Aeromedic

From a Supervisor's standpoint, if the protocol left questions, I'd expect my staff to talk to me. Somewhat echoing what has been said before, titrate to effect. I do know of some jurisdictions, services and even individual medical directors/consulting ER Docs that have different opinions on it. In the field, when in doubt, medical direction. My protocols state that doses can be repeated without direct medical control, but to be honest, I've only ever used single doses personally. Kristina mentioned that her son needs 2 doses, and I would take it under advisement and give him a second dose if needed. There is something really to be commended here though, asking questions. Don't be afraid to ask your Supervior/Education director/Medical Director what their preferred approach is in their service, because like you said, it can vary. I have worked for services where I had standing orders for absolutely everything in my kit (mostly because of communication difficulties due to remoteness) and others where I would have to call for gravol.

In Saskatchewan we have a 1 year renewal period with (depending on your certification level, EMT having the most required credits) Continuing Medical Education Credit requirements. All programs must be approved by the Saskatchewan college of paramedics, certain things are mandatory for certain periods (CPR yearly, Biomechanics of Safe Lifting every 2 years etc...) and others are whatever you can take that fits the requirements, whether online or through in-service training sessions. 5 year periods would be nice...

One of the professors that I am working with spent a fair bit of time working alongside the CSU in NY as well as the Traumatic Stress Response Group with the LAcoFD. There is great research and some great treatments and tools out there for it, and a lot of very large services have the resources and need to have full time staff (and even whole units) dedicated to it. The groups that I am targeting are those who are working for the services that contract out counseling and to try to help encourage people to seek the help that they need and to keep an eye out with partners and other co-workers to help spot symptoms before they become severe and possibly debilitating. As a sidenote, I've been asked by an RCMP psychologist to help design a program for their supervisors to help spot traumatic stress and after-effects of first hand and vicarious trauma in members, so there may be a "supervisors edition" as well.

I gotta say, I'm both encouraged by this thread and, well, disheartened. I'm very encouraged by the desire to have more education about stress, PTSD and ultimately, practitioner well being. Seeing that there may be a gap that I can take knowledge from my 2 passions and fill is an excellent motivator to create something "new" or at least improve upon what already exists. What disheartens me is the feedback that I am getting about lack of programming in so many different places. Honestly, I was hoping that I would get a lot of replies of "Oh, good idea but we have a great program here" or "A fresh idea would be nice to compliment our XXX program." One of the up and coming "trends" in psychology is something called Psychological First Aid. Very much like CPR is saving lives, PFA is starting to save minds. There is some great research being done right now on a broad scale as to the efficacy of the initial interventions, but the early results (which I have seen, but can't re-publish) are VERY promising. Now, PFA isn't an EMS thing, its coordinated and executed by Psychologists, but its principles of early debrief and guided recovery from incident to acceptance are what I really want to drive home for people. I must stress one big point, and I know I may offend a few people, and its not my intention, but it must be said. In House CISM debriefers and Counselors aren't psychologists. Some services outsource CISM to counseling firms where you will work with a psychologist, but the key is going through the process with a licensed clinical psychologist with experience in CISM and PTSD. The initial debrief, although very important, is only the first step to recovery. I'm sure everybody will agree with me that we rarely agree on anything... but we are all different. Finding the right approach for a person takes a lot of experience and training, and it is compounded by major traumatic events. Only a Psychologist (and occasionally Psychiatrist, but they train in very different ways)has the knowledge and base to work with you long term and create a solid treatment plan. I will probably be starting on this project very soon, and I hope to have a draft/demo up by the end of the month. I'm lucky enough to have most of the research done, which is the hard part.

Personally, I don't think that a Mosque should be allowed on the site. Not because of the religion of a terrorist, but because the site should house no church, mosque, synagogue or holy lemonade stand. People of all religions, races and beliefs were affected and I think that an "interfaith chapel" or something of that variety would be appropriate. Understanding that the Mosque is supposed to further "unity" I understand, but really, how many people go into somebody else's house of worship to further unity? Catholics go to Catholic Churches, Lutherans to Lutheran Churches. I would have no problem with an "Islamic discovery center" or something small, aimed at education, but not a mosque proper. I have no problem with anybody's religion but I think if at all possible, keep the site as open to all religions as possible. Have an Islamic memorial, a Christian Memorial, a Jewish Memorial, heck, even let the Pastafarians put up their own memorial, but make it accessible and comfortable for everyone.

Working at a small, single car station, we're considering using Wind to augment our existing power supply. I'm in Saskatchewan, so it is cold, flat and Windy (year round). We will of course still be on the grid as a backup but after doing some math with our power consumption (the majority of it coming from the unit's shoreline/block heater) we have figured that we will be making about $15/year re-selling power to the grid. (yea, $15, not much, but it'll buy us lunch one day) We were initially skeptical about what we could do with it, but then we realized that the majority of our grid-based power outages come during, you guessed it, windy and stormy periods. With a good battery system, we figure we may actually be able to functionally replace our generator with wind power (again, keeping it as a backup with regular on cycles and servicing of course). For us it hasn't been a matter of cost recovery or output cost, rather, just a desire to do something different and be an example for everybody. We are slightly different from most other services though, our station is just a garage. Quarters are located in the adjoining hospital or at home for our 3 members who live in town (our town spans 4 blocks, you can sneeze across it). Because of this, our power usage is quite minimal, again, with most draw from the shoreline (85%) 10% coming from our light sensing outdoor CFL Fixture (which I want to change to LED because it attracts fewer bugs), 3% from Garage Door usage and the remaining 2% for the odd occasion we actually turn on all the interior lights in the garage. Personally, I think Wind is a superior method to solar if it is feasible in the location (which of course it isn't always) just because newer windmills can put out a lot more juice with a smaller footprint than equivalent solar systems.

He looks like a card carrying member of the village people... As a side note, when do I get MY cool fanny pack?

I'm notorious for my pranks, but yea, this goes too far. Oral Glucose on a doorhandle = Sticky Hands, it washes off, its funny. Violation of Patient Privacy = No excuse ever. We've all got those "calls" that happen that we find funny and want to talk about, joke about and laugh about. I'm guilty of telling "stories" about my amusing calls, but I always try to change locations, times, etc... keep enough of the story to keep the funny factor and the "real" but distort it enough to keep it from infringing on privacy. I really think this is a good eye-opener for a lot of us, especially because he is a lieutenant and "should" know better.

I'll have to scan and post a strip that looks VERY similar, except my patient looked a bit pale and said she felt "kinda weak and a little bit dizzy". Extensive Cardiac History, meds took up half a page of my PCR, but yea, her pulse felt rapid on initial and she said she wanted to walk, she didn't want to be carried. When I got her on the monitor I nearly soiled myself, as it was my first time seeing a vtach that wasn't pre-code. Called for adenosine but the doc decided that as long as she was conscious and stable to let it run, set up to cardiovert if needed but rapid transport and have a cardiologist waiting. As for this one, yea, its V-Tach. Rate + Form + Duration = V-Tach. I would be very comfortable with that as my differential when I got to the ER.

Born and Raised in Calgary, I'm now from the land of the Green and White wierdos with watermelons on their head... aka Saskatchewan.

For those who don't know, I'll be graduating with my B.A in Psychology in 6 months from now. One of the projects I'm undertaking for my final semester is developing an education module on Post Traumatic Stress Disorder. I've had a few very nasty run ins with PTSD myself, and I was amazed at the lack of education about the signs and symptoms of PTSD as well as what can be done early on to help reduce the impact of it. I am planning on developing a powerpoint based course (about half an hour to an hour long) that is aimed at field level practitioners to help identify the symptoms in both yourself and those around you as well as some strategies for coping with stress in the workplace and at home. This isn't going to be an hour of psychobabble that you wish you could get back, rather, something that everybody from a MFR or Firefighter First Responder up to Critical Care Paramedics can find meaning in. I'm wondering how much interest there would be out there for something like this if I were to expand it from beyond my Health Region and made it available to others across Canada (and the US if so desired). The reason I'm asking is that if it is going to be used on a broader scale, I will have to tailor it more generally rather than using just the resources available within my region. Let me know if you think this would be useful for your service/area as well. (By the way, it will be free of charge)

Things do get lost after some time away. I spent 5 years off of "On Car" work, instead working mostly Flight and Clinic based where I didn't do as much on scene work and when I went back to On-Car work, I was kinda lost. The basics of patient care really stay the same - Try to keep patient from being dead. Although things change, the hands on experience you have far outweighs a lot of what people learn in school. So yea, maybe it is a good idea to sit in on a couple of classes to refresh the theory stuff, pick up a bit on new technology, techniques and protocols, but the foundation is there and the experience/knowledge of a career is also with you. I'd take your advice over a rookie any day.

My Service issues the following: Pants (usually 2 pairs a year, I've ripped a few, blown a few buttons, so I have gone through 10 in 2 years, have 6 right now) Uniform Shirts (usually 2 per year, but because I don't live in town or have laundry here, I have 10 to compensate for the up to 6 24 hour shifts I'll work) T-shirts (for night calls/undershirt so you can strip off a contaminated white uniform shirt, 3 for me, 2 for everybody else (again, because of laundry/amount of shifts I pull)) Long Sleeve T-Shirt (see above) 3 in 1 Jacket (good to -40 (because we need it here), not technically "yours" but sized to you, left at station in case other casual needs it, I'm an odd size so nobody else wears mine, worth about $700) And that is it. I supply my own duty belt (leather, not the 2 piece style), boots (Danner Acadia steel toe), shears, scope, pens, notepads, etc... TBH, I think every service should have a good supply of pens available for staff, as I seem to go through a few, and they're cheap to buy in bulk. As for our rig we are VERY well taken care of. 2 KEDs, Stryker Power stretcher, Stryker uber stair chair (with creepers), LP15 with BP/SP02 and our unit is a 2009 Demers Mystere III on a Chevy 3500 duramax diesel chassis. We are talking about having a $250 boot/gear allowance every 2 years for the active staff. The reason all of our gear is top notch is because we are run by a Volunteer group. We are "owned" by the Lions Club, so we are not for profit. The money we make goes back into gear. We tend to keep units for 3-4 years and then trade up for something else.

Hey everybody... I'm back. For those that don't know me, I'm Aeromedic, aka Vinny. I've spent the last 5 years working in remote areas either with municipal funded flight/transfer EMS or working with the petroleum industry as a safety/medical specialist (with on car and clinic time out there). I've left that world behind me, I'm engaged (getting married this summer) and now I have a cushy, slow rural ground EMS gig. The reasons for my absence are numerous and include everything from lack of time to major PTSD, but all that matters is that I'm back and looking forward to seeing all the old crew along with meeting all the new members. Sadly, it looks like I am starting at the bottom level for post counts...so I feel like such a n00b. Oh well... gotta start somewhere! Aeromedic aka Vinny "Death"

I'm with JT on this one. I tried a Master Cardio, a Cardio II, Master Classic while I was working remote/flight and they are all incredible scopes, but far too touchy for what I needed. I have an ultrascope and love it to death. Of course, while in the air, most of the time we had specialized digital scopes, but riding down rough backroads (and especially now doing rural) I found that a Master Cardiology meant that I heard EVERYTHING. The ultrascope is more pressure sensitive, so you can manually filter a lot of sound out. Really, the big 3 uses for the scope are Lung Sounds, BP and Chest Resonance (for me at least). Heart tones don't need to be as precise (again, for me and within my protocols) because I'm just listening for muffling and to get the big picture, same goes with bowel sounds, I want to know if they are present or absent in areas, I'm not listening for exact sounds. BUT... It really is personal choice. I really suggest seeing who around you has what scope and giving it a try if you can. I have a partner who swears by a $12 nursing store special and can do everything with it. I really don't suggest digital scopes for regular use, however. They are far too expensive and prone to mishaps and breakdowns in the field. (our digital for flight never left the cabin, we all carried our own conventionals for field). Don't be fooled by price, expensive doesn't mean good for what you want it to do. Also keep in mind replacement parts, ease of cleaning, ease of carrying for your own personal preferences and identification. I love my ultrascope because it is bright orange with flames on the head, it doesn't go missing because everybody knows it is mine and if they take it I'll break 2 non-adjoining long bones. Its like buying a car, really, take a few for a test drive if you can.

Thanks guys/gals, I appreciate the kind words (and the advice of don't do it...lol). Don't worry, I won't pass out.. (and if I do, I'll have an ALS car on standby anyway, its our "limo") For those who have already taken the plunge, is it usually this scary? I'm not a worried about the marriage part as much as the wedding part (we've been living together for 2 years), anything that I should plan for? Besides the usual food, booze (which isn't free...because I'm cheap), chairs, tables, plates, glasses? I think my time spent fixing the catastrophes befalling others has made me a bit nervous for planning my own event...

Hey Everybody, I know you haven't seen me in a while (about 2 years), but I'm back after a long period of travel, self-reflection and all the other crap my therapist told me to do... With my return comes, well, a Wedding. I know, I know... "WTF Vinny, you found a woman that puts up with you". In fact, I did. She is lovely, and although I may be shunned from the site for admitting it... she is also a dispatcher. She only works on a very casual basis now, she's a jewelery designer full time now. We're getting married this August in Regina, and its a terrifying experience. Honestly, this whole wedding planning thing is downright scary (not to mention expensive). But, I'm happy to know that I'm giving my life to a wonderful woman (just in case she's picked up my laptop and is reading this). There is going to be a distinct Warped EMS feel to the wedding. Our wedding favours are urine specimen bottles with customized yellow M&Ms. Anybody have any wedding advice? (besides the "don't do it you idiot") Really, any advice is useful for making the day go better, things I may not have thought about while working 2 jobs and going to university...

I guess part of the "issues" with my post come from my lack of experience with the US system. Our "BLS" level here carries IV, D50, Entonox for Pain control, Nitro, ASA, Gravol, Glucagon, epi, ventolin, atrovent and a couple of others I can't remember. You guys are right, Assessment is the key, and I did somewhat gloss over it. I don't know how detailed the training for EMT-B's is with assessments but I would hope that they have enough sense to be able to spot ABC problems and know if one of those exists that ALS intervention would be warranted. I think that there are a lot of experienced basics out there that we don't give enough credit to. I don't think any Paramedic can comfortably say that they learned to be good at their job just by going to school. I know I learned most of my best techniques and gained my confidence from Practicum and from experience with other medics. A basic who has been on car for 10 years has seen quite a bit and will often know when things are going south, so I don't think it is fair to discount the knowledge and skill of all basics. I think anybody else who has worked in environments where you are the only practitioner for 4-5 hours around will agree that having somebody with half a clue doing basic interventions for the X minutes or hours until you get there helps. When I was talking about having a basic set up an initial 12 lead, I wasn't talking about when you are 2 or 3 minutes behind, I'm talking about when you are the next service over and you might be 20-30 minutes away. I disagree with the whole "Scrap BLS" argument. I've spent my whole career in remote areas. Many "Ambulance" services are a single EMT with a driver because they get a call a month if they are really busy. There are no full time paid staff, it is all volunteer and they serve a population of under 200. It is just not feasible to have ALS providers in those situations because ALS skills need to be used to be kept current, and these places are remote enough that you don't have the option of working a second job with a busier service or working in hospital. I fully agree that ALS care should be universal, but sometimes BLS (or even glorified first aid) is better than nothing.Thinking that there could be ALS everywhere is utopian, it just won't ever happen so we need to find ways to make due with what we have. Personally, from what I know of the US System, dropping the EMT-B and upgrading to just EMT-I would be the best way to keep things cost-effective. Keep in mind, however, that paramedics don't grow on trees. I don't know any service that wouldn't love to be double medic, or even better, ride 3 medics to a car. It just isn't possible all the time with staff and available medics. Most cities in Canada try for 2 medics, but there just aren't enough medics to go around. To reply to Timmy with the BLS crew not transporting, the vast areas of nothingness in parts of Canada make it impossible to do. There are communities that are 1-2 hours from ALS service (some even more remote), and to let them sit with BLS providers for 1-2 hours until arrival, and then have another 1-2 hour transport (because lets face it, Air Ambulance can't run all the time, winter storms are common) when there could have been a .5-1 hour window of BLS only care with an intercept, and then only another .5-1 hours to hospital. Finally, about the drugs and the ALS/BLS stuff. Every drug in the box is important, every drug in the box can save lives. But using these drugs takes a LOT of education and experience. The drugs I mentioned as "Vital" are those that can be administered by anybody from an MD down to an EMT-B without needing to have the training and experience. Yes, a lot of things I mentioned and called "BLS" skills ALS providers do, actually, all of them do. The foundation of ALS is BLS. You don't start ACLS without CPR, (BLS Skill). ALS providers use BLS skills all the time, heck, a lot of calls that we do are straight BLS calls. The point that I am making is that BLS forms a foundation, and these skills are the base for ALS treatment. I'm not totally forgetting about easing suffering, that is the bread and butter of EMS because we're not all running codes all the time. I'll admit to the rocks in my head part for saying that we only need Epi and o2, it was late at night after being ass-deep in muck for a vehicle ex, so yes, there are other drugs that need to be carried. On Pain control, I agree that pain control is important for ALS practitioners, but that is because ALS assessment skills, experience and knowledge facilitates the proper administration, and most of all, knowing when not to administer them (altered LOC, our protocols are to withhold with ABD pain unless you call for a consult). These are ALS things, and you can't give a BLS provider pain meds without a LOT more training, and that is the point that I am making, that to be able to do ALS skills and use ALS meds, you need the confidence and experience that comes with ALS training.

This is an issue that has always been near and dear to me. I have read a lot of "Monkey Skills" comments, and yea, starting an IV or Intubation aren't that hard to do. But the time spent in class learning When to do it, How to do it right and most importantly, How to fix it when something goes wrong. Do I think EMT-B's should be trained to set up 3/4/5/12/15 leads, Heck yes. Emphatically, yes, do, please, but not in a diagnostic capacity. If I intercept, have an initial strip to look at, great. If I can have a 12 lead set up for me while I'm getting a line, doing a history, etc... great. Worst case scenario with a bad 12 lead placement is I get a useless strip. If they weren't trained, I wouldn't get a strip at all. All this being said, ECG's are a different animal from Drugs and invasive procedures. Lives are saved with BLS. Maintain Airway, Assist Breathing, Start CPR, Control Bleeding. Drugs are nice, drugs are good, but they can't replace rock solid BLS skills. Everybody has a place in EMS, and if B's were useless, we wouldn't have them. A lot of it comes down to cost. Medics are expensive to train, to hire, to pay and most of all, to outfit with all the goodies that they need. A Basic car to rapid respond, rapid transport and run with an AED and be able to pre-place for 12/15 lead makes a HUGE difference in EMS. If I can get to an intercept with an initial strip, patient packaged and ABC's looked after, I've got it made. A lot of this debate comes down to one of my biggest pet peeves... Overuse of ALS Skills. Not everybody needs an IV, and sometimes Oral Glucose is just as good as D50. The only drugs that NEED to be carried all the time are Epi and Oxygen. Those two save lives hands down. Cardiac drugs are nice, but they don't always work. Pain control is nice, but it can create huge headaches if you aren't COMPLETELY sure of your assessment pre-administration. Any ALS drug kit can kill somebody in countless ways (and it does sometimes), and that is with trained paramedics. I personally think this debate is less about skills and saving lives and more about feeling important and "needed". ALS Guys/Gals need to give BLS Guys/Gals credit for their work more often and show more appreciation, and most importantly, keep in tune with their BLS roots. Those are just my thoughts on it though.

First, I wasn't there, so I don't know all the details. As a Lt, if my partner (even if they are straight out of school) has a suggestion that they think will better patient care, I will accept (unless I feel it compromises care in some way), otherwise I will run with it, and discuss after the call. I don't totally buy what he said, but again, I wasn't there and I don't play with your equipment, or play by your protocols. I think it needs to be discussed, rationally, as to the pro's and cons, and something should be learned from it, by both people.

Don't Drink and...well...walk... http://www.thesun.co.uk/article/0,,2-2007280646,00.html

I've got a simple solution for this problem.... Toss him the keys to your captains car and tell him to go nuts....

I deal with this on a weekly basis. In a lot of remote reserves in Saskatchewan and Alberta, the band council pays for ambulance transport. We get frequent flyers who have absolutely nothing wrong with them, calling, basically for a free ride into town. Policy has kinda wavered on it a bit, in the beginning it was transport everything, then it was no transport unless needed. People started calling with SOB, Chest pain, etc... If a patient wants to get there by ambulance, they'll make something up. If I were to be doing that exact scenario, doors locked or unlocked, you're kinda screwed either way, you're gonna have to unlock something at some point. If I was in town, it would be a quick scoop and drop, no wait times, make him sit on the bench or airway seat so you don't have to change the linens, dump him off at the ER, he'll check himself out, no waiting, minimal paperwork, out of service time is under 15 minutes. If I was the only unit out in the boonies (where I usually am), especially the only ALS rig, I'd be a bit more hesitant, most likely calling MC for advice....and then he'd complain of chest pain and I'd end up taking him anyway.... I think the moral of this story is, no matter what....you're going to lose. Even if you tell him to go take a long walk off a short plank, there is a good chance something is going to hurt and you'll end up hauling him off anyway...

I don't usually have a lot to do with K9 teams. As for gear, all the standard ALS kit rides in a bag in my rapid-response truck. I am in a strange situation, because I do a lot of Rural Tac-Medicine. We don't always have an ALS unit available to respond, so I can take over when needed. Touch wood, I've never had a major trauma on a call, we haven't had any major incidents, however, little things are common. I get a lot of guys with sprains, strains, splinters, minor lacerations, the occasional broken nose from a door gone wrong. Worst I've treated was a broken foot from a ram being dropped on the instep of the lead. My narcotics are on my belt, however on my back I only have the absolute life saving basics, because if there is lead flying, I want to spend as little time as humanly possible in there. The last thing I want to do is try to get a line while somebody's trying to shoot me.

Things to learn from this post: 1.) They don't pay us enough to do stuff like that 2.) If PD isn't on scene for at least 6 hours after a triple shooting, something has gone horribly wrong with your local 5-0 3.) If there are that many of them, and they are that angry with you.....you probably wouldn't be typing that, having worked on a number of reserves, if they want you to go away, they make sure you go away, remember, "Hunting Rights" means they have guns, and are good with those guns 4.) A mass migration of people like that in POV would cause such a traffic and parking nightmare at a small little hospital, you'd be lucky to even get within 5 miles of the damn place.