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Mobey/firefly.....there you have it. Low volume resuscitation is not a new concept. It has been around for years, particularly in the Military. Yes, our success rates are much greater than the civilian equivelent. As a general rule, we try to keep our trauma patients between 80-90 systolic. In those terms we use two markers as a guide for titration or restriction of fluid. Radial Pulse and mentation. If a patient is mentating apporpraitely and has a radial pulse, we restrict fluid intake. Once there mentation or radial pulses go...they get fluid. However, a few things to note. As Croaker already mentioned. General trauma and Head trauma are two different beasts.....I will leave it at that. Second, most military studies (especially those on trauma are based on HEALTHY Adults with insult to the body), as opposed to average adults with insults to the body. There are some caveats when treating these two destinctly different demographics. As far as Hextend is concerned (Hespan) is one of use. The forementioned still apllies, but one of the biggest mistakes we see is providers using this substance for the wrong reasons. Generally, this fluid should only be used for trauma patients in shocK due to Hypovolemia. We usually see this with exsanguinating extremity wounds. Once we factor Belly bleeds, femur Fx's and pelvic's, we start to alter our parameters. Just some more food for thought.

American Heart and Red Cross both teach the 30/2 or 100/min. If you do that, then you have done your job. Unfortunately, once you turn care over, you cant direct how ED staff care for them or continue or discontinue efforts. Once a person is intubated the 30/2 goes out the window and the 100 compressions/min and breaths of 10-12/min comes into play. I understand that you want as much info as you can get, but busy ED staff will probably not see it that way. Doing the best that you can do for your patient while they are in your care is really all you can do. If you can walk away from the ED, knowing that, then questioning ED staff about why they do it differently should be a non-issue.

Assaults on ambo's are not a new thing here and they are getting worse. I know ambo's who have gotten broken arms, black eyes, had thier vehicle trashed or attacked, been swung at by people weilding an axe etc etc and that's not counting the foul language, verbal abuse or things like that. I say you shouldn't have an axe swung at you or your vehicle trashed by a guy with a 4x2 but if you can't take a bit of bad language perhaps its time to look for another line of work. We're up to about probably two incidents a month nationally where somebody is assaulted or threatned with some sort of weapon however little attention is paid to it. About three years ago there was a 10 minute piece on one of our current affairs programs but nobody really cared. New Zealand has since 2000 had an explosion in the amount of crime caused by meth (or P for pure methamphetamine); most of it's pretty nasty with people copping severe beatings or being chased down by guys with swords or nail guns or even just P freaks who have not slept in a while and are overly unpredictable and paranoid prone to violence. Single crewing (i.e. solo officer) responses are still part of standard operation here (it's getting less but rather slowly) so that increases the danger factor because you have nobody to watch your back and work with you to help you out of trouble. The incident where the ambo's got attacked by a guy brandishing an axe was really foiled because the second officer managed to get a gate between the offender and the officers; had this been a single officer response well who knows. Alcohol and youth culture in general is also to blame partly; back in the day if somebody got smart they got a smack in the head and that was it, now, you get knocked down and have six or seven guys kick the crap out of you and stomp on your head a few times while you are on the ground. In the past people left crews alone to do thier job but this no longer seems to be the case; often times you get a whole crowd of people gawking and cheering on thier friend (the patient) and trying to climb into, ontop of and over the vehicle. Tell them otherwise and you start copping a barage of abuse and guys making jestures they are going to shank you, well, are they, do they have a knife? I don't know, you tell me. On that note there have been noises about getting stab vests the same as the Police have; problem is that the service cannot afford them and they add about 2-3kg of bulk to the 20 or 30 kg of gear you are carrying anyway. Anecdotally the London Ambulance Service has them but very few staff wear them. And no, there is no provision here for special charges if you assault an ambo; if it's a first offense you might get a fine or a naughty letter, not much really to deter you and our courts are so backed up it'd probably take two years to get through.

It only "works" to give you a false sense of security. Guns are illegal in the murder capitals of the US. How is that happening if laws banning them "work"? Most EMS personnel injured or killed in the line of duty are victims of motor vehicle collisions. Why don't you push for outlawing motor vehicles? You aren't going to "scare" criminals. And personally, I'd rather be struck by a pool cue than have them resort to stabbing me with their legal beer bottles, or kicking my face in with their legal boots.

I hear that man, and get it. I wasn't thinking along political lines when I read the post. No offense intended. Roj. I guess this concept is mostly foreign to me. I can't imagine being mauled in a bar in most circumstances. The patrons just simply wouldn't allow it. If someone hit me with a pool cue while in the community where I work they would be begging for the police to come and save them, and I don't have the most pleasant of personalities, so this is really saying something! Again, this is the rule, and as always there would be exceptions. If attacking EMS personnel is not uncommon, and the patrons of the bar would allow such a thing, then perhaps it is prudent to take away the more likely weapons. It's just....without pool, I'd have had little reason to go to bars as a kid, and without bars, very little opportunity to be around seriously drunk chicks, and without seriously drunk chicks, I might still be a virgin!! See? This story attacked me at my most basic level. I panicked. :-) Nothing funny about people being in fear of going to work. I shouldn't have made light of it. My apologies. Dwayne

Phil, we're not against rules. Every polite society has them. But what we support are rules against criminal behaviour, not against inanimate objects that pose no threat to anyone, unless used by a criminal. If the "rule" against drunkenness and assault were strictly enforced, you could have guns and knives on every table and people would still not use them because of the known consequences. Making rules against ashtrays and pool cues is treating a symptom without treating the disease. As medical professionals, I am ashamed that the Australians apparently do not know better than to espouse such a foolish approach.

Oh sure.. cause it only takes about 120 hours to provide emergency medical care and we all know getting cross trained fire/police dudes there in 5 minutes is much better than getting ACLS there in 8. I mean, all those guys do is start IVs right? And as police and fire stuff requires ongoing education, training and practice, its a good thing that EMS crap is so easy.

If you want my attention, try bleeding. That is my absolute favorite, and it will be my first shirt once I am certified.

First off, homo- means "same," so homophobic would mean fear of something or someone that is the same [say, gender] rather than fear of homosexuality. Second, as Dust points out, phobos means "fear" rather than "hatred," which is signified by the prefix "mis-" as in misanthrope, which means one who hates mankind. Hatred of homosexuality would therefore have to be mis-ANDROKOITES, hatred of having intercourse with a man; mis-ARRENOGAMEO, hatred of those who marry men; mis-ARRENOKOITES, hatred of sodomites; mis-ARRENOMANES, hatred of those who are mad after males; mis-ARRENOMIKTES or mis-ARSENOMIKTES, hatred of sodomites; mis-ARRENOMISIA, hatred of sodomy itself, or mis-ARRENOPIPES, hatred of those who looks lewdly on males. Take yer pick.

I understand what you mean dust, however, what you need to understand is the cultural difference. If QAS did a media release stating that there was an increase in paramedic assaults with pool cues, the media pays little attention to it. They sensationalised it, then it makes high priority news because it threatens a cultural way of life, they therfore deem it newsworthy. Now it will be a point of discussion, the idiot factor will be reduced because we will now have many eyes watching & law enforcment will be easier.

It was a request. The main reason will be because of an serious increase in assaults caused by pool cues. Yes we have rules, but so do you guys & Dwane, I respect you man, but, most of the attacks here are from people other than the patient. Overall, we have a lot less rules than most other places As you said, most despise rules, but while this appears over the top, it is actually a way of gaurenteeing media publicity, thus ensuring people understand what is happening. It is nothing more than a scare tactic. The removal of glass drinking vessells from some bars was a direct response to a sudden & dramatic rise in 'glassings'. For those who do not know this term, the act of 'glassing' involves driving with force a glass into a persons face causing horrendous injuries. While they are caught & penalties are severe, they are not a deterrant. This was nothing more than a response & a law/rule to protect innocent people from a horrible act. I have attaches a photo to show the resultys & some are much worse

From what I've been told, 'four wall construction' is the way to go....... CH is a 'butt dialer'!!! As far as the ipad goes, congratulations to Steve Jobs and the 'apple orchard' for creating the world's largest iphone that won't make calls and won't fit into your pocket! I wonder if that comes with a handy belt clip like their phones do?

Ahhh..... that explains it. Sure, it means Pull your head out of your ass.