HellsBells

Doesnt really matter whats in my bags. I always just load the pt up and start treatment in the rig. I havent opened a jumpbag in months.

If the 20ml/kg fluid bolus and glucagon are in without significant change calcium cholride @ 8-16mg/kg would be indicated. To the previous poster, I think you misunderstood, I believe that the pt recently called his wife, but was last seen normal 4 hours prior.

It sounds by your reply that there wasnt sufficiently clear communication between you and the nurse/physician from the sending facility. Do you feel that getting a clearer picture of things from the hospital staff would have helped your transport decision and ethical concerns?

I disagree with Celtic. There was no reason for the OP to have his partner tech the call, its a cop out in my opinion. If you want to take a stand, refuse to transport and suffer the outcome of the decision. That said, I think you partner behaved like an massive prick. However, I cant agree more with the advice from Doczilla about consulting the ER staff.

Well Mobey, the what would you do if... question is often a bag of worms to try and answer, but I'll give it a shot. In your place I probably would have put a 12 lead on. Mostly because its a long trip, I agree, you most likely would have seen little to nothing of value, but something might show up. O2? Meh, maybe, there is a chance it could have helped bring the rate down, but no chest pain, no SOB? Im pretty happy with an sp02 of 94%. Fluid? Again maybe a small bolus. In the end I don't think you witheld any Tx that would have greatly influenced this mans outcome. As for the worry about what the sending facility may say about your interventions, who cares? They already talk behind your back anyway.

Yeah had the same thing happen to me, it was a unit aid, not a nurse who pulled the wires, but they were able to reestablish the pacer without any drastic deterioration. My partner was a little pissed though. I believe his exact words were " congragulations, you just killed our patient."

Yeah had the same thing happen to me, it was a unit aid, not a nurse who pulled the wires, but they were able to reestablish the pacer without any drastic deterioration. My partner was a little pissed though. I believe his exact words were " congragulations, you just killed our patient."

Oh and Alberta? Way better place to live then Ontario.

You may be interested in Alberta, if you actually want to get a job in Canada. As tuniqs said, you have to do a little upgrading to work here, but there are actually jobs available in our province. Check out collegeofparamedics.org for more info.

I was going to mention the fact that paramedics needed to have an ICU rotation as part of the program. This would be particularly important for those who wish to go onto the air medical side and even for those who work rural and need to transport pts on vents. Its quite the shame that this part of our program is glossed over somewhat.

Wow tniuqs I dont know why all your relpys are so brief, try actually including some detail in your responses. To answer your question I am a paramedic. As far as I know, and as I read the protocols, EMT's will not be administering CPAP, as it is part of the continum of care for CHF/Pulmonary Edema, including Nitro, which is also of EMT scope in that instance. I by no means take offense to your characterization of Paramedics knowledge of CPAP and ventilators. I learned a lot about the subject in school. However, the only expierence I have had with vents in practice was during my OR practicum, where I basically hooked it up to the ET tube after intubating and was sent onto the next pt. ACP seems to want us to be knowledgable about vents, based on the numerous questions asked about them on last summers paramedic exam. The same exam, in fact, that had exactly zero questions regarding 12 lead ECG's or ACS. Our training on CPAP was quite minimal. It involved a demonstration on its use. We had about 15 mins to set it up. Went over indications/contraindications. About a half hour on total I guess. As for your CPAP questions... Well lets just say I have some reviewing to do.

I have little knowledge of CPAP devices, I do, however find the "hurricane of air" tagline pretty weak for a device that is supposed to be used by medical professionals. "Hold on a sec miss, just let me prepare this device so I can treat you with a Hurricane of Air (as the scorpians hit Rock you like a Hurricane plays on in the background). I did treat a pulmonary edema pt the other day, but she responded well to Nitro, so I have still yet to give the prehospital CPAP a test drive.

Ha, No actually we had a supervisor on scene. It was a CO call, and he had to bring us a CO monitor and he witnessed first hand the trouble we had both convincing our pts to agree to transport and the difficulty contacting med control. So, we didnt get our hands slapped, it was just a frustrating process.

Does anyone have MAST anymore? Anyone... So, lets try sync'd cardioversion at 100J folliwed by 200J, 300J, 360J PRN.

First of all, its important to know that this device does not fit into the trachea, it is inserted into the esophagus. Personally, I have never used one, actually we just started using them about two weeks ago. However during training they seemed easy to use and should take a few seconds to insert. I think you will find they work much better than an OPA/BVM.

Lifeguard I never accused you of being a lawyer, barrister, or litigator of any kind. I believe associating someone of your intelligence with the practice of law would be a serious insult to the profession, and perhaps even put me at risk for libel. That said, what do you plan to do with your big refund? I suggest you use it for a downpayment on an apartment, so you can finally move out of your mothers basement.

Your opinion on the new protocols people? Its my first week back after holidays, so haven't really used any new drugs/equipment yet. However, I see major problems on the horizon with the regressive new on line medical control (OLMC) that we need to contact for certain treatments. Yesterday our crew needed to contact a doctor simply to talk someone into going to the hospital, we had to go through one automated menu, and two different human dispatchers, and one dropped call before a doc even got on the line. With all the waiting it was about ten minutes to connect. Sad.

Mobey, I think that this genius is refering to the fact that he finally received a refund for his paramedic course. Its unknown why he included a link about the strike itself, to give some background on the strike I suppose. Oddly, the story he links to is almost a year old. Bizarre. I guess they don't write news stories on fools who bleet about how unfair life and hold their breath until someone pays up. Hopefully lifeguard will take his refund, and never post on this site sgain.

Really? Really? This is your response? By that logic we should transport every pt on a longboard, just in case there is a crash.

It would be helpful if you mentioned what type of equipment you're talking about. However, if you feel your putting yourself at risk by working for this company, why continue to work there?

Well the cookie monster is out. With a very generous golden parachute too. Looks like he wont need that economy class ticket back to OZ after all. Not with a $20,000.00 payout for "moving expenses."

What practicum are you on? EMT? Paramedic-1st, 2nd, 3rd?

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.

Agreed, I'm not really for dropping Epi from codes, just thinking out loud about what the future may hold. That said, I recently finished the hands on portion of the new MCP's. We are using a dial-a-flow IV device instead of pumps to control Nitro, amiodarone, epi, and dopamine drips. Its interesting that on the packaging for a dial-a-flow it states "Not to be used for Medication administration."

Ok Gadfly, here is the part of the law you neglected to emphasize