JPINFV

^ I wonder what it would take to create an infant car seat style holder for monitors. You have a base that stays seatbelted to either a spot on the bench seat or to the captains chair. A frame that goes arour the monitor (doesn't have to be heavy, just enough to secure it) that locks into the base. Get to the hospital and you just push a button to release it and take it with you.

Ahh, but its an on-going problem at my work, and yes, at my work it really is just people hired to come in and check the units. If they were EMTs (especially if they could drive), then they wouldn't be stocking units at night.

SpO2 can give you a hint on if the patient is hypoxic, but there are other factors that would give you a "false" (ex. CO, cyanide, low H&H) reading or chief complaints where the SpO2 is irrelevant for treatment (ex major trauma, chest pain, etc). EMT-Bs aren't educated enough to understand what that number means and when to ignore it.

Everyonce in a while I forget, but I almost always buckle up, even if I'm on the bench seat. Especially for BLS, there is almost no reason to not be buckled up. You should be able to suction or bag from the captains seat and take BPs from the bench seat (or CPR seat if in a mod and taking BPs on the right arm). Personally, when I'm working on my paperwork during a transport, I find it easier to write with a belt on. I don't have to worry about being shifted around from starts/stops/bumps.

Comparison of clinically significant infection rates among prehospital-versus in-hospital-initiated i.v. lines. STUDY OBJECTIVE: To compare the risk of infection for i.v. lines placed in the prehospital versus in the in-hospital setting in a midsized emergency medical service system. DESIGN: A retrospective analysis was made of all i.v. line site infections among patients admitted to ward beds from a university hospital emergency department in 1992. METHODS: The hospital's infection control team conducted daily ward rounds and a surveillance of all wound and blood cultures. Patients with signs and/or symptoms consistent with Centers for Disease Control and Prevention guidelines for skin and soft tissue infection were reported to the responsible medical team. Infections were documented based on consensus opinion between the infection control team and the physicians responsible for the care of the patient. IV lines placed in the prehospital phase of care were identified by electronic retrieval from the prehospital database. RESULTS: Three thousand one hundred eighty-five patients who had a prehospital or an in-hospital i.v. line placed were admitted from the ED. Eight hundred fifty-nine i.v. lines were prehospital placed (27%), and 2,326 were in-hospital placed (73%). There was one infection in the prehospital group and four in the in-hospital group (infection rate: .0012 for prehospital patients and .0017 for in-hospital patients; P = .591 by Fisher's exact test). CONCLUSION: Both cohorts had exceptionally low infection rates. No clinically or statistically significant increase in the risk of infection among prehospital- or in-hospital-initiated i.v. lines was identified. http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Citation

Generally I won't note anything related to my patient's history. allergy, meds, or my physical exam in the narrative. My physical exam is a part of my primary or secondary on my PCR unless I run out of room (mostly due to pertainate negatives. An example would be not c-spineing an unwitnessed fall 4 hours ago when the patient denies back, neck, head tenderness, pain, etc). I leave my narrative for how I found the patient (in bed, on gurney, waiting out in front of their house, etc), what I did to the patient (placed on 15 LPM via NRB, splint, dressed and bandaged wound, etc), any change because of it (decrease SOB, increase LOC, etc), any thing that I can't think of a place to put it and abnormal (i.e. an irregular pulse secondary to a Hx of A-Fib is different then an irregular pulse in a patient with a Hx of "occasional" PVCs and is having runs of bump-bump-skip-bump-bump-skip or transporting a suspected CVA with onset the previous night code 2 because the patient has already past the window for tPA), and who I left the patient with (pT left in care of RN/MD/staff/family/etc). Of course an ALS PCR would be much more in depth.

Heck, I work for an IFT and I do that. Almost never a shift goes by that I'm not missing something (mostly finding empty spare O2 tanks) missing. My company even hires people to stock the units for us overnight. We are told that if the compartment is sealed (think yellow zip-tie thingie like is found on crash carts in the hospital. very easy to take off) that we don't need to check it. :evil: Management finally stopped pushing me out when I was missing my adult BVM one day (caught during check out). The compartment was sealed. :violent1: :violent1: :violent3:

Official: 24 hour Caring Services Unofficial: Love Your Nasty Con Home Ironic: IFT service with "Advanced Life Support" printed on the side (sure, we do some RN CCT, but not that many and the units are dedicated). Unofficial motto for the major local 911 company: Can't Assess Real Emergencies (ALS is pure fire with no private medics allowed in the county. So the 911 ambulances are BLS and ALS engines respond to all 911 calls)

:roll: :roll: I will have my methods. I will have my ways. Lets just say that I'm looking at 8-9 years (ok, maybe I used the term "few" a little loosly) more of education that does not include "the cert." Grant it, it doesn't look like you have "the cert" yet either. Pot meet kettle, kettle meet pot?

Well, maybe some of us DO have plans. We're just a few or more years away from being in any sort of place to even attempt to implement it.

The patient compartment looks tiny. And what are they going to do when there is a fire and they need to transport?

4 patients (bloody drag girl, moaning bush, truck boy, and the walker). I would check on the jeep, but if the patients heads are in the water, then they are dead with rescue 15+ minutes out. Send anyone into that water without gear (i.e. police or EMS) and they are done for the night on account of the cold. Are these "rescue" units ambulances or fire trucks (we don't call them "rescues" out here). Do the community hospitals have a helipad? Is the helipad on the way to the hospital (a map would be nice here, are the hospitals, for example, in the same direction?)? Are there ambulances 20-30 minutes away from the closest community (again, RN or P staffed)? This is going to be more about moving meat then treatment. As a basic I can treat A (suction) and B (NRB or BVM), but I can't do anything for C past bleed control. (ok, half of my dispatchers are idiots and what I'm doing is a little off the wall). Based off of the current resource info, I would TELL dispatch to start getting distant CCT/ALS units (i.e. 20 minutes from the far side of the hospital from me) to the community hospital. I'll have enough time to spend chatting about it later. Ok, patient impressions right now. Bush is alive and moving air. Is truck boy and bloody drag girl breathing following head tilt? If not, then they are dead. I can't C-spine alone. How many LSBs, scoops, and KEDs do I have? Is Jeep boy entrapped, or can we get him out? If I have a KED, then the walker gets it and a seat in the front of my ambulance. He also gets the spare O2 tank and a NRB if I have an extra regulator. I really don't care about V/S on him, he is the least injured. Taking a BP is going to just delay me from getting on the road and treating the other patients. Next move depends on the condition of jeep boy, bloody drag girl, and (maybe) the water people. End plan right now is transport everyone that is alive and that I can remove to either the community hospital (the ER doc should, at the very least, be able to start blood products, intubate, chest tubes, etc short of surgery) or to the landing strip. The CCT teams can take it from there. Hopefully I can get a few RN units there. This would keep the paramedic units in service instead of running them to the trauma center.

I want an easy button. Coming up to the scene I want to know what resources I DO have. Police, fire, aeromed, etc and where is the nearest hospital. If I can't get a helicopter, ohh well. If I can't get the number of units or medics that the scene needs, ohh well. No sense dwelling on what you can't have. If worse comes to worse, you can always get an ALS or RN staffed CCT unit in route to the nearest PRC and start shuttling the patients to it. The serious patients can get transferred via the CCT unit to the trauma center (the ER doc at the local hospital *should* be able to do basic stabilization). This should keep you available if you need to return. Considering the conditions, I would also want the local highway agency (CalTrans in my state) on the way. Get those nice little message boards set up leading up to the accident since it sounds like you're going to be there a while. Start warning drivers and start getting them to slow down as far away as possible. Scene safety (Were you able to get around the accident and able to park past the accident? Are there cars still running into the pile up? The last thing I want to do is become a victim, which just slightly more worse then working in temperatures below 60 degrees)? Number of cars? Number of patients you can reach broken down by START triage (Go Hoag Hospital. +5 if you get the reference)? Number of patients that you can transport, even if its by a passing POV that you put an EMT into (with the temperature, I want to transport everyone ASAP to prevent hypothermia. Just getting the minor patients off the scene will help. Fire and police can drive the ambulance).

Those things aren't air tight either /transported a patient with a rectal tube once. //was stuck in a vanbulance

And the guy who graduated last in paramedic school is still called "paramedic." I have always failed to see the point of this cliche. If you graduated, then you must have completed the requirements set forth for that education and deserve the title. There will always be someone who finishes last, even if the course is one person (that person gets to finish first too).

I believe that the "great" part was sarcastic. He is complaining that the paramedics didn't fully immobilize the patient based off of mechanism alone, but he has not shown yet why the patient should have been immobilized, besides the mechanism (which doesn't sound, overall, too serious to warrant immobilization).

Yes, 120 hours of advanced first aid training is not everything. This is why we need more education, especially at the basic level. Truth be told, any EMT shouldn't even be allowed to give oxygen without even a basic notion of cellular respiration. Does anyone else find it a little scary that basics give a "drug" and not understand how that "drug" works? Anyone else find it scary when an EMT-Basic text book covers the use of cellular phones enough to warrant a note in the index, but not enough about cells to warrant a note in the index?

May be it will, but at least the basics would know how to do something more for medical patients then take a BP, put on a NRB (because they only do it because you 'give O2 to everyone), and drive. /hates the basic SOP and level of "education."

Or does their level of education approach the level of education that the entry level position should have?

Going off of your analogy, it would be more like a whore house. Multiple girls (many receptors), multiple boys (Lets say boyA for narcan and boyB for morphine). Who ever doesn't get a girl gets randomly thown out over time. Also, over time, a boy will leave the room (vacate the receptor), but is still free to compete for reentry into the room (i.e. not eliminated just because he got a girl) All other things being equal, if you have more boyB (morphine) then boyA (narcan), then more boyB will find a room. Sure boyA will get some, but boyB will get more. Since there is more boyA out in the cold then there would be if there was a lower concentration of boyB, boyA is kicked out more often. Of course, in this situation, boyA is a prude and doesn't actually interact with the girl. He just keeps boyB from getting some.

^ I thought the EMT-B course was more of an orientation to EMS then actual training... /sarcasm, but only slightly

Is the morphine not just looking for a receptor to bind to too? At its core, chemical reactions and receptor binding is a random process. For a reaction, the two molecules have to make contact (random), with enough energy (Just because the total energy might be enough doesn't mean that each molecule has enough energy) with the right orientation (random) to cause a reaction. Similarly, a molecule binding to a receptor has to make contact (random) and has to hit in the right orientation (again random) to bind. A higher concentration makes it more likely that the conditions needed to bind to the receptor are met.

Well, some services do use paramedics for some CCT transfers...

Any LOC? Location of pain (i.e. flank vs mid-line)? Any tenderness along the mid-line of the back? Any neuro deficits? (PMS x 4?) Any distracting injuries, or was the only problem the back pain? Impact? If so, speed, location (including area, for example), etc (did the machine just tip over so that the machine and the truck formed a triangle and the patient was trapped at the apex?)?

Not directly, but the higher the relative concentration, the more likely it will be bound to the receptor and unavailable to be eliminated. Since less of the lower concentration is bound, it will effectively be eliminated quicker. This is not to say when the serum is saturated with Narcan that the rate of elimination of Narcan is low. It is merely inconsequential as long as Narcan continues to out compete the opiate for the binding site.