stcommodore

The college holds a graduation for thos of us who will finish with an associates, and the program(hospital) holds a small event as well.

Let's just put it this way then. Somethings happen in the back of an ambulance that are not totally "legal". Sometimes paramedic students acting as EMT-B's can "assist" simply on knowing what is going on, what is and will be needed and by that do things from 12 lead placement to "other things" in the back of an ambulance. Issue then is if the crew opperates this way are they willing to live with the consequences of there actions? Situations happen from time to tim where we make that call and we are left to live with it good or bad. Here is a spin... You are a medic student riding with your school's/services preceptor and respond to a mass casuality event. You are seperated from your preceptor for whatever reason and need to treat a patient you have ALS. Do you do it, or consider yourself a basic again since you are without your preceptor? ...We can say in a disaster all bets are off but beyond that what would you do?

screw all the debate...would 5mg of morphine really do crap for this patient anyway?

I guess nobody remebers the national scope that had a "advanced paramedic" in it...

I don't know if its true but my understanding is that current Act 45 doesn't reconize PA's in the prehospital setting for PA. But PHRN's are recpnized and may actually opperate under there own pratice and not require the "squad MD" to do what they do. Or in otherwards have "medical command." Like I said I don't know if thats true but it would also follow that a MD that was not the squad MD working as a paramedic would not require the squad MD for command or orders, etc. Hmm...

Best example I can come up with...driving in Philly with a girl both of us just back from a Banquet and close to getting on the highway to go home. We are within eye shot of trauma center X and see moderate speed MVC between to cars, its about 11p at night in Center City...what do you do? The light turned green and I kept on driving. Why didn't I stop? I could write a list a mile long, sometimes you just don't stop.

Do you know what caused the arrest? I don't want to rain on your parade but I suspect alot of the ROSC has to do with why he coded to begin with, obviously.

If you treated within your scope and only had limited equipment and did what you could with that eqipment how could you be wrong? Lets change the secene, say your a medic at a MCI and while your without ETI supplies you insert an OPA and intubation doesn't take place until the hospital. While the patient dies for whatever reason, you did what you could with what you had. I don't think its unheard of for medics to work for BLS squads that have no licence for ALS services, but if said service has a licenced medic truck and not enough medic supplies to have it service as such I would think the fault would fall to them and not the provider.

a very wise medic told me that etomidate is our 'baby steps' to RSI. I think this is a huge undertaking to unite an entire commonwealth under one set of protocals. For some its a step back and for others its a leap foward. Hopefully what it means is that someone in Pittsburg, Dillsburg, Warminster and Philly will all be able to receive that same level of care.

But does the Combi or King LT offer better ventilation then the LMA? The LMA at no fault of the device was designed for the OR and not for the street.

I wouldn't doubt any of the medic programs within a university/hospital would have this sort of thing. We did it in Anatomy 101 at Drexel using Hahnemann's facility but honestly that exibit with the plastic preserved people (can't recall the name) was a hell of alot better.

I don't think 'liking' the LMA is the problem it just isn't pratical for many/most EMS services. Any fool can shove that in someones mouth but it does alot of good if it comes out half way to the ED.

My EMS squad carries the atropine/2-pam antidote kits, escape hoods and a few other things in the trucks. But in the county Fire and EMS is 99% seprate so the FD's have Hazmat trailers. Most of the HZ trailers are placed within the that stations that have hospitals in there local. The county also has four MCI trailers and I believe one or two specialized rescue trailers.

We all know its a common phrase when teaching medics. But I think we need to redefine the phrase. No doubt you put on oxygen, bag, etc before you intubate or take a blood pressure before starting an IV but its not as simple as the phrase. A medic starts his assessment BLS but is always thinking at the ALS level. Mabye the phrase is made to be simple but mabye the phrase isn't used right. What do you all think of the topic?

Without experence using a King LT or Combi on a real patient and experence on an LMA I still am for the first to. I dropped my second lma in the OR friday and the general feeling is that while its as fool proof as the others its just not as secure. I still have issues as a BLS provider 60% through medic school with BLS using anything outside an OPA but I think it depends on the system. All ALS with BLS only as dsecond on the crew...opa only Urban ALS Responder BLS transporting...opa w/king lt on shockable codes Rural...combi and king lt, with good medical command oversight I'm no expert at anatomy but I feel its important to understand why your sticking said long tube into said patients mouth. I don't think you need college anatomy but more then some BLS programs teach.

nine months from the end and let me tell you it doesn't get any easier...work hard and work smart, find a study system that works for you and use it. Learn your cardio like its the back of your hand! Be strong at your BLS or your not going to get far. If you can't take a blood pressure your not going to get past that step three on the assessment and there is a page below that you have to get through. If you fail a test or miss something, go back and learn it! It won't do you any good to not know something because in the end either the test or a patient will have it and you will need to know it.

The reason behind two providers that has been told to me is that in the OR and other settings the standard is two providers. In the OR, ED, or other clinical setting you will have two or more people if not a line ready to go for the tube and we should be no different with the same drugs in our hands. I would also hope that etomidate is part of a process to getting other drugs apart of RSI. It will take time but hopefully we as a commonwealth can prove that we can meet the standards and provide the care the patients require.

I haven't been through it all but I think the Etomidate is a huge step foward, and hopefully a good one for the patients that require it.

My understanding is that if your command doc gives you orders to be able to take someone who they don't feel is able to refuse, then you take them. If the police on scene were unwilling to help I would either request another unit or there Supervisor, another one of my units or supervisor and go from there. We all have to make our own calls in cases like this and in the end documentation is really key to.

I don't know about your program in NY but I'll tell you what I've been through. I had to do one at Drexel that I took to my primary to do, then when I moved to Crozer did another physical that they did in Employee Health. Since I wasn't offically employeed by the hospital as of yet anything I had to do past the physical was up to me and my primary.

I think they were close to pushing 10,000 in 2005 and probaby just as busy in 06. If its not bad enough I think there were four or five other medic units that were in the 9,000's in Philly.

Is that class an advanced provider only class? Or would medic students could attend?

Alot of the medics I've worked with will take the time to sit on scene (if its safe) to get something done, and many are so fast they can get everything done in 5min.