RaceMedic

Thanks NY I hadn't looked it up before but i know that the ER where i work always mentioned EMTALA violations when small surrounding hospitals would transfer someone in and not call in reports or send a "code Red" in with a BLS crew. Clearly not an appropriate level of care given the condition ... However i will now read and review the law so i know . Race

Thats where i live, about 4hrs SE of your home city. you mentioned CO Springs .. never put two and two together until you asked Krysteen. I drive though on my way to Denver several times a yr. Race

I also don't think your treatment should have been changed think you did a good job. I was wondering if maybe the Dive doc was thinking that since the nitrogen is in the tissue that the hyperbaric pressure treatment will help it push back in to serum and be expelled back out the lungs faster. Realizing that it was not introduced through or in to the blood stream initially, but it is still in the tissue and was introduced under extreme pressure possibly creating the compartment syndrome because the nitrogen is now taking up space? The pressure of the hyperbaric chamber could desolve the nitrogen in to the blood stream and expel it from the body like in the bends. Im thinking of this kind of like when they inflate the abdomen for a lap-chole, there is always some gas left in the cavity following surgery but since that is a hollow space it is not as important that all the gas is eliminated. It has room to be there till it can be absorbed and eliminated through the lungs. Except this is in the hand and wrist where there is not room for the additional gas to take up space. creating the compartment syndrome along with the additional swelling from the initial trauma. Made sense in my head, What do you think ? Race

Yea in the metro area we dropped PTs in the waiting room as "triage appropriate" all the time. As i understand EMTALA, that only has to do with IFT, maintaining level of care from one hospital to another. am i mistaken ? Race

HAHAHAHAHA.... hell and if had been a Medic/RN she could have packed the wreck on her back and jogged home with it dropping it off at the body shop along the way. Just sayin, Race

Hey Dwayne, You ever been through Garden City KS ?

How many people do medics kill everyday ? Thats not helpful to the thread. troll somewhere else...

Well, the way i took this thread at the beginning wasn't was a Medic vs RN.. since having both i will stay out of that argument, besides the fact that it is completely counter productive.We have to work with RN's no matter what we do. Yes there is animosity taught towards each other in the respective classes. Even in the medic to RN bridge programs you can tell ( college based not mail order). There is an undertone. I am trying to belay that as much as i can not matter where i work in my corner of the world. There was a question as to why wouldn't a nurse just become a medic first if the want to work in an ambulance? To that i ask this, If you want to expand the medic field and work in an ER why didn't you become a nurse first? No i am not pointing fingers and saying that the poster that asked that is wanting to work in the ER, I don't know if they do or not. and Happiness posted that they are trying out medics in the ER's there in Canada. well thats been going on for yrs here i know of many hospitals that use Medics in the ER. BUT they still do no have full medic scope. The operate the same as an RN no intubations period, No meds or IV's with out a direct written or verbal order. AND they still make less money than the RN doing the same job, also they report to the RN and are supervised by the RN not the doc. (before someone gets a nipple twisted yes i know there are protocols that are followed in the ER than allow things to be started given specific criteria but it is nothing compared to and ambulance service.). I personally have benefited greatly from becoming an RN/Medic. It has expanded my knowledge base, the way i base my treatment plan, the holistic approach. it has opened so many things. Personally i feel that if they could find a way to blend the two philosophies and practices with out losing the highlights of what makes each special in their own right and turn it in to a Bachelors degree program for initial certification/licensure. That would be incredible, toss in the math, chem, ect .. and make it a PreMed degree... it would satisfy many things we are struggling to achieve as a career. However then there would be the fight over who would be in control ... well enough day dreaming ... Race *edit* Ohh and as far as skills between a nurse and medic, The only things we did not have to check off on in my nursing bridge that we were taught in medic was intubation and surgical airway management. ohh well of course LSB, splinting, that sort of thing as well. But NG, OG, Foley, IV, ... Ect.. all of that was taught to my medic class by the nursing instructors at our college.

I would love to work with a doc on the streets, However your unique ERDoc. I have offered our docs here to come on the truck an ride along ... always get lip service " yea ill come out sometime and show you how its done" yadda yadda blah blah blah... lol They been saying that since i started in 1992. Race

Not to be a pain in the ass and i know politics is HUGE in EMS, but shouldn't this be in Non-EMS discussion? And i do not feel Obama has a chance for a second term. but i was wrong last election too. Race

WM, I would imagine that your nurses there are well trained and have a better understanding of independent practice than ours do here. that is one of the issues we have in the US with our RN programs. We are beaten over the head with "Do nothing with out an order" " if the doctor didnt say it then you dont do it" . Sounds like a great system to get some experience in but i don't mind the non emergent calls. This is where the American system fails terribly. instead of getting pissy with the little old ladies and people that do not know that they could have made it to the Dr. office or hospital on their own. We should be using these calls as a time to educate the patient on what 911 is for. Instead we put on a fake smile hiding the irritation telling them "no no call us anytime" then as we walk back to the unit cussing and making fun of the PT for not knowing. PT education is a huge part of nursing education. I know it is not done a lot even by them but i try every opportunity that i have especially on the ambulance. Again i am rambling and this is probably something for another thread ... Race *edit* Licensure is only a step, that alone wit no command higher education, wages and respect. THe reason why i say this is because many states already have licenses for medics. Texas and Missouri are two of them. The wages are not higher than i make in Kansas as a certified medic. TO get what we all want for medics as far as wages, education, and respect. We need to have a united front. We need to separate completely from the fire service. We need to learn how to stand on our own. As an industry we are much older than the "30yr old" kid that refuses to leave home. We are now entering the 40 something creepy guy in the corner with the horrid comb over, shirt unbuttoned to the navel complete with gold chains trying to pick up on the 21yr old college girls at the local dive bar. We need to go get implants clean up our act, get a new wardrobe and educate ourselves in competent college programs. Sorry 600hr six month medic programs do not cut it. Damn rambling again .... Sorry Race

Just curious, My brother lives in VA Beach and works in Norfolk... He just retired from the Marines

What part of VA you in ?

Thats pretty cool, enjoy your rotations .. i miss class but would never do it again. Solu Medrol is a standard but can take an inordinate amount of time to take effect at times. Does not stop me form giving it though.. also the nebs by BVM is a great thing to remember. However i lost track of what i was thinking early in the thread and was treating CHF/Pulmonary edema instead of COPD... lol Sometimes not as easy to formulate a treatment plan when it isnt literally in front of you.

FireEMT, Great addition to the threat, thanks for including it. your absolutely correct with alternative treatments as well as your thoughts on the intubation. Of course you will have to stay with in your local protocols and if you have all of those at your disposal i want the number to your service... LOL But do not discount your input because you are a student. even those of us with yrs under our belt need reminded of things from time to time... Keep posting and taking part. Race

Matt, this is not a new thing. RN's have been prehospital providers since the beginning. However they have evolved in to what they are now. The nurses of today are not near what they were even 30 yrs ago in many ways. and in some ways they have expanded what they do. With that said i do not forsee RN's taking over EMS and prehospital care due to the low wages and working conditions. They do not need an expanded scope to operate in the field as most states Nurse practice acts addresses this situation. But unless the nurse has an EMS background to start with they will not pike the reality we see all day everyday. Before i earned my RN i was working the streets in a metro area as a medic. I would always encourage the ER nurses to do a ride along with my service. Many did and not a single one made it through 12 hours. They all said the same thing as they left the station, " I dont see how you can do this for 24 hrs" " How do you deal with the BS?" They like the clean protected world of the ER and Hospital. DO not get me wrong, i know there are exceptions to this rule but i do not believe the current nursing establishment is prepared to handle our world, nor do they really want to. Flight and IFT are totally different. they still do not pay as well as working in the hospital but in my experience they do pay better than 911. PT's are generally not as emergent, critical yes possibly but it is not the rule, and are clean as compared to when they come in to ER via EMS. The RN is not geared toward the EMS thought process until the enter in to the ER, then the do get the idea but yet come from a totally different thought process and theoretical background. It is not wrong or misled just a different focus. We as medics and EMT's are taught and geared towards first the next 20 minutes fix and reverse what we can in that time while delivering as viable PT as possible to the awaiting ER doc and nurses. The doc continues our efforts with the assistance of the RN's, The RN is also preparing the plan for the next few hours continuing to days, including rehab, physical therapy, occupational therapy ... ect. I think im off topic a little but again, No i do not believe we are in danger of losing prehospital to the RN's Race

Agreed...

Magic, Your right i did get mixed up. I openly admit it and apologize for any other confusion i may have caused. However i still hold to my initial disagreement with the forcing of the tube, if they had RSI protocol i would have agreed with a tube then. As Beiber originally posted his service does not have RSI protocols. I can not and will never agree that it is better to cram a tube down the throat of a person no matter how old unless they are in complete arrest. Any person that is clearly fighting the tube should not be intubated with out proper paralytics and sedation. It is very stressful on the PT mentally and physically. If the procedure can not be completed properly then it should not be attempted, PERIOD. As Beiber told the call the PT was responding to BVM ventilations favorably. Since this was the case brought up in the OP then that treatment should have been continued until arrival to the ED where the PT could have been RSI'd properly. Proper airway management with BVM and suctioning are basic skills that are often over looked by the advanced providers including myself. Race *Edit* The Diuresis would be for chronic CHF not acute pulmonary edema. Which in my experience an 80yr old woman would be suffering from and not just an isolated incidence of acute pulmonary edema. Just my thoughts... WOW i have no idea where my head was through out this post ... LOL thanks for the catch Magic...

Welcome ! Congrats on the new cert, read and post, ask questions and keep an open mind...

WOW...

Ruff, At my 911 we can still hang from the ceiling if the need is there. It is not common practice but it is another tool when needed! Race

The total degree from my program took me 4 yrs, i had to get the prereq's while working full time supporting my family at the same time. I did the main medic part of the program in 12 months. my GPA was slightly less than yours Dwayne at a 3.53. and my nursing was about the same GPA wise. I did take the Paramedic to RN bridge course and both were college courses. If a bridge program is in your future i would advise a couple yrs as a medic first then enter with an open mind. there is a huge theory and practice difference but when approached correctly makes an incredible combination.

I am really hoping by these statements that your "on the rag again" I know that it is hard to armchair this but in my experience respiratory arrest secondary to COPD is not a death sentence. I have personally bagged people out of the immediate danger enough that they could maintain on their own until i could get the CPAP set up and attached. Of these the most common out come was to spend the night in ICU then upgrade to a medical floor for diuresis and released with in a few days. I disagee that intubation is the only choice for proper oxygenation and lung expansion. As a basic you are taught to manage airways with BVM and positioning. Yes air can and does still enter the stomach and will eventually may cause vomiting, but this is again where a basic skill should come in to play; suctioning. By positioning i mean not only the airway but total body position. She needs to have her head up letting the fluid build up settle and taking the pressure of the intestines and other internal organs off the diaphram allowing easier and more complete lung expansion. That coupled with a foley cath (if you are able) and lasix to start shedding excess fliud. Just my thoughts Race *Edit* "* If your major concern right now is airway protection, and if BVM ventilation is giving you reasonable oxygenation / ventilation, the patient's mentation is improving, and there's some spontaneous respiratory drive, it might be worth deferring the intubation. If the patient continues to improve the hospital may be able to do some magic with BiPAP. * A lot of these patients are cardiac arrests, right? Remember that good CPR and correction of the underlying cause are the focus here. " I agree Systemet

Agreed !!!

WHAT !?!?!?!