Kiwiology

If you weren't bothered by things you wouldn't be human mate, that said dead people never really worried me

Don't target kids, target these evil bloody corporations who have brainwashed us into believing into thinking that soda and chips and fast and processed foods are healthy Eat food, not food like things! I admit it's not that simple but really, feed your kid a bloody apple or green vegetables not some cheap processed shit; OK OK I admit I'm guilty of going to drive thru at 1am craving fat, salt and sugar

There is no easy answer mate, confidence comes from an appropriately reinforced and solidified base of knowledge which comes from, yep, you guessed it, experience

Sorry mate not even SERT (Ambulance Rescue for our non Kiwi members) can get you out of this one ... you're buggered Tango 3 on location, status cake

The Ambulance Service strategy here has placed emphasis on Paramedics becoming the "first line of mobile health intervention" or thereabouts; in Nova Scotia they have EHS - the emergency health service

Congrats mate

RSI is very handy to have for e.g. critical asthmatics, poorly oxygenating post-seizure or post-cardiac arrest and some severe trauma It does however represent disproportinate clinical risk and is not something to be handed out lightly, its not like putting in a drip.

There is a difference between doing CPR on somebody who has dropped dead in cardiac arrest at the supermarket or pulling somebody from a burning car and driving around being a whacker in your car kitted out with $10,000 worth of lights and medical equipment looking for jobs to go to on your scanner. The only situation I'm going to do anything is for something like what I listed above - CPR or dragging somebody out a burning car or away from a bear who is about to eat him.

No. Let me clarify, it annoys the piss out of me when I see these long, rambling narratives which start off something like "ambulance dispatched at 11am to shady pines nursing home via 911 for patient complaining of shortness of breath which she said she has had for three days prior, on arrival patient sitting up in bed, complaining of shortness of breath and tightness in her chest which felt like her last heart attack" Your vehicle number, dispatch location, dispatch times, dispatched for (MPDS code or other) should be elsewhere in the PRF or in the CAD system. Two or three sentences won't kill it but there should be somewhere more appropriate to put it than in the clinical note. I am not sure why I am so friggin picky about it but it just pains the absolute shit out of me I agree, it makes my eyes bleed It's what the pulse of the patient did when you shoved a large bore cannulae through his neck I just reformatted what was provided in that blog entry the other bloke wrote, I didn't say it was the most medically complete thing in the world infact its horrendously lacking, as you point out We list interventions, medicines and vital signs last So for example I might write # R femur Hx of falling from 3m high scaffold - landed heavily on R leg heard loud snap, no LOC O/A pt laying on back on ground, conscious + alert, well perfused O/E airway normal, breathing fast/deep, circ normal ... blah blah blah Traction splint, morphine analgesia adequate Transported- no change 1200 Observations BP 120/80 RR 22 PR 130 GCS 15 (4/5/6) SPO2 100% on air BGL 5mmol/l Pain 8/10 1202 Entonox PO 1205 IV 18ga L hand 1207 Morphine IV 5mg 1210 Observations BP 110/70 PR 100 GCS 15 (4/5/6) Pain 5/10 No, that was in the original block of text so I re-wrote it You did not, it's more half of what is in the block of text is irrelevant or it's missing information that is important Wasn't in the original for me to write down, and no.I'm not I suppose what you call dispatch and pre-arrival info we put in the "Data" block of our patient report form, its the same thing I dno, it just annoys me for whatever reason, then when I see all these people writing huge blocks of text which include every detail under the sun my brain starts to boil For example 1. Your vehicle number should be recorded elsewhere 2. Really? Wow, nobody would ever think triage wasn't done on every patient! 3. Thats nice, but we're not talking about them. If it said "front passenger decased" thats important because it shows significant mechanisim of injury but otherwise don't include it 1. I hope the patient in your PRF is not somebody else's patient, it goes without saying so why include it? 2. Who cares? 3. Who cares? 4. This TELLS us nothing relevant, it INFERRS the patient has a certian level of responsivness or alertness but doesn't say explicitly, so leave it out 5. Who cares? 6. Do you really have to mention you took the patient to the ambulance? 7. Wow, I would hope so! Standard of care anbody? Hey Conrad Murray look over here! 8. Who cares? 9. I bet that makes you feel important! 10. Did you walk back to the ambulance afterwards, better document that too! 11. No really? Did you expect the HEMS Doctor or Paramedic to expect you to keep on looking after him in the helicopter even tho you didn't go with them?

Dude that makes my eyes bleed just reading it Professionalisim is the demonstration of adherence to specific standards and the upkeep or bettering of them in the interest of the advancement of whatever specific body of expertise, knowledge and competency the particular role in question involves. For example; well groomed, clean uniforms, appropriate interpersonal interaction (conduct)/communication skills and the use of knowledge and skill for the purpose of achieving role-orentaited goals. Now that might make me sound like some sort of academic wanker but in the situation you describe it's quite true. If you roll up with a weeks worth of stubble and shirt hanging out it shows you don't really care about your presentation or the negative connotation its going to have to those around you, by loudly yelling at the family and the doctor about this bloke having a head bleed it really shows a lack of knowledge, a lack of appreciation for the system in which you work and that you have a really bad attitude. I'd love to say our Ambulance Officers are better, and by-and-large they probably are, but I bet some out there are not much different.

I wouldn't argue its not important how the patient turned up, but it's probably not the most important thing out there. Because the hospital doesn't care and it makes no difference to them. Locally in the top block of our PRF we have a space to give the vehicle number, job type and dispatch/locate/depart/destination times as appropriate. The rest of the informaton such as the address, MPDS code etc are all stored in the CAD system. Your local flavour of patient report form may record them differently. Our MDT touch-screen has options for depart, locate, arrive destination etc so we use those as the basis for our job cycle times. Of course its important to document when something was done, heck wear a watch I'm picky about this because nobody wants to read some long, rambling novel full of superflorious information that doesn't have any clinical relevance. I've read some absolutely horrendously rubbish PRFs that go on and on and on like the story that never ends about every little detail and it just makes my eyes bleed. You are writing a clinical record, not a novel. If you're worried about getting sued or need to CYA then have the call taker record it against the job notes in CAD or something. For example here is an example of a supposedly "good" narrative (http://lifeunderthelights.com/2009/06/more-on-ems-narrative-reporting/) If I got handed that stack of text on a PRF as an ED nurse or doctor, Clinical Standards Officer or Medical Advisor it would make my brain boil over Here is what I would write Hx today restrained driver head on pick up v. pick up RTA approx 55mph ? no LOC Heavy front end damage to both vehicles w intrusion to passenger compartment C/O chest pain + dyspnea ? PTX O/A pinned in vehicle by steering wheel, pale + diaphoretic Imobilised; moved to ambulance O/E conscious + alert, unable to state time or day, airway normal, breathing shallow/laboured, circ pulse strong+rapid, No head trauma, PERRL. no tracheal shift, noted JVD, chest asymetrical, b/s diminished R lobes left clear Imprint of steering wheel visible on chest Abdo RLQ/LLQ tender to palp, no visible distention Pelvis stable Motor function/ sensation normal Superficial grazes and scrapes (... where?) ? R PTX ... increasing SOB, decreasing pulse pressure, JVD, increasingly confused + agitated Decompressed w 14ga needle R side 2/3 ICS w return of air from plueral space Once decompressed; SOB relieved, improved LOC Pt transported by HEMS 1200 BP 144/94 PR 120 RR 10 O2 15L NRB ECG sinus tacw w occasional PVC 1202 IV 14ga L AC 16ga R AC 1202 Normal saline IV 2L 1205 BP 128/92 1210 BP 110/98 1210 Needle decompression I am not the most skilled clinical documentor in the world and I freely admit that, but isin't something like that much more logical and easier to read than a block of text you have to go searching through that is full of superflorious information? Oh I also note no GCS was seemingly performed, the chest or abdomen were not percussed, no location of the various scares and cuts was given, it wasn't recorded which side of the chest had worse symetery than the other, no respiratory or pulse rates were given, and who still starts two large bore drips with fluid on a trauma patient?

Is there not a more appropriate place to record it than in the clinical record? We have the top part of our PRF which has a block to fill in times etc; I know the US generally uses electronic PRFs so is that information not all transferred across from the CAD system? Does the ED Reg begin their note with "delayed 30 minutes seeing pt because was taking a big steamy crap?" If I write down "History of being delayed 10 minutes because the train crossing was closed" the hospital is going to look at us pretty weird. Granted not everybody works like we do but the clinical record is for clinically important information, what happened on the way while you were getting there is of no value to the hospital, unless you stopped off at the ice cream store, damn that is important, I like my ice cream

Does anybody actually care about your dispatch and response information though? In the "Data" part of our PRF we put down date, vehicle number, dispatch, locate, depart and destination times etc The rest is strictly clinical information only

I'm not saying ours is definately superior, what I was saying is that you need to do RSI properly or not at all i.e. the benzo only crowd, or etomidate only, or lets give everybody RSI and see what happens etc The available evidence seems kind of mixed and not many studies show positive outcomes, yet we have consistently demonstrated extremely high success rates for nearly 10 years and as far as I can see the only thing we do different is tightly controlling who gets RSI and how they do it e.g. mandatory capnography, bougie, only two attempts at intubating with strict time limits on how long you can attempt laryngascopy for One thing I am interested in is seeing if we can get our data published somehow; I'm not sure it wouldn't be an RCT because there is no "control" group, it might be in the form of an abstract or something I am not sure, gah, where is my research book when I need it!

If you are going to do RSI do it bloody properly. our RSI is as follows - Only for selected Intensive Care Paramedics (who all have four to six years education + experience minimum) and have already been intubating dead people without medicines - Only for those selected ICPs who pass a three stage selection, training and exam process written by our Medical Director who is a Consultant Anaesthetist and a Consultant Intensivest (FANZCA/FJCICM) - For patients with poor airway and/or breathing who need intubating but cannot be intubated without medicines - Only two attempts at intubation - Each attempt must use a bougie and anterior laryngeal pressure is highly encouraged - Each attempt must be able to visualise cords within 15 seconds of laryngascopy and intuate within 30 seconds total - We use fentanyl, suxamethonium and vecuronium - Inducation is either with midazolam for patients with neurogenic cause for coma with GCS<10, ketamine for everybody else - Post RSI management is midazolam, morphine and vec - Each RSI or potential RSI must be debriefed with a Medical Advisor or Medical Director - Since 2003 we have >97% success rate with all failed intubations managed without cricothyrotomy

Best post ever

We have the combat application tourniquet

they have skiing in peru?

Should we give him some concrete pills so he can harden up? Might work better, and with less side effects, than viagra - esp when combined with the GTN

Combat application tourniquet and fast transport to the ho'biddle to see the chiurgeons (Kiwi for go to hospital with much fastness)

It was even published in TV Guide, that's peer reviewed right? Give him 2 panadol and write up some concrete pills so he can harden the frunk up

Sorry yo're having a rough time mate, I know it really sucks that Rob departed; I talked to him a couple weeks ago but never really got to tell him how much of an awesome bloke he was, I think he knew anyway but you still want to say it. I don't claim to have all the answers, if I had lthe answers do you think I'd be here, doing what I am doing now, dealing with this washed up sad fuckin existance of a life? No I'd be on some beach somewhere with my soulmate drinkin a Jack Daniels getting a tan and a blowjob while my millions cooled off in that term deposit and accrews interest so I can pay the pilot of my private jet. We are our own harshest critics, we look at ourselves and go "shit bro I should have done this or this" or "it would be different if only ..." it's the "coulda, shoulda, woulda" syndrome. We all constantlly beat ourselves up for missed opportunities, for things we should not have done or should have done but didn't etc, I know exactly what you are going through mate, it's a rough ride at times, but it's natural and unavoidable I think, we are our own worst enemy. I know it's easy for me to say but seriously bro, it'll be alright, I don't know if you're a religious bloke but I'll offer some words along that line anyway; Rob will know what you've done, he'll watch from up above and see you, he'll be proud of you, it sounds like you were good friends. There are some friends who have helped me immensly that I want to go back to when I've gotten to where I want to get to and say hey look I did it! I know exactly what you mean, it hurts like a bitch. Hope that helps mate, feel free to come talk to me anytime

I know Rob used to be stationed in Oak Cliff with Dallas-Fire Rescue when they had taken over Ambulance from Dudley Hughes at some point, I think it was in the eighties, man he had some awesome stories, he always said he preferred the blue-and-white Ford wagon ambulance the funeral home used to have. Accordingly, I'll mark 602 code 6 then.

This is terrible news that could not have come at a worse time, Rob was an awesome guy, like the McLovin of EMTCity seriously he was just an awesome guy, been everywhere, done everything, knew everything .... we just missed each other in Dallas a couple years back. Yeah I guess the bloody IAFF finally got him Rest easy bro. Ben

Her tongue has swollen up, her tongue swelling up and airway obstruction are two totally seperate while somewhat mutually interlinked processes. One does not extrapolate to the other. Do you do realise subcutaneous adrenaline has gone to the Ambo retirement home along with the Lifepak 5 and bretylium right?