VentMedic

The the State, local, OSHA and hospital policies and mandates. You should check your company's P&P for exposure guidelines. The Ryan White Act was not created for EMS. Many in EMS have no idea who Ryan White was or that this piece of legislation even existed until somebody said it was being eliminated. It is a multi-billion dollar ACT to provide assistance for people living with HIV/AIDS. Back during the early 1990s when this ACT was initiated, HIV was still in its infancy in this country. Through education, we have taken much of the mystery out of exposure. We've come a long way since FFs were afraid to fight an arson fire that destroyed the home of the Ray brothers in 1986. http://hab.hrsa.gov/about/ http://www.medadvocates.org/adapfund/drug_...n_main.html#new Finanacial info in brief - full document in above link http://www.hrsa.gov/about/budgetjustificat...yanWhiteHIV.htm 2005 Reauthorization which should take it through 2010. However, a Federally funded program this huge will be subject to the budget cuts of the government. http://www.hhs.gov/news/press/2005pres/ryanwhite.html For the diseases that are most are concerned with, the notification process must all also be reported to the Department of Public Health or some representative agency of the CDC. They will ask the reporting facility if all who had potential exposure were notified. However, the diseases where you should be protected by just standard precautions will not be a priority for them to notify you. Example of Florida Statute: http://www.leg.state.fl.us/statutes/index....%3ESection+1025 The 2008 Florida Statutes Title XXIX PUBLIC HEALTH Chapter 395 HOSPITAL LICENSING AND REGULATION View Entire Chapter 395.1025 Infectious diseases; notification.--Notwithstanding the provisions in s. 381.004, if, while treating or transporting an ill or injured patient to a licensed facility, an emergency medical technician, paramedic, or other person comes into direct contact with the patient who is subsequently diagnosed as having an infectious disease, it shall be the duty of the licensed facility receiving the patient to notify the emergency medical technician, paramedic, or his or her emergency medical transportation service employer, or other person of the individual's exposure to the patient within 48 hours, or sooner, of confirmation of the patient's diagnosis and to advise him or her of the appropriate treatment, if any. Notification made pursuant to this section shall be done in a manner which will protect the confidentiality of such patient information and shall not include any patient's name.

Quote from the article: To say you "thought" the baby was dead is not good enough. You either confirm death or you don't. It is not that difficult. If he couldn't "decide" which way to call it he could have called his medical control which is mentioned in the Cessation of Resuscitation section. I probably would have done that anyway since CPR had been initiated and it was a child just to cover the bases. Here's another article: http://www.southcoasttoday.com/apps/pbcs.d.../NEWS/906020336 NEW BEDFORD — The state Department of Public Health has recommended two New Bedford paramedics be suspended for 30 days for failing to perform cardiopulmonary resuscitation on a baby in cardiac arrest during an emergency call in December. The two paramedics — Rosemary Nunes and Ivan Brody — also were cited for inaccurately recording the details of that December emergency call, according to a complaint investigation report issued by the public health department. Mayor Scott W. Lang said Monday he intended to review the incident and would announce any actions within the next 48 hours. The recommended suspensions stem from an incident in the early hours of Dec. 4, when Nunes and Brody responded to a 9-1-1 report of a baby who was not breathing, the report stated. When the paramedics arrived, a New Bedford police officer was already there, performing CPR on the baby, according to the report. Nunes and Brody immediately took the baby to the ambulance where, according to the trip report completed by Brody, CPR was continued. However, when Thomas Pimental, then a supervisor with the department, arrived at the scene a couple of minutes later, he found the baby on a stretcher in the ambulance and neither paramedic delivering "medical care of any kind" to the infant, the report stated. Pimental, who has been a paramedic since 1984, is also a registered nurse and a certified emergency nurse. Pimental started CPR, and the baby was transported to St. Luke's Hospital, according to the report. The baby later died, Pimental said. In Brody's written trip report, he did not include any information about the cessation of CPR. The state investigation found that "the allegation of EMT-Paramedics Ivan Brody and Rosemary Nunes not performing CPR on an infant in cardiac arrest is valid ... there is no evidence that this patient met the criteria for EMTs to withhold or cease CPR efforts." No number was available for Nunes, and Brody said he would prefer not to comment without talking to his attorney. According to the state's investigation report, Pimental filed a written report about the incident with James Trout, director of the city's Emergency Medical Services department, just a few hours after taking the baby to the hospital. In a phone interview on Monday, Pimental said he told Trout in December that the incident needed to be reported to the Department of Public Health. According to Lang, the city's EMS department did report the incident to the state within a few days of its occurrence. However, according to the report issued recently, an investigation into the incident was not started until Feb. 15, a little less than a week after the state received a complaint about the incident. The report stated that the city's EMS department addressed the incident on Feb. 5, through a "call review," and then required the two paramedics to go through remediation training, which was completed on March 3. Lang said in a phone interview Monday night that he first learned of the December incident a few hours earlier in the day. However, on March 24, Pimental wrote Lang a three-page letter outlining his concerns about the incident; also in that letter, Pimental argued that such incidents point to why EMS supervisors, such as himself, were a necessary part of the department. Pimental and the city's other EMS supervisors were laid off by the city in February as a result of the mid-year cut to state aid the city had to absorb. Pimental, who said he received no response to his initial letter, sent a second letter by certified mail to Lang on April 7. William Burns, the mayor's chief of staff, responded to Pimental on April 9 in an e-mail, writing, "We received both of your letters, and have forwarded both of them to City Solicitor, Irene Schall." On Monday, Lang said he had requested a full report on the incident from the city's EMS department by midday today. "I want to look now at everything that they did and whether it was appropriate," he said. Lang said the issue is not the supervisor system: "It's (not) something I'm looking at from a standpoint of whether the supervisor system was the answer to preventing this, because obviously the supervisor system was in place when this happened," he said. "Irregardless of whether anyone made an anonymous complaint or not, I'm glad it's come forward, and we'll go from there." During the course of investigating the December incident, the state discovered two additional incidents — one involving Nunes and one involving Brody — that raised concerns about patient care. The first occurred on Nov. 19, when Nunes responded to a 911 report about a family of four suffering possible carbon monoxide poisoning; Nunes was accompanied on the call by an emergency medical technician-intermediate — a lower level of certification than a paramedic. According to the report, Nunes canceled a second ambulance that was on its way and transported all four patients to St. Luke's in an ambulance designed to accommodate no more than two patients. Additionally, the patients were not given oxygen before or during the trip to the hospital, the report stated. (Could the pulse ox have told Numes the patients' SpO2 was 100%?) The second call, which involved Brody, occurred on Dec. 13. Brody, along with his partner, also an EMT-intermediate, responded to a report of a child who had almost fainted. According to the report, Brody and his partner agreed at the scene that the child did not require any advanced life support and, during the ride to the hospital, the partner did not give the child oxygen, nor did he start the an intravenous line on the child. Dr. Jon Burstein, state medical director for the Office of Emergency Medical Services, reviewed all three calls and "found all of them to have clinical deficiencies of care" that did not meet the standard of care required by state protocols, the report stated. The two EMT-intermediates were issued letters of clinical deficiencies.

What about when the Paramedic left the ambulance and patient initially, which he himself stated in his own written words, to intervene and check on another possible patient? That is the event that supposedly escalated into the first assault.

If they did indeed document: That would be back peddling and not consistent with their assumption of death unless they were just going with those who had already started CPR.

APPENDIX C - CESSATION OF RESUSCITATION (6/06/2008) - Page 1 PURPOSE: 1) TO CLARIFY FOR EMS SERVICES AND THEIR EMTS WHEN RESUSCITATIVE MEASURES MAY BE WITHHELD FOR PATIENTS IN CARDIAC ARREST AND 2) TO DEFINE WHEN EMTS CAN CEASE RESUSCITATIVE MEASURES ALREADY INITIATED. Background and EMS Services’ Training/Support Services Obligations: Emergency Medical Technicians must begin or continue resuscitative measures for all patients in cardiac arrest except as indicated in this Protocol (also issued as Administrative Requirement (A/R) 5-515). If in doubt, begin resuscitative efforts. All EMS services must provide appropriate training on management of death in the field, including legal, procedural, and psychological aspects; and access to support services. EMS services and EMS personnel should be aware that the nursing staff of a health care facility, such as a skilled nursing facility, may need a physician order (including a medical control physician’s order, if allowed by nursing home policy) to halt resuscitation attempts, even in the case of patients meeting EMS “obvious death” criteria, as set out below. Nursing staff and EMS personnel should come to a cooperative decision on continuation or termination of resuscitation; this process may include obtaining physician input and orders. If the medical professionals at the bedside are unable to reach agreement on attempting or terminating efforts, the presumption should be to continue resuscitative efforts and transport the patient to an emergency department. I. EXCEPTIONS TO INITIATION OF RESUSCITATION Other than in overriding circumstances such as a large mass-casualty incident or a hazardous scene, the following are the only exceptions to initiating and maintaining resuscitative measures in the field: 1. Current, valid DNR, verified per the Comfort Care Protocol. 2. Trauma inconsistent with survival a. Decapitation: severing of the vital structures of the head from the remainder of the patient’s body b. Transection of the torso: body is completely cut across below the shoulders and above the hips c. Evident complete destruction of brain or heart d. Incineration of the body e. Cardiac arrest (i.e. pulselessness) documented at first EMS evaluation when such condition is the result of significant blunt or penetrating trauma and the arrest is obviously and unequivocally due to such trauma, EXCEPT in the specific case of arrest due to penetrating chest trauma and short transport time to definitive care (in which circumstance, resuscitate and transport) 3. Body condition clearly indicating biological death. a. Complete decomposition or putrefaction: the skin surface (not only in isolated areas) is bloated or ruptured, with sloughing of soft tissue, and the odor of decaying flesh. b. Dependent lividity and/or rigor: when the patient’s body is appropriately examined, there is a clear demarcation of pooled blood within the body, and/or major joints (jaw, shoulders, elbows, hips, or knees) are immovable. Procedure for lividity and/or rigor: All of the criteria below must be established and documented in addition to lividity and/or rigor in order to withhold resuscitation: i. Respirations are absent for at least 30 seconds; and ii. Carotid pulse is absent for at least 30 seconds; and iii. Lung sounds auscultated by stethoscope bilaterally are absent for at least 30 seconds; and iv. Both pupils, if assessable, are non-reactive to light. APPENDIX C - CESSATION OF RESUSCITATION (6/06/2008) - Page 2 II. Cessation of Resuscitation by EMTs Emergency Medical Technicians must continue resuscitative measures for all patients in cardiac arrest unless contraindicated by one of the exceptions below. 1. EMTs, certified at the Basic, Intermediate and Paramedic levels, may cease resuscitative efforts at any time when any “Exception to Initiation of Resuscitation” as defined in I., above, is determined to be present. 2. EMTs certified at the Paramedic level only may cease resuscitative efforts in an adult patient 18 years of age or older, regardless of who initiated the resuscitative efforts, without finding “obvious death” criteria only by the following procedure, and only if the EMS system’s Affiliate Hospital Medical Director has approved of use of this procedure, as follows: a. There is no evidence of or suspicion of hypothermia; AND b. Indicated standard Advanced Life Support measures have been successfully undertaken (including for example effective airway support, intravenous access, medications, transcutaneous pacing, and rhythm monitoring); AND c. The patient is in asystole or pulseless electrical activity (PEA), and REMAINS SO persistently, unresponsive to resuscitative efforts, for at least twenty (20) minutes while resuscitative efforts continue; AND d. No reversible cause of arrest is evident; AND e. The patient is not visibly pregnant; AND f. An on-line medical control physician gives an order to terminate resuscitative efforts. Commonwealth of Massachusetts 7.04 Official Version OEMS III. Special Considerations and Procedures: 1. In all cases where a decedent is left in the field, procedures must include notification of appropriate medical or medico-legal authorities. 2. EMS documentation must reflect the criteria used to determine obvious death or allow cessation of resuscitative efforts.

http://www.mass.gov/Eeohhs2/docs/dph/emerg...ppendix_704.pdf Commonwealth of Massachusetts 7.04 Official Version APPENDIX C: CESSATION OF RESUSCITATION EMTs certified at the Paramedic level only may cease resuscitative efforts in an adult patient 18 years of age or older, regardless of who initiated the resuscitative efforts, without finding “obvious death” criteria only by the following procedure, and only if the EMS system’s Affiliate Hospital Medical Director has approved of use of this procedure, as follows: a. There is no evidence of or suspicion of hypothermia; AND b. Indicated standard Advanced Life Support measures have been successfully undertaken (including for example effective airway support, intravenous access, medications, transcutaneous pacing, and rhythm monitoring); AND c. The patient is in asystole or pulseless electrical activity (PEA), and REMAINS SO persistently, unresponsive to resuscitative efforts, for at least twenty (20) minutes while resuscitative efforts continue; AND d. No reversible cause of arrest is evident; AND e. The patient is not visibly pregnant; AND f. An on-line medical control physician gives an order to terminate resuscitative efforts. Special Considerations and Procedures: 1. In all cases where a decedent is left in the field, procedures must include notification of appropriate medical or medico-legal authorities. 2. EMS documentation must reflect the criteria used to determine obvious death or allow cessation of resuscitative efforts.

Regardless, since they misrepresented the facts on their paperwork we may not know what was going through their minds. Giving false information on a patient care record should have been enough reason to get their licenses pulled.

I guess considering I do work in a large city in a very large ED, I would probably see more patients that have serious diseases. While we definitely see our share of patients who have the sniffles, we don't allow that to skew our attitudes to get lax with assessments and isolation protocols. We've already seen what TB did to our area as well as some healthcare workers in the 1980s and 1990s. We also still take it serious enough to keep A.G. Holley TB hospital open.

I would at least check to see if the baby was viable and not just stand there. Then, I would either continue CPR or comfort the parents. As the medical person on scene, it would be your responsility to make some determination and then back up your decision with the proper actions and documentation.

They may be better off at home if they do not present with respiratory complications. However, in a hospital people usually are not healthy and if you expose someone who is already compromised with something that can be easily acquired, you run the risk of doing serious harm to them. Thus, the reason your patients are in an isolation room. It is safer to consider someone with an infectious disease guilty until proven innocent than to have an occupation health exposure form to do and the extensive follow up with staff and other patients. If we have to contact other patients that they have roomed with a patient that had a serious infectious disease ruled positive, especiallly airborne, it is not a great experience to be part of but it sometimes happens. Those that are admitted to the hospital with influenza A for respiratory complications are sick. Many stretch to limits of our high flow devices, in an isolation room, to avoid intubation and yet some still do get intubated. Just the regular flu season is very deadly for compromised and elderly patients. The flu of any type should be treated with respect and not blown off or taken lightly especially when surrounded by patients whose immune systems are not as healthy as yours. Become more educated about precautions and the various diseases to protect both you and patients.

Brilliant move! The patient can now spray droplets with the aid of a NRBM running at a high flow rate. Did some in EMS not get the memo about devices such as masks using a higher flow rate and CPAP that are discouraged unless the patient can be isolated if infectious disease is suspected? Influenza A is taken serious in hospitals regardless of what animal it is named after and the patient is isolated in hospitals. We have cases pop up year round.

Yet the Paramedic admits in his statement to leaving the patient, exiting the ambulance to see what was going on with the trooper and the other person in the car. Once you have committed to a patient and are in transport, you do not leave your patient. Your partner may have a looksy and call for another truck if you approach an MVC or another patient. This Paramedic had already made the determination that his patient was well enough for him to step outside that truck to take care of another potential patient. That left no medical personnel in that truck with their patient. But again, this is the part of the video we don't see. Could all the ground shots been a convenient way of editing by the family member? Agree. There's enough bad judgement in this situation to go around and most of it was just due to some egos on both sides. No one person is completely free of fault. There are more than enough bad apples in all professions and EMS definitely has its share as do LEOs. Anyone read the headlines this week for the bad apples in EMS? At least this LEO picked on someone closer to his age and 2x his size instead of a child on a playground. Oklahoma Trooper: Paramedic Gave 'The Finger' http://www.emsresponder.com/article/articl...p;siteSection=1 OKLAHOMA CITY, Okla. -- A perceived obscene finger gesture apparently sparked a May 24 confrontation and scuffle between a state trooper and paramedic in Okfuskee County. The Oklahoma Highway Patrol on Monday released reports from two troopers involved in the incident with Creek Nation paramedics who were taking a woman to the hospital in Prague. In his report, Trooper Daniel Martin, who is at the center of the confrontation, said he was heading west into Paden to aid the Okfuskee County Sheriff's Office on a stolen-vehicle call. Martin said he had his emergency lights and siren on when he encountered the ambulance in front of him, which failed to yield to his cruiser. Eventually, the ambulance pulled over, he said, and he contacted the paramedics over their EMS radio, telling them they should be more observant. The ambulance was not running with its emergency lights or siren. Up to this point, Martin's account mostly jibes with reports filed by paramedics Maurice White Jr. and his partner, Paul Franks, who was driving the ambulance. However, the paramedics reported they never heard the trooper's siren. In his report, White said Franks threw up his hands in surprise when they received the radio call from Martin, urging them to check their rear-view mirrors. White said he thinks the trooper might have mistaken Franks' hands in the air as an obscene finger gesture. Once on the scene of the stolen-car report in Paden, Martin said he saw the ambulance pass and observed Franks extend his left hand out the window with his middle finger raised. "I took the gesture as a sign of defiance to (the) failure to yield earlier, and that they (ambulance) did not believe they had a responsibility to adhere to the rules of the road in regards to my emergency vehicle," Martin said. Seeing that the stolen-car call was under control, Martin said, he chased the ambulance until it pulled over. Once he got out of his cruiser, he was trying to talk to Franks when he saw White get out of the ambulance and slam the "door in a hostile manner." Martin said White kept getting between them, despite repeatedly being told by Martin to back off. The trooper told Franks he was going to be cited for failure to yield, adding that "I did not appreciate his hand gesture." White said the trooper bolted out of his car in a huff and yelled at Franks, "What do you mean flipping me off?" White said he tried to explain to the trooper that they were taking a woman to the hospital and asked if they could continue the matter once they got there. But White said the trooper would have none of it and insisted on giving Franks a ticket then. However, Martin said White kept getting in his way, and he finally tried to arrest him for obstructing an officer. That sparked the first of two scuffles as Martin said he tried to arrest White but the paramedic threw up his arms to resist. A number of relatives of the patient had followed the ambulance and were in the street. Fearing possible violence, Martin said he backed away from White and then went to his cruiser to radio Trooper Bryan Iker for help. The trooper said only when White got back into the ambulance was he able to speak with Franks. Martin said Franks assured him he did not give the trooper the finger gesture and apologized for not yielding. The trooper then walked back to the ambulance and tried to tell White he would be arrested once he arrived at the hospital, but the paramedic was not in the ambulance with the patient. Martin said he walked around to the passenger side of the ambulance where White was standing. White was angry, wanting to file charges against the trooper for assaulting a paramedic, he said. Another scuffle ensued, and Martin said White grabbed him around the neck, refusing to let go. Iker's report backs up Martin's account of the second scuffle. Martin said he applied a choke hold on White's neck to release the grip. With White calmed down, Martin said he told the paramedics to go to the hospital and he would follow. Martin said that if he were allowed to speak with Franks uninterrupted, the confrontation would not have happened. As it was, Franks was ultimately given a written warning for failure to yield. White was not arrested at the hospital. The troopers filed their information with Maxey Reilly, assistant district attorney in Okfuskee County, for possible charges. Reilly has forwarded the case to District Attorney Max Cook for review.

Not yet but we do a good number of mobile ECMO patients being transported by at least 5 facilities in the U.S. Also, don't forget that VADs may be seen in children as much if not more than adults especially if there is a large children's hospital that has a cardiac program near you. Many patients that have congenital heart anomalies are now adults and their meds, history, BPs, SpO2, and ECGs may look a little different than what you would expect to see from the "norms" in a Paramedic text.

But, if she lived for 24 hours and had been declared brain dead, think of the several others that may have had their lives saved by organ transplants. There are also now guidelines where brain death is not always a necessary criteria for organ transplant. While some in EMS see the near dead as a useless transport, others in the health care professions see it as an opportunity for some patients to regain their quality of life.

A couple of departments (California) have also stated something similiar to that when one of their FF/EMTs was charged with sexual assault and stalking. SFFD had initially stated his lewd behavior with kids did not have anything to do with his job as a FF/EMT. http://www.firefightingnews.com/article-US...articleID=36144 http://www.examiner.com/a-785975~S_F__let_...lt_charges.html Recently, a California county certified a convicted felon as an EMT. But his crime was only for killing a 2 y/o by shaking and throwing the child. I'm sure that won't have any effect on his job although it is unclear if he went through anger management classes in prison. The medical director of that county saw no problem with this guy's past crime. http://www.emsresponder.com/features/artic...p;siteSection=6 When you hold a job such as FF, EMT, Paramedic, LEO, RN, MD etc, that deals with the public's trust there is a higher expectation. So yes, it is a big deal when that trust is broken or questioned. Some may wonder what exactly is considered to be their professional standard. We also don't know if there had been rumors or complaints of this FF/EMT's behavior that were ignored or not taken seriously. Too often some think they are protecting their own when they are actually hurting them or the department.

I was going to link to that thread but it got pulled by the conservative moderator probably for being an advertisement or promotion of his own product.

Either it is April's Fools Day or that post is the reason why the EMT-B or "BLS" should be no less than 1 year in length based on a full time college schedule. spenac, time to change your depends...again.

We do not see on the video what transpired with the second ambulance attendant that caused the LEOs to restrain him. We do not see what he did to get himself arrested. However, once you are placed under arrest, you are an idiot to fight the police physically. Take it to court. If the LEOs are wrong, you win. However, with the video displaying your temper for the world to see, you will be the one looking stupid because those charges may still exist even if the others are dropped. This one incident has turned some EMS forums into a cop bash fest. It is just shameful and just bad form for professionals. LEOs are the ones who have our safety in mind at many scenes. Why all the cop hate remarks? Let us not wish harm to those in law enforcement. We've got just as many if not more stupid people in EMS doing much worse and often to patients. There are bad apples in all professions. If an LEO pulls you over even with a patient, it may be for a good reason. Have we not read the headlines with impaired and just unsafe drivers? He could be investigating a complaint. That LEO has a responsibility to the public and to that patient in the back. I have been in an ambulance for a truck malfuncition when a dual tire was loose and equipment was not secured. It doesn't take but a few seconds to get the situation under control and be on your way safely. Maybe if EMS policed itself a little better we could have prevented some of the deaths to patients and crew members due to collisions in ambulances. Instead, we would rather just sit around making excuses and bashing those trying to enforce traffic laws to keep everyone safe. In the video it seemed the driver had resolved the issue but the other ambulance crew member decided he needed his camera time.

What a horrible thing to say! I want no harm to come to any LEO just to prove a point about being needed as a Paramedic. These LEOs will also be first in on a scene to ensure your safety. Now, LEOs must wonder if you are going to seek revenge for some stupid video that was poorly filmed by withholding care for them or doing one of the many "just for fun" treatments discussed on the EMS forums? The officer's video cam film will be released in due time now that this is in the media just as others have been. Officers do pull over for ambulances. They even assist them through intersections. We don't know how fast this ambulance was going or if it was safe for the OHP to pass. If the ambulance was the slower moving vehicle, he should have given the OHP room to pass. We don't know what emergency the OHP was responding to. We don't know if the ambulance was just running L&S because they run them for all transports, emergent or not. We don't know why the other attendant got involved in a serious scuffle with the LEOs. There is a lot this video is not showing us.

Contact the producer. He'll give you info as to how to get it to a local independent theater or possibly purchase a copy. Thaddeus Setla http://www.setlafilms.com/

Nice to see you are promoting AMR for a change.

This article is told from this person's point of view: This is the guy who thought it wasn't serious and left the patient, one of his FFs, to work on the schedule because the guy would probably be out for a couple of days. He also told the guy's wife that everything was just fine. At least he did call for an ambulance with Paramedics.

I feel rather lucky to have taken my EMT-B and Paramedic training when I did. The 2 year degree was being encouraged for the Paramedic and the EMT-B was stated for what it was, a first-aid course for ambulance drivers. Your medical director was supporting you and your education because the profession had something to prove. The standards were high and the skills were perfected. There was also a pride in doing a few special skills in a very different environment with the trust of your medical director. It also didn't matter what uniform you wore...at least not in the beginning. Back then, the FDs were very selective as to who was chosen to go through Paramedic training. Of course, as times have changed, even the hospitals I am associated with now will no longer support intubation for Paramedic training within their walls. The ED is barely tolerating the IV training for the medic mill students. They have also been banned from L&D and NICU. PICU will still allow them in but at a distance. This is a shame but the hospitals have a reputation to maintain and if the schools will not screen and instruct their students better on just proper etiquette, not to mention basic procedures, the hospital will have to make the decision for restrictions in favor of their patients. It is a shame a few bad apples from less than reputable schools have forced the hospitals to place these restrictions. The students from other healthcare programs always have their own preceptors, approved by the hospital, monitoring them so any problem is dealt with quickly.

However, because of some Paramedics lacking the ability to intubate or not knowing when to stop trying and use an alternative airway or just bag, we are seeing many more swollen and bloodied airways that require the big tools to come out of the closet such as the fiber optic scopes to assist with intubation in the ED. We have definitiely seen a great increase in traumatized airways over the past 5 years. Combi-Tubes have also been part of the problem as some are just not mindful of what they are doing when the ram a tube that large into the throat and inflate cuffs that can do some serious damage if in the wrong place. There are now several pieces of literature being published on this new traumatic trend. Thus, some EDs have beefed up their intubation tools. Many of these patients may require traching if the throat does not heal in 7 - 10 days or if the ETT will further irritate a throat and cords already damaged. So it is no picnic for those of us in the ED when these botched airways come in. It definitely is not much fun for the patient who may have to adjust to a trach tube for awhile or learn a different way of communicating. The lack of education and proper training of prehospital personnel has a profound affect on the healing process if there are complications of a traumatized airway and aspiration as well as the initial complaint.

No, it can be just about any type of surgery where there are already expected risks. Any surgery that requires good blood flow such as flaps or grafts will definitely be cancelled as will some cardiac surgeries. Nicotine is a potent vasoconstrictor which can reduce blood flow to the flaps or grafted areas as well as increasing the risks of an MI under stressful situations which one might consider surgery to be. For Flight Paramedic you need at least 2 - 3 years with a busy service and some CCT experience in a progressive system. For Flight RN, you need at least 3 years experience with 5 preferred in high acuity ICUs of various types. If you are a Flight Paramedic that finishes nursing school, you will still have to meet the Flight RN requirements for experience(3 -5 years) in the ICUs to take a Flight RN position. Flight RNs can take a bridge course, challenge the Paramedic exam or do the requirements to get a nursing credential in prehospital medicine such as EMS RN, PHRN or MICN. The Paramedic patch is not required for RNs with Flight Programs in very many states. Many of their transports with be IFT or scene calls that require a higher level of Critical Care expertise.