Dustdevil

Fair points, to be sure. However the analogy is a little shaky. 5 year olds don't often suffer cardiac events. However, were I to respond to a 5 year old with serious chronic problems, confined to a nursing home bed, and who had suffered a cardiogenic cardiac arrest prior to my arrival, then yes... I would handle it the very same way. Any difference in how the two would be handled would be due to the younger patient's physiological viability, and no other reason. I don't get emotional about kids. That's why I chose paediatrics as a specialty.

Okay, I admit that my answer was not as long-winded and boring as many answers I give here. But I would disagree that I did not explain my answer. I pointed out that the care being provided by the medics is the most definitive care available (which should be understood to mean that it should not be delayed), and that transport is unnecessarily dangerous to the crew and everybody around them. I could go on with a lot of anecdotal stories to support those facts, but I am trying to get more directly to my points these days. My fingers are getting arthritic in my old age. If you need further proof of the dangerous nature of code-3 runs, I have several scars and a 6 inch stack of my own x-rays, CAT scans, and MRIs that I can show you.

Excellent! Plus 5 for making that point in a much shorter, more succinct post than I would have. The really sad thing is how many people in EMS lack the imagination or foresight to figure that very simple fact out.

I still don't see how this is a factor. Bystanders in bathrobes, I can deal with. Splattered kids on my bumper ruin my entire shift.

Asys, are you implying that those who are authorised to perform invasive medical manoeuvres should actually understand them? Don't be absurd. :roll: Minus 5 for a worthless topic name. Minus 5 for posting ALS in the BLS forum. Minus 5 for spelling. Minus 5 for failure to read forum rules.

Exactly. And any EMT out there who does not know or understand this concept is dangerous (and "cocky") and has no business in EMS.

No. Maybe you will once you become a paramedic. Or once you have had your skull broken in a pointless code-3 wreck. ACLS is definitive care for cardiac arrest, assuming there is no underlying medical or surgical problem.

Because, obviously, it is much better to hit a kid in a neighbourhood than to get stuck in freeway traffic. :?

The longer you spend in EMS, the more you will understand that NOTHING should be left to the "discretion" of 18 year olds with 120 hours of night school.

Ever person employed on an EMS providing unit should be a degreed paramedic. I really don't care what training ambulance drivers do or do not have. It has nothing to do with EMS.

Plus 5 to AK for beating me to the punch with that post. Now, to answer the original question, my speculation would be that your protocols allow for rapid action for emergencies and a more measured response to non-emergencies. Phenergan is not an emergency medicine. Vomiting is not (usually) an emergency situation. And the use of phenergan in EMS is very rarely an urgent, reactive prescription, but a routine, proactive prescription to prevent MS induced nausea (as well as the aforementioned "potentiation" myth). Medicine has been trying to step away from that for quite some time now. I remember in nursing school fifteen years ago getting my hand slapped for mixing MS and promethazine routinely on a post op patient who had both ordered, but not specifically to be given together as we always had in EMS and ER practise. I have seen such use drop drastically since then. So again, to clarify, it appears that your protocols are walking that fine line between allowing you to do what is necessary for emergent patients with a minimum of constraint, while still maintaining checks and balances for elective medications and procedures. I think that is a good thing.

I'd have to say you answered your own question.

There are no questions which have never been asked at EMT City before. Viola... http://www.emtcity.com/phpBB2/viewtopic.ph...ghlight=amputee

:shock:

Hehehehe... You said "hard on."

For the record, both AK and I are making less here -- under fire and living in tents -- than we did or could back home. You'd be hard pressed to find many RNs who would take my job here for this money. In fact, you'd be lucky to find many that would take it for twice the money. A flight medic from Dallas recently came out here and I was talking to him as he was passing through Baghdad. He was talking about how he hoped he could get his [better paying] job back when this was all over. He obviously is not here for the money. Most every brand new PCP in Ontario is making more money than me, with my three degrees and thirty years of experience. Any belief that we are getting rich out here is grossly misinformed. The only difference is, we are kept too isolated and too busy out here to spend any of it. Not exactly a "bonus" to most people.

Although it seems recent to me, the last time I knew for sure that MAST was still operational in San Antonio (Fort Sam/BAMC) was 1989 when I did a TDY there. Fort Sill was still running MAST in Oklahoma when I was there in 1988. Of course, in the last ten years, aeromedical services have exploded across the nation. I know they have at least tripled in Oklahoma, and I would suspect they have done so in San Antonio, as they have in Dallas-Fort Worth. If so, then there is certainly the chance that MAST has shut down in those areas. However, you know how hard government programs die. They may still be hanging in there! I'd be interested to know if Fort Bliss is running MAST. If any area could use it, it would be El Paso!

Exactly! You would have to immobilise your patient with [at least] a collar in order to get him on the mat in the first place. If he was not already supine, then you are going to have to use a KED too. So how are you going to remove that collar and/or KED without manipulating the patient? The only way I can think of to get the patient onto the board is by scooping him, then dropping him into the mold. Do you really want to drop your patient, even if only 6 inches? When we asked the manufacturer how we were supposed to get a patient onto this device, his entire reply was, and I quote... Obviously this company is run by clueless idiots who either haven't the common sense to realise their product is useless, or simply are crooked bastards who don't care since the world is full of similarly clueless idiots who will buy it.

AK afraid of the dark?? Say it isn't so!

We had a similar system in North Texas that covered about seven counties with 155.340. A federal grant bought radios for every hospital and almost every EMS ambulance in that region. Instead of the rotary encoder, we utilised the DTMS encoder. However, I went to work for the EMS provider in Arlington in 1978 and they had rotary encoders attached to the radios in the cab that were company purchased. The cab radios had the same frequencies as the grant radio, but also had the dispatch frequencies in it. The dispatch system did NOT utilise the rotary encoders. I asked quite a few people what the rotary encoders were for, but nobody, including the supervisors, had an answer. I never did figure it out. That's the only place I have ever seen the rotary encoders installed. And I have never seen them actually in use anywhere. Bit of trivia: The paramedic who set up the foundation to receive and administrate the federal grants for the EMS radio system in North Texas back around 1976 is still in EMS. His name is now Dr. Bryan Bledsoe.

Are we really discussing this pointless piece of crap again? I can recall at least two or three previous topics addressing it, including the one started by the manufacturer's rep, who quickly slithered away when a couple questions were asked that he couldn't answer. Looking at the link, I do see that they have made some design changes since we last discussed this. However, they have apparently done nothing to rectify the major problem associated with the device; there is no safe way to get a patient onto or off of the mat from any position.

So, are you going to work on your problem, or just hide from it? Medicine is not for the meek or the sensitive.

I looked briefly at them several years back when they were first promoting their programmes. I didn't really examine them carefully out of an intent to utilise them. Just a curiosity thing, as I am always interested in seeing what is out there. All I recall is that they seemed very focused on workplace issues, which I found to be a positive thing. The last place I was teaching formally, we used Medic First Aid International programmes for First Aid, CPR, and Bloodbourne Pathogens. Meh... I liked the way their information was presented in the materials and videos, but thought the material itself was sparse. It was, like AHSI, very focused upon workplace scenarios, which is good. But there wasn't even a section on burns at all. That is only one of the glaring omissions. I'm not sure how a programme could even meet OSHA approval like that. :?

I was going to deduct ten points from SOMEDIC for that pointless rant, but in retrospect, the topic name did include "AK bashing." And AK did invite us to join in. At least SOMEDIC was on-topic and followed instructions!

Good commentary above. I agree with Asys, in that while I probably would not have gone for cardioversion in this scenario (at least, not at that time), a good case certainly can be made for it. I would not have done so for a couple of reasons, both of which have been touched upon already. Airway and oxygenation was the primary concern here, so I would have focused upon that. And ACLS in a trauma victim is something for the road, if at all. I would not delay transport for it. With a perfusing rhythm (pulse), cardioversion would have been low on my list of priorities. If anything, I would have spent that time on a trach. But again, that's just me, not PHTLS or the NREMT talking. There are a million trauma surgeons who probably would have done the same thing y'all did, so again, it certainly wasn't wrong. As AK reminds us daily with his signature line, there is more than one way to skin a cat. And if it creates some introspective evaluation of your performance and options for the future, then I'd say this run turned out very well for you. And no matter what you did or didn't do, there was only one way it was going to turn out for the victim.