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  1. VinBin

    Prehospital Ultrasound

    I think you're still missing the point. It is a liability that should not be placed on EMS to document they used a field ultrasound and made a decision based on that (if it turns out to be incorrect). You are definitely right that the vast majority of trauma patients do not need a trauma center...
  2. VinBin

    Prehospital Ultrasound

    I have actually worked in rural EMS. What statements have I made that make you think that?
  3. VinBin

    Prehospital Ultrasound

    It opens up a host of liability that I don't think EMS is structured to take on. We should have a RULE OUT method to not taking a patient to a higher level of care instead of a RULE IN method. Having a young female with "classical abdominal pain" with a "negative" field ultrasound who then...
  4. VinBin

    Combitube Vs. King Vs. ET

    Yeah, definitely spot on. There are advances in LMA's to a point where they are not only easier to insert but allow a "rescue" intubation through the tube if necessary, suction ports for gastric tubes, temperature probes, etc. We are trialing new LMA's that have a pilot balloon that has a built...
  5. VinBin

    Prehospital Ultrasound

    If you have belly pain and a high suspicion for pregnancy related issue in your differential, you should go to a hospital which has capacities of managing an OB emergency. I don't understand what is confusing about that statement? My question is how would an ultrasound dictate your decision...
  6. VinBin

    Prehospital Ultrasound

    I don't think your reasoning is logical or justified in the realm of EMS. You should not consider a non-OB destination for a female who is pregnant with belly pain or presents with likely symptoms of an ectopic pregnancy. Even if it presents as a classical appendicitis or cholecystitis, any...
  7. VinBin

    Prehospital Ultrasound

    Correct destination in what regard? Are your potential transport destinations so exclusive that you could not take a patient with a couple differential diagnosis in for further evaluation?
  8. VinBin

    Antibiotics

    It's not a question of "dirty vs clean." You can prevent contamination in a sewer if you prep the patient and use strict sterile technique. It's a matter of which environment can accommodate that for a majority of blood draws. I have seen many contaminated blood cultures from the ED, but...
  9. VinBin

    Antibiotics

    I think rather than focusing on antibiotics in sepsis with hemodynamic changes (which is really the only reason I see to rush to abx in pre-hospital medicine), focus on stabilizing patients first with good BLS/ALS and fluid management. Trying to do lab tests to evaluate renal/liver function...
  10. VinBin

    Prehospital Ultrasound

    In the ED, the main purpose of ultrasound is to triage different pathology on findings (trauma/FAST exam, OB, abdominal organ pathology, etc). In EMS the focus should be on stabilization and transfer to the ED. Fooling around with an US in a seemingly benign case (questionable appendicitis...
  11. VinBin

    Federally Mandated Minimum Wage for EMTs and Paramedics Petition

    If you guys really want to raise the wages of EMT's just start colluding with each other to stop applying for jobs and/or pursuing it as a career. It's supply and demand, just reduce supply and you'll find that the "minimum wage" starts to go up magically... As far as I can tell, there doesn't...
  12. VinBin

    Narcan available OTC

    It's just a matter of risk reduction and cost savings to the taxpayer. It's a lot cheaper to hand out narcan to drug addicts than go through the drama that involves admitting and caring for an overdose. Even if it saves one person from a prolonged hospital stay requiring EMS response, ED...
  13. VinBin

    Student interested in EMS/ trauma kit help

    I admire your enthusiasm and don't want to sound cynical or jaded but what you have is probably more than enough for anything you could even remotely "encounter" as a civilian in everyday life. Also, there is an old saying that I've heard several times that the amount of items you carry (on...
  14. VinBin

    Deadlifts: Doing them religiously

    I'm biased against most "crossfit" exercises and videos, and the Bear Squats look like a mediocre workout for general fitness (probably more towards endurance than pure strength). But I would urge caution due to the extreme stress this exercise can put on the rotator cuff if done without very...
  15. VinBin

    Conscious Sedation for Wisdom Tooth Extraction

    Anytime you go "under" or are put in a "less conscious" state, there are inherent risks, why take them if you don't have to? I've had all four wisdom teeth taken with just local (all were impacted, if that makes any difference). I'll be honest, it was relatively painless after the initial...
  16. VinBin

    FDNY to jump on the fee bandwagon.

    With the massive budget deficits being seen in all states, eventually the entire public service sector will require payments for services rendered. Taxes won't cut it, not only due to the massive abuse of the EMS system, but especially because of the amount of graft and wasteful spending on...
  17. VinBin

    For all the anti-union people who trust the management......

    John E: I actually listed more sources than Friedman (I can't say I'm a "follower"). Those who believe that unions lead to higher unemployment include Summers (Obama's economic adviser), Mankiw (Harvard professor whose books on Economics are used in almost every Intro Econ class), Anderton (One...
  18. VinBin

    For all the anti-union people who trust the management......

    John, it's not my general views. Its what is concluded from applying basic economic principles (supply and demand). I would be hard pressed to find anyone that took an intro to economics class that would argue that comparing two economies, one with unions and one without the one with unions will...
  19. VinBin

    For all the anti-union people who trust the management......

    emt seeking, this isn't meant to offend you but I have a very hard time following your arguments. You seem to make discontinuous statements that don't always defend your main argument. DrParasite, it is generally accepted that unions will lead to all those negative events that I stated (higher...
  20. VinBin

    For all the anti-union people who trust the management......

    To be completely honest, I don't really follow your logic. You essentially threw together random stories about cops not being paid and something about fingerprinting and I don't really see how they support your argument. Also you never directly addressed my issues with unions leading to higher...
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