Your Controversial EMS-Related Opinion

E tank said:

Read a lot about N20 used in the pre-hospital setting, but I've been surprised about not a single mention of contraindications like pneumothorax or bowel obstruction, pts with vitreoretinal surgical histories...stuff like that...was it there and I just missed it?

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It’s usually mentioned (in the protocols I have read and textbook references). A lot of the use cases cite isolated extremity and soft tissue trauma. For example, see VT protocols

DrParasite said:

Chief wasn't there, and likely the FFs weren't following his directions, so he shouldn't take the blame or punishment for the freelancing of these idiots. Unless he actually told them that they shouldn't enter due to COVID....

From the outside, this looks bad.... really bad... but (and here is the controversial part) I'm going to wait until the investigation completes before I say what I think should happen to all involved.

In case anyone was wondering, a FF/PM in that is paid $88,093.00 a year as their base salary, with a total pay between 150k and 240k, as per https://transparentcalifornia.com/salaries/search/?a=rialto&q=paramedic&y=2019. Single role paramedics make between 36k and $512 as their base salary. If this story is accurate, the taxpayers are not getting what they pay for, and I hope terminations are in order.

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I doubt they were following explicit orders, more likely they interpreted a directive in order to be lazy and grumpy with a nursing home that they’re tired of going to.

We had an agreement with our local places that they’d bring stable patients to the door but we’d come after unstable patients. Every time the nurses forgot to do it, I heard about it immediately lol..

Never underestimate the capacity for being lazy in providers

DrParasite said:

The only issue I see with Nitrous is accountability (if that even is an issue). with Fent lollipops, you can count how many you have, and track their usage, just like you would any other medication; can't do the same with a gas.

But I wouldn't be against nitrous being offered as an EMT level skill.

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Never an issue in the multiple systems I have worked where we carried it. The bottle is sealed in plastic. If you crack the plastic, you replace the bottle. That simple.

If you decide to huff on it between the plastic cracking and the replacing of the bottle, then good for you. But we were technically "not in service" until it was replaced. Supervisor was bringing you one, or you were swinging by central or your station to pick one up.

akflightmedic said:

Never an issue in the multiple systems I have worked where we carried it. The bottle is sealed in plastic. If you crack the plastic, you replace the bottle. That simple.

If you decide to huff on it between the plastic cracking and the replacing of the bottle, then good for you. But we were technically "not in service" until it was replaced. Supervisor was bringing you one, or you were swinging by central or your station to pick one up.

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so it's not like an oxygen bottle, where there is an onboard or portable unit? if it works, and you can seal it (or even seal the nitrox system with a plastic tag), and you have the manpower to be OOS until a fresh bottle is administered, awesome. I did not know they worked like that, but sounds very doable.

DrParasite said:

so it's not like an oxygen bottle, where there is an onboard or portable unit? if it works, and you can seal it (or even seal the nitrox system with a plastic tag), and you have the manpower to be OOS until a fresh bottle is administered, awesome. I did not know they worked like that, but sounds very doable.

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Yes, it is a very portable unit. Comes in a small case with shoulder strap, you know, so you can administer at the patient's side prior to moving them. I love it on the old grannies who have fractured their hip and are laying between the toilet and the tub. If I am unable to get IV and medicate, or if I am delayed doing the IV and meds they can self medicate. It is great! The whole kit weighs less than 5lbs.

I said "technically" out of service as in your unit is not 100% stocked, however it is not a required item by the state to be a licensed ambo on the road. It just means you are not 100% stocked. And it is not really a manpower issue because it is no different than running out of oxygen, being low on other supplies, etc. You simply get restocked however your agency normally handles these things. And you are not using it on every single call either.

I have always worked County EMS or County/City Fire Rescue, so I have always had stations and plenty of supplies, with units and supervisors on the road, or we drive by Central which was near the hospitals or on the way from hospitals on the other end. Regardless, definitely should be a BLS skill since it is self administered. If given an option though, I still would choose Penthrane, used it overseas and loved it.

Bottle this size...

akflightmedic said:

It just means you are not 100% stocked. And it is not really a manpower issue because it is no different than running out of oxygen, being low on other supplies, etc. You simply get restocked however your agency normally handles these things. And you are not using it on every single call either.

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The difference being, I have a second spare portable on my truck (with a regulator, ready to go), as well as two full bottles under the bench seat. Plus the on board big tank (M tank? L? I could never remember the letter sizes). Not only that, I can use the Oxygen until it's under 500 (or 300 in the city), it's not a one and done like you describe. But as you said, you are low on supplies, so not OOS, but if it's not a critical or required item, you are still good to go for the next call (we used to typically have enough equipment to run 2 cardiac arrests or major traumas, back to back, so while we would be low, we could still handle another major call before needing to go OOS for critical supplies).

I'd be interested in seeing a pilot group study for a 911 system, with nitrous given to the BLS providers (either BLS ambulance or first responder), and actually seeing the data on how frequently it was used, if the administration was appropriate, and how long was a unit OOS for (if any) until the new supplies were provided. Even more so, I'd be curious to know (in the BLS ambulance system) if having the Nitrous allowed for BLS to handle the call with just BLS providers (while giving pain management), allowing the ALS flycar/ambulance to go back in service for the next call.

FiremanMike said:

There is no shortage of paramedics around here..

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That would be my take here, more or less.

3 medics on some pumpers, and 2 on each ambulance, plus various chiefs and supervisors - all medics.