Kiwiology

Perhaps, but what is he supposed to do? Wheel them through the front door into chairs and say to the nurse "this lady needs some pain meds?" I'm not saying do not do it but it's a bit dodge; not sure how obliging the Physicians would be It may have been put above and I haven't seen it but is this thing not supposed to be something your "medical control" is for?

NP requires a BN (BSN) + a Masters degree so think at least six years of studying A PA I think also requires a Masters degree so might be the same we do not have PA's here so I am not familiar with the education requirements I should put that on a polo shirt and send it over to you

Doing something when there is no evidence it has benefit is akin to voodoo and quackery; intervention without evidence should be dismissed without evidence. LOL that is kind of funny I am sure each day many thousands of people are electively anaesthetised and ventilated and then taken off a few hours later so that really wouldn't be an issue for me. I do not agree with anaesthetising, paralysing and intubating somebody just because they're a bit agitated from a mental illness. Give them some ketamine and he'll be having a great snooze with none of that cardiorespiratory worry.

There is definitely an answer to the health workforce problems that does not involve just generating more Doctors (although that is certainly required) I think there is definitely some merit in a mid level who has appropriate education being able to order certain tests, prescribe and refer within a very limited scope e.g. diabetes, cardiovascular, general practice. I do not support these people being able to "diagnose". It has been a very long hard road for our Nurse Practitioners getting prescribing rights, e.g. a diabetes NP cannot prescribe ACE inhibitors. We do not want PA's here and there has been overwhelmingly negative reaction to the small (2x PA) trial that is going on here or may have just ended. The Royal Australasian College of Anaesthetists furiously refutes any suggestion of a CRNA type person to fix our Anaesthesia workforce shortage. So I think this person could have a great career as an NP or a PA; now why do I want to be a Physician and not an NP? Quite simple, you cannot get a blue suit with "AMBULANCE DOCTOR" written on the back as an NP now can you?

As I said over at EMS1.com the other week; it deeply saddens and disheartens me that things are so FUBAR in US I loved living in the US; it's a great nation with much to offer and many wonderful people but it's also like following Alice down the rabbit hole (and WTF is up with the guy who wrote that being wasted on mushrooms? lol) And you can hardly talk Dr I'm from Lawn Guyland about teh funny accent

http://www.ncbi.nlm....pubmed/20385694 http://www.ncbi.nlm.nih.gov/pubmed/20858132 http://www.ncbi.nlm....pubmed/11485508 http://www.ncbi.nlm....pubmed/11145768 http://www.ncbi.nlm....pubmed/12957980 I agree with you (hey maybe that means I should become an an Emergenthesiologist?) I have no problem with intubating an unconscious patient who is post-ROSC so he can go straight to the cath lab after he's been plugged into whatever mix of sedation and paralysis the hospital is using because he's liable to wake up half way through angioplasty as the vecuronium the ambos gave him wore off. Touche mate, good point but still .....

Wait, which is harder to fight; the nurses, the firefighters or the medical directors? I'm progressive but unfortunately I haz teh funny accent so I'm not taken seriously At one point I would have embarked upon a great, lengthy, sense-making deconstructive argument in favour of such suggestions but I no longer have the energy. Sorry bro.

While I am generally not fond of the "mid levels" who want all the autonomy of a Doctor but not go to medical school it appears for you blokes in US you can get a good career path for yourself and rake in the bling as a PA or CRNA

Sure thing right there mate, if ROSC is achieved its totally appropriate to tube somebody and take them to the cath lab (providing you have anaesthetised and paralysed them first so they don't wake up halfway through angioplasty) That's a whole different kettle of fish or barbie of shrimp than intubation for the patient in cardiac arrest

See, I told you that you should of become an Anaesthetist Class IIb evidence is evidence in which "usefulness/efficacy is less well established by evidence or opinion" and for endotracheal intubation is based upon level of evidence C which is "consensus opinion of experts, case studies, or standard of care" Nobody in cardiac arrest ever died from not having an endotracheal tube shoved down their gob; there is one study acknowledged by the AHA from Victoria (Australia) from 2006 that claims endotracheal intubation increased the chance of ROSC but did not correlate to survival to neurologically intact hospital discharge. There is no evidence endotracheal intubation has ever increased the rate of neurologically intact hospital discharge in patients who had a cardiac arrest; it therefore has no evidence and should be dismissed without evidence.

LOL at gentlemens club I think they have food at the whore house, y'know at least a vending machine or something, or wander down to the takeaway shop two feet down the road after you're finished

Each individual orginisation

Come on now what is yoouse sayin eh fahgetaboutit ima go get a slice of pepperoni damn it its 4am and i cant get pizza I think I will blame Emergentologist

You are correct and I agree with you however no evidence that endotracheal intubation in cardiac arrest improves rates of survival to neurogenically intact discharge has ever been presented. Intervention without evidence should be dismissed without evidence. My interest away from fixing up super crook and heaps nunngered people is the role of diet and nutrition in the prevention and reversal of chronic disease; if I came into your Emergenemedicinotology department and started telling patients to eat plant based food for it will reverse their coronary artery disease and that they will never require any more stents, bypasses or GTN after having a carrot wax again you'd be on my case that I was practising charlatanism and that I must present some evidence that it works or stop purporting said charlatanism so I'd have whip out the published medical evidence supporting my claims. There is no no evidence that endotracheal intubation in cardiac arrest improves rates of survival to neurogenically intact discharge it is therefore an intervention without evidence and should be dismissed without evidence. The same can be said for the current traditional standard of spinal immobilisation; there is no evidence it is of benefit and should therefore be dismissed citing lack of evidence

All he had to do was click the bloody link it's not that difficult He didn't even have to do attempt to understandeth my speakings

I proclameth to you good sire abstracts of spontaneous inquisitorial cognition can be satisfied forthwith by a transfer of ACh across synapse resulting in flexion of digits which allows the entrance of key terms likely to be statistically significant in the retrieval of desired factoids into a apparati capable of finding said terms on various hosted files constructed in hypertext markup language http://www.nyc.gov/h...mployment.shtml

There is absolutely no evidence that is true, there is evidence that it is not; in fact such a notion even defies the basic laws of physiology. Just because you practice some voodoo ritual that refuses to die of attempting to shove a tube down somebodies gob does not mean it is going to do any good and there is plenty of evidence showing it in fact does harm. The leading cause of cardiac arrest is dysrhythmia; the leading cause of dysrhythmia is myocardial infarction. Ventilating somebody does not mean the inspired oxygen is going to reach the heart on a cellular level. There is evidence that supra physiologic amounts of oxygen actually do significant harm. Ischaemia is not hypoxia and oxygenation is not ventilation. No evidence has ever been presented that intubation has ever been beneficial in improving rates of neurologically intact survival in a cardiac arrest patient; it is tradition wrapped up in lure and nothing more; charlatanism if you will; it probably does more psychological benefit to the person trying to intubate ("Because I did everything I could to make sure his heart got oxygen!") than the patient receiving it. It never had any evidence, so any intervention without evidence should be dismissed without evidence.

You make a good point Mike if the women do not mind then I guess maybe its not a big deal; I mean bloody hell I dno, I'm off to the clubhouse to get shitfaced and stuff my gullet while I get served by an openly gay black male foreigner waiter

I think it says something about the values of the society in which the people who participate in such a venture live. I think, I am not sure if you can extrapolate that But you know what, I bet they dont allowz teh Kiwis ....

I proclameth to you good sire abstracts of spontaneous inquisitorial cognition can be satisfied forthwith by a transfer of ACh across synapse resulting in flexion of digits which allows the entrance of key terms likely to be statistically significant in the retrieval of desired factoids into a apparati capable of finding said terms on various hosted files constructed in hypertext markup language http://www.nyc.gov/html/fdny//html/community/ems_employment.shtml

Intubation for cardiac arrest is no longer recommended Nobody in cardiac arrest ever died from not having an endotracheal tube shoved down their gob

Cling film (glad wrap) is in the Australasian Burn Council and British Burn Association guidelines for covering of burnt area pre-hospitally It's cheap, holds in heat, is air tight and keeps out infection

LOL it makes me laugh (and kind of cry) that you blokes have a cookie cutter "advanced" class in "life support" for everything under the sun While I have no specific advice for said class I can offer the following pearls of Kiwisdom (KIwi wisdom) regarding burns 1) Stay at the scene cooling burns unless there are major life threatening problems with the primary survey; running saline in the ambo is nowhere near as good as 20-30 minutes of cool running water at the scene 2) If you have it, cover burns with cling film (Glad Wrap or kitchen film) if you don't have it, get it 3) Analgesia, analgesia, analgesia; burns are horrendously painful and will often require large volumes of pain killers

Well nobody could ever call me intimidating; I'm a weak skinny pale Kiwi with a shonky eye ... but if you piss me off I'll just shoot you in the head with my .50 Desert Eagle, so I guess that could be intimidating but you'll be dead before you've got time to be intimidated

As much as I like the Lifepak 12 it's bulky and somewhat awkward to use and store; the LP10 is a much more practical shape I have to admit the NiBP, 12 lead ECG (although you could do a 12 lead with a 10), ETCO2 etc are nice