WelshMedic

Hi all, I realise that I'm a little late on weighing into this discussion but I wanted to tell you about my experiences with ketamine. My opening line: it is simply the best thing that has happened to pre-hospital care in 10 years. Ketamine has been around since the 60's. It is a disassociative anaesthetic which means that it shuts the brain off to conscious experiences. You take a pt. literally writhing in pain from, let's say, a long-bone fracture and medicate them. The first thing they then remember is waking up at the ER. It's only real disadvantage is the re-emergence phenonmenon, which plays a part when the pt. is waking. It can be best described as intense nightmares and some people can wake up literally screaming. It's not all bad news though. Re-emergence can be effictively managed by co-commitant doses of benzodiazepines. My personal choice is midazolam, I find that it very effective in combatting re-emergence. To the extent, in fact, that I have not seen the phenomenon for at least 4 or 5 years. It's obvious advantage is that it has no negative effect on hemodynamics. Whilst it can lead to a positive intotropic effect, it is very transient. I have never encountered a problem in the 10 years I have been using it. Ketamine is safe, very effective and versatile. I would recommend that your service consider it as an option, your patients derserve it. WM

Join in the chat and maybe Brett and I can help Brett, you want to pop in as well?

Wish my better half would do the same... Might be difficult for me, but keep us posted and who knows... If there's one thing I have learned in the last few days, it's that life really is too short. Carl.

I am glad that I stumbled upon this thread. A lot of the stuff that has already been said, I felt too. The sick feeling in my stomach upon reading the banner, the regret that I have about not flying down to Texas in september. But it is what it is. No-one can change that. The best way we can remember Rob is to make the city the best educational resource on the net for EMS. There are enough of us here to do that. Now let's go and kick a few whacker's and newbies asses. That's a proper tribute to Rob! Take care all, Carl.

Randy, An extremely eloquent post and a fitting tribute to our friend. Thank you for that! Carl aka WM

Damn, that one made me cry....

It's a sad world... I find that "fancy a beer to go with the pizza" does it for me...

We have a meeting every 3 months with our colleagues in the ER. It tends to smooth out any wrinkles. As far as scope of practice is concerned, most of the pre-hospital nurses here (we don't have paramedics) have, at one time or another, all worked in the ER themselves. We therefore, mostly, speak the same language. WM Scott, I've heard that NZ is a lovely place. You get funding for the post, and I'll beat you to it! :icecream: Just kiddin' Carl (how's life, haven't been around here for a while...)

Well, for starters, it looks like you've already made a decision not to renew. I think that's also the best of action in your case. Your career progression into nursing will neither be helped or hindered by a recertification process. Bearing that in mind, I would leave it as it is and concentrate on being the best nursing student you can. If you then later decide to do something in EMS, you can always pick it back up. You'd likely get a lot of concessions for your nursing qualification. IN Pennsylvania you can even challenge the NREMT exam and become a PHRN (Registered Pre-Hospital Nurse). Go forward and don't fret about the past (or things you can do nothing about), It's a waste of energy. Positive enough for you? WM

Hi all, It would appear that the threat of litigation is the reason why everyone should be writing a novella on every patient, however mundane. Whilst I can see why that would be necessary, it seems a shame that your putting all the effort in for the lawyers and not the colleagues. Believe me, in a busy ER, no-one is going to take a second look. Now, as far as verbal reports are concerned, that's a different matter. They need to be short and sweet. Past research has indicated that the recipient will listen for about 30-40 seconds before their attention starts to wander. Thus, you have a 30-second window of opportunity to get your message across. Mmm.. when I come to think of it, the best of us could switch jobs and make millions in advertising We use e-PCR's which are a godsend, you don't really need to think much at all, everything is prompted. My verbal reports follow this structure: Mechanism of Injury: what happened? Injuries found or suspected: the findings of your physical exam. (In medical patients I would also refer to the appropriate history). Signs: the vital signs ( and whether or not they are pathophysiological in this pt.). Treatment: What did I do and what effect did it have? The above is all that is required for the radio report, when doing the handover at the ER then I will supplement with SAMPLE and information over the next of kin. WM

I am sitting here, numb. It's been a while since I have been here but I was in contact with Rob. I knew about his illness, we have been mailing each other outside of the forum since 2008. I just wish I could have seen this coming. I was in the States 3 weeks ago, I am so so sorry I didn't get an internal flight and go and see him on my trip. Rob, you inspired many here, including me. The birds have stopped singing here and it's getting dark. Now I know why.. Sleep well brother..... we will miss you! Carl.

I am a little more seasoned than you guys and have more than 12 years EMS experience at ALS level. Here's some good news: it does get better! You learn from each and every call you do, even the seemingly insignificant ones. That experince then translates itself into a calm. professional attitude. A few points to remember: If you feel things aren't going the way you'd like. Stop, take a deep breath and reappraise the situation. This may cost a little time but your pt will benefit from it. You are going to someone who having the worst day of their life. You can't afford to panic, because that will make them panic and the buck stops with you. If you don't know something, don't be afraid to ask someone who does. Following that, never be afraid to call for back-up if you feel uncomfortable in a situation. I'll let you into a secret: the people who do that in our profession aren't the wusses but the consumate professionals. Whenever entering an incident, take the time to register your first instinct, have a plan ready and don't be afraid to fall back on your ABC's if you're not sure what's going on. Try not to get distracted by external factors such as distressed family members. And perhaps the most important: when in between calls, don't watch Home Makeover or play on the Nintendo, but learn your protocols. A sound knowledge base removes a great deal of stress. Take Care, WM

Yep, it's synergetic with opiates which then leads to less of the opiate being required. Particularly good in the elderly without a history of hepatic disease. WM

Hello all again, I've been a stranger around here for a while again. I was shocked to see the the city is facing a law suit. We have to stand up to these bully boy tactics to protect not only the city but all such fora. I have justed donated the $150 and it was money well spent. Carl Ashman aka Welsh Medic

Biz, There are no statutory agreements within the European Union when it comes reciprocation of qualifications amongst EU member states. Nor is there any reciprocation of US qualifications. Greece is not going to be easy as it's currently in a very deep financial crisis (in fact it has just been shored up with a $110 billion loan from the other member states of the EU to stop it from efectively going bankrupt. The little I know of Greek EMS is that BLS is largely voluntary and ALS is hospital-based. This might help: Here Good Luck! WM

Dust, I think Harold is talking about nursing graduates without critical care qualifications, making the transition into ALS somewhat more difficult. (Correct me if i'm wrong, Harold..) WM

Hi Timmy (and everyone else of course), You make a good point here. I am one of the EMS clinical supervisors you mention above. I have been mentoring new colleagues for the past 10 years. Apart from the obvious aspects that need to been taught like scene management and safety, what also strikes me is that, although most of these people are already reasonably experienced CCRN's, they still need to be helped in certain areas. Not about which drug to give or how much but whether or not it's clinically safe to leave a pt. at home with an alternative care pathway. If that is the case with this level of student, what will it be like with young paramedic students without the necessary experience. I agree that a degree trained medic is more than up to the job of treating and transporting. I do, however, have my doubts about accepting the level of autonomy and responsilbilty with Dutch EMS in it's present form. WM

I do, indeed, agree. The paramedic role that has developed in anglo-saxon countries (for want of a better term) never really took off in mainland europe. I think the OP was looking for arguments in favor of changing the system, although I can't be sure due to the lack of reply. One thing we must recognize is that it's not about titles but education and experience. With these comes extended scope of practice and more autonomy. I am sure that a degree trained paramedic is more than capable of doing the job in EMS very competently. However, when you get into community-based paramedicine like we do, it may fall somewhat short. Bearing in mind here that we are talking about the Dutch system, which is unique and doesn't necessarily translate well in other settings. There are just 1600 ambulance CCRN's in the whole of the country. WM WM

My hunch would be beter called an "educated guess". The OP should reply though, you are right there. WM

Did you read my post? We are talking about the Netherlands, where EMS is nurse led (Bachelor's degree with critical care post-grad). EMT's are trained to US EMT-D level, don't independently treat. EMS at ALS level provided. The current system works very well and is often quoted internationally as good practice: Look here Rationale for change: current system expensive, shortage of CCRN's. Making the profession accessible to larger portions of the population (which, to me, says dumbing down; but heck, I'm biased). I think you'll find that all of the above has been mentioned, but the above is a short recap. WM

Too true, mate! You pay peanuts, you get monkeys...

Hi all, Although I can't be absolutely sure, I have a hunch that the OP is here in Holland. There is a discussion going on here whether CCRN's on all ambulances aren't a very expensive option (and in short supply). One of the iniatives is a feasibility study into a 4 year Bachelor's degree that has a 2 yr common core followed by either 2 years in either ER or EMS. The problem is that the practitioner that rolls out of this programme would, not yet, have a recognized title. They are neither nurses or medics. Whilst we recognize that change isn't necessarily a bad thing, our concern is that the programme will not prepare the student for the broad role that they will fulfill in EMS here. We are far more community based than the US. We treat and refer patients ourselves rather than necessarily transporting everyone. Anyway, there's a bit more background info for you... WM

Have you taken your medication yet today? WM

When I go and do a talk at one of the local schools I will usually get one of the class to do a test report to dispatch (of course, I've pre-arranged it with dispatch). Does that make me a potential subject for inveestigation? This is such a non-story. What they did here was try to calm a frightened young man down by involving him in the process. I see no harm whatsoever. As far as riding up front is concerned, it's not ideal but maybe there was no-one to look after him. Depending on his grandmother's condition then I would have preferred to have him back with me and his grandmother. Simply because I could explain things and reassure both of them. WM