CBEMT

$200,000 ambulances, here we come....

Is this the 5 year old one, or the 10 year old one? They all blend together after awhile.

+3. These are not questions to ask random people on the internet. Since you're clearly worried about them, I don't know why you haven't done so already.

I've seen a local crew blow off a "faker" that "failed" the hand-drop test, but the triage nurse put the patient in a critical room anyway because she just had one of those feelings about it. Patient turned out to have a head bleed. Yeah, I know, anecdotal evidence isn't. But if anyone can prove it works with a high degree of specificity, feel free to point us in the right direction.

Our trauma center uses it all the time due to the number of drunks they get (don't ask). If the patient wakes up with a 'cap and stays awake, they don't get a "critical" room. No response, in they go. They also have an even more noxious stimulant if that doesn't work, something they pour onto a small stick and hold to the nose. Me personally, it has no place in my care. You either respond to pain or you don't. Our trauma center uses it all the time due to the number of drunks they get (don't ask). If the patient wakes up with a 'cap and stays awake, they don't get a "critical" room. No response, in they go. They also have an even more noxious stimulant if that doesn't work, something they pour onto a small stick and hold to the nose. Me personally, it has no place in my care. You either respond to pain or you don't.

Trying to decide what I'm going to do..... But I do agree with Anthony, I was another one of the Citizens attending two years ago, and it WAS awesome.

How the hell is 45+ minutes of CPR in the best interests of the patient? Plus we need to add in roll-out, taxiing, gate hookup, time to get the ground crew to the back of the plane, start ALS care, package, remove from the plane (good luck doing CPR up the aisle), time to the truck, transport.... Get where I'm going with this? 45 minutes to wheels-down probably means 50+ to additional ALS care, and maybe 70 or better to the ER. Best interests? Really?

Don't even bother. Epi 1:1000 from an auto-injector is going to do nothing for this patient. If you can't start an IV, a BLS provider is not going to be giving any meds to a patient in arrest. For my part, have a flight attendant keep the doc on the phone. Run the code with the AED and BVM until the epi and atropine (and the lido if we get a Shock Advised message) are gone. Then, if we have No Shock Advised and no pulse, ask the doc on the phone for clearance to call it. Assist the crew in stashing the body, and tell the captain we can proceed to Houston. Edit: shoulda read the rest of the thread. I think as soon as we start CPR, any kids involved should be re-located somewhere, away from us AND other passengers if possible, and kept there by an assigned flight attendant. For young children or infants, I'm willing to bet a considerable sum of money that the aircraft does not have any equipment to deal with them- we're going to be dealing with CPR only. I might be persuaded to use a rotation of personnel to keep up a "Hollywood CPR" regime going while we divert, but after the first 15-20 minutes its not going to be much of an effort. Without any meds or supplies, there's really no other options.

DCPD just found themselves the proud owners of a very expensive but very undrivable car....

From what I've read in first-hand accounts of the North East Ambulance service, ambulances are already co-habitating with firefighters, but that's as far as the firefighters on the street want to take it. They don't even go to MVCs, for cryin out loud- you want more runs, start there!

Sounds like you both need to start applying to large municipal 3rd service agencies that aren't going to go away anytime soon- the A/TCs, Wake, Ada, Lee, etc....... Edit: speak of the devil.... http://www.emtcity.com/index.php/topic/18954-job-opportunity-lee-county-ems/page__pid__247823#entry247823

In order to grow and advance the profession, we need to enact best practices based on medical science- not continue response models on what best secures firefighter's jobs.

How can the municipality be sued for not providing a service delivery model that has no basis in science? Hell, if they wanted to they could contract for a BLS-only transport service and probably be in no more jeapordy than they are by cutting out FD-based ALS. Since most municipalities are under no statutory obligation to provide EMS in the first place, anything they do is, legally, just a bonus service anyway. As such, you are simply part of the problem, hindering the growth and development of EMS as a profession. Medical care is not about your feelings or "personal experience." Any moron can tell stories to justify their personal, biased opinion of how things should be. Medicine is about what works; what is beneficial to patient care, versus what doesn't work, is inefficient, and what does not improve patient outcomes. Guess which side you and the SFD are on?

http://www.ems1.com/ems-advocacy/articles/885722-EMS-approved-as-an-emergency-medicine-subspecialty/

Too bad the fire department can't back up such a premise with, you know, evidence. All it proves is that you don't know what you're talking about. ALS in general cannot be proven to make one iota of difference in cardiac arrest survival, and there is even less evidence for first-response ALS.

One thing you never say is WHY. Why do you feel that these patients should not be transported by EMS? Do you see yourself as some sort of gatekeeper for the EMS service? What do your protocols say about you playing "alternative transport coordinator"? Are these patients not getting an ALS assessment because you're shoving them all into private vehicles? Is pain management being neglected? Sounds pretty stupid to me, to be quite honest. You're putting yourself, your service, and your municipality at enormous risk for.... what? What's the benefit to the system as a result of your actions, and more importantly, what is the benefit to the patient?

Of course. The only thing they have to do to "prove" their value in the EMS system is to get there before the ambulance. In many systems, the fire dispatcher takes the 911 call, dispatches a fire company, THEN notifies the ambulance company dispatcher. The protocol is designed from the ground up to make sure the ambulance is running second. Pretty much my point- anyone wanting to maintain a system like Stockton's should be able to prove that ALS first response changes outcomes for the better. It won't happen.

Because of the costs and risks associated with ALS first response that can not be countered with any corresponding decrease in mortality?

You never know- a LOT of them have 911 contracts.

You're moving to "New Beige"..... willingly? Better you than me, bro.

I was asleep. Having no morning classes on Tuesdays and Thursdays, my habit was to stay up late on Monday night and sleep in Tuesday. My mother was watching the Today show when they started covering it, and saw the second tower struck live. She called me immediately, but the phone didn't wake me up. I didn't wake up until my ex-gf called about 10 minutes later. Turned on my TV and almost instantly said "Ohhhh.... Bush is gonna f#$%in KILL somebody," then turned on the TV in the living room and woke my roommates up. The only time I was out of sight of the TV for the next 14 hours was a brief trip across the street with one of my roommates to confirm that our mutual class was, in fact, canceled by the professor as were basically all others that day. Being directly under an approach path for [a major international airport] I agree that it was goddamn ERIE to hear..... nothing. When word came that there was an aircraft unaccounted for in the PA area, my cousin's 11-story dorm in Pittsburgh was evacuated. All I could do when the first tower fell (because I didn't realize that the whole thing collapsed, it appeared that just the top portion tipped over) was "...That just fell on top of the entire FDNY." I knew right then that the responder death toll would reach the hundreds. I had nothing to do with any response agency, and in fact EMT school was still 2 years in my future- but I still felt the heavy weight of loss of those that I sought to call brothers and sisters.

Thanks for reminding me to check for results.... I can only imagine what the "revision" was. Hmm..... Comment unnecessary.

We've got it for just about everything, now authorized IN as well. But it's not in our drug box per se, it's locked up with the morphine.

Our protocol is called "Comfort One." I have, but depending on your interpretation of the protocol, I may have done so in violation. Problem being, the out-of-facility patients almost never have the bracelet. Hospice is famous for having all the paperwork at their inpatient unit and nothing at the house. Last time I encountered a braclet, it was sitting on the nighttable next to the patient's bed. Most CO/DNR patients we encounter are nursing home residents with facility DNRs, none of which are ever the same and frequently have a "menu" of possible choices- Yes to hydration, no to hospitalization, yes to CPR, no to intubation... you get the idea. So the issue now becomes, do we treat according to "signed DNR status," which initiates Comfort One and everything it prohibits, or do we treat according to the patient's menu selections? Especially if they're still alive? For me, I suppose that depends on how you define "cardiac resuscitation drugs." Great, now I can't even start an IV on our crumping DNR! Jake- I like your form a lot better than I like my whole protocol.

Oye. They really need to read the Maryland study. Here penetrating abdominal trauma is considered one of the primary reasons FOR considering MAST. In fact its the most common scenario used at final practical testing. Penetrating chest trauma is an automatic no-go, however.