zippyRN

is it required for the data set ...

in narratives it's one of the things that has become ritualised , and given the lack of education of the average EMS provider it's unsuprising that ritual and drills predominate, ( even without fire monkey involvement- and we all know how the trumpton loves their drillz)

No necessarily though. There are plenty of para-lead CCT teams in the US doing level 3 transports daily, and SECAmb's CCP course looks to be heading that way (as well as the thoracotomy-in-a-ditch type work).

http://www.jobs.nhs.uk/cgi-bin/vacdetails.cgi?selection=912662233

but that is also a case of do the training = play with the kit it's only like the paeds retrieval services who employ their own clinicians

http://www.aremt.com.au/Index.php

http://www.iarcedu.com/default.aspx

http://www.acpet.edu.au/

It seems like it's a growing organization. It has affiliations with 14 Countries including the UK, Germany, Saudi Arabia, and South Korea. Can I judge on the validity of this organization or what Penthrox says? I can't. I've never heard of AREMT nor am I familiar with EMS outside my Lower Hudson Valley of NY and NYC. That's why I ask, share, and research. Of course this is all conjecture...

an AREMT 'qualification' is not going to get you a job in a NHS ambulance service or be recognised by St John Ambulance or the British Red Cross, it's not going to get you HPC paramedic registration ... and whether it is acceptable for private work as an EMT will be down to the CQC when they assess the provider organistion.

Sounds really bad. But, happens sometimes, yes. Just be sure to be not that a**hole next time yourself (with lack of sleep/food/toilet/luck some people simply tend to get nasty out of nothing - not to say, this should be an excuse for bad patient care).

Yes. Should be reported, doesn't help to ignore on the long term. A good EMS agency should have a quality management system which has an answer to such incidents sufficiently solving issues instead of just punish someone (hopefully...yes, I'm dreaming sometimes of such things).

the problem is in some places, the statutory service simply see themselves as 'above' other providers

Beside that individual fail, I see at least three other trouble causes here:

1. Why did they send an ambulance with no appropriate staff/equipment to such a scene? Not sufficient information given in the call to dispatch (improve next time!),
   

doesn't matter - see above

really wrong dispatch (another point to report) or simply no other unit available (sh*t happens)?

not all services dispatch on the basis of declared levels of skill of the crew , if response time is the primary metric and there is not penalty for not sending an ALS unit - they'll send anything - hence the phenomena in some places of 8 hour courses for 'community first responders' because the response target can be met by a monkey with an aed strapped to it

If there really is a protocol, that doesn't allow ambulance transportation with i.v. access (depending on EMT level or not), then THIS is a major systematic error. If this is really the case (I almost can't believe it!),

i doubt there is , what there is in many services in the Uk at least ( and i suspect elsewhere) a protocol that says if you aren't trained to manage it you can't transport a patient with it - hence the reason hospital staff are needed on transfers etc ...

then try to change this, maybe make it public!

see above

The original poster (Penthrox) seems to get easy pissed off, from what I see in the other posts above. Maybe there were some other more personal issues additionally leading to the unhappy event. Again, no excuse for bad patient care, but we have only one side of the story. Well, if the venting helps...

But please, just don't get on the "volly vs. paid" track here.That's not the issue in this case.

i'd agree with that Bernhard

Thank you for proving my point....

The company I work for is where, which is then regulated and checked by AREMT.

I have not mentioned the fact that I am currently studying the Bachelor of Health Sciences Paramedic at Flinders Uni and wouldnt you know I recieved RPL.

are you recognised as a Paramedic under the relevant legislation ? does AREMT 'registration' actually provide a licence to practice ...

alternatively does your Nursing registration allow you to independently administer the medication you administered ? whether that's via a Independent prescriber status or by virtue of patient group directives authorised by the State Service or by your employer and acknoweldged by the state service.

if you were to pm me your name , dob and location or registration PIN would I be able to verify your registration(s) ?

I am not here to have an argument with you Kiwimedic as I am assuming you work for St John Ambulance? Just the pinnicle of how an ambulance service is run.

if you want to play silly buggers over organisations - go boil your head mate, it killed ambulance999.co.uk and I don't want to see EMTcity dragged down the same route

Unless you have some constructive remarks instead of slander please stay out of my thread.

there has been questions previously raised over the legitmacy of AREMT , especially when they started suggesting to people outside Aus that 'their' qualifications could be used to gain certifcation / registration with other Countries Professional regulators

Oh I also have a Bachelor of Nursing from UniSA want to rip that to shreads aswell? I work in a trauma hospital here as a Nursing Specialist but hey im just a vollie dreamer.

you want to play Nursing pissing contests, EMT city is not the place to do it there are plenty of US RN+Paramedics / PHRNs / Flight Nurses and a generous sprinkling of other RNs from various countires who work in pre-hospital care including iirc at least one 'Dutch Paramedic' aka a Nurse Practitioner in pre-hospital care due to the way their system works , myself i'm an RN I don't claim to be Paramedic or imply that i can do Paramedic only procedures...

Not to side track but when is the IHCD Paramedic award set to die in the UK?

Our equivalent, the "old" National Diploma (Paramedic) expires next year here.

not yet, but each organisation offering it has to be HPC approved rather than the fact it's IHCD being good enough, this is where some of the issues with courses delivered outside the UK comes from, aside from the issues that HPCSA have with students not on a SA course practicing in in SA.

Have a look at this -

http://www.ronin.co.za/index.php?option=com_content&view=category&layout=blog&id=1&Itemid=50

there's big questions about whether the Paramedic courses Ronin run are HPC eligible as discussed above ..

I'm with Mike..

Other than a generalized 'feeling' when comparing the legs/ankles to the other extremities and even distal to proximal, pitting is the most important finding for me...not in the assessment, but in the finite edema/non edema context.

Dwayne

i'd agree with that

flab is 'springy' Oedema even if not barn door pitting oedema will take a little while to settle ...

the question that has to be asked is why are people going to the ED from Doctor's Offices or Urgent Care ?minor Injuries rather than direct to the relevant speciality bed base or via an Acute Assessment unit ... ? - obviously the need for resus room care negates this argument

again as symptom of the none joined up (not a )system ?

See this is why we have the Patient Transfer Service, a bunch of people with five days training driving people to the hospital who are not crook enough to need a Paramedic or IC. You guys should try it.

biggest problem is that certainly UK PTS with a month's first aid, AED, oxygen administration, communication skills, and patient handling training and a driving course are actually better/ more comprehensively trained ( although they may have fewer shiny toys) than the minimal requirements of EMT-B ...

There have been numerous previous discussions regarding Entonox use on EMT city, sadly where it's been in a general analgesia topic, the topic disappears off in to 'narcotic panic' ...

Entonox if used appropriately is extremely effective , so effective I have seen a quite a few dislocations spontaneously reduce under Entonox alone , it's also extremely effective when applying splintage etc ...

it's extremely widespread in use in the UK

have a look at the BOC site http://entonox.co.uk/en/index.shtml

Using Stephen Hawking, one of the most brilliant minds in the world- as an example is not exactly an appropriate person to try to prove a point about this. Even early on in the course of his disease, when he was a young professor, I am quite sure there would have been a long line of folks more than happy to help subsidize his care- and first in line would have been his university. I am also quite sure they DO help him with his medical expenses. .

point missed here, the fact is his university aren't required to contribute to his medical bills - any more than any other employee ( via the employers NI contribution and the usual pay roll functions related to income tax and employees NI), I do however believe that his Personal Assistant (carer) is employed by the university , equally Frank Williams ( he's a C6 tetraplegic follwing an RTC) PA is employed by Williams F1 - but many people directly employ their PAs - and i know people with carer PAs who run small to medium businesses who employ their PA through that payroll...

Certain ill-informed 'Conservatives' suggested that the NHS would have killed off Hawking becauae of the so called 'Death Panels' the fact is Prof Hawking like the vast majority of UK residents doesn't have to pay out of his/her own pocket twice for health care...

Money- and power- talks. Always has, always will. From communist Russia, to any uber-liberal European nation, to Castro's Cuba, this is reality. Do you really think Hawking's situation is in any way comparable to John Q British citizen, and that he needs to wait months for an appointment to see his doctors?

that's the point Prof Hawking just like any other legal UK resident isn't waiting weeks to access primary care and doesn't get held for days in the ED if admitted as an emergency , because quite simply it doesn't happen - legal UK residents have 24/7/365 access to NHS funded primary care and if they are admitted to hospital as amatter of clinical urgency they will not be held for days in the ED waiting for a bed as a 12 hour bed wait is a Serious incident which triggers a review lead by region and reported to the highest levels ..

There is a reason we are were the greatest nation on earth. Why are some folks in such a hurry to change that? We used to be the world's leader in so many areas. Why is this a bad thing?

becasue quite simply the USA is deluding itself over the quality and equity of access to health care.

Wonder why all those Canadians come to the US when they need real medical care ? Are you suggesting socialized medicine Ms. Obama

ah the myth of mass international Health Tourism into the USA for procedures ... and how often is the Queue jumping or cosmetic ?

please take your McCarhty award and then sit down and shut the fornication up about 'socialised medicine' as though it is is some great communist plot ,

because after all the 'Death Panels' in the 'socialist' NHS killed Prof. Stephen Hawking ...

http://blogs.telegraph.co.uk/news/jamesdelingpole/100006517/stephen-hawking-not-killed-by-the-nhs/

http://www.telegraph.co.uk/news/worldnews/northamerica/usa/6017878/Stephen-Hawking-I-would-not-be-alive-without-the-NHS.html

http://hopisen.wordpress.com/2009/08/11/stephen-hawking-not-killed-by-nhs-yet/

http://www.spectator.co.uk/alexmassie/5255761/stephen-hawking-has-not-yet-been-murdered-by-the-nhs.thtml

the USA has possibly the worst healthcare for a country which considers itself 'civilised' , odd how most of Western Europe , Canada, Aus and NZ comes out better in nearly every objective measure of performance other than ' how quickly can you get something done by paying cash', ' let's take so much blood for testing the patient will need a transfusion ' and ' let's irradiate people for the fun of it '...

We are not talking aboout Patient Refusals, we are talking about Lazy EMS people refusing patient transport. Big difference. No one is going to argue that patients refuse AMA, although I will contend there was rarely a patient I could not talk into going if I tried for more than 2 minutes.

the problem is none of this is about REFUSALS it's in fact aobut APPROPRIATE CARE OUTCOMES.

one of the reasons Health insurance is expensive inthe USA (aside from the admin bloat) is the way in which it encourages the status quo and unnecessary consumption of resources to meet some fantasy 'standard of care' promoted by lawyers and fee for service providers ...

You are sadly mistaken if you think a drop in call volume would be good for us. Just look at your brothers/sisters in the Fire Departmet, if it were not for EMS calls, most departments could not justifiy half thier equipment and people based solely on the number of fires they respond to. Thank God people call you for BS every day, cause once they go away, your job goes with them.

resourcing patterns would change, look at 'front loaded' systems, there iss a different skill mix and fleet mix , primarily because in the FLM - the practitioner in the response vehicle is not automatically backed up apart from certain types of job, s/he is empowered on the basis of clinical findings to prioritise any further resources not only by skill level but also by time -frame , there is also no presumption of transport as the default outcome of ALL calls.

A similar picture is being played out with the Fire Service in the UK where the traditional one response ( of 2 multi crewed rescue pumps in urban areas and one going and one standing to in the sticks)to everything ) is being challenged by the fact that a significant number of the fires reported during the early evening or all day in the school holidays are nuisance fires, often on waste ground and not involving premises, vehicles or technical rescue / extrication - meaning that the valuable resource of the multi crewed rescue pump is tied up using an extinguisher or at most a hundred litres of water from the HP reel on a bin fire or a unattended bonfire ...

And beiber, anytime you start a conversation with "this will undoubtedly cause patient deaths, but that is ok", you just gave lawyers everywhere a hard-on. Any policy or procedure that results in predictable patient death should result in the license being pulled from that service or individuals who spout it. If it were your grandmother, you would have a different opinion.

is there any evidence to suggest that avoidable patient deaths are a regular occurence in systems which don't transport everything ?

Hate to break the bad news to you zippy, but if you are a cop, you sometimes have to direct traffic in the rain, if you are a plumber you sometimes have to smell other peoples feces, and if you are a vet you sometimes get bit by animals. If you are a medic, sometimes you are a taxi driver. Let me ask you this zippyRN, I will assume you are a nurse since you have RN in your name; so how many patients do you routinely refuse to treat once you have done simple V/S in triage ? NONE !

hate to break it to you, we can re-direct from triage to other services ( usually out of hours primary care) and discharge from triage if there is no requirement to see another practitioner ( no need for legislation to prevent WALLET-ABC) ...

oh yeah, that's because I work in an evil socialised system where everyone has access to primary care, Registered Nurses and (Health Professional) Paramedics are trusted to use their knowledge, skills and experience as Practitioners and Doctors don't get paid per item of service.

Bieber, since when is leaving patients home to die a sign of clinical excellance ? Thats the problem with this generation, you are too concerned about the procedures and treatments you can do to a patient, versus good old fashion assessment. As long as you can do RSI or use a drill to IO someone, you think you have accomplished something. Be a patient advocate first, a paramedic practicum advocate second.

So you advocate being a taxi driver over using professional, education, knowledge and skills to direct your practice and determine what (if any )interventions you need to perform and what advice and information you give your patients? let's swap the LP12 for a AED and a taximeter ...

Its not about transporting everyone but if the patient wants to go to the ER; you take them to the ER. Your job isn't to make them refuse or tell them that they don't need an ambulance.

hate to break it to you but the role of the Professional Emergency Care Provider is to direct people to the most appropriate means of meeting their care needs , whether it's telling them to go to Wally-World for 20 p box of paracetamol or calling in helimed to fly them to a tertiary centre - via every outcome in between, the key variable is knowing what outcome when and documenting the decision process and differential findings that led you to that outcome.

while Ambulance services are glorified taxi services , ambulance crew will be paid as taxi drivers.

This may be true, (and I totally agree with you, BTW) but it's also the standard procedure in most places- at least around here.

buit it isn't in vast trtacts of the civilised world

We don't get to decide who we should and should not take. If someone wants a taxi ride, then that's what they get. The legal language states that an "emergency" is defined by the caller, not the responding crew, meaning if the patient convinces the call taker their problem is legit (AKA- lie), then they get a response. Even if the crew finds out the complaint as dispatched was total BS, we have no mechanism to refuse to take the person. Thus, in most places we have overwhelmed systems and overcrowded ER's. In this country, lawyers run the medical field and dictate how we do our jobs.

nothing to do with lawyers and everything to do with poor clinical management and poor preparation for clinical practice, the legal aspects are as a result of that and of the'mother may i' system rather than Paramedics being Health Professionals in their own right ...

Yep... irritation and inflammation. A rigid abdomen is caused by either of those and can be found in conditions other than a bleed. Massive amounts of fluid (e.g. ascities) would be more like a really filled up water balloon where you can induce a fluid wave over the abdomen.

and someone with bad constipation / bordering on impaction often has a hyper-resonant abdo due to gas trapped in the bowels ...

was the amputee on anything other than opiates for pain ? as his stump pain may well be neuropathic in nature ?

http://www.hpc-uk.org/landing/?id=7

is the link to the HPC page for applications for registration.

First up, welcome back!

Second, as I am uninformed as to what happened, when you are ready and up to it, tell us what happened.

Third and final for this posting, feel better soon!

richard's post sums it all up, great to have you back

I've been watching your posts for quite some time and generally ignore your attitude and posts. What gives? Are you just looking to upset people or do you honestly think what you type is good information?

I would love to see you be a floor nurse for one shift and get your ass handed to you.

most EMS personnel who haven't worked as Nurses or HCA /CNAs would get their backside handed to them on a plate to work as a floor nurse and that's before even considering the technical skills they don't have...

Unions seem to be another thing where the USA has taken a perfectly good system and messed it up, no doubt helped by the fact that the US retains closed shop practices with regard to unions,

Notwithstanding the increased risk of rollover, it just seems like it would better to be higher than the bumper of the unit that nails you in a side impact. You might toast your leg and/or hip, but I think you have a better survival chance in a full size truck/suv.

except of course when the KE transferred from the hitting vehicle flips you over ...

is there a US equivalent of NCAP ?

http://www.euroncap.com/Content-Web-Article/a09ae60e-8ee4-4e3e-b784-d7e07a1c1168/euro-ncaps-best-performing-cars-of-2010.aspx

something like a BMW 5 series or Volvo V70 or XC 90 may in fact be safer than a truck ...