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Jake, I can only speak for myself. We have protocols for each drug we use, & for each illness we go to (in broad terms). These do, as I stated in an earlier post give us the latitude to move & make decisions based on what we are presented with. For example, if we attend a seizure patient, we can choose IM or IV deivery, or both, our choice, to a total max dose of 15mg of versed. (Adults) It is recommended for 3mg IV doses, or 7.5mg IM doses, however, we can & I have on more than one occasion, adjust that dose to suit the patient, Better to have to give a bit more than to OD on an initial dose. If youpercieve this as a holier than thou mentality, for may part, it is nott meant to be. I simply answered a question with my opinion & responded accordingly to other threads that have specifically questioned me. I stand by the opinion that med control is an antiquated system that should be deleted. I will not try to make it sound any prettier than what I said. We are entitled to disagree but that does not make anyone holier than thou. I hope you read all of my posts in relation to this, especially the one where I said & further I stated Phil

I said this to highlight that EMS is limited to the tratment of a current acute illness, not address the causes. How many drugs do you carry in your bag that would fit that description? If we carried a pharmacy, yes I would agree, but there are also publications provided that will tell you the same thing. Med Control is a cop out. Nothing more, nothing less. It is a way for someone to justify their existence & CYA. None of these are good reasons for maintaining med control. Med control will make you lazy. Why remember stuff when someone is on the other end of the line to make the decision for you?

why? what needs to be said in a PM that cant be said here? Dwayne, I wasnt fortunate enough to get a PM like you. You are special Phil (also my real name)

Well said Kiwi, I do believe I tried to say that but I may have said it in Khazakstaki or Swahili. There is a complete difference in understanding what is happening & treating the root cause. We usually develop a provisional diagnosis, we advise the hospital what we see, but it is not up to me to tell an acutely ill person who is suffering with ischaemic heart disease to lecture them on losing weight, quitting smoking & exercising as well as dietry modifications. We are called to an acute problem. We treat the symptom. We should understand what our treatment is doing, how it will benefit the patient, but the patient described doesnt need me farting about talking to someone (mass) debating over what to give them. ASA, Nitro, O2 Morphine & diesel. Minutes mean muscle. Playing around on scene could cause infarction of muscle. If me being more concerned about getting my patient to difinitive care makes me a robot, then so be it. My patient needs to be in hospital for difinitive care, regardless of it being a medical or trauma issue. Give me the tools to treat my patients sufficiently to do that. That is my job. I am not a doctor & can only offer limited treatments. I know the pathophys. I also know my limitations. Medcontrol will not help with either of those. Brent, what you are talking here is a whole of health issue. We do it here. We refer, in some cases to aged care teams. We also advise directly to the hospital of what we find. So yes, but that is not our role, it is an adjunct to it.

Is that because that is the sum total of their mental concentration & why they feel the need to hold a long, firm hose........

I do believe I answered that. A medical Direstor is your medical (or should be) control. They approve what your SOP, Protocol or guideline should be. Add to that a Medical Advice Line, with the ability to add suggestions to yout treatment options, leaving the final decision to you is a different story. Why? Does the Physician have experience in Pre Hospital Care? There is a difference in what you do on scene compared to what is done in a more controlled ER. Discussion with a more appropriate person, experienced in pre hospital care can be of more benefit in many instances. Then there should be a review of your protocol SOP or whatever you want to call it. The person described as asthma extremis needs epi, so lets look at it, regardless of needing online approval, use your brain. The patient is tachycardic, elderly, history of heart disease. The person also has a severe airway limitation , so, do we risk increasing their tachycarida, thereby increasing oxygen use & opening the airway, or, alternativley we allow the wheeze to stop & let them die? Not much choice hey hot shot? I am simply saying one way there is a risk of death, lack of action seriously increases that risk due to lack of air movement. So we dont treat syptomatically? OK let me ask you this, because the 7 years I have in the field according to you makes me a complete fool. If you attend to a person with chest pain, what are you treating. This patient needs, O2, ASA, Nitro, Morphine, troponine assessment, possibly thromblytics, stenting, diet & lifstyle reviews, as well as some ICU time. So what do we treat? we treat the chest pain, we do that through vasodilation & inhibiting platlet aggregation, maximising O2 supply delivery & decreasing the pain with morphine (although it does have some coronary artery dilation properties, in the elderly however this is questionable) therby reducing the patients anxiety levels. Do we lecture the patient ablut the pack a day smoking habit they have, or the deep fried diet they have? Do we discuss the fact that they are a 500 pound tub of lard & they need to exercise? No way. That is innapropriate & something for the doctor to address at a more appropriate time. We treat the symptom, not the cause.

Fiz, I think you will find it was I that used pain relief as an example, thats all it was. It wasn't just about first round doseing, it was about the administration of analgesia. Just so were clear, here is what I said Changes the relevance of your comment. A protocol is nothing more than a guideline. Again, using analgesia as an example, I can give up to 5mg bolus with repeat doses of 2.5 to 5mg every 2 mins to a max of 5.mg/kg. NO further questions asked. Why does it have to be a doctor? We have clinical assistance lines that perform the same function. If you have to ask this question, then you really need to have your accreditation reviewed. Lets see. The person is having severe respiritory distress issues. There is minimal air movement. I give dose 1. Slight implrovment. I give dose 2. Slight improvment. What the hell am i calling for advice or, either the patient needs their airway open to breath, or they die. If they have a cardiac event post epi, was it caused by the epi, or was it caused because the myocardium had been working too hard when they couldnt breathe? This one is a no brainer. STEMI, I agree, ECG is open to interpretation & you are better to be sure. Huh? This is prehospital care. You have a symptom, treat it. I had this discussion in the chat recently. EMS treats symptomatically. It is not up to us to determine most root causes & the person you are discribing needs the benefit of a HOSPITAL with doctors, nurses, & those wonderful things called pathology labs. Treat what you see/find, & get em to hospital, you dont need a doctor to tell you that. I agree there is much we dont know, however, they are not a consult. they are a CYA tool for lazy medics who fail to use their brain. They are a failsafe method for people to say I only did what I was told, a Neuremberg defence when it all goes to shit. Now your stuff. Treat what you see/find, get rid of medical control. Yes doctors consult, but they are usually having a consult over a patient who has more care than they can poke a stick at. They have usually got the patient through the critical period & are looking at the case retrospectivley to determine future treatments & how they may have improved past treatments.

My heros. Wankers. More perpetuation of BS at an unprecedented level.

Good to hear from you Kim. Glad you & Roy are OK mate.

I have stated before tha whole US system needs a complete review. The notion of an EMT-B (sorry guys) really should no longer exist. There is evidence (we do work on evidence based parctice these days) for early cardiac reperfusion through the use of ASA nitro & O2, this is just 1 example. We need a medical director, there is no dispute about that, but they should be an advisor only, sign off on a protocol & pharmacology & then start a new review, looking at current evidence based practice. Other than this there should be complete autonomy with the officers on scene & with the patient. I do, however, have 1 exception to this rule. There are services worldwide that have conducted, are conducting or have introdced thrombolyasis for STEMI. To the best of my knowledge these are all done with the approval of a doctor. This should continue as this means that all personnel who can start a line can use these drugs. This will lead to improved patient outcomes. I fail to see why I should have to ask how much pain relief to give to someone. Knowledge & experience will tell me. Get rid of med control, overhaul the system to remove a EMT _ B's (an upgrade would be the best option) & provide better overall care to your patients.

So almighty one, you have taken to being a wise ass now hey.........

Google Maps takes me to the right place

Admin, I put my location on & it had me in the Indian Ocean, about 6000Km from where I actually am......

Squint, my service have what we cal Rapid (Rabid) Responders. These are either Intensive Care or Extended Care Paramedics. We also have Intensive Care Paramedics on Motorbikes. As a call comes in, it is run through a ProQ&A series of questions. Depending on te response, they will resopns one of the above, as well as a normal double crewed ambulance. In the city, the motorbike is on scene post haste & can then advised how they need the larger vehicle to respond. They are stocked with a full drug kit, defibrillator & small O2 kit. Enough to get them by until the other car arrives to back them up. The other 2 are used to deploy in more urban areas, but still respond quicker than a normal ambulance. Again, they are deployed on the ProQ&A questioning & dispatched with a double crew to back them up. Extened care is different again. They are called in by a double crew to treat the patient at home, with a view to non transport. They can perfom a number of additional functions & proceedures & assess the competency of the patient & appropriateness of non transport options. This means that one person is tied up, in a vehicle not designed for transport, instead of 2 with a transport vehicle. With healthcare becomeing a bigger & bigger issue, options cuch as Extended Care, Competency Assessment & Refferal, non transport are what all progressive forward moving services will have in their arsenal. Pre Hospital medicine is moving away from Pick em up, Pack em in, Piss em off, no treatment ambulance drivers, to highly trained professionals who have learned to recognise & distinguish when a person will need a hospital visit, & when they are better served at home. Phil

I think you will find that to apply for a 'graduate' position, you will need to hold a University degree. A diploma is what most people who go through general entry attain. I would suggest you contact the service you wish to be employed by to see if they actually will accept the qualification you have & if they will recognise the prior learning. The QAS web site lists qualifications, but they specifically relate to qualifications attained through other services & include working (not ride a longs)as an ambulance officer. *EDIT* I researched the QAS web site to find this I think this will more than answer your question.

A guy was playing golf one day and he got lost. He saw a lady up ahead of him and went to her and said "Can you please help me, I don't know what hole I'm on." She told him "You are one hole behind me. I'm on 7; you're on 6." He thanked her and continued playing golf. On the back nine he got lost again. He saw the same lady and went to her again kind of embarrassed. "I'm sorry to bother you again but I'm lost again, can you please tell me what hole I'm on." She told him "You are one hole behind me. I'm on 14; you are on 13." Again he thanked her and continued playing golf. When he finished he saw her in the clubhouse. He went up to her and asked if he could buy her a drink for helping him out. She accepted. As they were drinking and talking he asked her what she did for a living. "I'm in sales." He replied "no kidding so am I. What do you sell?" She said it's too embarrassing to tell. But after he kept pleading to know what she sold she said she'd tell him if he promised not to laugh. He Promised. She said, "I sell tampons". He immediately fell to the floor laughing hysterically. She said, "You promised you wouldn't laugh". He replied "I'm sorry, but I couldn't help it. I sell toilet paper. I'm still one hole behind you."

One of the things I have found is a comparison of the elderly (defined in an arbitary number as anyone over 65) & the young (a number I choose!!) usually under 25's is technology. When the 'elderly' learned to drive, many (as they were born prior to 1945) did not have the volume of traffic on the road, modern electronic items such as satnav's, I mean they were lucky to have a radio in their car. They were taught about concentration & its importance on the road & they too heed of what was said. Because of this, as they have gotten older, (& 65 isnt that old, just ask lone, AK or dust hehehe) they realise that they may have to concentrate a little harder for the same result, not just in driving. By comparison, younger people tend to be a little more reckless, they have a satnav, ipod, cell phone, as well as twitter & facebook on their cell to distract them from what they are, or should be concetrating on. We also need to consider that, when it comes to 'elderly', arbitary numbers do not work. I have seen, as many of you would have, people in their mid 50's on deaths doorstep, with people in their 80's still leading a full active & happy life. One of the things that happens here is that once people reach the age of 75 they have to have a full medical & receive medical clearance as well as a mandatory driving test each year. While some see this as a negative, there is an insurance company who sees the benefit, they offer discount rates to these drivers because they know their distances are shorter, they concentrate properly on what they are doing & they avoid distractions in the car. To say no 'elderly' person should drive is like implying that no man can cook, no woman can be a mechanic.

Firstly, I would like to say BRAVO to JEMS for a positive story. Congratulations to Paramedic Staci Bossack. However, I hope she doesnt expect this to be the normal routine for a cardiac arrest. Some of us have never seen a save......

Herbie, I have said repeatedly that the only reason Fire wants EMS is to justify their existance & pay rises. Let the seperate. The we will se how people like to pay for a service that literally does nothing. I know as a taxpayer, i wouldnt be real happy about it. You have just summed up the ONLY true reason for fire & EMS to be combined, finally some honesty.

Says it all. Let the tossers be tossers & let those who want to work in prehospital medicine only do that. This will be the next evolution joint services. Seperation.

You just wait to see the comments that appear from the so called fairer sex.......

When I get old & I am in a nursing home, I want to meet a woman with Alzheiers & Parkinsons........

And the change to normal would be????????

Good to see you have conceded & accept these Tezzaa, I of course assume you wrote these from personal experience.

There are a few things that need to be said here. Annie, why wouldnt I comment on such stupidity (she probably works as a fireman). Firstly, from the head shot, EWWWWWWW. Secondly I would say why stop at a bikini like, but EWWWWWWW. Thirdly, there is normally natural selection where some women are stunners, some have brains, few have both, she obviously has neither. Now ladies I am entitled to have a chauvenistic attitude on this one, you cannot deny me, besides, I have had no sleep Now Ruff, mate, I know new kid around & all the it has been a while but EWWWWWWWWW.