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Wait a minute... your not an English Teacher? Couldn't tell.

I am a 60 year old man who lives with his family in India. I too work in the medical proffession in a large Hospital in Delhi. I am a stretcher Bearer dealing with the movement of both dead and living patients and visitors. I am of low caste but am reasonbly intelligent and am of a polite and cleanly disposition. I wish to communicate with American Paramedics and learn all about your duties and tasks. It is my ambition is to become a Paramedic myself in your beautiful and affluent nation. Please communicate with me and allow me to fulfill my desires of moving my family to the USA.

I always found it a little unnerving that the AHA's official recommendation on the use of AEDs for infants under the age of 1 was "no recommendation." I recognize it's due to an insufficient body of evidence, but at the end of the day if you have an infant in your arms in full arrest, you still have to either shock or not; you can't just take a rain check. Everyone seems to punt on this one. My protocols don't address it at all. Realistically most providers I know seem to take the default attitude of not shocking, and I'm sympathetic to the idea that an arrest at this age is unlikely to be secondary to V-fib, but at some point you have to ask -- if you've tried everything else, and after however many rounds of CPR you want to bother with, does this fall under "might as well try"? I imagine most people would just haul ass for the ED, but that's not how we deal with a code in any other circumstances, so I'd hate to think we're just trying to do the safe thing (because we're scared of electrocuting babies) rather than the best care. Does anyone have a protocol or system policy that addresses this? If not, what would your personal decision be in such a situation?

Since today marked one of the two days of the year for the majority of us when our time zone changes (X Daylight Time to X Standard Time), here's a question. How do you document time to specify DT vs ST? To be honest, I've never seen anyone document time zones on their run sheet since the time zone is generally a given based on location. Similarly, for people who work near time zone boarders, how do you handle calls and documentation when you end up crossing the time zone border during your call?

Welcome Gupta. I had the distinct pleasure of visiting your country for a month a few years back and it was one of the best trips I have taken. I am a Paramedic in Canada (as is stniuqs). If you are interested in immigrating and working in Emergency Medical Services, you might find Canada to be a better place to land. Here (for the most part) the education requirements are higher to work as a Paramedic and as a result the pay, benefits and working conditions are very good. As a Paramedic in Ontario I make a very comfortable wage and am able to support a family without working excessive overtime or a second job. This is not the case in many areas of the United States. Of course uprooting yourself to travel the world is a monumental decision, so of course don't take my word for it. I echo the other members of the City in offering my assistance with any questions you may have.

<BR> How can you say this? Is it based on standards and scope of practice? If that were the case you could put anything into an "Epi-pen" style autoinjector, where would you draw the line. The autoinjectors used in WMD (generally nerve agents only - Atropine and 2PAM) are 1 1/2 inches long and are 18 gague needles, not remotely similar to an epi-pen (1/2-3/4" and 22-24 gague). I think these are nothing but blue sky statements. In New York State, EMT-Bs are allowed to "assist a patient in taking" specific meds, like Nitro pills, or epi-pens. Surprisingly, in a career of over 35 years, I have never been called on to do either. I'll chalk up the "vaccine as a WMD" as a typographical error. If exposed to a nerve agent, yes, I'd probably self-inject, for self rescue. I have not. In fact, the only thing we've spent time on, in my refresher classes, is a simulated autoinjector. When you press it, you hear and feel some kind of spring mechanism releasing within the device, and no needle is on the training device. I have been told that in one class, where Paramedic Trainees used an actual autoinjector with a placebo load, in classes at the FDNY EMS Academy, that a lieutenant had his finger in the wrong place, and the needle went through his thumb, complete to the thumbnail. It is my belief and hope that all EMTs, or Paramedics, in the US, Canada, the UK, or anywhere, are praying that a "General Order" to break out the 2PAM, and other "goodies" in the WMD kits, never becomes nessesary.<BR><BR>As for my statement that I'd be working the MIRV, I stated I'd be doing data entry. At no time did i say I was going to be actually doing any injections. If someone thought I WAS saying I'd be doing injections, I apologize for any confusion.

In my country we believe a man convicted of outragous offences of criminal activity or lewd acts of sexual or moral perversity must suffer the consequences until the day he dies. A man who is a criminal or murderer or fornicator must be punished and allowed no respite from persecution. Only in the next life is he free to persue a career in emt . His past sins will only then be absolved.

A specious argument, as prior to World War II civilian attrition almost always outpaced soldier casualities (Return of The White Plague). There is no fail safe method for 100% prevention. However N95 masks, goggles, gowns and gloves will greatly reduce the risk. I agee that having the H1N1 vaccine would be ideal, But how do we know thats what the pt has? What if its TB? Is the gown and mask good enough for those pts? Or should we refuse to transport them too? I applaud this woman for taking a stand and speaking out on this issue. All health care workers should be among the first to be vaccinated. However, for her to bleat about refusing to treat a sick pt because there is a 2 day delay is a little childish; particularly since she might get one call in the interm.

Gupta, What a honor to have you here! I look forward to reading posts from you, and learning from your experience. This is an amazing website, truly quality people with much to share. Welcome!!!

Looking at the second study, my question would be what the definition of "significant." For example, transporting with lights and sirens "[statistically] significantly" decreases transport time, however it is rarely "[clinically] significant."

gupta, welcome to the city. hope we learn just as much from you.

Point taken: Thing is sometimes you have to stir the pot a bit to get results and this swine flu panic generated over the long term will go a very long way to educate the non believers for all vaccines IMHO. I think tom5706 makes a very good point, you can't knee jerk response demanding an immediate yank a licence for an news interview to enlighten only, can you? I just believe in free speech we so need more leaders in EMS like her, I would bet shes on the road today is my bet ! On to the hand washing vs other methods to keep this thread on an educational track: Oddly enough both these papers present somewhat opposing findings, but note well the non enveloped virus and from my background an 70/30 or 60/40 blend of alcohol based antibacterials rupture the cell wall of the bacterium. So next on my little research project is does this release the virus attached to RNA/DNA ?

I m wondering if anyone has had language problems with their partner. what i mean is you speak one lang and your partner speaks another. sounds crazy i know, but where i am it happens. I am in an area saturated with bls private companies ( new companies popping up left and right) at least 50. 90% of the companies are owned by ppl from one country( i rather not say which one) needless to say a very good portion of the first responders and emt's ( basic) are from that country and they really don't understand or speak english. However the majority of the pt's do speak only english. Sometimes you get partnered up ( no set crews) with someone who barley speaks/understands english. you tell the boss that the language barrier is to much, what happens when i need my partner to do or get something and he/she has no idea what i m saying. so now you're putting your cert on the line cuase you can't do your job properly. the boss replies you have to teach him/her english. you say no that is not my job. now you can leave the company and try another company but like what was said earlier its the same with the vast majority of the companies in the area. you wonder how did they get certified when they can't speak or understand english Im just wondering basically if anyone has had a situation where there is a language barrier between the his/her partners? what did you do? how did you handle the situation or what would you do?

Vaccinated vs contracted to the best of my knowledge shouldn't change. To be honest, the time line I presented wasn't for vaccination per say, but was the text book time line for dealing with an infection since, in essence, the difference between an outside infection and a vaccine is simply virulence and port of entry. A vaccine is either going to be a dead or extremely weakened sample since the important thing is getting the body to be able to recognize the antigens so that it can start an adapted response sooner. My understanding is that flu like symptoms patients, regardless of type, should have the same precaution as any other droplet disease, as in gloves, mask, and gown. As always, hand washing is important. Alcohol hand sanitizers are good stop gap measures and more practical in some instances (like on ambulances), but shouldn't be the only source of hand cleaning. An important thing to remember with alcohol is that, unlike antibiotics, microorganisms won't become resistant to it. As such, use alcohol cleaners early and often and wash after every patient. I honestly don't know.

Basic immunology. The first time it your body is exposed to a specific antigen (note: antigens may change as an organism mutates. This is why the flu shot doesn't always work to prevent the flu) for your body to switch from the innate immune response (macrophages, natural killer cells, etc) to the adaptive immune response (B cells, T cells, antibodies). During this time, the receptors are undergoing somatic hypermutation to find the exact fit for the receptors and the antigen and the cells are undergoing clonal expansion to essentially gear up for battle. While the innate immunity is doing it's best to control an infection, the adaptive immunity is able to target specifically the antigens on the invading organism and bring heavier weapons to bear. It is this process that produces memory B cells. Once the memory B cells are produced, they tend to stick around for an extremely long time. Additionally, since they are able to recognize the antigen, your body is able to kick in an adaptive response in a day or two (no need for somatic hypermutation. Able to release some antibodies immediately as the cells start clonal expansion. Earlier response means the infection has less time to grow) instead of the week timeline. On a side note, this is why you don't have an allergic reaction to the first exposure, but do to the second. During your first exposure to, say, bee venom, you're body doesn't immediately recognize it as bad and overreact. The second time, it knows that the venom is bad and already has cells that can respond to it.

Send them back to Africa!

Well since I can't get a straight answer out of anyone else, and you seem to think you should know what your giving ... can you tell me everything in the H1N1 forumlary ? I said it in another thread will say it again ... we're an over worked system with 3500 calls a day .. if we had to give out inoculations, we would need everyone to help, couldn't tax all our ALS providers with this task ... No one would be left to take care of patients needing acute ALS care...

I am an Indian Gentleman who is employed in medical centre in Delhi as a stretcher bearer. I am 60 years of age. I am low caste but of average intellect. I am clean and do not lack some attraction to certain female people. I desire a life in Britain, prefrably with a job of great social standing and respect. Please May I request assistance from kind and honest Paramedics in Britain who will provide me with letters of recomendation for employment at a reputable and generous Hospital in your country. I will be very well disposed to anyone who is able to offer assistance in this matter.

I think he meant it more in the way that EMT-B's do not do drug math, and are not trained in any sort of injection other then auto-injector. If we are giving mass inoculations to the public does anyone really know the pharmacology behind the drug? Or anything about it ? I would be giving it as blindly as an EMT-B with an auto-injector ...

I don't really think it is a matter of how the medication is given. It is the medication itself. What you are saying is, pretty much if you put a drug into an epi-pen type of vessel, a basic can give it. That being said, morphine comes in auto injectors. Can a basic give morphine? This is why there are drug/med restrictions for different level of providers. If there is an MD, RN, or even specially trained Medic available in the facility, I don't have a problem at all really with ANYONE giving the inoculations. Given, these people are trained on how to do it. Since the inoculations are available in snort form, have at it!

You need to be able to communicate clearly at all times with your partner. Otherwise you will bump into each other in doing things on scene. Not to mention it's super annoying, and sorry to say... people who barely speak English use it as an excuse to get away with a lot of things and not doing things. Personally... I wouldn't want to work with someone who I could not communicate with. I don't think it is a good idea at all or very safe for that matter.

How can you say this? Is it based on standards and scope of practice? If that were the case you could put anything into an "Epi-pen" style autoinjector, where would you draw the line. The autoinjectors used in WMD (generally nerve agents only - Atropine and 2PAM) are 1 1/2 inches long and are 18 gague needles, not remotely similar to an epi-pen (1/2-3/4" and 22-24 gague). I think these are nothing but blue sky statements. As I stated in a previous post: Well, first the H1N1 vaccine would have to be classified as a WMD. Then they would have to develop a transport medium that would be compatible with autoinjector use (nothing at all kike an epi-pen). The use of autoinjectors at a BLS level (from my understanding) is for self rescue only, not for the general public. Even if for the general public, generally the acceptance would be the benefit of use vs. non use and even then, limited to nerve agents. The better argument would be to have Cipro autoinjectors for anthrax exposure. Have you ever seen an autoinjector used on a live model? The only exposure I have had is with an intoxicated swine model exposed to Sarin gas (nerve agent). It's not a pretty picture. Imagine using this to immunize the general public???? I'm sure a general order will be forthcoming!

We had a meeting with a state rep and our local hospital a few months back. In Colorado EMT-Paramedics are able to help with vaccinations, and it's my understanding that it's not only in the emergency setting, but any time additional resources would be useful. I do not believe that this is the case at the EMT-Basic level. I have not confirmed this, but am confident that this is how it was explained at the Emergency Planning Meeting. Dwayne

Here in Maine, USA we have a governors proclamation that essentially makes all EMT-I's & EMTP's govt employees in regards to giving inoculations to the public. The state EMS office developed a specialized 4 hour training course to deal with influenza/h1n1 vaccines. We are able to go to clinics set up by public health agencies and local hospitals and to go to the schools and assist getting the masses vaccinated if needed. The H1N1 vaccines are just starting to arrive at this time so we will see what happens and how often we are tasked to staff public clinics.

Fire, I would NOT worry about being sued! One only has to look to all of the Medical Apps available for the Iphone. What you NEED to do, from my Business Law MBA class, 1. I would form an LLC for your software company. 2. Find a good contract attorney who can write up the " Fine Print" for your software programs. This will include the disclaimers. 3. Make sure your software works BEFORE releasing it to the masses.....This is from a business point of view...If it sucks the first time, people are going to be hesitant to go there twice... 4. Find a good CPA JW

I am morbidly obese. Ok I admit it and am proud of my body image and am comfortable with it. I do not eat particularly excessively and have a genuine real problem with my metabolism. I have serious problems with uniforms at work. I have to have special ones tailor made for me(at my own cost). Vehicles are also modified and strengthened to allow me ease of access and safety. My employers are yearly becoming less sympathetic to my problems and special requirements. Recently I have been threatened with disciplinary action if I do not lose weight and become fitter. Those damn pen pushers and money men are claiming my ability to do my job is compromised by my weight problems. I love my job and am feeling threatened and in need of help. I am eager to know if anyone else has been in a similar situation and if they can offer any advice.

I just noted "day light savings" in the log and on the one or two runs it effected. Speaking with the dispatcher she was rather frustrated that entire hour. Our system puts runs in time order and as we ran out of squads she couldn't tell what Engine had been sitting on scene the longest without an ambulance.

From one urban ems'er to another thanks 'tsk' for giving ventmedic what for. We have a ed alarm abuser that has been know to press it 3-5 times a day. Medics have "damaged his alarm box" and used all means possible but the ems higher ups have yet to do there job and get him in a nursing home. This pt doesnt need our respect or lessons on being disabled he needs to stop abusing the system. This is just one example of abuse. Thankfully you didnt need ems tonight where we ran for 2 hrs constantly out of squads.

I have a great reverance for the people of Scotland which I believe is a small state in England. I wish to move to your country with my family. Are you able to facillitate this anticipated eventuallity by assisting me to find gainful employment within your work based organisation ? I eagerly await a mutually beneficial agreement.

I'd be okay with it if she were smokin' hott. Otherwise, forget it.

If they can put it into an Epi-pen style auto-injector, EMT-Bs in the FDNY EMS can do it, as we've been trained to use the injectors in the WMD kits. I am supposed to be on Major Incident Response Vehicle (MIRV) 2, doing data entry for this year's BioPOD (BIOlogical Point Of Distribution) drill, on Thursday through Sunday, when the H1N1 vaccine is supposed to be distributed to any and all FDNY Uniformed personnel who want it. Location and availability is subject to change.

System abuse is a dead horse. In many places, false alarms for fire and police- faulty burglar alarms, faulty fire alarms, etc DO generate fines after a certain number of responses. Is that a deterrent for someone to call 911 for a "real" emergency? No, but "automatic" systems are also prone to errors. In the Lifeline type systems I have seen, there is a telephone link from the patient to the company, which is supposed to verify the patient did not accidentally trip their alarm and does indeed need help. So, in the case of these nonemergencies, either the patient is lying to get someone to bring them a glass of water, the company is not properly screening the alerts, or it's a combination of the two. If the Lifeline type companies want to promote their service to be able to summon help for a patient that simply needs nonmedical assistance, that would be great, but they need to be able to provide that help in some way- alerting a friend, family member, or some 3rd party to provide that help. Defaulting that help to a 911 service simply because they know that help will ALWAYS be there is wrong. That would also be a departure from their advertised use- to alert responders to someone who is having an EMERGENCY. In these days of budget cuts, improper use of resources isn't just an annoyance, it costs a service money, and I know of no insurance company that reimburses for an FD, police, or EMS responder to fluff someone's pillow. Funding cuts, budget restrictions, and manpower reductions have finally hit public safety- the last sacred cow- so an honest look at things like this are not just to appease overworked first responders.

Welcome my East European buddie. Now you are free of commie oppression you can enjoy friendly and benevolent contact with the free West, particularly the great land of freedom ---- The USA. Good luck and may the red chains of communism never again wrap themselves around Poland.

Yes I know this is in the funny section but I have spent many hours getting patients with severe disabilities home and have tried to work with various agencies and professionals to make the transition go as smoothe as possible. It is not always a matter of "coping" but rather results of a traumatic brain injury that can bring about a personality change. Many family members are often shocked or ashamed of their loved one's different behavior when they do start responding after a traumatic injury. Some abandon their loved ones to where some of the rehabilitation is affected without their support. Let's look at this from the perspective of a rehab facility. Having our patients laughed at is one of the fears we do have when we are preparing our patients for as much independence as possible. Unfortunately services like Lifeline are not perfect and instead of notifying their appointed primary care giver, they call 911 only to put our clients through a situation like this. While the patient may seem to take this in stride, the remarks made on scene do affect them and they try to make light of it in spite of their embarrassment. When they gather for more training or group support, I am often saddened to hear how some have been treated especially when they are not always in control of who their Life Alert or LifeLine system notifies. Instead of taking it as a big joke, especially with the new EMS provider, maybe some education and some notes on how the notification system could be improved might be in order. We are always looking for suggestions to work with the various agencies such as Life Line (or whatever in the area) and EMS to make our patients' transition back into some type of independent living successful. Nothing like a bunch of snickering FFs to undo months of work toward building the confidence of someone who must live with a broken body. Do whatever you can to improve the system instead of just complaining or laughing about it at the patient's expense of possibly losing what freedom they do have because of a poor system function. We still have a lot of patients and are getting more each day that would like to have a chance at independence even when severely disabled.

I could have bet my mortgage you would respond to this with a holier-than-thou post. You did not disappoint. Do you require people to avert their gaze when they meet you? Just wondering.

I wish you could attend some of the training sessions we have with our quad patients so you could hear about their "stresses" as well. Unfortunately for them they don't have the option of leaving the business but rather just want to leave life. Some patients do learn the hard way that they must be thankful and express it often for whatever help and attention they get. The mad and unhappy ones will not get that drink of water when they want if if they are thirsty or will get decubitus ulcers. They also will not get their glasses placed on their face to watch TV or their eyes rubbed when they itch or get something in one. When working in the rehab center I may get as many as 10 STAT calls a shift for everything from misplaced glasses to a dislodged trach and a very apneic patient. I take each one as that patient's own emergency with a little coping education from myself and the other highly trained/educated professionals I work with. Hopefully each "emergency" will better prepare the patient for life on the outside. But, many find out all about the struggle starting from the transport home with a couple of poorly trained/educated EMTs. Thus, we teach our patients to become educators to teach the less educated/trained for their own survival.

The system is not perfect and the OP did not state what other resources the quadriplegic person had. I would hope that he had a voice activated phone but for some that might not be the case. Also, some systems do call the person before sending a fire truck and an ambulance. If it is not emergent, the primary care giver might be called. The systems are not always perfect but by no means is it always the patient's fault. Find out how the system can be improved and don't just lay the total blame of inappropriate use of EMS on the quadriplegic person.

It truly sucks to be a patient advocate in EMS. You can always expect to be bashed if you offer the views from the patient, hospital or HHA's side on some situations. Tell us about your experience with disabled patients and home care situations. Have you done anything to improve the situation? Have you talked to quads, paras and the elderly about their frustrations? Have you talked with the reps from LifeLine or whatever company in your area? Have you offered training to the home health agencies? It may sound like I'm over the top because I provide additional information and not just find someone or something to blame. Seeing the situation in only one dimension does not give you a full view of the problems. Blaming the patient is the easy way out. Of course, some in EMS would rather just piss and moan on an EMS forum about their dislikes about the system and patients rather than attempting to assist companies to find a better solution for their clients and patients. Thus, you become as much of the problem as those that "abuse" the system. As least HERBIE is consistent. However, he doesn't consider the budget cuts that have put patients into home care situations with inadequate resources. I seriously doubt if he has participated in any petitions to get more funding for Medicare. EMS is a "me first" profession which is also why it doesn't get much support from other healthcare professions in some of their efforts for better funding. Other professions (NP, PA, RT, OT, SLP, RN, PT, MD) include the patients when they are lobbying for better reimbursement and funding. They don't criticize medical needs patients or the agencies that attempt to provide the with care. They try to work with these companies to see how the patient can be benefited and in turn, it usually benefits them as well. But for some opinions here, it would probably be easier just to build large nursing homes warehouse style instead of trying to work out some home care situations. Now, for those who want to say "I'm over the top" again, please for to the national association websites for any of the professions I mentioned and see what legislative actions they are working on. I don't just pull this stuff out of thin air. It comes from many years of being active in both of my chosen professions. Unfortunately, EMS has been the toughest for legislative issues largely because of the "me first and only" attitudes that exist in this profession. This is true for some individuals and the many different agencies that do EMS. It is also evident by the 50+ different certs this profession has just to please some and not for the benefit of either the profession or the patient. The new big screen TVs, patio furniture and barbecue sets are a pretty nice also. I also find that those who run only 2 calls per 24 hour shift complaining the loudest about being overworked with LifeLine calls. Those in busy areas are usually relieved when it is a public assist patient where the lifting and paperwork are minimal.

Well Mister Im replying now ! Edited by AK..! Oh my god ! That a fellow American and a Medical proffessional should act in such a callous and heartless way leaves me shocked and hurting deep inside. I am so not happy with your disrespectful attitude. Im in a dark place far from my comfort zone. Your lack of empathy is sickening.

Here's a news flash for you Herb, the new education standards are coming out whether you like it or not. Having 4 -7 different levels for EMS providers each state and each state different from each other is of no benefit to EMS, the patient or the individual who tries to move from state to state. I grew up, got an education and starting working with those who didn't just sit in the easy chair at the station spewing complaints about their patients, their job and their life. Read you own negative comments on this forum and use those as an example to what I am talking about. There are some secret ways to staying in a profession for over 30 years and that is not to stop learning and not to put up with crap from burnt out EMT(P)s who have long ago stopped caring. I continued my education to make a difference and some can't handle change. I think your arguments for the many different levels and that everything is fine in EMS have demonstrated that attitude greatly. It is time some in EMS decide if they want to be part of the future or it they should just get out and shut up if they have nothing productive left to offer this profession and the public they serve. Change is coming whether you like it or not. Maybe you should also broaden your reading opinions from more than just an anonymous EMS forum. Have you even been to a regional, state or national education meeting to discuss anything pertaining to EMS? You actually know a few people on this forum that have and it is a shame you consider all of them "out of touch". I'm sure Dr. Bledsoe likes hearing he is out of touch. How about Rid? What about our two ED doctors that take time to educate those in EMS and support the providers? You generalize and bash way too many things and people you know very little about.

I never trust vaccines that just come out, it takes years to see side effects from them to start appearing. She seems to be the type to throw everyone else in front of a bus to save her own ass. Major? Makes sense. Selfish and self promoting. Hope Karma steps in. It's sad she feels she is too important to wait two days. What a pompous ass, and like Spenec said, there is always something out there to catch. It might be this flu, or something else. Who hasn't been coughed, bled, sneezed, or barfed on? Let her step in and be the the guniney pig!

Fuckin' OUCH!!!!!! I was going to point you towards UK immigration requirements, but having just been insulted (or is it libeled?) I will leave you your own discoveries. BTW, do the UK still own India?