Kiwiology

A tricky one, without her there ordinarily I'd automatically say "yes" because his DNR only talked about cardiac arrest, which he is not yet in With his daughter there I'd say something like "While I understand you don't want your dad to suffer and to have a dignified death right now he is not dying but is extremely sick and not getting much oxygen to his brain which if we don't treat he will suffer permanent draim brananage brain damage; what we'd like to do is put him to sleep and breathe for him, it's what they are going to do at the hospital anyway, how does that sound?".

HEMS are over rated and over used They do however allow the delivery of very highly educated and skilled providers who can deliver interventions over and above those possessed by most ground ambulances (RSI, chest drains, amputations, thoracotomy etc) and who use their skills frequently (look at Adult Retrieval Victoria and the London Air Ambulance) I am extremely biased towards having an appropriately trained Doctor on the helicopter

This guy is Really Fucking Super CrookTM and needs much Intensive Caring for his COPD exacerbation Do you have another set of obs and a temperature? I think he's got a respiratory infection (the most common cause of COPD exacerbations). Have somebody put him on the floor, get a good jaw thrust going and preoxygenate him by passive insufflation through a bag mask that has a PEEP valve attached at 10cmH2O I'm going to shove an IO into his leg and get some drugs drawn up to tube him; I'd ordinarily go against my natural instinct to give everybody ketamine and use midazolam in this case because of the transient cardiovascular stimulatory effects of ketamine and he's already quite tachycardic and hypertensive (but this is probably just be normal as he has HTN)

Dwayne you hit one of my nails on the head, if the machine interpretation says so perhaps there is a bias towards being "seeing what you want to see" or getting lazy and relying on machine interpretation Also boo Los Angeles Paramedics (both LAFD and LACoFD) who rely on machine interpretation for STEMI activation

The charge here is not based upon practice level of the crew

At least they don't talk like they are from Canada like people in Minnesota!

Lets be honest if this was hyper reality the patient would have run away screaming going "I don't want that guy with a funny accent treating me!" My problem with machine interpretation is kind of like cheating or something I dno, I guess it's not really a big deal and I always fold the top of the ECG over so I can't see it while I am interpreting it then I'll look at it

The "part charge" here has recently increased to either $65 or $80 (depending on where you live) for medical emergencies but there is no part charge for accidents because ACC (universal accident insurance) pays the Ambulance Service for that. From April next year the part charge is going to increase again to a national fee of $88 regardless of where you live. If you are from outside NZ you get a "full charge" which is $757 It was never really published that there was a charge and many people did not know which resulted in a bit of negative flack so now it's very obvious with it clearly spread all over the website and a brochure in the Ambulance. It's not directly told to people i.e. "Hello we're the Paramedics by the way your ass will be getting a bill!" but if the patient asks they are told obviously. The part charge applies to all patients who are assessed, treated and/or transported; if you are assessed because you were the back seat passenger in a road traffic accident who only had a quick set of obs taken you get a bill, if you have a cardiac arrest and resuscitation is terminated, you get a bill etc There have been ongoing discussions between the Ambulance Service and the Government for probably a decade now about removing the part charges provided funding from Central Government is increased to make up for it; the Ambulance Service has admitted they do not want to part charge people and believe the service should be free like Fire and Police, they've also said there is a high cost to administer the part charge system because of the administration requirements and to administer some debt recovery. Over 30% of the part charges are not paid and written off rather than recovered through a debt collector because of the negative impact that debt recovery has on the future ability of fundraising. The part charge may also prohibit some genuine Ambulance need from being met. A bill is generated from the data captured on the patient report form and sent in the mail, with the introduction of the electronic PRF there may be a link between the PRF and the billing system so removing at least a component of the manual administration requirement and reducing cost.

*raises hand ooh I know, I know, I know, pick me, pick me! ... overworked, dangerously fatigued and underfed House Surgeon/Senior House Officer?

So what do y'all call the other bit of The Mitten, like that bit by Wisconsin that kind of looks like a rabbit? Like is that where you banish the unwanted people across the water so they can't come get y'all? Hey I just realised Indiana looks like a sock, but I can say that, other than that the Great Nation of Indiana must never be spoken of negatively or Ima whoop your ass so bad ... so bad Bravo 711 calls Radio, be prepain for an ass whoopin, just in case

They probably do not, for such a tiny amount of work to crop out the name in Photoshop or Paint it removes the risk of them any problem and in sue happy American that's probably a good thing!

expired Paramedic (Intermediate Care Officer) modules from way back in 2007 ish i have crewed in metropolitan auckland and other major urban environments

Tips Remove the name of your hospital from the ECG posting Remove your initials from the ECG before posting Very importantly remove the machine interpretation from the ECG before posting! 1 - ST elevation II, III, aVR, aVF, V4-V6; consistent with inferior ischaemia and ? anterior 2 - Concur with machine interpretation 3 - Concur with machine interpretation 5 - Do not concur with machine interpretation, looks like a poor quality ECG with a lot of artefact, some ST abnormality noted I'll get back to you on 4

OMG you carry ketamine, I didn't think any US services were using it It is very popular in this part of the world

Must have been before my time

This is the most fucked up place on the internet, I don't think anybody has been banned, ever ... not even me!

That's what my ex wife said

oh great so you talk to him but not me? i see how it is .... its cos of my funny accent isn't it

Since when were you involved in my life?

If you want to enlighten me you know how to get hold of me

Dude, I told you I'm not a girl! Good on you for having the guts to fess up eh Lotus but bro seriously ...

Hmm looks like some bloke who got crushed by a stage needs to be collected from Small Town Jericho Health Clinic Start checks complete, go go big red chopper, Sugarland traffic helicopter mike oscar lifting southbound. Ambulance, Medevac airborne, about ten minutes until the overhead .... Kiwi - proud survivor of the 2011 Indiana State Fair

That could very really be the case I would have to go look at the literature again and I can't be bothered right now Either way I don't think artificial ventilation in cardiac arrest is really even necessary TBH but I that's only Level K evidence - opinion of Kiwi Not to be confused with Special K - 2/3 of your daily fibre requirement and some nice dreams to boot now in 200mg/2ml RSI size!

Interesting, I'm not even really convinced that positive pressure ventilation is required for a cardiac arrest patient, look at the studies from Arizona that show passive ventilation is linked to a better "outcomes" (I am not sure if it's ROSC or neurologically intact discharge)

Shady Pines? I didn't know you'd been moved into the nursing home already But hey on the bright side they have awesome pudding cup eh ...