ERDoc

I stopped watching long before that. It stopped being a medical drama that takes place in the ER and become a soap opera that takes place everywhere but the ER. I think it started jumping the shark about the time Doug Ross did a cric in a flood with a pen and had the TV helicopter film it so he could inform the ER.

I realize you don't make the equipment but that doesn't seem very useful. If you have someone who is 8 hours out from the ingestion your toxic level is 100 or more. If you have a pt with a level of 150 your pt would be toxic and your test would be negative. EDIT: Tylenol is one of those tests where you need a quantitative test.

Crap, I feel old now. You should be able to find the DVD sets on Amazon, no? I still think my favorite episode was the huge MVA during the snowstorm when the ER was empty.

Quantitative test for tyelnol OD? How do you determine what is positive and what is negative?

I think the one where the kid flying around the car, killing everyone else in the car who was wearing a seatbelt was pretty impressive. When I'm not at work, I'll see if I can youtube it in case you haven't seen it.

Sorry, I was just using istat as a generic term for the point-of-care devices since that is how we refer to them at my shop. Of everything we've mentioned I think anything that would tell you that the troponin is elevated, whether it be quantitative or qualitative, would have the most impact on prehospital care. I agree that a + or - would be sufficient since you will not be trending the level in the field.

Just like my patients.

I'm going to go off topic here, but in a way it does have to deal with the future and EMS. In regards to the WBC/lactate levels, jkc brings up giving antibiotics in the field. Here in the US, the Center for Medicare/Medicaid Services (CMS) and JCAHO set our core measures. One of the is that we must give antibiotics to pts who are being admitted for pneumonia within 6 hours of hitting the door AND we must have 2 sets of blood cultures from 2 separate sites before the antibiotic are given. Meeting these core measures will determine our payments. How will prehospital antibiotics affect this? I realize there is no correct answer right now, but it's a fun mental masturbation exercise. EDIT: drug screens are overused. They don't really provide much information that is useful. About the only reason I order them anymore is because the inpatient service or psych facility makes me do it before they will accept a pt. Sometimes it is fun to see what people are on, despite their insistence that they don't know how everything got in their urine.

We didn't have shows like Turd watch and Grey's Anatomy, we had ER (in the beginning) and Rescue 911.

I fully agree with the troponin level. It would definitely have an affect on destination. I would have to disagree with the ammonia level. I don't think it would add much in the prehospital setting. If you have someone with liver disease and they present with encephalopathy you pretty much have the diagnosis nailed. I think a BMP would be great. You could know if you are dealing with a potassium level pretty quick. It is something that can be rapidly fatal and is easily fixed. One issue I can see is overly zealous providers who over use the test. Think of the number of dialysis pts that EMS transports and now throw in a buff with a toy and see how many people who have a normally elevated potassium on a daily basis end up in the ER. Some of the istats can run a cbc, or at least a hemoglobin and hematocrit. I don't think WBC or lactate will have much use in the field. If you have someone where you are concerned about their WBC and lactate level, you shouldn't be considering not transporting them. I like the alcohol level, drug screens are more interesting than they are useful. I think PT/INR would be good. If you have a pt where you are worried about an intracranial or GI bleed, you could see if they are supratherapeutic and give some Vitamin K (of course you would need to carry the vitamin k).

Do you see a use for any other labs in the field using a system such as the istat? If so which ones and why?

Holy 1.21 gigawatts Batman. That man should play the lottery when he gets out of the hospital.

If you didn't document it, it didn't happen.

But this is EMS, drive fast or go home. You are right though, a diesel bolus could be a bad thing, especially when used to ignite the pt.

Well, they aren't going to get to the hospital without it.

If we are talking about the US, I see bad things coming in 5-10 years as the IAFF tries to further justify its existence and take more control over EMS. I think after that we might see things start to swing the other way as the EMS subspecialty in Emergency Medicine becomes more prevalent and more board certified medical directors start to pop up and push for improvements in the field.

Only because the EEOC says we cannot discriminate on the basis of mental capacity. I joke, I joke. I love all of you FFs, especially when you bring us pizza on a busy shift.

They don't work. All they do is squeeze the blood out the open holes. The only good prehospital intervention for shock is diesel. You could use them to stabilize a pelvic fx if you can find an ambulance that still carries them. My professional consultant fee has been billed and is in the mail. Be sure to look for it. My uncle trained in the days before they were called EMT (think mid 1960s). They were taught how to do trachs and were taught to apply cervical TRACTION on all neck pain due to trauma.

LOL, calling medical control from the pts phone. That happened so often. I can just imagine what the families thought. We were still using Thumpers for the first few years. Those were always fun to play with but never used one on a call. We had reuseable cervical collars, infection control be damned.

I was recently reminiscing with a friend about when we both started EMS back in the early 90s. He still rides and showed me his ambulance. Despite how much we bitch and moan about a lack of progress, the change over time is visible. I figured I'd start this thread so that we call a wax nostalgic about our early days and give the new people a little insight into what it used to be like. This is not meant to be one of those, "This is the way we used to do it so this is the way we should do it now," type of threads. When I started my basic training in the early 90s, we still used MAST pants and were tested on them on our state exams. We only suctioned the oral pharynx for 10 seconds because that is how long it was comfortable to hold your breath. The ambulance had 3 VHF frequencies, dispatch, switchdown (unit to unit) and hospital. There was no CAD/MDT or whatever it's called. The jump bag in the ambulance now has a portable, automatic CO detector. There were no CO detectors back then, much less ones that could be attatched to a jump bag. We had to go through 2 separate radios to get to medical control, now it's a simple phone call away.

Hey Dwayne, what state did this happen in and is the doc an MD or DO? Also, do you know what medical school this med student was from? I'm sure the school would love to know that it's students are not being properly supervised.

I am really beginning to love this cat.

Aw man, now you guys are making me want to check out another site. I will do my best not to cheat on you EMTCity. To the OP, welcome. As long as you are not an bigoted, racist asshole, it is pretty hard to get banned here. We welcome active, divergent conversation. Enjoy.

I agree with what Zilla said. Medical students cannot legally bill, nor write the chart for billing purposes. In the 2 states I have practiced in, even with residents, and attending physician must see every patient (I'm pretty sure this is either and RRC requirement or possibly a CMS requirement). Is there an insurance company involved? If so, let them know. They love to not pay for things and this may trigger some form of investigation. Evey state also has a medical board that oversees the licensing of MD/DOs. You could contact them also.

Congrats, Beiber.