tniuqs

tniuqs, I'm trying really I am, but I don't see how this is "Funny Stuff".

Argh...I screwed up AGAIN.

Any Mod or Admin out their in "internet world" can change this to the Right forum... would get some of that egg off my face. :oops:

Thanks in advance!

my bad, nope just stupid! :shock:

Terri: Whats wrong with Paramedics in an ER?

YES EXACTLY!

This valuable resourse in a cooperative Health Care Model is far to under utilized.

So just WHY is this?

I think I know...simple territorialism.

Good article. I happen to agree with the majority of what Scot Phelps talks about.

If you doubt what he is talking about, look at our neighbours to the North where EMS is a career and a has some stability.

Well:

I personally would not give that much credit just yet, the summary that Phelps is quite indicative of the actual reality in Canada as well.

Yes, I agree that the access to Health Care system here is a "bit" better and as it is more focused on the Care of the Patients instead of billing.

Realistically the pubic system we all seam to jump up and down about is NOT exclusively "PUBLIC" just in really a different billing process, start talking the reality (that has been forever a blend ) or Public vs. Private delivery then everyone gets their poop in a knot....and polarizing (sp) everyone, well this was quite clearly explained to me last November by Preston Manning, It is most likely the biggest problem to over come... stanch idealism.

The fact remains that the US HAS established the REMT-P nationally (lets NOT get into standards OK, Please) We here in Kanukistan have NOT, and we even a bill called "The Interprovincial agreement on Mobility of Labour" but no one yet has used this to an advantage some provinces have actually put in place barriers that should be kicked over in my view. Yet even though the lobby group PAC or Paramedics of Canada have made great strides very little change has come about just yet!

The difference is the typical apathy of Canadians and some sticks in the mud like ACoP in Alberta (thinking that the National Competency Based Objectives) needs to be revaluated based on the Alberta standards...good grief BATMAN...move forward, accept then modify!

Now here is a kicker too....most Alberta registered members have NOT a farking idea that they too are members of PAC!

Is it true that "ignorance is bliss?" tell me it isn't so...PLEASE.

cheers

ps The most discussion I see is on US based Website (s)....sheesh,

We do have our own but no one goes there to communicate these issues "North of the Border" and why I will never know.

I do know that a single entity lobbing federal government with solidarity in "support" could change things positively.

ah yes, i misused the english language once again...i shall burn in hell for eternity. what I meant to say was RECCOMENDATION. :?

Greetings Earthling!

Confucious says: You will have LOTS of company.

LMFAO...... nice comeback!

AZCEP : Yes I know your a Dean and all, Realistically we just about ALL adopt ACLS "guidelines" as wrote Protocol, this previso is a liability deferal for AHF...thats is all.

cheers

ps did someone moult in your oatmeal today?

This cut copy paste from a forward to myself:

[align=center:716f564b9a]The FAILURE of EMS[/align:716f564b9a]

In order to survive, the system must first collapse By Scot Phelps, JD, MPH, EMT-P, CEM, CBCP, MEP

The concept of an EMS system has failed. After 40 years, it is time to admit defeat. The concept of an EMS system has failed. After 40 years, it is time to admit defeat. While the idea of providing an organized system of advanced out-of-hospital care was a good one, internal and external forces have led to the imminent failure of the EMS system in America. I, for one, am glad, because the system as it is currently structured cannot work.

This collapse was about 20 years in coming. When I started EMS in the 1980s, there was a lot of hope for the industry. I grew up in an era when BLS ambulances were nearly 100% volunteer outside of large cities, when first aiders were transitioning into EMTs, and when statewide paramedic coverage was an almost-realized dream in New Jersey. It was also an era of mobile intensive care nurses (holy cow!

a decently paid career track with options), a strong tradition of volunteer crew chiefs with a decade of experience mentoring new cadets, and a billing system that let paramedics bill enough to cover the costs of operating the paramedic system. It was far from perfect, but it seemed to be moving ahead.

Twenty-three years later, when I talk to colleagues from my era about their experiences, I hear a common refrain: "I thought being a paramedic was going to be a real job." Instead, we have regressed into an EMS system that is only interested in cost, not quality; that equates certification with competency, with no field training and supervision; EMS providers (both career and volunteer) who work an endless series of 60-hour work weeks; no upward career mobility; and McJobs (no pension, no benefits) instead of careers. How did things go so wrong? I have a few ideas:

The Public Has Never Understood What We Do.

Until we jettison the acronyms that mean nothing to the public (EMT, BLS, etc.) and focus on using the term "medic" for all ambulance providers, we will never have a consistent public image. A SWAT police officer is still called "officer." We also need to be the ones who talk to the press about accidents involving injuries and fatalities. The police are not the ones who cared for the patients-- we are.

We Let Medicare Pay for Calls, But Not the EMS System.

When Medicare changed its payment rules seven years ago, we let them fundamentally change from paying for patients' pro rata share of system costs to paying for the actual cost of the transport, stranding a huge percentage of overhead costs if your agency has a normal level of utilization. We did not make it clear to our elected officials that they would need to pay the rest. We also accepted mandatory coverage from Medicare, which meant that systems had no reason to compete on quality, only cost, since their payment remained fixed.

We Let Other Disciplines Do Our Jobs.

Where I worked, I constantly heard the EMT crews complaining about the career fire department, yet on the scene, they always let the firefighter/ EMTs carry the patient. I will say it in no uncertain

terms: Do your own job. Fire takes care of fire and rescue, police take care of law enforcement. If it involves injury prevention, safety or health, it is EMS' job. Carrying patients, teaching injury- prevention programs in schools, installing child car seats and decontamination are all patient safety-related issues and clearly the role of EMS.

We Never Asserted Control Over Emergency Medical Care.

It is great that your community firefighters and police are EMTs and respond quickly, but providing care is our profession and we have a right to regulate it. Generally, communities should have sufficient EMS resources to be able to respond anywhere in the community within minutes. But where EMS permits fire or police to provide emergency medical care, it should be only under our direct control for care, oversight and quality assurance.

We Never Stood Up and Said "No More McJobs."

In the Northeast, the volunteer EMS ethic is that "this job is so important, I'll do it for free," yet inexplicably, when they begin to transition to a career system, they do not think that EMS is important enough to pay career staff a fair living wage (with benefits and pension) to do it. To be fair, this is also prevalent in the private ambulance sector, but at least they can point to a profit motive. The reason paramedics have to work a 60-hour week is that you need 60 hours to pay your rent, and nobody in EMS thinks that's crazy. If we all quit our per-diem jobs tomorrow, salaries would correct themselves within six months.

We Need to Admit That Paramedics and EMTs Are Not the Same.

EMTs are technicians with less than five weeks of full-time training (significantly less than the police or fire academy) who treat symptoms. Paramedics are professionals with at least 50 weeks of full-time training who treat a diagnosis. With the new curriculum, there is no longer even a continuum of education from EMT to paramedic. This is important for one key reason: It artificially depresses paramedic wages, because there are so many more EMTs in any bargaining group. This undermines a graduated pay scale that would pay paramedics significantly more and pay for their experience.

Without it, how can we ever expect to retain good paramedics when their long-term wages are depressed by EMTs? The primary reason we lose so many great EMTs, who choose not to become paramedics, is because the money just isn't there in the long-term.

We Abandoned the Concept of the Mobile Intensive Care Nurse.

I've never understood why we created paramedics in the first place in an era that also saw the development of specialized critical- care nursing. In New Jersey, and in many states across the country, almost every paramedic program had nurse preceptors for years. Nurses specializing in out-of-hospital care were quite common until the early 1990s. I never actually saw a paramedic work in the field until I began my clinical rotations. If we shifted to a three-year community college MICN program, we could ensure both a decent wage scale and true career path for medics (and it would solve #6).

Volunteers Are Fine, But the Year-to-Year Mind-Set Is Not.

EMS is a complex business, with eight-minute response times within your community, a stock that is both critical and time- and

temperature- based, burdensome regulatory requirements and continuing education for your staff. Who the hell told you that you can manage all this without a business plan? Without short- and long-term multi- year goals? Without strong management support for a volunteer labor force? Volunteer EMS organizations, even more than career organizations, need career managers with a multi-year business plan mind-set or your organization is going to fail. Even the Red Cross has career people who manage volunteer staff.

Regardless of Our Employer, When We Do 9-1-1 Response, We Have Not Said That We Are Public Safety.

After 9/11, I had the privilege of working with George Contreras and Richard Fox to try to secure federal line-of-duty Public Safety Officer Benefits for all of the municipal, hospital, private and volunteer paramedics and EMTs who died during that event. That experience really opened my eyes to the inequality faced by medics across the country. We are not public safety because of who our employer is; we are public safety because we respond to the public's calls to a public emergency number. That is a critically important distinction.

Summary

In summary, the problem is us. While we have become very good at

blaming everybody else for our troubles, in our hearts, we must think

that EMS is not all that important. If we did, we would be fighting

like hell, working together and pounding our fists on the table.

As it stands now, most of the talented paramedics I started with

20 years ago are no longer paramedics. Some got hurt, some died, some

burned out, and many of the rest work part time, because they love

EMS, but need careers to make livings for their families. It is

painful for me to say that EMS is not a career, but it is not. It is

also painful to see the EMS system, which I do value and once had

great hope for, collapse, but it is. While many of the problems I

have identified have fixes that could be implemented now, I

understand that most will only be implemented when the system

collapses. And that can't happen too soon for me.

Scot Phelps, JD, MPH, EMT-P, CEM, CBCP, MEP, is an associate

professor for the Emergency and Disaster Management MPA in the School

of Public Affairs and Administration at Metropolitan College of New

York. He has served as assistant commissioner for Emergency

Management at the NYC Department of Health and Mental Hygiene, as a

hospital emergency manager and as a professor of emergency medicine

at George Washington University School of Medicine.

Go big or go home. That's why I tube all my chest pain patients. I was taught that the only definitive airway is an ETT and obviously without A you can't go on to B or C so I first secure A.

Straight up...Your scaring me man, just because one "can" shoot a tube doesn'tt mean that blanket statement "get a tube" have you been following the CPAP vs PEEP thread...maybe you should?

Now first off you identify yourself as a PCP...is ETT even an option for you out there in Ontario... cause it aint here and over my dead body will that happen, without drugs to keep a tube in, one is not doing the best thing for the patient. AND when a tube goes in then it must come out, Ventilator aquired nosocomial infections, excessive costs +++ look at the intubated patients "discharge to door" vs non-intubated patients...hmmmm, i need say no more. The mark of an good Paramedic is do no harm first..!

Back to the regular sheduled topic, nicely done there ccmedoc I to believe that the "paradigm buster" that you included to support your opinion is well founded and appears a very valid study....only in Britian you say? Yes, we sometimes just follow wrote protocol for years without raising the question is Hi flow O2 the BEST for the patient ? Lots of studies are pointing to the fact that this may NOT be the optimal treatment, that said follow ones protocols and present the studies to the Topside Director for review.

cheers

DustDevil, you're right on mark with the terminology here.

I usually prefer graphics when trying to explain CPAP and respiratoroy phases.

You just made me reminiscent of Nancy Caroline's Text and the adventures of "Sidney Sinus node" for the dumbing down part. I see it is still presumed that some texts must be written at that level.

RT principles and fundamentals haven't changed; just a few more knobs and buttons on sleeker looking technology.

They always wanted us to use a PEEP valve on self-inflating bags but I find them a little futile at times. It retards the exhalation phase momentarily but ends before the next breath and the manometer drops to zero. I will run a valve in line with a free flow anesthesia bag (Jackson-Rees system) and try to maintain an elevated baseline with flow..."flow PEEP" from the DOWNES and EMERSON days. There is one disposable CPAP system that reminds me of a DOWNES generator and actually isn't too bad.

There are two devices that I have recently seen on the trucks that are essentially "nebs with a restrictive valve" running on 6- 10 liters off the flowmeter. One patient was being physically restrained to stay on the device. I've been wanting to toss a manometer in line to see what the baseline is holding at with this devices. I've just been too busy switching them to my technology so they can be unstrained and breathe.

Darn I missed all the fun on this one, a day late and a dollar short....rats.

Just one passing comment to throw a screw into this topic, the diffence of non-threshold PEEP and threshold PEEP, ie On a Vent if inspiratory demand (at the mouth) exceeds the set PEEP then the Machine then triggers an and additional valve kicks in to maintain true threshold PEEP, in the cheaper devices this is acomoplished with the use of Ball and spring type assemblys or valves...this is "the purist definition true PEEP" but it can make major differences to the success in oxygenation of the critical patient. Sounds picky but pulmonary mechanics can be quite complex, ie BEST PEEP, vs Optimal PEEP, la la la... and the beat goes on.

Fact remains (and as I always caution) with applications of PEEP/CPAP---- these methods whatever the type of delivery should be approached as a drug would be used --- arbitrary numbers can be a real concern in the circling the drain crowd that said this is an area that Paramedics need MORE edjumication, one can stave off the tube and provide improved care as well as save the costs of a Ventilator and an ICU bed, so please remember some of the patients have not read any of books!

cheers good thread.

Vent medic should we discuss the CPAP vs Pressure Support ?

WOB increases with CPAP, not PS...

I'm afraid I can't get on board with this suggestion. For us to start digging into this personally reeks of vigilantism. For us to just let it go is negligently apathetic. You are correct, that this is only an accusation at this time. That is why I don't think any discussion of names is appropriate. But the proper bodies to verify the specifics, and to act upon them, is ACP and the school in question. If they are not notified, then there will never be any verification, one way or another. If it never happened, or if this is all just the lunatic rantings of yet another Internet drama queen, then that will be easily determined. But if there is fire beneath this smoke, that too should be addressed by a regulatory body, not by us.

I believe our role here in the peanut gallery is nothing more than interested observers. There are SO many lessons to be learned from this scenario. Whether it happened as we have been told or not is irrelevant. This is still a very educational professional discussion.

By the way, the thread is -- as I predicted -- gone again, at the request of the original poster. Not sure I can really blame her, as it must be pretty embarrassing as she realises how inappropriate this scenario really was. Did anybody take my advice and copy/paste or screen capture the original post for us?

Well good words once again, I did not copy but yes quite the conundrum... but lets put things back on the track :

Always a BUT with me never has the word "apathy" been used to describe my character, that said.

Lots of other adjectives have been used, I wear them well, te he. I seriously doubt that ACoP can do this effectively or impartially they have not in the past, hey Dust you have dealt with the rhetoric haven't you ?

For us to start digging into this personally reeks of vigilantism.

YES an NO this can entirely dependant on the person that does go that one step further, vigilanties are renown to "HANG EM HIGH" there Duke.

Want to know the whole story here, I will attempt to explain with my very poor excuse of use of the English language.

First off a severe reprimand to 8151 you are completely WRONG,

You have brought disgrace by identifying someone that had NO part in this, factually, was never even involved in anyway shape or form...shame on you You are hide behind your anonymity but wish to identify someone by name AND attempt to discredit an educational provider that puts Heart, Soul, Blood and Sweat to apropriately train and prepare future students. The very people that could and will positively affect EMS in the future again hide your head in shame 8151. Most of the other other commentary was made theroretically and based on the information presented by a student and not "all" the info was represented in the correct manner.

SO was a discharge of 5 watts into a pillow to demonstrate the "click" of the capacitor...inapropriate or unsafe ?

Rationale: The LP 10 does NOT have a self test so without experience and in-depth knowledge about this model, operators would never be aware that the monitor was even functioning correctly. A very good learning experience as some industrial providers still use this piece of er artifact! (another topic) Besides, the capacitors need to be discharged after being charged, preferably into a testing base, inspected annually by a bio-tech, so the demo was justified in my mind but when you don't have a base at hand then just what does one do.... put them back in the holders and turn off and the capacitor will loose the charge, so now the students know, unfortunately the poster forgot to mention this piece of info too.

(I forgot this as well I was thinking of the LP 10C)

A comprehensive monitor with most of the bells and whistles WAS on the site, but it was not 12 lead capable, and there was lots of electrodes.... So does one do a 12 lead on an asymptomatic student that display absolutely no signs of any cardio pulmonary distress ? Just a possible adrenergic response, and like Warren Zevon said "Just an excitable girl"

(and self admitted by the poster as well......)

The paddles were never applied to the anyone's chest. It was explained the use of quik look selection but this was called "playing with the buttons or something like that" again by the poster, the paddles by applying to a student’s arms/hands (as previously discussed) the first simulated patient was a male, hmmm not the same story I first read about. Then electrodes applied to the arms, then the writer of the post applied the stickies to HERSELF, it was her curiosity about herself that lead to this not the instructor. A bit of a failure to communicate here and this lack of information lead us down the garden path. There was no impropriety at all of this I am quite convinced.

Mastabatter made a very good point, but we missed it, why did no EMRs report....because there was no breach of inapropriate touch....simple.

Hey I jumped on this too...shame on me! bad, bad squint go to your room without a beer.

Your just the village idiots helper after all !. :oops:

Could the fact "not mentioned" that this was a rather portly gal, the possibility of axis deviation should be considered. Again the writer i.e. "inverted T waves" forget to mention a strong but gentle advice to have this investigated further by the Instructor? NOPE!

It sounded like the student initiated that advice, so not the complete story. The writer themselves stated that they were IDDM for over 15 years and the possibility of infarct is not entirely "rare" these days in the bariatric population. Even at a very young age, the ectopy noted was multi-focal but that was not reported either, nor shown on the strip, this Instructor does know his stuff, a comment was that the inverted T waves started levelling out in lead 3....also indicative of some axis irregularities.

I know this man well and I would trust him with my life and that of my children.

I hope this speaks to his credibility and this well respected school.

8151 can treat my ex....oops, darn outside voice again.

Isnt it odd that those that are the students, always know best?

Now let us look at this writer, just her handle alone, this maybe just a touch of "look at me I'm different"? I suspected a very smart, but a bit oversensitive chicky that really wants to get more information, perhaps just a over exuberant is all, and I love keeners!

But here is the shining light in this excersise: The REAL Instructor was extremely concerned that this students feeling would be hurt and she would loose her confidence and be detured from futher attempts to be accepted by the community of EMS, so lets not eat our own, no matter how good they taste.

cheers

In Canada, is the legal system operating on the premise that an individual is presumed innocent until proven guilty, as we in the US supposedly do?

Also, if proven not guilty, as someone pointed out to me regarding a different person's alleged crime, "Where does one go to get their good reputation restored?"

Yes how true and unfortunate, the ideological concept of "innocent until proven guilty" has long been forgotten on both sides of the border, well except in Quebec it IS different. It is the reverse but then again the French are very Strange" or maybe they knew from the get go? I dunno.

Personally this has happened to me.... I lost a job there is NO way that even after winning a very long and very stressful battle (I had to sign a non disclosure clause to financially and finally support my family) It has on numerous occasions been asked if I was Fired....Yea well My bank account showes the truth.... whatever, I don't think I can ever live it down... so, it sucks to be me. :shock:

no cheer

[hr:ce68d7a965]

Thank you for saying that!

I just dont think that this can go without something being done, its one thing that it was done by a fellow emt, but its an entirly differnent that it was done by an instructor.

Having said that, now that us members of the college who are empowerd by the knowledge of this event, do we not have the responsibility to report it to Conduct and Competency comittee? Is this any differnt that the member who got his licence suspended because he did not tell ACP that he saw his partner relieving his sexual tension? (correction) while his partner was in the back with an u/c pt?

Yes : I would hope that alternative complaints resolution guidelines would be followed, the only problem excists that I see is that I have personally have very little faith that the individual at ACoP will actually make a choice to investigate....they have been known to protect the "College" and not the individuals rights...of this I have past proof of gross incompetance... yet another story and off topic... sorry, but rest assured a responsible individual has been apprised to investigate this "senario".

Well thanks for that, but when it comes to professionalism I am afraid now you too have let us down just a touch, come on man, no need to get gross here, shock value does not the point make. That said the point of sexual interference is valid, did that EMT touch the patient? Never mind I really don't want to know...ee gads he will go blind man, didn't his Mother tell him?

I do agree with your comment re: That a member of the Paramedic community that has used a position of responsibility to take alleged advantage of a situation...as a past Instructor myself, if the demonstration of a "Quick Look" is important for the education of a student then I use the "bilateral hand technique" discussed prior, or use my own very fish belly white chest... and that's SO not appealing to EVERYONE like fat bastard in Austin Powers...sorry for that visual! hey or just like aussiephil.....LMAO! Slam!

now thats cheers !

[hr:ce68d7a965]

Quoting Masta: Let us first verify the specifics of this allegation. The best situation would see the students involved (registered EMRs) come forward rather then those on the outside merely hearing of it through the grapevine.

Unfortunately it appears that this... can I say "child" here? Is not very aware that perhaps someone wants to check out her parts and perhaps even the "writer" could be baiting a bit too.....but that has never been done before...yea right.

But if this is truly an innocent and just interesed in paramedicine then it does fall upon the experianced veterans to point out a suspect impropriety. I have since returned to the "other" forum and lo and behold some very good advice is posed by the seniors on that site...I hope this gal listens to it and many others that know that this "senario is inappropriate" Or could it be that they, "the rookies" blindly follow "a god like paramedic instructor" without any question...jeese I hope not.

Fact that defib was discharged with some b.s. explanation raised some serious doubt in my mind as to validity of this rather impromptu due demonstration in the first place.

cheers

[hr:ce68d7a965]

Quoting Ruffems:

Professionalism starts at the individual level and not the industry level.

[align=center:ce68d7a965]DO I HAVE TO AGREE WITH YOU AGAIN?[/align:ce68d7a965]

I think I did just demonstrate that myself through my very action's....I hate when you do that!

[align=center:ce68d7a965]WHO ARE YOU my ex wife?[/align:ce68d7a965]

ps I'm pissed...and where is my occasional free stuff again? Oh yea in the mail just like last time :twisted:

cheers again.

I think it is more imperitive that we work behind the scenes of our own agencies and houses to assure that our houses/agencies are professional. WE all do things that others consider unprofessional.

Drive 5 miles per hour over the speed limit

Talk about patients to our co-workers. (HIPAA violation)

Talk about one another behind their backs (gossip)

Bitch and moan about management in a forum like this rather than confront the problems in management.

Until we as a group can say that we are professional 100% of the time then we start to walk up a very slippery slope in policing others.

I just don't think that our place as members of this forum or this forum overall to be the police. It's a noble gesture and noble endeavor but unless we are prepared for kickback and resistance then we need to mind our own houses and services.

Professionalism starts one person at a time. Not an industry at a time.

Well, sorry to disagree but leadership is of a key note importance in the area professionalism it should be modeled first, then others may follow that model. One HAS to establish the correct acceptable conduct prior to evaluating the actions of others, it appears that some peer pressure has been very successful, in this case now and an sincere apology issued as well. This Is the way to conduct the profession, not a review of all postings by who ever and whatever, everyone has a right to there opinions truely .... well, in the free world.

I would like to point out that this international forum (and to its membership) be cognitive to the fact that the laws of one jurisdiction vs another are a waste of farking time quoting....there is NO HIPPO in Alberta, on the other hand their is few Moose or two, that said it appears that there is a consensus of percieved professionalism with the membership that take the time to discuss issues pertaining to the industry is alive and well.

Professionalism and the RIGHT thing to do is a very strong influence in my world and it guides me as when I get a gut feeling that something is odd, I for one WILL put my nose in peoples busniess if I believe it will correct misadventure, so rest assured that "some" that have had their reputations placed at stake here, have been duly notified.

cheers

ps: sometimes one just never knows who they are speaking too and about....I digress.

I'd really rather we did not get into names on this topic. Who was involved is really irrelevant to this forum. It is the professional issues involved that are the important topic of discussion.

Naming names is just going to get this topic closed, and rightfully so.

Agreed totaly!

So on a sidebar, a Question posed:

Could the internet/ er EMT City be an effective means of assisting to unofficially "Police" the Worldwide profession of EMS?

Comments from the peanut gallery. :twisted:

Just my opionin my truely respected friend: But how can one individual speak for another ?

Lets drop this unfortunate "fau pax" by 8151 as an error in good judgement.

And my sincerest apology to the other web site, as it appears that the RIGHT choice and Correct has been made...

cheers to the moderators!

Ok so where are we NOW and what do we do about this do we as a group allow this type of INSTRUCTION to continue ?

We have heard of a "possible situation" and a possible very serious infraction of professionalism and safety, so lets not prejudge here, ok, but this sure sounds fishy to me.

IS it not up to experianced responsible Paramedics to Police ourselves..I think so! Especially when the future of more than just 2 practitioners are involved...question being: Will these students use this less than stellar 'instruction" in the future themselves..my GAWD I HOPE NOT!

It appears that the tread has been deleted by a less than outstanding/ responsible Administrator, possibly afraid of litigation ? Again I am uncertain too.....This should by all rights, be investigated by knowagable impartial individuals.... it is just the right thing to do...PERIOD, anyone disagree..??????

The logical rationale being : We ALL have heard of DEATHS in situations VERY similar... should we sit back on out asses and voice opinions based on conjecture or do we advance information to those that DO have intelligent influence on conduct ?

Unfortunately "someone" perhaps has had issues before and has fingered a likely individual perhaps a past history of this type of inappropriate behaviour? I really don't know and in hide sight this is NOT the best idea...if you catch my drift....ALL.

Bringing disrespect to a registered Member of ACoP is also a infraction as well on spec. One could be also under an investigation as well ....I digress.

Admin I request that you delete this fau pax...asap, but allow the thread to continue....just the right thing to do for EMT City a responsible website for professionals and just my opinion here, thanks YOU in Advance.

Sooo lets do the right thing.... OK.... so someone contact this GAL....forward my PM (as I am not a member of this other web sight) and I will assist to provide IMPARTIAL advice to the all parties involved.

cheers

Absolutely unacceptable behavior, discharging paddles with the justification of "needs to be tested or excersised" ? HUH?

For those that are knowledgeable the number of discharges of the capacitor is limited .. whatever.

If the instructor is up for a cheap thrill this would be the way to get it, sheesh scared the crap out of this chick.

I could not see the strips but sounds as if could be an adrenergic response....

cheers

Report this clown, it brings disrespect AND influences noobies very negatively.

With the many different ways that ACS can present I wouldn't fault anyone for giving ASA. There have been plenty of pts where I have thought, "well, I guess it could be an atypical presentation, let's just give the ASA so that we are ahead of the game." The only time you shouldn't give ASA is if you are thinking disection or aneurysm. ACS is a scary thing because of the varied and vauge ways it can present. Even with a 12 lead you can't definitely rule out ACS.

AGREED there ERdoc:

ASA is my wonder drug....I use it EVERY chance I get.

The oldest drug known to man (I believe)

NSAID

Analgesic

Antipyretic

Cardioprotective

In fact beneficial for suspected TIAs as well, not that we carry a CT scanner in most rigs.

The best use is for HA associated with drivel or ....hmmm .... over indulgence (which I endorse on a monthly basis) so just where did I put that cook book again?

Dustdevil wrote: "you don't have to deal with to much up there in Canadia."

I can find very few documents that associate death or serious side effects with one time dosage... long term is a wee bit different for GI complications. All in All patient benefit vs. risk should be ones guide to the galaxy in my humble view.

I started to post out of sarcasm but then I realized that the other side of the coin was not reviewed: That being "witholding" standard accepted care, approved by protocol. Granted if one cannot find any S/S of ACS as ERDoc states but one "suspects" ACS and witholds ASA....are they held accountable?

cheers

Etomidate Alone versus Rapid Sequence Intubation: a Study in the Prehospital Aeromedical Setting

Vicki L. Huggett, RN, EMT-P; William P. Bozeman, MD; Douglas M. Kleiner, PhD, EMT

TraumaOne Flight Service, Shands Jacksonville, University of Florida Department of Emergency Medicine

Introduction: We sought to evaluate the intubation conditions produced by etomidate (Etom) sedation alone vs. those produced by rapid sequence intubation (RSI) with Etom and succinylcholine (Sux).

Methods: A prospective, crossover trial design used two helicopters staffed by the same flight crew. One aircraft utilized the Etom protocol (20 mg of Etom with a second dose of Etom or rescue Sux available if needed), and the other used the RSI protocol with the same dose of Etom plus Sux (1 mg/kg). After 6 months the protocols were switched. Intubating conditions were graded at each attempt by three different scales: global difficulty using a scale of 1 (very easy) to 5 (very difficult), the Percentage Of Glottic Opening (POGO) score (amount of vocal cords visualized), and formal Laryngoscopy Grading Scale (LGS) resulting in a “good,” “acceptable” or “unacceptable” rating. Orotracheal intubation success was recorded at each dose.

Results: A total of 56 patients were intubated. Conditions were assessed for all 69 laryngoscopy attempts. Evaluations of laryngoscopy attempts using Etom 20 mg only were: Difficulty = 4.9, POGO = 9%, LGS G/A = 13%, success rate = 13%. Etom 40 mg had the following results: Difficulty = 4.4, POGO = 17%, LGS G/A 0%, success rate = 0%. RSI results were: Difficulty = 3.1, POGO = 59%, LGS G/A = 74%, success rate = 90%. Intubating conditions with RSI were significantly improved by all measures (P < 0.05) compared to each Etom alone group.

Conclusion: In the aeromedical setting RSI produced significantly better intubating conditions than Etom at either low or high doses and in turn resulted in higher intubation success rates.

Aeromedical Transport of Severely Head-Injured Patients following Paramedic Rapid Sequence Intubation

Daniel Davis, MD, David Hoyt, MD, Mel Ochs, MD, Jennifer Poste, John Cavitt, CFN

Department of Emergency Medicine, UC San Diego, and Mercy Air Medical Services

Introduction: The San Diego Paramedic RSI Trial documented an increase in mortality with paramedic RSI of patients with severe traumatic brain injury (TBI). This analysis explores the impact of aeromedical transport of trial patients on outcome.

Methods: Adult trauma victims with severe TBI (GCS 3-8) were prospectively enrolled. Paramedics performed RSI using midazolam and succinylcholine; aeromedical crews could be called for prolonged transports. Patients were matched to historical controls using age, gender, mechanism, ISS, and AIS scores for each body system. Aeromedical- and ground-transported patients were compared with regard to demographics, clinical parameters, vital signs, ABG data, and outcome. Regression analysis was used to determine the independent effect of aeromedical transport on outcome.

Results: A total of 352 patients were included (87 aeromedical and 265 ground transports). There were no significant differences between the groups with regard to demographic, clinical, vital sign, and ABG data. Aeromedical patients had decreased mortality (28% vs. 31%, OR 0.9) and ground patients had increased mortality vs. matched controls (33% vs. 22%, OR 1.8). Regression analysis revealed a decrease in mortality (P = 0.011) and an increase in “good outcomes” (P = 0.046) associated with aeromedical transport.

Conclusion: Aeromedical transport of paramedic RSI patients is associated with improved outcomes.

Yea I know its not tottally ON TOPIC, but thought I would post fer fun.

[align=center:f83da5dc32]UPDATE on the Investigation[/align:f83da5dc32]

Not Reuters:

[align=center:f83da5dc32]Firefighters rushed to hospital due to toxic fumes inhalation...believed to be smoke from burning rubber and silicone.[/align:f83da5dc32][align=center:f83da5dc32] This just in " leather cleaner was believed to be an accelerant "[/align:f83da5dc32]

Some little nerd is sitting in front of his computer at the media outlet laughing his arse of that he wrote that and they printed it.

I am soo laughing with him!

I might as well speak up on behalf of us in NS. We do have a operational community paramedic program in one community in the province and are in the works of developing several more. The community currently being served is Freeport/Westport. They are located over a hour away from the closest hospital and are in fact two islands at the end of a long neck of land. We have a unit stationed there 24/7 as part of our SSP. Due to the small but elderly population, being unable to get a doctor to cover the community, and the large ammount of down time for the medics working in that post, the CP program was established.

The paramedics work in co-operation with a nurse practitioner and a medical control physician from the local hospital. As the link indicates, they do wound care, suture removal, daily injection meds, blood draws, home visits for CHF assesment and falls assesment, they also have a adopt-a-patient program where the doctor identifies a patient in the community requiring specific attention and they are assigned a specific medic that monitors their overall condition.

Hope this helps

Are you trying to say that NS is leading the PAC.....say it isn't so, Lord Thundering!

LOL

ps and where is that "How to speak Nuffie" guide you promised me?

cheers

Interesting topic;

The point of having a Paramedic in this role does have serious advantages, in my hood (presently in Industry) the provision of Acute Care has been very clearly established, OH + S has recognised this. But we fall down in the delivery of primary care. (curently unaddressed in our Education System) combining these 2 roles could prove to be cost efective and improved delivery of care. Dare I believe that early intervention in primary care could avoid costs in Acute Care.

The only problem seams to be the lack of forward thinking...ie failing to recognise some Gap skills, ie suturing and bug juice delivery.

cheers

Er speaking of idears...did we rule out Trauma?

Any recent falls?

MVC?

???

Scope:

Which Nation? check out the flags!

We had several subjects of our degree devoted to professional studies,

Did not forget the all important lecture on BEER?

Reflections on Ice Breaking.....Quoting Ogden Nash, one of my personal favorites.

Candy is Dandy but Liquor is Quicker.

Thank you.

Now just in passing this IS not a Slam, but many of the informal gatherings "after class" are more far enlighting than the actual lectures...

cheers

Rid;

Some schools here have implimented "must attend" College Annual general meetings OR "do a paper" on the development on EMS in this province/ Canada..... 2 schools cancelled classes due to a memorial for a fallen comrade....

Participaction teaches more than any theory can...period.

KUDOs to those schools leading through example... Augustana, Northern Alberta Institute Technology and Canadian College of EMS.

60 y/o Hmm:

Ok: lets get the meat first svp.

LOC? Am assuming GCS = 15?

Soco economic status?

Wieght?

Primary survey? any dyspnea?

VS ?

Lung sounds, cough productive? what color?

ok: Hyperlipidemia...PMHX therefore ECG, the elderly female is high risk for atypical presentation for MI.

Pnemonia?...bug juice.. Did she take with food?

Any herbal remidies? has she taken any rx since onset?

Was abdo pain onset generalized? then focused to RLQ?

PMHX no surgeries.

Focused exam....tender abdo?

Rebound?

N + V?

LBM?

ps do me a favour there ERdoc....this "yall, meds stuff" can you use genaric names as in Kanukistan we have diff RX trades it sure srews me up...lol.

Diff DX: Stuck Fart?

You all are quite right, It is actually getting very boring now to see all of you get your panties in a bunch. It's not as fun as it used to be

What's wrong with tattoos????

-10 for off topic.

-6 for using this forum for your entertainment.

-300 for professionalism.

Personally I wil no longer bother to respond to your foolish giberish.

cheers

goodbye