p3medic

Bill them for services, get the refusal signed, do another call...problem solved.

LOL :oops:

I wonder what kind of lawsuit the actual victims family could seek from this individual. I couldn't imagine the pain it would cause me to see a story about my deceased loved one altered to serve someones warped agenda. Sue that....

No special license required, some agencies require no additional drivers training, mine does EVOC with annual recert.

1. No 2. Money, benefits, training, equipment 3. Act of Congress, not because of desperation, but because of a very effective Union. (Cuts both ways) 4. Friendly, but not welcoming with open arms. You will be expected to continue to swim upstream and improve your game, otherwise you will be ostrascized. You will likely be cut during the hiring process if you are a complete boob. Medics are all promoted from within the department, so there is no hiring of medics per se. All new hires are hired as BLS, with a requirement of completion of a 6 months training academy and another 6 months of probation. After that time, if you posess the credentials to work ALS and if there are posted openings a competitive written, practical and oral exam is given, those who pass are ranked, and the number of positions open go to the top of the list. Then you have another 4 months or so of clinicals, field internship and a final oral board. If you pass all that, another 6 month probationary period.

Some of the problems associated with etomidate, i.e. masseter spasm, myoclonus are aleviated by following it with a paralytic. Etomidate by itself can be problematic.

We had the Glidescope on the trucks for a while for a trial, really liked it. You could get a grade 1 view on patients that with DL you might get a 3. It had limitations, secretions and blood tended to muck up the view, despite the heated lens and passing the tube was different due to the angle difference. With the Glidescope you don't displace the anatomy like you do with DL, its "glided" along the natural curvature of the airway. As of yet we haven't purchased them, hopefully we will. There are patients out there that the GS could make a huge difference with. I had a patient a few weeks back that was 1 week post op from a cervical spinal fusion, had no neck mobility, a recessed jaw, malampatti 4 airway, and a grade 4 view on DL. I'm quite certain that the glidescope would have performed wonderfully for this patient.

INR = International Normalized Ratio. It is based on PT, "normal" value being 1. An INR of 2 would have a PT of 2 times normal, an increased PT. (prothrombin time)

Burn.... :oops:

Completely agree that pain management is warranted. It is the humane thing to do, no doubt. Early pain management is the goal, and it is certainly true that those who recieve pain management pre hospitally tend to recieve it sooner in the hospital. I haven't read any research suggesting that pain management early by EMS could reduce mortality in this group, but I don't doubt it exists.

agreed...push it back in.

Other than pain management (which is important) I don't see what an ALS provider would offer to reduce morbidity and mortality in these patients. The 2 year mortality rate may be 80%, but that is from complications down stream, not really something that a 30 minute ride in a BLS vs ALS ambulance is going to change. What initialy management do you suggest would improve the long term outcome of these patients?

There was nothing you can do. Traumatic cardiac arrest, especially prior to your arrival has nearly a 0% survival. There was nothing you could do differently. Unfortunately in this line of work you will occasionally see some very unpleasant things. You might feel better by talking about your feelings with your co workers involved or the hospital staff, or perhaps a professional who's job is to deal with post traumatic stress. In the end you need to come to realize that the outcome for this kid was determined long before you showed up. Good luck and take care.

Put driver in police car, drive to hospital, have hospital staff draw blood and submit to their CLIA certified lab. No need for EMS. Cops love to use EMS to make things go away. EMS has much better things to do than to be involved in this. Hell, put the cops through a phlebotomy course and let them do it themeselves.

I think he said they have no protocol for pre intubation sedation, they use versed for Post intubation sedation. I agree, that putting a tube in someone that is aware is inhumane, however we are all constrained by our protocols. My biggest pet peave are people who intubate a pt, with or without sedation and then give a long lasting NMBA without sedation.

I'm not sure what I would consider an adequate sample size, however I know 18 is way too few. Any given trauma center could generate 100 times those numbers of patients, which to me would hold a lot more water. There are too many variables with human physiology to accept this small a population when deciding to remove a drug from the RSI toolbox. We all know adrenal suppression happens, how clinically significant that is can't be derived from this small study. (I haven't read the study in its entirety, only the abstract.)

The most glaring problem is it is incredibly underpowered. 18 patients?

The IAFF propaganda machine is strong. I threw up a little in my mouth after watching that... :roll:

I've done them on anesthetized goats in ATLS , but never seen it done in the field or ED. With I.O. devices readily available and very quick to use, I think cut downs for emergent vascular access has fallen out of favor, but I could be wrong.

An elderly woman lying on a hard floor for an extended period of time can develop muscle breakdown and rhabdo from pressure necrosis, however we usually see other signs such as EKG changes secondary to hyperkalemia, both from the cellular breakdown and eventual acute renal failure. Without a complaint or a worrysome EKG, I'd probably hydrate with saline and transport.

Well, if jerking off management sounds like a better plan...

I'm with Dwayne, I'm of Irish desent, so this whole measuring thing is making me uncomfortable....

I'm not following your thought process on this, care to explain?

The etiology of the arrest makes all the difference. The VF/VT arrest? No brainer, shock the patient, cpr, go in to the hospital. Obstructed airway? Secure it quickly, go in to hospital. Trauma? Go in to the hospital. OB? Go in to the hospital. If it is something that we can IMMEDIATELY correct, do so, otherwise we are at the hospital, provide BLS airway management, cpr and go in.