VentMedic

Cost is the biggest issue. Many Americans do not have insurance and many of those do not qualify for assistance but may need a hip or knee replacement. Many of the corrective surgeries do not fall within our own government insurances. The cost is generally pennies on the dollar when compared with the U.S. if they paid out of pocket. No, these countries offer a lot more than just herbal treatments. Even many of my respiratory patients venture to Canada or Europe for meds that are not available in the U.S. The practitioners in the U.S. have followed the research for these meds but can not do anything until the U.S. conducts its own lengthy process for the FDA. Even for certain technology, which much of our high tech stuff comes from Europe, we have waited years for a new piece of equipment that has been proven to save lives especially in Neo/Peds. We waited for almost 6 years for a newer version of the Draeger vent for infants that Canada and Europe had been using for several years and finally have gotten it. But, Canada and Europe have now started using the latest model that is even better at saving lung and cerebral tissue while we have yester year's model. Thus, the U.S. is forever behind. There are also many forms of cancer therapies, not just those you read in People magazine, that could be of benefit to our U.S. patients but it will be years before they hit the markert. For EMS, it is fascinating to read an international journal like "Resuscitation" to see what is being researched in other countries. It is really exciting here in the U.S. when we finally get to start trialing medications, therapies and technology that we have been reading about for years in the international critical care journals. Even Cuba has access to the European pipeline of medical advancements that the U.S. does not and that makes it a popular spot for some to travel to including Amaericans.

Did you read the links I posted earlier in this thread? If you follow the links on those pages you will also see some of the clinical data collected. Also, the manufacturers of ResQpod were the sponsors of most of these clinical trials.

One would have to differientate between the illegals (from all countries and not just one), those who can qualify for government assisted programs legally(Cubans), tourists and Snowbirds who may need medical care during their stay be it ongoing or emergent. For the tourists and the snowbirds, just coming to the U.S. for medical care may not have been their intent. However, there are now many companies in the U.S. that specialize in getting Americans medical care in other countries. It is estimated that roughly 6 million people go to another country for their medical care. That number might be lower since it is difficult to track those that go to Cuba which is also considered by Europeans a more popular spot than the U.S. for medical care. Then there are the large numbers of U.S. citizens, especially the senior citizens, who get their prescriptions fill somewhere other than the U.S. For Europeans to get nonemergent medical care here, they must have an insurance that is agreed upon and accepted in the U.S. or they must pay cash. That would depend on them being emergent, a medical necessary or elective. Some American women get upset also when their doctors refuse to work around the mother to be's personal agenda to have a baby born on her time and her way. That also goes for the doctors that scheduled C-Sect day on Thursday so they could have a 3 day weekend.

Liquid perfluorocarbon ventilation, it is not just for science fiction movies like the Abyss.

Nitric Oxide also has the potential to produce nitrogen dioxide (N02) and we do monitor its level closely even though the INOvent should minimize N02 formation.

http://www.jems.com/news_and_articles/news/09/nhlbi_stops_enrollment_in_study_on_resuscitation_methods_for_cardiac_arrest.html http://clinicaltrials.gov/ct2/show/NCT00189423

Tomorrow they are filming a SWAT and bank robbery scene in Oakland. There are public announcements for people not to call the police if they see these idiots running around with guns. This episode will be called "Tunnel Vision". For playing with guns in Oakland, that seems to be an appropriate title. Considering the reputation of Oakland, this season could end sooner if certain members of the community don't get the memo.

Let's compile a list of informative websites that have been mentioned. CDC guidelines for many different groups http://www.cdc.gov/h1n1flu/guidance/ CDC with info for EMS http://www.cdc.gov/h1n1flu/guidance_ems.htm WHO http://www.who.int/en/ CDC updates including each week's statistics http://www.cdc.gov/h1n1flu/whatsnew.htm CDC more updates and maps http://www.cdc.gov/H1n1flu/update.htm WHO map http://gamapserver.who.int/h1n1/trend-resp-diseases/h1n1_trend-resp-diseases.html OSHA http://www.osha.gov/h1n1/ http://www.emsresponder.com/article/article.jsp?id=11020&siteSection=1 Oxygen Mask with filter (FloMax) http://www.blssystemsltd.com/flomax.html

Excellent advice. Unfortunately not every one else around you will follow the same advice. This especially applies to patients and kids. Thus, that is were the vaccine might be needed for those with high exposure risks. Don't speak too soon. The flu season is no where near being over.

There are different 4 year degrees in EMS and your future goals would determine which one is right for you. If you are looking for a promotion in the FD, a degree with a Public Safety, Management or Fire Science would be beneficial. Some that have a large EMS division will definitely see an EMS degree as a benefit that can get you moved up the ladder. You can check almost any FD's promotion requirements to see how they word their degree preferences. If you are looking at a future in Flight medicine, a degree in Paramedicine with an emphasis on either Management or the sciences would be worth your while. Many flight programs require their RNs to have no less than a BSN and they are also the ones who often advance to the head of a program. The reason behind that is generally the Paramedics will only have the minimum hours for a cert as their education. If you want to teach, with the accreditation requirements, the programs at the colleges may become more popular as medic mills start to disappear (hopefully). Teaching at a college generally requires an advanced degree. If you enjoy education and maybe would like to advance the ladder of promotion at a college, you will need at least a Masters and preferably a Ph.D. or doctorate. The Bachelors will give you a good start. There is a lack of EMS educators with higher education which then leaves the upper level positions that oversee EMS education open to the RNs. The same goes for many state office positions involving that state's EMS oversight. If you want to become involved in research, taking the math and statistics courses will be beneficial and the degree will give you additional credibility. You could also get hired to work with a clinical research foundation that does research in EMS or other areas of medicine. If you want to move towards a different health care profession, a college with different degree tracks can provide you with the science prerequisites for easier entry into another program. A good example of this is Loma Linda University. http://www.llu.edu/allied-health/sahp/emc/programinfo.page? From those degrees you could move laterally into just about any health care degree or get an entry level MSN in nursing. There are numerous job opportunities for RNs with an MSN especially if their Bachelors degree is in the sciences and/or health care. The PA program would also be easily within reach. Some will pick up a degree in Accounting, IT, Graphic Arts or Metal Working just to have a nice side job. Of course, if you got your Associates in Paramedicine and then got your Bachelors in just about anything that you preferred, you would still be well ahead of many in the EMS profession and ready for whatever future education changes occur.

Out of all the posts with many paragraphs in each that I have writen in response to the topic you only saw one sentence? Correct. No one is telling anyone to do what a Social Worker does. In fact, I doubt if some actually know what a Social Worker does or how many different health care professionals it takes to get one patient into a home care situation. However, some in EMS believe they do know more than any of the Social Workers or other health care professionals by their rants at the station and on the many threads on the many EMS forums. Yet, few will offer up anything or just dummy up when it counts at the ED or other area of the hospital and cop a "not a Social Worker" or "not my job" attitude. If you know something, some input could be beneficial to get the patient re-evaluated for a more appropriate living situation. If the patient doesn't at least get placed on the radar for tracking, situations causing the complaints will continue. Of course for some there might be a credibility issue as the EDs often hear a few EMS providers whine about every patient they bring in regardless of how sick and injured.

These are already issues that the U.S. CDC and the Canadians have been discussing just as the RT associations (AARC and CSRC) have been sharing there information. Back in the 1980s, with HIV came TB and that is still a serious issue which is part of the reasoning for my own HEPA/battery mask. That also brought the Pentamidine txs which required special considerations. The number of R/Os and treatments we see each day in the hospital is enough to warrant quality protection. RSV season in the 80s brought the Ribavirin which required masking. Then came the HANTA virus which again brought the exposure to both the virus and the Ribavirin again. Then Avian flu, SARS and H1N1. You can also toss in the rest of the alphabet of bacteria and viruses to get blasted around with the various pieces of equipment we now have. And, in the hospital one has to consider all the gases and medications we are using that are approved and being trialed. Even all the nebulized antibiotics we run can pose some possible occupational exposure problems. For CCT/Specialty, we do have the capability to run most of them. So, good luck with your ICU plans. Where are the HEPA filters located? Do you have a link to the type of NRBM you are using? The face mask itself does not form a good seal and without the side port openings, the gas will follow the path of least resistance.

I just had to emphasize that since many on other forums and the EMT(P)s bringing patients to our ED are under the assumption that oxygen masks are protection. Also, some believe that the BVM via FM or ETT filters out the particles but that is only true if some type of filter is placed between the patient and the BVM. The same for ATVs and other portable ventilators. Not only has H1N1 been a problem but also meningititis. I've taken more than enough Cipro this year from exposure to patients being brought in by EMS. Be mindful where you are aiming the BVM exhaust. Thus, I now greet almost everyone with a mask. I have seen enough severe cases of PNA caused by various flus, MRSA, MSSA, Strep and whatever other alphabet the lab can find that I now consider everyone guilty until proven otherwise or deceased.

No oxygen mask will protect against any aerosolized particles. In fact, almost any O2 mask will aerosolize the particle to spread t/o the immediate area. It was actually Canada and China that tracked the spread of SARS that came up with the O2 device guidelines which the U.S. CDC and RT association, AARC, have adopted. Also, just this week the U.S. nurses, especially CA, have won a victory with the N95 masks and hospitals will now be held to the higher CDC standards for protection. Thus, everyone is now trying to hold onto a mask. Myself, I am now wearing a battery operated HEPA full hood mask in the ICUs. But, we do have quite a few confirmed cases on serious O2 and devices. All precautions are also being taken when doing IFT with the truck, RW and FW.

Wear your N95 masks for patients on CPAP, nebulizeres, NRBMs, SM, etc. This may have to apply to anyone in the truck while these devices are on the patient. Everyone (U.S.) should be monitoring the CDC website for updates. Hospitals are being held to these guidelines and they are expecting EMS providers to be up to date as well when it comes to protecting the patients and bystanders in the care areas and entry ways. http://www.cdc.gov/h1n1flu/guidance_ems.htm http://www.cdc.gov/h1n1flu/guidance/

Avoidance of addressing issues concerning everyday healthcare situations do not make them go away. Every other profession has had to expand their knowledge, education, roles and ways of thinking to meet the challenges.

Please tell me you are not getting as old and feeble as spenac. Here are a couple photos of "face to face" or "tomahawk intubation. http://www.anestezjologiairatownictwo.pl/archiwum/2009_02_face_to_face_intubation.pdf http://highered.mcgraw-hill.com/sites/dl/free/0073520713/462736/SS16_ET_Intubation_Face_to_Face.pdf

So I am not allowed to have a tone but herb can? You don't have to read my posts. However, you should not criticize patient care issues that you do not have much information about or very experience with. Herbie has taken this to a very personal level and has bashed me on almost every thread I have posted on this forum for the past year. So yes, my tone with him will be cold. And yes, when I am discussing various quotes from the literature and formulas, the post is dry and not exactly warm and fuzzy. I also don't care to dumb down all of my posts as there are mature and intelligent people on this forum who can handle a discussion that is full of medical, government and welfare issues. We have had numerous discussions here about treating and leaving patients at scene but yet some are not willing to even tell the ED RN to check the "consult Social Sevices" box on his/her paperwork or fill out a little piece of paper in the ED. Thus, it appears some are not ready for EMS providers to take the next step in the numerous health care issues this country has and it isn't because of inadequate training but more the attitudes that continue to prevail. Thus, instead of being a health care provider, some will always have the "tech" mentality of just doing A task. Eventually, EMS providers will be recognized as health care professionals but there will always be those opposed to change and will continue to just destroy the patient's equipment rarely than doing a little "thinking" to find the correct channels to find a solution. Of course once one has destroyed the patient's LifeLine property, you can not follow the correct channels to correct anything. For this reason some in EMS will always have recipes to follow instead of guidelines. For some, there will also always be a union to tell you how to vote or think a certain way.

This is not that difficult. There are over 50 different styles of blades out there that are off the curved and the straight. I don't know which one you are using and frankly I don't need to know. The important thing is that you UNDERSTAND how and why your equipment is designed the way it is and the anatomy and/or condition of the patient. If you want to use your other hand, choose the appropriate equipment for the patient. Don't do something because someone says this or that or dares you. Use equipment correctly and the way it was designed and/or the way you have been trained. In the field is not the time to be screwing around trying to do something just to prove something. Also, wasting classroom time mucking around instead of perfecting good technique is not the best use of the lab either. Class time is too short already and too few intubations "the regular way" are required as it is now. I mentioned the "tomahawk" method. If you have not been trained for that method, don't do it. But, you should have an alternative method that you are comfortable with. Supraglottic devices are not always appropriate for facial trauma because of bleeding, foreign bodies and aspiration. Thus, have a plan A, B, or C handy. And yes I did answer your questions by this comment and the links I posted. Observe how the blade is to be positioned and how the light and groove assist the passage of the tube.

That depends on how long extrication will take and the injuries of the patient. C-spine shouldn't be a problem if you have someone holding the head. There are some facial injuries that may be unsuitable for supraglottic devices especially the Combitube. It is always good to have many intubation alternatives with indepth knowledge of various methods in your tool kit. I have used many different intubation methods t/o my career for whatever reasons including location/position of the patient and equipment failure. Also, when I first started in EMS, the EOA was about the only alternative airway device available. Thus, I became very knowledgable and proficient at ETI by whatever method. Of course knowing how to use a BVM and when not to do ETI or cause harm by repeated attempts are equally important. I will say Digital Intubation would not be my preferred alternative method for adults but for neonates it is an option.

You can pull up many intubation videos on YouTube and see why it is important for you, the light, and slide groove on the blade to line up appropriately. Also, it is a little more than just moving the tongue and jaw as each blade type has a specific anatomy landmark destination for correct visualization of the cords. Here is a good site. It also has some of the intubation methods and devices I have mentioned in previous posts. http://www.theairwaysite.com/video/videos.aspx?videoID=8 Here is a good animation. http://www.medicalvideos.us/videos-2121-Endotracheal-Intubation-Sample-Animation I believe the face to face method Anthony is referring to is also known as "the pick axe" or "tomahawk" method. This technique is performed with the intubator facing the patient and holding the laryngoscope like a pick axe or tomahawk. Unlike conventional laryngoscopy, the laryngoscope is held in the right hand with the blade facing downwards and the endotracheal tube is held in the left hand. The blade is inserted in the mouth from the patient's right side and the tongue is displaced to the patient's left while the intubator pulls the laryngoscope downwards and towards him/her. This technique is useful in the patient presenting in a seated position and is useful in motor vehicle collision scenarios. A variation of the technique can also be used in the limited access patient who is supine by having the intubator straddle the patient and bend forwards to be face-to-face with the patient. Such a scenario might occur when intubating an unresponsive patient who is wedged in a bathroom between the toilet and the tub or similar setting.

There is also the issue if you did do damage to the patient when intubating, you might have to justify why you are using a piece of equipment in a way other than what it was designed and how you were trained.

Intubation equipment is commonly designed for the right handed person. Since the world basically evolves around the right handed, left handed people are usually ambidextrous. Some left hand doctors do have their own left handed blades. And, left handed blades are also used by some right handed people for difficult intubations involving some type of mass or oral surgery if a flex scope is not necessary. We do keep a left handed Mac 3 and 4 on the main difficult airway cart, the OR and the bronchoscopy lab especially if teaching or videotaping. However, for someone just switching hands for the heck of it, the blade design and light may be a hindrance as akflightmedic already posted. Of course there are also intubations and procedures that can be done where the light source and support of the blade is used but it is not the primary intubation device. That technique may even be required when doing an assisted flex scope intubation.

Here's a news flash for you Herb, the new education standards are coming out whether you like it or not. Having 4 -7 different levels for EMS providers each state and each state different from each other is of no benefit to EMS, the patient or the individual who tries to move from state to state. I grew up, got an education and starting working with those who didn't just sit in the easy chair at the station spewing complaints about their patients, their job and their life. Read you own negative comments on this forum and use those as an example to what I am talking about. There are some secret ways to staying in a profession for over 30 years and that is not to stop learning and not to put up with crap from burnt out EMT(P)s who have long ago stopped caring. I continued my education to make a difference and some can't handle change. I think your arguments for the many different levels and that everything is fine in EMS have demonstrated that attitude greatly. It is time some in EMS decide if they want to be part of the future or it they should just get out and shut up if they have nothing productive left to offer this profession and the public they serve. Change is coming whether you like it or not. Maybe you should also broaden your reading opinions from more than just an anonymous EMS forum. Have you even been to a regional, state or national education meeting to discuss anything pertaining to EMS? You actually know a few people on this forum that have and it is a shame you consider all of them "out of touch". I'm sure Dr. Bledsoe likes hearing he is out of touch. How about Rid? What about our two ED doctors that take time to educate those in EMS and support the providers? You generalize and bash way too many things and people you know very little about.

I read the same comments on the American EMS forums with the ALS vs BLS discussions, the education debates and the EMTs who will never advance to Paramedic. If you've ever been around some of the larger American BLS transport companies you will hear the EMTs say the same things. The only thing that will get them away from that job is one on an engine with a FD.