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Ambulance: Niall Dickson's response.....:)

Written by RSS Poster Garth Marenghi
"The independent Shape of Training review was established by the four governments of the UK and was supported by a number of organisations including Health Education England, The Medical Schools Council, NHS Education Scotland and The Academy of Medical Royal Colleges. It was the GMC’s role as the secretariat to arrange meetings with a whole range of organisations to enable them to discuss the

Ambulance: Intranasal Narcan for All

Written by RSS Poster Medic ScribeMedic Scribe

I was on Park Street last week headed in to El Mercado to get some pernil(roast pork), yucca and tostones for lunch when a gentleman came up to me and showed me his overdose kit.  He said he’d gotten it at the local needle exchange program.  He said he had already used it once when one of his buddies ODed and it worked great (though his friend was initially a little pissed at him, but later came to understand when the friend smacked him and said, “But you weren’t breathing, bro!”.  The kit contained two 2 mg prefilled Narcan syringes and one atomizer.

photo (28)

photo (27)


My EMT partner Jerry just stood there shaking his head.  He didn’t understand how some dude on Park Street could give Narcan to his overdosed buddy, but as an EMT Jerry couldn’t give it.  In Connecticut basic EMTs can give intranasal Narcan, but only if their service is approved for BLS Narcan by their sponsor hospital.  That hasn’t happened yet for our service so no Narcan for Jerry.

And I stood there shaking my head because while as a paramedic I...

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Ambulance: Due process, or lack of it, and the Shape of Training

Written by RSS Poster Garth Marenghi
This week the BMJ published my opinion piece on the 'Shape of Training' review: "The GMC spent more than £4000 on legal fees in resisting my freedom of information request. The court also commented on information obtained from the GMC’s internal correspondence that did not relate to the Shape of Training review: “The evidence was that at one meeting an individual sought an assurance that

Ambulance: ECG Quiz

Written by RSS Poster Medic ScribeMedic Scribe

I found a great (And Free!) new web site for practicing ECG interpretation.

ECG Quiz

Check it out!

Ambulance: Intranasal Medication

Written by RSS Poster Medic ScribeMedic Scribe

One of the best innovations in EMS in recent years has been the introduction of intranasal medication through the use of an atomizer.  We currently carry three drugs that we can use intranasally.  These are Narcan, Fentanyl and Versed.

After several years of experience now with all of these drugs through the intranasal route, here are my impressions of the utility of each.

Narcan – I love intranasal Narcan.  I use it often and almost always for heroin overdoses.  It took a while for me to learn the patience required, but once I realized the patient would come around eventually (usually within 2-5 minutes, sometimes as long as 8-10), I stopped reaching for the IM Narcan and putting them into withdrawal with the IM Narcan added to the peaking IN Narcan. I have had conversation with many medics about this and each medic seems to have his preferred method.  Some like IV which gives you the ability to slowly titrate.  Some prefer IM for it fast action – the patient comes around sooner than the IV method...

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Ambulance: Devolution

Written by RSS Poster Xf
What's to be done? I'm actually starting to feel some despair about the situation.

I was sitting in my response car at the scene of a call. There was an ambulance behind me - the crew was in the back treating the patient, who'd felt faint but hadn't actually passed out. I was on the phone to a fellow paramedic when a man approached me and asked me to wind down my window, which I duly did (although these days I'm a little bit more cautious about doing so).

The following exchange then took place.

Man: "Sorry for interrupting but I pay for the NHS too, so can you tell me why there are so many ambulances parked on this road?" (I should remind you that there were two!)

He went on to ask, "Are you waiting for something?" to which I replied, "We are dealing with an emergency call"

Man: "Are you on stand-by?"

Me: "No sir, we are dealing with a patient. The crew in the ambulance is treating her right now".

Man: "And you are doing what?"

I have to admit I was mildly shocked at this question. I suppose being on the phone and not doing anything relevant to my role...

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Ambulance: The Jug

Written by RSS Poster Medic ScribeMedic Scribe

There is a clear plastic jug — actually it is an empty water cooler bottle — that several times a year gets put on the table by the check-in window in operations. A handwritten note is attached asking for donations to help a fellow employee in need. A lot of money has gone into the jug over the years. Few professions know about hard times as much as ours. And we are not immune to them ourselves.

People in EMS don’t make a ton of money. That wasn’t why they went into this work or why they have stayed. Most need overtime or a second job to get by. And when hard times hit, few have the cushion to absorb them. That’s where the jug comes in. It is never enough, but at least it is something. A brother or sister in need. We see the jug and we reach for our pockets. A child with cancer. A bad accident that has laid someone up unable to work and with a long road to recovery. A sudden death. Over the years I have watched my fellow employees put their money in that jug. Maybe a $5, sometimes a crisp $20, others...

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Ambulance: The Ideal Medic

Written by RSS Poster Medic ScribeMedic Scribe

I have been a full-time paramedic for over twenty years and a part-time hospital EMS coordinator for over six years. Over the years my ideas of who the best paramedic is have changed markedly. I used to think the best paramedic was the one with the swagger, the one without fear, who never hesitated to act, who never allowed doubt to enter the equation. And while I still admire many aspects of that paramedic archetype, from both my vantage of twenty plus years on the street and the newer position of someone who can actually match up what happens on the street (or at least as described in the prehospital run form) and what happens to the same patient in the hospital, I have learned that many paramedics I thought were never wrong, can actually be wrong quite often, and that some of the paramedics who I thought were rather dull, have actually pleasantly surprised me time and again.

So here is my new ideal medic(s):

A great medic will call a STEMI Alert even if he is not certain the patient is having a STEMI. He will...

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Ambulance: AHA 2015 Guidelines- Guest Post

Written by RSS Poster Medic ScribeMedic Scribe


I don’t have guest posts as a matter of course, but Anthony Randazzo,a paramedic from Knoxville, Tennesse offered to do one on the updates to the 2015 AHA guidelines, which we are all anxious to learn about, so I happily agreed. Take it away, Andrew


Back in January, Peter highlighted some of the upcoming guidelines for AHA. Today, Peter is letting me follow up with a post that will take a look at a few more changes and trends coming down the pike.

No More Vasopressin

This probably does not come as a shock to most of you. I don’t even remember the last time I used vasopressin. I think the only reason I’ve used it in a code is to say that I used it. Aside from the affects of the drug itself, it is very impractical. Typically you have to draw up 2 vials in order to get your 40 units, and it’s more time consuming than popping the caps on an amp of Epi and pushing them together.

Looking at the pharmacological effects of Vasopressin, statistics show that there is no superior benefit during...

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Ambulance: It's All Innocent

Written by RSS Poster StorytellERdoc
Happy Monday, everybody!

Although I pride myself on catching the obscure snapshots of typical life moments that occur daily while dealing with patients and their families in the emergency department, occasionally there are times when I am so focused on the task at hand that I completely fail to see a glaring moment of obvious humor, sadness, or tenderness. At times like this, then, I am glad to have our hard-working nurses and techs with me in the room to bear witness to such events.

For example, recently I treated a 62 year-old retired kindergarten teacher who presented to our emergency department for a nosebleed. By appearances, she was exactly what you would picture a retired kindergarten teacher to look like--perfectly permed grey hair, kind eyes, folded "liver-spotted" hands resting in her lap, and the perfect amount of wrinkles at the corners of her eyes and mouth. If not for the actively dripping blood from her left nare (nostril) and the gory blood stains on her white cardigan sweater, I would have sworn she was there...

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Ambulance Blog List

Hampshire & Isle of Wight Air Ambulance (806)
InsomniacMedic (217)
Trying My Patients (194)
Trauma Queen (178)
Street Watch: Notes of a Paramedic (158)
Garth Marenghi (107)
Xf (91)
Minimedic's Blog (71)
A Life In The Day Of A Basics Doc (57)
StorytellERdoc (50)
Brian Kellett (dot) Net (49)
Medic ScribeMedic Scribe (44)
Jerome Mowat (26)
Emergency Egg (19)
ambcontrol999 (14)
Hampshire and Isle of Wight Air Ambulance (14)
Purpleplus (11) (11)
Minimedic's Musings (10)
Random Acts Of Reality (6)


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