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Anyone can get one for a simple $2500 a year.. So.. If I give up my country club dues, I could join the SAG.

You're both right, he was a FF who also had a SAG card. (How Hollywood) If I recall correctly he eventually retired as a Deputy Chief or some other big wig with collar brass.

Woot for technology. I'm sitting @ a general store, in the middle of nowhere, town w/ like 12 ppl. All b/c there was a cell tower next to a barn a mile back. Anyhoo... I think he was chosen to be the driver on the TV series b/c he held a Screen Actors Guild card. Just happened to fit the part they needed.

I like chemical sedation

In the film, Dolly's character said it to Dabny Coleman's character, after he came on to her...again! The line was not in the song, and I apologise for any confusion I may have caused you.

That is cause for some concern. A ventilator still needs to be assessed as this is just a piece of plastic with O2 powering it and no monitoring capabilities except for manometer which could care less where it is getting its pressure measurement from. Not if they do IFT or critical care patients. This ventilator, and I use that term "loosely", is good for ventilating the living dead post code. It frees up your hands but that doesn't mean you do not monitor the airway. It is an automated BVM and should not be used on IFTs for patients requiring more precise monitoring and settings with some options. For those of you who don't know what a VAR is: http://www.floteco2.com/htm/Products/B-VOR_Automatic_Resuscitator.htm Unfortunately for 911 EMS, an ATV may be all the education, training and budget will probably allow for. However, one needs to know a little something about the pulmonary system to make these little ATVs work as well as they can for the patient. The generic settings I've seen in some of the protocols are...well.......okay I'm at a lost for words. If one understands the settings they have chosen for THAT patient and physically monitors the patient closely, the ATV has benefits over the bag for not causing flutuations in pH by varying the CO2 with irregular bagging or drastic changes in hemodynamic status with over zealous bagging. It is now recommended by the AHA for those reasons since counting while bagging with consistency for rate/volume is a difficult skill in an emergency for some. And, it does free up the hands but the ventilator should not be forgotten when it comes to continous assessment. kohlerrf I saw you post on the H1N1/Ventolin thread. Don't forget to put a good filter on this VAR to keep from getting aerosolized particles coming at you from the patient's lungs.

New hires, and newly certified Paramedics ?

My question would be why are you adding anything to giving glucose IV? Are you flushing the bolus because it's in ampoule form? I suspect we have not used 50% dextrose since about 1999 or there abouts. Our service uses 10% glucose IV that comes in 500ml bags and does not require a flush.

I got this in an e mail. Thought it was cute. > Q: Doctor, I've heard that cardiovascular exercise can prolong life. Is > this true? > A: Heart only good for so many beats, and that it... Don't waste on > exercise. Everything wear out eventually. Speed up heart not make live > longer; that like say you can extend life of car by driving faster. Want > live longer? Take nap. > > Q: Should I cut down on meat and eat more fruits and vegetables? > A: You must grasp logistical efficiencies. What does cow eat? Hay and > corn. What are these? Vegetables. So, steak nothing more than efficient > mechanism of delivering vegetables to system. Need grain? Eat chicken. > Beef also good source of field grass (green leafy vegetable). And pork > chop can give 100% recommended daily allowance of vegetable products. > > Q: Should I reduce my alcohol intake? > A: No, not at all. Wine made from fruit. Brandy is distilled wine. That > means they take water out of fruity bit; get even more of goodness that > way. Beer also made out of grain. Bottoms up! > > Q: How can I calculate my body/fat ratio? > A: If you have body and you have fat, ratio is one to one. If you have > two bodies, ratio is two to one, etc. > > Q: What are some of the advantages of participating in a regular > exercise program? > A: Cannot think of single one, sorry. My philosophy: No Pain...Good! > > Q: Aren't fried foods bad for you? > A: YOU NOT LISTENING!!! .... Foods fried in vegetable oil. How getting > more vegetables be bad for you? > Q: Will sit-ups help prevent me from getting a little soft around the > middle? > A: Definitely not! When you exercise muscle, it get bigger. You should > only do sit-ups if want bigger stomach. > > > Q: Is chocolate bad for me? > A: You crazy? HELLO .... Cocoa beans! Vegetable!!! Cocoa beans best > feel-good food around! > > Q: Is swimming good for your figure? > A: If swimming good for figure, explain whales to me. > > Q: Is getting in-shape important for my lifestyle? > A: Hey! 'Round' is shape! > > Well, I hope this has cleared up any misconceptions you may have had > about food and diets. > > AND..... > > > > > > > > For those of you who watch what you eat, here's the final word on > nutrition and health. It's a relief to know the truth after all those > conflicting nutritional studies: > > 1. The Japanese eat very little fat > > And suffer fewer heart attacks than Americans. > > 2. The Mexicans eat a lot of fat > > And suffer fewer heart attacks than Americans. > > 3. The Chinese drink very little red wine > > And suffer fewer heart attacks than Americans. > > 4 The Italians drink a lot of red wine > > And suffer fewer heart attacks than Americans. > > 5. The Germans drink a lot of beers and eat lots of sausages and fats > > And suffer fewer heart attacks than Americans. > > *CONCLUSION.....* > > *_Eat and drink what you like_*! Speaking English is apparently what > kills you.

Squint - one problem - that looks too much like Lone to be you !

Yeah, I'd volunteer too, but I'm pretty sure I have warrants out in California.

http://www.jems.com/news_and_articles/articles/jems/3208/the_high-tech_heart.html http://www.chfpatients.com/implants/lvads.htm CPR & other treatment: Due to the location of the LVAD and its proximity to the heart, there may be risks associated with performing chest compressions. CPR may damage the LVAD itself or dislodge tubing, resulting in massive hemorrhage. The use of hand pumping in place of CPR is possible and may be indicated in some situations. Decisions on whether or not to use CPR should be left to medical control.11 Further treatment considerations focus on physiologic changes related to their underlying disease process, such as dysrhythmias, electrical therapy (defibrillation/cardioversion), ACLS or trauma care. The use of electrical therapy depends on the make/brand of the LVAD. Keep in mind that the patient and family will be well versed in emergency procedures and know how to manipulate the LVAD system in case of an emergency. The patient and family will also be educated on which kind of therapy the patient can or cannot receive, so emergency care providers should always keep the patient and their caregivers together during treatment and transport.

Gotta love the Fark.com headline for this one. "Barack Obama linked to terrorist Yasser Arafat"

Hey anyone can PM me ... they just have to be a member of EMT city and hey Admin would like that to increase our membership Only one problem ... I WAS thrown out of Texas after EMStock and Dust as the evidence

The last time I heard of someone from real life portraying someone in "reel" life was the Fire Fighter "Mike" on "Emergency!" He actually was an Engine Motor Pump Operator for the LACoFD, and was used to drive the studio "Engine 51", as he already was licensed to drive that type vehicle. Saved the studio money by doing that.

Dear Mike: Speak for yourself there Mike, thanks could it be that the PC comments may be aimed at assuring continued revenue from standbys coverage ... just think how much the producers could save ca$h wise if they actually HAD a REAL REMT-P playing a subordinate role ... just thinking out loud here. once again I am available and it IS snowing here I can be contacted at Idontwannafreezemyassoff@leaveAB.ca.

That is a consideration; however, consider the following: D5W has 5 grams of dextrose per 100 ml. An eight ounce glass of cranberry juice has about 36 grams (~15 grams in 100 ml) Therefore, you would have to run your D5W at a rate of 300 ml/hr just to give the dextrose of a glass of juice. While this is doable, I am not sure that doing this is all that helpful for transport times of less than 20 minutes. In addition, once the dextrose is utilized, free water is left behind. This leaves a rather hypotonic solution behind. Not the greatest solution for already swollen cells, cerebral edema, or stroke patients. Since stroke should be on your differential list for altered mental status, even in hypoglycemic patients, you will need to be very careful and utilize good clinical decision making if you want to go down this route. Take care, chbare.

Seems to me that before we start nominating people for a peace prize, we should have peace.

The specs on it look better than some so it might be able to do decent CPAP and ventilate post code on an unresponsive patient. The thing with ventilators, if the patient is trying to breathe spontaneously and the machine isn't sensitive enough or doesn't have the capability to meet flow demands, few 911 ALS or even some CCTs have the ability to provide adequate sedation. In the hospital, we occasionally use the ParaPac portable ventilator for MRI. http://www.smiths-medical.com/upload/products/PDF/Respiratory.pdf (specs near the bottom - the specs for the Carevent are on the links above) It is a little work horse and can achieve a decent flow but we often have to give a good dose of something to chill some patients. Luckily Diprivan (Propofol) is usually hanging. I have quizzed patients who have been transported many times which they prefer and it usually the LTV 1000 or 1200 with a real liking for the 1200. The internal turbine in the LTV is hard to beat among the transport vents. I like the valving also for its responsiveness and ease of acceleration to meet the patient's demand. It is fairly rugged and handles the rough terrain of HEMS. The sleek design allows it to hug the curves to travel just about anywhere including cramped CT Scan rooms. Nice option package with can include a good monitor makes it versatile for CCT. It handles most critical care respiratory patients very well when taken for a long distance transport. Gas consumption gets decent mileage also. And, it was the ventilator choice of Superman. But, it is impractical for most 911 ALS unless they also do "real" CCT and have adequate training. I'm spoiled. After growing up with Elder demand valves, it is time for some luxury. BTW, my opinion of the Oxylator is that it is a Elder demand valve that they attempted to give some "thinking ability" to but the limited feedback data capabilities can fool it and the health care provider. http://www.lifesavingsystemsinc.com/documentation/LSI-Oxylator-BPM%20Rate%20Changes%20&%20Indications%20EM-100,%20EMX.pdf

Man, I wish I would have thought of that. So can I consider that as an endorsement that the ALS is a good machine?

YES YOU ARE

I am guessing you refer to Dolly Parton's comment in 9 to Five: ?

Ferrigno co-starred as a paramedic on "Trauma Center". Part of the problem is, we don't have a Jim Paige anymore, to go to bat for us, as he did with "Emergency!" Seeing how successful he was with the EMS aspect of the show, the Fire Fighters got him to try and make the fire fighting aspects of the show also more realistic. However, as visibility is nonexistant in a fire, and fire fighters don't usually stand up while directing a water stream during an interior attack, Hollywood still had to take liberties.

Rock I think you bring up a very good point. Too long have we been exposed to exhaled pathogens (it was TB in my day)and scooby, I think you offer a good "plan B" however the preferred is to not have air born droplets at all. I'm sorry I don't have experience with IV ventolin in addition I was always taught that nebulized and inspired it had its shortest onset and therefore sooner correction of the presenting problem. It may just be myth I don't know. I'm wondering if IV Ventolin is the best solution or having the practitioner put on an N-95 mask when treating a suspected respiratory infection? There are some inherent risks in our business.I am embarrassed to admit that when I started we never wore gloves and were sticking dirty needles in the bench seat cushion. In any event I'm going to start wearing our n-95's thanks.

HERE YA GO! EMD flip cards (50 of em)! http://www.state.nj.us/health/ems/documents/guidecard.pdf

Hasn't everyone? I remember when they were introduced in the mid 70's and we all wished we could have them, but were still stuck tying cravats onto Thomas Half Ring splints instead because our employers were too cheap. But between around 1978 and 1986, the Hare was all I ever used anywhere. Then the Sager came out and pretty well took over. I applied a buttload of Hares and Thomas Half Rings over the years though.

Indeed. There was nothing unrealistic about MJ&S. It remains the most realistic EMS movie of all time, and I expect it to remain that way. The funny thing is, is that it was produced and promoted as a comedy when in fact it was as real as it could possibly get. Maybe if "Trauma" did the same thing, they could achieve the realism they think they are producing now.

Exacerbation of pre-existing conditions and other infections such as MRSA are expected with the regular Infuenza B season. Influenza A will quite often present with respiratory complications such as PNA of various etiologies and ARDS is now the issue in younger populations. If you have a patient with suspected flu that is having difficulty breathing to where you are considering IV Ventolin and no pre-existing pulmonary hx, there is a good possibility HFOV, Nitric Oxide and even ECMO could be in their future. A ventilator of sometype will probably be needed. This is where BiPAP/CPAP was thought to be of use in the initial phase to prevent intubation but the devices used by EMS and the single limb circuits with vented masks pose an infection control problem. While the numbers for deaths are relatively small compared to the total number of flu cases, they are significant for the cause and the targets. U.S. numbers so far: http://www.cdc.gov/flu/weekly/ http://www.cdc.gov/h1n1flu/updates/us/ http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0710a1.htm Good case studies from Australia. http://www.mja.com.au/public/issues/191_03_030809/kau10748_fm.pdf Of course the challenge is getting patients from the less equiped hospitals to one with the resources safely for patient and crew. Thus, the filter conversation for the ventilators and masks for both patient and health care provider.

Nice power point but I think oscillation is a tad out of the league of most viewers, that said no harm, but are not the deaths we are observing due to underlying medical conditions and secondary bacterial infections (not that ARDS is NOt a serious consideration) and pregnancy ..i believe last count in the US was 28 fatalities in pregnant patients ?

Praise from Dr. Bledsoe is praise indeed . . . I just came home from my first day of Paramedic Prep at Daniel Freeman (UCLA). And of course the two textbooks I received both have Dr. Bledsoe's name on them. It's been a big day for me! Thanks, Dust, for sending him the link. And thinking about Johnny Gage from "Emergency" looking at something I did, and maybe having a laugh, is the absolute cherry on the cake! NickD

That's not what she said!

The ThermoFlo (ARC Medical), Drager TwinStar and the Hygrobac S (used to be Nellcor(?)) are so far the ones that seem to do the job with the less problems.

Vent raised a point about the use of non-rebreathers that I think makes sense to me. If we attach the neb to a non-rebreather than the exhaled droplets should be relatively contained right? Also a technique I do for asthma patients is double back the blue part of the neb and tape it down so the patient will breath some of the excess neb through the nose. Not sure if it actually does help but I would like to think that it can't hurt? Correct me if I am wrong.. and I second Dwaynes comment... never assume anything here cause you make an ass outta you and me!

You do bring up a good topic as many are trying to come up with safe and effective delivery systems for nebulized meds and O2 without risking exposure to others. We do not have that many isolation areas in the EDs or even in some hospitals. IV Albuterol is approved in Canada and a few other countries but not in the U.S. I believe a few years ago IV Albuterol was part of EMS protocols in at least one area of Canada. There is some research for it, and that includes what was also done in the U.S., but it is inconclusive as far as it being a better bronchodilator than the nebulized or other IV medications. Of course the side effects such as hypokalemia are beneficial to some patients more than the nebulized form but also has other potential complications. Nebulizing meds and O2 devices allowing exhaled particles into the surrounding area has been especially controversial since the recent SARS and in years past with TB becoming prevalent in some areas. We do have filtered nebs which have been used for Pentamidine and some of the antibiotics which offer some protection. Simple masks, NRBMs and definitely BiPAP/CPAP devices are in question. There is a recent editorial in the Canadian Medical Journal concerning the use of BiPAP/CPAP as it may prevent intubation in some Influenza A patients. However, the patients I have seen lately need to go straight to a High Frequency Ventilator for ARDS. In the hospital we can use a closed limb system with filters for BiPAP/CPAP by using a nonvented mask with the ICU ventilators. We are also trying to determine which filter is most effective with least resistance for our transport ventilators such as the LTV which can also be used for BiPAP/CPAP.

Never left too, but glad to see that your still posting.... R/r 911

Three weeks of classroom covering a wide range of topics. (just to be clear that 120 hours is not some EMT course. It's just employee orientation.) Three shifts as third. 20 shifts on driving restriction (L&S to a call, but not with patient on board; partner initials after each shift, reviewed by Superintendent before sign off) Six months of probation. And crotch, just because I've grown impatient with so much coffee today, what issue in EMS are we being blind to, how is it costing lives and how can I be made to feel guilty about it?

This could be interesting.

Trauma portrays us as unprofessional sex crazed sexist adrenaline junkies... THAT'S BAD! That video portrays Adolf Hitler, the worst villain in history, as the head of EMS and Bledsoe, RidRyder, and dustdebil as his Nazi generals... THAT'S FUNNY? Uhh.... alrighty then... I'm with Kiwimedic (but I'm not going to waste good booze) However, Downfall was very well done movie. http://www.downfallthefilm.com/

NOTHING is better than gravy and biscuits... NOTHING

Why would they miss a change to charge you for another card?

Hey all, One of the guys I work with is a fire medic and we got into an argument this morning concerning Fire and EMS. My argument was that most of the times that EMS has attempted to make a run at creating an entry level AAS for paramedic medicine that Fire has consistently opposed it. He claims that this is nonsense, that the fire unions are pro education and responsible for many increases in EMS education. I'm looking for articles, as I know I've seen a lot of them, to support my argument that Fire consistently stands in the way of increased education in EMS. I have no doubt that both arguments can be supported, but I am looking for support for mine only. Though I would be interested in seeing another thread to support the opposite if possible. It is not my intention to start a flame war here. I have many, many friends that also happen to be infected by the Firebug. This is a good natured argument between a medic I respect and myself and I simply want to smite him in a good natured way. I simply don't have the time, or the mad Google skills to do so on my own in short order. I'm asking as a favor that we avoid having this thread locked by keeping it in that spirit. Thanks for any help you can provide. Dwayne

Explain to him that the problem is NOT the FF-EMTs or FF-Medics, it is the Fire management and the bean counters. Management wants EMS call volume and income to subsidize and justify the fire side where calls are down thanks to building codes lobbied for by Fire. Part of that plan is to quickly and easily make and keep as many FFs as EMTs/Medics as quickly and easily as possible. Increasing the barriers for their FF's (who they want to wear many hats) to become and remain medics by increasing education standards is not in their plan. The line Firefighters are usually plenty professional. I think most Fire EMS people who actually want to do EMS (and there are plenty who don't want to do EMS) are people with no problem with increased education as long as they get out of it what they put into it (in opportunity and pay for time). However, most Fire Management isn't that interested. They are FIRE Management, right? Remember, it is Fire-EMS, not EMS-Fire. Nevermind which side gets more volume.