Ridryder 911

My opinion, most on here have and never will work in the field. What I mean by working is more than running 10 calls a month with the gang, so they can wear that neat FIRE/RESCUE T-shirt. We that generate the majority of the posts in regards to education, professionalism, career, etc. take this business serious, because it is our livelihood and career. We are not it for the fame, glory and therefore we actually take EMS what is was designed for..delivery of patient care. When I first started here, this site was filled with several whackers, and within the last year many have left to other whacker sites so they can talk about how many light bars they have on their vehicle, etc. Thanks to Dust, PRPG, Ruff, AZCEP, Anatomy Chick, and even ACE with his numerous studies and annoying soundtracks (LOL) as well as many others that I have failed to mention, this site has became more respected and if you note the numbers of posting(s) VERY, strong. I believe you would be surprised on how many e-mails, I receive daily about career & education choices, treatment modalities, as well as personal issues. We have steered or directed many away from disastrous thinking, and antagonized others to read, explore, and research, to hopefully make a wise decision. Sure there are many that attempt to sideline things, but usually the "core" will present documented, educated proof, as well as experience to either clarify the issue or to show the correct way. Does this mean we always agree... heck NO!, but, we as professionals can respect and appreciate each others opinion, and ALL of us realize we learn something new every day, and we will always do so. When a controversial subject occurs, that is when the posts start increasing, as well as the number of hits to read the discussion. There are many "feel good" EMS forums, that pussyfoot around things, never wanting to "hurt" some one's feelings, at least here... we are honest on ho we feel, like it or not! As well, we have no problems telling if you are wrong, and we will prove why. Again, this is why this site has flourished, and has several posts a minute, not days. Yes, we antagonize.. that's' our job...LOL Things to stay away from, I believe are some deep personal issues such as religion, sexual orientation and practices, and other private matters that will not involve EMS, working environment, or patient care.... I don't count politics, since that funds us.. :wink: .. Be safe, R/r 911

I have been wanting to recert for that.... problem is there is only one hospital I know of that teaches it around here and that's at Tulsa, and the classes are usually filled with residents.. maybe I can squeeze into one and get my Instr. cert for that again... R/r 911

A question to other EMS instructors particularly to services with experienced Paramedics'. I just left a FTO meeting a few minutes ago, attempting to plan & coordinate next years CEU's, refresher, plus have a PEPP/PALS class T & Thrs., question is how does one continue to teach the same monotonous stuff?... I realize, the need, but after your 5 or 10'th re-cert of PALS, it becomes pretty boring. It does for me.. & I enjoy learning, at the same time not introducing so in-depth material, without loosing them in space... and become disinterested. Where is the happy medium?.... any suggestions? Thanks R/r 911

Great post RuffEMS.. Ace, you know I love ya!.. But, if your the one posting the voice overs... :shock: R/r 911

So what they are saying is we can RSI, or elective intubate; but we cannot routinely intubate with sucess?.. hmmm... Yeah, this is dome good news, maybe the use of more skilled Paramedics, the use of EtCo[sub:2cabb00a31]2[/sub:2cabb00a31] monitoring. Maybe we can get our act together! R/r 911

Simple .. www.americanheart.org Now go to CPR training, you can watch the videos.. etc. Then take a refresher class! R/r 911

I am so sorry this young man was so naive and stupid that this tragic event occurred. Now a lifetime of suffering and financial loss because of a few seconds of glory!...Sad R/r 911

Sounds like they "punted and the field goal was good!"... You are right, COBRA definitely addresses scenarios on testing if an occurrence on hospital grounds and even surrounding area within so many hundred feet, the hospital is responsible. Might want to contact the risk manager and DON, to have them do a refresher.. I am sure they would love to hear about this!... I am sure you will some classes very soon!... R/r 911

Interesting, when I did a querry I found many researches that had been terminated using it, then NASA when it was invented, here is another one that goes into more patho-physio on the working of it in trauma pig studies. [web:5a7897909a]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15508668&dopt=Abstract[/web:5a7897909a]

First, yes there are too many crashes and deaths. Second, one needs to be aware of what FAA interprets and defines what "crashes" and "incidents" etc.. You might be surprised what a crash is defined as. I have to admit, it is a cut throat business. Very competitive and most of the time not nice to each other, except when one crashes or tragedy occurs. This business, is very costly and the pressure to fly in unsafe conditions is sometimes pressured to the pilots and crews. I was fortunate, we had a vote on every mission.. anyone had any ill feeling or uneasiness, the mission was scrubbed.... period. No questions, or harassment was to occur. The same as the pilot was never given details of the dispatch (such as infant, child or mother.. etc..) to persuade the pilot or crew to take the mission. Air EMS is over abused, and with the increase in ground responses, and less number of EMS units responding in urban and rural areas, I believe you will see more. This decreases the "out of town" truck, and the patient is delivered to the metro area in about half the time. However; I realize, that this study as well as Medicare and insurance companies are evaluating the necessity and payment structure along with this. Time will tell.. we will see some major changes in the future regarding the need and use of air transport, respectively so.

Although humorous and true, one could say MVC, falls in the home, could also be said in the same context. R/r 911

Interesting study, especially out of the range number that the number that was studied. As well, why there is such a change of attitude and thinking. There has been previous studies, as well demonstration Paramedics has an higher accurate interpretation over ER physicians. Maybe more studies will be presented on why, ER physicians are "lagging" and not taking quicker action. R/r 911

I understand the Polyheme, but what device is used for increasing inner-thoracic pressure (vacuum) ?.. Has anyone used this and the specific medication(s) they are proposing, Still a little vague and mysterious for such as scientific test. This will be interesting read, if Pepe is involved (remember the MAST catastrophe study). Be safe, R/r 911

I have had this for several years now, and use it for several types of classes. I particularly like it for refreshers, and give out prizes to the winners. This was also used for calculus, science, etc.. so it can be modified for whatever you like... There is also a another one, on EMS House DeFrance, web site. R/r 911

Yeah, I see a " locked" coming.... R/r 911

Anyone have any more detail of this ? Dallas to test resuscitation techniques by Dallas is one of 10 North American cities chosen to participate in the largest-ever clinical trial of resuscitation methods, a designation local doctors and researchers say will make North Texas one of the "safest places in the country to have a heart attack or a car wreck." The $50 million federally funded study, which kicks off this summer and will involve about 15,000 cardiac arrest patients and 5,000 severe-trauma victims over the next three years, will compare traditional life-saving techniques with two new resuscitation treatments – a unique airway valve and a highly concentrated saline solution. UT Southwestern Medical Center is coordinating Dallas' resuscitation research center, which will train paramedics and collect data from more than 30 Dallas-area hospitals and 11 emergency-response agencies participating in the National Institutes of Health-sponsored study. "The implications of this thing are tremendous," said Dr. Paul Pepe, chief of emergency medicine at UT Southwestern. "We're a center of excellence, and that's why they chose us." The study means Dallas heart attack and trauma victims being treated by paramedics at the scene or in ambulances will be randomly assigned to the traditional treatment or to a trial treatment. Starting in August, local trauma victims who lose significant amounts of blood or have severe brain injuries will receive a standard saline solution or one of two high-concentrate solutions, which experts believe more quickly restore circulation in bleeding patients. By November, heart attack victims will be treated with a traditional ventilator or one fitted with an "inspiratory threshold device." The device is an airway valve that creates a vacuum to return blood to the chest during CPR, improving flow to the brain and heart. The study is double blind, meaning the thousands of North Texas paramedics being trained for the trial won't know which kind of saline they're using or whether a ventilator is fitted with an active or inactive airway valve. The equipment will be specially coded for researchers. In the U.S., about 1,000 people a day die prematurely because of heart attacks; in Dallas, more than 1,000 people suffer cardiac arrest each year. Trauma is the leading cause of death for children and people younger than 45. In Dallas County, about 3,500 people die of severe injuries every year. Traditionally, it's been difficult to conduct clinical trials on patients who are severely injured because they are too sick or incapacitated to give informed consent, said Dr. Joseph Minei, vice chairman of surgery at UT Southwestern and an investigator in the study. In this trial, each patient will receive, at a minimum, the current standard of care. But residents concerned about being subject to a trial without their consent can call to receive a special wristband. "What we're doing now is letting the community know we're doing this trail," Dr. Minei said. "This is an opportunity for Dallas, and for the whole trauma system, to really deliver a potentially lifesaving technique." Both trial techniques have proved to be safe and have some lifesaving effects in smaller-scale studies in the U.S. and Europe, Dr. Pepe said. The concentrated saline is equivalent to two bags of normal saline and can be administered faster, potentially reducing brain swelling and preventing organ failure in trauma victims, said Dr. Ahamed Idris, principal investigator for Dallas' resuscitation research center. In North Texas, Dr. Idris estimates about 500 patients per year will receive the "hypersaline." The airway valve has been shown to double blood flow during cardiopulmonary resuscitation by drawing blood up from the legs and abdomen, he said. It will probably be used on 1,000 North Texas cardiac arrest patients per year. Permanent brain damage can occur within four minutes after a person stops breathing. "We hope to be able to answer the most important question," Dr. Idris said. "Will these treatments return people to a normal life?" The trial will be the first of several NIH resuscitation studies over the next five years to determine whether particular treatments improve survival and hospital discharge rates. Whether they prove effective, Dr. Pepe said, the mere attention and focus of a trial this size will seriously benefit Dallas heart attack patients and accident victims. "Experience has shown us that survival rates go up significantly in cities that provide this kind of research initiative for their citizens," he said. UT Southwestern was one of more than 100 city-university partnerships to apply for the resuscitation study. Other U.S. regions chosen include Birmingham, Ala.; Iowa City, Iowa; Milwaukee; Portland, Ore.; Seattle and King County, Wash.; Pittsburgh; and San Diego. In Canada, Toronto and Ottawa were selected for the trial. Dallas-area residents who don't want to be included in the trial without their consent can opt out by calling 214-648-6726.

Hmm I would read the medical emergency section of my text again. If your instructor informed you not to touch a seizing patient due to c-spine, they were an idiot! Restraining the head or for as that goes any part of the body forcefully, can cause damage, but not to administer or place an NP or OP in a seizing is not going to cause a C-spine fracture. Did they teach not to apply oxygen and suction PRN, as well?..(one has to touch the patient for that as well) Again, refer to national standards and curriculum. I do worry about instructors that "make up" things as they go. If your instructor would like to debate this issue, I welcome them to this site. R/r 911

So I guess, FDNY has not heard the philosophy of .... "too many cooks will spoil a dinner"..... Geez, the first part of working on any patient is control of the scene, and this means the number of persons involved as well. I don't care if it NYC, Boomesville, Kentucky. Control the scene, don't let the scene control you!.... sorry, lost count after 10 helmets around one patient... "ever seen vultures fly over a carcass?"..they even have more respect. Looks like cluster f***, very glad, I am not involved in a system that demonstrates that... and I am sure there were plenty of bosses in Chiefs in proportion of Indians. It all comes down to common sense. Yes, I am arm chair quarterbacking, it easy to do on this one... try to count the number of firefighters in front of potential hazardous area. Are we still learning?.. R/r 911

Good points Ace. This is one of the major points that is left out in the initial doctrination of EMTs'. As others have posted, including myself, we are seeing more and more irresponsible acts. Is this because they are happening more or the public and press is more aware of what are responsibilities are as well. I believe it is a mixture. So many take the EMT course, never wanting, having the significant knowledge, or performance of performing at the professions demand. Assuming it is someone else duties. As well, with maturity and exposure, the profession gets better understood by the public and the press... but; the good with the bad. More and more of carelessness, and flaws will be reported as well. Again, you have take the good with the bad. Ultimately, you cannot really control the action of others. Only lead, ask, be a mentor for them to hopefully follow. The first part is evaluating yourself.. are you really worthy of such a role?.. Just because you perform good patient care does not really make it so. Are you a good employee, partner, and medic .....person to yourself and to others? It is hard to look objectively at one's self. Usually medics are always harder on themselves, than others.. but, I have seen a different trend lately. This is what I feel is part of the problem. Arrogance, that one is not responsible for their own action, and that one cannot achieve any higher after receiving their certification/license. I am firm believer, that educational systems should have attitude grading that can be placed into the grading criteria. Those that demonstrate non-participation, no involvement in classroom, skills, and clinical objectives should be counseled and possibly failed. Whenever, we in the profession take our own job serious enough, then we will institute and demand better performance from our colleagues and our selves. R/r 911

It would be easier to say "What is right?"....

I am not aware of any specific that could be used. As well understanding ACTH, ADH levels, would be hard to examine in the prehospital arena. I do consider such if I can get information from clinics, dialysis, or critical care transfers. Fluid therapy is the usual suggested initial treatment (except dialysis of course) and possibility of magnesium IV. This is a far deviation, and I consult the physician, and there has to be outstanding circumstances with patients with Cushing syndrome, or Addison's disease. Usually, I prefer tie KISS method in these cases...LOL R/r 911

Okay Vs-eh?, you received your needed attention for the day... Can we move on now? Otherwise, you would not be mocking a persons belief, style or criticizing ones religion. For some reason you felt the need to post and draw attention to yourself and the change in your avatar... so here you go! .. You got it, now does that make you feel, better? Other members have changes without making notice to one self... as well as not trying to offend anyone personal & religious beliefs. Although, I may not believe in other faith, or religious institution, I definitely would not mock or desecrate ones symbols or founders, out of respect, and professionalism. The funny thing is you don't get it The uniqueness in true Christians is that belittling, mocking against our belief can actually makes us feel stronger and deeper in our faith, and all without anger.. We know what we have... and smile back at you, and wish you well. R/r 911

I can always tell of those that really never studied theology, or even Christian studies. If I was to post, an avatar of Buddha being mocked or other some other form of religion, some would be appalled. For us that know the true meaning, does not appall us, the worst thing & best thing ever happened over 2000 years ago. Now, we endure those that feel that they need to obtain special attention and smile ... It's called grace.... R/r911

Yes, and just remember he also died for you !.. thanks.for letting us, remember. r/r 911

Yeah, to think he initially hated EMT's.... When he agreed to take over as medical director in that small rural town he described he would, but there would have to be certain criteria. He was from Dublin, Ireland and used to some aggressive treatments... This was in 1985-1988, and we were performing multi lead placement (before XII lead was made prehospital) and RSI, and performed an FDA blind trial study for use of tPA, and O- in the field, as well as central lines.. although the town was only about 10,000 we ran a lot of surrounding areas, so we instituted diversion and field termination procedures as well (some transport times >1 hr). The State Health Dept. hated him, because he was always challenging them to find out why we were not doing something, instead of why we were. Now, let's be clear not all Paramedics was not able to perform such procedures so we developed Paramedic Level II, (CCP, now) and was closely evaluated by him on written and clinical tests. (We had to work in ER with him as well, with the ER Doc's and rotations) Yes, it was quite a bit of experience, that I have seen very few imitate, and learned a lot from. I can still hear his Irish brogue saying "...just because your small or rural is NEVER an excuse to give poor care..." Dilantin tox. can be dangerous, reason being Dilantin was initially a cardiac medication, it has several neurocardiac, etc.. side effects, that one can brush up upon. One neds to remember that is infused by slow IV adm, preferred drip. Like I said, it may not be the ultimate answer, but at that time in that community it worked great... Be safe, R/r 911