Niftymedi911

We have a CAM/DAI (Crash Airway Managment/ Drug Assisted Intubation) Protocol here. It entails the use of Etomidate and Succs in cocktail fasion. We also have a Fentanyl, Ativan, Versed cocktail for sedation in post-DAI intubations. The etomidate has been shown to reverse the ICP caused by direct largynscopy. It is an awesome tool when used properly and followed through flawlessly. We used to have Diprivan for post-intubation sedation, but too many people were finger flicking the doseages instead of using an IV pump, causing Diprivan dumps..... a no, no. Here's a copy of our Medical Guidelines: http://internet.lee-ems.com/intranet/EMS/pub/doc/2010/1/20100111103119_publication.pdf

ScoobyKate, he can bash them if he wants to, tis a free country. I find it comical sometimes. This issue and a majority of issues found with cases concerning vollies is plain and simple.... lack of medical oversight. Paid services have people who do that 24/7 (QA/QI). The paid services obtain training for their employees to be able to handle these types of calls. Just by reading what the news reporter wrote. The use of restraints was indicated with this incident. He presented with a classic case of agitated delirium, caused harm to himself (stabbed himself), and ran from authority. He's now a threat to himself, a threat to me, a threat to my partner, and a threat to anyone else on the road, while my partner is navigating the route. The unpredicability of mental patient's like this requires you to counteract that unpredictability and plan ahead. This guy wouldn't of step foot inside my ambulance without being restrained. Had the guy been properly restrained and monitored this would of never happened. Oh crap I forgot to clarify restraints..... soft wrist restraints with police escort following behind the rig. Ativan or IN Versed at the ready just in case.

Breaking it down Kiwi..... If you were to follow that SOB/CP/Rales protocol, it would indicate the use of NTG, Lasix, and CPAP. NTG is contradinicated to begin with..... But with the indicated heart failure due to poss pericarditis, he's dependent on pre-load. You give him NTG, you kill him plain and simple. Also, if you were also going to be doing CPAP, you will be increasing the intrathoracic pressure in the chest. With someone who's already suffering from an increase pressure on the heart, more pressure would also send him to asystole. Tx: (In this order) High Fowler's Positon on stretcher 15 LPM NRB and prepare for DAI Diesel IV x2 (Still kinda of leaning to giving this guy a fluid challenge, I'll start a 200 cc bolus and see how things change.) Continous NIBP,Cardiac, 12 lead, SPO2, ETco2 monitoring Radio report Offload to ED

Sounds pretty Asymptomatic to me, I wouldn't of treated it. Sometimes less is more. The question is simple, why would you even be treating that???? B/P is stable, negative chest pain. And for another thing you don't know how trul his condition as been going on. It's called the 48 hr rule. If it is fast enough for that long period of time, you have no business slowing the rate down. You might just already go ahead and make the neuro/cardiac ICU appointment for the patient. Fast rhythms of the heart that are confined to the atria (e.g., atrial fibrillation, atrial flutter) or ventricles (e.g., monomorphic ventricular tachycardia) and do not involve the AV node as part of the re-entrant circuit are not typically converted by adenosine. However, the ventricular response rate is temporarily slowed with adenosine in such cases.

One thing that's unique with us is our PCR program.... Its all electronic. The hospital can access our PCR once its posted to the server for reference and doctor veiwing. Priortiy 3 and 2 Calls (BLS / ALS Non-emergent): Whatever time it takes for the ED to give us a bed (average time is 15 min) with a RN to give report to and get a signature. After we have given report we call "patient offload" on the radio. We have 10 min from the time we call offload to clean the truck and restock. At that time we have to become available for call. Our PCR's are all done on Toughbooks (The one with the Rotatable Screen), with WiFi, Sprint Aircards. The EMT usually puts the info in the computer on scene. After we get to the facility. It has WiFi where we can download our CAD data (times, call numbers, addy's, milage etc....) into the PCR, our Zoll data cards record all of our ECG's, B/p's, Etc. in electronic format and all we do is import it all into the PCR and post what we have in the com,puter (can be finished at another time) it to the server before we leave the hospital. Usually takes about 20 min to complete this process Priority 1 Calls (ALS Emergent): We get the bed, give report and get the signature. (probably 5-6 min) Call "patient offload with extended clean-up" (The 10 minute rule becomes not applicable) on the radio and we then move to clean the truck. When the truck is ready to go, we begin the documentation. The patient info is typically already in the Toughbook (done by the EMT on scene). We import our CAD and Zoll data. Complete the PCR and upload it to the server before being able to go back into service. Usually takes about 1 HR for this process to be complete this process.

Well, the program sees 20 min into the future based on 10 yrs of past data. So if we've had 5 or 6 plane crashes in the same year and same time near the airport (which we've only had 2 or 3 (priavte aircarft, no commercial) in the past 5 yrs), and we're getting sent to the same general area. I'll just make sure to have my extra jump kits ready...... The thought process behind the milage and over usage of vehicles is based on our current stand-by policy. When two trucks which cover a response zone are out running calls, we have to send another truck to that area to cover the zone to maintain response requirements. Based on the new theory or program, if two trucks are out and a zone left uncovered, but according to the program no call will be dropping in the area and it does not reccomend a unit for stand-by, you don't go. Taking that same theory for one truck, apply it to our fleet of 37 trucks and it adds up in a yrs time of numerous cost savings for fuel, wear/tear on our vehicles, and wear/tear on employees. The county in which we live and work in believes in providing the best service possible to the residents and vistors. If that means we're supplied with the lastest in vehicles, equipment, and technology to accomplish the job and be finacially responsible and efficient, then that's what we're given. Our PCR program enables us to collect for this year, 18M out of 25M billed. In which essentially means our service pays for itself, and we're not private! We've been able to keep the priavtes out of our county....

Evidence Based Medicine..... the name of the game. And if your referring to the bunch of Jersey medics from 2005-2007, I know each and everyone of them, as I also am from NJ (Bricktown).

It's funny how all you have to do is watch that news clip and get what everyone else is thinking. I'm just curious now to watch and see how things pan out. I've seen this program in action already (during training) And can quite honestly say, that every time I would move a truck to a location, 20 min later that truck was in the worst possible area. This computer system looks 20 min ahead. If there are going to be 4 calls in one particular area within the next 20 min. 4 trucks will be sent to the outer ridge of the response time requirement to meet that requirement. We're right now 92% <8:59. To its full potential, this program can run 95-96%. And if this program keeps the private agencies out of our county, which is one of the reasons why it was purchased. I'm all for it. And to answer you 46Young, our agency is slated to be in the top 30 in the nation. We're very progressive and highly regarded. (We placed 3rd at CLINCON international EMS competition in July of 09) To the point where for 9 positions, we had 368 applicants (that was back in Aug). What your referring to now with the employee satisfaction and working conditions. We have 37 stations and 37 trucks. Everyone has a bed to sleep in at night. We are a busy system (nowhere as busy as FDNY or L.A., roughly 100,000 calls FY09) and as it stands right now, we really don't have much time to sleep (unless your at your vacation station with in your sector, 1 Sector= (4 busy and 1 slow to reduce employee burnout) 5 truck rotation, that is rotated every month. This is attributed to our "stand-by policy" or posting of trucks in other response zones during the night. We're also the top paid EMS department in Fla. This program can literally show you what the county will look like in 20 min. So if you have two trucks out of a response zone (which is the requirement for a stand-by) but the computer software isn't showing a call dropping in that area before one of those trucks becomes available, You don't roll to the stand-by station. We do not post on street corners when we're on stand-by. Our stand-by's are at other EMS stations, so we can have down time while till covering the zone. Regarding PCR finishing in the ED before leaving. We're EPCR based with WiFi, air cards and Zoll data cards which automatically import all of our ECG's, B/P's, 12 Leads, ETCO2 into our PCR. We do everything in our trucks en route, during, and after pt offload, unless we have a P1. For P1's we're then OSS at the ED until the PCR is completed and uploaded. Heck, even our truck checks are electronic now. Richard, the system that FDNY uses is I think what's called MARVLUS. It's designed by Motorola which I know is the cities main technology company for CAD and radios. SIREN was orginally designed as a pilot scheduler for airlines. It was developed in New Zeland and London for their EMS programs. It is currently in use in Toronto and London. The software was then redesigned for EMS use after the success of it was proven in those two cities. We're now the first organization (In the US) to utilize the redesign, in a complete EMS deployment. The one factor that SIREN has over all of the other CAD programs, is its unique ability to see 20 mins into the day. Thus preparing the system to get smacked. We are not transitioning to SSM. Our union won't allow it. With our new contract, the county can't touch any 12 or 24 hr trucks (closing it), they can't split the 24 hr trucks, and they can't make our system true SSM. Everyone has a hybrid form of SSM, regardless if they want to believe it or not.

http://www.nbc-2.com/Global/story.asp?S=11743716 Watch the video that goes with it too..... What do you all think?

Waht in the world is going on? What's with nobody besides Kiwi posting? Am I that bad?

I too agree with Lasix being a back-in-the-day Tx. With all the same issues you have presented. The big thing I have with MS is simple. Fundementally, If you got someone who's already working their butt off to breathe, why in the heck to do you want to kick their drive to breathe out from underneath them?? MS does have vaso and bronco dilatory effects, but they do not have enough effects for the Dx you are trying to treat. I think that further sedating their ability to breathe to maintain their own PEEP, its a definate FAIL. Leading to the increased mortality in patient's seen in every study that has utilized MS. WARNING: Last statment is my opinion and generalization.

I'm curious to seek a response on this issue. I brought it up in chat and got a good response. My agency has been talking for a while about removing Lasix for our guidelines. We practice evdience based medicine and always are looking to see what's good and what's not so good. I myself rely on early SL NTG and CPAP with Tridol Drips. I want to see what other providers think about this. Vote on the poll and then DISCUSS wether or not the use of pre-hospital Lasix is beneficial, harmful,or a back-in-the-day TX that should of been removed ages ago. Here's some food for thought references and studies: http://http://chestjournal.chestpubs.org/content/92/4/586.full.pdf From 1987 http://http://emergency-medicine.jwatch.org/cgi/content/full/2006/613/1 From 2006 To take it a step further... What do you think about the removal of MS in tx for pulmonary edema?

Welecome to the City!! You will find a wealth of knowledge from a mix group of providers. Two things that I will point out to you that will make your stay enjoyable. If you need a question answered...... use the search function to find it before posting something that has been brought up all the time. Secondly, if your going to post something that might ruffle a few feathers or what have you. Be prepared to have an adult friendly consversation and be ready to back it up. I can't tell you how many new people think their being raked over the coals and attack members just to make butts out of themselves. Most importantly have FUN!!!! Again Welcome! <><><><><><><><><><><><><><><>Nifty<><><><><><><><><><><><><><><><><

Thank Ya'll sooooooooooooooooooooooooooooooooooooooooooo verrrrrrrryyyyyyyyyyy Much!!!! Especially Terri!!! Now I can terrorize ya'll in chat.... . God its been so long I won't know what do to with myself anymore. LOL

Interesting enough..... I've never heard of this practice before. I'll have to ask around and see if anyone else is around here doing it. I wear Bates DuraShocks. Absoultely hands down the best boots I've ever owned. $114 bucks and had them for 3 yrs. Had them resoled after the second yr and the material is still going strong. My knees and ankles love em too.....

I'll kick your butt in COD MW2 anyday Kiwi... Just name the date and time. I'll be there with my ACR with heartbeat sensor, Red Dot Sight and akimbo 1887's

P3.... its a give and take, but its better then no union right now. I just wanted to show ya a article that has been going on in our county. You always hear FD's taking EMS over because of cuts. But, in this case EMS is taking over FD transport. (A little side note: Even though they voted it down, The county ultimately holds the C.O.N. They have a MOU with the county in place which enables them to transport. If the county truly sees inadequate service delivery they can pull the plug on them and takeover at any point. The only thing though, is if FD stalls enough, goes bankrupt and forces the county takeover, they can sue the county back for the right to transport after the enconomy has re-established itself here. If they give it up voluntarily they are giving up all rights which they will never get back. Which is a terrible game to play but never the less they're playing it. I live in this district so I'm watching it very carefully.

http://www.news-press.com/article/20091217/NEWS0103/91217025/Lehigh-Acres-fire-commission-keeps-ambulance-service

It's either 1000 or 2000 posts to be considered a premium member from what I can remember, FireFly.

Woot!!! Woot!!! Woot!! That means I win right????

A nom would be great.... I miss chat..... So many memories.....

Kiwi....... You scare me that you know that much............ Fort Myers, Lifeguard November Five Four One Seven Juliet.... that's about as techinical as I could get......... In the OP, I'm not an expert on how air ambulance procedures work..... I can start by getitng the ok from the pilot to disembark the aircraft, walk around to the back of the helo, pull the stretcher out and walk with my partner (CCEMTP flight medic) to the back of the ambulance. Scene safe enough for hot load or cold load? I'll approach the vehicle and enter through the side door at the head of the patient and await report from the road medic on the patient. My partner approaching from the rear entering through the back. So what's my report? Huh.....Huh.....Huh......

I've had 9. (8-1 record, 80% success I guess?). But there have also been (roughly 20-30) calls where I've practiced excellent BLS and there was no further need for anything more advanced. Not to mention our agency is a HUGE user of CPAP. (I think it is one of the most awsome tools for patients in respiratory distress). But in all seriousness, the less invasive for my patient's the better. Do I see where maybe doing them day in and day out would lead to mastering the skill? Yes. But I would have to also agree with Dwayne. It's nothing but a slide, lift, and stick.

Poor 4c6....... I've been catching up on all of them via the internet. Every night @ 9pm I've always been too busy to stop and watch the show. I admit at first the pilot ended my "hype" I had for it. But every show is starting to get a little more refined. This last one was still a lil off as for as the medicine goes. But all things aside, its not supposed to be a "reality series". So, as far as the drauma, characters are developing enough each week to show progression and the acting is still off. I'll be watching, and hopefully if it lasts long enough, looking forward to the season finalie where hopefully the characters are refined copies of that what started in the pilot as washouts.