nsmedic393

Yes, I have operated outside of my scope of practice. One thing i believe in is standing behind what you do so i will tell you about it. As a basic on a few occasions I pushed meds for my als partner. Never while i was working by myself, it was always a joint decision between myself and my partner as to what drug to give and it was not always in a case of absolute necessity.(sometimes it was just due to what side of the patient I was standing on) As I have mentioned before, and as in rids case, these type of situations were reviewed by our medical director and now we have a province wide policy that BLS providers can administer medications at the direction of their ALS partners. I have diverted to a regional hospital above a semi-rural hospital due to the patients presenting condition. I believe it was a stroke and annother was a broken femur. Both times i did call online medical but well after we were underway.(too busy) We had a protol change a few years ago for giving Lasix. It seems that an alarming ammount of medics were having a problem differentiating CHF from pneumonia so the powers that be restricted lasix use to patients already on a diuretic. I personally believe this is punishing the patients instead of the stupid medics and have on a couple of occasions given lasix to patient who needed it but was not on a diuretic already. I would also like to add that none of this was covered up or falsified in my PCR. It was all included in my report to the hospital, my PCR and answered for during call review in some cases.

Most hospitals have an established code system. Code blue, code purple, code black, code white etc... In the world of EMS we do not have such a system (as far as I know). When you are transporting in a violent patient do you say you have a code white?

I don't use the term code either. I call it what it is... respiratory arrest, cardiac arrest, do not ressuscitate order, advanced directive. I feel that the term "code" is slang and we should try to steer away from it. Nothing bothers me more than hearing some idiot calling into the hospital saying "we are coming in with a patient who is coded/code blue/full code or even full arrest". Where the heck did the term "full arrest" come from. As if there as such a think as half arrest or 2/3 arrest.

I agree with zippy. Any ROSC is a measured ammount of success for us in ems. Not soo much for statistical purposes but to say that we did our job, did it well and achieved something that is very difficult to do. Of course that is of no consolation to the patient. The family being able to say goodby is also a small goal achieved. Our statistics in survival rates only account for patients that live to one year after discharge and that is a true success and a measurment of how good the system on a whole is. Although if it weren't for EMS being the first link in the chain the ressuscitation rate for cardiac arrent in the home would be 0% as opposed to a whopping 3%.

I have done many medical calls where the patient was a family member of one of our medics and you are right, they have all stepped aside and for the most part just held their hand or something. I would probably do the same thing if it was one of my family members. Just be supportive. For some reason I think I would feel differently if it was an arrest. I don't think I would be able to just sit and watch I would need to be actively participating in the ressuscitation.

let them help. Looking at it from the off duty medic's point of view, if it were me and my family I would want to help. And god help the person that tried to get me to stand on the sidelines.

We required a 80% pass mark to graduate. Both a test and a quiz held weekly. Reading and writing assignments every week. 500 hours of hospital clinical preceptorship. (Emerg, ICU, L&D, OR, Amb Care, Peds) 500 hours of ambulance preceptorship (minimum of 2 preceptors) Mid term and final exams each year. Final oral exit boards with our PMD, head instructor and 2 field medics.

I'm not sure if its what you are looking for kev, but NS currently has a "community paramedic" program. Medics working in certain remote areas are tasked with working along with a NP in the community. They have an expanded scope that includes CHF assesment, fall prevention and home safety assesment, blood draws, urinalysis, suture/staple removal, wound care, immunizations, medication compliance, diabetic assesment, antibiotic administration and b12 injections. They also visit patients in their homes to asses the normal vitals.

I agree with AK. I put in a vote but could have used the option of selecting more than one.

Actually, my title starts with "advanced".

Here is the link to our policys, it is the last one on the list #6174. EHS Policies

We use the sager exclusively here. I have done some training with the hare though and i always thought the big flaw with it was that if you applied it to someone on the ground and then had to move them you lost traction...

Actually our medical director approached us... One day out of the blue the policy came out to allow BLS providers to draw up and administer medications under the direct supervision of the attending ACP. Aparently he thinks that there is some benifit and it may not be such a crazy idea after all.

Like i said earlier and rid as well stated... I don't care who pushes the plunger as long as the patient gets the right drug. That is not to say I think less of people who follow the rules to a T 100% of the time either. What they do in their truck is their business and I don't think any less of them for it. I hope that when it comes down to one person or annother pushing on a plunger, they would feel the same of me.

This type of thing has happened for years. I have given drugs as BLS at the request of my ALS partner and have asked my BLS partners to push a drug since I became ALS that I'm ALS. I know that technically it is wrong but the way we look at is we are both trying to take care of the patient in the most efficient manner possible. I can't be such a off the wall idea since our medical director just put out a policy allowing BLS medics to push ALS drugs. The medic is the one who makes the dicision on the drug, dose and route and has to witness their BLS partner pushing the drugs. There is also a caviat that both the ALS partner and the BLS partner need to be comfortable with it. We have also had a longer standing policy that intermediates when working with a advanced care paramedic can exceed there maximum doses of drugs up to the maximum dose allowed by the ACP. They also do not need to patch for drugs that they would normally patch for when they have a ACP partner.

Talk about reviving a old post.. Why don't you mosey on down to the local PD or sherrifs department and make that argument to one of the K-9 officers. See what kind of response you get.

Since you have used the device or something similar, i am curious to know how it facilitates your BLS skills, such as maintaining the airway, suctioning and ventilation. I perform intubations in the field quite frequently and personally don't think this device would contribute anything positive to how I perform my ALS duties. I would also like to know if it is less, equal to, or more effective than the standard OPA when performing BLS tasks and if it is easy to use. To answer your question about how excess light obscures the glottic opening.... The laryngoscope is an effective tool because it allows you to manipulate the airway and also delivers light directly on the area you need to visualise. The idea that more light wold be more effective is fals though and if you had ever tried to intubate someone underneath the bright sun out in the open you would know why. frankly you need the light on the cords and nowhere else.

I didn't say anything of the sort. We are on the same page then... Although involving the supervisor and possibly getting the basic suspended or fired would not be my style either. If the basic actually walked away from the verbal tirade I unleashed on them after such a occurance and had the balls to do it again, then it would be time for a chat with the supervisor and they would go on the "black list". I prefer to deal with people in house... I know basics aren't really people but I could probably do the same thing for them too.....

Who exactly are you talking to?? After watching the video a couple of times and then watching some tazer training videos, i think the police were justified in what they did. For all the same reasons dust stated.. Also after watching several videos including the manufacturers trainin video it seems to me like the from the time a person gets tazed to the time they regain their full composure is about 30 seconds to 1 minute. If that is in fact the case than it would not be untreasonable to suspect that someone could be tazed six times in 10 minutes and be fighting in between tazer jolts. Also from what I saw on the admittedly crappy video is that when the police tried to stand the guy up he began fighting/flailing wildly. Perhaps that was annother reason the tazer was used. I also don't believe that the police officers should have to identify themselves with their badge number to anyone that asks at any time, especially to a bunch of punk kids in a situation like that. They have enought to deal with already. I admit though I am not an expert on tazers or the law and this is just my opinion.

We had a big old graduation ceremony attended by the minister of health for the province and all that. We also had a big party afterwards which ended in drinking at a downtown bar. Long story short I got really drunk and the cops ended up on my doorstep at 0500 in the morning.......Gotta love trying to explain a case of mistaken identity while you are still pissed drunk

To continue my previous post..... Although I don't want my partner questioning my treatment decisions while on the call I would be more than happy to answer any questions you have about what I did or why i did it after the call is through. I am a big fan of being a patient adocate and carrying the best interests of the patient close to your heart. If you think i am doing something that is so wrong that you feel the need to speak up immediatly than you better be prepared to back it up. If you were right and I was doing something that needed to be immediatly corrected than I will thank you for speaking up but if you are wrong or doing it to try and make me look stupid to make yourself look better (it has happened) than I'm gonna come down on you like a ton of bricks. All that being said, Basics here in Nova Scotia have a much higher level of education. The average basic course is 1600 hours of classroom time and 500-800 hours of clinicals. Without trying to be condescending; I have never understood how you could learn what you need to know to work effectivly in a pre-hospital care role with such little training. Since I am used to working in my system and not yours I don't know if I could be comfortable with a EMT-B assesing and making treatment decisions for a patient. They would definatly have to proove themselves first.

I answered YES to the poll question. Typically on a call with a BLS partner I will rotate call for call if the patient doesn't need any interventions that I can provide for them. If it is the basic's tearn to attend I will get vitals, attach O2 and monitor (if required) while they do the assesment. However I always want to be present for the assesment to be sure that they are not missing anything and to make sure that their treatment plan matches up to their assesment/diagnosis of the patients condition. This is not because of a lack of trust but a concern that if they miss something and screw up its my license on the line. As far as treatments, if the patient doesn't require any ALS interventions and the Basic has an appropriate treatment plan than they are more than welcome to carry out their treatment plan within their scope of practice until we arrive at the hospital. I just want to know if anything changes and if they ever have any doubts to run the situation by me. When the call is over they do the paperwork and I restock the ambulance. If its my turn to attend its in reverse. I do the assesment and they do the busy work, they stock the truck. If the patient requires a drug that is in the basics scope of practice than I may ask the basic to give it before we transport if it fits into how the call is going. This is a happy go lucky scenario and doesn't always happen. Some exceptions to this happyu scenario are... The basic misses something on his assesment and I have to throw a couple of question in to get the full picture. If this happens than I may also need to consider that the basic doesn't have a grasp on the situation and I need to pay particular attention to their treatment plan or take the call. This would all be done in a respectfull manner and I would never tell the basic that I was taking the call in front of the patient to make them look like they were undermined. If I am doing a assesment on a patient I don't want the basic asking any questions at all. If you ( used in general statment meaning the basic) think I missed something on the assesment tell me in private and I will take it into consideration. My treatment plan is mine and mine alone. If its to the point of giving drugs and performing ALS procedures than I have already applied my knowledge to the situation and don't need to be questioned about it. call, finish later.

I never heard of this practice and have never seen anybody do it. If you are competant at starting Ivs than just monitoring closely while pushing D50 should be enough. Sounds like yet annother rule for the lowest common denominator.

Quite the generalised statement... hopefully it was a joke. We recently switched to an enitrely needleless system including blunts for drawing up medications. The only drugs we have to draw up though are morphine, valium, versed and epi 1:1000. Everything elser is in needleless preloads including adenosine.

Without getting into the whole canada vs US education thing... Here in NS BLS providers routinely perform 12 leads in the field. While they cannot give any meds for cardiac ischemia except ASA and NTG it has been proven that pre-hospital 12 leads even performed by BLS providers can decrease door to drug time for patients experiencing STEMIs. We also fax the 12 leads and do a reperfusion checklist prior to arrival in the ER.