zippyRN

Carry chairs have a design life of between 10 and 15 years assuming they are serviced ( 6 monthly or annually as dictated by the manufacturer) ...

i've never seen the method described by crotchity for use with a normal carry chair although some of the more elaborate ones or ones that are also DIN stretcher tops can be used in that way, ditto with carrying folding / furley stretchers

Doc,

You lost me with the "telling 1 million citizens they must now become employees of the state" bit. Where is that from?

Scaremongering from the 'reds under the hospital beds' pundits who believe that single payer must be a monolithic system , when outside of former communist states there are or were no monolithic health systems even if single payer not even the NHS is a monolithic system although the majority of consultant Doctors practicing within the NHS are employees of a Hospital trust or a University medical school.

interestingly enough the salbutamol / albuterol MDI discussed earlier comes into the NHS at a few pounds per unit thanks to centralised purchasing and if if you pay for your prescriptions you'll pay 7.40 gbp for it

issues like RSI is why the British MERTs are using using Merlins or Chinooks and flying with Doctor / Nurse /Paramedic clinical crews

To play devil's advocate, Ugly, why shouldn't medicine be allowed to be profit driven? Aren't doctors just small business owners? Aren't small business owners the supposed backbone of the economy? Why are doctors held to such a different standard than any other sector of the economy? Can you imagine if the govt tried to put the restrictions/mandates (socialism?) on the legal field that the medical field (including EMS) has endured?

see that cloud of steam ?

that's respect for you evaporating ...

or do you advocate privatising law enforcement and the judiciary ?

and the USA badly needs tort reform

i'd echo everything Jake and Bushy said

avoid over joints whenever possible , they make the line positional, easily dislodged and just don't quite seem to work as well

ruff was right to point out that biceps are an often under utilised site on people where you struggle with conventional sites

bikes make a difference where cars can't easily get - tourist ridden roads that aren't designed to cope with the summer influx or perpetual near grid lock major cities are their ideal setting ... which where the long lasting schemes in the UK are whether motorbike or pedal cycle...

it resurfaces as a great idea every few years for the past ?15 years

every used one ? no

every seen one on a front line vehicle - no

every seen one in the Hospital - no

current guidelines suggest that faster and deeper is better and that 100 is perhaps too slow ....

In London you also have Paramedics on motorcycles.

London and Heathrow also have pedal cycle responders as does York ( and as did Leeds and Sheffield until recently)

West Mids also have bikes in Birmingham and IIRC GWAS have them in Devon and Cornwall , various other services have tried them at various times and often the risk / benefit analysis doesn't pay off especially if weather restricts the operational days in the winter...

The second picture is probably the best way to sling a dislocated shoulder. That is what I know as the neutral position for the shoulder or the position of use. How often do we have our forearms lay flat against our bellies versus having our arms out a little and to the side? Even as I type this there is a little space in my armpit and my forearms are facing forward.

Think about how when a shoulder dislocates what happens. The humeral head in most cases will roll anteriorly and drop inferiorly a little bit. (I'm guessing your friend had an anterior dislocation so I won't go into inferior or posterior dislocations unless you want me to.) When you try to move the forearm across the abdomen and it is still dislocated, you are putting a tremendous amount of stress and pressure on that humeral head. By abducting (moving the humerus away from the body) the shoulder by about 15 degrees, you are relieving that pressure and more often than not easing the patients pain and reducing the muscle spasms.

After shoulder surgeries, depending on the type, you will see more and more often now people being placed in what is called an Ultra Sling which has that padding and holds the arm at a more natural position.

All in all when it comes to splinting, it's hard to do the wrong thing medically if your patient is more comfortable.

ETA: more info.

Pillows as splints, or for filling voids, can be useful, even with "sling and swath" crevats.

I agree with Kate and Richard here - support in the most comfortable position for the patient - pillows, rolled blankets all have their place - until we know what the dislocation is - forcing it into a text book position may do more harm than good.

For a dislocated shoulder? With proper pain control and sedation, I've had a zero failure rate. Next time it happens to you, give me a call and I'll make sure it goes back in. It should be a piece of cake so don't worry.

the number of anterior dislocations i have seen reduce 'spontaneously' in my care whether that's in an ambulance or in the ED is remarkable... getting the patient well and truely floating on the entonox helps immensely and if it;s still reluctant MSO4 + midaz or a spot of the 'milk of amnesia' in the ED and a quick pull by someone who knows what they are doing will sort 99.99% of anterior dislcations and are significant proportion of inferiors and even posterior dislocations - sometimes you need surgery but that's usually when the shoulder has been reduced to a jigsaw puzzle of a fracture / dislocation ...

Are paramedics allowed to pop back shoulders into place?

circulation critical = time for the first confident and competent provider to reduce ... also encouraging them back in via good analgesia and support doesn't go a miss ... but if it;s none circulation critical it'll wait to get imaging before pulling or for it to pop back into place becasue of the analgesia

and how long do you have your patient in sat or laid before starting your series of blood pressure recordings ...

personally unless you are working as an advanced practitioner in a system which might divert certain classes of calls away from transport to the ED , Orthostatic hypotension screening by EMS personnel is a waste of time for the following reasons

1. if you do it properly you drastically increase your scene time

2. it has no value as a screening tool to decide if ALS is needed ( see 1 above) and it is of little value in making decisions regarding which facility to transport to if thechoice is different EDs

however it has it's place in Acute and emergency medicine ...

also a finding of postural hypotension without all the other tests examination and the like is only a small part of the picture.

Health professional courses are not funded by the Dept Education they are funded by the DoH so the residency requirements may be different - in some cases it can be very hard for international (even EU) students to get on the courses due to the numbers and issues over clinical placements

Health professional courses are usually funded differently , but i'm not sure if there is a residency requirement for that - however if you don't meet the residency requirements you might struggle ot get a place ...

<snip>

I understood that every degree must be HPC approved - but the diversity of the different degrees is still a puzzle for me. How can they be so different to end with various degrees - while they are still all HPC approved. They all result in the same profession with the same competences (at least this is my understanding), there`s gotta be a reason for that?!

E.g. at Hertfordshire, you can either study Paramedic Science ending wih a Foundations Degree (3 years) - or, you can study it and end with a BS Hons (4 years, with one gap year in which you are working with the London NHS). They are both HPC approved, still they are ending with different degrees and you need different UCAS scoring points to start (being: Foundations Degree < Bs Hons).

Just to understand my confusion and persistence towards that point: if I would really take the decision and go that route, I would naturally try to get the best degree, which would give me the most knowledge and possibilities, available.

In the UK there is a degree of separation between the academic award and the professional qualification , there's a minimum academic level for the qualification but qualifications above that are allowed - this is why there are both Diploma /Foundation Degree (level 5 ) and Bachelors degrees (level 6) university courses and both Level 4 and level 5 courses running through employers whether it's the IHCD course, the UEA Cert HE or the Scottish diploma/Foundation degree )

this also applies to other HPC professions - there are both diploma and degree ODP courses and both Bachelor and Masters Courses in OT and Physio , and why there are both Diploma and Bachelors degrees for Nurses and Midwives approved by the NMC - although there will be no new diploma courses after 2012 for Nurses and Midwives...

UCAS points are a measure of the popularity of the course as much as they are of entry standards - Foundation degrees / Dip HE might break you in more slowly to university level work as well...

Hi Marius

as an EU citizen all ready you shouldn't have any difficulties working in the Uk from a paperwork point of view.

the exact title of the course doesn't matter - if it;s a HPC approved course you will come out with Registration as a Paramedic

http://www.hpc-uk.org/education/programmes/register/index.asp?EducationProviderID=all&StudyLevel=all&ProfessionID=10&ModeOfStudyID=all&RegionID=all&sSubmit=Search

excuse the long link but that's the link to the HPC list of approved education / training providers

many of the courses recruit through UCAS http://www.ucas.com , although other courses may recruit directly (e.g. the NHS services that can run their own courses - employing people as 'trainee / Student Paramedics )

if this was about a patient / client group we'd be talking about 'cultural competence' and that is exactly how the issue should be dealt with ....

the biggest problem is if the relationship is only between 'big wigs' and/or risk management , the only structured way of delivering feedback and asking questions is a shitstorm , where a clearly documented liasion person for the ED liasing with the Station Officer ( or equivalent) for EMS is a way for 2 way communication to be taken onto a more official but not management centred level.

Never officially had the post in any of the EDs I worked in but there have always been go to people to smooth out interservice friction whether that's been Johnners ( becasue we are 'bilingual' in hospital ese and ambulancese), people in relationships with ambulance staff ( not just spouses , in one of the EDs i've worked in one of the Nurses was cousins with one of the paramedics, and i know an ED (and Helicopter) Doc who has a brother who is a Paramedic) , or those who have 'changed codes' ( whether from the hospital to EMS or t'other way) -

A lot of it is about being 'bilingual' and having a real understanding of what being on a scene is all about - not just a couple of obs shifts in the deep dark past)

what what has been said so far, i'm thinking along the lines of some kind of CNS insult and/or something meds related , possibly compounded by a head or spinal injury from falling ( increased risk of spinal in jury given his age - has he got an 'old man ' kyphosed neck?)

i'm not necessarily worried aobut his temp at the moment given the environmental factors - it's very much remove him from the 'cold' surface time i'd not be actively rewarming him even in theabsence of a cooling guideline ...

Definitely.

A better system gives you a partner, not just a driver.

it depends on your 'emt' doesn't it ...

if we are talking 110 hours EMT-B they are a glorified first aider - as i've said be fore we have 'first aiders' in the uk we nearly as much training and our PTS Ambulance crews often have 120 + hours of clinical calssroom training plus their driving course ...

Volunteer crew and the 'bag monkey' ECA and Asssistant practitioner grades have 200 -300 hours of training ...

it also seems that those who aresaying that people need experience between EMT and paramedic are talking aobut systems where there is limited or NO placement experience , the direct entry Paramedics or Uni Paramedic Students in the Uk have thousands of hours of placements as part of their course ...

some of the answers to this thread once again how bigoted 'the land of the Free' actually is, I see the usual overblown panic reaction has surfaced almost immediately ... as SSG G- man pointed out prison time does not automatically equal a 'felony' charge or conviction ( welcome to the land of pointless and arbitrary distinctions )

If no one can agree, how could there ever be a mandate?

note the phrase ' elsewhere in the world ' in my previous message , i.e. comparators from outside the USA.

No one should go straight from emt to medic. You need time in the back of a bus (ambulance) by yourself with a patient in need to have the clinical experience to make you ready to be a decent medic.

If that is the case all it actually indicates is that the local programs are poorly designed and constructed courses, inadequately delivered. Here's a clue does anywhere else in the world actually mandate a period working at a lower level (in a substantive role - rather than as part of the training pathway having hired you as a Trainee Paramedic) before progressing to paramedic, or have they grown out of this ... ditto with other roles in healthcare ?

All Ambulance Officers here regardless of practice level can leave people at home, do alternate referrals etc but our Extended Care Paramedic you are able to write simple antibiotics and one or two other things sort of like Emergency Care Practitioner in the UK except we didn't make a mess of it.

ECP was made a mess of in the Uk for 2 reasons

1. trying to introduce it at a time when

a. the pointless metric was almighty - and there was not enough ring fenced funding

b. when there was a shortage of Paramedics at the time so to extract them for ECP training was a difficulty... ( the irony being that many of the Nurses who could have been appointed if the Services had all followed the original 'rules' were already doing part or all the ECP skills)

2. too many services just advertised internally rather than recruiting across professions and services - which led to the wrong people in the role in some places- as an easy way to either get off a truck or get up a band

1) Progressively worse over 36 hours, started with flu like symptoms.

2) Nope.

3) Nope.

4) What X-rays and tests do you want?

Full Blood Count, Urea and Electrolytes, bilirubin, amylase, lactate , lab glucose , ABG (or VBG for pH) , urine dip ( for signs of infection and Glucose), have blood cultures been drawn ?

chest X- ray is always a start as part of the sepsis screen, AXR /AUSS if anything significant on abdo exam

has he got a temperature ?

5) Sinus tachycardia.

6) 830 mg/dl

46 mmol/ l ??? is this a lab result on venous blood or from Near Pt Testing - if it's NPT, repeat the stick with scrupulous skin prep and a lab sample please ...

7) Increased respiratory rate and pulse.

Allergies ?

medications ?

Past Medical History?

Last ate ?

the pattern from the description given sounds as though it may be Ketoacidosis / HONK with possible infection / sepsis on top ...

unless it;s an epsidoe of 'House' , when it will be Lupus ...

We carry ceftriaxone for sepsis and meningococcial septicaemia

the UK paramedic drug list includes Benzylpenicillin for Meningococcal meningitis / septicaemia ...

and to be honest i can't see any particular reason for none extended practitioner paramedics to carry any other ABx. If you are doing out of hours Primary Care / Emergency Care practitioner jobs it's a little different ...

Early, emperic broad spectrum antibiotics are useful in sepsis. Cultures should ideally be drawn before administration (and really, how hard is it to pull cultures if your starting a line) but it's not an absolute.

I don't know about y'all, but I see urosepsis about once a week. In systems with a 5 minute transport, it's probably not worth the trouble. However, if your like my system and transports are from 30 min up to 90 minutes, it's worth considering.

fair and valid points ...

to answer another poster's point about cultures - also while cultures are useful if someone is life threateningly ill with baceterial meningitis or other sepsis beginning Empirical treatment with a broad spectrum Abx is right up there with resuscitation in things to do...

All our ambulances carry ceftriaxone, for what I'm not sure...

as kiwi says probably for meningococal meningitis, it's what we give in hospital that as well