WelshMedic

So you're alright then Jack, are you?

Exactly, that was what I was trying to say in my original post. The rise in the number of tropical storms in past years and the fact that towns like New Orleans are under sea level make this sort of occurence more likely in the future. There is a plethora of research into this subject and, admittedly there are some conflicting opions. However, there seems to be a majority consensus that it is having an effect. But believing this makes for some uncomfortable choices, doesn't it? Just imagine a world without SUV's or 24hr AirCon..... I'm afraid we'll all know who's right or wrong when it's too late. WM

Doc, You really should get out more, mate No, seriously, this is a major problem that a lot of people in the US don't seem to want to accept. And I understand that. Why? Accepting that climate change as a fact means having to do something about it - and that requires change in our behaviour. The US is one of the major players when it comes to global warming. Up until now all we've seen from a european perspective is a president that consistently refuses to ratify the Kyoto protocol, influenced by political lobby from the biggest polluters on the planet. Is there anyone left on the planet that still does not believe in the link between global warming and changing weather patterns? I find it hard to believe.... I'm sorry but New Orleans was no accident. A tragedy, yes. But no accident. Let me put it into (for me) a more personal context. You may or may not know that my country, the Netherlands, is for a large part under sea level. If global warming continues at the same rate for the next 50 years then by 2070 something like two thirds of the country will be under water. That's no longer a matter of hundreds of years, this will affect my grandchildren. With this knowledge you won't then find it a surprise that the first photo was a Dutch ambulance. Our government puts a tax on gas that makes it 4 times the cost that it is in the US, we recycle almost everything that we can, we have wind farms in the North Sea - all because we don't want to drown (Hans Brinker, the boy who plugged the dike, is dead). Why are we bothering when the big boys don't want to play along? WM

check your pm's carl

Hi Fiz, I'll have a go for you at a serious reply. I was directly involved in the games this year. I was one of the international judges. I don't remember any yankees being involved, by the way The competition is quite fiercely contested and in order to get anywhere near the finals you have to complete quite high scoring during the preliminary rounds. You are judged not only on your clinical skills but also how the team works as a whole, something which a lot of people tend to forget. It would not be appropriate for me to go into any specifics, as you can imagine but I can say that it requires a lot of practice and teamwork. Oh, and one more tip: pay attention to the small details as well. Last but not least, it is fun and the prizes are not to be sniffed at , either. The winners were sent to the Gold Coast in Australia for a conference on pre-hospital care. That's got to be worth haivng a crack at, surely. Oh, and by the way; I'm not judging in March next year, but I will come and cheer you along! Carl.

Hi, I do believe that Kristo was a little misguided in mentioning the Iraq situation but I also think the reactions were out of proportion. Dust, when it comes to a reaction on the justification of US presence in Iraq I don't think you can really mean the EU, I credit you with more intelligence. Isn't the UK a european member state? I'm also pretty sure that my own country has troops in the Middle East (Uruzgan). Each member state has it's own independent opinion on the subject, so please don't tar us all with the same brush. I'm also keen to find out which EU member states receive US aid as a result of foreign policy. I'm pretty sure we've finished with the Marshall plan. Although you may have a point about some being too lazy or stupid to manage their affairs, I think you'll find that it's a tiny majority. It's not about pandering to the ne'er do-wells that every society has, it's about protecting our most vulnerable citizens: children, the elderly, the handicapped, the poor. To have anything less than decent health care is morally bankrupt, especially for the only true superpower left. In 1999 the average American could expect to live 76.9 years, the average African American could only expect to live 71.4 years (National Center for Health Statistics (NCHS), Health U.S., 2002, Table 28.) I find this figure appalling, are you still telling me that the American way is the only way? WM

Hi, I'm with Kristo on this one, guys. I would consider myself right of center when it comes to political ideologies. I do think it's everyone's responsibility to look after themselves, I believe that a Welfare State is detrimental to a country's economical development. However, health care is a completely different matter. Why should a bank director be given better health than his janitor? They both work just as hard, don't they? And yes, taxation would go up. I have a moderate income ($78,000 a year) over which I pay 42% taxation. I see some eyes opening wider and wider................but here's the thing: I live in a country that can afford to look after it's poor and elderly properly. A child with leukemia will get the best possible treatment, not just what their HMO paysfor.New mothers get thirown personal maternity nurse at home for the first 10 -days. The elderly are cared for in state-run homes that are bright, airy and a joy to visit. But best of all (from my perspective): we have decent primary care options for everyone. If I get called to someone then it's because they are genuinely ill, and need hospital admission. The rest is taken care of by the primary healthcare team. I also tend to agree with Kristo that the current situation is a to the detriment of EMS. Billing and debt collection is, to a greater or lesser extent, a headache for every EMS organization in the US. We don't even need to think about it, it's covered, period. Maybe that's also why we are all full-time RN's with specialist qualifications in critical care and EMS. And that's also the reason why we earn a decent living wage and don't all have 3 jobs to support our families. Just my 2cents worth.... WM

New Castle County EMS is an integral part of the PD. They provide ALS intercept for a private BLS company in the city of Wilmington, DE and for a number of volly corps out in the sticks. Website: [web:3f4ca04bf1]http://www.co.new-castle.de.us/ems/home/webpage1.asp[/web:3f4ca04bf1] WM

What if prehospital providers were a branch of nursing. There are CCNs, Trauma nurses, etc. What if we were all trained to that level? That would take EMS out of the FD. Maybe keep paramedics as drivers as EMT-Bs are now. Just a thought. Smack away... Sarge What, like Holland you mean?

Kanga's avatar is the Welsh flag, and Cymru is the welsh word for wales Hence my appreciation of it.... WM

Kanga, I like that Avatar..... (and now back on-topic...) WM

Whoever coined the phrase "EMS eats it's own young"? I thought it was spot on at the time, and I still do..... If you're new to this game then there is so much to be absorbed that sometimes our "hard disk" freezes up. That's not a necessarily a catastrophe when you're working with more experienced people. You do, however, need to analyze why it is happening and try and work on it. There will come a time that you will be the most experienced crew member and everyone will be looking at you. Also, not to be discouraging, but there are just some people that are not cut out for EMS. It's not a crime and you'd be no lesser a person for it. In fact looking at some of the deranged people on this forum , then I'd rather consider it a compliment. I wish you well in sorting this problem out. WM

Hi all, I can fully understand how frustrating it would be to have to transport someone you knew did not require urgent medical treatment. I can remember a ride-along in the Philadelphia area (not PFD, by the way..) where we picked up a young woman. Chief complaint: she had got a bit cold waiting for the SEPTA bus to turn up. Referring party: the local police department! I was appalled at the misuse of the service by colleagues, but I was speechless when we then transported to the ED as well. I'm not going to launch into a sermon here about how much better we have it here in the Netherlands, you can't compare apples to pears. Yes, I can refuse but I would be the one standing before the coroner as an independent practitioner. No, there is, in my opinion, a number of basic flaws in american EMS: 1) The litigous culture has made every healthcare professional afraid to take risks, perceived or otherwise. I would think twice as well if I had a multi-million claim hanging above my head for leaving poor Mildred at home with her broken fingernail that, by chance, 6 weeks later got infected and gave her a mild case of septicaemia. 2) Whilst most of the EMS people I have met are wonderful people doing a great job, their scope of practice tends to be a bit limited. I guess I'm with Dust, AK and Ruffems on this one, education is the way forward. There lies a great future for EMS if you are willing to take the reins and throw the shackles of medical direction off. Become a profession in your own right! 3) Last but not least, if you decide not to transport then it's important to offer the patient another care pathway. This is not an option for a lot of people as they have practically no access to primary healthcare. This is why urban ER's are snowed under with a lot of people that shouldn't be there in the first place. The above is just my take on things. There a lots of things that american EMS does right, and we have all learned from them. Take for example PHTLS, this is franchised worldwide. But they have nothing to do with this topic. I know I'm just a presumptious foreigner. I also realise my experience is limited. Don't take offence at any of my remarks, it's not my intention. Just argue with me why I'm wrong. WM

Hi 4c, I liked your post about the AAA you worked on, it was a classic example of a burst AAA. I can tell you did your best for him, but unfortunately the outcome had been decided the minute it burst. The best thing you can do is a recognize a dissecting AAA in an earlier stage and get them to specialist care as soon as possible. Here are some of the tell-tale signs (sorry, if I'm preaching to the already converted, I have no idea what level of provider you are): Gender: occurs in far more males Age: tends to be the "older" members of our community PMH: more often than not there is a history of hypertension. Presentation: anxious, unable to find a comfortable sitting position, diaphoretic, sub-sternal of abdominal pain that radiates to the back area (this is a particularly tell-tale sign), need to defecate and finally, in certain types of aneurysma's you will record a marked difference in BP in both arms. Sometimes is a lack of femoral artery pulses on one side a sign, but this can be difficult to diagnose and is certainly not conclusive. Treatment: Hell for leather to the nearest center capable of dealing with the problem. Have a good day all, WM

I hadn't visited the chatroom much in past months as, indeed, the conversation was rather banale and nothing to do with EMS. The past few days I find myself invalided at home and bored. It led me to the chatroom where I had a great discussion with jmac and SAmedic about analgesia in EMS. It was rather refreshing and spurred me on to spend some time there. That's the thing, if all the interested (and interesting) people stay away, then the chatroom will never improve. It's down to us, it's that simple. So Dust, what's stopping you? WM. (I must admit that I have had some rather strange conversations in the past though...)

Welcome Back Bushy, It's quite simple really, in order to use the chat-room you have to have posted at least 3 times on the site. It's meant to curb the misuse of the chat-room by people who are not interested in the subject matter. So hence the joke about 3 posts. It obviously does not apply to old hands like you. WM

No, I think you"ll find it's because you have no decent refusal to send policy in dispatch..... WM

(sorry for going off-topic...) The WaWa is an institution.......so much so that it's fame has reached the distant shores of mainland europe . The Italian Hoagie with extra mayo is legendary. The coffee's not bad too. WM

Zippy, Just a quick question, why does almost every thread you get involved in end up in a pissing match? Are you frustrated? Then apply for one of paramedic science degrees (I'm sure you'd get some credits with your background). Do you enjoy winding people up? Then just think about this: if you used this behaviour on the street then it would be deemed to be unacceptable. Why should it be any different here? I think you are an intelligent person, your posts show as much. I just think that with your arrogant attitude that it's a shame no-one bothers to listen much anymore. You can take this advice as you wish. You could respond with a diatribe of my shortcomings, let's face it - I'm not perfect. But I never wind people up for the fun of it. It's just childish. I wish you luck whatever you decide to do.......' WM

I really was a man the last time I checked, my wife and kids may be able to confim this..... But seriously, education is the way forward. We went through the same struggle in the 70's and 80's. Before then we were seen as doctor's handmaidens. I started in the early eighties and I distinctly remember being told by a fossil of an RN that she thought there was something wrong about men in nursing. It just wasn't right! We weren't compassionate enough. To which I replied: "How come the first "nurses" were Benedictine monks then?" One of the misunderstandings is that people tend to have certain images and expectations of a particular profession. Nurses=white uniform/female/hospital based. But like many things in health care today, these boundaries are blurring. I happen to work in an EMS system where it is nurse based, we never had the military history that spawned modern-day paramedicine. But I do exactly the same job, I stand in a ditch at 3 am cannulating someone. I tell the firefairies how we are going to do things with an extrication (although often this is a question is teamwork). I think it's time to stop judging a whole profession on whether or not they're suited to EMS and start judging the individual on their skills and competencies. I carry the title RN, but I still do the same job as a medic. The only thing that matters is whether I do it well. WM

What is that with EMS and low-pay? It really is the same the world over. It's no different here either. I get paid less than my ER colleaugue even though I've been through the same post-graduate courses + I have my EMS qualification. He/she also doesn't have anything like the same responsibility, there's always a doctor on hand to run to. There really must be something about working on the streets that we let this happen globally Interesting - shall we have a ballot for a world wide strike? WM

Dust, I nearly choked on my egg when I read that......you are one mean SOB, but as funny as f*ck. Me; I'm a nurse and a medic, ánd I'm shit-hot at what I do. The dog's bollox! You may all bow down to me. (I was originally going to write an original and constructive piece, but couldn't be arsed). The all-seeing, all-knowing king of EMS, aka Welsh Medic

MY guess would be that he's a Mr. He certainly is a cock if he logs onto a US site and slags off EMT's when he's not even in EMS full-time WM

CH, I wholeheartedly agree that one shouldn't be too critical without first-hand knowledge of a particular system. Let me give you some perpective on the Dutch system: The degree nursing program takes 4 years and encompasses Adult, Pediatric, Mental Health and Learning Difficulties nursing. Once you have completed the degree program you then specialize in one of the 4 main branches. Should you wish to then become a pre-hospital practitioner (the translation of paramedic in dutch terms) you would then have to specialize in one of three critical care areas - ICU, anaesthetics or ER (another 18 months). Once you have completed this post-graduate program then you would be eligible for enrollment into the pre-hospital program. This, again, takes another year to complete and teaches the student to think outside the hospital environment and to prepare them for being an independent practitioner. It also includes the cornerstones such as PHTLS and Scene Management. It is true that we are independent practitioners, Medical Command is a completely alien concept to us. We also have the option to refuse transport to someone who doesn't require it. This mainly works because we have a good primary care system - we can always refer the pt to a family physician. However, it's not all a garden of roses - we are, despite protests, still not alllowed to using muscle relaxants in RSI. Although this will hopefully change in the not-too-distant future. I also have a reasonable understanding of the US system - I organize a yearly visit to the Pennsylvania/Delaware area for interested colleagues. Both systems have their good and bad. We win the autonomy hand, but you guys win in terms of investment and sheer volume of providers, making for a very fine network of responders to any particular incident. The legal norm for the Netherlands is 15 minutes between the call and arrival. How many SCA's are you going to save after a quarter of an hour? Vive la difference! WM (who's driving to Italy tomorrow for three weeks to enjoy the sunshine, good food and fine wine - there are some advantages to living in Europe). PS- I did a Powerpoint presentation on Dutch EMS for colleagues in the US. Does anyone know of a way of posting it somewhere here? (If anyone's interested, of course)

Fiz, Whilst I agree it's difficult to diagnose without seeing a pt yourself, I do think that you've made a number of subjective conclusions that are, at best, tenuous. No, JVD and distal edema aren't always present, but 9 times out of ten they are, to a greater or lesser degree present. I aslo think that History is a very important diagnostic tool in this case. It's one of the few ways that one can distinguish CHF from obstructive pulmonary disease - it's a question of asking the right questions, in my experience. There are no absolutes in emergency medicine (or in medicine, generally) and that why it's part science and part art. Therein lies the challenge that I enjoy taking up every day. I think our colleaugue in this case used good judgement and sound clinical reasoning. That there are always exceptions to the rule is fine, but don't lose sight of the ball for the 90% that present with text-book symptoms. WM