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Former: Well, if this comment is directed my way. I think you missed the Flag ... I don't think I qualify for your reserves somehow. Something about the wrong passport maybe ? Funny thing I helped out at Katrina and your homeland security sent me an application too ... but I think they missed my address and postal code. I thought this thread was working in a dual role as LEO and Medic ... where did the volunteer Military Model come from, maybe I am missing something here, but yes if one can help out in crisis in another role all the power to them, I do swift water, Hi angle, +++ when I have a patient ... Medicine is my primary role. IMHO can't do both LEO/Medic on a routine basis, well unless one is superman. :?:

Sorry to disagree, I do blame AHA the point is that the Cert at one time was something to be proud to recieve, it was a culmination of the Paramedic educational process and just why (in my hood) it became mandatory to practice yet today damn near anyone can be endorsed as a provider, I handed an EMR an old book and he could pass ... verbally at the present level of parroting the new guidelines. The paramedic Proffession has always been akin to a Para Military organization and that will never change, some badges and stripes are seriously well earned, well in past anyway. Just look to the abismal ETI rates comming out of some areas hence all the "inventions" to deal with this situation as opposed to addressing the real root cause. i.e. The Guidelines 2000 for Cardiopulmonary Resus and Emergency Cardiovascular Care.(500 + pages) ACLS: Princples and Practices, over 375 pages) I read them cover to cover. These books had some meat to them but today its honestly a freaken joke, I too handed my paint by number book back in without opening a page, in protest with the warm soft fuzzy crap, consider this consider that, how many pages it that new one ? Confronted WITH a REAL LIFE/DEATH Senario ... What Exactly will one do ? consider this, consider that ...... Show Me ! I my day you could not just "talk" through Mega Code, Real Time, and REAL Instructors threw everything they could throw at you .... trial by "Peer Fire" and one had to Intubate, one had to start a Line on a dummy, one had to actually make this or that drip, actually push the meds. Frankly, I am disgusted with this new world order to have every run of the mill RNs have their "ACLS CERT" to work in ICU or ER when they will NEVER be asked to actually run a code, why, because thats exactly why AHA has gone this route, Anyone tell me this is not the AHA goal and I will loose it. Ventmedic, cant tell you how many RRTs dont even bother to take this course anymore "I am just the A and B part ... just saying thats the reality. The "Why Johnnie Can't Fail" concept unfortunatly dominates the current politically correct Educational Programs. Failing is sometimes the BEST way to Learn, self esteem should have something to do with accomplishement. cheers

AGREED!

Well what if the Cop gets shot ? Does the Cop/Medic drive a cruiser or a rig ? Or what if the FF/medic gets burned or injured at a fire. Throw the patient on the Pumper ? The dual role deal is frought with complications but the city managers will do anything to count the beans and come up with "cost cutting" measures, oh yea and why is there no "medic" on Corner Gas ? cheers

HEY ... Dont limit this to Dust only and dont forget Bledsoe, He would love the place and so would Emma his lady. Hey let's tune a few up, want a free ACP registered with BCAS in April ... maybe do a bit of of a symposium in Masset ? ... wtf bring BEB in too. Dust already has an offer to see what its like in North Vancover Island it OPEN INVITATION. But I WILL be the Guide wherever I have assesed needs, my call, PERIOD. I have 22 ft Zodiac, 100 horse can take at least 12 or more bodies plus KIT and my 2 kids... my son at 15 can read a GPS hes my second ... a Zodiac of this size is licence to travel open water, Watch Whales and Bears, Crabing and Kill fish ++++. ps theres no snakes on Bledoes ranch ... I looked @ 6 in the AM ! LOL. Have a friend on Green Island (an ex Green Peace dude Medic, bosnia, somalia kinda deal ) I would have to visit him first, maybe a 3 day trip (a light house keeper) before the Charlotte's, pick a nice flat water day and blast over @ 30 knots or take the Ferry out of Rupert, I am open to suggestions. Big thing is fuel for me always in that area ... got any contacts over there Happiness like entrance to Douglas channel ? Don't forget we ARE dealing with landlubers here that have no idea what it takes to travel one KM in dense bush let alone 50 kms of open water .. ps I do have survival suits too, I will take care of em. Or maybe Fly anyone intested s into Terrace for a hot tub and go from there by car ... Masset is so awesome cool too, even if you sit on land with Binoculars eating crab and salmon till you explode. If anyone thinks I am kidding about this ... eat my DUST lol. contact pm if you want to see the most beautiful place left on the planet (seriously) and virtually untouched temperate rainforest, this is where Happyness really lives and provides service to her community. KUDOS cheers squint

Sorry did not intend to insult your Mother, just one of those situational ironic situations I guess. :oops: cheers

Can't Dx this in the field bang on, a VERY good point medic112. I have observed this wide tachy complex looking situation but was later diagnosed by Cardiology as old BBB, got a pat on the back for NOT complicating the patients situation and loading with any drug, just in passing. To the OP ... what were YOUR actions. And can you actually deliver KCL ? and whats a little ? crotchitymedic1986 : if you do not include ALL the PMHX then these senarios just become a guessing contest. <Edit> Is this Monomorphic or Polymorphic ... wide or narrow complex if its was Vtach ? sure would like to see that 12 lead ... 2 Rythums on the same pt. .... very curious indeed. cheers

I had a patient inform me that Dimenhydrinate (marketed under brand names Dramamine, Gravol, and Vertirosan) an antiemetic. Well apperantly it made him nauseated and puke .... talk about having to turn away and have ones partner step in because your laughing so hard your eyes water. I think Ventmedic has answered all the major queries, I must agree Hypoxia will kill far faster than acid/base imbalances and in passing COPD is a generalization for a group of pulmonary disorders a "triade" So ever hear of a drug called Bleomyacin ? Before one jumps and down laughing at how smart you are, too hard. There are meds out there in the real world that we as EMS providers are really not informed and not covered in most EMS textbooks and where we got this limiting of O2 therapy of a concern fpr Hypoxic Drive (a rarity) It makes me shake my head with this ongoing misinformation ..... an allergy to O2 not likely, severe side effects or contraindications to oxygen therapy oh yes ! A couple of other links ... but please remember these are quite a rare. http://www.ncbi.nlm.nih.gov/pubmed/1704473 http://ctec.uwa.edu.au/anaesthesiawa/bleomycin.pdf cheers

Ok first whats LOC ? TEMP again? Got any O2 on him, SAO2 ? Monitor shows ?, Any Pain control rx as in opiates morphine will slow the gut down. BGL? Lytes ? FLAT Plate of belly would be a good idea too. ABGs if possible ... any serious metabolic acidosis could indicate dead gut ... all bad. Pop two lines in fer sure. Big thing is he is an "anemic hypoxemic" no matter what the pulse ox is telling you ... this can lead to cardiac issues/ angina but he really needs blood and GI consult asap, dx of guts is not easy for ER docs, let alone medics. If we knew ABG (sats) and Hbg we could calculate O2 Volume % .. just for fun. The difference in BP is classic postural hypotenson and indicating he's a down a "few pints" in addition to Hemglobin of 10 ... Crit of .30 which is kinda odd ? has he had lots of fluid already ? I would give him a little more fluids if he's still hypotensive but going slow is good, my first choice would be Ringers prehospital and keep the target BP 100 if you can, don't want to fluid overload and complicate issues, or hemdilute. With Black tarry stools lower GI bleed is more likely and usually slower in onset from my limited experiance possibly this is not a super acute patient coffee ground's more indicative of bleeding ulcer, I sure hope they were gentle inserting the N/G ! but he really needs a GI consult. If this was a Mallory Weiss tear/ esophageal tear they are usually bright red and vomiting +++ in the cases I have observed and a really crappy way to croak. If this facility did have the capabilities then Type and Cross match would a dang good idea, pull couple of units of O pos . (yea, I know you don't have that in the senario but what the heck for competeness) when I see these numbers blood replacement is the best thing for blood loss and is the best choice hands down... that said any "volume expanders" Hepastarch, Pentaspan hiding in the supply room, grab a liter .. te he. Just wondering ...can you give pentaloc in your guidelines if given a direct order from sending MD ? cheers

Yup it was, I can't wait till Rick Mercer puts his .012 cents in, hey maybe Obama was watching that night and got a bit of education Owleymedic: I would like to remind you of the real reality here: The control of economics in any country in the world is quite simple It IS ENERGY (yup its almost too simple) so this bait of a "have not" province debate is quite laughable, SK is going to be the next powerhouse, and honestly for long term sustainability its all good, if you think the price of oil will stay down ... think again :evil: Heres a good one: So whats the Capital of NFLD ? .... Ft. Mac der bouys One of the biggest reasons the NFDL is now a HAVE province is because of the transient worker filing their taxes in NFDL and being generated in AB ... best look around there owelymedic and smell the cod tongues first .... talk about sweating. And although DocHarris was rather negative in re:negotiation of NAFTA well for the east this is a grand asumption. WE in Canada as a whole are idiots that said, NFLD has a far better energy development policy than AB! Point being we through NAFTA sell our resourses off like theres no tommorrow ... but there is. Continuing to GIVE away without development of any secondary industries is economic's grade 8 as to what will happen down the road. We in AB are building pipelines shooting raw materials south to be refined and sold back ... are we stupid ... YUP we are! Dont get me going on softwood with 3/4 of BC rotting in the forest ... and pine makes great pulp and paper btw. I highly suspect with Obamas politics that US nationalism will be a priority over the consideration of the continued raping of Canada. Thats why I liked Palin best (and she has nicer legs too) The thing that bothers me about the hypocrasy of this so called capitalistic state is that big business is getting a bail out when they should be going down (the survival of the fittest) If they built products that consumers actually wanted with the same high quality as the Japanese ... there just would not be a problem. besides a proven fact that downsizing improves profit margin's! Honestly if Dion (past tense) and Layton actually cared about Canada they would "as the public voted" become good and intelligent opposition ... but no the sought the golden chalis and now the grand coronation and more Liberal PR stunting, Bob backed out ... I think he's way more realistic. Lets just see what the budget looks like before we all go do the "get into bed" senario again .. THANKS IN ADVANCE.

This will work just fine.

Your right it has no part of the issue.

Westerners are tired of no representation and paying the bills, you want to be dictated too again from Quebec ... have them ... keep them as a present, make the NEW border Ontario and good luck with that. Besides thats because your Conservative Priemer "told you not to vote consevative" a bunch of sheep ... elections speak for the people, back room fanagling is crap. 60 % of voters, voted for "OTHER" parties and not as a 'cohabitation" .. sheesh.

Ok quite obviously YOU have never been to Saskatchewan ... corners, gullies ? LMFAO! Richard if you stand on a chair in Saskatchewan you can see your dog run to Mantioba, (sans fog of course or night) did you watch the video, this is ther perfect topographical application for FLIR . Oh I can see the standard "stubble jumper" jokes headed this way now .... te he. cheers

Ok I got to jump all over this wtf does VFR or IFR have to do with anything, were not flying here and the enviroment that you in the US for flight safety is abysmal at BEST ... dont go there. I just put down a FAA stats report, so tell me why FLIR is used on aircraft (single pilot) but not on ground again ... learning to fly VFR or IFR does not mean you JUST look at instrements ONLY, unless your on a "RiDE" In VFR one always is look outside but learning how to set up a proper scan of instrument's, very simple really. Talk about distractions ... lets talk about why we are going to more wrecks ... DAMN CELL phones and pple texting while driving ... sheesh. You have got to be kidding what kind of in-depth driver Ed do you want, issue superman vision or refusals to not go to that bus crash ? DUH ! But where this 1/8 of a mile came from that IS good driving weather where we come from. When your "ON" the road in a blizzard you can see EVERYTHING with a heat signature, yes pull over and stop is a great thing to do ... but so is " looking foreword" for safety. For argement sake .. when GPS came out Trainers were agast that students using map and compass would loose their skills now you can pick up a tom tom for $300.00 ok $200.00 in the US. On-Star or GPS cell phone transmisson ... should I go on ? Cabin Utilization .. ok: Have the attendant watch the FLIR on a response and do Comms too its SOAP, on return alway's give a good safe ride and not "rushed" to the hospital so any advantage I get is ALL GOOD. So lets talk utilization then use more ALS providers in Rural areas .. Get the ALS too the Patient FIRST then worry about transport .. In the modern EMS world carrying TNK/Volume Expanders/+++ this will save lives. This rushed patient to Hospital mentallity thing has got to be replaced with "Rushed the Paramedic" to the Patient to Stabilize! Logistics/ Senario ... Snow storm, or a even just "ground blow" no storm just crappy visability, so your 100 kms from a Major center and 50 kms from a rural hospital (Patient needs definitive care and to get to Major Center) no hope for Rotary or even Fixed wing support. So sit on the side of the road, go back to rural facility with ole Doc ? Or Hoping to get smoked by the next 18 wheeler that can't see your beacons from a 1/10 of a mile ... get the ass on the road. Disagree ... Call it Toy or Tool anything that will improve MY forward vision in a white out is safety not a distraction. Fact: at 50 mph your outdriving your lights @ night even with Hi beams on and who travels at 50mph at night with good visability, so recognising a jacked knife semi in front of you based on heat signature at 2000 ft. the down side of is a bad thing ? Cell phones, radar detectors, Scanners, GPS, computer dispatch screens could ALL be considered distraction or then just tools of the trade :twisted: Heck, I even know a guy has a Radar Gun (but thats just for fun) cheers

Range ? Sorry fer asking dumb questions but the attachment isn't working for me, sure wish I had a good IT guy to tell me what is up with my connection. cheers

Well don't know how I missed this thread after pasting a suicidal deer last spring ... I am all over this idea Just think of it avoid just one moose strike and you just saved lives, your own ! Was driving about 250 kms at night 2 weeks ago there were 9 deer strikes on the road ... most hit by 18 wheelers with bambi blasting bumpers, those aint chicken feed, this is proactive not reactive thinking. Question is what is the field of view ? cheers

Well I had no idea :shock: ... NO wonder I didn't get that cushy Government job :? I am so screwed ..... LMAO! Ya know: I used to think the Goth thing was a bunch of wierdos too, working in hospital and being approached if they could observe an autopsy... pfft. Then I watched a documentary, firstly, the average goth type is above average intelligence, just a trendy thing to do (as Ventmedic commented) like grow your hair long and protest in anti (whatevers) but they do suffer from lower esteem but because of association with others they (as most teenagers) need to find a sence of belonging, like bot scouts, football teams but the crap in the face I can do without , I must be getting old . But hiring or promotions based on popularity or based on diversity thing, I so have to disagree with that, age discrimination does excist out there but it works both ways, too old, too young ... the best one is OVER Quailfied wtf is that ? cheers

Well if you have a current study with good controls I would love to read it ... not just a "conclusion" although. Mag sulfate is a trace element ... the explanation of mechanism or action is not clearly understood, I give it on spec IV when ETOH abuse is a possible factor in MI, their is science behind that. The First Study that got this trend going was success in weaning a Ventilator Dependant Asthmatic from Support .. one patient does not make for good science .. another thing I have heard from so many Paramedics say that this is valuable medication (quite anicdotal when your giving 3 different meds via S/S neb)... thing is they do not understand peak thereputic effects of Salbutamol re: TIME Another Point being I have not seen a Human model comparing MgSuf nebulized (only) vs Salbutamol, as this is standard of care in the acute asthmatic patient, deviating from that is called experimentation. It becomes an ethical/legal delemia just as in comparing one antiarrythmic vs another ... cheers

Ok first RT Guys ? .... LOL, vast majority are females where I live ... so then they can take on the female RNs on an equal footing, again laughing. Just to add, oh yes have seen these devices lots most should be discussed with medical director (generally accepted) but just to be certian, if they have crapped out best to get them on a good ICU vent or NIPPV with a compensator (for lack of a better term) the cheaper CPAP machines do not have the plastic brain required to prevent auto PEEP. They consist of 2 pieces of ventilator tubing with a SVN "T" ed in ... this CAN cause iatrogenic "PEEP" and without recognition you could be affecting right side of the heart filling (ie Preload) a "relative" hypovolemia, DHI or Dynamic Hyper Inflation has become a serious concern and issue in educational in resus courses these days. As for Epi ... pretty old school for Asthma, selective Beta 2's and anticholinergics are the way to go ... we used to do IV ventolin but lots of "pasty looking dudes" from that, earlier nebulised Steroids are showing some positive evidence to support that practice. Mag Sulfate (in my neck of the woods) in Respiratory in Hospital nope ... this is a phenomenon in EMS only. There is as much evidence that this is myth vs truth, in the lit studies I can not find any realistic support that said it is really inert stuff .. called epsom salts ... you can buy this in a drug store for a 5 lb bag for 5 bucks .. it does work great for soaking my feet though ... anicdotal evidence only. cheers

OOPs .. my bad ? Sorry I was just fumming to see that Calgary Mayor Dave Bronconnier's is back tracking, taking note just how important we as essential sevices are reguarded ... the first cut to the buget nice, kinda makes thing clear in how essential we really are viewed . So ALL EMS in Cowtown take note when you vote in your NEXT local election, payback can be a bitch. cheers

Well move over, I am looking at Tommy Douglas land myself ... if I could just get more information :wink: EDIT: If you believe the flawed OPALs studies prove anything other than political influence then so me it ... OPALs has caused more disconcent and flawed thinking and has set us back in Canada 20 years ! Search OPALs in EMT city .. and how these stupid the studies (conclusions) were so biased especially in the Trauma comparison and so misrepresented. I debated OPALs with Dr. Westly (JEMS topic) ... he agreed and just laughed and said well good thing someone else has really looked at them with a critical eye. He was just attempting to generate controversy ... hes a hoot. cheers

Umm WAKE UP your dreaming ! :shock: So with the scare of huge reccestion looming, gas prices making oilsands production back on there heals and City Planners trying to lower tax increases ... cough, splutter it just aint a reality at ALL. What is a reality is privatizing the cities services for EMS ... tell me it isn't the most viable option right now ? Seeing as we can no longer LEGALLY take strike action ?

On the Darker side, most of the Paramedics involved in integrated services will jump ship in a freaken heartbeat, why would they want to stay in EMS even ? one does have a mortgage to pay ... and thats NOT roumer at all, has Calgary or EDM cut the fire budget ? NOPE! Artickat: Would you take a pay cut? Move your family and relocate in a rural area where in most cases you will work 24 hr x 4 shifts instead of 2 days 2 nights ... without a union to represent you and loose all senority ? Yup have to agree totally, best get off our asses collectively AND with ACoP doing absolutely nothing to improve pubilc image or educate (and don't anyone say its not in their mandate ...it is !) to explain the differences in levels in delivery of services, With HPA being modified to lower standards, change bylaws, appoint a registrar at a government whim. I am going to say I told you so .... ! With the 3 Options on the table in the delivery of the new improved Alberta EMS system which one do you think will be the most successful in recieving Government moneys ... hmm no rocket science need there. Hey maybe they Conservatives will give STARS another lottery fund so that the public will foot more of the bill to get an ALS provider to scene ... You know since the declaration of "essential services designation" and all the types jumping up and down saying goodie goodie ... well the REALITY is finnally sinking in that this is just payback from Calgary EMS taking a strike vote ... looking back we should ALL have supported that at the time. cheers

Nope this will guarantee that improvised practice should be reviewed.