Dustdevil

What sucks? That is the question. I am in the market for a couple of portable suction units and don't have enough recent experience with the current lot of contenders to make an educated choice. My previous unit had the yellow Laerdal LSU and it was okay, but we had battery failure problems. I always liked the SSCOR in the old days, but I have not used one in years, so I'm not sure how the newer models stack up. Please help me out with your opinions and experiences.

Sorry, folks. This just reeks of whackerism. The fact remains, if you are breaking glass on a regular basis, then you simply suck at extrication assessment. It is just damn rare a window needs to be broken by ANYbody, fire or otherwise. I sense a lot of people who think otherwise are low-time rookies and volunteers who simply have not been around enough to realise that, as has been stated repeatedly here, if somebody is hurt THAT bad in the accident, the windows are already broken, totally invalidating the idea of doing so yourself. This is just like one of the many medical procedures that get done by rookies and wankers because "they can," when they really don't need to. The actual need to break a window should arise in one's career about as regularly as the actual need to perform a cricothyrotomy. There are many, many more important and common eventualities to spend your time preparing for. Spend some time thinking about them and maybe -- just maybe -- you will someday be an adequate medic.

Because driving the chase car is not his only function. If it were, he wouldn't even need to be an EMT. An EMT simply brings very little to the table in EMS. And if the purpose of the response car is to get critical care to the scene of emergencies quicker, then it only makes sense to send a crew capable of providing it, not one medic and a driver.

Is it just me, or is anybody else thinking they'd like to see the female robot nekkid? Cherry 2000. Best movie ever!

This appears to be the root of your confusion. The electrical phenomenon and the mechanical phenomenon are not synonymous. While there is a cause-and-effect relationship between the two, they are definitely not the same thing. The electrical stimulus is followed by the mechanical response. They are not simultaneous. And, as the entire depolarisation occurs in a progressive wave, the contraction follows slightly behind in a separate wave. Remember how he explained the stimulation of the SA node flowing through the atria like waves from a pebble dropped into a pond? The same thing is happening with ventricular depolarisation. Obviously, since there are progressive waves in the pond AFTER the stimulus, then depolarisation cannot be synonymous with contraction. Consequently, repolarisation begins taking place at some parts of the cycle before other parts have yet depolarised. Therefore, both processes will be taking place simultaneously at different parts of the heart. However, the QRS represents only what the majority of the myocardium is doing at a given time, so the few cells that are already repolarising (or still depolarising) will not have their actions represented on the EKG because they are basically drowned out by the rest of the heart. [DISCLAIMER: I just made all that up out of my head on the fly. If it is incorrect, deal with it. :? ]

Ah, but you DID understand the logic of it! In fact, you touched upon the logic in your last post when you talked of using slave labour to save money. Now, using that same logic, how much money do you think DGH saved by posting all their ambos at the hospital, as opposed to paying to establish stations around the city, or paying for the fuel to keep them on the road constantly? Pretty shrewd business logic right there. Stupid, but shrewd.

Same thoughts as yours, except that I have never seen "a lot" of ambulances do this. Maybe twice in thirty years. Must be a California thing.

Sure, I thought seriously about med school on a few occasions. It was exactly what I planned to do when I got off of active duty at age 21. I went right into pre-med and started working on it. Even got my biology degree. But I made one fatal mistake during that first year of pre-med; I decided to become a Paramedic too. That decision killed my med school hopes, although it took me a few years to finally admit it to myself. But also along the way, I realised that being a physician wasn't my true dream in life after all. Yes, practicing medicine rocks. I love it. But many, many other things involved with being a physician are a grind. It's not all fun and games like television would have you believe. I know that I am much better suited in every respect to being a medic than to being a physician. Although, I have to say that being a medic is not really my "true calling" either. I keep coming back to it because I do love it and, quite honestly, it is the one thing I have done that I am best at. There are probably few people entering EMS who do not at some point at least give a long look at going to med school. Damn few every actually go. A lot mouth off about it throughout their careers, but never make it. I began working with a rookie medic in the early 1980's who was already talking about this just being his stepping stone to med school. For those first couple of years, we thought he might actually have a chance at it. But, alas, he got too caught up in the lure of the siren to ever make it, just like the rest of us. He died about fifteen years later, drunk and face down in his own vomit at an EMS party. At that time, he was still a pre-med student, more than a year away from finishing his bachelors degree, and still telling anybody who would listen that he was going to med school. The guy giving his eulogy joked that our friend was the longest-time pre-med student in history. He was, in fact, the inspiration for the line in my "occupation" listing seen under my photo. At least he actually stayed in EMS all that time. He was a damn good medic too. And all that pre-med education helped him immensely to become that good, so it was by no means a waste. Most guys who do all this mouthing off about med school neither finish their pre-med, nor even finish a decade in EMS. Becoming a medic, and then at some point realising that you want to actually practise medicine on your own terms, rather than be a wage slave protocol monkey for AMR for the rest of your life, is a natural occurrence, and a logical and admirable goal. But becoming a medic because you think it is some kind of first step towards becoming a physician is about as smart as thinking that amateur porn is a good first step towards becoming a Hollywood movie star.

I remain extremely sceptical of the frequency of this need some of you seem to find to break windows on a routine basis. In over thirty years, I still have fingers left over after counting all of the windows I have had to break. Yes, there were plenty that I could have broken if I wanted to. But the fact remains that the actual need to break windows is a lot less common than a lot of low-time rookies here want to believe. If you are breaking windows this frequently, you seriously need to go back for some more schooling, or simply slow the F down and use your head instead of breaking windows on every damn wrecked car you find. If you're making such poor judgements in access and extrication, your medical judgements are also suspect. Think about it. And if you're breaking glass, you ought to be wearing gloves anyhow, so the lack of the plastic guards shouldn't be relevant. And if you are so into being prepared for every possible eventuality that you would run out and buy Big Shears, then there is no excuse for not having gloves on you too.

You guys are forgetting one key factor in the success of this technique. While yelling loudly and slowly in English, it is important that you affect a faux foreign accent, mocking the patient's native language. This is particularly effective in Spanish, even if Spanish is not the patient's language. My honest answer to this is I just don't care. If they speak English, they get good care. If they speak Spanish, they get decent care. If they speak anything else, they get the same care as an unconscious patient -- ABC's and a ride to the hospital (whether they want to go or not) where it then becomes their problem, not mine.

So it's all about you? 8)

:oops:

Sorry.... I haven't heard a word since somebody mentioned the Mile High Club. :twisted: I got screwed by the Air Force. Does that make me a member?

Hey, at least Imagine89's intentions were good, even if he shot an innocent man. It's the thought that counts. But yes, in Bradlai's initial post (a different topic), he was thoughtful enough to apologise in advance for his English. And I would be the last person here to ever discourage participation by our International friends! Except for France. :twisted: And allow me to apologise in advance for my Chinese.

Nitrate gloves are even more dangerous than latex. If you use nitrate gloves on a patient who takes Viagra, it could very well kill him. 8) What exactly is the difference between an EMR kit and an EMT kit anyhow? :? So... you just stop everytime you see a couple of people chatting and ask them if they need help? You must be a busy boy. I call bull$hit on this one. Either somebody lied to you (a thousand times) and you're the most gullible person on earth, or you're just making this up to inflate your own sense of self importance. Regardless, your assertion is crap.

Horrible idea on SO many levels. But then again, so is the whole FAM programme.

Come spend a day in my aid station before you presume to speak for me. :wink:

Plus 5 for an excellent post. Going against the conventional wisdom is hard enough, but explaining it intelligently and convincingly is admirable.

And, just for the record, that is a matter of valid debate and local policy. Your personal protocols do not apply to the whole world.

You are misinterpreting the data. It is just numbers. Nothing more. Any actual "cause and effect" relationship is only speculation. This has been discussed at length here, and you can find some very informative discussion with a little searching. Good luck.

In America, almost always yes. In Canada, it varies with location, but generally yes also. If you want to be a paramedic, go ANYWHERE except the United States. I recommend The Netherlands.

You're not very Canadian looking.

On what information are you basing this assumption upon? Remember day 1 of CPR class? You can't kill a dead person. And, as already pointed out, you are less likely to cause "harm" with this procedure than with CPR. No harm = no foul.

Having been out of adult medicine for a good while before this current assignment, I had not used Vistaril in years. But back in my adult ER days, there were posters on the wall of every ER warning that Vistaril should ONLY be given by gluteal IM, utilising the Z-Track injection technique, which was illustrated on the poster. Although Vistaril was not covered in my paramedic school, it was one of the very first IM injections I ever gave during my ER rotations, and the nurse preceptor there made that information absolutely clear to me. And it was darn sure covered at length in nursing school. I am frankly shocked that anybody in a position to give this medication would not be familiar with this information. I take it back. I'm not shocked at all. In fact, this is exactly the sort of thing I have come to expect from EMS today. It is again part of the whole skills-centric culture in EMS where somebody who has been given thirty minutes of training on IM injections now feels qualified to administer any med in the cabinet. This is just more evidence that, without true education, training is meaningless. Which is why EMS has zero respect in the medical world. [NOTE: The above rant was not in any way aimed at the original poster. I commend him for asking the question.]

Sure. There are several reasons why you could or would refuse the order. If you honestly believed it was beyond your capabilities, you could refuse it. After all, as Rid pointed out, apparently this isn't even touched upon in passing in many medic schools anymore. If you honestly believed it was inappropriate for the patient, you could refuse it. After all, miscommunications are a very real possibility when the doctor is not there to actually see the patient. But yeah, your legal right to refuse does not guarantee you will keep your job. It won't even guarantee that you will keep your cert. On the other hand, following the order does not guarantee that you will keep your job either. Right and wrong are not of concern to your employer. They only care about appearances and other nebulous concepts. But, if the situation is indeed as painted in the above quote, then I don't see significant concern for licensure action. The tough part of this scenario, for me, is putting myself into the shoes of somebody who did not have adequate education to feel comfortable with the order. Yes, if I were freaking out and my mind racing with thoughts of decertification and unemployment, trying to remember what the xiphoid process was, and didn't know what Beck's Triad or pericardialcentesis was, I would quite likely pass on this order. But, being a well educated medic who is thoroughly familiar with the anatomy and physiology involved, and having been specifically trained on this procedure in both paramedic school and ACLS class back when both classes were actually worth a darn, I would have no problem with it. As for the differences in responses between the medics and EMTs, I think it goes back to the simple difference between education and training. EMTs (and far too many medics too) tend to be of the mind that, so long as you are trained on a procedure, that is all you need. We see this same scenario -- with varying particulars -- everyday here at The City. Everybody wants a new one-hour merit badge skill and is chomping at the bit to utilise it. They don't need more education. They just need more protocol! All that book learnin about anatomy and physiology and assessment aren't really important if you can start a 14 gauge IV upside down in a burning car, in the dark, in the rain, while being shot at (never mind that what the patient REALLY needed was to be pulled out of the car!). Once a provider is educated, it becomes painfully obvious how absurd this popular misconception is. And then the craving for protocol is replaced by a hunger for knowledge and understanding. And once you have that knowledge and understanding, you no longer need protocol because now you know what to do.