JPINFV

I haven't heard an actual ethnicity or religious affiliation of the two flying into San Diego while watching The Kingdom and speaking in a foreign language. Thus Ackmed and Muhammad could very easily be Jose and Alberto. Next, what should happen? People shouldn't speak those terrorist languages and only speak the Queen's English? After all, everyone who doesn't speak English must be a terrorist? Oh, and no action films. Only romantic comedies and children's cartoons can be watched on an airplane because some panzy passenger is going to wet herself over a movie? There's a difference between ethnic profiling and absolute stupidity. Of course, ya know, not taking a father ratting out that his son is a terrorist planning to bomb an airplane to the US foreign service serious is, well, stupid as well.

^ Ah... durrr... I have no clue why I never thought to apply off-label use to medical devices like it's applied to pharmaceuticals.

Since this got bumped, anyone who is using the King LT(s)-D airway needs to check the status of approval with the manufactuer. I don't know exactly how this get's played out in terms of consumer use of the product (i.e. ambulance companies), however King recently got hit by the FDA for mismarketing the LT(s)-D for emergencies. http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm191860.htm

You know, I've really gotta give al-Qaida some credit for this. 1. They get rid of Amit, the idiot terrorist. Thinning the ranks of idiots is always a good idea. 2. In the 1/100 chance that a plot like this actually does succeed, bonus. 3. Regardless, TSA goes crazy and issues new rules like no moving around during the last hour of an international flight and no personal items on your lap during the last hour of an international flight. It's only a matter of time before it moves to anal probes with the TSA not changing probe covers between suspects passengers. This, of course, hurts air travel and the airlines as people decide to drive or take the train when ever they can.

Say goodbye to all liquids and powders since the TSA can't keep people on the no fly list from getting tickets.

Of course, he was walking to work. Now if he was walking to breakfast then the story would have turned out differently.

I wanted to give my 3 y/o and 1 y/o nieces chlamydia and syphilis, but I couldn't find them, so I setteled for MRSA and chicken poxs.

To be fair, testicular pain can be a true emergency, and if the patient doesn't have anyone to drive them to the hospital that minute, then an ambulance ride is definitely appropriate. Exactly how good of a driver are you going to be when your junk feels like it's in a vice?

I think the issue with response time research is scale. Let's look at the differences in times gleaned from the studies discussed in the side column posted by Paramedicmike. The most easily comparable numbers was in the "unlikely survivor" (US) discussion with the "fast" response time being 3.5 minutes +/- 1.2 vs 5.9 +/- 4.3. First, it's worth mentioning that the US group is under the 5 minute mark that's discussed so much (I honestly don't know if it's from several studies or just one). This said, even still it's worth mentioning that the difference between the US group and the death group was an entire 2.4 minutes. Now, sure, there are a handful of of conditions that are truly 'seconds count' time sensitive (cardiac arrest and respiratory arrest are the archetype examples). However, it's a fairly safe bet that most other conditions, including serious conditions like MIs, are not a 'seconds count' emergency. 2 minutes, in reality, isn't that much time. However, I will say that there comes a point where response times matter and it's most likely not what's being researched. Saying 'well, there wasn't a difference in outcomes between the 5 minute and 8 minute response time groups, therefore response times are meaningless' isn't very helpful and is probably giving the data too much credit. 5 minutes vs 8 minutes probably won't make a difference, but how about 5 minutes and 15? 5 minutes and 30? 10 minutes and 45? Sure, the vast number of emergency responses aren't going to fall into the 45 minute mark, however you still see a 23 minute first response and 38 minute transport unit response times. Trying to apply a study comparing a short response time (6 minutes) vs shorter (4 minutes) to a long time (23 minute or 38 minute) response time is not a valid application of the research data.

Are you talking about the Orange County/California Highway Patrol incident from a few years ago?

At home, asleep, which was where she thought her child was and was doing until she woke up a 1:45am.

Unimpressed.

I'm going to be blunt and I'm going to do it in the open forum because this is something that everyone who is suffering from a similar problem should see. If it has been a while from the incident and it is still troubling you this much, then you should probably seek professional help. There is absolutely nothing wrong with seeking professional counseling over this. Seeking help (real help, not forum help) doesn't make you weak, just like someone calling 911 because their having a heart attack and using your professional services as an EMS responder doesn't make them weak.

Another thing to think about is that there's a difference between an emergency response and an emergency call. It's possible to respond non-emergently (no L/S) to an emergency call (patient going to the emergency room).

You know, I've heard of laws compelling the use of lights and sirens, but have never seen one. I'd love to see that statute spelled out that compels EMS providers to use lights and sirens when responding to an emergency call.

That's not a fair analogy. All physicians have the same basic education foundation and then specialize after graduation. To compare the concept of "basic life support," "intermediate life support," and "advanced life support" to physicians, a better analogy would be emergency room technician, emergency medicine specialized physician assistant, and emergency medical physician. Like the EMR, PCP, ICP, ACP desginations, these three levels have different levels of education, training (whereas all physicians have the same, or equivalent, level of education), and scope of practice.

It's a state by state issue. Most states only recognize the American Board of Emergency Physicians (ABEM) and the American Osteopathic Board of Emergency Physicians (AOBEM). Now the tricky part about this is how physicians are licensed. Physicians have an unrestricted license to practice medicine. In other words, they can do what ever they want, whenever they want. If a family practice specialized physician wants to preform open heart surgery, then he (legally speaking) can under his medical license. What restricts this from happening in most cases is hospital practice rights (no sane hospital will allow a FP to do open heart surgery in their hospital) and malpractice insurance (no insurance company is going to cover a physician operating outside of his training. Any one preforming open heart surgery is going to be held to the same standards as a residency trained cardiothoracic surgeon regardless of residency training). Additionally, services that are required to be certified by an outside agency (i.e. emergency departments that are allowed to accept ambulance patients from the local EMS system. For example, Orange County, CA certifies local emergency rooms as "Paramedic Receiving Centers") can have additional staffing restraints placed on them, such as requiring physicians certified in specific specialties through specific boards. In the OC example, EDs must be staffed by at least one physician certified by ABEM (I imagine that if it became an issue or the issue was forced, that it would be clarified that AOBEM would be accepted too. DO discrimination is against the law in California. California Business and Professions code, section 2453), or having completed an EM residency in the past three years (these physicians are known as "board eligible"), or an IM, FP, or General Surg specialist with ACLS training who devote a significant amount of time to working in the ED and fullfill additional CE requirements.

Probably the one for running code for patients who don't need to be ran code.

No. You don't run hot when running hot means that you can cause other vehicles to crash (such as forcing other cars into intersections against red). What should arguably happen more is more preplanning on the part of the driver. If there's a red light ahead with traffic backed up, switch to the opposite lane, if safe, and go against traffic (the other lane should have a red also, so there should only be a trickle of cars coming from turns) until you reach the intersection.

Wouldn't the better option to just allow the individual services to design (under guidelines of state or local regulatory bodies), order, and use their own PCRs?

I would argue that, in general, if you have the lights on you should have the sirens on regardless of if you are using an exemption to normal traffic laws or not. This isn't to say "always" (it's understandable with extremely light traffic conditions, late at night, etc to not have both on) have the siren on, however just the presence of the lights being on is going to change the driving environment and can cause other drivers to operate their vehicles differently.

They should have an AED on board. Also, why would they need a fire response once on scene? Paramedics? Sure, but why the fire department?

[biting sarcasm] Actually it's a wash. If the engine would have responded, they might have saved him, but the result would be the breaks failing on the engine. The engine would then crash into a building and kill the officer on the engine. [/biting sarcasm]

There's a few things to realize. The attendant can't push your foot down on the pedal. He can't force you to flip the lights on. The driver is the sole person in control of the vehicle. So if a situation presents itself where it's too dangerous to proceed (for example, I refuse to push cars into intersections against a red light. If that means an extra 30 seconds until I get a green light and traffic starts to move before I reactivate my lights/sirens, then so be it), the driver has the duty to shut down regardless of the wishes of the attendant.