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I disagree. Epinephrine is a powerful drug that we use for our sickest patients, and I think you'd be surprised to see the profound effect just 0.3 mg of the stuff can do for bad asthma or anaphalyxis. Just 1 mg in 1000 cc of fluid is a potent treatment for hypotension, better than dopamine in some cases. Same thing for morphine. There is absolutely no reason why a patient should have to wait to get to the hospital to receive analgesia when we can provide it in the field. Too many people focus on "saving lives" instead of "providing comfort and relief." Both are our responsibility, and I think ALS intercepts for these purposes are absolutely necessary.

Getting passed over sucks big time, but look on the bright side here just for a moment.... You made enough of an impression for them to remember your name and call you in for another interview. You made a good impression during the interview that the next opening that comes along, your name will be remembered again. Name recognition goes a long way in the hiring and interview process. You've been 'remembered' out of all the applicants that have filled out the paperwork, so you've got a 'foot in the door' on the next opening. I know it doesn't seem like it now, but this can work to your benefit. Don't give up and don't give in to depression! LS

I'd argue that that's too late. An EMT crew needs to request paramedics as soon as they realize that the patient needs a higher level of care. A perfect example is a patient in resp. distress secondary to acute pulmonary edema shouldn't need anything past a doorway assessment by an EMT crew to conclude that they need paramedics. The paramedics can be responding while the EMTs complete their initial assessment, treatment, packaging, and moving to the ambulance. Once in route, unless there's an excessive transport time, I see very little reason to request paramedics because a condition declines unless the paramedic base is between me and the hospital (however being at the hospital is generally not worth the paramedic response). Edit: Something I realized that I should have added and something that Anthony touched on. One of the reason I will call paramedics if I have a reasonable belief that the patient might require paramedic intervention now or in the immediate future. If an EMT doesn't call when there is a reasonable belief that the patient will decline during transport because there isn't an appropriate paramedic intervention at this immediate time, then everyone would be complaining that the EMT should have called for paramedics. This ends up putting the EMT in a 'damned if you do, damned if you don't' situation because they can't divine the future.

The problem is that mistakes are made (as high as 50% of the time) and there is poor inter-observer agreement (certainly the case every single time one of these threads hits the EMS bulletin boards). The most common error is misclassifying VT as SVT with aberrancy (as in this case) which has been proven to lead to clinical misadventure, including death. The algorithms have limited applicability for patients with preexisting intraventricular conduction defect (atypical right or left bundle branch block) and patients with an accessory pathway (antidromic AVRT). For a complete discussion about this see the ACLS Reference Textbook and Experienced Provider Manual (2003). Chapter 16: Stable Wide Complex Tachycardias. Some excerpts can be found here. I say the danger is greater in the prehospital setting because it's debatable as to whether or not antiarrhythmics are good or necessary in the prehospital setting in the first place. If the patient is hemodynamically unstable they should be cardioverted. If the patient is hemodynamically stable then there is time for expert consultation. Anitarrhythmic medications are dangerous and we should be handling them with the utmost respect. Tom

You cannot use the frontal plane axis to rule out VT. This kind of thinking is extremely dangerous. Wide and fast is VT until proven otherwise! This ECG shows RBBB morphology in lead V1 and left axis deviation. In other words, bifascicular morphology (RBBB/LAFB) which is the exact morphology we could expect if the VT originated in the left posterior fascicle of the left ventricle. In other words, one of the EXPECTED morphologies of VT. ERDoc used Brugada's critiera in the only responsible way, in my opinion, and that is to rule-in VT. Failure to rule-in VT does not rule-out VT and these criteria do more harm than good, especially in the prehospital setting.... by a large margin. Tom