ckroll

"Texas averages two to three snake bite deaths each year, according to information from Texas Parks & Wildlife Department. By comparison, an average of five to seven people die each year from insect bites and approximately eight die each year from lightning strikes, according to TPWD." Bicycle deaths in Texas? 53. Firearm deaths in Texas in 2002? 11 per 100,000. Snakes aren't the problem.

Yes, really. " I had him sitting there for several days thinking it was just a harmless variety of snake...." That is leaving an animal to suffer. It does not protect your family. I do not question that a rattlesnake does not belong in a house and one caught in a trap like that needs to be euthanized. That said, it is a sentient being who was near death and terrified. You could have dispatched it with a shovel, ended its misery and made your family and your trash safer. To claim it was necessary to watch it suffer to protect your family is foolish.

Absolutely disgraceful. There is no excuse to leave an animal to suffer, throw it out alive and then use it for entertainment. You should be ashamed.

Let us remember that the difference between a revolution and a rebellion is whether or not it is successful. It is probably dirty down there and there are probably a few scruffy characters. In any group there will be those whose intentions are self serving. A careful reading of history will show the founding fathers were not saints either. I am continually amazed that so many people think the problem is that the rich aren't rich enough or that making them richer will mean better crumbs falling from the table for the rest of us. 'Trickle down' is fine for body fluids but makes for poor economic policy. Protest is not just a part of the American fabric, it IS the American fabric. Free people standing up and saying "This is wrong, there has to be a better way." has been the foundation upon which this country is built. The established order makes the most of their power, sends in troops, the protesters push back, the courts interpret the rules. On a good day, no one gets hurt in the process. Life goes on. I think it's a great system. A life without protest would be like.... communism? So, thank you to the system for keeping us safe and thank you to the protesters who remind us that there is a better way and that we need to find it.

A doctor at WMC thought enough of a call that he called my agency to say something. I passed it along to the crew, but it's worth mentioning. It was a busy day and the call description didn't warrant a medic, but someone on scene thought that it did and called for one, then got on the radio to update the medic. The patient was packaged and ready to go. The decision was made to go to the medical center and no one complained. It was a smooth ride with good help in the back. Everyone chipped in, worked together and the result was solid, professional, compassionate care. It was a low anxiety call--no heroics--but at the same time, it was a low anxiety call because everyone stepped up to do their job. Some days we forget how important teamwork and attitude can be. And then there are moments like this one, when it all comes together because half a dozen people are trained and dedicated and put the patient first. So thank you Mahopac Falls. You guys did a really nice job out there.

I'm liking CAC, with a scruffy tabby cat hacking up a hair ball [star of Life] as the mascot. At least it's not misleading....

It's only a name. Can a fire department call themselves volunteer if they hire services like EMT's, or drivers? Heavens, we've been paying for services for years. We pay someone to clean the buildings, to service the rigs-- and a working rig is just as important to EMS as the EMT-- we pay someone to bill.... I think my home corps was even getting the rigs professionally detailed for parades for a while. Does billing or staffing define volunteer? Perhaps it is time to call ourselves 'profits' or 'not for profits', though that said, I think most 'profits' aren't making much and most 'not for profits' are raking it in. Whatever they call themselves, Brewster made a decision that puts patient care ahead of ego or tradition and for this they should be applauded. I am with those who wonder how this will affect mutual aid, however.

It's a remarkable idea, and thanks for sharing the information. I want one. The logistics may be a consideration. Can it be set up in rain or does it need some curing period without water on it, how much does it weigh, and will it cure in colder conditions? I'd also want to know how stable it would be to aftershocks.

First, it most certainly is a dig at individuals who participate in ART's. If you're going to put it out there, stand by what you've said, or be human about it and apologise. Second, know what you are talking about. //www.empiresart.com/ These are RESPONSE teams, not rescue or field teams. The intent is to plan in advance of disasters so that facilities that may be appropriate for sheltering can be identified and the logistics worked out prior to the emergency. The intent specifically is so that rescue of pets or their people can be avoided. Your assumption that EMS and ARTs are mutually exclusive or even related is not substantiated. Neither is your assertion correct about government priorities. Third, if you have chest pain and my cats are about drown...... take aspirin and call me back in the morning.

And Garden Clubs... What is WRONG with those women?

If someone could provide information on this law it would be greatly appreciated. It is nothing of which I am aware. Pet sheltering is complicated given potential for disease spread, among other things. For this reason co-sheltering pets and people under emergency circumstances is problematic.

If you're so fantastic, then why is your dog dead?

Yeah, it does bring to mind my favorite from the paramedic's prayerbook: Dear Lord, Let me be at least half as good as I think I am. If Willdog is looking for a useful pharm guide, I suggest he write his own as a learning exercise. There are basic and expanded sets of meds for cardiac issues, chf, diabetes, respiratory, anxiety, seizures. A simple list means a PCP has it under control, multiple meds for the same purpose means he or she doesn't. Medications are an excellent place to get information. It tells the provider what the patient's PCP thinks the issues are and it is what most ED physicians want to know, so Willdog, your instincts are good. That said, as a brand new medic I packed a drug guide with me, and not a pocket guide [unless one were a kangaroo]. I had a patient that looked like he was dying. He was on a new medication, I looked it up and he had absolutely every side effect. I read him the list and we both had a good laugh over it. He still felt terrible, but his vital signs improved.

Zero is an awfully low number, but I'm with those posters that want to see this person get a solid 4 year degree. It would be wonderful if EMS providers and the field itself were more respected. I think providers do that by bringing more to the table than just an EMT or AEMT certification. There is an interesting piece in the New York Times today about responding before the call, where paramedics are making house calls to at risk populations to cut down on emergency calls. That's a direction I'd love to see EMS take. A degree in public health administration might be a consideration for someone starting in the field that wants to move EMS forward while making a difference. And flying makes a great hobby....

Here's a thought. Cut a wire and see who shows up to fix it.

Interesting, and thanks for the reply. Learned literature seems to be making a distinction between COPD primarily as upper airway inflammation a.k.a. pink puffers and primarily emphysemic, those with compromise of the alveoli, a.k.a. blue bloaters. Obviously with a range in between. From a pre hospital perspective it used to be a distinction without a difference in that we treated it similarly. Now that CPAP is available, we may have a treatment option that will affect these mechanisms differently....or maybe not. I'm reading here that air trappers may benefit from BiPAP, not necessarily CPAP. Per literature, CPAP functions by holding open airways, increasing pressure in the alveoli and moving fluid back across the membrane, and decreasing the work of breathing. What puzzles me is what is happening physiologically. People primarily with upper airway obstruction may respond differently to CPAP than those with damaged alveoli and dead space. My mental model of events is that we are trying to increase ventilation, not oxygenation insomuch as O2 deranges blood chemistry and decreasing CO2 corrects that. Different causes of COPD will both have ventilation/perfusion mismatch, but perhaps for very different reasons. I'm not clear on what is happening in the pt.

Medscape has an excellent article on the same topic that I believe references the same work. [Jan, 2011] Chronic Obstructive Pulmonary Disease and Emphysema in Emergency Medicine http://emedicine.medscape.com/article/807143-overview#a0104 Among other things, it serves to remind us that COPD is a basket of comorbidities. Do knowlegable people out there have experience with CPAP/BiPAP with respect to bronchitis vs emphysema? At present, HVREMAC allows for CPAP in COPD, but WREMAC does not. Obviously different physicians have different opinions as to the value of CPAP for COPDers. Is it perhaps more effective with one type of COPD? I also think a take home message is that before intubating the conscious patient, or letting that patient deteriorate that CPAP is worth a try. Worst case, we take it off, correct?

It's a good topic to discuss. First, why do you think that CPAP could help someone with COPD? Can you describe the mechanism?

Wow, the stuff I miss when I go on vacation. First, the best way to avoid liability is to provide good care. Second, per BLS protocols..."Since patients do not always fit into a "cook book" approach, these protocols are not a substitute for GOOD CLINICAL JUDGMENT". Third, ACLS 2010 is clear on the subject. O2 sat of 94% and above does not need supplemental oxygen in most situations. Fourth, with COPD patients, a significant issue is pH. Hypoxic drive is secondary. the individual is borderline in terms of pH and the body is doing all it can to buffer. One buffering mechanism is in the red blood cell, which can hang onto 6 CO2 molecules. Heme groups preferentially bond to O2. If you have many of the heme groups loaded with CO2 and provide 100% O2, the body will dump CO2 to the blood stream to pick up O2 and in the process spike the pH down. Significant research in credited journals identify the pH spike as an important part of the pathophysiology. I'll look it up and post same.

I think we are making a fundamental error in trying to recreate the volunteer model of EMS as paid service and in doing so may be missing an opportunity. In an era when both time and resources were in abundant [relatively] supply, a system emerged where an over equipped $100,000 transport vehicle with a crew of 4 responded to every call for aid. Every town had one or two. We had, and have, people who want to help others and are willing to volunteer to do it. I don't think it has to be the same thing. A better model might be to step back from the idea that every time someone picks up the phone and says, "I need help" that the appropriate response is a police officer, a fire truck a paramedic and a fully equipped transporting ambulance. What is currently volunteer services might be restructured into a less emergent role of responding, evaluating, and arranging for transport or services. EMS could be restructured into a guaranteed ready response for those situations where private transport of one kind or another isn't enough. Yes, there will be times when this results in a delay of care. That said, if EMD can identify true emergencies, a ready response capable of transport combined with a corps of lightly trained responders may be getting vital aid and transport faster. Let us all accept that there may be a role for the 'what do you expect from volunteers?' people but that role may no longer be as the primary transport agency. Can we reconfigure a system so that volunteers can still volunteer and can provide valuable service to their community and at the same time find a way to guarantee emergency transport when emergency transport is needed? I don't think we need, nor can we afford, to reconstruct what we have now as a paid service.

Absolutely true, but for the sake of brevity I phrased it that way. If a dispatcher thinks he or she has a true emergency, send it all. I love the idea of volunteers and I loved being one. That said, as the volume of calls increases the system needs to adjust. And we have to work with what we have. Yes,a majority of Americans are overweight, under exercised, and inclined to blame someone else for their problems. We serve them and we help them. It is our duty to respond, not to demand that they change who are. I do think we can devise a better system than the one we have.

Then it is time for the masses to rise up. Run a flash mob MCI in front of the building where the powers that be are meeting. Trap a few decision makers in a building for an hour while we sort through 30 nuns on bicycles that have run into a hotdog truck carrying hazardous material.

Here's another suggestion. Keep doing it until we get it right. When my high angle team trained, we did a scenario, got reamed out, changed up the players and ran it again. We never made the same mistakes twice, we made brand new ones and about the 4th time we ran it, it was fast and pretty. My beef with every MCI drill I've been a part of is that the planners set up something way too complicated, it goes to hell in a basket and in wrap up we say, well, we learned something. How about smaller incidents and plan on working the scenario start to finish until we see what getting it right looks like?

The requirement for a mutual aid plan descends from Public Health Law Article 30 and part 800 where an agency may not legally operate outside their CON unless under a mutual aid agreement promulgated by the region. My understanding is that participation is voluntary and every county has one. It benefits individual agencies insomuch as particpating in a county plan satisfies PHL requirements. It serves a purpose. Once an agency accepts responsibility to provide a service, the question that must be answered is 'what will you do, if need outstrips resources?' Absent some sort of structure, significant emergencies will get overrun by freelancer/tourists who show up with an EMS shirt and a camera thinking it will help. A mutual aid plan sets useful structure for coordinating an EMS response. The fire service tends to be unfamiliar with PHL and in many cases believe it does not apply to them. For the most part it doesn't, unless the fire service wants to engage in the provision of medical aid. The moment that happens, PHL is a factor. As mutual aid documents go, Westchester has one of the better ones. If you want to vent over poorly written documents that desperately need an overhaul, get started on the 10 Commandments--coveting thy neighbors' donkey--- really? , the Constitution, and anything involving NIMS. We cannot have county run EMS in New York State because New York is a 'home rule ' state, so you might want to add NYCRR to your list of things that need fixing.