Dustdevil

Phil, we're not against rules. Every polite society has them. But what we support are rules against criminal behaviour, not against inanimate objects that pose no threat to anyone, unless used by a criminal. If the "rule" against drunkenness and assault were strictly enforced, you could have guns and knives on every table and people would still not use them because of the known consequences. Making rules against ashtrays and pool cues is treating a symptom without treating the disease. As medical professionals, I am ashamed that the Australians apparently do not know better than to espouse such a foolish approach.

Interesting take on the situation here: http://www.ems1.com/ems-advocacy/articles/749291-Trial-by-Media-The-FDNY-EMT-Case/ Feel free to join in the discussion.

Well, he did say that it was a "workable" rhythm, not necessarily a statistically salvageable rhythm. I have to agree with that. Look up asystole in any textbook and you'll find a strategy for working it. Therefore, it really adds little to nothing to your assessment of a DOS. Conversely, you will find no textbook protocols for resuscitating decapitation or rigor mortis, so those are useful assessment tools.

http://news.ca.msn.com/world/cp-article.aspx?cp-documentid=23343180 By Lee-Anne Goodman, THE CANADIAN PRESS, cp.org, Updated: January 27, 2010 5:33 PM Obama enjoys rock-star status in Canada despite struggles in the U.S. WASHINGTON - As U.S. President Barack Obama struggles to reconnect with recession-weary Americans, a new poll suggests his popularity is unrelenting in Canada. A new Canadian Press-Harris Decima survey says Obama would be elected with a majority north of the border regardless of whether he was leading the Liberals or the Tories. The survey suggests that if Obama was Liberal leader, 48 per cent of Canadians would vote for the party. That would result in the Tories losing a large chunk of their base, with 30 per cent of them saying they'd vote Liberal if Obama had Michael Ignatieff's job. If he was at the Conservative helm, 43 per cent of Canadians would cast their ballots for the Tories. Doug Anderson, president of Harris/Decima, says he suspects the health-care debate that's been raging in the United States for months has likely cemented Canadian affection for Obama. "That is something that is near and dear to Canadians, and he's out there fighting for it," Anderson said Wednesday, a few hours before Obama was slated to deliver his first offical state-of-the-union address. "Universal health care is something that we value, and he's espousing its importance down there, and that's something Canadians admire." Aside from party politics, the poll suggests the majority of Canadians continue to hold a high opinion of the president. Fifty-two per cent of those polled said he's exceeded their expectations since his election, while 15 per cent said he's done as well as they expected him to do. Nineteen per cent gave him a poor performance review. East of Manitoba, those surveyed gave him particularly positive marks for his job performance. From Manitoba to British Columbia, support was lower, but the majority were still of the view that Obama had done better than expected. Harris Decima interviewed slightly more than 1,000 Canadians between Jan. 21 and Jan. 24. The survey has margin of error of 3.1 percentage points, 19 times out of 20. The poll results might understandably prompt Obama to ponder a move north of the border, Anderson joked. "He could have another beavertail," he said, referring to Obama's jubilant visit to the Canadian capital last year, which included an impromptu jaunt to a downtown market to pick up one of the popular Canadian pastries. In the U.S., meantime, Obama's approval ratings have been sagging and now sit at about 50 per cent. The president has been humbled in recent weeks by the election of a single Republican to the late Ted Kennedy's Massachusetts Senate seat. Scott Brown's win essentially gives Republicans enough senators to put the brakes to Obama's legislative agenda, including his cherished health-care overhaul. In his first official state of the union address on Wednesday, Obama was expected to once again try to rally bipartisan support for some form of health-care reform in addition to charting his course for 2010. Some political observers say Brown's win was a populist repudiation of the president and his progressive politics. Canadians apparently feel no such distaste for Obama, Anderson said. "Right now in Canada, people are not soaking up the same kind of negative sentiment that Americans are; they are not feeling the ineffectiveness that some Americans are about him. They see him instead as pursuing something, in health care, that is worth pursuing," he said. "There has not been a significant reduction in admiration that Canadians have for him. What they see is the kind of persona that they admire and the kind of leader they'd like to see in Canada."

I don't like to use anything other than the big Ferno blocks. They do a better job than anything else I have ever used, plus there is the added benefit of having the blocks to use as chocks to wedge in between the patient's hips and the cot rails. After all, if you immobilise the head, but leave the rest of the body flopping around, you are defeating the purpose of immobilisation. I know of no other CID that provides for this possibility, and pillows and blankets simply won't do the job.

I sure hope so. I know they have their work cut out for them due to the union nonsense. But come on! A full month and no interview yet? That's crazy! I dunno, Bro. I was thinking that EMS leaving the FD and going back to a third service would be a positive thing for you.

Very interesting point. It is true that this study takes into account only the manipulation necessary to apply the collar itself, while ignoring the manipulation necessary for extrication. Extrication -- even simple manoeuvring from a supine position -- is a whole 'nother dimension of factors that is not addressed.

According to the article, chemical sedation had failed. While I think you are on the right track, I would submit that even suspension would be inappropriate. It's not quite kosher to punish someone for not doing something you never taught them to do in the first place. By sending them for a self-defence course, you are admitting that you have failed to provide that in the past, which puts the culpability straight back on you as an employer. And then what about the next guy? Are you going to send this one employee to a special course, but not all the rest? And was documented proficiency in self-defence a condition of employment to begin with? You can't change the rules and enforce them retroactively. This seems like a clear cut case of managerial and administrative FAILURE. The problem exists and manifested itself because of incompetent management, and even worse, they're trying to shirk responsibility by sacking the low man on the scrotum pole.

http://www.click2houston.com/news/22322687/detail.html Farmer's Mouth-To-Snout CPR Saves Piglet Wash State's 'Pig Pig' Survives With Help Of Dog, Farmer POSTED: Saturday, January 23, 2010 UPDATED: 1:39 pm CST January 23, 2010 LA CENTER, Wash. -- A Washington state piglet's recent tale of swine survival not only involves man, but man's best friend, too. Portland, Ore., affiliate KPTV reports that Pig Pig, who lives on Heidi and Jeff Olson's farm in La Center, Wash., had a rough start to life. The piglet's mother accidentally crushed her after becoming ill from complications during birth. "The mother pig was so sick she actually laid on her and didn't realize it," Heidi Olson said. When Jeff Olson realized what happened, the tiny piglet was near death. "She squished her flat," Heidi Olson said. "She was flat as a pancake, no heartbeat (and) cold." But Jeff Olson reacted quickly in the only way he knew how to save the animal. "He did the first thing that came to mind, which is mouth to snout," Heidi Olson said. After about five minutes of mouth-to-snout CPR, Pig Pig began to breath on her own. Pig Pig was the only surviving piglet of the litter, and her mother died, the Olsons said. Saving the piglet would be difficult with no mother to feed her, the family said. Again, the Olsons improvised, placing Pig Pig with a litter of Red Healer puppies to see whether their mother could look past the obvious differences. "The momma dog looked at me like, 'Are you crazy?' But nature took over and her mothering instinct took over and she brought her in as one of her own," Heidi Olson said. Weeks later, Pig Pig is thriving and appears set to live a long and happy life. "The only problem is the pig now thinks she is a dog," Heidi Olson said.

Is it just me, or is anyone else sick of the term "EMT Worker"? http://www.madisonrecord.com/news/224299-emt-worker-claims-he-was-wrongfully-fired-after-punching-patient EMT worker claims he was wrongfully fired after punching patient 1/25/2010 10:12 AM By Kelly Holleran A former emergency medical technician has filed suit against his former employer, claiming he was wrongfully fired after he punched a patient in an attempt to calm him. Jonathan Hayes claims he lost his job at defendant Mission Care of Illinois doing business as Abbott EMS after attempting to medically treat a large patient who was suffering from a seizure on Jan. 17, 2008. The patient became combative, so Hayes called for police assistance and another ambulance unit, according to the complaint filed Jan. 15 in St. Clair County Circuit Court. Eventually, the patient was placed on a stretcher, but that did not subdue him, the suit states. "Patient became even more combative, placing himself in harm's way and striking his partner causing him to become dazed," the complaint says. "Even after being touch stunned, patient started striking Plaintiff's supervisor, punching Plaintiff in ribs, and striking his partner." Several police and EMT attempts to calm the patient were unsuccessful, Hayes claims. "Plaintiff was required to use force in an attempt to protect himself and his patient from further harm, thus he punched the patient," the suit states. "Plaintiff was wrongfully terminated as for his use of force in his attempt to calm the extremely combative patient who was not responding to police stun guns and drugs." Because of his termination, Hayes has suffered a loss of hourly wages, health insurance, benefits and seniority, according to the complaint. Hayes is seeking a judgment of more than $50,000. He will be represented by Morgan Scroggins of Scroggins Law Office in Granite City. St. Clair County Circuit Court case number: 10-L-20.

Those aren't gloves in my wallet. They're "finger cots". Yeah... fingercots. That's it. That's the ticket.

Good point! That may have been what they meant. Of course, since we're talking about Houston FD EMS, anything is possible. When your paramedic school is a whole 10 weeks long, you're likely to see anything happen.

They are NOT prohibited or suspicious by TSA regulations. There is no reason you would not be able to carry them. I will, however, second the lack of confidence in the TSA and their ability to even observe their own regulations. Flying from Minnesota to Japan, they took my toenail clippers, but the non-US citizen next to me was allowed to keep her six 12 inch long knitting needles. Go figure.

Baylor study doubts neck brace standard In some cases, device might hurt accident victims By TODD ACKERMAN Copyright 2010 Houston Chronicle Jan. 23, 2010, 10:48AM Applying a brace to the neck of a trauma patient, standard procedure for many decades, can worsen the injury and lead to severe paralysis or death, according to a new study by Houston researchers. Baylor College of Medicine doctors used cadavers to confirm that so-called cervical collars can be counterproductive, a finding that could upturn the way emergency medical personnel and doctors act to stabilize and protect the upper spine in potentially fatal neck injuries, such as those that commonly occur in bad automobile accidents. "This study is a proof of concept that in cases of severely unstable neck injuries, cervical collars are not only not helpful, but harmful in many situations," said Dr. Peleg Ben-Galim, a professor of orthopedic surgery and the study's lead author. "More research needs to be done, but it might be that we can prevent some of the deaths and quadriplegia that occur in these injuries." The study appeared this week in the Journal of Trauma. Dr. David Persse, medical director of Houston's Emergency Management Services, called the study "compelling" and "concerning" and said it will come up for discussion at the annual meeting of the nation's 30 largest EMS departments in Dallas next month. But he also said he doesn't want to overreact. "We need to look at this thoughtfully before we change the standard of care," said Persse. "It concerned a particular kind of injury. It may apply to other injuries as well, but we don't know that yet." But Persse added that he understands the need to act quickly, that "it's not like a lot of areas where there's not as serious downside to waiting for the next study." Car-crash victims Ben-Galim said cervical spine injuries are found in the autopsies of up to 94 percent of people who die in car crashes, which claim about 44,000 U.S. lives annually. There are about 11,000 people annually who survive spinal cord injuries. There is no obvious alternative to cervical collars, though hospitals often place sandbags under the back of the patient's head and, less commonly, some EMS teams at the scene of the crash wedge the head of the patient between foam bolsters on the backboard. The injuries in question involve the area where the brain connects to the spinal cord. Doctors treating such injuries work to stabilize the ligaments, muscle and bone to prevent secondary injury and to protect the brain stem and cord. Baylor researchers undertook the study after a case in which a broken jaw precluded the use of a cervical collar on the survivor of a car wreck brought to Ben Taub. When the doctors started to put a collar on the patient, fluoroscopy showed two of the patient's vertebrae separate, causing doctors to immediately remove the collar. The treated patient ultimately walked out of the hospital on his own. Ben-Galim noted that there are other such case histories in medical literature. To study the phenomenon, Baylor researchers made an incision in cadaver neck ligaments based on patient X-rays, then simulated clinical scenarios by applying cervical collars and putting the bodies in ambulances and driving a distance. In all of the cadavers, imaging technologies found that the collar increased the rupture. In effect, the collars pushed the head away from the shoulders, Ben-Galim said. He said the rupture stretching occurs because of both the application of the collars and their continued use. One national expert called the study interesting but said he wasn't sure it would one day change the standard of care. "There are certain cases, like the ones in this study, that can be dangerous, but they're rare - most people who suffer high neck injuries die immediately," said Dr. Tom Scaletta, the past president of the American Academy of Emergency Medicine. "I think the study's importance will be to raise awareness about the special care that must be taken - preserving patients' normal head position, making sure they're not having difficulty breathing." Anecdotal cases Dr. Walter Lowe, director of the Memorial Hermann Sports Medicine Institute and team physician for the Houston Texans football team, said the study wouldn't change the care of injured football players removed from the field in collars and on stretchers because those injuries tend to involve lower areas of the spine. Ben-Galim said that since the study was undertaken, Ben Taub doctors have saved patients with severe neck injuries by loosening or removing cervical collars early and rushing them to the operating room, but he acknowledged such cases are anecdotal. He said the research team looked at 400 articles and found no scientific evidence that cervical collars can stabilize severely unstabilized spine injuries. I found this quote interesting: Is this really less common these days? I've been out of the street medicine field for awhile, so it's an honest question.

I often honestly wonder if they're even practising chest auscultation in EMT class anymore. It used to be that a new grad EMT could be reasonably relied upon to at least identify and interpret the basics, such as rales, rhonci, and wheezes. It seems to be extremely rare to find this anymore. But boy, they can sure regurgitate the theoretical criteria for busting out the EpiPen.

Yep. Think about it. Most of the true abusers we currently get are at least honest about it. They're standing on the corner with their bags packed and ready to go, in no obvious distress and simply say they need to go to the hospital. Changing the rules on them will only change their tactics, and they're going to have to resort to dramatic theatrics to get what they want/need. Consequently, we are going to have to spend more time and money on assessing them than we currently spend just transporting them. I'd rather the game at least remain honest.

Agreed. And sorry for the confusion. I was referring to the idea of extending the recert from 3 to 5 years for working personnel, not to the method of recert.

Well, since we can't neg-tag the nurse in the story, I suppose that is the next best thing, eh?

Ummm... and? How long did it take to get to the burn unit by ground? That is not an insignificant detail.

Exactly. Cops do not dictate my practice. And if they are taking control of the patient, then they need to actually do so. Cop fail for not doing it. Volly fail for allowing it.

Heh... that's the first thing I noticed too. This isn't a new problem for her. Too bad they didn't earn a Darwin Award, like the other bimbo who tried to break into the EMS station after placing a fake call, and got caught under the automatic door closer.

Meh... I think it's obvious who the troll is that is neg-tagging CrapMagnet. I am unconcerned.

I found this quote particularly interesting: WTF!?! They've had time to consult their union attorneys and serve a full 30-day suspension, but they haven't even been interviewed yet? That's total bullshyte. FDNY EMS should be completely disbanded this very moment. Obviously, they have totally FAILED to thrive as a professional organisation. The NYS DoH only proves themselves to be complete idiots for even considering such a retarded programme.

Exactly. It's been happening for years. Although, I bet that it is much more common in the electronic age. In the pre-CBT days, recerts were done by mail, so a lot of people just submitted hard copies anyhow, even if not required. I usually did, and this prevented a lot of audits, I suspect. Don't feel picked on. It's just random.

Vollies kill another one... http://www.star-telegram.com/local/story/1914110.html Justin man dies after jumping from ambulance, officials say Posted Friday, Jan. 22, 2010 BY BILL MILLER wmiller@star-telegram.com A Justin man died late Thursday from injuries he received while jumping from an ambulance that was taking him to the hospital, according to reports. The 29-year-old man died at 11:12 p.m. at Texas Health Harris Methodist Hospital Fort Worth, the Tarrant County medical examiner reported. The Star-Telegram generally does not report the names of suicide victims. Denton County Sheriff's deputies were called at 9:17 p.m. Thursday to the man's home in Justin, said Tom Reedy, sheriff's spokesman. The man, reportedly gripped by anxiety, had cut himself in the chest with a butcher knife and was running down the street, Reedy said. The man's grandmother called his sister, who then called the sheriff's deputies, Reedy said. Deputies found the man and then put him into an ambulance from the Justin Volunteer Fire Department, Reedy said. He was compliant and alert as he communicated with deputies, Reedy said. He said medics were taking the man to Texas Health Presbyterian Hospital in Denton to be treated for the cuts and to evaluate his mental health, Reedy said. The ambulance traveled about half way on the 20-mile trip to Denton, Reedy said. But, while a medic was communicating with people at the hospital, the man "unbuckled the belts holding him to gurney, opened the door, stepped on the back bumper and jumped out," Reedy said. That happened on Farm Road 407 near the overpass for Interstate 35W, about 11 miles southwest of Denton. The man, Reedy added, suffered severe head injuries. He was taken by helicopter ambulance to Harris in Fort Worth, but he could not be saved, Reedy said.