WolfmanHarris

Thanks, appreciate the info! Funny how some threads end up in a different place then may have been planned. And we all learn a valuable lesson or another very special EMTCity.

Umm... chemistry not being my strong suit, could you provide some context for that or a link so I can read up myself? I've got a 100 level Chem book here somewhere so I can hopefully make sense of things.

Likely, but we have to talk in generalizations for anything to be relevant. Otherwise Dr. Bledsoe is one of the best educated EMT-P's out there.

Of course you do. No one wants to admit they're not as qualified as they need to be. This isn't to say you didn't work hard and gave all you could to your intermediate training, but call a spade a spade. The truth isn't fair. All things being equal, a well rounded university/college education that includes a proper grounding in A&P, patho, pharmacology and even some liberal arts electives will produce superior providers. All things being equal. That is fair, but if that same student busted their ass in a proper education they'd be even better. You also assume that the academy class offers the same courses for the student to bust their ass in. If there's no proper course in A&P, they can bust their ass all they want on their courses and still be deficient in a key area. If the academy course has all the same courses as the college program then it's the exception and there's really no problem is there?

Does the tax system in the USA (or your state in particular) require a specific tax be levied for each service, or can the funding come from the common property tax base? Within my municipality, property taxes are set by the city and the total revenue is divided up to pay for services (less the ear marked Public school tax which is collected as part of property taxes). Budgets from Police, Fire, EMS, etc are presented to the city for approval. If the city coffers don't cover cost they either cut, increase the property tax or both. For example this year's budget shortfall resulted in a 3.6% tax increase. It would have been 4.1% except a provincial infusion of ~$800k allowed for an increase that wasn't much more than inflation.

Okay. I think I follow so far. Organophosphate as used in chemistry refers to multiple chemicals that can be used in various setting, but when we refer to organophosphate poisoning, that is specific to a type of organophosphate (acetylcholineesterase inhibitor)? Do these fall into an identifiable category or categories? How would one identify, other than signs and symptoms, whether an exposure to an insecticide, herbicide or other chemical will result in organophosphate poisoning and thus anticipate complications?

Thanks JPINFV, appreciate the direction. I'm not sure if I have a total handle on it yet and have a couple questions. If the aneurysm was right in the aortic arch would we still see the difference in BP as the location is right at the brachiocephalic trunk? What about if it's in the ascending aorta, before the brachiocephalic trunk?

They've got many uses, which is why you're more likely to see an organophosphate poisoning on a farm than from a terrorist attack. Irrelevant article that mentions organophosphate herbicide Wiki on Organophosphates

"Space Oddity" - David Bowie (it was on a commercial, got stuck in my head and I had to listen to it)

I hope I'm not, but I don't know yet. Is it common to be a spinner when you get started and to mellow out? Or is spinner a genetic condition?

Nothing but respect from me. If more guys had his attitude, Fire/EMS might not be such a joke. The oldest guy on the department is the one talking about guys not keeping up with the changes; gotta love that.

And now we're at the Catch-22 I guess. I'd argue that in the city they should have the same treatment options and know when it's appropriate NOT to use them, but of course without the education to back it up it's potentially putting a loaded gun in the wrong hands. So to prevent this, medical direction would either need more than one set of rules or would be forced to create rules for the lowest common denominator. For a second I thought including the same protocols for both with the indication including "...with an extended transport/extrication time." but I worry that might just be creating a false sense of accomplishment as those providers for whom that protocol may never apply would have no motivation to learn it and the background needed to go with it. That is unless Medical Direction stuck their thumbs in some pies and included it and a CME requirement for it, regardless of the objections that might arise. You could be right Spenac about the potential need for two sets of protocols for practical reasons. But the creation of two classes of providers is also problematic.

Okay... let's try this. First let's keep in mind that I'm considering this option to the exclusion of others at this point, so while higher education would give us more leeway in protocol and allow for more discretion by the individual providers I'd prefer to leave that aside for now. Plus I believe that high quality independent medical direction would slowly force out medic mills and would help lay the groundwork for higher education (if done right and allowed a free hand). Would an auxiliary protocol that covers long transport time address much of this? (i.e. greater number of doses of a drug allowed, other opportunities to use a medication) Currently CPAP is an auxiliary protocol in some jurisdictions and the individual service still has discretion on whether they will implement this (for now). Sorry Spenac, without a specific example for the rural vs. urban I'm not sure what problem would need to be addressed. My exposure to urban has shown more laziness than anything else as the main difference, since the providers can get away with just oxygen and transfer for most calls. - Matt

Congrats! I love that all babies seem to look a bit like Winston Churchill for the first bit. Of course I've always found Churchill cute as a button.

I'll preface this thread by saying my knowledge of how things work in the United States is limited to what I've learned from this board and news articles. Our topics are usually geared towards what is going wrong, so forgive me if my perception that the majority of EMS at a system level is broken in the United States is in error. I'm a just a student with no experience and still need someone to wipe my nose from time to time. The case in Collier County Florida and the revolving door of medical directors in DCFD got me thinking about the differing roles of Medical Direction in EMS. I'd ask those of you in services with excellent medical direction put that aside for now and consider that you are likely in the minority. How can a Medical Director provide objective, independent medical oversight when he or she is employed directly by the service? A Medical Director should have accountability, but should it be to the service whose providers they may potentially decertify? How can a Medical Director under the employ of an EMS service push for higher standards when their pay cheque is being signed by the service fighting against those same standards? My recommendation is a direct rip off of the Ontario Base Hospital Group (OBHG) and the Base Hospital System in this province. Let's say in your state instead of each service having their own Medical Director, that the state EMS board (or other similar organization) had a council of Medical Directors that meet and determine protocols for all providers in the state. Each of these Physicians represents a regional area for delegation and oversees a regional base hospital. Each regional base hospital will provide QA/QI, CME and review of medical errors and potential decertification or retraining of providers. For OLMC a list of approved physicians would operate under the guidelines of the Medical Director and regardless of the destination or sending facility would be the only OLMC. During interfacility transfers, Physician orders would either fall under standing protocol or would require confirmation by EMS OLMC. For QA/QI the Base Hospital's staff would receive copies of all PCR's, and have 100% audit on certain types of call. (i.e. all intubations, cardiac arrests). Regardless of major or minor medical errors that could lead to decertification, the Medical Director can require non-disciplinary CME (on top of normal CME requirements) to rectify perceived problems that may not warrant discipline. The key to this idea is that Medical Direction would exist entirely separately from the services they delegate to and would be accountable to the State. I don't know whether I'm describing something that already exists or would be totally unworkable, but if I'm not totally out to lunch, what do you think? - Matt P.S. Here is a link to one of the Ontario Base Hospitals in the OBHG that my thoughts were based on.

I disagree. It takes a combination of the will to make EMS a priority and standards that create a professional EMS system that has no room for those with a limited training. The following services are the most remote services in Ontario, all have paid Primary Care Paramedic staff. The smallest communities have volunteer, non-transport first response teams. This was not always the case. Prior to the download of EMS from the Province to the municipalities in 2001, volunteer/part-time EMA's worked in these north areas but due to provincial mandate they are being phased out. A volunteer is not going to go to school for two years. Algoma District EMS Superior North EMS Cochrane District EMS If EMS is treated as a money making industry then of course rural, low call volume areas are not going to get proper service. If EMS is treated as an essential community service that relies on a tax base instead of on billing than it can be supported and provide proper care. The problem it seems is that there is no impetus to change in these areas. In these small communities the citizens may look to their volunteers as a source of stubborn pride, despite limited service and especially when the alternative is higher taxes. The volunteers provide no impetus to change as any improvements to service within their community will always be filtered first through the assumption that their volunteer service must be the one providing EMS which in turn limits their options. At a government level, since neither the citizens nor the service are pushing for increased service levels and tax support, why would they move for a paid service on their own initiative? Unless something go horribly wrong drawing attention to the situation, they won't. At a state level, unless the government is willing to set a high standard and let the towns and cities figure out for themselves how to meet them, they will be just as affected by these other stakeholders and continue to create standards that pander to the lowest common denominator. This is not to say that I attribute malice or any sort of selfishness to any of these stakeholders, only a lack of appreciation for the big picture and perhaps a lack of the fortitude necessary to look past the perceived risk of change until their is no choice. We don't see these article about volunteer communities going paid as a way to enhance service, instead we see communities that already had limited service, that are unable to meet even that, being forced to pay some staff to maintain the previous levels. No if only some of these communities could get ahead of the game.

Interesting and good to know. This hasn't been made clear in class. Thanks.

So my fiance was late coming home from work and I gave her a call to see what was up (I mean dinner was sitting in the fridge uncooked and my tummy was getting - I mean I was worried. ). She tells me she's at the vet's with the dog. A friend had come by her work and volunteered to take our dog for the day to play with her dogs at her place and apparently my dog Sierra and a friend went exploring and found a bottle of weedex and chewed it open. The two dogs took a rush trip to the vets. Turns out it wasn't that bad and the vet just gave them both Apomorphine (to induce emesis) and activated charcoal and said to monitor them overnight. Of course Sierra seems happy as a clam for the experience and just wants to lounge on the couch and have her belly rubbed (about standard for my hound-mix mutt). So it looks like no harm no foul. Got me thinking though. They didn't give atropine; I trust because the vet didn't think she needed it (and I do trust my Vet). Vet's must have to have exceedingly good physical assessment skills to assess and treat a patient who can't tell them about their symptoms or history. Might be some things we could learn from Veterinary medicine.

Don't worry I'm not offended. I am by no means a fan of GW Bush. In terms of Iraq I'm not in favour of the pretenses by which the United States and Britain went to war, but I do believe that once you create a mess you clean it up, see it through and make sure that the effort and sacrifice of those who have done what was required of them by their country is not thrown away by a lack of political will. I won't say more than that at this time because I don't want to make this discussion about the war (Iraq or Afghanistan). Speak and show how they feel is indeed good and right in any democratic society. That right ends up the commission of a crime. The shoe thrower attempted to assault someone crossing the line from his right to speech to another's right to not be hit in the head with a shoe. Now I don't know Iraq's definition of assault, but a quick wiki search (a very reputable source. ) found that even the threat of violence can be an assault charge in some jurisdictions. Once again, not a Bush supporter. But I am a supporter of the rule of law and the democratic state and doing time for the crime is supposed to go along with that. Wiki Assault

That's quite possibly the best idea you've ever had here Crotch! I have no complaints this time. All joking aside, that is a good approach to consider. Approach the boss cheque book in hand and tell him you need workman's comp forms.

All right then. While in that case I'll inset my foot into my mouth and shut up about it.

I will never understand this system. Providing the Basics to transport FD's Medics isn't EMS, it's Ambulance driving. Just call it Durham County Ambulance and get it over with.

I wish there was a shortage around here, I need to find a job right out of school and that would make it easier. ;D No there is no shortage of Paramedics in Ontario. We go through cycles of good job markets in this province and we're in a slump at the moment. There's always jobs working transfer, but you don't need any medical qualifications to work stable transfer.

Now I think the Cops have some responsibility on this one. I don't know if the taser should replace all force including manhandling the patient from their car to the squad, but there's more than one video online of the taser being used in lieu of any force.

So I was thinking that with any luck I'll be working full time this time next year and potentially having to work Christmas. I got to thinking, is there anything special I'd do on that shift, either around the station with my co-workers or any little things I might do for patient's that I might be taking away from their family Christmas dinner? A couple of candy canes to offer the kids maybe? Pot luck dinner at the station? Do you or have any of you done anything special when stuck working on Christmas?