Kiwiology

I had high hopes for Squint but he make me rake leaves, tap a tree for syrup and watch hockey while tied to a chair and gagged with a gob full of moose. I walked for three miles in a blizzard to the RCMP detachment to report him but they were like "sorry we're closed, it's hockey season eh?" YEAH ... CANADA!

No but I will be more selective and thoughtful in my angry, deconstructive rantings

Well after a six month hiatus of crawling out the black hole and getting my noggin somewhat untwisted I figured I would see what is going down here ... now lets not get any ideas, I still hate you all with the very depths of my being but I just don't have the energy to go on long, deconstructive burnt out, lorazepam fuelled rants anymore because I just don't care Emergentologist also found out I was doing his wife at the Best Western on 29th St so yeah, I am kinda broke after the lawsuit ...

It was not

Good to see you are still alive mate I have crawled out the black hole myself ... *dusts off pants and throws away lorazepams Next time I an in Albertobianuckistanada I will be sure to pop by

IO in New Zed is only for people who are really crook and who you cannot get IV access in but have a time critical need for fluids or medicines. The London Ambulance Service says you must have 2 peripheral attempts and 1 at EJV before you can try IO. IO is very helpful but it must be used wisely, they are very expensive (some $200 per needle and giving set)

Great ... I disappear into internet land for six months and come back to this? Hang on; *scoffs down a handful of lorazepams .. there, thats better, now, let's have a nosey doodle at our patient shall we? What about some ketamine and a bit of non invasive ventilation? If access it a bother we can give ketamine 4 mg/kg IM. I don't really want to tube her and have to tie up an ICU bed for the night.

If you want to run 3 x 8 hour shifts then you need to let people choose their shift and they do that shift permanently because that roster just burns people out really quick; I know one system that runs 3 x 0700-1530 then 3 x 1530-2300 and then the 3 days off with the people who do 2300-0730 working the nights permanently; I know another place that does 2 x 0600-1500 followed by 2 x 1500-2300 then finally 2 x 2200-0700 and then 3 days off and man those people are so burnt out its not funny, the mate recently quit because he couldn't handle it. What is used here is generally 2 x 12 hour days then 2 x 12 hour nights and then 4 days off and that system works pretty well and people like the 4 days off. I think if you want maximum results you should do 12 hour shifts and let people choose either days or nights. Me, I am a night person, its great, love them, hate days with a passion. As for vehicles I think a Freightliner is a bit of an overkill; never have I seen such gargantuan monstrosity as in US. Most other countries use Sprinters (UK, AU, NZ, pretty much all of EU). The UK Sprinters with the curb door are very nice, the NZ sprinters have dual curb door with one for equipment and its great; check 'em out here http://www.111emergency.co.nz/F-I/GSR565.htm. They are also going to cost a hell of a lot less to buy and maintain than a freaking juggernaut Freightliner. The biggest thing I would stress is having some sort of alternate response to people with complaints that are not a threat to their life; things like toothache, abdo pain, the flu, cuts and bruises, you know, bullshit. We have a new triage system that basically took all of the thousand MPDS detriments and reassigned them one of five colour codes based upon how time critical the complaint was. They are purple (cardiac or respiratory arrest), red (immediately life threatening), orange (urgent and potentially serious), green (not serious or life threatening) and grey (telephone advice appropriate). Grey calls get a telephone nurse or paramedic and green calls get a paramedic in a car. Only red and purple calls get lights and siren automatically, orange calls get red lights at intersections as needed but other than that orange, green and grey calls are no lights and siren. I know of one agency that goes on a one to everything for frig sake!! Uniform - two piece polo shirt and cargo pants. High visibility yellow top is a good idea. What are your fridges for? suxamethonium? I would be interested in being part of helping set this up; look me up if you like

Give him one litre of fluid as a bolus (repeat as necessary), ondansetron and fentanyl prn and take him to the hospital.

Past medical problems? What brought on the feeling unwell? Has there been any vomiting or just nausea? How has fluid intake/output been? Any changes in poos? (frequency, colour, viscosity) Vital signs? (RR, HR, BP, SpO2, temp, ECG, GCS, BGL) Physical findings? (capillary refill time, skin colour/temperature, turgor, mucus membranes) Any pain anywhere? I think this patient is most likely dehydrated from gastro but it could be DKA/HHNK, AAA, MI, the bubonic plague, lots of things ...

You could always send them back to where they came from, or just keep them for painting the house or something There is a small collection of old uniform items from the regional ambulance days held at various stations here so I'd say keep them

By controlling guns all we are doing is attempting to control a symptom of a much wider problem; thus failing to actually fix the underlying problem. By all means sensible gun controls are not a bad idea; just like sensible controls on who can drive or operate a boat or perform heart surgery are not bad ideas but to say that guns are the problem is not true. If some dude flips out and wastes some people then what is really to blame; the gun? or whatever led him to flip out in the first place?

I will agree with this only because I know you are lost in the rural nowheres of Albertobianuckistanada; so in this case you are more likely to be in a situation where by virtue of your location there is a greater incidence of needing to have some sort of enhanced capability. There is a small handheld suction unit carried in the first response pack here, although a mini suction unit that is battery powered is carried in response capable vehicles that do not routinely do response work for example operations management or the clinical development team. There is also the good ole ambo trick of rolling the patient on their side and carrying nothing for fear of Dust striking you down

Well that's not gonna happen anytime soon, the movies are like $17 a ticket here, its easier to stay at home and download them off teh internetz although it would give the Fire Service something to do, you know a call to the movies they would send like five fire trucks, and we all know how terribly, terribly bored the Fire Service is, I hear in some parts they even take over medical calls to make up for it ... but surely such cannot be true?

Lets see, Nuggets vs Warriors hmm, Ima go with Nuggets on this one. Sorry California, its nothing personal, as much as I love me some California the Warriors come from Oakland, and Oakland sucks, unless you want to get murdered, then its not so bad.

Yep, there is the Kiwi EMS Academy, cos you know, after a hard day wrestling gators and such down on the bayou I love to teach me some ambo'ing and if you pass we can go gamble in Biloxi! Google is your friend mate http://msdh.ms.gov/msdhsite/_static/47,6496,307,368.html

These wankers who roll round with an entire Galls catalogue or hospital supply room in their car make want me to run them over my GMC Sierra 2500 HD ooos my bad didnt see you there I was too busy changing country stations and such .... There was a very interesting presentation by none of than Dr Tony Smith, Clinical Director for the Ambulance Service and Chair of the National Ambulance Sector Clinical Working Group on this very thing ... i.e. what to do at the scene of a road crash, and what to carry in your car http://www.rnzcgp.org.nz/assets/documents/Publications/Archive-NZFP/April-2006-NZFP-Vol-33-No-2/SmithApril06.pdf http://www.adhb.govt.nz/forum05/car_prehosp/car_prehosp.htm Now, this will obviously change if you are living in a very rural area and you need a vehicle that is capable of some type of response work because local circumstances dictate however even at that end I'd probably carry a basic first responder bag with a small tank of oxygen, not unlike our Community First Responders, basically its a large green Thomas Pack that comes with resuscitation gear, first aid bits and pieces, an LMA kit and an IV starter roll that has a couple ampoules of adrenaline and a bag of glucose 10% in the bottom.

Oh dear, I got this at work today, geography knowledge in US is worse than expected, Emergentologist what has become of your people?

Gun's don't kill people, people kill people, its like if some dude flips out and wastes a few people at the movies, its not really the gun to blame, like if some old dude with eleventy billion comorbidities falls down one step and dies two weeks later in ICU from VAP, its not really the fall that killed him, it was his comorbidities. New Zealand has some of the toughest gun control in the world and we've just taken it too far, if I want to be able to waste somebody who is breaking into my house by putting a couple into his head from my Springfield Armoury XD .40 17+1 that is patiently waiting for me back in US because I can't import it here, then so be it! Sensible regulation to keep mentally ill or undesirable types away from guns seems to be the best answer, but, in reality I reckon we should have a system that keeps these people from getting mentally ill in the first place. Excuse me, time for teh afternoon valiumz

You sir are absolutely correct; but if all of my time in the US has taught me anything, its that even if the US is dead last in something getting people on some sort of systemic level necessary to enact change is just near impossible cos "DIS B 'MURICA!" Sorry I am not more agreeable mate, In days gone by I would type up a two page massive rambling deconstruction of everything you had said and provide evidence that you are right, because you are, however I can't be bothered. My advice is to either valiumz yourself into submission and just accept it, or get the hell out. If you ever want to get out, I recommend teh Australia.

Richard, we have the Sierra Project in New Zed where calls that are triaged as "green" (not urgent or life threatening) are going to be sent an alternate resource known as a Sierra unit which is a Paramedic or Intensive Care Paramedic in a jeep who can do more thorough assessment and refer them to an alternate health resource such as GP, medical centre etc Calls triaged as "grey" (appropriate for telephone advice) will be transferred to HealthLine which is a nurse phone line. This practice is very common in UK just slightly different. The days of calling 111/999 etc and automatically being sent an ambulance are thoroughly over at least in some parts of the world.

So we asked for a copy of some guys CT scan ... the stupid fuckwit sent us a copy of the CD, like literally sent us a photo of the CD rather than the images that were on it Not even Emergentologist Chris is that stupid

That is what you get for living in country where specialist training is only three or four years and getting your degree from the University of Stoners Down here in Upsidedownlands its a minimum of seven years post-graduate to get specialist (vocational) registration; some are longer like certain surgical sub-specialities or medical toxicology or something fucked up like that

I want to work in France, only because SMUR translates roughly to Mobile Urgent Reanimation Service (Service de Urgence Mobile Renaimaitone or some near equivalent, my French not so good) and that sounds totally badass!

Like those who got their medical degree from the University of Stoners?