zippyRN

EMT-B does not exist in the UK , anyone claiming to offer such as course is effectively offering a first aid course with toys added. EMT-I does not exist i nthe Uk as there is no legal means to enable EMT-I scope of practice.

AREMT certification / registration holds little eight in Ausd and precisely Zero weight in the UK

the 'evidence based' best opinions seem to be keep the long EXTRICATION board for extrication and use validated selective immobilisation guidelines ...

unless and until you can rule out some kind of neuro pathology ... whether that's a CVA , a neck injury from the 'scuffle ' ( think central cord syndrome) ...

Hello. I don't have an answer for your question at this time. I just need to say that I have been a certified nurse assistant and I feel the same way we are treated just because we don't have a higher education or a degree of nursing. I really dont want to be a nurse because I see to much competition among the nurses and the B.S that goes on in nursing homes. so I decided to go to school for EMT-B and continue school for EMT-P. Here in PA paramedics salary get paid 50,000 to 70,000 per-year and EMT-B 35,000 to 40,000 per year depends on location. Been a C.N.A for 22yrs and dont even make what emt's make per year. CNA's only make 25,000 per year and with all the experience of 22yrs, it is sad what we get paid per year and no appreciation or no respect from no one. Even some nurses treat us like we are something that they carry on the botton of their shoe( crap ).

with accountability come responsibilty and rewards, this is why HCA /PCTs /CNAss and protocol munkey EMTs are paid relatively little compared to RNs or Cops ...

if you look at the places in the world where Paramedics are professionals with degrees they get paid what a professional with a degree is worth ...

PTS staff or 'advanced first aiders' doing event cover in the UK getas much if not more training than EMTs in the USA ...

as the OP is in Riyadh and not bound by US specification he could look at the some of the UK / German or french builders and EN1789 standards type B for for ordinary emergency ambulances and type C for speciality and critical care ...

Orthostatic hypotension is a non-specific indicator of low blood pressure which as we all know can be caused by 300 different things

If it were my educated guess, it was removed because it's got no real value

also how long does it take to do postural BP Properly ? and is this an appropriate use of scene time ?

it depends how much stuff you want - if you are ordering tens to hundreds of an item or a group of items ( e.g. BVMs, mouthpeices, masks and nebs ) it might be cheaper to go to a manufacturer

as 2c4 says bags etc might be cheaper if you buy the raw materials and find a local seamstress, upholsterer or even a sailmaker to actually make them ( sailmakers have slack time in the winter as there's little repair work coming in so they either try and sell at a discount to keep the cutting floor working or do industrial stuff)...

plastic cup with bottom cut out(hole big enough to fit the inhaler in) and put it up to the patients mouth and nose, make a seal and then push the inhaler. Then have the patient breath deeply.

even better is a 'large' or 'bat fastard' size cup (500 ml or imp pint ) from a fast food place as that is the kind of volume a real spacer is and generally provides a better face seal

interestingly the use of nebs is frowned up in some places vs 10 puffs via spacer repeated every few minutes - but some of this is trying to wean people off the idea that nebulisers are a cure-all and that MDI and spacer is an effective emergency option.

also if you are in the position of not having nebs as a treatment option ( either because they are not authorised for your grade or because you've run out) the patient's own MDI and a spacer may be the best option you have

Side bar and to which I don't agree - I have heard of medics using the facilities of the patient's home...

Toni

I have done this before, however it;s been in one of two scenarios that I can recall

1. having driven for around an hour and a half through rush hour traffic from base one morning to pick someone up to go to a tertiary referral hospital 3-4 hours away - i did go for a pee before leaving their home with the aim to try and do the journey with one stop ( for the UK people the person lived i nthe wilds of West Yorks - nearly Bronte country and the appointment was in Oxford - we took a break at Castle Donington services )

2. when doing discharges on support shifts - again usually in the back of beyond because knowing it's go now or not really be able to go until after you've completed the next job.

a lot of it is going to depend on the nature of the workload and your travelling times - if you are in an urban suburban service where jobs are 45 min -1 hour end to end you aren't going to necessarily be in the scenario of asking to use the toilet at a patient's home ,

Yes yes I've heard the excuses before,

"I'm not using my back and lifting a patient unless I absolutely have to".

How about this, if your THAT concerned about your back, get in the gym, drop some weight, do some core exercises, improve your health and conditioning to the point that your obvious physical limitations DONT affect patient care. If your too old/fat/stubborn to do something proactive, how about you go find a nice relaxing 9-5 job that's not going to stress your back too much.

How hard is it to just grab the stretcher? Its right there, it takes ten seconds, and that's what its designed for so why not use it?

and mindsets like this is why EMS in the USA is such a low status job....

the Europeans will have a different mindset on this , and not just because of EUwide manual handling regulations that aim to reduce or eliminate manual handling takss , our tightly packed due to population density and available land private houses don't have room to get trolleys in and if if they do there is no assurance that you will be able to get to the patient ...

Richard and Bernhard have covered a lot of the points i'd raise , there have been other threads on this kind of topic i nthe city , discussing provision and the differing apporaches in different places

The new stryker system is not available on the market yet .

I saw it this year as a demo. It is a nice concept.

I have a quote somewhere on my desk with the priceing. Somewhere in the neighborhood of 15k on top of the price of the power stretcher. total between 25-30 k for the package

VERY expensive

but compared to the fines and payouts for breaking staff ?

the advantage of the UK approach of ramps / lifts is that it allows the ramp or lift to be used with carrychairs wheel chairs or even an ambulant patient ...

what's the contingency method of operation ?

i'd echo all the above, from the two symptoms mentioned - Mobey's suggestion of a head injury is something to consider ...

being an effective clinician is more than just playing buzzword bingo to come up with a diagnosis ...

zippy RN

Canada vs UK .. 2 completely different sets of rules of engagement .

cheers

squint I've had these kind of discussions around 'Nurses can't do X, Y or Z' on a nursing based site with a wide international readership and oddly enough even with reference to statute law and the requirements of BONs often these statements can't be substantiated

Oh RumFiend, you know. I assume (yeah, I'm an ass) that he would be referring to our standing orders and capabilities. RN's cannot intubate, etc and need physician approval for pretty much everything. We can intubate, give narcs, suture, so on and so forth without having to see if Simon Says ...

oh dear oh dear oh dear ...

it'd would be funny if it wasn't showing the ignorance of individuals

from a UK perspective there is only one thing an 'ordinary' RN cannot DO that a paramedic can do and that is give IV morphine without an existing prescription. Every other Paramedic intervention requires either a small piece of administrative work ( e.g. Patient group directives for medications) or simply proof of competency - e.g. peripheral IV cannulation

Similarly for a Paramedic to do everything an RN does again requires proof of competency and various small pieces of administrative work, however there are a substantially larger list of things a paramedic would have to demonstrate to be able to do everything an RN can.

perhaps if those who are fond of saying 'Nurses can't do X, Y or Z' were to do a little bit of research they might find that aside from legislation surrounding medication , most of these prohibitions are nothing more than organisational policy or 'widely held truths' without a basis in regualtion or legislatiion.

The problem with benzo reversal is similar to reversal of narcotic overdoses with dependency and addiction issues. However, with benzo reversal you have additional risks. A patient can develop withdraw, hallucinations, aggressive behaviour and seizures. Unfortunately, the very medications that can treat these problems are not going to be effective. This is a bad place to be in. Unfortunately, it's not even treatable with say a paralytic because paralytics primarily effect peripheral nicotinic acetylcholine receptors. The only practical use I have for reversal agents is in benzo naive patients receiving procedural sedation.

yes and the UK product licence says as much as does ToxBASE

Isn't there any concept in your country (as I recall we have at least USA, Canada, Australia, NZ, UK, Netherlands and Mexico here) to occasionally add transport capacity for non-regular emergencies in your area despite mutual aid?

We have rapid response squads specialised in transport, prepared for multi casualty scenarios. Two ambulances per squad can be sent out in 10-30 minutes, volunteer based (mostly EMT level). In our little district we have two of those squads, so I can easily double transport capacity within short time. Additionally we have two volunteer treatment units that each may buffer 25 patients until transport could be set up. All of them have a call volume of about 2 per year (the vollies serve in regular EMS to keep in shape). That is even where we have a lot of ambulances (ground and air) available on mutual aid basis.

Wonder if such things exists and/or are commonly used in your country. If not, and if you encounter such scenarios often, it may be a good idea...what does you hinder?

EDIT: typo

UK point of view and speaking purely from the point of view of SJA equipment

2007 Floods we put 4 ambulances (3 type B CEN and 1 pre CEN A+E vehicle) an RRV (double manned) and a PTS bus out in under an hour from the call being recieved by the crewing co-ordinator. we've also excercised and had standabys where the same response has been ready...

there's also all the kit for rest centres and /or 'field hospital' either ready packed in the incident support vehicles / trailers or there on the shelves to be loaded

there's also all the CBRN and USAR kit that NHS HART have prepacked on their support tenders

If you want to try ketamine, stop by the local rave or dance club and ask the glossy eyed teenagers

*big fish , little fish ,cardboard box * *big fish , little fish ,cardboard box * *stacking shelves , stacking shelves * *big fish , little fish ,cardboard box * *big fish , little fish ,cardboard box *

patient 1 i'm suspecting a head injury if he tolerates an OP he's probably going to be falt enough for a Supra glottic airway or a tube

patient 2 has a low BP , but from the description given of other signs and symptoms his low BP may well be from Spinal Shock / Spinal cord injury - what are our examination finding head to toe? is there another cause for the hypotension ... 84 systolic in a fresh SCI isn't actually too bad.

patient 3 ROLE at scene - police to organise body recovery at a point the SIO decides that sufficient evidence has been gathered

I think we should staff every ambulance with a physician, but I may be a little biased.

there's strong arguments for field physician availability, but one on every ambulance ... as if enough ambulances don't fall over due to elevated centre of gravity ....

http://www.bclocalne.../130160053.html this is the opposite of the topic but I thought it was worth making a comment on.

Personally I have no problems with nurses being in the ambulance as the have great skills, but were I have the problem is paramedicine is a skill set on its own and nurses are not trained in the things we do and vice versa. If a nurse wants to be in the back of an amublance why didnt they become a paramedic in the first place?

that's a bit of a circular argument - a lot fo the skills f patient assessment, and decision making are independent of location - where each different location emphasises different skills aobut the location ....

Like the physician staffed ambulance that killed Princess Diana ?

Stay and play killed Diana not physcian to scene they had three options

1. rapid transfer to an operating theatre

2. open her chest on the back of the ambulance ( or on a pub table as London Hems doctors did sucessfully to someone)

3. fart about trying to 'stabilise for transport'

I heard a car crash killed Princess Diana. Geez man, at least go with Michael Jackson's physician if you want a good example. Yes, he wasn't on an ambulance, but boy, what a screw up.

I think paramedics trained as RN's are the best providers out there. Your day to day RN on an emergency scene? Ummmm, not so much. I'm not sure what it is about RN training that makes them fall apart on the scene of an emergency but its been my luck that it has happened unilaterally with me. I can give you the horror stories of ACLS instructors and RN sometimes but you probably get the picture. Paramedics: Good in an emergency, bad at just about everything else. RNs: Good at everything else except emergencies.

the ability and training to work at a scene is not magically something which paramedics and EMTs have exclusively

I submit that by virtue of education even a two year AAS RN is a far more qualified to practice prehospital medicine than a Paramedic in the US where the Paramedic may have received as little as sixteen weeks of "education" plus a few hundred hours of clinical skills (cough Houston Fire Department cough)

Does that mean you can just throw an ICU or ED RN out into an ambulance and they will be sufficiently dexterous without additional role-specific skill consolidation? Maybe not, but maybe you never know ... I can teach a 10 year old to put a drip into somebody and even I can shove a plastic tube through the right hole fairly easily.

exactly

Kiwimedic

No way a brand new AAS RN or a BSN will be able to step onto an ambulance and function. By virtue of education only as you say...seriously? Come on now...lay off the sauce

who said brand new and who said anything about not providing adequate role specific orientation and training ?

The 3-seated aircrafts (although also on the EC135 a 4 person crew is possible and this is a good choice if you're doing critical care transport) are not that adequate for critical care transport.

This is one of the reasons (together with the "more space"-point) that most critical-care helos in GER use EC145, BK117 or Bell's...

MD900 will happily take 3 or 4 seated people and one supine in the back

if you make the next jump to S92 sized aircraft ....

or just go the whole hog and use a merlin or chinook as the RAF MERT do in Afg.

Just wondering--I read an article the other day that mentioned that one day the future of EMS may be with RN's providing the care on an ambulance! The reasons they listed were that the Board of Nursing has their stuff together and could easily dominate the field of prehospital medicine if they wanted to! I know there is always that debate over the who's who of emergency medicine, RN vs Paramedic, but I never thought that RN's would want to start working the EMS system. I know that they are involved in flight care right now, and that they have the ASTNA (Air and Surface Transport Nurse Association), but do you think it will stop there? Are they going to remain the hospital? And if they choose to work in the field as a street medic (not critical care) will they be performing as a medic, or will they allow an RN an expanded scope? I think that the profession should continue to grow. Paramedics and EMT's are prehospital providers, RN's are hosptial based providers. Any thoughts on this?

Registered Nurses are NOT 'hospital based providers' , RNs work in every health setting going.

in the case of the USA while paramedics and their fire monkey / for -profit bosses are happy to be treated and trained as taxi drivers service development won't take place. This is in part due to the fragmented and billing orientated way in which healthcare i nthe USA (doesn't) work ...

If you look at the model the UK, Canada and Aus has and the Kiwis are heading towards, where Paramedic preparation for practice is equal to the preparation of other Health Professionals i.e. 'proper' Health Professional status, near ( 2/3 or 3/4) if not degree level entry, legal accountability for own practice ( not as the proxy of the medical director) proper own account responsibility and accountabilty to possess administer and in some cases supply medication ... ...

It's good to see you blokes wanting to dish out paracetamol (tylenol) but you have to give it at much higher dosages for it to be effective. 500mg is only one tablet (the recommended dosage is 2-4) and there is good evidence that 20mg/kg or 1500mg is very effective.

15 mg / kg with a max dose of 1g at time 4-6 hourly 4 g in 24 hours - is what the BNF would say and there's pretty good evidence for that regime as a good balance between wanted properties and minimising the hepatotoxicity which kills untreated Paracetamol ODs ...

i'm inclined to agree wit hthe rest of the suggestions and reasoning...

very very few vehicles couldn't take second patient ( the exception is extrication ambulances based on medium to large SUVs where there simply is not room by any measure unless they are well enough to sit in the front passenger seat ), the issues arise from securing that second patient in the vehicle especially in vehicles without a bench or a lie-flat option on the side seats ...

while it's very rare in the UK to have to wait prolonged periods for additional resources and the RN and RAF SAR helicopters ( plus other military helicopter resources) are happy to respond to inland incidents etc - so if HEMS (single pilot + air observer trained medics VFR apart from Helimed 27 (London) who fly twin pilot) can't make it due to weather there's a chance that the military will with IFR and Night vision and their 2 pilot 4 person ( 2 WSOp / loadies )crew

RIP Dust

What if you are a BLS car and all you can administer for pain is Entonox?

Would I be wrong to attempt to have dispatch page out the ALS crew to come and administer pain medication if I felt that my patient would benefit from stronger pain medication which I don't carry on car?

The town I work and live in we can be at the hospital within 10-20 code 3. Would it benefit my patient or just delay transport time if I paged out ALS to administer pain meds.?

firstly is the patient actually using the entonox properly , it is very effective if taken properly and kept 'topped up' ?

if entonox isn't enough you have to consider requesting back-up you also have to balance running hot to hospital and it;s increased risks with the extra time it will take to get that backup ...