WelshMedic

Erin, As a parent I can't even begin to imagine how that was for you. It's almost cruel to state it like this, but I think you "win" hands down on this topic. That's why I feel that it's run it's course and maybe it's time to put a lock on it. It's not about the sensation of someone's "saddest call" but how we deal with it. You are in my thoughts. WM

Here's what I started with in 1993: And here's what I have now: As you can see, Mercedes is a popular brand here. WM

I know of a very experienced anesthetist that is trained in EMS and he managed to inject the BIG into his thumb! I can happen to the best of us. My personal preference is the EZ-IO. (I have used the BIG). It's fast, easy and leads to a better result than the BIG. One thing we do need to remember is that the placement of an EZ isn't painful but infusion therapy sure as hell is! That's why we flush with 2% lidocaine first. WM

I'm still reeling from the fact your Medcom thinks that 4mg of Versed will knock them out enough to facilitate endotracheal intubation! It's very much a question of experience combined with science but I will not even attempt such an intervention until I've given a minimum of 10 mg combined with either fentanyl or alfentanyl. I agree, however, with Dust. Such potentially dangerous procedures shoudn't be attempted by cook-book practitioners. You need years of practice before giving these drugs safely. Intubating a pt with 2mg of Versed on board will generally lead to all sorts of problems, starting with an enormous ICP rise. WM

This is indeed not new. A pt with a drop in BP will ultimately already be decompensating to some degree. There are more subtle signs to watch for before this happens: a raised respiratory rate, restlessness, diaphoresis. This should be the basics but I guess some folk need reminding, so a good article all-round. WM

So true, and also: most studies point to the fact that the time difference is so slight that it has no effect on mortality and morbidity. Thus making it another EMS myth that needs addressing in order to gain respect from the rest of the medical community. WM

You could always come to Holland: if windmils and tulips are your thing.... WM

The decision to take away pediatric intubation, whilst being emotive, does appear to be evidence based. Pediatric intubations are thankfully rare, but the flipside is that maintaining the skill level required is difficult. Even with the best CE programs and OR rotations it is still very different to the actual practice. I consider myself to be reasonably well-educated, not to mention regularly trained. However, I still managed to miss a right stem intubation in a pediatric trauma a few years ago. We are not superheroes, we are just ordinary folk doing the best we can. OOH pediatric ETI may just be a little too much to ask of an EMS provider WM

It's a deal! Just to give my 2cents worth on this subject - I think that neither option is attrective, but if that I had to choose then I would go for professional. They are generally more accountable and have more time to train and hone their skills. WM

It's OK, I was just confused because your english is so good! I thought you were a native speaker (maybe you are...). Talking of 2003, were you in that group of Icelanders in Baltimore that we met at the meet and greet before the JEMS conference? If so, you still owe me a beer, haha! WM

There, in a nutshell, is the problem. Why are untrained personnel allocating resources on the basis of a computer analysis instead of actual need? It will all end in tears. wm

Hello Kristo, Where are you? Which country are you talking about? WM

The problem with a politician is that every time they get a brain fart, they feel the need to share it with everyone! Chill, chaps, this'll never make it through legislature. WM

Hello All, I didn't write the piece in French to show how wonderful I am at languages, I already know that . I also thought twce about replying in French, as I was aware that it would seem rude to some. However, Natacha posed the question to me in French and it seemed even ruder to not answer it in the same language. And to think i was telling her in french what a friendly bunch you are.......... WM

Non, je ne suis pas pompier. Je suis infirmier graduee en Pays-Bas. Ici, la service d'urgences medicaux est charger des infirmieres, pas de paramedics. Nous n'avons pas aussi les medicins, comme La France. M'èpouse ne sera pas s´advis comme elle est une femme! Desolée, cést une blague!! Bon chance avec la formation, vous réussira! WM

My intial guess would also be AFlutter. However, as we all know folks, treat the pt. and not the monitor. What did this pt. present with in terms of symptoms? I'm not sure I'm even going to do much with this rhythm as long as my patient is haemodynamically stable. We don't cure 'em, we just haul 'em in! The above may sound fairly flippant, but I do firmly believe that doing no further harm is an important tennet in our work. The good clinician is not the one who takes every trick out of his bag just because he can, the good clinician is the one who weighs up the benefits for the patient. An so also knows when not to do something. WM

Natacha, Félicitations! Vouz avez suivi vos reves. Je voudrais aussi l'habiter en Etats-Unis dÁmérique, mais ma femme ne veut pas émigrer. Bienvenue aussi ici, on peut apprendre beaucoup. Les membres sont sympa! Vos reves n'arret pas avec les pompiers-sapeurs, n'est pas? Nous essaierons changer votre avis, soins medicaux n'appartient pas avec les pompiers! Etudiez les postes ici, c'est une révélation. Bon Chance! WM (sorry for my terrible french, but I tried!)

Hello all, I know this topic has been done before, but I love it so much I decided te ressurrect it. I am currently in the process of writing a document on my time in nursing. This year it will be 20 years since I first sat in those chair/desk combination thingy's (you know what I mean, right?) in the lecture theater. In the meantime I have gathered lots of my own war stories, some of them sad. I don't want to focus on the bad side now though, I want to have some fun. Here are a few of my favorite stories: My first story is from 10 years ago, a dairy farmer collapsed in his milking shed, in full arrest. We pulled up as the second crew just in time to see all 2 tons of Daisy walking to the first crew, turning around and shitting all over their equipment and uniforms. I laughed so hard I couldn' t get my bag open to help. The second one stems from my time as a Staff Nurse at the Whittington A+E (ER to the yankees). We had a bloke come in with a cucumber up his arse. My mate Eddie, one of the other nurses, decided to have a bit of fun. So he sent in the most junior of the student nurses on her own. She was the twin set and pearls type that had had little experience of life. After a moment, she comes back out, looking as white as a sheet. "Eddie, THAT man had a cucumber in his rectum. What do I do?" (at this point I was already crying). Eddie studies her for a moment and replies: " Well, darlin', if I was you I would fast-bleep the greengrocer, that might help". She never said a word, she took it like a good 'un. I have an EMT colleague that is a great bloke but, erm, how shall I put it? He's not the brightest bulb in the box. We went to pick up a hospital transfer the other day. When we got there, the pt appeared to be somewhat overweight. She gets on the stretcher herself and my crewmate looks at her and says: "You're in luck today love, this stretcher can take up to 245 kgs". She looks at me, bursts into tears and says: "but I'm only 108!" . Try not laughing when she's looking straight at you! And the worst thing is: my crewmate, to this day, still doesn't understand why she started crying. WM

Why am I not surprised?

You are largely right. NCC has double medics. Usually the second medic will drive behind the ambulance that is transporting. If there is a second call, however, the second medic gets diverted. You then have to arrange a rendez-vouz after you've both finished your calls. Don't worry though, this rarely happens. WM (And yes, they carry all the equipment with them, and all the trucks are double equipped as well as double paramedic crewed.)

I feel an EMT city mini get-together coming on! Where do you work? WM

Hi, I know NCC as we have a ride-along programme going with them. The commute from Philly will take you about 45 mins, depending on traffic. There is no SSM, as far as I'm aware. The shifts are (or were last year, at least) )0700-1800 and 1800-0700. Equipment? Well they are an ALS service that does not transport so they utilizie custom built Ford Explorers instead of ambulances. In the city the private-contract BLS unit transports, out of town it is largely vollie Fire. They are largely based at Firehouses throughout the region. Career opportunities? Not really sure. What I do know is that you couldn't wish to meet a better bunch of people! Say hello to everyone when you get there. Especially Lt. Mark Allston, my buddy down there. We will be visiting again in september from Holland, so I'll be organizing a get-together. Hope you'll find time to join us! WM

Why, does she want to be taken to new heights? WM

Is this an option: Set a baseline of care at federal level that everyone is entitled to. Authorize a (limited) number of insurance companies to cover this baseline level of care through premiums. Then make health insurance mandatory for everyone. But make it income -indexed. Those who can pay, do pay. Those who can't get helped out in the form of premium subsidies or tax rebates. Simple really, isn't it! WM (well, it works here anyway)

The best time to visit Jim's is a summer evening. After eating the culinary equivalent of Nirvana you then walk it off by sauntering through South Street whilst people watching and visiting all the quaint boutique stores. You can finish up by visiting any one of the bars or restaurants on the street, although this is a personal favorite of mine: http://www.gethappypub.com/ WM