Scaramedic

I think that about covers it.

Peace,

Marty

:joker:

Has more equipment hanging off their belt and in the their cargo pants than most ambulances had in 1976.

Has a Paramedic hat, t-shirt, sweatpants, license plate frame, lunch box, sunglasses, shoestrings, thong, condoms, toilet paper, bumper stickers, and of course a Paramedic belt buckle.

Peace,

Marty

:joker:

In my experience, what everyone said above in regards to patches seems to be the norm. If you want to collect something from other services try pins, I have a handful from different services I have worked with from around the country.

Peace,

Marty

:joker:

Ok, How about this...We're saying the same thing different ways?!?!? Because from here the print just gets finer and the waters muddier......

Out here,

ACE844

I'm sorry ACE I thought the thread was "Is EMS definitive care?"

Oh wait it is, but whatever, airway is not definitive treatment. Yes it fixes a symptom of the overall issue, i.e. secures the airway in an arrest, but it does not convert the rhythm. OK, occasionally it actually does convert but that is rare.

I agree though we are probably arguing semantics here.

Peace,

Marty

:joker:

:banghead:

Ace your just not getting it. ETI is the definitive airway intervention, key word intervention. It is no different than an IV, defibrillation, or medication administration. An intervention is not the same as definitive care. Definitive care is returning the patient back to health by treating the underlying cause/result of the injury or disease. You are confusing "definitive airway" with definitive care, its not about fixing a problem, its about fixing the patient.

Nice google skills though.

Peace,

Marty

:joker:

I'm sure Ron Walls MD would disagree with you, without an ETI, in some instances your patient dies...That sounds pretty definitive to me. He even says so in his book. I don't have it handy, but as soon as I do, I'll post the info., or if "VS, or anyone else" does feel fre to post it.

ACE844

Definitive

Function: adjective

Etymology: Middle English diffinityf, from Middle French definitif, from Latin definitivus, from definitus

1 : serving to provide a final solution or to end a situation <a definitive victory>

Function: adjective

So you and Ron Walls, MD are just going to leave the patient on the vent for the rest of his life. Definitive is the final fix, not the care to keep the patient alive until that fix can happen.

I can intubate a head injury, but I have not fixed anything. I am only temporarily assuming airway/ventilatory control on a patient who needs further care to walk out of the hospital.

Peace,

Marty

:joker:

Ok, so everyone seems to agree.

Definative care seems to be defined as care that "fixes" the problem. AZCEP defined what we do that could be termed as definative care.

Now, let me ask this. What does an ER do that is "definative care"?

BTW...im going somewhere with this....so bear with me

Set broken bones

Tell Aunt Pudy her hemorrhoids are not fatal

Manual Dis-impaction

Diagnose petty medical complaints, and send the patient home

Prescribe antibiotics

I think I know where your going with this, now that I realize how short the list is.

Peace,

Marty

:joker:

You don't think ETI is a 'definitve' treatment?

ACE844

No it's not definitive treatment. ETI would be supportive care in my opinion. Definitive care would be treating and fixing the underlying problem that caused the need for intubation.

Peace,

Marty

:joker:

No, I said it hasn't been used for that purpose in over a decade and I haven't seen described in any of the back editions of the ACLS texts (which I own) since the early 1990's. As I said, you can abandon your cause. It isn't going to get you anywhere. :roll:

Punisher, it goes further back than the early 90's, 1987 ACLS on Calcium Chloride..

"There are no data demonstrating a beneficial effect from the administration of calcium salts during cardiopulmonary resuscitation. In theory, the high levels of calcium in the blood induced by the administration of calcium salts may induce reperfusion injury and may adversely effect the neurologic outcome of the patient. Calcium Salts should not be used during resuscitation except for treatment of acute hyperkalemia, hypocalcemia, or calcium channel blocker toxicity or hypermagnesemia."

Also the studies quoted in the book are from 1979, 1981, 1983 and 1984.

That is an exact quote by they way, "There are no data." This must have been before AHA hired a copy editor.

Peace,

Marty

:joker:

Emtcity is 95 members away from 7000. It would be kinda cool to have a pool to guess date and time of the 7000th member.

Ummm when I looked at the front page it said 7911 registered users. I assume you meant 8000 users.

I'm guessing June 16, 1000hrs.

Peace,

Marty

:joker:

Should chlorination be an ALS or BLS skill?

Lets make it a BLS skill or somebody will start a thread on why Basics should be allowed to use chlorine.

Peace,

Marty

:joker:

Superhero boots - That's it! Rocketwanker EMS to the rescue - Not quite sure about the skintight costume that would go with it - no room for tape and scissors.

Dare to guess where he has his tape & scissors?

Peace,

Marty

:shock:

Ahh, f' you! I'm sweatin' my ass off carrying your f'ng rope around. Must weigh thirty pounds...

Peace,

Marty

:joker:

Ace844 & Punisher drop in and clear the thread of stupid posters!

Peace,

Marty

:joker:

anyone ever seen one? I havent, was sittin here thinkin about it. I would think it would be a good setup seein as how the cummins is an excellent engine with a ton of power and the dodge interiors arent that bad either.

anyhow, just a thought.

I asked the same question 5 years ago to one of our mechanics, he said they have problems with the frames on Dodges. That the frames are too weak for the module and they were having problems with the frames bending.

Like I said that was 5 years ago, maybe things have changed.

Peace,

Marty

:joker:

Have to agree with Rid on this one.

If they spend the shift following a phleb around, they haven't really learned much. If they spend the time with the tech, they will discover how and why the numbers do the things they do.

The students won't be happy about it, and chances are the lab techs won't be thrilled, but it would be a great learning tool. We recommend that our students spend time with each of the ancillary departments to help understand how the whole system works. Some with lab, some with respiratory, some with radiology, we even had a couple in PT/OT helping out.

Each exposure adds to the picture that these students put together about their place in the system.

That's what I said, maybe its a terminology problem. I am a an MLT, when I say "bench time" I mean working with the lab tech, I agree working with a phlebotomist is a waste of time. Time spent with us, learning what the results mean, and in turn learning S/S of the of the results would help them understand the bigger picture.

Personally I would love the opportunity to have Medics sit in with me, there are some that wouldn't thats why you could have a sign up sheet for the techs.

Rid I also agree that this should include exposure to Micro. That is my speciality, and I would love to have someone plate my stool cultures for me. Just kidding. Blood bank is also important, as well as learning the "banding" procedures so maybe someday in the future the EMS crew could have blood drawn and pts banded when they arrive. That would be a very hard sell I know, but I can dream.

Sorry for any misunderstanding.

Peace,

Marty

:joker:

The thing is the paramedic preceptor was a real jerk to him and the practicum's purpose was for him to show improvement which he did but they still failed him because I guess they didn't like him or something.

Showing improvement is not a reason to pass someone on a preceptorship (practicum). If an intern starts the program with a poor performance, improves over time, yet at the end of the program the intern still doesn't cut it then I would & have failed them. Its not easy to fail someone after they have put in that much time and effort, but in the end its not about the intern its about the patients they would treat if I cut them loose.

I'm sorry for your friend but maybe re-taking the course would be a good thing for him.

Peace,

Marty

:joker:

Imagine trying to breath through a straw for a few days and you can appreciate what these pts feel.

Another thread I missed, sorry I am late on this.

In my Paramedic program we had to take tubes of various sizes and breath through them to get an idea what it was like. There is an exponential difference in the air you can move thru the various sizes, at least it feels like it.

I am very aggressive when it comes to airway treatment on burns also, that whole swelling of the tissues issue. Burns aside, I don't believe I would intubate that small on a normal adult for any reason, you could provide BVM respiration and move more air than you could through a 6.5 with cuff leakage, not much airway protection there if you ask me.

Peace,

Marty

:joker:

WHAT DO YOUR PROTOCOLS STATE

Denver Metro Protocols from 1994.

Current Multnomah County EMS Protocols (Portland, OR)

Did that answer your question?

Peace,

Marty

:joker:

Even though, I have lived in rural areas most of my life... now it has became urban. Yes those people are aware that they probably will not receive care like those in urban and metro and yes, it would be hard to make the decision for risking lives of those in far away land.. although we risk our lives for less ones (cranksters, gang-bangers, etc.) Please however; If I just so happen to be passing through to another town.. I hope me and my family can get the best..

R/r 911

I agree Rid we risk our lives everyday for even more mundane reasons.

Don't worry about ever "passing through" any of these areas of Washington, there is no place up there you would want to go in winter. I am not kidding, this is directional you will get from EOC for these areas...

"North on Lewis River road 43 miles to Forest service access road 1220, 4 miles NW on FS 1220, till you come to FS 1222, 3.6 miles north, until you come to FS 1222.1, cross over the river on the bridge made of logs, turn right, the road continues to the house on top of the hill. Hit your siren when you reach the house and the RP will come out and round up the dogs."

This is where I started out my EMS career 19 yrs ago, God I miss those days. :?

Peace,

Marty

:joker:

I dont know...we can try

12 & counting....

Thanks all, I had a seizure trying to read this thread!

Peace,

Marty

:joker:

Are there really only half a dozen people on this board who get it? Is the rest of EMS really this clueless?

I hope I'm one of those half dozen Dust. :wink:

I agree with you Rid & Dust, ALS should be the standard. The only exception should be tiny, remote communities and only until ALS can get to the patient or an intercept can happen. As a side note, Medicare will cover ALS intercepts so somebody will get paid for it.

I will take it even a step further First Response and EMS should be separate entities. An ambulance should be a unit staffed by Medics, with all the ALS toys it can carry. A First Response Unit can be staffed by FR's and only transport to ALS intercepts and carry the usual BLS equipment. I know it is semantics but the public needs to know the difference. The Basic level should be just that, the standard scope of practice, none of those "add on skills" that so many states and FD's love.

One last issue I have, people choose to live in these remote areas. Some of the "towns" we have in the mountains are all but inaccessible during the winter months. I beg to ask the question, is it worth it for a crew to risk their lives to go 40 miles into the mountains to save someone who chose to live at the butt end of the universe? If the people in that area want to help get them down that's fine, but crews coming out of the city shouldn't have to go 'mountain rescue' for the Ted Kazinski's of the world. Just my opinion, please fell free to flame me on that one.

Peace,

Marty

:joker:

I realize this may be inflammatory here...

...when they don't 'go cheap' and serve only fish crackers at the receptions

Chris

Damn right it's inflammatory, bad mouthing fish crackers, I love fish crackers jeesh!!!

The problem I have seen is protocols tend to become "what I can do" not "what I should do." Many Medics & EMT's get caught up in the skill parts of protocols, and forget the assessment part of their protocols. The scenarios you mentioned were not failures of protocol, they were failures to properly assess the situation and/or the patient. Hands on MC is one solution, better training in assessment in another.

Another issue I have seen in some of the systems I have worked is lack of consistency in MC. Some systems you contact the destination hospital and speak to the on duty Doc. In this situation you might speak to a ACEP Doc or a Dermatologist moonlighting in the ER. There is great inconsistency between Docs not to mention between hospitals. Another system is where you have something like a Medical Resource Hospital (MRH). All medical control for the region is handled in one call center staffed with an MD who has trained and tested on the regional protocols. This delivers a greater consistency to medical control and a better overall communication between field personnel and the Docs.

Oh yeah, don't be bad mouthing fish crackers!!

Peace,

Marty

:joker: