hertzvanrental

And for the record AUTONOMOUS pre hospital thrombolysis in AMI is old hat now (apart from a few services) opting for direct admission to a cath lab. We actually talk to the cardiologist on the phone, en route if we want. Everyone keeps banging on about cardiac pacing, cardioversion etc etc realistically how many patients a shift require it? I bet there are far more patients suffering from sepsis, respiratory problems, ACS etc etc. I mean we are so backwards in anaphylaxis we can only provide: Oxygen Adrenaline Antihistamines IV/IO Steroids IV/IO Fluids IV/IO Salbutamol Intubation Cricothyriodotomy (needle, most places - we use quicktrach, CCPs full surgical) Probably not enough to save a life eh.......... Nothing wrong with stirring it up lol Oh and how does everyone else treat adrenal crisis.............................

kiwiology, you obviously know all there is too know about us backward medics in the UK! Let's see: Prehopistal thrombolysing, been doing this for years. Would of been doing it as far back as the early 80's thanks to prof Douglas Chamberlain but Brighton paramedics were uneasy as it would of meant using stretokinase. Do you thrombolyse during an arrest! Know any where else that does? EZ-IO + local anesthetic, my service was the first in the world to have & use this year's ago AND in conscious adults + antibiotics for MS (again first in the world) CPAP is used by a few services and isn't just a CCP skill, admittedly it should be widespread. Sedation, well we can sedate various drug ODs just that a lot don't bother looking at the guidelines section with it in so don't know. Pretty hospital ultrasound Any where else doing finger thoracostomies.............hmm didn't think so. (maybe MICA) Pacing, it's in the guidelines but not many services do. And quite frankly I'm not loosing sleep over it. Look at the evidence for using it. As for cardioversion, if they're in VT with a pulse and then loose it then your dc shock will sort it out any way. Again not loosing sleep over it. Adrenaline bolus' for compromised pt unresponsive to atropine, it's in the guidelines. Ketamine & Midazolam are coming. We've always been legally allowed to administer ketamine just not possess it. Crazy drugs law. And considering the vast majority of 911/000/999/112 calls aren't life or death who else has practitioners who can suture/glue wounds, treat with a whole host of antibiotics, steroids, analgesics and refer to specific wards or back to community services. The only other places that even come close are wake county advanced paramedics & nova scotia community paramedics. And as scott33 stated IV tranexamic acid will be on all vehicles. We are using it and our lot have had it while anyway along with IV PARACETAMOL which is a brilliant analgesic (we've had that for 3 years). We also treat and refer patients all the time and have done for years. And the JRCALC guidelines are just the basis. Each service have their own guidelines. Extra drugs IV Tramadol, cyclizine, ondansetron, diamorph (that was years ago), codeine, co-dydramol etc etc. Syntometrine for PPH and soon Misoprostol, there aren't many places around the globe able to treat PPH. Christ, I bet there's still overseas services still using procanamide & bretylium in arrests and for what! You know alot of what we do is evidence based. It does piss me off getting comments without really knowing what we do.

We haven't had broslow tapes on our trucks/cars for years in SECAMB. We just use our JRCALC pocket books. The doses are based on an average weight. We used to use age + 4 x 2 and I still do if I'm caught out. This is rare as I have my own paeds laminated cards in my top pocket. Apparently the new guidelines will be out soon and should contain dexamethasone for croup.

In an opiate addict OD??? Fair enough if you give narcan diluted and keep the patient semi conscious. But unfortunately there are staff (over here) who still give narcan IV undiluted, imagine the patient waking rapidly and pulling out their EJVC line. I know, these medics need re educating. These are usually the old school types though. Which reminds of a patient who was tubed, given narcan IV, woke rapidly and ran down the street with a ET tube tied in still. He sounded like a kettle whistling as he ran off!

I definately wouldn't have gone IO first and would avoid EJVC unless in arrest situation. Do you guys administer narcan diluted or neat? If given IM then we give it neat but if given IV/IO then diluted in saline is best (shame there are lots of paramedics here who still blast it in neat ). Last thing you need is an addict waking up rapidly with an IO stuck in their shin.

Surely they can't be that bad can they? I mean every service world wide has it's stories of crap medics. I do know of the inquiry into 4 deaths in perth/WA area. Is it the medics themselves or is it more the organisation that is crap? And why is SJA Australia different to SJA NZ?

What I'm trying to find out is what can they/can't they do compared to that of their counterparts in other parts of OZ. Are they as advanced as MICA/other ICPs etc etc?

Just want to know if any of you guys can post a link with WA SJA clinical practice guidelines. I've searched and can't find anything. I've got a mate who is making the move from the UK to WA. I'm interested too but would rather ASNSW or Victoria (they are'nt recruiting at the mo).

http://www.bbc.co.uk/news/uk-11444927 It will be the worst thing to happen in the UK ambo service if this ever happens!

No, I apologise. I'll send the $2000 cheque in the post. DOH!!!!!! Hope he's doing OK.

What's so stupid. You're very clever if you can differentiate between a STEMI & a Non-STEMI over the phone!

Just out of interest how did you diagnose a NSTEMI over the phone? Or did you listen to the S&S over the phone and conclude that it may be a AMI of some description?

Sorry I know this is an old thread. Our Critical care paramedics are using IV paracetamol either as a stand alone analgesia or as part of Morphine/paracetamol combination therapy. It's good stuff.

RSI drugs will never be part of the everyday skill set in the UK. Some flight paramedics/road paramedics can administer ketamine and also have IV paracetamol now. I mean't to RSI will never be part of the everyday paramedics skill set. Only those with advanced training, still a long way off though. It's all about the so called evidence.

So if the patient also has Liver cancer or some other severe liver problem and you can't get a line. Glucagon hasn't (and probably wont of) worked. Are you still not going for the IO?

In my service (Secamb) in the UK we have been doing this for the last few years. Our version is called Protocol C. At the present time our return of ROSC and survival to discharge figures (over 35%) are among the best in the country. I've certainly noticed a massive different in successful resus cases. We have a criteria, it's not used on paeds, OD, pregnancy,trauma or witnessed arrests. For everyone else it goes like this: 100 compressions (a tube and line may be inserted at any time but no inflations until after the 3rd cycle) check rhythm 100 compressions shock (if non-shockable rhythm then we revert to UK/ERC resus guidelines-drug/fluid therapy etc) 100 compressions check rhythm 100 compressions (adding a ventilation every 6 seconds) which is basically 30:2 and carry on. I had a guy walk out of hospital after receiving 12 minutes of bystander chest compressions prior to our arrival. we turned up and shocked him once and he was GCS 15/15 by the time we got him on the stretcher. We also stay and play with most cardiac arrests and if we get a ROSC then we will wait for up to 10 minutes prior to moving, just to let them settle. As you all know many will arrest again if you start moving people straight away. Also if you start moving people while trying to carry out CPR it is pointless. You lose all the CPP that you spent ages maintaining and once that's lost you'll never get it back. Moving people will kill them.

We carry amiodarone for cardiac arrest. Some services also use it for treatment of wide complex tachycardia under PGD (patient group directive). We don't carry lidocaine any more. (Well we do where I work, for the EZ-IO). They are also looking into Adenosine (about time too!) but every thing takes an age in this dump of a country. Cardioversion is apparently going to be a critical care paramedic thing only. As for pacing, it's in our guidelines but I don't know anyone who is doing it. I'll just stick to using my fist. I agree with scott, stick the the best of both together and you wont go far wrong.

I still struggle with the North American concept of EMS with regards to Nitro. In the UK EMTs having been administering nitro S/L and Buccal for years with out having the skill of siting an IV. Never heard of any major problems. After all angina patients regularly self medicate nitro S/L. Just an observation and not a critcism

What you need to understand is that over here we may be put on a break but wont know that "little Tommy" has coded because no one has told us. Because we are on a break our control don't phone us. Where I work if we are on our break then there is usually another vehicle or response car on base covering us. If it isn't one of ours then it might be from another station. If however I hear over the radio that "little Tommy" is choking then I'll drop everything and respond. I don't know many who wouldn't respond that a critical kid.

There is no excuse for this behaviour. As far as I (and the vast majority of medics) am concerned once you have a patient on board that's it. If you are late finishing then that is just tough shit. It's part and parcel of the job. Here in the UK if you overun a shift then you just claim overtime. We've had a few situations where a crew that were close to finishing have pulled up to the station with a non-critical patient just so that one of the night crews can take over! We had emails sent out to say that this had to stop. Which it did. BUT there have been times when control have phoned up and asked a crew to jump on board! I would never entertain such requests and if control phoned up to ask me if I would mind jumping on board to take over from a day crew (with a patient on board) then I will tell them where to go. I wouldn't dream of asking another crew to take my patient just because I was going to be late. Absolutely absurd! What about continuity of care!

The paramedics had trouble getting the tube in.................... I blame on the bougie. When resusitating MJ, paramedics were heard shouting ' beat it, just beat it ' . . . . . . .

When I was in Richmond VA Jerry Overton expressed a keen interest in the ECP role and was looking in to getting something similar up and running. He has now left and Chip Decker is now interim CEO so I don't know what will happen. It imagine it would probably be difficult over in the US due to billing/med insurance etc.

Sorry. When Diazepam said don't go to jersey I thought he might mean it's not a good place to work. I didn't mean NJ medics. I put that wrong.

Sorry for being ignorant. What's wrong with NJ Medics?

Nice job. Great that we can provide prehospital AB therapy. Never really thought about Morphine though.