Ridryder 911

I have never used the camping device, and one would have to be careful it did not get to hot... I have although used a thermoangel device, that will warm the fluids as well as blood for pre-hospital and I used in the helicopter... http://www.thermalangel.com/?OVRAW=thermal...;OVMTC=standard R/r 911

As she can not snatch the pebbles from our feeble hands... :wink: ..... R/r 911

Unless you have a graduate degree in EMS and are board certified, that it is not true. Many P.A.'s and NP's started out as Paramedics. In the rule of hierarchy of medicine, P.A.'s & N.P."s are just below physician level, hence the reason they are given privileges and are considered professionals at hospitals. As well, why the average salary is at least a 6 figure. Yes, NP's and P.A. are both still considered physician extenders. The reason I chose the NP over P.A. is because of autonomy; in some states (11 and growing) at this time, NP do NOT have to be associated with a physician and can have independent clinics and perform their practice on their own license, and can bill medicare/HMO on their own account. Where as P.A.'s has to be directly associated and supervised by a physician (most within a 60 minute response or telephone coverage). As well, many of the ER's are now converting to NP' in lieu of P.A.'s since they are working on their own license. Again nothing derogatory to P.A.'s but since N.P.'s work on their own license, malpractice is on the NP license not the physician. As well NP's have prescriptive rights (limited to their specialty). Most are placed in the ER setting in fast track, minor emergencies etc..and knows their limits; as well some are placed in the acute side, and in rural ER's for stabilization. Remember, P.A.'s basically go through the medical model like medical school in 2 -2 1/2 years, after undergrad. They sit in the same classes side by side with medical students and attend a lot of the same course, the main difference is clinical and residency time. P.A.'s as well have to have CEU's and re-test the board every 6 years.. and you think EMT's have it bad. Where as NP's require to have a BSN and nursing experience. One then chooses their specialty, for example neonate, psych, geriatric, emergency, acute care, etc...for additional 2 1/2 yrs. Within this license each state, specifically allows the NP according to their State Nursing Practice Act to fulfill specific roles. For example a pediatric NP can not work on an adult... pysch cannot work on neonate, etc... This limit's their scope, but as well studies are directly where they are at a specialty only. One can re-attend course and then become diverse... and become board eligible and be multispecialty. By the year 2015 NP's will have to have a Doctorate level. As I stated, M.D./ D.O. should only hold the title of Medical Director of EMS. I don't believe you would find most P.A.'s or N.P.'s in disagreement with that at all, or any that would feel comfortable or would want that role. This is definitely for physician level and responsibility. R/r 911

Interesting, I just finished a medical ethics class and we discussed this. Actually, if anyone has taken the new NRP class, this is discussed in the new curriculum for U.S. as well. One of the neonate NP was discussing the new NRP criteria. Fetus < than 22 weeks, there is a VERY high chance that infant will be born blind, deaf, mentally retarded and then becoming vent dependent, then only to die in a few weeks to months. Yes, there are a few that does live on a vent .. and have reached the million dollar maximum claim if they have medicaid or insurance, then afterwards it goes to the family credit. The main point NRP is getting to a give good informed decision to the family... all the risks as just described or "let nature take it course"... and allow the neonate to die and family be prepared for such. The resuscitation team then should be prepared for either decision. R/r 911

When it ...."rains it pours"... of course, I can't say anything you have not heard before..... other than IT SUCKS!... For some reason or another, it appears, you currently have the "curse" .. 'black cloud" .... "Sh*t Magnet"... or whatever or however you label it, it sticks with you for a while. Then it when it does go away... you are dry again... it appears it comes in waves... Ditto .. to what others have said... I do know how you feel.. fortunately, I am on the dry side now.. had the weird sh*t magnet a couple of weeks ago.. glad that is gone... yet, I go back to work Thrs.. who knows? Hang in there buddy.. have a one on me !

Very good points... We just had a student that would not stay of their phone, then when asked about wanting to go with another truck.. refused to!!... So another call came in, and the patient had multiple dystrophy, retardation and was contracted and would flex at any touch.... the basic did not want to touch the patient, the medic informed them they would have to be aggressive, and be firmly to go ahead & put the cuff on the patient... the EMT still refused, and the medic obtained the v.s. .... the paramedic afterwards, talked to the EMT student privately and discussed how things can be difficult at times...etc.. ... The next week, other students informs us that the student went back to class and told other students that the medic assaulted the patient and was forcefully aggressive and mean to the patient. Now, we know the medic never did such... the student apparently was upset, because they were asked several times to participate in care.. etc. The shame of it is now, this student is now known by several medics and students... and probably will be known as such trouble maker. Foolish decision for the part of the student for his career..... R/ r 911

I believe one should have to have proper documentation, if you assisted or provided any care. I know our assisting agencies do not, but this has bit them as well. Since you are there as a part of the medical team, all chart and information may be pulled up in court if needed. I do think a brief narrative such as vital signs, and some brief physical assessment should be added... especially if there is a differential in findings, complication, potential call that will be controversial or litigious . ( child abuse).More the merrier, as well, if your service is pulled in as witnesses, they have something to refer to.... R/r 911

Sorry you feel that way, since they have a equal to higher diagnostic ratio than physicians and as well prescribe and order less than half the med.'s, procedures and tests to give them that diagnostic rating. What I have found out is most health care workers are ignorant of NP requirements and their capabilities. I was enrolled in a P.A. program at one time and dropped out due to the philosophy of being too closely to the medical model of treating the symptoms not the patient. Most as well are not aware that NP's are specialized.. they are not generic and cannot function as such, unless one would consider a family NP being generic. For example, neonate, pediatric, adult, geriatric NP's have specialized education in only those areas and then take a board certification test in that specific area. Like EMS, they are specialized and cannot crossover to another health care profession. I would find the NP being more closely to prehospital since they at least are required to have some form of medical education prior to applying to graduate school (most P.A.'s schools do not require) and most require a minimal of 2-5 years of patient contact experience. P.A. are a great asset and by no means, am I belittling them. But, in comparison a P.A. is similar to general medicine and after graduation the diversify into any area of medicine, where as a NP is only in that specialty. As well, I guess or assume a Trauma NP, Acute Care, Flight Nurse NP, Emergency NP that only studied in those speciality areas with an additional 2 to 2 1/2 years on top of their undergrad not to be qualified enough to be in the field right? ....NOT!.. since Paramedics training is so in detailed.....with all that 10 months of nighttime classes...LOL R/r 911

For your leisurely reading, and getting a good understanding of physiology, I suggest Guyton' Physiology. It is geared for medical students... http://www.amazon.com/Textbook-Medical-Phy...y/dp/0721659446 For a true understanding of basic medicine after you have read Guyton' physiology, then I highly recommend that you read one chapter a week in Cecil's Essentials of Medicine http://www.coderscentral.com/04_cecil_text..._medicine_e.htm One would have a pretty good basic understanding of medicine. R/r 911

I am sure the makers of EZ I/O are guarding their patent well. But, like everything else, it will have to run out someday. I am sure there are companies out there as we speak are attempting to "copy" such devices with enough difference to be able to produce the same effect, but enough difference to not infringe the copyright. I do wish, they would come down in price... they would definitely be used more. It appears they are taking advantage of "being required". I am sure they are trying to re-coup and make as much $$$ as they can... why the going is good. R/r 911

Many states only recognizes that EMS medical directors should be only medical licensed physicians. NP & P.A. are recognized physician extenders and are licensed as such. They should be able to give orders (direct and written) in their expertise field as a direct physician extender, but should not be even considered as the main EMS medical control for overseeing operations. Many areas do not have physician coverage, and are staffed by such physician extenders. I to question if an EMS has to do a specialty transport and the P.A. or NP wrote specific orders and they were not followed what the legality would be?... i.e. increase Pitocin drip etc...Since NP's are considered licensed practitioners and have authority in the state as such. R/r 911

I have not heard of such, but many years ago in ENA's JEN there was an article of "milking"the veins by placing the tourniqet at the a/c area, then encircling the extremity and applying presure as you go distal fills the veins... I have used this a few times. I have seen it works about 50/50... R/r 911

Some of the problems I have witnessed and seen with the FAST device, was initially displacing the "bone plug', and when removing the needle, one must have wrench or device. This device is very easily lost.. I know I have had more than one call, asking for another one. Yes, they work ... I can attest to that and are another option. In comparison, I do prefer EZ I/O over FAST, due to the ability of multiple injection sites, ability for pediatric and adult and multiple size of needles. The costs unfortunately is still high and with the recent advents of AHA standards recommend I/O in lieu of ETT med.'s, I doubt the price will reduce in the immediate future. Hopefully, more companies can make competition more available and reduce the costs of these devices. R/r 911

No matter how much we try to save their life either they will refuse or going on an end up dying on us!... We can never win! R/r

If he is conscious alert and well orientated, advise him and his wife of potential risks (including death), an dangers, notify medical control and see if they could convince him of transport. If not then there is nothing more you can do. It is his right (patent's rights) to refuse any treatment and transport. R/r911

A couple of things, I highly suggest you either read or learn on how and what pneumonia is caused by and second the euphoria feeling is quite natural in hyperthermic patients. Ignorance thinking that a vaccine caused pneumonia, should be addressed that you were probably already harvesting such either viral or bacterial prior to immunization, or that you immune suppressed prior and your body was unable to "fight or resist" such, even stress, poor diet can do as much. I do however, think it is asinine to be promoting unfounded 'paranoia", "delusions" and panic. As healthcare providers we should promoting the adherence of vaccinations, and healthy living. I guess you are not aware acquired community pneumonia is one of the highest killers among the elderly and young, so you promote ones to become sick? Obviously, you have never studied immunology, histology or even basic medicine. I am not concerned that the Government "is putting" something into vaccines.. No! I am sure they have much more to worry about..I am much more worried about anti-government wacko's blowing up people (please see my location).. I know I have treated several more hundred injuries and those that died from those types in comparison of "supposed government induced" B.S. Do I believe the parents should hand over the child ? I much rather prosecute them for neglect. If the child then becomes sick or ill from a known disease that could been prevented they should be prosecuted for child abuse, and the child taken away and placed into a loving home. Again, it is apparent as well, you have never treated children or adults with diphtheria,pertussis, tetanus, mumps, measles. Do you think it is fair, for that child to spread chicken pox to all others.. or again spread undetected measles to a pregnant female?..... all it takes is a sneeze or the kid handling a door knob with his mucus slobbery hand. There is a reason for vaccinations... it has been well studied by scholars and medical researchers for years. Even many medical research scientists died testing vaccines so others might live. Let's leave the paranoia to the pysch patients. R/r 911

Interpretation: Some states describe that having any identification on your auto, etc.. as identifying your self as an EMT may obligate you to stop as you are presenting yourself as having a "duty to act" ' otherwise, why have a star of life on your vehicle? Some states do not enforce it.. again, where others might... but why chance it... if you don't plan on stopping or being a "whacker"? R/r 911

I believe there is more to both sides of the story that is not being told. Settling for so little if something really occurred and medics being that stupid.... cheaper to settle than fight it... R/r 911

AMEN!!! WOW !! A healthcare web forum, announcing pharmaceuticals does not work and trying to establish paranoia attitude the "Government is out to get us"... Don't know what is in them, read the ingredients. Sure, you may get a little achy .. remember you are getting injected with a mild viral form... does it protect you 100%.. no !... nothing does. Yes, you have to take precautions, and yes eat healthy, boost immunity levels.. etc. When this winter and the flu hits... and there is about an 8 hour waiting time, don't whine .. don't comlain and tell me how bad you feel, or Oh God..This is awful!.. The same crap I heard 2 years ago, when people ignored the vaccine and we had no rooms left in the hospital, and patients stayed in the ER for 3 days....and the children and elderly were dropping like flies. The kid without immunizations, it is a shame the parents cannot be charged with neglect... let the kid get tetanus, and as he has seizures and muscle tetany so much it actually fractures bones.. or when gets measles and is still in incubation phase and exposes and spreads them to a pregnant woman and then the child is born blind, we can personally thank them!...Maybe he can get the mumps as well, and his testicles can swell up like grapefruits, and then he becomes sterile..... well at least he won't be producing any more of their ignorant genetics! Yeah, let's vote them as "parents of the year!"... their so loving... Ignorance is blessed, stupidity is not. Immunizations, are an important part of providing health care and is one of the main keys in preventing diseases to spread and reach pandemic portions. One might want to review the polio epidemic era...not that long ago.. anyone remember the iron lung? There are very few pharmaceutical companies that make immunizations, so there goes the "lining the pocket theory" and why there is more a shortage. Immunizations are much less in profit margin than let's say medications post exposure (i.e antibiotics). I can assure you pharmaceutical companies can make more money off you sick than you being well..... yeah, use common sense. R/r 911

Probably part of the new cardiac, trauma study that about 20 hospitals are performing. Pep'e and several others have been performing. I posted a reference of this study last spring, and I believe that EMS DeFrance web site has more info. I know the The OPALS study, and ROC, which has not brought much attention or is hardly mentioned in the U.S. I still believe that ACLS is one of those medical technologies, either it will work or won't. Unless resuscitation measures are started in a quick and in a timely manner and good CPR is performed, success rates is going to be dismissal no matter what and how it is performed. R/r 911

Thanks Hammer for pointing out Trendelenburg myth... as well, if 250 ml does not change any outcome, you are pissing in the wind then about fluid challenge... Amazing, most are not recognizing basic hemodynamic physiology though... R/r 911

Ironically, I went on a acute CVA yesterday, and I too discussed this, being the minority of the group that CVA's should be flown as well if even not more than trauma. In comparison, the survival rate of CVA's and reduction of damage, in comparison of those in trauma is greatly as well as timed events. The old theory of "blood and guts" are only timed related demonstrates again, that our field medics are not properly educated. R/r 911

I too probably study at least a minimal of one to two hours a day, by reading a journal, review a study or read a chapter or two (EMS)... other medical related I study another 2 or so.. I was taught, that it was part of the obligation of being in the business one has to study daily, to be competent. R/r 911

......"No, I'm healthy and I don't need one.".... These are the same idiots, we see every winter telling me in the ER, "Oh, I am so sick"... "I never get the flu!"..waaaaaah.... You get the flu, and did not take the shot..... good ! You deserve it! R/r 911

You guys have some great responses, but I believe we are over analyzing this a little bit. Let's keep this simple.. I too believe it is a rate induced problem, there is not clinical evidence of failure, i.e. CHF, etc..indicating otherwise. Sure, the rate may not be that low for a mid twenty year old, but for a post. inferior AMI in a middle age patient it should be raising red flags.. and is of concern. Remember, treat the rate if ...."the patient is symptomatic".. sure, give a fluid bolus, but doubtful it is going to help. Usually with afterload problems you will see clinical findings of such before sudden hypotensive. Dumping more fluid than 500ml is not going to help him other than to drown him, it is probably a pump problem and his rate is affected. Time to pace the patient. Worrying about a "possible side effects" and trying to treat an overdose of medication without really knowing that is the real primary source is going to bite you in the butt... while your patient is dying. It really does not matter.. you have to treat the immediate reaction at the time on this one. Try pacing and see if perfusion increases, if it does not, then use some form of vasopressors in conjunction. If you have capture and still no increase in perfusion, then you have identified the problem... and the patient is in need IABP... or has another horrible etiological problem.. R/r 911