JPINFV

Actually, I prefer to not use a lock. It's much better to just let the patient bleed out as it gives the EMT something to do (clean up the unit) and gives the patient a treatable problem. [start IV in other arm, run fluids]. /sarcasm

I'd rather be the raped ape.

I'm pretty sure that, for the most part, we aren't talking about AEDs or SAEDs.

The more you know...

Basics are on ambulances. Basic level ambulances respond to "emergency" calls for service [accessed either through the 911 system or directly through the company's dispatch center]. Basics show up and decided, regardless of if basics should or shouldn't be, if the patient needs paramedics and/or emergency transport is needed. Deciding not to call medics on a patient who needs a medic is a good way to kill a patient through inaction. Emergency transport presents a risk/reward relationship to the public at large (how big of a risk to the public is allowable for how little of a reward to a patient). That sounds like a good reason to provide a high level of oversight at the EMT-B level.

I work in such a system (County wide protocols) and it works great, if you don't expect much involvement at the EMT-B level from the medical director. The only actual written protocol for basics is when to call medics which no one follows ("moderate medical" and above require paramedic escort. Moderate is defined as a patient who "needs definitive care, whose vital signs deviate from normal, or symptoms/complaints of medium severity." That describes most nursing home patients and it would simply cause a mess if all of the basics followed it to a T by calling 911 for every patient that was being transported to an emergency room. 911 is paramedic first response though). Of course, this means that there is no medical director chart review at the basic level either. That is left up, for better or worse, to the individual ambulance companies. Unfortunately, outside of a PUM style system where all ambulance personal are within the same system, you will either have a regional protocol with more providers than one medical director can reasonably monitor, or you will have different services utilizing different protocols and with different procedures.

Wait, you've seen someone revived with little to no neurological deficit after being in arrest longer than 20 minutes including a significant (minutes) portion of time without CPR that would be required to carry the person down steps? Was it Jesus?

I guess I should be scared because one of the students in my class is on an insulin pump that is worn like a pager. OMG, the GERMS!!!!111oneonelevenone

Does anyone have any actual data on the actual transmission risk (similar to the risk of HIV transmission in a needle stick. Note: HIV risk from a needle stick is 0.3% (percutaneous), 0.09% for mucus membranes, 6-24% for Hep. B, and 1-10% for hep C. (Hep is going from an infected patient to a non-immunized provider)*) for transmission from provider to patient? It would be interesting to know how much of this is based on science and how much is based on hand waving freakoutery/emotion. There is a distinct difference between a 6-24% risk/needle stick incident for HepB and a <1% risk for HIV. If the numbers are similar, it would be interesting to compare transmission rate of needle sticks to ambulance collisions when transporting or responding with lights and sirens. *transmission risk is from the E-medicine article "Needle-stick Guideline". http://www.emedicine.com/EMERG/topic333.htm

Well, there are some legitimate medical tests that... [link safe for work]

Mass stupidity makes my head hurt.

What exactly is any drug going to be doing in a patient without CPR happening? I can't imagine that stopping resuscitation for several minutes while carrying a patient down the stairs helps your area's save rates.

Hate to be hijacking this thread, but why is any system having their responders carry patients in cardiac arrest down 4 stories?

Foramen ovale

But if you turn on the unit's AM/FM radio...

Rectum? It sounds like it damn near killed him.

Personally, I don't. Sure, it can be adjusted by taking a point off of each criteria to make it out of 12, but I see that just as cosmetic.

It seems to me that the original poster's local situation is that each service has their own medical director, and thus their own protocols. Due to this, there is a hodge podge of different skill sets offered (as well probably different educational standards as well, all of which at least meet the minimum standards) and thus the system feels fragmented. To me, there doesn't seem to be a clear cut answer. On one hand, every service should have a medical director to insure proper medical oversight. The only way to accomplish this would be to allow each service to have their own protocol based on their medical director's philosophy (or else I could see the medical director as viewing his hands are tied on patient care issues). On the other hand, regional protocols unify the treatments provided in the region, but at the same time cuts down on direct interaction between the medical director and the field staff. Simply put, there is no practical way for a medical director to develop relationships with field personal when s/he is overseeing numerous services of differing levels of care.

It's similar to the providers who don't qualify a non-verbal trach patient's verbal score for GCS. I learnt (not in school, unfortunately) how on one of my first RT calls (1 with a circled T. clarify in narritive) because it seemed, well, so misleading.

Well, there are heartless, spineless, brainless bastards out there. We know them better as lawyers.

There is a pretty good argument that it is in the best interest of the company to do so (provided that, prior to the break, the employee was a good employee). By "having the employee's back" you send a clear message that the company is investing in its employees. This should increase moral and increased morale will lower employee turnover, absenteeism, etc, while increasing employee investment back into the company (employee feedback, more people picking up shifts, better documentation, taking better care of the units, etc). Now, I'm not arguing that the provider might very well need to leave the field, but that doesn't mean that there are no placement options, especially depending on the provider's level of education. Liaison positions, education, quality improvement, and other non-field, but field related departments that might use a good provider.

Ah, the ad hominem attack. Best saved for when you have no real response to an argument. Do you understand why people, including some EMT-Bs on the site, are against basics being sole medical providers?

Do you have a better term for people who get paid to do a job and be on call? Is it different than the system where the response time and crew composition is dictated by who ever felt like answering their pager today?

Well, to be fair, the placebo effect is a well documented phenomenon.