Things we teach in EMS that are wrong

[Just Plain Ruff]

I don't know about these Bieber? I might have missed some past conversations on this, but what pain management procedures are good for patients in a state of shock?

I also don't know how we'd survive without lights/sirens in Los Angeles. For my local fire station it takes about 15+ minutes to cross some 2-block stretches... lights/sirens can cut down a transport time from 45+ minutes to under 10 minutes in a number of areas (more in some specific areas)....no speeding involved either..

I work in a rural area and lights and sirens helped not at all.

But that's rural.

Urban areas like Baltimore downtown are lit up by almost all ambulances either goign to a call or coming to the ER. Without l&S, there would be long long transport drive times in Baltimore.

[Chief1C]

When I took the course, some fifteen years prior to this date, the text books were printed in 1992. It took a good while to learn how to be a proper provider, and not just a schooled ambulance attendant.

[tac57]

That resp rate >28 = ventilate. No really this is what they teach to all first responders (EMT-B's in canada) and AFAIK primary care paramedics. It is taught that one should coach someone's respirations down w a BVM if rr > 28 resps/min. I don't need to get into the issues w this, but suffice it to say it should be adequate minute volume we care about at the BLS level. If the MV is OK, then give oxygen if indicated and monitor the pt. Hyperventilation can be pathologic/detrimental or be a normal compensatory response that you don't want to get rid of w/o being able to manage the pt to an als level. Think DKA or other causes of metabolic acidosis.

@MariB: these are still issues w the BLS and ALS standards in Ontario. These standards govern both paramedics and for the BLS standards all FR agencies (MFR in Canada=EMT-B in the US). Although when they don't require an IV pump to run dopamine on Ontario land ALS there is an issue...

[srothig]

GCS <8 Intubate, There are other intervention's that can be done before intubating if the GCS is below 8 right off the bat. PT condition can improve and bring them above a GCS of 8 by simply solving lets say simple Hypoxia via NRB.

[ERDoc]

GCS <8 Intubate, There are other intervention's that can be done before intubating if the GCS is below 8 right off the bat. PT condition can improve and bring them above a GCS of 8 by simply solving lets say simple Hypoxia via NRB.

And right here is an issue. GCS<8 was only meant to apply to head trauma. It was never meant to be used on medical pts. Unfortunately in all of medicine, especially in EMS, it has been used much wider and in circumstances where it wasn't meant to be used.