Kiwiology

Oh wow looks like RVH with right axis deviation but also looks like a bundle branch block (rabbits ears) in limb leads and V6 Man now thats making my chest hurt

Does the pain go anywhere? ie back (AAA) or jaw/neck/arms/face (ACS) Does the pain get worse with inspiration? (pleuratic type) No SOB? What does our high quality Tom Bouthillet approved 12 lead ECG including V4R show? Heck lets try posterior leads too, we got time its the middle of nowhere! I would like to give 324mg ASA PO and try 0.8mg GTN SL up to say, 2 or 3 if it helps if not no point giving it anymore. Venous access (lock) and if we can pull some bloods for later analysis would be good. Can we do a chest x ray at the clinic?

It may however my ticker would surely convert out of fear that Chuck Norris might show up Well, that is of course assuming Chuck Norris has authorised me to have a cardiac event in the first place!

I love that article .... there is nothing magic about slapping everybody on fifteen bloody litres by nonrebreather!

Man I feel sorry for you guys; all our stations have a kitchen[ette] and our breaks are not only a union but also a legal requirement. Oh and we don't sit on a street corner neither because we don't subscribe to Jack Stout's BS SSM theory.

Spenac probably got his arse whacked at school as a way to get off it and move around to warm up because fire was not invented yet! I think parents have just become too useless or somehow incapable of disclipining thier kids, plain and simple.

Then don't eat in the vehicle?

You are quite correct. Again, for the upteenth time, there is nothing magic about oxygen and it is often given to patients who either do not require it or in flows above what is required. The American mentality of oh slap everybody on fifteen litres needs to go. We have some totally volunteer ambulance stations here however the volunteer Officers are required to be at what we call Ambulance Technician level. This (for the volunteers) is about a 24 week part-time course which enables them to use oxygen, salbutamol, methoxyflurane, GTN, aspirin, glucagon, ondansetron and paracetamol plus do cardiac monitoring. As an Officer gains this qualification they are considered an "Ambulance Assistant" and have no independant clinical ability except to use an AED and provide advanced first aid. They can however provide the Ambulance Technician scope provided they are supervised by a Paramedic or Intensive Care Paramedic. The volunteers are also taught if the patient is really sick or something they cannout use thier bag of tricks on to call for somebody higher qualified to come towards them. Most of the time it will be a Paramedic although even with upskilling there are one or two situations which will still require an Intensive Care Paramedic.

Yes. That's why I bring food from home whenever I am on station.

Get Rob to do it, give him a few copies of JEMS to sign and wow, Larry Flint is back baby!

Chuck Norris doesn't need atropine, adrenaline, amiodarone or the monitor/defibrillator nor does he require any from of ECG monitoring. The mere mention of him is enough to convert even the most lethal arrythmia!

In New Zealand it is a legal requirement to have a 30 minute rest break after each 5.5 hours of work one of which counts as the paid 30 minute break for a meal as part of the Ambulance union contract. We can have ONE interrupted break during which we can go to a job but immeadiately after that job the crew is stood down fomr a break and another resource is moved to provider cover. So in this case, if during our first break from 11.30-12.00pm this job came in, depending on how it was coded and who else was avaliable we might go to it and get stood down afterwards. The EACC Call Taker codes the job as either p1 or p2, the Dispatcher makes a recommendation to the Team Manager as to which resource to send and the Team Manager has final authority.

I have yet to see an ALS (Intensive Care) level that has neither IV/IO or chest decompression so you're mostly correct there. Starting an IO maybe when thier veins have "collapsed" and you can't get an IV line sound reasonable but man that guy just makes himself and his whole roundup look really bad like seriousy I am laughing my ass off .....

You obviously haven't worked with me yet .... Seriously, OMG ROFLAMO hahahahahahah what a bunch of hillarious retards God makes a bunch of chimps at the zoo masturbating each other seem less amusing! :D :D

What a bunch of retards .... I mean they go on and on about NFPA 1710 and yet when it comes to what is essentially the equivalent for HEMS oooooh its big and bad and lets shoot it down. Wankers.

Exactly how did the IAFC oppose this? Maybe "dual pilot IFR" or "14 CFR 121/135" or other such terminology was too hard for them to understand?

So the Fireys now run CoAEMSP? Talk about the fox investigating the chicken coup.

You do raise a valid point and one that has come up here in the past. GTN used to be restricted to Paramedic or Intensive Care Paramedic because they could infuse fluid and do cardiac monitoring. Oh those were the days .... keep in mind that Ambulance here had been dishing out nitro for at least twenty years before we got 12 lead ECGs. In the early 2000s the Ambulance Service took GTN and IM Glucagon down to base level and it's been there ever since. To a point I do agree with what you are saying however I don't think the balance of risk vs benefit is really in favour of once-again restricting GTN, not here at least. Would I want somebody with 120 hour course dishing out nitro .... well that remians to be seen but I am leaning towards no. Thinking of that another way; do patients do a 12 lead on themselves before they take thier GTN, no. You don't have to give both squirts of GTN to make up 0.8mg you can always give one of 0.4mg if the patient looks sick or if thier BP is more towards the lower end of the threshold (ours is 100 systolic). We could argue the same about GTN for an RVI; I had this discussion recently on station over the "no GTN" vs "give the patient some fluid, then give them GTN".

Well I sure was, and we're talking the eighties here .... <tongue in cheek, ow my tongue> I must wholeheartedly agree with VentMedic here, there is an inherent difference between being "able" to perform a skill from a medicolegal or licensing perspective and being able to actually perform that skill or procedure. I am certified to do things I have not done in years and would not want to be thrust into a situation of having to do them, simply because the cobwebs in the noggin are a wee bit too thick and it's a risk I don't want to take. This case is a really good example of why the ambulance service here has divulged itself of high needs transfers simply because it's not something ambos have experience in. They may supply some wheels but Regional IFT and Neonate/Paediatric Intensive Care teams are used because they have the expertise to manage the patient that Paramedics do not.

New Zealand first started using the scoop in the mid seventies. Up until a few years ago we used the metal scoop which could be stored in a pillow case or joined together and stored under the stretcher tray however the Ferno yellow plastic ones are slowly replacing them. I absolutely bloody love the thing it's just fantastic and the evidence seems to suggest they are superior to a long backboard when it comes to less patient movement. However I must say they do have limitations in that people get themselves stuck in all sort of weird places and its often difficult to extricate them because our primary extrication tools are all long and rigid. They are the ubiquidos orange stair chair, scoop and the stretcher (either Stollenwerk or Stryker). Sometimes it would be nice to have a longboard to just drag people out onto and make a run for the vehicle.

I am certified to carry my razor sharp rabior type whit and sense of humour And if that fails I will beam you with the oxygen tank

California gets dissed because they are one of the poorest examples of prehospital medicine I can find - The legislated scope of practice are very, very restrictive and I venture a guess haven't been updated since Wedsworth-Townsend or there abouts! - The statewide EMS Authority has downloaded scope-of-practice and the use of "add on packages" to each regional or county level EMS Authority - This means what a Paramedic can do in Los Angeles is different to one in San Bernardino who is different again to one in Fresno - There are no Statewide standing orders and they vary by each regional EMSA jurisdiction - The standing orders that do exist are notoriously inadequate and (as JP points out and I have done before) require base hospital contact for just about everything! - Education is kept at a level that is acceptable (again, mainly to the Fire Service) for example Los Angeles County Fire Department Paramedics are not taught to interpret a 12 lead ECG and rely on the machine interpretation, which is notoriously inaccurate. - Local and regional tax is such a taboo subject, almost akin to witchcraft, that many jurisdictions have given EMS to the spare-capacity of the Fire Department for cheap, and get cheap when it comes to quality of service - Most services are intergrated with the Fire Department using dual role Firefighter/Paramedics so you get alot of people who need a quicky cert to get on the Fire Department Why did Michael Jackson get taken to the hospital? Because the Los Angeles City FD Paramedics have to transport despite thier trialling an out-of-hospital field termination for cardiac arrest without ROSC in the late 1990s or early 2000s. Then there was the 1992 intergration of Firefighters and Paramedics and the abolition of single-role civillian Paramedics. On October 18, 1992, the single-function EMS personnel ranks were consolidated with existing firefighter ranks. In September 2000 in response to the large numbers of "Firefighter-Paramedics ... decertifying and requesting to get off the ... [ambulance] and back onto fire companies" (source) what did the LAFD do? Why they came up with a plan to put a Paramedic at every Fire Station! Did I mention Los Angeles recently? On a positive note, the Paramedic programs in California are mainly all community college based and they are required to be accredited by CoAEMSP. Well, I know at least one place I will be visiting in Los Angeles ... the local neighbourhood fire station! Could somebody give me an example of the ubiquidos "base hospital contact"; like I immagine it just allows you to go further down the standing order with physician authorisation?

Our Intensive Care Paramedics can cric and not all have RSI, some do. What is this guy smoking? The same stuff the Fire Department did when they raped Department of Public Health and took thier Paramedics away in 1998? Well it IS legal in California ....

One thing I do like about our Ambulance Officers is that a spade is called a spade and you know it without a lot of touchy feely wanking off. That does not mean you have to rude, aggressive or insulting; but simply to clearly state the problem and why is is a problem, find out the factors behind it and fix them. How old is this person? What sort of background do they have work wise? Are they naturally a reservist? Do they talk much about stuff like what's on telly at the station or what the crew should have for dinner etc? Perhaps you could approach and ask if she is finding her role as an Ambulance Officer acceptable? challenging? is there something she needs help with? It sounds like you are trying but you could try some role play; get two or three ambo's around the table and work out a scenario that she has to act out and solve as if it were a job. That is often a really good way of getting somebody up to speed. You could act as her partner, perhaps take the lead role first and ask her what she would like to do with the information being gathered, what might you need etc. Then let her try. The other option you have is to involve whatever Clinical Support processes you have or if she is really that bad (you said don't let her near O2 and that is worrying) you should talk to your Clinical Management.

I am male and have had a female GP my whole life. I do not have a preference between male or female health care professionals dealing with me personally. My experience is that females (especially older) perfer female and that younger males perfer male Ambulance Officers.