paramedicmike

Welcome, Arytmica. I agree with CHBARE. As a nurse you'll probably do better to pursue reciprocity for your nursing license than try to immediately pursue an EMS certification. The reference and contact information provided above is what you'll need to get started as far as EMS certifications go. But I really do think you'd be better off starting with gaining reciprocity for your nursing education and then pursing EMS rather than trying to pursue EMS based on your nursing education.

Cripes, Doc. That blows. Condolences to you, your wife and your family.

Exactly. They're called ex- for a reason.

Make sure before you cut those winter coats off that your patient is not wearing a down coat. Flying feathers in the back of your ambulance don't make for a good time.

It would be interesting to see how this plays out in a system like Island's with only one or two hospital choices versus a larger system with four or five or more hospital choices. I'm not entirely sure what the author means by a potential loss of relationship with EMS based on increased rates of diversion. In smaller systems it's your only option. In larger systems I wonder how much of "goes around comes around" comes into play. Admittedly, though, the numbers listed are higher than I expected.

I found this article on the incident. It answers some questions Island posed. It also has a section on the medical ethics involved. People are allowed to refuse even if they're in custody. Also, it appears that there is a lot of coverage of this particular story out there in a variety of news outlets ranging from local TV to the most fanatical right wing propagandist blogs. While there are three sides to every story it might be possible to put together a pretty decent picture based on the variety of reporting sources. Or they're all just reporting off the same source and twisting things to fit their agenda from there.

Welcome. There are some nice areas of the Eastern Shore of the DelMarVa especially down in Maryland. Nice to see you're keeping MIEMSS and MFRI busy with your training.

The program you pick should be listed as accredited on this site. It it is not listed as accredited then please find a program that is. And welcome.

That was today for me, too. It was pretty cold here. We were steady but not busy. Everybody was at home watching football. Today's theme was "Nothing works but percocet! Can't you write me for a few more?" Stocking up for the holiday week, I guess.

Welcome.

Or simply laziness at having to transport over a distance.

The program you pick should be listed as accredited on this site. It it is not listed as accredited then please find a program that is.

Right. I agree. But asking how one identifies hem-/her-self won't always get you the answer you need if you're trying to ask for their gender. Gender and identity are two separate questions with potentially two completely different answers.

Identity doesn't always match genetics.

Welcome, LT. I think you'll find EMTCity to be a pretty open place for discussion and a good place to ask questions. Please understand, though, that we have a bit of our own subculture here. Until you get the feel for the multiple personalities try to take comments with an open mind. With that being said, the group almost as a whole, with some exceptions, tends to shy away from a whacker approach to EMS. This includes the use of utility belts and the carrying of a variety of superfluous items. Many of us are older and have been in the field for a while. While some of us used to share that same "Bat-belt" type approach we've mostly moved on as we've matured in this profession. If this belt is something you *have* to wear for school or work uniform purposes then I'm afraid you might be stuck having to rethread your belt every time nature calls. If this is something you wear because you want to wear it please understand that many will find it, well, silly. Mind you, this isn't anything personal. We don't know you from Eve. We can't make it personal so please don't take it personally. Just understand that we tend to call things like we see them and there is usually little tolerance for whacker-like behaviour. It's generally not personally motivated (unless you make it personally motivated). So, welcome. Enjoy the discussions.

Was it really that bad, were ambulances so poorly stocked, that inspections like what you're describing became necessary?

J306, I highly recommend the Manual of Emergency Airway Management by Ron Walls and Mike Murphy. The HEMS service for whom I used to work based their RSI guidelines on this book.

There's a lot not being reported here. I'm sure what's not being reported is just as important to the entire story as what is reported.

I try to look for every patient. Sometimes people will know what medications they're on. But we all know that the longer the list of meds the less likely they are to know what they're actually taking (e.g. "... well, there's a water pill... a sugar pill... a pressure bill... a heart pill... a green pill... a purple pill... the pill I take in the morning..."). At least this way I can see what's been filled for them recently. Using that list they might recognize the names of the medicines if I ask them. Of course it helps if I suspect someone is seeking. However, its usefulness isn't limited to that. ETA: It helps that I have two separate access points to the prescription monitoring program data. I can log into the State website. There is also access through our electronic medical record program. I'll check the EMR pretty regularly. I will only log into the State site as a double check if I think I'm missing something.

One thing I do like that we have access to is our state prescription drug monitoring program. I can look up to see if a particular patient has had any medications filled within the past 36 months. It covers anything from antibiotics to psych meds to HTN meds to narcotics. The only problem right now is that if they pay cash it won't show up... yet. (That's coming.) It's very helpful especially when your patient claims that he can't get meds filled or she hasn't seen her doc in years to be able to turn around and say, "Well, you just had 120 percs filled yesterday. Who wrote that?"

I don't believe Colorado allows eprescription of narcs. The State in which I'm working won't let us eprescribe them from the ER, either. Actually, we currently aren't eprescribing anything. I print out a paper Rx for everything. Discussions with several of the docs with whom I work and in my area seems to point to a trend of pain management docs moving away from just blanket prescription of narcotics. I'm seeing more chronic pain patients, who are routinely followed by a pain management doc, undergoing some sort of procedural method of pain control (e.g. blocks, trigger point injections etc...).

Well, there's that small issue of treating people with some basic human dignity. Even in emergency situations that's important. With that, sometimes you just need to know.

I read somewhere recently, too, that a little valium can help with the recovery from ketamine. Just make sure they're still breathing through it all. That being said, even with some pretty wicked emergence reactions, I've not seen this done.

Actually, it's an NMDA receptor antagonist.

Currently, ketamine is approved as an anesthetic. I can't find anything pointing towards approval for analgesic usage in the US. I think in the case you outline here the ketamine isn't acting in a pain management role. It is working as an adjunct to the morphine allowing for better sedation of the patient. Better sedation allows for better effectiveness of the analgesics. Interestingly enough, I did find this article discussing analgesic uses of ketamine in an ED setting. This study discusses ketamine use alone as opposed to morphine.