flight-lp

Ditto on what has already been said, skip the combo, go with Fentanyl..........

Well, I thought I said my piece earlier, until I read this crap. Wasn't going to respond, but something about the presumptuous nature of this individual inclines me to step up on my soapbox for a moment................... First off, I think there is more to this story than you "started working in the ER and now see the light of how little we care for our patients". Did something bad happen to you or someone you are close to? Next, you are wrong in your estimates. Since January 2006, I have run the following calls: OD's - 12 Cardioversions - 4 in flight Pedi Arrests - Typically don't fly arrests, but have worked 4 OB's - 3, we do not fly active labor patients Burns - 17 Seems your x10 estimate is slightly incorrect, go back and learn some basic math. You do not know my protocols for OD patients and I doubt seriously that you have anything close to available interventions pre-hospital. I don't think anyone cares about convincing you about anything as you seem to already be the all mighty knowledgeable about everything OD, except having the ability to read current literature and speak to people who are actually experts and get there recommendations. Plus you can spare me the whole "cleaning up a mess" crap. After the condition my helicopter is in after most calls, I would welcome an OD patient.................... Like I said before, there are reasons why EMS agencies do not carry the drug anymore and it has nothing to do with failing our patients. If all of these medical directors agree, who are you to change their minds. Let it go, or produce a PROFESSIONAL method of research and statistics to show validation of why our medical directors should change their mind. Coming in here saying that we are not "advocates for our patients" and that we "fail our patients", isn't going to get you far in this family! Go take some Xanax................

You were not in the wrong. I personally would not have stopped, but to each their own, I'm not going to recreate that thread. Sounds like you did fine.

Most services are single pilot VMC services. IMC + HEMS = bad outcome. Personally, I do not believe that any service should be flying in night IMC, much less with a single pilot. If the visibility is reduced, there is a reason why, usually associated with weather that is not condusive with the aerodynamics of flight. Plus if the minimums are below a companies VMC standards, then IFR capabilities aren't going to help much with scene flights or interfacility flights into smaller hospitals that lack an instrument approach. The only place it is remotely helpful is at your larger medical facilities that do have a published FAA approved non-precision approach. Then you run into the problem of having your heliport on top of a hospital. If your hospital helipad is 400 feet above the ground and your instrument approach calls for 800 feet minimum ceiling, then you have to have 1200 feet of visibility from the ground which is HIGHER than required for VFR flight. It makes no sense what so ever and will not improve the core safety issue associated with HEMS crashes.....

I have not given charcoal in the field in years. Many no longer carry it. There is a reason why and it has nothing to do with airway maintenence or the cleanup required afterwards. Many OD calls received allow a patient contact within 1-3 hours of ingestion. That time frame necessitates a gastric lavage prior to charcoal, you can't do it the other way around. Also if you exceed this time frame, more than likely, the substance has already been absorbed and reveals systemic effects. Now, its just too late, time for other interventions. Its not substandard, its common sense. If the drug is not indicated due to a better option being available or having knowledge that the drug just flat out will not work are pretty good reasons not to give it. Not to mention the fact that I have seen many dumbass medics trying to force charcoal down someone, on occasion even forcing an NG tube into them, when a patient took 5 APAP's because her boyfriend dumped her. Instead of griping about a medication not needed in the field, perhaps you could focus on a much bigger issue, COMMON SENSE!

I think this is why we are starting to see an increase in agencies bypassing the ER and going straight to the cath lab. Completely eliminates the "slow" factor. Several hospitals in Houston are doing this and the time to revascularization is remarkable.........

Key words, "select, experienced staff properly trained"! "A helicopter paramedic group's database of patient flight records (1999 to 2003) was merged with registry data of a suburban Level I trauma center." Kinda biased in IMHO, where is the data from the rural backwoods EMS service, the urban 911 service, and the routine interfacility transfer service. Hell, most people in the critical care realm focus heavily on airway management, lets see the data from those who do not necessarily receive the same advanced training............

"The first treatments to be tested will be highly concentrated forms of a saline solution similar to the body’s own fluids. Typically, in the crucial early minutes before blood transfusions can be safely administered in hospital, trauma patients receive normal saline solution intravenously in the field to compensate for blood loss and buy time. In the new trial, trauma patients with either signs of blood loss or severe brain injury will receive one of three saline solutions — standard normal saline, high concentration saline, or high concentration saline with dextran, a circulation-enhancing substance. The two concentrated solutions are designed to compensate for blood loss more effectively, lessen excessive inflammatory responses and prevent brain swelling. These effects in turn could potentially lead to a reduction in organ failure for patients with major blood loss and improved function for patients with brain injury." Concentrate it all you want, it still doesn't carry oxygen, period! So you decrease some swelling, yea great, but your still not perfusing! "Before blood transfusions can be safely administered in hospital", what happened to using it in the field? Is there some magical force that prevents it? Bottom line, trauma patients die if they do not circulate oxygen plain and simple, NS on speed isn't going to change that! "The implications of this thing are tremendous," said Dr. Paul Pepe, chief of emergency medicine at UT Southwestern. "We're a center of excellence, and that's why they chose us." This coming from the man who said fluid in the field for trauma patients was bad! Dr. Pepe has yet to come up with a research project that doesn't flop! I agree with Rid, this is going to be interesting..................

It is completely up to the crew. The old saying rings true, "three to go, one to say no!", meaning that any one crew member can say no and that is that, period, they do not fly. I actually didn't read the study itself, the conclusion said it all, further statistics over the upcoming year will be needed to see a change in trend or associated aspects that decrease or increase accidents. Personally, I think people who have no clue about aviation, i.e. doctors and medical researchers, need to remain out of the realm of accident statistics. The NTSB and FAA do a fine job of telling us what we do wrong! I think that time will tell, many programs will go under over next couple of years, especially with further state and federal medical cutbacks. I think only programs who watch their bottom line and operate with financial efficiency will survive. Again, time will tell.........

"I would say 99.9% of the private ambulance services in the Houston area don't need to be open and for business. I can actually only name maybe four or five who are actually good companies." I was thinking even less than that..................... Sadly, unknown to many, Goldstar's decision to pull out of Galveston County had little to do with the bankruptcy or the federal investigation...........It really left an already sour county helpless for a while though........

Weather minimums for my service are: Day local - 500ft. 2 miles Night local - 600ft. 4 miles Day x-country - 800ft. 4 miles Night x-country - 1000ft. 6 miles Decision for utilization of an aircraft should be the sole discretion of the EMS crew, not some beaurucratic type sitting in an office. I hate it when people try to define a presentation that must be present in your patient before you can call us. Your description given above is great and all, but it seems the state has clearly forgot an important aspect of rapid air transport; the MEDICAL patient. MI's, AAA's, CVA's, severe septic or cardiogenic shock, etc., etc. These patients need to be flown if your local ER does not have the capabilities to offer definitive care. Notice the term "definitive care" instead of "stabilization". All to often EMS agencies transport patients to the local ER to get "stabilized". In actuallity, all that is occuring is a delay in definitive care. Does your local ER have a cath lab? If not, ALL of your STEMI MI's should go to another facility, one that has the lab available. Same goes for strokes. No neurosurgery available? Then do not stop, keep going to a stroke center, pass go, and collect your $200. As said before, do no harm.......Get 'em where they need to go the first time around.........

Your not missing out on much, there has never been a tremendous difference, both are cookbook methods with minimal standards above the national bar. I was wondering how Acadian's protocols would be once they crossed "the river". I don't know if they still use state protocols, but if they do, their Texas operation will need to improve them greatly or write a completely different set......................

there seemed to be a big "retrograde" kick last year, but it seems to have fizzled out. Retro is an option, but one that a Paramedic who doesn't know what he's doin' can easily f#$% up. If you can't see the cords, try a bougie, reposition (if feasible), and try again. If after 3 attempts you can't get it, drop a failed airway adjunct. If ventilating becomes an issue, then cric 'em. Considering the recent debate on medics not being able to secure an airway worth a sh*^, I would probably avoid potentially lacerating someones tracheal arteries with a wire.................

So am I to understand that you are saying Houston F.D. has higher resuscitation rates than agencies such as Cypress Creek EMS, HCESD-1, Cy-Fair VFD, Northwest EMS, and Montgomery County Hospital District? If that is what you are saying, then show me the numbers as I have a real hard time believing that. Medically, Cypress Creek EMS has a greater than 80% ROSC on in field worked arrests with a discharge neurologically intact rate running in the low 40's% (As of earlier this year). Trauma wise, no EMS agencies have decent resuscitation percentages. EMS doesn't save the trauma patient, the trauma center does.......... Now if your referring to Houston hospitals having a higher resuscitation rate than the outlying hospitals, then yes you are correct. It may have something to do with the fact that the only level I trauma centers are downtown :wink: . My personal opinion, Houston does suck when it comes to trauma care. It's not Hermann's fault nor is it Ben Taub's fault. It's the fact that the 4th largest city in this nation needs more, but will probably never receive..................... Sorry, got a little off topic (hope admin didn't see it!!! )................

Dr. Ewy makes some great points, but he published his findings a day late and a dollar short. ALL of his observations are based off of the 2000 AHA guidlines, not the current 2005 guidelines which as we all know, places more emphasis on increasing circulation and less on the airway aspect. Many agencies, including the ground service I work part-time for have adopted these recommendations and it has shown not only an increase in ROSC, but an increase in the neurologically intact discharge percentage. Several EMS agencies will be releasing their statistical findings later this summer and hopefully will be published soon after.................

Shoes?!?!? 8, you need a sugar daddy!!!

Acute Care, Adult Health, Anesthesia, College Health, Community Health, Emergency Nursing, Family Health, Gerontology, Holistic Nursing, Neonatology, Obstetrics/Gynecology, Oncology, Pediatrics, Palliative Care, Perinatology, Psychiatry, School Health, Women's Health. So much for only one specialty......................

***Your Stripper Song Is*** I'm a Slave 4 U by Britney Spears "I'm a slave for you. I cannot hold it; I cannot control it. I'm a slave for you. I won't deny it; I'm not trying to hide it." You may seem shy, but you can let your wild side out when you want to! What Song Should You Strip To? http://www.blogthings.com/whatsongshouldyoustriptoquiz/ You have got be f^%#in kidding me!!!!!! LOL

I need some Compazine because after reading that I am now nauseated..................... Word of advise, if you do not want to hear what we have to say, don't open yourself up with further posts.

Ground EMS - Chemical (Versed) with soft restraints Air - Haldol and flex cuffs, if it fails to control them, they get RSI'd

Acadian is a good company that is extremely stable, one attribute that is rare in Texas. Acadian has talked about expanding into Texas for years, but now that Orange County EMS is folding, it may be a possibility. Their pay is o.k. now, when I worked for them it was horrible. Its worth looking into, they are always looking for people to work the Lake Charles area...................... @Weasle - Sometimes that's the price you pay to work for a larger, reputable, and most importantly, stable company. My fulltime employer has a 3 week orientation that is 650 miles away from my home. And I have to attend quarterly skills competency and an annual recurrancy training, both of which are no where near home. I get paid mileage, travel time, and hotel expenses. Sometimes its worth it in the long run!

"Documentation, please. Complete with citations. Prove what you claim." Well, here is two right off the top of my head............. Cause No. 98-614000; Estate of Evangelina Zamora Avila, et al. vs. Cy-Fair Voluntary Fire Department, et al; 189th Judicial District Court of Harris County, Texas. The plaintiff's family member coded en route to the ER and the volunteer medic was unable to operate the defibrillator. Soon after, the department had an in service covering the equipment that all should be able to; less than 50% showed for this continuing education offering. They since have established an Emergency Services District, obtained full-time paid staff, and are now a very competent, well equipped, and progressive service with excellent response times......... Cause No. 9763; Judy Squier v. Shepherd EMS; In the 411th Judicial District Court of San Jacinto County, Texas The ambulance never responded! Volunteers who were available did not respond, the pt. went to the ER POV after waiting over 30 minutes and died en route. since this incident this very poor county also established an ESD and now contracts with a private provider who staffs 4 24/7 911 trucks and a transfer truck during peak times. Due to the companies aggressive billing actions and very minimal subsidization's by the county after reducing some unnecessary funding and realigning the fire departments into the ESD (thus eliminating the need for the county itself to have to maintain the funding for fire), both fire and EMS services have greatly improved. It can be done, in any county, in any state (or commonwealth). Yes, you will probably have to tax the residents. Fact of life, the community will need to get over paying a minimum amount of pocket change for quality services. They also need to get over having to pay for EMS services. Hell, the doc isn't free, the hospital isn't free, EMS shouldn't be either. That's why god created health insurance! Can't afford insurance? Most can and just do not want to or believe they that need to, especially when some agencies offer it for free which is stupid as hell. If a citizen is truly in the need for insurance and can't afford it, they need to look at medicaid. Or perhaps the EMS agency could offer a reduced billing program for those in need. BUT LIFE ISN'T FREE, NEITHER SHOULD EMS SERVICES!!! Another thought for consideration is to start a membership program. IT CAN BE DONE, I JUST THINK THERE ARE TOO MANY HARD HEADED PEOPLE WHO JUST DO NOT WANT IT DONE!!!!!! Reality shall set in eventually.................................

Interesting read! From Jems.com............ http://www.jems.com/Columnists/emslaw/articles/85201/ And people wonder why Intubation is under such scrutiny currently!!!!!

Ditto on the EZ-IO, can't get a line in 90 seconds or 2 attempts, DRILL 'EM.......

looks like a good program, but in my opinion seems kind of expensive for an electronic version. Printed versions of translation guides start at $5...............