VentMedic

1. Does this company not have a written policy in place? 2. What state are you in and does it not have a statute or law that governs this for which the agencies base their policies from?

Someday there hopefully will no longer be a need for people to risk their lives only to find, if they live, that they are truly not free in the U.S. either. The Haitians do not get the same consideration as the Cubans that arrive with dry feet.

What happens if you get nothing but unemployment? If your lawsuit does not involve your employer but brings them a negative view in the public eye, they have no reason to keep you as their employee. If you also involve them in the lawsuit, they have every right to remove you from duty and it will be up to you to prove you are capable of doing the job especially if it is no longer a workmen's comp case. You will also have to disclose this as it will be public record on any future employment applications especially if the suit is still pending. Having a workmen's comp claim that has been handled, and sometimes almost expected due to the nature of EMS work, is different than having a lawsuit pending against your employer or a private citizen for a job related incident. This is the Florida incident I referred to earlier. It also mentions the LEO who tried the same thing. http://www.clickorlando.com/news/16157202/detail.html

You might be asked if you have any training for assessing scene safety or if you knew the job posed any physicial risks. Your own physical shape might be called into question as to whether you were physically fit to do the job at the time of your accident. And, are you going to blame the patient for the weather? The patient may have been on the stairs attempting to clear them when he started to collapse. It is too bad the patient coded before he got the stairs cleared for your arrival. If everyone in EMS or healthcare sued the patient for their injuries acquired on the job, the court systems would be quite busy. Patients would also be afraid to call 911 in fear of being sued by the people who are supposed to be there to help. There was a case like this in Florida a couple of years ago that did not turn out too well for the provider. Think very carefully and also consider what consequences this might have with your present employer. If anything, I would allow your employer's insurance to battle it out with the person's homeowner's insurance if there is truly an issue of negligence on the property owner's part.

Here's a little more detail about Pinellas County and the proposals. http://www.pinellascounty.org/EMS/default.htm Pinellas County maintains EMS contracts with 19 fire service agencies, and one ambulance provider (Paramedic Plus, operating in Pinellas County under the trade name “Sunstar”).

In this area, it has been the FD that has been getting laughed at which also has initiated this transport idea since as you may be able to tell by the article they are conflicted as whether they actually want to take on the responsibility of transport. They run an ALS engine with usually 4 Paramedics and a Fire "ambulance" with 2 Paramedics. They usually are left to standing around doing very little except to help the Sunstar Paramedics and EMTs, who may have arrived first, carry the patient. Thus, the public is beginning to ask "why?" is a big first truck needed and two ambulances when most of them just stand around. This is the one time that wearing a FD uniform and driving a fancy big truck is not an advantage nor has it been a good photo op since the photos have been presented as proof of this circus. There have also been a couple of news articles posted on this forum about Pinellas County's over abundance of response for each call which showed that something was about to change.

The FFs still provide the EMS but don't transport in Pinellas. There are a couple of hold outs such as Lee County and Collier EMS. In the Northern part of the state I believe there are a few non fire although Ocala just went Fire and Polk county is still in debate.

Poorly worded tite. Florida Panel Says No to Firefighter Victim Transport http://www.emsresponder.com/article/articl...p;siteSection=1 St. Petersburg Times By ANNE LINDBERG Times Staff Writer A proposal that would allow firefighters to take injured people to hospitals would be costly and unsafe and should not be adopted, concludes a committee established to study Pinellas emergency services. But committee members say parts of the plan may have merit and should be part of a larger study of Pinellas EMS service. They also recommend trying the idea in a pilot program. The plan, the brainchild of Pinellas fire unions, is known as the "hybrid proposal" because it does not fully change the way EMS services are delivered. "I think everybody agrees there is some value to some (fire department) transportation. We don't know how much," said James Dates, assistant county administrator. "We're all speculating what the numbers would be." Dates said officials have already recommended there be a comprehensive study of Pinellas EMS delivery. The hybrid proposal should be part of that, he said. Dates also suggested that a pilot program could be tried using one fire vehicle. That, he said, could happen within a year. Scott Sanford, president of the Palm Harbor/Oldsmar professional firefighters, said he was disappointed in the report. The County Commission, he said, wanted the committee to find a way to see if the hybrid proposal would work. Instead, the committee seemed intent on finding reasons it would not work, he said. Under the current system, firefighter/paramedics respond to emergency calls but do not take anyone to the hospital. Sunstar ambulances do that job. The goal is to get the firefighter/paramedics back on call as soon as possible in case someone else needs them. But with the advent of Amendment One and the economic downturn, the county sees the need to reduce expenses or run an estimated $18 million deficit. The County Commission recently passed two resolutions designed to cut costs. The first established the response time firefighter/paramedics must meet when answering emergency calls - within 7½ minutes at least 90 percent of the time. The other set the rules the county will follow in parceling out tax money to each of the county's 19 fire departments for providing EMS services. Firefighters object to both plans and suggested their hybrid plan could save $7.7 million the first year and $40.7 million over five years by allowing fire department rescue vehicles to take injured people to hospitals. The rescues (those boxlike trucks that look like ambulances) are already on the street and paid for and might as well be running to the hospitals, firefighters say. But a committee of city managers, city and fire district chiefs, and county administrators looked at the hybrid plan and concluded that it "is too aggressive and not fact-based." The committee said the plan would be costly because it might make Paramedics Plus, which contracts with Sunstar to provide the ambulance service, increase fees to make up for lost runs. The hybrid proposal would also keep the rescue units off the road for a longer time, meaning it would take longer to respond to 911 calls. In addition, the committee said, the proposal would overburden 14 of the county's rescue vehicles, making them too busy to "safely add patient transport to their current fire suppression" and emergency response jobs.

Florida will recognize the NREMT-P only to make one eligible to take the state exam.

No, that doesn't sound like Memphis Fire Department.

Memphis Fire Department?

Considering the way things are going for that system, you might want to rethink that especially if you like the medical profession. I don't know how far you are from this team but give them a call for a little inspiration. Dartmouth-Hitchcock Advanced Response Team http://www.dhmc.org/webpage.cfm?site_id=2&...mp;item_id=1868

If it is truly based on a California dept like SFFD, some are going to be disappointed since their protocols are very limited. But, it may all become just fiction and only those in the area will know how far from reality it may actually be. I don't believe there are even very many in the state doing 12-lead EKG or intubating regularly and you won't see RSI. Shoving Combitubes in just doesn't seem as glamorous. CPAP is also a stretch as is almost any medicated drip. They will often take chest pain to the nearest facility where an MICN with two EMT-Bs will then transport the patient another few blocks to a cath lab. There will, however, be lots of lights and sirens stuff as EMS rushes off from scene to the nearest facility although sometimes they do manage to get trauma patients to SF General (trauma center) and occasionally not. Once again an MICN and two EMT-Bs will transport to the appropriate facility. I will say California EMS has done a great job at increasing the role and visibility of the MICN.

Now for a little practical advice for the NICU. Avoind colognes. Avoid long or fake nails and nail polish. Avoid jewelry except for wedding band and that may include watches. You can usually put it in your pocket. Some ICUs frown on long sleeves on personal clothes for infection control reasons and scrubbing issues. A long sleeved hospital gown may be furnished in some cases when touching the baby. Don't touch a baby/child or patient area and then put your hands in your pockets. Don't be alarmed at all the alarms. Don't be alarmed when the RNs and RRTs "causally" respond to Apneas and Bradys in the unit. Respect the privacy of the families. Be mindful of the families and avoid inappropriate conversation in their presence. Don't go if you are catching a cold or the flu. This may sound like commonsense stuff but these are just a few of things ignored by some so that we no longer allow Paramedic students in our NICU and L&D. Hopefully your instructor has already addressed the basic rules of these units.

Mary Fran Hazinski is the Mother of pedi critical care textbooks. http://www.amazon.com/Manual-Pediatric-Cri...i/dp/0815142307 This is a good neonatal book: http://www.amazon.com/Handbook-Neonatal-In.../ref=pd_sim_b_2 Again, they both might be more than what you need but still a very good read since I sense you do want a little more indepth knowledge than what the Paramedic text and PALS will give you. You can probably check them out at the medical library. Good overview of pedi cardiology: http://pediatriccardiology.uchicago.edu/MP/pcmedprof.htm

Unfortunately some that write the protocols, and the providers as well, do not read the medication inserts or keep up to date with drug information. Again, this was only true for Atrovent MDI and Combivent MDI which contained the CFC propellant. So, unless your service is using these, it does not apply. The liquid form does not have a lecithin base and has never been included in this contraindication. There is another issue for Atrovent and that is glaucoma. Luckily I have only blinded 1 person in 20 years and it only lasted for 6 hours....a very long 6 hours for me and the patient. That was in the ED and the glaucoma meds were overlooked in the history taking by both the Paramedic with EMS and the RN. I then made the stupid mistake of assuming there were not other meds or medical conditions on the list. In the hospital and for prescribing Atrovent we do look at other things such as renal function but again, in EMS that probably won't be an issue unless you try to run "continuous Duoneb".

However, since there is a dispute between the city of San Francisco and the NBC executives (SF Chronicle 5/5/09), this show will probably be shot in Vancouver, British Columbia. The one scene they did film in the area during this past March was a tanker fire on the interstate similar to the one that occured about 2 years ago. While the driver of the tanker was injured with burns, he managed to catch a taxi to the hospital before FFs could find him. Now that was a good story from the taxi driver's perspective.

Look at the mechanism of action. Atrovent is an anti-cholinergic and not a beta-adrenergic agonist. Its affects on the airways is not as quick and may not have any effect for some. Long term anti-cholinergic use has come under controversey lately but that has also come with the newer long acting forms. http://www.news-medical.net/?id=41663 None of this will probably have any affect on prehospital care because you may not have the information to determine if you are only treating asthma or some other COPD component. Thus, some will just give Albuterol/Atrovent as a blanket with the anti-cholinergic possibly having some effect on the airways. I posted the Asthma guidelines just to show you it is not juat a random "give this med" type protocol. The guidelines offer many options to fit the treatment with the patient. However, again this is not possible in the field but looking at the meds may give you some idea of their severerity...provided they are under the care of a Pulmonologist. Often patients that go the ED and/or GPs get a hand full of samples and just take the meds without adequate instruction or any reason for taking them. We have patients come to the ED who are taking Advair, Symbicort, Flovent, Serevent, Albuterol, Combivent and Proventil at one time because they have no idea what they are taking. Their doctor just handed them a bunch of inhalers at the office.

I was referring to the Montreal Protocol. Although it was formed from an international summit, it is just easier to blame the Canadians because of the name as a little insider industry joke. The switch to HFA has brought alot of problems concerning the reformulation of the meds. Combivent is now having issues with reformulating and it may still go away if it can not. It also scraps years of research for the MDI vs Neb debate as now the velocity and weight of the particles appear different. Different delivery methods will again have to be repeatedly tested to see if there is actually no difference. However, the new canisters have made it difficult to adapt many of the MDIs to a ventilator or BVM circuit so it is difficult to even use in the same way as before. Long term MDI users are now preferring nebs in the ED where before we did give MDIs for rescue. They are not feeling the same force and coolness of the "freon" propellant and so they believe it is not effective. Also, the HFA MDIs are recommended to be taken with a spacer or holding chamber which many do not want. And, the open mouth/2 finger technique is no longer advised so timing for the closed mouth technique must be near perfect which is difficult to do at times of distress or for a new user in the ED. In the ICUs we have had to add nebs to our ARDS protocol again even though it goes against the VAP (Vent Associated PNA) precautions and if one does not use a spring loaded adapter in line to prevent opening the vent circuit, it defeats the purpose of running high levels of PEEP. This again is due to the redesign of the canisters that are difficult to adapt with the circuit.

Outdated information. This was true with ONLY the older MDI form with the CFC propellant. All Atrovent MDIs should be HFA and the soy allergy does NOT apply in any way to the liquid form of Atrovent or "Duoneb". However, the soy (lecithin base) does still apply to the Combivent MDI (CFC) since it was granted a stay of execution by the FDA...at this time. Here is powerpoint presentation of all the inhalers currently on the U.S. market. It might be wise to look through them since some GP MDs and EDs give them out like candy with little to no instruction. It is not uncommon for someone to mix up a LABA for a SABA and have serious consequences including death. As well, the inhalation techniques for administering MDIs have changed and we no longer float the canister in water to see how full it is. http://www.asthmanow.net/EPR%203%20Asthma%...Medications.ppt Here is how asthma is treated overall (probably more information than you wanted but it can tell you a lot about a patient by looking at the meds they are on and why.) The last section on exacerbations might be of interest. EPR-3 (2007) http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf Here is another general overview of asthma treatments (again probably more info than you want.) http://www.acep.org/WorkArea/DownloadAsset.aspx?id=44920 Now, for treatment, it depends on whether you medical director is reading the Asthma Guidelines EPR-2 or EPR-3 (2007 guidelines). It also depends on whether you are in Canada or the U.S., East Coast or West Coast, North or South, Northern CA or Southern CA, etc. Some doctors will treat everything with a "Duoneb" or Albuterol/Atrovent combo. Some say it is a was of time for those with asthma and no other COPD component. The new guidelines do not stress Atrovent in asthma. FACT: Atrovent by itself is NOT a RESCUE med. Some do use it similar to a SABA as an alternative for maintenance. However, there is very little data that indicates atrovent is effective in long term management of asthma. If you do give Atrovent to a child in the field, document it clearly and make sure the MDs/RNs/RRTs at the ED are made aware of it. We do NOT like to give back to back doses of Atrovent to a pediatric or even an adult. In summary there is not just one good answer because you will still have to do what your medical director puts in your protocol and he/she may not have had an update in the latest pulmonary meds in a long time. BTW, let me thank the Canadians again for their attempt to save the ozone layer and messing up the asthma inhaler industry.

St. Pete CC is an excellent college for a wide variety of certificate and degree programs. http://www.spcollege.edu/ Pinellas County also has Sunstar Ambulance with is one of the few non Fire services. If your daughter still is looking at technical schools, Sarasota Tech would be a decent choice at a reasonable cost. http://www.sarasotatech.org/index.aspx?page=180

I figured you had to be either in California or Florida. Definitely go with a community college in Florida. Or, there are a couple of decent state tech schools with good programs. Avoid the private career schools and especially those that say they now offer a "degree". They are over priced and will not be a benefit to the your daughter's education in the long run. The price of one year at these "career schools" could easily pay for a real college degree. Some hospitals also restrict what the students from these programs can do during their clinicals because of their bad reputations. For example, the students may not get to do live intubations but must rely on manikins for their entire check offs. With any luck these private career schools or "medic mills" will disappear over the next few years. They have done very little to improve the Paramedic as a professional and have been a hindrance to improving it as a profession. They have mass produced Paramedics to where Florida is saturated and some are still flipping burgers at Burger King after they graduate from these schools. However, if your daughter just wants to be a Fire Fighter and is just using the Paramedic certification to get hired and has no interest in medicine..... While I would like to say just scrap all of the above posts of information on education, it would still be good to be an educated Paramedic in the FD. Many of us here got our start as Fire Department Paramedics and some of us entered with a solid college education. Unfortuately, in Florida, to be a Paramedic in EMS, you may have to be a Fire Fighter. There are a few exceptions such as Lee County. I would also suggest a college based program for hiring on at Lee County since they are all for medically educated providers who can present themselves as professionals.

First, the school should be accredited by CAAHEP/COAEMSP. You should then consider the cost. A "career votech school" that costs as much as one semester at Harvard is not worth it regardless of how fast one can finish the program. Votech schools will usually give just the minimum amount of hours required for certification in your state and little else. At this time, the number of minimum hours for Paramedic will also vary from state to state. A good college program should offer college classes such as Anatomy and Physiology, the same level nurses take, as prerequisites to entry into the program. If your son or daughter decides later after getting a Paramedic cert that this isn't the career for them, they will usually have no college credits and must start over if they want to go to a real college. If they choose to go to another votech, they may end up doing the short term fix "job" route instead of trying establish an education toward a career. However, at a good community college, whatever credits earned can be applied toward another degree. This will at least apply for the general ed and the sciences while some of the other classes may be used as electives. If your son or daughter decides they want to advance their education, they also will have a good start. The votech credits may not always transfer to higher education. The pay as a Paramedic at this time does not differentiate as to where you went to school. However, working toward a degree at a college does show ambition that one may want a career and not just a job.

Albuterol can be given continuously for several hours at dosages of 5 - 30 mg/hr and it is usually given by O2 with an aerosol mask considered to be "high flow". To cause a shift in K+ effectively for a short time, one would have to give a high dose of concentrated albuterol (0.5%) at 15 - 25 mg with a rapid delivery time. Unfortunately, some (EMS included) believe they can do a continuous Albuterol treatment by just putting several unit doses into a nebulizer that might not be designed for that volume. At the rate of nebulization, the baffles may deliver an inconsistent output of particles size and dose. Thus, as we fondly call it when we see this arrive in the ED, "Sputtering in the Wind".

You are correct. In my state it isn't a problem due to that logic. Those gloves also protect the skin from everything...until you touch the exterior or they touch someone. /sarcasm