spenac Posted April 13, 2009 Posted April 13, 2009 I good education comes from both the classroom and the streets, while yes you can learn somethings in the street you do your patients a dis-service by allowing an untrained EMT-B (or even an EMT-I) perform a skill not covered in their classroom education. That sad I learned IVs in the field as an EMT-B before finishing EMT-I and I started to learn ECGs and Pharmacology from Medics I worked with while a Basic and EMT-I. But there is a limit, don't let your EMT-B do the medic's job so they can "learn" it is one thing to show someone how to read ECGs or what the drugs are and not have them making the call it is another to let them start lines and drop tubes before they have the book learning needed to understand what is going on with those skills. I run across FF who are not EMTs starting IVs and 70% of the time have to restart the line b/c they don't check it (oh I got flashback I am in the vine... forget that I went through the vine and the line is no good) your clinicals and field internships are when you need to start skills on the street not b/c you medic is trying to "teach" you or b/c your lazy. And don't forget the legal issues with exceeding your scope of practice. The best EMTs and Medics I know are always in the books and learning from the street, most of the bad medics I know have the attitude that once you finish school you can put the books down you just need to do the required co-edu and nothing else. Why are we placing IV's on plants? Think you have wrong forum we only place IV's in viens. And your statement is more proof that basics should not be doing advanced skills such as IV's and EKG. Get the education so you understand why, how, etc. A skill just to do a skill is a recipe to harm patients.
mobey Posted April 13, 2009 Posted April 13, 2009 Kind of a side topic but are terminations of resuscitation not that common for traumatic arrests? I mean in general we pronounce medical arrests on scene... is trauma less common? Not round here akroeze, I recently called our local M.D. for orders to cease CPR... the conversation went like this. "Hello Dr. XX This is Mobey with EMS" "Yes" "I am at the scene of a traumatic cardiac arrest and am phoning for orders to cease CPR........" Interupted by Dr "Oh ya.... you can stop traumatic arrests stay arrested" "thank you"
akroeze Posted April 13, 2009 Posted April 13, 2009 Not round here akroeze, I recently called our local M.D. for orders to cease CPR... the conversation went like this. "Hello Dr. XX This is Mobey with EMS" "Yes" "I am at the scene of a traumatic cardiac arrest and am phoning for orders to cease CPR........" Interupted by Dr "Oh ya.... you can stop traumatic arrests stay arrested" "thank you" Exactly. Province wide in Ontario we have termination of resuscitation for traumatic arrests but I'm getting the impression we are the exception and not the rule
CBEMT Posted April 14, 2009 Posted April 14, 2009 Traumatic arrest was a station on my final practical test day. I've seen people doing CPR inside of cars that still needed to be cut open. Time of extrication to transport was, oh, about 10 minutes or so. Transport time to Level 1 trauma center- approximately 3 minutes, give or take 30 seconds. Gotta get all that stuff done because the hospital expects it, y'know.
RomeViking09 Posted April 14, 2009 Posted April 14, 2009 Ya my spelling at 6am without sleep is not the best... opps
spenac Posted April 14, 2009 Posted April 14, 2009 Ya my spelling at 6am without sleep is not the best... opps LOL. Sorry could not stop myself.
HERBIE1 Posted April 14, 2009 Posted April 14, 2009 Kind of a side topic but are terminations of resuscitation not that common for traumatic arrests? I mean in general we pronounce medical arrests on scene... is trauma less common? In the case of a homicide, for example, if we confirm triple 0, the police can declare a crime scene and it becomes a medical examiner's case. We simply document our findings and call it in. Other than applying the EKG leads, no other treatment is rendered so as to preserve the crime scene evidence. For other trauma, the patient must meet the obvious DOA criteria - massive head injuries, copious grey matter, decapitation- (obviously), a suicide jumper from height with associated massive injuries, etc. Anything else- they get transported. I do know in some systems, if a person is a traumatic arrest and asystolic, they are NOT transported. The survival rate of such patients is essentially zero, so wisely, many systems opt to save the cost of a transport and protracted resuscitation attempt at the hospital. In the case of traumas, I have never terminated a resuscitation once started since if they are viable enough to work them, then what they need is a surgeon, not a paramedic anyway. We also have no such protocol to terminate a trauma resuscitation and don't suspect we ever will.
spenac Posted April 14, 2009 Posted April 14, 2009 Codes that are worked should be done on scene or in the back of a parked ambulance. No transport should occur unless you get ROSC or if organ donor and then no lights and sirens as they are dead no need to risk lives. If no ROSC then call it in the field.
HERBIE1 Posted April 14, 2009 Posted April 14, 2009 Codes that are worked should be done on scene or in the back of a parked ambulance. No transport should occur unless you get ROSC or if organ donor and then no lights and sirens as they are dead no need to risk lives. If no ROSC then call it in the field. Unless you are talking about medical arrests, I disagree. Screwing around with a soon to be or already down traumatic arrest is futile. Address the basics, correct what you can immediately, and do the rest enroute. Trauma patients need an OR, not prehospital care. Obviously it also depends on transport times, but in general, there is no reason to delay transport on a trauma patient. Stay and play is for medical calls. Good point about organ donations- if you can keep someone viable for that, it is well worth any effort you make.
spenac Posted April 14, 2009 Posted April 14, 2009 Unless you are talking about medical arrests, I disagree. Screwing around with a soon to be or already down traumatic arrest is futile. Address the basics, correct what you can immediately, and do the rest enroute. Trauma patients need an OR, not prehospital care. Obviously it also depends on transport times, but in general, there is no reason to delay transport on a trauma patient. Stay and play is for medical calls. Good point about organ donations- if you can keep someone viable for that, it is well worth any effort you make. A trauma code is a dead patient. On scene you can decompress chest, push fluids, intubate, probably no need to shock because odds are will not be shockable rhythm, IV/IO, push your drugs, etc. Same thing the hospital is going to do. They are not taking the patient to surgery unless they get ROSC. Even AHA now says no to rolling codes. If patient gets ROSC then get them to the hospital.
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