GAmedic1506

apparantly i am only preaching to you, please make a donation as the plate comes around.

Go to www.pandemicflu.gov --- everything I have stated is fact, and will make it's way to you soon. Our public health agency is taking great pains to educate ems, fire, and PD to this upcoming threat. I imagine other states will do so also. And there was no attack, I just wanted to state the "Facts".

IF we are about saving lives, then we should be involved in the things that save lives, just as firefighters are involved in building code. If we do not push for CPR and AED placement, who will ? And dead doesnt have to be dead if CPR is started sooner and an AED is available. As far as RSI, I agree with you, but our intubation failures are due to inadequate training, which is something that could be fixed. How many departments have REAL training every month, versus some canned pencil-whipped program where you just shuffle some papers to meet requirements. The value of lab work: Knowing the white count of someone with a fever, knowing the H&H of a trauma patient shortly after incident, knowing the calcium, potassium, and magnesium level on your dialysis patient, being able to do cardiac enzymes on a chest pain patient -- would it change what you do now, maybe maybe not ? Could it open new treatment doors, yes ? Computers can open a variety of doors besides patient reporting. You can load programs that improve safety -- such as Pharmaceutical Reference Guides, Haz-Mat/Cameo Programs. You can improve intradepartmental communication, dispatch capabilities, and probably several more things. Trauma -- no we cant do surgery, but how many people still have to wait to long for an ambulance, or do not have access to a trauma center ? Have we significantly improved the golden hour

You must have misunderstood what was reported about a vaccine. I attended a conference on this subject this month, and the epidemiologist stated that a vaccine could not be developed until about 6-8 months after the virus crossed over to humans. That has occured in central Asia, so a vaccine may be available for that particular strain. That will not do any good for anyone who gets it in the future, as the virus will change by then. Everyone should read up on this one, as it will kill more 20-40 year olds than the previous flus due to the immune system issues that were mentioned above (usually children and elderly are hit worse). The flu of the early 1900s killed 600 million people world-wide, the experts are predicting this one to be far worse.

I started a thread a few weeks back that asked what have you improved at your EMS Agency ? The results were miserable, hardly anyone could cite a single improvement. Atleast the Fire Departments can point to improved building code, reduced fire-deaths, and the overall reduction in actual fires. What can we point to: * Are cardiac arrest survival rates improving ? Seattle showed us the way to do it years ago, how many other agencies have stepped up to the plate ? * RSI is available in only a handful of communities * The ability to do lab work in an ambulance is now available through ISTAT, but only a handful of providers use it. * Have we impacted trauma deaths, which was our original mission -- probably, but hard to prove it is our accomplishment versus the surgeons. * There are many EMS services that do not have computer-based reporting, even though computers are cheaper than many of the other pieces of equipment we buy (stretchers, monitors, stair-chair) When the rookies ask what our generation did for EMS, what will you say ?

Well the quote of ACEs that you list presumes that there isn't any option but to have nasty blades. I dont think that is the case. Sure if i am dying, i will take my chances with any germ that might be on your blade, but again I ask why cant i have the cleanest blade possible (I didnt even ask for sterile - just properly cleaned) ? It sounds like that in your and ACE's service, I can expect to have a reasonably clean blade inserted into my mouth, but that is not the case country-wide. We have all reached into a jumpbag and grabbed a dirty blade at some point in our career, that couldve been used on a patient, had we not been so diligent in our morning inspection (and often times, it had been missed by 1 or 2 shifts).

Very good points, and i did not intend any blanket statements if I made them, but I sometimes type in haste as the alarm sounds. My point is that we as a generic industry, could do better in this area. I am not sure that there are any printed universal standards (nor do i know that there should be), but I believe the "Cleanliness Pendulum" swings widely in EMS. There are some extreme examples on both ends of the spectrum, and most of us are probably somewhere in the middle, or slightly above middle. And in some ways you are backing my argument, in that I agree that nosocomial and nail-bed infections are probably far more serious. But if we all tried to do our jobs a little cleaner than we have in the past, we will address 99% of the problems. If we washed our hands, and cleaned the surfaces of our workplace as often as we should, we would hit alot of problems with one big brush. Laryngoscopes were just the opening volley that I knew would be fairly universal, I am glad to see that the topic is now expanding as it should. Please continue on, and everyone should go back and read those posts that were just presented about nosocomial.

I agree NC, and I am not calling for our trucks to be sterile by any means. All I ask is that we do the best we can; I am just not sure that we are consitently doing that with blades or any of our equipment that we dissinfect. So even if no one in here is concerned about what the patient is being exposed to, you should be concerned about what YOU are being exposed to. Actually, the nastiest objects in your workplace are telephone receivers, computer keyboards, and door handles, which is why when one person gets sick at work, it tends to spread throughout the rest of the staff, even though no bodily fluids were exchanged (atleast you are usually wearing gloves when you handle equipment in the truck; in the office, you are not). We are fortunate that we have not had to deal with many of the third-world diseases that are currently killing thousands on other continents. But with the illegal exotic pet trade on our continent, and all of the intercontinental airline flights, our day is coming.

Well lets you and I let the others weigh-in, I feel comfortable that most will see it my way. But if I am wrong, and the majority of folks see it your way, I will kneal before this computer screen and apologize for my transgressions. And as far as belittling my contributions to this forum, I would ask you to look at the number of views and posts that my four topics have generated. Sure, none of them are siginificant enough to cure Cancer, but they have sparked good debate. And I dont see this as soapbox preaching, as most have agreed that the problems outlined are occuring, and I have never taken a position of superiority. I have admitted that I was guilty in every instance of making the same mistakes.

At the end of the day, if I randomly took a laryngoscope blade from all the services that immediately surround you, and asked you to put them in your mouth, you WOULDNT (unless you knew all of them were brand new disposable unused blades). That should be all the proof you need. If it's not good enough for you, its not good enough for your patient. Which doesnt make you a bad medic, or mean that you work for a bad service, but you have to admit, there is room for improvement industry wide. Change usually only occurs when the norm becomes too painful to endure. I hope that it doesnt take the death of a patient(s) to get us to correct this problem. You know that there are EMS stations out there that have had their cleaning agent in the pale or basin for days past its recommended date. You know there are some sloppy folks who do it half-way. You know that there are some poor services that may not have spare blades, and therefore can not allow the blades to soak as long as they need to. You never answered my question regarding whether or not you had personally ever found a dirty blade in your kit (you know we all have). There will not be any studies that prove that EMS caused a respiratory disease in an intubated patient, as no one would think to look in our direction, they would just assume it was hospital-acquired (and maybe most are). It will take someone from the inside to do that study, which isnt a bad idea: Maybe all of us can take one-blade at random and swab it, have it cultured, and report the results here. I will do it, if you will step up to the plate and do it too. Everyone in the public assumes that we are using the correct process to clean our equipment, and I imagine most of us are. But I know there are some that dont.

And for the record, Avian flu will be the most infectious pandemic we will ever see, if it occurs. And it is a solely respiratory based disease, spread through droplet form, that will kill 30-50% of people infected. This pandemic is expected to far exceed the death toll from the early 1900s that killed 600 million world wide. Since nothing can be stated in here without a scientific study, please go to www.pandemicflu.gov But lets not worry about future boogey-men germs -- lets just deal with the ones we have now.

I do love your list of 15 though, that was great. Just because perfection is not possible, doesnt mean that we shouldnt strive for the higher plateau. Using the logic you present, why bother cleaning anything ?

I would counter that misdirection is what you are using to ignore an obvious fact: Dirty laryngoscopes dont belong in patient's mouths, I dont care if you find 100 scientific studies that allow you to do it, my personal ethics will not allow it. There was a time in the US when the vast majority of people thought: That slavery was OK, That women shouldnt vote, That airplane flight was impossible, That space exploration was impossible, That curing Cancer and Polio was impossible, That Paramedics shouldnt be allowed to intubate patients, And they all had experts to back their "facts" -- it didnt make it right. Just because it is today's norm, doesnt mean that it will be heralded as a best practice in the future. There was a time when the best scientist of the day thought that leaches and lobotomies were good cures.

http://www.cja-jca.org/cgi/content/full/50/10/989 But like I said, its common sense. www.blackwell-synergy.com/doi/abs/10.1046/j.1365-2044.1999.01178.x - Most units autoclave laryngoscope blades at some time, but less than one-quarter ... Another study revealed that in two units in which only obviously dirty ... www.blackwell-synergy.com/doi/full/10.1046/j.1365-2044.1999.00755.x - File Format: PDF/Adobe Acrobat - View as HTML failing to maintain separate clean and dirty work spaces; ... In one anesthesia equipment study, sixty-five laryngoscope blades and handles that were ... www.dolphinmedical.com/brochures/Disinfection_Abstract1_Full.pdf - Similar pages Brindley M. Dirty ambulances endanger health. Western Mail. ... Disposable covers are provided for laryngoscope blades and single use bougies for intubation ... emj.bmjjournals.com/cgi/content/full/21/5/647-a - Similar pages

Its common sense ACE -- are you actually going to defend your right to put dirty equipment in your patient's mouth ?

The question was would you put your current blades, as they sit in your bag, in your mouth. I didnt mention anything about intubation, but since everyone is hedging with "If I were dying - yes", I guess the answer is no. The restaurant industry has a saying that goes, "If you wouldn't eat it, dont serve it to your customers!". My question is that if it is so nasty that you wont put it in your mouth, why is it good enough for your patients. And no, I am not concerned over dust or sand, I am concerned about the germs from the last patient's vomit or blood. If you were about to have routine surgery, and the Anesthesiologist was using the same practice for his blades that you do for yours, would you allow it to be placed in your mouth ? And not everything in life requires a scientific study to determine right or wrong. I dont need a scientific study to figure out whether or not i want to drink someone else's urine. Most scientific studies would conclude that it is OK, because urine is essentially sterile, but I still wouldnt drink it. Nor do I need a scientific study to figure out whether or not I want a properly cleaned laryngoscope blade put in my mouth (regardless of the percentage of transmitted diseases). Have any of you ever swabbed the various surfaces and equipment in your trucks, and sent it to your local lab to see what you are growing ? We all know that Hepatitis can live in dried blood for days, we know that community acquired MRSA is on the upswing (there is a good scientifc study for you -- all those supposed spider-bites we have been treating where the patient couldn't remember being bit, was really community acquired MRSA -- see CDC article on their website), we know that there is a possible pending pandemic from Avian Flu, and that all of our antibiotics are getting weaker, yet it is apparantly unreasonable to ask EMS personnel to clean their equipment properly. I will admit that the vast majority of EMS blades are clean enough, if you will admit that you have on occassion picked-up a blade during morning check-off that had dried emesis or blood on it (tucked around the lightbulb or in a crease), but was in your bag for patient use. How long has that Cidex or other agent been soaking in your sink ? Does everyone dilute agents that require dilution properly, or just eyeball it ? Have you ever seen someone just run the blade under sink water to get the chunks off, and then spray it with 1-10 bleach, and put it back in the bag ? I agree, that disposable is probably the way to go, but if not, you should work out an autoclave agreement with your local hospital. I know you hate it when I am right, and I am causing considerable heart-burn, but this isnt about me -- do the right thing for your patients, you would demand no less if your family was in the back of another company's ambulance.

You are a smart guy techno, give it 10 minutes I know you will get it.

I know it sounds to simple to be true -- I will site you the threads you need (I am working, and do not have these stored on this computer), but its really common sense if you think about what happens to the body in CHF versus COPD or asthma (think alpha/beta) for your first clue. And I meant it works as fast as D50 in reversing the condition, not that it was a carbohydrate (and note that I said Dobutamine, not Dopamine -- many get confused by that). You will also note that I said Dobutamine for those who are drowning, not every CHF patient. Nitro is still the first drug followed by Morphine -- Dobutamine is used for those who do not respond, or who are already circling the drain. Dobutamine does not cause tachycardia -- that is dopamine (although many believe the two drugs work on the same receptor sites, they are totally opposite). And techno, please cut back on the caffeine or increase the prozac -- you get worked up way too easy. I know it sounds to good to be true, and too simplistic, but it is, and it is the deciding trigger we have used for the past 3 years, and we have yet to be wrong. In fact, our Doctors are amazed at our accuracy in the absence of a chest x-ray.

autoclave

EVERYONE, PLEASE GOOGLE "DEATH BY EMS" (a merginet article). You will learn all you need to know about restraints in the EMS setting. And yes, most of us are doing it wrong. http://www.merginet.com/tgp/1998/9803/miller-9803.shtml

What procedures do you use to insure your blades are clean ? Do you autoclave, soak in cleaning agent, or use disposable. Would you stick any of the blades that are currently on your bus, in your own mouth. If not, why do your patients deserve less ?

Yes you did the right thing, as there are only two key things to consider here: 1. Someone who is addicted to drugs is dangerous behind the wheel and in their patient care. How often did he come to work with something in his system. With a 10,000lb ambulance he couldve wiped out a whole family coming through an intersection. How would you have felt then ? Even if this werent about addiction, he was stealing from patients. Our patients put a level of blind trust into EMS Professionals that they do not afford anyone else; we must honor that trust and be the professionals they think we are. 2. People with addiction problems can usually hide their addiction for years. At the point they start getting sloppy, they are way over the edge, and will test positive for a multitude of drugs. Which is a warning to everyone here. Anytime you see the symptoms that arouse your suspicion, report it to your supervisor.

You dont need any fancy machines, just look at the blood pressure. CHF is hypertensive, Pulmonary is normotensive 99% of the time (yes there are exceptions, but the signs and symptoms of those ailments are far more obvious). Try it on the next few times, I promise you dyspnea with hypertension will be CHF (and no, I dont mean 142/92). And yes I could give you many long paragraphs explaining why, but this thread is already too long. Also, if you guys havent tried it yet, Dobutamine is the drug of choice for those who are drowning from CHF -- works like D50-(minutes). NASA spent $36,000 to invent an inkpen that would write in space, The Russians used a pencil.

And to clarify my position on leaving the company -- that is not a high-horse answer because i am too good to work there -- but if the employer will cheat the customer and defy the law, how do you have any assurance that your 401k statement is accurate. How do you know if he has been paying payroll taxes completely ? If they break the rules and cheat, they will cheat you -- and one day you will come to work and find chains on the door, and will have to find a job ---at the same time all your co-workers are.

Please start over and read the post again. I did not mandate that you make a major change, quite the opposite, I asked for any small change. And i have not given or taken any reputation points from anyone, as I do not believe in that tool. The problem with this site, is that it is full of a bunch of blowhards (not saying you) who prop themselves up as experts, and sit around waiting on a newbie to ask a stupid question so that they make themselves look important.by chopping the newbies head off with sarcasm and sited studies. I have asked tough questions, maybe those questions have made some realize that they are not as perfect as they thought. I have not proclaimed myself to be god, or told anyone what they have to do. I have asked the tough questions, and then let the forum process work its magic. Making sausage isnt always pretty, but everyone needs to realize that just because i asked the question, doesnt mean you answer is wrong -- or that you are a bad person. There is no reason that two adults can not differ, without getting into a name-calling shout match. Instead of attacking me personally, why cant we just agree to disagree. I know I dont have all the answers, why is everyone else so sure that their answer is the only one that can be right. But again, can we just remove the emotion and stick to facts ?