Ridryder 911

Actually lowering your TV for potential ARDS and using Airway Pressure Release Ventilation has been out a while and does seem to be very promising. Many Paramedics in general over estimate their patients tidal volume bsed upon patients wieght rather than "ideal weight" and try to use the old ml/kg rule which is usually too much. Thanks for the up-date guys.. we carry vents on each truck and routinely use them about every day, I wil post updates for training.. R/R 911

I agree, there is a lot of turnover Noahmedic, but I see that in a any EMS. I am not totally against PUM. Actually, it leads to some creditability. Since it is not fire, or county-3'rd party, there is not the sense of being declared public servants attitude. I am not sure how Tulsa area feels but that's was were EMSA was originated and combined the 2 agencies (OKC & Tulsa) together. Which was really a pretty impressive endeavor for 2 large cities to do approximately >100 miles apart. Yes, it has its problems, but which EMS does not. The main thing I have seen, is there is no continuous whining or fighting in competition in EMS ... there is only one, no turf wars, one consistent medical control and administration. The local medial authority receives input every quarter from the medical society chapters, and ACEP, etc. for protocol review etc. labor they have a union (although not powerful) there are several medics that have been with the company since incorporation or greater than 10 yrs. So Dust, I have to disagree OKC & Tulsa appears to be pretty successful... yes, it has had problems like every EMS & although I am NOT a big EMSA fan, it has been running for over 15 years. Which in EMS years is a long time . Every so often there always the old rumor the "Fire Department take-over"... but, most of us in EMS knows that F.D. does not want to get up at night for granny calls, nursing home & B.S. calls. Even Tulsa has cut back the number required Paramedics on the F.D., and is perofoming a pilot study testing a new EMT /I level developed for them to allow Intermediates to give limited med.'s in lieu of Paramedics. From what I have heard, they have NO desire of having Paramedics, just the ability to state that they are "ALS" as described in their union contract. I have never worked for AMR, and everything I have heard has been opposite from each other. Either you love it or you hate it. I guess it like any other service all dependent on location, local management on implementing and adapting and maybe what the prior EMS was in comparison. From what I have seen although, is the downsize of services they have proposed at one time. The great and mighty conquer appears to be more puffing and coughing than steaming through.. this is like any health care agency.. (anyone remember Columbia HHC?) . Time has a way of taking care of things... Be safe, R/R 911

I am trying to establish a quality management airway program in our service. I have approval from the Chief anesthesiologist, but the EMS is not directly related to the hospital, so working out administrative and malpractice insurance etc.. is giving me grief as well. I know that AHA has a recommended number set, or to use a BIAD. I am afraid more will go towards this in lieu of maintaining airway skills. In all defense, I am not aware of any physician competency to do the same... non-excusable on our part, but the same should be true on all accountability. R/R 911

Yeah, the guys in surgery are a a "bunch of cut-ups"... R/R 911

Good discussion guys.. I hate to say, I right off hand don't know what LEMON stands for.. :oops: .. but yet again, ii might have been taught but I have never been the type to try to remember acronyms. ... ( I still have trouble with SOAP...lol) From what I read this is a newer study, that is what my concern was. Second, my medical director also brought up the number thing... which must be the buzz word in ACEP and EMSP meetings these days. She never really pays much attention otherwise. So I know if she is NOW concern, there must have been a lot of talk & more discussion lately. Even if the studies are not as represented, we still need to keep abreast of things, and at least make clarifications. We still need to become professional enough, to manage ourselves by enforcing a good thorough QI program. This as some have discussed should have skill retention and review as well. Again, this is OUR profession ans we should be responsible enough to police ourselves and correct our faults. Professionally, R/R 911

Actually AMR was never in Tulsa or OKC. EMSA is a trust EMS (Emergency Medical Services Authority) and was operated by Seiko management group before the current management. R/R 911

Very true, the problem is the "knee-jerk" reflex that can occur nationwide over things like this. Obviously there is a problem, and since it is OUR problem, WE need to CORRECT IT. Otherwise someone else will & we may not like their corrections. Yet again, I can see some of the problem by looking at lack of responses even on this question. Unless it has something to do with lights, gorry details, or sexual humor.. most medics are not interested. I am just curious on clinical education and QI processes, at least a start of an informal dialog. R/R 911

First you need to learn about CHF vs. Asthma.. etc. There are many good posts on this forum on both. Asthma is an obstructive disease, where as CHF is an overload from poor pump syndrome. Yes, may represent with "wheezes" but the etiology and treatment are not the same. Some studies has shown that administering Albuterol, may actually increase ischemia in CHF patients with Beta [sub:43a7e5dfa7]2[/sub:43a7e5dfa7] properties. Again, since the disease process, is separate ... separate tx.'s Now there is many patients that might have both or better yet have "cardiac asthma which is a totally different disease. The main point to remember is history, a good thorough assessment as well as using tools such EtCo2 Capnography which will immediate tell if you if they are having obstruction (shark fin waves) versus pulmonary without obstruction & monitor their oxygenation as well with Sp02. I highly suggest you review each pathophysiology of obstruction airway versus oxygenation perfusion diseases. The rationale for treatment, medications that are utilized will make better sense. Again, these disease are NOT the same and should not be addressed the same way. Look in the search on this forum, you will find many topics r/t this subject and other web site searches as well. Good luck, R/R 911

The link is the post. I am not sure all the details. What I am concerned the most is, I have seen more & more medic students that no longer have intubation clinicals. In fact it is now more the unusual to have them than not to. I am wondering is this the cause or other contributing factors, that need to be explored. I have rumors of the concerns of the Paramedic effectiveness in intubations and should this even still be considered for Paramedics. This also comes to mind with the new AHA 2005, recommendations of alternative airway, and airway interventions are now placed down the line of protocols. I hope we can do some research to correct this and prevent further detrimental discussions. Again, this study & other s are really being observed in the medical community. Something we need to correct and correct it soon. But, we need to find out why it is occurring. R/R 911

Altered level of consciousness, can occur from several reasons. Yes, trauma is one of the major causes. Medically, any changes in cerebral blood flow.. CVA, inner cranial head bleeds, diabetes (hyper/hypoglycemia), electrolyte imbalances, poor oxygenation (hypoxia), as well as poor cardiac functions, and even senility. Other conditions such as drug and substance abuse ( which medical problems can be combined with this, can occur as well). I have as yet read any journal or text that describes using "diesel" on any treatment or patient. Expedite and not delay, but giving the impression that "high tailing" to the hospital .. so many get the impression and actually "speed' back to the hospital is wrong. Again, it has been proven you are going to save only about 3-4 minutes total. Providing an ensure appropriate airway (positioning, possible NP or OP) airway, and oxygenation, caution on oxygenation lots of head injury patients have "projectile vomiting".. so cannula may want be utilized as well. R/R 911

I agree.. nothing worse than to have a cardiac arrest in a hospital. Actually, studies have shown you they also have a lower survival rate. We had a code in ICU the other night & I took one of medic partner with me, he had never seen a code in a hospital before... after seeing the nurse recommend uhh... maybe some epi or lido or let's do something for God's sake... to the Dr. standing there with his thumb in his sphincter.. he was surprised on how unorganized it was. .. I laughed, & I told him.. this was more organized than normal.... Yeah, I rather work a code in the field any day rather than in hospitals.. the old saying 'too many chefs'.." come into mind. R/R 911

Wow !.. all over a loose wire(s) on a monitor and defib, that would not change outcomes.... geez... someone reported it ..get it fixed. Reprimand someone because they reported a broken object.. wow, I am sure from now on things will be reported.. don't be foolish and punish people for minor and routine equipment problems... I worked at a hospital that actually hand out kudos for people that recognize damaged products. Let's not be foolish... If there is punishment .. which there should not be, it should be on the parties of not reporting in a timely manner. Get it fixed and everyone grow up.. there are a lot of worse things to worry about. This is one of things of micro-management problems of EMS. We get so worried about B.S. items that we loose sight or don't even pay attention with major problems like staffing, patient care, etc... These are daily routine things..if management has that much problems over minor crap they need to grow up and go on ! R/R 911

Again, the debate may not be "eliminating volunteers"...but; change the roles of the volunteers. Use them as the first responders to stabilize or initiate care. R/R 911

I thought this was "old news".. we have studied this stuff to death, since the 80's. I hope someday we will see them mounted and be requireed like each fire extiguisher unit. It doesn't tale a rocket scientist to use one. R/R 911

Resuscitation in hospital settings is quite different than you were probably taught. First there are usually several members that will be assisting, respiratory therapy, nurses, etc... You will notice, it will not be "text book" pausing for ventilation, usually more relaxed, and maybe short in time period <15 minutes in length.. Again, all dependent on the staffing, and circumstances. Sounds like your job, is to assist, to perform compressions and probably be a "gofer".. so I would suggest learning were equipment is. Good luck, R/R 911

This is where I am getting at as well. I would like to see what type of programs have in place for the "intubation phase". I know of very many that do not have a clinical phase requiring intubations, as well of those with CQI in place or not in place. Please, let's not bash those reporting. We as (professionals) need to be aware of what is going on and actually start evaluating what is the etiology, source of the problems. We need to correct the problems for the impact of patient care and for professional purposes. I know many EMS physicians take ACEP studies seriously, and I would hate to think that our scope may change because we did not correct this. R/R 911

Okay we have been fighting the slander and criticism of missed tubes in the field for sometime. But, now newer studies are showing even more screw- ups ... WTF is going on ! ? .... Here is a link from our luxurious Dr. Bledsoe on new reports : http://www.merginet.com/index.cfm?pg=airway&fn=ETprobs Here is a portion : Of the 1,953 ETIs performed over an 18-month period, ETI errors occurred in 444 patients (22.7 percent). Of these, 61 patients (3.1 percent) had tube misplacement or dislodgement, 62 (3.2 percent) had multiple attempts and 359 (18.5 percent) had failed ET placement. The ETI error rate per service ranged from 0 percent to 40 percent. ETI error rates were more likely in children < 6 years of age, trauma patients and non-cardiac arrest patients. Interestingly, the adjusted odds of ETI were higher for busier services (>5,000 contacts per year) and for slow services (<50 contacts per year). No other system characteristics were associated with ETI errors 22.7 percent !.. How much error should be allowed ?...0 %.. With better intubation equipment, Capnometric indicators, EtCo2 monitoring which shows exactly you are in or not .... WHY IS THIS OCCURRING !? As a profession we need to evaluate why our treatment modality is dropping down especially in the last 10 years? Is it poor skill level? Lack of training?.. yes, you should had O.R. intubation experience, where you intubated several patients prior to EMS intubations Poor CQI.. and maintenance level.. and continuation skills Are we getting half arse medics ?.. who don't know what they are doing ? Your 2 cents worth? R/R 911

Came across an interesting article on Heart Failure and poor ejection. Good reading for those in EMT & Paramedic school. Found it interesting the author does not recommend Digoxin/Lanoxin in women.. Actually this was in a non-emergency mag... http://www.geri.com/geriatrics/data/articl...339/article.pdf R/R 911

I found an interesting article relating to EMS diversions and current trends of EMS and ER numbers. Sorry, I can't post whole article due to copyright, and the link is also a paid site. I will quote portion's, I thought was interesting facts: Annals of Emergency Medicine: Volume 4, Issue 17; April 2006, Pages 317-326 "Study objective We describe emergency department (ED) visits in which the patient arrived by ambulance and estimate the frequency of and reasons for ambulance diversion. Using information on volume of transports and probabilities of being in diversion status, we estimate the number of patients for whom ED care was delayed because of diversion practices" How it was performed: Data was from the 2003 ED component of the National Hospital Ambulatory Medical Care Survey, an annual sample survey of visits to US hospital EDs, were used for the analysis. Data were provided by 405 participating EDs on 40,253 visits. Data from supplemental questionnaires to the hospital staff were used to describe volume and frequency of ambulance diversions. Results In 2003, patients arrived by ambulance for 16.2 million ED visits (14.2%). About 31 ambulances arrived at a US ED every minute. Of ambulance-related visits, 39% were made by seniors, 68% were triaged as emergent or urgent, and 37% resulted in hospital-admission. About 45% of EDs reported diverting ambulances at some point during the previous year. Among EDs that had any diversion, approximately 3% of operating time was spent in diversion status. In 2003, an estimated 501,000 ambulances were diverted, ie, 1 ambulance diversion per minute. Large EDs represent 12% of all EDs, 35% of all ambulance arrivals, 18% of all EDs that went on diversion, 47% of all hours spent in diversion status, and 70% of all ambulances diverted to another ED Conclusion : was the need of importance of study for next 15 years. " I thought this was interesting in the fact the number of EMS responses to ER's. The triage was placed in high categories "68% were triaged as emergent or urgent" in comparison of only "37% being admitted". Is this due to treatment alleviating the existing emergency s/p or is it over triage syndrome from field and ER staff ? I am surprised that approx 1/2 million EMS units were diverted to an ER and apparently no-one is really taking notice of this yet. By the response of the conclusion was to continuing studying, and working to decrease this in the future. That's it ?... Nice identify a problem, without any more suggestions than that... ? It appears to me ACEP might be like the old saying.. see no evil, hear no evil, tell no evil...At least on their side they are recognizing it.. now doing something about it is another problem. Open the discussion up, is this a major problem in your area, how does your system deal with this, and what do you see or predict in the future and remedies? R/R 911

A couple things point out... In Flight Nurses Association ...Will there be medics ? The other drunks with chest pains....and how many nausea and vomiting ..... and anyone remember the psycho the Fed Marshall's has to take out ? R/R 911

Happy BD ! R/R 911

Good luck, keep your eyes and ears open.... R/R 911

Check this site out. In it should be listed some upcoming classes in your area, if not contact course coordinator in your area to see upcoming events and classes. http://www.naemt.org/PHTLS/ Good luck in continuing your education. R/R 911

I have worked at both. I personally favor FD performs this tasks. I still come from the mind set a charged line should be available as well as staging, shoring, stabilizing, etc.. which most EMS does not have the time or personal. This allows EMS to perform more patient care as well. R/R 911

So true Medik8.. We have some females on my crew. Both are very opposites. One is truly female..but she is "one of the guys" and performs outstandingly well as a medic performing all her duties (she evens volunteers as a Firefighter on her days off) .. she is definitely not manly built, but can lift a well as others. The other female, uses her height and frame as issue more than the female gender, but does try to pawn off her size is due to her gender. Everyone is tired of her not pulling her fair share etc.... Over the course of several years, I have seen many as was described. I have seen many play games , it might be cute at first for some... buy, after a while..... it wears off and then resentment sets in. So those that are considering such behavior, I highly discourage it, if you want a career. This goes from clinical phase to being employed. The same goes for the "macho" type male, that has ego and being vain.... it wears out thin as well. Be safe, R/R 911