JPINFV

As long as tax dollars are going to pay for treatment that are a result of injuries sustained from accidents, the government, acting in the best interests of the tax paying public, should be able to legislate reasonable laws that reduce the financial liability from accidents, including seat belt and helmet laws. Now, if the law said that you would be fully liable for any costs that are a result of medical care rendered because you were not wearing a helmet or seat belt (without the ability to hide under bankruptcy protection), then by all means make those safety devices optional to use. Besides, in this case it's a football player. It's not like one more knock to the head would do any damage.

And the weather in Canada sucks.

It sounds like we're saying the same thing. I just left out the proton that was absorbed by the body.

It is not a Canadian thing... http://youtube.com/watch?v=pVAZJL_cdJs&amp...olbert%20report http://youtube.com/watch?v=652QzoMF8es&amp...olbert%20report

Covered the basics (input/output for Glycolysis and TCA, function of NADH, FADH2, and ELC) in high school. Covered step by painful step (inputs, outputs, enzyme [plus structure for the I and O) for each of the steps of glycolysis, TCA, and anaerobic respiration in college (as well as developed a great hate for biochem). I think that understanding the overall process is important, but I wouldn't expect a paramedic to be able to rattle off each step of the process. Of course, memorizing each step is a good way to gain an understanding of the process. No O2=no ETC=very limited amount of ATP production (net 2 from glycolysis only). Also no O2=anaerobic turnover of NADH=slow down of glycolysis and build up of lactic acid=bad. Anyone else notice what's wrong with the BBC website? [spoil:ead62ea1e7] NAD+ is reduced to NADH, not NADH2 as the website states. FADH+ is the coenzyme reduced to FADH2 during TCA.[/spoil:ead62ea1e7]

You know what's worse then that? Stuffed shirts that think their 120 hours (total) of advanced first aid training, general operation training, anatomy, physiology, and limited legal training should allow them to second guess the people with 11-12 years of education past high school or people with 9 months to 2 years of training/education (Ratio of training to education varies) who provide better care. These stuffed shirts think that they should be able to give any drug under the sun because they have 120 hours of magical medical training that trains them in everything that they need to know about the human body. /stuffed shirt with 120 hours of training.

That's just Northern California (Especially Berkeley) ruining our good name. Or maybe I've just lived too sheltered of a life behind the Orange Curtain [Orange County, CA = conservative. Rest of the Left Coast is liberal].

Oh G-r-oo-vy!... R/r 911

Pff, the entire US is full of wanna-be Southern Californians...

Oh, I've never said that this type of system was good for patient care. It forces basics to treat patients that should never be BLS AND is way out of the scope and education for basics. I do not consider the decision to call ALS or transport easy, especially for the borderline patients. Simply calling ALS because a number is above or below a specific limit should not be the only justification for a reroute or for summoning prehospital ALS. A good physical exam and history, though, does. The skills and education that is required to obtain and interpret the results is very lacking for most EMT-Bs. Combine this with a system with no online medical control at the BLS level and you have a recipe for disaster. Add in IFT companies that are willing to transport anything called in and basics that want to treat dispatch as medical control (ex. one idiot at my company recently called dispatch to get ALS [we are supposed to just pick up the phone and dial 911] when he was less then 2 miles from the hospital [i.e. transport code 3 would be the correct transport plan]. Because he was too stupid or scared to make a decision, definitive care and ALS was delayed).

If I'm reading that abstract correctly, it just shows how long the average length of a trauma call (activation, response, on-scene, and transport times) for urban, sub-urban, rural, and aeromed, but it makes no conclusions on if the time has an effect on patient outcome. My guess would be that the time element is greatly over exaggerated. Saving a minute or two is not going to change patient outcome. Saving 10, 15, 20, etc minutes, might change the outcome (the greater the savings, the better the outcome). It's important to not be on scene with a thumb stuck firmly up your butt, but there is no reason to rush. Its better to take a bit of time and get an IV/intubation/etc right the first time then to mess it up and take longer as you give it another try. You want that grey area between "waste makes haste" and "idle hands are the Devil's tools."

It depends, though. I've rerouted and not rerouted patients because I've had a better understanding due to my hospital experiences and education. You might not be able to treat the patient any differently, but it could mean the difference between a hospital 10 minutes away and a hospital less then 2 minutes away because you reconize what that one part of the exam that just isn't fitting properly.

HTN was the chief complaint with their monitor reading over 200 prior to arrival. The patient was slightly altered, which was a combination of a possible psych Hx (dictated physical in the records that we recieved stated this) and just finishing a dialysis treatment. In my area, you only find ALS with the fire department, so all private emergency calls are dispatched BLS by a lack of choice. She was also complaining about SOB (not really showing it, though), but I believe it was psychosomatic based on the rest of her presentation (she still got a mask, which she held on to and used PRN). My unit had a 20-30 min ETA (first call of the day leaving from our base) and a less then 5 transport (just down the street from the hospital). This is also why I believe that interfacility EMTs should be held to a higher standard then 911 EMTs in a system where all 911 calls get an ALS response (ALS can triage down to BLS in the field).

and try we might

I'll remember that you don't need a paramedic next time I get a SOB patient, or a hypotensive patient, or a patient that has had an obvious increase in ectopy over baseline (given by the chart). My last shift, I had 3 ER calls (out of a total of 6). A patient complaining of increased SOB, a dialysis patient that was hypertensive (200/100) and a SNF patient who pulled out her PVAD and was hypotensive (80/50). All of those were full code. All should have been ALS based on CC. Yes, that day was unusual. There are plenty of ER or 911 calls that can go BLS. There are also plenty that should have ALS from the start, and don't. I would rather have a system where a BLS call gets an ALS assessment and monitoring, then an ALS call gets a BLS response. So get off your high horse and learn how to use the enter key (remember, paragraphs are your friend).

I'll remember that you don't need a paramedic next time I get a SOB patient, or a hypotensive patient, or a patient that has had an obvious increase in ectopy over baseline (given by the chart). My last shift, I had 3 ER calls (out of a total of 6). A patient complaining of increased SOB, a dialysis patient that was hypertensive (200/100) and a SNF patient who pulled out her PVAD and was hypotensive (80/50). All of those were full code. All should have been ALS based on CC. Yes, that day was unusual. There are plenty of ER or 911 calls that can go BLS. There are also plenty that should have ALS from the start, and don't. I would rather have a system where a BLS call gets an ALS assessment and monitoring, then an ALS call gets a BLS response. So get off your high horse and learn how to use the enter key (remember, paragraphs are your friend).

I, personally, have seen how education changed how I look at patients. Just a little background, I'm currently a college student working my way though a bio degree (Dust would call me a part time yahoo out for the adrenalin rush... ). I finally got around to being able to take a human physiology class this school year (first 2 years was genetics, biochem, etc. All those lovely classes where half the information is not clinical applicable). The difference between my understanding of what I was seeing before and after that class was amazing. Simply put, the physio taught to basics is not enough to make any judgment calls. A basic education can be generally summed up as "If the number is out of this range, call medics, if the patient has anything worse then a stubbed toe, call medics." There is not enough to even attempt to decide what level of care is needed. This is a problem for those borderline patients. Nurses are not doctors either, yet they have been able to put together a mid-level provider (NPs) and been able to implement different levels of education for RNs. Would you rather have a RN treating you with a MSN or a certificate in nursing? Would you rather have a paramedic with a degree (higher the better) or a certificate?

Does this mean I get to write up a case report when my 70 y/o dialysis patient gives birth?

1. Generally, basic classes are 120 hours plus change. Being the exception to the rule does not change the rule. The A/P in the average basic class is just enough so that you might be able to write a decent PCR, but not enough to actually understand what is going on. 2. Um, ok. I like ice cream (ones pleasure with a level doesn't make that level useful or properly education). 3. How often do you actually use those medications? Or is it like OB. sure I'm trained and equipped to deliver babies, but the chance that I might actually do it while in EMS is slim to none. 4. By your own standards, EMT's (remember, you might be the exception, not the rule. We have to talk about the average basic) are incompetent because their education level is "inadequate to or unsuitable for" delivering medical care. An EMT should be more then a gopher or organic blood pressure machine when a medic is present. That will never happen as long as the minimum level of training is 120 hours with no education.

BLS: Use AED, get paramedics (only transport IF you are both closer to the hospital AND have enough people to transport. A 2 EMT crew does not meet that definition). Paramedics: Consult with base hospital MD for possible termination of resuscitation.

ok, I'll give int. Its not technically my protocol, but its the ALS protocol in my county. Medical arrests: http://www.ochealthinfo.com/docs/medical/e...delines/c05.pdf Trauma arrests: http://www.ochealthinfo.com/docs/medical/e...delines/t10.pdf

[web:90c1629c8c]http://nremt.org/about/article_00027_AHA_Test_Revision.asp[/web:90c1629c8c]

1. Not everyone has the same intelligence. Unlike in grade school, not everyone in the real world is smart. It's not about egos, it's about education and ability. 2. Blindly following protocols (which was what I was trying to counter with using doctors as an example) is bad. Not every patient will happily follow how the local protocols are written. Innovation is good. Understanding what you are looking at and how to treat it (be it strictly following protocols or not) is good. Throwing up your hands and giving up because the patient isn't presenting how the protocols says the patient should is bad. 3. Very few people are in it only for the good of the community, if even for that.

As if doctors always know what is going on, yet they don't.... Oh, never mind.

Well, according to your article, the medic and the basic were developed at the same time and evolved out of intern doctors (which would be Post Graduate Year 1 following medical school). These doctors (they finished medical school and had earned the right to place an MD behind their names) are ALS providers. The ALS provider came before the BLS provider. Paramedics are the current ALS provider. Therefore, the history of the medic starts earlier then the history of the basic.