VentMedic

The PAs have taken a leading role nationally for health care reform and have started gearing their programs to provide assistance in a broader area. This also give them the edge to advancing their minimum education levels as initiate many residency programs. http://www.aapa.org/ The Nurse Practitioners have also been proactive in legislative issues as well as advancing their minimum education standards. http://www.aanp.org/AANPCMS2 The Public Health Nurses are also making headlines across the country with some of their programs. They also have a strong national association. http://www.apha.org/membergroups/sections/aphasections/phn/ National Association of Social Workers - http://www.socialworkers.org/ Respiratory Therapists are petitioning for a variety of Bills that would benefit Medicare patients as well as increasing their own opportunities for those with Bachelors or Masters degrees. http://www.aarc.org Physical Therapists have been the leaders of the allied health professions when it comes to health care reform and being models for bringing about change for their patients especially those on Medicare. They also have raised their education impressively. http://www.apta.org//AM/Template.cfm?Section=Home Occupational Therapy is another impressive profession and their national association is gaining strength. Their education minimums also continue to increase. http://www.aota.org/ Speech Therapy also very impressive with impressive education minimums which has given them new roles and leverage. http://www.asha.org/advocacy/ Radiology Technologists and their national association have also made a difference in supporting projects that give access to medical imaging and treatment for those who otherwise might not have access to it. https://www.asrt.org/ Medical Lab Technologists must not be forgotten and their role in point of care testing regulations. http://www.amt1.com/ http://www.ascp.org/ BTW, these are not unions. In fact most of these professionals would rather not be with a union as it may limit their ability to negotiate for salary and legislation based on education and what they can do to benefit the patient. Also, if you attend the state and national conferences of these professionals, you will find that the attendance to the sections (political, reimbursement, legislative) that are normally only attract a few EMS providers are generally standing room only. They learned how to get the backing for reimbursement to gain strength to enhance services for their patients and offer their profession many more opportunities. Public Health care is a very large field which encompasses many different patients. EMS actually only sees a few but that may seem like a lot depending on that area's resources. Some will just complain about a couple of repeat callers but what they don't realize is the many thousands that aren't calling 911 because of various professionals and services available in some cities. There are numerous patients with TB, HIV, AIDS, pallative care needs, autoimmune diseases, diabetes, COPD, paralysis, cancer, advanced technology (ventilators, LVADs) congenital abnormalities and birth defects that require specialized care in the community. While Wake County may have a good thing, it might not work anywhere else because the support in not there nationally from the members of the EMS profession. Too many doing EMS (FDs, private, country, city, EMT-Bs through Z) have their own agenda and often the focus is not about providing the best patient care.

Wake County has a good idea but there are some from that area that complain they are tied up doing "social services" when they should be rushing over to help intubate a patient. Washington D.C. has tried to start something like that after their PR scandals. These programs should not of coures relieve the hospitals of their responsibility to referring the patients to the appropriate counseling especially for those with diabetes, asthma/COPD and cardiac problems. Every health care practitiioner knows their limitations when it comes to teaching complex care and a bandaid to prevent a couple of ambulance calls should stop the over deterioration of the patient if proper counseling is not instituted.

The example this article provided is not necessarily a 911 EMS abuse but rather a health care system failure. Also with this person's history, this could easily have become a medical emergency. Right now those of us who work in the hospital are seeing sicker patients because they can not get in to a doctor's office and the community as well as the state services don't always have available alternative transport. A taxi ride may cost $30 to $75 dollars cash which may seem like nothing to some here but to someone on a fixed income that might as well be a month's worth of groceries. The patients may also have put off calling 911 because the do know what 911 abuse is and used it as a last resort which did article did say the woman explored her available options so let's not label her as an EMS call sucking villian. It is sad when some get old, ill and have no close family members to take care of them. However, once they do get to the hospital, they may be admitted to the hospital for a lengthy stay which may even be in the ICU. Thus, that ties up critical care beds. The hospital may have to go on diversion for some patients and that is also sure to piss off EMT(P)s. It is a no win situation for anyone involved in any aspect of healthcre in this country. If there was a way for these patients to get access to early care, it may only be an office visit. This lady with her medical problems may spend at least a week in the hospital as the article did not say what her treatment or diagnosis actually was. Unfortunately, the community health Paramedic also has its draw backs in programs that have been attempted throughout the years. Some agencies used this position for those on light duty or when someone was removed from the 911 trucks for some screwup. While it can work, it has a stigma to it and not many Paramedics want to do the job of home visits any more than they want to do dialyis calls. Overall right now, the Paramedic is not in the best position to offer a solution as this profession still has to define itself. However, NPs, PAs, RNs and all the allied heath professions have been working through their own state and national organizations as well as collectively to bring about some change. If they hadn't been working on this for the past 20 years, EMS would definitely have seen more calls and there would be much more overcrowding in the facilities. A couple of recent articles: Researchers Study Whether U.S. Medics Can Make Transport Decisions Keith Wesley, MD, FACEP, Marshall J. Washick, BS, NREMT-P http://www.jems.com/news_and_articles/columns/Wesley/can_medics_make_transport_decisions.html Paramedic Determinations of Medical Necessity: A Meta-Analysis http://www.informaworld.com/smpp/content~db=all~content=a914292045

Even in the early 70s oxgygen equipment was not well suited for transport. There were no D tanks and the ones they had were heavy and bulky. Oxygen tents were still a popular means of delivering O2 in the hospitals. BVMs were still fairly primitive and not very practical for resuscitation. Modern CPR was still being improved upon. Not a lot of disposable equipment. The old Emerson resuscitator (later replaced by the Elder demand valve) was a bulky gas hog. Then when you added on the size of the defibrillator and the MAST to a stretcher that waa no were near what we have today, nor the stair chairs, it is a wonder we didn't just make the patient run along side while the equipment was on the stretcher. On one of my early pedi IFT transports around 1980, the RN and RT had the child strapped to an adult back board with an early verson of the Servo ventilator attached which was the closest thing we had to portable even then that could be easily adjusted. The Birds were also portable but bulky and gas hogs. Pulse oximetry (as well as ABG analysis) was also still in its infancy in the 70s and believe it or not if the patient didn't just get 100% O2, we actually had to assess the patient's color, HR, perfusion and breath sounds to adjust the O2. Actually some of the earlier devices had just one Venturi adjustment with either 100% or somewhere around 40 or 50%. CPAP has been around for since the mid 1900s and even in home care for a couple of decades before EMS saw it. Ambulance services were also not well regulated in the 1970s and California was of course having each county do its own thing.

The EMT-B is barely a good start in medicine. Take a few college level A&P classes and work a BLS transport truck until you can get into Paramedic school. You will have your own private lab with live patients to learn assessments, communication skills and read the charts where you will see disease names and meds that you will not get to in a 911 service. You will be way ahead of most Paramedics who ignored these opportunities when they were working BLS transfer because they just wanted the "action". The dialysis patient is probably one of the sickest patients you can have daily on your truck and yet, so few even take the time to know why the patient is on dialysis except for "renal failure". The acute rehab patients your transfer for advance physical therapy may have been some Paramedic's save from a trauma, CVA or cardiac arrests. They deserve someone who is attentive and they are probably over being the center of some EMT's "excitement". You might also see what happens to spinal cord injuries and learn how these are stabilized once they reach the hospital. You might also see how hospitals document how a patient is presented to them from the EMT(P)s especially for spinal and head traumas. That can help you later when you start doing 911 calls and will be giving report to the ED staff. They do take notes on everything even if they appear not to be paying attention. It would also be interesting just to read the extent of their injuries and see how they have progressed. It can be a big motivator for you to continue your education to learn how to better serve these patients or the ones you will see in the future as fresh traumas or cardiac arrests. Take advantage of asking questions of other health care professionals when you do transport patients in a more controlled environment. Network and you might be surprised at the opportunities that come your way. If you don't make good use of the opportuniites given to you on a BLS truck, don't get your expectations up to high when you get on an ALS truck. And again, never forget that the BLS or "BS" transfer patient or the dialysis patient could have been another EMT(P)'s save. Treat them with respect. They've got a lot to offer for anyone who is interested in "medicine".

Sad. Very sad. He was in an ambulance responding with lights and sirens to a car fire. http://www.wsbtv.com/slideshow/news/22066002/detail.html Thoughts and prayers to the family. Slow down and be safe out there on the roads. Expect the unexpected.

Some really sad news articles on the FF Close Calls site. This one is for the numerous newcomers to EMS who are anxious to equip their POV with trauma bags and cruise the roads looking for excitement. It is dangerous to approach any scene off duty especially when you are just starting out. Never put yourself or your family at risk. My thoughts and prayers go out to the family of this off duty FF who not only lost a loved one but had to witness it as well. Keep yourself and your family safe. Dial 911. If you really feel you must stop, get your vehicle to a very safe parking spot and don't become part of the scene as another patient. Stop only if you can make a difference and not just to be part of the gawkers. The family of this FF may or may not collect his benefits but he is dead. http://firefighterclosecalls.com/fullstory.php?98816 VERMONT FIREFIGHTER KILLED WHILE RENDERING AID Monday, December 28, 2009 - An off-duty Shoreham Volunteer Firefighter was killed while helping at the scene of a car crash. It happened at about 6:30 p.m. Sunday evening at an on Richville Dam Road in Shoreham. There was heavy fog and the roads were icy when police say a car, driven by 26-year-old Rachel Herrick of Shoreham, was heading west when she slid off the road into a ditch. Volunteer firefighter, 43-year-old Peter Coe of Shoreham, was driving with his family when he reportedly pulled over and got out of his car to help. That's when police say the driver of an oncoming pickup truck, who didn't see Coe's car due to its location, tried to avoid hitting the car. The driver, 30-year-old Jason Vandeweert of Addison, reportedly went off the road, hitting Coe, a power line, a tree and Herrick's car. Coe died from his injuries. Vandeweert wasn't seriously hurt. The accident is still under investigation but no charges have been filed.

Old? You are of course referring to spenac and not to those of us who are still waiting for our 39th birthday? Welcome piranah.

A watch is a personal choice. It should be functional with being easy to clean and I prefer the band not to conduct heat. It should be easy to see for your work environment and eyesight. It should stand up well to your work environment. I live, work and play around water so being water proof is a plus. I also don't like to switch watches a lot between work and play. The times I do change are for those occasions when only a Rolex will do to go with the shoes.

The whole sentence is: Also, many of the studies were done on long term effects and not for the 15 minutes an EMT(P) are with a patient. It is rare that a Paramedic will spend many hours with a patient and if they do they will or should have advanced protocols/equipment to deal with those situations. For Specialty, Flight and CCCT we will have several pressors, advanced ventilators, Nitric Oxide, Flolan or something similar and in some areas heliox might be available although the tank will not last very long. Each of these therapies may enable us to reduce the FiO2 as the situation allows. Again, a few situations will require us to remain at an FiO2 of 1.0. However, thanks for the compliment on my post. I remember back 2 -3 years ago when you and I used to have indepth conversations on another forum about these topics.

Let's do a little more background work since each of your questions can get rather indepth. The oxygen saturation measured by a pulse oximeter (SpO2) is not the same as the SaO2 measured by a laboratory cooximeter. The pulse oximeter measures the "functional" saturation of hemoglobin. Functional saturation represents the amount of oxygenated hemoglobin in a percentage form of the total reduced and oxygenated hemoglobin. The laboratory cooximeters use multiple wavelengths that distinguish other types of hemoglobin (methemoglobin and carboxyhemoglobin) and thus measure true fractional saturation, or amount of oxygenated hemoglobin in a percentage form of the total reduced + oxygenated hemoglobin + methemoglobin, + carboxyhemoglobin. This is why the SpO2 measurement can exceed the SaO2 reading in certain conditions. Oxygen delivery is a product of cardiac output and oxygen content. The equation for arterial oxygen content is CaO2= (1.37 X Hb X SaO2) + (0.003 X PaO2). From this equation, it is noted that normoxemia does not necessarily guarantee adequate oxygen content. However, since the PaO2 contributes only 0.003 volume percent to the blood oxygen content, the most important factors in determining oxygen content become the hemoglobin concentration and the percent saturation. In order to interpret the results of pulse oximetry, keep in mind the shape of the oxygen hemoglobin dissociation curve, which is not linear and explains why the SpO2 is not a replacement for the SaO2 and the PaO2. Due to the shape of the curve, large decreases in PaO2 may be accompanied by only small changes in the SaO2 in areas other than the steep part of the curve, where a predictable correlation exists between SaO2 and PaO2. A patient’s oxygen content may therefore drop steeply before it is detected by pulse oximetry. Shifts in the oxyhemoglobin saturation curve also influence the relationship between PaO2 and SpO2. The information provided by the pulse oximeter is not a replacement for the PaO2, but is complementary to the PaO2. However, the pulse oximeter becomes an ideal continuous monitor of tissue oxygen delivery in the face of normal hemoglobin concentration, and normal types of hemoglobin (vs. methemoglobin and carboxyhemoglobin). http://www.lakesidepress.com/pulmonary/ABG/PO2.htm Excellent for oxygen hemoglobin dissociation curve http://www.ccmtutorials.com/rs/oxygen/index.htm As much as I hate to do this, I am going to reference a thread from the other forum since it also addresses some of the same questions. http://www.emtlife.com/showthread.php?t=7157&highlight=PaO2 Now of course before one gets deeply into the physiology one should have an understanding of their oxygen equipment and the differences between oxygenation and ventilation. You may already have mastered that but many have not which is why I'm back tracking a little.

Bledsoe did provide some misleading information in that article. From the AAP and the 2005 NRP guidelines which were in effect when he published that articls: For babies born at term, • The Guidelines recommend use of 100% supplemental oxygen when a baby is cyanotic or when positive pressure ventilation is required during neonatal resuscitation. • However, research suggests that resuscitation with something less than 100% may be just as successful. It does not say room air. Some do start at 40%, 50% or 60% but not room air. • If resuscitation is started with less than 100% oxygen, supplemental oxygen up to 100% should be administered if there is no appreciable improvement within 90 seconds following birth. You do not wait for "failure". • If supplemental oxygen is unavailable, use room air to deliver positive-pressure ventilation. This article did more to explain the death of the hypoxic drive theory by way of the release of hypoxic pulmonary vasoconstriction and ventilation/perfusion mismatching. http://chestjournal.chestpubs.org/content/124/4/1312.full'>http://chestjournal.chestpubs.org/content/124/4/1312.full From the article (if this is the article you referenced): But then for asthma, oxygenation is generally not the issue but rather ventilation which is why 80/20 and 70/30 HeliOx mixtures are used. However, when 21% or 100% O2 can not be ventilated for gas exchange and no heliox is available, you use what you have available to maintain SpO2 even if that means 100% oxygen. For all the other situations, there are variables in each situation that must be examined. No blanket statment should be made for any one situation at there are some situations where 100% O2 will be necessary. Prehospital just hasn't gotten so far as to running SvO2 or StO2 monitoring on everyone to see the tissue oxygenation. Also, many of the studies were done on long term effects and not for the 15 minutes an EMT(P) are with a patient. Right now StO2 monitoring is becoming more populat if SvO2 is not immediately available although one can be obtained by iSTAT or other POC as soon as central venous access is available. Thus, the patient is then treated by that rather than the SpO2 or SaO2. If the patient is septic, there are also guidelines and protocols in place for 100% O2 to be initiated. Pulmonary HTN is also an issue after a traumatic event as is ARDS and both may require 100% O2 until the patient can be placed on the proper gases, ventilator and medicine. The same is true for PPHN of the neonate. Right now, O2 is used with caution and maybe not at all or even subambient for ductal dependent cyanotic heart lesions. For others, research is still being done in a very controlled environment. However, I think it is great that you are reading the journals. The further you advance in college, the more all of this will start to make sense. But, in medicine there are very few concrete answers which makes it an exciting field to be in. Just when we think we've got all our guidelines and protocols working smoothly the patient decides to toss us another issue just to see if we're paying attention. It is those who take everything in their protocols as "the word" and fail to look at the whole picture that miss what the patient's body is trying to tell you. When reading an article, look at the whole study to see similarities and differences. They may be focused on proving just their one theory when they have actually supported something else. Thus, that leads to another research article to be written. CEHST is a great journal for those who want to know what is happening in the world of Cardiopulmonary Science: http://chestjournal.chestpubs.org/ The Journal of Respiratory and Critical Care Medicine is also a great journal. http://ajrccm.atsjournals.org/ For prehospital: Prehospital Emergency Carehttp://www.informaworld.com/smpp/title~content=t713698281~db=all Resuscitation Journal also has some great articles from an international perspective. http://www.elsevier.com/wps/find/journaldescription.cws_home/505959/description#description For those interested in neonates and pediatrics: AAP http://www.aap.org/ NRP http://www.aap.org/nrp/nrpmain.html Johns Hopkins Neonatal Newsletter http://www.eneonatalreview.com/ Journal of Pediatrics http://www.jpeds.com/ Annals of Pediatric Cardiology http://www.annalspc.com/ Also, after reading the many articles in the various journals, one can easily see why "scenarios" are not always as simple as they appear. You may have treated an obvious symptom but have not actually diagnosed the cause but rather assessed for a working diagnosis to run the protocols you have available. The more knowledge you acquire, the more protocols or guidelines you may have to go with your assessments when working in different areas as a Paramedic such as Flight, CCT or Specialty transport. Keep researching the journals. They'll open you eyes even more to the vast information out there and hopefully inspire you to take your career to a higher level regardless of what title you work under. I almost forgot to reference the Canadians. They've been known to do some fine medical research also. Canadian Respiratory Journal http://www.pulsus.com/journals/journalHome.jsp?HCtype=Consumer&jnlKy=4&/home2.htm&

Quote from an article previously referenced by paramedicmike in post #36: http://ny1.com/1-all-boroughs-news-content/top_stories/110776/two-emts-suspended-after-they-allegedly-ignore-dying-woman Another article: FDNY EMTs may get jail time after refusing treatment December 24, 2009 http://www.ems1.com/ems-management/articles/734145-FDNY-EMTs-may-get-jail-time-after-refusing-treatment/ By Murray Weiss, Alex Ginsberg and Dan Mangan The New York Post NEW YORK — Brooklyn prosecutors are eyeing stiff charges that carry potential prison time for the two EMTs accused of failing to help a dying, pregnant woman on their coffee break, The Post has learned. The EMTs — Jason Green and Melisa Jackson — will likely be slapped with reckless-endangerment raps if the District Attorney's Office determines they acted criminally in connection with the Dec. 9 deaths of Au Bon Pain worker Eutisha Rennix, 25, and her prematurely born baby, sources said. First-degree reckless endangerment carries a maximum seven-year prison term upon conviction, while the second-degree charge calls for a one-year max. In building their case, prosecutors are focusing on regulations that obligate EMTs to provide help to people whenever there is an emergency, sources said. Au Bon Pain staffers have said Green, 32, and his 23-year-old girlfriend, Jackson — both of whom work as dispatchers in the same Downtown Brooklyn building as the coffee shop — refused to look at the stricken Rennix after being told she was in distress. Sources shot down a union official's claim that the two hadn't treated a patient in years, saying they had recently been recertified and were more than capable of helping Rennix. Their lawyer, Douglas Rosenthal, said, "While I cannot discuss any charges, as none have been served yet, I am confident the true facts and evidence will establish my clients acted appropriate to the best of their abilities." Yesterday, Rennix's mom, Cynthia Rennix, called Green and Jackson "very inhuman and heartless." "They have a duty to act, and they should have acted on that duty," the grieving mom told The Post. "I mean, if this was your own [daughter], how would you feel?" The city Medical Examiner's Office said it told the family it would foot the bill to have Rennix's body exhumed and an autopsy conducted. Her mother said she hasn't decided yet. Before the allegations against the EMTs came to light, "she would have rested in peace, and the family would have moved on," the mom said. "But because of new information, I don't know where to begin." Jeff Samerson, an executive with EMS Union Local 2507, yesterday resigned after members blasted him for coming to the defense of Green and Jackson Monday, when he told reporters the pair "have not had patient contact in years." Later, he changed his tune, saying, "I think they should be fired. They had a duty to act, and they didn't."

NCTI is AMR's "EMT and medic mill". They are very expensive where the community colleges are roughly $25/credit hour. Also, at the colleges, you get actual college credit which will transfer within almost any college system. NCTI's credits will go nowhere. You may not want to stay just as an EMT but may want to advance to Paramedic or some other health field. Being established in a college will be a plus. Of course, since NCTI is a private trade school, they are professional sales people and will attempt to sell you a package deal including their "week long" Anatomy and Physiology class which they say is exactly the same almost as what you get in a college. They will then attempt to get you to sign up for their Paramedic program for some obscene amount but presented to you as "all for just one low price of $xx,000 and 10 years of loan payments. Unfortunately, the EMT-B will not give you alot of clinical experience. However, I do think the lab at SF-CC is adequate despite being a little shabby if they are still in the same location. But, if their class structure is set up for more lecture as well as lab, that is way ahead of the 4 or 8 week programs that still only come out to 120 hours of training. But, again, the perk is getting your foot in the door of a decent college system for future endeavors. I also suggest taking some real college Anatomy and Physiology courses so you will have a better understanding of the skills you will be doing with the hands on part. A 120 hour course is not enough. You will also be better prepared for Paramedic school and whatever the future holds for EMS. Too many find Paramedic school difficult because they have not taken classes since high school. Paramedic school is also not that long and instead of giving you a good foundation first, it relies a lot on memorization. If you take a few foundation courses first, Paramedic school will be much easier for you. You are still young so don't get overly concerned about time.

Did you check out all the City/Community colleges before settling for NCTI?

I guess now the arguments would be if dispatchers have the same duty to act on the streets as other Paramedics, EMTs and FFs. What patches were these two wearing? They at least must have had on some identifying uniform that said NYFD or EMS on it.

I will be the first to argue that when off duty you should never put yourself or your family in harms way. You should not be forced to pull over on a busy highway to stop at every accident scene. You should not be forced to run into a burning building or dive into the ocean to rescue someone while off duty. However, you can still call 911. I only stop if there is something I can reasonably do and in a manner that I will not become another rescue or patient. For a situation like the one in the article, you can at least appear to be concerned. Since they were on duty, there is no excuse. But then, I'm sure the union will post a statement soon defending these two and their break time.

There's probably more to this story but a lesson can still be learned from it. When you are in uniform, either on or off duty, be careful what you say and do or how you say and do something. Those who like to wear some type of EMT patch or shirt 24/7 may fall under scrutiny some day and may not even be aware of it. You do get noticed regardless of all those who say the public doesn't know who you are. They know what EMT means even if they don't know every little skill you can do. The comments below the articles are also interesting. Another article today: Brooklyn mother rips 'heartless' EMTs who are accused of refusing to help her dying daughter BY Simone Weichselbaum and Jonathan Lemire DAILY NEWS STAFF WRITERS Monday, December 21st 2009, 4:00 AM Read more: http://www.nydailynews.com/ny_local/2009/12/21/2009-12-21_bklyn_ma_rips_callous_emts_as_heartless.html#ixzz0aLDesFP0 Interesting quote: The two EMTs were placed on modified duty and are barred from providing patient care, FDNY officials said. Reports of their inaction infuriated Mayor Bloomberg. "It was unconscionable," said Bloomberg. "But even if they weren't part of the Fire Department sworn to protect all of us, just normal human beings, drop your coffee and go help somebody if they're dying. Come on." More from the Mayor: Mayor Rips EMTs who refused to help dying pregnant mother http://www.nypost.com/p/news/local/brooklyn/mike_rips_emts_in_preg_mom_death_5d0UDQYANcSrLDN4ZnqitI

The title says it all: Union President Defends Fire Crews As well, so does this comment: The investigation into paramedic protocol at an armed robbery is not complete, but Atlanta Professional Fire Fighter Association President Lt. James Daws has already weighed in. The Medical Examiner and the Medical Director for the Paramedics have not released their reports.

How many times are people going to pay $1000+ in cash for a CT Scan? Of course if something is found it will have to be repeated. We could also complain about mammograms. But, for the underprivileged where the screening have been eliminated due to cutbacks, they might think denying them access to these tests is not very fair. As well, if you don't have insurance, you will NOT get a CT Scan unless you put up the cash or come through the ED and say the right words.

It is a good thing we didn't have kids together. I also worked in the cath lab for a couple of years. That is another area for radiation exposure for both the patient and the HCW. And let's not forget all the bronchoscopies we've done under fluoro. http://www.cathlabdigest.com/articles/Radiation-Tracking-Cardiac-Catheterization-Lab

Not having the CT Scan can be more risky than having it, especially if cancer is suspected. The risks and benefit must be weighed. I would rather have confirmation of something in my head, chest or abdomen before undergoing the knife. For a cardiac check up I would rather have CT Angiography than a Cardiac Cath. For piece of mind, I would like to know my headache post fall is not a subdural bleed. The risk of the effects of radiation is worth that. Yes, there are times when the CT Scan might be used excessively but that is usually for the ICU patient who may have 2 scans a day for several days. Of course, someone always justifies why each are necessary. Also, as a health care provider over the years in various patient care settings, I have worn the radiation badge to see how much I have been zapped with inadvertently. Now that is a concern and maybe more studies should be done on those in health care from various expenses to radiation, radioactive material and chemo meds as well as all the other medication and gas exposure in the work environments. Some CCT and Flight crews are exposed to some of these in close quarters of their vehicles almost weekly. What are the long term health effects? Now that is a study I would like to see.

I guess you haven't seen all the damage that can be done to the throat and cords by botched intubations or repeated attempts when ego takes over where commonsense should have stepped up. They don't come to us in the ED "all cleaned up" but rather their oral cavities are sometimes full of blood and vomit. Suctioning is even a lot art partly due to lack of training for the skill or too lazy to get out the equipment. It is sad when a patient who should have spent only a few hours on the ventilator ends up on it for over a week and possibly a trach to get them off of it while the throat heals. For some, vocal cord paralysis may be permanent. Unfortunately I have seen this happen too many times to young people who have taken GHB or OD'd on alcohol. Some Paramedics have even gone as far to say the patient got what they deserved to justify their lack of ability to intubate or the commonsense to back off and try something different. If some were given the better equipment, would that automatically make them better intubators? Some don't get a solid foundation for the procedure in the (U.S) Paramedic programs to where 5 successful passes on a manikin is considered adequate. Then when companies do not even offer refreshers on a manikin head for those who do get only one or two or none for the number of intubations, we have a problem much larger than just getting some new equipment. How many of our ALS IFT or CCT services even require a minimum number of intubations for their Paramedics. Some may have worked for years on these trucks without even starting an IV. You can also work for years on an ALS engine without the need to intubate if you can stall until the Fire Rescue truck or county EMS arrives.

JPINFV is our expert on this issue for LA County so you might PM him for the specifics. But some of the basic information is here: http://www.emsa.ca.gov/personnel/EMT_FAQ.asp You must also contact the individual county. http://www.emsa.ca.gov/local/admins.asp http://ems.dhs.lacounty.gov/ http://ems.dhs.lacounty.gov/Certification/Cert.htm

San Antonio Paramedics also thought that way at one time. I have seen many very bad TBIs or trauma to the face and head survive and actually do very well. Others survived long enough to be a good organ donor which is definitely okay also as one very tragic event can bring hope to others. If the person still has a heart beat and breath in their body, should we treat them like some injured animal lying along the roadside to die or do we make their last minutes, hours or days comfortable even if it is just allowing the family to know someone cared enough to check on them?