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OK, after repeatedly saying that I probably would not get the vaccine, I changed my mind. After weighing all the factors, and learning a few things, I took the intranasal inoculation today, although I did refuse the seasonal flu vaccine. The tipping points- Although you will shed the virus for several days after the dose, because it is an attenuated version, it is too weak to spread the disease, but it may actually impart immunity to anyone who is exposed to it. Concern about bringing home the virus to my family if exposed, even if I am OK. I have an at-risk child and wife-they both have asthma. Let's just say this: If this is another false alarm like the avian flu, I will not be happy since I NEVER get the flu. All the hysterics and warnings from the avian flue and now H1N1 will desensitize the general public for the next expected "epidemic". Even if there is a real threat in the future, I think a lot of people will simply ignore those warnings. Edit: Mods, please move this post to the appropriate forum. Sorry-

I'll see him in about 2 weeks and will ask. I imagine it was an LACoFD rule at the time. I'll ask.

The pneumonia seen in H1N1 is very different than that which the Pneumonia Vaccine prevents. The Pneumonia Vvaccine is given to prevent pneumonia caused by the pneumococcus bacterium. H1N1 flu is especially dangerous for young healthy adults because the H1N1 virus may cause a “cytokine storm” – a sudden release of inflammatory chemicals. This is the pneumonia type infection and inflammation we are now dealing with in the ICUs and which requires the more impressive technology.

Well, I can relate to the feelings so many of us have. I am in the military and go crazy watching shows/movies which do things wrong. My ex wife and current girlfriend will tell you that watching anything military on TV with me can be torture! Hell, I even biched during G.I. Joe!!!! (I wont watch The Unit o TV and almost lost my mind during the movie Basic!!) So we can do one of two things, quit watching or watch and accept the issues. I mean come on folks, was MASH correct either militarily or medically? But it was a grat show. I think people know that any TV show uses lots of creative license! I watched the first episode of truma togive it a chance and after that said it was not worth my time. I moved on. I think if "we" as a profesion put as much energy into making positive changes in our profession as we are in complaining about this show, we could make something happen! Take Care and Stay Safe!!!! Sarge

So this topic is twofold: 1) First I'm curious as to how much variation exists in STEMI bypass medical directives. So if you would be willing to post your local directive that would be great. I'd like to explore these different protocols and discuss the reasoning behind some of the variations (aside from the medic vs. machine interpretation argument if possible.) STEMI Bypass Medical Directive: (Only changed to remove identifiers for where I work.) When the following indications and conditions exist, a Primary Care Paramedic may bypass the closest hospital to transport a patient from within [Geographc Area of the Service] to [indicated Hospital] for Primary Coronary Intervention (PCI), according to the following: Indications: Patient who is experiencing cardiac ischemic “chest pain” or discomfort OR experiencing symptoms consistent with their typical angina / infarct events. Conditions: Patient is alert and ≥ 16 years of age Current episode of cardiac ischemia ≤ 12 hours in duration Paramedic interpretation of the 12 or 15 lead identifies an AMI (ST segment elevation in 2 or more anatomically contiguous leads: ≥ 1 mm in limb leads or ≥ 2 mm in precordial leads) Call location is based in [Geographic Area] Time from patient contact to arrival at [Hospital] will be ≤ 60 minutes. Contraindications: SBP ≤ 100 mmHg HR < 60 or > 160 bpm Left Bundle Branch block (LBBB) or Ventricular Paced Rhythm Hemodynamically unstable patient Procedure 1. Continue the care started according to the Acute Coronary Syndrome Medical Directive 2. Acquire and print a diagnostic 12 and/or 15 lead demonstrating evidence of AMI (based on paramedic interpretation and not the LP12’s interpretative software) 3. Confirm that the call is based in [Geographic Area] and that the time from patient contact to arrival at [Hospital] will be less than 60 minutes 4. Contact CACC to advise of the bypass and initiate transport. 5. Call [Phone number] as soon as possible to activate “CODE STEMI”. Advise you are EMS, from [service] and your ETA and the patient’s age and gender. 6. Continue care including oxygen administration, vital signs, pharmacological interventions and repeat 12 cardiograms. 7. On arrival at [Hospital], pick up the swipe card and bypass the Emergency department and proceed directly to the CCU on the 5th floor. 2) I know certain demographics are far more prone to atypical presentation MI's. I'm having trouble finding good info that really explores this concept and maybe has some numbers.

Great reply from Seb Wong! Kudos to him for taking the time and interest to share his thoughts with us, and thank you for posting it! This surprised me more than anything though: In the entire city of SF?? I've worked cities less than half that size that got that many a day. If the gays are that passive, I'm not sure I want them in my military.

To play slight devil's advicate: Is it a bad show to us only because we know how things *should* be? Or is it a bad show to anyone regardless of any knowledge of emergency medicne? This is something that I long ago had to learn. Personally I feel professional wrestling is awful and I can't believe it's been on TV for so many years. Though I had to realize I feel this way because I could see the faults. I went into stage combat at the way too young of age of 4. ( My mother and step father were both in the group and I joined to help grieve over a loss in the family.) I have tried more than once to watch pro. wrestling such as WWF and all I can see are mistakes. So I end up getting disgusted and turning it off. I can now watch it and use it for ideas when I go to plan a show. I will admit the Rock has gotten me out of some rock and hard places in my "fight dances" when I find one person on their back and I somehow I have get across a stage to their weapon of choice Could we as an EMS community doing the same to Trauma? We have been there, done that, or at least read the books so we see the problems and loop holes in the show. As people with knowledge we're getting frustrated, ranting and raving saying how bad this show is when in fact it's not all that horrid?

Many working professionals nowadays find it exceedingly difficult to complete a degree while working FT, and certainly can't afford to take a few years off work to pursue said degree. I'm facing that same issue myself at the moment, although my employer makes it easier than most. Things like medic mills, online medic-RN bridge programs, and other online dergrees have come about to address this population, but are frequently slammed for being inadequate. What's a working professional supposed to do when faced with legitimate financial/social constraints. damned if you do, damned if you don't. Completing a degree seems to be geared to the young adult population nowadays, who typically still live with their parents, and don't need to work FT. If you don't have the time, the profession doesn't need you anyway. Plenty of young individuals aiming for the healthcare field in general. Completing a FT, full speed program for ASN, BSN, RRT, PA, MBA, and such aren't compatible with those that absolutely must work FT jobs. What about the single parent that wants to do better for their family? Educational requirements for these fields weren't what they are now 15 or 20 years ago. Working professionals in healthcare fields are offered chances to upgrade their education to the new minimum standard, such as CRT to RRT, in a reasonable time/career friendly fashion, while newcomers have no choice but to complete the dergree in it's entirety at full speed, no other options available. So, before anyone knocks this program for not being a degree, remember that it IS 16 months, and addresses a business need while helping out those that wouldn't be able to attend otherwise. It's interesting to note that the article advises that there still exists a paramedic shortage. I know that I can move almost anywhere in the country and find work, especially with my resume. It's going to be an uphill battle to lobby for an increase in educational standards to a minimum of a 2 year degree when there exists a shortage of medics as it stands now. Until then, there's always going to be those that seek the quickest/easiest route, and employers that do the same. I don't see many employers requiring a two year degree minimum as a condition of employment without being forced to do so through legislation. That's where we are at the moment, like it or not.

HAHAHAHA love the video, especially a couple lines, especially "Dixie McCall's boobs...." You have to admit, Dixie was an amazing nurse - did she work 24 hours a day, or what? She ran the ER, and also was in on surgeries and other procedures, and was everywhere. Randolph Mantooth has, and always will be, my EMS hero - I had the BIGGEST crush on him when I watched the original "Emergency!" episodes on TV. But, Dr. Bledsoe, if I may ask a favor, there is something I have always wondered, and I am hoping you can ask Mr. Mantooth.. Why did Johnny and Roy always wear their helmets while driving to the scene, and then take them off when they got there? Was Roy's driving really that bad? Just curious.

Just to give credit where credt was due, I think you should look at the freedom House Project as most likely the first modern paramedics, not the fire service. And, BTW, the freedom house project was disbanded only after the fire department took over. Just had to show the flag.....

I've always been taught that femur fracture = c-spine. If it's strong enough to break the femur, the trauma docs want the patient immobilized until a CAT scan is done. But I digress.

A c-spine wouldn't necessarily be a bad thing in the case of a femur fracture. If the patient experienced enough force to break his femur, the spine could very well be damaged. I learned that off Trauma.

As with the previous two episodes, I watched the first two minutes before turning it off. And, sadly, I am left with the same question that has been in mind since the pilot... What the f*** is this sh**?

Ruff - that was a rather gracious response that Seb Wong provided to you. All along I've maintained the same thought - I feel sorry for him as he is the one that has to deal with the public's image, not only of EMS, but of his particular department. That puts him in a tough spot, especially since they are a municipal department as he states, they don't have the luxury of saying no. Their funding depends upon keeping the mayor happy. As much as some of us may not like fire based depts, ems I think it's time to seriously sit down and give this guy credit for at least trying. I know his job can't possibly be easy. Best of luck to him on cleaning up the mess this show may create and my sympathies certainly.

I cant believe this uppity group of wackers is willing to piss on this show. The latest attempt to bring our profession to the publc and there willing to step all over it then try and support it.