Who can see the future

[Arctickat]

Do you see a use for any other labs in the field using a system such as the istat? If so which ones and why?

I think the istat is overpriced. There are many other tools out there that can provide many similar results for far cheaper. For example, do we need to spend $16 per cartridge over the cost of the device to get a quantitative cTnI result, or is it just good enough to know that it is elevated into the levels that we know myocardium damage is occurring for $13 a test?

[ERDoc]

Sorry, I was just using istat as a generic term for the point-of-care devices since that is how we refer to them at my shop. Of everything we've mentioned I think anything that would tell you that the troponin is elevated, whether it be quantitative or qualitative, would have the most impact on prehospital care. I agree that a + or - would be sufficient since you will not be trending the level in the field.

[Arctickat]

Thanks Doc. I've been using qualitative tests for cTnI/myo, Acetaminophen Overdoses, methanol, and my hospital likes to use 10 panel urine DOA tests for determining what meds/drugs may be on board a patient. They can't do a tox screen here.

[ERDoc]

Quantitative test for tyelnol OD? How do you determine what is positive and what is negative?

[Arctickat]

Qualitative. 200 µM cutoff point. 2 lines = positive.

[ERDoc]

I realize you don't make the equipment but that doesn't seem very useful. If you have someone who is 8 hours out from the ingestion your toxic level is 100 or more. If you have a pt with a level of 150 your pt would be toxic and your test would be negative.

EDIT: Tylenol is one of those tests where you need a quantitative test.

Edited December 12, 2012 by ERDoc

[Arctickat]

I agree with you, I should have put that particular test into the past tense category. We tried a half dozen and then realised we were getting our patients too soon for the serum levels to actually have time to elevate to detectable levels.

[Bieber]

Hopefully less fire involvement, more emphasis on treatment and no transport, more evidence-based medicine, aligning ourselves more closely with primary care services, adding additional education, treatments and equipment for the management of primary care issues, field labs and imaging (ultrasound), the elimination of spineboards and the discontinuation of lights and sirens transport, Associates degree requirement for field work with additional Bachelors and Masters degree options for advanced practice, increased length of internship and education in general, decreased flight service use, increased scene times to spend on actually improving patient care, increased usage of safety features (non-modular vehicles, high-visibility paint and lighting schemes), increase in paramedics trained and able to serve as community practitioners to provide follow-up for non-transported patients, change in terminology from emergency medical services to mobile health services, decreased paramedic to population ratios, increased paramedic/EMT staffing models, decreased trauma activation services, elimination of protocols in favor of guidelines, elimination of online medical control (all standing orders) except for physician consultation, change in billing scheme from fee-for-transport to fee-for-service, increased provider-initiated refusal of transport, increased standards for practice. No more doing the same thing over and over and expecting the health of the community to get any better.

At least, that's the future I would hope to see over the next 5-20 years.

Edited December 14, 2012 by Bieber

[island emt]

Ahh young Jedi: in your future , I see crappy diapers and baby spit. Less sleep than you've ever gotten and lots of years of wondering why didn't I wrap that rascal.

The fire service will not go away as there is still a need for them on occasion , There will be cutbacks and maybe the dinosaur knuckle dragger mentality will go away. It just takes a top down decision to do prehospital care properly as the primary mission , followed by the occasional fire call.

Look for more combined services as cities and towns consolidate their budgets.

The michigan public safety model will reappear in many places due to budget cuts.

The on scene treatment and no transport will all depend on convincing the big health care systems it will not cost them too much revenue, and the insurance companies will have to figure out that they are saving $$$$$ by paying for field services.

It is nice to have a dream

[Just Plain Ruff]

Ahh young Jedi: in your future , I see crappy diapers and baby spit. Less sleep than you've ever gotten and lots of years of wondering why didn't I wrap that rascal.

The fire service will not go away as there is still a need for them on occasion , There will be cutbacks and maybe the dinosaur knuckle dragger mentality will go away. It just takes a top down decision to do prehospital care properly as the primary mission , followed by the occasional fire call.

Look for more combined services as cities and towns consolidate their budgets.

The michigan public safety model will reappear in many places due to budget cuts.

The on scene treatment and no transport will all depend on convincing the big health care systems it will not cost them too much revenue, and the insurance companies will have to figure out that they are saving $$$$$ by paying for field services.

It is nice to have a dream

And to do away with lights and sirens during transport means we will have to do away with LIghts and sirens all together because if you have them available people will use them.