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Safety of prehospital intravenous fentanyl for adult trauma patients

What prevents us from treating pain appropriately? Actual adverse effects of pain medicine or unwarranted anxiety, due to exaggerated fears of potential adverse effects of pain medicine? – In 1999,...

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Skills Monkey or Skilled Medic?

– What is a skills monkey? A skills monkey is someone who has been trained to perform skills well enough to pass a simple choreographed test of that skill. Medical skills monkeys are not limited to...

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Increased Standing Orders

– Peter Canning has been writing about the 16 biggest treatment changes over his 20 years as a paramedic. He starts his list by emphasizing the positive – Increased Standing Orders.[1] I would...

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50 Shades of Grey…Protocols

– David Aber has some nice words to say about me in a recent post, so it is a bit of a disappointment to disagree with his main point. He writes – I am one who believes that if protocols are well...

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Protocol Deviation and Mother-May-I Silliness

– – In response to the conversation David Aber and I had at the end of last week’s episode of EMS Office Hours, Jim Hoffman, Josh Knapp, Bob Sullivan, David Aber and I discuss the problems with...

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50 Plus Shades of Grey – Protocols

– Continuing from the first two 50 Shades of Grey parts, David adds Part 3. – And that same medical director is usually the ones whose license paramedics work under.[1] Paramedics do not work under a...

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Calling Medical Command for Deviation from Standing Orders

– I occasionally have conversations with paramedics who have been written up for violating protocol, even though they received permission from a medical command doctor. Some systems that require...

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Is Direct Medical Command Pointless?

  In some places, OLMC (On Line Medical Command) permission requirements are still used. Isn’t it dangerous to get rid of this physician oversight? We can’t have a bunch of cowboy medics doing as they...

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EMS Needs to Be a Separate Medical Specialty – Now – Part I

Ckemtp documents one of the major problems in EMS in Every Day EMS Ethics – Self Medical Direction? How are we supposed to deal with bad protocols, when some medical directors would rather endanger...

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The Medical Command Permission Ruse I

Ruse – ▸ noun: a deceptive maneuver. When using the term Medical Command Permission Ruse, I am using ruse to describe the role of requirements for medical command permission. The ruse is the...

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A Prehospital Pain Management Discussion at the NAEMSP Site

Also posted over at Paramedicine 101. Go check it out at the new location at EMS Blogs. – I would have also posted this at Research Blogging, but this discussion is not the kind of research blog post...

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EMS Garage Rant – Prehospital Pain Management

On BYOT: EMS Garage Episode 105 we discussed 2 things that I wanted to rant about – here is some of the second rant. The second topic was prehospital pain management. I think that Chris Montera saw my...

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Technology In EMS Part I – TOTWTYTR

Technology In EMS Part I is a post by TOTWTYTR that is critical of an article on technology. This is not an article that is about technology improving things, but about technology making it so that...

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Confessions of An EMS Newbie podcast interview with Dr. Bryan Bledsoe

–  For those who disagree with what I wrote in I am not the only one saying EMS education is Broken, go listen to the Confessions of An EMS Newbie podcast interview with Dr. Bryan Bledsoe. Dr. Bledsoe...

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Up in the Air – Suspending Ethical Medical Practice I

– In this week of holiday travel and the stress produced by the security theater of the TSA (Transportation Security Administration), it is reasonable to look at the stress that can be produced by...

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You Gave Her 20 Milligrams

– There is a great post at StreetWatch on prehospital pain management and one of the obstacles to good patient care. Peter writes about the way that they finally were able to approve standing orders...

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In Defense of Intubation Incompetence – Part II

– In response to In Defense of Intubation Incompetence – Part I, there is the following from PA_Medic, which results in this being Part II.   1. Ego? Really? Do you really think medics intubate due to...

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In Defense of Intubation Incompetence – Part III

– A continuation of In Defense of Intubation Incompetence – Part II. PA_Medic responded to Part I with –   If the patient woke up to a sternal rub, I do not see any reason to consider that as anything...

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Medical Oversight According to the Handbook for EMS Medical Directors – Part I

– Groups of people somewhat affiliated with EMS have decided that they know how EMS medical direction should be run. Their approach would have been progressive a few decades ago, but for EMS in many...

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Medical Oversight According to the Handbook for EMS Medical Directors – Part II

– The Handbook for EMS Medical Directors was developed by the International Association of Fire Chiefs (IAFC) as part of a Cooperative Agreement with the Department of Homeland Security (DHS), Federal...

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