Aeromedic

I've spent a good portion of my career doubling in Sports Med (actually, it was Sports Med that got me into EMS) and ACL can be either a total nightmare or a walk in the park. Having worked with quite a few ACL tears from Fastball, Football, Skiing and Hockey, the common theme for good recovery is persistent training and rehab along with following the directions of the Doc, Therapist and most importantly, your knee. First and Foremost, listen to the Doc and the Physiotherapist/Athletic Therapist that you are dealing with. If they give you a timeline, stick to it. I have seen many athletes kill careers by pushing too hard, trying to accelerate things and causing irreparable damage in the process. Like CrapMagnet said, it is a marathon and will take time and patience. Talk to your practitioners about options for braces as well. After injuring an ACL your knee will be more susceptible to re-injury and often a hard brace can take the strain off the ligament and help healing as well as preventing further injury. The most important thing to remember (and isn't stressed enough imo) is listen to your body. Your knee will hurt, when it hurts it is telling you to take it easy for a while. I know this sounds repetitive, stupid and/or common sense but it works. Too many people go into Physical Therapy thinking that the therapist is all knowing. Even the best don't know when something is getting sore, so tell them. "Hey, it hurts more when I do this" or "Its starting to get really sore now" are phrases that can be the difference between 4 weeks in rehab or a lifetime of pain. Finally, be aware of your limitations and the movements/stresses that can cause re-injury. By knowing what could put you at risk of re-injury, you can find ways to shift body position while lifting/moving that put less strain on the affected knee. Be careful of your other joints and especially your other knee however. Because you will be putting a lot more strain on the non affected side, it will become sensitive and susceptible to injury as well so be aware of both knees/hips/ankles and rest as needed. Here's to a speedy recovery.

One of the Laws that I'm really applauding up here allows professionals to apologize without it being a court-admissible statement of guilt. One of the Docs I work with, he was sued after he slipped with a scalpel while trimming cartilage in a knee and accidentally nicked a tendon. He apologized to the patient and told the patient that they would have to spend an additional week off of work because of the tendon injury, but would make a full recovery with no further adverse effects. Because the doc apologized, the patients lawyer argued that he admitted wrongdoing and accepted liability. Patient was awarded nearly $20,000 and the doc had no recourse because he apparently admitted guilt. After talking to the medical board (which refused to back him because he had "admitted" his wrongdoing), they told him that you never apologize unless it is court ordered because you leave yourself open to huge liability. That is one of the main reasons you won't hear even a quick verbal apology, which I think is a total shame because a simple I'm sorry (as illustrated by others) could go such a long way.

I'll admit to having used kitchen chairs to get patients out of tight spots before (if they were already on the chair and time was a factor) but only to a place where it was possible to transfer to stair chair, stretcher etc... I can see an ad like that REELING in the high power attorneys **snicker** but as for actual negligence, it looks like a judgement call that just went wrong. I can't say what I would have done, because I don't know the whole story behind it. I would prefer to use a stair chair if I'm going any further than out of the bathroom but sometimes improvisation happens.

Since I'm getting married in 2 weeks, I have no spare cash on hand, but... A group out of Canada may be able to be of some assistance. Look into the "Pirate Party of Canada" (http://www.pirateparty.ca). Although it started as a bit of a joke, they've become one of the big voices of Net Neutrality and may have some pointers, know some lawyers, etc... that could help out. I'd suggest getting in touch with them and seeing if they can help guide you. On a related note, I have a good friend who is a Corporate Lawyer in Toronto (who would offer his services, but he is on retainer with a media group, so it would be a conflict of interest) who says that this could turn out to be a 10 year battle because of the currency of the issue as well as the potential for precedent setting. His suggestion (like mine) was to talk to groups who do lobby for Net Neutrality and open information sharing as they often have pro-bono lawyers who support the cause and may also throw their resources behind you because of the potential mess that this could become. Both he and I are of the opinion that although EMT City is a means of distributing content, the liability for such content rests on the user with some liability falling on the site owner if hateful/criminal activity is allowed, condoned or encouraged. Since this is a simple copypasta "incident", he doesn't believe that you (as the owner of the site) would be the responsible party for the infringement, rather, it would be the user posting the content and your site was merely a vehicle. It could also be argued that the ISP that he used, as well as his hardware manufacturer, browser, and heck even the power bar he plugs into also aided in his copyright infringement. I'll keep talking to the people I know in the Free Information movements to see if they have any other suggestions.

Out here in rural SK there are TONS of ALS intercepts, and they do work for us quite well. The big difference with our policies (at least in south/central) is that we never unload a patient. Through intercepts we also get ALS Care up to a half hour before a "hot and hope" sort of BLS transport. Most of the intercepts that I have done have involved Respiratory Compromise (needing steroids, lasix or vent/combi), Major Trauma where patient either already is or may become hemodynamically unstable and of course the assorted cardiac. I know that a lot that I have done have involved little more than an IV and a bit of watching, but on occasion it has gotten hairy and ALS has made a big difference. My personal thought is that if the medics can pack well enough to be able to move just gear, rather than patient, it is a much more effective and efficient way of doing things rather than having to do a patient switch on a highway, etc...

Hey.... I know I may get slaughtered for saying this...but... the ACP could be a lot worse... I've been maintaining dual between AB/SK and the SK college of paramedics takes the cake for being a PITA to deal with. Along with fees... 1st year they were in, fees were $165... Second year, $425, next year, $475. I guess I am a bit biased though, the ACP did something really good for me a couple of years back, had my wallet stolen in West Ed mall, it got dumped, somebody saw my ACP id, called them to get my address, since they wouldn't give it out, they put me in contact with the person and I got it back. But beyond that, its been a money pit The last 4 years I've just sent them the money and let things be. Maybe if I'm back in AB next year I'll pay attention.

Kiwi does actually kinda have a point. Squint (aka tniuqS) had been around EMS so long he treated Moses for heatstroke... but seriously, yea, he's been around a long time and would be a good resource. Also, talk to the Alberta College of Paramedics, I do know they have a fair bit of stuff on the changeover from APPA (Alberta Professional Paramedics Association) which really was a turning point in Alberta EMS history (as well as Canadian EMS history). SAIT would also be able to help you out with training, as they started the first Paramedic program in Alberta (in 1974, I believe... one of my former partners was in the second class...). Hope this can help you out some more.

Thanks Jake. I did kinda gloss over something completely (that somebody pointed out in a PM) that a Spreadsheet may be the easiest way to do it. After finding out more what she wants me to do with it, it is less about payroll and more about simply keeping track of hours over the year for the purposes of provincial surveys etc... The split pay rate is the biggest pain in the rear, so I think the formula table for my spreadsheet is going to read like a university calculus text.

Well, high school is easy... I teach through a public access defibrillator program and I do mostly the CPR in Schools program here. Personally, I think the Jr/Sr High can both handle the basics of CPR, wound dressing etc... I also get asked sometimes to do little seminars in Athletic Medicine for high school sports trainers etc... and those are really useful skills too for the older ones (grade 10/11/12) things like wrapping/taping, splinting. I think doing little scenarios would be a great way to get them involved in a hands on way, and keep them occupied and having fun. Little ones can deal with calling 911 and identifying an emergency (heck, even look at the "stranger danger" sorta thing too if they'll let you) and then work up to projects for the older ones like planning escape routes in the house, identifying fire hazards, identifying poison hazards and maybe even the basics of using a fire extinguisher.

The number one problem with working in a small (under 10 employees) service is the double/triple duty you end up pulling. It just so happens I am the IT department for my service (among other things) and now, after a lot of adding machine tape from our old-school office manager, I have been tasked with creating (yes, creating, the techno-inept assume if you can do fancy things on a computer, you can program)a program to track employee hours. A seemingly simple task, Full time rotation of 6 on, 3 off for our 2 full time staff and casual staff picking up the rest. Where the fun kicks in is with the pay scale. We work 24 hour shifts and have 2 different pay rates, On Duty and On Call. We get on Duty pay for 5.5 hours a day and on call for the other 18.5. Nice and simple so far... until you throw in the call outside the normal 5.5 hour window (0900-1430), then we go back up to duty pay, but drop the on call pay for that time period. Add in Partial Shift Coverage and it turns into a jumbled mess. As of right now, our pay stubs and cheques are done by hand on a ledger book. and now that year end has come up and the Ministry of Health wants to know the hours worked total/on call/per person.... it has become a flurry of adding machine tape, headaches and me being VERY glad I just fix the computers and run calls. So... Here's my thing, does anybody know of a program (preferably free) that will take care of this for me or any pointers as to a programming platform to learn to do this?

Thanks for getting me to think long and hard about something... **smoke billowing from ears** I'm looking at it like this: (I have no definitive answer, but maybe my thought process will spark somebody else) Large fluid infusions can serve 2 purposes: Volume expansion and Electrolyte Balance (less with Saline more with Ringers). From a Volume point of view: Pros: More stuff to push around. Slight thinning effect allowing for the very remote possibility of a return of VERY slight perfusion beyond a blockage (I can't emphasize very remote and very slight enough... but everything counts when you're dead). Cons: Dilution of RBC's decreasing the amount of o2 carried in blood per ml as well as risk of pulmonary edema. Electrolytes: Pros: More solution to dilute harmful enzymes from tissue infarct. Rapid infusion would carry meds more rapidly than a slow infusion/small volume flush compensating for the decreased return from CPR. Cons: Dilutes meds beyond what a simple flush and TKO or slow infuse would do. Risk of creating further electrolyte imbalances through dilution. This is my thinking so far.

My advice is to not smoke, eat healthy, get good rest and try to live as low stress as possible. Then again, this is good advice for anybody. I also think that (like everybody else) you should go see a doc. I would be more inclined to offer an opinion if I could see a 10 minute interval 12 lead, pre, during and post incident. There is no substitute for a good 'ol visit to the doctors office. Keep in mind... I could make a diagnosis and suggest a course of treatment... and I also could just be the Janitor at an EMS station.

I think I watch too much Billy the Exterminator... but for spraying pests, I LOVE pyrethrin based sprays. Natural source compounds from the chrysanthemum flower, you could pretty much drink the stuff and still be fine (not recommended...). It is safe around pets and disrupts the ability of insects to process energy, kills them pretty much instantly. Great stuff for keeping around the house in case of insect invasion.

One of my favorite pest control tricks/products is Silica powder. The stuff works great in places where you think they are coming in (obvious windowsill cracks, etc...) Non toxic to humans, but is major deadly to insects (silica micro-shards rip the crap out of the parts in between the exoskeleton plates and then because it is such a good desiccant sucks the water out of them) Although it may not be the be all and end all, it may stop a few? Might I also suggest a large swarm of 7 year old boys with little glass jars and magnifying glasses?

My partner and I send our Condolences to the Family and the Department.

I'm lucky to have the time to be able to do this for somebody. If I was working in a busy urban service, I probably would have only seen him once out of 20 trips, made a mention about conditions to the nurse and I'd be off on my merry way. Working with a small rural service means I get to interact with everybody and get to know them. I know that my partners would do the same, and I'd think that a lot of others around would also. When I left my supervisors job in remote EMS and came to Rural for an R and R break, I was amazed at the community involvement and amount of community support we receive here. Our Ambulance Service is non profit and funded completely by donations (in addition to the trip fees of course) and I think that really makes you stop and look at the community you serve and go a bit beyond what is "required" in daily duties. Personally, I would like to challenge EVERY other person reading this to get more involved in their community, whether sponsored through a service or just as an individual. Some of the things that we have done recently are our yearly "Mock Accident" for students against drunk driving. 2-4 of our staff come in on our off days to do makeup and stage the event with the local fire department (volunteer). We also ran a number of stem cell/bone marrow DNA match swab clinics for something in Canada called OneMatch. This is a great way to get into the community and get involved without requiring a lot of resources. With this program, people would swab cheek cells to be entered into a national/international DNA bank to help find stem cell and bone marrow donors for those in need. All the staff have to do is sit and help people with paperwork and collect the envelopes. I know that in a lot of large urban services it can be hard both logistically and bureaucratically to do any of these sorts of things, but for those in smaller services, I challenge you to help better your community beyond what you normally do.

Not being Humerous.... I would go with "please move to the right/Please move to the left". Would work well in heavy traffic I suppose. Although deep down I think you could write anything on it and the only people who would pay attention to it are those who don't need the extra message...

As an update for you guys, I did call the social worker that has been assigned to his case (along with 200 others, so not much "face time" with the patients) but he will be looking into options for placement for him. Of course he mentioned that he had been informed by the ER staff about our concerns and would take them under advisement, but when I mentioned the frequency of his trips, his general condition as well as the circumstances around his living arrangements he seemed to become more concerned. I'm not really worried about the "reporting requirements" as when I mentioned to the ER nurse I'd done "due diligence". I do feel somewhat better now after talking to the Social Worker because it has moved his case up above a lot of the general "possible placement needed" cases that come in on a daily basis. Now it is completely in the hands of the Health Region to decide what needs to be done, but at least I've been able to make an impression on the case worker. Only time will tell now.

It has come to my attention as a Professional Driving Instructor and active practitioner that there are significant issues with people not yielding to emergency vehicles. I believe that if we mandate USDOT, Transport Canada and other agencies to change the required decals on the front of the Ambulance from ecnalubmA to one of the choices listed above (in reverse, of course). I believe that a change like this could make a huge impact on our response times and general staff and patient safety. Who's with me?

The biggest issue that I see now is the frequency. I have probably transported him 30+ times in the 2 years I have been here. At first it was once every 3-4 months for a similar issue (usually 12-24hrs post dialysis), then it became once a month, and now it is weekly. He wasn't even home 24 hours from the hospital when I last picked him up. He's a fairly large man who will have a pressure in the mid 80's throughout the trip. The highest I've ever seen it was 98. What he really needs is a hand to get around sometimes, a lot of supervision if he falls or feels dizzy. I do know that there is a significant isolation from family, as he is mostly looked after in the community by a neighbor. Where I think things are failing is that he is apprehensive about what a care home (whether independent or full care) entails. I did find out that I can talk to one of the social workers directly (without crossing any boundaries) so I may see if he would be able to arrange for a tour or even a "transfer" to one of the homes here that is used as a triage and pre-placement facility so he can get an idea of what to expect and he may consider voluntary placement. Honestly, I'm worried about the guy, especially because of the amount of fluid he retains. If he were to fall in a supine position for an extended period of time, pulmonary edema is a definite possibility.

I've been taking a frequent flyer about once a week lately. Really, nothing new for EMS, actually, he's not as frequent as some others, but this one has a twist. This is a legit patient, post-dialysis hypotension often resulting in fall/ataxia and dizziness. I know what you're thinking... suck it up, these happen... Personally, I don't care if I take him weekly, he's a nice guy, we have a good chat on the way in. Although he is heavy, lives on an awkward 2nd floor apartment (with no elevator, of course) so our stair chair gets a good workout, I don't mind too much because he does try to help us as much as possible. My big concern is for his own safety, he lives alone with only occasional visits from a home care nurse. We are in a Rural Area, and even a full hot response, we're 10-15 minutes out (in ideal conditions) so if something happens, help is quite a ways away. I know I've mentioned to the receiving nurse each of the 3 times I've taken him this month that he should be assessed for placement in a care facility. I'm not totally sure what all is going on behind the scenes, but I tend to get the smile and nod from the nurse, and then we get the call the day after he gets home to pick him up again. IMO, if he had even LPN care in a facility, he probably wouldn't end up in hospital at all (besides for dialysis). As far as my options, I've talked to him about it (he's not really keen on the idea himself), I've talked to the nurses and the social worker. As a sidenote, an EMT in my province was recently sued for using family contact information to discuss long-term care (in addition to having his license revoked and being fired), so family involvement from my position is not an option. I feel I've done everything I can to try to get him the help he needs, and honestly, I'm kinda frustrated by the lack of action on the part of the rest of the system. Anybody else have ideas? Similar patients?

I don't know if it is as much a function of age as much as physical ability and/or attitude. I think your military background would help you stand a much better chance of being hired on. Although it is much later then many others start with EMS, I do know a couple of other people who have done it and have been quite successful. I do know for sure that life experience counts in this job, so you do have a good foundation.

How about recommend buying 2 and send one to me, I need a new one

And now with some Science Geek Time: As mentioned before, CO has a stronger affinity for hemoglobin than o2. CO also turns hemoglobin a different colour. While this colour difference isn't necessarily discernible to the naked eye, the guys at Masimo realized that they could filter the light and in fact read CO in addition to o2. This is of course because it shines a light through the patients finger and measures the refraction of X wavelength of light to determine the total oxyhemoglobin (or carboxyhemoglobin) saturation.