EMS Research

[BVESBC]

To Tniuqs - Thanks for finding my coffee. Seems like a long road trip to get it back.

To BVESBC - 1. Since you seem to be indicating you have knowledge of equipment to lift Ms really Big to the power assisted cot. Please let me know what equipment we should use to lift MS Really Big who fell in an almost prone position between two brick walls with a 28" separation between the walls. After lifting them to a power assisted cot life is great, it is just getting the large person to that piece of equipment that's the problem. 2. Do not slam the people I work with you do not know them nor do you know our lifestyles. 3. Since it is apparent you can not do a Blood sugar check, I deduce your Medical Control is afraid you will stick your finger instead of the patient's

1. there are tools for getting ms really big to that cot and if it was my full time job like that of the services that I mentioned I would be more than willing to go into great detail on them. As I already mentioned that is not my job. send me you email adress and I will send you the contact information of the cordinators for both services.

2 It was not a slam agains the people you work with. It has been shown in many studies that we as a group are less healthy than other groups.

3. Our protocol set forth by the state has no reflection on my copetency, it reflects their intrest in dumbing down the EMT-B curriculm instead of culling out the stupid EMT's they usher through the system. Good EMT's take shit from people all the time due to a few hacks.

[AnthonyM83]

but I will stand behind my statements about advanced airways and diagnostics, IT IS TIME!!

Apparently you work within the perfect EMS system, So First Educate yourself on how to use spell check!

I noticed that only those of a higher medical authority responded, don't sit there and act like you are not overworked

Man you started off with a lot of assumptions. I think some excuse them because you're probably taking them based on the local experiences you've had. You're dealing with a national web board, though... take the time to figure out the nationwide trends. Also, take the time figure out who's who and what type of person they are before you go slamming them.

Honestly, a lot of the stuff you said makes you look really bad. Imagine having a new guy at a party start talking crap about another (who happens to be a professional fighter) and challenging him to fight. Or maybe he calls someone else wimp (but everyone at the party knows he just ran into a burning building and saved an infant last week). Or he's an EMT and starts telling the group "how it is"...without knowing that everyone there is at least an EMT, if not paramedics, nurses, respiratory therapists, medical doctors, EMS educators, political proponents, and leaders in their field.

It's almost embarrassing correcting that new guy...they're embarrassed FOR him...and since the party members are in their own house, they don't really need to puff their chests and argue. They'll just state what they know is true.

You have some good defenses, but nothing that will justify all you've said. You can get pissed off at the site and leave or you can keep arguing until you feel you've won OR you can see it as a little realization to take a few steps back and figure out what we're all about, then see where you can contribute to this community. I think you're the type who would benefit from it (especially if you learned a bit more tact).

(I'm honestly still smiling about not knowing the English spellings...you were too busy learning Latin from middle school through grad school to learn that one? That's just part of being educated and cultured... totally excusable if you've already shown you are....but when you're trying to push that idea but failing, THEN you make the mistake...man it's just funny)

Honestly, look forward to good conversation with you on the site as you settle in.

[rock_shoes]

WOW big question.

It is osmosis. basically it is the movement of fluid from an area of lesser concentration to an area of greater concentration.

Just imagine dropping a tablespoon of salt into a glass of water. Over time the salt becomes equally dispersed throughout the water (this is your hypertonic saline). Now drop a piece of fruit into that saltwater.

The fruit is hypotonic (less salt), through osmosis the water leaves the fruit to get to the higher salt concentrated water. Now the solution becomes isotonic (or equal salt concentration throughout the water.

Now apply that to the human body.

Our tissue is filled with low sodium water. If we fill our vascular system with hypertonic saline (more salt), osmosis will draw the fluid from the tissues into the vascular system in an attempt to become isotonic.

Confusing hey?

Actually that makes a lot of sense to me. A good scientific explanation works for me because I spent a couple of years taking engineering before I moved towards EMS (What was I thinking making that switch :shock: ). The human body is always striving to maintain equilibrium. By giving a patient hypertonic saline we are throwing the system out of equilibrium. The bodies own actions to regain equilibrium have the effect of increasing blood volume in the vascular system. I could see this having a lot of benefits should a patient need surgery after being brought in as it will reduce the amount of fluid in the bodies tissues.

The more I learn about the science behind the primed study the more I look forward to seeing the results. It would have been better if the action of the solution had been explained properly at the same time as the inclusion criteria was presented.

[Dustdevil]

Thank you! That was my point why can't we do it to provide a baseline prior to TX and it is usefull for other providers to continue the continuity of care.

Nice grammar. I suppose punctuation is different in Latin. :roll:

I find it amusing -- and quite telling -- that you come here boasting about all your knowledge of Latin (with a capital L), but have nothing but a smartass comeback when tniuqs quotes some Latin for you. Reminds me of the kids in school that would tell everybody they were a karate black belt, but then refused to demonstrate any moves because they were "2 d3adly". And you're wondering to yourself why nobody here seems to take you seriously?

The reason you should not do it to provide a baseline prior to treatment is because you will not be the one doing the treatment. The time that passes between your dubious diagnostic test and my evaluation and treatment of the patient is too long for your test to be of any value to me. Do you really think any doctor is going to just take your word for what the patient's blood sugar was half an hour ago and start treating the patient based on that number? Of course not. It's a waste of time, just to stroke your ego.

It's funny that you point out that only the advanced providers seem to be against your silly little idea. Have you also noticed that it is only the basic providers that are for your idea? That should be ringing a bell in your head. It's more than the mere fact that we don't want you to do it. It is that we don't need you to do it. And, if there is no need, there is no reason to even discuss it.

An even better reason why basic providers should not be doing this is called the Slippery Slope. Certainly a man with as much advanced education as you claim has taken a philosophy course or two, and understands that concept. I touched on this earlier. The ability for your basic providers to perform advanced diagnostics only eventually leads us down that slippery slope where they assert that they need to be "given" more therapeutic skills in order to treat the results of their diagnostics. That is what results in your community continuing to FAIL to provide paramedics since they think, "well, our guys have these advanced skills now, so we don't really need paramedics". And, of course, the basics encourage them in that thought, since it allows them to keep their pitiful little jobs without having to ever advance themselves.

Prohibiting basics from performing advanced interventions is not what is "dumbing down" EMS. Allowing basics to perform advanced interventions so that they don't have to go to paramedic school is what is dumbing down EMS. The profession is now beginning to realise that this mentality is exactly why we are still three decades behind the rest of the civilised world. And that is why, as AZCEP pointed out, the EMT-Intemediate is beginning to go the way of the dinosaur.

It's time to decide which way you are going to go. Do you want to be a subterranean carbon deposit, or do you want to be a professional medical provider? Others in your area have figured out how to become a paramedic. I bet you can too.

[Doczilla]

BVESBC-

You have f#$ked up a perfectly good thread with your drivel.

And you have demonstrated a complete lack of situational awareness by taking this tack with the veteran providers represented in this thread.

Go away.

'zilla

[BVESBC]

[The reason you should not do it to provide a baseline prior to treatment is because you will not be the one doing the treatment. The time that passes between your dubious diagnostic test and my evaluation and treatment of the patient is too long for your test to be of any value to me. Do you really think any doctor is going to just take your word for what the patient's blood sugar was half an hour ago and start treating the patient based on that number? Of course not. It's a waste of time, just to stroke your ego.

We already provide the BASIC treatment, every ER tech in the state that has little to no education can do this. Yet we are restricted by state protocol. The ALS providers in the area I provide service are severly overtaxed, this is not something which I cant do anything to change. The amount of time we generly spend on scene and the amount of time that is used to get to a acute care facility normally will be less the 15-20 min. We cant get ALS for a full code on a regular basis. The amount of harm possible from this Basic test small at worst.

[paramedicmike]

BVESBC-

You have f#$ked up a perfectly good thread with your drivel.

And you have demonstrated a complete lack of situational awareness by taking this tack with the veteran providers represented in this thread.

Go away.

'zilla

+1000

[tniuqs]

BVESBC-

You have f#$ked up a perfectly good thread with your drivel.

And you have demonstrated a complete lack of situational awareness by taking this tack with the veteran providers represented in this thread.

Go away.

'zilla

Agreed zilla :

BVESBC .... please go back to your cave.

[AZCEP]

We already provide the BASIC treatment, every ER tech in the state that has little to no education can do this.

You can provide the treatment without the test as well. The ER techs are not operating in a vacuum, and likely have more support for doing so than you do in your limited service.

The ALS providers in the area I provide service are severly overtaxed, this is not something which I cant do anything to change.

Then why do you continue to use it as the example for why you should be allowed to do something? The ALS providers do not "need" you to do anything. Save for perhaps becoming an ALS provider yourself. A finger stick blood sugar will not relieve them of their responsibility to provide care to the patients they are assigned to. Likewise, it will not alter your ability to provide oral glucose.

The amount of time we generly spend on scene and the amount of time that is used to get to a acute care facility normally will be less the 15-20 min.

How does this change with a finger stick blood sugar being done? The procedure takes all of 60 seconds from the time you decide to do one. Because you can't provide the treatment that the patient needs, your scene times should not be altered at all.

We cant get ALS for a full code on a regular basis.

Allowing you to perform a diagnostic test does nothing to alter the system problem you are describing. Your area is understaffed with ALS, and needs more of them. It is folly to consider that allowing more add-on skills to the BLS providers will fix this problem.

The amount of harm possible from this Basic test small at worst.

This is not a matter that falls under the standard risk-benefit assessment. You will not receive any information you can do anything with. Therefore, you do not need to be allowed to perform the test. If your patient is altered, and can protect their own airway, go ahead and use your oral glucose. The damage comes when the patient is altered and cannot manage their own airway, and you use the oral glucose anyway. The test is irrelevant based on the clinical context you find yourself in.

[Dustdevil]

...every ER tech in the state that has little to no education can do this. Yet we are restricted by state protocol.

<snip>

The amount of harm possible from this Basic test small at worst.

Dude, you just don't get it, do you? There is a valid REASON for the ER tech to do it. A physician is standing right there deciding what he is going to do for the patient. When you, as an EMT out there by yourself, with no advanced providers on scene, do it, there is no valid reason for it. It doesn't lead to any productive conclusions. It doesn't save the ER or intercepting medics any time. So what's the point? It's not about it being particularly difficult or risky. It's about there being no legitimate need. You have none. Period. Grow up. We don't do things just because we can. We do things because they are necessary. You will never, ever in your career -- even if it lasts thirty years -- lose a patient because you were unable to check his blood sugar. There it is. You don't need it, so just let it go,.

The ALS providers in the area I provide service are severly overtaxed, this is not something which I cant do anything to change.

Oh, yes you can. You can do several things. First, you can go to paramedic school. Second, you can lobby your local civic leaders and educate them on how inadequate the system is. I'd be willing to bet you that nobody has ever done that. Certainly no EMTs will ever do it, because then their jobs would be threatened, and it's all about them. Third, you could quit, leaving the community without that false illusion of having real EMS when they really don't. Again, it is painfully obvious that you FAIL to grasp the big picture. For you it's all about you.

EDIT: Ooops! AZCEP already provided pretty much the same answers I just did, but I didn't see it. I had started this reply before AZCEP posted, then got sidetracked. Sorry for the redundancy. Good job, AZ.

And ROFL@zilla