Ridryder 911

- 5 points for double post :wink: , it does not matter ALS or BLS the law is the same. If they are a licensed medical physician in that current state, in fact one has to turnover care legally. Most physicians are smart enough to 1) never stop 2) never interfere unless something is going bad... Yes, I check credentials and yes let them talk to medical control.. very few ever make it that far.. they are happy to assist, but do want to get tied up with a case. Again, I inform them they have to ride in and assume ALL responsibility for care... As a RN etc.. yes, technically I am higher trained than a Basic, Intermediate, etc.. as Paramedic I am as well = trained, but off duty I have no more control or authority to perform a procedure than the waver that flagged you down. Off duty, we are bucked down to 1'st responder level.. R/r 911.

I am concerned that you still have issues with his job and its responsibilities. First, it was working too many hours, working nights now holidays. Yes, its a pain in the rear.. Now, I am not trying to blast you by any means.. it does sucks and I do realize how hard it can be. I worked every Christmas, 4'th of July, for the first 4 years after my daughter was born.. no choice other than quit my job. We had to learn to celebrate life and holidays on other days.. you soon will find out that everyday can be a holiday and a celebration. No, it does not replace the true holidays, however you will learn to truly "cherish" those that you do get to spend with each other and try to realize that he as well probably hates working this day. Yes, its a shame someone has to cover for special days, holidays that illness and injuries still occur and never take a day off, but thank goodness there are men & women that do care enough to perform this job on days like this. There are caring and understanding spouses and children of those that have to learn to deal with it as well. I wish you the best of luck, hopefully you can meet somewhere for at least a brief period of time or call him and tell each other you miss him... it does make the holidays go a little better. I do wish you the best of luck, do hang in there it will get better...... R/r 911

I am sure that the cost will initially rise since the standards has changed as well, but maybe with some competition, they eventually go down. R/r 911

Sorry, did not mean to come across on you. I too have read the studies as well. Very true not much difference in performance, but again this was used in a controlled environmental setting. When reading studies, one needs to also consider the setting, the parameters, and subjects One could compare paddles versus external defib pads in the same manner, there is no significantly clinical difference, rather than the ease to use, and the safety of the product. yet, I have not used paddles over 15 years, because of the same reasons. What my main point is the needle was not designed to be used as a I/O. the outside only has a cap and the needle itself is very flimsy. Hazards such as bending, accidental needle sticks, etc..this would costs far more than the marketed products. Spinal needles is approx $40 for 20, which you cannot purchase separately, as well you will need different sizes. I have used FAST, EZ I/O, Jamshidi, and yes even spinal needles in the field & ER settings, my anecdotal experience will tell you it is much easier to perform an adult I/O in the 90 second limit, with tools that are designed to do it fast and easy. Yes, we need to be concerned of the cost but as well as use of practicality. If the product is difficult is hard to use, cumbersome, no one will use it.. then what have you saved? This is now the standard of care and no longer the use of ET med.'s are recommended. I know that some I/O kit's are now selling the needles separate and EZ I/O now has ped.'s as well as adult needle sizes, so all could be carried together. R/r 911

Wow!.. have not seen that on the internet, only in the field medic's guide..... R/r 911

As described by the Mayo Clinic, this is a rare and unusual situation. More than likely medics will be treating symptomatically rather than knowing the exact syndrome, it is described as very rare and infrequent, usually associated with pre-menopause. As well, I would doubt that EMS would be notified unless there is large amount of hemorrhage, most vag bleeds tend to arrive by car. There is nothing more to do except give some volume expander's and treat for shock.. even in the ER. more than likely Vitamin k will be administered, & possibility of administration of blood if H & H is low enough. Consult with a gyno, for a possible D & C after ultrasound. Although it sounds serious, usually it is easily controlled and not considered that emergent of a situation for majority of the patients. R/r 911

Here is a list from Bledsoe.. I hope this is what you are looking for..? http://www.ssgfx.com/CP2020/medtech/procedures/protocols.htm R/r 911

I was working in very busy ER one day. I asked the patient "What's the problem today?"... her reply was " I am dead".. I died 2 days ago and I thought I better get it checked out" .... Yes, she did have a pulse... The other one was I picked a lady not too long ago in her late 50's to early 60's who was hysterical claiming that a " Demon had impregnated her!" After reassuring her that she was safe, etc.. we got her into ER. Jokingly I told the ER Doc and of course he rolled his eyes, also laughing that a late 50 year old woman could even get pregnant!.... He called me later and wanted to talk to me.. I went by the ER, and he showed the video tape.. of the ultra sound .. she was pregnant.. too weird & spooky... she was sent for psych counseling... R/r 911

Didn't even see the category Dust ...LOL... I guess, the old typical male response.. "What's wrong now ?".... R/r 911

True, also called hypermenorrhagia. Very few women experience such, usually just premenopause stage. Usually is seen by o.b., and treatements may varies from Vitamin K, to a D & C, all dependent on severity. R/r 911

Actually, I do call their bluff and tell them to knock that sh*t off! ... after experience you can usually tell those of seizing or not. Past history, med's, and post ictal behavior. Check advanced neuro assessment, and treat accordingly. I respond to about 10 to 15 seizure calls a week about 4 or 5 are real. Yes, I have been dooped, no shame.. far as lab test myoglobin only shows muscle activity which will increase even if faking, an EEG is requires to document seizure activity. Most all the psuedoseizures are dramatic, and try to remain conscious during their activity. Yes, there are types that have to deal with behavior, psych and yes they can be conscious.. but a lot of these have other symptamology and know about their condition. Again, treat according real or fake.... R/r 911

I have been reeled in by the best .........I have even tried to nominate some for an Oscar. I agree, sounds like they were good at presenting the s/s . It does take a lot of experience and understanding seizures to detect some of the fakers. Since there are so many seizure disorders I have been careful, trying to determine real ones from fake ones. Always err on the patent's behalf.... r/r 911

Continuing education and refresher is not and should not be the same category, unfortunately most instructors, training officers as well as staff "lump" them into the same. When we give CEU's are they really learning new concepts and ideas or new or in-depth education to expand their knowledge or just the same old curriculum? Refresher is to review the curriculum, CEU's is increase knowledge and gain insight on new things. I feel we limit ourselves in EMS. If it is not directly related to EMS or prehospital then we should not learn it.. again, limiting our knowledge. Maybe we can compile a list of potential topics, then we can purpose for lesson plans, lecture outline, as well if needed skills sheets and pppt that could accompany it. R/r 911

"Lone Star":...."two simple words.....: Respondeat Superior...Let the Master Respond. The E/D phsician/medical control director must make the call after the EMT(?) brings the pt into the Emergency Department and transfers care to the E/D. If we do everything possible in the field that our license lvel allows, we are 'saved' from any and all liability incurred during treatment in the field"....... ??? I hope you are not describing that just because a physician assumes care you are then removed from any liability. This is far from it. You can still be held responsible for any and all your performance and care or lack of it. I have seen physicians testify against EMT's care... so don't make false reassurances that because a physician assumes responsibility you are cleared. R/r 911

This is an ethical and deep philosophical question, because we really never save a life, all must die. Then the definition of what "life" is interpreted as well. To cause a heart beat back and the patient has 3/4 of the brain matter absent or missing only the brain stem is producing the pulse, have you saved a life or just started a pulse back on a live corpse? Then, if they were an organ donor.. another philosophical question. I must correct you on ......."Once you passed the ER doors the patients care is in the Emergency Medicine certified doctor. He is the chief person in care of the patient. As we see in definition, 2, it states to keep in a safe condition."...... is not an accurate statement. In comparison there are very few board certified ER physicians in every ER. As well, they may not be the chief person in charge of the patient..i.e Surgeon, Neuro.. etc. I personally do NOT describe a save as one that regains a pulse... enough medications, right circumstances, can produce a pulse.. a save is one that is productive or able to brought back to society, family setting. A person laying, rotting with decubti, sepsis, non-responsive with deep neuro or EEG findings, rather just a pulse is a save?... There are many hundred times I have "shocked" a rhythm pattern, but I do not consider this a save rather than just treatment for a specific condition. Our job is very important, but we are just the very tip of actually performing medical care. R/r 911

Appearantly it as a big hit last year, although I heard there were some pay offs for the original negatives 8)

Here is the link.... all Medics should read this.. Really a good study and lesson for THI... for ventillation refer page 39 http://www2.braintrauma.org/guidelines/dow...prehospital.pdf R/r 911

Actually, hyperventilation is contraindicated in ICP and THI cases for the past 5 years. Studies and research has found, that it actually did too good of job that cerebral arterial receptors respond so well that it causes too much vasoconstriction and ischemia and maybe necrosis can occur distal from the arterial bleed. Normal ventilation rates as well fluid therapy is suggested. I will try to find the link, of CHI and Nuero ... that has all the updates for EMS. R/r 911

No it is cheaper to see rent the original... "Mother, Jugs & Speed" at least it had stars in it.....I doubt it makes it to the theatres.. prbably straight to video section R/r 911

I worked for Police EMS that was responsible for all rescue. It was an interesting system, in a large metro area. The F.D was only called for wash downs and fire proctection. The Police EMS was trained in Haz-Mat, high rescue as well as Tactical etc.. Yes, Police EMS units carried all the extrication equipment, (Amkus etc...). The F.D. did not get along, and more than once F.D. was asked to leave the scene.. Like I said different type of situation... R/r 911

Here s a new way I found works!.. When P.D. is about to leave them with you.. yell out they have a GUN!!!.. oops!:shock: R/r 911

Officially, it is a joint venture, however; Fire Department is better trained, equipped an have more manpower to function at this role. As well, I am a firm believer of having a charged line, haz-mat. availability as well. This is not EMS primary role, rather after the patient is in a safe environment to render treatment. R/r 911

Nownack to the oroginal post, they are mixing Heroin and Fentyl?... any nickname to this?.. I know it is common for them to steal Fentyl patches and freeze them.. then dilute them soen to inect them.. R/r 911

I don't know, but send some of that rain down this way.. we sure could use a couple of feet... R/r 911