herseyjh

From the EMCI & International Union of Operating Engineers collective agreement: PCP $20.59 to $23.08 ICP $21.58 to $24.53 ACP $24.61 to $28.52 CCP $27.27 to $30.85 From the base rate, to top pay, takes 5 steps. This agreement expires at the end of March 2011, so after that who knows.

Sadly the answer is no as the problems with Zoll monitors seems to plague the entire family. Our service uses the CCT, the m-series and is trying out the e-series. My recommendation would be to try anything else. I have made numerous posts about Zoll monitors, on a variety of forums, to the point now that I feel like an anti-Zoll zealot, but I do feel strongly about this: Look for something else. I am not a gear-head type of guy I just want equipment that works and I could care less about the name on the monitor, but when equipment starts impacting on your care it is time to try something else. For example, people say the NIBP is slow and inaccurate, and I would agree and to take it a step further I would say you would be hard pressed to get a reading on anyone under 100 systolic. Picture being stuck in a plane, wondering if your art line is accurate, trying to confirm it with a NIBP but guess what? You can’t get one so you go with the art line reading of 98/60, then you notice ‘phantom’ pacing spikes but you know the patient does not have a pacemaker so now the monitor is counting those as complexes so the rate on the monitor is faster than it should be, all the while your SpO2 sensor is beeping all the time because the cable is coming apart where it hooks into the monitor. What else? Battery life can be an issue. Oh and they are heavy and expensive.

Cost is always a difficult issue to bring up in health care, and for our service we made a compromise based on a few factors. The first being cost, as I mentioned, and the second was on the actual need for an IO system as we tend to place very few of them in a year, and the final factor was familiarity with equipment. We decided to stay on board with what our hospital is using and what the community based nursing stations have. I will be honest, until I looked at these studies I was all for a new system, first seeing them in the military and then their use (the FAST 1) with an urban EMS system, but as I placed a few I began to wonder if we could manage with a old-fashioned IO needles. So far this has worked, but as you pointed out, studies can not completely emulate the field environment, and maybe as adult IO placements become more common place the need to switch to one of these devices will become evident.

Perhaps you should take your issues up with the author of the study and not the person who is reporting it. Spinal needles aside, I am sure, if you review the studies out there you will find very little difference between products, therefore why not go with the most economical and compact models? Of course, I hate to be the master of the obvious here, but as you pointed out spinal needles suck to place as an adult IO. Then how did they manage to do so well in theses studies? All I am saying is before throwing out you old IO stuff and run off to get these new ‘high-speed’ IO systems sit down and think about what you are spending your money on. If the answer is ‘for something new that costs more but does not have any clinical benefit’ you answer should be not to bother.

Which IO device to use? This is a good question, and when I had to address this question for my service I was excited in the prospect of getting some up to date kit; however, after reviewing studies I was surprised to find out that none of these new devices have research to show that they are better than any other device. I even found one study that showed a good old fashioned spinal needle had a better success rate. I say go with the cheapest and smallest device out there as they all seem to do the same thing. Mind you some sound and look cooler than others.