Leaderboard

I agree with this as long as the crew isn't making the jump of 'positive psychiatric history means the patient is de facto a danger regardless of what an actual assessment shows.' A patient who is an immediate threat to themselves or others due to disease or disorder, including psychiatric illness lacks capacity, including the capacity to refuse medication needed to stabilize their condition. A patient who is violent while off their medication but is currently is medicated is not a de facto threat who lacks capacity though.

I really think you should pick a locale before you pick a school. There are good accredited schools all over the place. I think you can at least pick a region you can start to narrow things down quite a bit. I went to the program at Capital Community College in Hartford CT, which was a 1 year accredited program including lots of hands-on training (in hospital rotations are required as well as on-ambulance internships and laboratory sessions). If you're interested in the Northeast, give it a look!

FICTION The critical time to intervention varies by patient and injury type to such a degree that arbitrarily dictating an ideal window of time to surgical intervention for every major trauma patient is impossible. One patient might have a realistic window of 30 minutes to intervention (developing pneumothorax perhaps) while another patient might have several hours (slow progressing closed head injury). What can be clearly demonstrated is that reducing time to intervention can reduce absolute patient mortality in specific patient sub-groups. Rather than focusing on a specific time frame we should be focusing on research that guides our interventions, reducing scene times where appropriate, and perhaps even extending scene times in certain areas to perform critical interventions currently left out. This isn't calf roping where time to completion is the only thing that matters. The absolute focus of trauma care on time is only to our detriment. Time does matter. It is not however, the only thing that matters. With regard to major trauma patients in general, talk to a Trauma Surgeon and he/she will likely tell you to target a MAP pressure during fluid resuscitation that is permissively hypotensive. Talk to a Neurosurgeon and he/she will likely tell you to maintain a MAP significantly higher than that specified by the Trauma Surgeon to maintain CPP. Who's correct? In reality both are correct and both are incorrect. The lower MAP will result in greater body survivability due to reduced blood loss. The higher MAP will result in a higher percentage of patients that survive remaining neurologically intact. In reality best practice would include tailoring the target MAP to each specific patient based on their presentation. Not all patients with intra-abdominal bleeding have a TBI and not all patients with a TBI have intra-abdominal bleeding. Sounds like a great argument for improved education to facilitate the level of patient assessment required for that to happen does it not?

I think a few things are wrong with the country today. First is greed. Everyone is looking out for just themselves. Our politicans are too busy looking out for themselves rather than making decisions on what is best for the country. .We elect them under the premise that they will go and do what we feel is best for the country. In reality, they go and do what is their best interest. The lobbyist and special interest groups spend millions on politicans. They have to get reelected to be able to continue with this. I realize that they have to do some things for their constituants, but sometimes you have to sacrifice some small things for the good of the whole. Kind of like having a bad infection in you hand. In order to save your life you have to amputate the hand. Secondly is personal resposibility. Everyone is so busy blaming everyone else that no one takes resposibility for their actions. When you make a mistake, take ownership of it and learn from it. Lastly, is political correctness. If 90% of people blowing up airplanes are muslin males 18-35 it is not racial profiling to examine this group when they go to board an airplane. It is smart not descriminitory. We are too busy trying to not offend anyone that we can not provide proper security and other services to everyone else. If you do not pay into the system then you should not complain about the services you receive or don't receive. Illiegal aliens should not be allowed to get social security or other services. They should come in legally and contribute before they expect to received services. But as a country we are so worried about hurting their feelings. If they don't like it they can go back where they came from. Once again back to doing what is good for the whole. Ok, I am sure I have upset some folks now so I will get off my soap box.

WAY to general of a statement. Example, I am proud to say I believe I work in one of the top 10% of EMS agencies in the nation here in Idaho. We serve an indigenous population of about 350K with a transient workforce of about 75-100K from out of county, and are a pleasant mix of suburban, rural, and even a little bit of urban thrown in, with median income from near zero to over 1 mil and everwhere in between. Sounds great, right? HOWEVER, you go north of here into the mountains, where most of the land is federal or state forests, The populated areas are small barely sustained communities of less than 1000 people....and these are the the "LARGE" communities,and are separated by mountainous terrain and snowed out roads in the winter for WEEKS at a time. This is not the natural disasters you see on CNN. This is the NORM. These communities are unincorporated, and have no tax base to speak of, and the EMS lives of the generosity of donations. The Counties they live in are little better. These community first responder/transport units often get less than 20-50 EMS calls a YEAR. Some examples: Valley County Idaho- Population 8000 total over 3678 square miles. An average population of 2 people per square mile. Yet most of this population lives in three communities along HWY 55, and are SEASONAL populations. the REAL population once you get off the HWY into the 6 or 7 uncooperative communities is closer to 0.25-0.5 people per square mile. Custer County Idaho: 4,166 (and decreasing BTW)in 4,937 square Miles. Less than 1 person per square Mile, and most of this population is in CHALLIS (pop 909), McKay (pop 500), STANLEY (pop 100) and other communities with a population of about 25-50. , Population is very seasonal, and mostly around red fish lake. The remainder of this population is spread out among 4-6 "smaller" communities. Many of these communities are vacated (except for 1-5 families as caretakers) during the winter. Adams County, Population 3400 over 1,365 square miles, most are seasonal with a ski resort or between two small communities each with less than 900 and 500 respectively. The remaining are scattered through out the mountains and along the river, many are "off the grid", and real population density is about 1/square mile or less. These are typical Idaho counties in MID/Central Idaho (where the Mountains and Valleys are). Hopefully you can see the budgetary issues, not to mention the personnel shortage this causes. Making a system out of a seasonal workforce and without a decent tax base is neigh impossible. In Texas, I only found one or two counties resembling this demographics on simple square miles (brewster for example) , They were agricultural in nature, not necessarily seasonal as we understand it here, and arent ISOLATED like we are for weeks or months at a time. Most had counties less than HALF this size, and population densities far exceeding what we have here in rural Idaho. THATS the REALITY here. And there are similar areas in OR and WA too, and in other parts of the country (SD, WY, and MT for example) You seem to imply that these comminities simply are to lazy to do anything other than volunteer EMS with an EMT and A "driver"/ECA. You seem to imply that if they wont do it "right", they should not do it at all. Yet without their own volunteer EMS, they would be HOURS in winter from anyone getting in by snowmobile or snow cat, or 4x4. If you have a population of say, 1000 (wich is the upper end of the LARGER communities, amy have populations less than 100). and you have an unheard of rate of 2.5% voluntarism, than thats still only 25 volunteers. In this state fully half of those will go to a first responder course and be a "driver", as long as there is an EMT in back. Then , if they stick with it, the service will find a way to send them to a EMT course, many will have to travel an hour or more to get that course in the summer. Now the state requires an EMT in the back, and at least a driver in the front. Most will run with 2-3 man crews on call from home. Usually the same people will be on call for weeks at a time. In the summer, they ONLY have to manage the patient for 20 minutes until air medical can get there, if they can get there (mountains are tricky to fly in).......In Winter, due to weather, white out, and other concerns, it may be hours to ALS or a facility thats more than a clinic and a PA/NP on call. In these areas, called FRONTIER, or SUPER-RURAL by medicare, ECA/First Responder/Drivers are the brutal reality, and the step to EMT in areas with no budget and no support. I am all for "doing it right", but in the rural parts of this state, every certificate that is issued is a victory, and everyone that re-certs, is a triumph. You have to see these beautiful, scene, and terrifyingly majestic areas to appreciate the isolation you can find here. I have volunteered my time to teach in some of these communites from time to time. It is way more rewarding than doing it in the "Big City" of Boise... (I have to laugh when I say that). And these guys are wanting the training. They just dont have the resources. In some places, "Doing it right" is simply doing it. Respectfully submitted. P.S. There is a push by the state to legislate counties into taking a more active role in supporting and funding these communities EMS and forming SYSTEMS....., and in forming taxing districts to support those "systems"......but guess who opposed it. The various FF lobbies. They dont want to be told how to run EMS by anyone.....)

There were many attendees . . . . But they all sat in the back . . . Our first station is IO's, which we practice with real bone on real cadavers. Then, we practice get to needle decompress an induced pnuemothorax. BEandP and AnthonyM83 put their first intubations under their belts under the guidance of DustDevil, Akroeze, and the medical students. No pictures were allowed in these rooms for the privacy of the cadaver donors. Next is an airway station, which included various equipment, included two "video scopes" that made intubating a cinch. One dummy was even computer controlled, that allowed proctor to create edema and other difficulties intubating through his computer screen, realtime. Next was some practicing with surgical airways. We practiced on pig trachs to allow for multiple attempts, using different equipment. Here Dust performs his first incision into the cricothyroid membrane. Here Akroeze ponders what other impromptu surgeries he might get away with... Now, it's Brendan's turn. He jumps right into it. Things start heating up as AnthonyM83 heckles from the sidelines (Canadians were the prime joke targets for the weekend). Anthony takes a picture of the group (from Day 2...Sorry Jake and Chris) After spending almost five minutes showing a fellow EMT girl how to use his camera phone, Anthony is finally able to get in on one of the pictures. Yup, I'm as intense as always. Then, it's time for lunch. The group somehow ends up separated with ALS sitting on upper rows and BLS sitting on lower rows . . . hmmm. Anyway, then we back for a scenario where Brendan and Anthony save a life...with a little help from some local EMTs who do EMS for their university and another medic. The patient dummy was one of those state of the art ones that speaks, has a pulse, allows for taking actual accurate BP's,...and umm fully anatomically correct. The more experienced Dust, Akroeze, and others act as judges. Next station is Tac Med. Doczilla shows us his combat pack and various TQ's and hemostatic agents, as well as reviews the modified ABC's for combat trauma. Here Doczilla demonstrates an Israeli dressing (reminds me of a "BloodStopper" roll) on Alex. As much as I tried to convince him to do a real demonstration by amputating Alex's arm, he wouldn't allow it. Too much mess he said. I do have to say Doczilla turned out to be exactly how I thought he'd be. Great guy, great speaker, knows his stuff, and I recognized him immediately! Next we did the brain and heart stations, with anatomy lessons holding the real organs in our hands and explanations on what happens during CVA's and MI's, with review of 12-leads. Then, we went to the long-anticipated amputation station, which we ended up having to rush, through...but we all got a chance to cut some bone with different tools. No one got sick unlike the first day, apparently! Last station was a general cadaver anatomy station where I got to ask a bunch of questions relating patient conditions to actual anatomy...got to run the bowel (ref: House MD) and got great explanations on how different abdominal pains present (much better than any of the explanations I ever got in EMT school). The resident at that station was great. (and hawt) Lastly, Dust and I went out for some food and drinks with 'Zilla. Unfortunately, he couldn't quite hold his liquor and this is how we had after only 3/4 of a drink. I had to cut myself off too to make him feel better. Doczilla after one drink (with a meal):

well be about 2 weeks and i well give was thinking of saleing one of my guns aways