hertzvanrental

If the patient is ill enough to require an IO chances are they usually don't have 4-5 minutes spare. Especially if they are conscious and in agony. They want their morphine now not 5 minutes later. We got EZ-IO in 2005 with lido but  had lido removed last year so won't know about leaving it for 5 minutes. I thought it would be quicker onset. When I suture or use a digital nerve block I  find lido works very quickly

Here in the UK (in my service, formerly Sussex, now SECAMB)  we got EZ-IO on every vehicle.  We also had lidocaine 1%. Recently it was removed because it was found to make very little difference. I have to admit that I agree. I have used the EZ-IO in conscious pts and even in some unconscious pts their leg will raise up when pushing fluids or meds despite lidocaine.

There aren't many patients that really benefit from prehospital iv fluid. Trauma for a Start, particularly penetrating trauma. The first clot is the best so why risk blowing it of with Salty water! IV TXA, pelvic binder and traction splints for femoral fractures and get them into surgery. Also think about how permissive hypotension may benefit certain too. DKA,  do you  really want to fill patients up quick?  No.  I'm not saying IV fluid doesn't have its place just not in the excess that it's currently used. Here in the UK we've eased right  off. However my last patient today had some Ns, morphine, ondansetron for their acute pancreatitis!

Difficult really but I tend to agree with ER Doc. We don't know what her BP runs at normally and some patients with known HTN won't/don't tolerate a "normal" BP. Can we predict how much of a drop in pressure there would be post iv beta blockers? And as stated before she was mildy symptomatic. I'm in no way saying the OP was wrong in their treatment, it sounds like they did a great job with the pt, just saying that it's a tricky call to make. And as ER Doc stated there didn't seem a huge urgency to treat there and then. I can't remember but did she have chest pain? If so then that may warrant iv beta blockers in the field. Out of interest do any of you guys out there perform fundoscopy in the field? Anyone checking for papilloedema? As it's part of my scope of practice then I would be checking for optic disc swelling etc etc.

You risk an uncontrollable and potentially rapid decrease in BP by giving sublingual nitrates. With the potential for disastrous consequences. That is why hypertensive crisis is best treated in hospital. I'm only talking of symptom relief if required. You're not going to prevent end organ failure on a 5 minute ride to the ER. Morphine actually blunts vasoconstriction. Sub arachnoid bleeds and head injuries receive morphine with caution. And I'm not talking about loading someone up with 10-20mg, I'm talking 2mg-4mg to give some relief. A small dose like that is highly unlikely to be detrimental to the patient's BP

Iv paracetamol (or morphine titrated to effect) and Ondansetron for symptom relief. Monitor and transport. Avoid nitro, dangerous and outdated practice with regards to managing HTN in the field. You've got no control. What is the rationale for treating HTN in the field?

We have it here in the UK. My service was one of the first. Used it quite a bit. We obviously use it in Trauma but is also now indicated for post partum haemorrhage (we've had syntometrine removed and are not getting misoprostol), internal bleeding etc. In fact used it 2 nights ago. Eastern European guy was beaten by 6 guys and left for dead. Had lost about 600ml on the floor from a mouth injury. Had to suction him, apply constant direct pressure en route to the ER/AE. BP was down. Treated with fluid and 1g IV TXA.

Have a camera on a tablet so a Dr can interview the patient! WTF!

Train staff appropriately and have alternative pathways so patients can be referred on if required. No good trying educate the public, the great unwashed are too stupid or can't be bothered to even listen.

The first paramedics are trained in England - British heart Foundation

The first paramedics are trained in England

A traumatic episode at a patient's home leads to a new training course for paramedics in England.

In 1965 we helped Dr Frank Pantridge to launch the world's first ambulance-based resuscitation service in Belfast. Four years later Brighton-based cardiologist Professor Douglas Chamberlain was inspired to build on Pantridge's work after a catastrophic consultation in a patient's home:

'As I examined the patient's chest he apparently died. I started vigorous chest compressions and commanded his wife to dial 999. After what seemed a very long time I heard the two tone of the ambulance. The driver came in and I said, "Where's the defibrillator?" He said, "We don't have it. We have to report back to the Medical Officer of Health who will decide whether to send the coronary ambulance."'

After another wait, the right vehicle actually arrived. The defibrillator was brought upstairs, plugged in and turned on, 'and there was a great explosion,' remembers Chamberlain. 'Clearly water had got into it. I later learned that where it was kept had a leaky roof. It was quite a major bang, a lot of smoke. It was an awful thing; it haunts me still.'

The day after watching his patient die in such awful circumstances, Chamberlain told the Medical Officer of Health he wanted to shake up the system and train ambulance staff to do what Pantridge was doing in Belfast. 'And so we took the first six people from Brighton ambulance station in the first week of July 1970, and I very quickly had a six-month course mapped out. So by the end of 1970 we had six trained men - we didn't call them paramedics then. I went on giving that course for 26 years, every six months.'

Such schemes multiplied through the 1970s and 80s, maturing into a national training scheme.

Image: Professor Douglas Chamberlain

The POP video was great. What a great bunch of doctors. I know it was about US prehospital care but it's a shame they didn't get together with likes of Professor Douglas Chamberlain who was a cardiologist in Brighton, UK. He had a similar idea in the late 60's but due to politics couldn't the programme up and running til the early 70's. He's our honorary medical advisor still. Had the privilege of being taught thrombolysis etc by him. Wonderful man as I'm sure his American counterparts are

Ridiculous and unprofessional!

However obviously not a stroke then! O2 in a stroke, was she hypoxia then???? Highly doubt it.................

Ridiculous and unprofessional!

However obviously not a stroke then! O2 in a stroke, was she hypoxia then???? Highly doubt it.................

All the above

Can he straight leg raise?

Urinalysis etc etc

Altered neurology (Inc the left leg), reflexes

Full family hx re: cancers etc

CVA tenderness

Hx of recent trauma, exercise

We don't have the same transport ambulance service as you here in Sweden where I live. As this list shows all your meds I was woundering what kind of drugs you have in your emergency/911 ambulances? I guess the list is a bit different depending on which state and company we're talking about, but generally? Can someone post a list of your emergency-ambulance drugs? Would be interesting to compare with the drugs we're using over here.

Hi here's a list from the UK of what our services are using:

• Activated charcoal
• Atropine
• Adrenaline
• Amiodorone
• Aspirin
• Benzylpenicilln
• Buccastem
• Chlorphenamine
• Cyclizine
• Diazemuls
• Dicobalt edetate.
• Entonox
• Furosemide
• Glyceryltrinitrate
• Glucagon
• Glugogel
• Glucose 5%
• Glucose 10%
• Heparin
• Hydrocortisone
• Influenza Vaccine
• Ipratropium
• Metoclopramide
• Midazolam
• Morphine Sulphate
• Nalbuphine hydrochloride
• Naloxone hydrochloride
• Obidoxime
• Ondensatron
• Oramorph
• Oxygen
• Pandemrix
• Paracetamol po & iv
• Prednisolone
• Prochlorperazine
• Salbutamol
• Sodium chloride
• Sodium lactate
• Sodium thiosulphate
• Stesolid
• Syntometrine
• Tenecteplase / Reteplase
• Tramadol
• Tranexamic acid

Paramedic practitioner/Emergency Care Practitioner list:

• Aciclover
• Amethocaine
• Amoxicillin
• Benoxinate
• Cefalexin
• Cetirizine
• Chlorphenamine maleate tablets 2mg/5ml
• Chlorphenamine maleate tablets 4mg
• Chlorphenicol 1% eye ointment 4g tube
• Ciprofloxacin
• Clarithromycin
• Co-amoxiclav 125/31 suspension
• Co-amoxiclav 250/62 suspension
• Co-amoxiclav 375mg tablets
• Co-codamol 8/500mg tablet
• Co-codamol 30/500mg tablet
• Codeine phosphate
• Dexamethasone
• Diazepam 2mg tablet
• Diazepam (IV sedation)
• Diclofenac Suppository
• Diclofenac IV
• Domperidone
• Doxycycline
• Erythromycin antibiotic 250mg
• Flucloxacillin antibiotic 250mg capsules
• Flucloxacillin antibiotic syrup 125mg/5ml
• Flucloxacillin antibiotic syrup 250mg/5ml
• Fluroescein 1% eye drops minims
• Fucithalmic
• Ibuprofen suspension 100mg/5ml
• Ibuprofen tablets 200mg
• Instillagel Lidnocaine (pre-filled syringe)
• Levonorgestrel
• Lidnocaine Hydrochloride
• Locorten-Vioform
• Loperamide
• Metoclopramide
• Metronidazole 200mg tablet
• Metronidazole 400mg tablet
• Morphine Sulphate (IM)
• Naproxen
• Nitrofurantoin
• Nystatin
• Oxybuprocaine 0.4% eye drops minims
• Paracetamol tablets 500mg
• Prochlorperazine
• Phenoxymethylpenicillin
• Prednisolone
• Prochlorperazine injection
• Revaxis
• Tetanus/Diphtheria
• Tramadol
• Trimethroprim.

CCP:

IV Co-amoxiclav (open fractures)

ephidrine

IN diamorph

Calcium chloride

Diazepam for conscious sedstion

Flumazenil

Ketamine

Mag sulphate

Midazolam

Sodium bicarbonate.

HEMS:

RSI drugs

octiplex (for warfarinised head injuries)

O -ve blood

Hope this helps

but in this situation where is an "area" that it shouldn't have been?

Over here, sure the traffic cops want the road open ASAP, they also appreciate that the patient will always and does come first.

Forgive me if this has already been posted (I could'nt find it). But what is wrong with some of the cops on your side of the pond?

http://news.sky.com/story/1207268/cop-slaps-cuffs-on-firefighter-at-crash-site

https://www.youtube.com/watch?v=5OVCbadSqQg

Hi mate, you would have to go down the International route with HCPC which shouldn't be too hard plus you have an EU passport so no visa worries, but, do you really want to work in the UK? It rains a lot and they are a tad limited (although small moves are being made to address that) ... I would rather stay on the continent and work in one of the Doctor/Paramedic systems.

Now, can I have some kielbasa stat!?

Hmmmmmmmm, a tad limited. In what way?

Cheers Scott

Coocoocachoo

Hi, I know this is an old thread. However, me and the family are looking into Nova Scotia. My ex brother in law has emigrated there about 2 years ago (that's about as much connection as we have out there).

We're looking at about 2 years time. I know paramedic doesn't qualify for the skilled workers visa. Is there another visa? What about jobs etc etc. Would they employ a paramedic practitioner? Willing to do remote stuff etc or work for a DR out of there surgery doing community stuff. Extra skills above usual paramedic stuff include fundoscopy, supply & administer abx/prescription analgesia etc. Wound closure Inc suturing, medical glue, minor surgical procedures, otoscopy and treatment and/or referal of minor health problems/injuries. My ex bros in laws wife's cousin is the local DR and their neighbour is also a family DR. Enquiries are being made. Just wondering if there could be opportunities in that neck of the woods. Any help would be appreciated.

I think I remembered Doc talking about this before http://www.emtcity.com/topic/20644-military-approves-tranexamic-acid-for-major-hemorrhage/?p=264201

It's as cheap as chips in the UK and has been for years. Is it not used in certain types of surgery over in the states?

Completely agree there.

I sort of gathered that. I don't think any system is perfect and I have a huge amount of respect for my colleagues overseas particularly North America, South Africa and OZ/NZ.

Oh well hey ho

We're using this.

Where are you?

I only know of wake county ems using it but only in a tactical scenario.

If it's elsewhere in the USA thats brilliant.

co - amoxiclav for open fractures, procedural sedation etc etc for some advanced paras

London trialing adenosine in NCT AND leaving the patient at home!

NG/OG tube insertion.

Access to social services/district nurses/midwives/ECP,PP/GP surgeries etc therefore reducing the need to take every one in.

Clopidogrel/ticagrelor pre ppci

Low dose aspirin course & referral to a TIA clinic negating the need to transport every TIA that has fully recovered

Ring magnets in the treatment of ICD firing

Autopulse, lucas which we had years ago, now making a comeback.

Critical haemorrhage management. Inc CAT & pelvic Sam splints which we've had for years.

I could carry on

co - amoxiclav for open fractures, procedural sedation etc etc for some advanced paras

London trialing adenosine in NCT AND leaving the patient at home!

NG/OG tube insertion.

Access to social services/district nurses/midwives/ECP,PP/GP surgeries etc therefore reducing the need to take every one in.

Clopidogrel/ticagrelor pre ppci

Low dose aspirin course & referral to a TIA clinic negating the need to transport every TIA that has fully recovered

Ring magnets in the treatment of ICD firing

Autopulse, lucas which we had years ago, now making a comeback.

Critical haemorrhage management. Inc CAT & pelvic Sam splints which we've had for years.

I could carry on

I eagerly await the new JRCALC guidelines, maybe they'll look a little less like what we had 20 years ago this time

such as.........?

When did you guys get antibiotics for meningococcal septicaemia?

Steroids for asthma?

Oh and EZ-IO (inc LA) for conscious/unco kids.

And why is everyone waiting for new JRCALC guidelines? It's just the basis of UK standard of care. Each service has their own extras. And it's paramedic level. ECP/PP/CCP is a whole different level.

Yep we have it in my service in the UK along with a few others. Will be on every UK vehicle when the new guidelines eventually come out. In fact I used it the other night. Very cheap drug. It's been used for years in dental, knee and various other surgery. And PO for women with heavy periods. This is a huge step in prehospital care. It should be available to every paramedic around the world!