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Richard: Ok, I am not trying to start a war, really, but this protocol following is blind following of the leader like in playschool and is not freelancing renegadism. Well unless starting with 15 lpm is set in farking stone tablet somewhere: I think that the point (although controversial) should be intelligently presented by those that are providing initial front line health care, and these new concepts (research based) and treatment modalities should be forwarded to those that DO have the authority to change the "paint by numbers' picture book, perhaps a professional responsibility in point of fact? This mentality is very indicative of an overall problem for your advancement in the USA and the future of the EMS system there, in my humble perspective (and I am not pointing fingers) just south of the poorly defended border. The "Tecky vs. the Practioner Concept" this has been quite clearly demonstrated with numerous posts on this topic. So just follow the pre made cook book and the rules of engagement out of fear of litigation... simply a sad commentary overall. Hey do you remember when a witnessed arrest got 1 amp out of the blue box...and 2 amps for unwitnessed arrest...we were giving the "coup de grace" (excuse my french svp)! Perhaps a good thing the researchers looked into this notion. as for research and inclusion of studies in the field dare I say we should not do our part in the new equation? Nicely stated but, + 5 on the dust devil scale, but in addition (if you may be so kind to add) : To your profession (maybe even include this in your code of ethics) therefore put the onus on the practioner to advance the profession not others. ps: Have you ever noticed "My Mantra" I am not under the delusional belief that I am a "Life Saver" as the Great Spirit has not visited me in my sleep and declared me on a Mission, well just yet..... although, I do were my sunglasses at night and I did watch the Blues Brothers movie! This idea too, of self image is also a detriment to further development of the profession in my freelancing perspective. In closing : I believe I know what the cc stands for in this signature and so does dust....bit of baiting going on here? But then again Dust is very old and So stuck in his ways...sad but very true, come on dust open your eyes to progress.... :twisted:

OK nice story, but its apples vs orange's. Point being if Sao2 monitor clearly indicated NO hypoxia, and the paient is more comfortable and research indicates improved out (s) Come then don't live in fear, I thought this was the Land of the free and Home of the Brave? Do you know how hard this could be to prove in court ... that the practitioner was negligent? Nay... "trained" is to deliver O2 not the exact rate and method, your telling me no wiggle room at all.... Funny My patients are nauseated..... On to akroeze....WHAT a woosie ! GO for the Central Line and Crank up the Dopamine! cheers

http://www.emsresponder.com/print/Emergenc...E-of-EMS/1$5494 I hope that works fer you..... Now just a query just where am I on the Dust devil scale for posts...like over all. Am I out of the hole yet?

So what if the Lawyer...@#%$&#@! Sided with the newest reasearch, AND the expert witness MD +++++ that said you GAVe too much O2?

Ok good, so take this just a wee step further: Now your having chest pain, some scrambling type er FF, is ripping around in your house, ok your freaked out already...following so far ? Some chick puts a plastic smelly mask on your face, and your think this is IT ... with the noisy hiss on your face, some numbers come up on a machine. That you think is the Tricorder (on the origional Star Trek) reading 112 bpm and 100%. Hey right now I would pick the NC wouldn't you? So Your last lecture included toxicity of O2... and more questions than answers, now. Could there more to this research ? Are YOU hurting your patient with NRB mask....hmm. cheers

[align=center:4df1fd5903] :brave: [/align:4df1fd5903]

AZCEP : Oh I hear you absolutely, thank gawd that I can use a bit of spice in my cookbook ! But you know that "Heresy" is a "Burned at the Stake Type Offence... wait a second thats the very old guidelines. No apologie required that was just MY ideological evil twin speaking... sugar in the oatmeal is a good thing. :shock:

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:

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.

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.

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:

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

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...

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 ? 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

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] 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] 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] [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.

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.

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.

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? sorry to tell you but the past Gap training fiasco, this struck FEAR in the hearts of some BLS providers...so much so that they were afraid to "allow a patient to self administration" it for a cold and flu...good grief batman. 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

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] I am soo laughing with him!

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