Bieber

This right here says a lot to me, and is the reason why the Constitutional argument holds very little sway in my opinion. Ultimately, my opinion will depend on what the science says. Unfortunately, trying to conduct a study comparing the effects of gun ownership and gun violence is going to yield varying results, depending on the location, as so much of gun violence seems to be tied to culture. I know there are some countries with high gun ownership and low violence, and others with low gun ownership and low violence. Which one would hold true in America? No clue. I will say that I agree with the President when he says that assault weapons have no place in the hands of civilians. Sorry, guys, I just don't see where civilians need such high-powered war machines for their personal use. I would like to see less emotion, less hyperbole and more evidence-based, outcomes-oriented discussion among folks when it came to the gun-control debate. Judging from the media and Facebook, however, that may be too much to hope for. Asys, that post was so great that I think it just about sums up my views on the issue completely.

Step 1: Have a strong enough foundation in EMS and business management that you don't go to a random EMS forum searching for a step-by-step guide to opening up your own "ambulance transportation" business. Step 2: If you've completed step 1, no further assistance needed. Not to be a dick, man, but just consider for a moment what you're asking. You need to be intimately familiar with federal, state and local laws governing not only small businesses but also EMS agencies as well. You need to know how to acquire ambulances, how to meet federal and state requirements for ambulance maintenance standards, what equipment is required to be carried on the ambulances, how to actually go about getting the ambulances certified; what equipment you will stock and how to obtain it, the standards for that equipment set by the law; how to obtain staffing and how to hire someone legally, how to handle payroll, taxes, insurance (for personnel and for your equipment). And, most importantly, how to pay for it all. Nobody here could possibly hope to give you a step-by-step guide, and if you're asking for one that shows just how in over your head you are when it comes to starting your own EMS service. Sorry, man, again, not trying to bust your balls here, but like someone else said, unless you've got a lot of scrilla ($$) lying around somewhere, and a lot stronger of a foundation when it comes to this kind of thing, I'm afraid your dream is a lost cause. Go get some more EMS experience, and more importantly get some business education and experience. If you really want to make this a reality, that's the best thing you could do.

Hey everyone. We're starting to discuss community paramedicine and bringing it to my service. So in my over-eager attempt to try and become a part of one of what could be the greatest leaps in EMS since its inception, I'm working on getting enrolled in Hennepin Technical College's Community Paramedic program. I know that the whole concept of Community Paramedicine is still pretty new, but does anyone have any experience with community paramedicine? Either as a trained CP or as a program developer within your own service/agency? Thanks, -Bieber

This made me laugh just because we still use the tackle boxes at my service.

Hopefully less fire involvement, more emphasis on treatment and no transport, more evidence-based medicine, aligning ourselves more closely with primary care services, adding additional education, treatments and equipment for the management of primary care issues, field labs and imaging (ultrasound), the elimination of spineboards and the discontinuation of lights and sirens transport, Associates degree requirement for field work with additional Bachelors and Masters degree options for advanced practice, increased length of internship and education in general, decreased flight service use, increased scene times to spend on actually improving patient care, increased usage of safety features (non-modular vehicles, high-visibility paint and lighting schemes), increase in paramedics trained and able to serve as community practitioners to provide follow-up for non-transported patients, change in terminology from emergency medical services to mobile health services, decreased paramedic to population ratios, increased paramedic/EMT staffing models, decreased trauma activation services, elimination of protocols in favor of guidelines, elimination of online medical control (all standing orders) except for physician consultation, change in billing scheme from fee-for-transport to fee-for-service, increased provider-initiated refusal of transport, increased standards for practice. No more doing the same thing over and over and expecting the health of the community to get any better. At least, that's the future I would hope to see over the next 5-20 years.

I live! Busy, but alive.

Lol, thanks for saving me from having to make a post about this, Mike. It's true! Des had her first OB appointment today and we got our first look at the kiddo. She's going in on Friday to have a transvaginal ultrasound done so they can get a better look at it and determine the age/due date. =)

Like everyone said, in a situation where there are more patients than responders, spinal considerations go out the window. In a situation where it's just you and one patient, you might consider having the patient self-splint (i.e. "just stare straight forward and don't move, sir/ma'am"). People are not typically going to do things which cause pain or aggravate their injuries (I have yet to have to tell someone with a broken arm/leg to not to move their limb in such a way that worsens the fracture/creates other injuries).

Great information, man! What kind of medications and treatments are administered by EMTs in the Protection Civile? What about by your physicians? Do you operate under "protocols" or clinical guidelines? What is the education for EMTs and other healthcare providers like in France? Are you paid? Volunteer? If paid, how's the pay like? What is the career ladder like? You said there are no paramedics in France, so if an EMT wants to increase their clinical abilities, do they have to become nurses or physicians or what?

Best of luck to you in all your endeavors. Stay safe out there.

Stay and play?! What treachery is this? If patients could be competently managed on scene for extended periods of time by ambulance services... why that would mean that all of us blazing through the streets lights and sirens have been risking our lives for nothing! =) Bienvenue to the forum! I'd love to hear more about the French take on emergency medical/mobile health services. Tell us more about how you guys run your calls. What's your average scene time? What treatments do you provide on scene versus en route? Do you guys have mandatory scene times? What about for trauma calls? What is the criteria for lights and sirens use for you?

What's the benefit of this over medic-initiated STEMI alerts?

I've dealt with a number of hydrocephalic patients, though the only time it was ever for complications due to hydrocephaly was when I was still in school and a patient was having a shunt worked on.

Sequel, did you just give Haldol or Haldol + a benzodiazepine?

Before we do anything, what rhythm are we calling it? And explain your interpretation if you would.

Vagal maneuvers and fluid fail!

I did? My bad, rate's 280. You got your IV, you're pumpin' fluid in. Waiting for that to go. =)

In her chest. P - No worsening on palpation, hasn't moved from her seat since it started. Q - Like an elephant is sitting on her chest and a swarm of bees is flying around inside as well. R - None. S - 10/10 T - Constant and worsening for the last fifteen minutes. Shows a narrow complex tachycardia rate of 180 with normal axis deviation and no ST-elevation/depression, T-wave inversion or other conduction abnormalities. Took his Xanax about an hour ago, usual dose. None! None... so far! Pretty sure. =) Watching TV. No attacks for about the last week or so, but he states that his panic attacks have been getting worse over the last 3-4 months. Nada. Worsened panic attacks over the last few months, but none as bad as today. The wife insisted on calling today because she noticed a vessel in his neck "pounding". Nope! Yes. Relieved with time. Chest, yes, yes. Yes but not as severe though worsening over the last few months. Mucous membranes are pretty dry. No alcohol. Sitting watching TV. SpO2 is 98% on room air. What do you guys wanna do? What are we thinking so far?

Haha... wife looks normal. Not an obvious druggie or alcoholic, looks genuinely concerned, all of that good stuff. These folks are obviously upper middle-class. HR: 280 BP: 138/88 RR: 20 non-labored BGL: 78 Temp: 98.5 ADHD, anxiety. Xanax, Adderall.

Family called for the patient. About thirty seconds before you were dispatched. They've been feeling shitty for the last fifteen minutes. 10/10. Patient reports shortness of breath, lung sounds are clear bilaterally. Penicillin. A little cool, pale, clammy. Looks to be on the thin side. 140lbs, 5'10". Nothing that stands out.

You are working on a dual paramedic truck when you are dispatched to a patient complaining of anxiety. You are about 15 miles out from the nearest hospital in a suburban/semi-rural part of your response area. When you arrive on scene you are led inside a large, newer house to the living room where you find your patient, an approximately 35 year old man sitting on the couch appearing to be in moderate distress. Go.

I'm gonna guess probably not. It's not a real common thing around here so I know we don't, but I've never heard of any EMS services carrying antivenom. I think it's frequently EXTREMELY expensive... like tens of thousands of dollars per treatment... but I'm not that up to date on it. Hopefully someone else can come along with more knowledge on this subject than me.

Pay is a good incentive. =) Failing that, you could always pay for them to go to paramedic/nursing school so they could get paid for providing medical care. Although... That may be counter-productive... Don't know, man. I know I wouldn't devote a great deal of my time to this job if not for the pay. At least, not at the expense of other obligations that either put a roof over my head or keep me close to my loved ones.

Go ahead and throw away all of your spine boards, C-collars, and most of your oxygen cylinders... =D Haha, jk (you know, unless your service is cool with that, in which case you should without a doubt). Everybody else has given some pretty good advice so far, so I'll just add a few things: -Don't trust your education: Pardon the hyperbole of the title. The point I'm getting at is that you need to remember that medicine is a constantly changing practice, and that EMS education has historically been full of inaccuracies, inadequacies, and anecdotes. Don't just believe your book or instructor when they say give X treatment to Y patients for Z complaints because it's "what's best" for them. Go out and do your own research and really delve deep into the treatments we give, and find out for yourself whether or not the treatments you give are really are all they're chocked up to be. -Don't trust anyone else's eyes but your own (and maybe your partner's): I've seen/heard of a lot of providers get burned for failing to do their own assessment. A lot of times, this seems to occur when EMS responds to a patient care facility (nursing homes, etc) where they're given a report by staff who claim they already checked X, Y, and Z and it was all normal and then the provider fails to confirm it independently. Always do your own assessment, no matter WHO it is that's telling you all findings are normal. You don't want to be the guy who picks up an altered mental status at the local nursing home and gets told by staff that they already checked the patient's sugar and it was normal and not check it yourself only to arrive at the hospital where the ER staff discover the patient's sugar is 20. And don't trust that the treatment that patient's received from anyone but yourself is correct either. The way I like to remind myself of this is to just tell myself before going into any patient care facility "The goal of the staff here is to lie to me and to kill my patient." It may sound harsh, but you'll save yourself a lot of grief and may do your patient some good by never accepting anything other than what you can confirm yourself, independently. -Like Mike said, lights and sirens aren't cool. They kill people. Don't ever get into the mindset that you can race a patient to survival. Good medical care saves patients, and good patient care is administered in a low-stress, calm environment where everyone can think clearly and rationally. Slow is smooth, smooth is fast. Good luck to you, and welcome to this great profession!

We use the EZ IO, and I love it! Done it half a dozen times or so now... Looking forward to us going to that first-line for cardiac arrests. I practiced with the BIG and the manual IO's... prefer the EZ. I've only ever placed them in the tibia, but I know some people have done them in the humerus as well.