BushyFromOz

You see, Triemal and BushyfromOz, being that you are union and you support the unions there is no arguing with you.

Mate you are completely missing my point

A union is an Industrial body that exists for the sole purpose of respresenting the views of its members. Its members in this case are fiefighters

Anything the UNION states is a representation of the will of its membership, therefore the statement of the union are the statements of its constituents, they are one and the same

And for the life of me i cannot understand your issue with the "reduced services risking lives" argument. Just because no one has died as a result, does not mean the risk is not real. Organisations trot this line out all the time and we dont see you exploding in here about how low brow that tactic is.

No, i have reasonable and educated opinion on the topic of unions and unionism, the only one whose opinion who is blinded is yours.

HI kids

topic title is pretty much the question.

up until recently, our IC's used verapamil for SVT within some pretty strict criteria, then adenosine was introduced (in a very poor fasion may i add) and the controls around managing SVT's relaxed. So basically these patient are being managed a heck of a lot more than we used to. Because of this historical context, the experience in managing AVNRT and AVRT's is at the moment quite poor, and creates some hesitation when you get to the connundrum of is this SVT or is this really regular Atrial fib.

Reason i ask is i had a patient the other day with a HR of 202, no discernable P waves at all in Ld2, and when you mapped out the R-R intervals on a strip they were predominantly regular but occasionally had periods of slight irregularity. The monitored rate was also slightly variable at times in that it would run at 202 for 20 seconds, then 198 for half a minute in that sort of fashion.

On moving this guy to the stretcher before chemical reversion his rate dropped to 150 where it fluctuated +/- 6 beats per minute, so the decision was made to not chemically revert.

My question is, if you are unable to diferentiate between atrial fib and SVT, and you choose to give adenosine, is "paying off" as SVT, particulalry when symptomatic a sound clinical choice, or is erring on the side of it being Atrial Fib a better option? And if you give adenosine to atrial fib, are there increased risks involved.

Posted from a mobile phone so i have no resources to look at this myself for a few more hours

The industrial body representing firefighter made those statements? The whole point of a unions is to represent and if need be publicly state the wishes of thir fee paying membership. Its entirely appropriate for them to make these statatements, provided it is on behalf of their membership.

And what city councils and state government do is dishonest too.

No point bringing a cupcake to a gunfight.

Are you sure this about unions, or is this about firefighters?

i worked for a non union shop that paid 39K and another non-union shop that paid 52K a year. that was a very livable wage.

it can be done.

The problem I see with the IAFF when they do the collective bargaining is that they bargain against the citizens of the city or county who have no say in what they pay you. you are effectively holding a city hostage when you threaten to walk out when your current contract ends. that puts the city in a terrible position to be in.

in my opinion, a union has NO business being in the public sector, especially in the public safety sector because you effectively hold many of the cards. You don't get what you want then you can say "we'll go on strike and you will have no EMS or fire coverage" and the citizens call their city councilmembers and say "pay them what they are asking because we cannot be without fire coverage or EMS coverage" thus you get what you want.

You effectively hold me hostage to your demands and I'm not able to do a damn thing about it because your union really does hold all the cards.

sure it's a great thing for you because you get great pay, great benefits and you can lord over the heads of those non-union saps who make piddly and say "lookie here what we get and what you don't" but I really do not get a say in the matter of how much you get paid because your union negotiates your pay with the city council and the perceived threats of strikes and slowdowns and decreases in services of such a vital service almost ALWAYS ends up with the union getting what it wants.

And to me that is what is WRONG with unions,.

I have to take issue with this because by and large most Paramedics working in the public sector in australia are part of some form of union, and for this there are multiple reasons.

At the very basic level one requires a representative for colledtive bargaining, and it might as well be my union rather than forking money over to a third party negotiating body. A collective agreement is the only way as it is simply not feasible to negotiate individual contracts for 2500 paramedics + conditions for the thousand or so paid first responders on our books..

We dont negotiate against a city or a county. We negotaite against the state government who is quite happy to spend literally millions on legal council to hold your wages back, hence, a union is the only way to negotiate in a reasonably fair manner, but their pockets are much deeper than ours so they will throws bucketfulls of money at the issue when we throw dollar coins

Australian industrial law is complicated, we have what is termed legal or protected industrial action and then illegal or unprotected industrial action, Withdrawing some forms of labour may be protected, stiking is not. To strike is to take a significant risk in losing ones job, and in the case of failed collective bargaining, forcing the industrial court to write a collective agreement if we cannot agree on one with our employer.

My emplyer is large, it is a state wide statutory service. If i am unhappy with my conditions i cannot go to the next city and work for one of their companies, departments or whatever you call them, there is no other employer in the emergency sector unless i change states, which if you have seen a map of Australia is not as easy as ducking to the next county. And if i do move to another state they only have one statutory ambulance service to work for, so i still have litlle choice.

The state government and my employer occasionally like to make changes to rosters, services, operating procedure that are less than satisfactory to the publics interest. As i am a government employee i cannot speak publicly due to a code of conduct, but i can have the union do it for me. My union also provides representation for "disciplinary proceedings... some emplyers like writing procedures for grievances etc, but they dont like to follow them

Our industrial climate at the moment is toxic. the government has a public sector wages policy of 2.5% with any other rises due to productivity offsets "actual bankable cash savings" as a result of a negotiated outcome", which i am no position to provide because i do not control the purse strings, so the only thing is to give up conditions. 2.5% is not even in line with CPI so you give up your conditions to meet inflation, or, you wage a nasty industrial campaign and take illegal industrial aciton, because the reality is, illegal action is the only leverage you have here. Ironically illegal industrial action is probably what the state government wants because it will force the industrial courts to force an agreement on us, so the service and the state government certainly wont get what they want, but neither will Paramedics, so its a win for them either way. Paramedics in my state have not had payrises that have meant inflation rates for nearly a decade, so the thought of making that 14 years is pretty much unpalitable.

My union doesn't actually hold any cards, and is the only reason strike action is even mentioned.

Holy crap, you mentioned lil' old me? Whoa!

CONGRATS and GOOD LUCK!! You drink coffee, right? If not, I guarantee you'll start. I know an avowed non-coffee drinker who started during his intensive medical program... ;-)

Wendy

CO EMT-B

RN-ADN

Im already there... if i dont have a cup o char before 10am i get a violent headache, but i only need 2 cups a day to get by. Funily enough, we had a coffee percolator in our flat while i was at uni, thing was always brewing. I think thats where the problem started

Is there a common reason on the numbers of HEMS losses in the states?

Is there a common reason on the numbers of HEMS losses in the states?

NP, the thing that bothered me all during EMS week was all the EMS organisations touting that people should "Thank a paramedic" for what they do. I think that's a load of crap. We do our jobs 51 other weeks of the year and don't go around asking for thanks. That's just pathetic. I consider it a week for medics to reflect on the service they provide and renew their commitment to their patients.

Yeah, theres a thank a Paramedic Day here, gives me the shits. The only people i want to thank me are the state government and its called a payrise above CPI

Nothing useful to add except when I'm asked what's the worst thing Ive ever seen i use a modified line from "bringing out the dead"

My reply is "baked beans on a pizza"

The fact i dodged the question usually diverts them.

He he! I like it.

Nice post mike.

Any chance i could get a copy of your 3P's craig?

All the above is being done by the NSW ambulance service. In fact they received ans international recognition for their LAPP /ECP program ant they have as

Also received awards fro the implementation of pre-hospital thrombosis treatment of cardiac/ stroke patients

you guys are thrombolysing CVA's in he field??

Good for ya Bush, though bummed you forgot me. TheN again, Ive been dealing with life too, so Im not on as much anymore. Still... WTF,over?

Oh my god.. when i logged in i saw you were the last person to comment on the thread and before i opened it i thought about ho much of asshole i am not to drop your name as well

Sorry bro

It's not a CT scanner. It uses infrared and near infrared light to identify possible blood consolidations following traumatic injury. It's utility in this setting will be tested in time, so I cannot comment on its efficacy as of yet, but it's promising and may be of use in special situations. Unfortunately, I'm not sure it can identify intraventricular consolidations or perhaps subarachnoid bleeding in certain areas, so it's utility in identifying ischaemic stroke versus hemorrhagic stroke is probably limited.

STEMI's are being treated in some areas with prehospital fibrinolytics but I'm not sure what the data says about these services and the other countries where it occurs more often.

As soon as the online guidelines are updated i will link it, but the draft is out and our ICP's (and me at some stage ) will be managing STEMI's wiht tenecteplase, heparin and clopidigrel without physician consultation

Doc, whats the technique for measuring changes in the diameter of the optic nerve with ultrasound, and is it able to distinguish haemorrhagic from ischaemic CVA?

Non physician ultrasound in EMS i think is limited to FAST exams and pneumothorax identification in Australia.

You mean your not a hangar queen anymore??

holy crap Bushey: We thought you'd gone walkabout.

Good for you though it will mean going back to school and cracking the books.

Bare foot and pregnant too... well not really, but the food baby is growing.

In some ways this is going to be incredible., ive already decided that if im going to do this post grad diploma i might as well do the additional 8 points and get a masters afterwards. The time management is going to kill me though, 54 weeks back at university and then whatever hoops i have to jump through with my employer.

Its going to get crazy

I think the point with therapeutic hypothermia in TBI is that it is isolated TBI without or controlled gross haemorrhage and the absence of volume loss into cavities or large tissue masses.

Hey Kat

How do you guy go about preventing hypothermia in entrapped patients during the winter?

Greeing earthlings!

I started posting 6 or 7 years ago when i was still at university getting my batchelors degree, you know, when you have free time and life was measured between drinking sessions rather than assessments - i would log in and get the musings of dustdevil, paramedicmike, dwayne, eydawn (sp?), kat, akflight, chbear, davis and all the other names i cant think of right now, and i would think to myself that i would like to be half as good as these people

Then life (reality) got in the way

Then i got a job

Then i got a wife

Then i got a mortgage

And then i stopped posting, but it still drop in from time to time, but things have taken a turn the last few weeks, Becasue a fortnight ago on wednesday i was informed i had passed selection for MICA / ICP education which will bring with it a hole new world of hurt and adventure, so i will still lurk and not post.

But the people here are still part of my inspiration

Thanks guys

EMS is not a hobby.

Shit? Really??? Ive wasted all these years.....

Maybe she saw what happened on the grassy knoll in Dallas?

I don't know about the litigation. If they signed a form stating that CPR was not allowed, they knew the consequences. From what I have read, the family seems fine with what happened. It sounds like some dispatcher got her nose tweaked and wants to make a case out of it. The only ones that should have brought this to the media should have been the family.

Fair enough.... wouldn't want them as my family then, maybe there is a good inheritance involved

Assisted living facility or not. I cant understand how a health facility of any type can have policy of not providing basic first aid to its residents and it be "legal"

What i cant understand is that the family had knowingly placed their relative in a facility of any type who is presumably reasonably fit and a reasonable quality of life but knew should their family member drop thei bundle they would recieve no help? Where is the famlies morals in this?

The irony doesn;'t escape me that these people have paid money to an assisted living facility that provided no assistance for living... if she had have dropped dead i the street she would be better off. At least you can do that for free?

I would have thought that any health are facility would have had a legal obligation to provide basic first aid and care for any of their residents, and basic first aid includes CPR.

Dont usually advocate litigation... but sue the ass off this crowd for sure!

All good points, but it will take some convincing for me to believe that EMS should be involved for the toothache at 2am with 2 cars in the driveway because " its not that bad, and i would take my wife to hospital, but i didn't want to wake the children up" there is a point where we should stop absolving adults of the responsibility of being adults

Along the lines of what Bushy said...I was a member for a couple of years, but left as I felt it wasn't good value for money. However,

many of my colleagues seem to be affiliated. I will probably re-join at some stage, but can't justify it, espeically living in a reginonal area

Yeah. Occasionally they would run something thats worth seeing, but by the time you factor in the 6 hour round trip, meals and accommodation somewhere near the venue, you dont get much change from 600 bucks