Stretchermonkey

Just a quickie in response to Eng542ine. I'm not sure I've read what was said correctly, but the 'Ferno' trolleys we use have a hydraulic system which is operated by a foot pedal, which will raise and lower the trolley. As such, when moving the trolley from ambo to scene or the other way round, the trolley can be raised to an appropriate height to make the handling easier/comfortable. Also, when transfering the patient from ambo trolley to hosp bed, the trolley can be raised to the same height as the hosp bed and the pt can get themselves over, or they can be slid over with a pat-slide. Another point to consider is that if the pt is transfered to the ambo by carry chair, they can be lifted into the ambo on the tail lift. Therefore, not having to physically lift pt and chair. Hope this helps.

My ambulance service doesn't require me to take blood samples. However, they do not forbid it. So from my point of view I don't see the point in cannulating a pt, taping it down and pushing a flush, just so they can have another needle stuck in them somewhere else to get blood out for the lab. So I acquire the blood sample pots and the kit to draw blood from the cannula from my local A&E. They encourage this as it saves them a job, and it's the kit they would've used anyway, but instead I used it. Other than that, linen is exchanged on a one-to-one basis, and everything else I need is provided by my service. Often of a higher level of service than I could obtain from my local A&E...of course with the exception of 'drug rep' pens in some very fancy colours, and some very snazzy pink tourniquets...lol.

This type of 'tail lift' is quite common in the UK, and does reduce the incidence of back injury. Personally I don't like to use the trolley bed as a means of exrication from the scene unless clearly appropriate. However, once the pt is on the trolley bed, it is an excellent bit of kit for loading/un-loading them onto the vehicle. I have found a big thing to remember when off loading is that the person inside the vehicle pushes, and the person outside the vehicle guides. And the same in reverse when loading. Otherwise there can be torsion pressures applied which kind of defeat the object of the exercise. At the end of the day, using it regularly, it is a usefull piece of kit...Hope this helps. Stretchermonkey.

Hi Jemmat, In the back of AmbulanceUK New South Wales are advertising for UK paramedics this month. I also think Western Australia are recruiting too. Queensland Ambulance Service representatives will be in London from March 16th - 30th, 2007. Although I believe they are looking for people who already have a visa application on the go. If you go to www.ambulance.qld.gov.au there is a link there to recruiting UK paramedics. I hope this helps.

Wow, this is interesting. Over here in good old Blighty, the emergency ambulance service is a part of the NHS. The NHS is a non-profit making organisation. An individuals salary is based firstly on their level of qualification, which will place them into a pay band. Within that pay band there are levels which increase annually. So someone in pay band 5 for 1 year, will not earn as much as someone in pay band 5 for 3 years. The bottom of band 5, will be slightly higher than the top of band 4. If you're in band 4, the way to get into band 5 is to increase your knowledge and skills framework (KSF). I think this works well, because the person with the highest qualifications will ultimately be held responsible. For example, the ambulance technician with 20 years experience can not give Atropine to a pt presenting with a symptomatic bradycardia. That essentially makes his life easier. However, the paramedic can give the Atropine, because he has learnt why to give it, how to give it, how it will work on the pt, and perhaps more importantly, when not to give it. Therefore he has the ultimate responsibility. Now please don't get me wrong on this!! There are far too many people in EMS who belittle their colleague's who aren't as academically qualified as they are...they are arse's!! This, I believe, is because an experienced technician can look at a patient and quickly work out that that this pt is big sick and needs to get to definitive care post haste. Whereas the new paramedic may not pick up on this due to a lack of experience, and spend an undue amount of time on scene performing assessments or techniques on the pt that are really not appropriate, and ultimately delaying the pt's definitive care, and potentially the outcome. So yes experience & time served does count, and should be rewarded. However, so should the person with the higher qualifications and ultimately the responsibilty. If it all goes tit's up, and you find yourself infront of the coroner, if you're the paramedic that is ultimately going to be held to account and left holding the ball, you should be paid additionally for taking on board that responsibilty.

I think you need to be careful about branding someone an alcoholic! If they 'make an effort' after a hard day; is every day a hard one? Do they drink on their off duty days? Do they have to drink every day? As for you seeing your local medical contingent having a night out and being extremely inebriated; I don't think that is all that uncommon. When I have been part of a station night out (which isn't that often), we all party hard. Like the saying goes...'Work hard, party hard.' We all work in a fairly intense environment, and when we do get a chance to get together socially, we do let our hair down. I don't think alcohol abuse is a problem in my area of EMS, I can't talk for others.

[align=center:2776c536f5]HAPPY BIRTHDAY AMBO!!![/font:2776c536f5][/align:2776c536f5] [align=center:2776c536f5] :wav: :occasion4: :wav: [/align:2776c536f5] [align=center:2776c536f5]I hope your day is really good and I hope you get all you wished for.[/align:2776c536f5] [align=center:2776c536f5]Many Happy Returns, StretcherMonkey [/align:2776c536f5]

[align=center:a1ec7a08bb]Andy mate, don't talk it up!! Careless talk cost lives. [/font:a1ec7a08bb] :violent2: :wav: :violent2: Let's just wait and see :clock: [/align:a1ec7a08bb]

Funny...but soooo true

When a total stranger stops you in the high street, grasps you by the hand and shakes it vigorously, and thanks you so much for what you did...and you have no idea who they are, but you know you should!!!

Our local recieving hosp uses the same ECG machine as we do on our ambulances...hence why we thrombolyse on scene.

Over here in Blighty (specifically in the East of England Amb Service) we use Zoll 'M' series ECG machines, to diagnose and thrombolyse in the pre-hospital arena. Because a 12 lead ECG gives a more comprehensive view of different aspects of the heart, one can look for and assess reciprocal changes in the leads opposite to those with the S-T elevation. Having the 12 lead view is also essential to diagnose LBBB. With LBBB being present, is it almost impossible to certainly diagnose an STEMI, due to the corruption of the ECG caused. However, even with a 12 lead ECG it will not show a posterior MI. I place the chest leads posteriorly to obtain the view differently to look for a posterior MI, if I suspect one is present from what I see in the standard 12 ECG. I spend time doing this on scene, as I can thrombolyse there and then, if an MI is present. What I would question is why would one want to spend time on scene using equipment that can not definitively diagnose an STEMI, rather than get the pt to a place that can. Studies have shown that for every minute the MI progresses, 11 days of life expecantcy is lost. Our aim is to resolve the MI asap. Before the introduction of pre-hosp thrombolysis, all pt's presenting with chest pain, believed to be of a cardiac origin, were transported to hosp with lights and sirens and a pre-alert to the receiving hospital given. If it looks like an MI, smells like an MI & sounds like an MI...it is an MI until proved otherwise. If one can't disprove it on scene without delay, go to somewhere that can.

Over here in the UK, we use the European Resuscitation Council (ERC) guidelines. The main focus, as I see it, is to create an intravascular pressure, which by so doing will create a diffusion pressure of O2 into the tissues. So, one gets called to a cardiac arrest victim. 1. Global overview 2. Open airway and check for breathing and do a pulse check at the same time. 3. Start compressions (comps are started before any vents in any case). As I see it, at the point of collapse metabolism stops. As the partial pressure of O2 in the blood vessels needs to be higher than that in the tissues, the O2 that is in the blood will not diffuse into the tissues in the absence of any blood pressure. As such, whatever O2 was present in the blood and the lungs at the time of the collapse, will essentially still be there (I don't know the figures for the the rate at which O2 will just dissolve into blood). So, if one cracks on with good chest comps and develops an intravascular pressure sufficient to cause diffusion in to the tissues...there should be enough O2 still present to achieve something. I would think even more so in the case of FBAO, as essentially the lungs have been stoppered, and more O2 should remain within them. So, having got the blood flowing again, now re-assess the airway. If there is a FBAO, magills and laryngoscope should be able to remove it quickly. Personally, if at all possible I would do this without interrupting chest comps. Then with an open airway, oxygenation can be started by whatever means is best in the given situation. I am very much in favour of the new guidelines. I have always believed that good, un-interrupted chest comps, is one of the major keys to successful resuscitation. Anyway, this is my take on the new guidelines...I am interested to hear other points of view. Regards, Stretchermonkey.

Hello :hello2: , I think it's good we've got a UK based forum room, so I'll introduce myself. I live in South West Norfolk and work for the newly created East of England Ambulance NHS Trust. I strated with the LAS in 1990, became a paramedic in 1994, and moved to Norfolk in 1999. You can find out more about me in my profile. It will be interesting to see how many of us there are. Cheers :occasion5: .

"lest we forget that lay-people are taught to look for "signs of circulation" and no longer do pulse checks." Wasn't aware of that. In the UK lay responders are still taught to do a pulse check. "This does not happen to all people, hence the terms "dry drowning" and "wet drowing" I am aware of this, thank you. However, in this instance I would suggest that this is what happend. Regards.

I wish I'd picked this up earlier; but here's my thoughts...for what they're worth. Firstly, I think I good job done by you all round. Secondly, I really hope I am not about to state the obvious and insult you. These are just my thoughts and observations. As has been already said, you have to go on what you are told by the persons on scene, unless you can categorically say something is not true. That would be very difficult. The alarm bell that rang for me was that chest compressions were done without a pulse check first. In any event they were, so accept that and treat accordingly. I have no doubt that the patient was hypoxic, hence the cyanosis. Unless the water was incredibly cold, I don't think that preipheral vasoconstriction would have been that extreme to have shown as cyanosis in the timescale given. If one considers the pathophyisiology of drowning...the first thing to happen is laryngospasm when a concious person is submerged. This causes the glottis to shut, and water to enter the stomach (that could well be the reason the patient needed to urinate). When this happens the lungs remain 'dry', but although water doesn't enter the lungs, neither does air. The patient becomes hypoxic and cyanosed. It would be very easy for a rescuer to see a patient in this condition and assume they were dead, and start full CPR without doing all the checks first. Considering that, this appears to be what occured as the patients lungs were clear, and abdo was slightly distended. I have a feeling you already know this, but you asked if the critics would do anything different. From what I've read you appear to have done a good job. The only thing I would have done is to have put on cardiac monitoring, in case of any dysrhymias present due to the chest compressions. Just thoughts from accross the pond. Cheers, Stretchermoney.

Just a question for everyone.....In our area we carry glucagon IM shots for the times when we can't get a line. does anyone else and if so how do you like it?

Battery acid is sulfuric acid, if the meaning is in the common usage. This will cause massive site of injection (SoJ) damage. Anything that progresses past the SoJ will cause massive destructive damage along its way. Possibly leading to haemorragic/hypovolaemic problems before anything cardiogenic, depending on the SoJ. In any event...it will be lethal!!! Why the question?

The important thing about the flow rate of O2 with regard a NRB mask, is to make sure it is set to a bit more than the Pt is shifting themselves. So long as the flow rate is sufficent to keep the bag inflated, the Pt will always be breathing predominately what is in the bag.........oxygen. If one increases the flow rate too much, oxygen then gets wasted and leaks into the outside environment. Now if that is the back of my ambulance, I find myself in a very hazardous position when I go to light my cigarette to smoke while I'm doing the paperwork on the way in.....lol

At the risk of stirring things up, I feel I need to say something about this. Why were you in a hurry to post something that happened five days earlier? Also, with having five days to think about it, and hopefully after having worked a potentially stressful call and had a de-brief, would you not know the merits of scene safety. As many people have said, you declaring that you went into such a potentially dangerous situation, sent alarm bells clanging. Then, to say that a patient having a seizure was able to communicate with you, just leads people to believe that you are not clinically up to speed to deal efficiently with emergency situations. This really is a very basic thing to grasp. You say you have had your feelings hurt, and that you have been ripped apart. Yet you also say “I am a big boy and can take it.” Apparently not! I think you are new and want to play the hero. Thrive off the adrenaline (or do you call it epinephrine? lol). There’s no place for that in what we do. What we do always has consequences for others, often when they are at a low point, and need us to be able to care for them, and to be their advocate. Why should people need to apologise to you? You said “just because somebody posts something on this site doesn't give anyone the right to call it Bull Sh*t”. Of course it does, if it is. You stated that you went into a violent situation and that “The crowd is hitting us and cussing us” that was wrong! You stated “Pt. still siezing and complaing she can't breath.” That’s not possible. It is people’s right to tell you when you are wrong. Take it on board and move on. And as for saying “I will forgive but not forget. On that note, I will no longer post on this website but will continue to read posts and check in now and again to see if I can find useful information.” That just smacks of behaving like a child. So you don’t want to say anything in case you make a tit of yourself…but you are happy to lurk in the background and glean anything useful from those who have so offended you. At the end of the day you’ve dropped a bollock. Accept it and move on. Don’t run away with your tail between your legs, slagging people off. Stay and learn from the massive wealth of knowledge and experience that you can gain from here. You’re absolutely right, none of us are perfect. We all do, and all will make mistakes, but the better ones of us accept that, and move on.

Just wondered if there has been a resolution to this??? Stretchermonkey.

I know it's perhaps a bit late after the original post...but something I haven't seen mentioned is; other people. Along with stress, anxiety, depression or whatever the root of the suicidal intent is, often can go the loss of rational thought. If someone becomes so intent on ending their own life, they may not be too concerned on how they do it, just so long as they believe it will work. It is good to be concerned about your co-worker, but also be concerned about others that maybe around him. One of them might be you. Let's say one moment, one day, he really has enough and decides in a flash to drive the ambulance off a bridge, into a tree, into on-coming traffic...etc. The other person in the ambo might be you, or someone you care about. I'm sure you have acted already as you believe is best, I hope this is of some help. Cheers, Stretch.