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Our station is involved in a study trying to introduce and test the capabilities of Telemedicine in Germany. It's actually a fairly new idea over here since EMS has been pysichian-led for the past 40 years. The data is sent via cellular network only, not digital radio. There are two pysichians available at the dispatch centre, which receive the vitals on our monitor (NiBP, SpO2, live ECG, 12-leads, etCO2), we can send images, they can direct a camera in the back of our ambulance, and of course talk to us via headset. In case the patient is critically ill or severly injured, the ground-based pysician or HEMS would still be dispatched. Now I'm curious on how you work with Telemedicine and if you do at all. By what means would you send the information? What sort of information do you send? Can you send e.g. 12-leads or are you only able to consult with the doctor? What sort of doctor is that , where is he based (ED or somewhere else)? For what sort of emergency or medication would you call in and does that depend on your level of training? Do you have protocols covering most areas or do you have to call in often? Is the equipment reliable, how is the network or radio coverage? What do you do in case the radio breaks down and a patient needs treatment? Just generally, how are your experiences? Would you prefer working in another system without direct medical control? Are there even systems using independent practitioners in the U.S.? I understand that there will be a broad range of answers, just give me an idea on how you work with the technology. I've recently watched the first season of Emergency! so that's basically as much as I know I'll also be happy to answer your questions. Take care

Hey all, here's something I'd like to think about. What would be some good universal hand signals for working at an MCI? In a perfect world, of course, everyone would have the best radios that work all the time and all agencies involved would work together in a seamless fashioned. Unfortunately, that's rarely the case. I think that EMS should add the use of hand signals for line of sight communication in case of transmission problems with radios. For instance, let's say you were doing triage, and wanted to relay your count back to the incident commander. You could point to your eyes for "I see" then make a signal for "patients", then hold your fingers up for how many, and at a hand signal for the appropriate color, red, yellow, green, or black. I think a big one would be a universally recognizable signal for "evacuate", something equivalent to what three blasts of a fire truck's air horns mean. Something that when you see it, you relay it quickly and then GTFO. What other signals could be useful?

I was recently mentoring/precepting a paramedic student, called to a 57 year-old with chest pain. Patient normally well and healthy, on beta-blockers and a PPI. Anyways, presented with the following (of what I can remember): Central chest tightness, onset at rest, 8/10 at worse, clammy, nauseous, sinus rhythm, BP 165/90, anterior ST-elevation. Both the family and patient are quite anxious. The student, who was treating and doing the questioning/communicating with the patient, looks at me after the ECG is done to confirm what he's seeing. After a quick discussion of what the findings are and what our plan is, he says to the patient "It appears you're having a heart attack" +1 for being truthful, -100 for not thinking about another way delivering this to an already anxious patient and family. We had a good chat about the whole thing after the call, but wondering how everyone out there goes about this in an acute setting. Obviously there is no 100% correct answer as all situations are going to be different, but just curious of what sorts of methods work well from your own personal experiences.