JPINFV

It's not that PTSD patients forget about the event, it's just that they don't get the overwhelming memories coming back. Heck, why treat half the stuff medicine does if medication is bad? HTN? Sorry, lose some weight and get some exercise. Pain medication because you broke your arm? Well, just don't do something stupid next time, but no pain meds for you. Bipolar? Buck up Nancy and learn to control your self. Hmm, I couldn't imagine telling someone in either of those situations that a pill is the easy way out, but for some reason people think psychological issues are different and would rather perpetrate things like CISD.

The latest thread on PTSD brought back something I remember learning about in one of my upper-level bio courses (full disclosure: Dr. CaHill and Dr. McGaugh are both professors at my undergrad and the course I heard about this in was taught by CaHill. If trials ultimately pan out, could beta blockers be potentially prescribed as a prophylactic in the same sense as EpiPens and MDIs (start taking it following an event)? http://www.healthyplace.com/Communities/An...2006/ptsd_1.asp

People bent on doing bad things generally don't care if it's inconvenient.

In the county I worked in (ALS first response for 911 calls, no private company paramedics), the ambulance companies set their own protocol for a code 3/call medic (resp/cardiac compromise, internal hemorrhage, and imminent birth for mine) with the only county protocol to be to transport BLS is transport time is under response time. In general, unless you were calling calling medics or transporting emergent for insanely stupid reasons, there seemed to be little oversight past the company. It is important to note that for 789 sq. miles of county area (not all, but mostly, populated either) there were just over 20 hospitals with an emergency department, so short transport times are generally the rule, not the exception. For a "non-emergent" transport going to an ER, (a misnomer since probably a majority could be classified as urgent and a measurable amount could be considered emergent), I considered the entire patient. Simply put, chronically ill patients do not fit well into the boxes normally built by EMS officials and educators. Yes, it's nice to say that a patient with an irregular and borderline tachycardic patient should get ALS. That's nice, but considering the number of SNF patients that fall into that category (or, God forbid, an EMT-B actually puts the "Sick-Not Sick" CE patient assessment into use), the fire department would be run ragged. Due to those conditions, in general, ALS upgrades were based on how comfortable the crew was with the patient, and remember, ignorance is bliss. To add one final thing to the above, there are plenty of calls that warrant an ALS first response (abnormal labs is one of my pet peeves), but not necessarily an ALS 2nd response/emergent transport.

Dust, I think I've seen that picture someplace before... [spoil:2e74f91f3b][/spoil:2e74f91f3b]

No sharks? Sharks with laser beams on their head?

This:

Probably one of the funniest comments I've seen in a "What to carry/What steth do you use" was over at studentdoctor.net forums. An EM attending/resident (can't remember which) said that the steth she uses is what ever one the med student has.

No, just MRSA infected proximity badges. That said, it's much easier to keep badges clean, but its impractical if you go to more than 1 or 2 hospitals.

I think that there are one or two cities that use EMS based fire suppression, but it's rare, especially compared to the rest of Southern California. Also, the county has a list of chief complaints/assessments that non-911 companies are not allowed to take. By not allowed to take, I mean if a SNF calls an IFT for "Low O2 Sat," the IFT company is supposed to refuse the call and direct the SNF to call 911.

Schadenfreude To set up the scene since since I can't find one with video, the guy voice (Nicky) just got kicked out of his apartment and is living on the street in his neighborhood. The 'girl voice' is for the character "Gary Colemen" of Different Strokes fame who is the building's superintendent.

Let's not forget the code about the ER being crazy.

Strikes over with the only apparent concession being that the health insurance plan won't be touched until January '09. I hope the 4 days off were worth it instead of a counter offer.

Well, let's be fair about this. EMS can't even decide what to call a paramedic. Names for paramedics: EMT-Paramedic, Paramedic, Paramedic Specialist (from a state that calls EMT-I/99 a "EMT-Paramedic"), Mobile Intensive Care Technician, EMT-Advanced (while other states use an "advanced" designation for intermediate levels), Licensed Paramedic, and Mobile Intensive Care Paramedic. http://en.wikipedia.org/wiki/Emergency_med...levels_by_state Let's not even get started with the different names and levels for intermediates and the different names for basics. With 7 different titles for the EMT-Paramedic level (plus 1 intermediate level being called a paramedic), how can we expect the press to accurately report on our titles?

It's not always that simple, though. For example, I'm currently living in Boston for school, yet my area code on my cell phone (my only phone, for the record) is from Southern California (714). In addition, areas where phone numbers are running out are starting to adopt 10 digit dialing to increase the pool of phone numbers without forcing people to change phone numbers.

The only blame that I see being passed on to the fire medics is the justified blame against the ones who don't take their EMS job serious. Besides that, I see a lot of the "OMG, someone said something against XXX. I'm a part of XXX. Therefore, someone is saying something bad against ME!" The problem, though, is when you start seeing engines on every call. I'm sorry, but if I'm calling for paramedics while on an ambulance, a BLS staffed fire engine is not really going to help me out that much (which has happened enough to not just be a fluke). Also, if a system starts constantly sending fire engines to calls because all of the ambulances are tied up, then the solution is more ambulances, not more fire engines. It always seems, though, that the opposite happens. How often are news stories posted here about XYZ adding fire engines or converting engines to ALS to respond to medical calls? Finally, wouldn't it be more cost efficient (fuel, maintenance) to just split up the crew? Take 4 of the people off the quint and assign them to a SUV or pickup truck. If the quint is needed for a rescue or fire then everyone jumps into the quint. If people are needed for a medical call then 4 people jump into the SUV and off they go. If while out on a call (since the quint would be detained regardless) the quint is needed for its primary purpose then the SUV meets up with the quint on scene. So, in conclusion, sure, 90% of the problem with EMS based fire suppression has to do with management, but it seems that a lot of base level providers can't disconnect what is said about the system from what is said about them personally.

normotensive

Ok, I'm a little confused here. What good would bilateral needles do when the problem is air trapped inside the lungs and not air trapped inside the plural space?

Yes, let's all act like professionals please. Also, why not discuss scenarios that YOU put forth? You were the one that brought up the 400 lb code on the 5th floor scenario. Let's also knock off the personal attacks (i.e. "ASSumptions"). We're supposed to be professionals, not 3rd graders.

Well, with paramedics on site treat till ROSC or call the patient. It is impossible to preform good compressions while moving a patient and the time it would take to extracate to the ambulance and transport would be the final nail in the coffin for the patient. In the vast majority of cases, if EMS fails at resuscitation than the hospital will fail as well. Cardiac arrests don't get better with time. Do the police respond as well, just in case it gets violent? Yep, no one should say or discuss anything. That's the key to advancement! No discussion, no nothing. Just bury our collective heads in the sand. Well, if the engine wasn't needed at the MVA then why would it be released in a fire based system and not a single service system? Pick one. Either the truck is out on a call for both systems or available for both systems. You can't sit here and pretend that the truck isn't needed at the MVA in one situation and not in the other. I think you're failing to realize that Florida is just one of the more recent battlegrounds in the war between single function EMS and EMS based fire suppression in this country. It's a topic very worthy of discussion, but there's no point in talking to someone who just wants to ignore every comment with "You're not here!" or with scenarios that the alternative fails to address as well.

1. What are you doing transporting a "workable code" if you have a medic on scene. Shouldn't they be, you know, working the code? 2. So every medical call gets a ladder truck now 'just in case?' 3. We shouldn't challenge the system because it's styled in a manner to your pleasing? Strange how the IAFF and IAFC don't share the kum-by-yaw approach when challanging non-fire based EMS. 4. What's stopping your ladder truck from being at an accident at the time of the call anyways? Oh, fire based EMS doesn't respond to accidents now? Alternativly, is it because fire-based EMS decides that instead of buying more ambulances (the things that actually transport patients. See Chicago's New Years Eve incident) they buy more fire suppression and complain about the ambulance wait times.

But that's the point. I want to say that it'll be extremely hard to miss a big diesel truck or van pulling up with a bunch of shiny lights on it. It would almost be like the paramedics had to sneak up in a blind spot to the back of the ambulance. Damn you, you sneaky stalking paramedics.

I can't think of a single ER in Orange County, CA that doesn't have some sort of "lock" on it. Of course the quality ranges from a simple button near a door that is unlocked half the time to an intercom with video cam that requires you to be buzzed in by staff. Most of the locks are key pads, but over half of those use one of 2 combinations that are fairly obvious if you've spend longer than 5 minutes in California EMS.

They've saved as many lives as Chuck Norris' tears.