JoelEMT

yeah, we have Helos here, but that being said they don't always fly (weather etc). For the whole province of Alberta (as far as I know) there are only 5 Dedicated helos - 2 in Calgary, 2 in Edmonton and (I believe) a recent addition of 1 more for the Grand Prairie area. There are several fixed wing sites and services but usually are too slow to arrange in emergent settings as described in the situation. (The second helos in both Edmonton and Calgary are usually not manned and are used as mechanical spares.) Alberta is a Very Large chunk of land - 255,285 square miles (661,190 square kilometres), of which 6,485 square miles are freshwater. It is 756 miles (1,216 kilometres) in extent from north to south and 404 miles across at the greatest width. And only 5 choppers for the whole of it and a total of 1,149 missions flown in 2005. See the STARS (Shock Trauma Air Rescue Society) website for more information. www.stars.ca

Had one the other day - a perfectly healthy woman who had been "diagnosed" with constipation (after 2 days of "no go") she was seen at hospital a day prior (that's when she received the diagnosis) She refused to "drink more water and/or take some laxtives." So she called us. OH YEAH! I forgot to mention that she literally lived ACROSS the street from the hospital. Quite capable of walking but chose to call us because "it's too far to walk." We are talking about 100yds or less people! hmm - Hefty ambulance bill or short 2 minute walk from door to door. That would be a tough one in my books.....LOL Joel

My class was invited down to the M.E. office to observe an autopsy. - Not quite the same but allowed you to put everything in perspective as to location and size. Also, One of our instructors thought it would be "neat" (and it was) to get ahold of cow lungs and trachea for an airway lab. - He then intubated it and bagged it. It was very interesting to see the lungs inflate, the amount of air required to "achieve chest rise" etc.

We have been (or were) trialing some of the Ferno power stretchers. I have to agree with Dust about the fact that you end up with a lot more "lifting" than you would expect even in urban jungle. - way to many obstacles - ie:curbs. I wrote "(or were)" because all the ones that we have have now been pulled off car due to poor battery life, injuries/strains associated with the increased weight and awkwardness of how you have to change the battery. 20-25 lbs at an odd angle while you are extended forward causes significant strain on the lower back. They are an excellent idea for transfer services where you rarely see the outdoors. They have potential if they are re-engineered with improved battery life, much improved ergonomics and lighter frame (I dunno, maybe carbon fibre or titanium) if they could get the weight down to around 80lbs and make the "handles" less awkward to use (yes they adjust, but are still incredibly awkward) I would definately use one (again) but until then.....

I currently work 96 H on and 96 H off. It has both advantages and disadvantages. work and average of 15-16 days a month. (without picking up extra days.) Usually end up picking up about 4-5 extra days a month.

very well said AK. Seems to me that while reading through the mountain of posts in this thread and others that it doesn't matter what the truth is or what the studies say, people are going to disagree. Everyone sees things differently, whether by choice or through ignorance, there are people that will disagree just to piss you off. MY take on it is: L&S generally mean higher speeds. (not to mention, the "adrenaline rush" that the newbies get causing among other things: poor/irrational thoughts/judgement, tunnel vision etc. (some would counter - increased reflexes but yeah, whatever) High speeds have been CONSISTENTLY proven to cause an increase in the number of collisions as well as an increase in the severity of the damage and injuries sustained in those collisions when compared to the collision/damage/injury rates of those that followed the speed limits ( speed limit being the maximum SAFE speed for IDEAL conditions) We have all seen the confusion and panic and resulting poor judgment of people on the road that hear/see an emergency vehicle. Do we really need to further aggravate the problem by allowing everyone (including vollies) to have L&S??? I would rather see a decrease in OVERALL vehicle related trauma by properly educating the public as well as educating/training those that currently use L&S on how and why to drive safely. Prevention, rather than allowing everyone to respond hot to deal with problems that proper education/mentality (a.k.a. Prevention) could have prevented in the first place is ideal. Of course, all too many people THINK that they are better than most people, that they already do drive safely or "don't worry I can handle it" IT'S B.S. You may be in control of your own vehicle but you don't control nature, nor the other drivers on the road. It's time that people (aka EVERYBODY) takes our heads out from our rears and starts practicing safe and curteous driving. Collisions will still happen but that's why there is EMS to begin with. We just need to get over the "oh, WOW, SHINY!!!" mentality

Rid, I was wondering if you could provide the sources for the studies that you quoted. The use of the Trendellenberg position is one of discussion here at work currently. I read you posts with great interest and just wanted to read the studies for myself. 'Ppreciate it.

Thanks Devin, but my point was more along the lines that the GLYCOGEN not GLUCAGON was what was mentioned. That's all.

Itku2er: You said 1ml of glycogen IM I assume that you had meant 1 mg Glucagon IM correct????

to quote AK " I get paid in US dollars" Now, I have spent enough time in the US to know that the cost of living and prices of common commodities are relatively equal. That being said, It really makes no difference whether you are paid in US or CDN dollars because the ONLY time you will notice a difference in your spending/earning power is if you cross the border into the opposite country. It is only when you convert/exchange your cash that you notice a SMALL fluxuation (given the current exchange rate.) That's my rant. Sorry, but it one of my pet peeves. I make just as much a year as the majority of my US counterparts.

Please define CRF. Thanks

Point taken. But at least I'm not the only one that does it.

Sorry, I missed that the topic was "Pet Peeve SAYINGS", but I still hold my ground on what I said. (Wasn't trying to hijack the thread)

There are a few that irk me. Namely: P.S. the following are all based on former partners (of ALL levels) 1.) People that don't listen. ( Whether to what the pt is saying or to thier partner who is running the call.) #-o 2.) People that can't be taught. AKA, Never been wrong a day in their life. ](*,) 3.) People that refuse to listen to the voice of experience. (Textbooks are good but......) [-( 4.) Dispatchers that NEED to know everything that you are doing and why. ( You do your job and I'll do mine.) :twisted: 5.) Inexperienced partners voicing their inexperience in front of patients in an outside voice. (Talk to me AFTER the call or pull me aside) IF the shoe fits......but you don't like the shoe.......try a different style. :wink:

Just a note of interest, it may or may not be applicable to you in your area. In Alberta, we are only allowed to interpret lead 2, the only time that we use leads 1 or 3 is when we are @ a DOA to confirm asystole in "2 or more leads". So for us, jumping to another lead to increase suspicion of MI (Inferior MI the only one that you'd be able to see in leads 1-3 not to mention the previously stated monitor vs diagnostic quality) would more than likely garner some unwelcomed comments from paramedics. Of course, it depends on who your ALS backup is.

Juice, Sounds like you did fine and more or less everything by the book. The only comment that I would make is more of a suggestion than anything. --> It sounds like you got most of a history before your ALS arrived but you stated that you didn't get around to checking lung sounds. Now as far as I'm concerned, Lung sounds fall under your ABC's at Breathing. esp. if your pt is having resp. distress. As a responding backup person I would prefer to know what is ACTUALLY going on in the lungs (aka lung sounds : wheezes, crackles, little/no air entry etc. ) vs. knowing that the pt has a hx of asthma. If your pt is an asthmatic, they will mostly likely tell you (if they can) that they are having an asthma attack. if they have COPD you might have to pry a little more. Good questions to ask someone with a severe asthma attack or any other severe resp distress for that matter is whether or not they have been intubated before or if they take multiple meds for their condition. Good Work and keep it up in the Future. Don't let politics compromise pt care.

I had a "discussion" with a Doc recently on this very topic... I had a pt with all the typical S/S of AMI and had our ALS unit come out to intercept. The 12-lead showed acute injury in the anterior leads. NTG does nothing to relieve the pain. Neither did Entonox (nitrous oxide). so the medic gave 2.5 mg of morphine. That seemed to help it dropped the pain from an 8-9 down to a 4/10. All of the desired "feedback-loop stuff" from the morphine kicked in and it very quickly improved our pt's presentation and VS. But O/A at the ER the doc gives us flack for giving the morphine. In fact, he went so far as to call all of us dumb (2 EMT's, 1 EMR and 1 medic as well as his 2 RN's that happened to be there.) (benefit of the doubt; perhaps he was having a bad day to begin with.) After letting him calm down for a few minutes, I asked him WHY he did not want us giving pain control of things like MI's. His response was somewhat enlightening. He said: "they have pain, you treat that pain, then you bring the pt to me stating that they are complaining of chest pain, when I do my assessment they are no longer complaining of pain. Essentially, you have removed thier C/C. How can I, as a Doctor, perform an adequate assessment when the pt is now "feeling fine/much better"?" I can see his point and yet, it is still in our protocols, nevermind in the pt's best interest, to control pain. Are we really looking out for our pt's "best interests (read - their continued health)" when we don't do all we can to help decrease the myocardial demands through Appropriate use of pain control agents. Just my thoughts ( granted, I'm BLS, but I think my understanding of the concepts RE pain control at least, in this particular scenario, are correct. ) Correct me/ Educate me if I'm off the mark. Thanks

Well as far as my experiences, I've only ever used OPA's. Currently, the service I work for doesn't even carry NPA's (I've been asking for them for a long time but to no avail so far.) (Given the response time for the nearest ALS unit to where the vast majority of our call volume is NPA's would be fantastic in case of Trismus.)

I think that it depends on the two of you and what you deem necessary to have a relationship that works for both of you. My girlfriend is an EMT as well, we understand the others schedule and demands/restraints that are placed on the individual and our relationship. I can't say that we've really had to work in order to make it work. We both knew what we were getting into. I think that it helps us focus on making the time that we do get to spend together higher quality. I really think that it depends on the individuals involved as to whether or not they want to make things work regardless of the circumstances. Just my perspective on things though..it works for us.

Where I work it's not that bad...we do 24 hours shifts starting @ 1700. we can sleep anytime we want so long as we are at base for base duties/unit check by 10am or noon on weekends/holidays. If we go out after midnight on a weekday its also noon instead of 10am. if you are running all night then dispatch will try and help you out some by getting other units to do standby at halfway points so you can get at least a few hours rest. (doesn't always work but it's nice that they try and accommodate us considering we do 6 days of 24's)

I'll give it a whirl. However, Knowing that, yes, in fact, Steve is Sadistic when it comes to this kind of stuff..... I might just be a glutton for punishment. LOL. Let's see what you've got Steve.

I was in a scenario for my provincial registration and had a pt who had to be bagged. Said pt was suffering from pulmonary edema. So I tried bagging the pt in a semi-Fowler's position (as I was taught both in classroom and on practicum.) (said pt was also conscious at the time and would not, obviously, lay down.) Now, the $64 question is Can it be done effectively? I failed the scenario due to this while others claim to have done the same thing and yet passed none the less. Not looking to find out if I was wronged, I just want opinions as to whether it can be done effectively. Note: This was a BLS scenario.

I have read this thread with great interest. I was living in the Philippines when 9/11 happened. I remember getting a phone call advising me not to go outside for 48 hours due to the unknown extent of the terror operations and the high % of Muslims living in the Philippines. Then, there was the Missile strike retaliation of Oct '01 When once again, I was advised not to go outside. During the 2 years that I spent there from June '01 - April '01, I had to be very careful as to where I went, who I talked to etc. There were Rebel soldiers there, along with portions of Muslim extremist groups. I;ve had to avoid patrols etc. Too often, I had to hang back cuz right out my door were rebel soldiers heading into the mountains. Carrying a camera was a times grounds for suspicion as a Spy. Now, being Canadian has not excluded me from feeling the effects of 9/11 nor has it kept me safe. ( Over there, any white skinned person is an American.) I have "enjoyed" (perhaps not the best word...) the comments of this thread because it has allowed me to see how 9/11 has affected the individual. We see and hear in the news how it supposedly affects nations. I have to agree with Steve on many of the points that he has made. War/Terror= death. Simple as that. No glory, Rarely is it for a greater cause other than self-preservation. Dixie - I have to agree with you as well on many points. Living in a semi-socialist country as I do... I can barely pay my provincial health-care premiums right now. I took a friend to the emerg this past week with ABD pain - I think it took close to 6 hours before she was seen. Every system has its pro's and con's. Preferably it would be up to the end user (you and me) to decide which system they wanted. With Respect to voting. It has been said that It is a privilege and not a right. I have to disagree slightly. It is both. As a citizen you have the the right to vote. BUT, I feel that you should ONLY exercise the privilege of that right IF you are informed of the situations/ current events etc. that will help to make an informed choice. A right does not mean you have to do anything, nor does it necessarily mean that you should. ie freedom of speech. (as mentioned in another thread) I do NOT pretend to know of the suffering etc. of those directly involved with 9/11 nor do I pretend to tell you what to do in your own country regarding your politics/policies etc. Therefore I withhold any judgments. Just my point of view is all.

As far as I know, The family wanted the pt to survive via whatever means necessary. The nearest CT was 1.5 hrs away. And it is my understanding that even though the pt had spontaneous resps the pt was still hypoventilating (~8-10/ min) I agree that extubation may have been warranted, but usually not in the face of hypoventilation, also given that the pt was still unresponsive. (therefore, not fighting the tube) As to the extent of the injuries, I don't know specifically. I do know that the attending ALS crew were extremely upset with the decision not to transport to the city. (suggestive to me that the pts' injuries may have been potentially serious but not so serious as to warrant "pulling the plug") I don't really know the specifics. If transport time was an issue the pt could have been flown out by helo in about 60 min round trip. (out there and back)

So, While I was working last week, one of our neighboring areas gets a call for an unresponsive, non- breathing pt after being hit in the head. On arrival they find that the pt is in full cardiac arrest. After intubation/ first round meds, a spontaneous pulse returns. (no shockable rhythms) so all the way in to the rural hospital they are bagging this pt. shortly after arrival, pt condition improves to the point of spontaneous resps. (`8-10/min) Now, This pt NEEDS to go into the city for further testing/observation. But the rural hospital decides that they don't want to "waste" a bed in the city with this pt, that they are going to pull the tube and let them die. As EMS we (involved and those who heard the story) were choked that they had decided that this was going to be their course of action. My question is WHY was that their decision? The pt had been down for less than 8 min and had bystander CPR I believe. Not to mention the leaps and bounds in improvement from a full out cardiac arrest. The pt was however still unresponsive at the time that the decision had been made. (less than 1 hour ofter collapse) Now I don't want to jump to any conclusions here but the ONLY thing that I and the others can think of that may have resulted in this course of action was that the pt was a Downs' syndrome pt. I may be wrong, Maybe there is something I don't know about or what. But my question still remains as to why this pt did not go to the city and the decision to pull the tube and let them die was made? Any thoughts? comments?