Menningococcal Septacaemia

[scott33]

this is an international forum, why is it if something is done outside of the US it is either done badly or is inappropriate to some here

As has been mentioned, looking outside the box is an issue in many parts of the US. For example, I have noticed that I seem to be surrounded by two distinct types of EMS provider in my area (NY). Those who think that FDNY should be the national model for EMS, and those who know it is complete bollocks. There doesn't appear to be any middle ground.

Its just a case of people being set in their ways, and not being concerned with the possibility that there may just be more user-friendly alternatives. Try suggesting the more progressive vac mat for spinal immobilization in place of the spinal board, or the possibility of treat and release protocols becoming more of the norm, and watch the vacant looks you get... ](*,)

To be fair though, there are many in the UK (for example) who can be just as blinkered and elitist on the one hand, or disillusioned and bitter on the other.

[logos]

This sort of thing is likely to vary heavily by service. There is no need for things like antibiotics or thrombolytics in urban areas, but there very well may be in less urban areas.

[Dustdevil]

according to the stats on deaths from anaphylaxis due to allergy to penicillin in the UK over a period of 10 yrs is 27, those are good odds.

Sweet. While you're at it, why don't you tell us how many people died of TB in EMS care because they couldn't get Rocephin fifteen minutes earlier? Again, where is the justification? Lack of risk is not enough. Show us a statistically demonstrated urgent need for this that outweighs the risks, or else you are simply looking for something else to do "because we can".

this is an international forum, why is it if something is done outside of the US it is either done badly or is inappropriate to some here

Read much? I am known across the four corners of the Earth for constantly touting the superiority of Canadian and European EMS over American EMS, so you aren't going to paint me with that one.

...and why do some here, for all their preaching on the need for education, cut most EMS providers off at the knees in the US and say that they " don't have the education or are too lazy to get it "

You just answered your own question. It is because they still do not have that education. And a two-hour in-service on Rocephin at the fire hall is not education, so no, "most EMS providers of any level" remain insufficiently educated for the responsibilities they already have, much less anything more.

In other countries (non-US), pre-hosp providers are giving anti-bi's, thrombolytics ect, this is advancement, this is education for the pre-hosp environment, no matter how much time in the lab doing courses on micro or lab work, maybe good education but ain't really gonna help you in the field.

Funny... I've never ever heard anyone who has actually taken a college microbiology course say that.

You're not really saying that it is possible or acceptable to learn microbiological theory on the job, are you? Just kind of wing it? Give it a few times and see how it works out, without ever knowing the first thing about the target organisms and susceptibility? I suppose we ought to be giving cardiac drugs without knowing anything about cardiology too? This is the epitome of protocol monkeying. :roll:

why does every thread on here go down the line of a few philosophers telling their opinion on what should be,

Because so many people obviously still fail to get it. What's your alternative? I suppose you would prefer that we not call BS when someone starts spouting potentially harmful nonsense here? You would prefer that we just let you get your story in and accept it as valid without challenge? Wait a minute... you're challenging me. Why can't I challenge you? Don't be a hypocrite.

[ccmedoc]

w

... this is education for the pre-hosp environment, no matter how much time in the lab doing courses on micro or lab work, maybe good education but ain't really gonna help you in the field.

This is very probably one of the most ignorant statements I have read on this site..I am at a loss for words.. :oops:

[hertzvanrental]

This sort of thing is likely to vary heavily by service. There is no need for things like antibiotics or thrombolytics in urban areas, but there very well may be in less urban areas.

No need for thrombolytic therapy in urban areas! What are you talking about. We can deliver this type of treatment quicker than the hospital even in the parking lot of the hospital. In fact we are encouraged to initiate therapy asap. Once the ED Doc has assessed the patient and then pissed around making a decision on whether they will be treated in the ED or referred to CCU, we would have thrombolysed the patient and maybe even aborted the MI, saving valuable myocardium and still done it quicker than the hospital.

As for AB therapy, we are not talking giving it to every child with a fever or who is febrile. It's about recognizing the seriously child. Bacterial infection is one of the first things I want to rule out when dealing with a sick kid. I'll assess ABC in the home, high flow O2 tympanic temperature, blood glucose, cap refill. I'll stick a line in if necessary. ANY sign of a non blanching purpuric rash or petechiae ( also remembering the in the mouth and conjuvtivae) in an acutely unwell child then I won't hesitate to give Benzylpen. The earlier it's given the better. I've seen the rash of MS develop in front of my eyes, starting with one tiny spot on the abdo and within a space of 15 minutes all over. This got AB therapy from us and is alive and well today. The ED DRs praised us for recognizing and treating MS and says her speedy recovery was partly due to our early treatment. And there are lots of similar stories in the UK.

http://www.meningitis.org/health-professio...lance-personnel

[hertzvanrental]

Cultures! With bacterial meningitis there isn't usually time time to do cultures. If clinically suspected it's AB first then do the investigations (that's in hospital over here as well). As for the 30 year old with a Hx of a cough for 2 months (as quoted by LOGOS), I don't know anyone in their right mind who would treat this with AB. For a start I wouldn't even suspect MS and if he did have it and it was the bacterial form he wouldn't have lasted 2 months!

[jmac]

dust,

first things first this is not a personal attack on you, the stats i left up were for you because you like fact, the rest was just my opinion, as for TB, this is a thread about meningitis so what use are all those stats.

CC, if you feel i am ignorant, thats your opinion, you are entitled to it, in the context of being with a sick child, sorry lab work for the lab, don't have one on me at the time, i treat my patient, not guess about what results may or may come back from the lab.

dust, we don't use protocols or medical direction for these type of cases, we use Clinical practice guidelines, something i have heard you call for in the states, if we feel clinically justified to administer we do, for anything above or outside our CPG's we can call for medical direction.

throm's and AB's, these are time related, as hertz says needle to door time is essential, some on here (relax dust, not singling you out) seem to go for the negative aspects of of pre-hosp care in the states, though it was the US that was in the forefront of EMS, it has taken a backseat but i have a lot of good friends in the states at all levels and in discussion it appears that the education that has abandoned them, not their own laziness, CC, in my opinion all the lab courses and such are NICE to knows, well and good to have them but not worth a toss in the field, experience and judgement count, along with clinical responsibility

first rule of EMS, treat the patient following the four ethical principles, and staying within my remit, i have respect for a lot of people on here (you too dust ), but there is a lot of negativity, some things work here, why not the states, life goes on, air in air out is a good thing.

[mike_m]

Wow, I love the way a topic can generate such interesting discussion. It's the reason why I really enjoy reading this forum.

Back on topic, every Ambulance in New South Wales (Aus) carries Benzyl Pennicillin for the treatment of suspected meningococcal septicaemia

[air.stump]

Jmac and Hertzvanrental

I started the TB thing to illustrate a point. The point was not who to give AB to but in recognizing the symptoms of an illness. Dust pointed out on page one that every kid with BOM and a fever would receive AB therapy because some paramedics here can not differentiate illnesses from a set of symptoms. I chose TB because it is on the rise here in the states and has been seen by most anyone in the field over the past few years. Some of our colleagues believe that the common EMSer can not come to a correct conclusion about an illness based on a set of symptoms therefore can not be trusted to administer AB correctly. I don't agree with this. This is where education and in the field, precise medical direction comes in.

[VentMedic]

In the hospital when we take a sputum, blood or spinal fluid culture, it is usually done controlled and correctly. We are going to test for many different types of bacteria, viruses and fungus. Too many disease processes mimic others. There is little or no room for error when choosing the right antibiotic and dose or whatever course of treatment. With the rapid rise of resistant strains, we take antibiotic therapy seriously. This is not just the United States but a world wide problem including the other countries represented here. Anyone can do a literature search and see what problems the over use of antibiotics has created.

It may be just a matter of time before prehospital use of antibiotics in some countries for general symptoms come under question. There may be some rare exceptions in very rural regions, but few for an urban area. If only one Paramedic is speaking for himself and the number of times he has given antibiotics by his perception as responsibly, how many paramedics are doing the same across that country and may be giving the antibiotics just because they can? There are very few if any perfect systems with perfect providers regardless of how trained or even educated they believe they are.

It would be so nice if all the diseases we have to concern ourselves with are the few that are mentioned in a Paramedic text. Out of 100 ICU patients in the hospital right now, I can not even begin to list what the cultures and disease processes are. There are just too many with too many variants. Some our most renowned doctors also know their limitations and have no problem consulting with specialists when choosing the correct course of antibiotic therapy.

And yes, we still have TB. In fact, Florida still has a large hospital (A.G. Holley) dedicated to isolating the seriously non-compliant by court order.

For once, I do applaud the U.S. system for not establishing another "cert" for antibiotic therapy and not adding to a world wide problem. I am not saying there are not exceptions in very rural regions, post disaster or 3rd world countries. However, we have also seen what inappropriate treatment, even by perceived professionals, has done to escalate disease processes in impoverished countries all for the sake of "doing good".