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Lets put this in realistic terms for giggles shall we? Your called to a residence....possibly ??? a classic carpopedal spasm associated with hyperventilation. So just how does one treat this in the field ? Are there any presenting signs that may indicate this is your working DX ? Are there any possible differential DX that could be serious factors in your treatment ? squint scratches balding head......

HEY I sure hope we can get your problems solved here and soon ! I have to back to work in 2 days, and if I dared to tell you what EMTs and Paramedics wages were here your jaw would hit the floor, yes really, as I have said, fight the right fight. That is all. cheers

Are you Police State or Local...if you see where I am going with this again ? They are considered Essential, funding formula can change if it is mandated look up the food chain, not laterally. I may be misunderstanding you but 2 or 3 fly cars is redundant when one can put the Paramedic IN the Transport Truck....then Dispatch/Triage calls accordingly. You stated that the fly cars are profitable so who profits/controls this? Does the State tell the taxpayers how the funds are spent or should it be the other way around? A fundamental political science question is all.

logos: You beat me to the punch, seriously, a very good post and explanation, most probably better than my ramblings.... cheers. There is also "in a theoretical model" some consideration of the "Hamburger effect and Bohr and Haldane effects" and having influence in this odd phenomenon but thats making those nightmares of Chemistry come back again.... http://books.google.com/books?id=E9swm5ruD...mp;dq=hamburger +effect&source=web&ots=NLOj4cHlqu&sig=pmSKNQwut4dNNoQA-zNzCRJraoM#PPA240,M1

Ever see Midwifes sign, Docsilla ? Forgive my poor spelling in advance.... my evil twin made me spell that...te he.

An ALS tiered response then ? Triaged by whom....a dispatcher with a crystal ball? This is NOT a cost effective "in most areas" it is redundant, so explain to me why not put the Paramedic on the Truck ? Running another truck and a second party providing service when other's are not reimbursed for their time looks clear to me that its a rip off, no brainer. I believe with this information you provide, I do think your being dupped into believing this is a good thing for the longevity of essential care for your community. cheers... yet confused Best get after it I say!

YES for 2 of the questions you ask....unfortunately my proxy carrier has gone under deep cover and did not get back to me on the issues..... I think that she too maybe headed our east for greener pastures? Toba you say? :shock: Could it be that there is movement afoot to sway the brightest and keenest away from alberta...I have heard roumers of this! The point you make is good, but I have "heard of others" :roll: that have tried to motivate as well, yes of course become active in ones proffession if you want a future BUT there are many ways of acomplishing an objective, sometimes breaking a door down, sometimes political embaressment, sometimes just a gentle nudge. So I ask why then was a quarum not present hmm I wonder ? And if it was not then WHY did proceeding continue ? A sneaky go for coffee Bylaw perhaps, I bet my bottom dollar that if more proxies were carried, truely representing the memberships will or perhaps this bylaw were repealed then there WOULD be an improved attendance in place, this I bet $$$! Could it be that some past leaders of ACoP have failed to address issues important to the membership and focused on being Cops instead, regulation enforcement instead of advocacy? One must look back in time we were an entirely independant organisation and YES an association with vigour and true passion. One must understand that prior to the government's intervention or more like making the rules then basically "severing" the arm off that body to distance themselves perhaps an economic escape clause under the guise of "self governance" ? In order have "self governance" actually work there it is mandatory that an active and positive dialog is maintained...this I believe is why this College is recieving failing grades. The fact that ACoP has really no modern means at hand to deal with or communicate with the membership on a routine basis, sorry but the: agree, disagree, or agree somewhat type of questions just do not address the issues and are very open to manipulation. edit I suspect if the accounting types would listen to or be directed to change the calander year...this may be a very good start....well for those that are challenged by Christmas spending....oh those bean counters..... 8)

Oh yea nice isnt it ? But you can claim "penny for penny" association fees on taxes, what I love is the registration fees are due right when Christmas bills hit the fan....thats thinking about the membership too, try changing the buisness calender year end...now thats a positive step for the people that ACoP represents. Thing is just look at the Salaries of Audio, Speech Patho, Dental Hygenists+++ this is very poor justification for the EMR/ EMT/ Paramedic that works part time. BUT the thing that really gets mt GOAT is the crap that is "WE ARE THERE FOR YOU" ...really, I cant even get a straight answer from ACoP regarding records keeping for con ed. Now the CISM thang....Now thats entirely useless too, and the fine security measures to protect your records are a shameful, so where is the lesson plans, where does one make records and report presentations, in-services, mandatory courses +++++ Come on who has had real helpful cooperation from ACoP and notice once again the reference to HPA....ok then when then got a date yet ?

First off YES CYA, cover your ass legally, and dont talk to the reporters for the bs newstand crowd, big problems there too, look at all the fine print too. And don't undersell yourself cause it is a KEWL GIG, don't take anything less than the going payscale, or your opening the door to whankers and degrading the proffession.

An interesting post and very informed alternative view, but your talking pocket change Not a Concept: THE bottom line remains that the "ESSENTIALITY" of ALS Ambulance Operations is NEVER debated. So why is just the volunteerism from you folks down south debated at nauseam, I think your barking up the wrong tree entirely ! Yes, it is a factor in slowing the development of EMS granted but it is not surmountable, perhaps the first baby step, put it into the bigger playing field. So just for terms of reference/ comparison, just try paying the local Sheriff below poverty line and see what happens to your communities. Seriously: if I were a Volunteer and was offered any/some form of reimbursement for my time (on whatever level) I would be very pleased to augment any other income that I may have, its a start, but again that these Volley services are Essential to the welfare of the community and continues to go financially unnoticed ? Why do some states differ so radically? ps unfortunatly It happens here too. Even those that rely on Volunteers here receive "honorariums or tax breaks" granted a pittance but all in all a reward of some kind. Is it Socialism vs. Capitalism ? If that were the case then in theory you would be well paid for these essential services in the US. Now please don't get all crazy loonie on me and associate Socialism with Communism.... ONE is an economic state and One is a ideology, you Yanks get all heated under the collar with that type of stuff.... I can debate for hours and days the political science on this topic.... and I am not trying to hijack a thread here, I am not comparing counties either this is intended as a conceptual change in thinking only, EMS spans ALL borders. I do commend those that would further and support their communities in all of the other ways you mention, in Canada we are wholly dependant for Vollies in so many areas, just yesterday $250,000 was raised in one day for advancing literacy, over 2000 folks in one community alone volunteered to read to kids. Seriously, I think that in part defines our Country not saying you Yanks don't, but no where near the same level, these are serious cultural differences just across the undefended border. BUT there is very, very few Volunteer Ambulance Operations HERE so just why is that then? Yes true and unfortunately even in my "Country" in the majority of cases EMS Operations are the Bastard Son of Health Care, i.e. underfunded, and NOT identified as an ESSENTIAL SERVICE. EMS IN THE PAST just transport to the Hospital, i.e. ( I just love this phrase....rushed to Hospital ) or between facilities, but things can and do change, how about: The Paramedics rushed to the scene and stabilized the patient enroute....an entire attidude change is what is required. Now with the capabilities of actual treatment for the ALS provider i.e. stabilization of the cardiac patient, pacing, thrombolytics "they have put thrombolytics on Car in the UK in many places !" Treatment for 5 types of shock, the Asthmatic, shall I go on....nope. Point being that moving on down the road ALS Paramedics are making positive impact in decreasing mortality/ morbidity, so your saying that the status quo is acceptable ? If good reliable studies and research can PROVE this then ..... the door becomes unlocked persay, fight the right fight, I say. Why, say in large communities is ALS mandated and the Rural areas frequently forgotten, because I surmise that the volunteer service are in their happy place believing they are doing the right thing ? Simply BALDERDASH as these are the areas that can benefit the most when transport to Hospital is the longest... Good Gawd MAN we have it ass backwards! Dare to challenge the politicians, and that they could be held accountable for not taking steps to provide the best "standard" care available, put the thought in their heads that a "wrongful death suit" or the politicians were not "duly diligent" in proving standard ALS care to their communities, change the way they think, fear is a great motivator, Then again we do have a the trump card.....its called preserving LIFE! A communications Professor I had really changed my way of thinking when he introduced this concept to me: IF YOU CONTINUE TO THINK THE WAY YOU HAVE THOUGHT. YOU WILL CONTINUE TO GET WHAT YOU HAVE ALWAYS GOT. IS IT ENOUGH ? yes a bit cliché's, one can day dream or take action cheers

AK: I have saved your ass SO many times, but then that is my "volunteer job" as an unpaid helper to a Village Idiot. :twisted: Yes, I too would love to hear the story of just how a EMT basic has "SAVED" a Paramedics ass, there is that "Saved" word again, omg PLEASE explain. I am getting a wee bit postal myself now as Asysin2leads and Ruffems sooo just when does the squinting stop? Granted there are minor errors in judgement made at every level, but really Jen if this is occurring on a regular basis then VERY serious questions in regards to the competence of that "individual" Paramedic need to be addressed and not a general commentary that EMTs routinely assist in treatment modalities in patient care, so please stop the smoke, its tickling me arse. Bottom Line: an EMT is trained to be a linear thinker and that is not a bash in anyway shape or form, it has to be this way for "standards of care" with clear definitions as to scope of practice. In the Critical Thinker it is essential that a good solid grasp of physiology and pathophysilogy and current practices in medicine, hence ALCS. For example the EMT mantra: NEVER give Entonox to a abdo pain, I came across this one just the other day, so then ....... "labour is abdo pain" I said to my EMT ? Don't jump on me just yet as "absolute" contraindications @ the EMT level ie (abdo pain) can be "relative" contraindications on the Paramedic level.... and this Entonox administration is NOT a new thread ...just an example. (If some one wishes to debate this I would be more than pleased to present 20 + studies, pro and con, granted I haven't used Entonox in 5 years...I have way bigger guns than that but dependant on the circumstance it just might be the right treatment to implement) Dust: I too have made this error to by allowing a junior team member on whatever level to somehow believe that they are an equal partnership, an attempt to empowering that individual to feel a part of the team, "empowering" them has bite me in the ass on more than one occasion. NOW My word is the end all and be all on all call's, any disagreement and NO more MR NICE GUY. ps I stomp on bugs too. The entire concept of team building is really "nice" a warm, soft and a fuzzy logic so to speek, BUT the pecking order ( it works for chickens ) just has to be established from the start as there always HAS to be a TEAM LEADER. Ever hear in the military....ok all you privates lets talk about this and see what we can agree on to take this hill ! Bottom line as the buck stops at my ASS, it is not my helpers practice permit that is at risk its MINE! Somehow standing in a courtroom somewhere 'I just can't hear myself saying (Your Honour my "helper" told me to do it that way). For those that actually believe that they are saving a Paramedics ass on a routine basis .......... PLEASE get a grip on reality. Back on the real topic: After reading this it becomes very clear, you are not volunteering at all ! Your just not being financially reimbursed to advance yourself in the ALS experience and the more exposure you have to the good, the bad, and the ugly the better you will become, kudos, many folks out there would call this an unpaid clinical or practicum. That said: the individuals that offer there ideas and experiences to advance the profession on EMTCITY, We are all volunteers .......... So why do I feel impending doom? In Closing: I firmly believe that EMS is an essential service world wide and to those that Volunteer to staff a service "even in snowshoe" you have real power in the "threat of withdrawl of services" this is a grass roots movement and it is successfully changing in many communities to reimburse those that have the dedication to protect the public's interest. cheers

FYI: THIS IS GOOD NEWS:

Ventmedic: Your commentary is very true. Many of my patients have never read the "Cook Book" cheers

Well, I have done a couple of these gigs, for some very NOTABLE clients. The big ticket item is to assure that the company providing an EMT or Paramedic. Firstly has medical direction as a potential lawsuit could become a huge event, just think about say for example Jonny Depp with a suspected C spine injury...... Secondly: Assure that you are actually provided with ALL the toys, damn hard to administer anti arrhythmic drugs when all you have is a cheap AED and no screen to view. Thirdly: The local laws of that county, province, or even country should be well researched, as well as Medical Evacuation Plan to a chosen "pre approved" receiving Facility, many remote sites for filming have very serious logistics in an medical evac scenario, one should be prepared for confined space rescue, extraction, hi angle, water hazards wildlife and animal/actor interaction...and child actors.... as they bite too. One may find that a tremendous amount of hand holding is essential to success, on another note the expectations of the client MAY far exceed the scope of practice of the practitioner i.e. demanding antibiotics for cough and cold, or even be a waterboy. Some clients for example "high risk stunts" may want you to be watching every minute where others wish you to be in the wings on standby, without being seen by the Stunt guys as some are extremely superstious. ps MOST don't pay very well, due to the one having the "privilege" of having one associated with the glitz and glamour....this is supposed to be a reward in itself ?..... meh!

A very good teaching post, I must agree the idea of doing a surgical trach is definative and provides for superior airway when compared to all of the above, "adjuncts" a no nonsence positive aproach. This has always been the option available for myself but I have only ever needed to go this route on one occassion (on a small 14 y/o male with facial smash) in over 20 years as a para, this incudes 14 or so years in the air. Have used the EOA x 12 times in the dark ages before legislation ALLOWED us to "Tube" so going backward's is hard to swallow...no pun intended. In the MICU the bronch is the route to go, but that is huge pesos. cheers

The Bougie is MY favourite aid, and its cheap like cabbage like 10 bucks? cheers

Marty: One can find a scenario for everything and we should be looking at the BIG picture thing is about your scenario is your assuming it is a heroin OD, what if it is a mixed OD...and you just complicated an Airway capture opportunity? The real question in my mind is do we use alternatives in airway protection, when the real question is do we generally allow other groups to dictate and test their theories... a TECHNICIANS approach. OR do we assure a HIGH LEVEL of skill/ competency as a Paramedic Practioner, there is a huge difference here. As for basic levels having the ability and latitude to provide improved airway protection...hey I am ALL for that, because why you may ask....in most cases these are cadavers that they are practicing on....and a coarse as that may sound it will advance the more basic levels to promote better care in their communities. cheers

Firstly I have no idea where you have come to the conclusion that ETT (protecting an Airway is anything less that Definitive Care) many studies prove without exception that capture of the airway and control over the airway IS exactly the diference between survival and death. If your opinion was the truth why would we even bother to Intubate in OR or ICU, 75% of patients in the majority of cases due to complications of aspiration and resultant pneumonias, sorry to disagree with your opinion but it is seriously groundless. NONE of these rescue devices have claim to this, besides if your on the recieving end of a patient it is a serious complication to Intubate after any of these devices are used, and damn hard to set up a ventilator to ventilate these micky mouse airways, just try doing a Bronchoscopy via the LMA or Combi to suck out the peas and carrots, EMS SHOULD be part of the continuing cascade of care in health care..... not make it more complicated. Your assumption that most do not know how to ventilate nor preform this typically "monkey skill" set is frankly rather scary as these skills SHOULD be taught properly from the Educators themselves from the start. One could in conclusion, state that the Educators are the problem not the students....if one would want to go that far down that road. This is a very dark road that Paramedics should be disallowed what your forefathers fought for years to gain approval and advance Paramedicine. AZCEP: Your confusing comptency with a tecknique and devices made to compensate for lack of practice or skills....apples and oranges man, besides not all practitioners are short term care this is an assumtion as well, unless a 6 hour flight or 3 hour drive is considered short.

In My HOOD we tried so hard to actually be allowed to shoot an ETT, yet now I see an alarming trend to use rescue devices first, really it comes down to confidance and competency so one does NOT have to go this route at all. The ETT remains the definitive gold standard, bar none. cheers

In Conclusion: And no offence to climberguy, he has hat on the right way, just can't treat too much because his hands are tied up by ACoP. Timmy: it sounds like I have to cash in my airmiles and do a walk about, will you teach me how to speak OZ? cheers

OK; Now as far as I am concerned ..... oh btw I have worked for 5 years in the Patch, Movies, Hi Risk events, Blow Outs .....blah blah blah. Really throwing an EMR or OFA level 3 way out in the boonies and by yourself is absolutely crazy shit, besides the truth and advice from dust and others (so tell me that an First Aider can tell the difference between, food poisioning, a hot belly or a stuck fart)? Your so far out of your field it scary in most cases. And most of the ma and pa showes are just in it for the $$$$$ so make sure you have a Medical Director and Protocols in place or your hanging your ass in the wind, even the bigger shows slide by with just having the minimal gear. The EMR in Alberta does not do a hospital practicum, nor a clinical in hospital so take the rookie and have a wee trial by fire, ps there is a reason you have to wear a lid on these jobs.....NOW THAT SAID the Paramedic level too has no formal training in evaluation of the eye (corneal abrasion vs hyphema or what does Strep in a throat look like either. Now WHY are the EMR and OFA level 3 doing there in the FIRST place.....look way back at legislation in both BC and Alberta, OH+S or WCB, these idea's are over 20 years old WTF? when the oilfield rig manager or as I commonly call them an old rig pigs with a cell phone and still prevalent philosophy "GET BUDDY TO TOWN"! You are a legislated, must have, BANDAID (in ALberta as an EMR you can't even give anyone asa thanks to ACoP) An individual in a community that values physical work only, your status the lowest on the food chain, duties will include security watch, orientations to site (a pawned off responsibility from the company man) and my all time favorite LUNCH 911. Not the ambulance driving lifesaver oh that too has has been blown up way to many (insert part of the human anatomy used for excretion of solid wastes) as well, sorry off topic. OH+S and WCB is NOT a friend of Paramedicine....simple and its damn hard when an educated, multiple experianced provider of health care to walk in after the last 5 Bandaids screwed up and Try to change perseption and introduce appropriate care, when your asked "wheres the blonde eye candy we had last week" The due Dilegence laws ARE impacting the Topside Oilpatch Execs, but trying to implement this in the field is a tough row to hoe. ps The injured worker has an obligation to report injuries, the company that was doing that has stopped that type of safety initiative ???.....wonder who may have written a letter there, Oh and No way will I tell you that it was Precision or Nabors that do that. NOW factor in the boom and bust of this industry, dependant on world oil prices and the whim of the politicians to cash in, If your Lucky you will work half of the days that you THINK you will, then there is break up and waiting around for freeze up. THAT now stated I must quote again: REMOTE MEDICAL WORK IS NOT EMS!

Just my 2 cents...American on par now ! The LMA is NOT a good airway at all in my opinion at all....ever try to secure one and then come down 3 flights of stairs. These we designed for short term usage in ORs and are superior to the mask for short term ventilation, in the OR. Thing is that the studies done on the LMA are not the field, therefore the patients were npo prior to use, for EMS most patients eat 20 pounds of sausage and potatoe chips prior to arresting...i think this is an written rule? The piece of kit for b/u I want is a Bougie stylette. cheers

Is this "renegadism" rearing its ugly head once again? cheers

Yes ageed there dust or in teaching RTFQ...tater dude yes thats the whole point of this thread....High FiO2s CAN hurt the patient! your new so follow the whole thread...k? Ok now in "medic land" the application of a NRB is often called hi-flow, unfortunatly in Respiratory speek HI FLOW is defined as exceding the INSPIRATORY DEMAND of the patient x 4, this means inspiration, that is variable and dependant upon that patients needs, and can exceed 40 liters per minute ! RR (a biggy), the depth of breathing, = minute volume, sooo the if the I:E ratio is say 1:4, and the patients minute volume is say 10 lpm (typically someone who is in respiratory extremus) then do the math. No matter how high you twist that "thorpe tube" flow control (and it will deliver ~ 23 lpm on average) now even if the NRB baggy is reinflating with every breath, AND the mask is a good seal one is NOT I repeat NOT delivering 100% O2...sorry to tell you this but its true!this is a means of teaching in school, a very idealistic approach, but your not in school no more. OMG...don't tell me that your using really using these high flows on a bagger (ps This will deliver 100% and due to the resevour size not flows) BUT hear me loud and clear....YOU COULD BE AUTO PEEPING the patient, with hi flows going into the bagger then exhalation can be impaired resulting in IATROGENIC AUTO PEEP.....this can lead to a relative hypovolemia.....or as commonly called a PEA. If this occures in the comprimized patient ie lowered BP or no BP.....SLOW freaking down and allow for equilibration, like take your hand off the bagger for up to 90 full seconds...that said back to the originally sheduled programming. AntonyM83 : ...I like the way you think, nerdy logic LMFAO! but if your not getting decient Sats on 15 lpm with a NRB...time for da tube or CPAP or BIPAP 10 more lpm aint going to do it....although is is kewl to refill all those tanks or change out your Ds enroute to the gut wagon..... your not helping the patient if your delivering 25 one minute and room air the next. ps not spell checked off to work! cheers pppss...GETTO CPAP.....te he he.

Perhaps because we are not reading the posts prior? The point of the thread is that research "could" be indicating that high flow O2 may be detrimental to patient outcomes. Not specific to individual conditions as in WPW, this is a accessory pathway that is quite rare and the definitive treatment is obligatory surgery for thses pathways. It is highly unlikely that grunt or cough is going to be successful to convert to nsr .... welding may work. The thing is that welding in the field for this condition is a bit aggessive when the patient is awake and telling you of pain 5/5 and a query is just what level of Paramedic diagnosed this condition or was it PMHX that lead someone to believe that a 20 y/o with narrow complex tachycardia was WPW....looking for salvadore dali's "moustache" are we? But Bushy does have a good point, the windblown look is really svelt and very trendy........ cheers