medic001918

The thread doesn't go the way you want, so you'll just leave? That's a great way to demonstrate leadership and the ability to handle some pressure. While I don't agree with all of your statements, you're entitled to your opinion. Noone said we all had to share the same opinions. If we did, this would be a rather boring site to post on and read. If you can't handle some pressure when the thread doesn't go your way, maybe it's better that you simply go and don't come back. If you ever decide you want to come back and discuss things, I'm sure you'll be welcomed back. I think all of us can say that we've managed to learn something from this site. Maybe you need to remember that you're not always going to be the teacher. Sometimes you'll be the student. It's great that they take a class on starting an IV. That still doesn't really seem to be enough to me to allow them to do the skill. I'm big on pushing people to understand the theory of why we're performing an intervention. And if they're doing it under supervision, and I should be watching them I might as well go ahead and do it myself. A tech in the ER (at least where I am) can generally draw blood, but I don't believe they actually start IV's. And the bigger difference is that there are enough people in an ER that everyone can be assigned a task. I can say with relative confidence that if you're partner is starting an IV for you while you're doing something else; that there's probably something else that they could be doing (ventilating the pt, oxygen, bleeding control, etc) that is within their own scope of practice. But I guess all of this won't matter since you've chosen to simply walk away rather than continue to have an intelligent discussion. Good luck. Shane NREMT-P

Ativan Versed Morphine Atropine Epi Vasopressin Lidocaine Amiodarone Etomidate Phenergan Reglan Mag Sulfate D50 D10 Sodium Bircarb Cardizem Adenosine Benadry Glucagon Thiamine NTG SL NTG Paste ASA Lasix Albuterol Atrovent Calcium Chloride Neosynepherine Procainamide Tetracaine Normal Saline Lactated Ringers I think that's it off the top of my head. Shane NREMT-P

After reading your post again, I'd like some clarification...does this mean you're allowing EMT's (basics) to start IV's and push meds? If so, I find it hard to believe that you'd encourage someone to practice out of their scope. This would make you rather irresponsible as a leader for encouraging this practice. Shane NREMT-P

You sir are absolutely right in part of your statement. We should be more critical of ourselves before bashing EMT's. And if with a higher level of education we're still messing things up, what makes you think that allowing someone without the proper education to do things is going to improve the situation? Something to think about before anyone goes ahead and votes to add to the EMT scope of practice. It's good that you allow your EMT-I's to perform to their skill level. Anything less and you'd be holding a provider back. You really haven't done anything ground breaking there since most paramedics who don't mind teaching or aren't control freaks would allow an EMT-I the same liberty. We should check our CPR skills from time to time, but I strongly disagree with your statement that that is where we are "really going to change the outcome." It's statistically been proven (repeatedly) that our success rate with prehospital resuccitation is dismal at best. That's a product of many things...the biggest being time. There's not much we're going to do to defeat that. It takes time for someone to recognize a problem, activate EMS and for us to respond. I would go as far as saying that we provide the biggest change to a patient outcome in a patient prior to their arrest. When we just might be able to do something to prevent the arrest from occuring in the first place (think CHF, MI, etc). Once a patient arrests, their chances of survival are miniscule at best. Let's not kid ourselves into thinking that's where our best efforts lie. Shane NREMT-P

Thanks. You beat me to it. I was going to post the same thing. Especially when atropine is given slowly, it increases the risk for the rebound bradycardia. Shane NREMT-P

Bravo. That's what I like to see...someone who can admit their wrongs. There are many others who could learn from this example. Keep up the good work and continue to learn and you will go far. Shane NREMT-P

You did the right thing. I've been in the same situation before where they said the patient was a DNR but didn't have the paperwork at the location (it was on it's way from about 30 mintues). I called medical control and explained what happened and what the family's wishes were and they gave me the order to presume the code in the field w/o hesitation. You did the right thing. Strong work and I'm sure the family appreciates it. Shane NREMT-P

The problem isn't have a BLS partner, the problems is BLS providers wanting to continually add to their scope of practice without the required education and training to maintain a skill proficiency. Those are much bigger issues than the "EMT bashing." If you're an EMT that is competent in your own skill set and understands why the scope of practice is limited, that's great and there's no bashing involved. I still haven't really read any significant responses as to why people voted that BLS providers should be able to perform some of these ALS interventions, yet people have voted. Many other providers who have voted no have clearly and concisely explained why. This ignorance and willingness from any other provider to back up their position with a reasonable arguement (and hopefully factual) goes a long way towards getting someone respected in the field. But that's not the case here. We have people voting to increase the scope, but not even trying to explain why it should be that way. And a secondary airway device doesn't really make it a BLS adjunct. It's just what the name implies, a secondary device in the event of a failure of the first line. How does that automatically make it BLS? An example is that front line IV access is peripheral, if we can't secure an IV on a critical patient we can go to the EZ-IO as a secondary device...does that make the IO a BLS adjunct? No, it's just another tool that we are allowed to use in a situation that it's required (and FYI, our cardiac arrest protocols have the IO as front line access). As to you having saving "saved a medics ass." Good for you, I think. It's sad that the medics you're working with don't appear to be self sufficient enough to maintain their own level of care if their basic partner has done this multiple times as your statement implies. I work with my partners, but they don't save my ass or prevent me from making medical mistakes. It's my job to make sure that I use due diligence in assuring that the care that I provide is proper and adequate. I don't ever rely on the hope that my basic partner will have to step up to run the call for me or to prevent me from making what they percieve to be a mistake. The biggest thing that a basic partner can do is to be proficient in their own skill set, allowing me to do job. That way when we work together, the whole job gets done. If we show up to a chest pain patient, I shouldn't have to ask that you put oxygen on the patient (I'll even accept the question of do you want a mask or nasal as long as you're taking the initative to put oxygen on the patient); that is something that you should be doing anyway and without direction. It's part of your skill set. If I'm still directing every last aspect of patient care when I work with a basic than they're not really ready for any kind of increased scope of practice. I still don't think you'll find myself (or many other medics for that matter) that will be dependant on a basic to save them from making a mistake. Sometimes as a medic, we're thinking things through a little more or maybe we've picked up on something that you didn't. Shane NREMT-P

My guess is that it would depend on your protocols regarding a BLS downgrade. There are services in our area that require the highest level of provider to tech every transport. And there are others that allow for downgrades. If you have no provision for the downgrade of a BLS patient than you have violated established protocol and abondon your patient. If you are allowed to downgrade, write an assessment form detailing the call and the events and submit it as your documentation. I work for a service that allows me to downgrade a BLS call to the BLS transport ambulance but I am required to write a run form detailing my ALS assessment for every patient I come into contact with. And just for the record, my ALS assessment run forms are just as thorough as my transport forms since it's actually more liability in downgrading a patient. Shane NREMT-P

I vote no. With statistics of 78% of the time and 94% of the time, a paramedic would come under heavy fire from medical control. Those kinds of statistics for those skills would be unacceptable by nearly any standard. Having experience with both the LMA and the EZ-IO, 3 hours isn't nearly enough time to allow these providers to use those devices. While the theory of not being able to harm a dead person is being presented, is it fair to a higher level of provider to have a sub par provider either complicate an airway (or fail one by not recognizing that the LMA isn't functioning properly), or to blow an IO site on a patient? If someone's going to blow a site that I can use in an emergent case, I'd rather have it be myself. Then I can't get mad at anyone else. I think that as a paramedic, I should be able to take a short skills course and be able to perform any skill that a doctor might perform. Somehow, that just doesn't make sense and would never be entertained as an acceptable thought. Why should this be any different? Shane NREMT-P

Without being willing to provide the details of the call, you'll have a hard time getting any kind of decent feedback regarding your specifica scenario. I can understand that the call may be bothering you and you might be coming under fire from supervisors or medical control...we can't really tell you too much based on what information you've provided other than that a patient in v-tach can decompensate and die very quickly. If you provide more information, we may be able to provide more answers. Shane NREMT-P

The appropriate thing to do in this case is to notify dispatch of the second accident that you found and ask them what they would prefer you to do. They know where they have units assigned. As soon as someone calls 911 and you are dispatched to a call, you have a duty to act to that call. Anything less is abandonment. If dispatch reassigns you to the new crash and reassigns someone else, you have fulfilled your obligation and a new one is set forth (at the scene you're passing by). To stop at a scene while you're on the way to another call is not how the situation should be handled. Shane NREMT-P

I'm going to go a different route and suggest other reading than EMT textbooks. I would say start to read anything pertaining to anatomy and physiology. The EMT course hardly covers an acceptable amount of this material even though it's the foundation of all good healthcare providers, and the universal language of medicine. By having a better understanding of anatomy and physiology you can pull more useful information from your assessments instead of having them scripted by the acronyms that you will soon be familiar with (SAMPLE, OPQRST, etc). Add to that the benefit to talk inteligently to other healthcare providers (EMT's, medics, nurses, PA's, doc, etc) and you'll find the field far more welcoming and enjoyable. In fact, I recommend to anyone that wants to become a better EMT that they take some anatomy and physiology classes. One of the biggest differences in healthcare providers (other than the interventions they are able to provide) is an knowledge and understanding of how the body functions and using that to guide their assessments. The test prep will come from the class, but there really isn't much to the EMT-B program. Good luck. Shane NREMT-P

While not 100% positive, I believe that they were given orders to perform the procedue. It was still found to be out of their standard protocol and more importantly out of their scope of practice. This is what led to the demise of their careers as paramedics. This is just me trying to remember information from the top of my head. If someone else could verify that information, it would be greatly appreciated. Thanks, Shane NREMT-P

I do agree that this situation warrants a bit more effort that the traditional cardiac arrest, but the overall scenario comes into play. Would you give this patient higher priority than other critical patients (who are not in arrest) on the same scene? I'm thinking that I would still have to treat the viable living instead of the hopeful dead. It would be a tough call to say the least. And I can't say 100% for sure what I would do (since at this point I'm speculating) since I haven't been tossed into that particular scenario yet. It's something to think about and discuss. Shane NREMT-P

Just a suggestion, but you might want to post some more information regarding your scenario. The question you posted is rather vague and the answer depends greatly on the situation that the death occurs as well as also having questions about the pregnancy itself. If it's a multiple patient event (such as an MVC), and you don't have enough resources and mom is dead, then she's going to stay that way. You can't not treat other viable patients because mom is pregnant. If mom is the only patient, then you could transport mom in hopes of the hospital performing an emergency c-section and saving the baby. Also, it depends on how far along mom is in the pregnancy to determine if the baby would be viable anyway. You really need to give more detail and thought to your question before we can really answer it. Otherwise, it's purely speculation. Shane NREMT-P

On top of a more detailed history for this patient, the 12 lead would be an absolute. While having a pace maker can make a 12 lead more difficult to interpret, you may be able to see if her pacemaker is malfunctioning (maybe not capturing every time it fires) or if it's a demand pacer, you might see some underlying beats that don't have the pacemaker disrupting their etiology. This would allow you to make a better determination of what might be going on with this patient. And the majority of 12-lead EKG's on the lifepack monitors show up as "abnormal EKG." That doesn't mean that they are abnormal. The machine goes strictly on a numbered criteria to determine what's normal and what's not. One thing that I've suggested to medic students and new paramedics is to take the EKG when it's printed and to fold the machine's interpretation over so they can't see it while looking at the strip. This prevents them from reading something there and then trying to make their interpretation fit what the machine suggests. It's better to evaluate the 12 lead yourself, then you can see if the machine agreed. But by then you've already made an unbiased decision as to what you're going to call the rythem. I would have attempted to talk the patient into having the IV done, but if she wouldn't take it I wouldn't get too concerned with it. Before going the NTG route for this patient anyway, I'd want to know more about her chest pain. What did it feel like? Did it travel anywhere? What was she doing when it started? Did she get diaphoretic with any of the episodes? Did she get nauseous with any of the episodes? Severity? The pain was described as intermittent, so it's possible that in your presence she doesn't have any pain at all and has no complaint at the moment. I'd leave the 12 lead on, wait for the episode to repeat itself and be ready to try to capture a 12-lead in the event that she experiences the pain again (maybe looking for that pacemaker problem). I would have probably gone with the Asprin as it's a safe bet, but I can't say that given the story that I've been presented with I would have really pushed NTG as well without knowing more. The information given isn't really enough to make that decision. More history and more assessment would go a long way for this patient in to determining what was happening with her. That being said, I'm not saying that the assessment was not done, but it wasn't posted here for us to follow along. Shane NREMT-P

This point is no different than anyone else that gets charged and/or convicted...could they have been using whatever position they held for the specific intent and purpose? Teachers? Sports coaches? Any higher supervisor using their position of "power" to obtain what they want? There really isn't much of a difference...but their crimes still go unnoticed and unmentioned. Be uniform and bring every case to public, or don't bring them at all. It's not fair that someone has their personal affairs (the arrest) made more public because they happened to hold a given job. While as public servants, we should be holding ourselves to a higher standard...there will be exceptions to the rules. And these exceptions happen in every line of work and often go unnoticed and unmentioned. Just food for thought. I don't think this guy deserves any kind of rights personally, but to make his offense seem greater due to his position is not entirely a fair occurance since as has been mentioned, people get charged and convicted of these offenses dailys without notice. An example of a similar occurance was when the dean of students for a local college got arrested for DUI recently, she was forced to step down from her position for something that had nothing to do with her "on the job" performance. Think of how many people are arrested for DUI, and never have to tell anyone and never have it mentioned in the news. Because of her job, it was highly publicized. Doesn't hardly seem fair does it? All of that being said, I don't excuse anyone from drinking and driving. But there's something to be said for uniform enforcement of laws. Shane NREMT-P

The disappointment and let down should come from him being a friend that has done something like this. The fact that he is a paramedic has nothing to do with what he's done, regardless of how good or bad of a paramedic he is/was. I'm always amazed at how the news and people in general will play up something that someone has done based on their position. The unfortunate fact is, there are many other people like him that get charged and convicted daily and it goes unmentioned and unnoticed by the public. For some reason, people tend to treat it differently depending on the job function that the person holds which is totally irrelevent and wrong. I'm sorry that you ended up knowing this guy. Hopefully he gets what's coming his way... Shane NREMT-P

That's exactly how some systems set up with two medics in an intercept car work. One will take the car to the hospital to pick up his partner, but if another call comes in, he responds to that call with a second set of ALS gear in the truck. Shane NREMT-P

We have it but we have to mix it ourselves. We don't get the pre mixed doses of it. It tends to work rather well. I will often use it as my first neb, and then follow up with straight albuterol. I won't use this for patients with suspected pneumonia's though, the atrovent has an anticholinergic effect and we want to mobilize the secretions to allow them to breathe better, not dry them out. Shane NREMT-P

The whole point of this question being posed to a student is to keep their mind's open to the fact that there is so much to learn we're never going to know it all. It's also a chance to learn a little fact about a drug that's not "common knowledge." While it's nice to live in really simple terms and ideas of what's practical, there's no harm (and only benefit) from doing some extra research and learning things such as this. The thought process is what I get at with this question. It makes people think, gives them something to look up and reminds them how little we truely know in terms of all of medicine. It's not as much a practical application question. Shane NREMT-P

We do use capnography. It's requried for every intubated patient. But we also have nasal end tidal monitoring. This is valuable when you look at different wave forms to help realize the underlying pathophysiology of your patients condition, but more importantly to gauge how effective (or ineffective) your intervention is. There is a great deal to be learned from capnography and in all reality is a better indication of a patients respiratory status than pulse oximetry. Some recommended reading: http://emscapnography.blogspot.com/ written by a paramedic that works for the same service that I do. Shane NREMT-P

I'm thinking I wouldn't try the procedure. There's too much grey area that would open me up to litigation and liability. While I understand that the procedure could potentially save the patient's life, it's also not in my protocol anywhere and I haven't been educated on how to perform the procedure. The procedure seems easy enough, but how is this whole thing going to play out in court (where a case like this has a high potential to end up)? I believe there have been cases of paramedics performing other procedures at medical directions request and still losing their licenses over the events and being held legally responsible. If you pass on the procedure, at least you can say that you stayed within your education and did the best that you could with what you had. In a litigation free society, I would be more likely to try the procedure. It's sad that legalities and litigation come into play in making a medical decision, but that's the society we live in presently. Shane NREMT-P