Pulling the plug on EMS

[Veneficus]

Your pissing up the wrong tree, withholding Narcan in apneic opiate OD's is a FAIL, pick another tx to demonize.

I don't view looking critically at pathology/treatment which is seen like a nusance in the hospital more than an emergency as demonizing anything.

US EMS with perhaps with the exception of a handful of places doesn't treat and refer. If I am not mistaken there is also a study out of VCU that shows US EMS providers are not capable currently to determine who should be admitted.

Heparin is well studied, self administered by patients, relatively safe, why isn't that at many US EMS agencies?

Tell me, what makes any treatment modality anywhere, especially given the history of EMS treatments and effectiveness a free pass from scrutiny?

Incidentally how long in the toronto protocol are the patients being observed? Hours? 4? 6? 12?

I also don't veiw determining how to reduce an EMS system that won't advance to as cost efficent as possible as demonizing either.

 

[boingo]

Maybe, although Oxy's are a huge problem here, when they can't find the clean burning pharmacy grade stuff they end up on H.

 

[boingo]

I don't view looking critically at pathology/treatment which is seen like a nusance in the hospital more than an emergency as demonizing anything.

US EMS with perhaps with the exception of a handful of places doesn't treat and refer. If I am not mistaken there is also a study out of VCU that shows US EMS providers are not capable currently to determine who should be admitted.

Heparin is well studied, self administered by patients, relatively safe, why isn't that at many US EMS agencies?

Tell me, what makes any treatment modality anywhere, especially given the history of EMS treatments and effectiveness a free pass from scrutiny?

Incidentally how long in the toronto protocol are the patients being observed? Hours? 4? 6? 12?

I also don't veiw determining how to reduce an EMS system that won't advance to as cost efficent as possible as demonizing either.

Try to focus on the topic you raised, Narcan, your disdain for U.S. EMS is obvious, and I am on board with the need to revamp the educational requirements.

 

[the_negro_puppy]

[YOUTUBE]http://www.youtube.com/watch?v=8xU_vcb3kso&feature=related[/YOUTUBE]

 

[18G]

I think this is appropriate... in the video there should be one that say's... "revolution is not Venificus"...

But yeah, DONE about sums it up!

[YOUTUBE]http://www.youtube.com/watch?v=w3j5m1HukQE[/YOUTUBE]

 

[medicRob]

I think this is appropriate... in the video there should be one that say's... "revolution is not Venificus"...

But yeah, DONE about sums it up!

[YOUTUBE]http://www.youtube.com/watch?v=w3j5m1HukQE[/YOUTUBE]

What is with all the aggression toward Veneficus? Is he not allowed to have an opinion?

 

[18G]

It's not aggression. It's strictly professional and certainly I don't lose sleep over it. He crosses the line and speaks his philosophy with authority as if it is above current standards of care. And it's not right.

And I'm not one to hold back. I will address anyone who opens themselves up for debate directly.

Like I said, its all good and just having fun with the debate that's all

 

[Veneficus]

Try to focus on the topic you raised, Narcan, your disdain for U.S. EMS is obvious, and I am on board with the need to revamp the educational requirements.

Certainly,

Permit me to quote part of my original post?

Now I know it is popular to pull out the anecdotes and the "what if's," but really, how often does your service use sodium bicarb? Mag sulfate? Atropine? (which makes me wonder why people would use it to "poison" a stable patient to improve some numbers, that have grossly overinflated safety ranges.)

I sort of singled out medications in this post, but it is not limited to that.

Now the point of this post isn't to pick on EMS or accuse it of negligence or substandard practice, but really. You have providers performing treatments that are often not needed, then turning around and not providing treatments in most cases that are!

Look at the cost to maintain a quality intubation program compared to the benefits of intubation.

At which point in my first reply the only mention of narcan:

I was thinking that the point of narc reversal is to stabilize respiratory and vascular systems. Anesthesia never seems to use narcan, titrated or otherwise, and they give narc doses far in excess of EMS on a daily basis. One of the most common heard mantra of ALS providers is they are not afraid of narcs because they can reverse them, which of course, seems like flawed clinical judgement.

You suggest that the idea you can give narcan should be the reason not to withold analgesia?


all the way down in post 18:

Later this evening I expect to look up the exact physiological and pathophys of both opioid OD and the reversal of it to really see whether or not there is a flaw in the original theory of its use for EMS.

next time i mentioned narcan, right after you decided your argument was to put me in my place as a student :


It depends on a couple of factors.

1. Are providers titrating it appropriately?
2. Are they using it punitively?
3. Are they doing it for patient benefit or their convienience?
4. If less aggresive treatment achieves the same thing, what makes acute reversal the treatment of choice?
5. What is the sequele if you induce irretractable pain or acute opioid withdrawel doing it? Is it worth that?

Next was a question about my choice of education. Probably because that was the only response you could dream up after your initial attempt an an insult didn't work.

Honestly my first choice of school was the oldest in the Western world, my wife asked me if I would consider something closer to her home and i thought given her sacrifice it was the least I could do. But looking back I do not regret my decision to come to this school and I am rather proud of it. Especially when I see what is coming out of the US schools.

Tell me, Other than trying to coatail greater minds as demonstration of your greatness What exactly is your contribution?

somewhere in there, USA responded to a treatment question:

"Fluids, suction, an NPA and BVM?"

My next reply to narcan was the search I did on it.

So how far off topic am I?

 

[18G]

But looking back I do not regret my decision to come to this school and I am rather proud of it. Especially when I see what is coming out of the US schools.

Sounds like you don't have much like for anything in the US. Maybe you should stay where you are?

 

[Veneficus]

Sounds like you don't have much like for anything in the US. Maybe you should stay where you are?

I seriously entertain that idea, especially with the limitations on academic medicine in the US.

Really my main complaint about the US though is the blind propaganda that they are the best at everything even when the facts dictate otherwise.

Regretably it is quite pervasive.

What can I say? I give a lot, I demand a lot.

There is also probably a fair amount of counter culture shock as well.

 

[18G]

Umm.. people come to the US to receive medical care not available anywhere else. We are far from second-class world citizens.

Now your kinda starting to piss me off.

 

[Veneficus]

Umm.. people come to the US to receive medical care not available anywhere else. We are far from second-class world citizens.

Only the people who can afford it and a handful of charity cases. Most people in the US cannot dream of receiving the best care it has to offer. Most can't even go to a dentist.

Now your kinda starting to piss me off.

I am sure you will not be the last to say that.

 

[Scott33]

We discussed European EMS in my class back in 2004: they're load and go, that's it. They don't even do spinal immobilization for car wrecks.

Citation?

Vac mats are the norm in certain parts of western Europe when immobilization is indicated. The spinal board is typically used for what it was designed to do - extricate the patient.

As for loading and going, you may want to Goolge Emergency Care Practitioner.

 

[medicRob]

Umm.. people come to the US to receive medical care not available anywhere else. We are far from second-class world citizens.

Now your kinda starting to piss me off.

Name a procedure performed in the US that is not performed anywhere else in the world.

 

[rwik123]

Name a procedure performed in the US that is not performed anywhere else in the world.

With the exception of England, complete and partial facial transplants. Only one I can think of right now

 

[medicRob]

With the exception of England, complete and partial facial transplants. Only one I can think of right now

First Face transplant was carried out in France

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1315983/

"Less than a week after French doctors carried out the world's first partial face transplant on 27 November, the patient—a 38 year old woman—ate, drank, and spoke normally. Professor Jean-Michel Dubernard, who led the transplant team, said that it would be at least six months before they knew how much feeling or motor control the patient would have eventually."

 

[Veneficus]

With the exception of England, complete and partial facial transplants. Only one I can think of right now

The first was done in France if I am not mistaken.

As well, There is a shift to the use of mechanical Aortic valves for replacement in the US, not because of efficacy, but because of legal liability and the potential to not be reimbursed for "preventable" complications by medicare now.

 

[rwik123]

London was one of the places of comparison I was going to use in any named procedure.

yeah the UK is almost if not 100% equal in the care provided and medical procedures performed.

Does the US have some of the best teaching hospitals and care specific facilities? I would argue yes.

And yes the first one was performed in france

 

[medicRob]

yeah the UK is almost if not 100% equal in the care provided and medical procedures performed.

Does the US have some of the best teaching hospitals and care specific facilities? I would argue yes.

And yes the first one was performed in france

Please re-read my post (I apologize, but I did research and found that France did the first facial transplant, so I changed it completely)

 

[Veneficus]

Does the US have some of the best teaching hospitals and care specific facilities? I would argue yes.

It depends on what you call the best, compare what European students do in school, particularly in rotations to their US counterparts.

I probably shouldn't start in about teaching to the tests instead of medicine prior to residency so I won't.

Care specific is great. If you can afford it. It also depends on how you measure.

PS.

The first face transplant in the US was performed by A Polish born and trained Physician.