Ridryder 911

Ordered mine today, will let you know in a few days... R/R 911

This may clarify things.. please note age the legal & correct definition as well as age (<1y.o.) and special considerations. This site has some additional information, that some may want to review. R/R 911 [web:0f01d09bcb]http://www.sidscenter.org/ProfessionalRole.aspx?fromparent=parent&id=5&heading=ProfessionalsRole[/web:0f01d09bcb]

Wish you the best of luck..... reply back to this in 1 year, then 2 years.... if you are still together.. will place a BIG post about it.. again, good luck, R?R 911

We had some Tx. Paramedics, that used to work with me.. (the old patch style). With a few choice markings on the bar style EMT, you could form the word sh*t...some reason or another, they didn't like that ?..... :wink: R/R 911

I personally like just the bag, lot of the time they cancel. Since returning back into the field, most take the cot & leave the bag in the rig... since F.D. 1'st responds most of the time, they will give us a heads up, if its a legitimate call. Very little items I need in the house.. most of my tx is now in the unit, & yes the doors lock ... but, I usually demand more scene control. Yes, I back the rig close to the house as possible... those that have been in the field realize that carrying a damn stretcher over dips and crevices will cause it to tip & cause strain to medics.. why increase your work load because you can't back up a ambulance ?.. The way I figure it's a personal thing...who cares ? R/R 911

After seeing & discussing with many different students, I have found only one school (so far) that requires their students to write a thesis. I am really amazed that most do not even really know what it consists as well. As instructors do you require your students to write one and if so do you require the usual APA format etc ? Students, are you required to write one & which standards do you have to comply to ? R/R 911

I agree...sometimes it has to be directly hard hitting for some to understand. Thanks VS. I guess, I amazed that so many do not know basic guidelines of CPR.. R/R 911

Okay, maybe I missed something ?.. or failed to see a post about OSHA ?... but, one needs to remember that oxygen is considered a drug/medication so doucmenting is essential. R/R 911

Well, all I can say is job security ! R/R 911

Well, you might want to learn the differences between dressing (i.e. 4 x 4's) & bandages (i.e kerlix, kling). Bandages can be removed, but not dressings, so yes you can remove the bandages to apply more dressing. No bandages do not have to be sterile, but dressing should be since they will be covering the wound itself. Be safe, R/R 911

Maybe the facilities should be corresponding on Regional Advisory Committees (RAC's) & develop a trauma system plan, so small hospitals that do not have in house surgical capabilities 1) Do not & should not receive these patients 2) If they do, they should only stabilize enough for transfer to another appropriate facility. Local trauma system plans should had been in place, with diversion protocols and packaging and referring patient to appropriate facilities. Nice idea of P.D. , yet again it would take them a few minutes to go the the physicians house etc.. again, let us look at the whole picture as a workable system, not placing a band-aid or temporary fix. R/R 911

Our medical director has the same opinion.. like the old saying "don't take the temp, you won't find the fever".. LOL Now, seriously we are not talking about questionable or maybe situations... we are talking about, conclusive. One that are either have post mortem hemostasis, rigor, etc.. I was discussing this situation with an old Paramedic professor now attorney, he was described doubtful, but litigation could be held against EMT's for not following the standard of care .. even on the deceased. Especially if the autopsy or ER physician agrees it was too late for resuscitation measures to be started. Again, we are talking about obviously dead... if you flag an adult not an infant you are performing age discrimination.... there is no difference in criteria. etc..again, doing what is taught. Not knowing is why the thread was brought up.... R/r 911

Okay hot topic.. What is your standards or operations on restraining patients ? Leather, kling, commercial, chemical ?.... R/R 911

If one can not determine a dead, pulseless, body with conclusive signs of death, (or know what that means) then one does not need to be in this business. Period. Better go back to school, clinical etc.. Because you do not know how to perform your job accurately, is non-excusable. If you cannot detect a dead person, how in the hell, am I supposed to trust you with a live one? Guess what I wouldn't. Like I said, I would have the physician talk to your director or even the state boards. One that cannot determine a cold, levity, with rigor mortis does not need a certification or license. We are not talking about rocket science... If you have to err on the side of "oh, what my happen?", then you need to check in another profession. Resuscitate or attempt those that meet the criteria that have a chance, not to those that are OBVIOUSLY DEAD. So, do we now attempt resuscitate most traumatic arrest as well? This scenario was simple enough for even non-medical trained persons.. refer to basic CPR training. R/R 911

Good posts Kev.. you are right.. then there is hydrostatic pressure & cellular metabolism of how much glucose is actually being distributed then let's not forget the Krebs cycle...etc.. #-o ...and most medics get confused on cations vs anions.. lol Interesting but one can see how you will not see the forest for the trees.... R/R 911

Ace it is an aged old dilemma. But, the shift is occurring where EMS management soon will have to explain why performances and justify treatments instead of saying "it's the right thing to do" or "We always did it that way". It takes time for things to change.. but, $$$ talks and B.S. walks. Medicare and private insurance companies are tired of spending billions of dollars on glorified taxi rides. Look at medicare evaluation lately when the system was noted to had erroneously paid several providers. It shut down for a few days... but.. they are realizing there needs to be more scrutiny. If we think providers do not pay EMS now, whoa hold on... I know some of you think I over dramatizing the expansion of number of patients in ER. But, even my tiny ER has seen in increase over >18% each year in the last 3 yrs and now this year alone we have already had an increase of 13% in less than 6 months with no major change of population increase. It is now effecting the ER physicians, staff, when there is no beds available or foolish transports are brought in. In my situation, young residents whom are quite used to working very busy ER have become quite aggressive in knowing what we can do to prevent transfer of patients if possible. Maybe with increasing knowledge of physicians, protocols and standards can be & will have to be changed to make the system more flexible. ER physicians discussing with medical control, might expedite changes Good luck ! R/R 911

Good response, and basically you also answered why Insulin and D50W is given to patients who are hyperkalemic, along with some kaexalate, this is the standard treatment. R/R 911

I understand what you are describing and agree some. But you must remember that there is less than <8-10% chance of survival to respond after being treated by EMS PTA to ER. (2000 AHA Fact Sheet) Most ER physicians are beginning to immediately cease all resuscitation measures if there has not been a change in ECG, or patient condition(s), thank goodness. As one speaker at the ACEP meeting describes " EMS units needs to stop being hearses, with light and sirens there is nothing more that I can do, that has not already been done" (quotation mine). This dilemma is increasing more and more, even as lame as the AHA is at this time, they even recognize the need of terminating field resuscitation. With the new standards, this is to be recommended even more. Again, why increase costs to the families and tie up valuable ALS EMS units & ER beds? This is not calloused, but truthful. Some are also not aware of the cost. Let's look at the normal code EMS $500-1000, arrived in aystole ER charges Arrival charge base charge $200 *Code called $400, Medications $300, Respiratory therapy $200, ER physician charge $200.. now we have a approximate total $2000 dollars for a non-viable patient. Remember medicare only pays 80%, so grandma on a fixed income is now responsible for at least $400-800 of the bill. Now she also has to pay funeral expenses of several thousands of dollars.. there goes next couple of months medicines for her... Again, our action and treatment(s) effect more than just the patient. Reviewing protocols to give the best and effective care should be highly stressed. Especially as more & more volume of calls and more higher acuity level of responses are needed. Be safe, R/R 911

I understand the international use of the forum and that is why it is so unique and special. I do enjoy reading input from all parts of the world, as well as seeing that for the most part the treatment and regime, problems are the same all over the world. As well, I have learned from different areas on different approaches on how to manage or at least different ideas of management of patient. Even if I disagree, I still honor their opinion. The financial portion is important in the U.S., healthcare is not cheap (even EMS) and we need to be aware our actions can potentially cause medical treatments to be implemented & costing the family into the hundreds of thousands of dollars. The problem was initiated in another post, and instead of hijacking the thread I instituted this one. This posts was not originated here, but several other EMS forums, some years ago, with basically the same response. The problem identified was that sometimes many medics (especially new inexperienced) so not asses the situation and the patient. Pediatric calls are most EMT's nightmare. The most common error is that the medic becomes more emotional involved than on other calls, and allows the heart to make the decision instead of the brain. I have dealt with SIDS family, and been involved in grieving sessions, workshops and counseling of families & parents. Most are not aware that their senses are very misaligned at the time, and any activity, talking, actions may be misinterpreted by them. Some of these actions will be remembered for a life time by the parent(s). Again, the main point was to educate that with the clinical findings of conclusive death. Resuscitation measure should not be attempted. Although, it is stated in almost EMT textbook, AHA Health care Providers text... there are still some out there that perform it (as even seen by votes here). Yes, it would be had been easy to state "Don't do this".. but, that has already been done in all the texts & appearantly not been effective. Discussing why, with debate will leave more an impression in education than just a statement. The same is true on any post, such as intubations, we all know that one should confirm ETI before placing the patient on the ER stretcher, but obviously it is not done & now our skill level is being scrutinized. I guess, I consider forums prophylactic medicine. Maybe it will spark interest for the person to look it up, ACE to place a study, Dust to give some smart arse advise that is true, and maybe.. they will go to Google or Med-line etc.. to look it up. Medic should be able to defend & justify on why they performed treatment, gave the medicine, intervened on what they did, not reallying on "protocols" or single textbook. That is why we ask to defend actions of attempt resuscitation's, and as yet no one can defend or prove why it should be done. In medicine we need to remember most treatment should be performed by outcome measures, not anecdotal feelings. When discussing treatment regimes and new developing treatments be sure to cite studies or references where one can read studies and base an opinion upon it. Many, spout of different treatment modalities, but fail to back it up with literature. Then one needs to know how to logically interpret clinical studies and research techniques to accurate evaluate & not accept them on face value alone. I would be glad to see new development in the treatment of pre-cursor of SIDS. It is a horrible & tragic situation. Yes, we have came a long way but still have a way to go as well. But when describing research, if possible post link(s) , reference, citations etc.. we all would like to learn. Respectfully, R/R 911

Actually, some EMS was in the funeral home until late 70's & some even in the 80's.. from some of us that have been around. And 40 meq/ HCo3 was the inital treatment of cardiac arrest until late 80's... FYI R/R 911

I guess jmac, you don't seem to understand one it is is resuscitation, not resus, two the poll is to make some EMT' aware (newbies, students) to use common sense. Not everything is black & white like in the textbooks. The poll came from an idea off another thread. This is not a scientfic data collecting, for studies so parameters etc. is not needed.. this is an EMS forum, get real. I see countless EMS bring in SIDS only for the physician to immediately stop and pronounce.. Now, we have to explain in nice terms that the EMT were dumb-asses and should had never started and gave false hope, No they really did not know what they were doing. Have the M.E. now, try to get all the information from the infant, go back to the scene, etc... Then in 2 weeks they get a EMS bill, an ER bill... yes even if we did nothing they were brought in as a code.. about at least $500. A little awareness. Again, if the child is in cardiac arrest and there is NOT conclusive signs, that is another matter and a different scenario. If I have more that encounter with the same medic doing the same thing, I contact their EMS division for retraining, if this is not successful I contact the board for license review & formal investigation. Insensitivity to the family and not treating the patient appropriate (yes, coding when it should not be done). Even in BLS/CPR classes it discusses that NO resuscitation should be attempted on signs of conclusive death. Just because it is an infant makes NO difference. We try to educate and make EMT's aware on this site. To promote discussion at work, look outside the cookie cutter approach.. there are some that make few calls, or have little experience. To think "outside the box'....

Here's a piece of advice.. listen and take advice seriously.. there is a reason so many have the same opinion, another one.. if you don't, you will be looking for another career R/R 911

As an instructor, I used to place recording mannequins on back of moving ambulances, and have students continue compressions with ventilation's going hallways.. carrying down stairs... etc. It is impressive how much error can occur in compression strength and interruptions. Only a few of you might remember the non-interrupted technique of CPR. There used to be at one time the compression technique to switch With the chest rescuer would change on 3 and the second rescuer would immediately get prepared with the hand intercepting on 4 & 5. Marathons used to be held to raise money for AHA and P.R. Demonstrating CPR was never interrupted for 24 hrs or so.. etc. Wonder why AHA did not resuscitate that method since it was studied and approved successful... this would decrease the interruption period as well.... With more research we do .. the more it appears we should lesscare & treatment for the patient and declare death more often ? Food for thought. R/R 911

The problem It is predicted that ER & hospitalizations will increase 3-5 fold, within 5-10 years. VHA and other hospital administrator representation admit that there is not enough hospital or emergency beds to be handle this situation. If you work in a busier service, can you imagine what it will be like with 3 times the number of calls ? Even if you are in a slow call volume area (i.e 5 calls a day) will you service be able to handle 15-20 a day? You think ER's are crowded now ?... Guess what it will be like with the 3 times the number of patients (not including EMS visits) .. prediction of waiting times from 2 -8 hrs to be initially be treated. Plus, EMS diversions will be more than ever. There is another group that is as concerned with this dilemma as well.. and actually are studying remedies, more than the health care system and unfortunately, it is not to increase care or save lives... rather save trillions of dollars. The insurance company has the best predictors and most accurate trends than even most health studies..Insurance companies have been studying the increasing numbers of emergency responses, ER visits & of course admissions. Think of it this way... for every chest pain you run ... EMS costs $$$?...... ER (lab, radiology, meds, etc)visit $$$$ ?, admission to ICU for rule out $$$$$$$?.. now, multiply that by thousands a day. Or alternative possible non-cardiac chest pain tx @ home, monitor, lab, continuous ECG monitoring, video monitoring.. $$$ See patient tomorrow at HMO/PCP for follow-up.. 0$$ EMS will have to have a major paradigm shift... the role & the responsibilities of the Paramedic will have to drastically change, either that EMS will be a thing of the past as we see it now. Baby boomer mean age is 60 years of age in 5 -10 years will be 65 -70 years of age. These will be the highest population group ever in the U.S. With this increase response and ER visits , I predict the role of the Paramedic will be, to see whom gets to be seen, rather than transport to be seen. As I mentioned insurance companies has been studying on how to decrease emergency visits and as well as admissions. Alternative pre-hospital care such as Physician or physician representative (P.A./N.P) is still being studied and considered. Most patients can truly be treated at home, and many of the test is the result of malpractice results not the need for true diagnostic capability. If the standards of the medical community change.. the standards of the litigation will change as well. If there is no place to transport patients, what will EMS do ? EMS will have to expand their role in providing health care in a more broad expanded role as well. Insurance (including Medicare) will not be able to continue to pay $500 > for a glorified taxi ride. The same is true, even if it is not paid or is volunteered, the increased run volume will deter interest. Emergency Medicine on the Move As any on this forum is aware , technology is ever changing. Even the LP 12 is blue tooth capabilities, and has more capabilities than most are aware of. Examine what some EMS is testing now.... video transmissions, ultra sound, bed side blood-lab testing, etc.. still new, but definitely will be there. Education in EMS With the advancement of technology, and responsibilities the education will have to increase. Review other health care professions. Majority of the RN programs less than 25 years ago were diploma or technical trained. What happened? That profession became aware very soon their education level was poor and negligent. To be recognized as a profession, increasing litigation of law suits against nurses, increasing responsibility, increased number of patients, standard education had to be placed at a collegiate level. Volunteer nursing associations basically disbanded, do to the increasing demand of education, and the patient load. Yes, it still exists, but barely. The same will be true in EMS... it can't be stopped.. it is just the law of supply & demand. It is better to prepare the community for the change, and prepare the system as much as can be. What happens if we don't accept change? Well like every other profession and people.. resisting change is normal. Denying that it will happen will not change the out come... the facts are there. There is more people alive now, than was ever on planet earth since its beginning. Now, the highest level of population will be needing medical care more than ever. EMS has a good chance to actually grow. Refusing to accept and modify changes.. EMS may be only be for transports only. Medical care may be provided by outside sources non EMS related. As I discussed, insurance companies are studying and evaluating alternative methods today. Like I discussed, Physicians & there extenders, are placing continuous monitoring devices, rule out non-life threatening medical problems, saving millions daily. Let's remember most emergency patients do not have private insurance and those that do only a percentage is received for payment. People whom get shot.. stabbed , etc... usually do not have full coverage.. thus a major financial problem for EMS. Alternative, funding has to be explored to off set expenses. Again, we are back to the traditional role of the Paramedic needs to be explored and changed with education. So who knows what the true future is ?...nobody, knows. But, we can say that there is a crisis arriving, we are not prepared for it. Burying our head in the sand is not the answer. R/R 911

Is CPR Performed on a Moving Ambulance Stretcher Effective? http://www.merginet.com/index.cfm?pg=cardi...fn=CPRstretcher By Bryan E. Bledsoe, DO, FACEP March 2006, MERGINET—We are learning a great deal more about cardiac arrest. We know now that victims of blunt trauma who are in cardiac arrest when EMS arrives are dead and resuscitation efforts will be futile. Likewise, we are learning that if CPR and defibrillation are not applied soon after the onset of cardiac arrest, the chances of survival decrease by about 10 percent per minute. By the time the patient is 10 minutes out from cardiac arrest, without emergency care their chances of survival are dismal. In many countries, CPR and ACLS measures are provided in the field. If unsuccessful, efforts are terminated and the patient pronounced dead and left for the mortuary. This is a good practice. There is little an emergency physician can do for a medical cardiac arrest in a hospital that a paramedic cannot do in the prehospital setting. Now, this may change when we start inducing hypothermia in cardiac arrest patients. But, until then, we really ought to stop transporting dead people. I have always questioned the quality of CPR provided in a moving ambulance or on a moving stretcher. Many times in my paramedic career I “rode” the rails of an ambulance stretcher while attempting CPR. But, how effective was that practice? Now, researchers at the University of Pittsburgh have studied the technique. Using a prospective, randomized crossover design, volunteers (EMT students, paramedic students, EM residents) were assigned to two-person teams. Each team performed two 6-minute bouts of CPR on a recording Resusci-Anne either placed on the ground or placed on a moving ambulance stretcher. One team member provided bag-valve-mask (BVM) ventilations and the other provided chest compressions. After three minutes into each bout, the roles were reversed. There were 62 subjects and thus 31 teams. They found that the difference between the rate of compressions on the floor and on the moving ambulance stretcher were not statistically different. The tidal volumes delivered by BVM were not statistically different between the positions. However, compression depth and percentage of correct compressions were better when performed on the floor than on the moving ambulance stretcher. In addition, the percentage of correct ventilations was better for the floor position. They concluded that chest compressions and ventilation quality of CPR on the ground was superior to CPR performed on the moving ambulance stretcher. One point that was clear from the recent 2005 American Heart Association CPR guidelines is that uninterrupted chest compressions are very important in terms of patient survival. This study showed that the practice of attempting CPR on a moving ambulance stretcher resulted in compromised CPR. I think every EMS system needs to revisit their protocols and positions on field termination of CPR in medical cardiac arrests so as to minimize transport of patients needing CPR. Reference Kim JA. Vogel D. Guimond G. Hostler D. Wang HE. Menegazi JJ. “A Randomized Controlled Comparison of Cardiopulmonary Resuscitation Performed on the Floor and on a Moving Ambulance Stretcher.” Prehospital Emergency Care. 2006; 10:38-70. //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// So does this mean I can call more codes, because I have to move them ?... sounds like it. Definitely less work in ER. R/r 911