flight-lp

I didn't know you one of Fred's boys! I spent 4 years running out of 62. Best time of my volunteer fire career!

Haven't kept up with CLEMC lately, so I don't know. Most of Creek's trucks are running just 2-3 people due to staffing. Occasionally 4 on the truck with a student, their P class just finished and the students are finishing their clinicals.

No of course not :wink:

Guarantee its not Houston Fire!!!!!!!!

Nate, The ICP status that you are referring to is pretty limited to our area. Montgomery County Hospital District created the program several years ago to tier their system (P-I through P-IV) with different levels of training to complement the rollout of their new protocols, namely RSI, Pericardiocentisis, C-Spine clearance, Retavase administration, etc. Cypress Creek soon followed with a 3 level system for similar reasons. They seem to work well and it has done wonders in keeping idiot Paramedics from being incharge of a unit. As they say in Hollywood, it "weeds out all the non hackers............" Other agencies have attempted to adopt it throughout the metro area with varying levels of success. Personally I like it and clinically it has done wonders for patient care.....................

Thats how I figured you would answer. You do not "load up" a CHF'r with fluid regardless what their BP is. If they are hypotensive or in cardiogenic shock, you give them a pressor, preferably Dobutamine. While I think is nice that you are keeping such a close eye on the patients systolic BP, its really nothing more than a number. When titrating nitrates, especially in a patient with CHF, you need to keep an eye on the mean arterial pressure and look at the whole picture, not just the BP. Your ascertation is completely incorrect, "nitro, nitro, and more nitro" until the BP can "no longer handle it" and then giving fluid can and will kill your patient. Doesn't matter if it is an RVI or not. Yeah the lasix may very well eventually remove it, but why put it there in the first place. Not to mention the electrolyte depletion you are doing by continuing lasix to remove fluid that shouldn't be given in the first place. Fix whats broke, not what you break....................................

"Load him with NS and give nitro nitro nitro. This pt. is not having an RVI so load him up til his BP cannot take it anymore, then give him fluid and load him up with nitro again. Don't forget the MS." Just one simple question, why would you give fluid?????????

This has been covered extensively in the past. If a patient doesn't want to go and they meet informed consent requirements, then let them refuse and document apprpriately. But as far as a Paramedic or EMT refusing to transport, no, it should not be and currently is not allowed. I have been able to legitametely refuse to transport patients on one occasion, after hurricane Rita. I do have to admit that it was nice to look at someone in the eyes and tell them I am NOT taking them to the hospital and to follow up with their PMD for the runny nose they have had for 3 weeks! But on the other hand, there were several patients that needed to go and we just couldn't take them........................

Medik8 - You have a very sound point. Too often, the "machines" are overutilized. But, they do have their place in life and can be utilized with accuracy in the place of a manual BP. Thery're not a completely bad thing.

"Vaso 40u WITH 300mg Amio 5 minutes later Epi With Amio 150mg 5 minutes later Vaso 40u WITH Amio 150mg " Man, talk about an Alpha rush!!!!!!!!!!! That seems to be slightly excessive in my mind, why on earth would you want so much pure alpha drugs on board? I could see ROSC, but I can only imagine what 80 units of ADH plus Epi would do to ones neuro status. Not to mention an additional dose of Amio which is not recommended or needed. Studies have shown there is not direct benefit from the use of Amio vs. Lidocaine. I also question the practice of billing a patient or patients family for a very expensive medicine that is given in excessive amounts, especially when the practitioners know that the additional doses are A. harmful or B. ineffective.............

I use it regularly on the ground and in the air. My ground service used to use the sidestream, however they recently removed it from the trucks. Personally I like the sidestream because you can utilize it on your COPD'r with a NC and get a fairly accurate CO2 level. But supposibly there is some inaccuracy with the sidestream, I have yet to see substantiating evidence supporting it. Besides, even if it is off some, it still allows a reasonable baseline............

Texas A-M University has a great on campus EMS program with progressive protocols, quality equipment, solid clinical support, and good management. Give them a call, they can definately start you in the right direction............. http://www.tamect.org/new_website/about.html http://ems.tamu.edu/

God this has Houston area written all over it!!!!!!!!!!

Yup.........

I doubt it. No proficient medic in his right mind will stay on scene longer than the time needed to correct immediate life threatening issues. Airway, adequate ventilation, control major bleeding, c-spine if needed, transport.

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Paper isn't an issue, just print out a code summary and it will produce all pertinent data in a nice clean printout................

Porta-warmer, one of the greatest inventions since sliced bread!!!!!!!!!!! 8) http://www.allmed.net/catalog/item/1262

Interesting abstract for a study, but overall it seems they really couldn't answer a lot of their own questions. One piece of info that I found kinda humerous.............. "It seems likely that the potential for adverse events is significantly higher during air transport between two hospitals than on a trip to another department within the same hospital such as the radiology department. Alternatively, a possible explanation is that patients undergoing intra-hospital transports are sicker and/or the personnel associated with these transports are less experienced than inter-hospital transport teams." Gee, ya think!!!!!!!! Stay in the confines of the controlled environment and of course your risks and outcomes will be better. Pt. goes bad, call a code and you get a lot of multi-disciplinary resourses in a quick manner. But leave the controlled environment with a crew of 2 or 3 people and you are severly limited to what you can immediately get or get to. Plus, if a deterioration occurs outside the hospital, it is well known and documented. Despite the reporting requirements, we all know that not all deteriorations or bad outcomes are reported or documented inside all hospitals. To me this is a biased and not fully researched conclusion. I do not agree with the last sentence about less experienced transport teams. If a specialized inter-facility transport team is available, great, send them, but the fact of the matter remains that few facilities outside of large tertiary facilities have such capabilities. Most facilities around me will call for air resources which do have the knowledge and educational programs that can appropriately care for the critically ill or injured. For some transports if space limitations are present in the helicopter, then the flight crew will accompany a ground unit for transport. As far as the air transport aspect goes, yes there is a higher incident of complications. Courtesy of mother nature and the atmosphere of the earth (i.e. coriolis effect), there are more than a few extra considerations that the medical team must consider. Unlike some issues on the ground that you can improvise to correct, the gas laws are unbreakable. You must adapt to their properties or you will have a bad outcome. The study does not include any variables or information relative to this. I agree with the authors, more studies and information needs to be researched. Great finding though Ace! I enjoy these, keep 'em coming..........................

Nasal spray for NG or NT intubation. IV for septic shock, severe spinal injury with priapism, to prolong sedation and/or chemical paralysis, and in extreme cases as a last ditch effort to treat SVT (med control consult only and I've only known of one case where it has been used in our service).

Hydralazine, Neo-Synephrine, Reo-pro, Integrilin, Pancuronium, Propofol, Retavase

The bougie is awesome and I use it regularly for grade III and grade IV airways. It is simple to use if properly trained as is better than retrograde intubation as it is not invasive. I hope to see more utilize it in the pre-hospital environment............

There is nothing wrong with a helicopter being first in on a call. Again, it is what is best for the patient......

2003 Infiniti I-35...........

Valid point and in that given circumstance where a helo isn't available whether it be for weather, PM, or the local helo being out on another mission, providing it doesn't affect other care, then yes I guess it wouldn't hurt. But again, its an item that regardless of its diagnostic capability, will not change treatment. If its broke, you splint it. If you do not have circulation, then you set it and splint it. The insurance companies are not going to reimburse for its use as they will never allow a paramedic to interpret (hell, they are in the near future going to restrict much of their reimbursements with flight charges being at the top of their list!) and again it is really a cost issue. In this case I would just haul ass to the closest most appropriate facility and focus on reassessment and hemodynamic maintenence. I agree with you though that it absolutely sucks not having air resources when they are needed. Believe me when I say it is extremely bothersome to the flight crew too. But flight minimums must be maintained as it is always better to have one critical trauma patient than a critical trauma patient who is now dead along with 3 others....................