sevenball

I may be the only one here who doesn't think that AMR will shut it's doors. Downsize dramatically, yes, but close it's doors, I don't think so. First off I think that the northeast u.s. division is doomed, they have been from the start. Western division should be fine. If you remember, AMR is owned by Laidlaw. Laidlaw is a Canadian company. I know the Canadian economy is suffering as well, but it's my understanding that it is still doing better than ours. I could be wrong, maybe some of your Canadian members would like to chime in on that. If AMR REALLY wants to stay in this for the long haul, they will find finacial backers in Canada, and they will survive.

Do you taste the themometer to tell if it's oral or rectal first?

I have to go along with the thought that the pump is the way to go. Yes, it's good to know the formula, every good paramedic should, but the pump almost eliminates med errors. Of course, they can still happen, but certainly the frequency of more common errors are eliminated. As for starting care inside the house, shouldn't we be following our basics first before jumping right into dopamine? How about trendeleberg position? If you wanted to move into advanced care, why not try a saline bolus. From there, you've spent enough time inside the house and are probably moving towards the truck. If you want to look towards dopamine, you'll be in the right place to administer it safely.

Isn't that what we are in our regular EMS jobs?

Vent, I am aware that the DOT does not license us. That is why I said that the DOT governs us. On the same note, the national registry does not license us either. The National registry only certifies us. To be "licensed" you have to go through a state agency. Yes, a huge flaw in our system. Perhaps an argument for another post. My thought process on this was that the DOT sets the standards for the national registry. Those standards were origianlly set forth in the white papers, way back in the sixties. My opinion, and only MY opinion here, is that there has been little in the way of change set forth by the DOT to modify those standards. The government has allowed each state to stray from the National registry, create their own standards, and run wild. Until the DOT can put their foot down, require all states to conform, and set forth new, advanced standards by wich the National registry must adhere to, then we are doomed to waddle in our own staleness. My thoughts were only to create a higher, no, highest power to which we must all march to.

Everyone is talking about change needing to come from our home orginizations. Aren't we governed by the DOT? Don't they make the rules for us? Why should we be so content on changing our small orginizations? Why not push for the larger picture. Anything less seems like paint spatters on a building sized canvas to me. If I change what my orginization requires for pre requisites, what is your motivation to do the same? Do you really care what I do? I think not. You'll just take all my lazy run offs who refuse to rise up and conform to a new world of EMS. Change needs to be a requirement, not an option. Education must be forced onto providers. I cannot simply tell my medics to get one, just as I cannot tell you to get one. However, if the DOT tell us all to get one, we have no choice. Unless of course you look good in a headset and paper hat. "Would you like fries with that?"

The way I see it folks, you've got it all wrong. I think that all your educational shortfalls, gadget wizardry, better mousetrap problems can be solved with one change. Reimbursement! Unlike our economy, the "trickle down effect" would work here. If we get enough reimbursement for the calls we do, then we can afford to pay the medics what we are truly worth. If we get paid more, then there is incentive to enter the field, thus the nurse comment earlier. If there is an influx of medics into the market, then employers can become more finicky in picking who gets hired. In order to get hired, you need an edge. What better way to gain an edge, then get the most advanced degree you can. That will encourage every person looking to get into pre hospital medicine to push themselves to the limits of our educational boundaries. After that, we can all hold hands and sing Kumbaya!!! Rock ON!

My service just introduced the bougie, or BAM stick to our medics. I've had extensive training on these, and it is my understanding that in clinical trials, the bougie had a 99.9% sucess rate when used in accordance with the manufacturer. As my education coordinator plainly states "We should be able to secure an ETT every time we attempt one, there is no reason we should ever fail to introduce a secure and definative airway. If that means coming up with 10 different ways to tube, so be it." That being said, it is my impression that if we utilize the bougie after a failed attempt, then there would be no reason to resort to a secondary means of securing an airway, ever!

congrats on your save, and welcome to the city. couple of things to help you out. First off, when it comes to the emtcity, you'll find that the majority of people on here are very analytical, inquisitive, and intelligent. Explain yourself well, or you will be called out. (take this from someone who has been there...several times) Second, when posting, try to break up your post into paragraphs, it helps the rest of us blind folk read it better. Third, when it comes to EMS and code saves, savor this moment, it doesn't happen often. In fact, I would venture to say that it would be sometime before you save one again, but much like the other folks replying to your post, I offer the same advice. Don't give up, continue to fight on and become a better provider. Enjoy yourself in the field, think on your feet with your head, and get a thick skin, especially if you plan on showing up around here often.

tell her to get over it, clear with a signed refusal... Kidding... Certainly isn't that simple. You could be faced with a cardiac problem (all non traumatic chest pains are cardiac until proven otherwise), You could also be faced with a pleuritic pain from the sneeze, you could also be faced with an aortic separation (although rare and highly unlikely), but you never know. I worked with a guy that fractured a cervical vertebrae because he sneezed too hard. the body is funky like that.

It seems the harder the economic times, the increase in drug related deaths... funny how that happens...

be yourself - Audioslave

" I swear she looked like she was just faking it"

You pull your glucose reading from a capillary source. When you introduce glucose directly into the blood stream, you can measure it immediately (almost). After a few minutes, that sugar gets distributed to where it needs to go. Creb cycle uses it, cells use it, some gets used to replenish the sugar stores, ect... you get the point. That is where you can see your dropoff. There is actually a formula out there that you can use that will help you determine how much D50 you can give to prevent a drop, I just don't know what it is.

I'm with you, it doesn't stop here either, but that doesn't stop some companies from running 24's and such. I can attest, it really does make you feel drunk by the time you're done.