zippyRN

EMT-B does not exist in the UK , anyone claiming to offer such as course is effectively offering a first aid course with toys added. EMT-I does not exist i nthe Uk as there is no legal means to enable EMT-I scope of practice. AREMT certification / registration holds little eight in Ausd and precisely Zero weight in the UK

the 'evidence based' best opinions seem to be keep the long EXTRICATION board for extrication and use validated selective immobilisation guidelines ...

unless and until you can rule out some kind of neuro pathology ... whether that's a CVA , a neck injury from the 'scuffle ' ( think central cord syndrome) ...

with accountability come responsibilty and rewards, this is why HCA /PCTs /CNAss and protocol munkey EMTs are paid relatively little compared to RNs or Cops ... if you look at the places in the world where Paramedics are professionals with degrees they get paid what a professional with a degree is worth ... PTS staff or 'advanced first aiders' doing event cover in the UK getas much if not more training than EMTs in the USA ...

as the OP is in Riyadh and not bound by US specification he could look at the some of the UK / German or french builders and EN1789 standards type B for for ordinary emergency ambulances and type C for speciality and critical care ...

also how long does it take to do postural BP Properly ? and is this an appropriate use of scene time ?

it depends how much stuff you want - if you are ordering tens to hundreds of an item or a group of items ( e.g. BVMs, mouthpeices, masks and nebs ) it might be cheaper to go to a manufacturer as 2c4 says bags etc might be cheaper if you buy the raw materials and find a local seamstress, upholsterer or even a sailmaker to actually make them ( sailmakers have slack time in the winter as there's little repair work coming in so they either try and sell at a discount to keep the cutting floor working or do industrial stuff)...

even better is a 'large' or 'bat fastard' size cup (500 ml or imp pint ) from a fast food place as that is the kind of volume a real spacer is and generally provides a better face seal interestingly the use of nebs is frowned up in some places vs 10 puffs via spacer repeated every few minutes - but some of this is trying to wean people off the idea that nebulisers are a cure-all and that MDI and spacer is an effective emergency option. also if you are in the position of not having nebs as a treatment option ( either because they are not authorised for your grade or because you've run out) the patient's own MDI and a spacer may be the best option you have

I have done this before, however it;s been in one of two scenarios that I can recall 1. having driven for around an hour and a half through rush hour traffic from base one morning to pick someone up to go to a tertiary referral hospital 3-4 hours away - i did go for a pee before leaving their home with the aim to try and do the journey with one stop ( for the UK people the person lived i nthe wilds of West Yorks - nearly Bronte country and the appointment was in Oxford - we took a break at Castle Donington services ) 2. when doing discharges on support shifts - again usually in the back of beyond because knowing it's go now or not really be able to go until after you've completed the next job. a lot of it is going to depend on the nature of the workload and your travelling times - if you are in an urban suburban service where jobs are 45 min -1 hour end to end you aren't going to necessarily be in the scenario of asking to use the toilet at a patient's home ,

and mindsets like this is why EMS in the USA is such a low status job.... the Europeans will have a different mindset on this , and not just because of EUwide manual handling regulations that aim to reduce or eliminate manual handling takss , our tightly packed due to population density and available land private houses don't have room to get trolleys in and if if they do there is no assurance that you will be able to get to the patient ...

Richard and Bernhard have covered a lot of the points i'd raise , there have been other threads on this kind of topic i nthe city , discussing provision and the differing apporaches in different places

but compared to the fines and payouts for breaking staff ? the advantage of the UK approach of ramps / lifts is that it allows the ramp or lift to be used with carrychairs wheel chairs or even an ambulant patient ... what's the contingency method of operation ?

i'd echo all the above, from the two symptoms mentioned - Mobey's suggestion of a head injury is something to consider ... being an effective clinician is more than just playing buzzword bingo to come up with a diagnosis ...

squint I've had these kind of discussions around 'Nurses can't do X, Y or Z' on a nursing based site with a wide international readership and oddly enough even with reference to statute law and the requirements of BONs often these statements can't be substantiated

oh dear oh dear oh dear ... it'd would be funny if it wasn't showing the ignorance of individuals from a UK perspective there is only one thing an 'ordinary' RN cannot DO that a paramedic can do and that is give IV morphine without an existing prescription. Every other Paramedic intervention requires either a small piece of administrative work ( e.g. Patient group directives for medications) or simply proof of competency - e.g. peripheral IV cannulation Similarly for a Paramedic to do everything an RN does again requires proof of competency and various small pieces of administrative work, however there are a substantially larger list of things a paramedic would have to demonstrate to be able to do everything an RN can. perhaps if those who are fond of saying 'Nurses can't do X, Y or Z' were to do a little bit of research they might find that aside from legislation surrounding medication , most of these prohibitions are nothing more than organisational policy or 'widely held truths' without a basis in regualtion or legislatiion.

yes and the UK product licence says as much as does ToxBASE

UK point of view and speaking purely from the point of view of SJA equipment 2007 Floods we put 4 ambulances (3 type B CEN and 1 pre CEN A+E vehicle) an RRV (double manned) and a PTS bus out in under an hour from the call being recieved by the crewing co-ordinator. we've also excercised and had standabys where the same response has been ready... there's also all the kit for rest centres and /or 'field hospital' either ready packed in the incident support vehicles / trailers or there on the shelves to be loaded there's also all the CBRN and USAR kit that NHS HART have prepacked on their support tenders

*big fish , little fish ,cardboard box * *big fish , little fish ,cardboard box * *stacking shelves , stacking shelves * *big fish , little fish ,cardboard box * *big fish , little fish ,cardboard box *

patient 1 i'm suspecting a head injury if he tolerates an OP he's probably going to be falt enough for a Supra glottic airway or a tube patient 2 has a low BP , but from the description given of other signs and symptoms his low BP may well be from Spinal Shock / Spinal cord injury - what are our examination finding head to toe? is there another cause for the hypotension ... 84 systolic in a fresh SCI isn't actually too bad. patient 3 ROLE at scene - police to organise body recovery at a point the SIO decides that sufficient evidence has been gathered

there's strong arguments for field physician availability, but one on every ambulance ... as if enough ambulances don't fall over due to elevated centre of gravity .... that's a bit of a circular argument - a lot fo the skills f patient assessment, and decision making are independent of location - where each different location emphasises different skills aobut the location .... Stay and play killed Diana not physcian to scene they had three options 1. rapid transfer to an operating theatre 2. open her chest on the back of the ambulance ( or on a pub table as London Hems doctors did sucessfully to someone) 3. fart about trying to 'stabilise for transport' the ability and training to work at a scene is not magically something which paramedics and EMTs have exclusively exactly who said brand new and who said anything about not providing adequate role specific orientation and training ? MD900 will happily take 3 or 4 seated people and one supine in the back if you make the next jump to S92 sized aircraft .... or just go the whole hog and use a merlin or chinook as the RAF MERT do in Afg.

Registered Nurses are NOT 'hospital based providers' , RNs work in every health setting going. in the case of the USA while paramedics and their fire monkey / for -profit bosses are happy to be treated and trained as taxi drivers service development won't take place. This is in part due to the fragmented and billing orientated way in which healthcare i nthe USA (doesn't) work ... If you look at the model the UK, Canada and Aus has and the Kiwis are heading towards, where Paramedic preparation for practice is equal to the preparation of other Health Professionals i.e. 'proper' Health Professional status, near ( 2/3 or 3/4) if not degree level entry, legal accountability for own practice ( not as the proxy of the medical director) proper own account responsibility and accountabilty to possess administer and in some cases supply medication ... ...

15 mg / kg with a max dose of 1g at time 4-6 hourly 4 g in 24 hours - is what the BNF would say and there's pretty good evidence for that regime as a good balance between wanted properties and minimising the hepatotoxicity which kills untreated Paracetamol ODs ... i'm inclined to agree wit hthe rest of the suggestions and reasoning...

very very few vehicles couldn't take second patient ( the exception is extrication ambulances based on medium to large SUVs where there simply is not room by any measure unless they are well enough to sit in the front passenger seat ), the issues arise from securing that second patient in the vehicle especially in vehicles without a bench or a lie-flat option on the side seats ... while it's very rare in the UK to have to wait prolonged periods for additional resources and the RN and RAF SAR helicopters ( plus other military helicopter resources) are happy to respond to inland incidents etc - so if HEMS (single pilot + air observer trained medics VFR apart from Helimed 27 (London) who fly twin pilot) can't make it due to weather there's a chance that the military will with IFR and Night vision and their 2 pilot 4 person ( 2 WSOp / loadies )crew

RIP Dust

firstly is the patient actually using the entonox properly , it is very effective if taken properly and kept 'topped up' ? if entonox isn't enough you have to consider requesting back-up you also have to balance running hot to hospital and it;s increased risks with the extra time it will take to get that backup ...