AZCEP

It's not just you Ruff. This was very clear in the first few posts, and has been contorted beyond recognition into several entirely separate subjects. :roll: Don't forget the lying medic. His lying in his documentation paints a very poor picture of his ability, and calls into question all previous patient contacts he has documented.

If the EMT refuses, maybe the medic would realize that it was a stupid request in the first place. I've asked partners to help with some things that they might have been uncomfortable with. When they voice their concerns, it forces me to think about why I asked it in the first place. Sometimes the right thing to do isn't the easy thing to do.

Based on the information provided, the use of narcotic pain relief was not going to save a life. You are a BLS provider. You have not had adequate education on the treatment modalities that are in your scope. Whether you have taken it upon yourself to become more educated or not, the fact remains. YOU ARE BLS. The fact the medic lied on the documentation is just another nail in the coffin.

This probably happens more than people want to admit. The EMT was outside their scope, the medic should have administered the drug. The documentation of the event is the only legal protection they have, and now it is known that it was altered from the actual events.

If you don't have anything to replace it with, leave it. Really can't hurt to show that you were involved with some level of responsibility.

Someone is going to get their undergarments in a bunch on this one. The gift that keeps on giving.

For many things, they will go together. Hypoglycemia-->diagnosis based on a readily available bedside lab value, or symptom of another, probably bigger problem. Hypoxia-->tough to definitively diagnose with the available tools, but when the patient is blue and combative the leap can be made. Even the syndromes that Dust mentioned, we would be basing our treatment on what we have/have not found. Because definitive diagnosis often can't be made, we must rely on recognizing the patterns that some of these syndromes present with.

Is it safe to bring out the "idiot" tag for the nursing home staff? Maybe they are trying to drum up the numbers of DNR's in the facility by showing what happens during CPR.

How is this possible? http://www.cchd.org/ems/documents/download..._06_jun_min.pdf According to the developer, there is no historically similar device to compare to. Perhaps you could enlighten us, please.

Agencies will most likely not be buying them. The individuals that buy them would most certainly be as described. There are already several devices that accomplish this. The lowly OPA for one, the laryngoscope for another. On the outside looking in for most would also be the lighted stylette. The trouble is the OPA needs to be the first option. The benefit of the light to a BLS provider would be limited at best. Even ALS should consider that more light in the oropharynx can complicate visualizing the glottic opening. The benefit of this device is dubious at best. If someone wants to buy something with limited applicability, and excessive cost over something that is known to work, that makes them what exactly? And how is it not a concern? Every time you introduce a surgical steel/plastic implement into the mouth, you should consider that you might do damage to the teeth. Even more so to the soft tissue, but the risk is very real. Let me know when you manage an ideal airway. I'm willing to estimate that everyone that has looked into an airway, that was not in an OR, found something they weren't quite ready for. As are most paramedics and their medical directors. Those people that allow us to continue placing devices into patients want to be sure we know how to use the devices that have been around long enough to prove valuable. This device is not going to do any better job of airway management than the OPA does, even with the higher cost. Become proficient with the OPA and BVM that you have available to you on your response unit.

A device designed to prevent damage caused by sloppy laryngoscopy technique? Great idea, oh wait, that was the idea behind the combitube and the LMA. :roll: For the BLS providers, I can see this being a good tool. As mentioned, suctioning and airway maintenance would be much easier with something like this in place. Tough to convince someone to spend the money on though.

I will say that I'm glad there are some EMT's out there. By "some" I mean that a few, select individuals that are capable of critically thinking through a situation without my oversight. Several are actually capable of putting a coherent thought together, and communicating the what/why of this same situation. I applaud each and every one of them for achieving a level of education that the current state does not provide much of. While there is much discussion, worthwhile though it may be, of when a lower level provider can do something the fact remains that while a paramedic is on scene, they are the highest level of care. When you do something right the medic gets praised for it. Do something wrong that the medic isn't aware of, the medic takes the full blame for allowing it to. In the off chance that a flight nurse, depending on local rules, arrives on scene they would be considered a higher level of care, and they will be held accountable for the actions of everyone. We are all borrowed servants, and most jurisdictions have laws specifically designed to clarify these situations.

I've been on many scenes that required I not supervise everything my EMT partner was doing. Often they will be a bit more nervous when we arrive, and I've made sure to tell them, "Do what you need to, tell me about it later." If the EMT doesn't know what to do, then definitely ask. If they are unsure, they should not feel that they will be discredited or flogged publicly. Ask the question. There was a time, that I probably was a bit more hesitant to follow that advice. I'm sure some of my partners would be willing to tell you that I micro-managed them to an early retirement. At this point in my career, let's just get the task(s) at hand done, and move on.

As we are not providing definitive treatment for a great many disorders, there should not be a desire to provide definitive diagnostics for most things either. A provisional diagnosis is plenty to base initial treatment on. For the few items that we can manage definitively, our diagnosis is plenty.

Get the book you will be using in class. Don't waste time with a study guide until you understand the concepts they are presenting. Good luck to you.

When all small animals in your house understand what pager tones mean... When you back into every parking spot you come to... When your neighbors all ask your medical opinion on something because they've seen the ambulance at your house... When someone tells you to "Have a nice day", you explain to them exactly what that would entail, and they vomit at your feet... When your significant other tries to pick a fight with you and you can end it by palpating the landmarks for a subclavian/internal jugular IV...

I will allow the fluid to run wide open, patient condition dependent of course, and push the dextrose just fast enough to allow the fluid to continue running while I'm administering the medication. It can take quite some time to get the full 50 mL delivered in the case of small catheters, cold medication, etc. but the upside of less sclerosing of the vein is worth it.

It would stand to reason that if you don't have the ALS equipment, you can't treat patients to an ALS level. I wonder how this got by anyone. The pay rate doesn't determine how you treat patients, the equipment does.

It is one of the issues we are dealing with. Check the website for the direction we are going for. www.capem.org

Congress nothing. Try getting past current department administrators. The moans of "we don't have enough EMT's for our volunteer service" will get really loud. Remember, these are the same people that didn't want to expand the scope of providers a few years ago, and let the NSOP die on the vine.

Okay, so the paper identified the victim, the provider in the story described what he did to help. I still wouldn't be able to identify this person from a crowd. Name, and the "partial decapitation" don't give enough information to do anything nefarious with. Google the name, and I'll bet you will find a few dozen. Ak, I was under the impression that HIPPA only applied to those agencies that bill Medicare/Medicaid. Understandibly, if you generate a bill, you will probably bill these also, but if you only bill private insurance...

Our full time department commonly has response times of 20-30 minutes. One of the benefits of living in the sticks is not having your neighbors on top of you, but the drawback of not having services close by should be understood as well.

Actually, Phoenix fire department had a similar program for a while. They were using PA's and NP's as a backup to their ALS crews. The ALS crew would respond, assess the situation, then call for the additional help. I'm not sure if it is still in practice, as the PA/NP's found out they could make better money in an office than they could working for the fire department. Most places do allow providers to refer non-emergent patients following a consult with medical direction. They also get to bill at a greatly reduced rate than if they transport. Here's an article from JEMS about an agency in North Carolina doing this. http://www.jems.com/products/vehicles/articles/243886/

1. Yourself: concerned 2. Your boyfriend/girlfriend?: wife 3. Your hair: what 4. Your mother? attentive 5. Your Father? everything 6. Your Favorite Item: truck 7. Your dream last night: kidding? 8. Your favorite drink: water 9. Your dream car: Shelby 10. The room you are in: house 11. Your Ex: none 12. Your Fears: invaders 13. What do you want to be in 10 years: anywhere 14. Who you hung out with tonight? kids 15. What You're Not? swayed 16. Muffins: tops 17: One of Your Wish List Items: Powerball 18. Time: 1021 19. Last thing you did? answered 20. What You Are Wearing? clothes 21. Your Favorite Weather: fall 22. Your Favorite Book: pathophysiology 23. The last thing you ate: squid 24. Your Life: entertaining 25. Your Mood: planning 26. Your friends: few 27. What are you thinking about right now? answers 28. Your car: Ford 29. What are you doing at the moment?: answering 30. Your summer: working 31. Your relationship status: married 32. What is on your tv? Nickleodeon 33. When is the last time you laughed? daily 34. last time you cried? once 35. School? always

Timmy, the fuel you are thinking of is methanol and aside from top-fuel dragsters or formula 1/indy cars, very few racers will use the stuff. Really expensive and most engines can't tolerate the heat too well. Unless the victim had the unfortunate ability to inhale the fuel as it was burning, going against every natural selective law that I'm aware of, the fuel would not be a major concern for the damage done to the airway. Interesting thought, but not too likely.