chbare

We have to wear 5.11's as part of our "uniform." I am not all that impressed. Could pick up a pair of pants with all the pockets and thicker material for $20.00 at Wal Mart. Take care, chbare.

Depends on the person. They can receive medications and medical therapy for illness during Ramadan; however, some people may decide against the said concept. Take care, chbare.

Again, I was not asked and I do not claim to be a tactical medicine expert. However, allow me to throw out a few thoughts. Much of what a civi tac medic will do comes down to the department and team SOP's. My limited experience had me only enter the area with an armed escort after the threat had been resolved and back clear was initiated or completed. I was not armed and provided care only in relative safety. However, much of tactical medicine in fact takes place away from the actual operational theatre. For example, you will have to provide the team with a threat assessment, ensure adequate work rest cycles, ensure proper environmental supplies, sanitation, medical logistics such as food, water, and equipment, and training of your team members. Much of your work will involve providing your team with the tools, intel, and supplies to complete their job. This should include medical checkups and a medical dossier of your team members. You should also liaise with local medical resources and have plans in place for various scenarios. This means talking to hospitals, EMS agencies, and the such. OPSEC may dictate how far we can take this however. Medical SOP's should also be developed. Knowing about the terrain, flora, fauna, weather, and environmental conditions is important as well. In addition, you will need to set up a staging area, collection point, and have alternate plans in place. All or most of these concepts can be completed without you ever entering the "hot zone" or carrying a weapon. What I did as a military medic was similar. Of course, I was essentially an infantryman first. However, much of my job was preventative and supportive. For example, prior to our mobilization after Katrina, I was busy attending medical briefings on the environment and obtaining information on the expected medical dangers. In addition, we scrambled and set up a medical assessment process and vaccination station prior to deployment. Following the deployment, we did medical assessment and additional testing if indicated, and provided or arranged for follow up care for health issues. As far as what to carry, a really subjective situation IMHO. Typically, every team member had a kit on their person with basic supplies. Everybody knew where the kit was located and self and buddy aid was emphasized. I carried a primary bag but would throw it at the door or leave it at the designated CCP in some cases. In addition, I carried what I considered mission critical medical supplies in a pouch on my plate carrier. A pouch that I continue to carry in my rollout bag to this day. Much of our medical care was pre planned with designated aid and litter teams along with designated CCP's. This was coordinated with a specific phase line or LOA depending on the mission however. Take care, chbare.

I know I was not asked, but allow me to throw in my thoughts? We have flow a few patients where various hemostatic agents were used with varied degrees of success. In fact, my medical director took a flight today where the new Quick Clot was used without any success. I find many people have incorrect assumptions regarding these agents. One of the biggest is that they are a silver bullet in the hemostasis department. In fact, they suffer one of the pitfalls that any conventional treatment suffers. You have to get the treatment to the source of the bleed or it may not work. Much easier said than done when considering IED's and blast trauma. I think these agents are tools; however, we need to have a realistic understanding of how they work and their pitfalls. Take care, chbare.

Need to push for more information. Acidosis is usually related to the underlying condition. Take care, chbare.

Just read through the links and agree with Dustdevil. From what I gather, they want to have "APP's" perform risky modalities? They are assigned to an area and respond to calls where such modalities may be utilized? However, from what I can gather, they do not appear to have any more of an advanced scope of practice than many other systems. I fail to see how such a system could work. I suspect this could create confusion and potentially increase the amount of time it takes to deliver a patient to definitive care. We have to either wait around or meet up with this advanced paramedic if our patient may require a specific intervention? I too initially thought this was another debate on paramedics transitioning into a mid level provider role. Before we can seriously discuss this concept we have to talk about education. Midlevel providers typically have masters level education and I find a push for PHd level education for current or future providers. Clearly, this is a concept that EMS in our country simply should not be considering. We still have six month shake and bake medic mills and we want to talk about having a mid level provider medic? Once we establish a core level of paramedic education, perhaps we can discuss the pros and cons of paramedics moving into primary care. We already have APN's and PA's filling this role and taking on many challenges. EMS would have to change significantly before it could even consider moving into this area of medicine. Take care, chbare.

Funny you should say that. I always thought I would relate to the Australians; however, I nearly instantly befriended the South African bubbas. ( I have nothing bad to say about the Australians) They call me their imitation South African. Very neat people who work hard, play hard, and have an intelligence and sense of humor I seldom see in so many people from one country. (Include the USA in that category.) In fact, I have learned all I will ever need to know in the South African language of Afrikaans. They constantly ask, "Yo Chriz whaz it all about?" All I have to say is. "it's all about the blare." Blare literally equates to leaves; however, it is slang for money. What a bunch of capitalistic money hungry sellouts! Gotta love em. As far as the hair, I started out shaving for the sake of simplicity. Currently, I have gone local and have longer hair and a beard. Take care, chbare.

Yeah, I have been called that more than once. Take care, chbare.

Ok, so I finally posted a few pictures. Check my personal gallery. Hope you like them. I am only able to upload 10 pictures at this time. Take care, chbare. http://www.emtcity.com/phpBB2/album_person...hp?user_id=5277

Not at all. Some of the "mundane" stuff can be quite interesting. Managing people with chronic conditions for example. Fascinating how these people will change through their life span, and the pathophysiology behind some of these conditions is quite interesting. One of the problems with somebody who strictly does EMS is that they may not have a chance to see and learn about the continuum of illness. So, only conditions that cause acute changes of a patients overall condition are noticed by EMS providers. If I was ever to go to medical school, internal medicine would be the ticket. Take care, chbare.

I disagree. Why do we continue to accept HEMS as dangerous? I am so sick of people who say "well you knew the risks going in." Yeah, accidents will always happen. However, nearly forty people are dead. This has been a catastrophic year for the air medical industry. Yes, many ground incidents occur; however, pointing the finger at what happens on the ground cannot negate that fact that we have a big problem in the air. Take care, chbare.

Thanks, I am doing ok. Currently fighting a killer case of pharyngitis and feel pretty crappy. The first couple of months were nice as the weather was great and I was out and about all over the Kabul area. However, the security has been going down the drain over the past month or so. People are being kidnapped right out of their vehicles in the middle of Kabul, IED's are more common, and police and military personal are being targeted more often. So, our movements are much more restricted currently, and the weather is cooling off. Full winter will on us shortly and I understand winters are brutal in this area of the country. I am lucky to be involved in the medical evacuation aspect of this operation and have had the chance to fly into Iraq and spend a little more time checking out the Dubai scene. Of course, it was all over Ramadan, so the day life was non existent. I have considered posting pictures if people are interested. Take care, chbare.

Depending on the service, Albuquerque can have some real nice knife and gun club calls. Need to speak a little bit of Spanglish to really survive that experience however. Last time I herd, the fire department still has a shake and bake zero to hero course, so you know well what kind of medics may be hitting the streets. You have a level I knife and gun club at UNM, cardiac subspecialty at Heart, general medical and internal medicine services and Presbyterian, a womans hospital, and pediatric services at UNM. So, you have a fair amount of subspecialty resource hospitals within Albuquerque proper. In addition, you may be able to network with military bubbas at Kirkland AFB. The life style of Albuquerque is not bad and you have many outdoor options available as the Sandias are a few minutes to the east of Albuquerque. In addition, you have ski/snowboarding north of Albuquerque. Santa Fe and Taos both have ski resorts and the outdoor life experience is readily available in northern New Mexico. You can consider living in Santa Fe if you want to live like a starving artist among left wing nut jobs. Take care, chbare.

On a serious note, XP was a pretty good OS IMHO. Had on on my last PC (desktop) and used if for a few years without problems. Eventually, needed to upgrade the PC and decided to go with a lap top. My Vista experiences were nothing like my XP experiences. As I understand now, you are hard pressed to find a new computer that uses XP. What a shame, and a big mistake IMHO. With that, Microsoft is still huge and even I use MS office on my mac. Microsoft has good products; however, pushing out Vista was a really big mistake and I suspect it has driven up Mac sells? Still, you can buy an entry level lap top for $500 these days, so I still see these other companies dominating the market for now. Mac is smaller but has a nearly fanatical cult following. In addition, I notice many people are using macs for specialty applications such as video editing. Take care, chbare.

You could always buy the air and put it in a manila envelope. Pretty cool pulling a computer out of your pants, but pulling one out of an envelope, priceless. Well actually about $1,800 just to get in the game. In all honesty, I like what I have sen with the new line of mac books thus far. I was not surprised, but still dissapointed that Apple will not offer a cheaper entry level lap top. However, Apple has been pretty consistent about their prices. I suspect the mac book pro will become less popular as the mac books offer a good package at a moderate price. The older polycarbonate mac book gets to stay around at $1,000. As much as I love Apple and really think macs along with the OS are superior to PC and Windows based systems, I suspect other companies will continue to outsell Apple because they offer functional computers at half the price of the entry level macbook. Still, for people like me who have transitioned over to the dark side, there is no going back. Once you have had Mac, you can never go back so they say. Take care, chbare.

Yeah, I am going shopping when I take leave in November. http://www.apple.com/macbook/ Take care, chbare.

Nearly every ER I have experienced had a supraglottic device in their airway cart or difficult airway set up. I even worked in a five bed ER out in the middle of nowhere that had LMA's in their failed airway cart. Using technology to replace adequate education is indeed a step back. We cannot point to the bad behavior of other professions to justify our own problems. Like Fiznat, I am not against ETI; however, the burden is on us to prove that RSI and ETI can be used safely and effectively by pre-hospital providers. He brings up some great points. Take care, chbare.

Perhaps the crux of this conversation and a concept that some people simply cannot grasp. How many people do we need to RSI? Do most patients benefit from this procedure? What about intubation without induction and paralysis? Not mush evidence points to definitive benefit for intubating people in cardiac arrest. Funny, I can count the number of RSI's I have performed in the field on one hand. In fact, nearly all of my intubations have been in the hospital. Like Vent stated, most of the patient's I have flown were intubated prior to arrival. With that, there will always be a small number of patients who really will require invasive airway management modalities. Take care, chbare.

A little over-ambitious in assuming these people are able to recognize anything about Canadian education. First, they actually have to have some concept of what constitutes a real educational curriculum of instruction. Then, they would actually have to learn where Canada is located. Point to it on a map at a minimum. I may be a bit ambitious in saying we should go so far as to have them actually identify a province. (I suspect comparing and contrasting province and territory would be a bit much to expect.) Only then, could we actually attempt to consider talking about educational differences. Take care, chbare.

:oops: I am sure somebody is having a laugh at some of the conversations with my wife. Take care, chbare.

:laughing3: ROTFLMAO Do a quick Google search on US public education and perhaps "no child left behind." I think you will better appreciate the quality of public education in the United States. Take care, chbare.

Actually, that is not far from the truth and no offense taken. I have never known an ER doc to manually calculate medications. In addition, I could not imagine the doc would be happy or efficient if he/she had to go around calculating doses and flow rates all day long. A medication is ordered and the nurse will calculate the dose and rate, then titrate if required. Medication calculation is a fundamental area of knowledge that any ER nurse must know. Take care, chbare.

I also agree with the general trend of advice. Medication calculations are nothing more than simple linear algebra. Make an equation, cross multiply, then solve for X. Plus one point for having mandatory college level prerequisites. Take care, chbare.

Generally not indicated, especially as front line agents. A few large studies indicate that CCB's do not help and a few sub groups of patients actually developed additional complications. Phentolamine is an alpha blocking agent that can be considered if nitrates and benzo's are not helping. Pushing this a bit further, what does everybody think about fibrinolytic for cocaine induced MI? Take care, chbare.

Yeah, people still caution against beta blockers; however, there is not a large evidence base that supports this idea. With that, nitrates and benzos are still considered front line treatment for cocaine associated MI. Take care, chbare.