Eydawn

Dear Mr. Christopher... Why didn't you add the /sarcasm thing to the end of your newest "dumb statement"? You have much to learn... Wendy CO EMT-B

I've never really understood why the BGL is considered an advanced skill... I mean.. if you can teach grandma to do her BGL at home, why can't a Basic do it? It's another piece of information, even if they can't obtain IV access to correct it. Thoughts? Wendy CO EMT-B

I'm a fan of the insta-Kerlex barricade... "Hey you! Yes you... here, take this! Hold on to the end of it. You over there! C'mere... you hold that about 3 feet down from the first guy. Pass it down the line, and everyone hold onto it and DO NOT LET GO, ok?" Works like a charm... especially with Boy Scouts who all rush over "I have my first aid merit badge! I know! I have first aid!" Wendy CO EMT-B

Hmm... My point, which you seem to have missed, exactly. It is hard to think straight when someone is beating the ever living hell out of you. And we ARE trained to think straight. Which is why I have a hard time condoning the idea of prone transport, but decided to toss it out there that perhaps as flawed human beings in difficult situations, we could be faced with prone restraint or no restraint. I did read all of your posts, in their entirety. The luxury of the forum is that I don't have to formulate a lengthy response to every word you say, but rather can focus my time on the snippets I feel to be pertinent to the discussion, from my point of view. If we are not disagreeing on the appropriateness of prone transport, then why are we having this discussion, and why didn't we branch off on some of the other treatments? If this is about reconciling experience (which you have plenty of, no doubt about it and my hat is off to you for remaining in this field) with the newer educational standards, then why did we get so hung up on prone restraint as the only subject for discussion? If that's what you really want to discuss, let's create a new thread... because it didn't seem very clear to me that you wanted a devil's advocate situation and a philosophical exploration of old-school techniques vs. new education and protocol. It seemed to me that you were advocating the use of prone restraint should the situation warrant it, and many of us disagreed based on our knowledge base and protocols... And I didn't see this as an argument, I saw it as an impassioned discussion. Because the premise of the discussion wasn't quite as clear as it could have been, people got derailed a little bit by the implication that you could actually be advocating something that most of us feel is harmful to patient welfare. Now that I know you weren't actually advocating that, things change a little bit. Wendy CO EMT-B

Hey, it brought attention to the article... But it was a little racy for a title from Michael, I have to agree! Wendy CO EMT-B

Why can't y'all ever come to Colorado, damnit? Lol... Have fun! Wendy CO EMT-B

JP, I know you mean restraining prone not restraining supine *wink.* Their treatment is not violating protocol if they work for somewhere so archaic that they still carry and use MAST. Note the use of the word archaic... most services don't carry MAST anymore, because it's been proven to have little beneficial effect for the patient. There are many here who would argue that those protocols, if still in place in that service, are wrong. Doing harm, or doing something that does absolutely nothing of benefit and delays you on scene, thereby delaying definitive treatment, is *wrong.* Might be time for the agency to update its protocols based on research... not on "what they've always done." Medicine is not black and white, nor is it an exact science. Very much agree with you there, and improvisation is the name of the game. Note my previous statements about it potentially being useful in isolated incidents-- here's the crux though-- but not to the extent that it should be incorporated as an approved method of treatment/transport for everyday protocols. I do not foresee, in my area, a need to transport a patient in a prone restrained position. As a matter of fact, I would think that if you can get them under control in a prone position, that you could potentially get them into a recovery or supine position, which would be more suitable for transport. I know it's hard to think quickly when your butt is getting whooped, however... I completely understand having someone go ape-shit on you and struggling to get ANY control over them to protect yourself and those around you. I think it is never appropriate for ME to transport someone restrained prone, where I am and working with who I work with. I would caution about using prone restraint elsewhere, save in case of extreme last resort... and I would advise anyone finding themselves confronted with such a transport to ensure that PD rides along, and that documentation (including photographs of the exact position) be very thorough and clear. We all have to do things that are a little screwy sometimes to get the job done. It doesn't mean we should make screwy the standard of care... because then people get lazy and patients die. Does my position make sense? I'm very sensitive to the issue of restraint in general, because in the developmental disabilities world, we have a set of person-person restraints (no kerlex or cuffs) that we are allowed to utilize... and you do *not* deviate from approved holds without a damn good reason and some really in depth documentation to explain just why you had to vary on what's been approved. The reason we don't do any floor restraints, prone or supine, is because 2 individuals in Denver died a few years ago after being placed into prone floor holds. Does my reticence in regard to prone holds/restraints make more sense now? Wendy CO EMT-B

By the way... any provider that assumes that their job is done once the person is restrained (supine or otherwise) and fails to provide other treatment during transport is an idiot and needs serious review. Can you illustrate why you feel prone restraint is beneficial, over the wait for resources method? What instances have you used it in, and how did it provide better patient care? Not saying that it doesn't, I just would like to see your rationale on it. Wendy CO EMT-B

Yes, if that patient has abdominal trauma and we're squeezing all the blood into their abdomen for a false sense of elevated pressure and symptomatic relief. That would be wrong. And since I'm not an X-ray and don't have MRI visualization capacity... I'm not going to waste time with an intervention that is more likely to be harmful. When we learn new things about the risks and benefits of treatments, that should absolutely change our treatment decisions. That's why we go through continuing education... right? It *may* be appropriate in individual instances to restrain and transport someone prone. But I'm willing to bet you that even in those instances, one could probably find a safer solution than just falling back on the "old school" and what's "been done in the past." There's a reason we don't bleed people with fevers anymore... but do apply leeches post-surgical reattachment.... Wendy CO EMT-B

You asked us why, were given reasons as to the danger of its use and the opinion of most providers that it is an unnecessary risk (and by extension, therefore, never to be used). Then you responded and said why are you saying never do this- after it was explained by multiple providers. In continually arguing that it has merit in isolated instances of use, you are in effect asking us to change our opinion and add it to our toolboxes as a "last resort" type deal... or at least asking us to concede that it may be appropriate as a last ditch resort for some providers, even if we choose never to use it. I disagree! Obviously... I think it's something where the risk far outweighs potential benefit and I'd much rather wait for the person to calm down or for chemical sedation to be available... or for more hands to get them restrained seated or supine. Now, will I shoot you if you say you used a prone restraint because you ran out of options, and it was prone or let them get hit by a car? No... but you better be ready to justify how you did it and what safeguarding steps you used. And I will still probably second guess you... because that's what we do here on the forum. We Monday morning quarterback every call, to see what could be done differently next time. Wendy CO EMT-B

I disagree with never warning people that you've seen a cop... some people will zone out while driving and end up going way faster than they intend to. What was that commercial series... the faster you go, the bigger the mess? If I can wake someone up a little bit by flashing my brights and get them to slow down, don't I help reduce the risk that they'll cause a wreck due to their speed? Wendy CO EMT-B

Setting a backburn on your own property is different from deviating from protocols you use as a medical provider while working. Apples and oranges here. But I see what you are saying.... Sure, you can take the risk and get lucky and not kill your patient or contribute to their demise... but is that really what we're going for here? It's not like we *never* have any other options available. Sometimes we may have very limited options... but I can't justify transporting an agitated psychiatric patient in prone position! I can *never* justify it in my own head knowing what I know about the damage that kind of restraint has done to people. Let's use something else common... what about the old practice of epi down the tube? I have heard of it being done... and I know its even proved beneficial in isolated instances. You can't get venous access... is it worth the risk? It's against most people's protocols... so do you do it because it *might* work? The intent, as with prone restraint, is to care for the patient... but is the result worth the risk? Wendy CO EMT-B

If there is no other way to transport a psychiatric patient other than prone, then I'm not transporting them. I'm waiting for additional resources that will allow me to get the patient into a position that doesn't compromise their health or my legal standing. If it means waiting for out of county ALS to get there so they can administer a sedative, so freakin' be it. And you're supposed to follow protocols for a reason. It's good practice and CYA for you, and presumably protective for the patient. Case in point, I got my ass kicked by a client this weekend (and exposed to blood, hurrah for serial tests...) but did I go and punch her in self defense? Of course not... I used the protocols outlined for me and we both got through her aggressive outburst with minimal injury, and good legal standing. Could I have punched her? Of course... would it have been the correct thing to do? Nuh uh! Prone transport only for those not mentally compromised (AKA no mental illness or psychiatric emergency) and unable to ride in any other position due to injury/impalement. Gotta agree with CBEMT here. Wendy CO EMT-B

I found EMSvillage as a result of EMS House of DeFrance which was a link given to me in my EMT class... and I followed paramedicmike from EMSVillage to here. Wendy CO EMT-B

Think about how the respiratory process actually works... when you breathe, your ribcage expands outward and upward. Now think about being restrained forcibly in a prone position and how that might affect expansion. It's not just about airway. It's about positional asphyxia. That's why we never do prone now. And there are so many factors that go into whether a prone position results in harm... why take the risk? There's a reason I'm no longer allowed to restrain clients on the floor in my job... period. I can put them in a seated upright position if I have no other option... but I have to defend it afterwards. Wendy CO EMT-B

OMG... with all the warnings about anal leakage? You're a brave soul, Richard B... Good luck and dark pants to you... On a serious note, way to try to lose the weight. I know it must be difficult, and I hope it actually works well for you! Wendy CO EMT-B

Oh man... that puts you in a spot where you can either piss off the guy severely by dissing on his wife, or you can shut up and let him feel like the smug arse that he is. I'd have gone for it, personally... Sometimes it's worth poking the hornet's nest. Who knows, he might've had a cardiac incident from the rage and had to be attended to by your flashy, hose-dragging self.. Wendy CO EMT-B

There's a reason I didn't get it. I wait at least 4 years for a vaccine or drug to go to the general populace before I risk it... unless there is no alternative whatsoever. I was in the first wave of varicella vaccinations for teens who hadn't had chicken pox. Benefits outweighed the risks there for me... but I won't say I wasn't nervous. Wendy CO EMT-B

Did this kid use his rescue inhaler way too much before he got admitted to the ER? Does he use it on a daily basis? I'm thinking that plus 1hr albuterol treatment, his potassium has completely bottomed out.... Using too much albuterol can lead to fatigue, chest pain, arrhythmia, hypokalemia... Working on the hypokalemia theory, irregular heartbeat with premature contraction, muscular fatigue, weakened accessory respiratory muscles... Also, steroids may also contribute to lowered potassium. Is this kid on a daily steroid dose? I know some poor children that are for asthma. If he's using too much albuterol, and taking steroids, this would all make sense.. Am I off in left field somewhere? Wendy CO EMT-B

This Must Be It But the first link I found about it says the FDA has removed approval for it! Hm.... All the good stuff goes bye-bye... Wendy CO EMT-B

I think Timmy's mentioned this before... isn't it an inhaled anaesthetic that EMS units carry? What the hell is it... I can't remember the name but I know he's mentioned it. Wendy CO EMT-B

Who in the hell has an embedded hidden audio in their post? I've been hunting for it and can't find it! I love it though... Stop being a drama king! On the marshmallow note, you forgot the graham crackers and chocolate *evil face.* What KSEMT is saying makes a lot of sense. Now, before you all toast me along with the marshmallows, permit me to explain WHY it makes sense- from where he sits. If you have never been to college, and your family didn't value college or the only people with degrees that you know are stuck up people who think they're better than you are because they have a degree and have been *educated,* and you *know* you are an intelligent person doing the best you possibly can for your patients, a degree seems superfluous. Ridiculous, even. If you are looked down upon by those with degrees, you grow to hate the entire clan. Trust me. Y'all should meet my first biology professor... If you are intelligent enough to get by with the thinking skills you've learned through the education forced upon you in K-12, and you really hate the "go jump through hoop XYZ for this reason" mentality that so many colleges have endemic within their systems, there exists little motivation to get a degree, and little motivation to respect those with them. The view from OUTSIDE is *way* different from the view inside... and that goes both ways. You do not need a college degree to be a critical thinker, or even a decent (note that I didn't say the BEST) medical practitioner. HOWEVER- what the college education does, liberal arts, English composition, history, cultural science, math and all... is teach you to approach things in an integrative fashion. You learn to get inside many different disciplines... and once you've had enough classes, you find yourself making insightful connections that would NEVER have occurred to you. It teaches your subconscious to put the puzzle pieces together... even if the conscious is screaming "American History since 1970 is boring and I really don't care..." It teaches you to look beneath the surface, and approach things differently. I am not in any way, shape or form discounting "street experience" as that is a different kind of intelligence. Knowledge that comes from experience is invaluable. Now, in medicine, the trick is this... the broader your base when you go in, the more you will get out of that experiential learning as you pack on the years. You may be the best button pusher ever... but with a solid understanding of physiology behind you, all of a sudden it gets easier to critically analyze which button to push and WHY, rather than pushing the normal "correct" ones. Math is important. Calculating drug dosages should have solid mathematical ability behind it- not a memorized set of conversions. English is important- you can't continue to provide care if you get called out on a patient interaction and haven't documented in a fashion that clearly shows what you did and why. Poor trip reports indicate poor care (especially to lawyers who are looking for any reason to get you...) so English composition and spelling are definitely necessary. Even the best writer still needs refinement... Mark Twain still wrote shitty things from time to time... Social studies, history and philosophy help you integrate those difficult cultural or social contacts. You can have a much more balanced approach to someone with an alternative lifestyle, religious belief, foreign idea... and thus be able to communicate better and provide better care as a result of that communication. KSEMT, high school *should* teach you how to write effectively and do basic math. You should see some of the COLLEGE papers I'm working with at the senior level in my composition class... we peer edit, and I have to say... I've yet to see anything above an 8th grade level. Maybe one precocious 11th grader in there in terms of writing. The simple fact of the matter is that it doesn't... and unless you can pass a competency exam excusing you from those credits, you really should take them. Can you be a good paramedic without a college education? Sure. You can be a good one. Will you ever be the best paramedic? Not unless you have other education behind you- self taught, college taken, or otherwise. The paramedic specific education doesn't change; absolutely correct. But what you are doing is taking classes that have been written by those with all that extra foundation... physicians, nurses, etc.; if you have that foundation as well, you get inside the material to a depth level that is really not possible *without* the foundation. You can work with a piece of heavy machinery, and operate it well, with finesse... but if it breaks, you can't fix it without understanding the pieces. Paramedic education is currently for the most part missing the most important pieces... and focusing on finessing the physical skills. That's what we want to change. We don't think anyone WITHOUT a degree is stupid, or even an incapable medic. But we want the patient to have the best practitioner possible... and we all know doctors are the penultimate medical practitioners, right? So *why* do they have all the education, might I ask? They have to take the BS classes that have nothing to do with their actual physical practice... so why do medical schools require it? You could surely train a surgeon with proficient skills without it, right? It's not the skills. It's the mind behind the skills. Wendy CO EMT-B

You might ask her if she's ever seen someone specifically to address the pain medications and how they are working for her... you might ask if she's ever heard of becoming addicted to the pain meds, and that this type of addiction results in it not working as effectively for pain... and if she had ever considered seeing a specialist to evaluate that since you hate seeing her in pain like this... I mean... if you know her fairly well and have a rapport with her, you might try asking questions about what else is being done if anything... and then make small suggestions. Make sure you're not letting the emotion of "oh god, I'm taking YOU in again" filter into it, or she'll just think you don't want to deal with her, instead of being concerned the way you are. It's a risk... she might take it the wrong way. But then again, if you have a good rapport with her, it might just be the input she needs to get her going. Poor lady! I hate it when stuff like this happens. Wendy CO EMT-B

Rofl! These protesters are scared $h!tless at a RUMOR of a gun that makes you crap... Perhaps I should tell my friend who's in the police/fire/EMS cadets to wear her rain pants! She's been conscripted into working this event... On a side note, this has the potential to be a major cluster. I know where they're holding this convention... it's going to ROYALLY screw with Denver traffic, and the Pepsi center isn't far from some less savory neighborhoods. All it takes is one moron in a crowd of excited people to cause havoc. I like the supersoaker idea. Should I get some spare cash, I'll send some the way of the fellas in the sandbox(es). Wendy CO EMT-B

Do they have the "Vial of Life" program in your area? You put a sticker on your door that says "Vial of Life- medical info in freezer" and you put a very obvious jar with a big star of life on it that holds all of your info... it's easy, because it's in a contained location and the jar can hold quite a bit of paper. Might look into that! Thanks for looking out for us poor EMS folk who might not be able to get your history and care for you properly. Here's hoping that doesn't happen! Wendy CO EMT-B