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Check out the DAWN and DEFUSE 3 trials, which looked at retrieval presenting 6-24 hours after onset (DEFUSE 3 was 6-16 hrs). It's pretty new stuff, but many of the big academic hospitals are doing it.

I think endovascular clot retrieval is 24 hours.

Hormonal birth control does increase your risk of stroke, but the risk is still very small (unless you smoke or are fairly obese). However, stroke in pediatrics/young adults is more common than people (even doctors) think it is, and it should be on your differential for young people with neuro...

Yeah I meant as like a secondary data point. We're never going to see 100% success with paramedic intubation, but it would be nice to see if perfectly placed ETT tubes were better/the same/still worse than SGAs, even if it was just out of curiosity.

As far as medic vs basic, PA schools and med schools don't care about ALS vs BLS. Back in the day PA schools would care about time as a paramedic but these days you can get that "patient contact time" with being an ER scribe and having no realistic patient care exposure If you have professional...

Yeah the only factor that wasn't controlled for was first pass success. So of the 1,500 ETT patients, about 800 had the tube on the first try, but the abstract has no data if those patients did better than the 700 who needed a second attempt/rescue airway. Hopefully it'll be in the final full...

I was just responding to your comment that you get more of your tubes from non-arrest patients--most of our tubes (no real RSI in Pennsylvania) are arrests. Unfortunately this study doesn't address the effect of 1st time success with ETTs, so for now we have no idea what change that would have...

"I don't really know if it works, but it I guess it SHOULD" describes like how 90% of medical interventions/drugs got started.

I think in 5 years we'll think mobile stroke ambulances are huge wastes of money, especially the ones I've seen. They have one by me in Manhattan, where there are, count them, 13 stroke centers in 23 square miles. And obviously I'm not advocating for getting rid of paramedics and replacing...

You have to look at research skeptically and logically, sure, but it's also to important to remember that good research is hard, and it takes a long time, and even then it might not be completely generalizable. We can (and should) continue to study airways, but the fact remains that the data...

The second study has such a pretty huge dataset that appears to be from larger academic hospitals, and unfortunately it doesn't account for success rate. However, like Remi said, I would be shocked if the aggregate first pass success from in hospital intubation was lower than the 55% first pass...

They did use a matched dataset to try and control for those variables you mentioned, though apparently with no change in the results. The patient population is a good point. At least where I worked, patients with an IO were many times more likely to have poor access or a failed IV attempt.

To stir the pot a little, here's a study that also shows poorer outcome for IN-hospital cardiac arrests who were intubated within 15 minutes of arresting, presumably by physicians with more airway experience than paramedics. However, its data from 2000-2014, and I feel like the focus on...

The discussion section (I have a subscription, I don't know if everyone else can see it?) says that one of their suggested reasons is the unknown effectiveness of drugs given IO during arrest (how much of it just hangs out in the marrow). However, since there's a lot of data saying that epi in...

Like a grand for my basic, my fire certs were all free through work/the state, and what will eventually be a casual $220,000 for my medical degree, not including living expenses. My girlfriend's BSN is around $55,000 I think.

I volunteered there for a few years in college and know some people who work there

Yeah it's sad. It's not limited to EMS--it raises healthcare costs because physicians order tests or perform procedures just to cover their butts too. What can I say, America is a great place to be a lawyer.

In most places in the US it's not an option, thanks to (real or imagined) fear of litigation from management or the medical director. There are a few places that let paramedics refuse transport in the States, but they're a minority.

Honestly those kinds of "discussions" are never worth it. People paying for an ambulance ride aren't gonna call you for a med refill, and people who aren't paying (Medicaid/uninsured) don't care. I mean, if I were homeless and uninsured and my options were pay to take a bus to the ED or get a...

Per my friend who did AF fire at Dover and then DOD civilian fire after there are no commissioned officers in fire. DOD fire sounded like a sweet gig from what he said but it was boring as hell, and they did no medicals other than the occasional BLS first response. Between military experience...