Ridryder 911

Just FYI.. here is a link for verified Level I Trauma Centers, that met national standards. Appearantly, a lot of states are developing their own criteria (which is very understandable). http://www.facs.org/trauma/verified.html R/r 911

How ironic, and we wonder why the average life span of a Level I is < 5-10 years?... The need of a level I is definitely needed for appropriate patients. But to take all simple trauma patients to a level I is over taxing the system and is inappropriate as well as needless expense to patients. So if grandma (restrained) strikes a car <10 mph, they have to go to a level I ?.. If that is the case, the system needs to be reviewed and revised. Look at American College of Surgeons guidelines of recommendations for Level I trauma care.. Even these are debated of being too liberal... True not all places operate alike, (hence... the idea to study) but should be similar. HRSA developed national standards 15 years ago for states to adopt. (chart of those states in compliance and requirements ( http://www.hrsa.gov/trauma/survey/table2.htm ) Under the national system, most emergency departments are labeled as some level of trauma center, based upon their capabilities. Again, appropriate triaging is the key. Not everyone needs to be examined by a surgeon, especially the scenario described. Most likely this patient would categorized as a non urgent and definitely does not need a 5 figure trauma center bill... Okay, the scenario is flawed. At 50 mph a decelerating stop. and no major interior damage ?.. hmm something wrong. Either wrong speed or something missed on description of vehicle. A sudden stop of a vehicle at 50 mph, by basic kinematics, will tell you differently of an assessment. R/r 911

After last night searching in a rural area for 20 minutes ............Heck, NO ! I don't find it creepy. I believe it should be mandated for each emergency vehicle have them. It is a shame pizza delivery systems have better tracking and locating devices than EMS ! IF you are worried abut big brother, you need to wake up.. GPS is very minute in comparison.. you don't think they don't even monitor this forum, wihtyour IPS number and subscriber etc... ?... R/r 911

Sorry your feeling like feces.. darn patient ! Although, we would like to blame the patient... (fast virus affecting you in 2 hrs..) I do hate the ones that for some reason or another, have to cough or sneeze on you ... only a few days later, of course you have their illness.. I now carry the cheaper masks for patients, who love to share... Get feeling better ! R/r 911

Thought I would add some.. I was different I actually became a Paramedic before EMT, yes there are some of us by-passed the EMT initially. Second BLS is not always before BLS... really it should be performed concurrently. You are not really performing ALS procedures if BLS procedures are not established. Any discussion of ALS should always be read that BLS has been controlled or simultaneously performed. If you are attempting to perform an ALS skill without BLS, then you are performing a procedure not ALS. not knowing the difference is gross incompetence on the ALS provider. Semantics, not really .. All levels can have BIG heads...ever looked on the newly EMT back window ?.. The difference is most Paramedics will make a mistake, that their ego will be immediately deflated and will sweat over.. this, usually humbles someone. However some basics with hero syndromes may exaggerate their role and knowledge.. and never becomes humble. Both are bad for the profession... R/r 911

Yes & NO !! Again, what reason would anyone have to "run" with patients ?... Did we miss something in Basic EMT classes on differential of someone being severely injured and not ? Does this patient have or represent any airway, breathing or circulatory compromise?... any LOC change ..no ?.. Any gross hemorrhaging ?.. no.. no neuro deficits.. no other signs of major trauma or incidence of trauma ... I also question the treatment .. why the I.V.? Are you going replace fluids?.. Was there enough blood loss to even be concern of this ?.. Are you going to give meds?.. Why are you establishing an IV ?.. again why do you need one ? Please, don't recite protocols.. have a valid rationale. This is an obvious simple trauma call.. if he is aware of why the incident occurred (no syncope, etc) C'mon folks .. just because they were involved in trauma, does not mean they meet trauma criteria and definitely does not mean they need a level 1 trauma center. Our trauma surgeon, just ripped a new one on a EMT because of GSW to extremity (single shot . through & through, good perfussion intactness) for bringing it in emergency and for not appropriately triaging it to a lesser level..Level II or even III. Over triaging places burdens on overtax T.C's and poorly represents EMS in a whole. If you don't know your local standards and standard of care for any trauma ... better start reading & learning! R/r 911

So what have we learned from 14 pages of comments.... City managers and administration do not know how to fund, operate, emergency services... (something we all CAN agree upon) Volunteers "feel" they have a need to act upon Paid professionals, believe that communities need to place more emphasis on how they can provide, not that with what they can get by with. Volunteers sometimes feel threatened by professionals attitude Volunteers feel they are providing a valuable service Professionals feel they are providing a valuable service Professionals feel most communities, can afford EMS, when channeled and believe if volunteers truly want to help, they help establish a professional EMS service in their communities. Volunteers, feel if they don't act .. know one will. Professionals feel if they would quit "performing"; communities would fill they need with professional services. Volunteers will not acknowledge that "their interest"groups have actually hindered and digressed EMS systems nationwide. Professionals have not taken appropriate action to mandate more professional standards are placed into affect, thus causing true change. BOTH, acknowledge there will always be a need in some remote areas, for the need of volunteer services. BOTH, acknowledge.. that the level of care is not dependent of paid or volunteer... BOTH acknowledge, we in the health care is NOT prepared for the future.. BOTH acknowledge.. this debate will continue forever...and the topic has been over spoken... R/r 911

Good points Spock, we actually started mandating EtCo2 wave form, ECG and re-verification by medic & Doc..after the move. we use the EtCo2 for multiple purposes such as Co2 retention, differential in noting constriction verses obstruction, as well as noting a changes in DKA. You should detect immediate change on PEA & pacer with capture since EtCo2 immediately changes with perfusion level, way before Sp02 (3-4 minutes) as well as sometimes even a pulse wit poor perfusion's. Of course these are just more diagnostic tools to add to your assessment skills. I agree, EMS will Have to mandate EtCo2 soon, if we want to continue to intubate. Having documentation, is one way to disprove poor studies and presenting your treatment. R/r 911

sudden onset.. versus slow, curtain shade description, bright objects, painful, H/A, peripheral vision, pupillary reflex.. retinal detachment vs occulusion or cerebral bleed.. or the old hysterical conversion ? R/r 911

Main point ! Asthma is a constriction/retention disease, not an obstruction... R/r 911

Here is a link to something I posted a while back.... http://www.emtcity.com/phpBB2/viewtopic.ph...329&start=0 R/r 911

Acutally, I used to have a vanity license tag.... just to piss off whackers.. PARAGOD1 Their the same as RN's with an ego... they are called that they have RN'itis R/r 911

Don't know either.. played with toy ambulances when I was a kid, and wanted to be a Dr. in an ambulance (before, Paramedics).. so, it has always been a gimmee.... R/r 911

Yeah, I would like more info on the King airway. I agree Ays on their is no reasin why patients still arrive in ER with dislodged or "tube in the wrong place". With all the new advances there is NO EXCUSE ! Spock, since you work in O.R., I am sure you utilize EtCo2 monitoring as a routine as well, do you think we are not using this tool as much to our advantage (on top of the clinical findings) as much as we should ? R/r 911

Okay... I guess everyone can agree.. to disagree.. maybe time for this thread to die ! R/r 911

Ironic there is only 1 EMS in my state (200 services) that I am aware of that works a 40 hr shift.(8 hr shifts, few of the hospital based left) In fact, very few here even works 12 hr. Most EMS work the Kelly shift, like the F.D. either 24 on 48 off or 24 on 24/off for 3 shifts then4 days off..= 10 shifts a month. These shifts are VERY common in Midwestern parts.. R/r 911

I Can Do That First, I’m one of the biggest advocates for EMS that you’ll encounter. I’ve devoted more than 30 years of my life to EMS and its people. But it still concerns me that people believe that this profession can advance without education. When somebody mentions improving educational standards, people start to squeal, “I’ve been a paramedic for 10 years. I know what I need to do. I don’t need any more education.” Or they begin to lobby for “grandfather clauses” that grant them credit or advanced standing. Then, you see posts on various internet lists inquiring about where one can obtain paramedic certification in two months or complete the whole program online. Would you go to a physician who completed just one year of college and did half of it online? A common phenomenon occurs about two years into work as a paramedic. The paramedic becomes proficient and even excellent at what they do. They go to the ED and see the RNs starting IVs, giving medications, and similar procedures and say, “I can do that.” Then starts the call for allowing EMS personnel to practice in the ED on parity with the RNs. However, this is when the issue of education really comes to the forefront. Our society has determined that certain educational levels are necessary for a skill or trade. Some levels, because of the unique fund of knowledge, are called professions. Medicine is a profession and has high standards because mistakes can result in injuries or death. That’s not the same as the guy who tiles your bath room. I went from being a paramedic to being a physician, and I see the importance of education. For example, once in the ED, we were discussing the role of paramedics in the ED (of which I am in favor — with added education). The conversation basically was that the paramedics could do anything that the nurses could do. About this time, a new graduate nurse brought some lab reports to me and said, “His BUN/creatinine ratio is 62. Should I increase his IV rate?” I asked the paramedics what they thought. They admitted they didn’t know what the GN was talking about. Granted, an experienced motivated paramedic may learn lab data and such, but in the nursing program, this was a part of the initial education. I’ve met many self-taught paramedics who were sharper than many nurses (or doctors). But I have met some who self-taught themselves the wrong information and were, in fact, dangerous. On my shelf here in my study are 15 books from Pearson Education (the main company that owns Brady — my textbook publisher). The books include Pearson’s package for the two-year associate degree nursing programs, plus books on anatomy and physiology, medical surgical nursing, human development, pharmacology, medical math, psychiatric nursing, pathophysiology, ICU nursing, public health, nutrition, obstetrical nursing and more — all to become the lowest level RN! Paramedic instructors moaned when we found the science behind EMS so massive that we decided it best to be put into five books instead of one (or publish the whole damn thing on Bible paper). Several programs were indignant and changed to the competition — a single volume book — simply because it was a single volume and cheaper. When this became a problem, we had to counter it with an abridged single-volume book of our own. Solve this conundrum: How can paramedic education equal the lowest level of registered nursing education when the nursing program requires 15 books and 65 semester hours and the paramedic program requires one book (if that) and 700 clock hours. There are paramedic programs that rival nursing education. But attending these is hard to justify given the promise of 56-hour work weeks and just $28,000 a year. That’s why the National Scope of Practice is such a bad document. The movers and shakers in EMS had the opportunity to move the profession along. But much of EMS in the U.S. is fire-based, and we can’t have any EMS education affecting fire suppression activities or education. The fire services complained, and politics prevailed. So the minimum standards for EMS have remained stagnant. As for us, we push the science to the next level with cutting–edge books (and I mean books). Some programs will use them, others will not. I surmise we will also publish low-end books with lots of pictures for low-end programs. So, in answer to the often-asked question as to how EMS can get a seat in the house of medicine, I say — education. This is inevitable. Fortunately, a few EMS educational programs throughout the country will continue to push the envelope and enhance the education of EMS providers. Then, the resultant dichotomy among paramedics will force employers to seek those with the better education. In the end, Darwin will be right again — evolve or die. Dr. Bryan E. Bledsoe, DO, FACEP, is an emergency physician in Texas /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// /////////////////// All I can say to that is AMEN ! R/r 911

Most Kelly shifts (24/24 or 24/48 ) are usually 10 days a month.... R/r 911

Robot Birth Simulator Gaining Popularity by Noelle's given birth in Afghanistan, California and dozens of points in between. She's a lifelike, pregnant robot used in increasing numbers of medical schools and hospital maternity wards. The full-sized, blond, pale mannequin is in demand because medicine is rapidly abandoning centuries-old training methods that use patients as guinea pigs, turning instead to high-tech simulations. It's better to make a mistake on a $20,000 robot than a live patient. The Institute of Medicine, an arm of the National Academy of Sciences, estimates that as many as 98,000 U.S. patients die annually from preventable medical errors. "We're trying to engineer out some of the errors," said Dr. Paul Preston, an anesthesiologist at Kaiser Permanente and architect of the hospital chain's 4-year-old pregnancy-care training program, in which Noelle plays a starring role. "We steal shamelessly from everybody and everywhere that has good training programs." Noelle, from Miami-based Gaumard Scientific Co. Inc., is used in most of Kaiser's 30 hospitals nationwide, and other hospitals are putting in orders. The Northwest Physicians Insurance Co. is sponsoring similar training programs in 22 hospitals in Oregon and Idaho, rolling out Noelle initially at five of them. Other companies make lifelike mannequins to train paramedics in emergencies, but Noelle appears to be the only high-tech, pregnant model available. Noelle models range from a $3,200 basic version to a $20,000 computerized Noelle that best approximates a live birth. She can be programmed for a variety of complications and for cervix dilation. She can labor for hours and produce a breach baby or unexpectedly give birth in a matter of minutes. She ultimately delivers a plastic doll that can change colors, from a healthy pink glow to the deadly blue of oxygen deficiency. The baby mannequin is wired to flash vital signs when hooked up to monitors. The computerized mannequins emit realistic pulse rates and can urinate and breathe. "If she is bleeding, there will be ample blood in evidence everywhere," Preston said one rainy day recently as he put Noelle through her paces at Kaiser Permanente's Vallejo hospital. About 50 doctors, nurses and others involved in caring for pregnant women attended the training session, which started with Noelle hooked up to standard delivery monitoring machines and tended to by nurses and doctors. David Isaza, an engineer with Gaumard, sat in a corner with a laptop, sending wireless signals to Noelle. With a keystroke, he can inflict all sorts of complications, overriding any preprogrammed instructions. As Noelle's heart rate increased, a nurse examined her under the sheets. An umbilical cord was visible - not a good thing. Immediately, the nurse called a "code 777." Several more medical personnel burst into the room and wheeled Noelle off to the operating room where she gave regular birth to twins after a frenzied 20-minute operation. Then it was time for the debriefing back in a conference room. "We wheeled her through the hallway with her gown open," complained one nurse. "It was too loud," another said of the chaotic scene that include more than 30 people jammed into a small operating room. And so it went for another 30 minutes until it was a second group's turn with Noelle. "The mannequins are cool," Preston said. "But it is only one training tool." Nobody knows this better than Robbie Prepas, a Laguna Beach midwife who is a consultant to Gaumard. In 2004, Prepas was working for the Centers for Disease Control and Prevention on a $1 million Gates Foundation grant to train Afghan medical personnel in the care of women and children. Afghanistan has the world's second-highest infant mortality rate, according to the U.S. State Department. Prepas and her colleagues hauled three different models of Noelle, including one that worked by hand crank to move the mechanical parts, for medical training at the only women's hospital in Kabul. But while the Noelle mannequins were helpful, power failures and other technological glitches hindered the mannequins' effectiveness. Still, Prepas said Noelle is becoming standard issue in the United States. "It's a really effective way to teach people how to take care of patients without harming actual patients," Prepas said. /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// One of the Paramedic schools (nursing program) have access to this Noelle mannequin, I had the chance to see it the other day... weird! R/r911

Okay, I am a POOR ambulance driver ! Which, reminds me .. I have to get some longer string ! R/r 911

I am definitely all in favor for exceptional "back-up" airways, secondary to ETI. But, still ETI is the gold standard and still should be the primary airway when needed for securement of an airway. I would like to see studies & citations of this airway. Again, we need to be sure to correct the problems instead of throwing the baby out with the bathwater.. R/r 911

Actually it NOT an oil welled machine, unless you have not been reading the post, which is obvious. What is your answer when your run volume increases by 3 fold ? As well, you describe Volunteer is not the problem, I totally disagree. Curriculum changes in 1993 was made because of concern of "making it to difficult" to maintain status quo and educational standards on the volunteer systems. This again was evidenced again in 2005 on the National Scope of Practice, again with the same ideology of "making to difficult" on the volunteer systems. How does the effect EMS systems and even patient care ? Simple, educational standards has been diluted, advancement of educational standards have been fought by special interest groups prohibiting required standards of EMT levels. I have yet seen any rebuttal of this. I can cite the Basic Curriculum studies : D.O.T. /NHSA: Montana and Pittsburgh Basic EMT Studies 1990-1992 Again, my outraged is .. the concern of the system, NOT the PATIENT. Does no one give a damn about the patient care ? Obviously our "higher be's" must not. Convinced that the feelings of people performing care, and traditions as well as "buckling down " to special interest groups (volunteer agencies) is more important than the care the patient receives is grossly incompetent, and they should hang their head in shame to allow it to continue. Oh, by the way EMS is still not considered a profession (nor has it ever) . Try getting a loan, student grant or even money for EMS research. It is still considered a technical trade.(Blue collar) For it to be a true profession, it must require at least a collegiate education level , and it must be presented to have an high end profession level.. i.e doctorate or highest level possible. i.e engineer, attorney, physician, etc. Even Nursing is now considered a professional level with the Doctorate level and research capability. R/r 911

We have had a report of 10 cases in 24 hours... make sure your immunizations are up-to date, eve3n though there are reports of immunized patients. Especially if you are a male... :wink: R/r 911

As bad as some of the earlier television shows were, some portrayed EMT's & Medics as professionals. Yes, some scenes was for t.v. production only. What is truly scary is that Emergency is nearly 35 years old. Still so many communities do not even offer this level of care. Our profession needs to have more "watch dog" groups.like other professions do. To help assure, that our profession is presented in a positive light. Maybe, recommending that Paramedics do not transport obvious DOA with L/S . R/r 911