BEorP

To review the patients and how they would be triaged under the START system: - 16 year old female in cardiac arrest: she is dead and never coming back (Black/Blue) - eight people on the mini-bus: minor bumps and bruises, all can walk (Green) - 40 year old female with "BP 80 systolic and falling rapidly": even if she has radials right now she won't for long with that BP (Red) So after our triaging we have nine patients who require treatment and only one who appears to have serious injuries. The Greens can be watched and treated by the EMT-B and First Responder from the "rescue tender." Hopefully now that makes is clear why it would not be in the best interests of the patient to waste time on scene.

What service was this?

I wouldn't ague that there could be more prehospital research, but there is definitely some good research being done. A great example would be the Resuscitation Outcomes Consortium studies being done at a variety of sites in North America.

Wanting to help people is wonderful but it does not put food on the table.

There is no College of Paramedics in Ontario.

I'd say it's a pretty safe bet that jobs will be difficult to get again this year. There were the same rumors about Centralized last year and it still went ahead (although I believe Simcoe did not participate). If you're only willing to work in the GTA then study hard, spend lots of time in lab, and start meeting people in high places.

Two radios? Do you have a light bar on your back? :wink: Thanks for the pics again!

I understand the comments about liability, but can someone please explain why an EMT would need medical direction to do a little standby first aid gig. If we are talking about an EMT-B, truly providing only BLS care, then what is the physician needed for?

I don't mean to beat a dead horse since my reply will echo the rest of the replies, but I just wanted to point out how a little bit of knowledge can be a bad thing. When going from being a First Responder to completing the Primary Care Paramedic program, I have seen that things that first responders consider extremely important (let's say for example that in an unconscious patient you must check the carotid pulse on the side closest to you or you will stop them from breathing) that are not true. If someone is doing something that might be detrimental to the patient and you are knowledgeable enough to tactfully question it then I fully support you. We have established that you could have done so more tactfully. The other issue though is you can't even tell us what was going on with the patient other than that they were unconscious and had a "upper airway occlusion." If you are going to question something, make sure you know what is going on with the call.

The Ontario A-EMCA also has no expiration date, but it seems as though they only included active Paramedics in the numbers for Ontario in this survey. (Maybe I missed it somewhere and they explicitly stated that they were only counting active for Ontario but were counting all certified for PA.)

"Do Not Resuscitate" generally does not mean "Do Not Treat."

Well that "just you" wanting to "forcus" on the entrapped patient would not be following the rules of triage. In addition, they are dead from trauma anyway so the chance of them coming back is very close to zero even if they were the only patient and got full ACLS and weren't trapped.

Dust makes a good point here, but one thing that I found from my experience is that when I first started in the field as a student I was using my notepad as a "poor man's field guide" and would have "OPQRST" or other small prompts written down on it. As I did more calls though it became much easier to remember the details and I found that I would just write down things that stood out.

Nope, different people. Try clicking here.

Wow, we sure attract EMS's finest to the forum. Anyway, I just use cheap notepade bought in a pack of five that fits in my shirt pocket. I really don't think it is worth spending the money on something that is pre-made. It is way too easy to end up losing a notepad. What I would recommend is just a blank notepad and then if say you're going to a chest pain call, maybe scribble down "OPQRST" on the way which can help guide your questioning. It may be difficult to have one form that works all the time. I don't think you want to be spending much time on OPQRST when the Q is "like I got plowed down by a truck" and the O is "when I got hit by the truck."

Great thread. I had an instructor who had been off the road for a while but had many years of experience. They definitely still have a lot to teach because they at least have real life experience that students don't. The basics do not seem to change significantly so I think that an instructor like this is just fine for teaching the basics of assessment, lifting, etc. The problem comes (and this problem did come up for me) when an instructor who has not kept up to date is in a position to teach something that changes from time to time (neonatal resus for us) and is not up to date. This was extremely frustrating for me and was disappointed to see from a paramedic program with a good reputation overall. So to answer the questions: - I think there is some validity to it, but it all depends on if the instructor keeps up to date. - A classroom instructor should definitely be up to date with current guidelines, but a lot of what will be taught in class will be book stuff anyway (referring specifically to the quoted comments). It seems like the poster of the quoted comments does not understand the importance of education and seems to just want to go play on the ambulance. If there is some operational aspect of how things work in the field with the ambulance services in the area of the school that the instructor does not know I would not fault them for that though. That is the type of thing that can be left for a preceptorship.

I hope ALS did not actually expect you to wait on scene for 30 minutes for them, that is just crazy. You did the right thing and recognized the importance of time for this patient.

If we are treating this as a significant traumatic event (as I think we are) then maybe the Paramedic's point was that you wasted critical time. If we are looking at the "platinum 10 minutes" and the transporting vehicle taking 8-10 minutes to get there, that time is all but up upon their arrival. From your points... 1. It's going to hurt no matter what. I don't see this as being a reason not to move her. I do not know what the ambulance service or your fire medic can do for pain and maybe this would change my answer though. Even with pain meds though, it's going to hurt. 2. As was mentioned previously, it can get pretty hot in a car. Also see #3. 3. I have no idea where this happened, but unless it was the middle of a highway there must be some other place to put her. Even if there isn't, try other options as have been pointed out. Was the medic lazy? Maybe. But does that mean that you did the best possible thing for your patient? Not necessarily.

If I can assume that all of the people on the bus can walk then they would initially be triaged as green under START and dead girl is black/blue. This leaves the 40 year old female who would be be red if she had no radials (as she won't for long if her BP is 80 systolic and dropping). Seeing as you have the "rescue tender" that has some medical personnel on it who can worry about the greens then it would seem to be appropriate to transport immediately.

1. In regards to the part I bolded, it seems as though you are downplaying hearing difficulties that you have that others don't because otherwise you wouldn't even need to mention any. So I will answer your rhetorical question with "no, that does not apply to everyone." 2. Don't trust just one person you know who transfered their cert to mean that you can. Have you contacted the appropriate authorities in Ireland to see if they will recognize it? 3. Even if they do, if you have any type of medical problem (including hearing issues) is there no physical that you would need to pass in Ireland? An EMT-B is just a certification, from the time that anyone gets that they could easily become medically unable to do their job. An EMT-B certification is not a medical clearance. 4. Do you have any trouble when listening to breath sounds? 5. Google came up with this: http://www.caems-academy.com/emtb.htm

I think there is a whacker test somewhere online that is similar to that. What I was thinking of is actually a rating for the individual states.

Hmmm I like the sounds of the whacker scale. Maybe we can come up with the top 10 whacker criteria where each state receives a score from 0-1 in each category for a total score out of 10.

I know this is somewhat random (and hope it hasn't been previously discussed) but I am wondering what the best state is in the U.S. for a whacker. Specifically some of the criteria I was thinking of are: - full of low quality EMT-B programs that would never consider going above the 120 hours or whatever the absolute minimum is - not many paid positions, but lots of places to volunteer - along with volunteering, lenient regulations on emergency lights on personal vehicles - a wide variety of T-shirt suppliers for various shirts that tell the world how you save lives Plus any other criteria that you can come up with.

Do you know for sure they have a website? Google came up with this if it helps at all: http://oklahomacity.citysearch.com/profile.../react_ems.html