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dzmohr

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    dzmohr

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    Yakima, WA
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    EMS, Flying, Travel, Drag Racing

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  1. Not sure if this should go here or in the equipment section, so please don't yell if I am doing it wrong. California is drafting new AED regulations. Some are "interesting" in a California kind of way. If you would like to read the latest draft and their final copy here is a link: Link to California AED proposed regs and comments There is also a link to allow you to comment to the EMS Authority, but public comment section ends on 1/4/08. If this is in the wrong section please feel free to move it.
  2. dzmohr

    AED

    First responders were using fully automatic aed, not sure why paramedic was doing compressions. They had their monitor already hooked up but had not removed AED. They were not paying attention to the AED which had earlier given a "no shock advised" since the rhythm was not shockable. It was the medics not deep enough compressions that the machine thought was a newly developed shockable rhythm. As for the question as to my still being "on that" ... I was primarily responding because several mentioned these devices were dead or dying....and several asked if they were still making them without an answer in two threads.... they are actually being touted by CS and Medtronic as the latest new thing! They point out that just as an executioner is reluctant to flip the switch, they claim many are reluctant to push the shock button (THEY say that, not me!) Love how the equate a life restoring reset with an execution.
  3. There is a little blame to go around here...dispatcher clearly needs re-education at best, EMS, from what I understand was to hold back for PD because of the involvement of a gun -- officer would have been wise to have his weapon at ready till he knew what he had for sure..... All that is so easy in hindsight, I think I would have been thinking suicide too. Here is a link if you want more details, it is out of Niagra County, NY Unresponsive man shooting
  4. Keep in mind that in most systems a 911 hangup is law enforcement response, not an EMS response. If the caller collapsed before 911 answered law enforcement could shock minutes quicker. If the location is flagged violent or the 911 operator sensed or had a violent situation reprorted most systems have fire/ems stand back till cleared by law enforcement, again having an AED there quicker is better. You do get some interesting situations though! There is an officer involved shooting where he was responding to an "unresponsive man" with a shotgun by his side on the porch of a residence... Officer arrives with first aid kit and AED in hand thinking it a possible suicide. Sees movement, drops the medical gear and grabs his weapon and fires as he sees the "unresponsive" man swing his shotgun in his direction! Seems the paperboy that morning saw man sitting on the porch and asked if he was OK and the man did not answer him. Paperboy noticed a gun beside the man sitting in the chair who refused to answer when first asked if he was OK ( before the paperboy saw the gun and did not CARE if he was OK anymore).... Dispatch reported THAT as "unresponsive man with a shotgun beside him".
  5. dzmohr

    AED

    OK I know this is an old post, but I have not been around here for a few months and this one is important to me.... For trained responders who are likely to do resuscitations and use the machine with some frequency I like the Zoll for it's CPR feedback.... as for an overall public access defibrillator where frequency of use is reduced I have seen nothing that compares with the Heartsine PAD .... it is 300 dollars or more less then the next least expensive model, yet it is one of two that has a 7 year warranty ( Cardiac Science is the other) it is one of two that has an IP rating of 56 ( again Cardiac Science is the only other) it records up to 60 minutes of ecg, most only record 20 ... battery and pad module only costs 95 to replace where the battery alone in the Cardiac Science is 300+ and the pads for the Zoll , if you use the one piece, is 149 -- most of the batteries for the others is 150+ add another 30-159 for the pads. Heartsine has a model working toward FDA approval that will be in the 400-500 range list that is designed for home use. Phillips should have their CPR feedback model out soon from what I hear. Still looking for a bi-lingual model for public access use where appropriate. The only ones I would like to see off the market or available to professional only would be the fully automatic units regardless of the maker.... there are FDA reports on file where CPR was being done ( not deep enough for the AED to sense it but deep enough to make artifact it took for VF) and in loud environments the folks doing CPR did not hear the warning it was about to shock, so they got the full effect. Two of the reports were paramedics doing the CPR --- I fear it a matter of time before we have an issue with them.
  6. I honestly do not know the answer to this so I am asking.... I know the pads would sense motion, i.e pt breathing or someone doing CPR ... but if somebody was doing CPR, kneels upright but with knee touching patient, no movement ...how does the machine sense human presence?
  7. I would like to get as many opinions as I can about fully automatic AEDs ( no shock button) vs semi-automatic AEDs. I have heard a few reports about even experienced first responders not hearing the shock announcement for various reasons and if they were touching without movement being shocked. Might be an urban legend, but I am told there is an FDA link to such reports...if there is I can not find it even in MedWatch. This comes up because I have a hospital that is buying some AEDs from me for school application. I can just picture those doing CPR moving up but with knee still against patient or someone touching, or not hearing the announcement over crowd noise... Any of you have experiences with them? I have used manual defibs for many years and semi automatics ( with shock button) since 10 years but have never had any field experience with the fully automatics. They idea of them in the lay public scares me ( I know a human can still push the button with someone touching, but at least there is a human that claims to have checked and confirms they heard the shock announcement.) I have a link to the only FDA info I can find on my post here...Link to post with link to FDA docket ...
  8. Sure was cool to watch a predecessor fluid in " The Abyss" though( think they were using florurosol(sp?) , with the rat breathing the stuff submerged in it! Once they get it perfected there will be some amazing uses! ( by that way, that was NOT a stunt, I have watched it done ... the feeling was they will eventually be able to do an 80% exchange transfusion of the stuff without ill effect. Needless to say the blood industry ( a multi BILLION dollar industry) is NOT impressed or in favor, not enough profit in it yet! Like so many drugs it is not that expensive to make but the R&D costs and regulatory kickbacks -- I mean costs...are thru the roof. But give them time, they will find a way, then the stuff will be readily available and well used. Sorry, don't have proof about any of the above except the rat breathing it, just feeling a little cynical tonight.
  9. Contacting them is indeed best, if you need contact info PM me and I will send it. In all likelihood you will qualify for the test, if I knew what State you are getting your cert in I could answer with more clarity. Terminology can be a bit of a game here in the States. Only a few States are "licensed" most States "certify" as opposed to license. Everybody wants to control the medics! When California changed from certification to licensure and even endorsed the National Registry they made sure to still require county by county "acreditation". None if it had much value to us but it made for writing a LOT of different checks to all the agencies that wanted our money. Even where not required i recommend the NR, besides the fact that they have a really cool patch... I am the eternal optimist. It still represents our best chance to someday being able to practice nationally without needing a trailer to carry our certs with us. It also makes it a little easier to move around and challenge other tests ( so we can give MORE people money)
  10. WOW!!! I was just going to say what happens in Vegus stays in Vegus but his answer was better! I have NO idea why I had to say that but it had to be said, I was sincere about it being a very good explanation though!
  11. Actually we are teaching that test as part of the core curriculum for Red Cross, AHA and Medic First Aid now. And a NEW EMT finds themselves sitting and thinking a lot till they gain some confidence and experience, much like a new medic. I know a lot of seasoned and well educated medics who for any number of reasons still sit and think and waste too much time ( not sure if you meant it this way, but I do ...well educated does not mean they learned all that was taught ...just that they had the chance to.)
  12. There is a LOT that goes into that decision and it is great example of why this is BOTH a science AND an art! From the science end ... you would not work a patient who had rigor, lividity and no core temp, right? Think about why not? ( It is not a trick question, you would not cause there is zero chance at reviving this patient even though you read a couple times a year it seems of someone with RTSC in the morgue or funeral home hours or days later). Not even "for the families sake" would most of us consider transporting ... though there are exceptions to every rule .. I transported a decapitated person from a freeway in LA at the request of CHP and with agreement of base station for a VERY unique set of circumstances - I would not advocate doing that often) If the call was person not breathing, and that appears to be reliable information from your observations, and it took you 8 minutes or more to get there, you put them on the monitor and they are flat line there are a growing number of folks that say you should not even begin working this patient, they have not much more chance then the patients above, many would say the SAME chance, none.. If you DO decide there is question and it is not that clear then you work the patient with ACLS -- as to what is an adequate trial, as an ACLS instructor you know that is covered in the ACLS standard...local protocol may deviate slightly but if they started dead and stayed dead they are likely dead. As noted above we do not transport the dead unless there is a chance ANY chance that we can revive them! Science tells us there is not in these cases. And most of us in the field can anecdotaly confirm the science. Now comes the art .... Babies, by definition of SIDS, do not serve SIDS. 80-90% of the SIDS kids I have had I have pronounced and explained to the family that with SIDS nothing COULD have been done, not even had an ER fill of Drs and nurses been there when it happened, that, as sad as it is, this just happens sometimes. I call pastoral care for the family, get them family support and do what I can till PD arrives or however local protocol goes for handling, but I still care for my patients!!!! I was called for the kid, but I still DO have patients so I usually am not going to be in service quickly, unless ABSOLUTELY necessary ... my patients are the family of the dead kid! Some would argue working the baby "for the sake of the family" and there have been a FEW times that I have... but running lights and siren is dangerous for me and others, so we do THAT kind of "code" very safely and conservatively as we can ... often will not do much more then a show in front of the family briefly, just BLS and once out of their sight shut down and drive to the ER. We are back in service quicker and the family has the support of the ER staff, including psych and pastoral care. HOWEVER ... I make point of letting the family know they should not have high expectations, that it appears the baby is not likely to respond to treatment, but we will take it to the hospital and see if ANYTHING else can be done. I do NOT want the family to be prepared for this babies death, accept it ( most "know" the baby is gone) and transport for MY sake!!! Cause it is easier to turf it to the ER to deliver the bad news....who wins in that case? You just gave that family the expectation that the child could survive, only to have them dashed again, plus the added guilt that "if only I had..." whatever..... Does this help any? Not transporting makes our job harder in some ways, it adds the needed skill of compassion to the list of skills we must develop and perfect... but it is the right thing. In doing QA, I never am critical...OK, RARELY am critical... of those who elect to transport dead people, I do ask them what there thinking was, why they made that decision .. if I get ANYTHING meaningful, then even though I might have done it differently, that does not make what THEY did wrong ( usually)... science and art ... it's a beautiful thing.... when it works .
  13. Damn, Whit!!!! What's up??? Your Avatar shows some blood flow to the brain, but did you use it before you typed this?? ( Slow down, I am only teasing, though I do SEVERELY disagree with you!) You do sound a bit harsh and judgemental in a lot of posts, but then aren't we all at times. Most of us are passion driven...that is not ALWAYS bad. At least you have a position and you speak it. Let me ask you this, I am driving near your house, you and your family have just been in a MAJOR MVA right in front of me! You appear unconscious but your wife and three kids are trapped in the car trying to get out, obviously panicked and there is smoke and flame showing under the hood, do I follow your advise call 911, stay in my car and keep driving or stop, use my extinguisher and see what I can do to help your wife and kids ( leaving you alone to wait 20 minutes for the delayed response due to traffic, since that is your expressed wish from this post.)? I am not asking this to bait you, do not answer, please, without visualizing the situation I have described and answer honestly. Actually, I AM asking you this to bait you but let's see where it goes...just know I want to finish the thread when we are done as friends, I do respect your position and I am NOT advocating stopping if it is not safe to do so.
  14. Apples and oranges---take a breath!! You are agreeing with us and I think perhaps you do not realize we are agreeing with you!!! There is HUGE difference between 8 minute response time, unwitnessed arrest, asystole no RTSC after ACLS and no transport I think few would disagree that person is dead and transporting them does NOBODY any good vs 4 minute response, unknown rhythm ( on most AEDs and even those with a visible ECG rarely have anyone trained to read them on site), and nada on ACLS with unknown down time( perhaps less then 4 minutes) and all they get is a couple minutes of CPR maybe and the EMT with an AED pronounces? Not with MY family they don't! I suspect not with yours either. Bottom line is ... these are two different studies. I think most of us ( don't we?) agree that the >8 min response, asystole, no RTSC after (fill in the blank be it time vs rounds of meds) ACLS trial should not be transported except in rare circumstances. I sincerely hope that few of us would agree that the 4 minute response, unknown rhythm,no ACLS with available ACLS not far off ( be it hospital or medics) should have a chance and not be pronounced without more then a couple days training ( 100 hours or so). I have a modified DNR ( chemical code only no vent without positive EEG) and I would want THAT benefit!
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