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ALL Swift Water Rescues are inherently UNSAFE. You never without the proper training, experience, gear, to jeopardize your own life to potentially meet your maker (whom ever that may be) Unless Heroism or Martyrdom is your end game. Or I will get a call (from God or his designate) to go find your beat to rat shit body. Reach, Throw, Row, DON'T GO ! http://www.saw.usace...ater_safety.htm

Curtesy of PNN news http://www.paramedic-network-news.com/ http://www.cbc.ca/ne...g-kootenay.html Well as we let AK and Ruff sort out Gods involvement (in another thread) we are seeing an alarming trend here with drowning's during swift water rescue, hence one must logically must address cause, in case one this all dependant on "reporters" and some "conjecture" but both were called "trained" so just who trained them would be my first question, is that the famous International 3 course and golden accepted standard ? I personally have a fair amount of experience in this area and have been involved with many real rescue situations in SW, Open water and Heavy Seas (more being in the right place at the right time that said) and I do NOT have that "ticket" in my plethora of cards in my wallet. Recovering the bodies, well I have too much experience in that area ... so what to do ? So what is going on, is the training received delinquent ? Or are the rescuers not following the established safety rules ? When I was involved as an Instructor in this area .. Lines, Lines, Lines they can help or they can kill you. No intent to disrespect the lost but to rationally deal with this issue one must put emotions aside and address the root cause, point being we can learn from others tragic mistakes and typically / statistically 3 errors are made before a fatality occurs.

Bummer .. but don't knock the perkys .. I have been known to eat them like pezz LOL ... weeeeee ! Yup you would be a great instructor .. and gimme a call any-time bro.

Curtesy of PNN news http://www.paramedic-network-news.com/ http://www.cbc.ca/news/canada/british-columbia/story/2011/06/30/bc-sar-drowning-kootenay.html I have some personal information that I cannot disclose in regards to the Workplace BC investigation .. I will say if you do not have a means of eliminating "all hazards" then just do not go.

For those interested some links. The conclusions I take away from this is / are: the lower risk group of bleeding in trauma, because of the "high numbers" of that group statistically have the greater benefit over the higher risk groups, although in the high risk groups those with a systolic pressure < 90 and greater than 4 units of blood also will benefit, with very few adverse effects (best to watch the you tube presentation) This from Ian Roberts is "considered" as Massive Transfusion. (~ 15:30 minute mark on the Ian Roberts presentation) I can tell (in the ICU I worked) that compromised end organ perfusion and > than 10 units (this included cell saver or autologous blood salvage inter-operatively was included in "totals") ( inter-operatively and post operatively anything greater than ~ 20 units ) was defined as massive transfusion, the blood bank would be calling the unit and getting ethics committee involved. http://www.google.ca...=UTF-8&q=CRASH2 I do not know if this pfd can be opened (had a tech glitch with this one) http://download.thel...7361160278X.pdf

oops my bad ? ... dang those scrubs .

This is a "to follow" new treatment and because of the cost has the potential of positively affect many lives .. especially in 3rd world humanitarian zones. kudos ERDoc

Dear Ruff: I am so very sorry for your loss. This was part of my Fathers eulogy ... I hope it helps, even if just a bit. High Flight Oh! I have slipped the surly bonds of Earth And danced the skies on laughter-silvered wings; Sunward I've climbed, and joined the tumbling mirth Of sun-split clouds, — and done a hundred things You have not dreamed of — wheeled and soared and swung High in the sunlit silence. Hov'ring there, I've chased the shouting wind along, and flung My eager craft through footless halls of air. . . . Up, up the long, delirious burning blue I've topped the wind-swept heights with easy grace Where never lark, or ever eagle flew — And, while with silent, lifting mind I've trod The high untrespassed sanctity of space, Put out my hand, and touched the face of God. — John Gillespie Magee, Jr

Yes that MUST be correct .. FF are the most sexist .

Most Excellent Find Mike. Sure nice to know EMTCity is part of Sidewinder's hit the afterburners to supporting OUR troops and please never to forget the contracted Paramedics in the SandBox. another version of Rolling in the Deep, Angie will be a new house hold word very soon. A comment on youtube :How much better can it get than a good looking military women in camos with a knock-your-ass-over voice with heat strapped on her leg? HUA ! Here's one for Richard .... rendition of Empire State of Mind. Rumour has it Sidewinders first CD profits will go to the Wounded Warriors Project ..

And hear, I thought, this website was about EMS, not the poor down trodden FF that can't make the cut. PARTNER WANTED : One that does not speak for his/her "people", will consider green skin, 3 hands, one eye in back of head and can pass or exceed qualification exams. cheers

Unless your intubating for primarily "respiratory" reasons, the post-intubation ventilation target should be to match the pre-intubation ventilation status. The easiest way to do this with what's described is match ETCO2. The patient will need support, as you've significantly raised the patients WOB. Really have you with a tube has WOB really significantly raised, nope IMHO you have protected an airway. Whoo nelly ... I just read this and am under the influence or the dreaded pirate grog, Caribbean rhum ... but most seriously. Ok so this patient needed Airway protection with a GCS of 3 .. good with that, ETI awesome, stay off the VAP it is the proven gold standard. I would concure with chbare that PS or sensitively set trigger for AC would be the best way to match the WOB, and ETCO2 and well with a GCS of 3 not bucking the tube the patient is telling you something .. that said are you using long acting paralyticis i.e. Roc, Trac, Roc or Pav as one could screw up and plumet PH and increase Co2s something in DKA you really don't want to see. But you don't have an AC trigger on a vent Yup wean his O2 down to maintaining sats of > 93% ... really no need to hyper oxygenate, as Dwayne suggest's we are Hyperoxia is that the best case senario ? but certainly sure, 5 of PEEP is physiological. Paramajgc is also correct: re: ETCO2, If I could add its Minute Volume not tidal volume and RR. The dangers of leaving this patient breathing on his own are much greater. If you had a PEEP valve on your BVM and could try to synchronise some support with their respirations you may be able to support them, but I have always found this to be rather difficult. zactly ... watch the "duck valve" very closely and support as required in lou of the non long acting paralytics as they may be a complication to good patient care. When the rhum wears off will follow this thread suspected DKA, serousy is not an easy, simplistic topic. cheers

Agreed chris .. much to do about nothing .. if you have fur like a bear the wife will definatly not mind if when having chest pain steps are taken to cover all the bases in good patient care.

I blew a hole in my credibility ... interesting that. Although I did change my avatar as I love looking for Pirates to walk the plank, har har my dark well hung beauty .. you have been hoisted by your own arrogant petard. Should I apologise to hutsy or perhaps get back on the rails with this most valuable topic ? Care to positively contribute to the real thread crotch or continue your "the machine was wrong" "I am right and you kilt a patient" LS said it best ... Kill em in the classroom so they live on the streets. NO one has ever said it better in my books, sure wish I could staff a fixed winger with LS as a partner... we need that attitude up here in Kanukistan. crotch well not so much ... but a black friend in LA Acadian EMS FTO (call sign zantelhunt) thank my god I know a great paramedic that just so happens to be black as well as EMT-B saint Mikey and Videl, and Ferguson Kennedy in the Commonwealth of Dominica who would put you to shame dear crotchety in there knowledge of "bush EMS medicine" OMG thats the rhum speaking I so hate when that happens !

Yes happy very confusing with the multi thread jacking going on by you know who, point being in this thread was that high blood glucose in the perfusing MI patient is a predictor to outcomes it statred out as an excellent debate hell even this old bastard learned something from a "rookie query" .. where it went from that was "treat the patient not the machine" whatever really. So its open season on any topic now Absolutely incorrect .. that's your thread High Jinks as is your provocative no such thing as PTSD, just weak of mind, then mercury used as preservative causes Autism, then of course your favourable ME thread Whitey put me down. ERDoc has suggested that we don't respond to crotch's delusional musings .. personally the knee jerk posts that crotch makes and my responses is not as a result of any annoyance its more ... well ... as quoting Charlie Sheen .. It simply amuses me and entertainment value. Please crotch keep it up, I have lots of time on my hands to respond to your irrational rants, I enjoy blowing holes in your vast knowledge of EMS. cheers

edit for a contextual change.

Interesting that when your "scenario" presented the unconscious IDDM and not thought through clearly as evident now.. ie the "normal V/S " and a very pithy example IMHO most clearly an attempt to support the view that your "machine" is incorrect and the historical treatment of "treat on speculation" is the gospel to follow. Yet now you introduce yet another scenario, a pathetic "call-out" for help me prove my point <sniff, sniff> and "I know what I am talking about" and rookies do not, yet another jaded opinion. Fortunately and clearly these "rookies" are looking at a far bigger picture, not an emotional knee jerk response and personally I have never had a false positive high reading from new state of the art glucometers .... but then ask for help from god himself, well good luck with that. The tread did progress to the point that hyperglycemia was a predictor in survival rates of the AMI, was very informative and enlightening, until our beloved crotch derailed the train once again, believing only in 2 colours, black and white and ignores that shades of grey is more often than not "the typical presentation" of most patients that we are called to treat. So just push on spec a half amp of D50W (btw 1/2 is not in my guidelines) claiming that the machine was wrong, on a CVA and see how that works out on arrival to ER, a missed dx and incorrect treatment ... just saying . In light of the STEMI non STEMI perhaps a new or previously unrecognised BBB ? (the sidebar) then the 12 lead field ECG "interpretations" by non cardiologists, agreed entirely this is part of the picture only and why I am a huge advocate of serial bedside Troponin CPK Myoglobin.. yet another tool in my toolbox (that I have learned to trust) before pulling up the TNK. cheers ah remember the day when an IV on a chest pain call was just a "lifeline" and never a volume of fluid be permitted .. the wonders of modern science and the improved understanding of left vs right ventricular infarct, this when banks were never open past 4 oclock .. those were the days.

No argument here .. We are so PC its retarded, because we feel so guilty because that our political forefathers treated so many, so poorly 200 years ago, or maybe just too much back bacon that makes one insane ? Two wrongs never make a "Right"

Not in Canada, a white >40 y/o Male (Euro-Canadian) protestant, is not included in our Human Rights definition ... pitty eh ?

Doesn't that define racism ? Do the exam papers have a spot (where one puts in ones name) that asks "what colour are you" ? STATEMENT: Hiring based on gender, ethic origin, religious affiliation (or headdress) based on the breakdown of " the aforementioned" is without a shadow of doubt, political correctness at its finest and a means to end that will result in the failure of the concept called multiculturalism. cheers ps Crotch your right again, thanks for enlightening all of we white racists.

Herbie: I have been witness to this as well, vomiting fecal matter from bowel obstruction, a skinny little "trapper" this hermit blamed it on his christmas fruit cake. Although he had pretty much all the "other" fragrances as well..... Nasty stuff All. I count myself lucky as I can tolerate most smells, when I was a rookie we had to "bag 2 bad ones" before we were "accepted" that's back in the day when EMS did body removal. A trick we used is a mask with menthol shaving cream on the outside, works quite well, not 100% but better than full breaths of decomp's sweet fragrances.

A way for BCAS to not pay for: 1- Same scene, Same pay. 2- A means to keep more accountants employed, in a top heavy beurocracy. 3- Make my head implode. 4-A reason to have CUPE argue needlessly over penny's. 4- All of the above. Hey look what crawled out from underneath a rock ... LOL !

To recap: After reading my posts over it sounds like I am drunk with the very poor english and lack of punctuation ... eh ? A known diabetic, (because no one has ever worn someone else's bracelet) unconscious and diaphoretic, all V/S normal, in a public setting with normal BGL readings. I have been trained to not tunnel vision, sure this patient is pointing that way but with the very skinny S/S and zero P/E is just so very open ended to call, especially when this thread progressed to prognostic indicators of hyperglycaemia patient and poorer outcomes, just saying . I would start looking for other possible reasons of decreased LOC ? Yuppers, the AEIOUTIPS mnemonic comes to mind if one need's a crotch to fall back upon, highly suggested for students to be thoughout. I would be assuring an open airway ( while doing this ketone's on breath and Kusmalls type respirations (although in the senario presented "normal VS mentioned" as well as pupils size response to light and equality and GCS, the babinski reflexes checked as well (those would be observation that could be very useful and takes less than 20 seconds) Rx: C Collar, O2 titrated to Pulse Ox, boarded, then a line and repeat BGL just to cover all the bases, before I jumped to the conclusion of the machine is wrong. Perhap's then think thiamine, D50W, glucagon (btw the glucagon and the negative connotation (old school) of a back up for a poor Paramedic skills starting a line's) I sure would not want to give an IV medication with preservatives in it because it could cause Autism and / or ADD or worse <gasp> Or am I like just like crotch and Challenging What You Think You Know ? (or perhaps even himself EH ?) Quoting crotch " I just can not get behind this bs, get over yourself, this attitude belongs in a fire hall. I am no hero I am just doing my job . <edit for spacing>

MY point all preventable loss of life and injures affecting may for years. I contributed to the fund for the woman that lost her life in Camrose, she a single Mom and had won a stage pass on a local radio show, other wise she could not have afforded to go, her 7 and 9 year old were so happy for her. ... hello crotch ... get the picture <insert explanitive> starting with 6 letter in the alphabet and ending the same . cheers