ERDoc

A little googlefu turns up his page and he seems legit, unless someone is using his name for evil purposes. http://devingreaney.samexhibit.com/pages/about OP, as Ruff stated, we've been burned quite a bit in the past so please bear with the skepticism.

We already have a thread about gun control, so if anyone would like to continue it, find it and post there.

Yeah, it seems like these studies are competing. I think the best thing is rapid extrication from the scene to an ambulance is the best option. The police can do this, no need to send EMS in to create more victims. Providing minimal care before being moved would be enough. About the only thing that I can see doing is stopping any significant hemorrhage (ie throw on a tourniquet), anything else can wait until it is in the ambulance and on the move to the hospital.

Croaker, do you have a link to your protocols? I'd love to have a look at them. Sounds like a great place to practice.

Looking forward to the VooDoo medic info

Holy crap, Ruff. I'm glad you guys are okay. Definitely keep an eye on your daughters and don't hesitate to get them help if you think they need it. The one good thing about kids is they are a lot tougher than adults. They will process this in their own way and bounce back. Hugs to the Ruff family from MI.

But, would your brother stop at an accident scene and say, "Hi, I'm Dr. RichBBrother. What happened?" On the flip side, if I were to give a lecture that had nothing to do with medicine, I would never refer to myself as doctor and if the MD was irrelevant to the course or whatever I was doing, I wouldn't include it. MD is the degree I earned and the job I do, but it does not define who I am.

History, I agree and disagree with you. You can draw valid conclusions from the study. They looked at pts transported by PD because it is a convenient population for comparison. It was basically a way to compare a population that received no care in the field other than rapid transport versus a population that received ALS. It's not saying that ALS is bad, it is saying that it is important that the pt get to the ER (probably the OR) as soon as possible and staying on scene to provide a full ALS transport may increase mortality. It is not the ALS that is the problem, it is the time required to provide the ALS that is the issue. I do agree that if an ALS crew rolls in with such a pt that they will get a ration of shit from the hospital staff. This will take a culture change at the hospital, more from nursing than the physicians. As an aside, I discussed this article on a LinkedIn group and here was a comment provided: "Philly PD has been doing this for literally years. When I was an EMT in Cherry Hill in the 70s and early 80s, Philly often transported trauma and other serious medical patients in the back of PD vans. We saw it all the time. They may have started the study recently, but the practice is well over 40 years old. Part was necessitated by a lack of ambulances in the city back then (since resolved) and LOTS of trauma. To my knowledge they never stopped doing it. Also, this was common practice in Westchester County in the 70s. Bronxville, Mt Vernon and White Plains often did the same thing."

As others have said, if you want to survive in EMS, you need to be thick skinned. Think of this as your probie hazing. Honestly though, you set the tone of this thread with your original post. You told us not to bother with sarcastic or smart answers (or however you put it). If you don't want the ball spiked, don't set it. The fact that you are still here, contributing to this thread and defending/attacking makes me think your skin may be thick. I'm willing to give you the benefit of the doubt and say welcome. Will you accept the olive branch?

Those answers only work on a medical test.

I'm not supposed to but I'll give you the first few: 1.A 2.B 3.C 4.D 5.E

I remember when I took ATLS. Those pretests were treated like nuclear launch codes.

If you can copyright Happy Birthday, you can copyright the alphabet.

How do we know the answers aren't proprietary, copyrighted info? We could be sued for posting them. There may be a reason he wasn't given them and is having trouble finding them.

Hi.

If you don't want smart answers then are you looking for stupid ones?

Your dictionary definition will vary depending on what dictionary you are looking at. Most ambulances I have been on don't carry a dictionary so that the pt can determine what kind of 'medic' they are dealing with. Yes, there is something wrong with that. It is someone identifying himself as something he is not. As with everything in the real world it is all a matter of context/situation. It is no big deal if they are doing it in a non-medical setting where it has no meaning or significance. It is dishonesty when you do it to a pt or other providers in a healthcare setting. If you want the title then get the title but don't be dishonest to your pts and other providers. As for the distinction of 'doctor' with the other providers, there are many that don't clarify that they are not an MD/DO which is just as dishonest. Again, it is all about the setting and pretext. In your Army example, that is again situational. It has a well establish history and meaning and is common among all services. Navy corpsmen are also called 'doc'. The soldier/sailor/Marine/airman understands exactly who is taking care of them and quite honestly, most service medics probably could function as physicians and deserve to be called doc.

First, do not accept this transfer. You cannot transfer a pt from an inpatient bed to an ER. It must be an equal or higher level of care transfer so this pt needs the ICU, not the ER. What can the pt tell you? What is his past history? Let's see the admission cxr and the current cxr. Let's see the admission EKG and the current EKG. What meds is he on? Let's see all of his labs. Let's see the culture reports. Vitals, including Is and Os.

I find that there is a difference in appreciation for the literature betweens the ASNs and BSNs.

There, fixed it for. Sorry Island, I couldn't resist.

Fixed it for you. The way you handle the nurse who does stupid shit like this is up to you. You could simply say, "It's my protocols. If you have a problem with it, take it up with my medical director. Here is Dr. X's number. He'd love to tell you why you are wrong." As for the pt, let's define spinal precautions. A back board is total worthless so let's get rid of that. As for the cervical collar, well, we all know how useless they are. However, the way I think of these cases is that if I need to image them, then they should be in a collar. So, does the pt need a collar. That depends on which criteria you use. If you use the NEXUS criteria, the answer is, it depends. Is the arm fracture a distracting injury? There is no clear cut answer from NEXUS. You could argue for or against a collar in this case. Next, let's use the Canadian C-spine rules (CCSR). Step 1, any high-risk factors? Age over 65? No. Paresthesias in extremities? No. Dangerous mechanism? Yes. The CCSR define a fall of greater than or equal to 3' to be a dangerous mechanism. So, according to the Canadians this pt should be imaged and therefore should have a collar. Now, if you were to bring the pt in to my ER without a collar, I'd have no problems with it. If you put a collar on, I'd have no problems with it. Some people just get so uptight, much like this nurse.

I think it is also important to find a study guide/website/etc that prepares you for the type of questions you will see on the test. I can't say anything about NR as I have never seen the tests but we had 2 step multiple choice problems from med school on so it was more than just knowing the material. They would present a pt, a pathology or something like that and then, instead of asking for the diagnosis, they would ask for the treatment or the side effects of the treatment. So you had to think through the diagnosis, figure out what the "best" treatment was and then understand the side effects. It takes some practice getting used to a form of testing that is not just spitting out facts on a multiple choice test.

Only south of the equator.

Yeah, we do eat new people pretty quickly around here. It's survival of the fittest. The GPS is pretty awesome. I got my kids some smaller ones and they love them.

Eh, I would sweat it Ruff. Even if the OP never comes back it still creates good discussions. I agree that it would be nice if the OP did come back to fill in some of the blanks. Maybe we should wait until the person has made a second post before we start answering their questions, lol.