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Hello, If my memory is correct, EHS NS, is getting TXA. The CRASH2 study is a good place to read about TXA if you have not checked it out yet. It will be a good place to start for a protocol suggestion. Plus, TXA is cheap. The WOMEN study is looking at TXA for post particular hemorrhage and they should be publishing in 2014. That may be worth a look. Otaplex (PPC) is a part of the NS Massive Transfusion Protocol (just google ns massive transfusion protocol and they have a 40 page PDF that is quite good....I am using my new iPad and I do not know how to copy and paste yet). PPC is tightly controlled but it should be considered in any trauma patient or surgical patient will an elevated INR. Cheers

Happened to me the other day. I was drawing up my ket and sux, and my EMT kept on bothering me, and I couldn't understand why, and then I realised that the patient had actually been decapitated, so it was completely unnecessary to RSI him. We had a dig around, and ultimately found his trachea and stuck a tube in it, then my EMT was bothering me again, and I realised we were blowing air out his hemisected torso. It was a bit embarrassing.

In order to answer this question you need to define the terms "profession" and "organisation". I would submit that while I have met many people in EMS whom act in a professional manner, we are a vocation and not yet a profession. Our barriers to entry at both the paramedic and EMT levels are quite low. We have little control over the direction of changes in clinical care, and ultimately report to EM/Cardiology. There may be countries where the move towards professionalisation is more advanced, e.g. some parts of Aus/NZ where Bachelor's degree entry-to-practice is becoming the norm, or the UK with their consultant paramedic and paramedic practitoner roles, parts of Scandinavia where the paramedics are essentially nurse-practitioners, or the countries where EMS is provided at the advanced level by specialist physicians. I doubt anyone would argue that an anesthetist working on a French SAMU ambulance meets the traditional definition of a professional, for instance. We talk a good game in EMS about how professional we are, but when you can become an EMT in less than six months, and most paramedics have less education than a plumber, it's not that meaningful. This isn't a slam on the vocation/occupation, more a recognition of the opportunity for growth and transformation. ** Or a slam on plumbers, who intermittently stop my house from flooding. But if all we define professional as, is someone who makes money from a specific job, then "professional paramedic" may mean little more than "professional exotic dancer".

It is okay to do an addendum after the fact as long as you are clear that it is an addendum and that it is being written on X date but the call was on Y date. NEVER alter the original record. The addendum needs to make sense though. It should not state the exact opposite of your original report. It is used to clarify something in the original report or to add something that was forgotten. We do it all the time in the hospital. It will look suspicious if it is done after a lawyer has made contact or if it has been too long such as in Ruff's case where it would have been 11 months later.