ERDoc

Well, someone has to get them to the hospital and who could do it better than the ambulance driver? (ERDoc ducks and covers).

That could be, but it isn't his post we are discussing, it is the first response that has led to all of this.

I'm pretty such that would classify you as a whacker, lol.

SMR is also not in Stedmans. Hey Chris, please come back so we can move this scenario forward and end the abbreviation discussion.

Ohh, slippery slope. Is there any literature to support EMS even existing in cases other than early defib, out of hospital cardiac arrest? The trauma literature is pretty dismal.

My old VAC has posted some pics of equipment from the past. Wow, did it make me feel old. Here are a few pics from the equipment I trained on. They also have pics of stuff from the real old days (70s and 80s) that I will try to post when I can.

NY probably wants several first born children and virgins and finding one of the latter is often difficult.

Ruff, I can't say for sure, but as with everything else in NY, the requirements to actually run a class may be prohibitive despite those funds being available. An agency has to go through several certifications to be allowed to hold a class and might not have the manpower to do it.

Agree on the abreviations. There are so many that I see on here where I just scratch my head and hope I can figure it out based on context. WTF are DCAPSBTLS or PMS (not the female kind)? As for the original scenario, I think we are putting the carriage before the horse. Why did he fall? Was he walking and passed out? Did he fall off a ladder? Did he fall out of an unidentified Boeing 777?

Wow, I don't even know what to say about this. It sounds like the medic had his head up his ass (based on the limited info in the article). While nothing about this call says ALS is needed, the BLS provider obviously had a concern and the medic should have addressed it in a professional manner, even if he disagreed with it.

It's interesting that the AutoVent manufacturer advertises it as being a good vent for IFTs.

Guidelines are great and very useful, but when they become absolutes, deviate and there is hell to pay, then they become useless because it removes clinical judgement.

Yeah, never use something important like a vent in a way it wasn't meant to be used. You will have nothing to stand on when the shit hits the fan. EDIT: In this region (the US), in the situation you present rock_shoes, the crew is going to be screwed either way. The lawyers will be waiting in the ambulance bay to see which way they are going to run their arguments.

I don't think it is the not knowing that they have an issue with.

That is not heartless at all. There is no sense in creating a second and possibly third pt for something that is futile.

Don't even get me started. Most of these JHACO rules are not based on any evidence either. There was no evidence to the support the 4 hour requirement, which has now been increased to 6 hours. It's the same way with EKGs. We are required to get an EKG on cardiac chest pains in less than 15 minutes. This has led to so many unnecessary EKGs. Yup, that 12 year old who has been coughing for 5 days and now his chest hurts? EKG.

Etomidate and succs for all pts prior to being loaded up would solve this. I can't stand when JCHAO comes through. Everyone gets their sticks so far up their asses. The system prints out booklets on how to act and respond when approached by these people. Apparently when you are asked a question by the inspectors and you don't know the answer, the appropriate response is NOT, "I don't know and I really don't give a shit."

I think we will be seeing more and more of this as our pts get bigger and bigger. That center of gravity will keep moving higher and become more unstable. We will get to the point where the slightest breeze will push them over.

It's all a matter of your perspective. I miss being out on the streets, only dealing with 1 pt at a time, not having to deal with countless alphabet soup organizations looking over my shoulder on a daily basis. When I work, the only way I know if it is day or night is to look at the clock on the computer. I have no idea if it is sunny, snowing or raining (I usually guess snowing since I live in Michigan).

This is also being discussed on SDN in the EM forums. I think one of the best comments has to be the following (it's a little long): This result does not surprise me. Doctors have always desperately wanted to feel their super cool gadgets actually make any difference. So the fact that they found no benefit from cool invasive catheters is no surprise to me, anyways. It makes me laugh, actually. Mark my words though, nobody will use them any less. Lol. They'll just come up with other biases to justify using them. It reminds me of the part in House of God where they stop all of there treatments, orders and medications on their floor and the patients suddenly all get better and go home. Lol. EGDT itself was always a big "duh" event for me. The whole concept was equivalent to saying, "You know, it would really help if you did your job." You mean if someone is septic we're supposed to diagnose it? Yes. (Duh). You mean if we've diagnosed someone with sepsis (meaning "very sick") we're supposed to treat them right away, not in 6 hours or next week? Yes. (Duh). You mean we're supposed to pay close attention to abnormal oxygenation, hematocrit, and perfusion (signs of being "sick") and oxygenate if needed, transfuse if needed and give fluids if needed, sooner rather than later? Yes (duh) But to think that forming some supposedly simple and dummy-proof protocol and pathway and adding a bunch of gadgets and geeky technical tools and lines are going to improve outcomes for the patients of clinicians who were treating these patients with urgency anyways, and recognized they were sick to begin with, always seemed doomed to fail. On the other hand, is a checkbox protocol policy and a mandate to put in a bunch of invasive lines and focus on central venous numbers make a difference for doctors who couldn't recognize sick patients in the first place, at a hospital that won't staff up ratios to allow nurses to give antibiotics quickly when needed, where people are just slammed through as fast as possible to make room for the next easy-collect quick in-and-out level 3 preferred "customer"? I think not. If you do your job, diagnose sick patients, treat your sick patients quickly as you should have been all along, I don't think you need some fancy protocol involving lines and fancy equations. My point: if you know how to recognize and treat sick patients and you're at a place that carries out your orders promptly, you don't need these protocols that tell you what you should already know and be doing. If you don't recognize sick patients, let them crash while focusing on fast track, you're chronically shorted on nurses to pad the hospital profit margin, maybe you do need these protocols with cute names and can put in a bunch of invasive lines to run up the hospital bill by an order of magnitude. However, such people and places that need such such a "protocol" are exactly those who will not or are not capable of following such a protocol to begin with.

We are having issues with one of our transport companies and they use the Autovents and don't seem to understand why we don't want our pts on them.

Thanks for the input.

What about for pts who are post arrest or resp failure but have their own respirations?

I'm looking for some input on the AutoVent 3000 and 4000. Anyone have any experience with it? What are your thoughts? Are they appropriate for critical care, interfacility transports?

More like 16y/o but you got the rest correct.