Kiwiology

Thats unfortunate

If you ask me he should have stayed dead right there on the floor Honestly, he's already in the rest home so he's on the downhill so where is the point in resuscitating him to go on living at the home? Locally for you it may be different but here neither the patient nor family can insist on treatment which the crew does not think is justified and that's the way it should be

But it can be made more difficult than it needs to be Down under we don't give calcium, bretylium, atropine, lidocaine, magnesium etc for cardiac arrest; for years WA has not given any drugs in cardiac arrest as they don't believe evidence exists of their benefit (it doesn't .. really); one or two places (e.g. AV) still carries sodium bicarbonate but they are very much the exception and NZ is strongly considering removing drugs from cardiac arrest. Cardiac arrest really is quite simple - if it's in the best interest of the patient and you have a reasonable chance of success have a go but if it's been a half hour and you haven't gotten anything then stop

True that mate > 30 minutes I'm calling it

I didn't mean to come across like I'm shitting on your parade dude because I'm not trying to Cardiac arrest is a tiny percentage of workload (here it's ~0.3%) yet it's something people have put focus on for years and years and years and they tend to go all silly about it. Honestly if there is one thing that EMS (partic in US) "tries too hard" at it seems to be cardiac arrest. It has been held up as one of the "primary indicators" of success of any particular ambulance service when in fact it's really not and gets millions of dollars thrown at it blindly yet despite over 50 years of trying little has changed - and I don't want to hear about the cooked numbers from King County Medic One. Kiwi's rules of cardiac arrest 1) Overall cardiac arrest survival has not dramatically changed in the last sixty years 2) Resuscitation should only be attempted if it is in the best overall interest of the patient and clinically appropriate; i.e. Nana found in asystole with unknown down time shouldn't be worked it's clinically futile, somebody who will go back to a poor health related quality of life (e.g. end stage CA) if they survive neurologically intact shouldn't be resuscitated 3) If you don't get them back they don't go in the back - don't transport a non ROSC as there is nothing the hospital can do that you cannot except in a few very special circumstances e.g. haemopericardium or > third trimester pregnancy with small down time 5) Cardiac arrest resuscitation is a very undignified way to spend your last half an hour with people jumping up and down on your chest and periodically electrocuting you; who is it really the best thing for; the patient or the people working them because "they did all they could!" and "this is what defines me as a Paramedic! *crank crank crank" .. see #2 6) Can we just get rid of adrenaline in primary cardiac arrest already? The evidence is becoming clearer ... it's just not helpful and is in fact overwhelmingly more than likely harmful 7) Rhythms that degrade into PEA or asystole reflect a dying heart and the survival rate is probably < 1% 8) There is no absolute cut-off when survival is not possible but if you've been working somebody for > 30 minutes you really should stop if they haven't achieved ROSC; see #1 and #5

True that shit, at least at recert school (CCE/CTP) you get coffee and snacks Look it's simple, I don't care what rhythm this guy is in, if he doesn't get ROSC after 20 minutes of me working him I'm calling it right there, he's dead and I'm going back to the station to watch telly

Pay no attention to anything I say

No drug shortages here and our drugs come from all the same pharmaceutical companies, weird ....

You created a really unique username with a seemingly nonsensical mix of alphanumeric characters, I thought you were a spam bot ... carry on good sir

I appreciate you can only speak for the state(s) you have experience in but do the state boards or National Council of SBON not having a mandated minimum requirement for clinical hours? In NZ it's 1,100 minimum the same as Paramedic (ILS); midwifery has a crazy insane req of 2,100 hours! but what did they graduate as? the good thing about health professionals is that once you graduate finding work is pretty easy; out of ~500 first year doctors last year only 2 did not find a job and most graduate nurses are employed straight away into a transition program (around 90% in 2011); as for midwives, dentists, physios etc they can set up private shop straight away

Practice does change ones perception; I've gone to the GP clinic to pick people up and have basically had to put both arms through the straps of the Thomas Pack so I wasn't unbalanced lugging 20kg's of Thomas Pack while hurling garlic and reciting from the Bible to ensure the evil spirits of the "boring" primary care practice didn't corrupt me. Having actually had some exposure and experience in primary care I'm rather attracted to working at the "boring GP clinic where nothing exciting ever happens!" ... it's all about perception vs. reality Oh on a slightly related topic it's annoying that people spout how "useful" their EMS experience will be in another health profession it's honestly not that useful and not a pre-requisite for doing e.g. Nursing or Medicine and will probably hinder you more than anything.

The answer is simple - in US EMS is not a "health profession" ala medicine, nursing, physiotherapy, med lab science, dentistry, optometry etc; it is a semi professional trade that likes to think it is a profession but is unwilling to make the hard decisions required to advance it to the same level of other health professions which would ensure that people with high levels of knowledge and skill stay in the workforce and end this business of "stepping up" to something else e.g. Nursing. It breaks my heart, it does, it's honestly reduced me to tears.

All Ambulance Officers regardless of practice level can declare death (to include withholding and ceasing resuscitation) and Intensive Care Officers can sign the deceased person certificate for the Police. Such practice is regardless of suspected cause of death; remembering that only a Doctor (Medical Officer) can certify death and its cause; the difference is subtle but important The old Ambulance Standard Operating Procedures required a rhythm strip to be obtained "in all three leads" but the new Operations Manual does not have such a requirement, doing so is prudent however This type of practice is fairly common in the Commonwealth nations in more-or-less the same from; e.g. Australia, South Africa and the UK, not sure about Canada; nb in UK only a State Registered Paramedic can perform such the ECA/ECSW cannot, well they can't do anything except fetch bags and drive so that kind of goes without saying The ability to declare death (including withholding and ceasing resuscitation) is a power all ambo's should have regardless of their practice level; it doesn't take a Consultant Rocket Surgeon to figure that somebody who is unconscious without pulse, respiration and meaningful cardiac electrical activity is D-D-D-D-DEAD. I know in US it's fairly restrictive and in many cases only the Paramedic is able to determine death in very limited circumstances (obvious death +/- not able to withhold resuscitation +/- only able to cease resuscitation after working the patient and/or contacting the Medical Control Physician) which if you ask me is understandable but pretty bloody pointless and not very dignified for the patient or their family.

There is no role for transporting this patient if he has not achieved ROSC regardless of where he is physically located If necessary we can move him into the ambulance and work on him there, I've seen that done before We can grab a couple draw sheets out and get people to hold them up if we're concerned about privacy Now, if we cease resuscitation and the Police are some time away we have the option of transporting the patient directly to the morgue but the Police generally don't like that so once it's looking like we're going to cease resuscitation one AO generally steps out to call the police on the ambophone to say hey guys start coming

If I can't find a clear non-cardiac cause for his arrest then it's for all intents and purposes a primary cardiac arrest I'm happy working him for 20-30 minutes and if he doesn't get ROSC I'm going to terminate resuscitation

I would not intubate the patient until after ROSC is achieved If he stays in asystole I'm going to work him for maybe five to ten minutes and then call it then and there There is no role for transporting this patient unless ROSC is achieved

why transport him if he does not have ROSC; what can the hospital do the ambo's cannot in the field?

Unfortunately the National EMS Agenda for the Future has been underway since 1996 and oxygen, OPA, NPA, oral glucose, aspirin and "assisting" a patient to take their own Rx e.g. salbutamol is the best they could come up with ... in nearly 20 years, fucking breaks my heart seriously I expect no meaningful change before 2030 at least

I think Richard is referring to a saline lock or a luer plug I wouldn't piss around checking a BGL - a VT cardiac arrest is not a side effect of dysglycaemia Craig - in the US the national scope of practice for an EMT is oxygen, OPA, NPA, oral glucose, aspirin and "assisting" a patient to take their own Rx e.g. salbutamol but only after authorisation from a medical control physician

It's not so much "experience" as it is the right kind of experience Somebody can drive for 20 years and be an absolute terrible driver but by theory they should be better than somebody with one year of experience because they have 20x as much experience?

You mean those little round spot mirrors you can adhere onto the end of your regular wing mirrors, yes we have those

One of the dumbshit Mexicans who was laying bricks yesterday and moved into committing Medicare fraud this morning hopefully will buy a bulk list of 10,000 patients for a grand off a crooked healthcare professional and mine will be in there so there's your fee; even tho you don't get to see it Medicare will pay for it so um yeah What, the Daily Show is not news?

Magnesium is most likely not carried because doing so would not be cost effective given that its use would be extremely rare In my mind foggled state I cannot think of any contraindications to teh suxamethoniumz that this lady has

Those poor strippers waitresses Damn you Emergentologist I have a blinding headache, I've already taken 2g of paracetamol with my breakfast, now where in the bloody hell are my benzos so I can get wasted on valiums and not face stupid, soul crushing bastard reality?

Fuck this guy I've sat on scene for long enough, I could be at the damn beach by now living it up and that black man with an afro and a .357 in the glove compartment I have for a partner is getting itchy ... time to go back to station and swap him out for that large breasted blonde lady so I can go down to Venice and get my tan on Have the LAPD haul him down to the cop shop and if he needs attention they can get the Police Medical Officer to come visit him in jail or if he's really sick they can send an LACoFD Paramedic Squad to come fix him up with a blue box, a red box and one page of standing orders which are essentially unchanged since 1973