WolfmanHarris

Excellent point. I know in two years I have received less than 10 hours of class time on psychological conditions (not counting the required full course on psychology). Does that sound like enough to provide any sort of worthwhile assessment other than competency to refuse? I think part of the problem with psychological calls is that they feed into our own jadedness quite well because on a cursory glance they seem to fit better with our other BS calls and there's little we can do intervention wise for them unless they're an immeninent threat and we call the cops. EMS is far too often at the sharp end of our abysmal mental health system and with our current education and provider model, is woefully equipped to deal with it. Community Referral by EMS (CREMS) is a start, but these programs need to develop more so that we can get patients the help they need when a trip to the ER isn't it. Additional time spent on psychology during our educations is not the answer as while they will better prepare medics, they will not suddenly turn us into competent social workers, let alone psychologists. We do however need enough education in abnormal psychology to know how much we don't know. Maybe then we (EMS collectively) will treat our mental health patients better.

Agreed. The "I'm a volunteer" excuse is used too often by individual providers as the reason not to meet a standard, whether it be uniform, PPE, or education.

CONGRATS! Now, I have some prescriptions I need written. They're for my chronic pain, anxiety and ahh.. glaucoma. Getting to So Cal is pretty hard for me, so I'll just take unlimited repeats if that's all right with you. Seriously though, that's awesome. Good luck and congrats again!

To me this (being draino or similar ingestion) fits criteria for an L&S return. The upper airway trauma may be complete at this point, but unless the agent has been removed and the remainder neutralized we can't rule out further damage along the GI tract. Not to mention I'd worry about metabolic concerns, renal and hepatic damage/failure, potential aspiration/inhalation and respiratory damage. This to me is a profound multisystem insult that needs definitive, specialized care. As the only person in the back (with maybe a First Responder FF tagging along) I don't imagine I'd be able to get too far from the airway which means one of the best things the hospital can provide is enough expert staff to manage each potential issue.

I like those. Most aren't the self-affirming ego stroking words of wisdom you see, but instead shift the obligation back where it belongs; on the individual. I'm tempted to print them off to post in the lab for the 1st year students.

I think local department culture has more to do with it than an industry wide thing. For example the management of the service I'm consolidating with and the others in the area took on high vis and helmets on roadways as a H&S issue right off that bat. The equipment was issued universally and it was made clear that not only was it policy, but that the service would be disciplining and/or suspending those that didn't abide. This was reinforced by the labour board which made the equipment mandatory and would fine individuals and the service for failure to wear proper gear. After a short transition period people stopped forgetting and it became the new normal. If you're wishy-washy and don't make a heavy push for change then your results will be inconsistent. The example also needs to be set from top down. When the crews went his-vis, so did management, even though they rarely respond to scenes. If you're there properly decked out and the boss rolls up in shirt sleeves, what message does that send about the importance of safety?

When are you hoping to have these to us and then back to you?

1) Triage. Aside from the unresponsive patient do I have anyone else that would not be considered a green tag? 2) If no other Red priority patients one medic will begin assessment of that patient. I'd like findings from a standard primary assessment please. 3) Other medic can begin corraling the other minor patients (provided no other serious patients) and attempt to obtain incident history. 4) Can you paint me a better picture for scene size-up Ruff? How bad do they look (degree of distress, etc?) 5) 35 people is a large amount to transport if they are all N/V with no other symtpoms. I'm going to request a city bus or school bus to respond for transport with a medic escort. Nothing more specific from me until I have a better handle for what's going on.

I've never been a big proponent of private schools, but when I have kids I might just keep them out of public school to avoid this sort of paranoid, bubble-wrapped, liability and litigation obsessed, detached from friggin reality, assinine, politically correct, written by a committee of the ignorant, perpetuating everything that's wrong with our lack of personal responsibility, bullshit. I love to teach, but this social engineering shit is why I will never pursue teaching at an elementary or high school level. Frack! I was in a good mood this morning until I read that crap.

Agreed. My issue isn't with research by any means, it's with practicing cookbook medicine and not acting as an advocate for your patient. In terms of disagreeing with your online direction, I'm with TK in taking the proactive approach and working to build a better relationship with medical direction. See if you can learn why it is you have this disjoint between your CME and your OLMC. Perhaps you're missing something in the big picture or perhaps the Doc is just reluctant to go full dose right off that bat. Dust, I gave your original post another read and I think I read too much into your "cooking the book comment." Even surrounded in context, I managed to take it out of it. My bad.

Doesn't this run the risk though of perpetuating poor success rates and outcomes in prehospital intubation and putting another nail in the coffin for this procedure?

Ahh, but do you remember the game that preceded TRON? Loosed movie adaptation ever.

So I had a VSA call a couple weeks back; patient was obviously dead lying in bed and husband was in the kitchen freaking. It was about 0430. After PD had taken over the scene and we were sitting at the base completing paperwork I turned to my preceptor and asked, "So what do you think wakes you up when you're lying in bed with a dead body." He shrugged and said, "Probably all the heat loss making you cold." I nodded a second and couldn't help myself, "So you roll over and groan, 'Jesus Christ your feet are cold.' or 'F*&^! Stop hogging the blankets." We killed ourselves laughing. So my question is, what are some of the worst jokes you've made about a call? You know those awful bit of morose humour that you can't help but let out from time to time and that no one outside of EMS would ever find funny.

Welcome to the City!

Cool trick putting your writing upside down like that.

"Everyone's Dying to Meet a Paramedic: Please Don't Drink and Drive."

I'm finished my program in two weeks and looking back, I would have placed more emphasis on my A&P. I scored 75% in both semesters of A&P, but I still find too many holes in my knowledge that I want to fill. I'm strongly considering either auditing the same courses next year (even though I'll be working) or going back to Trent University (same town and where I did my degree) and attempt to get a letter of permission to take the nursing A&P courses (I don't have the time, money or inclination at the moment to take a BscN when I have no interest in working as an RN ad have just finished 6 years of post-secondary education). I'll probably audit though as it's cheaper and I really like the lecturer. Let me put it this way, I crack my A&P and patho books way more often to look things up than I do my medic books. If you have the option for a full year university level A&P course before starting Paramedic school, take it. At the very least make sure your Paramedic school has a full year of A&P.

There was a patient in the ER during clinical a couple weeks ago who had attempted suicide by drinking anti-freeze. Fortunately or unfortunately depending on your perspective, they didn't want to drink it all at once, so mixed a shot with cranberry juice and took one or two a day for the last two weeks. So while death is not forthcoming, liver failure is.

Seriously?! Your instructor thought "C" was FALSE?? Epic FAIL. Tell the idiot to go look up kussmaul's respirations, acid-base balances, increasing ICP to start. Actually do one better, look it up yourself and start filling the holes in your education. If I were to pick one I would also pick "A" as "almost always" may be overstating the case. Psychogenic is definitely a common cause of hyperventilation though. I'm not too sure about "D" due to the "rarely" there. Certainly most hyperventilating patients will not be cyanotic, but I could forsee some patients showing the signs of hyperventilation but being cyanotic. Plus, the implication of picking "D" seems to be that psychogenic hypeventilation commonly causes cyanosis, which I would definitely say it wrong. So I'll stick with "A" and curse the poor wording and the surface treatment of a complicated process.

I'm just an almost Paramedic, but I'd be more than happy to receive a letter and reply about how we do things in Canada. It might confuse things for them, so I understand if you'd rather not. Just PM me if you're interested.

Quoted for agreement. My fiance's the jealous sort, but she knows she has to trust me. Step one to a stable relationship.

Hell could you imagine the first crew responds, exposes the chest, craps themselves and calls the bomb squad leaving the patient on the ground twitching.

That's gotta be a typo. When I'm only doing a 3 lead I place the limb leads on the torso to cut down on artifact from the patient moving and so that there aren't as many wires in the patient's way. But RA just moves to around right midclavicular, not left. Look at einhoven's triangle, reversing them wouldn't work would it? Actually rereading the quoted material, a typo seems unlikely. I'm at a loss... Gonna go hit my books on this and see what I can come up with.

Hey Ruff, this probably goes without saying (but I've gotta hit 2500 posts, so what they hey ) but I hope your system is low-moderate call volume so that crews can actually get sufficient sleep reliably during their 2nd out time. Otherwise, despite the generous amounts of time off such a schedule allows for crews, I think the risk of errors during care or driving are too high.

So he's going to Saudi Arabia? Hardly an expert, but my impressions of the country was not one known for being a paragon of individual liberty and hands-off government.