Just Plain Ruff

That horse called and asked us to stop beating the tar out of it.

it's a good thing they haven't caught me yet.

WHOA wait a second, now it's cost versus benefit for us ole medics? We do have to watch our pennies but what the heck, withholding pain meds due to a cost benefit analysis. That's just plain Whacked out. I just spent the last 31 hours with migraine. I went to the local doc in the box clinic at 9am today and he said "to look at you I'd say you were a very healthy guy and not sick at all" but he gave me 100mg demerol and 50mg of vistaril for my headache because he believed me, not because it was a cost benefit analysis. So for someone to use that analogy "cost benefit" it shows me they have been to too many financial classes.

Just because she has an extensive history of drug seeking behaviour does not mean she's not in an emergent situation this time. It's thinking like that among providers, oh they are a drug seeker so let's not treat her agressively that leads to patients dying. Your assessment and your physicians assessment will make the differential diagnosis, not the fact that her chart shows extensive drug seeking behaviour. It should give you pause but it should not guide your emotions or treatment.

actually I would trust a teacher with the epi-pen for my son if he needed it under one condition, EMS is activated. If no EMS then they better be calling me when they give it. So I guess that you have a problem with bystanders using an ALS item. Then if you have a problem with laypeople using an AED or giving medication to the child which the parents have given permission for the teacher or nurse giving. Remember in many schools there are no nurses and the teachers are required to give the medications. I guess that letting teachers giving the child their add meds or their prescription medications is wrong then too. That's an ALS skill right? It's not a valid argument but the valid argument you just made was that no medications should be given by teachers or emt's because thats in the purvue of an ALS skill. So we need to stop allowing emt's to help patients take their nitro, glucose paste and whatever other medication that your local protocols allow emt's to help give because it is a ALS Skill.

Dahlio wrote about a 2 hour course on anaphylaxis - let me ask this how many hours in your EMT class did you get on anaphylaxis? I remember my emt class and I think the amoun of time allotted for anaphylaxis was about 15 minutes. I would hazard to guess that 2 hours is better than 15 minutes. So in essence in that aspect, teachers with a 2 hour class on anaphylaxis are infinitely better trained than EMT's.

why is having an Epi-pen in the AED box a bad thing? I fail to see why this is a bad thing. Be thankful the schools are forward thinkers. And I agree, the teachers know more about their kids than emt's or medics know about their patients. The teachers see their kids 8 hours a day for 5 days a week for the school year. Couple that with some medical training and the coaches and trainers and nurses and I think our kids are well protected medically. I for one find nothing wrong with having the Epi-pens in the AED box. unfortunately this is needed because some schools do not have nurses full time. Some schools have to deal with sharing a nurse between 2 or even 4 different schools. So having that type of life saving item available to the teachers is a step in the right direction.

well, you didn't say it was a disasater or blizzard. There might be allowable circumstances. What types of patients were you guys transporting in blizzard like conditions that warranted transport? I know you cannot shut down but you sure can shut down to the calls that don't require to go NOW. But I wasn't there so I'm not sure what you were working against.

i clicked on each of them and I kept getting a non-english version

I have a huge issue with 48 hour shifts There is really only one reason you should be working that many hours in a row. That's if there's a disaster happening. If any of us agree to work 48 hour shifts then you are just as much to blame if something happens. Your company is to blame but you must take some of the blame because you let yourself get into that situation. sorry if this makes anyone mad but sleep deprivation on a 48 hour stretch is terrible. The service you work for may say you have down time but unless there is guaranteed of downtime like 4-6 hours at a time then there is no guarantee that you will get some sleep. Errors are made by crewmembers on a full nights sleep and are even higher incidents of errors on less sleep. WE talk so much about professionalism but this is important people, how professional does it look to the public when we tell them we've been working for 48 hours or 56 hours straight. No court in the land would find you non-negligent if you tell them that when you made the mistake that cost a family their child or caused a very serious reaction med error that you had been working for 36 hours straight. There's no way you will win in any court in the land.

ok how do I get to the english version.

correct me if I'm wrong but doesn't glucagon deplete the stored glucose in the liver and if not treated appropriately post administration this could cause significant problems in the diabetic patient. I've not had the luxury of having glucagon as a med choice in a long time so I'm not up to speed on glucagon.

hey AK how bout this quote I heard from a good doctor friend of mine "when you really don't know that you really don't know, then you really don't know!!!!!"

You just made the argument for BLS crews not having access to a glucometer. You are working with a medic who can interpret and fix the issues presented with the glucometer result you just obtained. A Bls crew without glucagon or instaglucose could not do that. My whole argument is this - BLS Crews should not be doing glucoses in the field without ALS backup. Remember, some conditions present as decreased blood sugar as their main presenting symptom yet have something that a medic has to attend to so let's say you check a blood sugar and it's low, you give glucose and the patient doesn't get better. What are you gonna do now. Your precious glucometer did nothing but make you call ALS and have them transport anyway.

It's Nevada not neveda. Just had to point out the obvious.

I have read everyone of the posts in this thread and I humbly request that the people fighting here go to their respective corners and have it out in PM's. This is going no-where fast. one person discounting the other person and so on and so on. You can say you won't read any more but the desire comes back to you like a bad case of the runs, you just can't stay out of the toilet.

ok Who is Asjed? who is Toes? who is mr jullian? I'm totally lost.

Whew, yes the AED diagnoses and treats but it does all that without the lay person or EMT having to do anything. You are comparing apples to Boxcars on this one. As a diabetic, I have a glucometer. I can teach my son who is 5years old (I have done this already) to test my blood sugar if he finds me not able to do so myself. He knows that if I'm down or sick, then he hits two buttons on our alarm system and then gets my glucometer. He does not know why he does this other than to help the medics when they get to my house. He can give them the glucometer and they can see the result. Does he know the patho behind why my sugar is low, sure he does, he knows that my sugar is low because I either did not take my meds or I ate too much of something with a lot of sugar in it. But that's the extent of his knowledge. As emt's, there is not much to do for me if I'm unconscious but transport me. It's a good thing I'm covered in a area of Missouri that does not have bls crews. I have no problems letting a bls crew do a glucose but I do have problems allowing them to give glucagon or glucose. If they don't have a glucometer then what the heck are we giving them the ability to give glucose or glucagon?????? You don't just look at a patient and say "oh boy, they have all the signs and symptoms of hyper or hypoglycemia so they must need glucose or glucagon." "I don't have the ability to determine what their sugar is but I have this new fancy shmancy medication called glucagon and I'm gonna give it to them. To heck if they are having a stroke" To provide partial tools to help someone and not providing the total set of tools is tantamount to negligence in my book. If you cannot see a blood sugar number then you have NO business giving a medication for that problem. Any service that allows for this type of scenario to happen is just plain wrong. As for the AED, you can train a monkey to use that device because there is no real class to go to for it nor any real training. You just bare the chest, put the patches on, push the button and let it work. Comparing the AED to the glucometer is really a piss poor argument.

I've had this partner before also. I think that in EMS we all have the proverbial fruitcake that get's passed around from service to service, partner to partner. If you take the long view of these things, he will seldom stick around for a long time, he usually get's re-gifted.

http://www.news4jax.com/news/15239338/detail.html

I was in Belton MO the other day and saw a American Lafrance hook and ladder from the dark ages. It still looked really really good.

yep gives em liability protection but not protecction for practicing medicine without authorization. This is why I never stop or offer to help unless the ambulance crew is totally overwhelmed like a bus wreck or a train versus airplane disaster.

I usually tell them that I work for the Federal anti terrorist task force. when they ask me why I'm in the area I tell them that XYZ naval base or airforce base is missing 24 vials of high grade anthrax. That usually freaks them out. Or I tell them that I work as a medic and just got done treating a victim of smallpox or some other exotic disease. Oh I also tell them that "it's not airborne" pregnant pause for effect, and then say "at least they don't think it is."

Spenac, but can you limp like house, and pop the pain pills like house can?

Those people tend to be two distinct types in EMS 1. housewife who has the empty nest syndrome - usually are doing it out of boredom and then they go volunteer at a volly service 2. guy out of the biz world wanting to do something new - that person usually makes a good medic or emt. They seem to have more of a passion for the responsibilities of the job and not just a adrenaline seeker. of course this does not apply to all cases but it's the majority of what I've seen.