spenac

Good one Doc.

Well thank you.

Unless mass casualty where they would appreciate anybody with first aid, I would say you should just drive on by if ambulance already on scene.

Theres no elevators here in hicksville. But neat idea.

Well I thought the changes in player care was neat. :oops:

hello

Not enough for the crap we deal with from the city government.

and very cold

over blue water

flew the pair

Haha If only, definitely big city thinking. There is no bird that comes to my area. They meet us at the hospital or the airport just across from the hospital if fixed wing. Like I said earlier it's just me and my partner. Also in my limited experience with calling the bird, OB's often are not allowed do to limited work space. Most of the ones that we have that get transferred out they send a speciality ground ambulance from the nearest big city which is 2.5 hours north of our bandaid hospital. But maybe thats just our so called "local" birds protocol.

HAHA. Dust you hit it on the head. As you have seen many of my posts get people uncomfortable. I have gotten nasty comments on some topics. All because I try and get people to get out of the hospital is 5 minutes away so load and go mentality. In a perfect world we would all be given much more education including how to do many skills currently not done or only done in limited areas. Then medical directors could allow us to do more to the benefit of the patients. Pre-mature labor is when more is needed. On full term the only real work is the clean up 90%+ of the time. To have more info allows as you said to get everybody geared up or to realize lets just take our time with a smooth ride. I do realize I am in a semi unique environment as Dust is aware. We have lots of uneducated, poverty stricken, and often illegal patients that are to scared to get help until it's to late. Thats when we are called and we not doctors make the difference. As we have basically no communication with hospital until we are about 10 miles out. Even satellite phones in this area don't work well because of all the mountains and canyons. Now don't get me wrong just like everyone else most calls are BS and the only impact we are having is saving the person gas money to the hospital as they're not going to pay for the transport. But when it's real it's me and my partner and no one else. Thats why I say expand our education which in turn will expand our scope of practice. We are practicing frontier medicine. We do treat and release, we deny transports, we, well you get the picture we are allowed to practice medicine, thanks to an awesome medical director.

In Texas these procedures are up to the service's medical director. The medical director can make written protocols for pretty much anything that they are willing to allow. Our medical director educates us in and allows many procedures other services would never consider. Our medical director understands we are the only medical care for at minimum 90 minutes and often longer.

We get lots of no prenatal care OB's. Large number of pre term OB's, but don't break down our charts beyond OB, so not sure of numbers. Thankfully we get most of those to the hospital. I have delivered a couple of preterm over the past few years, sadly to young and did not survive. Thankfully most of the time we are able to bolus them and slow or stop contractions. If all else fails we go to terbutaline to try and stop pre-term contractions.

On the border. Minimum 90 miles to the hospital. Many OB's show up in remote areas that take more than an hour to get to, then that takes us 2-3 hours to get them to the hospital. Most are illegals, that get into the country illegally or even legally with a day pass then go hide out at a friends house till they go into labor. I actually went 2 years transported 300+ active labors with no deliverys. Last 2 years only about 200 active labors and 9 or 10 deliverys in ambulance. We used to put stork stickers on back window but got to a point you could not see out. So on new ambulance we don't do it.

Surely you are not saying the 2 month paramedic program is the best. :?

Obviously somebody hasn't done many OB calls. Nothing hot and nothing sexual about a vagina covered with all sorts of pre-birth goo(hows that for a medical term). Another poster mentioned having only looked under 1 OB's dress. If you do many OB calls that will bite you in the rear. Speaking from experience, the quite calm girl saying she has no pain will all of a sudden have something screaming from between her legs. Our policy is all OB's are naked patients. IMHO if you have not at least done a visual exam you can not say you have given proper care. Some woman cannot feel that the cord, an arm, etc is protruding. tniuqs thanks for posting about rural EMS. People in the citys just cannot seem to grasp that you are the only medical care available for more than an hour. As far as delivery for those that have not done it. 90% of the time the worst part is the clean up. I always choose to catch the baby and do patient care leaving my partner to clean all the goo(hey theres that medical term again) from the cot, the wall, ceilings, cabinets, and floor. Of course we actually keep lots of towels, sheets, and blankets. We if time allows cover everything so clean up is easier. People always laugh saying our ambulance looks like a linen truck because one big cabinet is full of linens, but when I have helped on their trucks they find out why real quick. Now those more rare cases where things go wrong, it takes it's toll on everyone. I do think in rural areas the options I have posed in this topic could really benefit number 1 the mother and unborn child and secondly the EMS crew.

Quick shoot it before it multiplys.

Headline 2008 Texas Rangers Undefeated to Start Season First game for the Rangers will ruin the perfect record. Go Rangers

Thanks for all the input. I do agree that 99%+ services just need to get a visual and go. With my minimum transport of 90 miles and often times picking OB's an hour away from the station we end up with 2.5 hour transport times often. I do feel it could really help us better monitor what is happening instead of just peeking and waiting for something to be peeking back at us. If your service does allow dilation checks can you pm me the protocols. Thanks. Now to educate those that do not do many OB's, to make sure you are not missing something when you look for crowning, gently open the vagina lips ( the labia ). You would be surprised how often at first look you think nothings happening, but when you open the labia you see hair(top of babys head) in the vaginal orifice where you should only see pink. You do not place fingers in vagina to do this. While we are on the OB subject, lets say no dilation checks in the field for most, but what about episiotomies? To assist a tough delivery should they be allowed? Yes I realise that it is better most times to allow the baby to come out on its own, to even allow the perineum to tear. But at times I have had some women not tear and we assist stretching as much as possible but babys head sets stuck just inside and episiotomy could free the baby quicker helping avoid airway compromise of the baby.

Yup can't believe the news crew called him an ambulance driver either, just no respect. :twisted: But in all seriousness, another black mark against our troubled profession. Later my fellow taxi drivers.

In Texas since 1972. They should have stayed in washington for all the bad baseball they have played.

As bad as the Texas Rangers play sadly we still have to call it baseball. Go Rangers all the way in 08.

Welcome to the site. Try this site : http://www.emtb.com/9e/ Do the pretests and see where you are weakest and study that. The NR CBT is going to find your weakness and ask more questions on it. Hope that helps.

I have delivered numerous times in the ambulance. 6 times this year. Took over 100 active labor the 90 miles to the hospital this year and delivered 3 more babies on the hospital bed before the doctor arrived. IMHO it could help us make a more informed call on whether to just set up and deliver vs just drive, also could help hospital decide whether to just wait till we get there or to activate a delivery team, yes small hospital. Already all active labor patients are naked patients and are visually checked but more info makes for better decisions.