Kiwiology

I am not quite sure where I am ... You are right Zippy I should have clarified: here (NZ) it is possible for the crew to refuse to transport the patient; if the problem is minor or if tarnsport is not in the best interest of the patient then we'll recommend for them not to come to hospital and check in with their PCP/GP or w/e as approprite. Having that said; different funding streams here do create a perverse incentive to transport trauma patients to get money and close the budget gap.

Oh well there goes my early retirement!

Yes, just as the crew are able to refuse transport if they do not believe the patient needs it; well; more like firmly recommend non transport but it the pt harps on enough they get it

True; I got offended when I was told "I don't like you drawing up my drugs" or "show me where you got that clear liquid from" by more senior officers; I thought it was personal; like I was stupid or something but it's y'know, thier arse so fair enough Most are pretty good tho; you draw it up and show them what you did n' its cool. I am exploring this whole issue more; I call it PRM (practitioner resource management) when I was working for the airlines I learnt a lot about CRM (crew resource management) ... I should cross the two over and god knows I'd make buckets of money

Most of our IM adrenaline is .3mg (I have seen .5mg given in severe asthma) but it's still a 1:10,000 solution The only time we give a 1:1,000 solution is cardiac arrest in which case we do not dilute it with saline. Anyway .... back to what we were talking about Threat hijacker, away!

Eh? Do you use different concentrations of adrenaline for IM as opposed to IV over there? We use 1:1,000 for cardiac arrest and 1:10,000 for everything else be it IM or IV. I don't quite get that: I read into it as being "was given too much adrenaline and did the typical throw up, look and feel awful, vital signs through the the roof response"

you make it sound as if my presence and contribution to medical safety is unwelcome at the risk of sounding flippant hey at the least the patient was knocked out

Welcome; I shall call you Foxtrot

It's probably DIC mate, careful now, you'll be bleeding from the ears, eyes and other orifaces pretty soon

I'd never be comfortable leaving soembody in this situation; per our policy if they are expressing or attempting self harm they cannot refuse.

Sounds good to me!

BLS here has entonox, methoxyflurane and acetaminophen ILS has morphine (coming soon: fentanyl) ALS has ketamine and midazolam

Good luck to the both of you and Ruffems Jr. Look fwd to the piccies, babies are sooo cute, awwwwww

Texas seems to be the land of the cowboys when it comes to EMS mate; 624 hours is the minimum requirement to get a cert down there! Tech Pro offer online: http://www.techproservices.net/emtp_info.php TEEX is a patch factory for the Houston Fire Department, offers a 10 week course in Bryan: http://teexweb.tamu.edu/teex.cfm?pageid=training&area=teex&templateid=14&Division=ESTI&Course=EMS130

Bloody fantastic idea mate

bloody hell thats fantastic!!!

That reinforces my theory that most people agree with me ... eventually That's like 99% of all calls is it not? I think something like 70-80% of our jobs are dispatched "priority 1" and turn out to be a stable patient. That said just because a job is p1 doesn't mean we *have* to run lights and/or siren, in a small town at 11pm for example you might just run the lights or decide not to because there is zero traffic. Yeah ... hard skill that one (I almsot wet my pants when I read that, it was good mate)

That I do not know

Should it not be the AO treating the patient who should make that decision? A lot of our trucks run Technician/Paramedic or Paramedic/Intensive Care Paramedic - if you are the officer treating the patient (even tho you have a lower qualification) you can decide what status to transport the patient. Lights and/or sirens are only to be used here in known or suspected "life threatning situations" ... I've seen lights used twice during transport and the siren once in 5 years. Going to a job it is the decision of the EMD as to what priority to assign the job, going to hospital it's who is treating the patient.

We have several protocols for things like this and they are absolutely brilliant I do like them! lol Within our service we can give somebody PO gulcagon (at the entry to practice level) or IV glucose (intermediate and higher) and make a recommendation they don't need to go to hospital provided that - There is a clear reason for the hypoglycemia eg a missed meal - The hypoglycemic episode was uncomplicated by seizure - They have recovered, are fully alert and have a GCS of 15 - They have access to food and a support person - They agree to follow up with thier GP (primary care provider) These protocols also exist for uncomplicated seizures (for known hx of epilepsy) and pallative care pt's.

.... if only we had CPAP lol; well, watch this space

You're called to a 43 year old male who has fallen down at a mall out in the burbs 30 minutes from hospital. Upon arrival you find he has been helped into a chair in the food-court, is struggling for breath and in obvious resp distress. Initial workup: GCS 15 4/5/6 Speaking 2-3 word sentences BP 105/90 RR 36, shallow and laboured PR 102 SPO2 89% RA Breath sounds reveal coarse bilateral crackles Patient denies any cardic hx; pmhx renal failure, has not been dialysed in 5 days 12 lead ECG: Initial treatment: - O2 NRB 10lpm - IV access - 0.8mg GTN SL His oxygen saturation does not imrpove and the Advanced Paramedic attempts rapid sequence intubation using midazolam and suxamethonium. Although successful at gaining an airway and bringing the oxygen saturation up to 97%; the patient sufferes a cardiac arrest and does not survive. So ... venture a guess at what killed this guy?

The officer treating the patient decides the status which in general determines the status of transport (emergent vs non emergent) Lights are used in transport I would venture about 1% of the time, lights and siren together about 1% of that 1%; generally emergent transport is only used for very sick people. If we feel the patient does not need transport we can decline thier request/make a non transport reccomendation.

Start an IO in the right femur; an EJ isint gonna do much good when we slap a collar on and drag him out into a scoop! Also I'd rather we do a quick IO in the leg and give a little lido for the pain rather than freak this guy out by shoving a needle into the side of his neck. FYI we use EZ-IO or the Cooks screw in; we threw the BIG out after a high failure rate

If the Fire Service is so bloody fantastic at providing "customer" service; why is it that in as far as I know, every other nation on earth (with the exception of like one department in Canada) is the fire department not involved in EMS? The New Zealand Fire Service Commission and the NZ Professional Firefighters Union have long refused to get involved in any form of patient care or ambulance response (beyond first response in a few very rural areas) because it's not the mission of thier service or in the interest of the public or thier members!