WelshMedic

I can relate to this topic. We used to have tagged everything, jumpbags, airway kits, the whole lot. I hated it because I was never really sure what I was going to find upon opening them. Usually I did it at the start of a shift but on one occasion we were paged out BEFORE the shift had actually started. We went to a chest pain patient who didn't get enough pain relief from nitro so I decided to give him fentanyl. Well, that was the plan until I discovered it missing. Luckily this was at the doctor's office so I could borrow some from him (great advertisement for my service, NOT). Back in the mess room later that morning I was bemoaning the situation to an EMT-colleague. He laughed bitterly and said: "Oh, that's nothing! I opened the airway kit last week at an arrest and there was no BVM!" Suffice to say that tagging didn't last much longer after that..... WM

Start a debate on bringing back public masturbation.....? (Oh, I'm for it, by the way) WM

Hi AM, You have made a valuable contribution to a great thread. First things first (to start off on a light note): You, my friend, have a funny accent with a twang in it. I, however, speak the Queen's english which is the only true form, my old chap! Education, Education and Education...we can't emphasize it enough, can we? Dust commented to me (in reply to a comment about the lack of confidence in EMS): Whilst this is undoubtedly true, I think there are other factors which perpetuate the situation in today's EMS. 1) Volunteerism: when someone is already doing 2 paid jobs and volunteering in EMS, how do they find time for professional development? They don't. 2) When a Fire Monkey is using EMS as a stepping stone then he/she also isn't going to hit the books much. 3) Educational standards need to be reviewed and reset. ALS should be the domain of someone with at least a Bachelor's Degree. It doesn't matter which country you are in, or which system. That level of critical thinking needs education. As far as your comment on personal responsiblity for keeping up-to-date: Amen, brother! Take Care, WM

You'd get a bigger BANG out of the Bangkok shuffle wouldn't you? (is that too rude for here?) May I remind you all that it's 1 april in a few days... WM

Yes, he is! The live in nurse would have to be a real tough cookie to put up with him though

Correct me if I'm wrong but I thought you mentioned either AK or Dust being ill and not able to post much these days? Send me a PM if you think it's more appropriate. Carl. PS - And yes, I read Aaron's blog AND show it to all my students..

Hey Dwayne, Don't apologize, I didn't take it personally because I knew I hadn't done anything wrong. As far as your mentors here are concerned, I couldn't agree more. I sometimes think that if I had half the knowlegde of those two individuals here then I'd be a bloody fantastic practitioner. I hadn't really thought about it before, but I guess you are right when it comes to Aaron (FizNat). He is willing to admit his mistakes and that makes him, per definition, a good provider. We've never met, but I think I could trust him with one of my own. I am left a little baffled about your comment on ilness...who did you mean? Carl aka WM

Dwayne, You have made some good points in your very eloquent post. So much so that you get gushing compliments from the Dust himself...so your day can't be ruined anymore.....However: That is very definitely NOT what I said. I said, in fact, the opposite:\ I know from experience that there are some damn good people out there that don't need handholding. That was my point: there is nothing wrong at all with a friendly consultation in your patient's best interest. Heck, I've done it before now because I wasn't sure of the right path to take. However when it becomes mandatory before carrying out an ALS intervention, then it becomes a whole new ball-game. That's where I draw the line. In reference to Jake's question about SOP's: yes Jake, we have a national protocols which are set every 3 years by a committee of EMS and hospital professionals. This book is then published in pocket-sized format which we are required to carry. It's an important framework, but we can and do make exceptions if in the interests of a particular patient. WM

Phil makes a good point here, actually. Not sure whether I would have been quite so blunt...but nevertheless.... MedCom is a way of avoiding responsibility. I'm not even really sure why, either. The people who hang around here seem to be pretty knowledgeable and committed. I'm sure most of you are more than up to the job of critical thinking in an acute situation. You don't need anyone to hald your hand for you. I can't help but wonder (genuinely wonder - this is NOT intended to be an inflammatory comment) whether our US colleagues have so gotten used to being told that they are at the bottom of the chain that they have started believing it themselves? I agree with Phil and Kiwi - MedCom is a cop out. WM

I now have to admit that I did not look into the specifics of the bill before posting my comment. I realise that this is going to cost people money, in some cases a lot of money. But surely those who are very poor will get some assistance? I still stand by my comment that healthcare is a right. It's funny, but it would only be an American that would think otherwise. The above by the way....mmm....I think you'll find we had democracies long before the US was even formed. As an insult: FAIL!

Well, since the vox populi here so far seems to pretty negative about the pending Healthcare reforms then let me re-adress the balance: I think that it's a travesty that one of the world's richest and powerful countries has waited so long to adopt decent healthcare for all, regardless od socio-economic status. Shame on you all for opposing this bill. And yes, I'm an outsider. An outsider that pays 52% income-tax to benefit from one of the world's most developed social security systems. No, we are not going to hell in a handcart from all the those free-loading parasites costing us a fortune. I live in a prosperous, caring country. No-one in the developed world such need to worry about a basic right such as decent healthcare. You want a strong opinion, you got it! WM

I think you'll find that a reaction to either of the drugs is fairly rare, I have never seen it in 20 years of ALS, both in and out of the hospital setting. Having said that, if you follow CH's logic then I think you made a pretty fair assumption. Fentanyl also has the distinct advantage that it's serum plasma concentration time is shorter than that of Morphine. In layman's terms that means that it is faster-acting but has a shorter half-life. This can also been seen as an advantage too, of course. Particularly in EMS. I gave a presentation last year to EMT-P students at the Montgomery County Public Service Academy in Conshohocken, PA. Although the first half is not relevant to this discussion, the slides of the second half are about pain-management strategies in EMS. Here's the link to that presentation. I hope it helps. WM

Hello all, This is an intersesting subject which shows the differences between different countries. Most of the salient points have been made but there is one aspect that springs out to me: Although MedCom is generally bemoaned within the profession, it appears that our US colleagues are not quite ready to go it alone. I have been in EMS for more than 15 yrs and have contacted an MD just once in that time. Other than this one incident which involved a very complicated post transplant patient, I cannot think of a single moment when I felt the need to speak to a doctor. Not that I think I'm God but because my education and experience guides me in my patient care. MedCom is, to my mind, delegating responsibility. You know what to do and how to do it, but insist on holding someone's hand to do so. Take STEMI, for example. 12 lead interpretation is a cornerstone of EMS. I have no problems at all with getting the cath-lab up at 3am because of an acute MI. ALthough I realise there are some potential pit-falls such as pericarditis, I am pretty sure that I have never given out a false alert. Even if it were the case: better safe than sorry! The profession does need more education (is there such a thing as too much education?) but I also think that the profession needs to recognize the leaps forward that we have made in the last 20 years. And to stand up and be counted! WM

Psychology is also a good class to follow. Preferably psychology of the ill person, but that's not available everywhere. Good Luck! WM

Well, that says a lot about you and your contribution to this discussion. The only way is the American Way...... Arrogance AND stupidity, you'll go far..... WM

It's also a fantastic example of a flail chest. I'm using that one in my next lecture.... (now, how did it go again with copyright? ) Scott, it's a real blast from the past, isn't it? The old bedford vans and Sierra Rapid Response (and the Met's Vauxhall Astra's). And that cell phone the mighty Dr. Davies is using, the size of a housebrick. Ah, those were the days... WM PS: Yes, I'm old and grey.

I think that piece is great. After being (sometimes) treated badly as a nursing student I decided I would go into preceptorship after qualifying. Making the bad good again, you know the score. I use the points in that letter almost daily. WM

That we can certainly agree upon!

I don't doubt for one second that you are a caring professional. That wasn't my point. I was making a comparison of the both professions as a whole. Besides, holding someone's hand all the way is not the definition of a holistic approach. That's called common decency and compassion. Oh, and I should hope you don't lie to your patients! WM

First of all, my reasoned argument would be that nurses are better educated, better trained to look at the whole patient (holistic approach)and better, generally, in communicating with patients (we do that class from day 1). As far as the flip side argument goes, I agree that paramedics could work in the hospital setting. In fact they do, as ER techs, as I'm sure you know. But what would a paramedic know about cytostatic regimes on an oncology floor? Not that I can remember much either but then I didn't choose oncology. I chose pre-hospital nursing. After trying ER nursing. The clue here is that a nurse is more broadly educated, opening more doors. A paramedic is trained in pre-hospital care, and does it fantastically. But that's where the door shuts too in almost all cases. WM

My general advice to you would be to treat the patient and not the monitor. Imagine, if you will, that you were part of a BLS crew treating a SOB pt. Would you have treated the pvc's then. NO, of course not, because they were asymptomatic and so you would have had no notion of their presence. That list of yours will stand you in good stead, I was going to post on VT salvo's but you already have the heads up there. Relax, enjoy the ride and be good to your patient. Give them what they need, not what your cookbook says.... WM. PS the word is aneurysm.

Thank you..I think.

Of course you would defend your profession, you are a medic student and therefore competing with a PHRN. However, a blanket statement like nurses belong in a hospital doesn't help your case. Have an argument but make sure it's a reasoned one. Maybe that's why nurses are paid and respected more No, strike that; it's unkind. I'm sorry. However, the point I am trying to make is that a paramedic does not have the god given right to pre-hospital care. There are other models that work just as well. WM Mark, Here is a copy of the presentation I gave in 2008 to the paramedic students at the Montgomery County Public Safety Education Campus in Conshohocken, PA. Here Don't hesitate to mail me if you want to know more.... WM PS: the cautionary tale mentioned at the end is

Whilst I have no objection to the creation of a Batchelor's qualification for EMS personnel, I do wonder why it's necessary to abolish the PHRN. PHRN's do have a role in EMS, albeit a different one in the US. Here in the Netherlands we are all RN's in EMS. We are not in some kind of Utopia because we have our issues too (pay and retirement benefits being just an example). However because we hail from a far older profession we are accepted as fully paid up members of the healthcare team. Autonomy to practice is essential to the development of any profession. How do you acheive that? By education. One of the nice things about my job is the fact that we aren't just looking to transport but arranging the most appropriate care pathway for our patient. Taking the elderly and/or vulnerable into a hospital ER teeming with all sorts of bacteria isn't always the right thing to do. However, in order to acheive this, I need to have a good system of primary care that can be relied upon to look after my patient after I've left. In order to do that those patients need to be insured for healthcare. Which is why it disappoints me to see that the US healthcare reforms are looking likely to strand. Sorry for making this a little political, but my point is that in order to modernize EMS (at least in the US) factors outside of EMS' sphere of influence also need to be adressed. WM

That's not familiar at all............. It's a time thing I guess. 10pm EST is for me 4am GMT+1 (Holland). Oh, I feel so lonely.. I need a hug. Welsh