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I think that most would disagree with you in the vast, vast, majority of cases. Traumas, excessive time down, etc. Dwayne

Okay - For those states where medics are allowed to terminate resucitation efforts OR declare death on scene - what is your protocol for doing so? Here there are a few things required 1. Determination of Death class must be completed 2. 6 inch strip must be ran confirming asystole in all 3 leads To even qualify for it - 1. Injury incompatible with life (burned beyond recognition - and no large surface area does not equate, we're talking entire consuming of body by fire and is blackened, or complete decapitation) 2. Resucitation effort exceeding 30 min with no return of pulse or shockable rhythm (or complete exhaustion of provider, but I'm not aware of a case involving that). They keep flipping back and forth - have to work it to the hospital and let doc decide 3. Presence of Dependent Lividity or Rigor Mortis Anybody else out there follow a similar protocol? I should think so, but with the amount of these cases happening, it's making me question whether the medics are just not following protocol and calling people dead they think should be dead OR further training needs to be happening. Either way, there's a problem and it needs to be fixed !

So, we had our first iPad impression today. What do you think? Frankly, I am underwhelmed. No camera. iPod/Phone based OS No Flash plugin No removable battery No multiple running apications No support for Verizon 3G 64 GB memory max What we have here is a tablet sized first generation iPod touch. My guess is after Apple makes their money selling this, they will introduce updated versions with the cool features and rake in more money. As an iPhone user, I am getting sick and tired of this tactic. Sorry to be a hater Apple, prove me wrong. Take care, chbare.

http://www.jems.com/news_and_articles/news/2010/01/firefighters_find_priority_4_victim_still_breathing_during_body_recovery.html Maryland. Although, in PA; our protocols use the wording, obvious death, to include incineration. I wish the article explained his injuries a little more. Any injury could be "life threatening", even burns to two extremities could be with infection and whatnot. Not defending them, a stethoscope would have worked, had they not been able to feel for a pulse. Clearly, if there was a fire, there could be obstacles which would make doffing firefighting gloves and touching things, dangerous. I can't imagine, if he was breathing on his own, the whole time, the toxins, smoke, water, heat; inhalation.

Resusci Anne Resusci Junior Baby Anne Husband... Rescue Randy Resusci-Rover?

An OPA/NPA is not a secured airway. Placing an ETT tube is what secures the airway. I've seen codes run without any type of advanced airway placed, and they usually go the same way: Pt gets bagged with a BVM/OPA throughout the code and their abdomen becomes distended and eventually induces vomiting, which gets immediately aspirated due to the ventilation through an unsecured airway. This is in adults of course as the subject of intubating pediatrics has shown it not to be beneficial unless they have a difficult airway or inadequate ventilation. The matter at hand is keeping the focus of a cardiac arrest on the compressions. They are the key to reviving someone and every action taken during the code should be done with consideration of good compressions. According to AHA, you stop your CPR every two minutes to re-check pulses and change the person giving compressions. During one of these breaks you should be all set up and ready to intubate. As soon as the tube is in (we're talking 10-20 seconds depending on the airway) you should immediately resume compressions while securing the tube. If this isn't happening, then you need to get with your employer or school or someone and practice intubations. There's nothing wrong or demeaning about that. In fact, it makes you a good medic for keeping up on what can be infrequent skills for many. So yeah, over a minute is grossly unacceptable and it sounds like that call could use some review to prevent it from happening again.

According to the article, chemical sedation had failed. While I think you are on the right track, I would submit that even suspension would be inappropriate. It's not quite kosher to punish someone for not doing something you never taught them to do in the first place. By sending them for a self-defence course, you are admitting that you have failed to provide that in the past, which puts the culpability straight back on you as an employer. And then what about the next guy? Are you going to send this one employee to a special course, but not all the rest? And was documented proficiency in self-defence a condition of employment to begin with? You can't change the rules and enforce them retroactively. This seems like a clear cut case of managerial and administrative FAILURE. The problem exists and manifested itself because of incompetent management, and even worse, they're trying to shirk responsibility by sacking the low man on the scrotum pole.

if it doesn't make it can we cook it?

Key word= properly. Additionally, it should be expected that there is some movement, however limited, as the collar is put into place. Given the current design of collars, there isn't any avoiding this. The opposite should be a better question. How many people not neurologically compromised would become neurologically compromised if no immobilization occurred? The reality is that showing lack of harm isn't enough. What should be shown is benefit of use. For the majority of patients, probably nothing will change in terms of outcome. Why aren't medical patients who need to go through all of those cases routinely placed into c-collars? In addition, even an ambulance with 300k miles on it can give a smooth ride if the driver knows what s/he is doing. Unfortunately, a lot of ambulance drivers are more concerned about how high they can peg their speedometer than how smooth of a ride they can give. Then why not push for more paramedics to be involved with research? Medics can push back, they just choose not to because it's too hard. After all, nothing is stopping paramedics from getting all of those letters (BS, MS, etc) behind their names and looking for research jobs or approaching agencies (state EMS, county EMS, etc) looking to start projects or research registries.

>>Baylor College of Medicine doctors used cadavers to confirm that so-called cervical collars can be counterproductive<< A couple of observations from my very limited experience: - All I've ever seen doctors do with cervical collars is remove them. - A properly sized collar shouldn't stretch the neck at all. - Despite the one case they cited where's beef? How many people not already neurologically compromised became so after the application of a collar? - Did these doctors take into account the situations we find our patients in? Let's see what happens if we drop the use of collars and start extricating patients from wrecks, moving them from floors to gurneys, going up and down stairs, and transporting them in ambulances with suspensions that belong in the scrap heap over roads built a hundred years ago. - Some doctors, especially the ones entrenched in academia, follow the theory of publish or perish in terms of career advancement. And EMS is easy prey for them because the street cred of medics can't push back against a group of doctors with a bunch of letters after their names. - Another counter study will appear soon (funded by an association representing the manufacturers of c-collars) with hired guns to refute the whole notion of the first study.

Unfortunately, after a couple of drinks, it happens....

I do believe they are up to twelve weeks now.

Good point! That may have been what they meant. Of course, since we're talking about Houston FD EMS, anything is possible. When your paramedic school is a whole 10 weeks long, you're likely to see anything happen.

No it;s not uncommon... Ever patient I board gets foam head-blocks as part of the stabilization. I've never seen a fully immobilized pt brought to any ER locally without those blocks.

Lone Star, I hope that is the limit of your stinging commentary. I'm just buzzing in anticipation of the described next opportunity. What is the matter with you, got a bee in your bonnet? Don't worry, I'm not bugged by it. FYI, the Bumblebee (the insect, not the Transformer) is aerodynamically incompatible for flight, as the body is too big for the available wing surface to provide lift. However, nobody bothered to tell the bumblebee, who just flew away.

I have a friend and her sister just died her sister had a DNR and it got me to thinking about DNR's and our profession. Has there ever been a time in your EMS career that you have wanted to try and save someone and not honor a DNR?

Pretty sanitized version from the EMTs in question. (note they made their first public remarks from their lawyer's office). The family's version is second hand from employees at the shop during the incident. I would be very surprised if the "eye-witness" official hand on Bible truth and nothing but the truth will be what they told the parents. People love to dramatize things, especially in situations like this. We may have been a bit hard on the EMTs in question. I wonder if we will ever get the whole story.

I do a lot of digging on here to try and find different things to learn about. As a newbie, I thought this was a fun string to read. I would have never thought about trying to find this specifically, so it was a nice surprise.

What your physitian was bringing forth is the newest info/science on permissive hypotension. If you check out the new ITLS-A and/or ATLS texts they discuss permissive hypotension in the trauma patient. What you have to consider (and what this surgeon was discussing) is what it takes to perfuse the brain in a head injured patient. When dealing with anything from a epidural bleed, to a simple cerebral contusion, you are always battling a common denominator..... Cerebral swelling. I do not have time to research the numbers today.... but I am sure one of my bro's here will. In fact, it is better for you to reasearch it yourself. Check out what BP it takes to maintain Cerebral perfusion pressure (CPP) in the brain injured patient. There is lots of info out there. In the trauma patient without head injury, permissive hypotension of 90 systolic is a good idea so you do not exacurbate any internal bleeding..... BUT as you will find out during your search, with even slight swelling/edema, it takes more pressure to perfuse the brain properly.

I've been in Canada for the last 2 weeks and I remember a lot of stuff about Canadians that I had forgotten. They are really really nice. Toronto is the most multicultural city in the world. Every language and culture you can imagine is represented. They are extremely educated and literate. The quality of the magazines, documentaries and literature available to (and ** gasp ** actually being read) by the general public is superb. That being said, Canadians are for a large part, homogeneous in their standards of living. A good school is a good school regardless if it is Nova Scotia or Alberta. They personally will argue that they have regional/ethnic issues and many resent the dominance of Toronto over the national dialogue but the huge fiefdoms (that Americans call states) are not a part of the political structure. The federal government has a lot of power setting standards and controlling the purse strings in spheres that would have Americans marching on Washington to burn the bastards out. They admire intelligence and the majority of people are what we in the states would consider left of center. I always thought I was a small c conservative (as opposed to the political right in Canada, the captial C Conservative) until I came to the US when I discovered I was a flaming pinko These people are not afraid. They don't have the crime or the personal connection to war that Americans have and thus see the world as essentially a safe place. (This view was greatly shaken by 9-11 btw.) Most firmly believe that if we all sit down and talk about things, the whole world will play nice. The general Canadian impression of the red-neck American with a bible under one arm, a bottle of whiskey under the other and a 45 frightens them. They consider themselves more sophisticated and intelligent. It's a tribute to the American fighting man/woman and his/her willingness to sacrifice for freedom that these cousins of ours safe across the border have so little idea of what it all costs. PS.. Their health care system and access to it is superb. It takes a lot of fear out of people when they don't have to worry about medical care. **edited to add the PS **

First this news was already posted in news feed. Second why do a strip? Asystole is a workable rhythm.