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It's not about the money. 1.6 million is a drop in the bucket for North Las Vegas, so this is certainly about politics and future financial maneuvering. It irritated me when he said something to the effect, "We just want to be able to get paid for what we already do..." C'mon, the reason fire started responding to all of the calls where they are seldom necessary is so that they could shore up their call numbers and get all of their fancy equipment...You're already seeing the benefit of "doing what you do" in your budget brother... It's a crazy world. I've come to be interested in the argument but have very little hope that there will ever be enough intelligent public debate to prevent Fire from playing these types of games. They have the tradition, the budget, and the media machine to keep the voting public in the dark. They will still be bullshitting my grandkids' grandkids long after I'm gone. God bless our brothers and sisters in the Fire services, but you chose wrong. You've chosen a career that is becoming in large part obsolete and can't survive without raping someone else. When you watch your unions take jobs from those that chose differently I hope that you can see that it's not because you deserve them, but because you picked the bigger bully. When you take their jobs, you haven't competed, you haven't proved that you are professionally superior, you've simply proved that you're willing to sneak in and snatch their wallet while your union is beating their head on the sidewalk. The stories that come from the fire services seem too often to be the same stories coming from the welfare population, they seem so often to be stories of entitlement. "I got this job, and that wasn't easy, so now you have to pay me forever whether you need me or not!!" For some reason firemen seem to actually believe that a fireman unemployed is just so much more tragic then a 'normal' person being unemployed... It's a crazy world.... Dwayne

So my partner and I were talking about a call in our service where someone gave an amp of D50 b/c of a misread glucometer. They believed the pt. was hypoglcemic when in fact BGL was aprox. 150. (non-diabetic pt.) It was a CP pt. I didn't believe an amp of D50 would be too harmful, as I thought it would be absorbed pretty quickly. My partner stated if the pt. was having an MI the amp of D50 would worsen the MI by making the blood more viscous. Thoughts on this? I couldn't find anything to support his claim. I thought this mistake was pretty harmless.

Got into a chat recently with another EMT and once everything had shaken out, I realized that I wasn't actually sure whether nitro had been definitely associated with positive outcomes in well-powered research. The gold standard here might be aspirin -- having an MI, take ASA, the data shows more live tissue and better survival to discharge. Does this sort of evidence exist supporting similar use of nitrates? Or is it just "one of those things" that in reality is done mainly as palliative care? I recognize the theoretical mechanism here, but that it makes sense doesn't mean that it works. And this is not an academic issue, since it is potentially important to deciding priorities when rendering care. Anyone know of any studies?

Yep... because emergency medical care isn't about quality, it's about jobfare for fire fighters. Oh, and the fire department is not the "local government" in charge of deciding who gets to play. That's the city council so stop trying to portray it as the fire department's choice. Additionally, if the fire department wants to play in EMS, then play the entire game. At least attempt to show that you care about the population that your "sworn" to protect past screwing them over for a pay check.

Depends what you want from your EMS career. If this is a temporary job for you, and not a 25 year career, I would search for other opportunities. That's my opinion there are no "right" answers to this. If you want a better and more explained opinion, please tell me what you are looking for in your career and where you are in your career currently. ***Side note FDNY EMS will check your internet activities. I would suggest using proper spelling, grammar, and punctuation. Not to mention people from the board can and will crucify you for this.

Brand new background on my computer. I LOVE IT! If it came down to it, I wouldn't hesitate to have the tattoos on my forearms removed. I love my tattoos, but they are not more important than ANYTHING else in my life. However, I would have to see first hand, and by personal experience, that they were the only reason why I did not get hired. I have also taken many steps into having a professional appearance in all aspects. Everything I do, I ask myself, could this affect me becoming a Paramedic? I took off the smart ass bumper sticker on my truck. I killed off my Myspace. I locked down my Facebook, and dropped anyone that wasn't friend or family. Dropped the stupid clubs and games on there. I had my (very) long hair cut, and am having the red taken out so that I can have a softer, "more natural" look. Every class I take, I make sure I stand out, and my teacher knows my name. Just on the off chance I may need them for any reason on a resume or as a reference. I have the card of a professional resume writter in my wallet, and I will be buying some nice pant suits for interviews next year. Even when I am driving I am way more aware of my speed and how I drive just because I know that any ticket will count against me. *edited to fix errors

There's mixed evidence on nitroglycerin use. It's one of those things that make sense if you understand its pharmacology, but research doesn't show much promise. The most important mechanism for nitroglycerin use is reduction in preload, and not coronary vasodilation. If you have an area of ischemia or infarction, the coronary arteries to that region are already maximally dilated anyway. Because of that, vasodilation of other branches may have two outcomes. One, you may worsen their ischemia by dilating alternate coronaries and allowing blood to travel by the path of least resistance, effectively stealing more blood away from that infarcting area. Alternatively, you may dilate a collateral branch somewhere downstream which does allow slight reperfusion of that region of myocardium.

Actually hyperglycemia has been shown to contribute to morbidity and mortality in many acute conditions, MI and CVAs being 2 of them. Multiple studies have shown that it can reduce hospital survival rates and glucose levels are often looked at as predictors of outcomes. Pt's are started on insulin drips to strictly control the glucose levels even when they are only slightly elevated no matter what the cause of the hyperglycemia. There are plenty of studies out there and it the adverse effects of hyperglycemia with head injuries and sepsis is also well documented. Here are just a couple of article to get you started: Controlling hyperglycemia in the hospital. hyperglycemia and MI Just learn from this mistake and remember that none of the treatments we administer are completely benign and all have some degree of risk associated with them. Cheers!

I was able to get my hands on the fulltext of one of the studies I linked (http://www.ncbi.nlm.nih.gov/pubmed/18347964?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=57). PM or email me (brandon@degreesofclarity.com) if anyone wants a copy; I think this falls within fair use. This one seemed to find from the available evidence that nitro generally improves short-term surrogate endpoints (reduced infarct size, for instance), but the overall long-term mortality rates are either unchanged or very slightly improved. Quote: Some of the research was done with IV nitro but I doubt this matters too much. The evidence does seem to suggest, though, that early nitro is the only nitro that could possibly matter, which tends to mirror our current prehospital usage. (For MI, that is; angina is a separate issue and nobody really disputes its benefit there.)

Just saw an older thread that treated with a similar topic. Some good stuff there. http://www.emtcity.com/index.php/topic/8456-evidence-based-use-of-nitro/

Thanks to those who posted studies. This one seems good, though somewhat dated http://www.ncbi.nlm.nih.gov/pubmed/8087820?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=30 If anyone can drum up research or academic access to these ones http://www.ncbi.nlm.nih.gov/pubmed/19681463?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=11 http://www.ncbi.nlm.nih.gov/pubmed/18347964?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=57 http://www.ncbi.nlm.nih.gov/pubmed/19445779?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=19 http://www.ncbi.nlm.nih.gov/pubmed/19445778?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=20 that would be very helpful I think. I was charmed to see that Viagara might be better than nitro...

Survival of the fittest. This is why I don't recommend the privates as a place to make a career in EMS. The local gov't ultimately reserves the right to run EMS as they see fit. I hate to see people lose their jobs, but it's an "us or them" mentality. If it's a choice of my job or the next guy's, I choose to keep mine. I'm not going to let my family starve if I have a way to prevent that. The IAFF uses yellow shirts to provide high visibility by choice. Because it works. Look at the video. Who jumps out at you, and appear to be in greater number?

Screw sabbaticals. They don't work. Take drugs. They work.