Dustdevil

PRPG, you can't be serious. You don't think I can tell from being in refresher class with them for a month how inadequate EMT's are? You don't think I can get a hint at their inadequacy from reading their posts here? Funny, you think you can judge me by my posts yet you don't think I can judge others? That's a little double-standardish, isn't it? Don't forget, your textbooks were written by people who have been out of the field longer than I have. You can stay very well informed and abreast of the world around you without getting your hands dirty. In fact, I find that most of the things that you and others tell me have drastically changed in the last ten years are usually BS.

I made plenty of mistakes as a B. And that is exactly how I know how inadequate they are. Get a clue. :roll:

Therein lies the problem. She's not there to do things for me. She's there to do things for the patient. I don't want a helper. I want a full partner capable of providing the same care for our patients as me. If I have to supervise and give orders to my partner just to get things done, that distracts from my patient care. Anything that distracts from patient care is unacceptable. Partnering a B with a medic is like putting nurses aides in the ER instead of RN's. The doctor ends up doing all the work.

Really? Interesting. I thought I made it perfectly clear. They lack the educational and technical sophistication necessary to safely practice alone. And -- as stated by many people here -- practicing with a medic partner, they become little more than a driver because they can handle only a very few patients. What part are you having trouble understanding? In 911 ambulance EMS, yes. However, B's are qualified for first response.

I'd love to! It sure isn't that way here. Doesn't look like it will happen in my lifetime either.

You can do that? Sweet!

Eh... don't get me started. Basics have no business working on an emergency ambulance. Period.

I understood him to be saying that they did NOT "make it so this guy doesn't go home a paraplegic," which would be consistent with the outcome, albeit a bit confusing.

That's the same nonsense they tried to pull in the study that showed you were statistically more likely to die if you arrived at the ER by ambulance than by POV. No $hit, Sherlock! I wouldn't have called an ambulance if I wasn't pretty damn sick! Another case of faulty extrapolation. When studies go bad. :roll:

Anybody seen one of the new Zoll E Series yet? Maybe it's better than the M. And according to the website, the E series is the blue and white one, not the M series. Ruggedness is what they are pushing as the big selling point for the E series. It still has that flimsy, pivoting plastic handle though. But at least it's on the bottom now instead of the top, which was exceptionally silly. The LP12 just has too many damn controls and gadgets on it. Too cluttered. Too big. Too heavy. Besides 12 lead capability and a bigger viewing screen, the 12 doesn't offer me anything useful that I didn't have with the LP10.

Textbook answer is maintain manual stabilization, utilizing towels/blankets/sheets or other adjnucts as appropriate. Real world answer is, "who cares?"

Hmmm... Okay, so I played with a Zoll M in class today. I like several things about it. Of course I LOVE the size of it! The friggin LP12 is definitely a boat anchor. And I love the logical layout of the controls on the Zoll. And I especially love that it is biphasic. Dislikes? The screwy accordion fold paper and tray. And it sure doesn't hold much of it. I can see having to put more paper in it during almost every code. And having to take my gloves off to do it. Also, it seems a little flimsy. Anybody had problems with the handle breaking off? I'll spend more time with it this coming week and check out the 12 lead features, etc... There is plenty to dislike about the LP12 too, so I could actually come to prefer the Zoll pretty easily.

Neo-Synephrine? Wow. That's one I haven't seen in quite awhile. What is it generally used for, spinal shock?

In other words, you preferred to be baffled with mass quantities of BS than to be dazzled by brilliance. Lists of studies which do NOT back up your point look awful impressive if you are playing a numbers game. But the point is quality, not quantity. And no studies can be found which scientifically conclude that field clearance safely eliminates unnecessary immobilization AND assures that no spinal injuries are not immobilized. In fact, none of them even attempt to conclude that. That's the problem.

You guys have absolutely got to be kidding me. Not being clear? I could not possibly make it any simpler. If you continue to completely misunderstand my views after restating them in three different ways, it is clearly a comprehension problem on your end. Or else you are intentionally misrepresenting my views for the sake of debate. Either way, I'm out. I find myself not even debating the issue, but simply spending my entire time correcting what you say I said. If I wanted to teach elementary English, I would have gone to school for that. This whole argument is retarded. You aren't even debating the points I made, dg. You're simply skirting the issues with diversions. Sounds kinda like this: Me: My cat has fleas. You: Well my poodle doesn't have fleas, so you're stupid for saying all dogs suck! It is a complete non-sequitor. As for the board being used for immobilization as opposed to extrication, I have already addressed that when it came up in previous discussion. I agree that the board is not necessary for immobilization and should be avoided. I am a proponent of dumping the patient onto the hospital gurney and taking my board with me. I don't care how they are immobilized, so long as it gets done. But the board is still required for extrication in most cases. My argument is not defending the practice of leaving patients on boards for long periods. My argument is merely defending the practice of initial immobilization. If the ER doc decides the patient needs to immediately come off the board, great. I have no problem with that. But in order to get the patient safely onto and off of my cot, they need to be on it.

I am trying to put together a comprehensive reference list of medications currently carried by EMS systems, both ground and air (not in hospital). If your service, or a service you know of, is currently carrying anything not on this list, please post it. And please, I am not looking for debate on what should or should not be here unless you have verifiable proof of a specific drug being pulled from the market altogether. I am neither advocating nor criticizing anything on the list. This is not my personal dream list. This is simply a list of what is being carried out there. Sort of an exhaustive reference list of all the drugs that a medic may encounter somewhere in the field. Thanks for your help! This list will be updated as your responses are added. Abciximab (Reo Pro) Acetazolamide (Diamox) Acetylcysteine (Mucomyst) Activated Charcoal (Actachar) Adenosine (Adenocard) Albuterol (Proventil, Ventolin, salbutamol) Aminophylline Amiodarone (Cordarone) Amrinone (Inocor) Amyl Nitrite Aspirin Atropine Sulfate Bretylium (Bretylol) Calcium Chloride Calcium Gluconate Carboprost Tromethamine (Hemabate) Cefazolin (Ancef) Ceftriaxone (Rocephin) Dexamethasone (Decadron, Hexadrol) Dextrose 50% Diazepam (Valium) Digoxin (Lanoxin) Diltiazem (Cardizem) Diphenhydramine (Benadryl) Dobutamine (Dobutrex) Dopamine (Intropin) Enoxaparin (Lovenox) Epinephrine (adrenaline, Vaponefrin) Eptifibatide (Integrilin) Ergonovine (Ergotrate) Esmolol (Brevibloc) Etomidate (Amidate) Fentanyl (Sublimaze) Flumazenil (Romazicon, Mazicon) Fomepizol (Antizol) Fosphenytoin (Cerebyx) Furosemide (Lasix) Glucagon Haloperidol (Haldol) Heparin Hydralazine (Apresoline) Hydrocortisone (Solu Cortef) Hydromorphone (Dilaudid) Hydroxyzine (Vistaril) Insulin Ipatropium (Atrovent) Ipatropium/Fenoterol (Duovent) Ipatropium/Albuterol (Combivent) Isoproterenol (Isuprel) Ketamine (Ketalar) Ketorolac (Toradol) Labetalol (Trandate, Normodyne) Levalbuterol (Xopenex) Lidocaine (xylocaine) Lorazepam (Ativan) Magnesium Sulfate Mannitol (Osmotrol) Meperidine (Demerol) Methylprednisolone (Solu Medrol) Metoprolol (Lopressor) Midazolam (Versed) Morphine Sulfate Nalbuphine (Nubain) Naloxone (Narcan) Nifedipine (Procardia) Nitroglycerine (NitroStat tablets, Nitrobid paste, Nitrolingual spray) Nitroprusside (Nipride) Nitrous Oxide (Nitronox) Norepinephrine (Levophed, levarterenol) Ondansetron (Zofran) Oxygen Oxytocin (Pitocin) Pancuronium (Pavulon) Phenobarbital Phenylephrine (NeoSynephrine) Phenytoin (Dilantin) Potassium Chloride Pralidoxime (Protopam, 2-Pam) Procainamide (Pronestyl) Prochlorperazine (Compazine, Stemitil) Promethazine (Phenergan) Proparacaine (Alcaine, Opthaine) Propofol (Diprivan) Propranolol (Inderal) Reteplase (Retavase) Rocurnium (Zemuron) Sodium Bicarbonate Sodium Thiosulfate Succinylcholine (Anectine) Terbutaline (Brethine, Bricanyl) Thiamine (vitamin B1) Tirofiban (Aggrastat) TNK (Tenecteplase) Vasopressin (Pitressin) Vecuronium (Norcuron) Verapamil (Isoptin, Calan)

This same thing happens everytime we have this discussion. Somebody accuses me of clinging to "cookbook" practice of spineboarding everybody. Any intelligent person who has read what I have written and still makes that accusation is being intentionally dishonest, because there is no way that could be inferred from my writings. I have NEVER said anywhere that I thought everybody in an accident ought to be boarded. In fact, I am on record multiple times -- even in this very thread -- agreeing that too many patients are boarded and that an appropriate limiting protocol should be developed. For the slow people out there, let me make this clear again: Although seeking to limit unnecessary spinal immobilization procedures is certainly a worthwhile goal that I fully support, NONE OF THE CURRENT PROTOCOLS, NOR THE SO-CALLED STUDIES SUPPORTING THOSE PROTOCOLS, ARE SAFE FOR EXTRAPOLATION TO FIELD USE. Read them. They were not even developed for field use. They are for hospital practice. Give me a protocol that is validated in the field and takes into account the differences between field and clinical practice, and does not completely discount asymptomatic spinal injuries as "insignificant" and I will readily embrace it. Having a healthy index of suspicion for spinal injury after seeing a significant MOI on scene is not cookbook medicine. It is using your head. If somebody takes a significant hit to the right upper quadrant, don't you suspect a liver injury? Do you need a protocol to tell you that this is a very real possibility? Of course not. It's common sense. I'll tell you what cookbook medicine is. It is asking five questions and then determining that your patient's chances of a spinal injury are insignificant without taking other factors into consideration. THAT, my friends, is cookbook medicine! If you haven't seen an accident victim with an asymptomatic (on scene) spinal injury, then you simply haven't been in the field long enough. Or else you don't have adequate followup with your patients. It happens. It happens all the time. NONE of the current spinal clearance protocols address those patients. If the ER docs want to kill those patients at the hospital just to show everybody how they can follow a five question protocol without using their intelligence, then good for them. That's their business. That's their insurance. That's their license. As for myself, I am looking for some scientific validation of my practice which shows it to be in the best interest of my patients. So far, we have not been given that. Oh, and by the way, where are all the studies that show us all these pressure ulcers that are allegedly occurring everywhere? Ha! Good luck finding that! You won't. Nuff said. More lies. The whole concept is smoke, mirrors, extrapolation and semantics. Not a lick of science involved. Screw that.

I'm open to new ways of looking at it. Yep. Wait til you get to the hospital and let them decide. Because they've had half an hour to calm down and actually start to feel where they hurt by then. In the first half hour after an accident, people simply don't feel everything yet. I have had several patients with c-spinal fractures who were ambulatory at the scene and denying any injury only to feel it later. You don't care about those patients?

Not even remotely analogous. Rubbers don't cause disease (unless you're allergic to latex, of course). However, the failure to immobilize somebody with a delicate spinal injury can cause catastrophic morbidity. Absolutely. And when we find it, I'm all for it. But I am not for practicing scientifically unsound theories on my patients in the meantime. Are you?

And that is the key phrase. Unfortunately, none of the protocols or associated studies have given us any conclusive information which safely makes that determination. Consequently, although spinal clearance is a nice theory for the future, it simply has not been perfected yet. Just like you would have to be a complete idiot to put an unproven experimental drug on your ambulance for haphazard use, you would also have to be a complete idiot to blindly follow any of the current spinal protocols. They are just theories. They have not been proven sound by the scientific evidence.

Exactly. The entire premise is absurd. Are we to stop performing all procedures that might cause the patient discomfort? Great! Our job just got a lot easier! You won't find a single study which points to the occurrence of pressure sores. Why not? Because they are about as real as the tooth fairy. It's BS. It doesn't happen. So to keep up their idiotic theory they have to change the language from "pressure ulcers" to "pain and discomfort." All these studies are interesting. Relevant? No. But interesting. Don't even get me started again on this nonsense. :roll:

I can't speak directly to the question asked. However, I can say that in the 48 hour basic refresher I just completed, HIPPA was not covered. Sure, the term came up frequently, just like it does here. But there was no formal coverage of the topic. The really sad thing is that I have found that most EMT's know more about HIPPA than they do about physiology. The system is broken. :roll:

Haha! It is unfortunate that you even have to say that. But with all the losers I see taking the test 4 to 6 times, a year after they finished school, you have to wonder if it might take some 20 years to get it done!

Yeah, I'm not sure it's even an incorporated town, lol. There is no town. No central intersection. Not even a Dairy Queen! They have schools out in the middle of nowhere. But that's what I love about it. It's beautiful!