p3medic

The International Association of Fire Chiefs recently came out with a postition statement OPPOSED to the merger of fire departments with police departments because they are completetly different jobs and would be impossible to provide the same level of service to both functions. They fail to make the same comparison to EMS oddly enough.

Next months follow up lecture will be on the best way to extinguish fires and respond to fire alarms, with a board of nationally respected surgeons, EM docs and third service paramedics.....WTF? The NFPA and the fire service have some balls dictating how EMS "should" be run.

Dart doesn't bother me, the McSwain Dart was around for a while for performing cx decompression, so I can see why the term stuck. Should have kept reading before writing....

There is little doubt that a fire department can run a good EMS system, the problem is, most don't, for a variety of reasons. Using Seattle as the example of a "good" system, you will see that they have very few medics per population, do not run fire suppression ALS companies, and being a medic is seen as a promotion, not a demotion. They staff few, well trained ALS providers that see a lot of sick patients, and pts that don't require ALS intervention are referred to BLS transport units, freeing them up to respond to another call. Now, system 2, perhaps San Diego, LA, Metro Dade repond medics on trucks, medics on engines, medics on bikes, ambulances, etc....More medics than you can shake a stick at, yet despite putting a medic on scene in 4 minutes there intubation success rates and cardiac arrest survival rates are poor...why is that? My theory is too many medics with not enough critical patients. This problem of oversaturation isn't unique to the fire service, however it seems to be more a problem there than elsewhere(in my limited experience). Increase the level of education and training, stop cranking out medics at a break neck pace, stop requiring firefighters to be medics, require a minimum number of intubations per medic or mandate OR time. I realize with 2500 medics this would be impossible, however if cities like Miami modeled there ALS system after Seattle, they would cut out about 2,000 of those medics, making it a much easier nut to crack.

This seems to be an issue with many systems with too many paramedics seeing too few critical patients, or competing with medics on fire trucks for too few skills. LA, San Diego, etc have medics on almost every piece they run, I'm curious how many intubation opportunities medics in these systems get on average each year?

I work in a tiered system, ALS trucks and BLS trucks. If I am on a call with a BLS crew, as a rule, one medic is on the chair with one EMT, unless of course they are new and less than half my age, in that case, I am more than happy to rest my weary bones and carry the monitor or drug box. "Got Shoes?" is a BLS thing, running on calls believed to be "minor", ALS calls almost always get carried unless they absolutely refuse, or are no longer "ill", i.e, resolved hypoglycemia, reversed narcotic o.d., etc...Around here, the BLS guys are more likely guilty of walking pts than the ALS crews.

It was a Tazmanian Devil on holiday.

Well I can tell you that the cops didn't agree to a pay freeze and they lost jobs, same with the teachers union.....Freezing wages for one year isn't going to kill me, losing my job and having to work for a private might. I don't think my union had much choice, it went to a general membership vote, the members could have voted it down but chose not to.

Our union agreed to a one year wage freeze to save members jobs. If we had not agreed to it several would have lost there jobs, not exactly "united". So far, no jobs have been cut, hopefully next fiscal year is a bit better. Time shall tell.

I think its great for him, and unknown for us. He has been at the helm for quite a long time, several police and fire commisioners have come and gone in his time, and he's well known locally and nationally. Who's going to step up? Will it be someone from the department? (hope so), will it be a non-uniformed civilian? A doc? No one seems to know, but for now its his second in command, which is a good thing.

My wife has been talking about NC lately, but I'd rather be by the ocean....third service would be my choice as well....

http://www.boston.com/news/local/massachus...o_post_at_fema/

Is there anything that you can think of that might increase the duration of action of one of these drugs?

If you have an angio that you can attach a syrninge to, use a 3cc syringe and aspirate as you advance, you will get immediate blood return as you enter the vein. The newer safety catheters don't have the ability to attach a syringe, so sometimes you get no "flash", and knowing when you are in the vein can sometimes be tricky.

Look at your drugs again, ask yourself which one might cause this presentation.....

First article, 10th paragraph down. I don't disagree that a better documented chart would have made this all go away, but I can't help but think this is all blown out of proportion by a layed off supervisor. Just my opinion, no facts to back any of it up, I'd love to see their chart as well as the ED's. Until then, I will give them the benefit of the doubt.

Really? They found a non viable kid, with dependant lividity, and some supervisor ordered them to abuse a corpse. I don't see where they were making anything up....

I can't make it bigger on my computer for some reason, but my dx is 2:1 flutter w/RBBB.

Not really. It is very possible the scene went to hell, hysterical family, cop out of his comfort zone, so crew opted to scoop and screw and do CPR on the way, leaving the final call for the hospital. They may not have begun resus immediately due to the patient being non viable, however w/o a chart, its all speculation. Not saying that is the most professional approach, but at the time it may have been the safest and most politically appropriate, although it would seem leaving the kid (if in fact the kid was non-viable) would have been the best choice in hindsight. I would bet a weeks pay the complaint was generated by the cop, just a hunch. I've been in a similar situation, with different results.

Agreed. I don't think we have enough information to make a judgement of these two paramedics based on the article. We have no idea what the patient looked like, what the scene was liked, perhaps the cop was upset when they stopped, so they changed their mind? I have no idea, just playing devil's advocate and not throwing them under the bus without the whole story, thats all.

So, you would "make believe" this was a viable patient and rush to the hospital? This could have been a crime scene for all we know. Transporting the deceased is not the function of EMS.

How about this: A non viable infant, cop starts CPR because he can't think of anything else to do, medics arrive, recognize a non viable pt, cop and family have melt down, opt to transport....Just a possiblity. To suggest a patient need to be transported w/CPR until a doctor tells them to stop is retarded.

I don't think you need an EKG to "prove" death. It is an MCI, multiple patients, the last thing I'm thinking about dragging around the highway is the LP-12. Its pretty simple. If he isn't breathing, even after you open his airway, he is dead. If you get more resources on scene, sending someone to double check probably isn't a bad idea, I really don't see where EKG evidence has any role in a multi patient trauma senario. Its likely that the patient in question WAS breathing, it just went unoticed. I suppose a monitor might have revealed a rhythm that might have prompted the provider to take a closer look, but honestly, this is a training/education issue, not something that should require a piece of technology to decide, IMHO.

No.