Arctickat

That would be a huge red flag for me. Any company that prohibits employees to use it as a topic of discussion has something to hide.

Bieber, check the link I posted earlier in the thread.

It depends which unit we're using and where we can find a spot to stuff it. Our previous spinal procedure was, and actually still is, to leave the infant secured in the car seat with padding to prevent movement. Unless one of the ABCs becomes compromised, the car seat is damaged, or the infant wasn't actually in a car seat, we'll leave it there, otherwise we used the KED, now the papoose.

Sounds kinda scammy, check out the "company" website. http://www.drakendesign.com/ If the OP actually has the software, he wouldn't have to "think" who the developer is at all, it would be clearly identified on the software. Having said that, I might have considered d/l it to see what it's like if I had a smart phone.

We've got infant car seats in our units for non spinal transports and for spinals we're evaluating one of these http://www.ossur.com/lisalib/getfile.aspx?itemid=21724

Hmm, I guess I was having trouble visualising it in my mind.

I'm coming into this late, I'd go with paramedicmike's treatment, save that we also have access to trach tubes. If the wound is amenable to using the trach airway I'd go with that rather than the ET. Even on the ground, I'd knock this sucker out with Versed/Fentanyl for his and my protection.

Thanks for the input guys, I appreciate your thoughts and views. Flight, I'd love a peek at that protocol.

BTW, if you're not too picky about where you'll be a flight medic, STARS is expanding into Saskatoon and Winnipeg. I think they still have positions.

Well, considering the quality of food there, it would likely become a recommendation to have a full time medic presence. What's the hold up? Wanna come work a little casual time in Sask while you're waiting to get your feet wet out there?

Good advice Flight, but given the current situation, this would actually be an improvement. Current practise is: Pick up patient at residence and transport to local facility; Local doc examines patient, then sends her back into the ambulance to one of two locations, one is 175km, the other is 235. Unless childbirth is imminent, they will not deliver the baby here. Closest I've come is that we loaded the mother up and 15 minutes later we're on the side of the road delivering the baby. Heck, once the mother is in the ambulance we're not even allowed to run L/S unless she's unstable. Our doctors are not trained, or at the least, are typically not current in PALS or NRPS, but we are. This bypass would have the patient in the care of an obstetrician likely before we would even leave our local hospital to transport to the other two facilities. There is a difference between imminent childbirth and 3rd trimester labour. A woman could be in labour for minutes, hours, or even days, thus the critical decisions that must be made to decide where to transport. If childbirth is imminent, then we'd go to the local facility. Mikey: This request for bypass is coming from our local hospital specifically because they do not want us to bring maternity patients in, just to have them be referred. We have the ability to monitor FHR in the ambulance. I believe this is the crux of the matter: Years ago women started to travel further afield to the care of an obstetrician rather than deliver their babies locally, it got to the point that the revenue that local doctors were getting from maternity cases was actually less than the insurance premiums for elective childbirth, so they dropped the insurance with the exception of emergency childbirth and send out every possible maternity that isn't imminent. The ambulance company has better insurance coverage than the docs do. Since the docs stopped doing deliveries, the hospital no further had reason to retain the infant care/delivery equipment. Personally, I don't care one way or the other, if we transport or not.

No, the local hospital wants to be on bypass, the other hospital wants to accept the added maternity cases, it's just that the Health Region and Provincial Bureaucrats seem to be reluctant to risk babies being born in ambulances...even though it happens all the time.

If these two are the friends you believe them to be, they will understand. Opportunities will open up for you in the future and if you're as much as a shoe in as you've been told, it would likely be better to wait for the next opportunity. How will you feel if your new employer has to consistently search for a short term replacement for you because a crisis has developed with a family member? I have a philosophy of never hiring a friend because it's a great way to end a friendship, and I have few enough to begin with.

Mikey and Flight have good questions and input, Kiwi...you're next to useless. My apologies for not being more specific, my wife was rushing me out the door. To answer Flight's question, we're in Canada. Mikey, the local facility is on board as is the receiving facility. They don't have any issues at all with the practise, and are actually under the same Health Region the issue is just that it's never been done before and the bureaucrats at the regional offices seem to be scared that something might go wrong. The framework of my proposal would include the following factors in a decision tree: 3rd trimester? Yes/No Contractions Greater than 5 min apart? yes/no Membranes intact? yes/no External Exam shows no indications crowning or prolapse? yes/no (I need to reword this question to something easier but you get the idea) All answers Yes, transport to far away hospital, No to any, contact medical control. In most cases they are expecting to give birth in one of three facilities and we could typically transport them directly there too because that's where they've been doing their doctoring. As far as your thoughts Mikey on why the other service refuses to transport to anywhere else, I can't say...but I suspect that your last idea is the most likely because that would be the greatest source of revenue.

Hi kids, I've been asked to put together a destination and bypass protocol for maternity patients. The current practise is to transport the patient to our local ER that has only one doc on call and bare bones obstetrical equipment. He's asked if the patients, the typical demographic being in a community 20 minutes away, could be transported to a hospital with appropriately trained docs and equipment. This would mean a transport time of close to an hour. He'd already asked another ambulance service and they insisted that they have to transport to the nearest hospital, I disagreed and told the doc that we are to transport to the nearest appropriate facility. Given that the local ER is not equipped to handle deliveries and definitely not complications, I intend to put forth a destination and bypass protocol that would have these patients transported to a facility that can safely handle the situation. Do any of you have such a protocol in place already that I could copy....errrr use as a template?

Hi Brett, what I've moved towards is a metal cigarette container that I've placed foam inserts into the bottom and lid. I'll see if I can locate the design online or send one to you next time I'm in town. Edit: However, my Health Region has not chosen to follow through with the new MFI protocol to date so I'm not sure if a 10 ml Etomodate will actually fit, Im pretty sure it will though...I'll get back to you on that.

Peddle would work fine if they'd remove the tool boxes from the cabs.

I understand, but to me it's a kneejerk reaction to an undetermined cause that could prove more fatal. Perhaps a lesson could be taken from the rail lines. Every 5 minutes a button in the cab must be pressed or a tone will go off in the event that the driver is incapable of concentrating. If the tone goes off too many times, it's time to swap drivers.

Did you happen to send an e-mail for clarification off to AHA? They might be able to help you.

Although the incident was tragic, there is nothing in the report whatsoever regarding sleeping as a passenger. You can make all the assumptions you want, but without video surveillance in the ambulances no one will ever know what happened in the case of 136K1N, I never suggested sleeping while unsecured either. Using this as a sole example is a poor argument when it even admits that the cause of the incident is unknown. I'd rather have my crew rested than bleary eyed and making poor judgments due to fatigue that could have been avoided. I also fail to see how identifying who is on the call would have helped either, unless your dispatch centre is tracking duty hours for every medic working. Is it?

You should really get your short term memory checked out.

Clue: How many leads does an AED use?

MedicNorth, you're clearly not alone in this. Even in higher density areas people still tend to be isolated. Our transport times typically exceed 2 hours one way, the back of our ambulances include DVD player, Video Game Console, Nintendo DS, and a cribbage board. Ambulances are also equipped with tablet computers and smart phones. However, I've felt that a stimulating conversation with my patient has always been the best for passing the time. We always take turns per call as to who drives or attends for the most part, but in cases where the crew is an ALS with BLS partner, it's typically the ALS in the back. a_shane2_go makes a good point, but it's a good idea that during those long empty trips back to base the attendant, who is now just a passenger, get some shut eye. Then, swap with his partner so he can get some sleep too rather than waste time and living on a 20 minute cat nap. I'd be interested in seeing your reference to a particular OHS regulation though before putting my job on the line because of his say so because I doubt that it exists. Refusing to work because one is tired is open to substantial subjective interpretation and most employers would likely succeed in terminating employment for just cause. I'm also not too sure what relevance there is in pointing out that it was a private service. For the record, my crews are 144 hours on call with a 16 hour maximum duty time in a 24 hour period and guaranteed an 8 hour rest period 97.5% of the time.

Well, provided that you refrain from de-icing your car windshield in -30° weather by using boiling water...you might do okay. AK is gonna be jealous though, I thought you wanted to work for him.

Not until you learn the proper Queen'd English and how to build an Igloo. You'll need a place to live. Besides, I tried that with our mutual South African friend if you'll recall. She didn't like it much.