AnthonyM83

We usually get in 2 - 3 hour's sleep between 4AM and end of shift at 7AM. That's on 24 hour shifts. Often we get no sleep, though.

Hey all, Could we discuss the relationship between BP and CPR? I was taught that as you do CPR, it builds up a blood or perfusion pressure that helps circulate blood through the patient's vessels allowing for air exchange. The reason to reduce interruptions in compressions is that it takes awhile for the pressure to build backup and get maximum blood flow going (as maximum as you're going to get with CPR, anyway). In another forum, I'm being challenged by someone says there isn't really a relation between the two. The point of CPR is blood circulation, but not blood pressure. I would argue that maintaining a blood pressure is also important (or at very least related) because BP relates to quality of perfusion. Measuring BP is also common in research papers when measuring effectiveness of CPR methods. I've also been given stats on how much BP drops per 5second pause in CPR and how long it takes for pressure to build back up to maximum after a short break in CPR. This would indicate to me that maintaining BP is important or at very least related. Also, taking a step back and just thinking about it (non-scientifically, just conceptually) it makes sense that higher BP would mean better perfusion of vital organs including brain. You could give continuous compressions at rate of 50/min and you'd be circulating blood, but is simple circulation enough? How did everyone else here learn it?

At our station, as soon as your head hits the pillow, the red phone will ring within 3 minutes (if not 30 seconds) guaranteed. We can stay awake in station for two hours with no calls, but the second we decide to lie down, phone rings. Like seriously someone should do a study on this. I'll warn people we're going to get a call b/c I'm about to lay down, and ring ring there's the call.

Most of the physical strength I've had to put in at work has involved the main/core/stabilizing muscles. Squats when lifting gurneys and back boards, as well as other torso muscles like abs when balancing and moving that weight once it's been lifted (like when sliding gurney in/out of ambulance or manuevering backboard/breakaway flat). These are usually short lifts. Your endurance and cardio seems to come in mainly during CPR chest compressions on larger patients. This (and occasional long stairways on backboard) are the few times I'll really break a sweat, but they really matter.

that icon's going to confuse me...

I've never heard of someone doing that for that reason. Cool if they'll let you though. They could argue that whatever traffic sites are an indication of how you might drive an ambulance and so the points should remain.... BUT great if they do take them off.

Yup, it's a classic movie quote as well. Also: "It came with a black dude, but he kept getting pulled over."

My name is Maximus Decimus Meridius. Commander of the Armies of the North. General of the Felix Legion. Loyal servant to the true Emperor, Marcus Aurelius. Father to a murdered son. Husband to a murdered wife. And I will have my vengeance in this life or the next.

Okay, I'm just getting back to this post. So, my question is now: How does the study I posted fall into that category of a bad study? I mean I certainly understand there can be poor studies and poor conclusions. The study seems limited, but I don't think that alone makes it a bad study. Just because they identified a problem, but didn't solve it doesn't mean it's bad study. Obviously the study needs to be reproduced and after a few of those, we can take it as fact that private transport increases survival. Then there needs to be SEVERAL other studies from different funding sources to find out WHY that is. I too look at studies with skepticism, though I've made mistakes before (like with the Trendelenberg / Blood Pressure thread) and believed to readily, but this study isn't that far out. If what a trauma patient usually needs is surgical steel, then it makes sense that long delays in getting that definitive care (as occur when you call 911 versus homeboy ambulance) might decrease survival. I'd rather see this study as a chance to explore what EMS can do better....not just write it off as a bad study.

"Daaaaaaaamn, You got knocked the F*** OUT!" "Now, no one go in ther' fo fifteen, twenty minutes" "This suit is NOT gray"

Damnit, in the time I took to write that post, Vistaprint went down...

So, three times now in the last 3 months I've been asked if I had a business card by patients as we're leaving the hospital. When I said no, they've said they wanted to write a letter or a give a call about the great service they received. I just kind of smiled and said, "that's okay"....and in my head thought "@#$@#$, damnit, I wish I had a card?" I probably should have just written down my information and company address and phone number....but it's kind of awkward stopping to write all that down in front of the ER nurses while they want to interview the patient. I don't want to LOOK like I'd love a good letter....even though I'd LOVE it. So, I think I'm going to get some of those free cards off Vista. I'm trying to find something professional...anyone else have cards? Got pics of them? I'd be willing to pay a little money to make them look good if I see something really great.

Agreed on all counts.

Okay, gotta run b/c I have work, but must remind you that this is how science works. You take baby steps. You have to show there's a disparity between ambulance and private transport FIRST, then you can get into the why's and how's which can be a huge undertaking. We don't know the limits to time/resources they had.

How exactly does it prove that? Explain the flaws with this study?

Just so we're clear, the OPALS study being criticized is different from the one I posted above. That's the one you guys are criticizing, right, the OPALS? The one I posted accounts for similar severity indexes and several other similar factors. It's not simply that less life-threatening traumas are more likely to go by private vehicle. The article might cause homies to rush to the hospital, but 1) Homies usually aren't too educated and 2) You can't stop research like this just for fear of that. It can lean to pinpointing what needs to be done to change it to decrease the ambulance transport death rate. It's a great study...and like all studies need follow-up studies.

WOAH. Why is the guard rail broken up ahead on the road? Was that from a different incident? Or how did he end up where he is facing toward the guard rail?

Well, we need further studies to be sure, but the most pervasive explanation seems to be that we take too long to "stay and play". Scenario #1: -Person is shot (or accident) -Friends call 911 -In LA likely hold-time, CHP dispatch gets brief call synopsis, then forwards you to municipal dispatch, which might transfer you again to EMS dispatch, you re-explain the story -Medics receive call, another minute or two to get out in the ambulance (depending on system & time of call), wait for it to be dispatched on air (in my system), might need to map it out, then they take off. Response time 4-6 minutes, but sometimes 8 depending on call volume at the time. -Arrive on-scene, unload gurney/first-on bag/backboard, ask overall questions on what happened (this is if they haven't had to stage) -Primary physical with clothes cutting and handling c-spine, then strapping patient to board, possiblely look for IV access, putting board on gurney (with everyone trying to keep IV and O2 lines untangled) -Get patient in ambulance, in LA contact base hospital, bla bla bla, receive same orders we always do, THEN we can take off. -Enroute, efforts to increase blood pressure with IV when patient is still bleeding might worsen him -Arrive at hospital, unload, and wheel in to waiting trauma team Scenario #2: -Person is shot -Friends rush to help/carry victim to their car -Friends basically drive code 3 to hospital anyway...depending on traffic might be faster or slower than if really going code 3 in a big ambulance -Friends drive right up to ER and help/carry patient in...trauma team assembles pretty quickly Obviously, there's a lot of things that can go wrong with Scenario 2...cspine injury, lack of proper hemorhage control, patient could code enroute THEN they'd have to call 911, friends might not properly keep patent airway, and they might crash b/c not thinking about safety and consequences. So, those who died as a result of those things would contribute some personal vehicle transport deaths...but overall more people seemed to survive. Things to slow down scenario 1: -Call forwarding -Response times -Lack of as much rushing/running (which is of course a good thing, overall) -Primary assessment and interviewing patient/bystanders -On-scene tx like IVs/O2/cpine/proper patient loading -Driving slow enough to going code 3 so you can brake to clear the intersection without knocking crew off their feet/seats (even if they're green lights, could turn red) and with due regard Seems like funding and proper training could reduce a lot of these...

Thanks. Totally blanked on PubMed. Here it is for all: Arch Surg. 1996 Feb;131(2):133-8. Links Paramedic vs private transportation of trauma patients. Effect on outcome. * Demetriades D, * Chan L, * Cornwell E, * Belzberg H, * Berne TV, * Asensio J, * Chan D, * Eckstein M, * Alo K. Department of Surgery, Los Angeles Medical Center, Los Angeles, USA. BACKGROUND: Prehospital emergency medical services (EMS) play a major role in any trauma system. However, there is very little information regarding the role of prehospital emergency care in trauma. To investigate this issue, we compared the outcome of severely injured patients transported by paramedics (EMS group) with the outcome of those transported by friends, relatives, bystanders, or police (non-EMS group). DESIGN: We compared 4856 EMS patients with 926 non-EMS patients. General linear model analysis was performed to test the hypothesis that hospital mortality is the same in EMS and non-EMS cases, controlling for the following confounding factors, which are not affected by mode of transportation: age, gender, mechanism of injury, cause of injury, Injury Severity Score (ISS), and severe head injury. Crude, specific, and adjusted mortality rates and relative risks were also derived for the EMS and non-EMS groups. SETTING: Large, urban, academic level I trauma center. PATIENTS: All patients meeting the criteria for major trauma. RESULTS: The two groups were similar with regard to mechanism of injury and the need for surgery or intensive care unit admission. The crude mortality rate was 9.3% in the EMS group and 4.0% in the non-EMS group (relative risk, 2.32; P < .001). After adjustment for ISS, the relative risk was 1.60 (P = .002). Subgroup analysis showed that among patients with ISS greater than 15, those in the EMS group had a mortality rate twice that of those in the non-EMS group (28.8% vs 14.1%). After controlling for confounding factors, the adjusted mortality among patients with ISS greater than 15 was 28.2% for the EMS group and 17.9% for the non-EMS group (P < .001). CONCLUSIONS: Patients with severe trauma transported by private means in this setting have better survival than those transported via the EMS system. Large prospective studies are needed to identify the factors responsible for this difference.

Thought I'd have a cool article waiting for ya, didn't you? I'm actually wondering if anyone could provide any articles on this. It's been brought up before, but I've never been able to find actual journal articles about this. Apparently, in some urban settings, your survival chance as a trauma patient increases if you transport to hospital by private vehicle. I believe the study was done in LA. Anthony

We're a private ambulance company...CEO wants that money. We don't refuse. I'm always trying to figure out the best way to dissuade patients, though....I'd like to not contribute further to abuse of the EMS system.

I think it was a good study...not a waste of time at all. Trying to prevent injuries by looking at the data and understanding what goes on. Valid research topic.

Anyone work for Gold Coast in Ventura County? Just trying to get feel for the company, it's employee and satisfaction, call volume, way things are fun, 911 system there...etce etc etc etc

Why do people think there's such a difference in standards across the nation? First thing that comes to mind is different demographics. What if you have a county full of uneducated hicks...anyone smart who grows up there, moves out...that type of situation. I think a lot of counties would find it a strain to keep up with a national curriculum that's too stringent, so might fight to avoid it...even if it means not requiring National Registry for their EMTs. Don't know if this is a realistic problem or not...but my point is let's try to get at the roots of resistance to change.

Well, I know the grossly distorted view of their capability to handle the contract came from ridiculously inaccurate reports given to them by AMR about call volume and such (this is what i've heard anyway, but seemed verified). Apparently, at LEAST one area gets only 9 calls per YEAR...but they still need to staff year-around crew...at the very least 4 employees, plus whatever costs to keep station house/supplies/utilities going. I'd be interested in hearing any other rumors, as I've been hearing all kinds of stuff from people lately and some of it just seems far out.