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Just wondering specifics of how other agencies do their spinal immobilization. Do you actually use padding? Under knees? In between knees? Blanket over the board itself? On EVERYONE? How do you immobilize head? Do you use head wedges? Cheese blocks. The styrofoam triangles and head pad? Rolled up blankets. Does it depend on patient? Do you use backboards always? Or do you have the hard foam boards? Spider straps? "Box Method"? Straps that click in like an X over chest? Binders? (Pre-ripped sheets that wrap around) Do you ALWAYS immobilize cervical if immobilizing lower back? Vice-versa? Do you use tape over the neck? Does it go straight across or angled up (perpendicular to the forehead tape). Do you use the arm straps? What do you do for unconscious patient's extremeties. Leave one arm out for IV? All in and you unwrap later for IV access? ETC ETC ETC Give me specifics. Pictures if you can, of either someone immobilized (blur out face, etc) or of student immobilized, or of the equipment at least.

OK, with only 7 shows left, the episode of November 2 caused me to form these comments and questions. 1) A good head/neck trauma from a softball to the nose was wasted, as it was only used as a setup for why Nancy and the rookie were in response in the first place. 2) The rookie's questioning Nancy about what would turn out to be the letter of recommendation was distracting him from the task at hand, that of driving the "box" (terminology used in the show, leastwise they are not calling it a "bus"). Was he going to include the letter in that book he revealed he was writing last week? That distraction, IMHO, contributed heavily to the crash. 3) In the "prequil", Rabbit gives Nancy a ticket to the ball game. Was he planning on "scoring" himself ands Nancy "scoring" afterwards? 4) Boone and his partner respond to an EDP standing in the middle of a busy street, but don't use the ambulance to attempt to blockade the road, for theirs and the patient's safety... 5) and then do nothing to secure the EDP, either to the cot, or the seatbelt on the crew bench, even when the EDP starts throwing things at Boone. 6) The inference I picked up on, is that the 2 rookies, the EMT and the intern, might be getting ready to have sex. 7) After the collision, Nancy is laying on the ceiling of the cab, implying that she didn't fasten her seatbelt. Yet she's a student doctor who left the classes? She's probably so smart, she's dumb (note that I leave off the fact that she is a blond, which is a totally different area for jokes). 8) Boone and partner respond to the MVA/MCI with a patient already aboard? That's violation of policy/protocol in New York City and State, but do they allow that in San Fran? 9) Boone made the hard, but correct, call, to follow protocols of triage, with himself, the senior Paramedic on the scene, as Incident Command/Manager, and the partner starting to do the triaging. Boone then took command by both reminding and ordering the firefighters to follow the protocols, too. 10) How many of the Fire Fighters are in lust with Nancy, as they were ready to violate protocol to rescue her first? 11) Again, the colored ground covers for triage purposes, and again, I like, I like! 12) Rabbit violates his own experience of a stated 20 years as a Paramedic, and beelines to Nancy... 13) and effects a "Paramedic Shove" to push the EMT out of the way. 14) Years ago, Lou Ferrigno portrayed a Paramedic in a show called "Trauma Center". He didn't need a pneumatic cutter/spreader, he WAS one. Rabbit must have taken lessons from him, as nobody (?) previously had simply used his boot to kick out the windshield of the ambulance. 15) Nancy must have been in some level of shock, as she called Rabbit by his given name of Rubin. 16) The pilot's concern for Rabbit's mental state was correct, but seeing the physical attack Rabbit made on the fat guy with chest pains, she should have declined the call, "grounding" Rabbit sooner than she did... 17) and, again, since when do helicopters make house calls? Must be another San Fran "thang". 18) At least Rabbit's message to the fat guy, after the pilot calmed him down, was correct. 19) Rabbit, and several EMTs IN UNIFORM, getting sloshed in a bar? That is an act the FDNY would call "bringing disrepute on the department"... 20) and then the drunk Paramedic, Rabbit, gives proper instructions to the lesser drunk EMTs in the bar, as they render aid to Nancy's partner the rookie, who had collapsed (again!)? I can practically hear the disciplinary charges growing, per my local protocols and standards. 21) The intern blew the diagnosis, and should have run it by her supervising doctor, as stated in the show. Bad move, as she is working on her (possible) boyfriend. 22) Nancy's dad seemed somewhat angry towards the ER's OLMC doctor, who wrote the letter of recommendation. Either something is going on, had gone on, or daddy thinks something is going on or went on, with him. 23) In some systems, the agency would pretty much shut down the station that all could be with an injured member, even if it means forced overtime of members at another nearby station to provide the coverage. This showed the next best thing, as they all assembled at Nancy's bedside as soon as they all got off duty... 24) but Nancy just had a spleen removed, and they're practically force feeding her a slice of pizza. I'd think she would be "nothing by mouth" for at least 24 hours, plus she has to start taking meds to replace the stuff a spleen adds to the digestive track. <BR><BR>Sidenote: There was no mention of Boone's partner being Gay, dispite what many here stated the show was going to do.

Here's my, so far, favorite comment from Amee's blog . . . "I was just wondering. Do you actually get to learn to fly the copter and fly it during episodes, or is it computerized?" johncarterER93

Facetious is my middle name Here is a link for those registered in another province interested in being registered in Alberta: http://collegeofparamedics.org/pages/Registration/AgreementonInternalTradeMutualRecognitionAgreement.aspx For those coming from a different country, it's more of an ordeal: http://collegeofparamedics.org/pages/Registration/IndividualSubstantialEquivalency.aspx

I haven't worked there since 1987, but I know a little about it, still living there. I think we have two members here who work there currently.

What bugs me about this comment is that we've been giving Nitro for years before there was even a capability of conducting prehospital 12 leads. Technomedics tend to forget the basic skills involved in providing high quality patient care. Were you never taught to treat the patient and not the machine? In regards to Nitro and prior IV access; I would like to hear from anyone here regarding how many times you had such a precipitous drop in blood pressure after one dose of Nitro that the patient became critically unstable. Time is muscle and the longer that muscle is ischemic the more damaged it can become, if the pressure drops significantly then discontinue and treat the patient accordingly. In 30+ years of EMS I have yet to see nitro cause a life threatening emergency, even when provided to those patients who are suffering RVI. Edit: Now, I'm going to throw in a true example that occurred in my service regarding a crew obtaining an ECG, even though they could not interpret it. This occurred about 10 years ago. A 65 year old male was feeling weak and dizzy, this had been occurring transiently for several months. The only crew available was a BLS crew. They responded and determined the patient had hypotension and bradycardia. Even though they did not know how to read a strip I had taught them how to apply the leads and acquire a strip along with some very basic interpretation. They acquired a strip and during transport the patient's condition improved significantly. Upon arrival at the hospital the patient was placed on a monitor which showed NSR. My crew realised this did not match what they had gotten and showed the doc their strip. The patient was transported directly to the CCU in a tertiary facility based on the strength of that 10 seconds of lead II ECG taken by a BLS crew who had no idea what they were looking at. The transient 3rd degree block required a pacemaker and had this crew not taken that ECG the patient would not have received definitive treatment and may indeed not still be alive. As you can tell, I don't care if the crew can interpret an ECG or not, if they have the time to obtain one there are people down the line who may find it invaluable.

On a long enough timeline though an active poster should see these incidental negative average out and not drastically affect their rating. A new member or a less active one will see more variation but will stay in the neutral category (where I'd imagine the majority of membership will always be). A negative on an individual post, is not in my mind a big deal (really, it's a forum; what is a big deal?) it's just a single persons expression of disagreement, disgust, anger, etc. That single point speaks more to the person giving it then the poster. When these come together and form a positive or negative reputation, then it actually reflects on the member and their relationship with the board.

Yes, there are several other conditions which could result in elevated S-T segments, pericarditis being one of them. S-T elevation is not the sole indication of STEMI on an ECG, there also has to be reciprocal changes in other leads. ie, S-T elevation in 2 contiguous leads as well as S-T depression in others. In a word, No, if only because the PCP can't start a line in Sask in the first place. The ICP and ACP can though. Having said that, I have used those blood tests from TnT Diagnostics. There is sufficient blood in the flash chamber to conduct the test and there is no reason I can't pass my sharp to the PCP to express the blood from the chamber and run the test. As far as being beyond the scope of practice, it's not an invasive procedure, therefore it is not addressed in our protocols. The nearest comparison would be a blood glucose test.

Realising that tomorrow is Monday again, I just now got around to watching this episode. Same observations as Richard. But really, it has become watchable. I still don't really care about any of the characters, except in the sense that I'd like to bang a couple of them. That's what hurts the future of the show. They really have a lot of potential with this show. But the director just sucks. He apparently hasn't the slightest clue of how to hook an audience. I'll say it again; even if the show were 100 percent medically accurate, it would still not be a very good show. Realism is the least of the problems here. It's just not that interesting.

OMG! I generally defer from reading topics that do not appeal to me when it gets to the topic itself. In this case, "Lifeline" is something that has no meaning to me since we do not have anything similar to it where I am from. Then I started "hearing" the chatter about this topic in the chat rooms and decided to read it. In my honest opinion it was a complete waste of time. The first few posts actually had something to do with the original posting then it just turned into the usual "I am this" and "You are that" posting. It always seems to be the same people that hi jack threads and turn into their own little personal kingdom and domain. Why is it so hard to stick to the original posting? Why does someone always have to start questioning the others methods, professionalism, ethics, training or ideas on this job? When will you people actually start realising that we are in the same business, however we do not work according to the same protocols nor do we work according to the same set of rules. Freaking hell, this is supposed to be a site for adults and professionals to discuss issues relevant to the job.

Well I will try to do this #1 We use the clam shell (scoop) for our spinals for many reasons and the one reason I like the most is that x-rays can be taken and the pt dosnt have to be disturbed also you dont need to roll the pt as far as you do with the board. We will use the back board when the pt needs to be extracated from a car and there the pt will stay. #2 I will package the pt in the position of how I found him if he cant tolerate having legs being moved then I will use padding to help keep him in that position also if the neck cant be aligned without pain then there it stays. If his legs are straight there is a blanket that is place between his legs and they are then zap strapped into place. We use the headbed when nessary and then sandbags or towels are placed beside their head. The head is taped down last and I do the big X and to make it easier to do this well I place the O2 tank under the clam shell to creat a good sized space so the tape can be placed farther under for better stabbility. #3 We will use spider strap on the board but when using the clam shell the straps on that are sufficiant. #4 If I need to do a spinal the neck will also be embolized along with it. I generally dont tape down the neck as if I need to check a corroid pulse its hard to do and the clam shell realy dosnt have a place to do that easily. #5 If I need to immobolize the arms I will tuck them under the straps or if on a board Triangular bandages are use to tie them together. Heres a cute story about hard collars. A young man was in the hospital waiting to be medivaced for possible c spine fractures. I go in and he is laying on the bed coller undone and he is moving around (probably a good indication that all is ok)but me being me I said to him with his girlfriend sitting beside him "You know you might have a fractured neck and if you keep moving around, you may do more damage. If that happens then you could be in a wheel chair for the rest of your life. If that happens you may never have sex again as you know it SO you might want to stay still" The girlfriend stands up and looks him in the eye and yells "STAY STILL". And to think I always thought it was the man that was more worried about his penis.

im glad god dont feel as u do god forgives anything people deserve second chances

Uh huh ... and how can you properly diagnose an RVI in the field without a 12/15 lead? An EMT can go and obtain a 12 or 15 lead all they want ... they cannot however base any treatment they provide on those findings as interpreting those ECG's are not in scope.

Jesus age...it was a good episode and yoh have no concept of tv or urban ems. Jesus age...it was a good episode and you have no concept of tv or urban ems "antects". Also triage rules/mci operations I've been taught say 'red tag and remove any injured emergency personel asap.' Mainly for those still on scene as injured providers are a distraction. And remeber the order were taught as emt-b's...you, your partner, your patient, anyone else. May I add this profession never deserves another tv show on ems again for the way it disowned this one.