Timmy

Certainly not a current trend in Australia...

You'll be fine! I always threat when it comes to Math, I'm completely useless at anything involving numeracy! Just remember the formulas and don’t panic. I wrote out the formulas on a card which clips onto my lanyard and always carry a calculator, just in case.

Us Aussies are fine Did not effect us. Havent heard from the NZ guys yet, news says only minor injuries with major building damage

I can’t find any literature to link concussion and effects of heat and I certainly have not heard of such a case. As you would know heat is a vasodilator so it’s not uncommon for an individuals blood pressure to drop and to display such symptoms as you mention secondary to exposure to the elements and heated environmental conditions. Generally speaking, symptoms of a concussion normally subside within a week or two and can sometimes be accompanied with other neurological symptomatology but with ongoing symptoms you need to investigate further into a possible minor ABI or closed head injury. I assume the patient had a head CT after the incident occurred? The only other suggestion I can offer is maybe the patient sustained some trauma to their hypothalamus, but you’d tend to see uncontrolled temperature regulation in both hot and cold conditions.

LOL! You my friend are what we Australians refer to as a Tosser… So, if you came to Australia you would give way to emergency services? because: A: You WILL be issued a penalty notice. B: Police can pull you over without probable cause. Just because your not issued with any pentiles in America doesn’t make your actions right!

Police dont need probable cause to pull you over, probable cause is not relevant in this situation because there isnt a warrant for your arrest, the police are merely doing a roadside check and if they find a fault with your vehicle you will be charged accordingly, the same as any road user, its all perfectly legal… If you fail to give an RBT then youll also be arrested. In Australia, good luck trying to sue the police for such a petty cause… Its a state government authority, hope you have a mountain of money and some good lawyers. Your cause is futile. Australian Road Laws: Giving way to police and emergency vehicles (1) A driver must give way to a police or emergency vehicle that is displaying a flashing blue or red light (whether or not it is also displaying other lights) or sounding an alarm. Penalty: 5 penalty units. Note 1 Emergency vehicle and police vehicle are defined in the dictionary. Note 2 For this rule, give way means (a) if the driver is stoppedremain stationary until it is safe to proceed; or ( in any other caseslow down and, if necessary, stop to avoid a collision see the definition in the dictionary. (2) This rule applies to the driver despite any other rule that would otherwise require the driver of a police or emergency vehicle to give way to the driver.

Initially I thought this thread was a joke until you posted the second time. Obviously something has triggered your stand off antics, care to share? I find your post very immature and quiet frankly you’re posing a risk to the community. While not every call is timed critical there are on the odd occasion patients who require urgent medical attention in which seconds do count (i.e serious bleeding, cardiac arrest, sever asthma and so on) so by every immature and idiotic behaviour you display towards an emergency vehicle your denying a human being the right to live. We had a similar situation to what you describe a year or so ago, we reported this individual details to the police, this individual was issued with a fine and every time the police see this vehicle it is pulled over, the driver is given a license check, RBT and the vehicle is inspected for any faults – this still happens a year on. It takes two to tango mate, you play the game and will play back even harder.

I still have my green VU overalls with yellow 'student paramedic' epaulets. They should have been issued with the overalls and with the sexy yellow pants, yellow tabard and white hard hat lol

I’m not familiar in regards to your health care system were you reside but there should be more resources available for this individual. Having been part of a discharge planning team it seems a little bizarre that no services apart from EMS and a home care nurse have been put into place. Speaking in Australian terms here but hoping you guys have a similar program. This individual has a chronic illness which requires multiple and continues admissions for treatment so he falls into the criteria for: Case worker – to oversee his care, resource funding and implement programs to assist in his optimal healthcare. Ideally a case worker should have been appointed by the discharge planning team at the hospital upon discharge considering their diagnosis and on going care needs. There should be funding tools available like HACC (home and community care) which provides funding for an individual who are fail, old, young with a disability and carers. There should also be some form of funding available for people with a chronic illness. Also, I assume you’re an ALS car? Being in a rural area I’m sure your recourses are stretched, is there any non emergency transport services available for permanent bookings? I think it’s a little sloppy and negligent that the nurses, knowingly discharge this patient who is at high risk of falls and further injury without at least trying to implement some form of help. I state knowingly because a paramedic has spoken to the RN about the issue yet they haven’t acted upon it… Discharge starts at admission! In all honesty if that was one of my patients when I was working in community health I’d expect the RN to make a referral to us based on the comments of the paramedics or general observation (EVERY patient should be assessed by the treating RN upon discharge to see if any further services are needed or if acopia will be a problem) Once the referral is received we have an interview with the individual and family (if applicable), ask some general questions about coping and management, based on the interview we might send in an assessment team (Community Health CNS, Physiotherapist and Occupational Therapist) to assess the patient within there normal home environment, there coping methods, nutritional status, hygiene, access and mobility and general activities of daily living would all be assessed. From there the team would report back to the case worker who would then source and implement the appropriate funding and interventions. It sounds as though your patient is not as ambulate as he would like to be? You state having to use the stair chair every time you pick him up and he lives on the second floor… This is not acceptable, if this man requires two paramedics to get him outside then what normally happens? His isolated to his unit? Not ideal at all! You could approach the local community services but they might come back and say you haven’t followed the food chain (referrals and the like). One option could be refusing to transport back to his residents based on safety issues, tell the RN you’re not taking him back unless they can guarantee his safety. The best option probably is to remove him from the current situation. If this mean placement in a low care facility then as much as he won’t like, it’s probably a safer option. There’s also other options like independent living units and the like. Most people are very apprehensive in regards to moving into care but I’m betting this man is socially isolated and maybe a little depressed so moving into a facility which is low care may be a good option. Once the situation is explained to the patient about what services are available and what low care facilities are all about there generally cautiously optimistic and willing to give it a go. I’ve had many patients in a similar situation to yours who are socially isolated and the general situation is less than desirable but there pride is very much intact go into care and very much enjoy it. There given privacy, independence but assistance if required, there social situation is very much improved and often there health status improves. A lot of people fall between the cracks but it only takes one person to activate the system and the patients situation improves, there is help out there, keep at it!

Yeah I know and it pisses me off too… I’m no expert on ambulance and I’m happy to be corrected but generally speaking an ACO is normally paired with an ALS officer? And CERT is generally backed by an ALS crew? It’s not like we have CERT officers transporting patients to hospital? At some stage during your transfer from the scene to the hospital your, generally speaking more than likely going to come into contact with at least one ALS officer? I’m broadly speaking here because I understand some remote areas have double ACO crews, resources are pushed but I don’t work in the industry, you do and you would have a better idea of what’s happening than me. It always comes down to money over lives, I see it with you guys and how hard they push you, I see it at work with doctors and nurses who should no longer hold a registration but if we say something who will cover those shifts, I see Personal Care Attendants slowly migrating into acute care, Div 2s working in ICU, NEPT transporting high acuity patients, St John covering insanely high risk events in remote areas and so on… It’s all very disheartening when you go to Uni, get all hyped up about best practise, putting your newly learnt skills into practise and being lectured about all these wonderful things that supposedly happen. I read the nursing journal about all the promises the government makes in regards to more healthcare professionals, better education and training and better pay only to go to work the next day and find everything comes crashing down into a underfunded, under resourced, under staffed and kayotic mess. Anyway, I’ll shut up now before I dig myself a deeper hole lol…

I wasn’t having a go at you but the whole situation just seems crazy. From what is said on these forums in regards to the American Healthcare System you guys just seem so hell bent on hard, cheap and fast providers. You have EMT Bs running around doing emergency medicine and Medical Assistance running around administering dangerous and addictive medications to people with no understanding what so ever but its ok because the doctor ordered it! Not good enough! It doesn’t matter if the doctor ordered the Morphine the fact is the Medical Assistant is administering an injection so they are ultimately responsible for what happens to that patient. Doctors give me medications orders all the time it doesn’t necessarily mean they’ve actually examined the patient, like you said, they can just be within the same premises. On the morning rounds the doctors have a quick 20 second look over the chart, ask the patient to take a deep breath and cough then scribble some new medications onto the chart or simply just give a phone order based on our nursing assessment of the patient or in some situations prescribe without even seeing the patient. You’d be pleasantly surprised how many doctors actually prescribe medications that are not indicated in a certain situation, prescribe medication when its not needed or prescribe medication that will interact with another medication, how can you possibly advocated for these patients when you have no idea about A&P, clinical assessment or pharmacology? How can I maintain a professional registration when I’m administering medications that I have no idea about? You need to take accountability and responsibility by having a basic knowledge on the medications you’re administering to provide this patient with an optimal outcome… If this means taking a minute or two to look the medication up in the drug handbook and have a quick glance over its action, precautions, interactions and adverse reactions then that’s what needs to be done. If I’m not comftable in giving that medication to that patient then Doctor Jones can give it to the patient himself but at the end of the day if I give a medication to a patient and my initials are signed on that drug chart then I have to be 100% certain that I’m not causing any harm to the patient and that this medication is the right medication for this patient. I could be in ED with Mrs Smith who’s been brought in with a fractured NOF, I do a quick assessment and report the finding to the doctor who’s within the same building or even ascertain a phone order because there is no doctor on site. The doctor orders 5mg of Morphine IV or IM STAT and will R/V the patient when his free. So I go ahead, draw up the morphine and have it checked by another RN, we then make our way to the patient with our 5mg of morphine but wait, Mrs Smith is a frail of lady who weights in at 30kg… Do I: A - just give her the 5mg of morphine because that’s what the doctor ordered. Or B – use my clinical judgement and education and say hang on a minute, if I give Mrs Smith this 5mg of morphine am I at risk of sending her into an altered conscious state or even respiratory arrest because I know her small body mass and metabolism will not cope with such a large dose and maybe I should just give 2.5mg now and 2.5mg a little later? I’m not saying we live in a perfect world were there are no medications errors, fact is errors will always occur but we can’t come back and say we haven’t had the right education because were provided with ample opportunity in both our undergraduate training, graduate training and continued education programs to gain knowledge on what ever we want. If we haven’t had the training and education then I strongly recommend not doing it.

I’ve just had a quick look over the website from a local college, it appears there is a course designed for LPNs who currently practise within a maternity unit or will be workplace supported to practise in such an area. Looks to run over 80 hours, plus clinicals covering - Anatomy and Physiology, Labour and Birth, Post Natal Care, Care of the Newborn, Breastfeeding, Discharge Planning - At Risk and an Overview. We did have new borns and mums transferred back to us for a few days of observations, I use to go into a mild state of panic every time I had to check the new borns vitals, attend to it or even pick it up, I think just handling the baby was my greatest fear! It always amazed me how the Midwives could just handle it like it was second nature. Who knows, maybe someday I’ll take the Midwifery course… Me too! Seriously, one night a lady came into ED with abdominal pains, I opened the door to let her in and her waters broke and I think mine did to!

I agree, in my LPN training we did maybe one lecture (3hours) on maternity. Even in my RN degree it doesn’t look like were going into great depth about delivering a baby. There’s a Graduate Diploma of Midwifery program here which runs over a year if you already have your Bachelor of Nursing and practising as an RN, this course entitles you to register as a Midwife. Unfortunately I must admit I’d be one of those young nurses who stood there like a deer in headlights, it happened a few times while I was working at the rural hospital. We had a on call doctor who had no obstetrics experience and would pretty much refuse to deliver a baby because of insurance. We were also lucky if there was a midwife on the shift so generally they were whisked off by the ambulance to a larger facility. Generally we’d have a lot of people present with bleeding during their first or second trimester, we also had a lady unfortunately pass away due to an ectopic pregnancy but we never delivered a baby while I was on shift. Things like preeclampsia, breeching, postpartum haemorrhage and so on send me into a head spin because I really wouldn’t feel confident in dealing with said emergencies. I’m also not at all familiar with the pathophysiology or pharmacology behind obstetric emergencies. Whilst midwifery and delivering kids is not my style at all I know I must ascertain at least some basic knowledge in the area because it’s enviable that one day the situation may arise.

Yes Yes I know lol... I've never really paid much attention to those threads because I'd never seen the show.

Holly Cow! My volunteer event standby first aid service is more equipped and trained to deal with an emergency than an emergency EMT in America. Were the lowest providers on the food chain and there’s no way we’d be allowed to responded to a 000 call or transport a patient to hospital. Most of the members are health care students (trainee doctors, nurses, paramedics, transport officers, physios and so on) or are retired from the above professions who are looking for some exposure and experience or want to keep there BLS skills up to scratch. We have different levels and scopes of practise but it would be a rare occurrence (in my area anyway) that we didn’t have at least an RN or advanced first responder paired with a first aider at every event. The advanced first responders and healthcare officers carry Methoxyflurance, Salbutamol, GTN, Adrenaline, Glucagon, AED, OPAs (talk of LMAs and 3 leads being implemented, already being carried in some areas). To become an advanced first responder it’s over 200 hours of training spread over a year and a half to practise at that level. I disagree with people taking comfort in anyone just rocking up to help because frankly, why should I get better care at the state lawn bowels pennant or the local school fete than an emergency call within my community? What’s wrong with having an all ALS system? For the most part Australia is ALS and intensive care, we only have BLS in areas were it’s not viable to have full time ALS (remote, rural, isolated settings) but the BLS crew does not transport and are always co responded with the nearest ALS crew. The difference here is our service is funded by the Government which sadly isn’t the case in America.

I hardly think giving Morphine is a menial task! There's a lot to take into consideration when giving it, as I'm sure your well aware its a very dangerous medication...

I’ve said it once, I’ve said it a thousand times - having BLS in emergency pre hospital care is irrelevant. When the public calls the emergency number (000, 911, 999 and so on) they expect a competent professional to arrive and deal with whatever there presentation happens to be, they do not expect someone who has basic first aid knowledge and can provide minimal care both on scene or whilst in transit to tertiary care. Like my headline thing at the bottom of the pages suggests sure, you may be able to deal with any medical eventually BUT it must fall within certain parameters before your knowledge and skill starts to reach those parameters and you don’t have a great deal more you can do for the patient until you reach further care or further care comes to you. I can assure you were I come from BLS is covered within the first year (of three years) of a paramedic degree. I can rest assure the paramedics are more than competent of managing my airway, controlling my bleeding and all those BLS skills BUT I also know that once those BLS skills have been preformed then the paramedics can go onto ALS care if it’s indicated. I live in a small rural community. The demographics are something like a population 6000 based around a farming/industrial industry. We have 2 ambulances, of which one is staffed by 2 ALS paramedics and the other is spare. Our hospital is a 30 bed acute care service with a 3 bed emergency department with limited medical imaging or resuscitation facilities thus most patients are stabilised (as much as they can be) at this facility and transported to a base hospital which is an hour away or by air to Melbourne. Now, let’s make things simple here, say tomorrow I fall over and fracture my leg. I call 000 and have confidence that the attending paramedics have adequate knowledge in anatomy & physiology, patient assessment, pharmacology and all things Basic Life Support AND Advanced Life Support. So once they arrive they can assess me appropriately, provide adequate analgesia (methoxyflurane, morphine, fentanyl and even midazolam if I give them too much cheek) then they can splintmy limb appropriately and get me to hospital. Now, in America in a town with a similar demographic area… I might get a group of Volunteer EMTs who are attached to the local Fire Department who can not offer me analgesia, they can split my limb causing more pain and transport me for over an hour to the base hospital with no analgesia. Which option would you take? Now to the topic at hand. I do not agree with BLS members doing ALS skills, there not qualified and there would be no insurance. I’m a registered nurse division two (LPN), were registered the same as a registered nurse division one (RN) but we have separate scopes of practices, roles and responsibilities. Were regulated by a governing body called the Nurses Board and our code of ethics and policy come from an organisation called The Australian Nursing and Midwifery Council, dare step out of place and be dragged in front of these people and your up the creek with out a paddle. I’m also a second year RN student but I CAN NOT practise out side of my scope of practise as an LPN even if we’ve been marked competent at university for it, this is what clinical placement if for. The whole point of clinical placement is putting your theoretical knowledge into practise in a controlled environment under the supervision of a higher authority. The same would go for an EMT who is a student paramedic… As much as I’m extremely keen to further my knowledge and practise at a higher level and scope of practise there is a process and this process must be completed over time. I’m also only 20 and want a long and rewarding career in healthcare so I’m not going to put my self at risk by doing silly things. But hey, just my opinion.

The other Monday night I endured 10mins of an American TV series called ‘Trauma’. I can’t believe they broadcast such rubbish! No wonder it’s on late night TV lol…

Not at all, I've never meet you or worked with so so I don't pass judgement. Not at all, I've never meet you or worked with so so I don't pass judgement.

Your comments remind me of my younger days on this site! I was 16, had basic life support qualifications and got a little over excited/naive on many occasions. I do, on the odd occasion reflect on my past posts from many years ago and feel nauseas at some of the stupid things I wrote but appreciated the blunt advice given to me by senior providers on this site. I then became a student paramedic and my world came crashing down! It appeared that in reality I knew nothing at all and soon learnt to grow up. I’m now 20 and have a Diploma of Paramedical Science, Diploma of Nursing and front line emergency care qualification and I still know nothing… I’m also a second year Bachelor of Nursing student and still dread killing someone in an exam because I don’t have enough knowledge… In reality I’m never going to know it all but I’m doing my damn best to become the best health care professional I can be and to provide the highest level of care to optimise positive patient outcomes. After next year, providing all goes well with the nursing degree I hope to start on a paramedic degree. I’m only an LPN (I think that’s what you Americans call it) I really have no experience, defiantly have minimal ALS experience. I’ve worked in a sub acute hospital for 18 months doing my Diploma of Nursing through hospital based training, as soon as you mentioned anything ALS everyone went weak at the knees. I’m trained to cannulate, insert nasogastric tubes, insert LMAs, catheterise and so on but rarely get a chance because the RNs frown upon LPNs doing anything above basic patient care. They’ve only recently improved the LPN training to run in line with the nursing degree but most RNs refuse to acknowledge our existence. But when I think about it, what would I want if I was sick? A young LPN with 2 years training or a RN with a 3 year degree and graduate education? Back in the day I thought my volunteer events first responder service was the bees knees, now I spend most of my time bickering with our headquarters about improving our education, training and recourses because quiet frankly, the quality of some first responders is laughable. I still volunteer with this organisation, in fact I’m actually a manager… You ask why? I also asked my self the same question when I was assessing a group of Nuff Nuff’s in there vain attempt to gain a basic resuscitation certificate (AED, BVM, OPA) running around the room like a pack of morons, they clearly had no idea or understanding and subsequently didn’t pass. Perhaps I’m fighting an up hill battle in thinking I can make a difference to the quality of education, skill and person who is given a uniform and placed in a position of authority only to have the State Paramedics laugh in our face every time they come to transport a patient a hospital. I now only roster my self on with members who are competent and have some idea on how to provide good patient care. I mean, this organisation has some pretty major event contracts that are worth BIG bucks, yet they don’t have the number of volunteers to staff such events which means they let the Nuff Nuff patrol out of there box…. Don’t get me wrong, 90% of this organisation is ok, we do have quiet a number of well known Paramedics, Nurses and Doctors who volunteer but it only takes one Nuff Nuff to screw up all the good work. Then I look at the American system, your emergency EMT’s are less qualified than our volunteer event standby first responders so maybe things aren’t so bad… So in conclusion, I’m sure what I’ve written is pointless but I can speak from experience… Having BLS doing emergency care is not the best move. There needs to be a greater level of education and training to be fair to the people your providing care to.

Could you just narrow down what you mean by partial quadriplegic?

I say thank god we only have Advanced Life Support and Intensive Care Paramedics were I come from!

My comments are not to be taken into consideration in your circumstance, this is just based around a scenario that you have presented. Again, you need to speak with the treating MD. To be very brief and in layman’s terms: NSTEMI is a Non ST Segment Myocardial Infarction. Non occlusive, small blockage of the coronary artery. I haven’t examined the patient so I can’t comment on the appropriate treatment. Non Q Wave clot is usually non occlusive or is only temporary so some damage to the heart muscle occurs. Troponin is a cardiac enzyme, it elevates when there’s damage to the heart muscle. 0.86 is only slightly elevated. Hyperlipidemia indicates a high level of lipids (fats) in the blood stream. Hypertension A-symptomatic – high blood pressure with no symptoms. Cardiomyopathy is a cardiac disease which causes deterioration to the myocardium (middle layer of the heart) Ejection Fraction is the amount of blood pumped from the ventricle with each heart beat. Not familiar with Akinesis or Hypokenisis so I won’t comment. Mononitrate is a vasodilator. Can be used for angina and hypertension. Is this the only medications the patient is on? The above is quiet a substantial cardiac history and leaves quiet and number of co morbidity’s which can place the patient at high risk of further cardiac events, flying can be stressful especially for older people, it may raise blood pressure or cause a DVT… But I won’t comment on whether or not I recommend flying because it’s not my job, just making you aware of the risk factors… Ruff beat me to it

Hi UglyEMT, While we understand your concern your questions are best not answered on an online forum, you need to discuss your concerns with the treating doctor. Take care and best of luck

I agree, there are backup methods there... Do not blame the equipment when you have failed to provide basic care and assessment.