fiznat

I really think you should pick a locale before you pick a school. There are good accredited schools all over the place. I think you can at least pick a region you can start to narrow things down quite a bit. I went to the program at Capital Community College in Hartford CT, which was a 1 year accredited program including lots of hands-on training (in hospital rotations are required as well as on-ambulance internships and laboratory sessions). If you're interested in the Northeast, give it a look!

This resurrection of ancient threads thing has got to stop!!!

I don't carry it, but several of my coworkers do. I'm not sure of the specific coverage limits or terms, but I believe the premium is something like $150.00 per year.

There has been talk here about whether or not it is a good idea, as liability insurance can sometimes play the role of attracting litigation. A 1 million dollar policy can be a pretty sweet looking carrot for the potential plaintiff.

This is comparison to the public AED's. The studies show that yes if you attach the zappy thing within minutes the pt will have a higher rate of making it to the hospital, but in reality the mortality rate has not changed.

I guess it is a nitpick, but this is not true. The link between early defibrillation and neurologically-intact survival has been well documented. This is why the AHA uses early defib as one of the links in the chain of survival, and why there are AEDs everywhere these days. It definitely does make a difference (assuming the rhythm is shockable of course!).

If one person is saved by the term Golden Hr or by the zappy thing then why the issue.

Because pushing this "golden hour" doctrine diverts resources away from approaches that may actually work. One life saved by chance does not compare to the potential of many more saved through good science and good practice. We have a responsibility to our patients to provide treatments that have been properly vetted through the scientific method. The "golden hour" does not stand up to that test.

haha I was gonna say, I was pretty sure EMS Expo is in Dallas this year... haha.

I have serious doubts about any "school" that offers paramedic training that is less than 4 months in length.

Your limb lead (II, III, aVF) electrodes should start at the limbs and then work in towards the chest only if necessary.

Barring some unseen circumstance, I can't see a real justification for giving a sedative for the purpose of cleaning up ECG artifact -- especially in the ambulance. I suppose there is a time and a place for such a procedure, but it seems like a very rare and narrow window to me.

The notion that you need ALS for a bit of morphine or adrenaline, or a BGL check, or some fluid is a wee bit out dated if you ask me.

I disagree. Epinephrine is a powerful drug that we use for our sickest patients, and I think you'd be surprised to see the profound effect just 0.3 mg of the stuff can do for bad asthma or anaphalyxis. Just 1 mg in 1000 cc of fluid is a potent treatment for hypotension, better than dopamine in some cases. Same thing for morphine. There is absolutely no reason why a patient should have to wait to get to the hospital to receive analgesia when we can provide it in the field. Too many people focus on "saving lives" instead of "providing comfort and relief." Both are our responsibility, and I think ALS intercepts for these purposes are absolutely necessary.

just

let

it

die

If you are in school already, why not take some A&P and/or biology? If you want to know this stuff well then you've got to put in the time and learn from the ground up. Casually reading a few books will give you a very small part of the story, and even then you'll only remember bits and pieces. That can sometimes be more of a problem than a benefit.

The Littman Master Classic is a good choice IMHO-- its the scope I've always used and has never let me down. It is high quality but doesn't cost a ton of money (runs around $75), so you get that balance between good sound and street-usability (AKA not AS afraid to lose it or have it stolen). I see no reason why any EMT, or paramedic even, would have a need for a $200+ master cardiology.

If this is the same thing I heard about before, it is in regards to CPR cards.

Now, I know this is taboo and everything, but for the sake of discussion who here doesn't know someone who has had a friend "get him/her a card" for their CPR refresher? It happens all of the time in professional EMS, because a lot of people feel that it is a waste of time to re re-learn how to pump and blow when we do it so often. A lot of people also feel like CPR refresher is more about $$ for the AHA than actual education or proficiency.

...Even for those who attend the class, can you honestly say it is conducted in a serious and rigorous manner? Most of the CPR classes I've been are nothing more than rubber stamp conventions. How is that practice any better than just having a friend/instructor refresh your card for you?

Once I stop at a accident and say I'm a paramedic, am I no longer covered by the Good Sam laws?

It is really going to depend on your state, and even then your personal result could vary widely. I know for a fact that American Medical Response has lobbied (successfully in a lot of places) that the "good samaritan law" should be applied to their employees on the job in order to reduce liability. The law on the books is open to interpretation and a subjective jury decision, which a lot of times makes things much less black and white. You might be fine, you might get hammered. Another reason to never stop.

That said,

What about stopping in your coverage area and you pull a medical pack and begin to treat by starting an IV or putting oxygen on?

Just what kind of liability are you opening yourself up to?

This seems like a bad idea to me. There are probably places and situations where you would get away with it, but it seems like a lot of risk for very questionable benefit. I doubt that a lone IV or even supplemental O2 will make any difference whatsoever, and honestly if I were the medic responding to a call where some off duty douche started an IV because he felt like it, I would never ever actually use that IV unless the world was coming to an end (IE not gonna happen).

Barring a few rare circumstances, I wouldn't stop at a car crash either. Especially if I didn't witness the accident and there are other people already stopped, I see no reason how my presence there on the side of the highway would do any good at all.

Ah, what?

Yeah, CPAP and NTG are working pretty well here.

^^ I agree with Dust. Just get rid of that glucose and ESPECIALLY the charcoal.

Hey Anthony,

Is this suspension you are being put on paid or unpaid? How many hours of pay are you losing while they "investigate" this? Is your place of work unionized or no?

I agree with everyone else that commented that employers making employees pay for vehicle damage is inappropriate and possibly illegal. I think you should simply tell the truth (which you have already done), but do not offer to pay for the damage. "Classy move" or not, in my opinion it is not appropriate and it sets a bad precedent. My opinion is that if they fire you for this, then you're better off not working there. You can't work for a place if you have to constantly worry that the smallest error will get you fired.

Hello,

Hmmmm...no access to my work account to look up the Journal. So, I will guess...

Virchow's Triad has no predictive value?

I actually asked questions that are answered in the article's abstract, which is available for free.

What are the names of the 4 specialized conduction pathways of the atria?

Had to look it up. Apparently the existence of these is still controversial, but the previous theory (that conduction between the SA and AV node propagates through a homogeneous field of myocytes) does not explain the unusually rapid speed at which signals arrive at the AV node. The AHA identifies four "internodal tracts:" the sinoatrial, anterior, middle and posterior.

According to recent research (released this month- Ann Emerg Med), what 3 factors were previously regarded as risks for venous thromboembolism ("implicit" risks), but were found to have no predictive value? Extra credit: list 5 of the top 17 risks for venous thromboembolism (same article).

We do "system status management" where I work, so we are out in the ambulances all day either driving around or staging for a call. There are no designated meal breaks, but at the same time there is no maximum time we are allowed to spend at a hospital after a call. If a crew really needs to grab some food or use the facilities, there is usually time to do that right after dropping the patient off at the hospital by simply not making themselves available for dispatch until they've got what they need. It isn't an official policy, and dispatch doesn't like it, but it seems to be a necessity in a system that doesn't give us official breaks.

I didn't say AMR isn't deserving of criticism. Of course it is. Start a thread on that topic and I will happily contribute.

All I'm saying is that the company is not relevant in *this* thread. We all stage for PD at violent scenes, what does the fact that it was an AMR ambulance matter? Unless we are just looking for another excuse for ad hominem attacks....

I agree with those that said the crew made a mistake when they chose to stage within eyesight of the scene. True the press seems to be drumming it up a bit, but the first mistake came from the crew, and it seems like they only made it worse by not opening the doors when the patient was brought directly to them.

This really doesn't have anything to do with the fact that the company involved was AMR. "Staging" policies like this are not unique to AMR, and are an important step that we all take to protect ourselves. Those taking cheap shots at the company are off topic, IMHO.

I have to say that this is not my favorite kind of call to go to. In general, I don't really like getting "reports" from first responders as the quality varies quite a bit, and I am going to have to repeat everything they did anyways. To be honest all I really want from the first responder is a QUICK (as in, less than 10 seconds) wrap up of the "must know" kind of stuff that I can't easialy get elsewhere. If the guy was seizing or unresponsive or something else prior to my arrival, that is relevant. On the other hand, I don't really care about the SAMPLE history and a narrative of the unremarkable 10 minutes prior to my arrival.

In my personal experience, a lot of first responders like to give long-winded and exhaustive reports about unimportant stuff, and oftentimes just get in the way. When I get on scene my first instinct is to get to the patient's side so I can hear their story and start assessing, not have 10 minutes of conversation with witnesses/first responders on my way there.

That said, I have had a few first responders who were really on the ball and gave me really professional quick, crisp reports. Its really hit and miss...

I remember we spent a day on it (>8 hrs I believe) in medic school. As I recall the mix was about 90% "how to avoid these situations and maximize your safety," and maybe 10% involving actual "self defense." It seems to me then as it does now that 9/1 was probably the appropriate ratio.