Copperhead24

Dust; Whoa! If you look I pointed out that I didn't know the lawyer's exact credentials [ "don't know if they got there degrees from a cracker jack box"] & if you had taken the quote, that you stated, further I advised to not even take my opinion as the final word. I later pointed out that I myself had gotten off track from the original topic, which was the administration of ASA on the advice of dispatch prior to EMS contact. My point was to research the topic & not just accept an opinion or opinions on it. In my view the best way to learn about a topic, especially a controversial one is to research the subject & "see" it from several different sides. If there are questions in my class on a topic without a finite answer I have my students "Google" it. If it's a big enough topic I have them create a presentation for the class. They won't learn that our industry is always evolving & changing from just taking someone else's word. What was appropriate treatment 10 or 15 years ago can now be considered harmful [someone discussed MAST; Bretylium; etc. earlier] in many circumstances. Remember the days when the emphasis was on the admin of bicarb & calcium ? As to the "guys" at the conference; it was a large conference that was not presented in a Q & A format. To be fair, while they did have material to support their discussion, it was information that they had produced. As to their background, that I do remember because it was unique. One was a lawyer / paramedic from the Chicago area; another a lawyer / paramedic-student from Missouri. The third was a former paramedic & EMS administrator from New York. Their discussion on dispatch was an example of many examples surronding liability & malpractice in EMS. Their emphasis was that "the good samaritan" laws & the days of "gunslinger" EMS with people looking at us like we were "Johnny & Roy" with William Shatner "narrating" were long passed. I would love to discuss legal issues in EMS further, but believe that it either belongs in another thread, or you could PM me & we could talk more. Don't know if I would enjoy discussing your dis-taste for EMD-type systems; or if I'm qualified to discuss it, but I would be willing to, I think By the way; enjoyed your photo gallery

Spenac - You're correct in a nerve being struck, but it wasn't necessarily struck by you . The educator in me was frustrated with the topic moving, in my opinion, off course from the original & valid question. That being the administration of ASA, on the advice of dispatch, prior to EMS contact. My desire was to answer the original question as factually as possible. As to my medical control allowing dispatchers to administer ASA, this is not the case. We are two seperate entities. It would be their [the dispatch agency] medical director allowing it if he chose to follow the AHA guidelines. This [ASA administration prior to EMS contact] is not necessarily my opinion [or the opinion of this station & it's staff ]; it is something that the AHA is now recommending on a national level. Again, for everyone, I was just trying to answer the original question. And I myself am guilty of getting pulled off task. As previously mentioned the new AHA/ACLS course demonstrates this [ASA administration prior to EMS contact] during the ACS portion of their video presentation. I have provided the link twice, but to quote from that link; "Should I take aspirin during a heart attack or stroke? The more important thing to do if any heart attack warning signs occur is to call 9-1-1 immediately. Don't do anything before calling 9-1-1. In particular, don't take an aspirin, then wait for it to relieve your pain. Don't postpone calling 9-1-1. Aspirin won't treat your heart attack by itself. After you call 9-1-1, the 9-1-1 operator may recommend that you take an aspirin. He or she can make sure that you don't have an allergy to aspirin or a condition that makes using it too risky. If the 9-1-1 operator doesn't talk to you about taking an aspirin, the emergency medical technicians or the physician in the Emergency Department will give you an aspirin if it's right for you. Research shows that getting an aspirin early in the treatment of a heart attack, along with other treatments EMTs and Emergency Department physicians provide, can significantly improve your chances of survival." This is directly from the American Heart Association website & is part of their new recommendations. Whether they choose to follow those recommendations is up to the individual dispatch agency & their medical director. This is just as it is up to EMS agencies & their medical directors what, if any portion, of AHA/ACLS guidelines they choose to utilize. Ultimately it is a physician's choice; in this case the medical director. Khanek - As to dispatch being held responsible, I would certainly hope that an individual dispatcher would not be held responsible for the action or mis-action of their employer. If a lawsuit were to be brought for an action, or lack of action, that was written [or not written] in a dispatcher's protocol that should not be their fault. That should be the responsibility of their employer & their medical director. And you are right, in that, if an individual decides to go off the reservation & treat or give advice outside of their"prompts" they should be held accountable.

Dust; I totally agree that you can make a "study" say just about anything you want. And when it comes to the "money" talking we need look no further than the anti-arrhythmic changes in recent years for a prime example of that [& I teach the stuff]! While I don't know if there have been any impartial studies in regards to EMD dispatching I do know that in recent years there have been law-suits brought for agencies not providing pre-arrival instructions.

Just located the AHA link for ASA in Heart Attack & Stroke. It is http://www.americanheart.org/presenter.jhtml?identifier=4456 The heart attack scenario is presented with the patient potentially receivng ASA from the dispatcher. You will note that the AHA advises against the administration of ASA in stroke victims because it could potentially cause more bleeding with a hemorrhagic stroke, even though ischemic strokes are more common. I guess that's why medicine is considered a healing "Art" & not a science to quote many a physician.

This thread, in my opinion, has taken an unfortunate turn from the original topic to the maligning of one another's chosen professions. I do not have direct/reliable information or involvement in the original incident, or the "examples" that have been cited since then & therefore don't feel that it is professionally appropriate to comment on them. As to the original discussion - the administration of ASA prior to the arrival of EMS & more specifically for a possible brain [CVA] attack or heart [ACS/MI] attack. At the national level, AHA/ACLS guidelines recommend the administration of ASA prior to EMS arrival per the direction of appropriately trained Dispatch for a heart attack, as long as there are no contraindications. So it is an "accepted" standard based upon American Heart Association guidelines. During the AHA/Acute Coronary Syndrome video this procedure [dispatch asking the appropriate questions - e.g. indications; contraindications; etc. & directing the administration of ASA] is demonstrated. In fact, one nationally known aspirin manufacturer has advertisements touting that there product might help save your life in this very situation. As to the administration of ASA for possible brain attack patients. The majority of CVA's are ischemic in nature. The outcome of hemorrhagic CVA's are poor in prognosis. Several years ago our medical director consulted our local neurology/neurosurgery dept. & was advised to put ASA in our TX protocols for possible CVA patients. There opinion [the neurologists & neurosurgeons] was that it would have little to no effect in the final outcome of a patient with a hemorrhagic stroke & that it could possibly benefit an ischemic one. As to dispatch. Locally our 911 dispatchers are certified "EMD" [Emergency Medical Dispatch] dispatchers. They are required to have a medical director [their's is a board-certified emergency room physician] that reviews & certifies their protocols [e.g. what pre-arrival instructions, including treatment or the administration of medication, prior to EMS contact]. I do not know what their specific protocols allow for them to do or not to do. That is not my job; it is their's. I know that locally I have witnessed dispatch save lives prior to EMS contact through the direction of various skills including CPR & the clearing of airway obstructions. I have been told by another medic of the successful direction of an infant's birth by certified dispatchers. EMD "flip-card" or "flash-card" systems have been in place for many years & have been proven in numerous studies to be more reliable [when used correctly] than untrained [e.g. not trained in EMD dispatch] EMS personnel attempting pre-arrival instructions. And, I have been told by both dispatch trainers & lawyers knowledgeable on the subject that pre-arrival instructions are the accepted standard. Those that choose not to provide uniform pre-arrival instructions are considered to be sub-standard in the dispatch industry.

I agree - funny in the community - not so funny out in the rest of the world. That said for me the funniest are the "Thank you for your continued support" T-shirts. Come in various versions. One such version: [align=center:06d3c334d2]Feed the Bears Let the kids ride the Moose Take a dive off a Cruise Ship Forget your Mosquito Repellent Drive 35 on that Scenic Highway We Thank You for Your Support Alaska EMS[/align:06d3c334d2] Another personal favorite that I recently found that goes along with the "FF Heroes" Tee from earlier [i apologize to all of my FF friends right now] [align=center:06d3c334d2]"Real paramedics don't roll hose"[/align:06d3c334d2]

You know it's going to be a bad call when you are advised, during the initial dispatch, that the coroner has already been dispatched :shock: . LEOs' [rural sheriff's dept.] weren't dispatched for another 30 minutes :evil: . The dispatcher didn't want to disturbe them while they were in court! :roll:

p.s. Tibby; My wife partially paid her way through college as a D.J. and now has her own music machine. Her sound machine and lights are way more fun !

Rid; Most definitely yes! Boiled down the basic definition of "a professional" is the helping of others. In my opinion we are no different in what we are trying to accomplish everyday we go to work than any other profession. And like most professions we do it for the right reasons because we are certainly NOT financially compensated for what we do ! I am sure that you have heard the age-old question "How can you do that? [be an EMT or Paramedic]"many times. I always answer by telling them that certain people are equipped for certain things. My wife use to be a field investigator for children svcs. I could never have handled her job. That said at the end of the day the majority of professionals [law, fire, ems, education, social services, clergy, etc.] all have the same job. That job... To help others, in our own way, when there is no one else to help them. With or without the lights and sirens that's our job, to help.

While not new to EMS I am new to this forum, so I apologize if I step on anyone's toes! :wink: Rid, you brought up an interesting point earlier that I think should be re-visited. You brought up a point about people treating the Pulse Ox and not there patient. A friend of mine [who occasionally visits this site] reviewed ETT stats from the state where I work. There was a marked increase in the number of ETT's put down in service's the year after they added RSI to there bag of tricks. [sorry I don't have the exact numbers but it was a BIG increase!] Did that mean that all of those patient's needed to be tubed OR that they could be tubed. We need to remember that we are clinician's and not technician's. We need to treat our pt.'s and not the cool new procedure that we have available. Am I against RSI - No! We need every tool available for our patients. I am against RSI for the sake of RSI, though. If you need practice, do it in a controlled enviroment [the hospital that supports your local training entity for one]. Practice makes perfect, but practice is for guinea pigs, not for patients. Having been involved in training and QI I am a firm believer that every skill should routinely be reviewed and practiced, especially the invasive ones! My point is - don't perform a skill because you can, do it because you need to do it. While it may sound preachy the old adage of "treat your patient, not the algorithim" always hold true.