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Student or not, your opinion is just as valid as anyone else's. Don't ever be afraid to express it. Again, LOC is merely one of multiple S&S's, vitals, assessments that we check. It's also pretty easy to check if a person is "faking it" or they truly have a diminished LOC. Pupils, relfexes, neurochecks- plenty of ways to determine if your patient's mental status is truly depressed. You also need to consider the age and environment you find your patient. A 20 something, found "unresponsive" in the bathroom of a nightclub- well, it doesn't take a rocket scientist to suspect you may be dealing with alcohol or drug issues. An "unresponsive" 20 something at home, with a group of peers, and you find out your patient was fighting with her boyfriend- well, chances are you are dealing with an anxiety/drama type situation, and alerting the critical care team may not be my first priority. Does it mean you do not rule out more serious problems- of course not, but your index of suspicion changes based on where you find your patient. If you find a 70 year old "unresponsive", chances are the person has real medical issues that may have caused the change in your patient. Would you immediately consider using an ammonia inhalant on such a patient? Of course not. Time, place, circumstances, age- all the result of an appropriate history and observation of the scene and they should help to dictate your care. Good to be proactive and aggressive when treating patients, but don't always look for zebras. You have to put the whole picture together- based on your history, the scene, bystander information, assessments and any tools we have. In the vast majority of cases, these things will paint a pretty accurate picture of what's going on with your patient. If it looks like a duck, walks like a duck, and quacks like a duck... I agree that you may be in a situation where you have a choice of a small, community ER vs a larger, comprehensive hospital and your assessments will determine what level of care a person receives, then at that point, leave it up to medical control. Present your case, paint a thorough and detailed picture- especially if you are unsure as to what is going on- and let medical control dictate where the patient goes. Yes, ultimately you do what's best for your patient, but there is also a limit on the amount and type of information we can gather. Often times the subjective information you provide is crucial in determining the proper course of action once the patient arrives at the ER. The docs have the training and plenty of tools, but they have no idea the surroundings their patient came from, what was going on, the bystanders, the demeanor of witnesses, their statements, etc. That is your job to relate those details to them when pertinent. Dangerous thing to do sometimes. If you have a patient- maybe they have serious psych problems, are very angry at a significant other, etc, and after they take a sniff of ammonia, they can "wake up" swinging at you. Now you have an angry, abusive, and violent patient on your hands who still has whatever issues that made them become "unconscious". Whatever their issues are, chances are you will not be fixing them any time soon. Maybe the just want to get out of some situation, maybe they want to escape some personal problems. They often feel that is they present themselves as "seriously ill"- ie as being unconscious- they can ensure they will be removed from some real or perceived threat and someone will take them seriously. We may have no idea why a person is feigning being unconscious, but even if it's a momentary escape from their world, this is what they want. It's not up to us to decide whether their reasons are worthy of a transport and/or hospital visit. I used to have regulars who would be oblivious to needle sticks, arm drops, ammonia, noxious stimuli- the works, and we KNEW there was nothing seriously wrong with them. Often times they just wanted a warm bed and a meal. Chronic ETOH abusers, homeless- you would be surprised at how tough some folks are. They know the drill, the know how to play the game, and will do whatever they need to just to get what they want. Everyone comes up with their own program, and with experience and time you will determine your own path. Sometimes simply playing detective and asking the right questions of bystanders, family, or even the patient can give you far more information than any exam or treatment we can provide. After you do this for awhile and develop a relationship with your local ER's, other things also come into play. You will see- especially in the case of busy urban systems- that as simple as dropping an IV into someone changes how an ER must handle that patient. Some places require any patient with an IV to have a bed. An example- years ago when we first began administering nebulized albuterol, our protocols dictated that we start an IV, put them on the monitor- the full ALS work up. In the area I worked, we could have literally a dozen asthma cases in a day. Now multiply that by other rigs, plus walk-ins, and an ER could easily become overloaded. A couple ER's asked us to NOT start IV's on simple, stable asthma patients who were mild, maybe with some wheezing, with good sats and vitals. This way they could put them in a chair VS a bed, keep an eye on them, put them on a portable O2 sat machine, and give them more albuterol. Against protocol- maybe, but once they trusted you, they would ask if the person could sit in a chair vs needlessly tying up a bed. They also trusted us to say- "No, this person is pretty sick, I would keep an eye on them", and they would find an available bed for them. Eventually our protocols relaxed and full ALS was only required if the person was decompensating . Now I am not advising you to violate your protocols,(well, in a way I am, I guess), but I think you understand what I'm saying here. Yes, sometimes we are required to do things we KNOW are not necessary because we are limited by our training and scope of practice. But- like most of medicine, nothing is simply black and white, and being a good provider is about seeing those grey areas and making reasonable adaptations as much as possible. We are all in this together, and speaking as someone who also worked in a busy Level 1 trauma center for years, in order for the system to work as smooth as possible, to be effective and provide the best care for the most people, we need to consider both sides of the equation, and the impact of what we do.

There are apps available for iphone and android that will provide the necessary information without unlocking the phone first. One such is Appventive's "ICE: In case of emergency" (android @ $4). On a locked screen it will say "click here for contact information", which, when triggered, will show 3 names/numbers and other helpful info (illnesses, meds etc.). If this was a free app I'd install it myself, and if I suffered from anything that could place me in such situations, I'd definately get it. It's not uncommon for people NOT to carry wallets nowadays, in my experience this is especially true with younger people. You really don't need anything but a smart phone and some cash these days, and I anticipate this "trend" will grow as more and more people discover how useful these smart phones are (writing this on one now, and a few of you are probably reading this on one too (by the way: EMT City forums render perfectly on smart phones - though sadly, chat is not yet supported)). I think this discussion is very much needed today, even more so next year. Personally, I would rummage through any thing I find to ascertain the patient's ID, and I wouldn't risk anything doing so. But, then again, I live in Norway where we seldomn need to deal with law suits and bullsh... ox excrements. As for not being able to dig out ICE info from someone's phone, I just won't buy that. If the key lock doesn't call for a code you will be able to find what you are looking for within 30 secs, guaranteed.

Why are these the only 2 medical calls that can be canceled on? For intance, we have a protocol where we can cancel on Pts with preexisting SVT that converts with one dose of adenosine. This issue of refusing transport is of course very divisive issue, particularly with the various levels of education that EMS practitioners have. In the major metro centre in Alberta where I work primary care physicians are becoming very hard to come by, and many people call 911 for problems that are not strictly emergent in nature and may not require a visit to the hospital. We in effect become the first point of contact for many people and have, in effect replaced doctors that used to do house calls in a bygone era. As has been stated before, we are woefully underequiped to act in the capacity of primary care physicians. That said, we cannot continue to take every pt who calls to an emergency dept just because they think its an emergency. There is chronic overcrowding in hospital waiting rooms and we have to come to terms with this. I think that the prehospital situation is somewhat different in Canada than the USA for a number of reasons. For one we don`t seem to have the fear of litigation that is a common theme through this thread, I honestly can think of very few instances where legal action has been taken against EMS for non-transport. That said, I have no statistics to back up that claim, its simply my opinion. Secondly, we have a more uniform standard of training across the country, particularly now in Alberta, where there are a new set of provinical-wide protocols coming into effect, giving us a clearly defined standard of practice. Personally, I think that a shift is needed in the curiculum in paramedic education towards community health care. The you call, we haul mentality is outdated. There are other options to hospital tranport, such as transporting to 24hr medical clinics, referring pts who are prone to falls to transitional social agencies, transporting homeless pts to shelters, etc. Now of course, not tranporting to the hospital opens us to libability and risk, but I think that in conjunction with proper medical oversight we can be better advocates for our pts that don`t actually require transport to an ER.

Then you treat appropriately, right? What is the down side if you're wrong? I see increading numbers of people thinking that they're cool for 'catchin' those that are faking, but what's the upside if you're right? What's the downside if you're wrong? The upside is minor, bragging rights at best, the downside is a bruise to your paramedic soul, so do you find that to be a worthwhile cost/benefit? If so, then I think that you're shameful. Care for patients, care for people, but let the wankers brag about withholding care. Just my thoughts.. Dwayne

I have used the Actar Defib manikins, and I don't like them. They don't stand up well to classroom use. The little clips that hold the head together break. The clips that hold the chest plate in place break. If you are doing a lot of teaching, you will be replacing parts or entire manikins regularly. I haven't used the Actar AED trainer though, so hopefully someone else can post on that. I have used the PhysioControl (Medtronic) 500 series and CR+ trainers. I don't like either of them. I don't like the Physiocontrol (Medtronic) AED's in general. Their public access models aren't that good, and they have had a lot of recalls. What I don't like about the 500 is that the spot where you have to plug the pads in is difficult for students to find, even though it is marked, and the connector is difficult to get inserted properly, and students get frustrated, and end up breaking the connector. The CR+ lid breaks easily, and has to be replaced on a regular basis. I use both of these models at the hospital where I do nursing CPR recerts, and they are a pain. The hospital ordered 12 of the 500 series trainers, and all had to be sent back in the first comple months due to battery and programming issues. FOr my personal instruction, I use the Phillips OnSite, and FR2 trainers - love them both. I have had the FR2 trainer for almost 5 years, and it is nearly indestructible. Students like it because it is easy to use. I got the OnSite trainer 2 years ago, and love that one too - have never had any problems with it, and the students like the CPR coaching that it provides. I am biased - I do like the Phillips stuff the best, but, I have had the best luck with the Phillips products, and when I researched, the recalls on their public access products were WAYY less than PhysioControl. I haven't used the Zoll product so can't give an opinion on that.

Well with that point you WIN the debate hands down it is acceptable to protest in this manner. (see video again) I have now saved it to my desk top in my "freedom of speech file" and I will set up a Power Point Production for next years Remembrance day presentation in my home town, to demonstrate why the US, CAN, BRIT, OZ, and NZ troops died for "freedom of speech" Yes JPINFV your absolutely correct in everything you have written and I must agree with point you have made, I bow to your superior knowledge, your understanding of the ramifications of global politics and interpreting the Laws of many lands for the readership. Will you ever forgive me ? FUCK OFF YOU CLOWN !