mvfire8989

I have no idea what the protocols for this study are, that being said in the hospital environment FFP is a relatively small volume product and in current use is most often used to correct factor deficiencies that can develop in an acute hemorrhage. Many trauma centers have a massive transfusion protocol that calls for the replacement of plasma and platelets when transfusing more than 5 units of packed rbcs. What I imagine that this study is looking at is if earlier normalization of pt/ptt would be beneficial to patients. I would be surprised if they are looking to replace crystalloids for fluid resuscitation. There has been several large studies that have looked at doing that with various colloid fluids like albumin and hydroxyethyl starch but to date they have not been shown to be superior and may have their own problems. Like Bnechis mentioned transport times for the most part are short in metro areas where this would be likely to be used, getting some NS or LR running and diluting their blood is the best in the short term. That way the volume the patient is losing is not all blood, and they lose less oxygen carrying capacity.

Just to be clear this article is talking about blood plasma, it does not have a major role in transporting oxygen to tissues. This is a product with plasma proteins and coagulation factors only. It does not contain red cells, white cells or platelets.

Mt Vernon says it isn't needed (in bold caps no less) http://cmvny.com/wp-content/uploads/2014/01/2013-Firefighter-Exam.pdf

I think a lot of people are missing the whole point of why people who have contact with patients should be vaccinated. We are talking about a disease that has a significant mortality risk for the elderly and otherwise immunocompromised, that we can transmit to our patients when we have NO or very minimal symptoms. It's not going to hurt us that bad, but it could kill them. This disease has a high incidence and prevalence, and it is highly infectious with respiratory droplet transmission. Most other vaccinations that you receive, such as hepatitis B are things that you could potentially get from your patient but not something you would transmit to patients using standard precautions. Hepatitis B is blood borne. I understand the desire to control your own body. The risks from this vaccine are extremely low, it DOES NOT and CANNOT give you the flu. The efficacy is somewhere around 60%. No vaccine reaches 100% efficacy but we administer them because the risk reduction is well researched and statistically significant.

For most people, egg allergy is no longer an absolute contraindication to being vaccinated. Here is an excerpt from a recent paper published in JAMA. For many years, egg allergy was a contraindication to influenza vaccination, and those with severe allergic reactions (ie, anaphylaxis) should still avoid influenza vaccination. However, recent evidence-based guidance advises that all other egg-allergic patients should receive influenza vaccination based on the rationale that the risks of not vaccinating outweigh the risks of vaccinating these individuals as long as basic precautions are followed. Specifically, the Advisory Committee on Immunization Practices advises that those with an egg allergy who have only experienced hives after egg exposure should receive influenza vaccine with postvaccination observation for 30 mintues.9 However, egg-allergic patients with a history of angioedema, respiratory distress, nausea, vomiting, or a reaction that required epinephrine or emergency medical attention after egg exposure should be referred to an allergist for further evaluation. Talbot TR, Talbot H. Influenza Prevention Update: Examining Common Arguments Against Influenza Vaccination. JAMA.2013;309(9):881-882. doi:10.1001/jama.2013.453. I suppose that if you still cannot get the vaccine and the non egg based vaccine is not available to you, then yes you would be stuck wearing the mask. It is the responsible thing to do as a healthcare provider. Edit: Per the company making the "flublok" vaccine with no egg components, availability is expected by thanksgiving. http://www.prnewswire.com/news-releases/flublok-influenza-vaccine-availability-update-product-to-be-available-to-allow-vaccination-by-thanksgiving-227219901.html This same article has a point for you to consider, "“I never get the flu/I am healthy.” This rationale neglects one of the major reasons vaccination is recommended. While some people, such as healthy adults, may not develop a classic, severe influenza-like illness when infected (and a substantial proportion may have minimal to no symptoms), they likely still can transmit the virus to others. Refusing vaccination because of a perceived low risk ignores the potential risk to close contacts, especially those who cannot get vaccinated or who will not mount a strong immune response to the vaccine and rely on herd immunity for protection. This risk has driven many health care facilities to require influenza vaccination for their HCP as a professional and ethical intervention to protect patient safety and promote a safe workplace." While I'm sure that someone is crunching the numbers about the masks vs. shots issue that you bring up, that is not really the central issue. If your workplace decided providing masks were cheaper, then they should be worn. In my mind that does not change the ethical responsibility of anyone coming into contact with patients to be properly vaccinated. We have a responsibility not to expose our patients to danger that can easily be prevented. The best way to prevent the flu is to be vaccinated.

You are welcome not to get the shot, and since you are young and probably healthy you will almost certainly survive. Influenza is also potentially avoidable if you either: A. get the vaccine B. avoid people during flu season OR C. Wear appropriate respiratory protection for the duration of the patient contact through the time when your ambulance is decontaminated. People can transmit influenza before they experience any symptoms. So this means that we must treat every patient as potentially infectious, and that we also may become ill and transmit this infection to our patients. You may certainly choose not to get vaccinated, I just hope you are willing to stand behind that decision and properly protect yourself from infection, and more importantly protect the patients from being infected by you.

Since you have access to a computer, you are the best person to evaluate the effectiveness of any supplement that you are considering taking. From a quick search on the lipozene that you mentioned, I'm fairly certain that you would have a better result saving that money to spend on healthier food choices, the gym or investing in some exercise equipment for your home. The only effective way for anyone to lose weight is by consuming less calories than you need in a day. One thing that a lot of people struggle to do is understand exactly what they eat in a day. By using one of many websites or apps available, you can track the number of calories you are consuming and also track things like fat and salt. There are some medications available that can increase your metabolic rate slightly, these are prescription only and generally only used in people with a BMI of 30 and above. The only verified pharmacologic way to help you lose weight available OTC is Orlistat/Alli which can decrease fat absorption, but commonly causes diarrhea, fatty stools and flatulence as a result. You also mentioned that you don't consume much in the way of fluids. In general, if you are considering a supplement of some kind this is not a good idea. The lipozene is a fiber, acting as a bulking agent to hypothetically feel more full after consuming less food. If you were taking it in a dosage to be effective it is going to absorb fluid in your colon and potentially cause constipation. All of the recommendations for fiber intake presume you are consuming an adequate amount of fluids. In summary: 1. Consume less calories than you burn 2. Track the food you consume and adjust accordingly 3. Try to exercise 30min a day most days of the week. Aerobic exercise such as running or biking is best for weight loss. Aim for a HR of 50 - 85% of your predicted max sustainable HR = 220 - Age 4. Shoot for a weight loss of 1-2lbs/wk if you want to maintain the results.

For those who know better than I do, lets say this was the situation. He was stopped for speeding and during the course of the traffic stop he identified himself as possessing both valid pistol license and the firearm listed on his permit was on his person and loaded. Now the the officer is aware of the firearm what can be required of this individual under the new gun laws. Here are my questions 1. Regardless of what would be polite or nice, does does a duty exist for someone with a concealed carry permit need to notify the officer at all? 2. Can the individual be required to surrender the pistol during the course of the encounter with law enforcement? 3. If the pistol comes into the officers possession, but the person is not being arrested, what can the officer do to render that firearm safe. Does emptying the magazine entirely of all rounds constitute a search more that what would be necessary to make the firearm safe?

I'm in

Maybe I am missing something or don't understand the legal intricacies, but how is the new magazine ban not an ex post facto law and therefore unconstitutional under Art. 1 Sect. 10 of the constitution? I purchased all of the magazines that I own legally, according to the law as it existed at the time of my purchase. It seems that retroactively banning these items would be a prime example of an ex post facto law.

Here is an article that deals with the issues surrounding testing for THC concentration in blood. It seems like there is no clear standard at this point. http://blogs.seattleweekly.com/dailyweekly/2012/03/the_science_behind_stoned_driv.php

Not sure that one will buff out.

But there IS a different requirement for neurosurgery between area and regional trauma centers. I would argue that this can and should impact your choice of destination for some patients, especially in a case with relatively equal transit times to the receiving facilities. This may have been a good case to consult with on-line medical control while the air medical resource was en route. We don't always need to make the destination choice on our own.

No medical director is required for that, but per HIPAA they should not be receiving information on the disposition of that patient without the permission of the patient in question. In the context of QA/QI information can be released, but the "minimum necessary" rule applies, so generally things like names should not be included in this either.

This is really a terrible policy on behalf of the Justice department and the court system for establishing disparate impact as a standard for proving discrimination. Just because there is a statistical chance that minorities may score more poorly should not and in my opinion does not prove discrimination. If anything it is indicative of a failure of the education system to prepare those from less well off areas adequately. It is a shame that they were possibly not afforded an equal chance to succeed as a child, however, it is not the responsibility of civil service tests to accommodate those who the system has failed in the past. The tests should be hard, because we should strive to challenge the applicants, especially for the promotional exams. I would argue that even tests that don't have "job related" questions, can be of value. If everyone is aware of the content of the exam and provided study materials, those who preform the best have shown the drive and determination that is necessary to succeed in any position. It makes me ashamed to be "represented" by those who have such an obvious agenda. I have yet to see how a written test can be racially biased, since I am reasonably certain a test cannot see the color of the person taking it.

Thanks for getting back to me Goose, The study should have somewhat controlled for that since vitals were matched statistically between the groups. They used 161566 ground transports and 61909 flights to come up with the number.

Could you clarify what you mean by "too much is open to interpretation?" If nothing else, it is interesting that when variables such as severity of the trauma, vitals and others were controlled for nationwide any patient who goes by helicopter is better off.

Here it is: http://www.health.ny.gov/nysdoh/ems/policy/05-05.htm

I just had a chance to read the original article in JAMA, while the authors did conclude that there was a 1.5% better chance of survival they were not able to control for many of the factors affecting mortality. This figure comes from comparing two groups that were statistically matched by values recorded on arrival to the ED. Due to a high amount of missing data about transport times "that cannot be assumed to be missing at random" the study was not able to make judgments about how the total time from dispatch to the ED played a role.

As I think ny10570 was trying to say, the fact that the number of volunteers involved in accidents is higher is not surprising, but this number alone is meaningless without further data to make an objective comparison. You are comparing the numerators of two fractions while ignoring the denominator. Since there are vastly more volunteer than career firefighters, the comparison is not valid until you can compare it by the vehicle mile or something to that effect. 100 is larger than 10, but 100/10000 (0.01) is less than 10/100 (0.1)

There seems to be sector and role portions of the profile. My role was somehow modified to police officer. Looking through this thread there seems to be number of other "police officers" as well.

Sir, since you asked I've been an EMT for four years. In the interest of full disclosure I am also a medical student. In the State of NY there is no duty to act when you are not on duty. Please correct me if I am wrong but this document would seem to support this fact. The important part reads, "NYS statutes do not obligate an individual citizen, regardless of training, to respond to a situation or provide care unless there is a formal duty by job description or role expectation. Such a duty to act arises from participation with an agency having jurisdiction." Which I take to mean that if you are not at work you don't have the duty to act. The full document is here http://www.health.ny.gov/nysdoh/ems/pdf/98-05.pdf . I am aware that there are many skilled prehospital providers out there, whom I would also trust my life to if necessary. However, I disagree that doctors need "tests and machinery" to act in a circumstance where an EMT would have no need for the same. The risk of lawsuit would also be no different, http://www.health.ny.gov/nysdoh/ems/art30.htm "1. Except as provided in subdivision six of section six thousand six hundred eleven, subdivision two of section six thousand five hundred twenty-seven, subdivision one of section six thousand nine hundred nine and sections six thousand five hundred forty-seven and six thousand seven hundred thirty-seven of the education law, any person who voluntarily and without expectation of monetary compensation renders first aid or emergency treatment at the scene of an accident or other emergency outside a hospital, doctor's office or any other place having proper and necessary medical equipment, to a person who is unconscious, ill, or injured, shall not be liable for damages for injuries alleged to have been sustained by such person or for damages for the death of such person alleged to have occurred by reason of an act or omission in the rendering of such emergency treatment unless it is established that such injuries were or such death was caused by gross negligence on the part of such person. Nothing in this section shall be deemed or construed to relieve a licensed physician, dentist, nurse, physical therapist or registered physician's assistant from liability for damages for injuries or death caused by an act or omission on the part of such person while rendering professional services in the normal and ordinary course of his or her practice." Given that both have no duty to act and equal protection from lawsuit and adequate training to respond to a situation when they have no equipment I see no reason for treating anyone differently.

I for one think think that police and fire are too totally different things. The stipulations for police riding free are justified, if they are armed and under a duty to respond. Once you start handing out free passes to fire/ems on the basis that they are most qualified if there is a medical emergency how do you justify that? Take this to the logical endpoint if you have a ER doc and EMT sitting next to each other on the train, both on their own time, how can you say that the graduate of a course that is a few hundred hours long compares to 7-8 years of medical education? Both have no legal duty to do anything, neither has equipment so I don't really see where your coming from at that point.

PFDRes47cue had some good advice above in the thread, probably a good place to start if you do want to diet is to figure out how much you are eating and what you are eating. Try to keep a record of everything you eat or drink for one week. Calculate the calories in it, look at other components such as cholesterol, triglycerides. If you identify the areas, such as a lot of soda or late night snacking it might be relatively simple to cut those out. Your right to be concerned about possible medical consequences for obesity. It is one of the most serious risk factors for a host of conditions down the road. Calculate your body mass index (BMI), under 25 is where you want to be. BMI over 25 is correlated with many things (see the list below). The best thing we can do is be proactive at managing our weight and making changes when necessary. From the CDC http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Interpreted HypertensionDyslipidemia (for example, high LDL cholesterol, low HDL cholesterol, or high levels of triglycerides)Type 2 diabetesCoronary heart diseaseStrokeGallbladder diseaseOsteoarthritisSleep apnea and respiratory problemsSome cancers (endometrial, breast, and colon

I'm sure that your aware of this if you have done a lot of research into this area, but this is a lot of weight to lose in a relatively short period of time, physicians generally recommend about 1-2 pounds per week as a reasonable goal. It has also usually more sustainable over the long term. It may be a good idea to talk to your doctor if you haven't already. Since you brought up the BMR, I wanted to make sure that you were aware that this will change as you lose weight. It will actually decrease to a value that is lower than that of someone who is at any given weight normally. For example, if your lose weight and reach a target weight of 150lbs, your BMR could be 1200cal, while someone who has always weighed 150 will have a BMR of 1500cal. This is the physiological basis of yo-yo dieting, since you will often need to cut out even more calories to maintain your target weight compared to the number of calories cut to reach that weight. You'll need to maintain that weight for at least a year before your body begins to more normally maintain your metabolism around that set point. Again, you may already be aware of this but I thought it might be helpful as general advice.