Subject: Re: First Aid Kits.

From: [email-masked] (Yes, I'm still here...)
Date: 23 Sep 1994 19:03:35 GMT

Jason -

Consider this a blanket response to your previous posts and replies.

First, you are certainly welcomed and appreciated on this newsgroup
and I am confident that you have alot to offer.  Please accept the
following input as constructive - seriously, ok?

First, you're a little behind in some of your replies.  Allergies 
and anaphylaxis have already been discussed, and some possible
solutions, such as improvising a skin test, have been proposed
for pre-test of drug allergies, But that's ok....

More importantly I want to share my perspectives on the EMT scope
of practice and basic outlook on medicine.  First, understand
that I'm an EMT, and previously certified Wilderness EMT.  I teach
wilderness medicine, I'm a field surpervisor for a privately-owned
*non-EMS* medical support company and have had some very unique training
in third-world based survival medicine from a course that my company
hosted.  In addition to this, I have completed the educational requirments
(both medical and general) for a Physician Assistant program in a major
University and will apply *again* this Feb.  While I feel I certainly 
have trained in access of my EMT peers, obviously I'm no MD, RN or even
a paramedic at this point.

What I am confident of is that the DOT EMT scope of practice and perspective
is completely inadequate as medical training for any circumstance or situation
where EMS, a hospital or an MD is not rapidly available.  Much of what you've
posted so far represents the mainstream attitudes of a good EMT student,
and/or a dependable EMT, but not much more.  

Please note that the newsgroup here is misc.survivalism which pretty much
implies that "pre-hospital" medicine falls short of the basic tenants
of the readership.

Here's some specifics;

In your first reply you speak of "current protocols" and differing laws
in EMS systems state by state.

My response - Current protocols mean absolutely nothing in the backcountry,
or in a disaster situation.  If someone is sick or injured, you do what
you can do, or you don't.  There is currently no known legal precedent
involving the prosecution of someone who worked outside of their scope,
either professional or not, in a time of true crisis or in a situation
where EMS was absolutely unavailable, though this excludes professional
EMTs or paramedics currently working during an assigned shift.
There have been some incidents of this sort.  If you know of such a
precedent, please share it with me, I would like to know of it.

In your second reply you suggest compensating for a lack of patient contact
experience by taking an EMT refresher course.

My response - If survival medicine is your goal, refreshing inadequate training
with more inadequate training doesn't make sense.

In your third response you poke a little fun at Robert Allen for carrying
sutures, warn him of the danger of using betadine in a deep wound, correct
him for suggesting glucose for hypothermia, and correct him for carrying 
superglue. You also mention using hydrogen peroxide but state you won't
carry it because of protocols. You state that the BP cuff and stethascope is
important and to be careful using an Epi-pen.

You end it all by stating the Robert probably isn't trained to use what he 
carries.

My response - You picked the wrong guy to reprimand.  Robert has practically
the same training I do.  He knows very well when and when not to suture,
he knows the correct and incorrect uses of betadine, recently got very 
state-of-the-art info on the use of glucose in treating hypothermia (they
didn't tell you about that in your course did they?) and you couldn't begin
to imagine the usefulness of superglue in first aid.

Also, you couldn't have known this, but Hydrogen Peroxide is a very weak
anti-microbial agent and it's only real usefulness is in removing dried
blood.  Your stethascope's main usefulness in a survival situation is in
listening to breath sounds, NOT taking BPs and as an EMT you should know
that we simply record a history, we do not determine a patient's condition
by taking blood pressure readings though maybe your training in MAST 
requires this, I don't know, we can't use them here.

Also, your statement "I would neer use an epipen on someone whos b/p is normal
or above normal." makes absolutely no sense.  As it states in the paperwork
that accompanies every Epi-pen, there is no known contraindication for the
use of epinephrine in the treatment of life-threatening anaphalaxis, not 
known heart problems, not hypertension, not age, none.

In conclusion, whether you Jason, chose to work outside your scope in a
catastrophic disaster, or not, will be an ethical question you will have
to grapple with.  The question that I feel is most important is whether
or not you will have the *real* medical training to even be faced with  
that question.

Remember, as EMT's we always based our legal doubts and fears (i.e. will I
be sued?) on treating patients with whom we do not have any personal relationship.
In reality, in a disaster, these patients are more likely to be our best friends
and our family.

As an EMT, you should know how to assess a pneumothorax, but how will you
treat it if you can't call 911 - for days or weeks?  Most paramedics have
excellent IV skills, but how many have you met can make and sterilize
their own IV fluids?  In a catastrophy, your EMT training, the best part of 
it, will last about as long as your 2000 lbs. of O2 holds out, say, about
30 minutes on 15 lps.?  That's not long dude.  Your EMT program told you
alot about what you aren't suppose to do, but they didn't tell you *what*
to do if the "system" breaks down, or disappears altogether.

Greatest regards (sincerely)

Greg