Dustdevil

I wouldn't let anybody from Harris hear you say that. :?

I'm completely with you, Asys. There are two very significant misconceptions that lay providers tend to take away from CPR classes. First, that CPR is for heart attacks, and second -- and more frightening -- is that heart attacks are the only thing CPR is for. Unfortunately, the structure of CPR education, having been developed by the American HEART Association, leads students directly to both conclusions by the way it is presented. What is the first hour of a CPR class? Talk about heart attacks. So it is really no wonder that people get this mistaken impression. Of course, good luck talking the AHA into changing the focus. They have their agenda, and they intend to pursue it. Anytime I teach CPR, I make a very clear point to the students that this is NOT about heart attacks, and all the bull$hit they just heard about heart attacks has nothing to do with the CPR they are about to learn. I make sure they understand that CPR is for any person they ever encounter who has no pulse or respirations, regardless of what caused it, so long as they are not stiff and they still have a head. Then I reinforce it by giving them a patient "scenario" each time they practice. And those scenarios will be electrocution, drowning, shooting, MVA, snakebite, fall, allergic reaction, etc... The one scenario I do NOT give them is a heart attack so they will begin to think beyond the film example. I agree, the silly way that CPR classes are currently structured leads to both inappropriate use of CPR on heart attack victims, as well as underuse of CPR on non heart attack victims. It takes about five minutes to fix that problem in a CPR course, but I know of very, very few instructors who do it. And since less than one percent of CPR instructors nationwide are professional rescuers, most don't even know the problem exists.

Ah, thanks! Now we're talking! What do you pad with? Where does the padding go? Under the webbing? The only place I have found void padding to be of significant value is inside the ambulance. If they aren't being driven around, then lateral movement isn't usually a significant problem. Therefore, simply padding between the hips and the cot siderails has proven sufficient to maintain spinal alignment. Once we're at the ER, it's no longer a big issue.

It is very definitely not a job for somebody with no experience. Without a solid foundation of street medicine, you won't have the skills necessary to competently assess your patients. It's more of a job for burnouts and those who just want to give their back and psyche a rest. If you go in there with no experience, you are doing your employer and your patients a grave disservice. But, unfortunately, that happens a lot around here. Six Flags, Hurricane Harbour and the other water parks, and the stadiums tend to hire wannabe's with little or no experience because those with experience either want to be on the streets or want completely out. And, of course, there is the politics of those already working there giving jobs only to their loser friends who also can't get a real EMS job, compounding the problem. Any parks like that in Calgary?

Richard, do you by chance mean US Air 5050, the 737 that went into the East River? I got a piece of that action. Last plane crash I ever worked.

I've worked a baseball stadium and several kids camps, which is pretty much the same atmosphere as an amusement park. I hope you are paired with a competent nurse, because ninety percent of what you will face is nothing an EMT-B has the slightest clue about handling. It's fun though! I'd rather do it than working the streets.

I remain sceptical about the magical powers of this webbing to hold a patient immobile. I suppose if your patient is a wide load whose body spans the width of the board, then yes, if you turn the board on its side she probably won't shift too much. But to "immobilize" a smaller patient to that board so securely to the board that she would not slide laterally would require binding her entirely too tight for my professional comfort. I repeat my concern that binding people this tightly is contraindicated by the simple laws of physics. Simply laying them on a board at all has come under serious medical question of late. That's why the Nexus, Maine, and Canadian spinal protocols are quickly becoming a standard of practise. So I fail to see how binding our patients even tighter to the board improves their condition. All this webbing is great for temporary use during a vertical rescue or similar situation. But to routinely use this in a misguided attempt to "immobilize" the patient during transport seems short-sighted and very poorly thought out.

Good! Then you obviously got more out of the class than your friend did, lol. Don't worry about silly theoretical legal what-ifs. Just do the right thing. :wink:

Some might say that any patient reeking of chemicals is hot until proven otherwise. Can't say I necessarily disagree with that policy. Hell, I've heard of medics refusing to work on MVA victims just because they had air-bag talcum on them.

Wow. Tough crowd tonight! :shock:

Is the patient on fire, or what? :? Seems like every text I have seen in years very clearly says "dry sterile dressings." If you have an isolated, minor burn area, then cooling is a valid option. However, removing cream would not be part of the plan. However, when you describe "a good portion of his body" being burned, attempts to cool the patient are likely to result in profound hypothermia. Not a good idea. Morphine would be a much better plan.

That is where I was going with this. Cardiac arrest is not analogous to psychogenic or vasovagal hypotension. They are very different situations. Yes, Trendelenberg is, in my experience, beneficial to the faint patient. And it stands to reason, given the physiology. However, it is also just as likely that the victim feeling better has nothing to do with the position, and he was simply coming out of it on his own, regardless of position. I have seen no study which establishes a proven cause/effect relationship.

Sure, if you learn from taking the exam you don't like it. But it doesn't happen that way. And finding out you don't like it is the best thing that could happen to you. The worst thing is to find out that you DO like it, do it til you're fifty years old, and then realize you have nothing to show for that time except a bad back, high blood pressure, a fat ass, and massive debt. You won't be able to afford a vacation, a new car, or college for your kids. And you have nothing but a certificate for 136 hours of night school to show for it all. Now what job are you going to get? I know you're gonna do what you wanna do. The lure of the siren is quite seductive. But she is a fickle bitch that will spit you out in a few years wishing you had never met her. It won't be a fond memory you are glad you have. It will be five or ten years you really wish you hadn't wasted. And I take great pleasure in saying, "I told you so!" :wink:

Wow, what a great story! Thanks for posting that here! Cross country trips in a fire truck are definitely interesting. I got to pick up our new Wheeled Coach ambo in Florida once and drive it back to Texas. Got to pick up an E-One pumper in Ocala and bring it back too. Good times! Some friends from the nearby town of White Settlement, Texas drove their E-One quint back to Texas from Florida. They said it was very uncomfortable in many small Southern towns as the locals would stare at them menacingly because of the words "WHITE SETTLEMENT" in three foot letters on their ladder boom.

I'll be there. I plan on getting married there. Anybody else going to get married at the EMS Expo in Vegas this September? Maybe we can get a package deal. Can I say "package" here?

Yes, exactly. Nothing personal against you, Ghost. I know nothing about you. It's just that particular description of the patient and event was so bizarre and confusing that I couldn't get past it to consider the rest of the statement. Not that I am above making bizarre and confusing statements myself.

Nope. Life experience and maturity are definite assets in this business. Although, I would certainly never suggest that being 35 means you are necessarily mature. I'm just giving you the benefit of the doubt. Unless you are physically worn out from age or a life full of personal trauma, then no, your age is not a bad thing at all. Probably. You're going to spend less than ten years in the field. You are barely going to make a living in that time. You're going to burn out both on the horrible conditions and the horrible pay. Then you are going to get out at age 45 with nothing in the bank and no marketable education. Then what? So no, you're not too old. But yeah, you're wasting your time. It's retarded.

If it takes anything more than that to make an impact on somebody, they are beyond help. Execute drunk drivers. First offense. No mercy.

Of course we know that now, but we didn't know that when the run was dispatched. The run was an unconscious child and should have been dispatched ALS. If you are looking for true "stay and play" scenarios for the basic, you had better limit it to uncomplicated extremity injuries that require splinting. There really is no other patient I can think of that a basic can justify spending any time on the scene with. If I were your instructor, I would be very pleased if you were to recognize that, and very disappointed if you didn't.

Absolutely! They should have about ten times as much time on an ambulance as they currently get in lecture, for that matter! I'm just saying that to say there is a big difference between a school that sends their kids on a handful of rideouts and one that doesn't is silly. Go big or go home, is what I'm saying.

You're kidding yourself if you think that is even possible, no matter how "careful" you are. :roll: If you are concerned about being careful, use a KED.

So, what you are offering is empirical evidence that talking about a stressful event is cathartic. That's not earthshaking news. But you don't have to go to CISM to talk something out, as all the CISM weenies would have you believe. Where is your evidence that they wouldn't have been just as well off talking to any other medic? Where is your evidence that they would not have been better off talking to a mental health professional instead of you? It's a good thing you don't need proof, because you wouldn't find any. Beating the CISM drum and recommending it to everybody is tantamount to forcing it. You are promoting it as a standard of care. You're saying, "Hey, all the cool kids are doing it! You need to do it too!" You're promoting results that you have zero valid clinical evidence to support. You are endorsing it as both safe and effective. There is scientifically validated evidence showing that it is neither safe nor effective. And anywhere that standards are maintained based upon current evidence, it is not a standard of care. In fact, it is contraindicated. It is, at best, a stupid idea. But continuing to endorse it after being disproven is worse than stupid. It's fraud.

I define "good" by improved survival rates. So far, Autopulse has failed at that. Pink cadavers aren't worth $15k.

I'm confused. You call the first one a "stay and play?" What can you possibly do for this kid? :shock: And why would the second scenario be "load and go?" Why would it be a candidate for aeromedical evac? :? And why would a basic be sent on either one of these runs? When it comes right down to it, all runs are "load and go" when you're on a basic ambo.

Meh... even those basic programs that do give you ride time give you so little that it really isn't of any significant value to you. Unless the the EMT basic program is significantly expanded, both classroom and clinical, then it is really a joke to quibble over a couple of rideouts. What is the difference between a basic with four ambo shifts and one without? Four ambo shifts. Big deal. :roll: I'd much rather have a student who soaked up his lecture and lab like a sponge than one who had a month of rideouts. I can teach any partner to take a BP and make-up a cot in one shift. But I can't teach him all the stuff he should have learned in lecture and lab. I've said it once, and I'll say it again. Experience is extremely overrated. In fact, it's a joke.