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  1. Remi

    ALS Billing Question

    This is a good example of just one of the many things wrong with CMS. I don't know all the ins and outs of the medicare rules for ambulance billing, but my understanding is that if an "ALS assessment" (whatever that means) is done and charted, then the run can be billed as an ALS run. No IV...
  2. Remi

    Want to support women in EMS? Paint an ambulance pink.

    I mean, its clearly not intended to be insulting. But it is pretty silly overall, IMO…..and more importantly, probably more of a virtue signal than a sincere expression of appreciation to female EMT's. But that's just my anti-PC cynicism showing.
  3. Remi

    No ETI.

    But the problem with that (and I'm talking about airway management overall, not just in the context of medical arrests) is unless you are doing a lot of arrests, it's probably not enough practice to make a difference. Remember the learning curve for airway management is steep at first (50-100...
  4. Remi

    New to HEMS, looking for advice

    Civil air crew member (55.5 fatality rate) is the third most deadly job in America, with the subset of HEMS probably being more hazardous than than the larger industry. Only commercial fishers (86.0) and loggers (135.0) are more likely to be killed at work. For comparison, police don't even...
  5. Remi

    Medication Error Learning

    It isn't that personal accountability has fallen out of favor. Can you give an example of anyone who has suggested that this nurse shouldn't be held personally accountable? What you are confusing for a lack of personal accountability is a recognition that the way to reduce the chance of these...
  6. Remi

    Medication Error Learning

    I completely agree. She should lose her nursing license, and of course will be found guilty in the civil trial that is sure to come. That's plenty. Criminal charges should require intent to do harm, or at least intent to do something that you know has a high likelihood of causing harm to...
  7. Remi

    Survival Flight Ohio Fatal HEMS crash

    Right. But if Program A's minimums EXCEED the FAA's minimums, and Program B's minimums ARE the FAA's minimum's, then program B can correctly say "we have different weather minimums", and possibly legally take flights that program A turns down for weather. Of course I don't know that this is the...
  8. Remi

    Survival Flight Ohio Fatal HEMS crash

    Not necessarily. I don't know anything about the programs in question, but a reasonable assumption about what point #5 means is that the program represented in the picture adheres to FAA minimums, where other programs in the area have higher minimums, as a matter of internal policy. So...
  9. Remi

    Social Media Advice

    Did you read the hypothetical story? No one did anything "dumb". I am witnessing a somewhat similar thing going on with an acquaintance of mine right now. Who was actually at fault (the school) is wholly irrelevant. The important point is that when you post on social media, you are creating a...
  10. Remi

    Post Intubation Sedation (pre-hospital)

    What about using vec aren't you "sold" on? I have always advocated for maintaining paralysis in the transport setting. I've been told by many people over the years that that's "not necessary" or "not optimal care", but I have yet to hear a good, well reasoned argument against it. As you've seen...
  11. Remi

    Drug dose calculations

    Who said anything about having a phone "glued to your hand"? I'm talking about using an app to calculate doses and volumes to give for medications that aren't used frequently. People say med math is easy, yet errors are very common. No one should be doing anything but the absolute simplest math...
  12. Remi

    Let me ask you about uniforms...

    That looks good for sure, but you look just like cops, and I think polos are generally way more comfortable.
  13. Remi

    Drug dose calculations

    Yeah, that's a bad policy. We should actually be using technology as much as possible for this.
  14. Remi

    Let me ask you about uniforms...

    Up top, a synthetic, "tactical style" polo shirt in any color other than white with the agency name or logo on the back, and the employee's name and title on the chest. Pen pockets on the sleeves are useful. Either no visible t-shirt under the polo (with chest hair appropriately trimmed) or a...
  15. Remi

    New to HEMS, looking for advice

    For a long time the industry thought that the key to safety was CRM and a robust "three to go, one to say no" policy. While CRM certainly has it's place, it gets a LOT more lip service than actual utilization, and I don't think there are many places that train it effectively. "Three to go, one...
  16. Remi

    Predicting a difficult airway is darn near impossible

    I do rural anesthesia myself (including OB), so I'm familiar with the challenges. There are plenty of times that I'm the only provider in the building outside of the ED doc, who is busy with his own patient load. And I can tell you that meth or not, prenatal care or not, having a CRNA in the...
  17. Remi

    Predicting a difficult airway is darn near impossible

    A CMS designated Critical Access Hospital, AND a Level IV trauma resource? A trauma resource with that not only doesn't staff an EM physician, but has NO ONE in-house who can manage an airway? Anesthesia has to be in the room for all deliveries - WTF? Paramedics are used interchangeably with...
  18. Remi

    To Degree or Not to Degree. That is The Question.

    My original reply to this thread was specifically in response to the implication that EMS care in the US was somehow woefully behind that of the Commonwealth nations. From a systems and educational standpoint, I know that's true. But from a clinical outcomes standpoint - which is really what...
  19. Remi

    Predicting a difficult airway is darn near impossible

    It's worth pointing out that this study is not the first one to come to the conclusion that we are, collectively, not very good at predicting the degree of difficulty of either intubation or mask ventilation. There have been at least a few others than showed essentially the same thing. IIRC...
  20. Remi

    Thoughts on High Flow O2

    It sounds like you are thinking of absorption atelectasis. Room air is mostly (~78%) nitrogen, which does not cross the alveolar-capillary membrane and is the primary contributor to the ~2mmHg natural PEEP that keeps your alveoli open. When you use a high fi02, you replace the nitrogen in the...
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