Ridryder 911

I usually look the circumstances too. Dependent on hx. and actual documentation time of confirmed being down. I might add sometimes, it is dependent on the situation of outside factors of family, crowd, and special circumstances. It is hard to "flag" someone, with 30 angry family members in the "wrong side of town". We are revising our protocols make them more liberal and user friendly. With multiple options, dependent on the medic discretion. Usually, documented and confirmed time >10-15 minutes in aystole we can declare, or special circumstances (where the medic perceives any resuscitation is futile)we can get a verbal DNR if the patient is aystole or agonal rhythm. This is becoming more routine even on shorter responses and those with an outstanding medical history or aggravating factors. R/r 911

In my definition and many others is defined as one has brain function and mobility equal to what they had prior to cardiac arrest. If one "regains a pulse" and never leave the hospital or remains in vegetative state is defined as a successful resuscitation, not a "save". I have had maybe a thousand or more "successful resuscitations", however; saves probably less than 200 in thirty years. About the average of 10% or less of cardiac arrest. R/r 911

:shock: ??? As well, why bring back an OLD thread ? .. Standards has been out for quite a while now, many may not even know what the old ones are ... R/r 911

It was a gag?.. I thought it was some of the EMS I had seen... r/r 911

Another no-brainer.. Cardiovascular Surgeon $5000.00 Cath lab $2000.00 Cath lab team $2500.00 ICU/CCU $1200-5,000 a day Possibility of having a patient with an AMI that needs a cath and then has insurance to pay, priceless.... Having cath lab 24/7 would be neat, but very costly.. yes, even on call... Funny, even cardiologist don't even like to work on week-ends... R/r 911

The reason I would like to stress is not so much of loosing the law suit rather, I wonder where people would come up te money for attorney fees... this is my main reason for the liability insurance. Attorneys, fees costs more than most people make yearly.. R/r 911

As well, this would had been a simple statistic study that could been performed in a matter of a few minutes to hours. Each Level I Trauma Center is required to have a Trauma Registry that has filters to be able to compose and analyze any information such as TRISS, age, GLASGOW, etc.. for a comparrision analyses study. It is routinely performed for check and balances for TQI, for most EMS Services as well as re-accreditation of the T.C. on outcome events. So, again a published nothing.. again, that appears to be tainted of having biased opinions. R/r 911

Here is the real life, you have $1.75 they will go for you.. it costs the same to sue everyone as it does to choose with money or not. As one attorney told me if it just 40 cents, that will pay for postage. It used to be they would only sue the wealthy of them, but not "shot-gun" approach, where everyone involved is named, it is a game to how much one can accumulative can get. If you think that your service will stand behind you and protect you (even if you are right) you are a fool. I have malpractice as a nurse and paramedic, considering attorney fees alone is about $15-20,000 just to defend yourself, again even if you win. Can you afford the legal costs and legal fees ?..... It is worth the peace of mind for a $ 100.00 or so.... R/r 911

OMG !.. I can't believe this..Ays has some mild whacker in him..! just joking, the last person, I would ever expect to have an EMS necklace.... R/r 911

Anthony, you don't have to remind me of what studies consist of like I stated I worked in trauma research and development as a profession for over three years. I am a big proponent of scientific studies. Then I can say ." I have seen the good, the bad and the ugly" I do read more studies than most, and I as well can tell those followed scientific methods and those that were published just to be published. It happens in the world of academia and medicine that is why a thorough understanding on how to read a study is important. I have seen great research that was shot down because the end result was not what the powers to be wanted, and as well seen half arse manipulated number crunching and poor controls be published and be praised as great works. That is why there is always studies that contradict each other. Reading a study on face value without reading into it is foolish and not being very educated. Validity of any study is how well it can be scrutinized. Lack of funding, resources, poor controls and population is how studies are brushed off as having poor credibility. Reading a study and having a knee jerk reflex off it is common in EMS and emergency medicine. Look at treatment regimes that immediately changed from the initial PASG study . When that study never displayed harm to patients rather it claimed no difference in outcomes; yet those whom even had education in how to read studies failed to read below the label of the study and recommendations. Fortunately, other studies that had better research tools and controls validated their intent. But it is scary on how many medical directors and states will change from one initial study, even albeit to be flawed. This maybe the reason why there is so many medication(s) being recalled and later to found it to be detrimental to patients. Pushed and tainted studies with heavy hand from special interest influences. For example the medication Cordorone vs. Lidocaine is being pushed per ECC and AHA; although there has been no significant difference to be found as yet. Many describe that would never occur in such an organizations, all I can do is refer them to Bretylol. The same claims was made in the eighties and we see what the outcome was. Many studies are very legitimate and follow close scientific methodologies, and I honor those that perform such. Unfortunately, there are as many poor ones that discredits and sometimes make bigger headlines. Medical studies are essential for us to be able deliver the best care. For it is the best scientific method available. With that saying it is the responsibility of the reader not just to read a study but to check and have a understanding of multiple methods of the study before reaching a final opinion. R/r 911

Naww.. I know Croaker from other forums. The only disagreement is the "band-aid" system of having multiple responses. Why run BLS and then ALS, when one can have ALS on every call ? Since, the H & P really should be assessed by an ALS provider and then decided if it is warranted, it would be as economically feasible for that ALS provider to transport. Of course this has been debated and will continue to be debated forever. I agree with that EMS is placed in the wrong system nationally. Yet, again we have an army wanting us to be removed from DOT to another non medical liaison (project homeland). This of course is for strong political reasons of recent and non-specific grant monies that was being served out. Until we are placed under a health care umbrella agency, we will never receive substantial amount of funding from payors such as medicare (insurance, medicaid). Yet, again we would have to make a choice of being medical and to respect of that being held accountable academically and professionally, that many EMS is not willing to make. This also means the main focus of the job would have to be providing medical care, not fire fighting, rescue, law enforcement, etc.. this is why there has not been a demand and shift to be united or placed into a public health or medical liaison agency. Until we have internal regulating medical organizations such as JCAHO to mandate or place pressure upon EMS administrations to maintain quality and performance, EMS will never advance. I would never believe I would ever be endorsing such an organization such as JCAHO, but I do see the need of such. (Although, JCAHO has become out of hand) The current EMS accreditation is a joke, and no EMS administrators see any benefit of a becoming accredited. If medicare and insurance companies placed pressure on EMS services, similar in comparison to hospitals in payment claims, we would see a change, not until then. All ALS procedures should be monitored through a good QI program which I doubt very many EMS actually have ( and again, they won't until mandated). Then have a system to correct identified problem areas. Just because one identifies weakness is not a success until they correct it and re-evaluate that it has been truly corrected. R/r 911

Just because the numbers and outcome base adds up to quantity does make one a good study. Please refer to L.A. political underlying problems of keeping and maintaining Level I trauma services. The proportion of the number of Level I closings in the past ten years is astronomical, as well as the abuse of EMS units in L.A. I did not see where in the study of identifying factors of why EMS transport caused death or why p.o.v. transport increased survival. The main emphasis of the outcome of the study is non directional, so really this is a poor study when they addressed a outcome change without addressing the reason and etiology of such. You just have a poor quantitative study. When you have identifying markers or make such claims, one needs to investigate the reasons and the etiology, not just the outcome numbers. As well review the numbers and make up... ....RESULTS: The two groups were similar with regard to mechanism of injury and the need for surgery or intensive care unit admission. The crude mortality rate was 9.3% in the EMS group and 4.0% in the non-EMS group (relative risk, 2.32; P < .001). After adjustment for ISS, the relative risk was 1.60 (P = .002). Subgroup analysis showed that among patients with ISS greater than 15, those in the EMS group had a mortality rate twice that of those in the non-EMS group (28.8% vs 14.1%). After controlling for confounding factors, the adjusted mortality among patients with ISS greater than 15 was 28.2% for the EMS group and 17.9% for the non-EMS group (P < .001 Now, one has to read that the ISS was almost 10% more than the non-EMS group. No mention of appropriate triage occurred, or if there was a delay in care at either markers. Was there peak and slow times included in the variables ? As well as turn around time at the TC ? Was the severity of type of wounds was the cause of change in the outcomes even though the ISS was near the same? (i.e. penetrating trauma versus blunt ?) this makes a substantial difference. Was the decrease in outcome from delay in transport, what was the average transport times(s) of patients ? Was these patients in same region or was the patients in all the same local and region or was there a close proximity of the TC when transported per POV ? Again, the study was poor in addressing any specifics of location(s) of the patient and variables of location. Time of notification from incident to transport time variables. If one is really going to adress and claim that delay caused an increase, one needs to be specific that the patients were from same regional locations as well. Again the conclusion was not clear nor any recommendations were addressed, which means this was a an initial or preliminary study. In real world terms means this was a study for political reasons to get more money for another study. This might be needed for accreditation purposes. (TC are required to publish research). This is part of the differential from level II and level I criteria according to American College of Surgeons (ACS). I did not see any outcome markers, except initial outcomes. Was the outcomes based on survival rate such as admissions to ICU, rehab or official dismissal ? It was not specific as well in identifying what their definitions as were as survivors. In conclusion, I feel this was a very poor study. Read what is not said as well as much is said. What was the initial hypothesis, the study and involvement of patient locations and service area regions. It is too late for me to see figure if the numbers are skewed (sorry, I do not always trust their statistician). As well as is there a hidden agenda (if any) to make study a biased one ? (yes, it happens) Unless we see a follow up within two or three years, we can concur this was a "needed academic study". Be sure to ask to read more into a study than taking a study at face value. I worked in Trauma Studies for 3 years and I know how studies and numbers can be manipulated, dependent on what they want the outcome to be. Even those with the "most respected, scientific"publications. As the final statement described .."Large prospective studies are needed to identify the factors responsible for this difference...Which means they need more funding for another study.. hopefully they will identify factors and be more specific on their findings. R/r 911

I have "mainlined" Valium for seizing patients and sedatives such as Ativan for agitated to calm them down, then establish the line afterwards. As other pointed out there are complications to everything, such as lacerating the vein and if the med is caustic causing phlebitis and scaring of the vein. R/r 911

http://www.emtcity.com/phpBB2/viewtopic.php?t=7485 R/r 911

As well it does not describe level of trauma in comparison, and speak of the EMS unit being diverted (how many times ?) before arriving at a Trauma Center ? (National average is EMS unit gets diverted every 11 minutes) So, yeah I presume they get in faster in the trauma bay, when homeboys presents them to the ER. I am beginning to think this "Golden Hour" is a myth, after reading more and more of the studies that was performed. I believe it is a good standard to judge by, but MOI, amount, where, that all adds up on the trauma severity index score is really the indicator of outcome. R/r 911

I have a problem with the post, because it is talking out of both sides... refuse a hypertension if the destination was not an ER or if the patient required oxygen or a vent type patient they could not transport ?.. WTF You won't transport to SNF or rehab units ? .. Not all patients need an ER, but may require critical care transport or even BLS such as oxygen to even a residence. As well refuse if the scene is not safe.. hmm.. sounds like an excuse, not to work. Sorry, you have to be careful it is true, but unless the "psych" patient is armed and dangerous, and the whole ER was on lock down I am sure it was relatively safe. If not, leave and have them call you when the situation was handled and return to transport the patient. Like I said.. not very clear.. R/r 911

Basic EMT is just a little more in-depth than a first aid class. That is why enforce memorization work in lieu of understanding the etiology and understanding of the problem. Unfortunately, many medic classes never go any further as well, so the memorization and use memonics. R/r 911

Times must be bad to have to research and publish such hogwash. Apparently, we have cured and solved too many other world problems. I agree with Ruff, kids will imagine no matter what. Of course we have attempted to limit their imagination and play time by new inventions. When I was a child, I remember I would make a superman, batman costume out of whatever I could find. If I did not even have one I would pretend.. Yes, I am sure I took risks that was dangerous, just as any child does. The main point no matter costume or not, superhero or playing with any toy, game we our responsible (guardian, parent) and do not need studies or research to confirm such. We need to be careful and watch and supervise our children.... it is called parenting. R/r 911

Most Dopamine and medication drips are not fast enough to keep the vein open as well. That is another reason for "piggyback" IV. Lock's are fine as long as you have another site for fluids, and remember to flush after each one. R/r 911

Okay, I will say more.. I live in tornado alley. It is obvious that many don't know or aware how fast and how dangerous these storms are. One of the first thing is not to be out driving around. No one exactly knows which direction and the intensity, how fast it may move. Technology is wonderful, but nature still wins. It is not like you usually have an hour to be prepared at times. Sure there will be advisories, watches then after a sighting a warning. With the changes in weather patterns lately, more and more states should be more prepared. Officials advise one to not to get out and especially to be on the highway. Many die each year attempting to "out run" storms. Remember, there is a high chance of large hail and heavy rains so visibility is poor. As well, the old myth of seeking shelter under bridges and revenues has been proven deadly. I personally retrieved a body that the woman was "sucked" away from her family as she held onto steel beams. Cars are tossed like toys. So yes, seeking shelter in a building is much safer. Yes, practice makes perfect. We have tornado's monthly (even in winter) and I can attest, students are much safer inside than running amuck attempting to get home. In fact my high school was built as a "below ground" for that reason. For as basements, I can literally count on one hand how many homes in my area have basements. In the Midwest the soil is more clay and thus basements are not usually built because of shifts causing severe cracking and crumbling. as well, when a home is hit the house collapses onto the basement area. The only true safe area is an approves storm shelter or safe room. Where the concrete is reinforced with over 8 inches of concrete and either placed into the earth or into the foundation. Even then a F5 can destroy such... there is research to improve safer protection devices. I agree we sometimes spend needless time and money on what if's.. but in some areas this is not a what if ... rather when situation. If it saved one life, would it not be worth it ?

Thank god for computers and word perfect.. now, everyone can be a published author and have a valid opinion. Let's see, lets not have a plan let chaos happen... then he write another article on the tragic event and how they should had controlled persons action. There are people that need to get a life ! R/r 911

I can't think of any medication for field use in a lower dosage form. R/r 911

Me too.. we had to apply a Thomas Half Ring as well as a Hare.. I think I still can tie an ankle hitch.. LOL

Actually, Etomidate and Diprivan are long term enough for analgesia.. Both are very strong and have potentially dangerous side effects. Diprivan is a very potent analgesic. Remember, NO EMS is licensed or permitted to perform anesthesia. That is why the initial term RSI was changed from Rapid Sequence Induction to Intubation. This is a very touch legal issue and definitely getting into grades of anesthesia is way out of a Paramedic scope of practice. The patient is usually only needed to be sedated for a short period of time for transport (<2-4 hrs). Albeit, it is preferred to sedate for ventilator care, it is not always necessary if coaching and patient acceptance of therapy is possible. Long term sedation can be very dangerous. R/r 911

Time to find a service that will be proud of you! R/r 911