stcommodore

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...

MMy question is, everyone in here is talking about a duty to act if you see an accident, but how many of you could drive by a bad accident if you saw one? I don't get the logic that if you saw an accident with the potential of injury you wouldn't atleast stop and check on the occupants of said vehicles. ..... but if I saw a significant MVA, I don't think I would have to worry about a "duty to act" I would act. Now granted, you're limited (atleast I am) to a pair of gloves and whatever napkins I can pull out of my glove box. However, I think offering first aid, calling 9-1-1 and holding c-spine until providers with equiptment show up is not much to ask of an EMT/Medic. Maybe that's just me...

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 do get the plates be sure your prepared to stop for anything you come across.

You come across a accident or something to that effect & fail to stop with these plates

you will pay the price.......quote]

That doesn't make a single bit of sense, and doubt has any legal ground to stand on.

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.

Different clinical sites can be just like that. My last programs home hospital was a university so we would have a better chance of getting a tube in the ER then the line for the tube in the OR. We got sent to another hospital that gave us a better chance so its just a matter of getting out there, giving it time, letting them get to know you and if you have to talking to your instructor to figure something else out.

I think when all things are equal it would only be fair for a nursing home nurse to provide a breif report to the EMS crew. I honestly don't care if your busy, have three other patients, etc. Clearly this is supose to be an "emergency" so you can at least provide that report and there paperwork. Everyone has there bad days both NH staff and EMS crew but we are all in it for the patient so for there sake I wish things were better.

I have as much experence as your little toe but during a ER rotation I saw a patient sustain runs of VT. He clearly was unstable, looked like crap, etc etc but it was a learning experence none the less. I believe he was in a SVT they tried to break with Adenosine and when the rate dropped the salvo's of VT would kick in. Oh and feel free to feel special hitting an IV like that, but only a 20?(jk)

How about the push away from ET drugs and IO or IV. I know we rolled out the ez-IO guns to some degree because of that.