Kiwiology

I don't like SSM and Jack Stout can eat poos as far as I am concerned. Now, as for prioritised dispatch I will defend the concept as I think it's a good idea. I am not referring to the ProQA/MPDS product as I think its biased and flawed in over-prioritising calls. For example: An eight year old child has a sore throat from tonsillitis and some chest pain from coughing. Anybody with half a brain can figure out this one is a low priority (no anaphylaxis, asthma, altered LOC etc) but what does ProQA do, well, as soon as Mum says "CHEST PAIN!" it has us beating a path to the truck and racing up the motorway at 100-120kph lights flashing, siren screaming going against red lights at rush hour because the job has come in as a chest pain (specifically non traumatic chest pain with nausea and vomiting). The problem with MPDS is that its relies on civillian calltakers who are forbidden from making any clinically subjective judgement about a call. Some calltakers are ex RNs or Ambulance and likewise, since the introduction of ProQA/MPDS they have been largely forbidden from stepping outside the ProQA algorhythm. The Dispatcher does have discretion in moving calls around and reprioritising them. Gone are the days when one was required to be an Ambulance Technician (National Certificate) to work in Communications. While I don't really like ProQA to be honest I feel that there is a need for priority dispatch in some form; for example a hurt knee is a lower priority than a cardiac arrest.

You guys need stronger industrial representation; Police have the PBA and Fire has the IAF/IAFC while by comparison EMS has very little.

Yup I'd also be worried about causing PEA Eh, not a lot

It gets people really trashed and they think their name is banana! :D: :D NMDA receptor antagonist, it "dissassociates" the electrial signals between the brain and the spinal cord causing patients to have significant issues with perception. One of our ICPs explained to a patient "the pain is there but you just don't care about it" truer words were never spoken! Why is critically important to manually ventillate an asthmatic patient at a slow rate?

He's working at Chotchkies now after they fired Joanna. I do wonder how many pieces of flair he has .... :D :D

I'll get warmed up then .... Tehran morning Hawker november niner zero one november bravo medivac checking in at three six zero, squawk charlie six one seven eight, we're direct SIDAD then direct TASMI, we'd then like to proceed to hmm ... let me get back to you

I like what our local IAFF man has to say, resources need to be sufficent to ensure adequate breaks. I mean after all ambo's are human too! The resource levels here sort of just enough to ocver the workload and you do run into problems around people taking breaks however the good thing is that the law is on the crew's side.

Nasty, at least when I was in US (CA/TX/NY/NV/AZ) it was a "dry heat" .... didn't mean I didn't need three showers a day because it was so god damn hot! Yes, I just love respiratory calls! But that chick who was doing assessment reckoned it was OK because the accessory muscle using, trippoding asthmatic was ok well because he didn't have a wheeze!

Oh I dno might not be that bad http://www.abc.net.au/4corners/content/2009/s2615353.htm And init a long way from the baking desert of WA to the cornfields of Iowa?

Better not tell whoever came up with our 24 week part-time Technician course or the magic 9 week ECA course in the UK (five weeks of which is driving), no press please Malcom Wollard

Apology accepted True but you get the same thing here with 6-8 observer shifts. My problem with the driver only or driver/minimally competent clinican concept is that it keeps standards down and prvents any real progression.

Yeah small capillaries of the lungs was what I was thinking of

I also support your opinion, what do you think that minimum level of knowledge should be?

How come? What about ambo, or para, or medic? Ambo is common here in NZ and also in Oz Para is quite common in Australia Medic is quite common in the US

Johnnos is slang for St John Ambulance; they have a habit of killing people in Western Australia. They just haven't ended up on TV here yet ... for killing people anyway.

Iff the top of my head I would say III ..... sweet, I was right, what a guess! Where is ACE used to convert angiotensin I into angiotensin II

Like Doc I am not in the US (New Zealand) and agree with him. A 120 hour course in advanced first aid or a 24 week part-time course in "Ambulance practice" (and I use the term liberally) is not adequate for the job of being a prehospital medical professional. Unfortunately New Zealand is unable to get its thumb out its ass and do away with "volunteers" and move towards a totally college-level education system unlike Australia, Canada and the UK (which we oddly have done for Paramedic and Intensive Care Paramedic). Define "quality care" for me please? Is it "quality" care if you have to wait 20 or 30 minutes for advanced pain relief because you don't even carry entonox? Is it "quality" care for somebody to wait with crushing chest pain because you cannot give GTN? How many times a minute would you ventilate an astmatic patient who is catatonic and respiratory arrested, 10, 12, 15? Is it "quality" care if you cause them to have a PEA arrest? Did I say that you personally were a disgrace? No, I did not so don't take it so personally. Define "great learning experience" for me? The driver only concept is a disgrace. It is disgraceful that system administrators, funders and operatives consider it appropriate in a first world nation, in the twenty first century, to staff a prehospital medical resource with somebody who has no independant clinical ability and is only there to drive. Lets say there is you, the EMT, and Wheels the Driver. Can Wheels do CPR? Can he help you apply a traction splint? What about extricate somebody from a car using a KED? How about treat the other person in the car because there are only the two of you there? This is simmilar to what the UK has done with its Emergency Care Assistant program in that it places a huge onus on the crew member who has some actual clinical ability because they must take charge of a scene almost solo and attempt to supervise or instruct Wheels the Driver in helping them while making decisions around patient assessment and treatment. That is not safe clinical practice and is a huge risk for clinical error.

I think the "driver only" concept is an absolute disgrace and a total cop out. Our fantastic twenty-four week part time trained "Ambulance Technician" is also a bit dodge if you ask me.

Sadly this highlights how poorly setup the US system is in some areas. You require ALS to check a blood sugar, are you freaking kidding me .... actually it doesn't suprise me at all but it does sadden me deeply. The original issue of not having two qualified EMTs on each ambulance is in itself just wrong. The fact that some would actually oppose such a measure is in itself even more wrong. I am careful to be critial because our system is not perfect and we're probably five-to-ten years behind Australia thanks to the freaking Johnnos. Oh and no Speanc aint drunk, he's probably had a stroke, at his age, it's a good probability!

I wouldn't be keen to stress test somebody who might be having an infarct as you know he migt um, die.

You know Rob I usually agree with 200% of everything you say but this is a rarity mate ... I have to diagree with that statement. As I say the Ambulance Service here is obligated to give each crew 30 minutes of uninterrupted break for each 5.5 hours of work. There are excemptions for a priority medical emergency but there can only be two per 14 hours and four per watch cycle (4 days). Lets look at the most basic way this can work: Start at 0630 Break 1200-1230 Work 1230-1800 Break 1800-1830 (finish time) You can have something like this too Start at 0630 Break begins at 1200 Job at 1210, no closer resource, ask Team Manager for exemption Go to job, finish at 1300 Break 1300-1330 Work 1330-1830 (finish) Keep in mind you are only allowed two exemptions per shift and four per watch cycle (four shifts) when you reach 2 you must have a 12 hour break and when you reach four you must have a 24 hour break. If you have sufficent resources there shouldn't be a problem in assigning crew to break and moving veicles around to provider cover. Let say my vehicle is on break, we'd move somebody else to that area to cover; and no they don't sit at a gas station they come to my station and enjoy conditions fit for a human.

... nooooo I mean the Johnnos in South Australia! <tongue in cheek here> Yeah I think I did mean the ACT.

Greeting We have recently adopted the "Paramedic/Intensive Care" nomanclature for our staff (we also have Ambulance Technician for the vollies) and I really do like the name change a lot. There are one or two Australians lurking around here (NSW mostly) although there are some Victorians too. I know one state runs an all Intensive Care service .... I think it's South Australia. Hang on, whats that? ... oh bugger, nine echo. Well, good to have ya here! Kiwi

Honestly I have no idea, showing the limits of my knowledge here!

Wouldn't the horrendously exaggerated QRS complexes in V1-3 be indicative of RVH? I see what you are saying about a left BBBB now in V1. Anything outside of STEMI on a 12 lead I ain't so good at