Bieber

Um, not to be a dick, but dude, let me point out two things: And then: And again: So, if you don't know the data, how in the world are you coming to the conclusion that EMS personnel are not over-represented or that we don't account for a higher rate of accidents? Just "because"? http://www.emsworld....mbulance-safety So, the root cause is that it's not as difficult to get a driver's license in the U.S. than it is elsewhere. How is it more difficult? Are they expected to have more experience driving? Do they have to take more driving classes? Does that additional training they get include defensive driving? It's no surprise that with a lack of training in emergency driving ambulances get into wrecks, but at the same time, the lack of emergent driver training isn't the root cause? Uh, what? Like I said, man, not trying to be a dick, but you're contradicting yourself and saying you don't know the data, but at the same time refute that data you've never looked at.

That's amazing, and proof that there's nothing inherent about our job that says that we have to suffer any of our own to die in an automobile accident. What's goin' on in the up in here?! vs Hello, love, how are you this evening? That's all right, you don't need to go to the hospital. I'll pick the one that's safest for everyone involved every time.

The papoose? I haven't heard of that before. I'll have to check it out! That's a great point that I hadn't even considered, and an important one at that. Are there any particular techniques in general (aside from the usual) that you use to help comfort kids or to facilitate IV access?

Life really is chock full of irony, Asys. Kiwi, you know, I think you're on base with regards to the US having some of the lowest drivers and safety standards (in practice if not on paper). You still have ambulance envy hardcore, but I'd be willing to bet that a smaller percentage of Kiwimedics are killed each year than red white and blue medics are.

Does anyone have any experience using diphenhydramine for nausea? That's literally the only thing I have on the truck right now, though I'll have to call for orders to use it for that...

Thanks for all the replies so far, guys. I think the pedi-mates are what we're getting. How do you guys like them? Are they pretty easy/simple to use? Do you use them on critical pediatric patients as well or does that ever get forgotten in the heat of patient care? Arctickat, where do you guys keep your car seats? In one of the outside compartments? I had a look at that link you posted, looks like a pretty secure spinal immobilization device. What do you use to immobilize infants currently? Croaker, you said you preferred to use a car seat strapped to the cot, any particular reason why?

So Dwayne mentioned something in another post that got me thinking. This was his quote: So, let's talk about it. I know we don't deal with a lot of pediatric patients, but it happens and it seems like, especially for the itty bitty ones, restraining them safely can be a delicate task. I know that our captain chair has a fold down child restraint harness, but what about infants? What are the policies/equipment your service uses to ensure that infants are safely secured during transport, or do you have such policies in place? I would have to look, but to be honest I'm not sure that we actually do have a policy set in stone regarding this. My last pediatric call was a four month old with a fever, and as we picked him up while the mother was headed to the hospital herself (she stopped because she heard him gasping and was concerned) she had the car seat ready to go. Luckily, the mother was able to help guide me through securing it to the stretcher (it was a reverse facing car seat and I was a bit lost trying to find a spot on the back to loop the belts through, not knowing that the hooks were on the sides of the seat), but I know that there may not always be a car seat available to me. So, what do you do in such situations? Do you have any special equipment that you carry on the truck (infant restraint systems, car seats, etc)? Or do you sit mom or dad on the cot and have them hold onto baby? What about critical infant calls where you have a lot of work to do? Do you throw them on the stretcher and hope for the best? I think we are supposed to be getting specialized infant restraint somethingorothers that attach to the cot and have child/infant-sized belts, but they're not out yet.

Myself and about ten other new orientees divided up about four hours of time and two ambulances between the lot of us to drive around a big parking lot as our drivers training. And I had to give them a copy of my license. We've changed our hiring process a lot since then, and we're continuing to change it with the implementation of our FTO program. But I was honestly given very little service-specific training and direction before I was put out on the streets to work with medics who more often than not either complained that I wasn't going fast enough or yelled at me to slow down, regardless of my comfort level. Infrequently I got constructive criticism and advice, but most of the time it was my partners being frustrated with the new guy. Once I went full time and got a regular partner, things got better. Do I feel like I was ready to begin operating the largest vehicle I've ever driven before I started to work on one regularly? No. There were entire shifts where I took all of the calls (17, one night) just to avoid having to drive that beast. Even now I'm still nervous about driving it in the snow and ice. Our training process has come leaps and bounds since then, but I can't say that I felt prepared for the job when I started working.

Like many things in EMS, I think that the flaw here has a lot to do with our over the top, adrenaline-fueled, chaotic response to the very emergencies we're supposed to be bringing order to. Really, there's no need to drive like a bat out of hell. There's a very small number of conditions that are time sensitive, and only one that I can think of where that extra minute saved literally makes all the difference (cardiac arrest). We need to slow down, take our time, get to our patients safely and efficiently. And while we're at it, once we get there, we need to again take our time, provide what treatments we can in a meticulous, competent and thorough manner. I've never heard of high stress situations enhancing a person's concentration; all we do by working ourselves up is produce sloppy results. Slow is smooth; smooth is fast.

Your post was kind of confusing, but I'm guessing you were asking how we keep infants warm? We pretty much just use blankets, though I wouldn't be opposed to the idea of putting some warm IV bags around it as well.

We were carrying metoclopramide, but with the drug shortages a lot of trucks have run out--including my own. Our new protocols include ondansetron, but those aren't coming out till August (supposedly).

I'd like to get a more in depth history if I could. Was this the patient's first time doing that kind of work, or is he regularly exposed to those same conditions? If not, a diagnosis of hantavirus is unlikely, given the rapidity of onset. Any trauma associated or past medical history? Any significant family history? Meds? Known allergies? He's tachycardic, so my suspicion for cholinergic exposure is low. Let's give him some supplemental oxygen to help decrease his tachypnea and dyspnea, establish a second IV site if we don't already have one, and get him to a facility with a pediatric ICU. Aside from that, it's going to be mostly supportive care. Number one on my list of differentials is a hypersensitivity reaction following mold/dust exposure.

We do the same thing as Nypamedic here too. And you're right, Kiwi, that you never know when you'll need it and that it can be a hassle getting narcs on scene when you need them. That extra work is just one of those excuses people use to not treat pain on scene (or at all).

Really? Care to share it with the rest of us? =)

For your viewing pleasure! http://circ.ahajourn...064873.abstract While the science does in fact change constantly, that's part of the beauty and greatness of medicine--we're dynamic. It's not a sign of weakness in previous studies if something new comes out that refutes a previous change, but a strength of our deductive skills to learn from what we thought we knew and to adapt our practice. Ultimately, the science of resuscitation is probably going to be an amalgamation of a multitude of different practices which individually or in a certain combination with other treatments may not produce great results, but which, when worked together in just the right way, gives us the very best chance for positive outcomes with our patients. But if there are studies which say that patients aren't, in fact, served well by intubation, can we really say that it is effective? I'm not arguing that there isn't a place for intubation in EMS, I just don't think that, typically, it is what we need to be focused on while treating patients of cardiac arrest. In the post-arrest period, sure, there may be a role for it, as well as in other conditions, but the only two things that have been definitely proven to make a difference in cardiac arrest are CPR and defibrillation. This. But the question remains, when there's so much risk to interrupting CPR to place a tube and so little evidence suggesting it provides any benefit in patients who are in active arrest, should we even be attempting to get one in? Even if we're confident that we can do so without interrupting CPR? Addendum: Also, insert something here about the associated problems regarding high flow oxygen and ischemic tissue.

Oh, to have lactate meters here. I know there's a service up north that's started carrying them, primarily for sepsis patients.

Ha!

In my limited experience, the two most common things I've seen in patients in shock are pallor, diaphoresis and tachycardia. I'm not sure what I would say is the least reliable indicator of shock though, honestly. Maybe tachycardia, but that's mostly because the heart rate seems to vary so much from person to person and there are so many extrinsic and intrinsic factors that can alter it. No clue if my experience is at all representative of shock patients as a whole, but from my limited window of experience, that's what I've seen.

Keeping entertained on a call isn't often an issue for me. I rotate between a busy urban station next to one of our hospitals and a slower one in one of the towns out in the county--and even my more rural post is only about a twenty minute drive to the nearest hospital. Occasionally we'll get a long distance call where there's nothing to do and I'll just work on paperwork on the way. That or talk to the patient and chat it up with them.

Haven't read anything from the AHA about it, but a couple of weeks ago our medical director put out a memo stating we no longer needed to confirm asystole in multiple leads. They reprogrammed all of our monitors to go immediately to the paddle view upon being turned on too.

Admittedly, I have a bad habit of wanting to barrel headfirst through whatever obstacles are in my way instead of the more tactful, patient route. Yeah, I'm starting to see that now. And you're right, I think I did think that just getting on the committee was the hard part. Now I'm definitely seeing the real challenge of it. Thanks for the kind words, Dwayne, though you might have some rose colored lenses! You're right, though, that the change I'm trying to push for is already--at least in part--being accomplished by others in the system. And I think I could learn a lot by trying to examine the way they present their ideas in a way that results in more success than my "bull in a coffee shop" method. Hey, AK, how about some lessons for the Bieb? As always, Dwayne, you're a constant source of inspiration for me. I'll think about what you said, and keep fighting for what I believe in, though I'll definitely reconsider my tactics...

Haha, we can hope, Arctickat. I don't know about your service, but where I work there are a lot of very aggressive medics who seem to think they're a lot tougher than what they probably are in actuality.

Wow, AK, that sounds like a serious gamble that really paid off. I assume this is a private EMS service you run? Where can I sign up? Haha. The profit sharing sounds like a great way to boost morale.

That's a good point to make, Asys, with regards to what police considers safe versus what EMS considers safe. Not that the police are invincible with their guns and vests--far from it--but they definitely have an advantage over a stethoscope wielding, non-vested EMT or paramedic, not to mention all of the vast amounts of training that they have in mitigating violent situations.

Thanks for sharing this with us, Steve, and thanks again to Dwayne for kicking some sense into me. Does anyone know how much (if at all) the shock index is used in their local ER's and hospitals? I'll try to remember to ask about it when I go back to work after my vacation, next time we're up at the hospitals. Ultimately, like you said, Steve, there's no single diagnostic test or assessment that can give us the full picture when it comes to assessing our patients. Utilizing as many tools as we have available to us to try and paint a picture of what's going on is only going to benefit us, so long as the science is strong.