Leaderboard

"Horak said San Bernardino paramedics have recently taken on training to detect heart attacks with what's called 12 lead EKG technology and to deliver medication directly into the bone marrow if a patient's lungs are collapsed."

For goodness sakes JP! Do you not know how to search for neonatal statistics? The stats quotes at 50% came from JEMS. It just took a few quick checks to see where he pulled that number from on the internet. I never made any direct statement as to where he got that information because JEMS was not part of the trial. Just look at the reputable neonatal websites and you can read all about neonatal stats. I also take NRP which is full of fascinating stats in the reference section that makes taking the course over and over again worthwhile as they are being updated as medicine evolves. Like ACLS or any cert class on has to realize its limitations. However, if you do not put forth ANY effort to acquire at least the bare minimum of training, how can you even justify being capable of handling a neonatal transport. This baby did not get intubated during resuscitation. If a company wanted their employees to do neonatal IFTs, they should have seen that they got the training by whatever means. Bashing NRP still does not make it right. As least the NRP would show they put forth some effort if they can not come up with any other proof of competence. Also, when you do get the chance to take NRP you will find they make the same disclaimer as any other cert makes like ACLS or PALS. It does NOT replace proper education and training. If they had actually taken the NRP, they might have known this and realized their limitations. Some physicians are better than others. Quite possibly if another physician has been on during this particular incident, the outcome might have been much better. I do many specialty transports from these little hospitals and I do find most doctors are not stupid. They also seek out advice from the higher facility and now for neonatal transports, the receiving doctor at the higher level of care will be deciding who and what is needed. This change came from the lesson learned from transport disasters like this. If you advocate for a system that continues to fail and just want to make excuses, other ambulance personnel will be put into the same position. Realize the mistakes and move on with proper education and communication with your medical director. See my previous comments about certs. EMT-Bs deliver babies. Mothers deliver their own babies. However, the mother is just part of the equation and in no way is a preemie self sufficient unless someone can provide the minimum comfort. I am repeating myself but EDs in the U.S. have a pedi/neo code cart, warmer, infant ventilator and a variety of staff that can offer some level of expertise in their own specialty be it lab, nursing or respiratory. S.T.A.B.L.E. is also taught at the hospitals in that area and this is something that EMS providers generally are not aware of. And AGAIN, we do neonatal transports from these little hospitals with very few problems that can't be handled with doctor to doctor communication prior to our arrival. The babies will also do well provided there not other complications but I can tell you it is a very rare occasion we find a baby in an ED without an ETT and under a warmer. That is the bare minimum. Even when we go to less privileged areas both in and out of the U.S., certain minimums are done. So, why do you feel it is safer for the baby, mother, EMS providers and the public to have an ambulance running L&S for almost 70 miles without someone who can intubate a baby to provide oxygen and provide adequate warmth? If the hospital stuck by a decision not to transport with the local ambulance because they were calling specialty teams, there is still a chance they would have been sued but by showing the ambulance was not capable of providing a safe transport alternative, their damages would have been less. The ambulance had good reasons not to accept. Then you should realize that defending mistakes made by the ambulance only justifies they have all the training they need and there is nothing more they should do to improve patient outcome. Arrogance should not replace education and ignorance is not a good defense. The hospitals and physicians knew where they screwed up. This ambulance service should have realized their limitations and had their medical director be more proactive for them to prevent them from being placed in this situation. It is not like there were no other transport teams and those with access to helicopters that could have at least provided someone who could establish a neonatal airway. There is also a good chance if that mother delivered in that ED that someone would have been able to do ETI on a neonate and under a warmer. And again, if an advanced team felt it was unsafe to move the patient, they would have remained until stable or additional resources could arrive. Any other health care professional would be held accountable and if they accepted something they were not qualified for, they would have to answer for it and why they made the decision. Why should EMS be the exception? So JP, when you become a doctor, are you going to pressure EMT-Bs and Paramedics to accept transports that put them outside of limitations? Are you still going to rely on L&S and a real fast ambulance ride to get critical patients from point A to point B? Do you also not have the ability as an EMT-B to call for ALS? Hasn't this been discussed over and over on these forums? Again, there is also a difference between some adult airways and that of a neonate. The adult can be managed by BVM. However, the 25 week neonate that is coding requires an ETT. You may not have enough education in this area to understand this which is also what happened in this situation. I also find it absurd that I am being criticized for explaining changing that have evolved from mistakes made or that I am suggesting some should know their limitations while establishing a line of communication with their medical director. I also find it unsettling that some would just let their emotions out weigh their common sense on an IFT to run with anything just because they think it sounds good without really understanding what they are getting into and the minimum that should be expected.

JP and ERDoc, I already provided links to Volusia County and the court documents. Sorry but I am not going to spoon feed either one of you and you will have to click on the links yourselves. ERDoc, Are you comparing your education and training to a Paramedic with 6 months of training and very little baby or peds education? Even without NRP, as an ED physician, did you not do a rotation in the NICU or L&D? Did none of your training and education address this? If you wanted a cardiac patient transferred out of your ED to a center of higher care and the Paramedic showed up without a cardiac monitor or O2 tank because the truck they were on didn't have the equipment for a 60 mile transport, would you be okay with this? JP: that is a silly argument and you know it. If they didn't take the course to begin with, you can't even begin to argue competence or no competence. Knowing the EMT and Paramedic courses are very weak in neo and peds, would you not want staff to at least make some attempt to get more information about these age groups? Or, do you believe the Paramedic program makes you more than qualified to do high risk delivery transport and neonates? Hell, even doctors must get some additional education even if it is not NRP to be proficient for working in areas they will come into contact with these patients. If they choose not to, they will have to explain their actions if something goes very bad. If they have some additional training, explaining the consequences might be a lot easier. Why is it both of you are arguing it is okay to show up for a critical transport with little to no preparation as far as equipment and personnel? Why is this acceptable to you? ERDoc, if your patient required a Specialist OB consult, would you settle for a GP because the OB was busy? Would you feel you did right by your patient? This area has access to at least 2 hospitals that have helicopters and specialty teams and that didn't include Halifax. Contrary to what you are believing about the public, not everyone is out to screw over the poor EMT or Paramedic. However, there comes a time when they can not always hide behind the old way of just providing a fast trip to the hospital or that people will automatically think they did a great job because they are a Paramedic and as EVAC keeps stating, "must put up with suffering everyday". EVAC accepted a transport of almost 70 miles with very little resources. The hospital goofed by sending that patient out without a PROPER TRANSPORT team to provide for both the mother and baby. Not every child that suffers the effects of prematurity or will have a family that sues if it does. Usually the neonatalogist can explain the circumstances well enough to where they accept the fact EVERYTHING was done that could be done. However, even the best neonatalogist in THAT AREA of FLORIDA would have a difficult time explaining why an ambulance crew accepted a baby without proper preparation. ERDoc, do you honestly believe the U.S. is not capable of saving 25 weekers? We've been saving 23 weekers since the 1980s. If you look at the literature you will find the stats run from 50% to 80% depending on the level of care closest to them. If the baby is born outside of the hospital or a hospital, the stats will be at the low end. In this situation, it was chosen to take a chance or accept the lower stats when the decision to put mother and child on an ambulance. Also, if you want more impressive stats, pull up the numbers from Canada and other countries of civilized medicine. BTW, ERDoc, what do you do when a Paramedic brings you an ETT in the esophagus and then blames it on you when you try to explain how it could have happened or give him/her some pointers on assessment? Or, do you just ignor it or cover it up because the patient only had a 50/50 chance of survival? Would you allow a cardiac or any patient to have drips discontinued just to accomondate a crew with less training take your patient to an ICU in another hospital? Would you not expect to be scrutinized by your peers? I've also wasted too much time trying to show where those in EMS may be held accountable for their actions and the "underdog" "they're picking on us" mentality will have to go away to be replaced by one that resembles a medical professional. Diesel medicine and just providing a real fast trick from point A to point B will have to be replaced with critical thinking, education and more training especially for the CCTs or ALS IFTs. Have either of you noticed the level of training/education required in other countries for a Paramedic to be on a truck for IFT critical care transport? There are literally thousands of babies born in Florida each year. While there are lawsuits, compared to the volume of deliveries, including those that require a specialty team to get the baby at some little general, there truly are not that many. Most can be settled and do not drag into a jury trial. Yes, the risks are high especially in neonatalogy but there are still many health care professionals that assume the responsibilty to work with that population and know what it takes to be successful in that career. However, this is why I am an advocate for taking a patient to the more appropriate facility to begin with if at all possible. As I have stated several times before, getting the proper IFT can be a pain and take hours. In some areas, a BLS truck may have to do and the patient will have to go without meds or a monitor to a higher level of care from a little general. That is a sad statement the U.S. but that does not mean we should settle for this as a profession every time or continue to make excuses.

That article gave in detail examples of points I was trying to make in my earlier post although I don't believe the author sees it the same as I do. Highlights: Known high risk at 25 weeks gestation. Contractions at 4 minutes apart. Ground transport of over 60 miles. 1 Paramedic. (article only mentions one Paramedic being honored by EVAC for a good job) Must consider both the mother and the baby to be patients and SICK. No fetal monitor mentioned for a 60+ mile transport. Only a silver swaddler with a known possibility of a 25 week preemie being born. 8 minutes of CPR without ETI or a missed tube since the baby "gave a weak cry". NRP is clear about ETI and prolonged resuscitation on a neonate. CPR Had to divert to another little hospital. This was an IFT...not an emergency from field. The patient was at a hospital which is still capable of delivering a baby which can then have a neonatal specialty team transport. The sending hospital should have weighed the risks of sending this patient without more transport preparation. That can be considered an EMTALA violation. Fish Hospital must have realized they mucked up and settled. One would hope the Paramedic had voiced concerns but sometimes when babies and children are involved, people tend to let their emotions lead them rather than good medical practice. Some must also realize the limitations of NRP just like those who take ACLS and expect to be proficient at intubation and resuscitation. Also, when asked can you as a Paramedic intubate a neonate, most will reply yes because it is in their state's scope of practice and they may have a protocol for it. However, that does not necessary mean YOU can intubate if you have never attempted it on a human baby. Considering the distance, the birthing and the resuscitation, this was a transport that could have had an even worse outcome for all involved with an emotional and stressful L&S emergency run. This would also be a good case review to have with your medical director which might get you more education for babies, peds and the many new technology dependent patients such as those with LVADs, various vascular access devices and ventilators. Some good things can come out of situations like this if the opportunity is taken to learn something. Of course as I mentioned earlier Florida has rewritten its IFT neonatal transport statute which some in EMS have criticized because it increases the requirements of the transporting Paramedic who must also have a neonatal nurse accompanying the baby.

There are a few out there.... http://www.witcc.edu...index.cfm?id=30 I think this is a little to far of a distance for ya..........

It wasn't the title ... it was the fact that you actually came across as being a dickhead in your subsequent replies.

You obviously haven't worked with me yet .... Seriously, OMG ROFLAMO hahahahahahah what a bunch of hillarious retards God makes a bunch of chimps at the zoo masturbating each other seem less amusing! :D :D