VentMedic

Wow! So EMS is the only service that gets abused? Guess where you transport all of those that you hate to have in your ambulance? But, others in the healthcare professions are expected to deal with whatever for alot longer than 15 minutes. They are there not only for the drunkedness but all the DTs and the patients' other healthcare problems. Also, one healthcare professional may have several of these patients to take care of at the same time. And, they are expected to deal with any and each patient with a professional manner. Yes, it may eventually get to these professionals but they also know why they entered a healthcare profession. Too many in EMS enter the field and then realize it is about patient care rather than just the pretty trucks with L&S. If you don't like dealing with people and the good or bad they present with, any aspect of healthcare is not for you.

MSP: Use of scene personnel criticized Sunday, March 08 2009 http://www.washingtonpost.com/wp-dyn/conte...9030701842.html When she climbed aboard a medevac helicopter in Charles County in September, emergency medical technician Tonya Mallard had no helmet, no flame-retardant flight suit and virtually no training. Hold the patient's hand and listen to the flight paramedic, a colleague told her over the roar of chopper blades. Had it been almost any other medevac flight in the country, Mallard would not have boarded. Maryland's state-run service is among the 3 percent of operators whose crews include only one staff medic. In one of every five missions, the helicopters pick up another medic from the rescue scene to care for a second patient or one who is critically injured. The helicopter that carried two victims from a Waldorf car accident Sept. 27 crashed in Prince George's County, killing four people, including Mallard, a volunteer with a Waldorf fire department. She suffered severe head injuries, chemical burns and bone fractures. For decades, the Maryland State Police medical helicopter program has been praised as a national model for emergency care, but documents compiled since the crash make clear that it adheres to some safety and flight standards that are less rigorous than industry norms. Police officials say adding a second medical provider to each flight would be a poor use of resources. State lawmakers are expected to discuss the issue and other possible changes to the program this week. The sole survivor of the Washington area's only other fatal medevac crash in many years, a 2005 accident that killed a pilot and a paramedic near the Woodrow Wilson Bridge, called recruiting medics from the ground "one of the most egregious breaches in air medical safety." "They are putting these ground providers on helicopters who have never had survival training, no helmet, no flight suit, no boots, no idea how to use the medical equipment," said Jonathan Godfrey, who was a staff nurse on a flight run by a private service. "It's all of this risk with very little benefit to anyone." In addition to using a single crew medic, the Maryland service follows less restrictive Federal Aviation Administration flight rules than private medevac companies do, meaning the state's operation is not subject to the same inspection and maintenance rules. Maryland's pilots are not required to conduct a written or computerized risk assessment before accepting a mission, a routine step for most private medevac companies. Maryland State Police pilots are trained to mentally evaluate potential risks posed by weather, crew fatigue, distance, the type of mission and other factors, officials said. They are allowed to turn down missions and are not punished for doing so. On the night of the September crash, pilot Stephen H. Bunker discussed the possible flight with a duty officer who did not mention that two patients would be transported. It was stormy, and the two discussed flying conditions, according to a transcript of the exchange. Bunker, who was among those killed, reviewed cloud ceiling reports and noted that a MedStar helicopter had just landed at Washington Hospital Center in the District. PAGE 2 at http://www.washingtonpost.com/wp-dyn/conte...30701842_2.html

If you read your State's (any state) statutes, there will be this statement made for the licensing, denial or revocation of an ambulance's license/certification for transport. violation of OSHA or other federal standards that it is required to meet in the provision of the EMS service. You violate OSHA regs and your ambulance service can be penalized severely. The other consequence will be the hospitals and facilities that contract with you for transport may drop your service when they hear it has been cited for this OSHA violation. Infection control is a hot issue and a source of denial for payment to hospitals by insuring agencies including Medicare.

Where do they get the nail files? Hospitals can't even get nail clippers for the patients. Anyway, trying to justify the actions of a few bad apples by taking a swing at another entire profession doesn't make it okay. Regardless of what is right or wrong about this article, it just shows that the public does pay attention to EMT(P)s on a scene. How the EMT(P)s choose to conduct themselves while in public view can make an impression. Even though it might be difficult under adverse conditions, one should conduct themselves as professionally as possible. Unfortunately, it will usually be the loud mouth burnt out obnoxious EMT(P)s that are the most noticeable.

Neither of those ventilators are in ANY WAY close to the Evita series. Not in flow, sensitivity, demand valve action or modes. The Evita series are excellent but still have problematic exhalation blocks. That is like comparing a Ferrari to a moped. The reason providers need to know what their machine is capable of, and not just the pretty settings or knobs, is not all the ICU ventilator numbers will translate the same to a transport ventilator. Some will even say "But I put the same numbers into the machine". Everything I mentioned can be different and you will have to know how to get the most out of whatever technology you are using or you might as well use the BVM...which isn't always the best for the patient either.

LTV: If it is good enough for Superman, it is good enough for my patients. We now use the LTV 1200 for both Peds and Adults for in/out of hospital transport. It is so easy to carry we don't always call for an ambulance for transport to and from the airport if the patient is not picked up yet. The hospital shuttle van or a contracted taxi can take us. That spares all those on the ambulances who complain about being used as a taxi. It is also a good way to avoid a lengthy discussion and sometimes argument as to why we don't want L&S. After a disasterous experience ($250K worth) with the Newport HT-50, one of our largest sub-acutes is going with the Veramed-i and LTVs. The LTVs are perfect for those that want mobility especially the quads. The long term patients do many of our equipment reviews for us. It is almost like test driving a car with a ventilator having many of the same performance characteristics. Unfortunately, many prehospital ventilators can be out performed by a used YUGO. Of course, I started my transport career with tricked out Servos, PLVs and Birds. Any of those older ventilators still in use can out perform much of the stuff on the market today...they just don't carry as easily.

I don't advise anyone to use the Autovent, the Carevent or any ATV for CCT. Some have and some have failed miserably. Although, I can't blame the machine totally for the failure. In some cases it was the providers who didn't recognize their patient and the ventilator weren't compatible during the transport.

People here are presenting their own opinions when all they have to do is find out what the policy is from their local healthcare system. There may be a mandated reporting system established. The hospital will have some idea about the legal status at check in time. I mean for those that are really concerned about this, find out what the correct procedure and laws are for your area so that the patient can still get care and your do gooder law abiding conscious can get some satisfaction.

They should have called the jail's Special Response Team and then she could have had something to whine about after she recovered from the tear gas. These officers should have probably had a 3rd officer recording the conversation that took place between the inmate and them. They actually may have had another camera running which will show this from a totally different view along with voice recordings that will later be presented in their defense. It they verbalized everything correctly to her and she continued to make threats against them or herself, it was their duty to control the situation swiftly without giving her a chance to struggle. While this video may look rough to some who may not have been in a situation like this, it is not the time to do hand holding and talk sweet nothings to this inmate. It doesn't matter what her charges are and no matter how minor. Those charges may have been the ones she happened to get caught at. You treat every inmate as having the potential to harm you or themselves. Animals and people do stupid things when caged. It is every officer's responsibility to go home safely after each shift.

I can not imagine effectively working a patient on a CT scanner sled. We turn our patients to do a full assessment and will do many procedures in the ED since not all trauma patients require an OR. We also see alot of head trauma which have the tendency to be combative, as do some of our locals, and restraining to the sled is difficult without losing access to parts of the body. However, the MSCT is available in many hospitals throughout the U.S. We're quick and it doesn't take long to get diagnostics and pocedures done. Central lines, A-lines, LPs and chest tubes are done in the trauma room. In the U.S., our trauma centers are rated with levels also with consistenvy of available equipment and services for each. Even the local little generals must meet certain criteria to maintain ED accreditatoin. We also have a level which is a shock trauma hospital or medical center and has the qualifications to be a free standing hospital with all services dedicated to trauma. Our trauma rooms each have access to: Intervential radiology and C-Arms Portable ultrasound STAT lab POC machines for electrolytes and ABGs Monitor: SpO2, ECG, ETCO2, NIBP and invasive pressures - venuous and arterial Portable and ICU ventilators with various gas mixtures (HeliOx, Nitric Oxide) Various ETTs and intubation devices include fiberoptic Fiberoptic scopes of various types for airways and GI - Endoscopy (Video and portable) Acute Hemodialysis Capability OR suites Lab and Radiology services dedicated to trauma Helipad with elevator straight to trauma area The hospital also a full service pedi and burn center as well as the hospital having a high risk maternal unit and Level 3 NICU. We also have a cath lab available with a thoracic surgical team (the team also does chest trauma). Everything is also stored in cabinets or in sealed sterile packages.

Are you saying every trauma room has its own MSCT? Does it also double as a stretcher for other procedures?

Many COPD patients may be diabetic or on the border from long term steroid use. Glucose monitoring is essential. Nebulized or MDI steroids may already be in use by the patient. Pulmicort (budesonide) is available in liquid for nebulization or MDI. It is also found in Symbicort. Flovent is in MDI form by itself and in the Advair diskus and MDI. Decadron (dexamethasone) can also be nebulized. In the hospital we may hold the nebulized or MDI corticosteroids while the patient is receiving them IV. We also budesonide and Decadron nebs for airway inflammation post extubation. Steroids IV may be started 24 hours prior to extubation or before if there is edema and inflammantion. Update in Chronic Obstructive Pulmonary Disease 2007 http://ajrccm.atsjournals.org/cgi/content/full/177/8/820 Steroids in acute exacerbations of chronic obstructive pulmonary disease: are nebulized and systemic forms comparable? http://www.co-pulmonarymedicine.com/pt/re/...#33;8091!-1 New EPR3 (American) guidelines for Asthma management:http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm http://www.nhlbi.nih.gov/guidelines/asthma/index.htm Canadian Asthma Guidelines: http://www.lung.ca/cts-sct/guidelines-lignes_e.php These guidelines take most of the mystery out of these medications and like ACLS, they are updated as new research is made available. A complete new set of guidelines is published every few years to reflect the most recent changes. There is controversy like with any other medical treatment so it is important that you stay current with the medical journals rather than just waiting for JEMS to publish a warm and fuzzy watered down 6th grade reader note on the subject.

Personally I would like to see her get a prison sentence where she could try that whiny voice and wimpy story on the big girls, both the inmates and the guards. Within 48 hours she would be begging for the hospitality these two officers showed her.

For the ED, majority of the time we know the names are false. Not knowing their SS# isn't a crime since many people don't always know that. We have LEOs onsite but no one detains. Without verification of personal data, we don't issue them a regular county card but they do get a card that tracks their healthcare if they continue to use the system. The information is collected if INS or DHS wants to continue the process. Occasionally we hear where they've followed up. If the patients are admitted to the hospital, further investigation is done usually. In the ICU, if the patient is not able to communicate PD may need to fingerprint to learn the true identity for family notification. Then, INS or DHS may be called to assist in the identification through their connections. If they are admitted to med-surg, it is a discharge planner's responsibility and nightmare to get them the further assistance they need or to seek advice from INS or DHS. Here's some more info: Type in illegal aliens or whatever in the SEARCH box. http://www.fha.org/index_html We have illegals or undocumented immigrants of all nationalities and some from countries where English is a strong language.

The requirements are also for enough force for the take down to be quick and avoid any chance of a continued struggle. If you go in with the "now now dear tell me all about it" attitude, someone will get injured. While the hair pulling once she was cuffed might have been a little extreme, their swift restraint may have prevented her from harming herself or them.

The biggest difference is someone is being physically hurt which requires the reporting. LEOs also report the same mandated acts of abuse. However PD is not always present at medical calls where child or elder abuse may be suspected which is why EMS and other healthcare providers get involved. If there is an arrest to be made, PD does it...not the EMT(P)s. Unfortunately there had to be a law mandating the report of such abuse because some, including those in EMS, thought it was nobody's business if someone beat their child, spouse or elderly mother. It was a family matter. Some could view the reporting of illegal aliens as a duty to report. Could it also be detrimental to their children if they are afraid to get them healthcare? Absolutely! That could also be a form of child abuse but from a situation created by those that are hell bent on enforcing the law regardless of what is at stake. But then who cares? They don't have any right to be here in the first place. Of course there is a stereotyped group being discussed in this thread. Would you feel the same towards the young well groomed person who appears to be a business professional or college student but their visa has expired and are in this country illegally? Are you going to question everyone or just single out those YOU don't want in your country? See that the person gets the appropriate healthcare treatment first. EMS shouldn't make the life and death decisions based on whether a person is illegal or not. People also shouldn't be afraid to call you if their child is sick. Reporting illegals should not distract you from doing your medical job.

You are not going to defeat Fire-Based EMS with an anti whatever compaign or advocacy group. The fragmentation of the Paramedic profession is what has gotten it into the mess it is in. To create lines of division that are even more harsh will not accomplish much for the profession as a whole. For such an organization to be successful you must unite the advocates for EMS in medical terms regardless of where they work. If one is a Paramedic, whether it is for the city, county, FD or private service, there should be higher minimal education and standards or for professionalism or at least working toward these goals. Some in both the FDs and non-fire services have already achieved this. But, there are also many in private, county/city EMS and Fire based sectors that still promote the warm body idea of professionalism. The focus at this time should be about education and professionalism. Once those standards are raised we'll see who can maintain to the higher level. Fire may decide if a two year degree was to become mandatory that they may lose interest OR they could use it to their advantage to get more money for education through grants and taxes. Private services that had been milling their own for years could also feel the pinch. Either way, it will be up to the individuals to decide if they have got what it takes to get a degree and be held to a higher standard regardless of where they work. It may discourage many who join the FD just for the benefits if they had to have a two year degree as a Paramedic instead of the 3 month special. It might also discourage the "every FF must be a Paramedic" mentality. For the private sector it might discourage the L&S freaks who have nothing to offer in terms of patient care. Then, we can get back to have only those with an interest in medicine being on the ambulances regardless of what service.

We don't allow teenagers to drive cars until they are 16 or 18. You can not drive an ambulance in most states until you are 18. We don't allow them to use FF extrication equipment until they are 18. We don't allow them to work with certain blades and saws in the food industry until they are 18. You can not have a medical license with access to medications until you are 18. This government also has child labor laws to restrict employers from taking advantage or exploiting them. Some states now have laws against smoking in a car with children present. Which of those do you also disagree with? Sometimes where children are concerned the government has to step in because some parents are misinformed about certain dangers and some are just too clueless when it comes to commonsense and parenting.

The little red one is a tricked out Elder (demand) valve. The Autovent 3000 is an automatic BVM. Both should connect to a 50 psi connector as the O2 source. When determining VT, a height and ideal body weight chart would be helpful to estimate. But, I prefer the old fashioned way most of the time in the field or ED (unless thinking about a specific protocol) by looking at chest rise and listening to breath sounds while watching skin color, HR and SpO2 (ETCO2 if available). I also use the BVM first to see what the compliance is like and to anticipate problems that the ventilator will have to overcome. I start the ventilator tidal volume setting slightly lower than what I estimate incase the lungs are more restrictive than anticipated. For the rate, you also want to match or slightly exceed what you believe the patient's minute volume was before intubation if the patient was intubated for pending respiratory failure. The rate doesn't have to be the same as the patient's if rapid since you can give a slightly larger VT to even it out to meet their MV demands. Since this is controlled ventilation, you rate setting can vary from 8 - 28. If you set 10 and the patient is still trying to breath 20, you may have to increase the rate to meet his demands or asynchrony will occur and the ventilator will not be effective. But, watch your VT and try to get a happy median to the patient, their disease process and the ventilator. Check breath sounds and learn how to judge the PIPs (Peak Inspiratory Pressures) for each patient and how they can relate to the ventilator settings and disease processes. These machines are automated BVMs without a lot of variables. However, since it's hands off ventilation, complications can occur quickly if one puts to much faith into the machine. They also have few or no alarms to warn you and will just keep pumping the volume into the patient or NOT if the tube is kinked or plugged.

The 754 can be a good ventilator as long as one understands its little quirks. For most patients, AC control is all you'll need. Patients on ventilators should also have some sedation available for comfort. These little ventilators are very different from the big ICU machines. I had to put up with a quadriplegic patient complaining when I switched him from the ICU vent to a portable for the transition to rehab. It wasn't until we got him into the wheelchair and mobile that he finally quit griping. It just took a little getting use to. Patients that are air hungry on an ICU ventilator may have a hard time switching. Meds may make the transition easier but for heavy respiratory patients, not all transport ventilators will perform well enough to meet the demands of the patient.

Here's a better view. http://www.kumc.edu/SAH/resp_care/univent.ppt First: This vent does not function well in SIMV since there is not a Pressure Support mode to augment the spontaneous breaths between the mandatory. Thus, use the Assist Control Mode. Second: The Plateau Pressure button does not measure a true plateau pressure in relation to compliance. If it did, there is so much information you could obtain from it. But, NOT with this machine. http://anesthesia.slu.edu/pdf/plateau.pdf http://www.impactinstrumentation.com/PressurePlateau.htm Sedation may also be important since the sensitivity and demand response with this machine for some patients may be crappy and they will fight the ventilator. Think of it as trying to take a large drink from a garden hose that is barely dripping. Also I like to compare ventilators in terms of cars since their characteristics can be described in the same manner. The two devices on the other threads you mentioned are somewhere between a Yugo and a Vega...maybe an Escort...somewhat sturdy and can be practical for some situations. They are great for ventilating the barely living dead that won't fight you or ask for much. Some basic principles of ventilation: http://www.aic.cuhk.edu.hk/web8/mechanical_ventilation.htm Some basics with pictures: http://www.ccmtutorials.com/rs/mv/

This bag may not even be stocked for the U.S. nor do we know the exact purpose of it. Blackwater is huge as are their associations. Not every med is going to be needed for a healthier group they might be serving.

Their black hawk series is similiar to the one pictured. The kit does have very practical purposes and it would be a shame if some idiot was trying to use it for "whacker" stuff. When it is a mandatory evacuation, there shouldn't be any regular citizens around. This kit should be enough for the physician to help the rescue workers if needed. Of course, during some of the major storms, especially in the Keys, it can take several days for the state to clear a hospital to open.

Blackwater lists their training centers and posts some of their equipment on the internet. Their logo is easily recognized. And, it is fairly easy to copy and paste photos. Some of the hospitals in Florida also issue a few kits like this to doctors during a hurricane evacuation. If they can set up a temporary ED in an evacuated hospital AFTER THE STORM until additional resources arrive, they have some starter supplies. All meds are signed and accounted for by the doctors, pharmacists and administrator of the hospital. Of course these bags won't have Blackwater written on them with that cute little paw logo.

You guys do know that Blackwater owns that bag? Correct? That is their name and their logo on the bag. These pictures can probably be found on their websites.