Blogs from Police &   
 other Emergency Service Workers

Ambulance: In Defense of ALS

Written by RSS Poster Medic Scribe » Medic Scribe

In our state (Connecticut), BLS (with sponsor hospital approval) can do the following life-saving interventions:

Defibrillate with AED

Give Epinephrine in Anaphylaxis

Apply CPAP to Severe Respiratory Distress

Give Narcan to Hypoventilating Opiate Overdoses

Give ASA to Chest Pain.

Transmit 12-lead ECG

Speed Trauma and Stroke Patients to the Hospital

Here’s what They Can’t Do:

Cardiovert Conscious Patient in VT

Give Epi IV for Refractory Anaphylaxis

Give Benzos to Seizing Patients

Give Benzos (and sometimes Haldol) to Crazy Violent Patients

Give NTG to Patients in Pulmonary Edema

Give Breathing Treatments to Wheezing Patients.

Perform a Surgical Airway in a Patient Without an Airway.

Give Fentanyl or Morphine to Patients with Broken Bones or Severe Abdominal Pain

Do a Needle Decompression for a Hypotensive Trauma Patient with No Lungs Sounds on One Side

Give D10 to Hypoglycemic Diabetics

Interpret 12-lead ECG and Call STEMI Alerts

Protect Airway with ET Tube or Alternative Advanced Airway

Use McGills to Clear...

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Ambulance: New England Paramedic Treatment Guidelines

Written by RSS Poster Medic Scribe » Medic Scribe

Many years ago here in Connecticut each of the hospitals in the state had their own set of treatment guidelines for the paramedics they sponsored. In our company some of our medics were sponsored by Hartford Hospital, others by Saint Francis Hospital.* Each hospital had a different set of guidelines, even though their medics worked the same basic territory. Due to the nature of EMS in Connecticut, and the multiple number of ambulance services at the time, some medics worked for three or more services and had to keep all the different guidelines in mind.

About twenty years ago, the hospitals in our region got together and agreed on a single set of guidelines that are reviewed and updated annually. Our regional guidelines became somewhat of a model for the state, and large portions of them have been incorporated by other regions or hospitals. We were early adopters of controlled substances on standing orders with generous analgesia doses (eventually up to the current total of 300 mcgs...

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Ambulance: Passive Ventilation Study

Written by RSS Poster Medic Scribe » Medic Scribe

The main question left in the wake of the study,Trial of Continuous or Interrupted Chest Compressions during CPR, that dominated the news coming out of the American Heart Association’s 2015 Scientific Sessions Conference in Orlando, Florida this past week, is “How does passive ventilation compare with positive pressure ventilation in the early stages of cardiac arrest?” While only a large randomized controlled study can answer this question, at the same scientific sessions there was a poster presentation that offered evidence for the passive ventilation argument.

Improved Survival in Out of Hospital Cardiac Arrest: Withholding Positive Pressure Ventilation, authored by Scheppke, Ippolito, Breyer, and Chait, cited evidence out of Florida that “withholding/delay of positive pressure ventilation can improve out of hospital adult primary cardiac arrest survival.”

All adult cardiac arrest patients in Palm Beach Gardens, Florida received chest compressions only for the first 10 minutes of arrest or until...

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Ambulance: Continuous Cardiac Compressions Come Under Scrutiny

Written by RSS Poster Medic Scribe » Medic Scribe

Several years ago studies out of Arizona and Wisconsin trumpeted continuous cardiac compressions, known as CCC or sometimes known as CCR (cardiocerebral resuscitation), as offering increased survival for out of hospital cardiac arrest. Neurologically intact survival from witnessed vfib arrests increased by 250-300%. For the first several cycles of CPR stop compressions only to shock, insert an oral airway and apply a nonrebreather, ventilate passively. It made sense. You had to keep the heart perfused and avoid hyperventilation. CCR has spread across the country like wildfire. Here in Connecticut, we have made it our statewide standard for all arrests of suspected cardiac origin. The AHA ignored CCR in 2010 and in the just released 2015 Guidelines offered tepid support for it, giving it a IIb recommendation. (A IIb recommendation means the evidence is WEAK, but it may be reasonable to practice the method. A IIa recommendation means MODERATE evidence, is reasonable to...

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Ambulance: Dear Mail Group.......

Written by RSS Poster Garth Marenghi
Dear Mail Group I am writing for several reasons, all under the same general umbrella of admiration for your mighty journalistic tradition which invariably serves the public interest above all else.  It is most excellent that you are now taking such an interest in the junior doctor contract story, particularly the way in which you are now focusing on the characters involved, it is most

Ambulance: Letter for Jeremy Hunt via HEE

Written by RSS Poster Garth Marenghi
Dear Health Education England I am writing in response to the message sent by Jeremy Hunt, the Secretary of State for Health, which was sent out to all junior doctors by you on the 4/11/2015.  It is most excellent that there is now a direct channel of communication between junior doctors and Mr Hunt.  As you now appear to be acting as his intermediary, I would be very grateful if this could

Ambulance: Thoughts on Lights and Sirens: Stroke

Written by RSS Poster Medic Scribe » Medic Scribe

I hardly ever go lights and sirens to the hospital. I feel so strongly about not going lights and sirens unless absolutely necessary, I wrote what became our statewide policy on lights and sirens. Although it was toned down through the various committees it went though, the gist of it remained the same. You should only go lights and sirens to the hospital if the hospital can do something in the minutes saved by going lights and sirens that you can’t do that will make a difference in the patient’s mortality or morbidity.

Here’s how it was eventually worded:

When transporting the patient utilizing lights and sirens, the need for immediate medical intervention should be beyond the capabilities of the ambulance crew using available supplies and equipment and be documented on the patient care report.

I used to go lights and sirens quite a lot when I first started, but then I began to wonder. Here I am going lights and sirens, making cars veer out of my way, and running the risk of...

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Ambulance: ALS Versus BLS

Written by RSS Poster Medic Scribe » Medic Scribe

BLS outperforms ALS in terms of patient mortality outcomes. This from a study, Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies, published in the October Annals of Internal Medicine authored by Prachi Sanghavi (and team) of Harvard University. The study includes cardiac arrest, trauma, stroke and MI care.

The authors looked at a large random sample of Medicare data compiled between 2006 and 2011 from nonrural areas. They were looking at survival and neurological functioning at 30 days, 90 days, 1 year, and 2 years.

You can see the abstract and results here;


Their conclusion: Advanced life support is associated with substantially higher mortality for several acute medical emergencies than BLS.

Go to this link to watch the author of the study present her case.

You Tube Presentation

The video is instructive because it lets you know that her view of EMS is simple. She believes that care is best achieved by getting people quickly to the hospital because the hospital is...

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Ambulance: 2015 AHA CPR and ECC Guidelines are Here!

Written by RSS Poster Medic Scribe » Medic Scribe

The long wait is over. The AHA 2015 CPR and ECC guidelines are finally here. For the first time in many cycles, there are few changes. No, you will not have to relearn CPR, and your drug kits will not see an overhaul. The guidelines finally offer a lukewarm acceptance (“it may be reasonable”) to cardiocerebral resuscitation (aka CCR, aka passive ventilation) as a alternative for trained responders but only in witnessed arrests with shockable rhythms. Vasopressin is no longer necessary in asystole arrests, not because it is any worse than epinephrine, just because they see no point in have two drugs when one will do (for better or worse). There is a great deal of emphasis again on providing quality CPR, including a compression rate of up to 120 a minute.

The truly big and best news in the 2015 Guidelines is this will be the last 5 year update. The AHA is now going to a continuous web-based update model that will keep the guidelines as current as possible with the latest...

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Ambulance: Changes

Written by RSS Poster Medic Scribe » Medic Scribe

People are always asking me what changes I have seen over the years.  Here are four changes I have been thinking about lately.

More paramedics.  When I started we had anywhere from two to six paramedics on to cover the entire city of Hartford and backup the other three large towns we covered.  On many days I was the only medic for the northern half of the city.  I never did transfers unless they were ALS, I was rarely deliberately dispatched to drunks or psychs, and I intercepted constantly with BLS cars.  Today, we have anywhere from five to twelve medics on, and I believe if we could do it, we would put a medic in every car.  How do I feel about this?  I miss the old days, but if I was a patient and I was sick, I would want a paramedic taking care of me.  Going along with this, I think today it is much easier to be a paramedic.  Today’s medics have capnography, CPAP, combitubes and other backup airways, EZ-IOs, and much wider array of drugs that no longer require an IV.  Intranasal Fentanyl, oral Zofran, IM...

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Ambulance Blog List

Hampshire & Isle of Wight Air Ambulance (806)
InsomniacMedic (219)
Trying My Patients (194)
Trauma Queen (178)
Street Watch: Notes of a Paramedic (158)
Garth Marenghi (113)
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 (46)
Jerome Mowat (26)
Medic Scribe » Medic Scribe (22)
Emergency Egg (19)
ambcontrol999 (15)
Hampshire and Isle of Wight Air Ambulance (14) (14)
Purpleplus (11)
Minimedic's Musings (10)
Random Acts Of Reality (6)


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