of the immature isoform has also been provided by assessment of messenger RNAs for the unit. When depolarized, the immature isoform has a prolonged open channel time, which may exaggerate the K+ efflux that occurs with depolarization. Thus, the potential for profound, denervation-type upregulation of AChRs is present as early as 3 days after burn injury when the burn-injured area is adjacent to muscle. The dramatic upregulation of AChRs on all muscles beneath the burn is also accompanied by the expression of the immature isoform of the receptor. In fact, burn injury of a single limb (8-9% body surface area) is sufficient to cause potentially lethal hyperkalemia. The concomitant presence of immobilization with and without prolonged administration of muscle relaxants can accentuate the upregulation of AChRs. Immobilization alone can induce modest upregulation as early as 3-4 days. Although in EMS, we will have the lack of clinical reports. Hyperkalemia before 7 days after burn injury is probably a result of the following: the previous treatment philosophy of not treating major burns aggressively with early excision and grafting did not provide the opportunity for challenge of major burns with succinylcholine within the first week; and increased awareness of the dangers of hyperkalemia with succinylcholine has resulted in its lack of use in burn patients as early as 1 week during early excision and grafting of major burns. That is why some EMS service uses succinylcholine for burns up to 48 hr after burn injury, but it may be wise to avoid it beyond that period. Patients may be particularly vulnerable if they have been immobilized in bed because of severity of illness or concomitant disease (e.g., inhalation injury and fractures) or if they have received prolonged muscle relaxant therapy to facilitate mechanical ventilation. I hope that answered your question. Be safe, Ridryder 911

Again proper education. Such as burns ( which Sux is sometimes contraindicated). Bird, or ground tx is tx..work both.. Be safe, Ridryder 911

If you do it properly, you will successfully sedate the person before paralytics.. paralytics does not affect mentation.that is why it gets a bad rep... In-depth education, on the use of sedation infusion, neuro muscular blocking agents (NMBA), Depolarizing agents for AcH & non de-Polarizing agents. When to use & what use on specific case by case bases. It is not a skill for the new or recent graduate Paramedic. Definitely, not any lower than that. Be safe, Ridryder 911

RSi, if performed correctly, is very smooth. I would not judge by seeing just 1 case. Been performing since the early 80's. Usually, I don't RSI infants.. no teeth, etc. Neonate crews hardly ever. Be safe, Ridryder 911

Yep... Entim., Sux's, Fentyl, Versed, Pavulon, Diprovan Gtt. Pre- Med . Lido for ICP, Atropine for kid's Be safe, Ridryder 911

I would hope that an advanced airway techniques would take more than a 3 hour class. Yes, a monkey could intubate, & probably drive an ambulance, perform cardiac arterial by-pass graft if trained properly. That is not the POINT ! Knowing the indications, risks, the mechanism, anatomy of upper airway is essential. Maybe this why 8-10% of intubations techniques is difficult*. 75% of "Adversary Respiratory Events"* are caused by inadequate ventilation's, esophageal intubations, & difficult tracheal intubations. Was these students taught the Coumack grades ? or Malamati Tongue class ? Or how about thyo-mental distance ? I suppose it is the old "see the chords ?" stick the tube in it; routine. Monkey see...monkey do..ee.eee;Hey while your at it; throw the medic a banana. It is because of this "training" not educating EMT's; we have lot anesthesiology rotations rounds lost. Intubating live patients in O.R. has become a prime clinical spot, among EMS educators. Intubating someone who's oropharynx looks like a garbage disposal in reverse is not the time to learn You should have mastered the knowledge of airway control & the clinical expertise before field practice. Do you really want someone to intubate your child or love-one's with a couple hours of lecture & practice on a mannequin ? I find this interesting since some of the recommendations of the "the national scope of practice model" has emphasized not even letting basics ventilate through intubated patients, as much as advanced airway techniques ? We will see.. till then, I hope we will strive maintain & up-grade our level of education for all levels. Be safe, Ridryder 911 _________________ RN CCRN, CEN, CCEMT/P, NREMT/P & all the other vowels.

It depends.. if the off duty EMT seems reasonable, I will listen, & continue to ask the patient questions as well. I will use their help, if needed & seems to be helpful. However; if they are apparently lacking in knowledge or like the above scenarios, I inform them ,we have it under control. Like Richmondmedik, I ask them 3x's; after that there outta there. There is a Lot of wanna-a-be's. Ones who only run a couple calls a year & gets excited about anything. On the other side I have stopped off-duty & became disgruntled. This is one of the reasons I don't stop off duty. Sometimes I find on-coming crews that are responding not very well trained or educated. All I do is offer my assistance & bite my tongue. After several years of this, all I got was a sore tongue, & ulcers. I have since ceased stopping off-duty, & notify 9-1-1. Be safe, Ridryder 911

We have a peer review for TQI program. This is for following protocols & standards, medical charting & skill percentage review. Day to day activities is monitored by management & filed performance by field supervisors. Be safe, Ridryder 911

I too was influenced by Johnny & Roy. I was fortunate enough to be a Paramedic while it was still on the air. Yes, I remember having bi-carb cap challenges... ( if you don't understand, you are too young to remember) . The show did open the door of EMS as we have today. I am sure they were not aware of it at that time, but consultants such as Jim Page was a visionary of EMS. Other shows such as 240- Robert. which was based the cavalier knights ( Sheriff/Paramedic/Rescue was popular as well. Then of the cavalcade of drama series. Rescue 911 was not always appreciated by the EMS community. It was considered to "cheesy". I appeared on the show once for a call we ran on. Of-course the citizen got the credit for "saving" the persons life. I remember the producers wanted us to "run" to our rig. We refused, stating we never run.. man were they pissed. Reality t.v. shows has at least shown some of the realistic effects of our profession. Although, public & future EMS perspectives, do not understand that it takes weeks to film to get the "right calls". Now I wonder since the cancellation of 3'rd watch, what the new show will be ?

As I have posted before, I have worked a code in a real tepee.. during a funeral (from a previous code that did not do so well) & yes they had the deceased on the alter. Worked several calls in houses of repute. Funny how all their names was John...hmmmm? Code in a Rodeo Arena with Bull still very pissed off at every body. Worked a double shooting at "Elmwoods Do-it-to-Death-Cafe".. yes, that was the real name of the knife & gun club bar. At a prominent Christian University in the women's dorm.. the poor thing fell from the bottom bunk bed. The patient & her roomies had just been to Victoria's Secret.. thought I 'll never get the fireman outta-there.. Those are some of the top of my head Be safe, Ridryder 911

Check out Defrance web site. Site usually has the current research on Polyheme. Like to know how it is going, & if favorable to buy stock yet.... Be safe, Ridryder 911

I tried a new approach to help EMT student to learn to focus their attention & learn to deal with stress. I would give a pop test, before each class. Music was played during the test.... & the test was timed; starting at 60 seconds. Each week the music changed progressive from soothing classical to hard rock & the time got shorter & volume increased each time. The final was a tape of an EMS call with the sirens etc.. & the radio chattering in the background. The last test question was "What was the physician order on the tape"? I was surprised on many students claimed that this helped them on clinicals, filtering out extra noise & focusing on things. Just a thought.. no this score did not change students outcome. Be safe, Ridryder 911

If used as a flag, not a yoo-hoo redneck, or used a curtain, car tag, belt buckle etc... Be safe, Ridryder 911

shorthairedpunk wrote: We were the pilot system for first responder AED Maybe for your state, but nationally... sorry! Prehospital trials began in Brighton, England, in 1980 using the Heart Aid. The device weighed 28 pounds and used an oral/epigastric and a precordial electrode to record ECG tracings and deliver electrical shocks. It was also capable of transcutaneously pacing the heart. In 1982, the US Food and Drug Administration (FDA) gave approval for EMT-defibrillation (EMT-D) clinical trials. Early US investigations of manual EMT-D were carried out in Washington, Iowa, Minnesota, and Tennessee. Cummins RO, White RD, Pepe PE: Ventricular fibrillation, automatic external defibrillators, and the United States Food and Drug Administration: confrontation without comprehension. Ann Emerg Med 1995 Nov; 26(5): 621-31; discussion Sorry, for those who were around & actually helped perform those studies. Respectfully, Ridryder 911

Approximately a little over 50 %, which is more than I could say with EMT's over-all. Either they are too ignorant in emergency medicine, or to stupid to realize that they are not truly don't know it. There is a difference in ignorance & stupidity. Stupidity is not wanting to grow in education or thinking you have already learned it all. Ignorance is just not knowing, which is o.k. if you recognize & change it. Be safe, Ridryder 911

My medical director has it even published in our protocol book (over 200 pages) that "Protocols are guidelines ONLY" It is upon the desecration of the EMT or Paramedic to utilize and make decisions upon clinical knowledge. She would fry us if "we stuck to the protocols" on every call. As from her mouth "I don't want cook-book medics".. She expects us to be clinicians. Be safe, Ridryder 911

I like the original, but the best is not listed.. NCIS. Be safe, Ridryder 911