Ridryder 911

Unfortunately, I have personal experience regarding pleural effusions. Many leading cancer and thoracic research physicians forewarn "tapping" pleural effusions. (check out MD Anderson web site for more info) Studies have indicated irritation of cells may increase cell development. My significant other had a pleural effusion of approximately 2 liters before "tapping" thoracentesis occurred. We knew the source and problems, finally a thoracotomy had to be performed because a rhine developed over the lung tissue & prevented needle tap. Talc powder was introduced into thoracic cavity to help eliminate re-occurring effusion, which appeared to work some. Effusion re-occurred, but at a slower rate. I do make a suggestion of different views are needed in x-ray for more clarity, such as swimmers, etc. to detect level until CT can be performed. R/r 911

The word(s) is Cocaine induced AMI... R/r 911

Just to show anyone can publish anything on the internet without credentials or references. Sorry, it appeared poorly written and confusing with emphasis on "plumbers analogy" only to resort to use the analogy as well. I first thought it was written by a disgruntled plumber.. R/r 911

You don't expose, you can't see, you can't see you can't document, you can't document you did not assess. R/r 911

Short spine board.... Geez, I have not seen one of those ins about 14 years. I did not know they even made them anymore, I know I have no seen them sold anywhere. I used SSB and they were a pain in the arse and was a piece of crap. KED and other similar extrication devices are much simpler to use. R/r 911

I agree this is an area that EMS is very lacking in. Part of the problem is most of the medical directors and orders come from the mentality of ER physicians (sorry Doc's). They assume most of the patient's that are in pain are seekers... (as they usually are in ED's) but this carries over to EMS. ER's have had a battle convincing pain management for years, until JCAHO stepped in and required pain management programs and requirements. There appears to be no continuity of degrees of what is acceptable. I understand pain is subjective evaluation, but not to allow adequate level of analgesics for specific events is cruel. Ironically, some physicians will load patients up on analgesics, while others barely treat at all. I can usually tell the difference between an FP and ER quickly. We are in the midst of adjusting our analgesics, and I am discouraged. We have retrograded instead of advancing. At least a few of us fought for Toradol for renal calculi and muscle skeletal injuries. We have the usual M.S. & Valium, but that is all now. Hopefully, we can adjust for more later. R/r 911

Ironically, they had Tigers listed on the banners. Which reminds me, I was working in a rural ER, when an elderly entered with large puncture marks on her forearm.. chief complaint .."Tiger bite".. I asked again.... Tiger bite? Yep, they had an exotic zoo and she was right. I have to admit it felt weird to document "Tiger bite, cleansed"..etc . I am sure the coders on billing had to look this one up!

I believe we have discussed this topic (although maybe not directly) plenty. It is the person, that matters.. I may not agree with their lifestyle (as well they may not agree with mine) but, I have worked and been friends with many, although they know my personal feelings about their choice. R/r 911

Actually Raquel Welch was "Jugs", Bill Cosby was "mother" for his experience, and Harvey Keital was Tony (aka Speed, a possible dirty cop). What makes you feel old is remembering watching at a drive in movie (with my girlfriend :oops: , before she became my 1'st wife ) and seeing my medic partners car on the other row! Code Red sucked, as well as Saved any many others. Emergency as corny as it was, is one of the few that actually promoted EMS without too much showboating. It did have some seriousness as well as humor. Unfortunately, many EMS wish they were as aggressive as that "corny" television show, still providing nothing but BLS care. R/r 911

I have seen them usually identify themselves as EMS and ambulance service. This being, usually as they will provide EMS and then provide ambulance transport for non-emergencies. Many of these services will also provide non-emergency services as well, again to increase profit. For as "transport" anything, I do wonder on the percentage of payment and then how much paperwork in coding is changed to be able to justify for payment? R/r 911

I personally like Etomidate for sedation, although I much rather have a paralytic on top of it. The good thing is Etomidate is there is not much hemodynamic changes, and short life span. To your question, I am a proponent of pre-med of Lidocaine. The problem is one has to administer Lidocaine sometime before induction or intubating. Usually 2-3 minutes prior to the RSI or intubation process. Although this can be controversial, personally I don't believe it is not going to harm, and possibly prevent increasing ICP. Although, some may not recommend since you are not using a defasciculating medication, but remember you may produce an ICP by way of "vagal" through manipulation. I have worked at services that had Atropine & Lidocaine pre-RSI on pediatrics and be prepared for decreased heart rate. R/r 911

Hi Brock ;long time .. One of our employees is wanting to attend and was attempting to get enough information to justify the costs. I do believe it would worth the money, but convincing the boss is another thing :wink: R/r 911

That's what I thought as well. Also, it appeared that they knew the etiology of the arrest so immediate correction could be made. Although, this maybe promising in that it will peak other studies, it appears to be hyped on headlines with little facts otherwise. I agree, the by-pass is not even considerable in emergency events. R/r 911

I would inform him the rules of transport. I will examine and assess him or no go, this is my unit and my way or no way. As well if there is no chief complaint other than hunger he can call a taxi. I would suggest checking a FSBS to be reassure it is not hypoglycemia talking.. If he continues to be cantankerous and everything checks out okay, then a visit from the local P.D. is warranted. As well, inform him the special had been changed... *As for locked doors, our newer units have locks in back, but the older ones do not. We do not routinely have locked doors while responding only after arriving and exiting the vehicle.

I do understand your frustation. Hang in there... I wish I could say it would get better. R/r 911

Interesting findings. I do believe that we do not fully understand death yet. Now, with this saying, I understand their hypothesis but the difficulty would be correcting the etiology that caused death to begin with )of course in the study most were post op patients). Now, the studies need to be focused on the amount of oxygenation or allowable hypoxia before the cell death occurs. Of course the numbers were limited and findings were intriguing but just at the tip of the iceberg. At least, this will cause debate and repeated studies. R/r 911

I understand your point, however; I believe you as many others may get confused on how the cart before the horse scenario. Let us look at the whole picture. Not just bits and parts. In rural settings (where most the multiple levels are placed) why is there a shortage? Lack of funding, pay, uninterested participants, not enough resources (educational facilities, etc). Is the other health facilities lacking in providers as well? How involved is the current level of participants in legislation, researching for Federal & State funding for grant monies and educational scholarships? I have seen states (including my own) develop multiple levels. This is not always for the "need" of patient care, the best for the public or any researched reasons rather for a "quick fix". If you place a band aid on a arterial bleed it won't last long. EMS has always used short cuts and half ass excuses for remedies. When in comparison, if you were to analyze the costs of developing multiple levels, the educational supplies, testing, over all would had probably been a nice amount to fund scholarships through the full Paramedic course. Many in EMS do NOT want full levels, for multiple reasons. Many would have to pay appropriately, and if they are billing there is no incentive for level difference (profit over salaries) as well with a limited certification that is not transferable; where else are you going to go? It is not the.."legislatures to get the ball rolling"... and as far as MD's caring, most are ignorant and apathetic on what goes on prehospital, they have their education and career. Rather it is the job of the EMS to educate them the need for change. It appears, many are satisfied with the easy way out. Multiple levels and half training. Unfortunately, it is the patient that makes that ultimate sacrifice. No, it is not an ideal world, not will it will never change unless someone gets the ball rolling.... R/r 911

Okay, maybe I am missing something. What is the rush? How long does it to establish an IV and a XII lead? 1-2 minutes ? Sure, if you have a true AMI that the only thing that will save them is cath and PTCA... However most chest pains, I am in EMS to stabilize, which includes performing in a calm manner (remember, we need to attempt to lower the patients level of stress not increase) performing in a quality manner. I believe we are loosing the point of our existence, to stabilize for transport, not treat while transporting. I attempt line before going, it is much easier on the patient stress level and me as well. Yes, I can hit a moving target but then why when it is not necessary. As well, for those that do not understand the need for prior IV establishment must not have much experience of patient's experiencing arrhythmias, chest pain and nausea. I am by far not condoning playing around, but I have seen so many EMS go into load and go mode, that no treatment was really provided, no assessment was actually made other than a simplified ECG and a set of VS. R/r 911

Geez, I wished that song would make a come back... I wished the newbies and many other realized that real life is like that! R/r 911

Okay, no one realizes how important our position and job is than me. With this is in mind, we also need to stand back and look at our job as well. (Forest & trees analogy would do well here) We are there to transport the sick and injured to the hospital. Yes, that is the main objective. The main point of our existence is to stabilize and prevent further injuries and harm to the patient during transport. In reality, and unfortunately majority of EMS personal is not educated enough to perform adequate triage skills. Now, before you jump to conclusions, I am not discussing MCI casualty type scenario, I am discussing day to day ER triage, involving those that present with difficult scenarios and symptomology than the obvious trauma casualty. Even the government agrees to this, as per EMT's and even Paramedics are not to initially perform triage and assessment in the ED setting. Sorry, that 10 month course did not cover enough. Are you going to flag that non life threatning rash on the child? Only to later find out that it was meningococcal rash and the child arrested. Yes, sure, there are some that could do an excellent job...but overall the education coming from a junior high level text book is not enough. Spenac, I don't understand the continuation and ranting of being called an "taxi cab". Sorry, there are times, we are used inappropriately and this will happen but it will always occur as long as there is any medical programs. As I inform newbies, it is just as easy to transport them sometimes than to "flag" the patient. You are already there...besides, are you really sure that patient does not need medical attention? I see way too many new medics that feel that their position is far more important than it really is. The same thing in the major ER's when you see the patient with dental carries why you attempt to take care of the GSW at the same time. It is part of the beast of the job... yes, that is what it is a .. job. As well, since it is such...validation of services is needed to maintain your position. Remember : You are there for the patient, not the other way around. You describe a medical director not being comfortable not allowing non-transports. Let's review some medical directors positions. I know of one that has close to 150 Paramedics and another 200 EMT's under his direction. Do you think he would ever time enough, to know each ones level and competency level in even non-emergency scenarios. I agree, there is abuse.. but it may partially be the EMS fault. How much education did you place in the community on notifying an use of the EMS? Does the EMS provide an alternative non emergency transport unit or help establish other means of transport, such as volunteer transport vans, etc.? As I tell many, before complaining attempt to have a solution of the problem.

It all depends upon the job description you are in. Some prefer years experience, some may not, and all depends upon what your intention is for later. Remember, EMT training is not designed for hospital setting, but one can perform in some roles with additional training. R/r 91

I understand the point, but let's look at the whole picture instead of focusing in on just the symptom. Does physicians and other practitioners get to tell those that arrive "you don't need my services?"... Yes, they can discharge the patient of "not requiring treatment for non-life threatening conditions" after they perform a medical systems assessment and hoping and praying they don't immediately have an AMI or SAH moment they walk out the door. Thus very few times I have seen practitioners actually disregard without going ahead of assessing and treating. Is there a need of protocols for non-transports? Yes, definitely for absurd calls but as everyone describes we are working as an extension of their license and practice. Sure, the medics should be competent enough for the medical director to trust, but; everyone makes mistakes. If I was a physician could I trust my livelihood and license/practice from every medic and every situation ? Something to think about. Even though I am very pro-medic as my license and livelihood increases, I examine those that I would say as competent medics, I don't know I would totally trust a 10 month trained individual of making such decisions ? Remember, medics are educated in very limited medical conditions. The one time or mistake will be the potentially the end of your career, again a mistake you did not actually make, except for trust. I am not in favor for transports of the isolated items that does not warrant such transports that common sense obviously informs continuous medical care and stabilization is not needed. Maybe, consultation between medical control would be more informative and reduce potential litigation risks. R/r 911

I was thinking the same thing Doc.. as well as possible esophageal spasms, with increased anxiety. Need more pertinent history, and details. R/r 911

To me this is much more a situation and danger than any assailant, or attack that might occur. Unfortunately, we have had at least five or more EMS personnel killed in the past five years due to this situation. As well with the new graduate of troopers and LEO, staging and safety appears to be a non-priority, ....rather to "keep the flow going"..I have had more than one encounter with state officers on this. I have informed my family in the event of any such accident to be sure to seek litigation against the LEO agency and personally against LEO as well. It has become ridiculous. I know of one of the cities affected by slain firefighter and EMS personnel totally block off the highway with large pumpers & engines, daring any LEO to move them. This at least changed the attitudes and SOP in that area. R/r 911

Stick true to your own objectives. If preceptor gives you hard a time it is because they are worried of their own account. I am sorry, maturity and the ability to handle one's self is a large part of the job. Hang in there, many of the young ones only see this as a stepping stone and not their idea of a profession. You will be surprised afterwards that how well you will do. R/r 911