JPINFV

[rant] You know what? I'm sick of this "Have you been trained" or "We'll switch when everyone gets trained" BS. We sit here and preach about how "protocols are guideline" blah blah blah, but when push comes to shove we refuse to change. Is it really that hard to tell people, "You know how you you use to do 15 pushes between when I squeezed the bag thingee? Yea, well push 30 times now" "You know how you used to do 3 analyze/shocks and then CPR? Yea, well do 1 shock now and 2 minutes of CPR before you try again." The only problem you should have is reprogramming the AEDs, and even then, the management should have it either done or scheduled by now. These changes aren't that ground breaking, for the most part its changing a damn ratio with a few minor changes depending on arrival at an arrest (basically do 2 minutes of CPR before turning on the automatic lunch box of life if your responding on an ambulance because you probably didn't arrive there that quickly. CPR PTA counts for this). If you truly believe that protocols are guidelines, then take charge during an arrest and do what the evidence currently shows to work. If you don't, then all the talk on this board about "guidelines" and "evidence based medicine" is a sham! [/end rant]

First, why would evidence based practice be bad? Wouldn't it be good if we change to improve our care (new CPR guidelines) or get rid of treatments that sound good, but either doesn't work (pacing asystole) or hurts the patient (fluid resuscitation)? Evidence based practice isn't so much something that can be researched on its own, but a philosophy that states that what we do should be proven to work instead of just being an idea. The evidence to support this philosophy is when ever we change because multiple studies prove that something either works or doesn't work and people are saved because of it.

It's possible. While not exactly the same thing, the bio program at my school (BS degree) spends the first 2 years weeding people out. Mostly because they don't have enough upper division labs to get everyone through in 4 years.

California has a safe surrender law for all PDs and hospitals. Locally, all of our fire departments are safe surrender sites. The only thing the bugs me about safe surrender is the fact that parents can reclaim their kids within 3 days of the surrender. If you can't take care of a 3 day old, the terrible twos are going to be hell. "Hey, honey, you know how we need a baby sitter for that trip this weekend? Well, the fire department has a program where we can drop them off and pick them back up in a few days..." (ok, this would only work if the baby is under 3 days old, but you get what I mean).

Wouldn't you have the same problems as a CRNA that you would as a paramedic because you are operating outside of the "supervision" of a doctor? I know that my company's RNs (yes, not exactly the same thing, but...) can't use the ALS gear if we happen upon something on the way to/from a CCT call because they don't have "orders."

And I blame the employees for this as much as the company. There are too many panzies out there that are willing to sacrifice their morals and standards for the company. My company wants us out in the morning in 15 minutes. We have people that are supposed to "check" and "stock" the units (after which the cabinets get sealed) overnight (private, transfer service. Only a single 911 back up contract). Personally, unit check out takes as long as it takes. If it takes me 30 minutes because I'm chasing down supplies (it's fun when you find that you are missing a BVM from a sealed compartment) or filling up/replacing O2 tanks (it's a safe bet that on any given day, one of the spare takes is either broken or empty), then it takes me 30 minutes. If it takes me 10 minutes, then it takes me 10 minutes. I have no problem getting into a "discussion" about my check out times. If calls are backed up, then maybe we should have more units on! :idea1: There is an assisted living that we are not supposed to reroute or call medics from (granted, the next closest is about the same distance away and it's arguable that emt-P ETA would be > or = transport time, but it's borderline). Our dispatch has to call the owner if any unit is rerouted or transports with medics. To me, my patient comes first. Anyone who accepts orders that are morally (if not legally) wrong when they know better is just as wrong as those giving the order.

Intubation kits don't explode and a BVM is always hooked up to an air supply with at least enough O2 to support life (22%). Medical O2 is supplemental, not a replacement.

Process by which the majority of NADH and FADH is produced for use during the electron transport chain, but also a single GTP is produced for use by the cell. Also known as The Citric Acid Cycle, the process is a cycle because of the regeneration of the first intermediate by the last step. The main input (besides NAD, FAD, and GDP which are required to produce the products) is Acetyl-Co-enzyme (CoA). CoA is produced from Pyruvate prior to the start of the Krebs Cycle (2 pyruvates are produced from Glucose in the first main process of metabolism called Glycolysis). The krebs cycle occurs inside of the mitochondrial matrix (The space surrounded by the inner-membrane) of the mitochondria in eukaryotes. In prokaryotes, the Krebs Cycle occurs inside the cytoplasm. The classical model for the complement system.

And we enjoy the same rights to tell him to take it off. The first amendment is an almost blank check from government control. Populist sentiment is not controlled by the first amendment.

It's actually harder to get into vet school then med school. The average GPA is about the same (3.55 for vet, Med is starting to push 3.6), but there are a lot more med schools then there are vet schools out there.

It's Ebaums World, what else would you expect? http://ebaumsworldsucks.org/

^ Wow, time to open up a can of worms (anyone who ever goes over to SDN's allied health board knows what I'm talking about). An RN is below a PA. A PA is equivalent to a NP or CRNA. These levels are considered "mid-level providers" and operate under the "supervision" of a MD or DO (actual level of supervision and control varies by location).

6-10... When my mom was in the hospital (crappy hospital, we got her transfered after 2 weeks. I hate Vencor (now Kindred)), I remember watching the local drive-in from the window/

Another thing to remember is that a drawn out EMT-B class is very easy to do along with a college schedule. The one day a week for 3-4 months is much easier to fit in then the 2 week, 12+hour/day courses (and at least in my area, a whole lot cheaper).

assessment and treatment are not two completely seperate things. You can do both at the same time, especially if you are working as part of a team. You can be asking a lengthy set of questions while your partner is applying the high flow O2. Also, you need to assess both before and after the treatment (which, in the case of O2, should be simply noting the degree of SOB in terms of effort, rate, spO2 (if applicable), and amount of words the patient is able to speak between gasps). You can't know if your treatments are working if you don't know the patient's status prior to the treatment (again, use common sense).

Our single 24 hour car is a 0700 car. Shift change for them is just like any other shift change, the replacement crew is supposed to be at base (not at the station) at 0700.

Hmm, why can't EMS owners come up with unique names for their companies? (I don't know which Lifeline came first, California or Mass.) http://www.lifelineambulance.org/index.html

Even non-profits need to make money if they want to survive. A local non-profit hospital near my house didn't just build a new tower and add few hundred beds because it's loosing money. Said hospital is also one of only two Magnet hospitals in my area and has one of the busiest, non-trauma ERs in the area. Profit isn't always a bad thing and not all non-profits loose money.

According to Dogma, God was a she...

Simple. You are there to apply the skills and education you learned during your class. The fact that the nurses' job is easier is a side product. There is a difference between "being there to help" (goal=help nurse. The hospital should already have a bunch of these people employed. They're called ER techs, transport techs, and CNAs/PCAs) and "helping by being there" (You are there for a secondary reason then to help the nurse, but your actions assist the nurse with their patient care).

While I agree that a person doing clinicals (certified first responder [do they even have clinicals?] through med students) are not there to make anyone's job easier. They are there to learn. Now, we need to ask ourselves what actions are educational. Sure, anytime a student gets to practice their skills (assessments, especially, but also things like injections, IV starts, etc) and use their education (interpeting their assessments, picking treatments, etc) is educational and useful. What about the other things? Is helping clean up a patient helpful? Sure, especially if the person is lacking clinical experience (especially emt-Bs), because you learn that there is no privacy sphere in medicine. How about running labs? Can be, take a few seconds to talk to the lab techs and get a feel for what their part of patient care is (even if it is indirect patient care). Is getting coffee useful? Generally no. Finally, we need to ask ourselves if it is worthwild to complain about doing scut work? As a general rule, probably not. So you get a cuff of coffee? So what? Get the cup and get back. Sometimes it is better to just go with the flow then to get everyone against you. Of course, excessive scut is a problem.

Congratulations on your new pets, Unfortunately my house is a scabie free zone.

Move to Orange County. No need for an extended scope course, but be prepared to be a driver/oxygen attendent/paramedic's bitch [for lack of a better term and not meant as a slam to medics].

I guess everyone who said no also doen't believe in capital punishment for no matter the crime. Personally, if you're willing to take a life, then you should be willing to give your's (I don't care if it's death or life in a super-max where you see sunlight a hour a day. That hour is more then your victum got). Furthermore, it doesn't matter what the mechanism of death is, an MD/DO would still need to be there to declare death (unless we want to return to the guillotine). Furthermore, if the state is going to engage in capital punishment, then the convicted does deserve to feel the least amount of pain possible (I'm not talking about swabing with EtOH before putting the IV in). Every mechanism has its problems, and its protocol. If you tye the noose wrong or set the drop distance wrong then you end up strangling the person or snapping their head off instead of snapping their neck. Electric chair? Anyone else here seen Green Mile? Firing squad? Who says you can't miss?

I picked three, just because I think that 1 and 2 can be accomplished if 3 was done. Personally, I don't care about what other countries think about our system (4) and you can't have a one size fits all solution (5, should we have a minimum of x amount of ambulances in areas where people don't live or where people don't get sick [say soccer-mom territory vs Leisure World]).