JPINFV

1. Well, using a pulse ox is just as easy as sticking a probe on a finger and reading a number, why not let basics do it? Well, determining a AMI is as simple as putting a bunch of patches on and reading a print out (12 lead, machine interp), why not let basics do it? Well, generalized trach care is so simple that a patient can be taught how to do it, why not let basics do it? Where do we draw the procedure/intervention line for providers at a level where the national "standard" (NHTSA) is 110 hours, total, can do? 2. If it doesn't change a providers treatment, why use it? What is an EMT-B going to do different for an unknown ALOC vs a diabetic ALOC?

Yes, leeches are used to increase blood flow in some cases and maggots are used to clean up some wounds. That said, the use of maggorts and leeches are not used nearly as much as they were 100 years ago, which was my point (used "for just about everything."). That doesn't negate the point that the standard of care has changed and the use of maggots and leeches are not even close to being as wide spread as they used to be. There is something to learned from seasoned providers. That said, if a lesson begins along the lines of "back in the day" or "when I first started," then it's generally a bad lesson. If that trick or tip was still relevent to current practice then there wouldn't be a need for a chronological qualifier like those. Not all tips, tricks, or lessons are created equally, and some do change or die out.

I actually try to force myself to speak quieter because of that very reason.

Aye, thanks for the catch

What exactly is the point of CMEs and following changes in medicine if we don't change our standards? What was right 10-20 years ago might not be right today. Similarly, what was wrong 10-20 years ago might be right today. Just because someone was around 20 years ago doesn't mean that they should still be providing care the same as 20 years ago. Similarly, a provider who restrains a patient supine is wrong because they are violating the standard of care (which is more than just a simple vote of current providers. There are way too many morons out there providing care to make me not care what an average EMT-B thinks) of today. Sure, it might have been the standard 20 years ago, but that was 20 years ago, not today. Otherwise we should be carrying leaches since they were the standard of care 100 years ago for just about everything.

I'll agree with not warning motorists about police once the speed limit is set to a reasonable level. When everyone, including the police, are going 15 MPH above the speed limit, then the limit is unreasonable.

Would you be happier if we used the words "standard of care" and "unncessary risk?"

Hushed up, yet posted on a public website? I wonder how many skeletons you'd find if you looked through all of the official sanctions pages for all the states.

A single layer of fabric, like a shirt, will not have any impact at all on the cuff. Now, yes, the bell/diaphragm should come in contact with the patient, but there are ways to do that without disrobing a patient at all.

Emotionally disturbed person.

Negative ghost rider. CHF is when the ejection fraction of the heart drops on one side. Normally the right ventricle and the left ventricle pump the same volume of blood over the same period (there are small variances over time, but it averages out. The big difference between the two sides in a normal adult is pressure), but if one side isn't pumping the same amount of blood as the other, the blood backs up into the veins increasing venous pressure. This increase in venous pressure can drive fluid out of the capillaries in the lungs at a greater than normal rate and it's this movement of fluid that leads to pulmonary edema ("fluid in the lungs") in patients with left sided heart failure.

That the patient is found upon arrival to the hospital to be hyperglycemic. This implies that the medic didn't take a blood sugar himself? Way too many short choppy sentences (the first two, for example, would flow better if the period was a comma).

Probably because the patient never actually left the emergency room. I can probably count on one hand the number of times on a non-emergent transport that I've taken vital signs before loading the patient into the ambulance. That said, I've never restrained a patient prone under a LBB either.

I'm sorry, maybe I'm a little confused here. On one hand, you want people to post on whether or not they support a rather politically charged policy proposal (for the record, I was the 3rd person to vote in the poll), but on the other hand you do no want any "political discussion." I don't see how you can have one without the other and it's not fair to not allow someone to justify their position in a post. What sort of non-political/policy discussion are you expecting?

Hehe, for me, at least, the decision to restrain is a final one and the patient won't be released until we arrive at, and entered, the receiving facility (assuming no extenuating circumstances).

It takes a lot to offend me and the first time I get offended simply because someone disagreed with me will be when I stop posting on internet forums. The biggest part of my argument wasn't the "emergency" part (that was more of a counter to people who say that psych patients don't count as an emergency), but that pysch patients are a type of medical patient. While I do agree that the number one priority is to go home at the end of a shift, there are risks of the job that are tacitly acknowledged by simply showing up. I'll go out on a limb here and say that police and fire fighters all want to go home at night as well, but that their jobs also are dangerous to a point that no preparation, planning, or training will fully eliminate all danger and risk. Now if a person is being violent not due to any medical condition (including, but not limited to, psychiatric issues), then I agree that the proper service is law enforcement. On the other hand, if a person is being violent due to a medical condition (again, including, but not limited to, psychiatric problems), then the primary service should be EMS with law enforcement assisting as needed.

Protocols: restraints PRN on patients on holds or who obviously lack the ability to refuse treatments (implied consent). Restraints should be 4 point, non-locking and have the ability to quickly release them. No handcuffs unless the police are either transporting with the patient or (acceptable, but not suggested) following behind the ambulance in the squad car. Leather restraints or nylon restraints are fine. No hog tie, restraining prone, or sandwich allowed (positional asphyxia. Hey, if it didn't happen then it there wouldn't be death, lawsuits, or rules against it). Paramedics do have the option of chemical restraints, as well I've transported many a psychiatric patient who was given a sedative immediately prior to transport. The county I worked in had zero rules requiring restraints, unlike a county next door (there, any patient on a hold was supposed to be given 2 point restraints as a preventative measure). Continuing assessment should include extremity checks for PMS q 15 minutes in addition to immediately after application of restraints. Personally, I do my best to not need restraints in the first place. If that means that I can catch a trigger (had a patient where any discussion eventually led to him becoming more agitated. That was a very quiet transport) and keep from hitting it, then I make sure not to hit the trigger. If that means that my patient gets an extra pillow, then he gets an extra pillow. A happy psychiatric patient is a quiet and calm psychiatric patient (you can't make all patients happy though). This also means that if the patient wants to go to a different hospital (for example, one 5 minutes further down the road) and the facility has no real objections, then I have zero problem honoring the patient's request. On the other hand, if I pick up a patient that is currently being physically restrained (say, hand cuffed), then I will continue restraints. This alone is the only automatic restraints situation that I can think of. Otherwise it comes down to the patient's actions/activity/state of mind, the report I receive from the staff/on-scene personnel (has this patient been violent? agitated? etc.) and how my partner and I feel about it. I'd rather not restrain if I don't have to, but I have no problem restraining if need be. Furthermore, restraints should be done properly. Best setup is 9 people (person to hold each limb, person for the head, and a person to apply the restraints), but this can obviously be cut down [significantly] depending on the situation, patient status/size, and who exactly is on scene. :steps onto soap box: To be honest, anyone who thinks that all psychiatric patients need restraints is an idiot. Similarly, anyone who thinks that all psychiatric patients need to go by police is also an idiot. There is a time and a place for restraints and a time and a place for police. Psychiatry is a medical field (medical, as in the second word in Emergency Medical Service), and there are psychiatric emergencies (emergency, as in the first word in Emergency Medical Service), therefor EMS is the proper place for these patients (proper place, as in primary service. Not to be confused with "don't draw upon available resources such as police). Law enforcement. Notice the lack of the terms "medical" in the name. :steps off soap box:

So are you saying that the news paper made up the quote then to fill up a line? Frankly, the story seems pretty clear cut. Mother with a fair amount of children including 2 special needs gets on the airplane with a relative. Parent+relative can't keep control of the kids. Airline kicks the group off at the next airport. Remove any one of those three elements and there is no story. Now throw in a quote from the mother saying, in essence, "Boys will be boys," and I don't think that there's really much left to doubt or hyperbole.

So am I not supposed to take a direct quote from the mother as gospel?

“The children were out of control on the flight you know, they were restless, excited and worked up and they are kids,” said Slaughter. And you're their mother. It's your responsibility to take care of your kids. It's not the airlines or the other people on the plane's job.

Kinda of a broad questions. Pretty much every company has a multiple choice test covering basic EMT-B knowledge. In addition, you are going to want to have a copy of your EMT-B cert, your ambulance attendant license, your DMV history printout, your DOT card (physical card), CPR card, and ambulance driver certificate.

$550 one time isn't bad. I spent about $6-700/year on books during undergrad.

Well, the VA can get away with it because they do have an emergency room. In the system that I worked in, you actually see in big red letters "No emergency care provided" at all of the non-acute care hospitals to warn the public that they can't go there on their own to get something checked out. Instead of an emergency sigh, most of these hospitals will have a sign saying, "Ambulance Entrance."

Albuterol doesn't dilate the lungs, it dilates the bronchioles.