Medic26

Each patient has to be decided on a case by case basis, I usually don't give ASA unless I'm pretty darn sure its cardiac in nature. Syncope and N/V is surely not cardiac enough on there own to convince me.

Damn Dust I like you more every day As far as giving narcs to belly pains, we still have alot of old school docs that have yet to see the light. But, we still keep plugging away and someday the old school will be us and what we do today.

Wouldn't you consider this a breach of the privacy laws? Don't get me wrong, I hate seekers but......

I have a cheap caribeaner that is attached to a keychain.....non-locking kind and in the last 5 years not once has it come off.

Short Board, I thought everyone burned them years ago. LOL

We have standing orders for fentanyl and morphine for isolated extremity trauma, burns and suspected cardiac pain. But these are very recent and we are so glad to have them. Had this question been asked 6 months ago I would have answered no due to no standing orders and frequent low doses ordered by MC when you actually did call in, 2 mg's of MS isn't shit when someone just had a hand chewed up in an auger.

I agree it is preference, but that being siad a 12-lead is usually done first then an IV enroute or on scene depending on transport time for that particular patient as sometimes we are 20-30+ minutes out. But I will usually perform needed treatments before going enroute regardless of transport time, as in CPAP or medications. I beleive the patients in most cases benefit more from us giveng them the treatments they need rather them having to wait for a 3 minute transport with 5 minute patient care transfer time then another 20-30 minutes before a ER Doc see's them. Each case has to be wieghed out. I also agree with the previous comment that an IV is not a treatment, most of our patients only get IV's "in case" we need to administer a "IV medication treatment". I am willing to perform a 12-lead first and IV second on 99% of my patients, but I was trained under the guideline of 12-lead within 3 minutes of patient contact for chest pain, etc.

Well lets see, In ACS or chest pain cases we are supposed to complete a 12-lead prior to any treatment including oxygen, personally I administer oxygen if the look bad or if they are in obvious distress. I also give ASA while applying the monitor to get that out of the way. As far as NTG in right vs. left CHF.............our protocol is NTG for Pulmonary Edema and chest pain as long as they have a pressure > 100 systolic. We have had this debate at our company because we have a PA (works for cardiology in local clinic) who is also a paramedic for over 15 years as well. He try's to preach the whole fluid instead of NTG, but our medical director likes us to stick with the protocol. If there pressure drops < 100 systolic we give them fluid anyway and withhold NTG.........problem solved. Personally I believe if you have providers trying to figure out Right vs. Left sided failure you will have incorrect or delayed treatments in more cases than you have now by sticking to the standard treatments. But, this is only my OWN view!

Once they get this bad there isn't much you can do but attempt to help with the tools you have.

Its funny this subject has come up now, services in my area have kicked the idea of getting our people CC classes for about 5 years now but nobody has done it. Most of our rural area services end up transporting these patients with little knowledge or experience. I am not saying this is right, wrong or indifferent........just that it happens due to lack of managements commitment to have properly trained staff. The most common reason for not sending our providers through this type of training is "too costly", "not required" or lack of willingness to compensate those who go the extra. Sad if you ask me.

This has opened up a can of worms in our region, some of the volunteer squads started getting out every time. But other has faded away and are being taken over by paid services. No matter how you look at it, BETTER PATIENT CARE.......doesn't matter if its a volunteer or paid giving it, its getting done sooner.

Its like this in many places, you can't blame anything but failing systems in these area's. In our region ALS units are almost always dual disptched with all BLS calls so by the time we get there if the volunteers have not crewed up, we take it in the MICU. I personally think that PRU's in the proper system would be a great advantage. I have/do work for services that utilize them in different ways and if administrators and policy makers understand the limitations of these units, they will work well.

Ditto

Pupil response, Skin signs, vitals and any other signs of drug abuse?

Our local law enforecment practices ABC's A- ambulance B- before C- cruiser

Spock, I was surprised to read the requirement of 2 ALS providers in order to use the facilitated intubation protocol, ours is and always has been written for a single provider....Then again our region has not had many issues with bad tubes or poor providers. Combitube use is almost non-existant but we look forward to the King airway being added to our units. The lasix thing was just a WTFO, we have CPAP anyway....used in conjunction with NTG we should have no problems. The only question I have now after reading them agian is.......why are we giving suspected stroke patients a NSS bolus? Maybe I missed some new study, but wouldn't this promote more intracranial bleeding in the patients who are having hemorrhagic stroke?

I have been told that this was a problem somewhere else in the state, as with everything else with progress comes headaches. Regarding the sedated intubation, we've had that protocol in our region for about 5 years but using versed 5 mg withed mixed results. I also now see that they have written in a requirment for capnography effective in 2008, another smart move.

Not really.... But this has been a long effort from what we where informed. Currently each region in the state has designed its own protocols and practices from them. Some of these are VERY different with regards to where the command line is. Some services have had protocols where they NEVER contact medical command, these are the folks (as we are told) that have held up progress with regards to state-wide uniformity. Improvements for our region is the addition of pain control above the command line in ACS and extremity trauma, the adition of phenergan, and the use of etomidate in leu of versed for sedated intubation (we hear its a much better drug). On the other hand, a few drugs we did not need command to give orders on before have to be given with medical control orders now. Most notable of these changes is in pulmonary edema......patients who are not normally taking lasix will now have to wait until we can get orders, instead of us being able to administer. We frequently have transport times > 30 minutes, so this will be an issue for us due to poor radio communications in some area's with no cell service for contacting medical control. Oh yeah....almost forgot. The state has added the King LT airway as an approved rescue-airway. This is big news.

OK for anyone that is interested......these are the new draft statewide protocols. They are currently in the final stage of the approval process. http://www.dsf.health.state.pa.us/health/l...protocols05.pdf Any of the yellow boxes are optional areas that each region can modify. For some of us this is a step up and others a step backwards. But at least we have a starting point to even the level of care offered and maybe be able to move forward.

Never did say it was an "acceptable" replacement for ALS, it is someone who can do more that is closer until a paramedic arrives. NOTHING MORE, AND NOTHING LESS. In this area BLS units can wait for up to 30-60 minutes until they interface with ALS, it would be nice if they could do more!! And just for the record, an EMT-I is not ALS in my book, just an advanced form of EMT-Basic. ALS = Paramedic.

Are EMT-I's vital in EMS.....In my opinion yes if they are used correctly. Of course a national standard making them the same in all 50 states would be helpful. I work in Rural PA where as we speak the state lawmakers are deciding whether or not to implement an EMT-I's scope of practice, as it stands now we have basics, paramedics and pre-hospital RN's (healthcare professionals as the state calls them). I do believe that this would be very beneficial for both rural and urban services if utilized correctly. The current proposal as I understand it is only the addition of IV's and an airway device like the combitube, as little as this is it may be a big help. Not to mention the addiotnal assessment skills that these providers may have from additional class time. Personally I would love to have an EMT-I as a partner, especially on those pucker factor calls at 3 am when its just me and my partner. I do work part time at a service that runs dual medics and what a difference it can be when time is critical, but not all communities can afford this kind of coverage.

Thanks for the information......as far as standardization, it IS our goal. Another point here, I have used both the LP12 and Zoll M's equally. They both have great features, but LP12 is not an option for us due to the fact that our old LP12 failed 3 times to deliver therapy in less than 2 years. It was traded in on our current Zoll's and NOBODy here will consider them agian. :wink:

I agree here, we just recently started using versed intranasal route when IV cannot be obtained and have had good luck so far. We were told by our medical director that valuim was not to be given this route under any circumstance!!

Its amazing how many homeowners have built things like this and never considered fire/ems!! :roll:

We always have one paid crew in house, if a volunteer is running they come to the station for the allotted time of there shift. Of course if we get multiple calls people are responding from home but even then the truck is out in about 5 minutes or less, sometimes we meet along the way and pick up the additional crew when this happens. We had an MCI a few weeks ago and all 7 trucks were on the street in about 10 minutes.