Eyegor

Hey, Ugly. Thanks for letting everyone know about your latest undertaking. I've been thinking about DMT for years, even before I started diving myself. Glad you are able to make it happen. Be sure to keep the forum updated with your progress. Should be interesting.

I have a different issue. Like AK says, 2nd chances aren't necessarily a bad thing. I'm against GA creating a new "restricted" EMT provider level. Both in the states, and nationally, we need fewer levels, not more. What if GA DOC gave them the training and let them work in the infirmary while incarcerated. If that worked out, and depending on their prior conviction, they then MAY be eligible to sit for their GA EMT cert. Jsut a thought.

NY State requires 2 on each truck. In practice, these are normally sealed and stashed away in the bottom of cabinet somewhere to pass inspection. In day-to-day use, pillows are a hot commodity. We try to get them from the ER, and they attempt to get them back. While not the intention, our cots often do not have pillows available.

Going old school and probably oversimplifying but what about the infamous neurogenic shock? The S&S don't really support what little I know of SIRS, but I certainly am not questioning that. I'm more interested in the classic idea of overwhelming insult to CNS causing systemic vasodilation. Not very precise but it does happen. Usually transient over an hour or two.

As an active SAR member my thought process is the administrative route: In my "perfect world" any person in need of SAR resources would be free to call without fear of being personally billed by SAR. EMS transport, medical bills, etc. etc. are fine. If the person's actions are deemed civilly or criminally negligent then fines or charges will be levied through that process. All other costs of SAR would be paid for through private "rescue insurance" user fees, local, county, state, fed, tribal budgets, etc. Most municipalities of whatever size have a pot "usually small" of SAR money that comes from licensing, park fees, fines, % of land management budget etc. All routes of financial support need to be actively sought in order to keep user fees, fines, and insurance affordable. Please don't try to make any deficit up by billing the person.

I think the reason many of folks in EMS don't like the films such as Bringing Out the Dead or MJ&S is that they are closer to the truth than many like to admit. Me, I see the entertainment, the irony, and the nuggets of truth that holds the rest of it together.

I am a big fan of the SKED and have used it several times for SAR type evacuations. Always in a horizontal and/or carry mode. I have not used it in a vertical or lifting environment. I recently received instruction that emphatically stated that an OSS, KED or other vest-type short board must be used whenever you are using the SKED, irregardless of the MOI. Based on my experience I don't agree and am looking for other opinions. Thanks.

Chbare, I have read most of the same studies you sight and can't fault the science. But in the realm of outcome based medicine, you have to look at outcomes. MAST works. I've seen it. I have also seen perfusing and awake patients die in the ER when the MAST is rapidly removed. We all know that is a no-no but.....that's not what we're discussing here. Now for the flip side of the coin. Have BLS providers ever killed or caused permanent deficit in anybody who otherwise would have survived by using MAST? I don't know the answer and I don't think anyone else does either. MAST obviously should not be a 1st line or stand alone treatment. I'm even OK with states removing them from the mandatory equipment lists based on their inconclusive results and infrequency of use. But when studies keep having conclusions with the words may or might or inconclusive then IMHO MAST deserves more than a shelf in the museum. Thank you for the debate and exchange of information. I hope everyone else finds it as interesting and/or helpful as I.

Fair question, and don't worry I have thick skin. In NYS at the BLS level there is no options for fluid resuscitation. Therefore when significant blood loss is noted or suspected the only option is to maintain what the patient still has on board. Therapeutic hypotension is one thing, exsanguination is quite another. My goals in this instance is to keep the brain, and vital organs in the chest cavity perfused. I want every trick available. Trandelenburg, direct pressure, MAST, tourniquets, etc., etc. One more tool in the tool box. Another mild side track. It was once common practice to apply MAST (but not inflate) to any trauma patient who you feared may decompensate. Then if your ongoing assessment showed a patient deteriorating you could rapidly inflate. If the garment is already on the patient this can be accomplished very rapidly. Of course, you had to watch for negative outcomes such as PE, or increased bleeding of injuies superior to the garment. We even understood the concept of "tritating" the MAST. If it was decided to use for fx management, then only the compartments necessary would be inflated and then never ever to the point where distal perfusion was profoundly effected. All of this took place in an environment where paramedics were only seen in "the city" and there was this mythical chariot called a helicopter but even that was at least 45 minutes away if available. MAST will probably never again be used at the level it once was, but that doesn't mean it is no longer useful at all.

New York still has them but the protocols call for their use only for profound hypotension with pelvic instability. I may be old school but I think they still have their place in rural BLS services. And I believe they have other uses besides the written protocol. YMMV. P.S. I used to use them a fair amount but haven't in years. Mostly because the areas I now serve usually have readily available ALS.

There are some key components of this story missing. The hospital did this after obtaining a court order. I believe the court would ensure that the patient's guardian was well informed of the proceedings. Furthermore, I don't see how the patient's immigration status has anything to do with the case at all. A foreign national received a debilitating injury while abroad. After 3 years of therapy and care, the medical provider consults with diplomatic officials and is assured that medical care is available for their patient in his country of residence. After this patient's appointed guardian fails to show ability to care for subject (didn't pay the bills or make other arrangements) the patient is repatriated to his family in his home country at no charge. Of course I don't have all the answers. We don't even have all the facts yet. That being said, what is clear is that this acute care facility is not responsible for long term and custodial care of its patients.

Somewhat OT but a good story. Many years ago I bringing in a patient who was presenting with classic "cardiogenic shock" As a relatively new Basic with no medics available we were high-tailing it to the ER while I was trying to keep this guy alive. Literally as we are backing into the ER the guy codes. In our haste to get our patient out of the truck and into more definitive care, we drop the stretcher. To our immense relief (and amazement) this shock caused the patient to ROSC. And yes, he was definitely pulseless and apneic before hand. Not exactly what they meant when the dinosaurs use to tell us to "thump-em" but it worked.

My $.02: 1) All bleeding will eventually stop 2) All patients will eventually die 3) Cardiac Arrest = Stable Pt.

I have not used either the Power-Pro or the Ferno so my views may be skewed. Our neighboring agency has the Stryker and had to call a 2nd unit during a CPR in progress call because the batteries went dead and no one on scene could manually move the stretcher with the patient on it. Plus the stretchers are heavier all the time, even when you don't need the power assist. I have been against them from the beginning and this simply re-enforced my opinion. EMS personnel need to be able to lift. If you have any situation (including large pts.) where you need additional manpower or equipment, call for it and call early. IMO powered cots have a place on bariatric or other specialized units but for your every day rig it is just one more thing to go wrong when Murphy comes calling. Most public safety jobs have some sort of physical requirements to perform the job. EMS is no different. You have to be able to lift, and smart enough to a) know your limitations and understand body mechanics and lift correctly.

If your agency is allowing people on your truck that you feel are not qualified, you may not be able to put a halt to the practice. What you can do is take responsibility for your crew. Get them up to speed so they are not a danger to you or anyone else and eventually so they are actually helpful. If your team can't support you, make sure they can or find yourself a new team.

I have been attacked by drunks, spousal abusers, etc. but the worst battle I've encountered on duty was a rugby player suffering from heat stroke who due to his decreased LOC decided that I was sleeping with his girlfriend. Alone in the back, BLS, RLS response to the hospital (closest place I was going to find help). As we are backing into the bay, pt. loses consciousness. I walk into the ER, shirt ripped, bleeding, drenched in sweat. I get the normal "What the F--- happened to you?" I just point at the unconscious pt. and shrug.

I'll 2nd the vacuum mattress. I'll add vacuum splints, SAM splints, blanket rolls, and head blocks. Of course don't forget that if the helmet comes off, the chest armor does too. One last trick that will make almost everyone cringe: We had a MXer c/o severe shoulder/neck pain who was adamantly refusing a C-collar. No deformity, pulses and neuros normal all around. We also found he refused to lay supine due to pain/pressure it placed on the scapular area of his back. We wound securing him into a KED (no collar) with the head straps replaced by cravats. We transported him sitting up to maintain in-line as much as possible and to minimize pain. We got some strange looks at the ER but upon explanation the doc agreed.

The constant comparison to nursing is ironic. This same battle was fought several years ago in hospitals and skilled nursing facilities all over the US. Administrators started hiring fewer RNs and more allied health people, (LPNs, CNAs, etc.) Why? The bottom line was money. Who won? The bean counters. Why? Because health care is a business. Did the quality of pt. care decrease? Yes, in some areas. Not in others. The techs and assistants loved the opportunity and rose to the challenge. Now the same question is being raised in EMS. While I feel that the goal should be to have every ambulance an ALS ambulance and to have Paramedic become a degreed, licensed professional; I disagree that EMTs don't have a place on the road. Basic/Medic crews provide IMVHO the best bang for the buck.

Since I am not up on MI DOH laws I can only give you a general picture. In rural upstate NY we have many 100% volunteer ALS agencies. The problem starts with that many of these agencies only have a small handful of ALS providers. This leads to the medics either getting burned out or vast gaps in coverage, usually both. Now many of our counties do priority dispatching but.... until a crew is assembled they never know if they are getting ALS or BLS. If the vollies can only muster a BLS crew and now must request ALS from a commerical provider you've lost valuable minutes when a intercept may take 20-30 minutes and the tones dropped 10 minutes ago. I guess what I'm trying to say is that 3 medics does not an ALS agency make. Its not fair to your medics, your patients, or your dispatchers. Your goals are admirable. Keep working the problem.

It depends greatly on what your needs are. Do you want the best product? The cheapest? Whatever will pass inspection? Hare: IMVHO this provides the best traction and is the most comfortable for the patient. My personal choice. Harder to use and set up than some others Sager: Much easier to apply. If I get trax splint duiring a skills station I will pick the Sager. Although perfectly adequate, I don't think it does as good a job as the Hare. My$.02 KTD: Never took it seriously. If I needed something to carry in a pack until help arrived, it should be fine. Likewise, if the DOH recognizes it and I'm running a private transport service with Type IIs, I would be very tempted. Otherwise, not my cup of tea. PS: In 17 years I've used a traction splint 3 times. 1st time all we had was a Hare. Last 2 I had both Sager and Hare available and went Hare both times.

Not to steal any thunder from Rain but does anyone remember a group called the Dysrythymics who released a whole album of EMS material. "Running Red", "Intubation", and "91-1". Good Stuff. Wish I still had it.

Here in NY, quite a few of the EMT-B instructors emphasize that while yes, a BP needs to be taken, it is the least important of the VS. In fact, when us old farts are recerting, they always make a note of saying something when the first thing we reach for after the primary assessment is the cuff. Now they want to see pulse, resps, even skin temp and condition prior to BP. I haven't quite been convinced of this new way of looking at VS, but I definitely agree that without other findings it has very little value.

This question pertains to documentation requirements but let me paint the picture. We are a volunteer EMS agency with career ALS fly car. Upon dispatch fly car responds immediately, volunteers respond to squad building to pick up ambulance(s), rescue truck, etc. New York State requires call sheets (PCRs) for each responding unit. This means almost every patient will have the medic's PCR and the ambulance crew PCR. The argument arises when the pt. is ALS. Many of our ambulance crews feel they can have a PCR with almost no pt. info because "it is on the medic's PCR". I disagree. I have always believed in complete documentation. Obviously the BLS crews' documentation will not state procedures performed by the medic. But 1 line reports of "Care provided by ALS" should not be enough either. What do you guys think?

Well, it looks like I'm going to have to stick up for the stretcher jocks. In a former lifetime I worked ALS for a private that did both interfacility and 911. We were always a 2 man crew and usually a long way from the hospital. The stretcher always came in with us. At least to the door. If we were not in the truck in fifteen minutes then something was seriously wrong. Minimum scene time was our key. One trip to the truck vs. 2 or 3 = saved time. Now days, my agency is a combination career/volunteer agency with career ALS 1st response. As a volunteer on the ambulance, the medic has almost always preceeded me to the scene and began his/her work up. Again, we take the stretcher with us (when appropiate) because we have a much better idea of what the scene entails. BTW: When I am on the ambulance, once we get on scene my driver has two primary jobs. 1st. Position the ambulance in the best location. Driveway, roadway, whatever works best. 2nd: Plan a route to remove the patient from the location. Does furniture need to be moved? Is there a back door with easier access? etc. When this topic started I flashed back Larry Hagman and the stretcher on the stairs from M,J and S. 8)

"Non-ambulance" jobs I have held as an EMT-B. Day Camp EMT, Summer Camp EMT, Alcohol Crisis Center EMT. There are others out there. Obviously, the more education and experience you can offer the better your chances.