HellsBells

A specious argument, as prior to World War II civilian attrition almost always outpaced soldier casualities (Return of The White Plague). There is no fail safe method for 100% prevention. However N95 masks, goggles, gowns and gloves will greatly reduce the risk. I agee that having the H1N1 vaccine would be ideal, But how do we know thats what the pt has? What if its TB? Is the gown and mask good enough for those pts? Or should we refuse to transport them too? I applaud this woman for taking a stand and speaking out on this issue. All health care workers should be among the first to be vaccinated. However, for her to bleat about refusing to treat a sick pt because there is a 2 day delay is a little childish; particularly since she might get one call in the interm.

Drunkest Guy Ever Needs More Beer You have to respect this guys single minded determination.

There are 2 possible solutions, charge the obese people an extra fee, or absorb the cost by increasing the general fee for everyone who uses the service. Its not really fair that all patients shoulder the load (so to speak) for the obese few. However, from a cost recovery stand point, its probably easier to recover small increases to many than large increases to the few. I'd say we draw the line where special equipment, or increased manpower is needed, wasn't that the point of the article?

She may have simply crawled in under the door sensors. Our ambulance bay doors are located about 2 feet off the ground. So, if she was going in commando style she may have crawled in below the sensors. Sounds like a recepient of the darwin award.

Wise move Mobey, I may have had more evidence of your perverse proclivities, had you not cleared that up. This is a very good topic, and it has got me thinking. In my urban setting we really don't have to worry too much about resedation, usually one or two doses of fentanyl/versed are all thats needed. In my recent ER practicum at a major trauma centre, it seemed that most doctors order sedation by bolus doses of fentanyl/versed. I'm not sure why this is so common in the hosp, as it keeps the nurse quite busy sedating the pt, a drip would maintain more even sedation. Interestingly, Mobey, I have heard that Ketamine is supposed to be approved in Alberta's scope of practice for ground ambulance when the new protocols do come out, no official word on that yet of course.

In our urban service, a lot of our transports are less than 10 min, if anyone followed this nurse's policy, a great deal of our pts would not receive analgesic. I think that the nurse in question just has an axe to grind, and wouldn't pay her much mind. Our service has Morphine, Fentanyl, and Versed for pain control. The problem is our protocols state we have to give morphine first, fentayl if, and only if the pt has an allergy to morphine, and versed, only after the pt has received 20mg of morphine without pain relief. Fentanyl is mainly used along with Versed and paralytics for our RSI.

What is the MRX and QCPR? I'm not familiar with those terms.

what do you mean by that?

I typically set the NC flw rate @ 4LPM, I have maybe used 5 or 6LPM a couple times, but for any higher doses I start an NRB. On a similiar topic, does anyone here use a simple face mask? Or do you go directly to an NRB?

Geez Mobey, your a bigger pervert than I thought.

Its interesting that I read this thread tonight after just working a code a few hours ago. My answer to the original question, in terms of the average prehospital ground ambulance, would be purely observational. That is to say, watch the person performing chest compressions. If you can observe the person doing compressions using their shoulders, causing the pts chest to depress an adequate depth and then recoil, I'd say the compressions are probably being done properly. On today's call the end tidal C02 probe wasn't working, luckily we had a bunch of big strong fire fighters on scene and they were able to perform what looked to me like high quality compressions. In retrospect, I gauged the CPR by observing the compressions, watching the ECG waveform in lead II- a wide, regular pattern, and also by asessing femoral pulse. With respect to the OP, the 2 times I did attempt to assess femoral pulse I felt nothing at all. However, when it comes to CPR, why not just stick to the basics? If compressions are being performed the way we were taught- hard and fast- then we really don't need to worry about a lot else. I will agree that end tidal C02 is a fantastic tool, and should be used on all cardiac arrest and intubated pts. If the femoral pulse checks are useless, as the posted study would suggest, then yes, I agree we shouldn't be wasting our time doing them. But, if someone does have a audacity to check one during compressions, I fail to see what harm it does to the overall delivery of CPR.

I find it shocking that there are ALS services that operate without 12 lead ECG's. It is simply unheard of in this province

This was a pretty good article, but fails to ask a very basic question: If fire calls have gone down by half and medical calls have increased 213% since 1980, why are there still many more Fire trucks then ambulances?

Interesting, I wonder if we may see similiar changes in Alberta in the near future.

Really? This made the news? Really?

I believe Mobey may have been refering to the bolus being smaller than expected for the pt's presentation (correct me if I'm wrong). I can see your reasoning for giving the atropine, i understand that you don't want the pt to code. However if the slow heart rate is caused by internal bleeding, increasing the rate may cause the bleeding to increase and hasten the transition to V-Fib or asystole. If like Mobey suggests, its the result of spinal shock, the increased heart rate may help with the BP. Now, from my computer quarterbacking position, I would have first tried a 20cc/kg fluid bolus. If that didn't work, I'd consider perhaps going to the pressor route. Maybe Dopamine @ 10 mcgs/kg/min, my thinking would be that the vasoconstriction would increase the return to the heart, hopefully increasing its rate as well as increasing the BP.

WOW, mobey you must have had some good paramedic education if you're that close to being a specialist, what school are you going to again? In all seriousness, for arguments sake, why don't we just assume that we are referring to an unstable pt? I think Mobey raises a good question, and one that I am going to explore further, as my services choices for Tx are: 1. vagal manuvers 2. Adenosine 3. Cardioversion

Actually, I would think it would be better if the pt had just got a pulse back as the medic went down. Now you can focus compressions and use the monitor soley for the coded medic. Of course the original pt could become pulseless again, but like a previous post stated, you could have defib pads on both pts and swap the cables back and forth.

So Mobey lets see how our education compares so far... Of the top of my head For some reason I was thinking of glucagon as a treatment, but apparently it may be a factor in hyperkalemia.

Well... I have to call bullshit on this one, I've never heard of the McSwain dart before, and I'm willing to guess that most who use the colloquial term "dart em" are not referring to it as some whimsical, sentimental tribute to a grandfather of modern paramedicine; "As I pass this DART into your chest, lets have a moment of silence in honor of the great Dr. McSwain." I would bet that it became part of our EMS nomenclature because of it's resemblance to an actual dart being thrust into a dartboard. However, in your case tniuqs, I'll make an exception.

I don't konw if this is nessesarily true. Unless there is was some iron clad guarantee of a job after graduation, this may just get thrown out long before it gets to court, clearly this case has no merit.

What is a line officer? Why can he have lights on his POV?

The problem is that only a "select few" wore the shirts to work, the statement is only effective if everybody participates, they can't send everyone home. This sounds like a poorly planned stunt by the union that makes them look weak and ineffective.

Münchausen syndrome perhaps?

That is a sick, cruel, offensive joke. ...Which is why its so funny. Back when JFK Jr. died in a plane crash and Chris Reeve was paralyzed my favorite joke was... Why didn't Supermean save JFK Jr.? Because he's in a fucking wheelchair