Party like it's 1999!

[DesertMedic66]

You must not understand how private EMS works during an MCI in my system. Unless we are the first or second piece of equipment on scene all we are going to do is pull up on scene and talk to either the IC, MedCom, and/or ground transport coordinator who will say “you are taking this patient to this hospital”. Unfortunately our fire department believes the RT in START stands for Rapid Transport and it Rapid Treatment which means get everyone off scene ASAP.

If we show up on scene and they give us 2 greens then that is what we are taking. We are not told “hey, we have 4 red, 5 yellows, and 3 greens”.

 

[VentMonkey]

I wonder how treatments would change if each person in the "orgy MCI" had cardiac involvement in opposing parts of cardiac muscle? Also, an orgy MCI just sounds gross.

When I did my internship in @DesertMedic66's county in 2007 it was almost a 50/50 split of engines staffed with paramedics to BLS engines. That said, IIRC fire still had a hold of MCI's and trying to take command of such incidents was both realistically unheard of, and cause for more confusion amongst them.

Having moved to a part of the state where it doesn't exactly operate this way in an MCI situation a few things have changed. If the paramedic arrives and finds that the call no longer warrants a med alert (MCI) they can call it off. A lot of the times the paramedics won't either because they lack the scene command, and/ or experience to do so, they're from a different county or state, or they're just lazy and let fire take "med group" control; med group is soley on the highest trained medical personnel in our county (i.e., the medic). Or, and this seems to be becoming more commonplace, they are in fact clock-punching cook books.

Fire won't typically argue one bit if our medic calls off an MCI. Many times they're too caught up in the rescue to even acknowledge the patients triage color, and what all resources they in fact do or don't need. Some batt chiefs are definitely more keen on wasting vs. efficient utilization of their manpower and resources, but way too many just remind me why California fire-based medicine is all sorts of haywire.

I kind of feel @DesertMedic66's pain, and if it were me still in that county I would personally be frustrated to no end. My experiences with ALS fire departments in my state is equivalent to giving the ball back to the schoolyard bully.

Don't believe us? Take a look at this forum on any given day and you'll find a thread that pertains to some sort of riff between some California EMS agency and their local FD.

Like I have already eluded to, my options are limited, as are many of my peers. The only way to get ahead in this state is to outsmart the schoolyard bully, and that really shouldn't be that hard to do.

 

[CWATT]

MI + NTG = vasodialation with increased bloodflow, which is usually a good thing during an MI.

My understanding is that coronary artery dilation occurs high in the therapeutic range and only to a maximum of 15%, but I don’t have a source to back me up at the moment. I imagine this would occur long after resolution of ischemic chest pain, the point at which our protocols say we titrate to.

It can also reduces cardiac preload

.

This. I was literally looking at my lecture slides earlier today that described Nitro as “symptomatic relief” followed by the statement that it has not been proven to reduce mortality. That said, it’s a pretty easy line to draw IMHO between relief of ischemic pain and reduction of cardiac workload and subsequent preservation of tissue.