mikeymedic1984

Because in 1978, we did not have any other means, or at least I did not. I cant remember what year glucagon was introduced to my rig, but I know it was not the first few years. So between let them die, or put some goop in their mouth, there was not many options. And remember in 1978 and most of the 80s there was no internet to find such obscure studies, so you would have had to subscribe to this publication to see this study.

I know your intentions are well intended, but once you start down this slope (who really needs an ambulance ?), you head down a slippery slope. It is our fault (EMS & Medical Community) that we get abused; for years we told everyone to call 911 for everything and there is a perceived notion in the community that calling 911 will get you in the ER faster. Treat the patient in front of you now, let your supervisor worry about the "possible" critical patient down the road that has not called yet.

A more positive thing to do, rather than get everyone in an uproar: 1. See when the last time your B/P machine was calibrated (or cuff if done manually). Machines need to be serviced routinely and maybe yours or the ER's machine is out of whack, more likely that it is yours. 2. Was the B/P taken in the same arm both times (next time you may want to make sure the same one is tested, as that could account for a variance). 3. The treatment itself could have temporarily raised the B/P. 4. Sounds like the whole facility could use some teambuilding. You have to see it from the ER's side, to them you and the Urgent Care "dump" on them all the time, what do you do to help them ???? No, its not really dumping, it is their job but that is how they see it. So try to find ways to be their buddies, get to know each other, it is harder to get mad at a friend.

I am not against trying to find things that work better, just saying before you adopt the latest greatest scientific change as fact, realize that it rarely meets the hype (think of all the money wasted on Amiodarone, when we could have just kept using Lidocaine and used the savings to buy more AEDs or hold more community CPR classes).

I have not seen faked injuries in a long time, but I have seen a lot of faked pain, but I just realized how much that has dropped off since the "pill-mill" pain clinics have flourished. Guess they do not need the ER as much anymore.

I agree that science is a good thing, but I have been around long enough to see multiple changes in ACLS and AHA recommendations throughout the years, BASED ON THE LATEST SCIENTIFIC STUDIES, and guess what --- there has still not been any substantial change in survival rates. So yes, you can find a study by now that says intubation is bad, but in 8 years we will be putting it back in. I will boldly predict now that the next ACLS changes will bring back pushing 2 amps of bicarb and a D50 in every code (lol, along with some D5W TKO says gage). I also agree that we should not do things just because we always have, but in this case, "intubation" (when done right) has served patients well for many decades, so I am not willing to just throw it out the window. Lastly, many scientific studies that are done outside of the university setting, are done by drug or equipment company that may or may not use that study to push a product. I can not tell you how many times I have watched a doctor write a script because the big-boobed drug rep showed him scientific proof that this new med was better, only to have the patient come back or call back to the doc to say hey I cant afford this $200 drug, give me the 30 year old $10.00 drug that works just as well, which it does.

I am sorry, the whole "you have to have a scientific study to prove something" is bizarre to me. I agree if you are introducing a new product, then it should be thoroughly tested, but intubation has been around for decades, and if it were useless or dangerous it would have been discontinued by now. And when you do convert any cardiac arrest patient, what proof do you have that the conversion was due to CPR, Good Ventilation, a certain drug that had just been pushed, or the combination of all ??? Just because a blind man can not see that there is a pink flower in front of him, does not mean pink flowers do not exist.

I wonder if it would be better if we went to regional systems that shared fire/ems/dispatch capabilities, and used that savings to do something else. Think about how many different departments there are within 50 miles of you, that each have Admin overhead, billing systems, and independent dispatch centers ?

I always say, if you got a job that paid you to have sex 100 hours per week, sooner or later you would get tired of having sex. Be careful about doing the same job at a ridiculous amount of hours, you will get burned out. Instead of increasing income, try to reduce expense, the 2 job thing is a trap that is hard to get free from.

I will not label all of EMS as generally negative, but in most of the organizations I have been affiliated with, it seems that we (among employees not managers per sae, although it probably happens there too) tend to point out what is wrong more than what is right. With the vast amount of different organizations represented in this room, there must be several that are doing at least one thing really really well. So I ask you to name one thing that your organization does really well, and if you can provide a little detail, it may help another organization improve in that area ? If disclosing this might get you in trouble, because your employer is known, then describe something from a past company or neighbor that you admire. In my current company, we have always been at the top technology and equipment wise, on everything from the radio system to the biometric locks on the drug box room. I often take for granted that there are organizations who do not have the tools that I do. We have been aggressive with lease agreements and grants to help us obtain what we wanted/needed.

OK, but the problem is that I am not sure that they are just vaginally-intolerant. It seems that they did not allow black members until the early 90s, and up until then, all caddies "HAD" to be black. So not sure how you counter-balance those views. Nonetheless, I am guessing that somewhere here that they are incorporated, if for no other reason, for legal protection against bankruptcy and lawsuits. Then again, if it were that open and shut, I am sure some fringe legal group would have been successful in getting them to change by now

Ok, I will play along, what would you consider the gold standard then ? If I go to the ER and arrest, will they intubate me ? What about ICU or OR ? Granted, if I am having a short procedure, they may choose to use some other temporary form of airway management, but if I am in respiratory arrest for any long period of time, I bet I wake up with a tube and a ventilator. You could make the arguement that the Paramedics are the problem, not the procedure (I think Doc suggested that earlier), but I still think the industry experts would say that intubation (when done right) is the superior method. But hey, I do not pretend to know everything, please feel free to educate me to your position.

How would you hold that study in the US ? Any city that chose to throw away their laryngoscopes would be swarmed upon by the lawyers. He did not die because of that massive aeoritc aneurysm, it was that medic who only used a BVM to ventilate him, instead of the gold standard that has been around for over 30 years of EMS ?????P.S. Kiwi, when you take 40% out of someone's paycheck in the form of a tax, your healthcare is not free. Not saying our method is any better, at least in your world everyone pays something towards their healthcare whereas here, the insured pay for the uninsured.

Sam Elliott

http://www.tvspots.t...ROSS--AMBULANCE Unbelieveable, I can not believe I have never seen this one on TV.

It has nothing to do with golf, it is just that golf happens to be the vehicle for discrimination this month, in this setting. It seems there are two camps on this one, one that says discrimination is wrong regardless of where it happens, and those that champion the right of a private club or group to select whomever they want, and not have quotas or membership decisions forced upon them.

There was some discussion in the other thread about intubation no longer being warranted in pre-hospital cardiac arrest, which was news to me. Some of us cited that protecting the airway and providing oxygen straight to the lungs was beneficial, whereas others cited that there are no studies that show that intubation has any effect on survivability, which makes sense because there is such a small percentage of those who survive regardless of what you do. So let the debate begin.

Of the choices provided, stopping at an inbetween facility would have been best for the patient, but the inbetween facility probably would have had a hissy fit. To sit on the side of the road for 2 hours waiting for ALS does not seem to be the right thing (patient is still in pain). But again, to answer all of these weird freak occurence calls, you should always have on-line Medical Control to hash out these problems. I wonder if a manager was involved, I may have missed that part of the conversation.

Yes, lets please get back to the original thread. And just to add a little truth to something that was said: An INT does not meet ALS 1 requirements, if you are billing all calls with an INT as ALS 1, you will get a visit from the Feds at some point. Also to those who suggested that a 19 year old newbie cannot convince a Nurse to push pain meds for the ride, that may have been true 20 years ago, but these days most facilities/nurses are really good at pain management; I have never been denied this when transporting from a hospital or hospice. Now if the patient was in severe pain (maybe being transferred for the ER), I agree to send ALS, but since this patient was pain-free or at least pain-controlled at time of dispatch, I see no need for ALS. By the OPs on admission, the patient was fine for the first 2 hours.

????????????? I agree that you cant kill a dead person with any act that you do after they are in arrest, but you have a much better chance of rescuscitation if their lungs are not full of puke, and the heart is actually getting a little oxygen.

I am not sure we can understand, as white males, how others may feel about not being allowed. But so far, the women in the room seem to not have a problem with it, so I guess I should not be offended, but I still am. How would the inclusion of women destroy their precious club ? An all male club sounds gay to me. I wonder how many blacks, openly gay males, and foreigners are in the club ?

If you need ETCO2 to tell if your patient is not being ventilated properly, then I agree, you should not be doing vent calls. What would you do for an out of hospital cardiac arrest if you did not have it ? Just saying, Roy and Gage never killed a patient and the only technology they had was a 50lb defibrilator and a 10lb portable radio to call Dixie at Rampart.

Why do I say it is the wrong thing ? Substitute any other category for "women" and then ask is it OK: We do not allow blacks, jews, atheists, gays, small breasted women, red-heads, trekies (ok that one is OK)

The fact that i wear my jeans down near my ankles might preclude me from a job. what I post on facebook might keep me from a job. The fact I can't write a clean sentence might keep me from a job. The amount of gold in my teeth and ink on my ASS might keep me from getting a job. the fact I have 5 kids before I was 20 might keep me from getting hi gh paying job. Why didn't you just say "black", would have saved you some typing, maybe you should read eyedawn's post on biases.

Why do you have to be government funded to do the right thing ?