JPINFV

Emergency Medicine is an established specialty. What they are looking for is to make EMS (wouldn't "prehospital medicine" be a better name?) a subspecialty of Emergency Medicine. Kinda of like how cardiology is a subspecialty of internal medicine.

To be fair, DCAPBTLS is the most useless acronym ever. I first heard it and thought, "So you want me to look for trauma injuries? Got it."

...because NPs and PAs don't have any physician oversight (or "collaboration")?

Basically this. When you have two providers pulling a multi car Chinese fire drill with grins from ear to ear, it's not practice. This is play.

Why?

Office of Emergency Medical Services New Jersey Department of Health and Senior Services P.O. Box 360 Trenton, NJ 08625-0360 If you wish to file a complaint, you may contact OEMS at (609) 633-7777, Monday through Friday, from 9:00 a.m. until 5:00 p.m. Situations that may warrant the filing of a complaint include, but are not limited to, the following: * Unprofessional and/or unlawful conduct or care rendered by a certified EMT-Basic or EMT-Paramedic; * The rendering of care by an individual representing himself/herself as a certified EMT-Basic or EMT-Paramedic, when in fact that individual is not certified; * Unprofessional and/or unlawful care rendered by a licensed MAV, BLS or ALS service provider, including unfit vehicles; and/or * The rendering of services by an unlicensed MAV, BLS or ALS service provider (excluding volunteer ambulance, rescue and first aid squads) http://www.state.nj.us/health/ems/legal.shtml Why is it so tempting to make a phone call on Monday?

Why not an anklet? It's in a harder to reach spot from the patient's view point, easily covered up with a sock to prevent more playing with it, and there aren't other warnings (like allergy, fall, patient ID, etc) on the ankle. Now it's just up to educating the providers to check the ankles while initiating resuscitation (you can always stop resus if an anklet is found).

Then you need to clarify that you are talking about your specific facility and not the entire US. It is next to impossible to make any blanket statements about DNRs and advanced directives in terms of prehospital care because of the vast variation from location to location in terms of protocol.

It is patently untrue that you must have paperwork present in addition to a bracelet in all locations and/or at all times. It is highly location dependent and anyone who makes a blanket statement in terms of honoring DNRs and advanced directives is most likely to be wrong. If someone is wearing a DNR bracelet and ends up not being resuscitated, then that is the risk they take for making such a bone headed move.

I think you really need to look outside of your area. Quiz questions: "Do you agree that most Americans do not know EMS requires a Nonhospital DNR Order?" Well, when I was working in So Cal patients did not need a prehospital DNR order. "Have you ever arrived at a private residence and was told the patient was a DNI/DNR, but because the family could not “Find” the Nonhospital DNR Order, you had to start CPR? " There are places where, either via standing orders or online medical control, that would be a DNR despite the lack of physical paperwork. There are also established companies that provide a DNR bracelet service, such as the Medic Alert company. Again, in So Cal one of these was recognized as a valid DNR and the prehospital DNR paperwork (note: There is a prehospital DNR form available in California, it's just not required to be used) included instructions on how to receive one. I currently work and go to school in Massachusetts where they include the stupid "We will only recognize our DNR form (Comfort Care/DNR verification form)" rule. That said, there is a paper DNR bracelet that can be printed out and worn for quick identification. http://www.medicalert.org/Main/AdvanceDirectives.aspx#dnr Link to Orange County, CA EMS DNR protocol which takes a more liberal approach to DNRs than most areas. http://ochealthinfo.com/docs/medical/ems/P&P/330.51.pdf

I wanted to respond to the rest of this, but needed to go get lunch first after clarifying the "cult" quote. Maybe I'm giving EMS too much credit than is due, but I firmly hope and believe that most providers at any EMT level (B through P) understands that more than one condition can be present at any one time and that conditions can present in multiple ways that may change the appropriate treatment. Essentially we're down to the education and job requirements question. If EMS is to be simplified down to a "give every patient a NRB at 15 LPM, c-spine any trauma to the body, head, or neck and for any mechanism that could cause injury to those regions, splint any limb that hurts due to trauma, and transport ASAP to nearest ED with lights and sirens" then we can train EMTs in about 5-10 hours since the only thing needed is motor skills and we can cover all of the "what ifs?" under the current scope of practice for basics. The alternative is that EMS providers need to be educated to the point where they can make proper assessments, can design an appropriate treatment plan, can justify that treatment plan, and are empowered to implement their treatment plan. Until that time we're currently either drastically over educating or drastically under educating current prehospital providers. Otherwise EMS treatment (especially basic level treatment) is going to be contingent on cute sayings (treatment ABC (lights and sirens, NRB for all patients, c-spine for all patients, and a few others) doesn't hurt anyone, so why would you consider withholding it?) and what I've come to call "first mover education" (i.e. the first person, regardless of level, to talk to a new provider about a disease process or treatment plan that wasn't covered in class. Generally when a provider justifies a plan by saying "Well EMT/Paramedic/Nurse/Doctor John Doe once told me to do this and he's really smart and knows his stuff!"). Sometimes those are the only places where studies can be done. How hard would it be to get IRB approval for a study that basically says, "We want to study something that has always been done, is expected to be done, and by most accounts is a logical treatment." I understand the concept of comorbidity and hope most other EMS providers understand the concept as well. Maybe I'm a little too hopeful, but it's a known character flaw of mine.

Sorry, I was referring to in EMS with that, not in medicine in general. Where else in medicine do you see text books saying that the 'indication for a nasal cannula is that the patient won't tolerate a NRB?' Where else in medicine do you see protocols that say every patient that enters the care of a provider gets placed on oxygen?

http://www.emtcity.com/index.php?showtopic=14530&hl=

Vent, that's all well and good and all, but if you look at what was highlighted by Dr. Bledsoe it was mostly cardiovascular diseases (stroke, ACS, cardiac arrest). I don't think very many people in their right mind would argue that EMS shouldn't be using a NRB for patients with respiratory complaints (outside of, arguably, post cardiac arrest, but that also goes back to induced hypothermia, as mentioned). Either saying all patients need a NRB or only patients in extremis as backed up by assessment tools should get a NRB is throwing the baby out with the bathwater. As I'm sure you're well aware of, supplemental oxygen has gotten sorta of a cult following as a cure all for everything from respiratory diseases (where it is very well indicated) all the way down to leg pain. As with any other intervention, I think it's important to flesh out exactly where the intervention is helpful and where it isn't with science, not the hairs on the back of some tech school EMT with a GED teaching an EMT class with witty saying. Should we discount spinal immobilization studies that show pain, skin breakdown, and other side effects because those studies normally look at the intervention over a few hours while most patients who are immobilized aren't going to be immobilized nearly that long?

Ah, and the cycle of EMS providers advocating emotional based medicine over evidence based medicine continues.

My dad did that once. He was trying to be lazy and make only one walk around the pool adding acid and chlorine. It didn't take long to realize just how stupid mixing those two chemicals together after the fact, but thankfully this was done outside.

Brakes failed while returning to the station. One fire fighter killed. Yes, the ladder truck was on a medical call.

Come again?

This not the way to get a little a head of the competition. I do feel sorry for the anchor, because it sucks when slips like that happens. Fellatio.

Too bad people don't think about that when it comes time to approve that new tax/fee to support the local emergency medical system.

Meh, why not just ban it until they are 18 a la smoking, alcohol (21, thanks feds), etc. Besides, this is just just deserts to everyone who wants socialized (free) health care.

As much as I believe that the proper path to citizenship for illegals is to go home and come back the legal way, I can not justify reporting an illegal immigrant found while on duty nor can I justify not treating an illegal.

How often do you think that FF driving the IFT unit is going to be asking for permission to drive emergently?

I'll add a few more to Doc's list. CPR mask but no AED or anyway to actually bring back ROSC C-Collar: So how long are you going to keep your patient still?

Who is John Galt?