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MCSOU

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Posts posted by MCSOU

  1. Both anecdotally and documented, "Junkies" have exhibited violent tendencies towards someone who ruins their "high" with Narcan. Unlike EMTs and Paramedics, First Responder Firefighters, and civilians (read as friends and family), LEOs have the equipment, training, and perhaps the most important of all, the authorization to "handle" such attempts at violence.

    How frequently do these violent tendencies occur? Can you find any statistics?

  2. MCSOU,  I just taught my 12  year old son how to give me my glucagon for when and if I ever drop to a critical blood sugar level.  I taught him that he is only to give me this, AFTER he calls 911 and if 911 tells him that the response will be delayed.  He is to tell 911 that he has a glucagon injection and he is getting ready to give it per my doctors instructions.  The 911 operators on the phone are all paramedics (so I've heard) so they will be able to tell him if an when glucagon is appropriate for me.  

    Now if we are travelling to my in-laws, which are 15 minutes (at least) away from the nearest ALS unit, he will give the glucagon, but only after calling 911.  (I only know this because I used to work for this service)

    Should we not allow him to give this life assisting medication because he is not a medically trained person?  I think not.  

    But I do agree with Triemal, Each service needs to evaluate their readiness of their emt's as to whether they should be able to give this medication, The proof will be in the pudding and if their skills with the BVM are sorely lacking, OR if they are going to be with the patient for a very long time before ALS arrives OR if they are only a BLS service, then maybe they should think about allowing to give this medication, but ONLY If they have ALS intercept agreements in place.  The worst thng to happen is that they give enough to get the person breathing or breathing well enough on their own, only to have the narcan wear off and they are back to square 1 which is not where they want to be.  

    I'm not sure we are on the same page here but I agree with you. My post was sarcasm in an effort to get the individual to see what they were saying didn't make sense.

  3. Having been an EMT for 12 years before "moving up the 'food chain', so I can say this with some authority:

     

    I'll start with the standard "120 hours of class room education" argument.  Having sat through the EMT-B course twice (with a significant interval in between classes), I can attest that the EMT-B program really hasn't changed much, and the young EMT's are still being taught irrelevant information, and it is not adequate enough to start administering pharmaceuticals (especially those with such serious ramifications when administered incorrectly).

     

    Additionally, is the EMT-B really equipped and trained to deal with the effects of improper administration of Narcan?

     

    The EMT-B is barely taught more than the superficial mechanics of the body systems, and not to think about the 'why' of treatments.  If it's bleeding, stop the bleeding (insert ICE mnemonic here), if it's not breathing, ventilate, if it's at an odd angle, splint it....high flow O2 , and rapid transport (radio for ALS intercept if necessary).  Is this REALLY the educational level that is appropriate for the administration of Narcan?

     

    I'm in no way busting the chops of the EMT-B, but I AM railing against the educational levels that they receive.  I'm also advocating for the patient, which I can see ending up in dire straits because of an inadequately trained, over zealous EMT-B 'slamming Narcan'...

    I find that most people that start anything with "I have been *insert title* for *insert number of years* " usually aren't authorities. Use your statements to guide peoples thoughts on you.

    First off, improper administration of Naloxone can induce:

     

    Abrupt reversal of opioid effects in persons who are physically dependent on opioids may precipitate an acute withdrawal syndrome which may include, but is not limited to, the following signs and symptoms: body aches, fever, sweating, runny nose, sneezing, piloerection, yawning, weakness, shivering or trembling, nervousness, restlessness or irritability, diarrhea, nausea or vomiting, abdominal cramps, increased blood pressure, tachycardia. In the neonate, opioid withdrawal may also include: convulsions; excessive crying; hyperactive reflexes.

    The rest of your sarcastic (and highly unnecessary) post included a lot of 'talk' and 'ifs', so it's based on facts not entered into evidence.

     

    EMS education in the United States still tends to accommodate the 'lowest common denominator', and with only 120 hours of classroom education and 24 hours of clinical experience, it's not a good idea to start pushing pharmaceuticals until an education system is implemented that accommodates higher educational requirements for entry level EMS (another topic that has been beaten  to death). 

    Find a study that indicates significant clinical detriment as a result of IN narcan. Most (actually all) of the signs/symptoms you listed won't kill you, hypoxia will.

    I am an advocate of leaving the 'medical stuff' to the 'medical folks'.  Sure, Band-Aids on boo-boos is alright, but putting pharmaceuticals in the hands of the uneducated/improperly trained can never be a 'good thing'....

    Correct me if I'm wrong here, but doesn't the amount needed to improve respiration depend on the amount of the opiate in the system?  Is the LEO drug box going to be enough to properly mitigate the situation?  If LEO want to get into medical, they should go to school like the rest of us.

    So should diabetics not have access to their insulin? What about their family members giving them insulin? 

    • Like 1
  4. Study anatomy/physiology, biology, chemistry and any other basic sciences that interest you. Go to college and get a degree in some science while you are getting your EMT at night (its about 4 months long depending on where you go). Go to paramedic school. Your science degree with help advance you if you end up wanting to go to other professions and benefit you as a paramedic.

    • Like 1
  5. Our main event is our open house each year. Bring in a bunch of fire departments, cut up a car, showcase our services, etc. Standbys are also a great area to hand out some flyers and talk with the public about what you do. We are also starting a new program where we schedule visits with the local homes and take blood pressures for an hour or so at each place, rotating throughout the day.

  6. At least he's not from Jersey. Welcome MC, as you have found out already, we have a very opinionated bunch of ambulance drivers here that enjoy lively debate. What part of NYS are you from?

    Rochester area

    Thanks for the welcome everyone!

  7. Go ahead, debate with me. I've already answered several questions/opposers on here, jump on in.

    I believe that is what Mike is Referring to in his comment. :whistle:

    It wasn't a malicious intent, I'm welcoming debate, it helps us grow.

    Except when that picture causes the pt to receive an invasive procedure that they didn't need in the first place. There are very few emergency indications for bedside US, even in the ER. I will agree that a FAST exam can change pt care in the field. In the proper setting (ie trauma), fluid in the belly means go to the trauma center. There are not very many services that allow pericardiocentesis. OB, eh. If they are pregnant and have anything that might be OB related you should be going to a properly equipped hospital anyway. Anything else is to reduce length of stay in the ER and not really necessary in the field (gallbladder, DVT, retina, etc).

    Thats why you must take into account the whole clinical picture. Do you want a technician who says "I see picture, I stick needle" or a clinician who says "I have imaging, a physical exam and a presentation to match this diagnosis, here is my treatment."

    I'm with ERDoc on this...and it's my new toy. It's a simple case of treat the patient, not the machine. Just because I might see a Pneumo doesn't mean it'll get a dart. The patient's current presentation is the defining factor in my treatment decisions. I have two reasons for buying the U/S:

    1. Bypass the Doc in the Box direct to a trauma centre (Edit) In situations that warrant such measures, and the criteria are specific.
    2. monitor changes and let the trauma centre see any changes that may have occurred over the two hour transport time.

    I think we all agree even if a pt has a pnemo they may not necessarily get a needle decompression.

  8. Figured since I was posting in some other topics I would introduce myself! EMT-B for about 4 years with 2 months under my belt as a new paramedic (best decision I ever made) in NY. Work for a suburban moderate call volume agency and a rural lower call volume agency. Im involved in fire as well along with the local special operations/tech rescue team. I enjoy chocolate chip cookies, long walks on the beach and looking for ways to advertise and improve EMS.

  9. You're willingness to be so combative in the face of a post you either didn't read or didn't comprehend is telling. A much simpler, and less confrontational, answer existed to the single question I posted to you.

    I'm not sure where my post was confrontational but I apologize if it was taken that way. I accept debate and think of it was one of the best ways to research a subject and grow with it. Get to know me more than a single post and we can have an educational discussion on many things! Until then, cheers!

    Your US will not make a diagnosis of a tension pneumothorax. It will only identify a pneumothorax. This will quickly turn into one of those situations where someone has a new toy and overuses it. Not all pneumos need a needle or a chest tube. You can bet your ass that if this were introduced, there would be medics putting a needle into every pneumo, regardless of whether it is needed or not. Anyone that gets a needle ends up with a chest tube. You have now given a chest tube to someone who never needed one in the first place. Not to mention that the number of tensions are very small.

    While I agree to a degree many people will have the "new toy" stuck in their head and over use it I could say the same thing about nearly any advancement within medicine. With a solid education and quality assurance I think this can be reduced. Any while I agree the whole picture will make a diagnosis (at least I think this is what you are hinting to) a picture is worth a 1000 words. While a positive FAST doesn't always mean blood it can add to the clinical picture to dictate treatment paths.

  10. It's going to take a lot of convincing me that ultrasound in the field is beneficial in urban environments. I can see their potential use in rural areas with extensive training, but it's just not useful in my opinion. They can be mis-read and as all of us in the EMS field can have a tendency to do, we would treat the machine instead of the patient. If the hands-on assessment is telling me there is a high suspicion of abdominal bleeding, I am going to transport to the appropriate facility regardless of what some machine will tell me, and I feel that this technology in just anyones hand will cause problems. I may be wrong as people probably initially thought the same about 12-lead ECG in the field, but bouncing down a road enroute to a hospital hardly seems like optimal conditions to interpret the FAST exam.

    "Common features in patients who are awake include universal symptoms of chest pain and respiratory distress, with tachycardia and ipsilateral decreased air entry found in 50–75% of cases."

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660039/

    How comfortable are you with diagnosing a tension pnemo? Location to hospital doesn't matter if your patient requires decompression, but what if you are wrong?

  11. C'mon. You can do better than this.

    If that's your website you linked it's pretty poorly done. You have the same study linked at least twice (and I think it's actually linked 3 times) all from different publications. Most of the links are to videos. That doesn't do much to support your argument.

    I use ultrasound regularly in the hospital. I don't use it in the field. While I'm not going to disagree that it has potential for field use you really didn't do anything to support your argument. Care to tease out your argument a bit or are you willing to let that blog post of a website stand as your reasoning for prehospital ultrasound use?

    No, it is not my website. Research will be limited as it is a relatively young technology (about 50 years with the last 25 seeing all its potential). Find me research of the advantages of using a stethoscope in the prehospital field from 1970. Why cant you? Because date is limited. Go ahead, debate with me. I've already answered several questions/opposers on here, jump on in.

  12. Assuming of course your Paramedic crew has sufficient A&P knowledge and the willingness to learn the FAST system.

    I can teach a Paramedic to perform a FAST examination within 4 hours of hands on instruction.

    Are these things that we should really be taking the time in the field to complete? What does the science and research show?

    You can do it while on the way to the hospital.

    Here is a website that lists several links and studies showing benefits of the devices

    http://www.paramedicultrasound.com/

  13. I truly believe ultrasound is more beneficial than 12 lead technology for EMS (not saying we should take it away by any means here). If you do your homework and practice a handheld ultrasound can provide a FAST exam within 30 seconds, tell you in minutes why your patient is in shock, assist with IV placement, do cardiac, vessel, and fetal assessments.

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