Ridryder 911

Wow!.. This type of situation is a pain in the gluteus and further south!.. I did not read if there appeared to be a high degree block sustained or a consideration of such in the rhythm ? I might had considered using the traditional Atropine trial dose of 0.5 mg to 1.0mg RIVP and see if it would had worked. As a possible treatment regime. If it is successful, then I would attempt to consult physician to seek some suggestions. I have had non capturing even maxed out on amps. In my experience I have several non-capturing in comparison to those capturing. I personally, do not feel there is any significant difference in A/P versus traditional anterior sternal/apex. As well, most EMS utilizes fast patch in lieu of the older version of pacer pads, which is recommended for anterior aspect. Again, I agree Atropine can increase infarct size especially in high degree blocks (2nd degree/ type II to 3'rd degree) Although, I have seen it work quite effectively on nodal rhythms as you described especially those in higher nodal rhythms. Again.. if possible a consultation is not a bad idea... this situation is not good one This should also give the ER physician a heads up to prepare for a venous pacer to be placed ... Sometimes even venous pacemaker will fail to capture, the ischemic or necrosed myocardial tissues will fail to respond to any electrical therapy. Traditional pacemaker placement is sometimes the only treatment that might be of success.... Your description of the scenario sounds like a a bad predicament, the type no one wants. It appears you handle the best you could given the situation.

Dwayne, it is all about dumbing down America, one State at a time !.. ....[/font:01d89a49d6]

Discussing rings.... uh.. sort of... :shock: We had a gentleman the other day present to ER with a a ring approx dime size diameter that placed around the top of the scrotum (anterior aspect) at he base of the perennial area. Unfortunately the man describes this occurred "a couple of days ago" ( 3-4 ) and had attempted to remove it several times with multiple devices and lubricants... now he arrives basically ("banded" farm and cattle people will understand this.) in excruciating pain (no kidding!) . We attempted to remove with ring cutter (titanium).. etc. no avail..we sent him to a metro hospital for a surgical eval chances are he will now sing in a higher note.... R/r 911

Sorry, you had a lousy clinical but welcome to EMS. I have yet to meet an EMS crew that were not cursing...yes, they probably did not walk around with shirt tails tucked in at the base (home) all day, hopefully they presented themselves better in public.. For as not paying much attention to you.... remember they probably see at least 6 or 7 students a week never to see them again... sorry basic clinicals are like ride-a-longs. Yes, they definitely should had performed better assessment and care.. period. But, if that is all it took to get you to leave EMS, then you are in for a surprise when you enter an LPN program (especially when they do not usually even understand how a pulse ox work) ... you will see much worse in your career. R/r 911

I suggest to look at multiple lead... yes, it's nice to have XII lead, but one can determine by moving the leads around and looking specifically without diagnostic setting. Check out Bob Pages web site : http://www.multileadmedics.com/ R/r 911

I hope these are all separate ! Mine usually are a day that ends with a Y... R/r 911

The answer is you can't .....here you goUncle_Salty..! How does it feels to be compared to a pedicurist and that they require longer length school than an EMT ? And their average salary is more than the average EMT!... Kinda knocks the wind out huh?.... Just think the people that cut your toenails and fingernails requires more hours in education...! Pedicurist: Career Education Profile Pedicurists are specialized cosmetology professionals. They primarily work with a client's toe nails, shaping and cleaning them. Read this article for further details about what a pedicurist does. What is a Pedicurist? A pedicurist, also known as a nail technician, specializes in cleaning, shaping, and painting clients' nails, specifically toe nails. Pedicurists may add acrylic nails to a client's natural nails to give it length or to make it easier to style. Most pedicurists work in nail salons, hotel spas, or other all-day spa facilities. Education Overview for a Pedicurist: According to the U.S. Bureau of Labor Statistics, www.bls.gov, the training for manicurists and pedicurists takes significantly less time than the training for barbers and cosmetologists.(Approxinately 300 clock hours) In order to become a licensed pedicurist, students must complete a cosmetology program. These programs are available at community colleges, technical schools, and cosmetology schools. Most students enroll in a manicure program and take courses that are specifically related to pedicures. Occupational Information for Pedicurists: In the upcoming years, the U.S. Bureau of Labor Statistics predicts that there should be continued growth in the number of nail salons and full-service days, which will increase the number of available jobs for manicurists and pedicurists. Salary Information for Pedicurists: In 2004, the median salary for manicurists and pedicurists was $18,500, as reported by the U.S. Bureau of Labor Statistics. R/r 911

Old CPR Annie's used to be inflatable.. I remember carrying the big old green suitcase box that she fit in and when you opened it, her arm or leg would naturally pop out..!... That would get the class attention. Epi pre-load used to intra cardiac needles on them .... didn't know what a short needle was for years. Remember "visibars" the two separate beacon lights with the siren in the middle, most started calling the long rectangle ones those but the original were the two separate lights. As well as Mars bars... strips of color mounted in the lenses, and Kojack lights? Yeah, we used Planos 747 and 727 tackle boxes before they caught on and colored them orange and started charging double the price. I remember when in ER we used to have to "ground" the defibrillator (it was a separate device, before we shocked someone. ALl oscilloscope were the "bouncing" ball... can you imagine medics trying to underpart those now? I remember the MRD2 ?.. The prototype of the fast patch.... yes, folks there was not always such. You connected and pushed 2 buttons simultaneously... problem is Physio voided your warranty when you used them. Then the portable external pacer... yes, before LP5 had pacer, we had a little box about 3' that had a 9 volt battery that connected to pads and would pace the patient. Worked great! for such a little device. As well as a stylus on the print out... hated when those things burned out, always at the most opportune time. Now a days most medics never heard of such. Awww.. these kiddos has such luxury these days...

I think it is a phrase for and by basic levels to sell t-shirts & many other wacker devices such as T-shirts, and other paraphernalia and mainly to inflate ego's of those that don't truly understand total patient care. One that really knows medicine realizes that BLS and ALS intertwine and can occur simultaneously. Why would I have to wait for a blood pressure to start an I.V. or check a pulse before placing on a ECG on conscious, alert patient ? One can do both simultaneously. There is no separation, it is called patient assessment.. period. If one reads many advance level material it always recommends that one to make sure BLS or ABC's are maintained. Simple enough, if one really knows how to perform their job and to provide care..... R/r 911

OMG!.. Flashbacks... We had the MRL in the aluminum case that came with the Fed grant money with telemetry. The only reason we agreed was a free monitor... and hey.. they med channel as well as the intercom in the truck was fun.. no one monitored the channel Anyone ever used the Burdick brand... it had at least 8 feet of cable on the paddles, but only had a 2 inch oscilliscope... yes the bouncing ball type. I remember pulling over many times to verify the rhythm. Yes, Dust I remember the god awful blue or orange Dynamed kits.. with everything but what you needed. As well, you might remember the magazine EMERGECY ! sponsored by Robert Hare (yes the maker of Hare traction) nice little gimmick for an LA cop... NAEMT actually had a scientific journal, then poof!! Everything went to a magazine.. I found my Boston Paramedic pouch the other day.. OMG I bet it weighed 5 pounds!..no wonder.. I have back problems.. window punch, buck knife ,straight and curved hemostats, and regular bandages and yes the velcro tourniquet with stamped initials.... I have to admit it was a whacker pack. I never used anything but the scissors... R/r 911

I have done upside, side ways.. etc.. what ever it takes.......that is one reason to learn the tomahawk style. R/r 911

Although it is all important more important is the osmolarity level after it enters the cell if it is iso, hyper, hypo... which there is very little difference in IV fluids in a short period of time and the small amount of fluids administered. Again, although it is important to know the what the over all ratio is. R/r 911

ACEP ACLS is the same as the regular AHA ACLS. : http://www2.acep.org/1,32615,0.html R/r 911

Wow.. it has been a while since I have seen one. I will check with the hospital and see if we still have one.. we never used them, but had them because it came with a grant. R/r 911

My suggestions is to talk to a guidance counselor and the EMS Instructor/Coordinator and they will assist you in a establishing an schedule of classes. I would not suggest buying any books at this time and focus on your studies alone. You will purchase enough books in the courses alone. May I ask why you are pursuing being a Paramedic when your long term is Police Science ? .. You might be better off going into that from the beginning. Good luck R/r 911

Just to show you that they can make anything into an abbrv.

I believe it has potential, now with that saying I would not want to be the hospital legal defense team for the ones that did not get informed consents etc.. on trial studies. R/r 911

A lot of people can not face their own faults......... period. R/r911

No...or should that be know as in knowledge ?...

ANy of this sound familar? From EMSNetwork News http://www.emsnetwork.org/ Insights “Insights into the IOM Report - EMS at the Crossroads” Jul 21, 2006, 15:56 In 1966, the National Academy of Sciences/National Research Council’s published it’s infamous report; “Accidental Death and Disability: The Neglected Disease of Modern Society”. That publication revolutionized pre-hospital emergency medical services. Now, forty years later, the Institute of Medicine has released it’s landmark report on the state of emergency care in the United States. The EMS component of the IOM report, “Emergency Medical Services at the Crossroads”, affords the leaders of our troubled industry the opportunity to capitalize on many of the recommendations made by the IOM. Discussing the report with several colleagues, I’ve heard some incredible comments. One of my favorites was “Well, now the wool is really off the sheep.” Here’s another good one, “Why are they being so critical of us.” But here’s my favorite, “There’s nothing in that report we did not already know”. That one statement completely sums up what really is ailing EMS systems across the country. We know what is wrong, but are either too apathetic or feel we are too powerless to fix it. Before the dust starts to collect on the report as it sits on some shelf in Washington, D.C., why not invest a few moments to take a deeper look into some of the recommendations contained in the report and perhaps, just perhaps, use them to effect change in our local communities and across the country… {WARNING – the words you are about to read are not for the faint of heart – they are carefully crafted to stir enough controversy to hopefully foster substantive dialogue in across the EMS industry.} IOM Recommendation: “The Department of Health and Human Services and National Highway Traffic Safety Administration, in partnership with professional organizations, convene a panel of individuals with multidisciplinary expertise to develop evidence-based categorization systems for EMS, EDs, and trauma centers based on adult and pediatric service capabilities.” ‘Evidence-Based’??!! Hmmm, EMS leaders have been saying for years that we need more research data to see what we do that works and what doesn’t work. Since we have not done it as an industry well, HHS and NHTSA will do it for us. This is a good thing…? IOM Recommendation: “The National Highway Traffic Safety Administration, in partnership with professional organizations, convene a panel of individuals with multidisciplinary expertise to develop evidence-based model pre-hospital care protocols for the treatment, triage, and transport of patients.” “Evidence-Based’…? Dang, here we go again with the ‘proving our worth’ stuff. So, if HHS and NHTSA come up with ‘national’, evidence based protocols, is that now the national “standard of care”. What happens to EMS agencies who don’t use them? IOM Recommendation: “The Department of Health and Human Services convene a panel of individuals with emergency and trauma care expertise to develop evidence-based indicators of emergency and trauma care system performance.” Well now, those two words just keep popping up, don’t they… Wonder what ‘evidence-based performance indictors’ means… Response times (including ALL times) perhaps? Do YOU know what your TRUE response times are? From the time the phones rings at your primary PSAP, to the time you arrive at patient-side?? Some systems actually do and use it for quality improvement. For example, a city fire agency in Volusia County was concerned about the lengthening of their ‘activation’ times (call taking complete – to unit enroute) and realized that the process of sending ‘alert tones’ for the response units added unnecessary time to the activation times, so they eliminated them during non-sleep times. This means everyone has to actually listen to the radio, but it shaved valuable seconds off their response times. How about ALS skill proficiency? Do you think that a procedural intubation proficiency rate of 50% is more or less beneficial to patient outcome than say, a proficiency rate of 85%? Hopefully, implementing this recommendation will finally force all of us to objectively look at the WHAT and WHY we do the things we do. Reviewing the list of the six clinical and 12 system delivery research topics, it is very clear that the IOM is seriously looking to see if what we do, and how we do it, is clinically and economically sound. Here’s a short list of the recommended studies: · Impact of EMT training level on the patient’s conditions at hospital arrival and long-term outcomes · Identification of the safest and most effective way for EMS to manage respiratory insufficiency · Time-interval modeling identifying when, where and what in EMS changes outcomes · Testing administration of IV fluids to correct hypotension before trauma surgery · Impact on outcome of EMS medication administration for selected medical conditions · Safety and impact of EMS treat and release programs · Incremental value of advance life support over basic techniques in trauma care Are YOU ready for the answers to these questions?? IOM Recommendation: “Congress [should] establish a lead agency for emergency and trauma care within two years of the publication of this report. This lead agency should be housed in the Department of Health and Human Services, and should have primary programmatic responsibility for the full continuum of EMS, emergency and trauma care for adults and children, including medical 9-1-1 and emergency medical dispatch, prehospital EMS (both ground and air), hospital-based emergency and trauma care, and medical-related disaster preparedness. Congress should establish a working group to make recommendations regarding the structure, funding, and responsibilities of the new agency, and develop and monitor the transition. The working group should have representation from federal and state agencies and professional disciplines involved in emergency care.” This issue has been contentiously debated for the past year with opposing views on where a federal lead agency should be ‘housed’. One camp felt that a federal EMS agency should be in the Department of Homeland Security, while others felt it should be as is in the National Highway Traffic Safety Administration. In my very first “Insight” column, I proffered the concept that EMS is HEALTHCARE. Guess the IOM agrees. HHS is the appropriate location for a federal EMS agency due to the clinical nature of the services we provide, not to mention the fact that for most EMS agencies that charge service fees, about 45% of their revenues come from CMS, which is another agency within HHS. IOM Recommendation: “The Centers for Medicare and Medicaid Services (CMS) convene an ad hoc work group with expertise in emergency care, trauma, and EMS systems to evaluate the reimbursement of EMS, and make recommendations regarding inclusion of readiness costs and permitting payment without transport.” Two fundamental issues here. First, during the Negotiated Rule Making sessions for development of the Ambulance Service Fee Schedule, CMS repeatedly resisted the concept of reimbursement for the cost of readiness arguing that this cost is most appropriately borne by the taxpayer. CMS does not pay a physician for being ready, nor are the hospitals reimbursed for costs associated with being ‘available’ 24/7. Years ago, when Medicare was on a cost-based reimbursement method, cost associated with ‘operating’ the hospital or other covered service could be built into the cost-basis. It has been more than ten years since Medicare used cost-based reimbursement because it caused providers to increase costs to increase reimbursement. This mal-alignment of incentives nearly bankrupted Medicare. Most providers today are reimbursed on either a fee-schedule, or diagnosis-related-group (DRG) basis. Don’t hold your breath waiting for cost of readiness reimbursement. However, payment for non-transport has sound basis in economic and clinical reality. Recently, several Florida managed care organizations were approached about the concept of paying for treat and release, or treat and refer programs. Without exception, they all felt this was a logical enhancement. There motives were that if the patient is always transported to a hospital, the MCO will have to pay out the ambulance bill (typically $400 - $700), plus the emergency department charges (typically $2,000 - $4,000). If the patient could be SAFELY treated at the scene and referred to their own physician, the MCO would save thousands of dollars. Further, allowing the patient to seek care from the healthcare professional who actually is familiar with their medical condition is an enhancement to their medical care continuum. To them, investing in a treat and refer fee of $200 - $300 made sense. CMS may deduce the same reasoning and allow this practice. IOM Recommendation: “The Department of Health and Human Services should adopt rule changes to the Emergency Medical Treatment and Active Labor Act (EMTALA) and the Health Insurance Portability and Accountability Act (HIPAA) so that the original goals of the laws are preserved but integrated systems may further develop.” Arguably, EMTALA laws dramatically changed the face of emergency medical care and at the time the law was passed, there was sound reasoning for this public policy. However, there have been many unintended consequences. Allowing safe relaxation of the EMTALA statutes would allow EMS systems (including hospitals) to develop more appropriate service delivery models. By focusing on the “right patient, right time, right facility” concept, we will be able to design more effective, efficient and creative service delivery models. What to do Now: Historically, Congress listens to the IOM and acts on their recommendations. My gut feeling is that many of the recommendations WILL be enacted by Congress. But where EMS counts is at the local level. Local communities should use the media and political awareness created by the trio of IOM reports to further their causes on a local level. In my area, a coalition consisting of the hospital association, emergency physicians, EMS Medical Directors and EMS has been formed to bring about changes in our state based on the IOM report. The plan is a three-part strategy. First, develop a year-long public education campaign focusing on when to call EMS or go to the ED, as well as the issues facing these healthcare safety-net providers. Second, put together a legislative package to implement some of the IOM recommendations locally in our state, using the public education component to build grass-root support for legislative changes. Third, to develop a series of best practices which have been implemented to alleviate issues such as emergency department delays and diversions, and inappropriate EMS use to be a ‘self-help’ resource. Dramatic change is on the horizon my friends. Those who embrace the changes and help shape the future will have a hand on the ship’s wheel. Resisting appropriate changes will eventually lead to the use of a life jacket

Appearantly wrong places or something is wrong?... 2009 ? Wow ! R/r 911

The NREMT Basic written can now be taken per computer, so there is no excuse. As far as NREMT improving.. no, I don't believe there is any, however anyone should be able to pass this test if they were taught the NHSTA curriculum and AHA guidelines, in which it is based upon. R/r 911

Yeah, that saying that the test and text books are written at junior high to high school level... yeah I trust them... R/r 911

I thoght it was basically describing that his acknowledgement that his firfighters was too stupid to pas teh the test. Excuses, aare not valid. Again, the real motives of Fire Service are beginning to peak its ugly head out... "We want control, but not play by the same rules"... (not all F.D." but many!) You are right, every one should be educated on the same level (duh! that is why it is called a curriculum!).... does this mean the moment they leave that area they are no longer an EMT's? .. it should. Anyone, not know the simple procedures of scorpion stings, and snake bites is silly... even Boy Scouts are taught this in First-Aid... Hey there's a thought for him.. let the Troop teach his firefighters .. yet again it might be to-in-depth,, but maybe they can water it down for them... and it would be cheap too... R/r 911

Tooth ache for 8 years... catfish "finned".. R/r911