Ridryder 911

Unfortuantely, like EMS not all respiratory technicians are created equal as well here in U.S. There is not one R.T. in my moderate size hospital that has a college degree. Rather they were grandfathered in and completed a correspondence program. We do have a well developed associate degree program in nearby community and at one time had a cardiopulmonary B.S. program, but the last I heard was discontinued due to lack of interest and employers wanting to pay qualified graduates. I do agree an well educated respiratory therapist is an adjunct to any unit and hospital. I do not agree that just by having dual education as a medic/therapist allows or qualifies one to be able to work in a unit. The same as in an EMS unit as a RN, the scope of practice, education methodology and objectives are not focused or designed to function in those areas as that type of provider. R/r 911

So what we have learned from the posts so far is .. professionalism can be viewed and increased by multiple ways. Increasing education at all levels, we recognize that the current system is poor to say the least. We in EMS do not police professional behavior nor do we stress and educate it much in our educational programs. Communities attempt to provide services for EMS, but rather place the best for the citizens, many rather have individual services filled with pride and egos than to combine and pull resources together for the betterment of the patient. Some feel it is much better to respond quickly in unsightly attire, but still wonder why many think of them as unprofessional? Apparently, many do not still understand intoxication not only presents a poor picture, but as well is dangerous to patient care and those staff that might depend upon their actions (as well as illegal). Continuing to allow someone to do so, is just as unprofessional. Many feel they have to defend behavior and therefore do not understand the "whole picture" of professionalism. Professionalism is much more than one thing. The belief and sincerity one has about how they deliver care to the patient. This includes their sincerity to the profession, their attire, education level, the level and the type of care that is delivered. Each attribute develops and make up professionalism. Removing just one thing, can fragment professionalism... being from poor behavior, poor knowledge or poor care and image one portrays. We should be reminded to keep in check with all the attributes of professionalism and attempt to maintain those at all times. R/r 911

or better yet... change clothes. How long does it really take to place on some better suited clothing ? .. R/r 911

You are right fluid will go to least resistance and will follow flow of gravity. The difference is blood flow is controlled in the circulation by way of pressure gradient and valves. Even veins have controlled valves ( as anyone whom establishes IV's can attest) and when the valves are closed helps prevents back-flow ( as seen in patients with prolapsed valves with conditions of varicose veins and hemorrhoids). Remember as well, patients in hemodynamic compromise blood, will shunt into deep capillary systems (pale skin) and will be entrapped as well in that system. The reason for EJ may due to large amount entrapped blood in the thoracic area thus backwash into the veins. I agree attempting to change the paradigm shifts will be difficult with old school medics and thinking. Hopefully, organizations such as ITLS and PHTLS will at least discuss the dilemma and confusion. Of course there are those that will refuse to accept anything other than what they were taught initially, such as hyperventilation of head injuries and the mythical fluid resuscitation of trauma patients. R/r 911

We have a few services that utilize these devices. Since one can remove the mask and N/C and use the percentage desired, (similar to venturi) it makes it nice. The problems I have heard is the costs, as well the device has to be kept in its container as smashing or compressing it, will cause malfunction of the design of the mask. R/r 911

Yep....Alcohol toxicity even seen them die with it. Welcome to emergency medicine.. R/r 911

Apparently, I don't get it ! Life must be pretty boring to film anything...wow someone pulling out an IV WTF? Why, is someone on IV fluids at home, and not monitored, and what did the moron expect ? R/r 911

I always thought that was funny that has always been placed in the ECC criteria, usually followed by an asterisk * . Ironically, I have never sen that performed in the 30 yrs, I have been doing this...lol The other technique, I have seen to be successful as well is the mammalian diving reflex, which you place the patient face in ice water... R/r 911

The problem is the EDC is usually vague and not always accurate. That is why the accepted guidelines is used from the AAP standards, as well as viability <28 week old. R/r 911

Why do each town.. have to have an EMS unit ? What is the problem with qualified and well trained first responder units. Amazing larger services utilizes them until ALS responds, and as well most can stabilize for at least 15 to 20 minutes, until ALS respond. Second, why cant there be established EMS regions and districts ? Pulling communities together and placing units in acceptable areas. Again, I still say it is pride, not really the concern they have towards of patient care. The attitude of "we have to have our own"... Well, it will change.. sorry fight all you want to, but economics and as well increasing run volume due to the increasing age of the population will make it impossible to maintain volunteer status. So, would it not be wiser to work on a workable system than to "fog' the picture with egos and pride. IMHO it would be must better to have a implemented system than within 5 years no system and be in panic. In my state, there is a panic due to rural areas now going from poor private private to volunteer, to no EMS. Yes, I mean no one will be there to respond. Mutual aid from neighboring communities (30 -50 miles) is responded. It would had been much better if all those smaller communities "banded" together and work as one, than as separate identity. Volunteer first response units, until the regional area responded. Change is hard to accept, deciding upon which change would be the best in the long run.. r/r 911

The reason of < 50 is possible plaque build up and possible dislodgement while performing CSM. Different literature and standards advise of different ages; again the main concern is dislodging a clot. SVT ( albeit a true generic term) is more commonly used for those rhythms above the general range of atrial tach, and definitely not to be misconceived of nodal (high, medium, low) or junctional rhythms. Although, there is evidence that it is originating from the above the ventricles. p.s. I do know why and whom taught this... :wink: R/r 911

It is part of the job requirements per Department of Labor to "reasonably lift" with this saying, no accomaditions has to be made. Sorry, it sucks but that is life. If he values his back and as well I am sure the pain and agony that he had suffer, I would highly recommend another public service or volunteerism or possibly assist in an office position such as dispatch.. etc. Even lifting equipment or assisting is one of the majot causes of back injury in EMS. Albeit bad news, I wish him luck.. R/r 911

These are the official "guidelines" used for most emergency and intensive services. Do not be confused on "newborn = or synonymous with neonate" the same standards apply and guidelines are the same. For more information I refer you to Neonatal Resuscitation Program (AHA/AAP's) http://www.aap.org/nrp/nrpmain.html and PEPP http://www.peppsite.com/ for more course information for field medics and current literature and standards. R/r 911

I have found CSM more effective than valsalvas. I do listen to bruits as well, and do not perform it on those >65. I have had great success with the procedure, in lieu of giving of Adenocard. One of the cardiologist I witnessed used it routinely for most tachyrhythmias. Very few times I witnessed medication for reduction of rate.. interesting modality. R/r 911

Don't know what institution that is from ? The highest paid Nursing professor job I have seen offered is $38 K requiring a a PhD or DNSc. Unless you are discussing a chairperson position or one of the largest state university. Two of my associates was offered at the second highest tuition school in OK. a nursing professor full time position for $28 K a year ! They as well requested you have a Doctoral level within 6 yrs. They stayed in ER because they would have to take about a $15K year cut. The average pay for RN's here is about $18-25 hr which is = $32-40k a yr. .. Managers make about $40-60k a year.. R/r 911

There is not a paramedic shortage, there all disguised as "greeters" at your local Wal-Mart. .. (not joking) The difference between EMS and Nursing is the way of dealing with the potential shortage is multi faceted: 1) It is way too easy to be a Paramedic, within 9 months the shortage can be corrected. If it was hard and time consuming, there would be no volunteering. After a student loan of $40,000 .. I doubt anyone would be "donating" their services all the time. 2) Where as nursing has held their ground and refused to lower level of education... EMS has decreased and gone the opposite, lowered, made on line, expedited (weeks long) courses. 3) Like others described there are Paramedics out there, but where is the money ? As well communities that could afford paramedics, can get them for free as volunteers. 4) There are too many "pseudo" paramedics.. EMT/fill in the blank . Over 156 assorted titles and flavors .. that can always ...' perform similar, or almost like a Paramedic, but; much cheaper! ... and the company can get reimbursement the same as having the real thing. So to answer your question, yes at one time it appeared to be there might be a shortage. But, thanks to those involved in EMS we have ruined any chances of taking advantage of the supply and demand. As usual, we ruin a good thing..... R/r 911

I have worked and managed EMS in areas that was even more less populated than rural, it was classified as frontier country, so I am very familar with very rural settings. Wanting and getting is one thing. How competent are those medics and skill level on a town of 100 people. If they were to run 5 calls a month that would be over half of their population! Now, you tell me their going to maintain skill levels enough to justify existence and expenses ? Again, it the "closed mindness" thinking that they deserve and should get monies from the fed grant (which it was never designed for) because they want and think they deserve something. My EMS general response is in areas 30-40 miles everyday... One does not need a transport EMS to help people! As well I bet it takes at least them at least 10 -20 minutes minimum to arrive at the scene. So now we are at only 15 to 20 minutes difference from ALS arriving. Having qualified First responders, should be able handle the situation for the first 20- 30 minutes until ALS until arrives. Guess what there is little difference in a BLS EMS unit responding than having a first responder responding... In the real world.. not everybody gets what it wants...That is the choice one makes when they choose to live in remote areas. I can speak personally, since I as well live in a rural area. I much rather see a tiered response with good BLS and ALS intervention, so everyone gets a real chance of survival than every town thinking they have to have a ambulance in their community or fire station. R/r 911

Okay, let's remember a few things.. NTG is prescribed for patients at home for anginal episodes NOT an AMI. As well I have seen numerous episodes of just one squirt has caused syncope and pressure to fall. Yes, I administer NTG to a patient without a IV line, if their ECG does not reveal right side, and their normo-to hypertensive. But, administering NTG blindly is asking for troubles. Having a patient "bottom" out is much more complicated than just treating by raising their feet (which is a proven myth) and giving some fluids. Congrat's and thanks to your action(s) their infarct size has just probably increased ! This is due to an increase workload and demand placed on the myocardium, from the receptors sensing the hemodynamic compromise. Thanks to your actions they now have develop a full thickness wall infarct. Now, we are looking at potential major complications... This is one of things being re-reviewed and should be changed... even at a Paramedic level. R/r 911

Great posts Asysin2leads ! Very true. The costs is all relevant for what region you are living in. So the true dollar amount is negotiable and should not be stated as such. I know of two local "small towns" population of < 2000 each , that contracted with an EMS service and have a 24 hr paramedic staffed truck for $6,200 a month. The "difference" is made up on billing to patient. Sorry, a township of less than 100 people does not need an EMS. It can't afford nor warrant enough call volume to support anything. Now, combining with other communities as described might be able to support something. That is the risks one takes when determining to live in such an area. Now, what I do ask is there not any professional EMS services within 20 to 30 miles of these communities ? That small communities could have a first responder program to initially treat and summon a rendezvous ALS EMS ? Just like all other communities, one has to weigh what the community can have and expect. Townships that are composed of a total less than 500 would love to have several things, hospitals, sewer plants, etc.. as well as a EMS. However; unless they receive grant or work other similar townships it is not feasible or expected to be able to provide those services. Again, many do not explore options. Rather they feel that it must be that "they" have to provide such service or nothing at all. In my area there very few volly EMS. In fact, many places are now going without EMS, which is more a problem. They will volunteer for F.D. but not EMS. So many larger services are now combining areas to provide extended coverage or remote stations in those areas. It can work, but one has to be more open than to one mindset. R/r 911

Have the option to. Personally, I believe it is a waste of time. I have yet seen it work in the past 30 years. It will make them sleepy enough to decrease the nausea, or they will vomit while they are drowsy and aspirate. I much rather stick to Phenergran, Compazine, and Zofran. R/r 911

I agree. One should be sure they are not looking at a right sided AMI. That is why it is I am against Basic EMT's giving NTG, without either EKG or hx. of angina. True, people self adm. NTG all the time without an EKG, but they have been dx. with angina type syndromes. R/r 911

Ditto .. especially if you carry Cordorone and Mg+... R/r 911

I always find amusing when comparing "medical professionals" so many compare such honorable organizations such as Doctors without Borders, and others.. Now, compare with how many weeks or days a year those professionals volunteer. ]One does not usually go to medical school for 8 to 15 years and then volunteer from then on. As of yet, in my nearly 30 year career have ever met one. Yet again, those are professionals that volunteer not laymen volunteering as professionals. The reason such organizations are successful because they are composed of professionals that can afford and as well go where there is no health care or poor established one. I have not seen such organizations establish clinics in a metropolitan area to be operated as their full time health care providers. Again, there are remote areas that will have to depend upon volunteers. We professional EMS providers realize this and are satisfied with such. However; if your local offers any public services then they could offer EMS. Again, " Why buy the cow, when you can get the milk for free ?". I won't continue the debate, those that know that they are not able to provide 24 hr a day ALS care, with immediate response are failing their citizens. Placing an attempt to make and rationalize excuses instead of adressing the problem is much easier... R/r 911

It can be very confusing, but basically the continuum of care is allowable for follow ups as well as possible exposure etc.. Hospitals have to offer either the ability to disclose or private. I have yet found one that would not give me pertinent information in regards to care. Yes, I may have to jump through hoops to get the "password" etc.. but, when they find out it is for educational and TQI process, there is less resistance. R/r 911

The reason the topic went from the original post is so many put false faith into CISD/CISM. As well things to get so technical is because we as health care providers need to be sure that the suggestions we promote are valid and well sounded. Discussing, with a mentor is nice, but this does not solve true problems. Touchy, feely, statements are nice but being sure one of our own is taken care appropiately is a big deal. An appropiate mentor would advise you to see true profesional help. Medics are not trained or educated enough, for these situations. Thank you Dr. Bledsoe for addressing this issue with your research and comments. I agree with your position and as well have always thought the same, since the conception of CISD. I refused CISD during the OKC bombing due to the poor research and no known scientific basis to validate it. Again, another form of medical care without validity and based on assumption. R/r 911