Kiwiology

I strongly suspect if no further evidence is found supporting adrenaline in cardiac arrest it will be removed here come September, 2013

It was removed because there is no evidence it does anything beneficial

I was just taking the piss bro

Here it is most common for both Officers to drive and alternate calls. It is thought that exposing the lower qualified Officer (particularly Technicians) to stable patients builds experience so if the patient is stable then the higher qualified Officer drives. Sometimes, by mutual agreement of the crew (except where patient status dictates) they alternate one shift driving and one shift attending Personally i think both crew members should drive; it is not fair to have somebody that never drives.

Awesome bro, last time I moved it was because some bloke called Hank Scorpio offered me a job at Globex Corporation; that video was right, my dreams did vary from those of Globex Corporation, its subsidiaries and shareholders! I myself am more partial to the Midwestern and Southeastern US; love the people, nicest most friendly people I've ever met, absolutely love being able to drive around in my giant gas consuming SUV, eating bacon triple cheeseburgers, blasting contemporary country rock music and hating on Obama en-route to the gun range. Take a look at North Carolina or Texas; they are very progressive as is EMSA in Oklahoma City/Tulsa

We do not have osteopathic physicians and to specifically answer your question, no we do not. Our medico-legal framework is much more relaxed and less labyrinthine than yours, we are autonomous practitioners who make our own decisions and as such are responsible for them. The likelihood of a Doctor wandering up out the blue and offering to help is extremely low so much so I've never experienced it and heard of it happening once; even if they do offer in all truth they are likely to be put to work holding a bag of fluid or getting a BGL CPR, providing manual ventilation or some other task like that. Let's say I can't intubate somebody (not that we should really be intubating people any more anyway) and there just happens to be a Consultant Emergency Physician or an Anaesthetist pop up out of the blue who is volunteering to have a go for me sure I'd let him at it. Should a Doctor or any other healthcare professional identify themselves and offer to help the most they'd get 99.9% of the time is "we've got it thanks". Now, if I'm really stuck on forming a diagnosis and a physician happens to pop up and offer a hand sure, who am I to disregard their knowledge and experience?

I would seriously recommend you give strong consideration to NZ or AU then; specifically Victoria, NSW or Queensland (i.e. NOT the NT or WA) We don't have winters ... or medical control

Locally speaking we are autonomous practitioners who do not work under the thumb of a physician nor do we have such a complex medico-legal system designed to sue the pants off of everybody left right and centre; having said that if a physician wants to help then it would be pretty ignorant of me to disregard their opinion.

And here I was thinking those who attended the emergency department were the patients? I want our hospital to get one of those signs that boasts "Comprehensive Medical Care / Physician on Duty 24 hours" below where it says "EMERGENCY" ... wow I am so relieved knowing the hospital has a Doctor there 24 hours! You know I believe such a statement is only a legal requirement in California

What? Are you insane? Why the bloody hell not? You know how important it is to ventilate the absolute snot out of somebody at a gadzillion times a second to force that oxygen into their lungs right? I mean come on you even have to ignore the dangers of dynamic hyperinflation and cardiac arrest risk in an asthmatic who requires manual ventilation and forego ventilating him at a slow rate because it's imperative to force as much oxygen down his gob as possible!! Come on man! And you call yourself a Consultant Physician

Why would you want to move to the US anyway? If you want a change of scenery come here eh; you will find pay and working conditions comparable with near total clinical autonomy

It's a bad thing bro, Dwayne is a usurper who will take your money and booze and ditch you halfway through your winning streak at the casino because he found some cheap hooker at the bar ... next minute you're cashing in your profits and he's on the ground outside having the shit beaten out of him by LVMPD and hauled off to Clark County Detention Centre. I mean he's in fucking French Polynesia or some shit and he doesn't even swim down to see me or so-much as have Skype sex with me anymore, he says his internet is too expensive. Prick .... love you Dwayne

I want to go back to the days of very early ALS when we had people with massive afros driving around in a Caddy sporting gold chains, a blue boiler suit with "PARAMEDIC" on the back in yellow letters, glass IV bottles, sodium bicarbonate and a Lifepak 4 or some shit

You give me nightmares straight from the fires of Hell ... oh wait did I say that shit my bad, inside voice Kiwi inside voice

You may be surprised to realise such an attitude here can breach your patients legal rights under our Health and Disability Act and Code of Health and Disability Consumer Rights. Specifically you may be found to have breached the patients right to independence, right to be free from coercion, right to receive services of an appropriate standard and right to effective communication. You may also be held accountable by the professional authority for Paramedics and their Code of Conduct when it comes in next year. Patients often know what is best for them, or what works and what doesn't, e.g. where to put in a drip, if glucagon works for hypoglycaemic Little Timmy, whether or not adenosine works for Nana, if Cousin Cletus with the chronic pain syndrome after being run over by them Sperlunkin boys down yonder's pickup truck responds well to morphine etc.

You have to take the entire courses again from scratch as if you had no qualification whatsoever then take the NREMT exams

We can't all be as cool as the Supreme Fire Monkey

Die words die! I know what you mean, i.e. you do not have an unrestricted scope to practice medicine but to take another flip, the "we are not doctors!" line just makes my blood boil. Much professional advancement comes from embracing knowledge and being able to apply it; I'm not a Physician and many non-Physician Paramedics and other healthcare professionals I know can hold intelligent conversations with the Physician collegiate; for example just today I was discussing Carry-Comb's murmur, meningococcial septicaemia and ceftriaxone for Paramedics with a Consultant Physician; I've told a House Surgeon if he doesn't stop embarrassing himself by being an arrogant wanker I'm going to have to start arguing biochemistry with him to show him that he isn't the only educated person in the room. Far from it to be for me to talk myself up (shit I'm just so wonderful aren't I tho?, not like that drunk fucking white trash piece of shit Dwayne, man, he's in fucking Niue or some shit and he doesn't even swim down to visit, arrogant prick!) but rather the examples I have given mean that knowledge is free and non-discriminatory; if you (rhetorical) want to get away from alphabet soup classes and "contact medical control" then there needs to be some serious investment in education and professional progression; tell the NAEMT to go suck themselves off and get a real representational and educational body; vis Canadian colleges' of Paramedics (oh man Squint better not see this or he'll never shut the fuck up about ACoP lulz) This. Oh and I like going to my dentist, he is an expert practitioner; I just don't like the fees he charges This ... makes me sad

I wish I got what you were saying, I can't understand your white trash speak and you're probably fucking drunk half the time anyway Georgia Protocol (1) states on page 1-9 Again, as to whether or not this conforms to the alphabet soup class way of teaching .... eh that's like following Alice down the rabbit hole, and the bloke who wrote that was high on mushrooms or something at the time so hey, y'know it kind of all makes sense This is why we don't have alphabet soup classes. Lone, I know you're an intelligent bloke (sure, you're a bull headed prick some of the time and I want to kick the shit out of you with my safety boots) and I know how much you want to better yourself and see the profession advance; this is admirable and it has been obvious from the outset of our exchanging ideas and insults that you get very frustrated with the current complexities and inconsistencies and discombobulations that constrain you. Such desire for betterment is admirable. (1) http://ems.ga.gov/pd...15-08%20Web.pdf

The guy is dead it's as simple as that Whether your "local protocol" conforms to whatever flavour of alphabet soup class being taken is another question entirely Now if you'll excuse me I have to go to the Resident Medical Officer lounge and eat the House Surgeons lunch, he died from fatigue so wont be needing it no more

I'm just not even going to get into this because its going to make me get all worked up

Good point

Um, duh, yes because I'm up front driving fast using the new steering-wheel mounted siren control because it's so important right? More than likely not but at most I'd turn on the red lights and use the siren at intersections; which is overwhelmingly what we do here. Now, while we're waiting for the latest Trop-T and CKmb to come back on this bloke and for the nurses to fight over which one is going to come with us I'm going to nick into the Resident Medical Officer's lounge and get something to gnaw on, I don't have any body fat so it's very hard for my adipose tissue to release stored triglycerides which don't exist for beta oxidation into pyruvate and eventually ATP when I get hungry .... you wouldn't want me flaking out halfway to Big Academia now would you? Aw shit, that sounded a lot like basic science, we're going to have you in the corner aren't we ....

You raise a very interesting point and for a moment let me take a little bit of a spin on it To say (rhetorically) "I know better" is a bit arrogant and/or rude but sometimes you need to be forcefully suggestive to somebody e.g. lets get going to hospital now, this patient is crook, stop snuffing around with that blood pressure or whatever ... let me put another spin on it I've seen Physicians who are just down right awful, they've put patient with chest pain on one litre of oxygen and then gone to hide in the corner or they get snarky when you elicit from the black women with an IUD, who smokes, who has had two kids previously, who has had multiple sexual partners that she has diffuse abdominal rigidity and pain which makes you think it's an ectopic pregnancy, or they tell you that you couldn't possibly know it's DKA without doing biochemistries for anion gap, pH. glucose, pOsm and testing for ketonuria despite their blood sugar is 30mmol/l (like 600mg/dl) they are polydipsic, polyuric and they stink of ketones. Many have an attitude of "you're not a doctor so how can you know XYZ or you don't need to ask all these questions just take the patient to the hospital or whatever". If you're making a total snafu of the situation and somebody picks up on it then there's nothing wrong with telling the other person, again you don't have to be rude but as I said sometimes you need to be forcefully suggestive in the best interest of the patient. While the attitude of "I know better" seems to be rife in the medical world it's particularly bad amongst EMS I've noticed; that somehow the limited education given somehow justifies a big ego. And you're clearly an American Physician, you haven't cottoned on to the idea that the House Surgeon is at the bottom of the medical food chain (in most commonwealth nations/ outside the US/Canada you must do one or two years post-graduation of general hospital experience before applying for specialist training)

I was going to make a joke about fitting a clock in a nebuliser bowl but then it struck me, you know the really sad part is that the EMS Education Agenda for the Future has been in development since 1994, thats nearly twenty years and the EMT level (which is your backbone level esp in rural areas and where patients will benefit from the most increase in education and scope of practice) still can't independently administer salbutamol? Now I'm not about to get into a pissing match or derail this thread into another education argument but that makes me die a little inside.