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I have no doubt to authenticity, just another application for a spine board in Missouri EMS ? Hey it is only fair ALL trauma patients need to have proper spinal precautions and far easier to pack around. Mateo I am SO with you on this one we sometimes refer to them as organic speed bumps or MVD. AND this really in'st funny because I pasted a Muley one a month ago with my truck and its still in the $#&^$@!!! shop.... I learned my lesson and when it ever gets fixed . .......... it will be coming out with a big ass bambi busting bumper, so next time its the spray wand.

Recently I was asked to run a marathon. At first I said, 'Naaahhh!' Then they said to me 'Come on, it's for handicapped and blind kids.' Then I thought........ Fuck...I could win this.......!

Called a Snow Flake, I did that back in the day it was great fun blowing $yte up, one usually makes it it up the ranks as a Pro Patroller before being allowed to play with det cord and Power Frac unfortunately unless your (government employed in some way) the pay sucks. I am thinking Weather Man too.

I think a head or 2 will/should roll, just who hired buddy ? And just a few "like 17 months" to bust this guy ... wow !

North please stop trying to "fit test" the livestock again, AND we told you last time to stop trying to put lipstick on the sheep, goats and bucks. te he Just thinking out loud here, would one not be more successful in an interview with pants, I guess it depends on what the interview is for ? LOL cheers

Just a tad alarmist don't you think ? I just can not fathom as a reality with this statement by AFoL leader Gill Mcgowan. Mind you EMS workers in the major communities do have vests and have sharp scissors, IV catheters and syringes. Funny thought too as if EMS workers armed with a stretcher can not access just about any where they wish in the first place .... just saying. Or perhaps Gill just shot HIMSELF in the foot is all. I think the suggested "violence" may just be between the different unions vying for ... yup you guessed it, more members ? cheers

Yes I must agree with your tenor and opinion's from you post # you are new to this site and I feel obligated to greet you, wiil be looking forward to you input as an outsiders view looking in. Yes it has been quite a busy week for Mr Stelmach. 1- Large labour group (s) are poised on the steps of the Legislature, protesting the new improved Labour regulations, thing is I think the Gov. may have twarted one of the big red machines options and not in the handbook. btw we have another type Big red machine here too they have a lotteries fund .. thank you Ralphy. 2- The opposition is up in arms unfortunately a very tiny voice these days. 3- "Restructuring" Health Care with a Superboard administration to improve the system ? 4- EMS restructuring is being recieved with caution but some optimism/ apathy. 5- The rather HUGE MLA raise, and slipped under the rug .. at least their trying to, justification to increase the 'cat bird seat' based on the estimated salary of the leader of the oppositions salary ... comedic. Instead of remaining the "status quo" which personally I find acceptable and just provide for the increases of municipalities budgets to provide and plan for solutions to resolve the EMS underfunding issues in there communities. In the majority of cases EMS services are quite stellar including many rural of operations and "correct me if I am wrong" more ALS services in those outlying communities per capita than Ontario ? But in this Conservative Government's wisdom they have felt fit a fitting time to change dang near everything, I can't get my head around why they just did not just provide the much needed cash to the municipalities, maybe by removing the cash removes the control ? Rats I missed the early news, well all in all this is quite entertaining, but everyone forgot the price of gas ? sheesh. cheers

I see your point as "declaring a local emergency" and making it illegal to walk, legal or not many groups have and will continue to do so. At the end of the day, no one really benefits from a walk out or strike, it sets back everyone's pocket book, if one does the math, unfortunately in Mr. Lieperts statements to the press he is under the assumption that EMS workers should be familiar with that (the loss of the right to withold services)..... never say never .... I'd say. The walk out by Edmonton Ambulance Authority many, many years ago was true chaos, as a later result many heads rolled after the drama and it brought about many changes. The not so prepared supervisors driving skills assured that body shops profited in a major way, and still laughing about that one, very good thing no one was killed. What would have made a better and much sharper tool is that the entire province of EMS workers to back their brothers and sisters or perhaps the union was banking on that they would receive more than the pittance they did receive through binding arbitration. but that was the city of Calgarys purse then and now it will be the Provincial wallet and its way fatter. This opening of Pandora's box just may result in labour organising on a provincial scale. Even though Shane's nose is stuck in a book on the state of diseases, some situational irony perhaps in this case. He does make some good point's, this could open the door to very large corporations bidding on contracts and further eroding the quality of care (although we are assured in the booklet that this will never happen :^( I always find it amusing there is no signatures at the bottom of this plan, I sure wish I could do that on my cheques, my chequebook would always balance then. No where in the government publication did I see improved funding for education or more stringent standards for the levels of training even hinted. Allowing for just one individual to become the head of the EMS state of affairs is very undemocratic, it so smacks of a dictatorship. I think his lifespan of rule will very limited as one perceived error by Cesar and a thumbs down, the crowd will roar ... sorry, was watching gladiator last night. How this "restructuring" of the transport of patients will some how change the number of beds available in ER or the Hospitals in general is a bloody red herring an appeasement move perhaps, IMHO to "make it appear" to the taxpayers that something is being accomplished, when it is really affecting the publics right to choice. ps Wendy T. it is "not" the Parliament in the province it is called the Legislature, and the conservative sweeping victory in the last general election, by an estimated whopping 22 % of the population's popular support, or those that even bothered to vote in this last election. Is it apathy that is the problem here or have people just given up on politics entirely in Alberta, frankly I just can't see how "flower power" or a chicken little "the sky is falling" or chanting slogans will make any difference at all. I do agree with your statement regarding Pandora's Box although, I was hoping for something more than the introduction of an concept or a real action plan, and here's my bet .... the moneys for transition will be doubled before anything is accomplished, hey maybe I could get on a comittee it pays well and they always have donuts. Well: I was eating pickled eggs last night and something is starting to smell around here. Maybe best to shut down my computer for fear of explosion. cheers

She did have a long life, my condolences.

My parents told me about Mr. Common Sense early in my life and told me I would do well to call on him when making decisions. It seems he was always around in my early years but less and less as time passed by until today I read his obituary. Please join me in a moment of silence in remembrance. For Common Sense had served us all so well for so many generations. Obituary Common Sense Today we mourn the passing of a beloved old friend, Common Sense, who has been with us for many years. No one knows for sure how old he was since his birth records were long ago lost in bureaucratic red tape. He will be remembered as having cultivated such valuable lessons as knowing when to come in out of the rain, why the early bird gets the worm, life isn't always fair, and maybe it was my fault. Common Sense lived by simple, sound financial policies (don't spend more than you earn) and reliable parenting strategies (adults, not children are in charge). His health began to deteriorate rapidly when well intentioned but overbearing regulations were set in place. Reports of a six-year-old boy charged with sexual harassment for kissing a class mate; teens suspended from school for using mouthwash after lunch; and a teacher fired for reprimanding an unruly student, only worsened his condition Common Sense lost ground when parents attacked teachers for doing the job they themselves failed to do in disciplining their unruly children. It declined even further when schools were required to get parental consent to administer Aspirin, sun lotion or a sticky plaster to a student; but could not inform the parents when a student became pregnant and wanted to have an abortion. Common Sense lost the will to live as the Ten Commandments became contraband; churches became businesses; and criminals received better treatment than their victims. Common Sense took a beating when you couldn't defend yourself from a burglar in your own home and the burglar can sue you for assault. Common Sense finally gave up the will to live, after a woman failed to realize that a steaming cup of coffee was hot. She spilled a little in her lap, and was promptly awarded a huge settlement. Common Sense was preceded in death by his parents, Truth and Trust; his wife, Discretion; his daughter, Responsibility; and his son, Reason. He is survived by three stepbrothers; I Know my Rights, Someone Else is to Blame, and I'm a Victim. Not many attended his funeral because so few realized he was gone. If you still remember him pass this on. If not, join the majority and do nothing. Author unknown

Well hells bells it was Gerry from Deadmonton I was quoting thank for the correction: Union blasts 'essential service' tag Designation vindictive measure by Tories, critics claim Jason Markusoff, With files from Kim Guttormson and Renata D'Aliesio, Calgary Herald The Edmonton Journal; With files from The Calgary Herald Friday, May 30, 2008 EDMONTON - The Tory government's decision to remove ambulance workers' right to strike will weaken their abilities to push for better contracts, the Edmonton paramedics' union president said Thursday. Emergency medical services will be deemed an "essential service" in April, once the province's health superboard takes control over ambulance services from municipalities. Last summer, the Tory cabinet prevented a strike by Calgary's EMS by declaring a public emergency days before workers were set to walk off the job and deprive the city of one million people of ambulance services. It led civic leaders to urge the province to declare the work essential. It had been less of a major issue in Edmonton, where paramedics representative Gerry Wiles protested the government's move. "It's not that our membership ever wants to go on strike, but it is a bargaining tool," said Wiles, of the Canadian Union of Public Employees. "And if you take a wrench away from a mechanic, that's a tool they can't do their job very well without sometimes." Health Minister Ron Liepert argued that having no right to strike shouldn't be too unfamiliar for people working in the life-saving business. "Most of these people work alongside fire and police and they already don't have the right to strike," he told reporters. "They work integrated with the health-care system and they don't have the right to strike. So it's our indication that it's not going to be a huge issue." Calgary's paramedics union is one year away from its current agreement expiring, after it lost its wage-hike demands last year in arbitration. "Some of the recent difficulties around collective agreements typically are the direct result of not enough funding," said union head Rick Fraser. "Our issue is not the ability to strike; it's the ability to be heard." Unions' complaints were tempered somewhat because they generally like the idea of the health superboard overseeing all ambulance services and have long wanted the option to send ambulance patients to places other than emergency wards, which Liepert said he will allow next year. NDP Leader Brian Mason suggested the essential-service designation might be a vindictive measure following the union-backed Albertans for Change advertising campaign during the provincial election. "This is unnecessary and quite frankly strikes me as a slap at working people in this province," he said. Liberal MLA Bridget Pastoor agreed. "I see more and more things in the province being eroded in terms of fair bargaining practices." Wiles said EMS crews still have the right to strike in Saskatchewan and British Columbia, which are notoriously more union-friendly than conservative Alberta. jmarkusoff@thejournal.canwest.com © The Edmonton Journal 2008

Not acording to union representatives in CowTown and headed into negotiations very soon, just one less tool in the tool box their saying, other commentary regarding who now decides level of care ? So why would a plan be secret anyway ? I believe there is no real plan at all. I am still chuckling over the idea that by somehow this will reduced ER waits and quicker release of Trucks to respond when both Calgary and Edmonton have both hired Paramedics to off load to a triage before triage .... meh

So status quo with level of providers, any squigle room for funding for education ?

Totally agreed ME TO! Just look to history of Government involvement in Health Care "restructuring" Air Ambulance contract's awards for example would be a good start. The premise is that this will somehow lower costs and reduce wait times for EMS response? Folly plain and simple what about improving the bed availability in the ER ? A Ten year study to consider "Ambulance" is an essential service ? Hey dood just look in the phone book under 911. A is for Ambulance its at the top of the list .... Mr. Liepert, I could have saved you a lot of time and wasted money with "those studies" ... sheesh. Could it be that this Conservative Government and in passing and an true Oligarchy by definition has opened the door to follow the Nova Scotia's lead ? They can punch any legislation through on a whim sooo just farm all EMS operations out to one contractor for the entire province ? .... OMG its going to be a freaken mess I think read the anouncement again with a critical eye for where YOU will now fit into the system, no chance of stricking now and bringing the government to its knees .... like anyone had enough the bollocks before, Calgary totally whimped out when the HAD a chance ... nice try but now we all are restricted to the cost of living ONLY ... pffft ! I remain so very skeptical like really, really so best pick a Good Union and right damn quick with enough clout to represent all EMS workers fairly, just saying this sure changes the picture big time. AND Rural managers/operators be very, very afraid, I think your all toast, time to get the Jam. The plan is to eradicate regional managers and make a SUPER stupid Board of Govenors ... please look to the required "quals" to be a Board Member ..... Thanks Ralphy it worked so well in 1993 with that "restructuring" So just what happens to ACoP now, an arm of Government ? or is it still a viable self directing democracy for the proffession ... like as IF it ever was, was there even a Quarum for the last AGM AND has anyone actually read Bill 41 ? No rocket science needed for to consider my "non attendance" ... AGM a week prior to sweeping changes and announcements and with a ton of forshadowing by Alberta Health .... I was fishing. Mobey, I love you man but I believe your idealism is about to be smashed into the Dirt. no cheer at all. squinting

The vernacular / terminology used when describing what one is auscultating to a ER doc can be very clear and besides the development of 'slang' in Emergency Medicine is not a new concept at all. Tight = Wheeze / Asthma / COPD Wet = Bibasilar fine creps or crackles = CHF Rhonch (coarse) = +++ secretions = Pneumonia Leathery crackling sounds (and not easy to pick up) = Plural rubs The silent chest is the most serious consideration to my way of thinking, so why make it so complex with old terminology from the dark ages of time, if you have to patch for advice or orders .... the KISS theorem is quite applicable in most cases and far more easily understood. BUT if the C/C of a "tight feeling in the chest" this is a entirely whole different concept. Personally I use the term "your quite musical sir/madam" when speaking with patients .... somehow this term is far less "stressing" to the patients .... IMHO. cheers

Why am I thinking its time for a bath ? Dust are you gearing your very over simplified analogy for a volley basic from snowshoe alberta ? Come on dood , you have not included the "container" with my oversimplified explanation. So was that: SpongeBob physiology ? So lets blow a few hole's in this anlogy just for giggles shall we, no compesatory mechanisms, and no SPINE. LOL. :roll: Could this be the exact explanation for the failure of MAST ? A sudden loss of pressure when fluids or "control" of the container is "iatrogenically" lost? I propose the rubber ducky would be a far better model, at least one can stick in a line up that little butt hole to bring the pressure up, or not release the preussure maintaing the pressure .... the sponge senario more akin to septic shock model ..... pumping into space, don't you think ? END OF STORY ? :shock: So then just forget about trying to improve the treatment of Trauma ? Love the words in Predator (Arnie btw) when the native guy says : "Were all going to die" ! :twisted: It is very similar to this lit study debunker, so whats his name again ? Does this texan ever do any research on his own ... like a positive input ? hmm please shoot me the links if I am missing something .... PLEASE. Hey perhaps HE does need a more positive attitude enhancement training or maybe even attend a CISM couse as well :twisted: ... just saying, he's only one man and not so NOT the god of EMS. :wink: cheers

Thats kinda curious because we here (in acute hypovolemia and prior to going under the blade) We transfuse uncross matched blood if we have access, When we HAVE crossmatched blood all the better, Packed cells and other factors for clotting, best case is senarios are cell savers which are labour intensive but worth the time and efforts. Point being is this not simmilar situation, autotransfusion vs transfusion, that said stored blood has citrates and in the past (attempting to normalize PH was perhaps a folly as well?) Newer studies are indicating that acidosis may be a protective mechanism at the cellular level. Tropes to increase SVR are a later choice and but if transport times are excessive and the typical 3:1 of NS has been attempted/ infused a huge third spacing vcan occure ... seen a few of those, we called then the stay puff marshmallow men.... bit of black humour there sorry. But: I do see your point as permissive hypotension was found to be of some benifet with those seriously injured in the Fauklands experiance, then again, hypothermia may have been a serious consideration as well under those nasty conditions. I try to use Traction devices when possible, I only use MAST with Pelvic fractures as (iliac artery leaks are 3 biggest killer in trauma quite insidious .. and very difficult to dx/ treat) Lots of my acute transports are by air and that damn Boyles Law thing. With long bone extremity fractures "muscle spasm is the major source of the pain" therefore I try to relieve that pain and use less narcotics (if possible) as that does complicate the picture in a polytrauma patient. 3 things in "shock" to put it in the most of elementary terms. 1- The pump. 2- The volume of fluid. 3- The control of container. perhaps better control of the container then? Well I am now :roll: but not Labatts as we just sell that to the tourists EH :wink:

Phil: I think you missed this part, I may be OLD but I can still take a accurate BP ... some of those OLD BOYS arn't as drunk as you initially thought. Will take you to task on this one my upside down fiend .... YES, this does tell us something like who took them off incorrectly ? ... let me guess a cut happy surgeon NO tell me it aint true ? Could this be the Surgical approach over the Medical ... hey mate, can't tell you how many times I watched (in ICU) bellys get freaking shiney .... and "no cut" I was told let it tamponade their "too big a risk for surgery" ... FM gently ....a couple even made it out of the unit btw. What's that is this the explanation ? Tell me again that suddenly changing from 200 lbs to 1500 lbs because your feet are full of blood is Normotension ? Does the mechanism of action define "Hypovolemic Shock" ... not where I come from it don't ... take for example Iatrogenic Dynamic Hyperventilation ..... this also is a relative Hypovolemia is it NOT impedance of blood flow to the left side of the heart through a low compliace system.... hmm? So just when "do you" suggest implimenting this garment then, Let's jusr remember that the first parachutes were not so successful either, funny its now a sport. Thing is that maybe the we were using them too late... doing the 30, 50, or the crackle of velcro indicator, thing was the problem OR maybe ??? The bleeding as I refered to prior was not controlled and we were causing multisystem failure ? Hey what about the OTHER options I suggested ? Is it getting too hot in AZ or OZ land to open the door or think ? Phil/ Timmy: Don't you use still use the big "T" with snake bites, I would have no idea because all the snakes here wear suits when the go to the Legislature or Parliment. cheers :twisted: ps ummm ... pirates rock

mobey: your always about the FOOD. I bet you keep the chicken legs from IO practice for lunch too ? :roll: Yes must agree with dust/ others, very good point's all, but not advancing just a tad more (~3mm) after the flash is a very common error. But going "Blind into AC" IS ill advised as one could be starting an Art line inadvertantly. SO NOT a good idea, look to your own arm for visual reference if needed. Lighting: LED (headlamps) are not good light source IMHO 'I found this out in a non-dedicated chopper once with very crappy lighting (an old hand me down Huey from Somalia I think) LEDs tend have a bluish tinge which tends to obscure veins, but your mileage may vary. cheers

Ruff: Your probably "bang" on with that one ... te he, mobey did say married couple didn't he ? Kaisu: This is an urbal myth! I have no date for this weekend, perhaps we could set up evidence based medical ..... interview ? :oops: to discuss this further ? cheers

I have always wondered why MAST just about disappeared as I too have had the distinct pleasure of observing that they do work ... granted anicdotally, but then again maybe I'm just old fashioned or can't take accurate BPs ??? Hey sometimes the OLD ways are the best ways then again maybe not. I don't agree with Bledsoe that this an issue of emotion at all, moreover the curiousity of the human to shunt blood to core organs in shock, an alpha adrenergic response this just made sence to me, hey how about Levo ..... (ps I heard that whats is in Chuckies tears) ARNIE ROCKS PERIOD !<edited after JPINFV boast> :twisted: I think my confusion is partly is because the "G" suit continues to be in exsitance and continues improved to allow the human body to withstand up to 7 "G"'s, did human physiology suddenly change or are we more concerned in keeping pilots alive than the general population ? hmmm. :roll: I believe that with the abismal survival rates with the trauma patient we should revisit many other "ideas" as well but, primarily focusing on decreasing blood loss. 1- teach more hemostat application (s) 2- increase use of tourniquets, (obliterate the old myth that continuallys to being promoted as "last ditch attempts" by FA schools that have not looked at there curiculums for more than 30 years) 3- pack off penetrating injuries. 4- stop making kool-aid, get some volume expanders on the trucks: GO hypertonic and spans GO! 5- or cooking mashed potatoes .... wonder who will pick that one up ? OR .... Maybe just ask all trauma patients to grunt instead for that "golden hour" and they will ALL be good to go. cheers ps trandelenburg is a ems myth as well.

Perhaps - Vaso-Vagal Sycopal Episode ? With a side order of Myalgia Paresthesia (L5 S1) ? :shock: Ok they are 60 +, eyesight and/or wife was dreaming ?

I think that pnemonic is already taken ..... :shock: But I am :oops: that I didnt think of that first :shock:

Umm not all, you forgot one P.L.S. ....... Primative Life Support ! The new catch phrase is, so easy a caveman can push "analyse" zactly ! I think we have to disagree on this on NS, without a standardization across the country we will never accomplish reciprocity .... this IS without a doublt the biggest first hurdle to overcome to advance PARAMEDICINE. The public is under the false impression that they are recieving "Paramedical Care" when in fact they are NOT! cheers Now for the Ontario Math Part question ? What is the difference in cost between a "Flash box" and a fully loaded 12 Lead ? (whatever flavor) About 15 G perhaps ?