X-rays in Ambulances

[Dustdevil]

....maybe when he is done with school and my children are a little bit older, then I would probably reconsider my choice, but now my family needs me more than I need to go to school (with the exception of CEU's).

If anybody has ever wondered why the nursing profession is so screwed up with it's perpetual shortages, there is your answer right there. Any profession predominated by women is going to have such problems. They simply (and correctly) have priorities that take precedent over their careers. As the percentage of women in EMS increases, we will undoubtedly encounter those same problems profession wide.

*takes mental note to hire as few females as possible when running EMS agency*

[EMS-Cat]

If anybody has ever wondered why the nursing profession is so screwed up with it's perpetual shortages, there is your answer right there. Any profession predominated by women is going to have such problems. They simply (and correctly) have priorities that take precedent over their careers. As the percentage of women in EMS increases, we will undoubtedly encounter those same problems profession wide.

*takes mental note to hire as few females as possible when running EMS agency*

Hot button here, so be warned.

Bit of a generality there, don't'cha think? That a woman's priorities should be directed to the home while the man's is directed outside of it? What if the woman can command a higher salary then the guy? A married relationship should be a partnership, not an assumption.

I worked up to the Wednesday before I delivered, has three months off post C-Section and went right back to work. Out of all the years since I left high school and got into the medical fields, the only reason I stopped working full time was health and that was courtesy of a 20+ year career in the US Army [active and reserve].

There are a lot of reasons nursing is messed up. Family may be one of them, but there are a lot of others. I'll be if you took a real close look, a good percentage of the women who've had to choose between their careers and their family are single moms because dad took a hike. Or women who had to stay at home because their husbands didn't feel that child care should be one of their duties [you can help make them, you should have to help take care of them].

FWIW: Both my parents were registered pharmacists from the 50's through the mid 80's, back in a time when women didn't go into medical professions. They owned a retail store in a small country town with one clerk to help part time and they did all their own buying, stocking, inventory [i remember spending nights sleeping on the floor down at the store while they did a count], clerking, patient and billing records, etc. Store was open from 0900 to 1700 Mon say through Sat and the rest of the time on call. They raised myself and my sister. Mom was a pharmacist in the Navy in WWII and dad was a Navy corpsman with the Marines in the Pacific [iwo Jima and parts around]. I grew up with the understand that the family raised the children, the family ran the business, etc. It was about as non-gender specific as one could be in those days.

I applied to the U of W med school in 1969 aiming at starting in 1970. Made it thorough all the paperwork with flying colors. And then came the final face to face interview [that's how they did it in those days]. And guess what - I was refused. Know why? Because they didn't realize I was female [my name is very masculine and they never really bothered to look things over] - and I only had a 3.7 GPA. You see, back then, a guy only needed a 3.6 GPA to get into Med School, a woman was required to have a 3.8 GPA to prove she could 'make the grade'. I was refused the chance to even try because of someone's antiquated belief that gender made a difference.

So, please take a good hard look at what you just said, stating that you would use gender as a criteria for hiring. Or do you want the world to turn backward 40+ years? Bigotry is bigotry, no matter what it's using for it's criteria.

[Dustdevil]

Bit of a generality there, don't'cha think?

Such is the nature of statistics.

There are a lot of reasons nursing is messed up. Family may be one of them, but there are a lot of others. I'll be if you took a real close look, a good percentage of the women who've had to choose between their careers and their family are single moms because dad took a hike. Or women who had to stay at home because their husbands didn't feel that child care should be one of their duties [you can help make them, you should have to help take care of them].

Bad choices or piss poor planning. I've managed not to knock anybody up in the last 48 years. Those who are less responsible are not my problem.

So, please take a good hard look at what you just said, stating that you would use gender as a criteria for hiring. Or do you want the world to turn backward 40+ years?

Nope. I only want to meet my primary responsibility: to provide reliable service to the citizens I serve. Absenteeism by females is a concern when planning for that provision. Therefore, I will take it into consideration.

[medstudent30]

Well now that the subject had gotten off the topic, I'm going to say this. I do not miss work because of family. I take my work and my job very seriously, I'm sorry that I just happened to get into doing EMS a little bit later in life that what other people did. I worked 2 full time jobs, and was in school atleast 3 days a week (not including clinicals). Everything I did in almost the last 2 years was to benefit my family more than to benefit myself. I'm sorry if I made a promise to him to FINISH college before I go back to go into nursing, not to mention that I felt that I needed the break. It is now his turn to finish college. Relationships work on 50/50 terms. He gave his 50% when I was in school and did the womanly duties so that I could go to school. Now it is his turn. Eventually I will go back to college to get a degree in Nursing, so be it if I am 50 years old when I do decided to do it. Right now my family needs me to do family oriented things. Oh and by the way, I work 40+hours a week and still have time to play Madden with my son and dolls with my girls. :wink: [/font:5cd9ff2c08]

[Ace844]

Hmmm...interesting comment , never realized we are over educated...especially since EMT & Paramedic education is based upon junior high and high school equivalent level ?

Be safe,

Ridryder 911

The only place this will have any potential usefulness is in those areas that would be the very last to afford it. It's pointless in an urban system. And rural systems are still whining how they can't even afford to hire paramedics, so they're not going to show up in those areas.

Instead of all this focus on expanding the paramedics scope of practice, how about somebody seriously focusing on educating paramedics to the level they SHOULD be for the skills they already have?

I agree with "Rid and Dust" on this. It's pretty much akin to giving a FR the "ability" to do a 12 lead...after which they get it and then look and go.."Now what..????" Furthermore, most EMT's/paramedics have little to no exposure/training on the interpretation of X-rays, etc...Thus without the an extensive chnage in training and education...It serves no purpose, as well as serves little change to your management.

Even in the ER most of the treatment is on a "clinical" basis.

out here,

Ace844

[Just Plain Ruff]

Goodness I thought that the xrays in the ambulance suggestions were a thing of the past. First off where are we going to put this new fancy piece of equipment. I've worked in Van ambulances that had less space than my studio apartment's bathroom, and that is small let me tell you.

The fact that we have the ability to do this does not necessarily mean we should do it. We are reimbursed horribly by medicare and medicaid as well as private insurers yet we still want more and more and more bells and whistles.

I agree with Dust, that we educate our ems personnel to be able to do their job and not require them to have to take x-rays. This means more hours spent in school and the way that licensure is in most states you would have to get licensed as a EMS provider and a radiology tech.

Where are we going to put the developer also.

Plus what is the quality of the image? I can just see this huge expenditure going into each ambulance and then the hospital saying the quality isn't good enough or a territorial battle over who takes xrays and the hospital just retakes the xrays.

Let's get off the "I wish we had this cause it would be cool" and get on to the more practical aspects of patient care.

[fire48emt22]

Honestly on one hand it may be a good idea but on the other, we do get reimbursed something bad from insurance companies and then there is more training that has to be done, the lack of room in the back of an ambulance, the fact that the ambulance is moving ( I really don't wanna have to stop w/ a critical pt unless it is vital to pt care) and that fact that we are in too close of a space to safely take an xray, w/ out causing harm to others in the ambulance. (the harm my not effect them now but it will some where down the road called life)

where would the machine go?

how much room would it take up?

how much radiation would it give off?

do we really need one in an ambulance?

who is going to pay for it?

just a few questions that probable should be addressed prior to the approval of this crazy idea.

[Ace844]

Honestly on one hand it may be a good idea but on the other, we do get reimbursed something bad from insurance companies and then there is more training that has to be done, the lack of room in the back of an ambulance, the fact that the ambulance is moving ( I really don't wanna have to stop w/ a critical pt unless it is vital to pt care) and that fact that we are in too close of a space to safely take an xray, w/ out causing harm to others in the ambulance. (the harm my not effect them now but it will some where down the road called life), where would the machine go? how much room would it take up? how much radiation would it give off? do we really need one in an ambulance? who is going to pay for it?

just a few questions that probable should be addressed prior to the approval of this crazy idea.

HMMM....Let's see, where to begin. Ok, for everyone interested, here's a "pic and article" about the machine;::

http://www.yet2.com/app/insight/techofweek/35135?sid=200 ,

http://www.bjhc.co.uk/news/industry/2004/ind40920.htm.

As you can see it is small, portable and "space friendly". The insurance companies would most likely not re-imburse services using this technology for quite sometime, next you have to take into consideration the immense battle you would have to fight to get the FDA, State OEMS, your local service, and MD director to even allow you to use it. I mean at just a dollar per "exposure" cost it isn't prohibitively expensive in operating cost. Then as mentioned there is the huge training and saftey requirement and the actual efficacy of the machine vs its impact on patient care treatment modialities and changes it would or wouldn't take effect. I said this previously and I will say it again. I would be dumbfounded if even 2% of current cert/licenced Medics even knew the basics of interpreting an X-ray, MRI or CT !!!!!!

Next, even if in this 2% there were medics who could "interpret" them, what difference would it make to your treatment. It would make little to none. Even in the ER the majority of urgent and emergent treatment is based on H/P alone. Next you have the other issues of physics...Penetration, density, etc.....add an unstable environment, a patient in extremis and "upset" and you have a recipe for many "useless" films, unned rad exposure,etc... As "rid," and others mentioned you also have the issue that the hospital may not even accept "the ambulance films" and need to "repeat them".

As I mentioned before, even with "a minimal amount of training" using this machine pre-hospital would be akin to giving a FR or layperson a 12 lead monitor and training them "how to do" a 12 lead placement, etc... but leaving out all of the ancillary important stuff that goes with it. What you would have then is an item which would be "cool" but serve little clinical purpose, and not change the pt care provided...:study::dontknow::sign3:....:tongue3:

CXR:: http://www.vh.org/pediatric/provider/pediatrics/ElectricAirway/RadImages/DoubleAorticArchCXR.html ://http://www.vh.org/pediatric/provide...icArchCXR.html ://http://www.vh.org/pediatric/provide...icArchCXR.html ://http://www.vh.org/pediatric/provide...icArchCXR.html ://http://www.vh.org/pediatric/provide...icArchCXR.html , neck A/p::: http://www.vh.org/pediatric/provider/pedia...alAirwayAP.html

out here,

Ace844

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[PRPGfirerescuetech]

Do we act differently for a confirmed break, versus a patient with no confirmed break? I dont think so...

Do we set fractures? No...

Cool thought? yes.

A true need for it? no

Field lobotomies sound just as cool too tho...and would serve just as much purpose...

[Dustdevil]

Acknowledging all of the afformentioned problems related to this concept, I do have to admit that I see some potential benefits to this. While I suppose it is natural to think "ortho" when talking x-rays, we have to remember that there are many, many other diagnostic values to radiology. Here are some examples of a few non-orthopedic conditions a field x-ray could tell me of that my patient would benefit from me knowing:

• * Endotracheal tube placement

* Hemothorax

* Pneumothorax

* Pleural Effusion

* Pulmonary Edema

* Pericardial effusion

* Foreign body location (bullets)

• Of course, as originally mentioned, the value of any radiology in the field is going to be dependent upon the proximity of the patient from the hospital. Therefore, Dallas, Texas has no use for any of this, but the next county south might greatly benefit from it since their nearest trauma center is an hour away in Dallas.