Kiwiology

Reversing camera? You lucky bastard, it's the wing mirror special around these parts

We do not carry magnesium in NZ so the only option here would be knock her down with midazolam until she stops seizing If that doesn't work technically she would come under the "poor airway and/or breathing with GCS < 10" criteria for RSI; although anaesthetising, paralysing and intubating her may not be the best idea it's a roundabout way to terminate her seizure (or just cover it up) and avoids the hypoxia and hypercarbia that would be associated with a seizure Keep going towards the big hospital; there is no role for "stopping off" first to get something done because meaningful intervention is going to be carried out at the tertiary centre and ~10 minutes means SFA

Mum or dad usually sits on the stretcher and holds them I don't know of anywhere (except the front passenger seat) you could attach a car seat; the stretcher has a seat belt but I wouldn't want to attach it there. Unfortunately it's rather basic here; the basic design of our ambulance has remained virtually unchanged for thirty years and this piece of absolute crap "turnkey" Londonesque barf box being introduced is not a whole lot better TBH

Maternal hypertension with pre-eclampsia although a DDX would be a neurogenic cause e.g. sub arachnoid haemmorhage or a stroke but this is unlikely She needs to go to a major hospital with OB/gynae capability without delay; put a drip in and give some analgesia, get her out the house and get some wheels moving My assessment of her is status 1 or immediately life threatening problem There is no role for a helicopter

Clearly his Metro TAP card ran out so they kicked him off the bus and he has been corrupted by meths drinking bums on skid row, this is LA people, DUH 1. Send the LAFD Engine company back to the station as their improperly parked fire truck is blocking the bus stop 2. Go across the street to the 7/11 and get something to drink 3. Perform primary survey So what does that tell us?

Clearly he was on the Santa Monica flyer down to the beach and couldn't handle the hyped up coeds from UCLA so had some sort of cardiac event What does an examination of the scene and a primary survey tell us?

Most states require a learners permit for six months and then a driving test to get your full, unrestricted license. Some say if you are over 18 you do not require a learners permit and can go straight for a full license. No state that I investigated ever had any logbook or verified driving requirement you could get your permit never drive and just wait six months nobody checked Here to get a license you must have a learners license for six months, show 120 hours of supervised driving including 20 hours night driving, pass a 45 minute road test (failure rate is half) then you get your restricted license which you can drive on your own between 0500-2200 but not carry passengers; you must hold your restricted for at least 18 months (12 if you do a defensive driving course) then pass another road test then you get your full license Australia is much tougher they have all sorts of vehicle power and passenger restrictions and an additional test which we do not have at the moment Here if you have any points for anything you are automatically disqualified from not only the Ambulance Service but also the Paramedic Degree program. In Canada most of the Primary Care Paramedic programs require a clean class 4 license (class F in Ontario) and you need clean Class C1 in UK for the DipHE/FdSc Paramedic degrees as well. You also need to have passed a defensive driving course before doing the ambulance driving course here too

Trev mate seriously

I had some very good thinkings about this topic tonight with others and it's very simple as we saw it; the biggest since problem is the general complacency of drivers and the real cultural shift towards poor driving being more accepted in society; combine that with the bare bones requirements to get a driver license (we have one of the toughest graduated licensing systems in the world but I still don't think its good enough, Australia has (from what I've seen) the toughest system)

Alien vs Predator bah they are both bitches who need a good smack down Kiwi vs AK or something is where its at

The poor reputation of the AAOS (Nancy Caroline) book is because apparently it's full of lots of errors and contradictions Locally the Brady PHEC book was used for the old Certificate but when the Diploma was introduced for Technicians a custom course book was written because it was felt the American books were not appropriate - and I don't think they are to be honest for our local requirements While I have the Paramedic texts and resources I do not use them for my research and tutor work and rely on established medical texts such as Guyton and Hall, Harrison, Rosen, Beck and Williams, Miller, BMJ, NEJM etc I'd rather teach somebody cardiology from a cardiology book or physiology from a physiology book than the little excerpt covered in the ambo book; not that I should probably be teaching anybody ANYTHING because I'm a dumbshit; oxidative phosphorowhat? bloody devil talk! I was previously part of a consortium looking at publishing an Intensive Care Paramedic level resource for New Zealand however it is my strong view that we should not fall into the American trap of a level specific ambo textbook as such a resource will invariably become quickly outdated (the problem with most texts I suppose) and probably not cover material in sufficient depth; instead we should draw upon the expert material available in other resources; the Intensive Care Officer course mainly focuses on more advanced understanding of cardiac, trauma and respiratory pathology so there are plenty of resources to draw upon than some made up ambo book And just the training required to look fucking awesome sporting your hip pouch of ketamine and vecuronium requires a monstrous tomb in itself

Don't worry dude I have just spent the last ten months crawling out of the gutter being unable to think clearly, unable to sleep, sometimes unable to perform basic human functions because of being in a never ending nightmare of intense psychoemotionospiritual agony (a word I made up) or spending hours in a ball in the corner crying or thinking hey shit the last time i tried to hang myself did not work and i don't want to step infront of a bus so how can i off myself because i was a lowly failure who couldn't even make what i have worked on for the better part of thirty years reach fruition and had to question the entire point of my life .... Anyway so I think I know how you feel bro, take it one step at a time and it gets better Oh and where is "where are you" vs were "were you there?" Now, back to the corner

I don't honestly think that's really that important; certainly we have a little bit less traffic I suppose in most places but then again cities like Auckland, Melbourne and London are some of the most congested in the world. Age does not determine competence although the two may be coincidently correlated

My ambo-sense tells me more than likely not a great deal but as I am not working for St J WA I wouldn't know for certain I think they have introduced AMPDS Unfortunately the Enquiry by WA Health and the Parliamentary Enquiry into Ambulance here (also run by St J) have both recommended that St J continue to provide services in both jurisdictions which is at odds to the other emergency and health services.

St J WA has been in the news for killing people and running a smoke and mirrors outfit in country WA purporting to be an ambulance service http://www.abc.net.au/4corners/content/2009/s2615353.htm

You can still turn up in your gargantuan monstrosity of an ambulance brimming with lights and six tone siren and air horn that rivals the opening weekend at the Indy 500 and takes up two freeway lanes ... but just drive it safely duh

Exactly, the standards in this part of the world (and similar) are much tougher and so they bloody should be! Now, I might say the American method of rolling up in a huge Ford ambulance brimming with lights and six tone siren and air horn and charging down the freeway in it at 120k an hour is good fun (at it is!) however low driver education standards and requirements are not quite as much fun and they should not be tolerated. The driving course here uses the systemic driving technique which you probably used as well; based on the Metropolitan Police driving school. Once you do the course you can drive non emergent only then you get a logbook to do which is peer-reviewed then signed off then you can drive P1 this is on top of having had a clean license for at least three years Officers on the Motorcycle Response Unit have to pass the Police motorbike course and apparently only half a dozen have passed, all of whom have been very experienced bikers (20 years exp etc) Any warm pulsed muppet can jump in the ambulance and rip around going woo woo (read: nee naw nee naw for you lol) but it takes a skilled driver to do it safely and professionally just like any homeostatic imbalance of an ambo with a wonder ticket from joe's firemedic academy can put a drip into somebody but that doesnt mean they should or are doing it safely

Yep, pretty bloody rare indeed around these parts, and probably in UK too I bet

You need to cut down on your crank smoking or find a better dealer

I was waiting for something like that; man I'd love to get a read of those Unfortunately the AAOS books are not held in very high regard

Not that I am aware of directly nor heard talked about; such a thing would be fairly huge here and as I said before, I've never known any AO to be killed at work ever; there was one case from Wellington way back like 70 or more years ago; even in the Police and Fire Service it is extremely rare (fingers of one hand sort of thing) A few vehicles have been written off in accidents that I can remember but the other driver has always been found at fault There have been a few (like count with fingers on one hand) cases of Paramedics crashing the ambulance in AU in recent years but it's quite rare over there too Good to see you follow the NZ news!

Yes, zero, I have never heard of any ambo being killed on duty, ever, like not for probably the last forty years And I can count ambulance accidents on one hand

I have had a look at the PHECC website and I don't think an EMT with "a few months" experience would be accepted in WA; it certainly won't by any other state or here in NZ given the restrictions on scope of practice and your limited experience; I would be more leaning towards the (Irish) Paramedic but even then the scope is only around a third of what exists in AU and NZ You can try asking SJAA but I would focus on upgrading to Paramedic or AP level and getting at least two years of work experience

I don't need Viagra I need some valiums to get wasted on so I do not have to face reality Also Richard the American Academy of Orthopaedic (sic) Surgeons is AAOS and they lend their name to the most awful textbooks for ambos out there

I am not sure, I wouldn't think so, I know nitrogen can expand with flight (e.g. decompression sickness) or gas filled spaces (e.g. N2O in pneumothorax) but most helicopters fly very low anyway, 500-1,000ft and i do not think oxygen would be a problem I know SFA about flight physiology, which is interesting considering all the aviation and medical crap I've done