Vorenus

Yeah, Propofol can be useful in chemical restraint. It acts pretty fast and you can control it pretty good since the effect wears off pretty fast too (this also means you`ve gotta stock up your propofol reserve if you`ve got a long drive) and most contraindications aren`t found in your usual psych patient, so yeah, it`s pretty handy. Course you`ve gotta take a close look at their saturation, same as Ketamine.

I never used a spine-board or KED outside of the classroom, since none of the services I worked for so far had one of these devices (except a station I did some shifts with while playing sick leave cover, but didn`t have a call in which either was required). Vaccuum matress and scoop-stretcher does seem to be the better devices, though, from what I can tell, in regards to real immobilisation and patient comfort as well. Seeing as to how you`d need to use random tools like towels or BP cuffs to fill voids while using the spine-board to make the patient comfortable and to acchieve some kind of immobilisation - well, let`s just say, if you alwyays need to improvise with a device, because you can`t run it properly otherwise, in my book that just sounds like it isn`t really thought through in the first place! Just my two cents.

I`m a bit lost and can`t concentrate right now (I know, lame excuse). Has he experienced something simliar before? First onset of Multiples Sclerosis?

Would be kinda risky, though, seeing that you`d might get burned too, if you were standing all too close to a zombie...

Headache? Dizziness? Vommiting? Nausea? Any obvious marks with the neurological examination that could be separated from his ETOH intake? Pupils, etc.? SOB? Thoracic Pain? Any traumatic injury prior? Heavvy Lifting? Prior problems with back/spine? First thought says either cerebral problem or propable spinal/nerve thingy, although presentation would be kinda weird with only both arms being affected... Circulation/motivity/sensibility in legs or arms in any way changed?

Guess that`s one of the major regional differences - since we never had standing protocols like 15 lpm for most pt. (like I seem to remember exist/existed in the US), we were always a tad more selective about usage of O2 anyways,

Don`t forget the double tap! Safety first!

Was told the same in training, with the exception of COPD and propable problems with ventilation drive (although grandly exxagerated). But most studies concerning the propable harmfulness of hyperoxaemia are of newer origin, hence why the recommendation of careful use in ACS only made it into the 2010 AHA/ERC guidelines. Another example why it`s important to stay up-to-date in this business.

Well, there is a recommendation from the central insitution of physicians in germany, stating that a Rettungsassistent could use a certain procedure (some meds, IV, intubation, etc.) under certain circumstances (no physician available but called, procedures is needed, etc.). Some say, that`s it. Still, it`s only a recommendation and not a law (things are really fucked up legal-wise for us around here - which the new law won`t change either...) and the tendency shows, when these kind of things go in front of a judge, that the Rettungsassistent has a good chance of winning- In practice, it`s always different out there, regarding the use of procedures. We aren`t bound to protocols, so we are free to make our own decisions.

I`d say it`ll still be comparable to the US Paramedic - but the Rettungsassistent is already comparable to the Para, hence, with, in some aspects, even more education in certain topics (e.g. A&P) as far as I understand. Not want to sound to downbeat, but I`m not as cheerful about the new law as Bernhard is. There are some pretty sweet facts about it, like finally getting pay during training, etc. The most important thing - the work of a Rettungsassistent/Notfallsanitäter (whatever they`re gonna call it) - won`t experience a heavy change, though. As most of you know, the highest ranking bloke on the streets in Germany is an emergency-physician, therefore our scope of practice is pretty restricted (although we`ve gone through a lot of the procedures and meds in school in detail anyway). Now, the major point of a new law would be, to expand that scope and making it more secure for a provider to use it, legally. That won`t happen though. Important institutions already implied that there won`t be a change in the scope of practice. So, in conclusion - more education is always important and should be greeted warmly. Since grandfathering rights seem to be complicated in this case though (I wonder why), it`ll be another few months of school and an exam for already qualified providers. Naturally - no one can tell, when you should do these months, who`s gonna pay for it (my boss? yeah, that sounds likely...), how you`re gonna live through the months you`re in school without an income, etc. That`s what`s freaking me out with the new law, and all that circus for more education you`d need for more skills, which you won`t use anyways (as we already had in the old system).

I`ve sent him an e-mail.

Guess the attitude comes from the fact, that you can`t do much for these patients. It`s not like that "fancy" medicine, working meds and doing big procedures. Sure in a suicide, you may get to really do something (though in your usual attempt, not even than that much - and the most primarily succesfull attempts, you`re usually not in a position to get to do much, at least in my experience) and you could use chemical restraint in a violent or agitated person. But with your "normal" mental patient, that poses no danger to oneself or his surrounding and just has a chronical condition - it`s mostly just observational taxi-driving, so maybe there`s a tendency to place this calls down.

Sure, sorry, got kinda distracted Hell yeah for getting experience an` all... erm... see my first post which was not totally Off-Topic.

Hey, thought we were talking `bout you... Me? I`ll always go for the brunette doc.

Lol. I was under the impression you always thought abound blonde HEMS doc, when thinking about Medic One.

Even smaller the niche, seeing that Medic One`s the real deal...

From what I read on the other (very simliar threads, you should search for `em and take a look) threads on this topic, you`re a good amount of time away from becoming part of a SWAT team. Starting with EMS might be the best shot to start with, but honestly, I wouldn`t be too obsessed with the SWAT thing. It`s cool to have an overall dream, but seeing how many years lay between you and that dream of yours, and how precious few positions there are available for a hell of a lot of folks who`d like to fill in - I`d say mainly concentrate on advancing in one field and trying to exceed in that (either EMS or LE) for now. As stated above, though, I`m only forming my opinion by having read the other threads on that topic, since I`m situated in Germany, and around here, you have to be Police -> SWAT -> SWAT trained medic, as far as I`m aware, so there´s no civilian-entry-route for that position.

What ERDoc said. Especially seeing that he was jogging - which suggests that he`s trained (or not, but at least he`s trying to start training ). A little bit OT: Most UK Ambulance Services demand a fitness test prior to employing. If I remember correctly, there you`d have to be back under a 100 HR after 2 minutes post-exercise (varying) to be deemed fit for service.

Just to wait a few minutes would have been my route of treatment, too. Assess, vitals, line, then start transport. Depending on how long a drive you expect to have to the ER, there might have been a call for medication or not, but Adenosine with a HR of 170 instantly after post-exercise wouldn`t have been my first thought.

Epic Movie, watched it at least 4 times in the last 3/4 year or so at night shift.

LOL! Now that`s a nice one... You might also try: "Hey, my name is X... what can I do for... oh - wait... sry, I forgot my credit card reader in the ambulance... just wait a minute, I`ll be right back!"

I guess, most often I say: "Good day, this is X, can you tell me why you`ve called?" or something like that. It varies, I never really thought about it until now.

Doubt there`s going to be anyone, disagreeing on the father`s action. He was acting in self-defence (enlarged to a third person, who was assaulted) to protect his daughter. It doesn`t even sound like he intended lethal force - he took some swings at the guy. Then, when he realized the gravity of the medical condition of the bloke, he dialed 911 to get medical help and even thought about getting him into his own car to drive him to the hospital. Justifiable both from a judicial and ethical standpoint.

We have four "pieces" I might take with me on a call: - Monitor (with Defi ait`s unnd pacemaker) - Emergency Respirator - Jump Bag (Everything that`s needed, i. e. airway stuff, meds, syringes, bandages, etc.) - Suction Unit If it`s unlikely to be a possible airway/resus/cardiac scenario I don`t take the respirator and the suction unit, in those cases I only take the monitor and the jump bag. For known minor trauma (tripped and fell on knee, etc.) I might only take the jump bag and get the monitor if I need it.

Can`t comment on protocols, but just to add to the points made above by Wendy and paramedicmike - it`s not that unlikely not to have 36 hours of sleep in EMS (or very little at least, depending on where you work and how long your shifts are), so you would need to be clear about the possible consequences, would such a situation arouse and wether you could cope with it.