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So now i am to be berated for pointing out the bleeding obvious???????? All I want is to know that: * The author is clearly stated * The information is correct * The person who is posting can defend the claims they have made Is this too much to ask? Dr Death, the age of Timmy is irrellevant, as i said, to take 1 study, irrespective of a persons age & base everything on that is a nonsense. I would expect you as an ER Doc would NEVER do that. Please tell me where I am wrong

Timmy, while u make that assumption, u still need to reference properly. This also does not answer the lack of relevant information that was supplied. That is more pertinent & relevant. If u want to quote it, it is up to you to make sure it is right. check the facts, ask others, don't assume because Colleen M Hayes, MBA, RN, EMT-P has researched it, it is complete, look at the info i provided, & u will see it was lacking in a number of areas. The reason i wanted to know the author is to challenge her findings & ask why it is an incomplete report? If u have so much admiration for her maybe you could ask for me. Remember Timmy, the tobacco companies, asbestos companies & others had 'eminent experts' telling us their products were safe & in the case of tobacco, even healthy for us. This is one report. Look at it properly, then make the same judgement.

The article was written by Americans, I can only assume that EMS workers have written it, so when it states that Oz is more advanced than the U.S it’s coming from U.S people, not me. The article is generally referring to Australian health care as a whole, not by state. Timmy, this is where the problem lies. The way i read this is that it was written by you & there was nothing to indicate otherwise. Ruffems, it is important to reference, that way, should someone decide to challenge, it ensures you have not made a fool of yourself & people do not mistake the work & quotes as your own. That is a basic of any report writing. I would also prefer to see that the information provided is more accurate that a cut & paste like this was. I respect the american system,but, when a report is posted (unreferenced) & bases its findings on severely limited information, i think there is some degree of irresponsibility on the person posting. To me it also says the person posting has not read properly, or does not fully understand what was written as there are no comments added by timmy, in this case. My concern with this is that they have based their opinions of the word of 4 people, one is a student whom i presume has very limited experience. While I have extensive use with this drug, it is NOT the primary drug of choice & has limited applications not listed here. For example, unlike entonox, Pentrane/Penthrox/Methoxyflurane requires the patient to hold the application device. This is great with patients over approx 9 through to middle ae, however it can be a problem with the elderly. Due to the rapid washout, history taking becomes a very drawn out affair as the pt must keep breathing the drug to ensure maximum effect. In NSW (yes Timmy, I will only speak for the service I work for) we are prohibited from attaching O2 to the inhaler due to the concern of droplet inhalation & also, as we have areas of extreme heat, he concern for flash fires in the cars as the flash point is greatly lowered with the addition od O2. This severely limits its usage for patients with cardiac chest pain. (What is more important the delivery of high flow O2, or the administration of inhalation pain relief?) The nephrotoxic effects are not fully addressed & there have been studies on these effects, not on patients, but on the officers administering the drug & we, in NSW are limited to administering a maximum of 6ml per day. What Timmy also failed to advise is that many services across Australia are now embracing the use of Fentanyl as it is accepted that IV Morphine is the Gold Standard, there are other Opiate options, administered in other ways that can be more effective & less reliant on patient complicity. Fentanyl intra nasal is that method. It is non invasive -requiring no IV access, does not require the patient to hold something & is fast acting. It also has the advantage, like Penthrox of being short acting, but dose not have Dosage restrictions, like Penthrox. While Penthrox is a good drug to have in the kit & works very well in conjunction with IV Morphine, & Itra Nasal Fentanyl, I no longer consider it as a first choice drug, but a back up. The opinion that is expressed by the author (not Timmy) is not necessarily correct. The criticism here is only on pain management, not the overall systems, which I have discussed elsewhere. I hope this explains why i was not happy with the post Timmy originally left. I will accept criticism, however I will not when the information provided is lacking & not credited appropriately. I also am offended when a person appears to be speaking with authority about when it is not necessarily the case.

Timmy, i assume this wasnt your work, who wrote all this? Penthrox/methoxyflurane is an inhalation anesthetic that has analgesic qualities. It works. I know because i use it. I dont need a volume of crap to tell me as much. I speak from experience. To say we are advanced of the US is a bold statment & i hope u can back it up. I will ask you again, when making reference to services here, please know your facts. If you are spaking for Vic Ambulance, state that. ASNSW also use Fentanyl. The primary reason is to allow for extended transports, & reducin the possibilities of nephrotoxicity in both patient & more importantly the administering officer. Timmy, please learn your stuff, not quote for all of us & read other posts before usin cut & paste in the forums. Phil :twisted:

If it was from Australia, then you were seeing Methoxyflurane, or Penthrox. It is a CNS depressant & works well, acts quickly & washes out quickly. It is also used as an anesthetic agent, with the risk to the patient of renal damae in extended uses. The dru is nephrotoxic & the pt is limited to a max of 6ml/day 15ml/week. Officers on the cars administerin are also limited in my service, to givin a max of 6ml/day as well. Any other questions, let me know Phil

Mal I get frustrated with the whole notion that u have brought up here, as well as the attitudes of us Vs them in ems. Just a few basic points to start. We all start somewhere. We r all different & have different goals in life. The attitude that any particular level is better than an other is just plain dumb. For a basic to say they save medics, is as well. Should we not all be looking to help each other & for those more experienced, impart knowledge to those who want to hear it. If we are asked a question & provide an answer that may be different(opinion wise) to some one else, should that not be the catalyst for a healthy debate instead of allowing the debate fall into an insult fling about who is better, who is smarter? The bast way for people to learn is to seek information, this site is & always will be a valuable resource, BUT, there is a need for respect to be shown by all members & guests to everyone else in the rooms, PM's & forums. This is not a healthy debate to have & we need to learn to work together. Basics help medics & medics help basics. End of story. Phil

We are lucky here & our service has an agreement with one of the Univercity facultyies of medicine. This allows us to study in detail the disections they have stored. We also get to 'play' in the wet lab & are activley encouraged to get hands on to inderstand the forces needed to cause damage. If we are lucky there may be some med students prepaerd to allow us to watch them undertake disections. I would recommend it to anyone in the field. Phil

they r used as matter of course here for spinals on choppers here & work well.

I would be looking for a new doctor

Timmy, Well I was mainly talking about the services in Victoria. I don’t really know about services outside of Vic. As far as I know both Rural Ambulance and Metro Ambulance only have ASL or MICA Paramedics. I've never come across a volley paramedic. There’s a CERT team near were I live but I don’t think they've ever been call out. I agree when you say St John should NEVER be a 000 provider. We shouldn’t even be at most events my division covers! I wasn’t bagging out ANSW but I live on the border of VIC & NSW. We called them to one of our duty’s. Out jumps this young guy and an older chap. Young guy didn’t look much older than 19 and the older bloke looked like his dad. This young bloke has a white billabong hat on, blue overalls, and white globe shoes :roll: He then makes the patient move from our stretcher to there’s with out any pain relief. Let my remind you this person had multiple fractures to there L tib/fib, Pain 10/10. I’m sure that most ANSW medics are more professional than that, but this was just my first taste and impression of ANSW. But I don’t think it necessary that they dress like this just because they live in a rural area, the older bloke was in perfect uniform.

Timmy, I think u need to look at the dfinition of a BLS/ALS providor is more closely. ALL states in NSW have both BLS & ALS providors. Yes there are a number of "Ambulance Services" in our country, however, primary emergency response is the responsibility of government. Can St Johns respond to a 000 call. The simple answer is no. To the general public, BLS providors in any service in Australia are seen as providing some sort of advanced life support. This is because oropharangeal airways, & drugs are not taught in first aid courses!!!!!!! I am not denegrating the volly services provided by St Johns & the like, but, before you start to make posts like you have, I think you need to develop a better understanding of what services in this country do & what defines ALS from BLS.

James, i think that you should either whipe your chin cause the BS is flowing to fast. Either that or you should really think about what the hell you r doing my life is worth more than this job & if you think otherwise then u really need to get yr head read. Personally i think i am right on the first count Phil

mail

Tank you PRPG. at last some common sense. AZCEP, I also stated, which you apear to have overlooked, that you treat what you see. Waht you see is based on your observations, history etc. This can only provide you with a PROVISIONAL DIAGNOSIS, a platform from which to commence any NECESARRY interventions. as has been stated repeatedly, a DIFFERENTIAL DIAGNOSIS can only be done when it has been confirmed by results of tests not available in a pre hospital environment. It all boils down to what is the role of EMS? Pre Hospital care. Not difinitive care.

Ace, I agree with what you are saying in this thread. Medicine can be machine oriented & we forget the human factor. However, we cannot forget that to gain a full differential diagnosis, most illnesses require a number of tests to confirm suspicions. This is common sense, & usually done in hospital. As an EMT we all need to use our experience & common sense to determine our provisional diagnosis. eg. a person presents with mid retrosternal chest pain with radiation into their arm & jaw & is ashen gray has a high probability of having a cardiac event. We then use an ECG to confirm this & instigate treatment. However, there are many different causes of chest pain that do not require the same regime of therapy to be instigated. Present differently, & the use of a cardiac monitor in this situation can be useful to assist with diagnostic exclusion. Our initial observations should be without machine & use the technology to your advantage. Work smarter, not harder. I will always maintain that in the prehospital environment, we should treat what we see (based on our initial observations) & aim to get the patient to hospital ASAP, alive. We use history & examination to assist with our index of suspicion, and we instigate treatment based on that information. Nowhere in the articles does it say that the use of technology should not be used. My reading of the information provided by you is that a good history & examination will give a diagnosis, however, "it was possible to confirm anatomical and etiological diagnoses in 40 by matching the clinical syndromes with highly specific laboratory findings." Pre hospital medicine is not the appropriate place to try & diagnose specific illnesses. We have limited resources in the vehicles, limited (usually nil) testing facilities, & where in an ER a general physician has available to him any number of staff specialists, we have ourselves & our partner to cover the entire list of medical specialties. All medicine is continual learning & we should always look at it as such. To close our mind is not right. However it is not, & will never be my job to determine conclusively a patients illness, my job is to take a history, do an examination, instigate treatment based on my observations & hand the patient over to the hospital. Most importantly, my job is to reassure the patient, talk to them & make them as comfortable as possible. Let the doctors do their job, let the doctor decide conclusively with whatever testing they believe is appropriate the diagnosis & ongoing treatment for this patient. EMS is just that, an EMERGENCY MEDICAL SERVICE. Phil

Ace, I agree with what you are saying in this thread. Medicine can be machine oriented & we forget the human factor. However, we cannot forget that to gain a full differential diagnosis, most illnesses require a number of tests to confirm suspicions. This is common sense, & usually done in hospital. As an EMT we all need to use our experience & common sense to determine our provisional diagnosis. eg. a person presents with mid retrosternal chest pain with radiation into their arm & jaw & is ashen gray has a high probability of having a cardiac event. We then use an ECG to confirm this & instigate treatment. However, there are many different causes of chest pain that do not require the same regime of therapy to be instigated. Present differently, & the use of a cardiac monitor in this situation can be useful to assist with diagnostic exclusion. Our initial observations should be without machine & use the technology to your advantage. Work smarter, not harder. I will always maintain that in the prehospital environment, we should treat what we see (based on our initial observations) & aim to get the patient to hospital ASAP, alive. We use history & examination to assist with our index of suspicion, and we instigate treatment based on that information. Nowhere in the articles does it say that the use of technology should not be used. My reading of the information provided by you is that a good history & examination will give a diagnosis, however, "it was possible to confirm anatomical and etiological diagnoses in 40 by matching the clinical syndromes with highly specific laboratory findings." Pre hospital medicine is not the appropriate place to try & diagnose specific illnesses. We have limited resources in the vehicles, limited (usually nil) testing facilities, & where in an ER a general physician has available to him any number of staff specialists, we have ourselves & our partner to cover the entire list of medical specialties. All medicine is continual learning & we should always look at it as such. To close our mind is not right. However it is not, & will never be my job to determine conclusively a patients illness, my job is to take a history, do an examination, instigate treatment based on my observations & hand the patient over to the hospital. Most importantly, my job is to reassure the patient, talk to them & make them as comfortable as possible. Let the doctors do their job, let the doctor decide conclusively with whatever testing they believe is appropriate the diagnosis & ongoing treatment for this patient. EMS is just that, an EMERGENCY MEDICAL SERVICE. Phil

I agreecompletley. To dismiss a pts S&S is leaving yourself wide open. Unless you have all the right diagnostic tool, your aim should be to have this pt in the hospital. Yr boss needs to have the benefit of keeping this pt alive compared to the EMT's arriving with lights & sirens & any associated percieved bad publicity associated with it. Any idea on the outcome & diagnosis of this pt?

Trench, excuses are like belly buttons, everybody has one. :twisted:

They say it is used for military pilot aptitude testing. Try and beat 14 seconds. http://members.iinet.net.au/~pontipak/redsquare.html It's harder than it looks. Try this . IT WILL DRIVE YOU NUTS!!! The object of the game is to move the red block around without getting hit by the blue blocks or touching the black walls. If you can go longer than 18 seconds you are phenomenal. The US Air Force uses this for fighter pilots. They are expected to go for at least 2 minutes. Give it a try !![/font:8aa149d7f5]

Happens hear all the time. i see the problem as 2 fold. 1. the person driving is ignorant & doesnt give a rats ass about anyone but themselves 2. modern cars have progressed to the point the have removed too much road noise & people today drive with their windows up & radio up & just cant hear u. Therfore they too are ignorant. Unfortunatly, i cant see it getting any better with more & more cars on the roads. Phil

With the exception of sharpes, i will usually ask the patient or family member if i can use the bin, or i will tell them that i will clean up when i colllect the rest of my gear, they usually tell u its ok & they will do it.

fishing and hunting and played golf a lot and drank beer and left the toilet seat up and farted whenever he wanted!. u mean this is supposed to stop when u get married? damn. I have to admit it is good to see Terri is offering some balance for a change!!!!!!!!! :twisted: :!: :!: :!:

I agree with all of the above, however i will throw a spanner in the works? U have a patient who will take a collar, no problems, u size them up, but cant place it because they have had thoracic surgery 6 weeks prior & the pressure on the wound is too painful, even before u put any pressure on it & the patient is complaining of severe neck pain. I know what we did, but what would u do? :twisted:

f*&#@ No more f@#$%^&&***^%&^%$&%^$ swearing. Kill me now. You did forget one tho Dan instead of F@#% off u idiot - use - with all due respect

Does it really matter? The dictionary describes a Paramedic as "related to the medical profession in a supplementary capacity, usually in a pre hospital environment" Using the same dictionary a technician is described as "one skilled in the technique of an art, as music or painting" Based on this I think Paramedic as a generic term is more appropriate that EMT. The use of terms within that - PCP , ICP etc is probably the best way to define skills further & is more for use within the service you work. The notion of keeping the name Paramedic for those with IC training only further pushes the elitist notion & is not needed. In many cases, our patients do not know the difference & most can be supported with BLS until backup arrives.