Arizonaffcep

Actually, I can tell you the most probable answer to that. The answer being, there is most likely no standing order or protocol in place that gives off line direction for its use. Also, as it is not an immediate life-threatening drug (when compared to 1:1k epi w/anaphylaxis for instance), then they would need orders for it. I would imagine though, that if it was given within an appropriate time frame and for the right reasons, the hospital would be hard pressed to say no.

I will admit, there are a FEW really good FF/Medics that I've come across. I at least like to think I was one when I was in the field. But...predominately FF/Medics (I've seen BOTH sides of the coin on this...and worked them both) have a large tendency to brush things off that ARE important medically. Frankly, seeing both sides of the coin, I can tell you...if I could hand pick the medics that would work on me or my family...there would be a higher percentage of "Box Jocks" than fire medics. In fact, there would be almost twice as many. And LESS THAN 5 people who work for the City of Tucson are on that list (second largest FD in AZ). It's a joke. I worked very hard to keep my skills up with FF and medic stuff when I was in the field. It's hard...and frankly, from first hand experience, the preponderance of FF's who go through medic class, one of the big reasons is the $ increase...which is a BS reason to do it, and almost guarantees failure for patient care in the end. :director: Now take your crap and go away.

That's retarded...AzDHS requires it be on the trucks...he can't take it off. Just not let you use it? Perhaps one of the Docs can explain a potential for his rational...I don't get it.

Amen bro! We should start writing one..."As the Wheels Turn"! :hello1:

Happy Thanksgiving! I am thankful that our foster kiddo is FINALLY being transferred to the adoption agency so we can move forward to make him part of the family permanently!

Interesting. From what you've posted, I would assume that you are still ACTIVELY coding this person? My only thought on it vs not doing it is, what is the 1/2 life of the medicine? Would it be worth setting up an infusion if a therapeutic level can be maintained with 1mg every 3-5 minutes? What would the gain be? Also, after about 3mg of Atropine, you have maxed out its effectiveness.

Along that line, the charcoal we used to give was premixed with Sorbitol (a laxative) which was very sweet. The taste was quite pleasant, but it was gritty. But now...we have removed Sorbitol from prehosptial use, so we are stuck with the grit, I guess.

What rhythm were you discussing with this?

Typically, these pelvic binders are used to immobilize unstable pelvic fx's, where there is at LEAST the potential for significant bleeding (if it's not evident already). Reason-one of best ways to slow or stop bleeding due to fx is to splint and immobilize.

No. But if we get a pulse & pressure back, Levophed (nor-epi) is usually used in combo with Dopamine. From my understanding, Levo has at least as good inotropic effects with lessened chronotropic effects when compared to Dopamine.

True...just hard to get past those three elbows per arm...

R u kidding? Breast fed kids are WAY FATTER than formula babies!

:oops: :shock:

I don't buy that for a second. I have been through SEVERAL departments that have had to increase the base rate plus milage rate that is charged to a patient, with the first one actually being an almost 300% increase! No dip in calls...in fact, because the area was growing, the calls have done nothing but increase in frequency.

Well...let me put it this way...they've pretty much expanded as far as they can in Arizona...

Yes and no. If the decision to not use it is based on a "I don't want to make a mess," then sack up and do it, if it will benefit your patient. If it's a decision based on a "s/he took xyz drug 60 minutes ago" and you know at this point, the drugs have already been absorbed, then it's a moot point, and not worth giving. Keep in mind, with activated charcoal, time is the factor. Once the drug is out of the digestive system, it's fairly ineffective because it must come in CONTACT with the drug, in order to adsorb it.

Are you looking for Southwest in Tucson or Phoenix? Big difference. Never worked for SWA in Phx, but in Tucson, it's a great place to be from...if you know what I mean. They have gotten better since I left them, but are still "ambulances are forever, crews are temporary" in their mentality. Dispatch rules the roost, they know more than you, even though they are not certified in EMS certs (dispatch certs, yes, but not EMS). Pay isn't great, but ot after 40 hrs. Bennies from my understanding are not that great. Typical private, for profit company in that fashion. Medical director is OK...not on the forefront of EMS, but above the norm for AZ. In Tucson, SWA has the CON (certificate of necessity) for MOST of Pima county, they do the 911 transports for Oro Valley (Golder Ranch Fire) and have a good working relationship with them, and also do the transports for the extreme majority of Northwest Fire District, and it depends on the crew...most are good, but some can be pricks. They are the only ALS for South Tucson, and also cover some of the area covered by Rural/Metro Fire (the same company as Southwest Ambo), and crew relations are great there. They also are the 911 for Green Valley (mostly old people) and have good working relationships there. If you are a medic, then after a while (I believe) you can get qualified to use RSI, have Zofran, Versed and Cardizem. In Phx, they are the 911 transport for a LOT of Maricopa County...it's easier to tell you where they aren't...they are not in Scottsdale, 1/2 of Chandler, Tempe, Sun Lakes, City of Phoenix, Daisy Mountain Fire District, Buckeye Valley, Sun City and Sun City West (I know it seems like a lot, but they are in more cities than not). In the Phx area, Fire rules. Chandler and Mesa are a joke to work with. In fact, EMS only responds code 3 in Mesa when requested to upgrade, or on pregnancy problems and one other thing, which I think is an OD. Ya...pretty F'd up. Other than that...I've heard the best place to work for SWA is actually in Pinal county (Maricopa Operations), because other than Casa Grande Fire (uses SWA for transports), and Eloy (does their own transports), they are the ONLY ALS in the county. But...draw back is only 1 hospital (slightly higher capability than a clinic). That's what I know...hope it helps!

I've used it several times, all with fairly compliant pts who would end up drinking it on their own (with encouragement). But...it's affectiveness is low after about 30 min, when most things have been absorbed by the body. The big thing on using it vs. not in AZ is just the time frame involved.

No...it was 2 day latte when the medic on one shift quit, and I got thrust into the roll...although I will admit, it was a good challenge.

Or...you could do it right...immobilize the patient and BRING THEM to got cot.

I agree. But...the OP was talking about a 19 yo LT. I believe that they said you have to be 18 in order to take the FF1 test. Which means, he has 1 year experience. This is what I was refereing to. There is no way they have the knowledge base, proper classes and experience to properly advance to a rank of LT.

As was the case when I worked private EMS. But, with a fire dept. it is different. 1 person is in charge of 3 others (on a 4 person engine). This person MUST know the ins and outs of command, command structure, strategy and tactics. Just like (in theory) with the supervisor for EMS, public or private. Although the knowledge base is different, the ability to command is similar. Would you feel comfortable if you were placed into the roll of the supervisor? Responding to calls, not as the provider, but as the supervisor, keeping in mind the big picture, organizing large scenes and multiple agencies? Unified command? Etc. etc. etc? I would agree that it doesn't necessarily have anything to do with age...but more often than not, the younger you are, the less experience you have at something. This is where the age thing comes into play.

Maybe ARDS?

I would be curious to find out where the most problematic schools/school districts/systems are located. Anyone know of a link off hand? Why do I have a feeling AZ scores pretty low....

Ya, but there is an element of tact...both for choosing a TIME and PLACE to limit the risks of officers involved, and, it's a funeral. Bad timing, full of family who would (I assume) at least make an attempt to help their fallen family member, plus it's a time where emotions are already running high. All that combined leads me to believe it's just bad planning on PD's part because of officer safety.