Timmy

I know this isn’t much help but in Australia we have a workplace level 2 first aid course which is required for most workplaces, quiet a few people will do this course. Covers basic stuff like: -Calling for help and providing the right information. -Approaching an incident, dangers ect. -Burns -Bleeding -Fractures -Shock -Medical Emergencies (AMI, asthma, diabetes ect) -Unresponsive patients -Moving patients in emergency situations -Chocking -SAED -CPR -Soft Tissue Injuries -Infection Control -Legal aspects Duration is 2 days, total of 12 hours, mix of practical (mostly), theory (powerpoint) and written (workbook). The first aid side is valid for 2 years and CPR is valid for 12 months. It’s not at all clinical, the aim is to provide the general public with a common sense approach to an emergency. Take for instance, someone having a hypoglycemic episode their taught to recognize a few symptoms, call for helping and give a glass of lemonade. Or recognize that someone has no signs of life, set up the SAED and follow the prompts. Wrap the newspaper around someone fractured arm with slings ect. Any up to date first aid book from the red cross or similar should suffice.

Happy Birthday

The 44 different areas need to be backed by evidence based practice and data that needs to be presented upon review. The nurse unit manage and her accreditation team work throughout the 3 years to meet these requirements. This is how long it takes to develop what you’re presenting to the review panel and to answer there questions in a certain timeframe. I’m not saying it’s all perfect but it works pretty well. The Department has just closed 2 nursing homes in my state in the last few weeks.

I don’t get it Dwayne… You say you’re qualified, educated and comftable to perform an intervention outside your scope of practise and do so if needed but why aren’t you working for someone who will let you do this? You seem so contempt to practice out side it just seems strange that you haven’t perused a career that legally lets you perform to your level of education and confidence. You should be sitting down with your company and telling them you have these skills and feel confident to practice them onroad. Here in Australia Paramedics work to guidelines not protocols and we don’t have medical direction but that doesn’t mean they can go around working out side there scope of practice because they feel its needed. Our paramedics also complete a 3 year degree but have a lesser scope of practice on road to there level of education, this does not mean they can perform outside there scope.

I’m in the middle of a 3 months placement in a high care geriatric facility. This is ridicules! If this was in Australia and I walked into a geriatric facility described as you have my first phone call would be to the Department of Human Services to report the facility. In Australia geriatric facilities must meet strict government regulations and guidelines in 44 different areas all encumber 80 points which range from how the residences are treated clinically and as a person to how environmental services clean the toilets, no stone will be left unturned. I think it’s every 3 years a facility will be inspected but they may have multiple spot inspections within those 3 years. If you fail to meet these standards, depending on the severity they may give you a warning and set a timeline for review or they’ll shut you down then and there. A simple urine analysis would be ample for the time being, a quick preliminary dip stick test, a sample off to pathology and a quick set of vitals. Even if she had pain on voiding and other symptoms I doubt this would warrant emergency ambulance transport. I don’t know why they didn’t just make an appointment with the general practitioner. I would like to see the LMOs order for the ambulance. I’m lucky, our geriatric facility is attached/part of the hospital. We have all the equipment to deal with most problems that may arise and if not we’ll just transport them across the footpath to the acute ward. Our doctors are pretty cool with anything we want to do, we can take a pathology sample, send it to pathology and email the patients doctor who will then send a request. Its quiet sad to hear what is happening in some facilities. These residences are someone’s loved one, there more than likely going to die in this facility and they disserved good quality care. I get the feeling there is more to the story, so please enlighten us.

You have your opinion, I have mine. I don’t believe in breaking the rules, this applies to every practice in my life. I don’t feel comftable breaking the rules for one person. Lack of action may be but you’re still breaking the rules. If things happen to go pear shaped your, your senior medical crew and service may suffer from irreversible damage. If you’re not happy with the scope of practice your service currently has and you have the urge to practice out side of your scope of practice then why are you working for this company? Following the correct channels may not be so bleak. If you follow the correct channels post incident who is to say that a new intervention is not added to the scope of practice, in this case you and every other paramedic in your service may be granted this new intervention on the count of your suggestion, who knows how many lives it may save. Every medic has this new scope or it’s just a one off stunt that you’ve pulled to help one patient and you’re happy to fill in the paperwork? If you’re willing to take the consequences for your actions, no matter how server they may be, then I respect that. We both reside in different countries and have different experiences. I can see your point and respect your empathy towards patients but it goes against my morals and values. You appear to be clinically sound and I’d hate to see you suffer from the ill effect of a one off mistake, it would be such a waste. It will prove futile in any further debate as we are so strongly opposed to one another. Good day.

My comments weren’t directed at you, this is why I didn’t quote you. I merely used some points in my context of generality. To me, my scenario is not hollow. It may be hypothetical but I certainly am not withholding treatment, I will be treating a patient to my scope of practice. If your son dies because I’ve stayed within my scope of practice it would not phase me, I have done everything I could and done what is expected of me to the best of my ability. Sure, I may have a little guilt but what if I’ve made the situation worse? I’d rather the guilt of knowing that I’ve stayed within my scope, even though I may think I can benefit the patient by stepping outside my scope than causing further harm and not having a leg to stand on. There’s a fine line between emotions and common sense, if I’m stepping outside my scope of practice to treat a patient I think emotion may be playing a bigger part. If a medical professional has harmed a patient in my presence I will follow the proper channels in addressing this issue. Same goes when I’m treating a patient, if I feel I could benefit this patient in another way that is outside of my scope of practice then I will follow the appropriate channels and make a suggestion to the relevant persons to include such a skill in my scope of practice. I will need to show them that I am capable, well educated and skilled to perform such a treatment intervention. I will also need to show this relevant person some evidence and justify why I think this skill needs to be added to my scope of practice, it’s called being proactive, not just yahooing around stepping out of my scope of practice when I feel like it because I think it may be best in the spur of the moment. If I was to witness a medical professional practice outside of ones scope then I will also follow the appropriate channels to reporting this person for being negligent . Another question, if you have been trained to perform such a skill yet it is not include in your scope of practice why are you working for a company that is holding you back? This is medicine, don’t play with peoples lives.

There’s a fine line between ethics/humanity and what is to be done. Say you perform an intervention outside your scope to save one life, your found negligent, fired and de registered. Your company is having trouble finding another medic to fill your shift at such short notice. The following day there is a bus crash and because there short of a medic 4 maybe 5 patients subsequently die because you wanted to save one person. You can no longer work as a medic without registration and you end up working in a dead end job. I’m a caring person and I will do everything possible within reason to help you but asking me to step outside my ‘bubble’ is out of the question. As for going against medical direction, I think this is lack of respect. The person you’re talking to is there for a reason, if you want to go against there orders then why don’t you become a doctor? I work in a hospital, I see this time after time doctors making less than desirable decisions and us nurses knowing better. It kills me to tears sometimes when I see a doctor make a decision or perform an intervention that the nurses don’t view as the best option but I bite my tongue and go with it because I respect the doctors, I also wish to be walking though the hospital doors the next day. No offence, but if your company decided to sack you because you went against a senior persons then I have no problem with that. Everyone signs up to be a paramedic knowing what is expected of them, the rules and protocols, what is right and what is wrong if you step out of this variation you also have no self respect.

Interesting analogy, not sure how relevant it is to EMS. If you get a question wrong does he also make you go look it up and ask you again?

I’ve only been trained to use OPs, NPs and LMAs so I’m way out my depth talking about this as RSI/ETT will not be taught till I’m way older and have way more experience and education. I think common sense is severely lacking in this scenario. I’m not quiet sure what the patient is presenting with to warrant RSI but there are some no brainer things to follow. I haven’t been trained in RSI and only know as much as I’ve read in my spare time but administering a paralytic without a sedative (if I’ve got that right) just doesn’t make sense. Anywho, I agree with what’s been said already. If I was the patient I would sue. Indeed, I beat them away with a stick.

Good Lord!! :shock: :pottytrain5:

Hey Mar! Go grab the bamub'lance from the barn, we needa get down to ol Geroges ranch fast! Dosnt matter the road is slippey from ice, every second counts!!

If it was a family member/good friend I may. Defiantly not in a work situation. If something goes wrong you don’t have a leg to stand on, especially if the coroner gets involved, being dragged though the courts is not my cup of tea. Besides, you may save more lives because you still have your registration to practise lol…

I see..... :?

I've been on here for around 2 years, in this time this exact topic has arose quiet frequently. Has anything changed? I would have no idea, but from what is said on here it doesn't appear so. America holds its reputation as the wiz bang county yet some individuals refer EMS to that of a lesser service than some 3rd world countries. I really having nothing to contribute to this issue that could help solve your problem. It is a very hard problem to resolve and something a lay paramedic could not solve single handedly. It appears your government doesn't really have much to do with EMS and this may be the issue? Here in Australia our EMS and emergency system is government run and funded, each state has its own service, we don't have private emergency providers, the minimal entry level is three years of paramedic education, we do have volunteers but this does not effect the paid paramedics, our volunteers provide care in remote areas were it is not feesable to have a paid paramedic due to minimal workload. On the whole it appears to be doing ok, we do have a few hiccups now and then.

lol! I’ll elaborate just for you asy, casue your special I nursed this lady while she died from natural causes. Thanks everyone for your input. That doctrine proved to be an interesting read, thanks Matt.

One is never too old (within reason) to begin a career in EMS or indeed rekindle that spark to become involved again. I have a lot of middle aged individuals in my nursing class and there were also quiet a few in my medic class. They bring a lot of life experience, knowledge and advice to the group. They knew when to pull us youngsters back into line when we got sidetracked or preoccupied. I’ve been fortunate enough to be in a learning environment were most of the class worked well as a team and got along with each other. They also approach situations in a different manner when on road or in the work environment. Some of my closest friends are quiet older than myself. I say good on you for jumping back in and good luck.

You can say that again! :shock: Some of those videos are grossly inappropriate!

Euthanasia is a topic of discussion that is emerging in the Australian media at present. I want to know how people feel about this issue? My opinion: I’m currently working as a hospital based student nurse on a 3 month rotation in a high care/geriatric/palliative care facility. We have patients ranging from 23 year old with server brain damage to 90 year olds with advanced dementia. I’m pro euthanasia. If you had asked me this question 3 months ago I may have given you a different answer. I recently nursed a lady to death, this lady had been in our care for about 3 years. She was admitted after a server CVA, she could only move her eyes, she had a PEG line in situ and this is how we administered nutrients, she was a mess of pressure ulcers, break down areas and thrush to the point of bleeding. Despite our best efforts nothing would work. I used to go sit with her and hold her hand, if you sat there long enough tears would begin to roll down her cheek. I have no doubt in my mind she had some cognitive function and the amount of pain she was in would have been unbearable. There was something about her eyes, you could tell she was trying her very best to let you know she wanted to die. When she finally past, I wasn’t saddened but relieved that her suffering was over. We also have a 23 year old who was born with cerebral palsy, blindness and epilepsy. He was a still birth and was down for 45 mins, this left him with sever brain damage. He has very minimal cognitive function and sits on his bed all day waving his arms around, this is what his down for the past 23 years. When it comes to the point of losing cognitive function to the point of having no sensation to use your bowls, not knowing how to eat, where you are, who you are, who your loved ones are, incontinence, what comes from your mouth, how you act, how you lived your life, hallucinations ect then it’s time to go. I can’t begin to imagine what it must feel like to be first diagnosed with a condition like Huntington’s, dementia or Parkinson’s and know that slowly your life will fade away before your very eyes. I also couldn’t bare the thought of being admitted to a place knowing that this is the end, I will never leave here. I think the most confronting thing for me working in this area is knowing that this is how my life may end up… A world of my own, a world of nothing. This may sound extremely harsh but a majority of people who are residents at my work are existing not living. When is enough, enough?

There’s minimal information to make a creditable conclusion to this situation. I must admit, I did jump to the conclusion that the patient was indeed intoxicated. But who am I to conclude this? For all I know this patient could be hypoglycemic, hypoxic, suffering from a mental condition, closed head injury ect. I’ve been in plenty of situations were I haven’t assessed every patient. Do I treat/assess every intoxicated patient? No… I’m sure we’ve all been called to a drunken brawl outside a night club/pub/football match, there could be 50 patrons that have been struck in the head, chest, abdomen multiple times but I find myself drawn to the patrons supine on the ground or bleeding profusely. Out of those 50 patrons most will walk away, some will require police intervention and some will require ambulance transport to hospital, whether that be by a responsible adult or EMS. Out of the majority that will walk away, how do I know that one patron hasn’t been struck in the head causing a subdural hematoma? I do admit, I sometimes feel intimidated by a group of drunken youths grouping around myself and the patient. I have been in situations were the patient has presented to the ambulance after being assaulted at a concert or youth event only to have a mob of intoxicated youths following him and start fighting right in front of us. But touché, this situation appeared to be quiet some what different. Police were on scene. In a change of tune, if I was in situation depicted in the video, providing the patient already in the ambulance is quiet stable and consents to waiting I may do a quick assessment (neuro, BP, Pulse, SP02 and BGL) if this proves nothing out of the ordinary then I’m happy for PD to take custody. Every situations is different and each person will deal with it in a different manner.

:shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: What the!!! I’m speechless. But on the other hand, I question the credibility of this article… Is it a coincidence that “Clive Greedy” is eating celery?

My sentiments exactly. I failed to see why that douche bag needed an ambulance. The police were in attendance, they should of shoved him right into the back of a divvy van. Even after he head butted the ambo I doubt if he really needed ambulance transport. I also fail to see why the 2nd truck came belting down bells and whistles? Drunk and disorderly is hardly a medical emergency nor does it really concern EMS. Big thumbs down for waiting on scene.

To elaborate. Any Joe Blow off the street with some level of common scene can help control my bleeding, offer reassurance, use a break glass AED in the local shopping mall, preform chest compressions, support C spine ect; hell, I bet most people are capable of driving an ambulance. What Joe Blow can't offer is medications to help eleviate my pain, read my cardiac rhythm and administer relevant medications, provide advanced airway management, decompress my chest and so on. If I have something as simple as a # tib/fib you cant even offer me basic pain medication, you may be able to apply an air or fracboard splint but it's most likely going to make my excruciating pain even worse while your fiddling around. Your more than likely going to have anxious relatives asking you questions like “why aren't you giving my son something for the pain!!” While your telling the parents that your doing everything you can the patient begins to go into shock, you can't auto infuse because you cant give pain meds and you cant give fluids. The patient then begins to feel some nausea and begins to vomit but you cant give metoclopramide. See how a simple situation can turn quiet sour and all you needed was basic medications that are commonly carried and used on an ALS truck. Personally I'm paying $90 a year for ambulance membership, if I call the emergency number for the ambulance service then that's what I expect to have turn up, a fully equipped ambulance with trained paramedics who can do what ever is needed in a professional and timely manner. If I wanted first aiders to come then I'd call my mum or one of my mates who are advanced first aid trained, they can do the same as a basic and take me to hospital in a car. The service I used to volunteer with doing event FIRST AID had a better scope that an emergency EMT and we didn't deal with a huge amount of timed critical patients nor did we work emergency response or transport patients. We had everything you'd find in a basic unit plus S4 drugs and a few other bits and pieces of equipment to play around with. It makes me quiet angry when an EMT goes on about saving the paramedics and I don't even reside in America. Put it this way, in Australia a level 3 first aid course which goes for 3 days entails the same amount of scope that an EMT has. Level 3 first aid is the required course for most workplaces like factory's and offices. I fail to see the purpose of EMT basics in the emergency pre hospital care setting.

12 Pages eh... Hmmm... I wonder if anything constructive has been made of it...