tcripp

Wow. So what's the incentive for getting the paramedic patch?

So, your intermediates can push any drug that a paramedic can? I'm not following you...

Um. I would. Becuase it isn't forbidden to drill a diabetic who is hypoglycemic. Where is that written? Even the makers of the EZ IO market that "intraosseous (IO) access is the preferred method for establishing vascular access in diabetes". They also promote that "any drug you can give IV can be given IO". As a matter of fact, there are multiple locations you can drill, so if you are cautious about the damage you can cause by drillng in the lower extremities...well, go for the humeral head. Now, let's look at the effect of the glucagon that has an onset of 5-20 minutes vs the instant access provided by the IO delivery. With a stroke, time is of the essence. And, lastly, Dwayne mentioned that his concerns were that she had used up all of her glycogen stores which would have made the glucagon useless. So, if Dwayne is called to the stand...I'd be part of the peer review that would agree (with what information has been presented here) that he's not alone in he treatment decision.

Giggle. It must be my age. After a few pages of the 'mud slinging', I get bored. I like a good debate and can assure you that I typically walk away with learning something along the way. Heck, that is half the reason I am here. But, seriously, there has to come a point when we hug it out and move on. Uncertanties, for me, drive me to do more research or maybe even change up the question to get a different view point. Frankly, I'd like to think that is what JB was doing with his new post but it's already evident that the rest do not believe that to be an honorable intent. Can't disagree with that one at all!

Very interesting forum, this one. Must say I didn't catch it at all until JohnnyBoy's post today and Ruff's reference to an earlier post. So, if it's not too late for my 2 cents... One of the things I like most about where I work is that what we have are guidelines, not a cookbook or step-by-step instructions. Bieber, as a new medic (I just celebrated my 1 year anniversary), I too have had to learn that it's never a single page to follow but rather how to mesh well all the options available to us to the betterment of the patient. Another thing I have learned is that as long as you can stand by your decisions and they are not grossly negligent, termination is not usually high on the list of things looking atyou. (See my posts about adenosine and "lack of RSI/intubation".) I must admit that I did not read every post...some of it was getting to be dribble. But, what I recall most was the decision that Dwayne made to insert an I/O. So, the first place I went to review are my own Standards of Care. For I/O placement, it clearly reads "I/O therapy should be initiated in those patients who present in serious or life-threatening circumstances when IV access is unobtainable..." To me, what Dwayne did was just that...he had a patient in a serious circumstance and he clearly could not get a line. So, in my opinion, what he did is not considered gross negligence at all. However, in my service we do not have glucagon, IM...IN...or otherwise. So for us, we have to get a line, regardless of the type/location. Now for the kicker. The ONLY drug that we cannot administer I/O just happens to be D50 without clear medical direction. So, since my medical director has made that point evidently clear, I'd be on the phone pretty quickly to get permission or I'll start driving that direction. I figure I have been given enough leeway on so many other areas, I can deal with this one when it arises. Now, to the point of glucagon IN - while I have no scientific backing, I am aware of other services who do push it IN when an IV cannot be established. Since we have neither glucagon or IN capabilities...I haven't had the need to read up more on it. It is a shame that when there are differences in opinion that we can't simply state, "Let's agree to disagree on this one." *edited to add back in the spaces that magically disappeared...

Metal, What I admire most about your post is that you took the time to recognize where your weak spots are...and alreay have a plan of action to work on them. That is a great way to focus on your education and it will serve you well even after you get your cert!

Define "unjustified". Do you mean, somone decided to place one in the appropriate spot for no apparent reason? ...or... It was placed for reason but not in the appropriate spot? Your question alone leads to some type of gross negligance... Toni

Me too!

Got a better one for you, Ruff. I have run on a patient with a GCS of 3...no obvious signs of trauma...vital signs all within normal limits...and aside from the fact that you can't wake this person...his color is good and breathing is normal. Yes...treat the patient, not the number. I TOTALLY agree with that statement. OH...the patient above? He has basilar migraines that drop him hard. First few times we ran on him, we intubated and flew him out. Now, we load him up and transport him to the closest facility for observations...as is.

I'll preface that I'm from Texas where each service's capabilities are dictated by medical direction...which I think is pretty cool, by the way. My particular service is comprised of three levels...basic, intermediate and paramedic. Intermediates would be considered the Advanced EMT and our paramedics do work in a critical care capaticy. Our trucks are staffed with EMT/Paramedic and, for the most part, the paramedic will take about 95-98% of all calls. Our Intermediates (Advanced EMT) can push via IV narcan, dextrose (10, 25, 50) and thiamine. We occasionally have the patient (most likely coming out of a nursing home going to the local hospitals < 20 miles away) with a chief complaint of nausea/vomiting or possibly a stubbed toe but the patient wants transport and, oh by the way, gets car sick. After an assessment, I occasionally believe the call could be handled by my intermediate partner without any issue. However, because I've determined that ondansetron (Zofran) is necessary, it becomes my patient. Now, while that is not an issue and it is my job...I was curious if there were any services out there who had that medication at the intermediate level. For the record, I didn't expect anyone to pony up to it being a basic skill since IVs aren't a basic skill either. Toni

For those that use Zofran in their system and are at an EMT Basic or Intermediate level, does your system allow you to push the drug? Or is that considered an ALS treatment?

Fantastic! I truly believe that 98% of it is confidence. Not arrogance, but confidence.

HIPAA is designed so that you aren't telling the world about your patient as it relates to their care as provided by you or their personal information obtained by you. If you have a legitimate concern that your patient/friend isn't doing well and is depressed...that is continuity of care. If your plan is to notify his/her doctor/nurse or to contact a family member, then you are doing it for the betterment of your patient. Of course, what I'd be curious to understand is the health condition of your patient. Is he terminal? Is he so old that he's just tired and really ready to let go of this world? Maybe it's just time and he knows that it is coming? You aren't violating any laws by letting someone know that he is depressed and potentially suicidal. Not to mention...you are visiting this person now as a friend...not his medic. But I go back to my questions...

In the grand scheme, I would have to say that the number is provided in our radio reports and patient care reports for speed. If I'm doing a handoff, obviously I'm not going to tell the GCS unless there has been a significant change in score and, even then, I'll just tell give the actual change in patient condition.

If it's 14 or 15, I don't break it down. Anything less than that, I do so that it is meaningful.

So, for those who do report the score, do you not report it with the separate values?

Had an instructor tell me once that in his world he found it to be cyclical. He could go for 6 months and hit every attempt, first time. Then he'd go for 6 months and not hit a one. Essentially, don't stress over it. You'll need more than 20 to get comfortable with your technique. What I've found is that I have to find the vein. If I try to go for a vein that someone else finds for me, I miss them. They have a different vantage point/light source so if you shoot for that - you'll need to move to where they are standing. Also, right now, I'm working with an EMT partner who apparently is a jinx. If he is on the truck with me, I miss first time...every time. So, I've been having him start the drive or simply step off the truck and we are good. Odd.Funny maybe. True.

If you do, how often? every call Is it confusing for you to remember the point system? not especially, but I do have a small "cheat card" attached to my badge to quickly refresh and which part of the country are you from? Texas

Interesting. Female here. I do the EXACT same physical agility test to get hired in to my service. I do the EXACT same physical agility test every year to assure I am in the same shape I was upon hiring. Lifting 150 lbs on a backboard between two stretchers is the minimum. So, we do run dual female trucks, although it's by rotation. (We rotation between 4 stations so that every month I move 'to the right' and the EMTs move 'to the left'. This way, we have a different station/partner each month. Does that make sense?) Legal? Why not. It's the company's policy and I assume it's documented. Asinine? Probably, but it's at the discretion of the company and was probably based on some history. Policies have been created for a reason - most likely from something someone somewhere did...once. Options? If they really want to work together, have them take the case to the manager and ask for an exception to the rule on a trial basis. If it's seen that it won't work...then split them up. This may well be the best team ever...and they wouldn't want to miss out because of a gender thing. *edited for my own grammar errors...ugh!

I work rural as well, and your quote is one reason why we are required to have a 2nd uniform on shift so that we can change after such a call. These occurences are usually not the norm. If our need is great, we can go out of service to decon ourselves and our rig. Then, each of our stations has a washer/dryer so that our soiled uniform can be cleaned and then becomes our new backup uniform.

Just to clarify, I didn't say it's no longer available, but rather that it is no longer manufactured. You are correct that the FDA is extending the expiration dates at this time. However, there could come a time... This was all great information. What I specifically was looking for was "real life experiences". I like to get the anecdotal type of information on top of school book learning. You say, "we get" in your post. What is your position and where do you work? Sounds like you've seen many? Absolutely agree and would never attempt to do so. However, the handlers know what they know and I simply told them I can not do anything they don't want me to do. They each have their own suction to remove venom and have experience enough that they felt they could make their own decisions. Now, as for myself or the crew...we'd be moving much faster.

I know you are all waiting with baited breath to hear how this event turned out...so here I am with all the fantastic details! Well, to be honest, nothing happened which is just fine with me. The three handlers actually told me that, if bitten, they would take a few minutes to determine if it was serious enough to call me in. Fine. I told them that I don't work on 'em until they give me the high sign. They each had been bitten several times before and knew exactly what to do and when to get EMS involved. Go figure. Now, a little twist in the conversation for you. I'd heard this last year but it didn't really sink in until today. Did you know they no longer manufacture an anti-venin for coral snakes? It's too expensive and no manufacturer will step up to do it. Now, how's that for those of us in coral snake territory?

No and no. But it's a beautiful day for a helo to fly and we have a really good landing zone. ;-) I'm ready.