ccmedoc

The Riddler---Nightwish Obscure? Its in my head......

This would be a study I would be very interested in. I think the only way to quell the ranting about taking intubation off of the streets may be this type of study, broken down by educational backgrounds. This may also give a kick in the keister to increasing the educational requirements...period! At the risk of being overly pessimistic, I may have to look into this in the coming months.. I will take any studies or reference to studies if you want to send them to me..This may be a way to burn off some angst by the pool..

We had one paramedic in the area amputate a womans leg after she was trapped under a train car. From the report I read, he used a hacksaw at mid femur and the patient tolerated it surprisingly well. She later died from sepsis. He was cleared by Med Control due to his experience and their knowledge of him. No approval was given via HERN or other communication. No protocols exist for this, however, and I would say it is on a case by case basis. There are classes around here that teach field amputation. They are about 16 hrs long, and include a cadaver lab. Necessary background is necessary, such as college level sciences, to ensure understanding of the concepts and repercussions. There is no certification, per se, but I believe that on the right day, with the right staff at the med comm..it could happen with approval....

I kinda do...I have not seen many good outcomes from short courses, thats all. :wink: Medic mills around here have put a bad taste in my mouth.. I can name all 206, by the way!! This is what I would like to see...for starters anyhow

I find it comical that the only ones who know what they are doing is the students. I am not sure of their experience level, or maybe I am, but how do they "know" what they are supposed to do..only compressions? I would chalk it up to a bad case. Sorry, but it happens. The call starts in the field and, if it is a cluster in the field, it will most likely to continue to be a difficult code. I would imagine the staff was shocked to have a patient transported by three paramedics and getting a patient with no IV, no ETT, and no ACLS initiated. Short transport or not...WTF? Given this letdown, it is not surprising that some staff had to alter their plans..To say it fell apart and they had no direction is, for me, hard to fathom. Maybe the OP just didnt know what he was seeing and assumed the worst. I have seen this also, but for such a "cookbook code", it happens quite often in the field. I am amused that a person, who has most likely never had to run a code as leader, can offer such bold observations and accusations..it never ceases to amaze me.. :roll: I am offended...both as a nurse and a paramedic... OK..I'm over it..

Maybe add to that, a pharmacology class and medical terminology class..Good basics for continued learning. It's hard to push the learning envelope when you don't understand what you are reading. Online or otherwise. :wink: Just my opinion, as always, for what it is worth..

Not acronyms again... :shock: :shock: :shock:

Utilitarianism is a form of Consequentialist philosophy.. Consequentialism is a term with many sub-philosophies or ideas pertaining to the same basic thought..the end is what matters, not the means. Utilitarianism, itself, also has a few different sub-philosophies... Probably the most direct contrast to Consequentialism would be Deontology... I would argue that EMS would be more of a deontological profession.. search Immanuel Kant and categorical imperative... Back to the thread..enjoy the search My answer to the OP is.....sometimes..I wish philosophy and ethics were that cut and dry... :roll:

Just one last word about the infection of the patient. This portion of an article may be a some interest...or maybe not... These are the real HCW related infections out there..not some hypothetical 'HIV transmission from EMT to patient' phobia.. If you do ECF transfers, IFTs, or general 911 response, the acquisition and transmission of these bacteria are a probability, not a possibility. especially in the "sanitary" conditions of an ambulance..So who's out of a job today?? :roll: ...Just sayin' edit..smileys

This is an honest question..Others may be are you volunteer or professional, and how busy is our service? If you do not stay busy, new EMTs may not get the field training they need. This begs another question with this statement: This is quite possibly the root of the problem. If your FTO program is crap..your new EMTs will, in the end, function like crap. I think it comes down to field training, if they are fresh out of EMT training, they have very little knowledge, and less practical training. To expect them to act quickly and instinctively is ludicrous. If these are established EMTs that freeze, or cannot commit to treatment of patients, then they work with FTO, get remediated, seek life elsewhere..probably in that order. Its hard to know what the problem is without knowing educational/practical backgrounds and existing, or potential, training protocols. /opinion

It had better be... :?

Is this a paid professional position? Paid per call, volunteer? Just curious :wink:

[stream:1830af02b4]http://ccmedic.fileave.com/Myfailure.wav [/stream:1830af02b4]

This argument is fruitless..Do you go to work when you don't feel well? As a nurse, working around people all day, do you think you come into contact with immunocompromised individuals everyday, the elderly, the young, those that have no clue that they are,indeed,at risk? If you are sick with strep or another virus, or the common cold, do you think these could lead to complications quickly leading to death....certainly. There is probably a greater risk of these, droplet and airborne viruses and bacteria, infecting your patient than hepatitis or HIV.. And yes, the seemingly inane microbes and viruses are indeed infectious disease. They are also contagious...Which risk is more acceptable? Are we better than the health care worker with HIV that never infects anyone even though we infect many others daily when we are sick? Is HIV more contagious than influenza? Given that you are most likely contagious before you show symptoms... You can , and probably do (especially nurses), carry MRSA on your skin all day long..You are contagious.. I think we should just agree to not agree....we should be seeing some better arguments though, not just "because I say so"...

No...And they don't need any more forms...paper nazis :evil:

You know..I seriously doubt the Mexican government would mandate that their employees learn English or get fired if the roles were reversed. I believe that if you reside in a country, you should speak the language native to that country..at least enough to function. Thats why I dont live in Canadia or Newfoundland...I cant make heads or tales of those languages..especially the Newfies.... :shock:

Agreed..If it progresses to ecg changes from suspected hyperkalemia. After looking at the med list, there are some other options for the hyperkalemia....We have glucose, insulin, and albuterol... A couple amps of glucose, around 10 units of regular insulin, and albuterol nebs...5mg/3ml..give or take. This would help with the hyperkalemia and acidosis. We need an I-STAT, or equivalent..without blood gases, its a crapshoot. I would have a hard time giving bicarb without a pH. I'm saying fluids, diuretics, the drugs above..use calcium if cardiac irritability and, if deemed necessary, maybe a bicarb drip...not push. (edited for content and continuity)

Your point?? :?:

:wav: 8-[ 8-[ Thats a fair amount of strange......interesting.....but strange

Just EMS vehicle...it is what it is....

Do any agencys have protocols in place providing for the notification of gift of life on traumatic dead on scene, or other deaths in the field? Do any of you have protocols that allow for continued resuscitation simply to preserve organs? I have a meeting with Gift Of Life about this and would like some other input. We have federal mandates for notification on in hospital patients, we are looking into the same for pre-hospital. Gift of life

I gave up the superstition years ago...I'll be thinking of you if I get one though 8)

I've never had someone come up swinging, or vomit for that matter. Just lucky, I guess..

I have not read the entire thread so if I am off base here...sorry I did see this though and .. The administration of Bicarb in crush injuries with extended extrication would be in respect to the lactic acidosis from the resultant anaerobic metabolism from the hypoxic muscle. Not the rhabdomyolysis. Envenomations also have the possibility of creating a compartment syndrome, which is similar to crush in that it creates a lactic acidosis from the same mechanism. The rhabdomyolysis will most likely be treated with dialysis once to the hospital. ARF, Hyperkalemia, hypocalcemia, and marked hypovolemia will most likely present with this patient. Probably not within a couple of hours though. I would expect to maybe see ecg changes throughout transport, though. Fluid resuscitation may be required with long transport to the hospital. The bicarb is usually only administered in crush injuries with some kind of extrication. Bicarb administration without labs and a blood pH.... this would be close to malpractice.. Calcium chloride in judicious amounts for the hyperkalemic effects on the cardiac muscle, fluid resuscitation, and possibly diuretics to diurese your patient may be advised if your transport would be hours..get the urinal ready, if you cant foley the patient.. This would potentially be a VERY difficult patient to manage in a small hospital, let alone in the back of an ambulance. Just my experience.

I don't think you have a legal obligation to transport the patient if the transport is not, in your mind, medically necessary. You need to triage him, make your findings known, maybe call MC, and at the very least indicate you will be back for him later. If you must leave, that is. You just need to be sure he is stable. If something happens remotely related to the ankle problem that turns out serious, then you are is huge trouble. I figure, why take the chance?