HERBIE1

From what I gather, this amount of time from testing to vaccination is not unusual- it's pretty standard when dealing with the annual flu shots. It makes sense- they want to wait until the last possible minute to ensure they are using the correct strain of the virus. That's fine, except when you start throwing around the term "mandatory"- that's when I get nervous. My kids are scheduled to see their doc this week, and I will be asking for her recommendation on this. My wife will be getting one(she's already had the seasonal shot)- she has asthma, and one of the kids is borderline. If the doc suggests it for them, I trust her opinion. As for me- I still see no compelling evidence for me to get one, but that may change.

Well, I may be a bit of an old fogey- at least that what kids may say... Generalization alert based on having kids and being a preceptor for years: I really think there has been a shift in the attitude of the up and coming generations for awhile now. Kids these days seem to have the entitlement mentality down to a science. Whether it's a new college grad with a BA who expects a corner office, 6 weeks paid vacation, a six figure salary, and a company car, or a brand new EMT or medic who thinks they already have all the answers. Granted, the slow economy has toned down those expectations quite a bit, but I still think this is a prevailing attitude. For some time, I have had to reign in the egos and attitudes of new students and make them realize that as was noted above, book learning AND experience are vital components of being a good provider. Simple things like conducting a proper interview, actively listening to and evaluating the patient are important, and not just to get to the part where they get to use their new found skills on their patients. Patients and their families appreciate the little things- listening, holding a hand when necessary, and realizing the family may need almost as much as your patient, if not more. Most of the time they don't care if you got a difficult IV, did a good assessment of their lung sounds, or maybe even gave them treatment that saved their lives. They want to know you have showed compassion, empathy, and tried to make a bad situation better. I've had far more people thank me for giving them a laugh, listening to their problems, or easing their concerns. I don't know what the answer is- people are who they are. Our jobs as seasoned professionals is to temper enthusiasm and channel energies in a positive direction.

Welcome Angie, and where the heck is UC?

Welcome to the community, WinterMedic!

Kiwi- What is your average transport time?

The thing that was stressed to us in this symposium is that if at all possible, the patients need to be at a facility capable of dealing with this devices, although the coordinators give a heads up to whatever ER you arrive at. Depending on where you live, clearly that may mean a significant transport time. Dennis Rivard of the Mid Atlantic Region Prehospital Task Force is the guy who discussed the color coded tags for his area. I did a quick search but could not find any contact info on the guy. Maybe you'll have better luck. Try to contact one of the vendors like HeartMate or Thoratec- they would probably be able to help.

Yep. It's one of several places in the area that utilize the devices. Apparently East Coast EMS is more familiar with the devices. One of the lecturers was from that area and he said they actually have color coded tags on each LVAD that gives the basics- proper settings for the patient flow rates, etc, type of device, and items particular to that model. The color coded tags correspond with a field guide provided to prehospital providers- nice.

Went to Oak Lawn, Illinois. We got to play with the various models- learned how they work, how to change batteries, etc. Hands on stations with the company reps as well as the LVAD coordinators. Since they are on call 24/7 and very anxious for us to utilize them. I actually have their phone numbers programmed in my personal cell phone. If I know we are going to an LVAD patient, I will be on the phone with them before we even arrive on the scene.

Went to an all day seminar a couple weeks ago about LVAD's. Turns out we have a couple patients in our area on the devices and I wanted to become more familiar with them. Amazing stuff. Learned a lot, and the future is even brighter. The latest model, still in clinical trials but implanted in patients in Germany, is about the size of a hockey puck and is completely implanted within the chest. Some of the devices are temporary while awaiting a transplant, while others are destination devices, designed for people who are not transplant candidates. Take away points- Use the LVAD coordinator, who is always assigned to LVAD patients. The patient/family/caregiver will have the number of this person and they are a great resource. They are familiar with the patient as well as the device and are more than happy to assist. No CPR. These devices supplement or completely take over the heart's pumping, so compressions aren't really necessary. As was noted, compressions will probably damage the hoses. These devices are attached by boring a hole directly in the heart muscle and if the hoses are torn, the person will bleed out. Also, any problems you see will be from the patient, not the device, so treat the patient. In the unlikely event of a pump/battery failure, some models also have manual devices which fit over the hoses to take over the pumping, and essentially look like esophageal detector devices used to confirm ET placement. Vitals signs are also different- a lower systolic pressure is actually desirable- higher BP's and it may cause problems. Probably the most interesting- and strange- a person may be in Vtach or Vfib. Unless they are symptomatic, immediate defibrillation or cardioversion may not be needed, especially if the person is conscious and awake. Take time, evaluate the person and their complaints and discuss with the LVAD coordinator and your medical control as to what you should do. Since they will be perfusing regardless of their rhythm, you have time to take a step back and see what other problems may need to be addressed- hypovolemia, electrolyte imbalances, fluid retention, etc . Also, bring ALL the equipment with the patient- including back up devices and spare batteries. There's more, but these are probably the biggies. Fascinating devices, and truly life savers for people. We met 6 people who had these devices, one for nearly 5 years. They can lead relatively normal lives when before getting out of a chair was a struggle. One guy has traveled all over the world since having hi LVAd implanted 2 years ago, I'm certainly no expert in LVAD's but at least I have a familiarity with these devices now.

This is an article from Time magazine. It speaks of a guy who was nominated by Congress for this prize, but obviously did not win. Seems to me that someone who does more than simply talk deserves the recognition vs a guy who talks a good game but has yet to do a damn thing. http://news.yahoo.com/s/time/20091009/us_time/08599192939500/print From the article: Compare this to Greg Mortenson, nominated for the prize by some members of Congress, whom the bookies gave 20-to-1 odds of winning. Son of a missionary, a former Army medic and mountaineer, he has made it his mission to build schools for girls in places where opium dealers and tribal warlords kill people for trying. His Central Asia Institute has built more than 130 schools in Afghanistan and Pakistan - a mission which has, along the way, inspired millions of people to view the protection and education of girls as a key to peace and prosperity and progress. (See an interactive guide to Obama's first 100 days as President.) Sometimes the words come first. Sometimes it's better to let actions speak for themselves.

Like you noted, if all you need to do is want world peace to win the Nobel Prize, then there would be millions of winners. It would be like finding the prize in a Cracker Jack box- nice, but not exactly special.

I have lost all respect for the Nobel Prize Committee. It is my understanding that the nomination for this award is due in February. That means Obama was in office a grand total of less than a month, but somehow that merits a Nobel Prize to whomever nominated him? Are you friggin kidding me? It's one thing to be nominated- lost of people are, with various degrees of worthiness, but it is quite another to be selected. I'd love to know who was the one who nominated Obama. First Al Gore, and now this? Boggles the mind...

I've said this in several different threads, on multiple topics- there is no universal answer to the problems in EMS, so a "compromise" is really not possible. Look at the attitudes here- volunteer vs paid. Fire based EMS vs 3rd service, single role vs cross trained- everyone has their particular niche they want to protect or one they pick on. What is a huge issue in NYC may be irrelevant in Chicago, or SF, so it's not even an urban vs rural problem. Pay scales vary widely, depending on who you work for and where you provide care. Some folks live barely above the poverty line while others are making quite a comfortable living. In other words, there is no single issue that we can rally around, which makes things like political action difficult. I don't know what the answer is, but I think we are at a crossroads in EMS. The push seems to be for fire to absorb EMS, and too many times, the group that loses out is EMS- as well as the patients. I think that single role providers are being pushed out in many areas because of budget issues. From an economic standpoint (from a management perspective) anyone who can perform multiple tasks is the wave of the future. It is more cost effective, less complicated from a manpower standpoint (one person can perform multiple roles, depending on the needs of the day). The bottom line for municipalities is $$, and anything that costs less will be embraced. One of the favorite buzzwords of planners in recent years is "interoperability", which essentially means multiple diverse agencies need to play well with others. It also means we have turf wars and power grabs- nobody wants to be seen as irrelevant or nonessential, and groups like the IAFF have millions of dollars to play with. They can promote their service- even while fires are down, and because they have established assets and manpower, it's easier for them to crank out a few EMT's or medics from an EMT mill to keep their manning and justify jobs. Fire understands the need to tap into something that generates revenue to stay relevant and keep staffing, so the logical solution is to go after EMS. EMS does not have the numbers, organization, national recognition or power structure to absorb fire departments. Notice nowhere did I mention what is best for the patient- that is the least of a city manager's concerns. As long as SOMEONE shows up, they are happy. "Hey look- we have 5 people and a fire engine here to provide care for you!" They never explain the level of training or skills of those 5 people- it's all for show.

Funny stuff. I have yet to watch this show, and I honestly don't know if I ever will. Based on the responses here, it would seem I'm not missing much. As for realism- well, unless it's a documentary, I don't expect anyone to realistically portray EMS. Think about all the early shows based on law enforcement. ADAM-12, CHiPPs, Hooker,- some were downright comical, and cartoonish, and certainly not accurate. Did LEO's boycott these shows or pitch a bitch to the studio heads? If they did, the studios did not care, and it certainly didn't matter because the public loved them, and if they generate $$$, that's all that matters to them. Being accurate is the least of their worries. The daily grind of real EMS is not action packed or glamorous enough to make viewers tune in every week, but a fictionalized TV show may just stir interest in the profession and get people to look deeper, and maybe generate some interest. I look at it like "Backdraft". I loved the movie, but... to the uninformed, they think that every time a fire engine pulls out it's a multiple alarm fire with people hanging from windows. We know that is not the case, but it makes for great drama, and it did provide an upswing in interest for firefighting. Same for Top Gun and Navy pilots. Sadly, "Bringing out the Dead" with Nicholas Cage had more truth in it to me than most of these silly TV shows. I knew a couple guys who could have played lead in that movie, but thankfully they are out of the business now. Is it frustrating to see a lack of realism, which does nothing to help promote our cause, but I think we need to keep plugging along and remaining professional. Push for higher standards, push for parity in funding and respect, and take shows like Trauma for what they are: FICTION. WE know they are silly, and I think most of the public does as well. For those who think this is what EMS is all about- well, let's just say those folks probably also think a show like "Reno 911 is a documentary- meaning- you can't fix stupid.

Need more info. PMH? Similar past epiosode? Events leading up to EMS involvement? Argument? Stressful situation? Personal problems? Medications? ETOH or drugs? Psych history? Carpal/pedal spasms? Tingling fingers? I've had countless hyperventilation syndromes and have NEVER had a patient actually lose consciousness because they have completely screwed up their respiratory drive. Had a few come close, but that was after probably an hour of rapid, shallow breathing.

Agree with everyone here about what happened, except that I have a question. Why were they attempting to intubate the patient with O2 sats at 89%- what's the big hurry? Granted, we are limited by not having a chemistry profile, but it doesn't take a rocket scientist to surmise what was going on with this patient. High flow O2, diuretics, NTG, CPAP, CaCl2, Bicarb- all options depending on your system, and what you know. Unless this patient arrested, I see no reason to rush to intubate (even then, it's not priority one), since if you address the underlying issues, the breathing will improve. Assist ventilations PRN, but even without knowing the interaction between sux and K(we do not use it), intubation should not have been job one. I'm all for being aggressive in patient care when appropriate- especially those with signs of heart failure, but I think the crew's priortities were screwed up here. If they knew the patient had not been dialysized in 5 days, it should have easily explained the EKG as well as the patient's signs and symptoms. Too often we get focused on playing with our toys, using our technical skills, and forget the KISS principle(keep it simple, stupid).

Agreed about how poorly this story was written. Apparently journalism schools have seriously dropped their standards. As to the cops who f'ed up- bad news. I am the first to defend LEO's and give them the benefit of the doubt, BUT... Everyone makes mistakes, but my gawd. Even if it WAS the bad guy they shot multiple times, dragging someone outside by the leg, onto gravel and throwing them on the hood of the car? WTF are these clowns thinking?

Mods- please delete duplicate posts. Having browser issues... Thanks.

I've used a traction splint about 15-20 times in my career, and other than a couple equipment malfunctions-ie a failure of the ratchet system used to apply the traction, it worked great. I am not surprised that there is a lack of literature on the device, and here's an example of why. A couple years ago we had a 10? year old boy who was struck by a car while on his bike, and his primary injury was to his leg. He had an obviously fractured and angulated femur, upper mid shaft, with compromised circulation. He was obviously in a lot of pain, and we applied the traction splint. We gave him some MS, and it worked like a charm- he was pretty comfortable after the splint was applied. We took him to a pediatric trauma center, and a few days later, we heard from the hospital he was doing fine. One of the ER docs was asked to relay an atta boy from the peds ortho guy. First, the surgeon had no idea we had the ability to use such a device in a prehospital setting, but thank gawd that we did. Apparently the fracture was a millimeter or so from severing his femoral artery, and unless the limb was reduced and immobilized, simple movement or even a strong muscle spasm could have cause him to bleed out. The fx was repaired and the boy will be fine. Although we appreciated the thank you, I was more concerned that a world famous children's hospital, known for their state of the art treatment, would know so little about prehospital care- especially with a device that has been around forever. Just a thought- I would contact trauma docs to get at least anecdotal information about their experiences with such devices. Good luck. I've used a traction splint about 15-20 times in my career, and other than a couple equipment malfunctions-ie a failure of the ratchet system used to apply the traction, it worked great. I am not surprised that there is a lack of literature on the device, and here's an example of why. A couple years ago we had a 10? year old boy who was struck by a car while on his bike, and his primary injury was to his leg. He had an obviously fractured and angulated femur, upper mid shaft, with compromised circulation. He was obviously in a lot of pain, and we applied the traction splint. We gave him some MS, and it worked like a charm- he was pretty comfortable after the splint was applied. We took him to a pediatric trauma center, and a few days later, we heard from the hospital he was doing fine. One of the ER docs was asked to relay an atta boy from the peds ortho guy. First, the surgeon had no idea we had the ability to use such a device in a prehospital setting, but thank gawd that we did. Apparently the fracture was a millimeter or so from severing his femoral artery, and unless the limb was reduced and immobilized, simple movement or even a strong muscle spasm could have cause him to bleed out. The fx was repaired and the boy will be fine. Although we appreciated the thank you, I was more concerned that a world famous children's hospital, known for their state of the art treatment, would know so little about prehospital care- especially with a device that has been around forever. Just a thought- I would contact trauma docs to get at least anecdotal information about their experiences with such devices. Good luck.

Guilty as charged, sir.

How often do you think that happens(EKG returning to normal after o2, NTG and ASA), doc? I assume the patient must have called EMS immediately after the first twinge in his chest. Am I to assume his symptoms would have returned fairly quickly after the Nitrates wore off, especially if he was that occluded?

I don't know if your points would improve, but it might get you a promotion...

Of course, just ask your kids. We don't know ANYTHING.

I agree with everything you said except about the powerpoint lectures. For us old old farts, it was slide shows and flip charts. LOL