Ridryder 911

Whomever stated that was F.O.S. (full of stool) ! Obviously ignorant of EMS within the United States and probably their own state. They need to come to my state, and tell the citizens that does not have ANY EMS. We currently have at least two to three counties without EMS. In addition we have lost approximately nearly 12 EMS within the last four years due to poor funding, operations, etc. In fact JEMS had an article in regards on how bad the current situation is. Our state legislature much rather spend the money on other pork projects, I just forewarned them not to have an accident as they drive through those unprotected counties, the buzzards will be there before help arrives. Unfortunately, rural areas do not have the means and revenue to fund most EMS. This is even at a single provider/county level. Unlike most states, mine has very little volunteer EMS agencies, rather the F.D. will be volunteer with the EMS will be paid. Realizing that EMS has approximately 80% more call volume, attempts are made to be sure there is someone can respond. Most volunteers, cannot respond to the number of required calls. At this time, those without EMS are being served by other agencies, but the response time is ridiculous and coverage is sparse, as this taxes the responding EMS services business. It is a never ending viscous cycle. Unfortunately, the citizens assume there will always be someone there and that somehow someone will do it. Well their wrong and until someone of prominence dies, nothing will change. New legislation was introduced but tabled (or shot down ) to help fund districts (by combining local EMS) and forming districts so better management, reduction of duplicate services, and grants for EMS education to promote and recruit into EMS. Hopefully, this will be reintroduced and pass. If not, rumors is we will be loosing more agencies. So should EMS be required, yes. Compare it with other public agencies, per volume, production and even risk management. Albeit most cities and communities do not see it that way, and see it as a luxury, we need to encourage and promote ourselves. This has to be done with education, professionalism and the support of the local medical community. R/r 911

Appearantly at least 48 other viewers (at this time of posting).... Good one, you got us! R/r 911

My point exactly.. it should not be "advanced" even my daughters junior high school biology class was taught this. Albeit, it does not take a rocket scientist to do this job, it apparently confuses many in pathophysiology. Any idiot can tell an arterial bleed and the consequences afterwards... but, to understand why pressure is the way it is in a septic patient or hypoperfused patient, without gross findings may be more taxing. Just like the first part of the quote was actually the definition of the hemodynamics of a blood pressure, one should be familiar with such., Then not to rely upon such just blunt clinical findings.. which even a non trained person should be able to understand. Again, many times our patients may not have such presentations, this is what separates us from having medical knowledge base and just providing first aid. R/r 911

The static portion is there for a reason. Like in real life, one may have to make hasty decisions of an ECG in a hurry, even from poor readings of monitor such as poor printing, artifact, electrical interference, etc. Stating you passed AHA ACLS and PALS is not credit as well, We all know the credibility of such is not worthy and really hardly no-one fails those courses anymore. What I do suggest is to make flash card style of ECG's, even those with poor tracing. Better if you can convince someone else to do it., so you will not be "memorizing" strips. There are plenty of strips on the Internet, one can paste and copy. Get plenty and only allow small amount of time for interpretation, using the usual and proper measure of interpretation. Usually < 30 seconds. Study hard and practice. Good luck, R/ r911

There really is a reason MAP is used in the critical care arena. It is not that difficult to calculate (MAP = [(2 x diastolic)+systolic] / 3), and not understanding it and the implications does reflect not having a full understanding of physiological responses; such as problems in end organ systems failure. Having a working knowledge in other perfusion criteria; can be used far more utilized than in just ICP, from a head bleed. Other indicators such as sepsis, and varying degrees of poor perfusion from cardiogenic to hypovolemia. I far much know the MAP than just the reading of the blood pressures. Yes, it is very unlikely we are able to monitor true pressures such as having an CVP, or art line in place in the field, however; again we need to be careful on limiting one self just to prehospital care environment. It is a shame such monitors such as impedance monitoring that can measure ejection fraction, etc. is so costly and makes it difficult for the prehospital environment to have. I guess, I much rather have Paramedics having a thorough understanding of something simplistic such as MAP than to waste teaching non-sense stuff. I still wonder why, we have to go backwards in teaching. In reality, understanding the basics of hemodynamics then obtaining the results. It is so much easier to explain and learn, the foundation first then add upon it. R/r 911

I highly encourage to have the minimum of two years of active duty as a Paramedic first. It is not that you cannot understand, rather you will have the clinical experience to understand and have seen some difficult cases to fall back upon, onto experience. As well, to be able to troubleshoot and understand critical care versus emergency care. If you are in the KC area, then I realize that there is multiple providers from FD to MAST. MAST has a specialty division for critical care transports, and many require years experience before considering to be able to provide such. I personally would recommend at least a couple years experience in hospital as well. There is a major difference between prehospital and ER and then a MAJOR difference between critical care and emergency care. You are lucky! One of the best CCEMT/P courses is in your area. I highly.. highly recommend Blue Springs F.D. CCEMT/P course. Albeit, I am not a F.D. supporter, they have one the most progressive and academic systems that I have ever seen in my 30 year career. I just attended their course a month ago to renew mine, and I cannot say anything bad about it. They had contracted excellent speakers, teachers, to give the best education possible, with hands on and clinical exposure for those that need it. (Life Eagle is also stationed at one of their stations) Their course is slightly higher in price, but definitely worth the difference, again in your area. Here is a link to their site : http://www.cjcfpd.org/. Talk to Capt. Mike Wallace for more information. They are considering offering the FP-C test, after their course to ensure credibility. If so, I highly recommend good critical experience prior, and a very highly knowledge of medicine, not just prehospital care. Good luck, R/r 911

Your uncle has the right to refuse to sign. The only thing the signature is for is acknowledging that you have received the information and understand the usage of HIPPA in the health care system, as you described. Albeit that it sounds that your uncle is a little cantankerous , but at least tries to be safe. I recommend any HIPPA site on the web that describes the intent and usage. R/r 911

I believe that MAP is not understood and used enough. Like ChBare, I use it on CHI:ICP, as well many other illnesses and injuries. Remember, MAP is a good indicator or perfusion pressure to both coronary and systemic circulation. R/r 911

I hope this does not come out rude, but if one does not how much to charge then I would be concern starting a transport business. I would contact American Ambulance Association, and local government officials. EMS and ambulance has one of the highest failing rates among business. One should have at least six months to one year reserve of operating budget, before even attempting to open the doors. Most states now require large bonds to assure that there is at least enough operating budget to pay contractors, suppliers, and staff. Again, I would contact the American Ambulance Association per their web site, and maybe their local chapter representative that might be able to help you get into contact with appropriate persons. R/r 911

I used to work as a Burn Nurse at the Burn Center Brock works at. It was the third largest in the nation. So we seen quite a few burns. Personally in the field, one should attempt to avoid a burn site.. (common sense) however; I much rather see a line than no line at all. Yes, it is a site for infection..yadda.. yadda.. Realistically, they are going to (or at least should) to specific cultures and place these patients on high doses of antibiotics. Remember, people do not die from burns, rather burn complications (infections, respiratory involvement, shock, etc). So your bi-lateral IV is not going to cause any more damage, as well doubtful will be strong enough for the fluid resuscitation as well. Although, again it is a patent line, so med.'s, analgesics can be administered. I have started lines, where no one would ever guess.. (yes, especially on males.. hey: it has veins!) Burns so serious, that central lines were difficult to near impossible to track and cannulate. Like most of EMS, use common sense. Avoid burn sites, use alternative, if using site, cleanse and observe closely for contamination and infiltration. R/r 911

I agree, it appears to be an impostor with a possible Dig tox effect. In the initial 12 lead, examine V[sub:0989caa612]6[/sub:0989caa612] and compare your axis deviation. R/r 911

LOL. Not smoking anything. Just remember the first time I discussed someday they would have an ECG machine that could read ECG's and automatically deliver an electrical shock....and then maybe possibly attaching it to a pacemaker device. I remember my fellow medics lauging at me and describing, "that would never happen.. there are too many variables.. artifact, etc.." Nothing could be that small and deliver such a shock!... Video cameras with talk back capability is not out of the question and few EMS in the U.S. are trying them out. The same with robotic surgery is being tested in the military being used in the back of a transport vehicle. A few years ago, this was to be far out as well.... Technology is always developing, unfortunately we are not educating our personnel as fast... R/r 911

Good thinking.. hopefully I would ask if there was a hx. of being a sicklar.. I usually have seen other associated symptoms though... R/r 911

I was also on the old Rescue 911, Trauma Center, etc.. not really cool.. so much editing, told to run to the ambulance... well, to say the least.. I never run to the unit. As well as a camera stuck up on your face after having helmet head.... aghh... Not much on my 15 seconds of fame... R/r 911

Vital , you know I love you in a non-gay way.. but serious dude, you need to get a better hobby. One can be suspicious on why you have so much obsession, anger & resentment.. maybe a good counselor & therapy could help.... R/r 911

Interesting case. I believe this is one of those cases, one may not really know the etiology until the post mortem. Not to be pessimistic, but such a a young age without precursors and continuation of ischemia type presentations is not a good sign. I agree, pericarditis should had been initially suspected as well. Although the cath may had been clean, I do believe there is something "cooking', just not sure exactly what it might be. I have seen many people die after a "clean cath" from arterial coronary spasms. In regards of activating the "cath lab", this is one of those personal calls. In most 21 y.o., I would admit, I would probably not.. then again, I had a 21 year old with a massive anterior septal wall infarct. No previous PMHX, in fact a basic EMT student and in excellent shape or co-existing conditions. So one can never say never...There was something gnawing at you to treat so aggressively. The old saying.. if you thought you should.. you probably should had, usually is more true than anything I have found in the field. Gut instincts are there for a reason, along with some good physiological indicators. Although, this is how we continuously learn... Interesting case, see if you can obtain further follow-up and work up. R/r 911

I know of very few F.D.'s that have a successful EMS program. Again, usually it is because what has been mentioned previously. Unfortunately, I am beginning to see and witness more and more of the same attitudes in EMS. The .. "I am here to save a life, otherwise don't bother me" .. type. Yes, some of those are awaiting to be able to get on a F.D. Until EMS can prove to the public, the powers to be, that we should be an individual service, nothing will change. It will definitely not change with the current education level, the current attitude and activity of the majority of EMS personnel. Same old song.. and same old verse... R/r 911

You know it is ironic, that 30 years ago I predicted that someday that a "real person" would not have to be in the back of a EMS unit. That we would develop a "shuttle" similar to those vacuum tubes that tranpsorts items to transport patients, and have pre-measured med.'s, automatic defib.'s., and electronically monitored ECG's and patient viewed by video link...... The only real reason a medic would be there, would to establish the IV, place the equipment on the patient. No one's laughing anymore......

The main point I guess we have to concur is; whatever they did.. worked. The patient went into an arrest and then was successfully resuscitated. I have to admit, Murphy's law would had never allowed such on my shift.. especially being filmed for coverage. I have never heard or even thought of any contraindications regarding NTG in post-arrest. What makes the difference? If the hemodynamics are stable enough and if they do not present an inferior wall (which in itself is a debatable topic) then why not give NTG ? Especially if the indicator might had been caused by coronary spasm, occlusion or obstruction. I have routinely have placed patients on NTG drips post AMI. Still contiunously do, especially those that do not meet fibro requirements or unable to be cath. Yes, there are now alternatives (in -hospital) but very few services still have any other choices. Again, we are only able to see a "snippet" of what treatment occurred. They might had bolus the patient with Lido as well. Which is now controversial and was not then. Again, I wished I would have such results.... R/r 911

Well, we see where the budget ($$) just went. Does the van ambulance respond behind it to transport the patient when it turns out to be a fever call? Yep, real genius we have in fire services.... R/r 911

It is not unusual to still administer NTG post arrest. Coronary arteries are still occluded and ischemia can still occur. Of course now, we would rule out the possibility of inferior wall involvement. I still see it used on post arrest until cathed or those that are not eligible to be fibro or cathed. Actually, I do not see any major "problems" with this video rather I see poor editing. Editing can be seen from the oxygen mask then BVM then back to oxygen mask which can be misleading. I have been on Paramedics and other similar shows, which can paint a poor presentation. ASA might have been given, but not displayed such as the I.V. and possible other med.'s R/r 911

Maybe and then maybe not. We all know that some analgesics are given out easier on some instances than others. As well, Strep can be severely painful, and yes... I have seen analgesics administered and rightfully so. Remember strep can infect and yes kill..... JCHAO and other well defined medical authorities have emphasized that patients should be .. as much pain free as possible, and directed to.... Patients are asked upon discharge pain level (0-10). Our policy is that anything greater than 3 has to be addressed by the physician before discharge, if analgesics are not administered or prescribed, then it has to be documented why it was not ... not why it was. Also, it is much easier to prescribe and hopefully ..satisfy.... than to have to see them again the next shift. As we know, that does not always work. R/r 911

I too plead the Fifth, but there was such thing a DynaMed and Emergency magazine....

A little over dramatic aren't we? Really, because the medic had a brain fart .. the patient died? Then the new medics turn to a basic instead of knowing what to do?.. Piss poor trained medics then on both counts. Sorry, it will be a cold day before I turn to a basic to ask what to do? Sure to assist me and work with me and maybe offer a suggestion.. but to ask what to do? EMS is not that complicated. Generally we take care of a lot B.S. calls, and every so often the poop hits the fan that we actually are required to use the knowledge and skill we have been prepared for. Like any other medical profession. Go to school, get a job, then get experience. My philosophy is in two years one will have medic experience or EMT experience.. now, after the two years, see which one check is larger and more employable. R/r 911

I have seen aneurysms have an increased perfusion when lay them down.. ( as in when you were going to intubate) as well they may not have much pressure but the stroke volume is able to compensate (for a short period of time). R/r 911