Ridryder 911

All the above + Technically, D5W in some text is an isotonic solution, especially the amount that would be given. R/r 911

I have to admit I stick more in ER, but yet again, I get more ped.'s cases in ER. I usually stick at least 10 12 times a week. R/r 911

Sorry ... can't resist .. New meaning for "deep throat"[/font:9d793c752f] :oops:

This was discussed last year, and it still stinks. The excuse of being there was not enough EMT's and this is a piss poor excuse of bumping the numbers. Sorry, you got a record you should not be in health care business ....period. The public needs to know they can trust and have respect for us that are in it. Sorry, you made a mistake, that is the consequences. Train and educate them on another profession that does not require or demand such as dealing with peoples lives both physically and emotionally. Part of our responsibility is to make sure that the public can trust us. How would you feel if you were to find out that your physician had prior felony conviction? Sorry, that breaks trust, even if it was fraud, or a bad check.. there has to be some integrity to the medical profession. R/r 911

Wow ! Haven't got a clue, what is going on. My internet crashes for one day .. and I miss all the gossip.... dang! R/r 911

You will start seeing this trend even more so in community based EMS. The cities are looking for any cheap avenue to get rid of any debt or even potential debt. I too have seen EMS in cities even making a profit been ditched because this is one less thing the city, or community has to deal with. Allowing privatization to occur to remove the city responsibility or headache. Seriously, folks the community really don't care about the details of EMS. As long as their is an orange/white vehicle (or any color) and someone that has a few patches and met the "states requirements" is all they care about. The bottom line is more money for budget and less responsibility. R/r 911

I usually ask the student if this was from the instructor, or text etc..? Sometimes, I have found out that it was an misinterpretation or poor communication of student - instructor. The student had actually misunderstood what was said. If not, then I will correct them on local policies, and plan of care. Sometimes, I have found it is not they are so incorrect; however; it is the application and interpretation of it. If this not the case, then I will cite or give references for clarity. Students need to be educated and informed on correct way, before wrong method or idea is set in. R/r 911

1) License as health care providers by doing so, one can write in the requirements to be fulfilled. This would automatically bring up educational and professional standards if written properly. Have some teeth in them as well for those that do not adhere to policies. Service should be licensed as well, with strict adherence of rules and regulations this should as well include staffing, educational requirements etc. If they are not able to meet requirements, then they either loose or not able to have license to operate. 2) Reimbursement rates and Qualifications I did not see listed. You place requirements on management to get or obtain money, they will conform, until then nothing will happen. Make administrators responsible to hire and ensure that their staff (including administration) meets educational and license standards, has a true education and TQI program as well. Insurance providers will not allow policies to be given unless they have such in place. Then and only then we will see a change in EMS... from the top down. 3) National Curriculum review and change: We need an over haul of those that have done it in the past, and the way it has been performed. Standards of medical care are universal, and as such education should be as well. There should NEVER be changes or allowed changes to the curriculum because of systems are rural, metro, paid, volunteer, etc. Medicine is medicine.. application of how it is performed is applied after receiving the essential knowledge, not circumventing before it is even taught. 4) National Scope of Practice: Nice idea, never will see it as long as there is no true national standard curriculum, that meets standard expectations. You cannot put the cart before the horse .. it will not go any where. Too many are making things difficult and complicated, (this is why it is so bureaucratic) and things will never change. Like all other business, it is about money.... once you have required or entice those that they have to meet certain requirements (teeth), then things will change, but until then we are blowing smoke.... R/r 911

Uhhh.. morse code was used for military and other communications... just like smoke signals.. but that was before voice transmission. Morse code is a transmission of dots and dashes... which is many still study and learn, although not as popular as it used to be. So to answer your question... no, morse code was never used for EMS work, since progressive EMS started in the late 50's to early 60's radio dispatch and verbal communications were effective then. R/r 911

Congrats to you and all your kids!... R/r 911

Yes, I was quite aware of the physiologic response of ADH, but did not see the implication or the consideration of such in an emergent situation. You discussed volume decreasing uterine contractions, this is true , however in a normal homeostatic environment. Remember ADH is responsible for the release of Angiotension II when baroreceptors are enacted, in shock syndromes. Sympathetic overdrive usually occurs, causing more conservation measures. Fetal distress can occur immediately. I was confused by the implications of needing the response of such in cardiac arrest versus traumatic injuries. Regardless, physiologically both would have the same outcome. One, should remember the key treatment and emphasis should be on resuscitation of the mother, and maintaining fetal circulation. A dead mother is not going produce an active labor nor a viable child. Resuscitation of the mother so possibly an emergency C-section, if warranted (>30 weeks, gestation) must be performed rapidly and is very controversial. There are many dependent factors that one has to consider and this is definitely not a pre-hospital decision. Again, resuscitation of the mother is our primary goal. Let's not forget seeing the forest without seeing the trees first. R/r 911

Okay .. hmm why? I have used Pitocin, Brethine, Magnesium, etc.. R/r 911

Since EMS is hitting crisis mode, especially concerning payments, management etc.. Curious on the education level of your CEO, upper management levels.... R/r 911

Unfortunately, part of the problem is we have no public support. We are considered by many communities as a "luxury" not really an an essential element of public service or health care. Notice that community's will have a police department (of course for crime, protection) have a fire department for ISO (insurance ratings) but what enticing point is there to have an EMS ?... With the gross number of basics that would do it for free, and the ignorance of community leaders, and the public assuming an EMT is the same as a Paramedic, I highly suggest we use any other methods before considering any strikes etc... (it could be like the air traffic controllers fiasco). We have a lot of work to do. From the top to the bottom and vice versa... Part of the problem is we do not have properly educated management as well. Just because they are a good medic does NOT mean they can manage well. R/r 911

Ever notice the higher level of education... the lower number of whacker identities...? R/r 911

I have always praticed and suggest to prepare for the worst, and if it is not you will be pleasantly surprised. R/r 911

Hmm I only believe every 10'th word that the press prints.. so it is the, a etc.. Too many rescue rangers out there, and I do wonder on the validity on the story. Okay he pulled someone out.. good give him a pat on the back, attaboy and 2 star of life decals of his choice that CANNOT be placed onto his car. This is what any person should do in any auto that is TRULY catching a fire..... R/r 911

I am trying to avoid double posting, but for those that reside in my state, really needs to pay attention. I had a lengthy discussion with my State EMS Director a week ago Shawn Rogers. Shawn and I go back a few years and when he was my Paramedic preceptor, so we have a candid relationship. I informed him about EMT City forums, and he told me he would attempt to drop by sometime. Now, back to the topic of EMS changes and lobbyist etc. We in Oklahoma is at a crisis level. Although, my administrator is the Governor appointed representative, and Chairman of the EMS task committee, I was not aware on how dangerous it was. We currently have 186 EMS services serving our state, this is down from over 200 less than ten years ago. We have lost over 34 full time EMS with only 21 returning for coverage. This means 13 areas are without EMS at all. Yes, this is becoming an epidemic not just locally but nationwide as well. Local studies here have demonstrated several things: Most EMT's and Paramedics leave rural areas to seek employment in metropolitan areas (Tulsa/OKC) The mean age level for rural areas is >35 years of age ACLS or Paramedic Life Support licensed personal, leave < 1 year of service in rural areas. The responses in rural areas is increasing to potentially doubling by the end of this year, to prediction in tripling in volume in 5 years. As most EMS providers are aware, rural EMS is really where ALS procedures are most needed. Areas that do not have trauma centers < 15 minutes away, no cath lab, or even ICU capabilities, is where the Paramedic skills and knowledge can be utilized the most. Unfortunately due to pay, benefits, run volumes, and attractive packages, most new EMS personnel will go to metro areas. So now, what can be done? In Oklahoma, they have initiated a "grass roots for EMS" campaign. EMT's are encouraged to knock on doors and petition for a bill to increase funding and establish EMS districts similar to those of Fire districts. State monies can be more defined and appropriated to EMS districts to help rural EMS areas. This could be by consolidating EMS services, funding to those in rural areas, educational programs, communications etc... Local EMS services will have to face the truth the days of private EMS, and local community EMS unfortunately are over. It is too hard to fund, manage, keep personnel to staff these services as well as keep up with the demand of increasing number of responses. Just like the problems smaller hospitals have had in the past 20 years, now we in EMS are faced with. It is no longer feasible for small towns, communities to have "their own". It is much better to have a sub-station than to have none at all. Yes, it is hard to face and realize that even though it has been a tradition, history of the community and well meaning, big hearted people can no longer be responsible for local EMS. A lot of egos, pride must be shifted and the main point to remember is the patient. To have a service there for them. Does this mean to remove them entirely... NO! But, again it might mean to change their role and responsibility. Volunteers will always be needed, in fact more so now... but, the role as a first responder is greatly needed. Stabilization prior to transport units, early activation of flight services, rapid response, etc.. This is a drastic, devastating issue and it must be corrected. Even if you live in metro areas, it will affect you.... increased taxes, higher acutiy level of patients, means less rooms, less personnel to take care of those locally as well. These are issues and problems .. " we can not ignore or bury our head in the sand" they will not disappear, it is a large cancer in EMS and it is growing each second. Unless treated, it will spread and cause damage. What can we do? Become involved... be a member of your State and National EMT association. Voices are not heard unless they are in unity and loud enough. I was a bureaucrat once, I know.. unless you have full support of your profession no one will listen. Contact your State EMS Director's office, State and local EMS Association see what is being proposed and being done. Call your legislator, and Senator. I highly suggest mabe we contact the U.S. Surgeon General from the forum as well. He is a former Paramedic, ER/ICU RN and Trauma Surgeon from AZ. His daughter is a trauma nurse at a level I trauma center. Maybe he can assist us on whom to contact... Food for thought.. R/r 911

DMAT is a disaster medical assistance team that is composed of trained volunteers that may be organized for disasters locally and nationally by FEMA/ Homeland Security. MRC is a medical reserve that as well is group of medical experts that is usually categorized for speciality i.e. immunizations, emergency care, housing, psych etc for local assistance. Many opt for MRC for local disasters, and the dedication of being away from home, work, etc.. Both require intense workshops, and training. R/r 911

Officially someone addressing the problems. Yes, the systems is collapsing as we speak, right underneath our feet and no on e is doing thing about it. Many have and continuously bury their head in the sand or wear rose colored glasses that do not want address the current and new problems we face. The problems are here now folks, just because your service has not faced them directly yet, does not mean they have not already occurred.. wait about another 6 months to a year. R/r 911

A underlying current bleed (albeit it may be small) cannot always be caught in the field, even with a damn good physical and history. Even with such one should not be delaying care and transport for these individuals. Until, we can have a portable CT with confirmed readings from a Neuroradiologist .. heck NO! This is way to dangerous of a procedure. I have seen missed active bleeds from great Doc's with a great H & P as well as radiology clearing the CT, and them have an active bleed.... cancel Christmas. Now, most prefer intra arterial, in lieu of peripheral thrombolytics. Faster, more effective and less complications. For the AMI, for rural areas greater than 60 minutes to a cath lab ... potentially yes, especially those with increasing ischemia and ECG changes continuously changing. Chances are they will not be able to CABG them for at least > 1 1/2 -2 hours... better open the vessels or these patients will die. Yes, it is a bummer for the chest team later, but it is better than the latter. R/r 911

What many consider post cholinergic response, such as Epi etc. after a code has ceased. There is sometimes agonal respirations, and gasps that one could associate with "breathing attempts" and the patient be pulse less or very bradycardic. There are still debates if there is truly an asystolic patient if one could perform a sensitive enough ECG. The pneumotaxic areas will respond sometimes to the levels of Co[sub:94b82267fe]2[/sub:94b82267fe] along with high doses of catecholimine rush, causing an increase in nervous response (hence- agonal breaths) R/r 911

I have used it in ER and CCU occasionally. I doubt we will see it pre-hospital. It is a potent vasodilator and as well one needs to know renal functions, as much as possible. What I have seen it works great, but, very one has to be very cautious that not too much damage from an AMI has occurred, or old infarcts, that will produce poor ejection fractions. I believe the medication is still quite expensive and has to be closely monitored through IV drip (pump) and it is recommended some form of wedge pressure monitoring be done if possible. Good medication to be aware although for those critical care transports... R/r 911

I too feel it is time we get off our lazy butts... I do believe we have the highest percentage of whiners possible. Let's compare with others... Fire Departments: Have unionization, benefits, and heck even when they back into the F.D. station house with a patient on-board.. they support each other. Police/LEO: Want to see some organized guys? This is who we need to follow... yeah, they fight amongst each other, but they know how to combine thoughts, professionalism, and education.... look at their lobbyist and they have yet lost any funding bills.... hmm maybe we should take notes? Nurses... OMG, talk about a sisterhood... they may fight amongst each other, but YOU better not put one down!... As well, they have increased their level from OJT to Doctoral level. Look at the Surgeon General, he was a former Paramedic, RN and Trauma Surgeon. He still write his title RN, M.D., FACOS.. very proud of his history. We do not need to re-invent the wheel. Let us take notes of other success and failures, but there is one thing you have to do .. medics have to get off their butts, and take action!. The other agencies DID something other than moan and whine...! Don't like the pay..the working hours, the patient load, the type of patients, the benefits, the education level? Truthfully, what have you done personally done to change it? uh-huh.. Should we be proud of you ? R/r 911

My rule is all females with abdominal pain, between ages 11- 35 y.o. is pregnant unless they have had total hysterectomy .. or until ruled out, by beta HCG and U.S. Yes, there might be other clinical manifestations but, I still consider them potentially pregnant. R/r 911