Medic26

OK peoples I have searched for hours on the net and this site, I am at a loss here and am looking for some help. My service currently has 4 different types of cardiac monitors in service, I hope to persuade them to eliminate or move towards elimination of all different types in hopes of standardization. We currently have 8 ALS units with a mixture of Zoll M's, LP11, LP10 and even a LP5 still inservice as a last due unit and an additional as a reserve. Our eventual goal (a few of the senior staff) is to standardize in accordance with our 2 - Zoll M monitors that are fully equiped with pacing, 12-lead, NIBP, SPO2 and capnography. These monitors have worked great for us since we got rid of the LP12 that failed 3 times on us a few years ago. So my dilema is I cannot find enough research and studies that support the added cost, but I know it exists somewhere. So I am asking your help in finding research and data to support our goal and anyone who has info on LP5 lawsuits and failures or sub-standard information regarding the LP5 would be great too. I know we can convince them with the right sales pitch. PLEASE HELP

I like It!!

"Dustdevil" There are some good services here and some bad, I don't think that having 2 ALS providers on the truck makes it better just because of that, there are many services with basic + medic that give excellent care as well.

I work part time at a city service, our average transport time is 5-7 minutes. We generally run 2 paramedics per truck and usually will spend a few extra minutes on scene to get treatments done, when appropriate. In my opinion......we take ALS to the patient and in many instances the patient benefits more from on scene treatment than if we had rushed them to the hospital where they won't see a doctor for 30 plus minutes or recieve any other treatments. At my full time service the providers many of times will elect to transport without getting treatments started, blaming short ETA's for not giving meds, etc. In my opinion this is just pure lazy because 90% of our patients would benefit from the additional 3-5 minutes in the feild with meds, etc. having been done. :roll: As you can imagine I tend to treat rather than run and be lazy, of course this is not always appropriate but it can be done often.

My service went to mainly 13 hour shifts, this gives an hour of overlap to give report, bullshit and have coffee......we weldom catch a late run. We still do 24's on occasion though we actually doa 25...in at 0600 and off at 0700.

I have used verapakill twice, both times it worked fine but the pucker factor is high. We actually just removed it from our bags about a month ago.

We don't carry any kind of antidotes for those meds, so support ABC's and transport. I would consider charcoal possibly via NG tube only if I were a great distance from the hospital and we knew apprx. when the meds were taken, of course medical command or poison control would be a resource here.

I use the Littman master classic, purchased it 7 years ago and have used it on every shift since then. I have had no problems with it as I have a slight hearing problem and am sure it will last me another 5+ years. Not bad for a $70 investment!!

Thanks for the info...... At my service we are unable to transmit however from our report the ER docs generally recommend a STEMI alert if its indicated. Our local facility is recently accredited as a chest pain center and this has been a hot topic for them. We are currently researching the best way to transmitt 12 leads to the hospital and will most likely see this happen by years end. As far as treatment of chest pains with morphine, if they still have pain when I get to that step I call for it regardless of the 12-lead. The docs generally order it if indicated.

As far as your treatment of the Seizure activity, I don't thing you could have done it any better. If its not obvious to you, your partner or the ER staff I would be willing to bet you were right. Of course there are a few people who are damn good at faking seizures, and even if they did fake it you won't be getting sued later on for it. Just remember, if it looks and smells like something...its usually true. On another note, a patient doesn't have to be unresponsive, icontinent and having a full tonic clonic seizure to benefit from treatment. I have seen a few patients (however rare) that suffer from focal motor seizures usually after a stroke event that have no diagnosed seizure history. These patients usually are still able to talk but act disoriented and somewhat lethargic like a diabetic. Just keep alert and do your best!!

Check this out..... www.gvems.org

Not really, but she would do in a pinch. TPBM......needs a good night of multiple orgasms!

How did you know, I love to harrass my partner when he can't find his phone!! The person below me frequently farts silently and leaves the room for others to enjoy with no warning.

My fire department does rescue, my EMS agency also does rescue for 5 fire districts for which we cover. Personally I have seen good and not so good extrications from both. The advantage to my EMS agency doing rescue is that we have a pool of 5 fire companies to pull from for manpower.......the result is a well rounded, experienced and thinks outside the box as a team group of people who have proved they can get the job done. Its great having people from different companies who can share knowledge. Anyway, I just think you have to look at each situation differently........what works for us will most likely not work for you. EMS or FIRE..........who cares as long as it gets the job done!!

I wear Rocky Paratroopers, my last pair lasted me 5 years wearing 48+ hours a week on duty, only had them re-soled once. I keep them polished and treated with mink oil on a regular basis. After I get them broke in I put a pair of Dr. Sholes work boot insoles in them and they are comfortable as I could ask for. I have tried many other boots but they just don't seem to hold up longer than 6 months to a year.

It doesn't make a difference whether you are a volunteer or paid when it comes to training and industry standards. If a training/education standard is set for all agencies, then all agencies would have to abide by it. Lets just remember that just because you had 10 million hours of training, doesn't mean you are a better provider unless you actually learned something. We need to keep it practical and keep in mind that small towns USA outnumber by far those "urban" area's you all think should be modeled after. The rural citizens deserve the best care their own communities can offer. And as a side note.........the paid vs. volunteer thing is nothing but a bunch of crap. There are good/great and bad/terrible providers on both sides......so stop puffing up your chest just because you do it for a living. I do this for a living, but routinely interface or work with volunteers who are just as good as the paid folks. So grow up, move on and discuss a practical standard that would provide good care to all of our country not just urban area's. This is a profession regardless of pay.

I think that this was a no brainer from the beggining.......STOP the seizure first, then treat low blood sugar when you get to that point. It was really fun to read some of your thoughts though. :oops:

Our local facility does not accept, but all of the others will accept pre-hospital labs. We generally don't draw them here at all. As far as pre-hospital IV's........they use ours here. I don't know of any local facilities that pull them.

The statewide protocols have been designed so that there is consistent care across the state, as of now you have each region writing their own. The pitfall to them is that they will have to be approved by each region and may be modified by your local/regional medical directors. For our region, the statewide protocol will be a step backward in some area's and a step foreword in others. Our medical director has already verbally approved several upgrades for us including nasal medication administration, the King airway and a standing pain management protocol........he just likes to use what someone else has already written so we have to wait for the hard copy to be approved at the state level. All in all I think this will be a good thing.

Spock, I too work in a rural PA region where we have had an ongoing ET study....out of 2-300 intubations so far there have been 2 confirmed misplaced tubes, both by the same medic (discipline issue here). I don't believe that this is as big a problem as some people would like to think. Wave-form ETC02 monitors are required in the NY state region where I work part-time and I think.....not sure that the entire state is requiring it now for pre-hospital intubations. We have them but not enough for every truck yet, wish the state would mandate this so we could upgrade!! As far as rescue airway devices, we use the combi-tube with great success. I have seen the King demo and would like to carry this as an additional device with the combitube. What would be even better is to get the state onboard and let us have a study with basic providers placing the king in cardiac arrest patients as we sometimes are 30-45 minutes behind them in the rural areas.