croaker260

Back on the original topic... Here is our RSI/MAI protocol. http://www.adaweb.net/LinkClick.aspx?fileticket=%2bAHDTKMw3B8%3d&tabid=798

OK, besides this being REALLY funny, its the brain child of...ahem...some nameless providers in the local EMS world. Be forewarned, its completely non-EMS,and it is about Jesus as a rap star so some may not be into that.... nuff said..its really funny.

Now I understand your statement and in part agree with it, thats why I think firearm safety should be taught along side the safe sex classes and social studies in Jr high....but there is one fundamental difference between the driving and firearms. Driving is NOT a constitutionally guaranteed right. Firearm ownership is. There is the problem, and is why I believe that concealed carry permits are borderline unconstitutional, but that is another debate and a tiresome one. Regardless, you dont need a license to exercise free speech, vote, privacy, freedom to make medical decisions, or otherwise exercise any other constitutionally guaranteed right. Driving on tax funded roads (as opposed to private property) is a privilege and thus can be regulated. Free speech, voting, and firearm ownership is a right. I am sure there are various political and religious parties that would like to license and restrict my free speech, but the constitution wont let them. And I am sure that those same groups would like to prevent certain groups from firearms ownership for the same reasons......reasons that have nothing to do with safety. States/cities are not too LAX (though I do wish they would all use the same standard so I could carry across state lines), some are ridiculously restrictive based on poor understanding of firearms themselves, fear mongering, and special interest groups. The federal Brady Bill was an example of a colossal failure on all counts. Just look at Washington DC and Detroit as examples of the results of the anti gun nut crowd run amok. The only thing the anti gun laws have done is prevent law abiding citizens from owning and carrying guns, criminals dont care. Anyway, Ill shut up before the FBI knocks on my door.

We dropped phenergan 2 years ago and went straight Zofran, in large part to the increasing warnings from the FDA. 20 plus years of clinical experiance not withstanding of course. Anyway, so prior to that, Phenergan was a second line H1 blocker for us in anaphylaxis. HOWEVER, I am looking for a drug to augment our H1 blocker with an H2 blocker. Solumedrol has its own batch of issues and problems that are often overlooked. I am not saying we are looking to replace solumedrol, just looking to improve and expand out treatment. The research I have reviewed specifically list using an H1 blocker WITH an H2 blocker (i.e. Zantac). I am just curious who else is doing it out of hospital.

Actually my experiance has been totally different, and my reasoning is different as well. We are an unusual mix of urban/sunburban/rural and frontier all in our county (1000 square miles). We have transport times ranging from 5 minutes to an hour, and thats not counting the rare BLS assists out of county and the wildland fire fighting standby's. So based on the research we are looking to sustain the anti-histamine effects over a longer period of time in addition to the broad spectrum shotgun effect of solumedrol. We are not looking to imitate the ER, but to incoperate a treatment of proven value that will have wide acceptance by the medical community we give our patients to. As far as our protocols, we actually have very progressive protocols with a "standards of care committee" who is tasked with constant revision of our SWO's. I personally was responsible for our 2005 version of our SWO's major revision which included all the grunt work and research. So I am well used to the trials and tribulations involved. We have already had the preliminary informal conversation about it, thats why I am doing the formal proposal. Fortunately our agency has a 20 year history of open interaction with out medical directors (we have two) and revisions, presentations, etc are well received. Our protocols are very provider driven.

We already have Epi IM, Epi nebs, Benadryl, Solu-medrol. Adding it to the existing protocol. Using both H1 and H2 inhibitors combined decreases severity, duration and incidence of multiphasic reactions when compared to H1 blockers alone. Locally it is standard treatment once they get in the ER to give Zantac IV even if they have had steroids and benadryl,

OK, How many of you are using IV Zantac in Anaphylaxis. I am going to be doing our proposal to add it to our protocol and am wondering who else is doing it and using what regimine. Also if you can post the costs per vial I appreciate it so I can compare it to our prices.

Outstanding statement, Can I steal this? Im (very slowly) writing a book on the FTO/FTEP in EMS...someday it will be done. Someday.

In my experiance and research, Mag is not really useful or indicated in COPD/obstructive airway disorders, whereas is use in Asthma/reactive airways is relatively better understood and accepted. We to have a combined protocl for COPD and ASTHMA, but we also state that mag is for asthma disorders only.

News flash, as I have been a part of our hiring for many many years, and we also correspond and work closely with our local LEO's..I can promise you many agencies, especially LEO agencies… are absolutely hip to what you post and how you present yourself in internet land. EMS is a small world, and I know of several would be hires we have passed over after review of what they said and the pics they posted on their face book pages, on internet sites, and such. Fair? No. Reality? Definitely. As for an "in" to being a swat medic? Not to be harsh, but grow up, focus in the first 5-10 years on becoming an oustanding medic. In addition, work HARD on your physical fitness, most LEO circles recommend a cross-fit type program for "functional fitness". I would strongly recommend becoming a reserve deputy/officer in the process. Finially, becoming a part of the "warrior" culture through shooting and martial arts will help too. This is a years long process. I speak from knowing all the members on our TAC-MED team, as well as many LEOs. And trust me, we all can sniff out badge bunnies and B.S. from a mile away. Get serious about your career first, and then worry about the TEMS team. On the plus side, I know of three very fit females on our team over the years who were very successful in TEMS, so it is absolutely achievable by a female. And trust me, not one of them exhibited an ounce of groupie behavior.

Excellant example. Other great examples as well. At our service, the last thing we want to be caught doing is extening an informal break on the charges to a cop or EMS member when the public doesnt get those. It appears to be a "good ol' boy system". That said, we have a memebership program. All of our employees and the counties employees are members by default, therefore their bill gets written off for anything we dont recover from insurance. Strangely, a lot of our fellow LEO's are members as well... as our our local air medical providers, etc etc etc. In short, what was an informal subjective practice that would be a PR nightmare was made into a legal program that would pass public scrutiny. As As a TAX BASED agency, this was important. Especially since our local populance ar every sensitive to "abuse of power and monies" issues. I cant speak for my fellow medics, but occasionally local FF's have fallen under my care. Even a few that have been above and beyond rude while under my care, though most are nice enough when they are alone in my rig. Usually for orthopedic/injury/back related reasons. I have taken the (very) high road and provided them with absolutly high end care, complete with heavy doses of analgesia, same as I would do for my own co-workers. Probably a lil more than I would the lil old lady with a fractured hip, but physiologically they can take it anyway.... Sometimes this has resulted in a change of attitude the next time we are on scene, but not usually. To most of those guys, if you aint a FF, your pond scum. Still, I would do the same tomorrow when one of them ends up in my rig. Conversely, the local LEO's absolutely love us, because when they have fallen under our care (for the same reasons) we tend to take very good care of them too. Additionally, when on scene, we make sure to restock their gloves, give them sani whipes to whipe off their cuffs, etc. Sometimes it the little professional curtesies that go the farthest, far more than the "big ones".

SO, My service (I hate the term "company", call me an idealist) transitioned about 5 years ago from strict SOAP narritive to a modified SOAP in an EPCR narritive to decrease redundancy. Some unfortunatley have digressed into lazy charting habits. I, as an FTO, find myself frequently correcting those habits. Here is a cut-n-past of several documents I use in my one on one training. The first part is a ddescripton of Proper SOAP charting writtten by one of the first EMTs I ever FTO'ed. She passed a number of years ago, but I kept the text to use. The second part of my document is a "Template" of a full SOAP format: This final part is the current "Modified SOAP" template; And here is a HIPPA safe version of a modified SOAP: SOAP Report Guidelines for EMS.doc

Hey , I am curious on this "online refresher" program , if it is approved for use through the NREMT? I cant find anywhere it is approved through www.cecbems.org and am curious if the NREMT will accept it. I have plenty of hours but my ex-wife is using this for her refresher and I am trying to keep her from getting in a bind (I dont know why....) -Steve

I have an actual text book of "Paramedic skills" dated 1986 with this listed along with a skill sheet for testing. Weather it worked is debatable, like Isoprel, some older medics still swear it worked. This worked by breaking the surface tension of the pulmonary edema, breaking it up and therefore (in theory) allowing better O2 transport. The problem was it also destroyed surffactant and caused other VQ mismatch related issues.

Ada County Paramedics is hiring, we are a progressive service, but it is competitive. Its also about as far from the caribbian as you can get. www.adaparamedics.org

Hey, Welcome to the forum... I am a 20 year vet, 15 as a medic, and if it matters I have the alphabet soup for instructor certs too. My email is croaker260@gmail.com. I am happy to help... Regarding the difference between EMT and Medics, tere is a HUGE difference, but that topic has been beat to death and is a complex one. It also differs GREATLY by jurisdiction. As for the clinical question.....Anyway, Ill take a stab.... Well, this is clinically more complex than you would think. The throat is the "upper airway" and the lungs are the "lower airway". Any number of inhalation of flames, high temp air, etc can cause upper airway "burns". By contrast, due to laryngeospasm (spasm of the vocal cords), it is unlikely for a patient to sustain thermal burns to the lower airway (the lungs). A major exception is STEAM burns where the patient is subjected to high pressure flame, blast, or steam exposure. Most lower airway injuries are from smoke inhalaltion (CO poisoning, etc). I can elaborate as needed. I have had a fair share of thermal trauma over the years, I can give you several examples if needed, in a HIPAA compliant way of course. What an EMT would do differs GREATLY on the level of the EMT (i.e. medic) and the exact cause. BTW, the email function isnt working for your profile.

Perhaps you misunderstand my point, what I am saying is that the simple 4 question (person, place, time , and event) A/Ox4 exam is inadequate (and never was intended) to determine if someone is legally competent to refuse care. Not even close. I have used this example before, but I promise you that on any weekend you can go into any bar outside a military post and find a completely hammered, completely and utterly altered soldier/marine/sailer/airman, and ask them the basic questions and their SSN, and they will respond clearly, LOUDLY I am sure, and quickly. Because this is a simple rote memory reflex and not a determination of cognition. Here are links to 3 different cognitive assessment/questions in common use in medicine. All are mostly reproducible in the field and provide a better picture of cognition. Why? Because if a patient cannot be shown to be cognitive enough to understand the refusal process, they cannot make that decision. I am not endorsing one over the other, but I feel EVERY provider should be familiar with these questions and incorporate them seamlessly into your assessments/documentation, especially on refusals. http://en.wikipedia.org/wiki/Mini-mental_state_examination http://en.wikipedia.org/wiki/Abbreviated_mental_test_score http://en.wikipedia.org/wiki/General_Practitioner_Assessment_Of_Cognition Can you provide a link or more information?

Oh good, creeping about here and there poking my head in to offer sage (AND NOT SO SAGE) thoughts....

Someone made the comment about "tricks" for this situation. Sadly there are no"tricks" that are common accross the majority of the patients. There are, however, "pitfalls" that will land you in a world of trouble. It is probably more useful to you to consider the pitfalls and avoid them. Then, of the options that do not fall afoul of the pitfalls...chose the best ones that the situation allows. I dont know if that approach makes sense, but sometimes its hard to explain things in this format. NOW...what are the pitfalls? 1- For most EMTs/Medics, we do not (unless we are LEO/CO's) empowered by law to seize, apprehend, or otherwise detain a subject. To do so is a volation of the 4th ammendment. It is a civil liberties /constitutional issue, so before you lay hands on some one you must be absolutely sure you have the right standing and that you must act immediately. "Implied Consent" is unsteady ground at best if an adverse result occurs.... 2- There is a clear difference between restraining someone for their own safety and defending yourself. Therefore techniques that are perfectly OK if you are DEFENDING yourself are NOT OK if you are restraining someone for their own safety. Be sure you are in the right "mode" at the right time. 3- When determining if someone is competent to refuse care, remember that there is much more to determine mental status than simply Alert and orinented x4. If you are simply using A/Ox4 to determine if you can lay hands on someone , or that is all you are documenting....you are setting yourself up for trouble. 4- As someone mentioned, what ever we do we should make every effort to avoid harming the patient. It is important to remember that when restraining a patient, even if you are doing it perfectly, can still result in harm and even death. There has been much written about Excited/Agitated delerium just to name one cultrpit....restraining someone ....should not be taken likley. 5- and most important....Gordan Grahmn says that High Risk low frequency descisions like what we face in EMS (and Law enforcement) can be furhter broken down into descretionary time and non-descretionary time ... in otherwords, do you have to ACT NOW, or can you de-escelate and wait for the problem to either resolve it self or be resolved with the expertese of Med Control or a supervisor. Frankly, half the problems in this situations are because EMS providers JUMP IN before they have to. Remember that slow is fast.... I hope this helps. Sorry for any TYPOS...Sinus Medication is killing me.

I dont know if I have the exact reference available.....but I recall two extreme cases where suddden immersion hypothermia was the proximal cause and the arrest lasted (IIRC) close to 6 hours. Both occured in Canada AND (IIRC) the same paramedic was involved in both cases. But it has been a number of years since I read the articles so I may have some of the facts wrong.

Your hitting my old stoming grounds, though I never worked for the old LFR, or prior to that the Jefferson County EMS.. LMEMS has had a long and somehwat troubled employee relation history starting with the (reportedly) advisarial takaeover by Louisville Fire and Rescue, then the forced merger back into a Metro 3rd service EMS. That said, many great things have been done there. The best way to find CURRENT information on LMEMS good and bad is to hit up the KY EMS COnnection Forum www.hultgren.org I would add that if you are expecting RSI, etc, your not gonna find it there, but Georgetown-Scott EMS instead. Also, if you are feelng pinned in after only 5 years...I RESPECTFULLY suggest that you give it some time. If you feel that way after 7-10 years, then consider a move. 5 years is nothing in this job. Just MHO without knowing your exact situation. Also, if you want another gig, that has vents, RSI, etc.... My service is hiring www.adaparamedics.org. Apply now though, the deadline is approaching.

Actually I didn't do it, but our employee association did. I agree, its very nicely done. If anyone wants to purchase the calenders, I can post a link. They are 18 month calenders.

Trevors Trek is a Cancers Survivors Charity. This video features images from a calender fund raider we did. You will note that unlike the Beefcake calenders, we specifically made a calender that focused on the REAL Heroes...the Kids. Yes, all these kids are Cancer Survivors or are struggling with Cancer now. The video speaks for itself.

I have and will do some of that, but I am also trying to get pictures of providers from agencies other than my own.... But good idea, Appreciate it. I have and will do some of that, but I am also trying to get pictures of providers from agencies other than my own.... But good idea, Appreciate it. I am well aware that many agencies, my own included are cracking down on cell phone camera use....

This is pretty much my view exactly. After all, I would hate for the inmate to get a cellulitis from a crappy IV stick, or suffer undue pain from a misplaced catheter and delayed action of the medications/lethal injection.