island emt

The lost my airway refers to once placed properly , it is hard to keep a good seal when bouncing down rural roads for 30 minute to an hour. Yes they work great in the OR setting when the pt is sedated and they have fasted. I learned the use of it from a highly respected gas passer who preferred the LMA to intubation in most procedures. However when trying to prevent aspiration of beernuts and budweiser, they don't work so well. Use of McGills is a very handy thing when you need to remove the lobster tail from a tourist esophagus , Ask me how I know. I agree with you on increased levels of education & knowledge for all levels of licensed prehospital provider. PM sent

I haven't transported a deceased body in many years. Not since I stopped working for a funeral home. We do transport a fresh code that we are working and sometimes they do survive, usually not. Or a cold water hypothermic drowning will be transported . But to transport a traumatic arrest or already cold corpse: no In this case once it was determined to be a traumatic arrest and to transport to the hospital would place all involved in real risk then turning around in the parking lot and going back to the ski patrol room made perfect sense. There the case was turned over to the proper authorities. Law enforcement and the ME's office. This was following our State protocols.

As I said in the earlier thread : All the Press information was coming from a distraught widow from Nova Scotia and reported in the NS press with info from her only. Of course she was upset and looking for someone to blame for her husbands death, but the facts are different from what was initially reported in the press. Maybe they can convict the tree for growing in the forest! When you purchase a lift ticket there is a waiver saying you accept the risks inherent in sliding down a snow covered mountain with boards attached to your feet.

I understand what your saying Chris: The problem i have is in an effort to make a commonality across the board nationwide they have taken away educational standards and skills + interventions that have been successfully done by the I-99 license level for a long time. a well seasoned and educated Intermediate can handle a large majority of calls, saving the Paramedic level practitioner for those calls that really need a higher level of intervention. We have a system that has a Paramedic level flycar available for backup intercepts when needed. I don't particularly have a problem with them taking away endotrachael intubation, instead relying on blind insertion devices. We were only intubating in cardiac/ respiratory arrest as it was. Then they gave us the choice of LMA[ Lost my airway} or the King airway/ combitube as devices, Instead of educating and training on the airway structures and learning the Malapatti scale, they are teaching stick in a blind insertion airway if the pt is not breathing. A case of cookbook medicine: Not breathing ::: do this! Then they take away the ability to use McGill forceps, basing that decision on the fact that the data weenies figured we weren't using them much anyway. What is one supposed to do in a FBAO when you know there is an obstruction but you can't reach with a finger sweep? {I've never been a fan of putting my digits in anyones mouth} Our only course of action will be to insert a blind airway device to force the FB deeper into the trachea? You know as well as i do the Heimlich maneuver doesn't always have the desired effect. [ Yes i know we're not supposed to call it that anymore} abdominal thrusts. So at that point a FBAO become an arrest caused by the obstruction! Maybe I'm just old and set in my ways after 40+ years in the business, but it seems to me that the national standard is going backwards. OR what the powers that be really want is for a Paramedic on every call , no matter how minor. Too bad they don't want to pay for that to happen. Yes it would be nice to have , but it's not practical in many rural areas. I wish you well in trying to educate your AEMT's in that few hours.

I would question [not you personally Chris or Steve] how you can accomplish all the required curriculum in that few [200-250] hours. The current EMT-B courses my wife is teaching run into 150 hrs classroom plus field clinical time. When I took my EMT I-99 course 14 years ago , it was a total of 540 classroom hours and an additional 200 clinical hrs. The clinical hours included ER time=24 hrs ICU time 24 hours, OR time for airway management/ intubation ,minimum of 10 successful inttubations & 12 hrs, ride time on other service 48 hours, community service health projects [flu clinics etc. Then we have been mandated to complete medication modules, IO module, and other updates along the way. The whole AEMT philosophy will be to dumb down many of the existing standards to meet a national curriculum . Using the Peter principle to make it fit the lowest common denominator. Getting off my soapbox now!

You need to remember that this is a very remote area, where the two crew members stationed on the truck down in the valley at Carrabassett, are the only crew available unless they move a second truck up from the next station.. The crew heard the call on the mountain and had started towards the ski area before being dispatched to it. That triggered the next truck starting the trip towards the valley for coverage from 45 minutes away. This was why they have the ski patrol take a familiarization course in driving. In one news report it was questioned why they didn't fly the pt out? High winds and whiteout conditions had grounded rotary wing transport statewide. And if you haven't looked at a map recently , Maine is a very large state. Our protocols would prefer we not transport bodies to the emergency room and the hospitals don't really want them either. Thus we have a situation where continuing down the mountain in a whiteout snowstorm with this gentleman's body would have increased risk to crew and victim's safety, so since they were still on the mountain and in a parking lot on the access road when the pt died , they returned . For all you flatlanders , this is not a fun drive in nasty road conditions, winding ,twisty and in places can be spinchter tightening in nice weather with long drops off the sides..

Maybe because they let their gay side come out in the locker rooms and don't want the wife & kiddies to know. Just sayin!

Actually there is very little blame for Mike as a 19 yo emt-b, he was sent by the crappy transport company he works for on a long distance transport. He could have been a better pt advocate, but how much can we expect from a newbie without road exposure?] This is not picking on you Mike, just a fact of lack of experience. His dispatcher should have known that the pt required Paramedic level of care and those medics should have analgesia in their protocols and on the trucks to be given as needed. The fact that none of his company trucks have medications for pain relief speaks volumes about the type of service it is. The second part of this big fail is the shipping hospital and Dr that felt the pt could travel for 5 hrs without further pain relief. The bottom line is a greedy company trying to make the most they can , at the least expense. Wanna bet they billed it as ALS-1 ????

It's a private club. Period . one of many in this country that decide who can or can't be members.

#1 5% is probably close to accurate. #2 I would guess it is even lower % to release with full neurological function intact. #3 probably right. #4. We as an industry have made large steps in improving recognition and treatment of heart attacks and getting them to appropriate cath lab care. Along with having more access to cardiac units in more hospitals. This is one area of great improvement over the past 10 years. #5. probably even lower %. One of the big strides in this area is prehospital spinal clearance protocols. using an evidence based system to develop and institute a selective spinal immobilization protocol]. We have been using these for close to 15 years in our state and the studies prove that EMS has been almost as accurate as the ER docs with their access to X-Ray and CT scanning. Very few missed potential injuries not immobilized over thousands of pt's studied. As far as justification of the cost: We need to be able to provide the level of service the taxpayers are willing to support financially. Are there better ways some things could be done? Of course there are. There are many different models of delivering prehospital care and no one model will fit all locations. What works in a large urban area with access to a half dozen emergency rooms, will not work in rural areas due to the logistics of covering large areas of terrain and low populations with access to a single hospital, which might mean an hour + transport time. Again it depends on what level of service the customers demand and are willing to pay for. Some places want two Paramedics sitting in a truck on every other street corner and others have an expectation that when they call 911 an ambulance will get to them in a reasonable time and provide the care they need in a professional manner.

As I stated in the earlier thread about this call, Northstar is a highly regarded operation and we were only getting one side of the story from the widow. Because of all the press involved , you can be sure that the investigation was extremely thorough and no stone unturned . In no case would this Pt have survived an hour plus trip down the mountain to the nearest hospital, much less the trip to CMMC where the nearest trauma surgeons are located. Unfortunately this was a tragic case and an accident where the skier ran into a tree at speed and suffered life threatening injuries. This case is a good reminder to all of us to remember to DOCUMENT every thing we do. disclaimer: I do know some of the parties involved from EMS conferences and classes, but had no knowledge of the call other than what was available in the press.

We used to have Pherergan, then they took it off the med list to be replaced with Zofran. Now there are shortages of Zofran , so they brought back Pheregen as a replacement. Go figure!

Wendy: Where do we draw the line? I have mastered the language of my land of birth along with the variations per mutated by the Brits, Scots, Aussies and even the kiwi's. I also learned sign language & enough japanese and vietnamese to get by, and took a couple years of texican spanish in school 35 years ago. I have a few phrases of Polish and Russian and enough Quebecois to be able to order a decent meal and a good beer. Why should we as providers in our own country be responsible for learning any one of the other several hundred dialects being spoken by the many immigrants to our country. English is the International language of the sea and for airline pilots and air traffic control OK stepping down off my soapbox for a while

1c: I do the exact same thing. Different supplier Fluorescent hot pink shears and stethoscopes are what I purchase for the truck and crews jump kits. I consider them disposables. Now when it comes to other hard equipment ,I buy the very best we can afford on our budget, which might take a little longer to purchase , but will last a lot longer.

Applaus Applause de jour Dwayne. +5 to use a dustism.

What in the world is a NR approved program??????? The national registry is nothing more than a testing company that charges fees for service.

Trauma shears need to be strong enough to cut through just about anything::: And cheap enough to be toss-able when they are covered in spooge

Mobey: The best thing for you is that you are recognizing that there is an issue that needs to be dealt with. When you have accumulated stress over long periods of time and no way to release it, it starts to affect things.not eating right, not getting enough sleep, night dreams of previous calls & Pt's , irritability, short fuse with friends & family are all signs. Thats why they call it PTSD. We deal with lots of mental trauma on a regular basis and all need to find a release. Been there, done that, Got to the point that I worried what would happen if I went away for a couple days. I got better! You can too.

The biggest fault here is the crappy transport company you are working for. Bad enough they sent a BLS truck for this transport, but your management doesn't have the protocols in place for your medic level trucks to have any pain medications. That is a major fault and would make me wonder how they can keep an ALS license. As I understand the current practice in Texas, they allow a service medical director to determine the scope of practice for their staff. This tells me you have a could care less medical director, and the company is only interested in their profit margin. If I was your patient, I would be talking to an attorney.

Now that we've finished spanking you: Do not let the TV view of EMS saves everyone cloud your mind. In reality a very low percentage of cardiac arrest survive to release from the hospital with neurological function intact. I would gander a guess that the actual number is less than 2% of all out of hospital arrests. In hospital arrest numbers are not much better. In my forty years in the business , I've had three saves that continued through the healthcare system and survived to walk out the door under their own power. They were all witnessed by us and had immediate CPR , and defibrillation within a minute. Yes there were more that regained a spontaneous pulse through our interventions, but in the end did not make it home as a fully functioning person.

CAPTKA :You are Ruff: Paramedic Mike is that The other person who we are commenting on runswithneedles first came on here with his name Mike E@@@s. He then got bitch slapped for comments he made and then became a subscriber , so he could change his posting name. Thats who I was referring to in my post

You don't even need a subpoena to find Mike. After his first round of stepping on his crank here, I spent less than 5 minutes on google and found out who he is , where he lives, where he went to high school, his phone # and who he was trying to get hired with. Not real hard to make the connections. There are a bunch of people with the same name in Texas , but only one his age. I tried being subtle in my comments above,Ruff but you state it all pretty clearly. My guess is that Mike has a lot of maturing to do if he 's going to survive in the business.

I hope you didn't SHOVE the combi tube in! maybe you inserted a blind insertion airway adjunct. Pay attention as the dead guys lawyer will be. Feeling release while working a code can be a normal thing. Don't get too involved with the how or why of the pt's personal life. if you manage to survive more than a short time in this business , you will encounter ALL lifestyles and levels people from abject poverty to wealthy folks that all have the same problems and addictions in life. Working most codes you will find the same smells and fluids leaving the body One more question: why did you transport the body away from a crime scene?

ouch!!!!!! kinda hard to get a good look and see what your doing with sharp objects down there. Unless your double jointed .

He was here a couple years ago and did 4 different presentations in addition to being the speaker at the annual banquet. His classes varied from laughing at ourselves and how serious we were ,to a really deep look into our souls and how we deal with death and destruction every day and the effects it has on our long term health. All of his presentations had plenty of his cartoon work involved. He made you take a look into the deepest closets of your mind and to quote him "LIGHTEN UP" it's not your emergency.