zippyRN

as others have said it;s workplace liability issue

in the UK we have legislation called the Provision and Use of Work Equipment Regulations (commonly referred to a PUWER)

in these regulations is a requirement for employees to have received training before using equipment in the course of their work

' for trained responders only' on an AED or other work place first aid equipment is to cover the organisation against liability if it's used by untrained employees - as others have suggested the building and the organisations within in will have nominated first aiders - who it is only sensible to assume will be trained AED operators given the building has AEDs dotted around ...

as for those saying aobut A|EDs being designed for untrained users - not all are, machines of the LP500 or FR2 class certainly aren,t where stuff like the G3 is ...

<snip>

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By "Perform[ing] at the EMT level", are you talking about manual skills such as applying KEDs and tractions splints? Well, yes, most RNs do not need to learn how to use these, although they could easily be taught to a performing chimpanzee. However, I would put any RN, even a lactation consultant, up against a 110 hour first aider to obtain a more comprehensive history and physical exam from their patient.

It seems the poster Scott was replying to is confusing 'interventions' with 'skills' , most RNs couldn't put a KED on if you just threw one at them, ( same as most EMTs couldn't apply 4 layer bandaging, change a VAC dressing on surgical wound or do a continence assessment )

but then again most RNs aren't pre-hospital care providers or ED specialists ... those of us (RNs) with a decent amount of emergency care clinical practice and the necessary 'performing chimp' training can do so .

I also suspect we (RNs) can better rationalise the choices and clinical decisions we make than many EMS providers, especially where it's solely a 'training' preparation for clinical practice and people are working to protocols , regardless of whether they have 'mother may I?' medical control or not ...

4000 hours that's a novel one - the EU requires nurse pre-registration education to be 4600 hours in length 50 / 50 split between the (university) classroom and clinical practice ) that's 122 and 2/3rds working weeks ...

1. there is a 'patient specific direction' so the issues of local protocols over autonomous supply and administration are out of the equation

2. unless your contract of employment and Job description require you to be an EMT at school then you aren't... they can't just flip things about, especially as you state you need medicla direction to practice as an EMT.

tisk tisk

remember where is kiwimedic ?

in other civilised countries, mbulance staff are empowered to make transport decisions, rather than transport decisions being forced because of regressive system management and billing considerations

i'm suprised our special friend and self appointed expert on such matters hasn't popped up to offer his 'expert' opinion ....

an online EVOC course seems ridiculous , surely the point of any driving courses ( even if it s shorter than the international standards by an order of magnitude) to to lookat people;s driving...

this is yelling sod the sugar in relative terms and start worrying about what is going on in side this guy's head

So, I have been tasked with looking into our staffing needs, and I have a question for system managers and bosses.

How do you calculate your manpower needs ???... For example, how many Parameidcs do you need to run 1 unit 24/7 365....

I know in NYC, the old formula was 3 medics per shift x 3 shifts =9 medics at a minimum to run the unit 24 hours a day, factoring in vacation, they used 10 medics to cover 24/7....

The unit i am curently with runs a little diferently, and i was just wondering about any "formulas" out there to help with this little tidbit..

Factor in that a lot of our medics are senior and get 3-5 weeks per year of vacation.

Thanks in advance for the help.

365*24 = 8760 hours in a year

* 2 crew per vehicle = 17520 person hours to be covered ...

you then need to factor the 'average' working year in hours of your crews

what is their contracted hours per week

do you wish to include any other time off the road e.g. CPD time as well as vacation ...

then you have to consider whether you want to include any sickness cover - you should be able to find out wheat percetntage of hours are lost due to sickness

has someone had to jump or boost start the vehicle at any time ? and did they do so counter to the instructions provided by wheeled coach ?

just some of the vehicles in Use by SJA here in rightpondia have a to have a pair of fuses pulled to isolate the emergency warning devices and body electrics and their computer controlled 'brain' before jump starting because you can fry the brain if you don't

within the organisation -

1. make a referral to occupational health

i can see a number fo grounds where this may be appropriate

- mental health - the paniccing etc.

- obesity if it genuinely hampers his ability to work

- should he be crewing if he is on a disability pension becasue he is 'unable to work'

- if he is an authrosied driver - get the driver medicals updated ( this may however be a clutching at straws approach)

2. look carefully at revalidation/ continuning development / requalification criteria , if he genuinely can't communicate with patients or other members of the team adequately this is a possible route to restrict his activities, if necessarily go above your locality management to bring in assessors from elsewhere if you think your usual assessors are unduly lenient, or arrangefor their revalidation as assessors to be undertaken when asessing this particular individual

3. enlist the support of locality management in going down the disciplinary route if you consider that he is failing to perform to an appropriate level on a consistant and repeated basis despite extra assistance, support and being given 'words of advice' ....

outside the organisation -

let the benefits / social security people know aobut his activities - he may no have informed them or may be ignoring a requirement to limit the scope and/.or quantity of volunteering work - this individual could then be facing criminal proceedings for benefit fraud, which would also trigger a review of his membership of the organisation following a conviction for a crime of 'dishonesty'.

The lif that is incorporated as part of the rear doors is something done in Great Britain. My understanding is that is it a mandated feature for ambulances (maybe by their union?)

the unions have comparitvely little to do with it , Statute Law which requires manual handling operations to be assesed and minimise d whenver reasonably practicable effectively manadated lifts or ramps on Ambulances in the Uk .

When a device such as that is incorporated into a vehicle design as "standard" equipment, the overall developments costs can be absorbed by a large quantity of vehicles. This is especially true when someone like an ambulance service trust in Great Britain orders a large quantity of vehicles.

Orders especially with PASA recommendedand approved vehicles and the size of the regional services can run into hundreds of vehicles

They only have a few manufacturers over there and most tend to only last a few years until they are liquidated or sold to another firm. Very unstable marketplace where the government orders large quantities of vehicles and vendors really try to claw for those "deals." Most end up being unprofitable.

not sure where you got that impression from , the market in the Uk has been relatively stable for quite a while ... the relatively few makers is down to the fact that orders are so large which means that breaking into the market propelry needs a lot of investment

Cot lifts are available in the US and I see a good many installed, especially on critical care units and bariatric transport units. I only know of one firm in CA that provides these to most of the ambulance industry. The "run of the mill" street ambulance normally doesn't have one due to extra cost, weight, service issues, etc. Additional weight is a significant issue on many ambulance chassis- they become overloaded quite easily. Many are opting for an electric cot that seems to have more practical value to many EMS systems.

then there is obviously a problem with either the payload of the vehicles compared to their kerbweight or people are attempting to use too small a vehicle to achieve the result they needed ( as the UK saw with coachbuilt bodies on the renault chassis)

you won't see " St. John's Ambulance" anywhere , because they don't exist... you'll see plenty of St John Ambulance vehicles especially in london, there's often up to 20 out and about working for London Ambulance service, plus the 6 Ambulances and 4 team response vehicles used by the paediatric / neonatal retrieval service ( www.cats.nhs.uk), before counting whichever vehicles are out doing public duties work, and that's just London, up and down England and Wales SJA crews both paid and volunteer are regularly undertaking work forthe NHS both Emergency and Patient Transport as well as the traditional event cover activities .

SJA were the first responders to both the bradford city fire and the Hillsborough crowd crush.

does the London Marathon get any coverage in the States - all the EMS resourcres for the marathon are provided by SJA including BLS and ALS ambulances RRVs, cycle responders, plus the posts on the route and foot patrols in crowd areas , physician response vehicles and the 'field hospital' major treatment facility at the finish ....

SJA provides the ambulance cover for the British Superbike series, and the ambulance cover at silverstone, brands hatch and Donington park ... SJA is the largest medical contractor on site for the V festivals working with immediate care schemems and the NHS ambulance ( I only have experience of one end of V , but at that site SJA is public face of the medical provision unless you come over the front the pit at the larger stages when security and NHS ambulance staff will meet you and have you over to a treatment facility managed by SJA and staffed by SJA and the Doctors from the immediate care scheme ( many of whom are also SJA members and will be doing similar work in SJA uniform at other concerts and festivals across the year)

hi jimpy nice to see you on here, there's a few others you'll recognise from the other site being discussed ...

"SJA"?

St John Ambulance - perhaps the largest operator of emergency ambulances in the UK - only becasue of the national reach of the organisation... on a county by county basis the NHS has more vehicles but that's 11 seperate regional services ...

"ITU"?

to paraphrase mr. T you a foo and pity you ... how can you expect to be taken seriously on a EMS site if you don't know what an ITU /ICU/ level3 critical care unit is ... and understand that these patients may on occasion have to be transferred between facilities.

Don't encourage him. He is *cough, cough* special.

My English friends agree

you referring to mr Gift there scott ? - without replaying the original thread, his lack of understanding and appreciation of the different working practices and legal precedents was stunning, and also seemed to fail to appreciate the safety record of Uk emergency services drivers vs those elsewhere i nthe world.

to the thread in hand...

when doiing Ambulance support work with SJA in the locality i do most of it in - we don't run on lights and noise to calls becasue they are calls which have been priortised and/or health Professional triaged to be suitable for a response time somewhere between send the next suitable resource but cold response and 4 hours from the call ... there's a handful of calls in the 8 years i've been doing this kind of work that were definitely wrongly categorised, and the majority of those were ones where primary care physicians had seen the patient but failed to assess them properly.

even on 999 work the number of patients transported to hospital on lights and noise is a small fraction of responses.

in terms of interfacility transfers unless the patient is an ITU transfer or has a definite clinical need to be transferred as an emergency they are transferred under normal road conditions ...

I have lifted a 450+ pound patient with just one other person. If people would learn to use the stretcher to their advantage and evenly distribute the weight it would not be a problem. Try this. The next time you lift a person on the stretcher, instead of lifting from the "traditional" head to toe position, stand on the side of the stretcher. There is a handle on the side to release the wheels there. You and one other person can lift a much heavier weight by lifting in this side position then you can the other way. You are using the physics of the stretcher and your legs better in this position. Let me know what you think after you try this.

that was the answer i nthe Uk 25 years ago , fortunately EU member state legislation and practice has moved on from there ... to power trays for DIN cots or powered lifts / ramps and the yellow locks for ferno mk6 trollies

OK I'm an idiot, but I don't get it.

So you lower the lift to the ground, then roll the cot onto the lift.

Then lower the cot all the way down, then use the lift to load the cot into the ambulance?

Uk trolley cots generally are not moved around when raised ... the old York type cots stayed low until you transferred the patient in the mhospital on the the ED trolley / bed

the current generation of ferno cots work to that model

To be honest I would rather do it the way we do now, if the other option is to have to lower the cot to the lowest setting with every patient!

Now combine the lift with a hydraulic stretcher..... now your talking.

the cot is already at the lowest setting

and the cots are hydraulic anyway

as pond life says you forgot the option of 'when the telco connects the emergency call to your comms centre'

yet more zanuliarbour spin , but a much closer actual measure of response time from the point of view of the caller.

I don't think it's possible to reach many locations in our coverage area in less than 8 minutes. I may take as long as 35 minutes to drive from the station to the scene. That is on a clear, sunny day; when it's snowing it could take close to an hour.

which is why (none whacker) community based first responders are a valid model for either

1. response to high priroity emergencies in any area

2. any emergency safe to send a single responder to in 'really rural' areas

My company has an actual policy that says that if you get a DUI while on your own personal time, then you are fired. They have a zero tolerance for it. In the state I live in you have to report it to DHS and I believe, although not certain, that the state pulls your cert. Again, I'm not certain on the last one. But I know for certain that my company fires that employee.

also if you job requires you to hold a driving licence you will be sacked for frustrating your contract ... in the Uk they wouldn;t be able to get insurance even when the driving ban expires

new sprinter we've just got - not yet in commission

Hello! I have a question in regards to checking for postural changes in a Pt's BP. I'm almost finished with EMT class, and the checking for posturals has a become a big thing all of the sudden. We have been instructed to check posturals in Pts who are dizzy/weak, ab pain, or any Pt with suspected volume issues -unless they're already hypotensive, have cardiac issues, trauma, or 3rd Tri vaginal bleed-. SO, If there's a change of at least 20 mm/Hg in their systolic, does this indicate the need to call for ALS? I know this may depend on where you are, but I'm interested in what others have been taught. Thanks!

other than the fact that this will add up to 20 minutes to your scene time ...

Ok i have a question? On seat belts, in any one's experince have you seen better out come of survival with a seat belt on or off? For example, in a roll over accident the pt was not wearing his seat belt and he didn't make it. But in another accident the pt was not wearing a seat belt and that saved her because in the crash she was thrown in the back seat and the dash folded down around the front seat had she been in the seat she would have been crushed from the waist down.

the simplest answer to this is a rollover RTC i saw patients from about 5or 6 years ago - car was 5 up car hasd 5 seatbelts, one passengerwasn;t wearing theirs ....

4 people walked out of the hospital either that night or the next morning, bruise battered and sore but with no significant injuries, thefifth didn't even make the ED - traumatic arrest on scene

people will come up with 1 in one million stories of howa seat belt would have killed someone, the epidemioligcal data says otherwise

'manual' lap and diagonal seatbelts work - especially combined with european spec airbags

That is interesting so I have learned something and they say you cant teach an OLD dog new tricks. Why are there no colleges over there no funding or just no requirements for advanced education?

i think krumel was actually saying that germany, like most EU member states and Commonwealth states has in theory direct entry to medical school rather than requiring a Bachelors before like the US system

also differences in terminology and 'false firends' in terminology of education can confuse

because a'college' in the UK generally refers to either a high school (<place name> community college) or a Further education college, not a University, although just to confuse things there are some smaller universities who can't issue post graduate degrees known as 'University Colleges' ...

Are Friday nights bad call nights there or just people not wanting to work the weekend?

increased call volumes due to people going out and drinking alcohol to excess because they don't need to get up for work in the morning or becasue their sports teams have lost (professional sports wise in the UK rugby league sides play on friday evening or saturday, a significant proboption of the football league and premier league games oare on saturdays, but more spread through the week now due to tv rights - but the none televised matches and the lower leagues many play on saturday, Rugby union generally play on Saturdays as well ) and amateur participation at the adult level is usually sunday morning or afternoon

That his service either doesn't have many ambulances contrary to his claim or he is unaware of how many vials it takes to add up to 300mg of morphine.

Maybe he will reconsider because if you have morphine on the ambulance you need at minimum 2 vials. A lot of ambulances brings to my mind more than 20 ambulances. So there should be at minimum levels per ambulance a total of 400mg of morphine if they are all together.

Also just showing it's not as much as some claim. So really 300mg is not a big deal.

morphine sulphate injection comes in (rightpondia) in 10 mg/ 1ml ampoules usually, - thereare larger ampoules / stronger solutions avaialble but from the point of view of the pre-hospital practitioner or theED it comes in 10 mg ampoules.

I currently work 'in real life' on a regional tertiary specialist rehab unit - we don't use alot of morphine - but we keep 100 -200 mg of morphine sulphate injection in our Controlled Drugs cupboard aswell as a small amount of diamoprhine, and morphine oral solution and controlled release tablets , similar amount of oxycodone, plus 100 mg or so of midazolam and apacket or two of temazepam ( as these benzos are sch 3 CDs inthe Uk and require the same storage as the Sch2 or treated as Sch2 opiates)

in the ED or on the Acute Assessment Unit 300 -500 mg of morphine sulphate injection was pretty typical stock holdings ... plus all the rest and bearign in mind that asit was rightpondia we were also holding diamorphine and in the ED injectable fentanyl and alfentanil

300 on an ambulance is probably excessive unless you have very liberal dose guidelines and/or very long transports

60 -100 is probably more realistic - allowing you to treat somewhere between3 and 10 patients before having to restock

the Resus rooms in the average UK emergency department looks not dissimilar to those in docharris's pictures of Toronto

CT access is usually 'across the hall' in new builds in and older hospitals it's often 'round the corner and across the hall'

ventilator, multiparameter montoring, defib, gantry X ray and the like in the room ...

prehospital communication - vehicle cellphones to 'red phone' dedicated landline with extra loud ringer, ideal world trauma nurse leader takes the red phone call ....

comparing a anglo-antipodean-Americaan system to the Franco-german system is also different due to the differing patterns of the staffing and the differing models or care delivery...

without diverting the thread too much is the anglo-antipodean-American model still one model or is the UK a model of it's own perhaps becoming more on the Dutch /scandinavian model as UK paramedics become better educated and there is increased and increasing ly professionalised field physician provision i nthe UK ....

i think the pt should be immobilized . the pt may have damage and just doesn't feel it at that time. better to be safe than sorry.

i think you need to put a little more criticla anlysis into your posts ?

the arguement for immobilisation as it stands

- Altered LOC - either from passed out/ knocked out in the collision or simply from the hypoglycaemia

the argument against

- patient 'passes' whichever selective immobilisation algorithm you choose or passes on everything other than Altered LOC and doesn't appear to have a particular altered LOC on assessment ...

- no distracting injury - is there any evidence of the 'heart attack' mentions by the first person on scene ?

all this means is that the frankly pretty poor automatic interpretation thinks there is too much artifact ...

the cardiologists had the medical equipment people turn the automaticinterpretation off on everything in the Hospital with automatic interpretation because even with brilliant quality traces from a diagnostic machine running off interna l batteries etc etc etc it;s still usually wrong